Gabrielle A. Jacquet

The injury burden of the 2010 Haiti earthquake: a stratified cluster survey.

INTRODUCTION On January 12, 2010, a 7.0 magnitude earthquake devastated metropolitan Port au Prince and surrounding areas and resulted in widespread injury, mortality and displacement. This study aimed to estimate the injury rate among the affected population and the resulting demand of emergency medical care in the aftermath of the earthquake. METHODS In January 2011, a cross-sectional stratified cluster (60×20 household) survey of the earthquake-affected population in metropolitan Port au Prince was conducted to assess their well-being, unmet needs and perceptions of humanitarian assistance one year post-earthquake. Mixed effects simple and multiple logistic regressions were used to measure the total unadjusted and adjusted odds of injury. RESULTS A total of 261 injuries were reported in the pre-earthquake population of 6489 individuals with reported injury status. The overall earthquake injury rate was estimated at 40.2 injuries/1000 (CI: 35.6-45.3). Individual characteristics such as age, gender, and education status were not significantly associated with risk of injury. Elevated injury rates were observed among households residing in camps at 46.7/1000 (CI: 39.7-54.5) as compared to those in neighbourhoods where the injury rate was 33.7/1000 (CI: 27.8-40.5) (p=0.018). Extrapolation of the survey injury rate to the affected population yields an estimated 124,577 earthquake injuries (range 110,048-140,033) which is substantially lower than the 300,000 reported injuries. CONCLUSIONS Estimates of the injury burden in disasters in lower- and middle-income countries is essential for disaster preparedness and response planning in future natural disasters. Given the difficulties in reporting injuries in emergencies, including both challenges of aggregating information and lack of standardized definitions and inclusion/exclusion criteria for injuries that are not severe, ascertaining the injury burden of disasters will be a persistent challenge.

Guidelines for Safety of Trainees Rotating Abroad: Consensus Recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association

The goal of a global health elective is for residents and medical students to have safe, structured, and highly educational experiences. In this article, the authors have laid out considerations for establishing a safe clinical site; ensuring a travelers personal safety, health, and wellness; and mitigating risk during a global health rotation. Adequate oversight, appropriate mentorship, and a well-defined safety and security plan are all critical elements to a successful and safe experience.

A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region

Introduction According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. Methods We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. Results The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. Discussion While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.

Earthquake related injuries in the pediatric population : a systematic review

Background: Children are a special population, particularly susceptible to injury. Registries for various injury types in the pediatric population are important, not only for epidemiological purposes but also for their implications on intervention programs. Although injury registries already exist, there is no uniform injury classification system for traumatic mass casualty events such as earthquakes. Objective: To systematically review peer-reviewed literature on the patterns of earthquake-related injuries in the pediatric population. Methods: On May 14, 2012, the authors performed a systematic review of literature from 1950 to 2012 indexed in Pubmed, EMBASE, Scopus, Web of Science, and Cochrane Library. Articles written in English, providing a quantitative description of pediatric injuries were included. Articles focusing on other types of disasters, geological, surgical, conceptual, psychological, indirect injuries, injury complications such as wound infections and acute kidney injury, case reports, reviews, and non-English articles were excluded. Results: A total of 2037 articles were retrieved, of which only 10 contained quantitative earthquake-related pediatric injury data. All studies were retrospective, had different age categorization, and reported injuries heterogeneously. Only 2 studies reported patterns of injury for all pediatric patients, including patients admitted and discharged. Seven articles described injuries by anatomic location, 5 articles described injuries by type, and 2 articles described injuries using both systems. Conclusions: Differences in age categorization of pediatric patients, and in the injury classification system make quantifying the burden of earthquake-related injuries in the pediatric population difficult. A uniform age categorization and injury classification system are paramount for drawing broader conclusions, enhancing disaster preparation for future disasters, and decreasing morbidity and mortality.

Academic affairs and global health: how global health electives can accelerate progress towards ACGME milestones

Global health electives (GHEs) have become a standard offering in many residency programs. Residency electives should aid residents in achieving outcomes in the Accreditation Council for Graduate Medical Education (ACGME) competency domains. In this paper, the authors review existing literature and provide expert opinion to highlight how global health electives can complement traditional training programs to assist residents in achieving ACGME milestones, using emergency medicine residency as an example. Recommendations are provided for identifying exemplary global health electives and for the development of institutional global health elective curricula in order to facilitate milestone achievement. Global health electives can advance progress towards ACGME milestones; however, they may vary greatly in terms of potential for learner advancement. Electives should thus be rigorously vetted to ensure they meet standards that will facilitate this process. Given that milestones are a newly introduced tool for assessing resident educational achievement, very little research is available currently to directly determine impacts, and further study will be needed.

Availability and diversity of training programs for responders to international disasters and complex humanitarian emergencies.

Introduction: Volunteers and members of relief organizations increasingly seek formal training prior to international field deployment. This paper identifies training programs for personnel responding to international disasters and complex humanitarian emergencies, and provides concise information – if available- regarding the founding organization, year established, location, cost, duration of training, participants targeted, and the content of each program. Methods: An environmental scan was conducted through a combination of a peer-reviewed literature search and an open Internet search for the training programs. Literature search engines included EMBASE, Cochrane, Scopus, PubMed, Web of Science databases using the search terms “international,” “disaster,” “complex humanitarian emergencies,” “training,” and “humanitarian response”. Both searches were conducted between January 2, 2013 and September 12, 2013. Results: 14 peer-reviewed articles mentioned or described eight training programs, while open Internet search revealed 13 additional programs. In total, twenty-one training programs were identified as currently available for responders to international disasters and CHE. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Each of the programs identified has different goals and objectives, duration, expenses, targeted trainees and modules. Seven programs (33%) are free of charge and four programs (19%) focus on the mental aspects of disasters. The mean duration for each training program is 5 to 7 days. Fourteen of the trainings are conducted in multiple locations (66%), two in Cuba (9%) and two in Australia (9%). The cost-reported in US dollars- ranges from

Prevention of burn injuries in low- and middle-income countries: A systematic review

100 to

Global Health: Preparation for Working in Resource-Limited Settings

2,400 with a mean cost of

Global emergency medicine

480 and a median cost of

Global Emergency Medicine: A Review of the Literature From 2011: GLOBAL EM LITERATURE REVIEW FROM 2011

135. Most of the programs are open to the public, but some are only available by invitation only, such as the International Mobilization Preparation for Action (IMPACT) and the United Nations Humanitarian Civil-Military Coordination (UN-CMCoord) Field Course. Conclusions: A variety of training programs are available for responders to disasters and complex humanitarian emergencies. These programs vary in their objectives, audiences, modules, geographical locations, eligibility and financial cost. This paper presents an overview of available programs and serves as a resource for potential responders interested in capacity-building training prior to deployment.