[Results of provisional use of a system for voluntary anonymous reporting of incidents that threaten patient safety in the emergency medical services of Asturias].

PubMed

Galván Núñez, Pablo; Santander Barrios, María Dolores; Villa Álvarez, María Cristina; Castro Delgado, Rafael; Alonso Lorenzo, Julio C; Arcos González, Pedro

2016-06-01

To describe the reported incidents and adverse events in the emergency medical services of Asturias, Spain, and assess their consequences, delays caused, and preventability. Prospective, observational study of incidents reported by the staff of the emergency medical services of Asturias after implementation of a system devised by the researchers. Incident reports were received for 0.48% (95% CI, 0.41%-0.54%) of the emergencies attended. Patient safety was compromised in 74.7% of the reported incidents. Problems arising in the emergency response coordination center (ERCC) accounted for 37.6% of the incidents, transport problems for 13.4%, vehicular problems for 10.8%, and communication problems for 8.8%. Seventy percent of the reported incidents caused delays in care; 55% of the reported incidents that put patients at risk (according to severity assessment code ratings) corresponded to problems related to human or material resources. A total of 88.1% of the incidents reported were considered avoidable. Some type of intervention was required to attenuate the effects of 46.2% of the adverse events reported. The measures that staff members most often proposed to prevent adverse events were to increase human and material resources (28.3%), establish protocols (14.5%), and comply with quality of care recommendations (9.7%). It is important to promote a culture of safety and incident reporting among health care staff in Asturias given the number of serious adverse events. Reporting is necessary for understanding the errors made and taking steps to prevent them. The ERCC is the point in the system where incidents are particularly likely to appear and be noticed and reported.

Recommended emergency preparedness guidelines for elderly and disabled rail-transit passengers. Final report, November 1987-March 1989

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hathaway, W.T.; Markos, S.H.; Balog, J.N.

1989-08-01

Rail transit has become an important source of transportation for many elderly and disabled persons. The principal reasons for the increased use are improved accessibility, low cost, and expanded areas of service. For the purposes of the report, 'elderly' is defined as any member of the population who is 60 years of age or older, and 'disabled' is defined as any person who has some type of disability. The Urban Mass Transportation Administration (UMTA) has recognized the need to consider the unique characteristics of elderly and disabled passengers in rail-transit emergency response planning. The needs of these passengers can bemore » addressed through carefully planned emergency response procedures, proper training of transit and emergency-response personnel, and effective use of equipment. The recommendations contained herein are therefore intended to assist rail-transit and emergency response organization personnel in evaluating their emergency response plans in terms of the needs of elderly and disabled passengers and, if necessary, to modify or supplement those plans accordingly. The report is intended to supplement the UMTA publication Recommended Emergency Preparedness Guidelines for Rail Transit Systems. That report contains general guidelines designed to assist rail-transit systems in assessing, developing, documenting, and improving their capabilities for responding to emergencies and in coordinating those efforts with emergency response organizations.« less

Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report.

PubMed

Harle, Christopher A; Listhaus, Alyson; Covarrubias, Constanza M; Schmidt, Siegfried Of; Mackey, Sean; Carek, Peter J; Fillingim, Roger B; Hurley, Robert W

2016-01-01

In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A review of in-flight emergencies in the ASRS data base

NASA Technical Reports Server (NTRS)

Porter, R. F.

1981-01-01

A series of 154 in-flight emergencies as reported to the Aviation Safety Reporting System are described. The various types of emergencies are examined and an attempt is made to determine the human errors and other factors associated with each incident, as well as the measures taken to resolve the emergency. It is concluded that nearly one half of those emergencies reported were related to failure or malfunction of aircraft subsystems. Of all the emergencies, nearly one quarter were associated with power plant failure. Other frequently encountered emergency types are associated with operation in instrument meteorological conditions without appropriate clearance or qualification, and with low fuel state situations. Human error is prominently featured in many of the incidents, appearing in the actions of pilots and air traffic controllers.

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

10 CFR 205.351 - Reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205.351 Reporting requirements. For the purpose of this section, a report or a part of a report may be...

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Ma, Matthew Huei-Ming; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Ong, Marcus Eng Hock; Travers, Andrew H; Nolan, Jerry P

2015-11-01

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. Copyright © 2014 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier Ireland Ltd.. All rights reserved.

Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

PubMed

Perkins, Gavin D; Jacobs, Ian G; Nadkarni, Vinay M; Berg, Robert A; Bhanji, Farhan; Biarent, Dominique; Bossaert, Leo L; Brett, Stephen J; Chamberlain, Douglas; de Caen, Allan R; Deakin, Charles D; Finn, Judith C; Gräsner, Jan-Thorsten; Hazinski, Mary Fran; Iwami, Taku; Koster, Rudolph W; Lim, Swee Han; Huei-Ming Ma, Matthew; McNally, Bryan F; Morley, Peter T; Morrison, Laurie J; Monsieurs, Koenraad G; Montgomery, William; Nichol, Graham; Okada, Kazuo; Eng Hock Ong, Marcus; Travers, Andrew H; Nolan, Jerry P

2015-09-29

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. © 2014 by the American Heart Association, Inc., and European Resuscitation Council.

Report: EPA Plans for Managing Counter Terrorism/ Emergency Response Equipment and Protecting Critical Assets Not Fully Implemented

EPA Pesticide Factsheets

Report #09-P-0087, January 27, 2009. EPA has progressed in implementing the counter terrorism/emergency response (CT/ER) initiatives, but is behind schedule in implementing the Radiation Ambient Monitoring (RadNet) System.

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... stations or air traffic control systems, were or are interrupted. To the extent known or reasonably...

Space shuttle EVA/IVA support equipment requirements study. Volume 1: Final summary report

NASA Technical Reports Server (NTRS)

1973-01-01

A study was conducted to determine the support equipment requirements for space shuttle intravehicular and extravehicular activities. The subjects investigated are; (1) EVA/IVA task identification and analysis,. (2) primary life support system, (3) emergency life support system, (4) pressure suit assembly, (5) restraints, (6) work site provision, (7) emergency internal vehicular emergencies, and (8) vehicular interfaces.

Quarterly Performance/Technical Report of the National Marrow Donor Program

DTIC Science & Technology

2011-01-28

emergency notification system, the NMDP public announcement system, Government Emergency Telecommunications Service calling cards (GETS cards ), and the...Contract Audit Agency RCC Renal Cell Carcinoma DIY Do it yourself RCI BMT Resource for Clinical Investigations in Blood and Marrow Transplantation

Report: EPA Has Not Fully Implemented a National Emergency Response Equipment Tracking System

EPA Pesticide Factsheets

Report #11-P-0616, September 13, 2011. Although EPA spent $2.8 million as of October 2010 to develop and implement an EMP emergency equipment tracking module, EPA has not fully implemented the module, and the module suffers from operational issues.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

PubMed

Elliot, A J; Hughes, H E; Hughes, T C; Locker, T E; Brown, R; Sarran, C; Clewlow, Y; Murray, V; Bone, A; Catchpole, M; McCloskey, B; Smith, G E

2014-08-01

This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

ENVIRONMENTAL TECHNOLOGY VERIFICATION: JOINT (NSF-EPA) VERIFICATION STATEMENT AND REPORT FOR TREATMENT OF WASTEWATER GENERATED DURING DECONTAMINATION ACTIVITIES - ULTRASTRIP SYSTEMS, INC., MOBILE EMERGENCY FILTRATION SYSTEM (MEFS) - 04/14/WQPC-HS

EPA Science Inventory

Performance verification testing of the UltraStrip Systems, Inc., Mobile Emergency Filtration System (MEFS) was conducted under EPA's Environmental Technology Verification (ETV) Program at the EPA Test and Evaluation (T&E) Facility in Cincinnati, Ohio, during November, 2003, thr...

Central Federal Lands Division data collection packages : final report.

DOT National Transportation Integrated Search

2011-03-31

The purpose of this research study was to develop a proof of concept, prototype electronic data-collection and reporting system to facilitate the completion of Emergency Relief for Federally Owned (ERFO) Roads Damage Site Reports (DSR). The system wo...

10 CFR 205.350 - General purpose.

Code of Federal Regulations, 2011 CFR

2011-01-01

... developing legislative recommendations and reports to the Congress. (Approved by the Office of Management and... OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205...

10 CFR 205.350 - General purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... developing legislative recommendations and reports to the Congress. (Approved by the Office of Management and... OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

10 CFR 205.352 - Information to be reported.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System Emergencies § 205... involved; and whether any known critical services such as hospitals, military installations, pumping...

