Introducing an antibiotic stewardship program in a humanitarian surgical hospital.

Antibiotic stewardship program (ASP) implementation in humanitarian settings is a new endeavor. Doctors Without Borders/Médecins Sans Frontières introduced an ASP within a hospital in Amman, Jordan, where patients from Iraq, Syria, and Yemen with chronic, often multidrug-resistant, infections related to war are managed. Antibiotics were reviewed, and real-time recommendations were made to optimize choice, dose, duration, and route by a small team. Over the first year of implementation, acceptance of the ASP's recommendations improved. When compared with the year prior to implementation, antibiotic cost in 2014 declined considerably from approximately $252,077 (average, $21,006/month) to <$159,948 ($13,329/month), and a reduction in use of broad-spectrum agents was observed. An ASP in a humanitarian surgical hospital proved acceptable and effective, reducing antibiotic expenditures and use of broad-spectrum agents.

Assessment of prehospital care and disaster preparedness in a rural Guatemala clinic.

INTRODUCTION: In October 2005, Hurricane Stan impacted Central America, causing severe damage to Guatemala. The main objectives of this study are to report on the effects of Hurricane Stan in rural Guatemala, to assess the responses of a rural clinic during and after the storm, and to identify ways in which the clinic can better prepare for future disasters. The clinic is located in Catarina, San Marcos, Guatemala. Roughly 400-500 patients are attended to each week at the clinic. METHODS: Survey data were obtained during a two-week period using a convenience sample of people at the clinic and in the surrounding community. RESULTS: The major medical problems after the impact of Hurricane Stan included fungal infections, upper respiratory infections, diarrhea, and emotional problems. The most needed supplies included food, electricity, home repair, potable water, communication, and clothing. In the immediate aftermath of event, 61% of the participants could not get to a hospital; however, most did not require medical assistance. CONCLUSIONS: Hurricane Stan had a devastating effect on the San Marcos region of Guatemala. While the clinic could have served as a resource center and a base, it was not prepared to address the community's health needs after the hurricane as there were no previous plans in place for disaster response for the clinic or for the community. Next steps include developing a preparedness plan to utilize the clinic as a local resource center , in the event that the planned national disaster responses are delayed or unable to reach the affected area.

Training medical students in bag-valve-mask technique as an alternative to mechanical ventilation in a disaster surge setting.

OBJECTIVE: The objective of this study was to evaluate the rapid training of medical students and their ability to provide effective manual ventilation using the bag-valve-mask technique. METHODS: A rapid training session highlighting essential aspects of the correct bag-valve-mask technique was given to 31 medical students. This was followed by a simulated experience with a certified respiratory therapist, monitored according to a checklist of essential bag-valve-mask (BVM) competency requirements. Pre-test and post-test surveys assessed the medical students' knowledge and ability to provide adequate BVM technique. RESULTS: Thirty-one students participated. Pre-survey results demonstrated a clear identification of the potential risk for a disaster (pandemic, natural, bioterrorist) with 55% of students responding that a definite risk did exist. Their usefulness in such an event also was ascertained with 55% of students replying they would assist with basic medical tasks, assist doctors, or assist with cardiopulmonary resuscitation. Post-survey results administered after a 30-minute didactic session on the basic features of resuscitation equipment and the essential components of BVM technique demonstrated that a majority of students knew the proper head positioning maneuvers in cases not involving trauma (93%) and in cases involving trauma (72%). All students completed and passed the competency checklist. CONCLUSIONS: Medical students can be rapidly trained and be utilized as a potential resource to carry out the potentially lifesaving task of manual ventilation using the BVM technique in a disaster situation in which the availability of mechanical ventilators and respiratory therapists may be limited.