| 1. |
- Djalali, Ahmadreza, et al.
(författare)
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A fundamental, national, medical disaster management plan : an education-based model
- 2009
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Ingår i: Prehospital and Disaster Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 1049-023X .- 1945-1938.
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Tidskriftsartikel (refereegranskat)abstract
- During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME). The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≥2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants’ knowledge regarding disaster management; the mean score on the pre-test was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan in the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing country.
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| 2. |
- Englund, Liselotte, 1964-
(författare)
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Healthcare and Media Interaction in Major Incidents and Disasters : Experiences Based on Swedish KAMEDO Reports in 20 years
- 2023
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 38:S1, s. s96-s96
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Major Incidents and Disasters are often associated with early, extensive and prolonged media reporting. It is important to understand the interaction between first responders/rescue services and the media to create better conditions for providing and making available correct and objective information to as many people as possible.Method: A systematic literature review and content analysis was made on all Swedish KAMEDO reports (emergency medicine observations published by the National Board of Healthand Welfare) from the last twenty years, in total 39 reports. KAMEDO’s primary task is to feedback experience data (lessons learned) from disasters worldwide, through expert observers at the site of an emergency event. The aim of this study was to evaluate and analyze the experiences made regarding the interaction between media and healthcare in connection with major incidents and disasters, both on site and in hospitals.Results: The analysis resulted in the following main themes:(1) Communication problems and other challenges in Major Incidents and Disasters• No protection and restrictions• Information craving and news hunt• Interviews as intervention(2) Recommendations for efficient interaction between healthcare and the media:• Strategies from alert to action• Satisfying information needs• Clarity measures on site• Key actors of importance• Proactive media alertnessConclusion: Some conclusions regarding lessons learned about interaction between healthcare and the media, as well as about communication with the afflicted and citizens, in brief: The hospital management should take control of the communication through efficient communication strategies. An accommodating approach to the media's presence can facilitate the dissemination of the necessary early, correct and balanced information. Joint authority press conferences are a model tested and positively evaluated. Healthcare communicators are key actors in hospital crisis communication and media management. Healthcare and media both benefit from developing routines and reciprocal respect for proactive and efficient interaction in emergencies.
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| 3. |
- Andersson, Elin, et al.
(författare)
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Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke.
- 2018
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Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; , s. 63-70
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Tidskriftsartikel (refereegranskat)abstract
- Introduction the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important. Problem The study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.METHODS: The study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.RESULTS: In total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows: a) More frequently documented symptoms from the face, legs/arms, and speech; b) More frequently assessments of neurology, face, arms/legs, speech, and eyes; c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation; d) Less frequently documented symptoms of headache, vertigo, and nausea; and e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled. In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.CONCLUSION: Among 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations. Andersson E , Bohlin L , Herlitz J , Sundler AJ , Fekete Z , Andersson Hagiwara M . Prehospital identification of patients with a final hospital diagnosis of stroke.
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| 4. |
- Andrews, RA, et al.
(författare)
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Sharing international experiences in disasters : summary and action plan
- 2001
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 16:1, s. 42-45
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.
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| 5. |
- Ardalan, Ali, et al.
(författare)
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Impact of the Bam Earthquake, 26 December 2003, on Activities of Daily Living and Instrumental Activities of Daily Living of Older People
- 2011
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Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 26:2, s. 99-108
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: This study compares self-reported Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) status among elderly survivors of the 2003 Bam Earthquake before, two months after, and five years after the event, and explores related determinants.METHODS: A two-stage cluster survey was conducted on 210 elderly survivors in the earthquake-stricken area five years after the event.RESULTS: Both ADL and IADL scores decreased two months after earthquake compared to prior status (p <0.001). No differences were observed between two months and five years after the event (p >0.05). Access to medical services were not related to level of ADL or IADL (p = 0.52 and p = 0.74, respectively). Elderly survivors with lower functional capability in terms of ADL experienced more problems in access to relief items (p = 0.04), but no similar association was found for IADL (p = 0.26).CONCLUSION: The Bam earthquake adversely affected functional capacity of the elderly. Disaster responders must take into account functional capacity of elders when planning for medical and relief operations.
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| 6. |
- Axelsson, Christer, et al.
(författare)
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A description of the prehospital phase of aortic dissection in terms of early suspicion and treatment.
- 2015
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Ingår i: Prehospital and Disaster Medicine. - 1049-023X .- 1945-1938. ; 30:2
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Aortic dissection is difficult to detect in the early phase due to a variety of symptoms. This report describes the prehospital setting of aortic dissection in terms of symptoms, treatment, and suspicion by the Emergency Medical Service (EMS) staff.BASIC PROCEDURES: All patients in the Municipality of Gothenburg, Sweden, who, in 2010 and 2011, had a hospital discharge diagnosis of aortic dissection (international classification of disease (ICD) I 71,0) were included. The exclusion criteria were: age<18 years of age and having a planned operation. This was a retrospective, descriptive study based on patient records. In the statistical analyses, Fisher's exact test and the Mann-Whitney U test were used for analyses of dichotomous and continuous/ordered variables.MAIN FINDINGS: Of 92 patients, 78% were transported to the hospital by the EMS. The most common symptom was pain (94%). Pain was intensive or very intensive in 89% of patients, with no significant difference in relation to the use of the EMS. Only 47% of those using the EMS were given pain relief with narcotic analgesics. Only 12% were free from pain on admission to the hospital. A suspicion of aortic dissection was reported by the EMS staff in only 17% of cases. The most common preliminary diagnosis at the dispatch center (31%) and by EMS clinicians (52%) was chest pain or angina pectoris. In all, 79% of patients were discharged alive from the hospital (75% of those that used the EMS and 95% of those that did not).CONCLUSION: Among patients who were hospitalized due to aortic dissection in Gothenburg, 78% used the EMS. Despite severe pain in the majority of patients, fewer than half received narcotic analgesics, and only 12% were free from pain on admission to the hospital. In fewer than one-in-five patients was a suspicion of aortic dissection reported by the EMS staff.
