Selected resources for emergency and disaster preparedness and response from the United States National Library of Medicine.
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SUBMITTER: Hochstein C
PROVIDER: S-EPMC2772141 | biostudies-literature | 2008
REPOSITORIES: biostudies-literature
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Selected resources for emergency and disaster preparedness and response from the United States National Library of Medicine.
Hochstein Colette C Arnesen Stacey S Goshorn Jeanne J Szczur Marti M
Medical reference services quarterly 20080101 1
The Toxicology and Environmental Health Information Program (TEHIP) of the National Library of Medicine (NLM) works to organize and provide access to a wide range of environmental health and toxicology resources. In recent years, the demand for, and availability of, information on health issues related to natural and man-made emergencies and disasters has increased. Recognizing that access to information is essential in disaster preparedness, a new focus of NLM's 2006-2016 Long Range Plan calls ...[more]
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Project description:IntroductionEmergency medicine (EM) physicians serve at the frontline of disasters in our communities. The 2016 Model of Clinical Practice according to the American Board of EM identifies disaster management as an integral task of EM physicians. We described a low-cost and feasible tabletop exercise to implement such training for EM residents.MethodsThe exercise took place during 2 hours of resident didactic time. A lecture introduced the incident command system (ICS) and triage concepts, followed by a tabletop scenario with a map of a disaster scene or emergency department. Facilitators presented situational prompts of tasks for residents to address during the exercise. These exposed residents to challenges in disaster scenarios, such as surge and limited resources. The exercise concluded with a debrief and short lecture reviewing scenario-specific topics and challenges. Residents completed an online pre- and postexercise assessment, evaluating knowledge and perceptions of disaster scenario management.ResultsEighteen residents participated in this exercise. The response rates to the pre- and postsurvey were 76% and 72% respectively. Using a Mann Whitney U test, no statistically significant difference was demonstrated on the medical knowledge component of the survey. There was, however, a statistically significant increase in perceived confidence of the residents' ability to manage disaster incidents.DiscussionWe developed a simple exercise that is an easily adaptable and practical option for introduction to disaster preparedness training. These concepts are difficult to teach and assess among learners, however it remains an important component of education for EM physicians-in-training.
| S-EPMC7970644 | biostudies-literature
Project description:ObjectivesEmergency preparedness becomes more important with increased age, as older adults are at heightened risk for harm from disasters. In this study, predictors of preparedness actions and confidence in preparedness among older adults in the United States were assessed.MethodsThis nationally representative survey polled community-dwelling older adults ages 50-80 y (n = 2256) about emergency preparedness and confidence in addressing different types of emergencies. Logistic regression was used to identify predictors of reported emergency preparedness actions and confidence in addressing emergencies.ResultsParticipants' mean age was 62.4 y (SD = 8); 52% were female, and 71% were non-Hispanic white. Living alone was associated with lower odds of having a 7-d supply of food and water (adjusted odds ratio [aOR] = 0.74; 95% confidence interval [CI]: 0.56-0.96), a stocked emergency kit (aOR = 0.64; 95% CI: 0.47-0.86), and having had conversations with family or friends about evacuation plans (aOR = 0.59; 95% CI: 0.44-0.78). Use of equipment requiring electricity was associated with less confidence in addressing a power outage lasting more than 24 h (aOR = 0.66; 95% CI: 0.47-0.94), as was use of mobility aids (OR = 0.65; 95% CI: 0.45-0.93).ConclusionsThese results point to the need for tailored interventions to support emergency preparedness for older adults, particularly among those who live alone and use medical equipment requiring electricity.
