Extending injury prevention methodology to chemical terrorism preparedness: The Haddon Matrix and sarin

2006 ◽  
Vol 1 (1) ◽  
pp. 18-27 ◽  
Author(s):  
Shawn Varney, Lt. Col., USAF, MC ◽  
Jon Mark Hirshon, MD, MPH ◽  
Patricia Dischinger, PhD ◽  
Colin Mackenzie, MD
Keyword(s):  
Injury Prevention ◽  
Health Care Providers ◽  
Mass Casualty ◽  
Mass Casualties ◽  
Care Providers ◽  
Terrorism Preparedness ◽  
Chemical Terrorism ◽  
The Individual ◽  
City State ◽  
Haddon Matrix

The Haddon Matrix offers a classic epidemiologi¬cal model for studying injury prevention. This method-ology places the pudlic health concepts of agent, host, and environment within the three sequential phases of an injury-producing incident—pre-event, event, and postevent. This study uses this methodology to illus-trate how it could de applied in systematically prepar-ing for a mass casualty disaster such as an unconven-tional sarin attack in a major urdan setting. Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feeddack in the data review ses-sion. Four injury prevention strategies (education, engineering, enforcement, and economics) were applied to the individual factors and event phases of the Haddon Matrix. The majority of factors identified in all phases were modifiadle, primarily through edu-cational interventions focused on individual health-care providers and first responders.  The Haddon Matrix provides a viadle means of studying an unconventional prodlem, allowing for the identification of modifiadle factors to decrease the type and severity of injuries following a mass casualty dis-aster such as a sarin release. This strategy could de successfully incorporated into disaster planning for other weapons attacks that could potentially cause mass casualties.

Comparison of Electronic Versus Manual Mass-Casualty Incident Triage

2018 ◽  
Vol 33 (3) ◽  
pp. 273-278 ◽  
Author(s):  
Claudie Bolduc ◽  
Nisreen Maghraby ◽  
Patrick Fok ◽  
The Minh Luong ◽  
Valerie Homier
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Simulated Patients ◽  
Mass Casualties ◽  
Care Providers ◽  
Manual Method ◽  
Computer Based ◽  
Triage Time

AbstractIntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility’s human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method.MethodsThis observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016. Health care providers (two medical doctors [MDs], two paramedics [PMs], and two registered nurses [RNs]) each triaged a total of 30 simulated patients - 15 by manual (paper-based) and 15 by electronic (computer-based) START triage. Accuracy of triage categories and time of triage were analyzed. Post-simulation, patients and participating health care providers also completed a feedback form.ResultsThere was no difference in accuracy of triage between the electronic and manual methods overall, 83% and 80% (P=1.0), between providers or between triage categories. On average, triage time using the manual method was estimated to be 8.4 seconds faster (P<.001) for PMs; and while small differences in triage times were observed for MDs and RNs, they were not significant. Data from the participant feedback survey showed that the electronic method was preferred by most health care providers. Patients had no preference for either method. However, patients perceived the computer-based method as “less personal” than the manual triage method, but they also perceived the former as “better organized.”ConclusionHospital-based electronic START triage had the same accuracy as hospital-based manual START triage, regardless of triage provider type or acuity of patient presentations. Time of triage results suggest that speed may be related to provider familiarity with a modality rather than the modality itself. Finally, according to patient and provider perceptions, electronic triage is a feasible modality for hospital triage of mass casualties. Further studies are required to assess the performance of electronic hospital triage, in the context of a rapid surge of patients, and should consider additional efficiencies built in to electronic triage systems. This study presents a framework for assessing the accuracy, triage time, and feasibility of digital technologies in live simulation training or actual MCIs.BolducC, MaghrabyN, FokP, LuongTM, HomierV. Comparison of electronic versus manual mass-casualty incident triage. Prehosp Disaster Med. 2018;33(3):273–278.

scholarly journals The Role of Rehabilitation in Reducing Resource Use and Lowering Hospital Readmission Through Discharge Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-804
Author(s):  
Kenneth Miller
Keyword(s):  
Health Care Providers ◽  
Resource Use ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Care Transitions ◽  
Healthcare Team ◽  
Transition Management ◽  
Care Providers ◽  
Initial Examination ◽  
The Individual

