Abstracts of Oral Presentations-WADEM Congress on Disaster and Emergency Medicine 2019
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Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
AGED CARE AND DISABILITY
Dallas Mega Shelter Onsite Medical Operations 2. FEMA. 2010. https://www.fema.gov/media-library-data/
Supporting Evacuee Functional Independence and Family 20130726-1831-25045-7316/fnss_guidance.pdf.
Unit Integrity During Response to Hurricane Harvey Prehosp. Disaster Med. 2019;34(Suppl. 1):s1
Prof. Raymond E. Swienton, Dr. Kelly R. Klein, doi:10.1017/S1049023X19000220
Dr. E. Liang Liu, Dr. Lindsay A. Flax, Prof. Raymond L. Fowler
University of Texas Southwestern, Dallas, United States
Development of an Evacuation Exercise for Residential
Introduction: In the United States, over 50% of people have at Aged Care Facilities Using the Emergo Train System (ETS)
least one chronic medical condition, access, or functional limi- Mr. Karl Cronan, Ms. Linda Winn
tation. In 2017 during Hurricane Harvey, the establishment of a NSW Ambulance, Eveleigh, Australia
comprehensive multidisciplinary onsite medical clinic provided
health and medical services to over 3,800 evacuees at the Dallas Introduction: Events such as the Sydney Quakers Hill Nursing
Mega Shelter, providing large-scale general population sheltering Home fire highlighted the great need for robust evacuation
support to all evacuees and prioritizing family unit integrity by plans for Residential Aged Care Facilities (RACFs). However,
meeting physical, sensory, and cognitive limitations, and chronic plans alone are not sufficient and routine exercises are necessary
medical conditions. The effectiveness of the Dallas Mega Shelter to test the capability of a facility’s emergency plan. Current
onsite medical operations supporting this aim is reviewed. methods of exercising facility evacuations, such as live drills, are
Aim: To utilize onsite health and medical resources to meet
limited and only test isolated elements of the evacuation proc-
access and functional needs of evacuees seeking general
ess, which fall drastically short of being able to simulate the real-
population mass sheltering in Dallas, Texas during Hurricane
time resources and procedures required to perform a large scale
Harvey.
evacuation of a RACF.
Methods: Observational.
Aim: To develop an exercise tool that assists Residential Aged
Results: Over 3,800 evacuees were evaluated for functional
Care Facilities (RACF) to evaluate their evacuation procedures
needs support services (FNSS) resulting in over 2,500 evacuee
patient encounters during 21 continuous days of onsite health using quantifiable data, based on real-time and providing min-
and medical clinic operations.1 A comprehensive array of ser- imal disruption to existing residents.
vices were available at no cost to the evacuees and were in accor- Methods: Utilizing the existing ETS framework, an aged care
dance with the Federal Emergency Management Association resident patient bank was developed by NSW Health Emergency
(FEMA) published Guidance on Planning for Integration of Management Unit, including:
Functional Needs Support Service in General Population • A bank of 200 residents from data sourced from the Australian
Shelters.2 The goal to maintain nearly all evacuees choosing to Institute of Health and Welfare.
• Layout for the resident gubers and Summary Care Plans.
stay in the Mega Shelter was achieved. The challenges, limita-
• Resources and equipment routinely used in RACF’s.
tions, and risks identified are reviewed.
• Real-world testing of the prototype in exercises across NSW,
Discussion: FNSS guidelines require all persons, regardless
Australia
of limitations, when evacuated from home be provided all ser- • Mortality and morbidity data to measure outcomes.
vices necessary to allow them to remain in general population • Validation of the exercise tool nationally and internationally.
sheltering.2 This prioritization of personal choice, functional Results: A bank of residents was developed to test evacuation
independence, and family integrity for those with compre- systems and processes, in a scalable, realistic simulation based
hensive FNSS requirements presented notable challenges, on patient outcomes. This will result in improved planning
including public health and safety risks impacting the wellbeing and process, empowerment of RACFs, better patient outcomes,
of others. Meeting these expectations must be balanced with
and increased resilience and preparedness.
maintaining shelter integrity.
Discussion: A significant investment of data, time, and effort
References has gone into producing this resident bank for use in RACF
1. Liu, EL, Morshedi B, Miller BL, et al. Dallas mega shelter evacuation exercises across NSW Australia. A presentation
medical operations response to Hurricane Harvey. DMPHP delivered at the ETS World Congress in the Netherlands
2017 Dec;6:1–4. (2018), by NSW Health Emergency Management Unit,
May 2019 Prehospital and Disaster Medicines2 Aged Care and Disability
showcased the relevance and suitability of this tool across 1995-2017. The gathered information included the reason
the world. for evacuation, injuries, deaths, and locations within the
Prehosp. Disaster Med. 2019;34(Suppl. 1):s1–s2 United States.
doi:10.1017/S1049023X19000232 Results: From 1995 to 2017, there was a total of 51 evacuations
and 141 deaths in nursing homes. 27 (53%) evacuations were
due to external events which resulted in a combined 121 (86%)
Mortality in Nursing Home Evacuations in the United deaths, and 24 (47%) evacuations were due to internal events
States from 1995-2017 which resulted in a combined 20 (14%) deaths. Hurricanes were
Dr. Sharon Mace1, Mr. Daniel Caicedo2, responsible for the majority of deaths during evacuations, fol-
Miss. Aishwarya Sharma2 lowed by fires and floods. The number of evacuations and
1. Cleveland Clinic Lerner College of Medicine at Case Western deaths increased the greatest between 2005 to 2008.
Reserve University, Cleveland, United States Discussion: External events have the greatest impact on loss of
2. Ohio University Heritage College of Osteopathic Medicine, life. Internal disasters are about equal in the number of inci-
Warrensville Heights, United States dents, however, external events have a much greater mortality
rate. Exact numbers on injuries, morbidity, and mortality are
Introduction: There are an estimated 15,600 nursing homes difficult to ascertain, but it appears to be related to natural
with a total of 1.4 million residents in the United States. The disasters. In view of the increasing likelihood of natural disas-
number of residents will continue to increase due to the aging ters related to global warming, a drastic improvement of
population, and the associated morbidities will make it difficult standard evacuation procedures of long-term nursing homes
to evacuate them safely. is critical to decreasing mortality of nursing home residents.
Aim: This study is the first of its kind to provide an analysis of There also needs to be a nationally standardized method
the number of nursing home deaths caused by external and of reporting evacuations in order to better analyze data on
internal events following evacuations. nursing homes.