| S-EPMC7704536 | biostudies-literature
Project description:Background. The emergency medical service (EMS) provides first-line medical care to people who require urgent medical care in emergency and disaster situations. Preparedness is the most effective approach for the management of disaster risks, and it is essential for the emergency medical service (EMS) providers, such as paramedics, emergency medical technicians (EMT), and other EMS personnel. This systematic review will explore evidence on the preparedness of emergency medical service providers in emergency and disaster situations by reviewing peer-reviewed journal articles. Methods/Design. This study will be conducted on peer-reviewed articles published between 2005 and 2019 to explore the preparedness of emergency medical service providers in emergencies and disasters. Scopus, Web of Science, PubMed, and Google Scholar will be thoroughly searched to identify published studies on emergency and disaster preparedness. The following keywords will be used for searching the databases: "Medical Technician," "Paramedic," "Emergency Paramedic," "Emergency Medicine Technician," "Emergency Medical Technician," "Emergency Prehospital Provider," "Emergency Preparedness," "Disaster Preparedness," "Hospital Preparedness," "Disaster management," "Disaster Competencies," "Disaster Readiness," "Disaster," "Disaster Role," "Readiness, Preparedness, Terrorist," "Mass Casualty Incident," "Major incidents," "Mass Casualty," "Mass Gathering," "CBRNE," "Weapons of Mass Destruction," and "Chemical, Biological, Radiological, Nuclear, and Explosive Event." Discussion. To the best of our knowledge, no comprehensive review study has been conducted on the preparedness of emergency medical service providers in disaster situations. This study is the first attempt to address this gap. It will also explore the key dimensions in disaster preparedness of EMS providers and the strategies to enhance their preparedness. Identifying the key dimensions of disaster preparedness is the first step in designing and developing valid instruments to evaluate EMS provider's disaster preparedness and as well as adopting appropriate strategies to improve the level of their preparedness (This systematic review is registred in PROSPERO with CRD42020149689).
| S-EPMC7683168 | biostudies-literature
Project description:Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers.To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians.Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016.Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount.Our analysis included 12?337 emergency medicine physicians from 2707 hospitals and 57?607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen (median, 5.0; IQR, 3.5-6.7 for ?20% uninsured), and location (median, 5.3; IQR, 3.8-6.8 for the southeastern United States).Across hospitals, there is wide variation in excess charges on ED services, which are often priced higher than internal medicine services. Our results inform policy efforts to protect uninsured and out-of-network patients from highly variable pricing.
| S-EPMC5818801 | biostudies-other
Project description:PurposeSmartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones.MethodsIn 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women's Hospital about their smartphone use and prior training experiences. Scores (0%-100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test.ResultsA total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3-4 residents, 15.0/20 (75.1%) than year 1-2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3-4 residents, 16.1/44 (36.5%) than for year 1-2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use.ConclusionResidents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.
| S-EPMC4671182 | biostudies-literature
Project description:IntroductionThere are over 200 emergency medicine (EM) residency programs in the United States. While there are basic criteria defined by the Accreditation Council for Graduate Medical Education (ACGME), there can be significant variation between programs with regard to rotation distribution. Therefore, it would be valuable to have a benchmark for programs to understand their rotation mix in the context of the national landscape. This study aimed to provide a breakdown of the length and percentage of EM residency programs with each clinical rotation in the United States. This study also sought to examine trends and changes in EM residency programs since 1986.MethodsA list of all current EM residency programs was obtained using the ACGME website. All program websites were reviewed, and data were independently dual extracted by two investigators with discrepancies resolved by consensus with a third investigator. Programs without curricular data available online were queried via e-mail for the data. Programs were separated into 3- versus 4-year lengths. Mean, standard deviation, and range were calculated for each rotation.ResultsA total of 200 of 202 programs (99%) had data available. Of these programs, 84.5% had a dedicated pediatric EM rotation with mean length of 9.7 weeks among 3-year programs and 12.1 weeks among 4-year programs. A total of 88% had a dedicated ultrasound rotation, 60% had a dedicated toxicology rotation, 73.5% had a dedicated emergency medical services rotation, 74% had a dedicated orthopedics rotation, 60% had a dedicated administration rotation, 29% had a dedicated research rotation, and 95% had dedicated elective time.DiscussionThis study provides summative data regarding the rotation distribution among EM programs in the United States. Compared with prior data, there is less time dedicated to internal medicine rotations and increased pediatric, trauma, ultrasound, toxicology, and critical care experiences. These data will inform current and new EM residency programs when determining rotation selection.