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| 7. |
- Axelsson, Christer, et al.
(författare)
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The Early Chain of Care in Patients with Bacteraemia with the Emphasis on the Prehospital Setting
- 2016
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 31:3, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about the early phase of severe infection. This report describes the early chain of care in bacteraemia as follows: (a) compare patients who were and were not transported by the Emergency Medical Services (EMS); (b) describe various aspects of the EMS chain; and (c) describe factors of importance for the delay to the start of intravenous antibiotics. It was hypothesized that, for patients with suspected sepsis judged by the EMS clinician, the delay until the onset of antibiotic treatment would be shorter.All patients in the Municipality of Gothenburg (Sweden) with a positive blood culture, when assessed at the Laboratory of Bacteriology in the Municipality of Gothenburg, from February 1 through April 30, 2012 took part in the survey.In all, 696 patients fulfilled the inclusion criteria. Their mean age was 76 years and 52% were men. Of all patients, 308 (44%) had been in contact with the EMS and/or the emergency department (ED). Of these 308 patients, 232 (75%) were transported by the EMS and 188 (61%) had “true pathogens” in blood cultures. Patients who were transported by the EMS were older, included more men, and suffered from more severe symptoms and signs.The EMS nurse suspected sepsis in only six percent of the cases. These patients had a delay from arrival at hospital until the start of antibiotics of one hour and 19 minutes versus three hours and 21 minutes among the remaining patients (P =.0006). The corresponding figures for cases with “true pathogens” were one hour and 19 minutes versus three hours and 15 minutes (P =.009).Among patients with bacteraemia, 75% used the EMS, and these patients were older, included more men, and suffered from more severe symptoms and signs. The EMS nurse suspected sepsis in six percent of cases. Regardless of whether or not patients with true pathogens were isolated, a suspicion of sepsis by the EMS clinician at the scene was associated with a shorter delay to the start of antibiotic treatment.
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| 8. |
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| 9. |
- Bremer, Anders, 1957-, et al.
(författare)
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Balancing Between Closeness and Distance : Emergency medical services personnel’s experiences of caring for families at out-of-hospital cardiac arrests and deaths
- 2012
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Ingår i: Prehospital and Disaster Medicine. - Cambridge : Cambridge University Press. - 1049-023X .- 1945-1938. ; 27:1, s. 42-52
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem thataffects between 236,000 and 325,000 people in the United States each year. As resuscitationattempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services(EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced byfactors other than patient clinical characteristics, such as EMS personnel’s knowledge,attitudes, and beliefs regarding family emotional preparedness. However, there is littleresearch exploring how EMS personnel care for bereaved family members, or how theyare affected by family dynamics and the emotional contexts. The aim of this study is toanalyze EMS personnel’s experiences of caring for families when patients suffer cardiacarrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviewswere conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and familycare, and sometimes failed to prioritize these responsibilities as a result of their ownperceptions, feelings and reactions. Moving from patient care to family care implied amovement from well-structured guidance to a situational response, where the personnelwere forced to balance between interpretive reasoning and a more direct emotionalresponse, at their own discretion. With such affective responses in decision-making, thepersonnel risked erroneous conclusions and care relationships with elements of dishonesty,misguided benevolence and false hopes. The ability to recognize and respond to people’sexistential questions and needs was essential. It was dependent on the EMS personnel’sbalance between closeness and distance, and on their courage in facing the emotionalexpressions of the families, as well as the personnel’s own vulnerability. The presence offamily members placed great demands on mobility (moving from patient care to familycare) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family membersto avoid additional suffering. Opportunities to reflect on these situations within a frameworkof care ethics, continuous moral education, and clinical ethics training are needed.Support in dealing with personal discomfort and clear guidelines on family support couldbenefit EMS personnel.Bremer A, Dahlberg K, Sandman
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| 10. |
- Brokopp, T, et al.
(författare)
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KAMEDO Report No. 91: 2004 tsunami disaster in Asia--home transport and emergency care in Sweden
- 2008
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Ingår i: Prehospital and disaster medicine. - : Cambridge University Press (CUP). - 1049-023X .- 1945-1938. ; 23:5, s. 472-5
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Tidskriftsartikel (refereegranskat)abstract
- This is a descriptive report of the Swedish authorities' responses to the tsunami that affected Southeast Asia in December 2004. The main focus is the care of survivors and the injured during their transportation from Thailand and their return to Sweden. The psychological and physical after-effects also are presented based on a poll conducted one year after the tsunami.
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