Tag: disaster preparedness

Categories : Emergency Medicine Injury & TraumaTags :

Optimal Placement for Bleeding Control Kits for the Public in Disaster Situations

On By ModernMedia
Photo by Camilo Jimenez on Unsplash

In the event of an accident or an attack, members of the public can save lives by performing first aid measures until the arrival of emergency medical services. But those people willing and able to serve as first responders will also need access to first aid equipment.

“There must also be certain equipment available to manage major bleeding. The question then is where this equipment should be placed, so that people who want to help can quickly access bleeding control kits,” says Carl-Oscar Jonson, adjunct senior associate professor at the Department of Biomedical and Clinical Sciences at Linköping University and head of research at the Center for Disaster Medicine and Traumatology in Linköping.

The first recommendations

Until now, there have been no guidelines for where such bleeding control kits should be located to ensure maximal utility. The current study, published in the journal Disaster Medicine and Public Health Preparedness, now contributes research-based recommendations.

“We found that the largest number of lives saved correlated with bleeding control kits being placed in two or more locations on the premises, but most importantly they shouldn’t be placed at entrances. We also concluded that the equipment must be accessible within 90 seconds’ walking distance,” says Anna-Maria Grönbäck, doctoral student at the Department of Science and Technology at Linköping University, who was involved in developing the simulation.

This means that bleeding control kits should not be placed at entrances, which is often the case with automated external defibrillators (AEDs). The reason for this is that they may be difficult to reach in a situation where many people have to be evacuated at once, such as in the case of attack or major accident. According to attack statistics, roughly 20 injured people will need first aid including a bleeding control kit each. It may be helpful to locate bleeding control kits in the same places as clearly marked AEDs, as long as not located at the entrances.

Bomb consequences simulated

The recommendations are based on conclusions reached by the research team by developing a computer-based simulation of an explosion in a large shopping centre with thousands of simultaneous visitors. In their simulation, the researchers have looked at what happens right after an explosion. The majority of the simulated people try to get out of the premises and move towards the exits. Simulated people close to the blast suffer varying degrees of injury and start bleeding.

In the simulation, some individuals help those injured by applying direct pressure to reduce bleeding, or by trying to find equipment. It is a race against time. Depending on how long it takes to get the equipment, the simulated casualty may die from blood loss.

To find the best strategy for the placement of bleeding control kits, the researchers tested four different scenarios in their simulation. They weighed together the outcomes of the many simulated courses of events for each scenario and compared them to understand which placement of equipment saved the largest number of lives.

Source: Linköping University

Categories : Environmental Effects HospitalsTags :

Cape Town’s Newest Hospital Recognised for Exemplary Water Conservation  

On By ModernMedia
Netcare Christiaan Barnard Memorial Hospital has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management and aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.

Netcare Christiaan Barnard Memorial Hospital (NCBMH) has earned a prestigious five-star rating from the City of Cape Town’s Water and Sanitation Directorate, joining the esteemed ranks of organisations dedicated to water sustainability. The accolade underscores NCBMH’s commitment to responsible water management.

The City of Cape Town’s Water Star Rating Certification Awards acknowledged NCBMH’s dedication to best water use, supply, conservation and discharge practices. This recognition aligns with the hospital’s ongoing efforts to champion prudent and sustainable management of natural resources, supporting water-sensitive urban living.

“We are proud to be part of a community leading the charge in climate-smart healthcare transformation and are committed to playing a proactive role in averting a potential water crisis in Cape Town and across South Africa,” said André Nortje, Netcare’s environmental sustainability manager.

Nortje emphasised Netcare’s dedication to minimising environmental impact: “Our commitment extends beyond accolades. Efforts to conserve water, reduce waste and save electricity should be high on every South African’s agenda, and we are committed to doing our part to drive sustainability.”

NCBMH’s water conservation initiatives include a sophisticated greywater harvesting system, as well as a desalination plant capable of providing the entire facility’s water needs. These initiatives, as well as the installation of low-flow showerheads and aerator-equipped taps throughout the hospital, can achieve water savings of approximately 60 000 kilolitres for the facility per annum. The hospital’s desalination plant, installed in 2019, also has the filtration capacity to support all Netcare facilities in the City of Cape Town in a disaster situation.

