Aplicabilidade da simulação realística na graduação de enfermagem: experiência em incidentes com múltiplas vítimas / Aplicabilidad de la simulación realista en el pregrado en enfermería: experiencia en incidentes con múltiples víctimas / Applicability of realistic simulation in nursing graduation: experience in incidents involving multiple victims

Objetivo descrever a aplicabilidade de uma simulação realística de incidentes com múltiplas vítimas no processo de ensino-aprendizagem na enfermagem. Método estudo descritivo, com abordagem quantitativa que envolveu uma simulação realística. Participaram da simulação 250 pessoas, sendo incluídos no estudo 30 acadêmicos de enfermagem. Para a coleta de dados, aplicou-se um questionário para analisar a experiência acadêmica com simulação e paciente simulado. Resultados a maioria (80%) dos alunos não vivenciou experiência anterior com simulação e 53,3% concordaram que houve integração entre medicina e enfermagem durante a simulação. Para 66,7% dos graduandos foi possível colocar seu conhecimento em prática, havendo contribuição para melhora do raciocínio clínico e sobre as condutas realizadas. Conclusão a utilização da simulação realística na graduação de enfermagem é uma estratégia metodológica que contribui para o aprendizado e possibilita aos acadêmicos vivenciarem situações do seu futuro ambiente profissional.

Objetivo describir la aplicabilidad de una simulación realista de incidentes con múltiples víctimas en el proceso de enseñanza-aprendizaje en enfermería. Método estudio descriptivo con abordaje cuantitativo, utilizándose una simulación realista. Participaron 250 personas en la simulación, siendo incluidos en el estudio, 30 estudiantes de enfermería. Para la recolección de datos, se aplicó un cuestionario para analizar la experiencia académica con la simulación y el paciente simulado. Resultados la mayoría (80%) de los estudiantes tenía experiencia anterior con la simulación y el 53,3% estuvo de acuerdo en que hay integración entre medicina y enfermería durante la simulación. Para el 66,7% de los estudiantes, fue posible poner sus conocimientos en práctica, contribuyendo a la mejora del razonamiento clínico y comportamientos. Conclusión el uso de la simulación realista en la graduación en enfermería es una estrategia metodológica que contribuye al aprendizaje y permite a los estudiantes experimentar situaciones de su futuro entorno profesional.

Objective to describe the applicability of a realistic simulation of incidents involving multiple victims in the nursing teaching-learning process. Method descriptive study with quantitative approach involving a realistic simulation. The participants were 250 persons, including 30 nursing students. For data collection, a questionnaire was applied to analyze the academic experience with simulation and simulated patient. Results most (80%) students had previous experience with simulation and 53.3% agreed that there is integration between medicine and nursing during the simulation. For 66.7% of the students, it allowed putting their knowledge into practice, contributing to improvement of clinical reasoning and behaviors. Conclusion the use of realistic simulation in undergraduate nursing is a methodological strategy that contributes to the learning and allows students experience situations of their future professional environment.

Simulação de incidente com múltiplas vítimas: treinando profissionais e ensinando universitários / Multiple victims incident simulation: training professionals and university teaching

RESUMO Objetivo: descrever estratégia de ensino a partir da simulação de Incidente de Múltiplas Vítimas (IMV), discutindo e avaliando a atuação dos discentes envolvidos no atendimento inicial às vítimas de trauma. Métodos: estudo transversal com abordagem quantitativa que contemplou a execução de uma simulação realística de IMV, envolvendo discentes, docentes dos Cursos de Medicina e de Enfermagem, além de profissionais do atendimento pré-hospitalar. Resultados: a partir da análise de 17 checklists, foi possível perceber que a classificação segundo o método START (Simple Triage And Rapid Treatment) aconteceu de forma correta em 94,1% dos atendimentos. Seguindo a avaliação primária com o mnemônico ABCDE, todas as etapas foram realizadas de forma correta em 70%. Contudo, só houve oferta de oxigênio em alto fluxo em 64,7% dos atendimentos. A pesquisa por fontes de sangramento visíveis e ocultas foi realizada em 70,6% dos atendimentos. A avaliação neurológica com a escala de coma de Glasgow e avaliação pupilar ocorreu em 70,6% das vítimas. A exposição da vítima foi realizada em 70,6% dos atendimentos. Conclusão: ambientes simulados permitem a consolidação e o aperfeiçoamento de competências e habilidades profissionais, principalmente quando se trata de uma área pouco treinada na graduação, como o IMV. O treinamento precoce e o atendimento em equipe estimulam o raciocínio clínico, a integração e a comunicação, aspectos essenciais diante de situações caóticas.

ABSTRACT Objective: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. Methods: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. Results: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. Conclusion: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.