Methods: Information from the databases Lexis Nexis and Prehosp. Disaster Med. 2019;34(Suppl. 1):s2
PubMed were compiled and limited to news articles from doi:10.1017/S1049023X19000244
Prehospital and Disaster Medicine Vol. 34, Supplement 1Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
AUSTERE SURGERY
Surgical Procedures Performed by Emergency Medical 1. University of Sydney, Sydney, Australia
Teams in Sudden-Onset Disasters: A Systematic Review 2. Médecins sans Frontières- Operational Centre Brussels, Brussels,
Dr. Charles Coventry1, Prof. Andrew Holland1,2, Belgium
Dr. Ashish Vaska3, Prof. Rebecca Ivers4, Dr. David Read5 3. National Critical Care and Trauma Response Centre
1. University of Sydney, Sydney, Australia 4. University of NSW
2. Children’s Hospital at Westmead, Sydney, Australia
3. University Hospital Geelong, Geelong, Australia Introduction: Emergency medical teams (EMTs) have helped
4. University of NSW, Sydney, Australia to provide surgical care in many recent sudden onset disasters
5. National Critical Care and Trauma Response Centre, Darwin, (SODs), especially in low- and middle-income countries
Australia (LMICs). General surgical training in Australia has undergone
considerable change in recent years, and it is not known whether
Aim: To describe the types of surgical procedures performed the new generation of general surgeons is equipped with the
by emergency medical teams (EMTs) with general surgical broad surgical skills needed to operate as part of EMTs.
capability in the aftermath of sudden-onset disasters (SODs) Aim: To analyze the differences between the procedures per-
in low- and middle-income countries (LMICs). formed by contemporary Australian general surgeons during
Methods: A search of electronic databases (PubMed, training and the procedures performed by EMTs responding
MEDLINE, and EMBASE) was carried out to identify articles to SODs in low- and middle-income countries (LMICs).
published between 1990 and 2018 that describe the type of sur- Methods: General surgical trainee logbooks between February
gical procedures performed by EMTs in the impact and post- 2008 and January 2017 were obtained from General Surgeons
impact phases a SOD. Further relevant articles were obtained Australia. Operating theatre logs from EMTs working during
by hand-searching reference lists. the 2010 earthquake in Haiti, 2014 typhoon in the Philippines,
Results: 16 articles met the inclusion criteria. Articles reporting and 2015 earthquake in Nepal were also obtained. These case-
on EMTs from a number of different countries and responding loads were collated and compared.
to a variety of disasters were included. There was a high preva- Results: A total of 1,396,383 procedures were performed
lence of procedures for extremity soft tissue injuries (46.8%) and by Australian general surgical trainees in the study period.
fractures (28.3%). However, a significant number of genitouri- The most common procedure categories were abdominal wall
nary/obstetric procedures were also reported. hernia procedures (12.7%), cholecystectomy (11.7%), and
Discussion: Knowledge of the types of surgical procedures specialist colorectal procedures (11.5%). Of note, Caesarean
most frequently performed by EMTs may help further deter- sections, hysterectomy, fracture repair, specialist neurosurgi-
mine the necessary prerequisite surgical skills required for the cal, and specialist pediatric surgical procedures all made up
recruitment of surgeons for EMTs. Experience in basic plastic,Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
BEST PAPERS
Addressing Adolescent Mental Health after Disasters: Prehosp. Disaster Med. 2019;34(Suppl. 1):s4
The Critical Role of Chronic Stressors doi:10.1017/S1049023X1900027X
Dr. Elizabeth Newnham1,2, Dr. Xue Gao1,
Ms. Elizabeth Nathan3, Dr. Mark Boyes1, Dr. Feng Jiao4,
Dr. Bhushan Guragain5, Professor Jennifer Leaning2 August 24th, 2016 Central Italy Earthquake - Validation of
1. School of Psychology, Curtin University, Perth, Australia “Modified Utstein Template for Hospital Disaster
2. FXB Center for Health and Human Rights, Harvard University, Response Reporting,” A New Tool for Reporting Hospital’s
Boston, United States Reaction to Disasters
3. Women and Infants Research Foundation, Perth, Australia Dr. Matteo Paganini1,2, Dr. Luca Ragazzoni1,
4. Kunming Medical University, Kunming, China Dr. Fabio Rossitto1, Dr. Aurora Vecchiato1,3, Dr. Rita Bonfini4,
5. Centre for Victims of Torture, Kathmandu, Nepal Dr. Maria Vittoria Mucciante5, Dr. Alessandra Nisii6,
Dr. Francesco Della Corte1, Dr. Pier Luigi Ingrassia1
Introduction: Prolonged conditions of chronic stress have the 1. CRIMEDIM Research Center, University of Eastern Piedmont -
potential to cause mental health difficulties and disrupt devel- Novara-Italy, Novara, Italy
2. Emergency Medicine residency program, Padova, Italy
opmental processes for children and adolescents. Natural disas-
3. Emergency Medicine residency program, Sassari, Italy
ters disproportionately affect low-resource areas, yet little is
4. Emergency Department, “S. Camillo de Lellis” Hospital, Rieti,
known about the interaction between trauma exposure, chronic Italy
stressors, and mental health. 5. Health Administration, “S. Salvatore” Hospital, L’Aquila, Italy
Aim: To determine the rates of post-traumatic stress disorder 6. Health Administration, “C. e G. Mazzoni” Hospital, Ascoli
(PTSD), depression and anxiety among adolescents affected by Piceno, Italy
earthquakes in China and Nepal, and examine the specific roles
of trauma exposure and chronic stressors across the three mental Introduction: After Action Reports analyze events and recom-
health outcomes. mend actions to facilitate preparedness and response to future
Methods: A school-based, cross-sectional study of 4,215 ado- similar disasters. However, there is no consensus among the
lescents (53% female, ages 15-19 years) was conducted in dis- templates developed to collect data during disasters and little
aster-affected areas of southern China and Nepal. Participants is known about how to report hospital responses.
completed a series of translated and culturally adapted stand- Aim: The hypothesis was that the use of a new assessment tool
ardized assessments. Mixed effects logistic regression analyses for hospital response to natural disasters facilitates the system-
were conducted for each mental health outcome. atic collection of data and the delivery of a scientific report after
Results: The overall rate of PTSD was 22.7% and was higher the event.
among Nepalese participants (China: 19.4% vs. Nepal: 26.8%, Methods: A data collection tool, focused on hospital response
pBest Papers s5
managers and patients’ charts. Patients were uniformly distrib- disasters were associated overall with more cases of chronic
uted across the four hospitals, and the hospital capabilities were health conditions.