Cellular-based preemption system

NASA Technical Reports Server (NTRS)

Bachelder, Aaron D. (Inventor)

2011-01-01

A cellular-based preemption system that uses existing cellular infrastructure to transmit preemption related data to allow safe passage of emergency vehicles through one or more intersections. A cellular unit in an emergency vehicle is used to generate position reports that are transmitted to the one or more intersections during an emergency response. Based on this position data, the one or more intersections calculate an estimated time of arrival (ETA) of the emergency vehicle, and transmit preemption commands to traffic signals at the intersections based on the calculated ETA. Additional techniques may be used for refining the position reports, ETA calculations, and the like. Such techniques include, without limitation, statistical preemption, map-matching, dead-reckoning, augmented navigation, and/or preemption optimization techniques, all of which are described in further detail in the above-referenced patent applications.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

NASA Technical Reports Server (NTRS)

Rodenberg, H.; Myers, K. J.

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine.

PubMed

Rodenberg, H; Myers, K J

1995-01-01

The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

International Radiation Monitoring and Information System (IRMIS)

NASA Astrophysics Data System (ADS)

Mukhopadhyay, Sanjoy; Baciu, Florian; Stowisek, Jan; Saluja, Gurdeep; Kenny, Patrick; Albinet, Franck

2017-09-01

This article describes the International Radiation Monitoring Information System (IRMIS) which was developed by the International Atomic Energy Agency (IAEA) with the goal to provide Competent Authorities, the IAEA and other international organizations with a client server based web application to share and visualize large quantities of radiation monitoring data. The data maps the areas of potential impact that can assist countries to take appropriate protective actions in an emergency. Ever since the Chernobyl nuclear power plant accident in April of 19861 European Community (EC) has worked towards collecting routine environmental radiological monitoring data from national networked monitoring systems. European Radiological Data Exchange Platform (EURDEP) was created in 19952 to that end - to provide radiation monitoring data from most European countries reported in nearly real-time. During the response operations for the Fukushima Dai-ichi nuclear power plant accident (March 2011) the IAEA Incident and Emergency Centre (IEC) managed, harmonized and shared the large amount of data that was being generated from different organizations. This task underscored the need for a system which allows sharing large volumes of radiation monitoring data in an emergency. In 2014 EURDEP started the submission of the European radiological data to the International Radiation Monitoring Information System (IRMIS) as a European Regional HUB for IRMIS. IRMIS supports the implementation of the Convention on Early Notification of a Nuclear Accident by providing a web application for the reporting, sharing, visualizing and analysing of large quantities of environmental radiation monitoring data during nuclear or radiological emergencies. IRMIS is not an early warning system that automatically reports when there are significant deviations in radiation levels or when values are detected above certain levels. However, the configuration of the visualization features offered by IRMIS may help Member States to determine where elevated gamma dose rate measurements during a radiological or nuclear emergency indicate that actions to protect the public are necessary. The data can be used to assist emergency responders determine where and when to take necessary actions to protect the public. This new web online tool supports the IAEA's Unified System for Information Exchange in Incidents and Emergencies (USIE)3, an online tool where competent authorities can access information about all emergency situations, ranging from a lost radioactive source to a full-scale nuclear emergency.

Radio System for Locating Emergency Workers

NASA Technical Reports Server (NTRS)

Larson, William; Medelius, Pedro; Starr, Stan; Bedette, Guy; Taylor, John; Moerk, Steve

2003-01-01

A system based on low-power radio transponders and associated analog and digital electronic circuitry has been developed for locating firefighters and other emergency workers deployed in a building or other structure. The system has obvious potential for saving lives and reducing the risk of injuries. The system includes (1) a central station equipped with a computer and a transceiver; (2) active radio-frequency (RF) identification tags, each placed in a different room or region of the structure; and (3) transponder units worn by the emergency workers. The RF identification tags can be installed in a new building as built-in components of standard fire-detection devices or ground-fault electrical outlets or can be attached to such devices in a previously constructed building, without need for rewiring the building. Each RF identification tag contains information that uniquely identifies it. When each tag is installed, information on its location and identity are reported to, and stored at, the central station. In an emergency, if a building has not been prewired with RF identification tags, leading emergency workers could drop sequentially numbered portable tags in the rooms of the building, reporting the tag numbers and locations by radio to the central station as they proceed.

Information technology principles for management, reporting, and research.

