Jennifer L. Chan

Management of hemorrhage complicated by novel oral anticoagulants in the emergency department: Case report from the northwestern emergency medicine residency

Anticoagulation has long complicated the care of hemorrhage in the emergency department and other acute care settings. With the advent of novel anticoagulants such as direct thrombin inhibitors and direct factor Xa inhibitors, the absence of any direct antidote for these medications presents new and difficult challenges in the management of hemorrhagic complications in these patients. We present 2 cases of patients with hemorrhagic complications taking novel oral anticoagulants, their management, and outcomes.

Applied technologies in humanitarian assistance: report of the 2009 Applied Technology Working Group.

Information and communication technologies, especially in the forms of mobile telecommunications, satellite imaging, and geographical information systems, promise to significantly improve the practice of humanitarian relief. A working group convened at the Humanitarian Action Summit 2009, has begun investigating the challenges to implementing these technologies in field operations, keeping in mind the ethical considerations of linking people to place, and pledging to build a community of practice among academics, practitioners, and developers.

Responding to gender-based violence in disasters: grappling with research methods to clear the way for planning.

In this issue of Disaster Medicine and Public Health Preparedness, Anastario et al1 bring to light a vulnerability that is often hidden. Using sequential cross-sectional randomized surveys of trailer parks in Mississippi that were home to individuals displaced by Hurricane Katrina, Anastario et al documented a quantitative increase in gender-based violence (GBV) among a population living in protracted displacement after disaster. Among the population surveyed, the crude rate of GBV increased from 4.6 to 16.3/100,000 per day after the hurricane and remained elevated at 10.1/100,000 per day in 2007. The majority of this sustained increase in GBV was due to intimate partner violence (IPV).

A framework and methodology for navigating disaster and global health in crisis literature

Both ‘disasters’ and ‘global health in crisis’ research has dramatically grown due to the ever-increasing frequency and magnitude of crises around the world. Large volumes of peer-reviewed literature are not only a testament to the field’s value and evolution, but also present an unprecedented outpouring of seemingly unmanageable information across a wide array of crises and disciplines. Disaster medicine, health and humanitarian assistance, global health and public health disaster literature all lie within the disaster and global health in crisis literature spectrum and are increasingly accepted as multidisciplinary and transdisciplinary disciplines. Researchers, policy makers, and practitioners now face a new challenge; that of accessing this expansive literature for decision-making and exploring new areas of research. Individuals are also reaching beyond the peer-reviewed environment to grey literature using search engines like Google Scholar to access policy documents, consensus reports and conference proceedings. What is needed is a method and mechanism with which to search and retrieve relevant articles from this expansive body of literature. This manuscript presents both a framework and workable process for a diverse group of users to navigate the growing peer-reviewed and grey disaster and global health in crises literature. Methods: Disaster terms from textbooks, peer-reviewed and grey literature were used to design a framework of thematic clusters and subject matter ‘nodes’. A set of 84 terms, selected from 143 curated terms was organized within each node reflecting topics within the disaster and global health in crisis literature. Terms were crossed with one another and the term ‘disaster’. The results were formatted into tables and matrices. This process created a roadmap of search terms that could be applied to the PubMed database. Each search in the matrix or table results in a listed number of articles. This process was applied to literature from PubMed from 2005-2011. A complementary process was also applied to Google Scholar using the same framework of clusters, nodes, and terms expanding the search process to include the broader grey literature assets. Results: A framework of four thematic clusters and twelve subject matter nodes were designed to capture diverse disaster and global health in crisis-related content. From 2005-2011 there were 18,660 articles referring to the term [disaster]. Restricting the search to human research, MeSH, and English language there remained 7,736 identified articles representing an unmanageable number to adequately process for research, policy or best practices. However, using the crossed search and matrix process revealed further examples of robust realms of research in disasters, emergency medicine, EMS, public health and global health. Examples of potential gaps in current peer-reviewed disaster and global health in crisis literature were identified as mental health, elderly care, and alternate sites of care. The same framework and process was then applied to Google Scholar, specifically for topics that resulted in few PubMed search returns. When applying the same framework and process to the Google Scholar example searches retrieved unique peer-reviewed articles not identified in PubMed and documents including books, governmental documents and consensus papers. Conclusions: The proposed framework, methodology and process using four clusters, twelve nodes and a matrix and table process applied to PubMed and Google Scholar unlocks otherwise inaccessible opportunities to better navigate the massively growing body of peer-reviewed disaster and global health in crises literature. This approach will assist researchers, policy makers, and practitioners to generate future research questions, report on the overall evolution of the disaster and global health in crisis field and further guide disaster planning, prevention, preparedness, mitigation response and recovery.