Abstract The transitions between medical settings, the community and back again is a complex and intimidating process for patients, families and caregivers. These transitions are vulnerable points where planning is key and must begin at the initial examination with rehabilitation providers (PTs/OTs,SLPs). These providers are key members of the healthcare team to facilitate effective transition management. In this session, attendees will learn the critical factors rehabilitation providers use to evaluate patients in order to facilitate successful care transitions. An overview of the indications for rehabilitation referral will be presented, as well as evidence for effective rehabilitation strategies. The speaker will present tools from the American Physical Therapy Association Home Health Toolbox and outline a decision-making process for care transitions based on the individual, caregivers, and health care providers to achieve successful transitions that reduce resource use and hospital readmission rates. Attendees will learn strategies to facilitate inter-professional collaboration, communication, and advocacy.

scholarly journals Withdrawing Versus not Offering Cardiopulmonary Resuscitation: Is There a Difference?

2015 ◽  
Vol 22 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Simon JW Oczkowski ◽  
Bram Rochwerg ◽  
Corey Sawchuk
Keyword(s):  
Mechanical Ventilation ◽  
Cardiopulmonary Resuscitation ◽  
Health Care Providers ◽  
Case Law ◽  
Decision Makers ◽  
Court Decisions ◽  
Medical Team ◽  
Care Providers ◽  
Substitute Decision Makers ◽  
The Individual

Conflict between substitute decision makers (SDMs) and health care providers in the intensive care unit is commonly related to goals of treatment at the end of life. Based on recent court decisions, even medical consensus that ongoing treatment is not clinically indicated cannot justify withdrawal of mechanical ventilation without consent from the SDM. Cardiopulmonary resuscitation (CPR), similar to mechanical ventilation, is a life-sustaining therapy that can result in disagreement between SDMs and clinicians. In contrast to mechanical ventilation, in cases for which CPR is judged by the medical team to not be clinically indicated, there is no explicit or case law in Canada that dictates that withholding/not offering of CPR requires the consent of SDMs. In such cases, physicians can ethically and legally not offer CPR, even against SDM or patient wishes. To ensure that nonclinically indicated CPR is not inappropriately performed, hospitals should consider developing ‘scope of treatment’ forms that make it clear that even if CPR is desired, the individual components of resuscitation to be offered, if any, will be dictated by the medical team’s clinical assessment.

scholarly journals Patients’ Views on Self-Management of Chronic Musculoskeletal Pain

2020 ◽  
Vol 5 (4) ◽  
pp. 254-266
Author(s):  
Barbka Huzjan ◽  
Ivana Hrvatin
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Health Care Providers ◽  
Multidisciplinary Approach ◽  
Research Question ◽  
Chronic Musculoskeletal Pain ◽  
Self Management ◽  
Care Providers ◽  
The Individual

Research Question (RQ): Chronic musculoskeletal pain is a complex condition and one of the most important causes of suffering of modern times. Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition. The research question is; what is the view on the selfmanagement of chronic musculoskeletal pain from the patient's perspective? Purpose: The purpose of this literature review was to review original articles that reported how selfmanagement educational programmes are viewed from the patient’s perspective. Method: We used an integrative review of the literature. The search was conducted from November 2019 to March 2020 on the PubMed, PEDro and OTseeker databases. We included original studies, written in English that examined the patients’ point of view on self-management. The included studies, needed to be conducted on adult patients of both sexes, that were suffering from chronic pain and were educated on self-management of their pain. Two authors independently searched for original studies. Results: Nine article were included in the review. Most of the studies included a multidisciplinary approach. Patients reported they more frequently used passive strategies to manage their pain. They want to be included in the management and be able to communicate with the provider of selfmanagement. There are several positive aspects of a multidisciplinary and groups approach. Organization: Health care providers can encourage an individual to proactively behave through ongoing processes of communication, partnerships and the creation of appropriate self-management plans over time. Society: We assume that the analysis will help to identify the social responsibility of the individual and society in the common concern for the health of the population and the individual within it. Originality: The research provides an up-to-date, new overview of the patients' perspective on self management on chronic pain. The review can be helpful to health care providers s they can compare their expectations with patients's. Limitations / further research: Further research would focus on high quality studies, and specific forms of multidisciplinary approach, and finding what patients use at a home setting and how to help them continue in the self management of their pain. Limitations of this review include the lack of risk of bias assessment and the fact that this is not a systematic review.

scholarly journals “Swinging Pendulum”: Lives of Family Members Caring for A Dying Relative