PubMed

Gillam, Michael; Rothenhaus, Todd; Smith, Vernon; Kanhouwa, Meera

2004-11-01

Information technology holds the promise to enhance the ability of individuals and organizations to manage emergency departments, improve data sharing and reporting, and facilitate research. The Society for Academic Emergency Medicine (SAEM) Consensus Committee has identified nine principles to outline a path of optimal features and designs for current and future information technology systems. The principles roughly summarized include the following: utilize open database standards with clear data dictionaries, provide administrative access to necessary data, appoint and recognize individuals with emergency department informatics expertise, allow automated alert and proper identification for enrollment of cases into research, provide visual and statistical tools and training to analyze data, embed automated configurable alarm functionality for clinical and nonclinical systems, allow multiexport standard and format configurable reporting, strategically acquire mission-critical equipment that is networked and capable of automated feedback regarding functional status and location, and dedicate resources toward informatics research and development. The SAEM Consensus Committee concludes that the diligent application of these principles will enhance emergency department management, reporting, and research and ultimately improve the quality of delivered health care.

The public health dashboard: a surveillance model for bioterrorism preparedness.

PubMed

Foldy, Seth L; Biedrzycki, Paul A; Baker, Bevan K; Swain, Geoffrey R; Howe, Donna S; Gieryn, Douglas; Barthell, Edward N; Pemble, Kim R

2004-01-01

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.

Development of the Inventory Management and Tracking System (IMATS) to Track the Availability of Public Health Department Medical Countermeasures During Public Health Emergencies

PubMed Central

Sahar, Liora; Faler, Guy; Hristov, Emil; Hughes, Susan; Lee, Leslie; Westnedge, Caroline; Erickson, Benjamin; Nichols, Barbara

2015-01-01

Objective To bridge gaps identified during the 2009 H1N1 influenza pandemic by developing a system that provides public health departments improved capability to manage and track medical countermeasures at the state and local levels and to report their inventory levels to the Centers for Disease Control and Prevention (CDC). Materials and Methods The CDC Countermeasure Tracking Systems (CTS) program designed and implemented the Inventory Management and Tracking System (IMATS) to manage, track, and report medical countermeasure inventories at the state and local levels. IMATS was designed by CDC in collaboration with state and local public health departments to ensure a “user-centered design approach.” A survey was completed to assess functionality and user satisfaction. Results IMATS was deployed in September 2011 and is provided at no cost to public health departments. Many state and local public health departments nationwide have adopted IMATS and use it to track countermeasure inventories during public health emergencies and daily operations. Discussion A successful response to public health emergencies requires efficient, accurate reporting of countermeasure inventory levels. IMATS is designed to support both emergency operations and everyday activities. Future improvements to the system include integrating barcoding technology and streamlining user access. To maintain system readiness, we continue to collect user feedback, improve technology, and enhance its functionality. Conclusion IMATS satisfies the need for a system for monitoring and reporting health departments’ countermeasure quantities so that decision makers are better informed. The “user-centered design approach” was successful, as evident by the many public health departments that adopted IMATS. PMID:26392843

Critical incident reporting in emergency medicine: results of the prehospital reports.

PubMed

Hohenstein, Christian; Hempel, Dorothea; Schultheis, Kerstin; Lotter, Oliver; Fleischmann, Thomas

2014-05-01

Medical errors frequently contribute to morbidity and mortality. Prehospital emergency medicine is prone to incidents that can lead to immediate deadly consequences. Critical incident reporting can identify typical problems and be the basis for structured risk management in order to reduce and mitigate these incidents. We set up a free access internet website for German-speaking countries, with an anonymous reporting system for emergency medical services personnel. After a 7-year study period, an expert team analysed and classified the incidents into staff related, equipment related, organisation and tactics, or other. 845 reports were entered in the study period. Physicians reported 44% of incidents, paramedics 42%. Most patients were in a life-threatening or potentially life-threatening situation (82%), and only 53% of all incidents had no influence on the outcome of the patient. Staff-related problems were responsible for 56% of the incidents, when it came to harm, 78% of these incidents were staff related. Incident reporting in prehospital emergency medicine can identify system weaknesses. Most of the incidents were reported during care of patients in life-threatening conditions with a high impact on patient outcome. Staff-related problems contributed to the most frequent and most severe incidents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Wireless local area networking for linking a PC reporting system and PACS: clinical feasibility in emergency reporting.