Guía para la enseñanza del apoyo vital avanzado ante múltiples víctimas. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching advanced life support in the presence of mass casualty. Consensus for the project of training and research in life support. Cienfuegos, 2018

Fundamento: en situaciones de desastres, cuando el número de enfermos o lesionados es alto y los recursos limitados, la atención médica precisa de cambios de estructura y procesos si se quiere salvar un número elevado de personas. El personal de salud debe estar entrenado para enfrentar esta situación cada vez más frecuente. El "Proyecto para la formación e investigación en apoyo vital en emergencias y desastres" puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante víctimas múltiples. Métodos: taller nacional realizado el 10-11 de julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del apoyo vital en situaciones de desastres, tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso "Apoyo vital avanzado ante víctimas múltiples" permiten la preparación de los profesionales de la salud para brindar asistencia médica en situaciones de desastres, con escasos recursos y en ambientes complejos.

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course "Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments.

Reflection on rescue and treatment of mass burn casualties in 21st century / 中华烧伤杂志

The rescue and treatment of mass burn casualties is a test for both the burn treatment level and the disaster emergency response ability of a country or a region. In recent years, burn disasters happened occasionally around the world despite of the improvement of safety level in production and the awareness of fire prevention. On one hand, mass burn casualty events caused catastrophic damages to human health. On the other hand, they also promoted the development of burn treatment and disaster medicine. This paper may provide some references for further improving the management of mass burn casualties in the future by reviewing several typical cases of burn disaster rescue and treatment in the world since the 21st century.

Characteristics of mass casualty chemical incidents: a case series

OBJECTIVE: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. METHODS: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. RESULTS: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. CONCLUSION: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.

A Study on the Disaster Medical Response during the Mauna Ocean Resort Gymnasium Collapse

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.

Preparedness for the Rio 2016 Olympic Games: hospital treatment capacity in georeferenced areas / Preparação para os Jogos Olímpicos Rio 2016: capacidade de tratamento hospitalar em áreas georreferenciadas / La preparación para los Juegos Olímpicos de Río 2016: capacidad de tratamiento hospitalario en áreas georreferenciadas

Abstract: Recently, Brazil has hosted mass events with recognized international relevance. The 2014 FIFA World Cup was held in 12 Brazilian state capitals and health sector preparedness drew on the history of other World Cups and Brazil's own experience with the 2013 FIFA Confederations Cup. The current article aims to analyze the treatment capacity of hospital facilities in georeferenced areas for sports events in the 2016 Olympic Games in the city of Rio de Janeiro, based on a model built drawing on references from the literature. Source of data were Brazilian health databases and the Rio 2016 website. Sports venues for the Olympic Games and surrounding hospitals in a 10km radius were located by geoprocessing and designated a "health area" referring to the probable inflow of persons to be treated in case of hospital referral. Six different factors were used to calculate needs for surge and one was used to calculate needs in case of disasters (20/1,000). Hospital treatment capacity is defined by the coincidence of beds and life support equipment, namely the number of cardiac monitors (electrocardiographs) and ventilators in each hospital unit. Maracanã followed by the Olympic Stadium (Engenhão) and the Sambódromo would have the highest single demand for hospitalizations (1,572, 1,200 and 600, respectively). Hospital treatment capacity proved capable of accommodating surges, but insufficient in cases of mass casualties. In mass events most treatments involve easy clinical management, it is expected that the current capacity will not have negative consequences for participants.

Resumo: Recentemente, o Brasil sediou eventos de massa com relevância internacional reconhecida. A Copa do Mundo FIFA de 2014 foi realizada em 12 capitais estaduais e a preparação do setor da saúde contou com a história de outras Copas do Mundo e com a própria experiência do Brasil com a Copa das Confederações FIFA de 2013. O presente artigo objetivou analisar a capacidade de tratamento de instalações hospitalares em áreas georeferenciadas para eventos esportivos, nos Jogos Olímpicos de 2016, na cidade do Rio de Janeiro, com base em um modelo construído a partir da literatura. Os dados foram coletados nas bases de dados de saúde do Brasil e da página de Internet da Rio 2016. As instalações esportivas para os Jogos Olímpicos e os hospitais circundantes em um raio de 10km foram localizados por geoprocessamento; foi designada uma "área de saúde", referindo-se ao afluxo provável de pessoas a serem tratadas em caso de necessidade hospitalar. Seis fatores foram utilizados para calcular necessidades para surtos e um fator de cálculo foi usado para as desastres (20/1.000). Capacidade de tratamento hospitalar é definida pela coincidência de leitos e equipamentos de suporte de vida, ou seja, o número de monitores cardíacos (eletrocardiógrafos) e respiradores em cada unidade hospitalar. O Maracanã, seguido do Estádio Olímpico (Engenhão) e o Sambódromo, teria a maior demanda para internações (1.572, 1.200 e 600, respectivamente). A capacidade de tratamento hospitalar mostrou-se capaz de acomodar surtos, mas insuficiente em casos de vítimas em massa. Em eventos de massa, a maioria dos tratamentos envolve uma fácil gestão clínica. Espera-se que a capacidade atual não terá consequências negativas para os participantes.

