The Transitional Medical Model: An innovative methodology for a community's disease outbreak and pandemic preparedness and response plan.

Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak-whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission-can quickly degrade a community's healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities.

What Do Emergency Department Patients and Their Guests Expect From Their Health Care Provider in an Active Shooter Event?

Background: "Run-Hide-Fight" is the summative life-saving mantra taught by governmental and private agencies in active shooter training. Initial research focused on patient expectations of health care provider responses in life-threatening situations suggests patients believe health care providers will take significant action to protect patient well-being. The potential disparity between expectations of the public and health care practitioner training must be examined, as conflict, confusion, and delays may have mortal consequences in active shooter situations.

Developing "Herd Immunity" in a Civilian Community Through Incorporation of "Just-In-Time" Tourniquet Application Training.

Introduction: Herd immunity, a concept normally applied in vaccinated populations, is a preventative measure to determine if a significant portion of a population can protect vulnerable individuals against a certain disease. Like vaccines, tourniquet education can be a form of herd immunity to protect vulnerable individuals in a population and prevent the loss of life from a peripheral hemorrhage. The authors have identified a deficiency in simple, quick, and effective hemorrhage control education.

Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?

Objective: The aim of this study was to explore the clinical decisions that health care students would make if faced with an active shooter event while providing patient care.

Methods: A cross-sectional study design was used to survey 245 students from 6 different professional programs. Participants read 4 case-based scenarios, selected 1 of 4 actions in a multiple-choice format, and responded to an open-ended question.

Killer amoebas: Primary amoebic meningoencephalitis in a changing climate.

Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is a rare and deadly disease that requires prompt treatment with multiple therapies. Although N. fowleri previously was only found in warmer areas, climate change appears to be contributing to its geographic spread.

Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer.

Background: Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable.

START versus SALT Triage: Which is Preferred by the 21st Century Health Care Student?

Unlabelled: IntroductionWhile the art and science of disaster triage continue to evolve, the education of the US health care student in matters pertaining to disaster preparedness and response remains stifled. Unfortunately, these students will be assuming major decision-making responsibilities regarding catastrophes that will be complicated by climate change, nuclear threats, global terrorism, and pandemics. Meanwhile, Sort, Assess, Life-Saving Interventions, Treatment, and/or Transport (SALT) triage is being advocated over the globally popular Simple Triage and Rapid Treatment (START) algorithm for multiple reasons: (1) it's an all-hazard approach; (2) it has four medical interventions; and (3) it has an additional triage color for victims with non-survivable injuries.

Salivary protein changes in response to acute stress in medical residents performing advanced clinical simulations: a pilot proteomics study.

Context: Quantitative changes of salivary proteins due to acute stress were detected.

Objective: To explore protein markers of stress in saliva of eight medical residents who performed emergency medicine simulations.

Materials And Methods: Saliva was collected before the simulations, after the simulations, and following morning upon waking.

Immersive simulation education: a novel approach to pandemic preparedness and response.

Pandemic management involves strategic and tactical concepts rarely experienced with other disasters. To comprehend the enormity of these tasks and experience the critical decision-making required, local public health and other stakeholders participate in tabletop and functional exercises. Students in Master of Public Health (MPH) programs not only rarely experience this educational format, but also are seldom afforded substantive time to appreciate the critical decision making that is unique to pandemics.

A national survey of emergency nurses and avian influenza threat.

Introduction: The purpose of this study was to determine the perceived likelihood of emergency nurses reporting to work during an avian influenza outbreak, to consider options if nurses decided not to report work, and to explore Protection Motivation Theory constructs as predictors of reporting to work.

Methods: A descriptive, nonexperimental, cross-sectional survey of emergency nurses within the United States.

Results: A total of 332 nurses (46%) responded.

The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department.

Objectives: The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction.

Methods: Patients in the intervention group were offered and received a 5- to 10-minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care.

An assessment of nurses' knowledge of botulism.

Objective: To assess nurses' knowledge of botulism, a Centers for Disease Control Category A bioterrorism agent, one case of which constitutes an emergency.

Design: The study utilized survey research.

Sample: The cluster sample included 1,414 registered nurses.

Considerations for the vertical evacuation of hospitalized patients under emergency conditions.

Hospitals and other healthcare institutions in the twenty-first century face myriad challenges to their survival against a number of threats from many sources. A number of those threats, eg, internal, external, accidental, or intentional, may require the prompt evacuation of both patients and staff Although rare, this possibility is becoming more frequent in the United States. Unfortunately, despite accrediting agencies' mandates, there is a profound paucity of strategic and tactical guidelines in the medical literature.

Single-Breath-Count Test: an important adjunct in the triaging of patients in a mass-casualty incident due to botulism.

Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative.

Using an H1N1 vaccination drive-through to introduce healthcare students and their faculty to disaster medicine.

Currently, the H1N1 pandemic does not approach the worst-case scenarios that have been predicted by the Centers for Disease Control and Prevention and the World Health Organization. Nevertheless, its impact, fueled by its predilection for nontraditional victims, assorted governmental miscalculations, and journalistic hyperbole, has led to an environment of both fear and skepticism. In this environment, the healthcare infrastructure must sift through relevant data, set aside political rhetoric, weigh the risk-benefit ratio of health-related mandates and recommendations, interact with diverse agencies and departments, and still attend to the medical, psychological, and educational needs of its patients and the community at large.

The transitional medical model: an innovative methodology for a community's disease outbreak and pandemic preparedness and response plan.

Infectious disease outbreaks, epidemics, and subsequent pandemics are not typical disasters in the sense that they often lack clearly delineated phases. As in any event that is biological in nature, its onset may be gradual with signs and symptoms that are so subtle that they go unrecognized, thus missing opportunities to invoke an early response and implement containment strategies. An infectious disease outbreak-whether caused by a novel virus, a particularly virulent influenza strain, or newly emerging or resistant bacteria with the capability of human-to-human transmission--can quickly degrade a community's healthcare infrastructure in advance of coordinated mitigation, preparation, and response activities.

Botulism Questionnaire: a tactical tool for community use in a mass casualty incident.

A botulism-induced mass casualty incident has the potential to severely compromise a community's health-care infrastructure, based upon its lethality, rare occurrence, and duration of symptoms, which require extensive support and care. Although early recognition and treatment with antitoxin or botulism immunoglobulin are essential to the effective management of this type of an incident, the two major challenges in recognition and treatment are the hundreds, if not thousands, of casualties or potential casualties requiring rapid screening and the fact that most clinicians remain ignorant of the management of botulism. The purpose of this article is to present the Botulism Questionnaire, which will assist with the screening of casualties, provide educational and diagnostic cues for clinicians and the lay public, and create a layer of protection for the health-care infrastructure.

An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident.

Botulinum toxin is one of the most toxic substances known to humankind. It is one among the six Category A agents in the CDC bioterrorism lexicon. This suggests that, while the possibility of a botulism mass casualty incident (MCI) is remote, its unique acute and long-term ramifications must be addressed and planned for.