| S-EPMC6194041 | biostudies-literature
Project description:BackgroundLarge-scale burn disasters can produce casualties that threaten medical care systems. This study proposes a new approach for developing hospital readiness and preparedness plan for these challenging beyond-surge-capacity events.MethodsThe Formosa Fun Coast Dust Explosion (FFCDE) was studied. Data collection consisted of in-depth interviews with clinicians from four initial receiving hospitals and their relevant hospital records. A detailed timeline of patient flow and emergency department (ED) workload changes of individual hospitals were examined to build the EDs' overload patterns. Data analysis of the multiple hospitals' responses involved chronological process-tracing analysis, synthesis, and comparison analysis in developing an integrated adaptations framework.ResultsA four-level ED overload pattern was constructed. It provided a synthesis of specifics on patient load changes and the process by which hospitals' surge capacity was overwhelmed over time. Correspondingly, an integrated 19 adaptations framework presenting holistic interrelations between adaptations was developed. Hospitals can utilize the overload patterns and overload metrics to design new scenarios with diverse demands for surge capacity. The framework can serve as an auxiliary tool for directive planning and cross-check to address the insufficiencies of preparedness plans.ConclusionsThe study examined a wide-range spectrum of emergency care responses to the FFCDE. It indicated that solely depending on policies or guidelines for preparedness plans did not contribute real readiness to MCIs. Hospitals can use the study's findings and proposal to rethink preparedness planning for the future beyond surge capacity events.
| S-EPMC8628445 | biostudies-literature
Project description:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency department visits, 2009-2011. PATIENTS:Adult (age, ? 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90?mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ? 14, respiratory rate ? 22 breaths/min, or systolic blood pressure ? 100?mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). CONCLUSIONS:Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated sepsis classifications may impact national estimates of emergency department sepsis epidemiology.
| S-EPMC5609499 | biostudies-literature
Project description:PurposeThe aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum.MethodsThe study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference.ResultsUsing a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was -3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points.ConclusionReplacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.
| S-EPMC5801323 | biostudies-literature
Project description:BackgroundProper disaster preparedness by community pharmacists has the potential to counter many of the factors that cause threats and high-risk outcomes. Their preparedness and awareness may also help health practitioners and governments to improve disaster response planning.ObjectivesThis aims to explore the knowledge, attitude, and practice (KAP) towards disaster medicine preparedness and readiness among community pharmacists in the United Arab Emirates (UAE).MethodA cross-sectional study was conducted over the ten months among licensed community pharmacists who had three months' professional experience or more. Face-to-face interviews were carried out and a structured questionnaire was used for data collection. Logistic regression models were used to determine the factors influencing aboucine preparedness and readiness. SPSS Version 24 was used to analyze the data collected.ResultsA total of 500 community pharmacists participated in the study. The average knowledge score was 25.6% with a 95% confidence interval (CI) of [21.7%, 29.4%]. Better knowledge scores were observed in the male gender (OR 2.43; 95% CI 1.05-3.72), participants aged ≥ 31 years old (OR 2.97; 95% CI 1.16-7.6), postgraduates (OR 4.36; 95% CI 2.6-7.3), participants from independent Pharmacies (OR 6.5; 95% CI 4.04-10.4 3), chief pharmacists (OR 3.1; 95% CI 1.86-5.07), participants with 16 years and more experience years (OR 2.42; 95% CI 1.063-5.522) and participants who graduated from regional/international universities (OR 5.92; 95% CI 2.65-13.2). Better attitude and practice about disaster medicine preparedness were observed in postgraduates (OR 2.54; 95% CI 1.26-pharmacists from independent pharmacies (OR 1.35; 95% CI 2.43-2,.66), and chief pharmacists (OR 1.26; 95% CI 1.17-1.35).ConclusionsIt's essential to provide a continuing education program using different educational strategies urgently needed to improve community pharmacy competencies (e.g. knowledge attitudes, and perceptions) to improve the skills and practices regarding disaster medicine preparedness and readiness.
| S-EPMC9409571 | biostudies-literature