able to cope with this mass influx of casualties. The Modified Discussion: The analysis of nationally-representative popula-
Utstein Template for Hospital Disaster Response Reporting is tion data provides a consistent method to examine the unique
a valid tool for hospital disaster management reporting. This national imprint of disaster exposure and distinct profile of
template could be used for a better comprehension of hospital disaster health risks to inform future detection, prevention
disaster reaction, debriefing activities, and revisions. measures, disaster health preparedness, and response planning.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s5
References doi:10.1017/S1049023X19000293
1. Debacker, M, Hubloue I, Dhondt E, et al. Utstein-style
template for uniform data reporting of acute medical response
in disasters. PLoS Curr. 2012 Mar 23.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s4–s5
Resurgence of Vector-Borne and Vaccine-Preventable
doi:10.1017/S1049023X19000281 Diseases in Venezuela in Times of a Complex Humanitarian
Health Crisis: A Regional Menace
Dr. Adriana Tami1,2, Prof. Maria Eugenia Grillet3,
Dr. Alberto Paniz-Mondolfi4, Dr. José Oletta5,
Examining the National Profile of Chronic Disaster Health Dr. Martin S Llewellyn6, Dr. Juan V Hernández-Villena3,
Risks in Australia Ms. Marilianna Márquez4, on behalf of the working group on
Dr. Lennart Reifels1, Dr. Michel LA Dückers2, emerging and re-emerging diseases in Venezuela
A/Prof. Grant Blashki3 1. Department of Medical Microbiology, University Medical Center
1. Melbourne School of Population and Global Health, University of Groningen, University of Groningen, Groningen, Netherlands
Melbourne, Melbourne, Australia 2. Faculty of Medical Sciences, Universidad de Carabobo, Valencia,
2. Nivel - Netherlands Institute for Health Services Research, Venezuela
Utrecht, The Netherlands 3. Laboratorio de Biologia de Vectores y Parásitos, Instituto de
3. Nossal Institute for Global Health, University of Melbourne, Zoología y Ecología Tropical, Facultad de Ciencias, Universidad
Melbourne, Australia Central de Venezuela, Caracas, Venezuela
4. Infectious Diseases Research Incubator and the Zoonosis and
Introduction: Despite a longstanding focus on examining Emerging Pathogens Regional Collaborative Network,
acute health impacts in disaster research, only limited systematic Department of Tropical Medicine and Infectious Diseases,
information is available today to further our understanding of Instituto de Investigaciones Biomédicas IDB, Clinica IDB
chronic physical health risks of disaster exposure. Heterogeneity Cabudare, Barquisimeto, Venezuela
of studies and disaster events of varying type and scale com- 5. Sociedad Venezolana de Salud Pública/ Red Defendamos la
pounding this challenge highlight the merit of a consistent Epidemiología Nacional, Caracas, Venezuela
approach to examining nationally representative population data 6. Institute of Biodiversity, Animal Health and Comparative
to understand distinctive profiles of chronic disaster health risks. Medicine, University of Glasgow, Glasgow, United Kingdom
Aim: This epidemiological study examined the full spectrum
and national profile of chronic physical health risks associated Introduction: Venezuela has plunged into a humanitarian,
with natural and man-made disaster exposure in Australia. economic, and health crisis of extraordinary proportions. This
Methods: Nationally-representative population survey data complex situation is derived from dismantling of structures
(N=8841) were analyzed through multivariate logistic regres- at the institutional, legal, political, social, and economic level
sion, controlling for sociodemographic variables, exposure to affecting the life and wellbeing of the entire population.
natural and man-made disasters, and other traumatic events. Aim: This study aims to assess the impact of Venezuela’s
Key outcomes included lifetime national chronic health priority healthcare crisis on vector-borne and vaccine-preventable
conditions (asthma, cancer, stroke, rheumatism/arthritis, diseases and the spillover to neighboring countries.
diabetes, heart/circulatory) and other conditions of 6 month Methods: Since October 2014, there is a paucity of official
or more duration (based on the World Health Organization’s epidemiological information in Venezuela. An active search
WMH-CIDI chronic conditions module). of published and unpublished data was performed. Venezuela
Results: Natural disaster exposure primarily increased the life- and Latin America data were sourced from PAHO Malaria
time risk of stroke (AOR 2.06, 95%CI 1.54-2.74). Man-made Surveillance and from Observatorio Venezolano de la Salud.
disaster exposure increased the lifetime risk of stomach ulcer Brazil and Colombian data were accessed via their respective
(AOR 2.21, 95%CI 1.14-4.31), migraine (AOR 1.61, 95%CI Ministries of Health.
1.02-2.56), and heart/circulatory conditions (AOR 2.01, 95% Results: Economic and political mismanagement have pre-
CI 1.07-3.75). Multiple man-made disaster exposure height- cipitated a general collapse of Venezuela’s health system with
ened the risk of migraine (AOR 2.98, 95%CI 1.28-6.92) and hyperinflation rates above 45,000%, people impoverishment,
chronic back or neck conditions (AOR 1.63, 95%CI 1.02- and long-term shortages of essential medicines and medical
2.62), while multiple natural disaster exposure heightened supplies. In this context, the rapid resurgence of previously
the risk of stroke (AOR 3.28, 95%CI 1.90-5.67). No other well-controlled diseases, such as vaccine-preventable (measles,
chronic health risks were elevated. Despite the relatively greater diphtheria) and arthropod-borne (malaria, dengue) diseases has
chronic health risks linked to man-made disasters, natural turned them into epidemics of unprecedented magnitudes.
May 2019 Prehospital and Disaster Medicines6 Best Papers
Between 2000-2015 Venezuela witnessed a 365% increase management staff to engage with clinical colleagues. This
in malaria cases followed by a 68% increase (319,765 cases) allowed likely EMT assistance to be pre-planned, which facil-
in late 2017. The latest figures have surpassed 600,000 malaria itates further planning with national and local emergency man-
cases with a prediction to reach 1 million by the end of 2018. agement, border, and registration agencies for rapid entry into
Measles and diphtheria have recently re-emerged after a pro- NZ, including onward transport and logistical support. While
gressive interruption of the national immunization program, with injury treatment ratios had to be refined to reflect NZ context,
vulnerable indigenous population being particularly affected. the methodology proved useful for Ministries of Health to
In response to Venezuela’s rapidly decaying situation, a massive pre-identify the need for international assistance in national
population exodus is ongoing towards neighboring countries emergencies.
causing a spillover of diseases. Prehosp. Disaster Med. 2019;34(Suppl. 1):s6
Discussion: Action to halt the spread of vaccine-preventable doi:10.1017/S1049023X19000311
diseases within Venezuela is a matter of urgency for the country
and the region. Global and hemispheric health authorities
The Importance of Enforcing Road Safety Laws to Reduce
should urge the Venezuelan government to allow establishing
Road Traffic Collision (RTC) Occurrence and Fatalities in
a humanitarian channel to bring relief.
