Managing anaesthetic provision for global disasters (original) (raw)
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A disaster is an unplanned event in which the needs of the affected community outweigh the available resources. A disaster occurs somewhere in the world almost daily, but these events vary considerably in scope, size, and context. Large-scale disasters with numerous casualties are relatively unusual events. Certain widely publicized disasters, including events such as the terrorist attacks on September 11, 2001, Hurricanes Katrina and Sandy, and the Boston Marathon bombing, have focused people’s attention on disaster planning and preparedness. Disasters are becoming more frequent, and the number of persons affected is also increasing. This greater morbidity is attributable not only to the greater number of events, but also to population dynamics, location, and susceptibilities. This chapter focuses on the principles that need to be addressed when planning to manage and overcome a natural or human made disaster.
Anesthesiologists and Disaster Medicine
Anesthesia & Analgesia, 2017
A total of 1.7 billion people worldwide have been impacted by disasters from 2005 to 2014. 1 Over the past decade, the United States has been 1 of the top 5 countries most frequently hit by natural disasters (NDs). 2 The American Medical Association has outlined physicians' obligations to participate in public health-related activities BACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval). RESULTS: Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23-38] ND, 14% [9-21] RE, and 40% [31-49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14-33] ND, 16% [8-27] RE, and 17% [9-29] PI). Greater than 85% of attendings (89% [84-94] ND, 88% [81-92] RE, and 87% [80-92] PI) and 70% of residents (81% [71-89] ND, 71% [58-81] RE, and 82% [70-90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47-64] and 58% [49-67] of attendings; 59% [48-70] and 48% [35-61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24-40] of attendings and 28% [18-41] of residents). Fewer than 40% of attendings (34% [26-43]) and residents (38% [27-51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71-85) of attendings and 73% (62-82) of residents indicated WTR to a ND, whereas 81% (73-87) of attendings and 70% (58-81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55-71] of attendings and 52% [39-64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5-55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5-19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia. CONCLUSIONS: Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.
Trends in Anaesthesia and Critical Care
2015
summary The international medical community has identified medical students as a viable resource to be used in response to national and international disasters. However today there is still no formal pre- or postgraduate training in disaster medicine for medical students in Denmark. The Students' Society of Anaesthesiology and Traumatology (SATS) in Copenhagen developed a three-day disaster medicine course called Trauma Days 2013. The course curriculum was designed to give participants insight in and the basic skills required during a disastrous event and consisted of lectures, workshops, and full-scale simulations. The course may be useful as an educational introduction to the topic of disaster medicine. A formalized curriculum in medical schools, eventually as an elective course, may educate medical students in disaster medicine.
15Th World Congress on Disaster and Emergency Medicine (Wcdem)
Australasian Journal of Paramedicine, 2015
Attracting more than 900 delegates from 60 countries, the theme of Preparedness: Knowledge, Training, and Networks, at the 15th World Congress on Disaster and Emergency Medicine offered 130 sessions and 285 posters on a wide range of topics. The Congress delivered very clear products to enable experts, organisations, and governments to be better prepared for the next disaster or crisis as a critical need for consistent standards and benchmarks in emergency preparedness around the world. To address this need, intense workshops were held to develop recommendations on a focused subset of hospital emergency preparedness benchmarks; define and implement an ongoing process to pilot and evaluate those benchmarks, and promote a consensus building process that would be used to develop and implement these and additional benchmarks in the future. Pre-Congress workshops The local organising committee offered three different courses to Congress participants. These internationally accredited and certified courses covered all aspects of disaster and emergency medicine in: •
Worldwide disaster medical response: An historical perspective
Critical Care Medicine, 2005
Disaster medicine and disaster medical response is a complex and evolving field that has existed for millennia. The objective of this article is to provide a brief review of significant milestones in the history of disaster medicine with emphasis on applicability to present and future structures for disaster medical response. Results: Disaster medical response is an historically necessary function in any society. These range from response to natural disasters, to the ravages of warfare, and most recently, to medical response after terrorist acts. Our current disaster response systems are largely predicated on military models derived over the last 200 yrs. Their hallmark is a structured and graded response system based on numbers of casualties. In general, all of these assume that there is an identifiable "ground zero" and then proceed with echelons of casualty retrieval and care that proceeds rearward to a hospital(s). In a civil response setting, most civilian models of disaster medical response similarly follow this military model. This historical approach may not be applicable to some threats such as bioterrorism. A "new" model of disaster medical response for this type of threat is still evolving. Using history to guide our future education and planning efforts is discussed. Conclusion: We can learn much from an historical perspective that is still applicable to many current disaster medical threats. However, a new response model may be needed to address the threats of bioterrorism. (Crit Care Med 2005; 33[Suppl.