Resumen: Recientemente, Brasil fue sede de eventos de masa con relevancia internacional reconocida. La Copa Mundial de la FIFA 2014 se llevó a cabo en 12 capitales de los estados y la preparación del sector de la salud tenía la historia de otras copas mundiales y con la experiencia de Brasil en la Copa Confederaciones de la FIFA 2013. Este artículo tiene como objetivo analizar la capacidad de tratamiento de las instalaciones hospitalarias en zonas georreferenciados para los eventos deportivos, en los Juegos Olímpicos de 2016, en la ciudad de Río de Janeiro, basado en un modelo construido a partir de la literatura. Los datos fueron recogidos en las bases de datos de salud en Brasil y en el sitio web del Río 2016. Las instalaciones deportivas para los Juegos Olímpicos y los hospitales circundantes dentro de un radio de 10km fueron localizados por el geoprocesamiento; un "área de la salud" fue designado, en referencia a la posible afluencia de personas que van a tratarse en el caso de una emergencia hospitalaria. Seis factores se utilizaron para calcular las necesidades a los brotes y un factor de cálculo se utilizó para los desastres (20/1.000). Capacidad de tratamiento hospitalario se define por la coincidencia de camas y equipos de soporte vital, o el número de monitores cardíacos (electrocardiógrafos) y respiradores en cada hospital. El Maracanã, seguido por el Estadio Olímpico (Engenhão) y el Sambódromo, tendría la mayor demanda de hospitalizaciones (1.572, 1.200 y 600, respectivamente). La capacidad de tratamiento hospitalario ha demostrado ser capaz de adaptarse a los brotes, pero insuficiente en casos de víctimas en masa. En los eventos masivos, la mayoría de los tratamientos implican un manejo clínico fácil. Se espera que la capacidad actual no tendrá consecuencias negativas para los participantes.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved > or = 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources.

Disaster Medical Responses to the Disaster Scene of Long-distance on Highway-Field Triage and Disaster Communication by Social Media for 106-vehicle Chain Collision in Yeong- Jong Grand Bridge

PURPOSE: This study describes the disaster medical responses to the disaster scene of long-distance on a highway; 106-vehicle chain collision on Yeong-Jong Grand Bridge on February 11, 2015 and we discuss the disaster communication by social media. METHODS: Records of disaster medical responses from records of relevant organizations and messages of social media were collected. Medical records and the results of triage were reviewed retrospectively. Casualties were categorized into four groups according to results of triage; Red- Yellow-Green-Black. Kappa statistics were used to measure agreement between results of triage and casualties' outcome. RESULTS: Disaster Medical Assistant Team (DMAT) arrived on the scene one hour after accidents occurred. DMAT settled in a temporary base camp in the middle part of the scene and did not build an emergency air shelter. DMATs from four hospitals were separated into four mobile units of DMAT and they joined the rescue team. Disaster communication by social media was useful. Seventy six casualties were transported and two died; 28.9% of casualties were transported to the nearest regional emergency medical center; 20.0% of red casualties were transported to a higher level of care again. Kappa statistics were 0.122 (95% CI, - 0.049~0.291; p=0.094). CONCLUSION: In the disaster scene of long-distance on a highway, adequate location of triage and treatment area may be the front or rear of the scene and separation of DMATs can be helpful. Disaster communication by social media was helpful. Education and policies will be required for more effective triage and dispersion of casualties.

Experiences of Disaster Medical Response System in a Fire at Goyang Bus Terminal

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.

Disaster Basic Physics and Disaster Paradigm / 한양의대학술지

Disasters are unpredictable and unavoidable. The definition of disaster is a serious disruption of the functioning of society, causing widespread human, material, or environmental losses that exceed the ability of affected society to cope using only its own resources. Disaster medicine is a discipline resulting from combination of emergency medicine and disaster management. The field of disaster medicine involves the study of subject matter from multiple medical disciplines, and disaster medicine presents unique ethical situations not seen in other areas of medicine. Disaster can be classified into two categories, natural disaster and manmade disaster, each type of disaster has its own characteristics. Disaster management has a cycle of 4 activities, preparedness, response, recovery, and prevention/mitigation. Disaster medicine specialists have a role in each part of this cycle. To achieve effective disaster response, the National Disaster Life Support Foundation suggests the DISASTER Paradigm(TM), which consists of detection, incident command, safety and security, assess hazards, support, triage and treatment, evacuation, and recovery.

