Knowledge, Perceptions, and Practices on Risks and Disasters Among Medical Students. A Multicenter Cross-Sectional Study in 9 Latin American and Caribbean Countries.

Purpose: The objective of this study was to describe the level of knowledge, perceptions, and practices in relation to risks and disasters in medical schools in Latin America and the Caribbean. Participants and Methods: Multicenter, observational, analytical, non-probabilistic convenience sample study with 2546 medical students in 9 countries of Latin America and the Caribbean. An online survey was conducted between October 2020 and November 2020, using an instrument validated in each country to assess knowledge, perceptions, and practices regarding risk and disaster prevention measures. Frequencies, percentages, mean and standard deviation (SD) were used for descriptive analysis. Differences resulting from the relationship between the variables studied and the level of knowledge were obtained using the Chi-square test. P-value <0.05 was accepted as statistically significant for all analyses. Results: The highest proportion of responses came from women, third-semester students, and those studying in public universities. Students from Colombia and Honduras had the highest percentage of high levels of knowledge about disasters, while Peruvian students had the highest percentage of low levels of knowledge. Women and students from public universities showed a higher proportion of high levels of knowledge. 52.7% considered that they live in a country with a medium risk of natural disasters, while 91.2% said that Latin American and Caribbean countries are not prepared to face natural disasters. Only 43.6% believe they are prepared to help in the event of a natural disaster. Conclusion: Most of medical students from Latin America and Latin America and the Caribbean have high and medium level of knowledge in risks and disasters. However, the implementation of disaster training programs for medical students has the potential to improve the preparedness, knowledge, and skills that are important for medical personnel to improve their self-confidence, and their ability to respond, resulting in more effective systems.

Evaluation of Escherichia coli Inactivation at High Altitudes Using Solar Water Disinfection.

INTRODUCTION: Solar disinfection (SODIS) is an effective method for microbiologic inactivation of contaminated water using ultraviolet rays at low elevations. The aim of this study was to determine the effectiveness of SODIS at higher elevations. METHODS: The ability of SODIS to inactivate Escherichia coli bacteria was evaluated at an altitude of ≥1600 m using Nalgene bottles, disposable plastic water bottles, and Ziploc plastic bags. Bacterial viability was determined through measurement of colony forming units (CFUs). Decreases in CFUs were determined at each time point relative to those at the baseline, and a multivariable regression analysis was used to assess significant changes in CFUs. RESULTS: Bacterial CFUs in exposed containers decreased by >5 log after 6 h of exposure to sunlight. In contrast, the CFUs remained nearly unchanged in unexposed containers, showing a mean decrease of 0.3 log. By 2 h, bacterial inactivation at high altitudes was 1.7-fold greater than that at lower altitudes (P<0.05). By 6 h, nearly all bacteria were inactivated at high or low altitudes. At 6 h, no statistical difference was observed in the efficiency of inactivation between elevations. Compared with Nalgene bottles, plastic bottles had a 1.4-fold greater decrease in CFUs (P<0.05). No statistical difference in bacterial inactivation was found between plastic bottles and plastic bags. CONCLUSIONS: At high altitudes, SODIS is an effective method for inactivating E coli. Further research investigating other microorganisms is warranted to determine whether SODIS is suitable for disinfecting contaminated water at high altitudes.

Post-Hurricane Distress Scale (PHDS): Determination of General and Disorder-Specific Cutoff Scores.

The Post-Hurricane Distress Scale (PHDS) was developed to assess mental health risk in the aftermath of hurricanes. We derive both disorder-specific cutoff values and a single nonspecific cutoff for the PHDS for field use by disaster relief and mental health workers. Data from 672 adult residents of Puerto Rico, sampled 3 to 12 months after Hurricane Maria, were collected. Participants completed a five-tool questionnaire packet: PHDS, Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and Post-Traumatic Stress Disorder Checklist for DSM V (PCL-5). ROC curves, AUC values, sensitivities, specificities, Youden's index, and LR+ ratios are reported. The recommended single cutoff value for the PHDS is 41, whereby a respondent with a PHDS score of 41 or above is deemed high-risk for a mental health disorder. The single field use PHDS cutoff demonstrated high specificity (0.80), an LR + ratio (2.84), and a sensitivity of 0.56. The mean ROC values of PHDS for Kessler K6, Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, and PCL-5 were all above 0.74. The derived cutoff for the PHDS allows efficient assessment of respondents' and/or a community's risk status for mental health disorders in the aftermath of hurricanes and natural disasters.