Netcare achieved a 23% reduction in water consumption at Group level between 2014 and 2020. Nortje outlined the 2030 aim to further reduce the company’s impact on the natural potable water sources by implementing grey- and black-water recycling projects within selected facilities.

The company’s sustainability strategy, initiated in 2013, addresses electricity use, waste reduction, and water management. The Group aims to further reduce its impact on water sources by an additional 20% from the 2020 baseline. The strategy includes efficient equipment deployment, the evaluation of greywater and blackwater treatment for potable water and an operational efficiency drive.

“We believe every business should be a good corporate citizen contributing to our country’s future. At Netcare, we want to show South Africa and the world that sustainability is possible and that YOU can make a difference. The certification allows us to showcase our efforts to inspire businesses around us to join in the fight against wastage,” concluded Nortje.

Categories : Expert OpinionTags :

The Healthcare Threat of Chemical Warfare in Ukraine

On By ModernMedia
Photo by Pablo Stanic on Unsplash

Writing for MedPage Today, two experts examine the possibility of chemical weapon use in Ukraine. Gavin Harris, MD assistant professor of infectious diseases and critical care, and Joel Zivot, MD, an associate professor of anaesthesiology/critical care, both of Emory University School of Medicine, explained the consequences of such an attack, noting that Russia has used such weapons in the past.

Though it’s uncertain whether Russia would launch a chemical attack, A/Profs Harris and Zivot wrote: “one thing is clear: in a large-scale chemical attack within the current Russian-Ukrainian conflict, the prospect of any meaningful healthcare response is bleak.”

Chemical agents fall under a number of classifications, which include blistering/vesicants such as mustard gas, blood agents such as hydrogen cyanide, choking/pulmonary agents such as chlorine gas, incapacitating agents such as opioids, and nerve agents such as sarin or the Russian-made Novichok. Development of modern chemical weapon traces back to the 1930s with the development of various nerve agents: organophosphorus cholinesterase inhibitors, each with particular potency.

Russia has recently complained to the UN Security Council that Ukraine and the US were cooperating to produce chemical and biological weapons for use in the war. The US government has responded that Russia is laying this claim to prepare for its own use of such weapons in Ukraine.

The preparation of chemical and biological agents can be done in secret, and easily introduced into the air, water, or food supply.

Invisible and odourless, nerve agents include sarin, soman, tabun, and the American-produced VX. The V agents were at one time considered to be the most toxic agents ever produced and are ten times more toxic than sarin. VX, tonnes of which was produced by the US government, can kill a person rapidly after they have been exposed to an infinitesimal amount.

Exposure to such nerve agents can cause a “constellation of symptoms,” according to the authors. “Nerve agents block the action of acetylcholinesterase, and this leads to accumulation of the neurotransmitter acetylcholine,” they wrote. “High levels of acetylcholine in the synaptic cleft causes overstimulation of cholinergic receptors. Symptoms related to excess accumulation of acetylcholine are divided into three groups: muscarinic, nicotinic, and central. Overstimulation of muscarinic cholinergic receptors causes pupil constriction, glandular hypersecretion, urination, defecation, sweating, and vomiting. Nicotinic symptoms are weakness and ultimately paralysis. Central nervous system poisoning will manifest as irritability, delirium, fatigue, lethargy, seizures, coma, and death by respiratory depression.”

Chemical weapons would have a devastating impact on already strained healthcare systems, A/Profs Harris and Zivot concluded. “Such weapons can create a complex mass casualty event where the treating personnel and the healthcare facilities may themselves be within the zone of conflict,” they wrote. “Chemical and biologic attacks require intense and complex treatment, and in both types of attacks, treating personnel may themselves be at risk of becoming exposed and therefore decontamination may be required before the initiation of any supportive treatments. Emergency and medical providers would also need to have access to proper respiratory protection and hazardous material/chemically resistant suits, and in a widespread attack, in an ever-deteriorating war zone like Ukraine, such treatment capacity would be highly limited.”

The authors note that such an attack would not be the first for Russia, which has shown a willingness to use chemical agents on more than one occasion.