Disaster Medical Assistance Team / 한양의대학술지

A modern Disaster Medical Assistance Team (DMAT) is a group of professional and para-professional medical personnel organized to provide rapid-response medical care during a disaster situation. DMAT is a part of the disaster response system that acts as a trained, mobile, self-contained medical team in the acute phase of a disaster to provide necessary services such as triage, treatment, and transportation of injured patients in the devastated disaster area. The timeliness of DMAT response is critical to the administration of medical care and reduction of immediate mortality in disaster. While the number of members in a DMAT may vary between different nations. A small-scale DMAT is often composed of five to six people and there is good reason to consider this an effective unit for early disaster medical responses. An adequate structure and training system should be provided for Korean DMAT development in the near future.

Scientific Framework for Research on Disaster and Mass Casualty Incident in Korea: Building Consensus Using Delphi Method

We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS(R)) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in > or = 10 of death or > or = 50 injured victims; 3) the feasible definition of MCI as the events that result in > or = 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends.

Incidence and Mortality Rates of Disasters and Mass Casualty Incidents in Korea: A Population-Based Cross-Sectional Study, 2000-2009

The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world.

A Case of Carbon Dioxide Poisoning by Malfunction of a Carbon Dioxide- Based Fire Extinguishing System

Carbon dioxide is a colorless, odorless, nonirritating gas with many practical uses. In particular, because it can displace oxygen from the environment, it is used as a fire extinguisher. We describe an incident that occurred as a result of malfunction of a carbon dioxide-based fire extinguishing system in our hospital. Twelve casualties reached our emergency department. Symptoms of exposure included nausea, dizziness, loss of consciousness, vomiting, chest discomfort, and seizure. Results of initial arterial blood gas analysis showed acidosis in five patients. A new pneumonic infiltration at the left. upper lung field was observed in one patient, while sinus tachycardia in electrocardiography (ECG) was observed in another patient. Oxygen was initially supplied to all casualties, until symptoms of intoxication had disappeared. Three patients were admitted to the hospital, but were discharged without complication. Despite occurrence of massive casualties, with significant symptoms due to unintentional exposure to high concentrations of carbon dioxide, patients' symptoms were relieved by supportive care.

Interoperability in disaster medicine and emergency management / Interoperabilidade em Medicina de Desastres e Administração de Emergência

Accurate and timely information is critical for health early warning and effective emergency management. Health Information Technology (HIT) standards address the challenge of integrating information from disparate healthcare resources e.g. devices, people, and information systems to support not only the effective handling of emergencies, but also their analysis for long-term resource planning. In the management of emergencies, co-operative use of standards facilitates effective sharing of information among the parties involved in search and rescue, continuous disaster assessment, and public awareness. This paper discusses the cooperative use of interoperability standards from Health Level Seven (HL7), the Organization for the Advancement of Structured Information Standards (OASIS), the European Committee for Standardization (CEN), and other Standards Developing Organizations to harness the power of Information and Communication Technologies (ICT) in emergency preparedness and response. The paper reports on the experience gained from the deployment of ICT in the Satellites for Epidemiology and health early warning (SAFE) civil protection exercise and interoperability considerations in technical solutions to be deployed in the ?POSEIDON? exercise (earthquake followed by tsunami in the Mediterranean) still at the planning stage.

Informações acuradas e na hora oportuna são essenciais para a emissão de alertas precoces de saúde e para a gestão eficaz de situações de calamidade pública. Os padrões de Tecnologia da Informação em Saúde objetivam resolver o desafio de integrar informações de diferentes recursos de saúde, como por exemplo dispositivos, pessoas e sistemas de informação para apoiar não só o tratamento eficaz nas situações de emergência, mas também na sua análise, para planejamento de recursos de longo prazo. Na gestão de emergências, o uso cooperativo de padrões facilita o compartilhamento eficaz de informações entre as partes envolvidas na busca e salvamento, de avaliação de desastres e conscientização pública. Este artigo discute o uso cooperativo de padrões de interoperabilidade do Health Level Seven (HL7), do Organização para o Avanço de Padrões de Informação Estruturados (OASIS), Comité Europeu de Normalização (CEN), e outras normas das organizações produtoras de padões para fortalecer o poder de Tecnologias de Informação e Comunicação (TICs) na preparação e resposta a emergências. O artigo relata a experiência adquirida com a utilização das TIC nos satélites de Epidemiologia e de alerta precoce de saúde (SAFE) exercício de protecção civil e os aspectos da interoperabilidade nas soluções técnicas a serem implantados no exercício ?Poseidon? (terremoto seguido de tsunami no Mediterrâneo) ainda em fase de planejamento...