Nigeria
Prehosp. Disaster Med. 2019;34(Suppl. 1):s5–s6
Dr. Oluwafunbi Awoniyi1,2, Dr. Michael Molloy1,3,
doi:10.1017/S1049023X1900030X
Dr. Alexander Hart1,2, Amalia Voskanyan1,2, Dr. Ritu Sarin1,2,
A Prof. Gregory Ciottone1,2
1. BIDMC Fellowship in Disaster Medicine, Boston, United States
Surge Capacity Planning to Inform the Need for 2. Department of Emergency Medicine, Beth Israel Deaconess
International and Domestic Emergency Medical Team Medical Center, Boston, United States
Deployments Following a Severe Wellington, New Zealand 3. University College Dublin, Belfield, Dublin, Ireland
Earthquake
Mr. Charles Blanch1,2, Dr. Emma Lawrey1,3 Introduction: Road Traffic Crashes (RTC) are one of the most
1. New Zealand Medical Assistance Team, Auckland, New Zealand preventable causes of death worldwide, yet are the number one
2. Ministry of Health, Wellington, New Zealand cause of death in Nigeria. In March 2010, the United Nations
3. Auckland City Hospital, Auckland, New Zealand General Assembly launched “The Decade of Action for Road
Safety (2011-2020)” to “reduce road traffic deaths and injuries
Introduction: Wellington, New Zealand has a significant by 50% by 2020.”
earthquake risk with unique response challenges posed by its Aim: To analyze trends in RTC and deaths in relation to
geography and limited road, rail, and sea access. In 2014, current road safety laws in Nigeria, and possible future
the World Health Organization (WHO) Emergency Medical interventions.
Team (EMT) initiative published minimum and technical Methods: Annual reports from 2013-2017 were obtained
standards for EMTs in response to failures by responding from the Federal Road Safety Corps (FRSC) of Nigeria. These
teams to deliver appropriate and ethical clinical care during reports were analyzed for trends in RTC, deaths, and reported
a number of disasters (Norton, 2014). The initiative has evolved causes to find areas of possible improvement.
to develop national and International EMTs in addition to a Results: The number of RTC and deaths declined yearly from
support capacity building within Ministries of Health to better 2013-2017. Crashes decreased from 23.4% in 2013-2014 to
coordinate clinical capacity during an emergency. 6.2% in 2015, to 0.4% in 2016, and then increased to 3.2% in
Aim: Over the last two years, the WHO EMT Coordination 2017. Results showed that fatalities from RTC in 2013-2014
Cell (EMTCC) course has trained over 300 health personnel decreased by 8.4%, then by 9.3% in 2015, and by 7.1% in 2016,
globally to coordinate clinical surge capacity using a three-step but had a 1.3% increase in fatalities from 2016-2017. Analysis
Impact Assessment, Needs Assessment, and Tasking process showed that speed violations (SPV) were the top cause of RTC.
informed by disaster epidemiology and mass casualty ratios. These had a decrease in the number of crashes from 5,495 (32%
Methods: EMTCC planning methodology was applied to of RTC) in 2013, to 3,496 (29%) in 2014, to 3,195 (26.5%) in
the “Wellington Earthquake National Initial Response Plan” 2015. They then increased to 3,848 (33.9%) in 2016 and to
(MCDEM, 2017) to develop a Health Action Plan for a sig- 4,840 (44.1%) in 2017. There was a decline in reports of RTC
nificant Wellington earthquake. Known earthquake impact caused by driving under the influence (DAD) from 1% in 2013,
modeling for injuries was applied against predicted capacity to 0.8% in 2014, and 0.5% in 2015 and 2016.
in receiving hospitals in the affected region, and the ability Discussion: Current road safety laws have been effective in
to transfer patients nationally to determine unmet response decreasing the total number of RTC and deaths. While certain
needs. EMT minimum standards and operational insights laws such as those regarding DAD have been effective, other
from recent disasters were then used to determine the number laws such as speed limits have been less successful and may
of EMTs required for optimal tasking. require further changes in legal codes and/or enforcement.
Discussion: The surge planning methodology provided a Prehosp. Disaster Med. 2019;34(Suppl. 1):s6
theoretical framework for national and local health emergency doi:10.1017/S1049023X19000323
Prehospital and Disaster Medicine Vol. 34, Supplement 1Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
CASE STUDIES
Epidemic Thunderstorm Asthma Introduction: Disaster medical team response by governmental
Ms. Alison McMillan and non-governmental responders is highly variable and poorly
Department of Health and Human Services, Melbourne, Australia characterized. Each response is unique in terms of caseload,
patient demographics, and medical needs encountered. This
Introduction: On November 21 and 22 of 2016, Victoria variability increases the difficulty of determining team member
witnessed an unprecedented epidemic thunderstorm asthma composition as well as supply and equipment needs. In an effort
emergency event in size acuity and impact. This scenario was never to demonstrate this issue, we have reviewed the National
exercised nor contemplated. The event resulted in a 73% increase Disaster Medical Response to Hurricane Sandy.
in calls to the Emergency Services Telecommunications Author- Methods: This project was a retrospective chart review of
ity and 814 ambulance cases in the six hours from 6 pm on Hurricane Sandy data abstracted from the National Disaster
November 21, 2016. A 58% increase in people presented to pub- Medical System (NDMS) Health Information Repository
lic hospital emergency departments in Melbourne and Geelong (HIR) medical records from the NDMS system response, and
on November 21 and 22, 2016 (based on the three-year average). were abstracted for data including vital signs, ages, sex, chief
313 calls were made to the nurse on call from people with breath- complaint, and final impressions. In addition, length of stay
ing, respiratory, and allergy problems (compared to an average among other parameters was abstracted. The data was analyzed
of 63 calls for the previous month). Tragically, ten deaths are using Microsoft Excel and Access with descriptive statistics. In
linked to this event. addition, the results were compared to similar indices in a com-
Methods: A substantial amount of work has been completed, munity emergency department and prior NDMS responses.
much of which goes towards addressing the Inspector-General Results: The results indicate a wide range of patient ages, chief
for Emergency Management recommendations following a complaints, and final impressions. The vast majority of patients
review of the event, including: seen by Disaster Medical Assistance Teams (DMAT) were sta-
• Release of an epidemic thunderstorm asthma campaign and edu- ble with relatively low acuity issues. The total number of charts
cation programs which were rolled out across Victoria for the reviewed were 7,905. Respiratory complaints were the most
community and health professionals from September through frequent at 845 patients followed by toxicology/injuries at 706
November 2017; patients and mental health issues at 452 patients. In approxi-
• Development of a new epidemic thunderstorm asthma forecast- mately 3,400 patients, no diagnosis was present in the chart.
ing system on 1 October 2017 and updated warning protocols Length of stay averaged below 1 hour and peak patient ages
during the 2017 grass pollen season; were between 50-60 with a significant number of infants less
• Implementation of a Real-time Health Emergency Monitoring than 2 years.