Unpredictable, unpreventable and impersonal medicine: global disaster response in the 21st century
The EPMA journal, 2015
The United Nations has recognized the devastating consequences of "unpredictable, unpreventable and impersonal" disasters-at least US $2 trillion in economic damage and more than 1.3 million lives lost from natural disasters in the last two decades alone. In many disasters (both natural and man-made) hundreds-and in major earthquakes, thousands-of lives are lost in the first days following the event because of the lack of medical/surgical facilities to treat those with potentially survivable injuries. Disasters disrupt and destroy not only medical facilities in the disaster zone but also infrastructure (roads, airports, electricity) and potentially local healthcare personnel as well. To minimize morbidity and mortality from disasters, medical treatment must begin immediately, within minutes ideally, but certainly within 24 h (not the days to weeks currently seen in medical response to disasters). This requires that all resources-medical equipment and support, and healthcar...
The role of emergency medical teams in disaster response: a summary of the literature
Natural Hazards
In the aftermath of natural disasters, emergency medical teams (EMTs) are dispatched to help local rescue efforts. While some impact evaluations of EMTs are available, few comprehensive evaluations of the implementation of EMTs in natural disasters, have been published to date. As a result, the evidence base to inform global guidelines and best practices, is remarkably thin. This paper aims to provide a better understanding of the role of EMTs, by summarizing recent reports and case studies. Specifically, this summary aims to identify key improvement areas, as well as obstacles and opportunities for improvement. After a search of the literature, 40 publications met the inclusion criteria, and were included in this summary of the literature. The effective functioning of EMTs is codependent on interactions between different actors, including national governments, international organizations, NGOs, local government agencies, community stakeholders and the private sector. Five key impro...
The Role of Surgical Nurse in International Disaster Response (IDR) in Japan
Asian Journal of Human Services
Objective: With regard to medical doctors and nurses who had participated in international disaster response(IDR), the purposes of the study were as follows:①To identify the factors related to recognition of the need for "surgical nursing practice" in IDR provided by Japan ②To clarify the role of Surgical Nurse in future IDR. Method: The survey was conducted between June 20, 2016 and July 31, 2016 targeting medical professionals (doctors and nurses) with experience in IDR. We distributed self-report questionnaires to authors and coauthors of academic papers that described studies examining IDR and been published within the preceding 5 years. Results: We received responses from 54 of the 110 participants (recovery rate: 49.1%). Data for 51 subjects (valid response rate: 94.4%) were ultimately analyzed. "Organization (Governmental Organization [GO] group and Nongovernmental Organizations [NGO] group) at the time of dispatch" differed significantly recognition of the need for "surgical nursing practice" in IDR. Discussion: "Organization at the time of dispatch;" was the main factor related to recognition of the need for "surgical nursing practice" in IDR. GO group recognized that the role of Surgical Nurse in IDR was not only nursing care through the perioperative period but also disaster nursing care to perform a wide variety of activities will be required in the provision of medical support following international disasters. NGO group recognized the importance of nursing care during operations as the role of Surgical Nurse in IDR.
Crit Care, 2005
Disaster medical response has historically focused on the prehospital and initial treatment needs of casualties. In particular, the critical care component of many disaster response plans is incomplete. Equally important, routinely available critical care resources are almost always insufficient to respond to disasters that generate anything beyond a 'modest' casualty stream. Large-scale monetary funding to effectively remedy these shortfalls is unavailable. Education, training, and improved planning are our most effective initial steps. We suggest several areas for further development, including dual usage of resources that may specifically augment critical care disaster medical capabilities over time.