Prehospital and disaster medicine
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Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base. ⋯ The results highlight the small empirical evidence base for drawing conclusions about the use of debriefing with children and adolescents, and they call for further dialogue regarding challenges in evaluating debriefing and other crisis interventions in children.
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Prehosp Disaster Med · Jun 2015
ReviewHumanitarian assistance and accountability: what are we really talking about?
In the past two decades, there has been a worldwide increase in the number of disasters, as well as the number of people affected, along with the number of foreign medical teams (FMTs) deployed to provide assistance. However, in the wake of the 2010 Haiti earthquake, multiple reports and anecdotes questioned the actual, positive contribution of such FMTs and even the intentions behind these aid efforts. This brought on a renewed interest in the humanitarian community towards accountability. Between 2000 and 2012, the number of "Quality and Accountability" initiatives and instruments more than tripled from 42 to 147. Yet, to date, there is no single accepted definition of accountability in the humanitarian context. ⋯ The concept of accountability is defined poorly in many humanitarian organizations. Humanitarian providers often refer to different concepts when talking about accountability in general. The lack of a common understanding is contributed by the semantic and practical complexities of the term. The lack of emphasis on "enforcement/enforceability" is noteworthy. Other aspects of accountability, such as its "measurability" and by whom, similarly lack a common understanding and community-wide consensus. To what extent these vague definitions of accountability affect agencies' work in the field remains to be documented.
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Prehosp Disaster Med · Jun 2015
ReviewExertional heat illness: emerging concepts and advances in prehospital care.
Exertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. ⋯ External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.
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Prehosp Disaster Med · Jun 2015
Meta AnalysisSufficient catheter length for pneumothorax needle decompression: a meta-analysis.
Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis. ⋯ A catheter of at least 6.44 cm in length would be required to ensure that 95% of the patients in this pooled sample would have penetration of the pleural space at the site of needle decompression, and therefore, a successful procedure. These findings represent Level III evidence.
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Prehosp Disaster Med · Jun 2015
Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.
In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. ⋯ Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.