PubMed

Yoshihiro, Akiko; Nakata, Norio; Harada, Junta; Tada, Shimpei

2002-01-01

Although local area networks (LANs) are commonplace in hospital-based radiology departments today, wireless LANs are still relatively unknown and untried. A linked wireless reporting system was developed to improve work throughput and efficiency. It allows radiologists, physicians, and technologists to review current radiology reports and images and instantly compare them with reports and images from previous examinations. This reporting system also facilitates creation of teaching files quickly, easily, and accurately. It consists of a Digital Imaging and Communications in Medicine 3.0-based picture archiving and communication system (PACS), a diagnostic report server, and portable laptop computers. The PACS interfaces with magnetic resonance imagers, computed tomographic scanners, and computed radiography equipment. The same kind of functionality is achievable with a wireless LAN as with a wired LAN, with comparable bandwidth but with less cabling infrastructure required. This wireless system is presently incorporated into the operations of the emergency and radiology departments, with future plans calling for applications in operating rooms, outpatient departments, all hospital wards, and intensive care units. No major problems have been encountered with the system, which is in constant use and appears to be quite successful. Copyright RSNA, 2002

10 CFR 205.379 - Application for approval of the installation of permanent facilities for emergency use only.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency Interconnection of Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.379 Application for approval of the installation of...

Emergence of viral hemorrhagic fevers: is recent outbreak of Crimean Congo Hemorrhagic Fever in India an indication?

PubMed

Lahariya, C; Goel, M K; Kumar, A; Puri, M; Sodhi, A

2012-01-01

The emerging and re-emerging diseases are posing a great health risk for the last few years. One such category of diseases is viral haemorrhagic fevers (VHFs), which have emerged in the new territories, worldwide. Crimean Congo Hemorrhagic Fever (CCHF) cases, for the first time in India, were reported from Gujarat, in January 2011. The emergence of diseases not reported earlier, pose great economic and social challenge, burden health system, and create panic reaction. Nonetheless, with recent experience in control of epidemic diseases, and advances in basic scientific knowledge; the public health community is better prepared for these unexpected events. This review provides information to physicians on CCHF for managing outbreak, and identifies public health measures to prevent emergence and re-emergence of VHFs (including CCHF) in future. The authors suggest that though, there are a few challenging and unanswered questions, the public health preparedness still remains the key to control emerging and re-emerging diseases. The countries where virus activities have been reported need to be prepared accordingly.

Ultrasound credentialing in North American emergency department systems with ultrasound fellowships: a cross-sectional survey.

PubMed

Bellamkonda, Venkatesh R; Shokoohi, Hamid; Alsaawi, Abdulmohsen; Ding, Ru; Campbell, Ronna L; Liu, Yiju Teresa; Boniface, Keith S

2015-10-01

To describe the credentialing systems of North American emergency department systems (EDS) with emergency ultrasound (EUS) fellowship programmes. This is a prospective, cross-sectional, survey-based study of North American EUS fellowships using a 62-item, pilot-tested, web-based survey instrument assessing credentialing and training systems. The American College of Emergency Physicians (ACEP) distributed the surveys using SNAP survey (Snap Surveys Ltd, Portsmouth, New Hampshire, USA). Over 6 months, 75 eligible programmes were surveyed, 55 responded (73% response rate); 1 declined to participate leaving 54 participating programmes. Less than 20% of EDS credential nurses, physician assistants, nurse practitioners and students in EUS. Respondent EDS reported having an average of 4.2 ± 3.3 ultrasound faculty members (faculty identifying their career focus as EUS). The median number of annual point-of-care ultrasounds reported was 5000 (IQR 3000-8000). 30 EDS (56%) credential each examination individually and 48 EDS (89%) use ACEP credentialing criteria. 61% of fellowship leadership believe their credentialing system is either satisfactory or very satisfactory (Cronbach's coefficient α=0.84). The data show heterogeneity among North American EDS with EUS fellowship programmes with regard to credentialing systems despite published guidelines from the ACEP and Canadian Emergency Ultrasound Society. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Incident Management Systems and Building Emergency Management Capacity during the 2014-2016 Ebola Epidemic - Liberia, Sierra Leone, and Guinea.

