Disaster triage : evidence, consistency and standard practice

Triage has military origins, with the initial purpose being to direct care to those most likely to be able to return to the battlefield. Conversely, modern disaster triage attempts to ensure both the prioritisation of care for those who need it most and a fair distribution of resources, so that health responders are able to ‘do the most for the most’...

Progress and challenges of disaster health management in China : a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Comparación de parámetros de atención en una escala de triage de 5 niveles con los parámetros estándar

Introducción: La escala de severidad en emergencias es una herramienta que ofrece seguridad a pacientes en servicios de urgencias. Este trabajo evalúa la aplicación de la escala ESI 4.0 en términos de oportunidad de atención y consumo de recursos en la Fundación Santa Fé de Bogotá, para comparar los resultados con parámetros estándar. Metodología Estudio observacional analítico de corte transversal. Se incluyeron 385 pacientes aleatorizados por nivel de atención. Se tomaron datos demográficos y variables como consumo de recursos y destino del paciente para su descripción y análisis. Resultados: El promedio de edad fue 44.9 años IC95%42.9–46.9, el 54.5% fueron mujeres. Se encontró un tiempo promedio de espera para nivel 1 de 1.39 min, para el nivel 2 de 22.9 min 2, para el nivel 3 de 41.9 min, para el nivel 4 de 56.9 min y para el nivel 5 de 52.1 min. El tiempo promedio de estancia en urgencias fue 5.9 horas y el 78.9% consumió recursos. Al comparar los tiempos con estándares mundiales en el nivel 1, 2 y 3 son significativamente mayores (P<0,05), en el nivel 4 es similar (p0,51) y en el nivel 5 es significativamente menor (p=0,00) Discusión: La escala ESI 4.0 es una herramienta segura, con un comportamiento similar en oportunidad de atención y consumo de recursos con respecto a los estándares de cuidado en los servicios de urgencias.

Emergency department triage revisited

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.

Emergency department surge capacity : Recommendations of the Australasian surge strategy working group

Background For more than a decade emergency medicine organizations have produced guidelines, training and leadership for disaster management. However to date, there have been limited guidelines for emergency physicians needing to provide a rapid response to a surge in demand. The aim of this study is to identify strategies which may guide surge management in the Emergency Department. Method A working group of individuals experienced in disaster medicine from the Australasian College for Emergency Medicine Disaster Medicine Subcommittee (the Australasian Surge Strategy Working Group) was established to undertake this work. The Working Group used a modified Delphi technique to examine response actions in surge situations. The Working Group identified underlying assumptions from epidemiological and empirical understanding and then identified remedial strategies from literature and from personal experience and collated these within domains of space, staff, supplies, and system operation. Findings These recommendations detail 22 potential actions available to an emergency physician working in the context of surge. The Working Group also provides detailed guidance on surge recognition, triage, patient flow through the emergency department and clinical goals and practices. Discussion These strategies provide guidance to emergency physicians confronting the challenges of a surge in demand. The paper also identifies areas that merit future research including the measurement of surge capacity, constraints to strategy implementation, validation of surge strategies and measurement of strategy impacts on throughput, cost, and quality of care.

Surviving the Titanic disaster : economic, natural and social determinants

The sinking of the Titanic in April 1912 took the lives of 68 percent of the people aboard. Who survived? It was women and children who had a higher probability of being saved, not men. Likewise, people traveling in first class had a better chance of survival than those in second and third class. British passengers were more likely to perish than members of other nations. This extreme event represents a rare case of a well-documented life and death situation where social norms were enforced. This paper shows that economic analysis can account for human behavior in such situations.

On ensuring continuity of mobile communications in a disaster environment

Natural disasters and deliberate, willful damage to telecommunication infrastructure can result in a loss of critical voice and data services. This loss of service hinders the ability for efficient emergency response and can cause delays leading to loss of life. Current mobile devices are generally tied to one network operator. When a disaster is of significant impact, that network operator cannot be relied upon to provide service and coverage levels that would normally exist. While some operators have agreements with other operators to share resources (such as network roaming) these agreements are contractual in nature and cannot be activated quickly in an emergency. This paper introduces Fourth Generation (4G) wireless networks. 4G networks are highly mobile and heterogeneous, which makes 4G networks highly resilient in times of disaster.

Protecting the protectors : legal liabilities from the use of Web 2.0 for Australian disaster response

The traditional model for information dissemination in disaster response is unidirectional from official channels to the public. However recent crises in the US, such as Hurricane Katrina and the Californian Bushfires show that civilians are now turning to Web 2.0 technologies as a means of sharing disaster related information. These technologies present enormous potential benefits to disaster response authorities that cannot be overlooked. In Australia, the Victorian Bushfires Royal Commission has recently recommended that Australian disaster response authorities utilize information technologies to improve the dissemination of disaster related, bushfire information. However, whilst the use of these technologies has many positive attributes, potential legal liabilities for disaster response authorities arise. This paper identifies some potential legal liabilities arising from the use of Web 2.0 technologies in disaster response situations thereby enhancing crisis related information sharing by highlighting legal concerns that need to be addressed.