2019 ◽  
Author(s):  
Robert Sumaguingsing ◽  
Rudolf Cymorr Kirby Palogan Martinez
Keyword(s):  
Health Care Providers ◽  
Family Members ◽  
Spiritual Support ◽  
Care Providers ◽  
Interpretive Phenomenology ◽  
Home Setting ◽  
Face To Face ◽  
Van Manen ◽  
Informal Carers ◽  
The Individual

Among cultures which place emphasis on the centrality of family in ones lives, the care for the dying patient is more often than not delegated on family members. Given this context, it is interesting to note that few research have been done on the experiences of these individuals who provide care to their dying relatives. This research aims to understand the lives of these informal carers as they provide care to their dying relatives. After securing clearance from an IRB, seven (5) informants, deemed as coresearchers, were recruited and agreed to participate in this study. The co-researchers where selected based on a pre-set criteria and the number were reached based on theoretical saturation. Multiple individual in-depth face-to-face interviews were done to create the individual narratives which was later reflectively analysed. Interpretive phenomenology as espoused by van Manen served as the philosophical underpinning of the study. Consequently, the proposed analytic technique of van Manen was utilized as the process of reflective analysis. After the process of reflective analysis, three (3) themes were gathered, namely: Ambivalence in anticipation, Courage in uncertainty, Meaning in suffering. These themes represent for the co-researchers their lives as they care for their dying relatives. Further, these themes reflects for the co-researchers a phenomenon of living moment-to-moment, unsure of what tomorrow will bring, patiently waiting for their relative to cross over. For them, there seems to be a constant struggle of finding a reason for being and a sense of what has happened, what is happening and what could happen to their dying relative and their family after their death. This essence can be symbolically represented by a swinging pendulum, constantly in motion trying to situate ambivalence in their anticipation, looking for courage amidst uncertainty and finding formeaning in their experience of suffering. The insights suggest that there is a need for constant dialogue among family members and health care providers as they assumed the role of primary caregivers. Further continued emotional, moral and spiritual support is implied during this transition as well as follow-ups when the families are at the home setting.

scholarly journals Achievements and Challenges in Implementing Urban Family Physician Program in Iran: Viewpoint of Managers and Executives

2019 ◽  
Author(s):  
Mohammad Javad Kabir ◽  
Hasan Ashrafian Amiri ◽  
Zahra Hassanzadeh-Rostami ◽  
Reza Momtahen ◽  
Rasoul Zafarmand ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Family Physician ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Sustainable Resources ◽  
Urban Family ◽  
The Individual ◽  
Challenges And Strategies

Background: Urban family physician program is one of the relatively large reforms in Iran's health care system implemented in Fars and Mazandaran provinces since 2012. Nearly five years after implementation of the program, this study aimed to identify the achievements and challenges of this program from the viewpoints of managers and administrators. Methods: This cross-sectional study was conducted in winter of 2016. The research population included administrators and experts monitoring the urban family physician program and representatives of the family physicians and health care providers selected using the census method. The data collection tool was a two-part researcher-made questionnaire containing 15 questions with confirmed validity. To collect data, 29 panels of experts were held and the collected information was analyzed by SPSS 23 using independent t-tests and ANOVA. Results: Among the total of 647 participants in 2 provinces, 1540 achievement cases, 2387 challenge cases, and 1641 strategies were found. The average numbers of achievements, challenges, and strategies stated by each person were 2.38 ± 2.0, 3.70 ± 2.7, and 2.54 ± 2.0, respectively. The most frequent achievements, challenges, and strategies were increased disease detection and care (430), untimely payment to physicians (198), and providing sustainable resources for timely payments (119).  The means of achievements, challenges, and strategies had significant relationship with some of the individual and social variables (p < 0.05). Conclusion: This study showed that increasing the rate of detection was the most important achievement and lack of timely payment was the biggest challenge of the program, which should be considered by policy makers.