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands.

OBJECTIVE: The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands. METHODS: Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018. RESULTS: ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms. CONCLUSIONS: Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.

Nonintensivist Training to Increase the Staff Capacity of Intensive Care Units During COVID-19 Pandemic Surge in Argentina.

OBJECTIVE: The aim of this study was to report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic in Argentina. METHODS: Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of Web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. RESULTS: After 4 m, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing, and 3.1% were inactive. Most students were female (74.2%) with a median of 37 y old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (standard deviation, 0.9), and 90.7% considered they were able to apply the contents to their practice. CONCLUSIONS: This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

Health Care Needs in the Aftermath of Hurricane Maria in Puerto Rico: A Perspective from Federal Medical Shelter Manatí.

INTRODUCTION: On September 20, 2017, Hurricane Maria, a Category 4 hurricane, swept across Puerto Rico (PR), wreaking devastation to PR's power, water, and health care infrastructure. To address the imminent humanitarian crisis, the US government mobilized Federal Medical Shelters (FMS) to serve the needs of hurricane victims. This study's objective was to provide a description of the patients seeking emergency care at FMS and the changes in their needs over time. METHODS: This retrospective, cross-sectional study included all patients presenting to the FMS Manatí from October 6, two weeks after Hurricane Maria's landfall, to November 2, 2017. Categories were created to catalogue the nature of new acute medical issues by patients presenting to the Shelter. Descriptive, graphical analyses were performed to assess changes to presenting complaints over time, and by age groups defined as infant (age ≤1 years), child (1 year < age ≤10 years), adolescent (10 years < age ≤ 25 years), and adult (age > 25 years). RESULTS: Over the 30-day period, 5,268 patients were seen in the FMS seeking medical care (average 188.1 patients per day), spending less than five hours in the facility. The distribution of patients' age was bimodal: the first peak at one year and the second at age 50. The most common patient complaint was infection (38.8%), then musculoskeletal (MSK) complaints (11.8%) and management of chronic medical conditions (11.8%). The proportion of patients presenting with chronic disease complaints declined over the course of the period of observation (21.4% on Day 4 to 8.0% on Day 30) while the proportion of patients presenting with infection increased (31.0% on Day 4 to 48.6% on Day 30). Infection complaints were highest in all age groups, but most in infxants (80.2%), while MSK and chronic disease complaints were highest in adults (14.9% and 14.9%, respectively). CONCLUSION: Infection treatment and chronic disease management were important medical needs facing patients seeking care at FMS Manatí after Hurricane Maria. These findings suggest that basic needs related to sanitation and shelter remained important weeks after the hurricane, and a focus on access to medications, infection control, and injury prevention/management after a disaster needs to be prioritized during disaster response.

Social Participation Strategies and Resilience in Mexican Population Affected by the 2017 Earthquakes.

OBJECTIVE: To describe social participation strategies and resilience in the people affected by the 2017 earthquakes in Mexico. METHODS: A cross-sectional study was carried out with 1504 participants from Mexico City, State of Mexico, Oaxaca, Chiapas, Puebla, and Morelos in November and December 2017. A nonprobabilistic convenience sampling method was used to recruit voluntary participants who met the inclusion criteria: age 18 or over and residents in damaged states at the time of the earthquakes. Postearthquake social participation strategies were assessed with the formats used in the postearthquake Chilean survey in 2010. The Spanish-validated version of the resilience scale RS-14 was applied for measuring resilience in the Mexican population. RESULTS: The most frequent social participation strategies were related to emotional support and aid supplying water, food, and clothing. The highest resilience was observed in the state of Oaxaca and in Mexico City. Men, people age 40 or over, and people who defined themselves as indigenous were the most resilient. CONCLUSIONS: Factors related to resilience were male gender, age over 40, did not participate in activities of help to the community, no household damage, and belonging to an indigenous community.

Overcoming Challenges in the Medical Response to Hurricane Dorian in the Bahamas.

In September 2019, the northwest Bahamas suffered unparalleled damages due to Hurricane Dorian. The storm disrupted all the essential community services, including water, electricity, and medicine. Heart to Heart International provided medical support in a very austere environment to the people of Abaco island. This article examines the challenges faced by the response team from Heart to Heart International in the immediate aftermath of Hurricane Dorian.