System to alert the department of demands on public hospital Discussion: Characterization of NDMS responses by DMATs
emergency departments on the system; and and comparison with prior events and community emergency
• Introduction of a new State Health Emergency Response Plan
department caseloads can provide an insight into the needs of
in October 2017 to improve coordination and communica-
DMATs and other response organizations in future responses.
tions before and during a health emergency.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s7
Discussion: The presentation will concentrate on the lessons
doi:10.1017/S1049023X19000347
learned more than two years down the track from the event
in November 2016.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s7
doi:10.1017/S1049023X19000335 Level of Emergency Preparedness Before and After a False
Missile Alert in Hawaii
Dr. Kristine Qureshi1, Mr. Gary Glauberman1,
Hurricane Sandy - Initial Evaluation of Patient Ms. Michele Bray1, Dr. Robyn Gershon2, Ms. Qi Zhi3,
Characteristics Dr. John Chen1, Ms. So-Yung Choi1
Dr. Marc Rosenthal1, Dr. Robert Dunne2 1. University of Hawaii at Manoa, Honolulu, United States
1. Detroit Medical Center, Wayne State University, Grosse Pointe 2. New York University, New York City, United States
Park, United States 3. University of California at San Francisco, San Francisco, United
2. Wayne State University, Lyon Township, United States States
May 2019 Prehospital and Disaster Medicines8 Case Studies
Introduction: On January 13, 2018, a false ballistic missile alert Results: Informed by a Conceptual Framework for a Hazard
that lasted 38 minutes was issued across Oahu, Hawaii, United Evolving into a Disaster (Birnbaum et al., 2015), Wong and
States. As a result of a system failure, an erroneous text message colleagues promote a Core Structure of a Comprehensive
was sent that stated, “Ballistic missile threat inbound to Hawaii. Framework for Disaster Evaluation Typologies (Wong, 2017).
Seek immediate shelter.” This Core Structure provided an adequate model to examine the
Aim: The research team wanted to know the degree of reported sequence of events in the Morwell event. Definitions of cascading
anxiety triggered by the event and if knowledge, attitudes, or effects is more complex (Zuccaro et al., 2018). Our analysis of the
behaviors for individual/family emergency preparedness (EP) Morwell event used the authoritative definition of cascading
changed post-event. disasters published by Pescaroli and Alexander (2015). Using this
Methods: A 50-question survey that asked about individual definition, the Morwell event increased in progression over time
and family EP pre- and post-event, and the level of anxiety trig- and generated unexpected secondary events of strong impact.
gered by the event, was administered to a convenience sample The secondary events could be distinguished from the original
of full-time adult residents of Oahu. The study was conducted source of disaster, and demonstrated failures of physical struc-
over a 6-8 week period post-event. Statistical analysis was used tures as well as inadequacy of disaster mitigation strategies, while
to identify factors associated with an increasing level of EP post- highlighting unresolved vulnerabilities in human society.
event and reported event-triggered anxiety. Discussion: The Morwell coal mine fire of 2014 reflects the key
Results: 209 participants completed the survey (29% male, 71% criteria of a cascading disaster and provides understandings to
female) with about one half living with children. One third mitigate the consequences of similar events in the future.
were essential workers. Key factors that correlate with increasing Prehosp. Disaster Med. 2019;34(Suppl. 1):s8
various areas of EP post-event include higher educational, receipt doi:10.1017/S1049023X19000360
of electronic emergency alerts, prior emergency training, and
higher reported connectedness to community. Those with higher
Multiple Patients with Burn Injury Induced by a Chemical
event anxiety were more likely to develop and practice an EP plan
Explosion Managed by Physician-staffed Helicopters
post-event, encourage EP with friends, and report a higher level Prof. Youichi Yanagawa, Akihiko Kondo MD,
of community connectedness. The elderly were more likely to Hiroki Nagasawa MD, Ikuto Takeuchi MD, Kei Jitsuiki MD,
have higher levels of EP before and after the event but were less Hiromichi Osaka MD, PhD, Kouhei Ishikawa MD, PhD,
likely to receive emergency alert notifications or have EP training. Kazuhiko Omori MD, PhD
Discussion: While the event was very unfortunate, it did seem Shizuoka Hospital, Juntendo University, Izunokuni, Japan
to stimulate citizen disaster EP among some groups. Additional
research should explore the utility of increasing EP education Introduction: The management of chemical and explosive
for communities immediately after disasters, tailoring this events is critical to reducing morbidity and mortality. However,
education for groups, and targeting the elderly for participation initial patient care considerations and protective actions for staff
in the emergency alert system. are unfamiliar to most frontline clinicians.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s7–s8
Methods: This study evaluated an Incident report.
doi:10.1017/S1049023X19000359
Results: On December 1, 2017, a factory of chemical industries
in Japan exploded. Dust forming as a byproduct from the crushing
and packing process of the resin for ink exploded at the facility. A
Morwell Coal Mine Fire as a Cascading Disaster: local fire department requested the dispatch of two physician-
A Case Study staffed helicopters (known as a doctor helicopter [DH] in
Mr. Dudley McArdle, Dr. Caroline Spencer, Prof. Frank Archer Japan). The first party of emergency services established a head-
Monash University Disaster Resilience Initiative, Clayton, Australia quarters and first-aid station. However, this area was feared to be
at risk of a second explosion. Physicians performed re-triage for
Introduction: Despite the influential Hyogo and Sendai all 11 burned patients. Three severely injured patients were trans-
Frameworks, risk remains poorly understood in the emergency ported to emergency medical service centers either by ground
preparedness sector. Hazard assessment and risk management ambulance or the DH without undergoing any decontamination.
are usually considered before events. An alternative view consid- The physician who escorted the patient by ground ambulance
ers risk as a cascade of potential consequences throughout an complained of a headache. One of the severely injured patients
event. The 2014 fire in the Victorian rural community of was treated at a local hospital and then transported to an emer-
Morwell included a three-phased event: a small bush fire, from gency medical service center after undergoing decontamination
which embers ignited a persistent fire in a disused open cut brown and intubation. Fortunately, all patients who were transported
coal mine fire. The consequent air pollution precipitated a public to medical facilities obtained a survival outcome.