Development of an Evaluation Framework Suitable for Assessing Humanitarian Workforce Competencies During Crisis Simulation Exercises

The need to provide a professionalization process for the humanitarian workforce is well established. Current competency-based curricula provided by existing academically affiliated training centers in North America, the United Kingdom, and the European Union provide a route toward certification. Simulation exercises followed by timely evaluation is one way to mimic the field deployment process, test knowledge of core competences, and ensure that a competent workforce can manage the inevitable emergencies and crises they will face. Through a 2011 field-based exercise that simulated a humanitarian crisis, delivered under the auspices of the World Health Organization (WHO), a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers.

Acute Incident Rapid Response at a Mass-Gathering Event Through Comprehensive Planning Systems: A Case Report from the 2013 Shamrock Shuffle

Planning and execution of mass-gathering events involves various challenges. In this case report, the Chicago Model (CM), which was designed to organize and operate such events and to maintain the health and wellbeing of both runners and the public in a more effective way, is described. The Chicago Model also was designed to prepare for unexpected incidents, including disasters, during the marathon event. The model has been used successfully in the planning and execution stages of the Bank of America Shamrock Shuffle and the Bank of America Chicago Marathon since 2008. The key components of the CM are organizational structure, information systems, and communication. This case report describes how the organizers at the 2013 Shamrock Shuffle used the key components of the CM approach in order to respond to an acute incident caused by a man who was threatening to jump off the State Street Bridge. The course route was changed to accommodate this unexpected event, while maintaining access to key health care facilities. The lessons learned from the incident are presented and further improvements to the existing model are proposed.

Data Value in Patient Tracking Systems at Racing Events

PURPOSE With the growing popularity of long-distance running races, an emerging area of interest for race organizers is the ability to electronically track and understand participant status throughout events to optimize runner and spectator experience and to identify and respond to the dynamic needs of both communities. This study examines the potential value of developing real-time patient tracking systems (PTS) at marathons based on the Chicago Medical Patient Tracking System (CMPTS). METHODS Data collected from the CMPTS and timing mats along the course for two running races in 2012 and 2013 were analyzed for data completeness and data value. Subjects consisted of patients who were tracked electronically in the system. RESULTS A comparison of medical data collected by PTS and paper forms is provided. Once fully implemented, PTS have the potential to capture more accurate and more detailed information compared with paper forms. A significant amount of records obtained by paper forms lacks any time or diagnosis information. CONCLUSIONS A set of best practices for tracking applications and data collection at marathons is proposed to improve accuracy based on CMPTS implementations from 2012 to 2013. Developing and conforming to standards for data collection at marathons and other mass-gathering events could improve data sets created from PTS, which can be used to improve operational decisions at such events and can provide the foundation for prediction models for enhancing planning and preparedness.

Applicability of consumer activity monitor data in marathon events: an exploratory study

Abstract Emerging opportunities to measure individual and population-level health data with activity monitors during recreational running activities may set the stage for new research possibilities in mass participation running events and marathon medicine. This study explores the applicability of consumer activity monitor data in a preliminary study for future marathon health research with a cohort of 12 (n = 12) participants completing a 3.379 km walking or running course. This study explored the feasibility of collecting pace and distance data from Fitbit brand consumer activity monitors, from access to user data to reporting of data characteristics and data analysis. We show that a large percentage of participant data can be successfully retrieved from Fitbit consumer activity monitor devices for analysis in marathon health research, and that identifying variations in pace across participants is a practical possibility. We note a mean absolute percentage error of 13% over the true distance of 3.379 km, a higher error than that reported by other studies. We also observe a Pearson correlation coefficient between participant variation in pace and absolute distance error of 0.61. This study provides preliminary evidence to support the applicability of consumer activity monitor data in marathon health research.

Politics and Disaster Response: Recent Experience in Asia

Vulnerabilities are often more severe and chronic in developing nations. Individual and structural vulnerabilities, such as fragile economies and unstable governing bodies, exacerbate the human toll of natural disasters and continue to impede the progress of development. Women, children, and other minority groups are not only more likely to be harmed by natural disasters but they also face struggles to rebuild their lives because of their preexisting and ongoing vulnerabilities.