Team Rubicon Medical Response to Hurricane Dorian in the Bahamas.

On September 1, 2019, Hurricane Dorian made landfall as a category 5 hurricane on Great Abaco Island, Bahamas. Hurricane Dorian matched the "Labor Day" hurricane of 1935 as the strongest recorded Atlantic hurricane to make landfall with maximum sustained winds of 185 miles/h.1 At the request of the Government of the Bahamas, Team Rubicon activated a World Health Organization Type 1 Mobile Emergency Medical Team and responded to Great Abaco Island. The team provided medical care and reconnaissance of medical clinics on the island and surrounding cays….

Respuesta del sistema municipal de salud al huracán Irma. Aguada de Pasajeros, 2017 / Response of the Municipal Health System to Irma Hurricane. Aguada de Pasajeros, 2017

Fundamento: en la respuesta del sistema de salud ante un huracán, los municipios y sus establecimientos tienen un papel protagónico.Objetivo: describir la respuesta del sistema municipal de salud del municipio de Aguada de Pasajeros ante el paso del huracán Irma por el territorio. Métodos: estudio prospectivo, transversal, en sistema y servicios de salud, desarrollado en el municipio de Aguada de Pasajeros entre el 7 y 30 de septiembre de 2017. El universo lo constituyó la totalidad de trabajadores e instituciones del territorio, todos involucrados en la respuesta al huracán Irma. Se incluyeron la revisión documental (planes, indicaciones de los Consejos de Defensa y del Ministerio de Salud) y la observación participativa. También se revisaron indicadores de posible impacto y del cuadro de salud municipal. Resultados: se planificaron y ejecutaron un total de 88 acciones por el sistema municipal de salud; 50 durante la fase informativa, 29 en la de alarma y nueve en la de alerta. El plan de reducción de desastres fue cumplido en su totalidad, al que se le agregaron ocho nuevas tareas como parte de las lecciones aprendidas. No hubo fallecidos atribuidos al huracán, ni cambios en la morbilidad posterior al evento. Existió cobertura asistencial mantenida en sitios de difícil acceso y albergues. Todas las instituciones mantuvieron su vitalidad. Conclusiones: las acciones desarrolladas en el municipio permitieron mantener el cuadro de salud, la atención integral a las personas que demandaron asistencia médica durante el paso del fenómeno natural, así como la vitalidad de las instituciones.

Foundation: in response of the health system before a hurricane, municipalities and establishments have a protagonist role. Objective: to describe the Aguada de Pasajeros municipal health system at the Irma hurricane's path across its territory. Methods: prospective cross study, in the health and service system, developed in the Aguada de Pasajeros Municipality between September the 7th and 30th, 2017. The universe was the territory total of workers and institutions, all involved in the response to Irma's hurricane. A documentary review was included (plans, instructions from the Defense Councils, and the Minister of Health) and participating observation. Indicators of possible impact and municipal health situation. Results: a total of 88 actions by the municipal health system; 50 during the informative phase and 9 in alert. The plan for disaster reduction was totaly achieved, to which 9 new tasks were added. There were no deaths due to the hurricane nor morbidity after the event. There was maintained assistance coverage in sites of difficult access and shelters. All the institutions maintained vitality. Conclusion: the actions developed in the municipality allowed maintaining the health situation, the comprehensive care to the people who demanded medical services during the path of the natural phenomena across the territory institutional vitality.

Rural Community Disaster Preparedness and Risk Perception in Trujillo, Peru.