health emergency in the nearby community of 15,000 people. Discussion: Chemical, biological, radiological, nuclear, and
Aim: To examine this event as a case study to investigate con- explosive incidents are rare, but can be fatal for responders to this
cordance with accepted definitions and key elements of a cas- kind disaster. As such, all who work at such scenes should be pre-
cading event. pared and train adequately to ensure they have the knowledge and
Methods: Selected literature informed a risk cascade definition skill to both manage patients and protect themselves from harm.
and model as a framework to examine the key post-event public Prehosp. Disaster Med. 2019;34(Suppl. 1):s8
inquiries available in the public domain. doi:10.1017/S1049023X19000372
Prehospital and Disaster Medicine Vol. 34, Supplement 1Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
CBRN
Chemical, Biological, Radiological, Nuclear, and Explosive Crisis State of Medical Readiness and Citizen Preparedness
(CBRNe) Preparedness: Perceptions of Australian Importance for Radiological and Nuclear Incidents
Emergency Department (ED) Doctors and Nurses Prof. Raymond E. Swienton, Dr. E. Liang Liu,
Dr. Karen Hammad1, Dr. Jamie Ranse2, Dr. Luc Mortelmans3 Dr. Lindsay A. Flax, Dr. Kelly R. Klein
1. Emergency Department, Flinders Medical Centre, Australia University Of Texas Southwestern, Dallas, United States
2. Griffith University, Australia
3. Department of Emergency Medicine, Ziekenhuis Netwerk Introduction: In 2017, members of our workgroup published
Antwerpen, Belgium on the readiness for nuclear and radiological incidents among
emergency medical personnel.1 Our findings, along with a
Introduction: Clinicians working in emergency departments review of pertinent literature, suggest that the state of medical
(ED) play a vital role in the healthcare response to chemical, preparedness for these incidents is in crisis. A 2018 publication
biological, radiological, nuclear, and explosive (CBRNe) events. addressing nuclear terrorism preparedness relegates medical
However, ED clinicians’ individual and workplace prepared- preparedness to a low priority and describes it as potentially
ness for CBRNe events is largely unknown. dangerous.2 The crisis status of medical preparedness for these
Aim: The aim of this research was to explore Australian ED incidents is addressed.
nurses and doctors’ perceptions of individual and workplace Aim: To establish a prepared medical workforce and trained
preparedness related to CBRNe events. public for those at risk from nuclear or radiological disasters.
Methods: The study populations were Australian nurses and Methods: This Institutional Review Board (IRB)-approved
doctors who work in EDs. Data was collected via a survey with survey published an article and used a relevant literature review.
43 questions requiring binary responses or a rating on a Likert Results: Readiness for nuclear and radiological incidents is
scale. The survey consisted of questions relating to the partic- lacking in multiple areas including education, training, identi-
ipant’s previous disaster training, perceived likelihood of a fying medical needs, willingness to come to work, and percep-
CBRNe event impacting their ED, perceived level of knowl- tion of relative risk among medical personnel.1 Confounding
edge, perceived personal preparedness, perception of ED prepar- this is recent prominent publication downplaying and discour-
edness, and willingness to attend their workplace. Data were aging medical preparedness for nuclear terrorism.2 The impor-
analyzed using descriptive and inferential statistics. tance of a readied workforce and a prepared public is identified.
Results: There were 244 complete responses, 92 (37.7%) Discussion: In 2013, we formed a multi-national workgroup
doctors and 152 (62.3%) nurses. When comparing doctors focused on preparing health professionals and the public for
and nurses, there was a statistical difference between gender clinical management of casualties during nuclear and radio-
(p = < 0.001), length of employment (p = < 0.001), and role logical disasters. Modeling has demonstrated predictable casu-
in the ED (p = < 0.001). Doctors and nurses had a similar alty injury and illness patterns suggesting that early appropriate
level of previous training except for practical training in mask medical response will save lives. Readiness demands an educated,
fitting (p = 0.033). CBRNe events were considered separately. skillful, and willing-to-engage medical workforce. Our 2017
Perceived level of knowledge, perceived personal preparedness, publication identified several areas that place medical prepared-
and perception of ED preparedness were significant predictors ness at risk.1 A significant risk to medical preparedness may lie
of willingness to work in all CBRNe event. Perceived likelihood in prominent publications discouraging the pursuit.2 We firmly
of a CBRNe event impacting their ED was not a predictor of believe that medical preparedness is essential and begins with a
willingness. prepared public.
Discussion: This research contributes to an overview of the
current status of Australian ED clinicians’ preparedness for References
CBRNe response. To increase the willingness of ED doctors 1. Dallas, CE, et al. Readiness for Radiological and Nuclear
and nurses attending their workplace for a CBRNe event, strat- Events among Emergency Medical Personnel. Front Public
egies should focus on enhancing individuals perceived level of Health. 2017 Aug 18;5:202.
knowledge, perceived personal preparedness, and perception 2. Gale, RP, Armitage, JO. Are We Prepared for Nuclear
of ED preparedness. Terrorism? NEJ 2018 Jun 21;378(25):2449–2450.
Prehosp. Disaster Med. 2019;34(Suppl. 1):s9 Prehosp. Disaster Med. 2019;34(Suppl. 1):s9
doi:10.1017/S1049023X19000384 doi:10.1017/S1049023X19000396
May 2019 Prehospital and Disaster MedicineAbstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
CIVILIAN MILITARY COOPERATION
Disaster First Responder Training: A Train-the-Trainer Prehosp. Disaster Med. 2019;34(Suppl. 1):s10
Veterans Program to Combat PTSD doi:10.1017/S1049023X19000402
Dr. Jenevieve Kincaid1, Dr. Elaine Reno2, Dr. Jay Lemery2,
Dr. Todd Miner2
1. Reno School of Medicine, University of Nevada, Reno, Key Elements of Civil-Military Disaster Rescue Operation
United States in China
2. School of Medicine, University of Colorado, Aurora, United States Mr. Haitao Guo1,2, Pro. Shusen Guo2
1. Logistics University of PAP, Tianjin, China
Introduction: There are many health challenges faced by those 2. Joint Services College, National Defense University, Beijing,
returning from military service. Posttraumatic stress disorder China
(PTSD) is a serious problem in veterans. PTSD is a risk factor
for suicide in veterans. Standard treatments include medication Introduction: In China, many disaster rescue operations need
and talk therapy. Non-traditional treatments include civil ser- cooperation between civil forces and military forces. Under-
vice and leadership training. standing the key elements of civil-military disaster rescue oper-
Aim: Assess the effectiveness of Veteran Focused Train-the- ations is a basic problem faced by Chinese rescuers and scholars.
Trainer (TTT) Community Disaster Response and First Aid Aim: To summarize the key elements of civil-military disaster
(DRAFA) Programs in promoting health, wellness, reintegra- rescue operations in China.
tion, and decreasing PTSD symptoms of veterans. Methods: On July 17, 2016, an expert round-table meeting
Methods: A longitudinal cohort study was conducted using a was held on our campus to discuss some basic problems in dis-
convenience sample of veterans living in Denver, Colorado or aster research. The participants arrived at a consensus that the
Reno, Nevada. The sample size was over 50 (N=50+), with key elements of civil-military disaster rescue operation under
25+ case-matched veterans at each location. This is an ongoing Chinese cultural context should be carefully analyzed using Six
project lasting through the end of 2020. Inclusion criteria Sigma (Why, Who, What, When, Where, and How, 5W1H)
selected veterans interested in DRAFA training and education. Methods: The minutes of the meeting was summarized into a
Exclusion criteria disqualified those who are not a veteran or brief report.
those unable to perform physical tasks required by curriculum. Results: (1) Why to rescue - it is the responsibility of modern
The null hypothesis was that there is no relationship between government to protect its people; (2) Who are the rescuers -
the DRAFA TTT program and the health, well-being, and rein- individuals or groups with passion and ability to do such work,
tegration of veterans back into their communities. Statistical but they should be organized properly; (3) What to do - make
tools used were SPSS Statistics (Version 25) and NVivo vital systems of the community run normally as soon as possible;
12-12.2.0.3262. Research activities were conducted under the (4) When to rescue - different disasters have different laws,
auspices of the University of Colorado and guided by the but it is better to render help in the golden hour; (5) Where
principles of the Institutional Review Board (IRB). to rescue - it depends on the input process (material, human
Results: Results are being evaluated using a mixed methods resources, etc.) and output process (patients, waste material, etc.)
impact model. The main outcomes measured health, wellness, of the rescue operation, not merely confined to the disaster site;
and reintegration using Veterans RAND-12 Health Quality of (6) How to rescue - cooperation among all branches of social
Life Survey, the Military to Civilian Reintegration Survey, and a sectors is vital to succeed, especially civil-military cooperation.
satisfaction survey. Preliminary analysis may indicate a correla- Military force is the backbone force in an austere environment.
tion between participation in the DRAFA TTT program and Discussion: The discipline of disaster medicine is developing
improved health/wellness outcomes, better reintegration into rapidly in China. The research and evaluation framework
society, and decreased PTSD. should be established carefully. Civil forces and military forces
Discussion: There is growing evidence that expedited struc- should have an identical understanding of the same question.
tured reintegration programs in community preparedness and This abstract is only part of the research framework.
disaster leadership roles for veterans alleviate PTSD symptoms Prehosp. Disaster Med. 2019;34(Suppl. 1):s10
and improves quality of life. doi:10.1017/S1049023X19000414
Prehospital and Disaster Medicine Vol. 34, Supplement 1Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
CLIMATE CHANGE
Rising Sea Level and the Growing Threat of Hazardous project includes several components. One part identifies haz-
Material Releases: A Pilot Project in Coastal Virginia ardous materials sectors that could be affected by rising seas.
Prof. S.M. Becker Another component consists of case studies of locations that
Institute for Coastal Adaptation and Resilience (ICAR), have already been affected. A third component involves stake-
Old Dominion University, Norfolk, United States holder workshops where participants work collaboratively to
enhance safeguards and strengthen preparedness.
Introduction: Hazardous materials are widely used in modern Results: Designed in 2017 and 2018, the project secured initial
society, including in industry, business, agriculture, research, funding early in 2018. Since then, the project has worked to identify
healthcare, and other sectors. As sea levels continue to rise around sectors and activities that could be affected by rising seas and estab-
the globe, locations where hazardous materials are produced, lish links with key stakeholder agencies, sectors, and organizations.
stored, transported, or utilized become increasingly vulnerable The next steps, to be completed in 2019, involve preparation of case
to flooding, storm surge, and other problems that can result in studies from facilities already affected by rising sea levels, and the
accidental releases. Such releases can pose threats to health, implementation of the first in a series of stakeholder workshops.
the environment, and the economic viability of communities. Discussion: As sea levels rise, more hazardous materials locations
Aim: This paper reports on a new pilot project in Coastal become vulnerable. Proactively addressing this threat is an essen-
Virginia to increase awareness, enhance safeguards, and tial part of sea level rise preparedness, adaptation, and resilience.
strengthen preparedness for the growing threat of hazardous The new pilot project in Coastal Virginia is intended to help
material releases posed by rising sea levels. address this challenge by increasing awareness and bringing stake-
Methods: Launched under the Institute for Coastal Adap- holders together to collaboratively identify practical steps forward.
tation and Resilience (ICAR) at Old Dominion University, Prehosp. Disaster Med. 2019;34(Suppl. 1):s11
with support from the ODU Resilience Collaborative, the doi:10.1017/S1049023X19000426
May 2019 Prehospital and Disaster MedicineAbstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
COMMUNITY RESILIENCE
Positively Adapting to a Changed Reality Dr. Caroline Spencer, Ms. Suzanne Cross, Mr. Dudley McArdle,
Ms. Rose Henderson Professor Frank Archer
Canterbury District Health Board, Christchurch, New Zealand Monash University, Clayton, Australia
Introduction: Following the New Zealand November 2016 Introduction: Global conversations emphasize strengthening
earthquake, mental health staff were deployed to assist with communities’ resilience to disasters. These conversations inspired
the immediate levels of distress in the community. The work the Victorian Compendium of Community-Based Resilience
included working with individuals, couples and families, staff Building Case Studies. The Compendium motivates community
wellbeing sessions, psychosocial education, and participating members to build expertise, reduce program duplication, and save
in outreach clinics to isolated communities. valuable resources. Case study analysis identified critical success
Aim: Aware of international evidence and the experience follow- factors. Between 2012 and 2018, community groups completed
ing the 2010/11 earthquakes, the aim was to provide mental health an Expression of Interest to present at the MUDRI Advancing
assistance to address issues as early as possible with the intent that Community Resilience Forums, which provided an opportunity
this would reduce the future demands on specialist services. to impart resilience activities and knowledge. It also solved chal-
Methods: Following the response phase, a small team of mental lenges and shared unforeseen learning. Over six years, 72 groups
health specialists formed the Recovery and Wellbeing Team presented. Subsequently, 35 submitted their activity for consid-
working in the affected communities undertaking clinical, con- eration into the Compendium. Of these 35, 30 were included.
sult, advisory, and educational work as needed. The team flexed Aim: This updated research analyses critical success factors
and evolved to meet the changing needs. A range of data was of 30 case studies. Success factors support the key tenet of
collected and analyzed to monitor the work and the outcomes the Victorian Compendium of Community-Based Resilience
of this team. Building Case Studies: to promote the sharing of achievable,
Findings: With additional support provided following the practical resilience building activities. The online Compendium
earthquake, there has been a significant positive change in provides free access for all communities to explore activities
the numbers of referrals to secondary mental health services before, during, and after disasters.