During a hostage crisis in 2002, where Chechen rebels took over a Moscow theatre and took 700 hostages, Russian authorities used a gas to incapacitate the rebels – as well as the hostages. The gas may have been a mixture of remifentanil/halothane or an aerosolised form of carfentanil, a synthetic opioid that is approximately 10 000 times more potent than morphine. Overdoses from carfentanil from substance abuse have been seen in recent years. In many cases of opioid overdose, death from respiratory failure is a consequence. After the raid, at least 33 Chechens and 129 hostages died, mostly from gas exposure and inadequate medical care. Russian authorities refused to release information on the gas used, hindering emergency response.

Russia has also apparently used Novichok, which may be up to eight times as potent as VX, in recent high-profile attempts to kill opponents of the Russian government. The most recent use of Novichok was an attempted assassination of Alexei Navalny, a prominent Russian dissident. Though whether Novichok was the agent, Navalny’s treatment was for nerve agent exposure, featuring large doses of atropine. Though he survived, his treatment was an intensive, organised effort. A large attack using Novichok or other chemical agent in Ukraine promises to be almost entirely lethal to civilians, military and first responders.

Source: MedPage Today

Categories : COVID HospitalsTags :

How One Hospital Met the COVID Surge Head-on

On By ModernMedia
Photo by Artem Podrez on Unsplash

Since March of 2020, the COVID pandemic has put an unprecedented strain on hospitals as large surges of intensive care unit patients overwhelmed hospitals. To meet this challenge, Beth Israel Deaconess Medical Center (BIDMC) expanded ICU capacity by 93% and maintained surge conditions during the nine weeks in the first quarter of 2020.

In a pair of papers and a guest editorial published in Dimensions of Critical Care Nursing, a team of nurse-scientists at Beth Israel Deaconess Medical Center (BIDMC) report on almost doubling the hospital’s ICU capacity; identifying, training and redeploying staff; and developing and implementing a proning team to manage patients with acute respiratory distress syndrome during the first COVID surge.

“As COVID was sweeping through the nation, we at BIDMC were preparing for the projected influx of highly infectious, critically ill patients,” said lead author Sharon C. O’Donoghue, DNP, RN, a nurse specialist in the medical intensive care units at BIDMC. “It rapidly became apparent that a plan for the arrival of highly infectious critically ill patients as well as a strategy for adequate staffing protecting employees and assuring the public that this could be managed successfully were needed.”

After setting up a hospital incident command structure to clearly define roles, open up lines of communication and develop surge plans, BIDMC’s leadership began planning for the impending influx of COVID patients in February 2020.

BIDMC – a 673 licensed bed teaching hospital affiliated with Harvard Medical School – has nine specialty ICUs located on two campuses for a total of 77 ICU beds. Informed by an epidemic surge drill conducted at BIDMC in 2012, it was determined that the trigger to open extra ICU space would be when 70 ICU beds were occupied. When this milestone was met on March 31, 2020, departmental personnel had a 12-hour window to convert two 36-bed medical-surgical units into additional ICU space, providing an additional 72 beds.

“Because the medical-surgical environment is not designed to deliver an ICU level of care, many modifications needed to be made and the need for distancing only added to the difficulties,” said senior author Susan DeSanto-Madeya, PhD, RN, FAAN, a Beth Israel Hospital Nurses Alumna Association endowed nurse scientist. “Many of these rooms were originally designed for patient privacy and quiet, but a key safety element in critical care is patient visibility, so we modified the spaces to accommodate ICU workflow.”

Modifications included putting windows in all patient room doors, and repositioning beds and monitors so patients and screens could be easily seen without entering the room. Lines of visibility were augmented with mirrors and baby monitor systems as necessary. Care providers were given two-way radios to decrease the number of staff required to enter a room when hands-on patient care was necessary. Mobile supply carts and workstations helped streamline workflow efficiency.

Besides stockpiling and managing medical equipment including PPE, ventilators and oxygen, increasing ICU capacity also required redeploying 150 staff trained in critical care. The hospital developed a recall list for former ICU nurses, as well as medical-surgical nurses that could care for critically ill patients on teams with veteran ICU nurses.

Education and support was provided from . In-person, socially-distanced workshops were developed for each group, after which nurses were assigned to shadow an ICU nurse to reduce anxiety, practice new skills and gain confidence.