Introduction Disasters will continue to occur throughout the world and it is the responsibility of the government, health care systems, and communities to adequately prepare for potential catastrophic scenarios. Unfortunately, low-and-middle-income countries (LMICs) are especially vulnerable following a disaster. By understanding disaster preparedness and risk perception, interventions can be developed to improve community preparedness and avoid unnecessary mortality and morbidity following a natural disaster. Problem The purpose of this study was to assess disaster preparedness and risk perception in communities surrounding Trujillo, Peru. METHODS: After designing a novel disaster preparedness and risk perception survey based on guidelines from the International Federation of Red Cross and Red Crescent Societies (IFRC; Geneva, Switzerland), investigators performed a cross-sectional survey of potentially vulnerable communities surrounding Trujillo, Peru. Data were entered and analyzed utilizing the Research Electronic Data Capture (REDCap; Harvard Catalyst; Boston, Massachusetts USA) database. RESULTS: A total of 230 study participants were surveyed, composed of 37% males, 63% females, with ages ranging from 18-85 years old. Those surveyed who had previously experienced a disaster (41%) had a higher perception of future disaster occurrence and potential disaster impact on their community. Overall, the study participants consistently perceived that earthquakes and infection had the highest potential impact of all disasters. Twenty-six percent of participants had an emergency supply of food, 24% had an emergency water plan, 24% had a first aid kit at home, and only 20% of the study participants had an established family evacuation plan. CONCLUSION: Natural and man-made disasters will remain a threat to the safety and health of communities in all parts of the world, especially within vulnerable communities in LMICs; however, little research has been done to identify disaster perception, vulnerability, and preparedness in LMIC communities. The current study established that selected communities near Trujillo, Peru recognize a high disaster impact from earthquakes and infection, but are not adequately prepared for potential future disasters. By identifying high-risk demographics, targeted public health interventions are needed to prepare vulnerable communities in the following areas: emergency food supplies, emergency water plan, medical supplies at home, and establishing evacuation plans. Stewart M , Grahmann B , Fillmore A , Benson LS . Rural community disaster preparedness and risk perception in Trujillo, Peru. Prehosp Disaster Med. 2017;32(4):387-392.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades.

The current work describes the program of the Medicine of Disasters subject that is imparted to the future physicians of the Latin American School of Medicine in Villa Clara since 2003, as an exclusive experience in the world. It consists of 120 teaching hours distributed in two rotations that are developed during the fourth and fifth years of the career, with a theoretical-practical character. Its contents are guided to the familiarization with the topic of the disasters-causing factors, their effects upon health and the dynamics of society and the communities, as well as to the incorporation of knowledge about risks and vulnerability, besides the associated procedures to diminish them; where the preparatory work with the population and the interrelation among sectors to face adversities are predominant.

Diseño y validación de un instrumento para valorar las funciones especiales en estudiantes de sexto año de de la carrera de medicina / Design and validation of an instrument to assess the special functions in 6th year medical students

Con el propósito de validar instrumentos de investigación orientados a evaluar la efectividad del currículo en relación con las funciones especiales del Médico General (Preparación para la Defensa y Medicina de Desastres), se realizó el diseño de sendos ejercicios teóricos y aplicación a una muestra de estudiantes de sexto curso, cubanos y extranjeros, de una facultad de Ciencias Médicas, quienes respondieron una encuesta acerca de estos. Profesores de la facultad actuaron como contraparte en la aplicación de dichos ejercicios te¾ricos y dieron su valoración en una entrevista. Se procesaron los resultados obtenidos por los estudiantes al responder los instrumentos, los relativos a las opiniones estudiantiles y las profesorales sobre estos y su aplicación. Los resultados indican que los instrumentos propuestos son adecuados para valorar el conocimiento acerca de las funciones especiales de los mÚdicos generales y recomendables para la evaluaci¾n de las funciones para las cuales fueron diseñados.

With the objective of validating research instruments for the evaluation of the curriculum effectiveness in terms of the special functions of the general physician (preparation for defense and disaster medicine), two theoretical exercises were designed and applied to a sample of 6th year students, both Cubans and foreigners, from a medical school, who answered a survey about this topic. The professors acted as a counterpart in implementing the said exercises and gave their final assessment in an interview. The results obtained by the students in answering the instruments, those related to the opinion of students and professors about their use and finally their application were all processed. The final results show that the suggested instruments are adequate to assess the knowledge about the special functions of the general physicians and can be recommended for the assessment of the functions for which they were designed.

Serving in haiti: perspective of a physician.

In the wake of the 2010 earthquake in Haiti, medical relief organizations and individual practitioners mobilized to provide assistance. Here, an emergency medicine physician who worked with a Louisiana-based team in the mountains in one of the hardest hit areas relates his experiences.

Orthopedic anesthesia in haiti.

Healthcare practitioners from around the world responded almost immediately in the aftermath of the 2010 earthquake in Haiti. This article reports on the efforts of an orthopedic trauma team in Haiti and its efforts in providing surgery without general anesthesia.