Flood fatalities in contemporary Australia (1997-2008) : disaster medicine

Objective: Flood is the most common natural disaster in Australia and causes more loss of life than any other disaster. This article describes the incidence and causes of deaths directly associated with floods in contemporary Australia. ---------- Methods: The present study compiled a database of flood fatalities in Australia in the period of 1997–2008 inclusive. The data were derived from newspapers and historic accounts, as well as government and scientific reports. Assembled data include the date and location of fatalities, age and gender of victims and the circumstances of the death. ---------- Results: At least 73 persons died as a direct result of floods in Australia in the period of 1997–2008. The largest number of fatalities occurred in New South Wales and Queensland. Most fatalities occurred during February, and among men (71.2%). People between the ages of 10 and 29 and those over 70 years are overrepresented among those drowned. There is no evident decline in the number of deaths over time. 48.5% fatalities related to motor vehicle use. 26.5% fatalities occurred as a result of inappropriate or high-risk behaviour during floods. ---------- Conclusion: In modern developed countries with adequate emergency response systems and extensive resources, deaths that occur in floods are almost all eminently preventable. Over 90% of the deaths are caused by attempts to ford flooded waterways or inappropriate situational conduct. Knowledge of the leading causes of flood fatalities should inform public awareness programmes and public safety police enforcement activities.

A national framework for disaster health education in Australia

INTRODUCTION: Recent events have heightened awareness of disaster health issues and the need to prepare the health workforce to plan for and respond to major incidents. This has been reinforced at an international level by the World Association for Disaster and Emergency Medicine, which has proposed an international educational framework. ----------- OBJECTIVE: The aim of this paper is to outline the development of a national educational framework for disaster health in Australia. ----------- METHODS: The framework was developed on the basis of the literature and the previous experience of members of a National Collaborative for Disaster Health Education and Research. The Collaborative was brought together in a series of workshops and teleconferences, utilizing a modified Delphi technique to finalize the content at each level of the framework and to assign a value to the inclusion of that content at the various levels. ----------- FRAMEWORK: The framework identifies seven educational levels along with educational outcomes for each level. The framework also identifies the recommended contents at each level and assigns a rating of depth for each component. The framework is not intended as a detailed curriculum, but rather as a guide for educationalists to develop specific programs at each level. ----------- CONCLUSIONS: This educational framework will provide an infrastructure around which future educational programs in Disaster Health in Australia may be designed and delivered. It will permit improved articulation for students between the various levels and greater consistency between programs so that operational responders may have a consistent language and operational approach to the management of major events.

Vulnerability factors for disaster-induced child post-traumatic stress disorder : the case for low family resilience and previous mental illness

Objective: The aim of the present study was to investigate whether parent report of family resilience predicted children’s disaster-induced post-traumatic stress disorder (PTSD) and general emotional symptoms, independent of a broad range of variables including event-related factors, previous child mental illness and social connectedness. ---------- Methods: A total of 568 children (mean age = 10.2 years, SD = 1.3) who attended public primary schools, were screened 3 months after Cyclone Larry devastated the Innisfail region of North Queensland. Measures included parent report on the Family Resilience Measure and Strengths and Difficulties Questionnaire (SDQ)–emotional subscale and child report on the PTSD Reaction Index, measures of event exposure and social connectedness. ---------- Results: Sixty-four students (11.3%) were in the severe–very severe PTSD category and 53 families (28.6%) scored in the poor family resilience range. A lower family resilience score was associated with child emotional problems on the SDQ and longer duration of previous child mental health difficulties, but not disaster-induced child PTSD or child threat perception on either bivariate analysis, or as a main or moderator variable on multivariate analysis (main effect: adjusted odds ratio (ORadj) = 0.57, 95% confidence interval (CI) = 0.13–2.44). Similarly, previous mental illness was not a significant predictor of child PTSD in the multivariate model (ORadj = 0.75, 95%CI = 0.16–3.61). ---------- Conclusion: In this post-disaster sample children with existing mental health problems and those of low-resilience families were not at elevated risk of PTSD. The possibility that the aetiological model of disaster-induced child PTSD may differ from usual child and adolescent conceptualizations is discussed.

Policy into practice : adoption of hazard mitigation measures by local government in Queensland : a collaborative research project between Queensland University of Technology and Emergency Management Queensland in association with Local Government of Queensland Disaster Management Alliance

The focus of the present research was to investigate how Local Governments in Queensland were progressing with the adoption of delineated DM policies and supporting guidelines. The study consulted Local Government representatives and hence, the results reflect their views on these issues. Is adoption occurring? To what degree? Are policies and guidelines being effectively implemented so that the objective of a safer, more resilient community is being achieved? If not, what are the current barriers to achieving this, and can recommendations be made to overcome these barriers? These questions defined the basis on which the present study was designed and the survey tools developed. While it was recognised that LGAQ and Emergency Management Queensland (EMQ) may have differing views on some reported issues, it was beyond the scope of the present study to canvass those views. The study resolved to document and analyse these questions under the broad themes of: • Building community capacity (notably via community awareness). • Council operationalisation of DM. • Regional partnerships (in mitigation/adaptation). Data was collected via a survey tool comprising two components: • An online questionnaire survey distributed via the LGAQ Disaster Management Alliance (hereafter referred to as the “Alliance”) to DM sections of all Queensland Local Government Councils; and • a series of focus groups with selected Queensland Councils

Post-disaster housing reconstruction : challenges for community participation

The extant literature suggests that community participation is an important ingredient for the successful delivery of post-disaster housing reconstruction projects. Even though policy-makers, international funding bodies and non-governmental organisations broadly appreciate the value of community participation, post-disaster reconstruction practices systematically fail to follow, or align with, existing policy statements. Research into past experiences has led many authors to argue that post-disaster reconstruction is the least successful physically visible arena of international cooperation. Why is the principle of community participation not evident in the veracity of reconstructions already carried out on the ground? This paper discusses and develops the concepts of, and challenges to, community participation and the subsequent negative and positive effects on post-disaster reconstruction projects outcomes.