Michel Debacker

Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters

Background: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. Methods: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. Results: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. Conclusion: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.

A refugee camp in the centre of Europe: clinical characteristics of asylum seekers arriving in Brussels

Background In the summer of 2015, the exodus of Syrian war refugees and saturation of refugee camps in neighbouring countries led to the influx of asylum-seekers in European countries, including Belgium. This study aims to describe the demographic and clinical characteristics of asylum seekers who arrived in a huddled refugee camp, in the centre of a well-developed country with all medical facilities. Methods Using a descriptive cross-sectional study design, physicians of Médecins du Monde prospectively registered age, gender, origin, medical symptoms and diagnoses of all patients presenting to an erected field hospital in Brussels in September 2015. Diagnoses were post hoc categorised according to the International Classification of Diseases. Results Of 4037 patients examined in the field hospital, 3907 were included and analysed for this study. Over 11% of patients suffered from injuries, but these were outnumbered by the proportion of patients with respiratory (36%), dental (9%), skin (9%) and digestive (8%) diagnoses. More than 49% had features of infections at the time of the consultation. Conclusions Asylum seekers arriving in a refugee camp in Brussels after a long and hazardous journey suffer mostly from respiratory, dental, skin and digestive diseases. Still, one in seven suffers from injury. These findings, consistent with other reports, should be anticipated when composing emergency medical teams and interagency emergency health or similar kits to be used in a field hospital, even in a Western European country. Trial registration number ISRCTN13523620, Results.

Education and research in disaster medicine and management: inextricably bound up with each other

Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Research Group on Disaster Medicine, Vrije Universiteit Brussel and Executive Committee, European Master in Disaster Medicine Course, Brussels, Belgium Correspondence to Ives Hubloue, Department of Emergency Medicine, Universitair Ziekenhuis Brussel, and Research Group on Disaster Medicine, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium Tel: + 32 2 477 51 53; fax: + 32 2 477 51 20; e-mail: ives.hubloue@uzbrussel.be

Improving the science and evidence for the medical management of disasters: Utstein style.

Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden and Research Group on Emergency and Disaster Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Belgium Correspondence to Maaret, Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden Tel: + 46 8 616 5238/ + 46 70 891 5086; fax: + 46 8 616 2933; e-mail: maaret.castren@ki.se, maaret.castren@sodersjukhuset.se

Children in the Syrian Civil War: the Familial, Educational, and Public Health Impact of Ongoing Violence

OBJECTIVE The Syrian civil war since 2011 has led to one of the most complex humanitarian emergencies in history. The objective of this study was to document the impact of the conflict on the familial, educational, and public health state of Syrian children. METHODS A cross-sectional observational study was conducted in May 2015. Health care workers visited families with a prospectively designed data sheet in 4 Northern Syrian governorates. RESULTS The 1001 children included in this study originated from Aleppo (41%), Idleb (36%), Hamah (15%), and Lattakia (8%). The childrens median age was 6 years (range, 0-15 years; interquartile range, 3-11 years), and 61% were boys. Almost 20% of the children were internally displaced, and 5% had deceased or missing parents. Children lacked access to safe drinking water (15%), appropriate sanitation (23%), healthy nutrition (16%), and pediatric health care providers (64%). Vaccination was inadequate in 72%. More than half of school-aged children had no access to education. Children in Idleb and Lattakia were at greater risk of having unmet public health needs. Younger children were at greater risk of having an incomplete vaccination state. CONCLUSIONS After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers. (Disaster Med Public Health Preparedness. 2016;10:874-882).

Disaster Preparedness and Response Improvement: Comparison of the 2010 Haiti Earthquake-Related Diagnoses with Baseline Medical Data

Objectives Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits. Methods Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years. Results Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, particularly respiratory (23%) and digestive (14%). More than 53% developed infections within 3 weeks after the event. Médecins Sans Frontières registered 6407 patients in 2009; 6033 in 2011; and 7300 in 2012. A comparison indicates that postearthquake patients suffered significantly less from violence, but more from wounds, respiratory, digestive and ophthalmological diseases. Conclusion This is the first comparison of postearthquake diagnoses with baseline data. Within 2 weeks after the acute phase of an earthquake, respiratory, digestive and ophthalmological problems will emerge to the prejudice of trauma. This fact should be anticipated when composing Foreign Medical Teams and Interagency Emergency Health Kits to be sent to the disaster site.

SIMEDIS: a Discrete-Event Simulation Model for Testing Responses to Mass Casualty Incidents

It is recognized that the study of the disaster medical response (DMR) is a relatively new field. To date, there is no evidence-based literature that clearly defines the best medical response principles, concepts, structures and processes in a disaster setting. Much of what is known about the DMR results from descriptive studies and expert opinion. No experimental studies regarding the effects of DMR interventions on the health outcomes of disaster survivors have been carried out. Traditional analytic methods cannot fully capture the flow of disaster victims through a complex disaster medical response system (DMRS). Computer modelling and simulation enable to study and test operational assumptions in a virtual but controlled experimental environment. The SIMEDIS (Simulation for the assessment and optimization of medical disaster management) simulation model consists of 3 interacting components: the victim creation model, the victim monitoring model where the health state of each victim is monitored and adapted to the evolving clinical conditions of the victims, and the medical response model, where the victims interact with the environment and the resources at the disposal of the healthcare responders. Since the main aim of the DMR is to minimize as much as possible the mortality and morbidity of the survivors, we designed a victim-centred model in which the casualties pass through the different components and processes of a DMRS. The specificity of the SIMEDIS simulation model is the fact that the victim entities evolve in parallel through both the victim monitoring model and the medical response model. The interaction between both models is ensured through a time or medical intervention trigger. At each service point, a triage is performed together with a decision on the disposition of the victims regarding treatment and/or evacuation based on a priority code assigned to the victim and on the availability of resources at the service point. The aim of the case study is to implement the SIMEDIS model to the DMRS of an international airport and to test the medical response plan to an airplane crash simulation at the airport. In order to identify good response options, the model then was used to study the effect of a number of interventional factors on the performance of the DMRS. Our study reflects the potential of SIMEDIS to model complex systems, to test different aspects of DMR, and to be used as a tool in experimental research that might make a substantial contribution to provide the evidence base for the effectiveness and efficiency of disaster medical management.

Monitoring the mental well-being of caregivers during the Haiti-earthquake.

Introduction During disaster relief, personnel’s safety is very important. Mental well being is a part of this safety issue. There is however a lack of objective mental well being monitoring tools, usable on scene, during disaster relief. This study covers the use of validated tools towards detection of psychological distress and monitoring of mental well being of disaster relief workers, during the Belgian First Aid and Support Team deployment after the Haiti earthquake in 2010. Methodology The study was conducted using a demographic questionnaire combined with validated measuring instruments: Belbin Team Role, Compassion Fatigue and Satisfaction Self-Test for Helpers, DMAT PsySTART, K6+ Self Report. A baseline measurement was performed before departure on mission, and measurements were repeated at day 1 and day 7 of the mission, at the end of mission, and 7 days, 30 days and 90 days post mission. Results 23 out of the 27 team members were included in the study. Using the Compassion Fatigue and Satisfaction Self-Test for Helpers as a monitoring tool, a stable condition was monitored in 7 participants, a dip in 5 participants, an arousal in 10 participants and a double pattern in 1 participant. Conclusions The study proved the ability to monitor mental well being and detect psychological distress, by self administered validated tools, during a real disaster relief mission. However for practical reasons some tools should be adapted to the specific use in the field. This study opens a whole new research area within the mental well being and monitoring field. Citation: Van der Auwera M, Debacker M, Hubloue I. Monitoring the mental well-being of caregivers during the Haiti-earthquake.. PLoS Currents Disasters. 2012 Jul 18

Generating and managing realistic victims for medical disaster simulations

We propose a methodology to generate realistic victim profiles for medical disaster simulations based on victims from the VictimBase library. We apply these profiles in a medical disaster model where victim entities evolve in parallel through a medical response model and a victim pathway model. These models interact in correspondence with the time triggers and intervention triggers from VictimBase. We show how such a model can be used to assess the impact of asset availability and implemented victim prioritisation rule on the clinical condition of the victims.

Diagnoses, infections and injuries in Northern Syrian children during the civil war: A cross-sectional study

Background The civil war in Syria including the deliberate targeting of healthcare services resulted in a complex humanitarian emergency, seriously affecting childrens health. The objectives of this study are to document diagnoses and disease categories in Northern Syrian children after four years of conflict, and to document infectious diseases and injuries in this vulnerable population. Methods In a prospective cross-sectional observational sample study conducted in May 2015, healthcare workers registered demographics, comorbidities, and diagnoses (categorised according to the International Classification of Diseases version 10) in children visited at home and in internally displaced persons camps in four Syrian governorates. Results Of 1080 filled-out records, 1002 were included. Children originated from Aleppo (41%), Idleb (36%), Hamah (15%) and Lattakia (8%). Median age was 6 years (0–15; IQR 3–11), 61% were boys, 40% were younger than 5 years old. Children suffered from respiratory (29%), neurological (19%), digestive (17%), eye (5%) and skin (5%) diseases. Clinical malnutrition was seen in 4%, accidental injury in 3%, intentional injury in 1%, and mental disorders in 2%. Overall, 64% had features of infectious diseases (OR 0.635; CI 0.605–0.665). Most common comorbidities were chronic respiratory diseases (14, malnutrition (5%), acute flaccid paralysis (5%), and epilepsy (4%). Logistic regression analysis indicated that the risk for children to have communicable diseases was higher in Aleppo than in Idleb (OR 1.7; CI 1.2–2.3), Hamah (OR 4.9; CI 3.3–7.5), or Lattakia (OR 5.5; CI 3.3–9.3). Children in Aleppo and Lattakia were more at risk to be injured than in Idleb (OR 5.6; CI 2.1–14.3), or in Hamah (OR 5.9; CI 1.4–25.6), but more often from intentional violence in Lattakia. Mental problems were more prominent in Hamah. Conclusions Four years far in the conflict, 64% of the studied children in four Northern Syrian governorates suffer from infections, mostly from respiratory, neurological and digestive origin, while 4% was injured or victim of intentional aggression. Substandard living conditions and the lack of paediatric healthcare put Syrian children at risk for serious infections, epidemics and morbidity, and ask for urgent international humanitarian relief efforts.