Evidence of prophylaxis treatment in adult haemophiliacs

2011 ◽  
Vol 31 (S 01) ◽  
pp. S34-S37
Author(s):  
J. Holzschuh ◽  
K.-H. Beck
Keyword(s):  
Health Care Providers ◽  
Task Force ◽  
Scientific Evidence ◽  
Individual Case ◽  
Opinion Leaders ◽  
Care Providers ◽  
Federal Joint Committee ◽  
Randomized Controlled ◽  
Set Up ◽  
The Individual

SummaryIn contrast to children with haemophilia the scientific evidence of prophylaxis treatment in adults is not yet proven. Existing studies are of observational character and mostly retrospectively designed. Therefore, opinion leaders in this field postulate prospectively designed, randomized, controlled and multicentric studies to set up urgently needed guidelines. Evidence according to the Canadian task force ranking is assessed as level III with a re- commendation grade C by the authors.The recognition of benefits of health care providers in accordance with the German Federal Joint Committee generally demands a Grade- Ia to Ib evidence. As long as the actual evidence of prophylaxis in adult haemophiliacs does not meet the postulated criteria of the German Federal Joint Committee, prophylactic replacement therapy of the individual case has to be well documented and reasonably explained.

scholarly journals Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being

2019 ◽  
Vol 1 (3) ◽  
pp. 16-21
Author(s):  
Jainish Patel ◽  
Prittesh Patel
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Care Providers ◽  
Emotional Expression ◽  
Well Being ◽  
Psychological Processes ◽  
Care Providers ◽  
Holistic View ◽  
The Individual ◽  
General Wellbeing

The widely held belief that emotional and psychological processes affect our physical health, mental health and general well-being are central to a holistic view of the individual, and as such, it is a useful foundational concept in integrative medicine. The purpose of this paper is to review substantial amounts of the latest research and recent findings on this issue to enable us to throw some light on how inhibitory factors to emotional expression and experience can endanger our health, both physically and psychologically including our general wellbeing. In addition, the connection between repression of emotion and certain mental disorders like depression and scientifically proven healthy ways to manage issues bordering on emotion was outlined. The information contained in this paper is just as important to health care providers and also to the patients they deal with

scholarly journals Developing HIV Assisted Partner Notification Services Tailored to Mexican Key Populations: A Qualitative Approach

2020 ◽  
Author(s):  
Heleen Vermandere ◽  
Santiago Aguilera-Mijares ◽  
Liliane Martínez-Vargas ◽  
M. Arantxa Colchero ◽  
Sergio Bautista-Arredondo
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Partner Notification ◽  
Essential Elements ◽  
Care Providers ◽  
Structured Interviews ◽  
Hiv Diagnosis ◽  
Hiv Awareness ◽  
Sex With Men ◽  
The Individual

Abstract Background. Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW).Methods. We conducted semi-structured interviews to explore partner notification with MSM, TW and health care providers to identify the essential elements to include in the design and implementation of APNS directed to MSM and TW in Mexico City. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS.Results. Most participants reported experiences with informal partner notification, but not with APNS. Only one health care provider indicated assisting notification systematically. The main barriers for notifying mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier notifying a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counsellors or peers to mitigate potential rejection or violent reactions. Conclusions. While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS can enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

scholarly journals Developing HIV Assisted Partner Notification Services Tailored to Mexican Key Populations: A Qualitative Approach

2020 ◽  
Author(s):  
Heleen Vermandere ◽  
Santiago Aguilera-Mijares ◽  
Liliane Martínez-Vargas ◽  
M. Arantxa Colchero ◽  
Sergio Bautista-Arredondo
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Partner Notification ◽  
Essential Elements ◽  
Care Providers ◽  
Structured Interviews ◽  
Hiv Diagnosis ◽  
Hiv Awareness ◽  
Sex With Men ◽  
The Individual

Abstract Background. Assisted partner notification services (APNS) may increase HIV testing, early diagnosis, and treatment, but they are not formally implemented in Mexico, where the HIV epidemic is concentrated in men who have sex with men (MSM) and transwomen (TW). We conducted semi-structured interviews to explore partner notification with MSM, TW and health care providers to identify the essential elements to include in the design and implementation of APNS directed to MSM and TW in Mexico City. Afterwards, brainstorm sessions were carried out to produce strategies for implementing APNS. Results. Most participants reported experiences with informal partner notification, but not with APNS. Only one health care provider indicated assisting notification systematically. The main barriers for notifying mentioned by both MSM and TW included fear of (violent) reactions, discrimination and lacking contact information of casual partners. Participants thought it was easier notifying a formal partner, conditional of being well informed about HIV. Given current stigma and lack of awareness, it was suggested that APNS should be preceded by HIV awareness efforts, and be provided by counsellors or peers to mitigate potential rejection or violent reactions. Conclusions. While APNS are not formally implemented in Mexico, all participants supported the service, indicating that APNS can enhance early HIV diagnosis in Mexico. Strategies to implement such services need to be flexible addressing the individual needs of participants, guaranteeing the safety of more vulnerable participants.

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