“Staff identified the shadow experience as being most beneficial in preparing them for deployment during the COVID surge,” said O’Donoghue. “Historically, BIDMC has had strong collaborative relationships with staff from different areas and these relationships proved to be vital to the success of all the care teams. The social work department played a major role in fostering teams, especially during difficult situations.”

One of the redeployment teams was the ICU proning team. Proning is known to improve oxygenation in patients with acute respiratory distress syndrome is a complex intervention, takes time and is not without its potential dangers to the patient and staff alike. The coalition maximised resources and facilitated more than 160 interventions between March and May of 2020.

“Although the pandemic was an unprecedented occurrence, it has prepared us for potential future crises requiring the collaboration of multidisciplinary teams to ensure optimal outcomes in an overextended environment,” O’Donoghue said. “BIDMC’s staff rose to the challenge, and many positive lessons were learned from this difficult experience.”

“We must continue to be vigilant in our assessment of what worked and what did not work and look for ways to improve health care delivery in all our systems,” said DeSanto-Madeya, who is also an associate professor at the College of Nursing at the University of Rhode Island. “The memories from this past year and a half cannot be forgotten, and we can move forward confidently knowing we provided the best care possible despite all the hardships.”

Source: Beth Israel Deaconess Medical Center

Categories : Hospitals Medical Research & TechnologyTags :

Battery Backups Can Protect People Dependent on Medical Equipment

On By ModernMedia
A battery. Photo by Danilo Alvesd on Unsplash.

In countries prone to blackouts from extreme weather events (and in some cases solar flares) battery backups could provide a viable alternative to keep the medical support systems for vulnerable family members functioning. As climate change is set to increase the frequency and severity of weather-related blackouts, a study from the Columbia University Mailman School of Public Health examined the value of battery backups.

Millions of people are reliant on home medical equipment – the elderly, ill people, many of whom are poor or otherwise vulnerable. Medical equipment such as oxygen concentrators, nebulisers, ventilators, and dialysis and sleep apnoea machines often have no backup power in case of an outage.

In a 2019 wildfire which caused power outages, many vulnerable residents reported complications, such as one man who awoke, unable to breathe when his sleep apnoea breathing machine stopped functioning.
Community centres such as schools are often turned to for services when power fails, such as using their refrigerators to store food, but many do not have backup power.

“Climate change coupled with aging energy infrastructure is driving extreme weather-related power outages, as we’ve seen recently in Texas,” said study co-author Diana Hernández, PhD, Associate Professor of Sociomedical Sciences, Columbia University, “The technology to improve resiliency and energy independence exists, and it needs to be made more accessible to those who could most benefit. Battery storage units, particularly those powered by the sun, are a critical tool to help vulnerable individuals and communities survive the climate crisis.”

In the US territory of Puerto Rico, following the widespread destruction of the electrical grid by Hurricane Maria, many residents used solar panels instead of diesel generators due to ease of use, low cost, and not emitting fumes that exacerbate asthma and other lung conditions

A review of literature showed that blackouts can result in negative health consequences ranging from carbon monoxide poisoning, temperature-related illness, gastrointestinal illness, and mortality to cardiovascular, respiratory, and hospitalisations for kidney disease, especially for individuals dependent on electrically powered medical equipment.

Beyond electrical backup, in the US, older adults, poorer families, and individuals of non-Hispanic Black and Hispanic race/ethnicity are also less likely to have emergency supplies of food, water and medicine in the event of disaster.

Overall, the researchers found that more work is needed to better define and capture the relevant exposures and outcomes. “There is urgent need for data to inform disaster mitigation, preparedness, and response policies (and budgets) in an increasingly energy-reliant world,” said first author Joan Casey, PhD, assistant professor of environmental health sciences at Columbia Mailman School.

Eskom in South Africa is already facing a shortfall due to users abandoning its services for solar power generation, forcing tariff changes and increases. An uptake of battery backups to complement the solar panels may greatly alleviate vulnerabilities of people dependent on medical equipment in an uncertain power supply environment, as well as improving resilience to natural disasters, without the health hazards of generators.

Source: News-Medical.Net

Journal information: Mango, M., et al. (2021) Resilient Power: Battery storage as a home-based solution to address climate-related power outages for medically vulnerable populations. Futures. doi.org/10.1016/j.futures.2021.102707.