in Christchurch. A new model of care has now been collabora- Methods: A thematic analysis identified critical success factors
tively developed, as the mental health system positively adapted of 30 Compendium case studies.
to a changed reality. This model is essentially an easily accessed, Results: Case studies revealed unique and valuable learning in
early intervention, comprehensive model of mental health ser- diverse settings. The critical success factors included: (1) strong
vice to maintain the positive gains. governance, Board support, leadership and trust; (2) partner-
Discussion: Following a significant disaster, all involved will ships; (3) commitment, adaptability, and stamina; and (4) com-
benefit from some form of psychosocial support. For most, this munity-based initiatives. Other success factors included a paid
will be achieved through the person’s own networks. For some, facilitator and local government support, stamina, and celebrat-
the event will trigger responses from previous traumatic expe- ing success.
riences and a few mental health supports will be required. Discussion: The Compendium represents an Australian first
Having skilled professionals with the ability to cope with the and offers an innovative contribution to resilience practice and
constantly changing needs, and who are available to meet people research. It enhances other Victorian initiatives such as the
at the earliest opportunity, has enabled issues to be resolved Rockefeller funded Resilient Melbourne Strategy, which incor-
rather than leaving these issues to escalate over time. porates the Compendium to bring people together from across
Prehosp. Disaster Med. 2019;34(Suppl. 1):s12 sectors to deliver distinct, yet connected actions to strengthen
doi:10.1017/S1049023X19000438 resilience. The Compendium enables diverse communities to
adopt or adapt proven resilience activities, thereby preserving
valuable resources. It offers the opportunity to extend to a
Victorian Compendium of Community-Based Resilience national or international Compendium.
Building Case Studies - Critical Success Factors Help Prehosp. Disaster Med. 2019;34(Suppl. 1):s12
Communities Strengthen Resilience to Disasters doi:10.1017/S1049023X1900044X
Prehospital and Disaster Medicine Vol. 34, Supplement 1Abstracts of Oral Presentations-WADEM Congress on
Disaster and Emergency Medicine 2019
COUNTER TERRORISM
Chemical Warfare Agent Terrorist Attacks in Latin Prehosp. Disaster Med. 2019;34(Suppl. 1):s13
America and the Caribbean Region (CWA-LAC) doi:10.1017/S1049023X19000451
Dr. Killiam A Argote 1,2, Dr. Michael Molloy1,3,
Dr. Alexander Hart1,2, Amalia Voskanyan1, Dr. Ritu R Sarin1,2,
A Prof. Gregory R Ciottone1,2 A National Model for Tactical Emergency Medical
1. BIDMC Fellowship in Disaster Medicine, Boston, United States Support in Finland
2. Department of Emergency Medicine, Beth Israel Deaconess Dr. Juhana Hallikainen1, Dr. Vesa Lund 2
Medical Centre, Boston, United States 1. Department of Emergency Medicine and Services, Helsinki
3. University College Dublin, Belfield, Dublin, Ireland University Hospital, Helsinki, Finland
2. Division of Prehospital and Emergency Medicine, Satakunta
Introduction: In the past five decades, the region of Latin Hospital District, Pori, Finland
America and the Caribbean (LAC) has been subject to several
types of terrorist attacks, with most committed by local terrorist Introduction: Tactical Emergency Medical Response (TEMS)
organizations. However, there have also been attacks by inter- originated in the 1990s in Finland. It is a nationally standard-
national terrorist groups. Internationally, terrorist attacks are ized joint-effort with EMS and police special units, such as
increasing in both frequency and complexity. Significant con- SWAT.
cerns exist regarding the use of Chemical Warfare Agents Aim: To describe a national system of TEMS in Finland.
(CWAs) in civilian settings. Asphyxiants (e.g. cyanide), opioids Methods: In Finland, TEMS is a national response system of
(e.g. fentanyl), and nerve agents (e.g. sarin) represent some of specially trained paramedics and pre-hospital doctors, working
the most lethal CWAs. To date, there is very little published normally in HEMS or a local physician staffed rapid response
data on their use in the LAC region despite the fact that the car. There is a two-tier selection to get accepted in the basic
recent attacks in Syria have sparked international interest in course. The police run background checks for all participants
the use and regulation of CWAs. before they are accepted to the course. The course itself is four
Aim: To improve civilian health service preparedness in days and it covers the basics of police tactics, protective gear,
response to CWAs attacks by describing the types of agents penetrating wounds, evacuation, etc. After graduating from
historically used within the LAC region. the basic course, the paramedic/doctor is qualified to participate
Methods: Information was extracted and analyzed from the in missions. Although healthcare professionals are involved, a
open-source Global Terrorist Database hosted by the Univer- TEMS mission is under the police command and is used as
sity of Maryland, regarding CWA-LAC from January 1, 1970, one of the police’s special teams to operate in areas where nor-
to December 31, 2017. mal EMS cannot be allowed for safety reasons. TEMS does not
Results: During the forty-seven year period reviewed, there carry any weapons. The Police provide the teams with the same
were 29,846 terrorist attacks in the LAC region, with 63.6% protective equipment that the SWAT/CTU has. After some
occurring in the southern region. Twenty-nine CWA attacks years, there is a three-day refresher course for active TEMS ser-
were reported, with the most common agents being tear gas vice. In this course, the main training points are working in aus-
(37%) and cyanide (29.6%). The most frequent targets were reli- tere environments, such as helicopters, boats, and in urban
gious figures/institutions (22.2%), law enforcement (18.5%), and environments wearing civilian clothing. Police pay for the usage
government agencies/personnel (18.5%). of TEMS in missions, but they do not pay for training days.
Discussion: Cyanide is one of the most prevalent agents used Results: TEMS has good national coverage. In 2017, there
for chemical weapons attacks in the LAC region. Preparedness were 131 TEMS activations. The normal response to a mission
should be enhanced for CWA terrorist attacks, especially those is a team of one or two TEMS operators.
involving cyanide, given its life-threatening nature, prevalence, Discussion: TEMS has achieved good national coverage and is
and the existence of reversal agents. First responders, physi- deployed often. TEMS has also channeled information and
cians, and nurses should be aware of this potential hazard training, such as TECC, to normal EMS personnel and raised
and be trained to respond appropriately. Additionally, regional their preparedness as well.
stockpiles of antidotes should be considered by governmental Prehosp. Disaster Med. 2019;34(Suppl. 1):s13
bodies within the LAC region. doi:10.1017/S1049023X19000463
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