Evaluation of an On-Site Disaster Medical Management Course in Nepal.

The great 2015 Nepal earthquake of magnitude 7.6 killed about 9000 people. To better ensure a more coordinated disaster response, a Basic On-Site Disaster Medical Support (BOS-DMS) course was designed in 2017. This study evaluates the effectiveness of the BOS-DM course. The course was conducted twice and attended by 135 participants, of whom 113 (83.7%) answered pre-test and post-test based multiple-choice questions. Qualitative and quantitative feedback was provided by 94 participants (69.6%). Mean test scores for the participants increased from 4.24 ± 1.42 to 6.55 ± 2.16 (p-value < 0.0001; paired t-test). More than 92.0% of participants felt that the course prepared healthcare workers to manage acute medical situations at a disaster site. Subject knowledge scores increased from 34.8% to 90.2%. A three-day BOS_DMS course has the potential to improve on-site disaster management knowledge. Our study noted that precise scheduling, making attendance compulsory, translating course materials into the local language, inclusion of disaster exercises and training local master trainers can enhance course effectiveness.

Knowledge of signs and symptoms of heart attack and stroke among Singapore residents.

AIM: To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. METHODS: A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. RESULTS: The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4) out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9) out of 10 for stroke. Respondents who were ≥ 50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. CONCLUSION: We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.

National population based survey on the prevalence of first aid, cardiopulmonary resuscitation and automated external defibrillator skills in Singapore.

AIM: This study aimed to assess knowledge, attitudes and practices among Singapore residents towards life-saving skills and providing emergency assistance in the community using a population representative sample. METHODS: A population based, random sample of 7840 household addresses were selected from a validated national sampling frame. Respondents were interviewed using face-to-face interview method. One adult aged between 18 and 69 years within each household was randomly selected using the "next birthday" method. RESULTS: The response rate achieved was 65.2% with 4192 respondents. The distribution of age, gender and ethnic group were similar to the Singapore resident population for 2009. A high proportion of participants believed that adults should be trained in first aid (89.1%) and cardiopulmonary resuscitation (CPR) (82.6%) while a lower proportion (57.2%) believed this for automated external defibrillator (AED). Proportion who had ever been trained in first aid was 34.3%, CPR was 31.4% and AED was 10.7%. In an emergency, respondents were most willing to use life-saving skills on family members or relatives (87.6%), followed by friends and colleagues (80.7%) and complete strangers (61.3%). Common barriers to applying life-saving skills were lack of knowledge (36%), fear of doing harm (22.1%) and lack of confidence (15.3%). Respondents who were more likely to have current life-saving certification were younger employed Malay male (p<0.05). CONCLUSION: This study found that although a high proportion of respondents believed that adults should be trained in first aid, CPR and AED, the proportion who had ever been trained in these skills are much lower.

Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.

OBJECTIVE: Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. METHODS: A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. MAIN RESULTS: After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, p<0.005), and from 0.24 to 0.18 (decrease=0.06, 95% CI 0.01-0.11, p=0.02) for the next 5min. The mean time taken to apply Autopulse™ decreased from 208.8s to 141.6s (decrease=67.2, 95% CI, 22.3-112.1, p<0.005). The mean CPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, p<0.005) and the mean total NFR for the first 10min decreased from 0.33 to 0.23 (decrease=0.10, 95% CI 0.07-0.14, p<0.005). CONCLUSION: Implementation of cardiac arrest teams was associated with a reduction in NFR in the first 10min of resuscitation. Training cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED.