Conference Agenda

Development of guidelines for psychosocial support for uniformed services, volunteers and hospital staff in case of a Chemical, Biological, Radiological or Nuclear (CBRN) incident

Magda W. ROOZE

Impact/Arq Psychotrauma Expert Group, Netherlands, Kingdom of the

The goal of this study is to develop a guideline for uniformed services, volunteers and hospital staff in case of a CBRN incident, as a standard for quality psychosocial support, scientific, expert and consensus based.

The guidelines will be based on the ‘European guidelines for psychosocial early interventions after terrorism, disasters and other shocking events’ (Impact, 2007). And the ‘Guidelines psychosocial support for uniformed services’ (Impact, 2010), both developed in the context of a European project EUTOPA.

People’s own resilience is the starting point for these guidelines. The majority of people are able to cope with shocking events without the need of professional help, moreover uniformed services, (trained) volunteers and hospital are trained and educated to deal with complex emergency situations. From scientific literature it becomes also clear that they have a high risk profession which asks for supportive measures.

Methods: Development of the guidelines in the specific context of CBRN on the basis of a complementary literature review (PubMed, PsychINFO, Embase 2001-2011), site visits to 7 different European countries to interview experts and workshops and conferences to reach consensus with the relevant stakeholders.

Results: first guidelines on psychosocial support for uniformed services, volunteers and hospital staff in case of CBRN as a solid foundation for implementation in the different countries.

Discussion: The discussion will be on the process to create attention and backing for the guidelines amongst key stakeholders and how to take the differences into account among the different countries.

The dual use of field hospital in peace time and in war time. The Italian experience of Alpini field hospital during disasters.

Alessandra ROSSODIVITA¹, Roberto FACCINCANI¹, Lucio Pantaleo LOSAPIO², Michele CARLUCCI¹

¹San Raffaele Hospital Scientific Foundation, Milan, Italy; ²Gruppo Intervento Medico-Chirurgico , Ospedale da CampoA.N.A. Italian Association of Alpini, Onlus Foundation; Bergamo, Italy

In a “ disaster “ local health services can be overwhelmed, and damage to clinics and hospitals can render them usefulness. Damage to the health care infrastructure will further compromise the delivery of health services. A field hospital is a large mobile medical unit that temporarily takes care of casualties on-site before they can be safely transported to more permanent hospital facilities. Lessons from past complex disasters such as civil conflicts, wars, humanitarian emergencies showed that field hospitals – as temporary hospital civilian or military plays a significant but sometimes controversial role during disasters. The authors describe an Italian model of mobile field hospital of ANA - Italian association of Alpini, who had worked and works in a case of a disaster or an humanitarian crisis. This field hospital supports the activities of civil protection in national and international context, implementing local emergency services and hospital bed surge capacity in the treatment of mass-casualties for a specific period of time. The hospital on field of Alpines, born in 1976, and actually operates in Italy, jointly with the aid of two major Italian hospitals, the San Raffaele Hospital Scientific Foundation of Milan and “Ospedali Riuniti di Bergamo (Italy) “, and civil protection in different national and international context during disaster emergencies and humanitarian crises. The authors would like to suggest the dual use of a field hospital in supporting countries and population needs during disaster time and peace time. During peace time the use of a field hospital should be suggested as support in mass gatherings events; in public health prevention programs for population, in teaching role activities such as emergency and in disaster preparedness training programs. During war time or disaster time how to use field hospital as support to population affected .

Multi-Agency Surge Tactical Facility (MAST-F) - applicable lessons from a mobile hospital team

Michael Kellyn THRALLS^1,2,3

¹MESH, United States of America; ²Indianapolis EMS, United States of America; ³Developing World Missions, INC., United States of America

MESH is a non-profit healthcare coalition operating in Indianapolis, Indiana, USA. In addition to providing daily healthcare intelligence, policy analysis and training it also provides assistance in the recovery phase. One of the recovery assets is the MAST-F or the Multi-Agency Surge Tactical Facility. The MAST-F is a Western Shelter product used as a 25-bed mobile hospital system, a cooling station, a command post, or a training facility. In this session learn about the intelligence pushed out to the team prior to deployment, training of the team, how MESH uses volunteers, storage and transportation of the system and more. There are many concepts which you could borrow and apply to your unique system.

Once the decision is made to deploy the MAST-F the intelligence team provides topographic maps of the deployment area, risk analysis, resource proximity and weather forecast. During activation up-to-date data is pushed to the team providing changes in weather and other critical intelligence.

The team made up of volunteers from all walks of life (firefighters, emts and paramedics, nurses, students, real estate professionals, day laborers, etc.) Learn how the team is trained and remains engaged throughout the year.

The MAST-F provides nearly 1500 square feet (457 meters) of covered floor space, fluorescent lighting, temperature controlled heating and air conditioning, 25-70 Kw diesel generators, desk space, benches, hospital beds, cots, waters systems and many other items. The storage containers for these things weight from 100-400 pounds (45-181 Kg). How is this stored? How is it deployed?

Medical treatment options and patient preference: the case of the limb-trauma victims of the earthquake in Haiti on January 12, 2010

Nezha KHALLAF¹, Lou SHANG¹, Joel MULLER¹, Stéphane CALLENS¹, Nikki BLACKWELL², Marie Christine DELAUCHE², Thierry ALLAFORT-DUVERGER², Hervé LE PERFF²

¹LEM UMR 8179, Lille, France; ²ALIMA (Alliance for International Medical Action), Senegal, Republic of

The 2010 earthquake in Haiti raises questions about the optimal management of severe limb trauma patients after natural disasters. SUTRA² (Suivie et traitement du traumatisme des membres en cas d’afflux massif des blessés dans les contextes difficiles) is a longitudinal interdisciplinary study with the objective to determine the most appropriate management of severe limb trauma victims and improve the quality of care provided to them. The SUTRA² data base has been established for two years, commencing the date of the earthquake (12th of January 2010). It consists of the medical files of 306 limb trauma patients, which includes one control cohort, one cohort of amputees and a cohort of patients who received reconstructive surgery. The data is derived from a set of socio-economic, psychological, medical and functional domains. It uses validated methods (SF-36, quota evaluation). The chosen reference scenario is reconstructive surgical care. The method is participative, conforming to ethical principals of clear informed consent. The quota evaluation shows that victims perceive benefit from a reconstructive surgical approach (on average consenting to pay more than 15% of their income for this care). The percentages of those victims consenting to pay are very scattered with some high values, despite a situation of general financial ruin. The results obtained can be explained by a situation of poor medical infrastructure in Haiti and underlines the problems of equity and quality in the health-care system.

One-year follow up of care received by a cohort of patients treated with limb amputation following the earthquake in Haiti

Marie Christine DELAUCHE¹, Hervé LE PERFF¹, Nikki BLACKWELL¹, Thierry ALLAFORT-DUVERGER¹, Stéphane CALLENS², Joel MULLER², Nezha KHALLAF², Lou SHANG²

¹ALIMA (Alliance for International Medical Action), Senegal, Republic of; ²LEM UMR 8179, Lille, France

Severe limb trauma is common in earthquake survivors. Long term outcome assessment of patients rarely occurs. The aim is an assessment at 12-months of a cohort of people treated with limb amputation for injuries received in the Haiti earthquake.

Patients injured during the earthquake with post-traumatic limb amputation, were recruited by-phone from an existing patient database. Clinical and functional assessments were conducted by a doctor specialised in rehabilitation and a physiotherapist between January and March 2011. Data analysis consisted of cross and frequency tables, Pearson Chi2 and Student t-test for independence and means comparisons. A 2-year assessment will also occur.

Of 188 patients assessed: Mean age 28yr (2-66yr), 55 % (105) female, 21 % (40) upper limb amputees (ULA), 79 %(148) lower limb amputees (LLA). Amputation was the primary surgical treatment in 159 (85%) and was performed more than once in 35% (57). Stump revision rate was 24%(46/188).

92%(136) and 12%(5) of LLA and ULA patients received a prosthesis within a mean of 136 days (16-420 days) (CI 95% [123; 149]). 66%(88) of patients were satisfied with the prosthesis which was worn a mean of 9 hours per day (0-18 hours) (CI95%[8.5; 9.96]).

169/188(91%) patients received physiotherapy. 57%(106) had persistent pain, usually moderate (4.3, as a mean according to VAS), mainly at the stump (90; 90%); 79%(146) had phantom limb perception, not systematically associated with pain (58;40%), rarely (15/58,27%). 5%(9) of patients had skin erosions of the stump, 30%(55) local tenderness. 95%(142), 23%(35) and 68%(99) of the LLA were able to climb stairs, run and dance. 49%(89) and 23%(41) of the patients were satisfied or very satisfied with functional results.

Amputation is not a simple undertaking in the aftermath of disasters. Hospitalisation may be prolonged, second surgical interventions and complications are not uncommon and prolonged rehabilitation is required.