PubMed

Brooks, Jennifer C; Pinto, Meredith; Gill, Adrienne; Hills, Katherine E; Murthy, Shivani; Podgornik, Michelle N; Hernandez, Luis F; Rose, Dale A; Angulo, Frederick J; Rzeszotarski, Peter

2016-07-08

Establishing a functional incident management system (IMS) is important in the management of public health emergencies. In response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC established the Emergency Management Development Team (EMDT) to coordinate technical assistance for developing emergency management capacity in Guinea, Liberia, and Sierra Leone. EMDT staff, deployed staff, and partners supported each country to develop response goals and objectives, identify gaps in response capabilities, and determine strategies for coordinating response activities. To monitor key programmatic milestones and assess changes in emergency management and response capacities over time, EMDT implemented three data collection methods in country: coordination calls, weekly written situation reports, and an emergency management dashboard tool. On the basis of the information collected, EMDT observed improvements in emergency management capacity over time in all three countries. The collaborations in each country yielded IMS structures that streamlined response and laid the foundation for long-term emergency management programs.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

Electromagnetic Pulse (EMP) survey of the Louisiana State Emergency Operating Center, Baton Rouge, Louisiana

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crutcher, R.I.; Buchanan, M.E.; Jones, R.W.

1989-08-01

The purpose of this report is to develop an engineering design package to protect the federal Emergency Management Agency (FEMA) National Radio System (FNARS) facilities from the effects of high-altitude electromagnetic pulses (HEMP). This report refers to the Louisiana State Emergency Operating Center (EOC) in Baton Rouge, Louisiana. This report addresses electromagnetic pulse (EMP) effects only, and disregards any condition in which radiation effects may be a factor. It has been established that, except for the source region of a surface burst, EMP effects of high-altitude bursts are more severe than comparable detonations in either air or surface regions. Anymore » system hardened to withstand the more extreme EMP environment will survive the less severe conditions. The threatening environment will therefore be limited to HEMP situations. 76 figs., 2 tabs.« less

Health Information Exchange: What do patients want?

PubMed

Medford-Davis, Laura N; Chang, Lawrence; Rhodes, Karin V

2017-12-01

To determine whether emergency department patients want to share their medical records across health systems through Health Information Exchange and if so, whether they prefer to sign consent or share their records automatically, 982 adult patients presenting to an emergency department participated in a questionnaire-based interview. The majority (N = 906; 92.3%) were willing to share their data in a Health Information Exchange. Half (N = 490; 49.9%) reported routinely getting healthcare outside the system and 78.6 percent reported having records in other systems. Of those who were willing to share their data in a Health Information Exchange, 54.3 percent wanted to sign consent but 90 percent of those would waive consent in the case of an emergency. Privacy and security were primary concerns of patients not willing to participate in Health Information Exchange and preferring to sign consent. Improved privacy and security protections could increase participation, and findings support consideration of "break-the-glass" provider access to Health Information Exchange records in an emergent situation.

Visualization of tandem repeat mutagenesis in Bacillus subtilis.

PubMed

Dormeyer, Miriam; Lentes, Sabine; Ballin, Patrick; Wilkens, Markus; Klumpp, Stefan; Kohlheyer, Dietrich; Stannek, Lorena; Grünberger, Alexander; Commichau, Fabian M

2018-03-01

Mutations are crucial for the emergence and evolution of proteins with novel functions, and thus for the diversity of life. Tandem repeats (TRs) are mutational hot spots that are present in the genomes of all organisms. Understanding the molecular mechanism underlying TR mutagenesis at the level of single cells requires the development of mutation reporter systems. Here, we present a mutation reporter system that is suitable to visualize mutagenesis of TRs occurring in single cells of the Gram-positive model bacterium Bacillus subtilis using microfluidic single-cell cultivation. The system allows measuring the elimination of TR units due to growth rate recovery. The cultivation of bacteria carrying the mutation reporter system in microfluidic chambers allowed us for the first time to visualize the emergence of a specific mutation at the level of single cells. The application of the mutation reporter system in combination with microfluidics might be helpful to elucidate the molecular mechanism underlying TR (in)stability in bacteria. Moreover, the mutation reporter system might be useful to assess whether mutations occur in response to nutrient starvation. Copyright © 2018 Elsevier B.V. All rights reserved.

Status Report on Power System Transformation: A 21st Century Power Partnership Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, Mackay; Martinot, Eric; Cox, Sadie

This report has three primary goals: (1) to articulate the concept of power system transformation; (2) to explore the current global landscape of ‘innovations’ that constitute power system transformation and provide evidence of how these innovations are emerging; and (3) to suggest an analytical framework for assessing the status of power system transformation on an on-going basis.

DoD Global Emerging Infections System Annual Report, Fiscal Year 1999

DTIC Science & Technology

1999-01-01

findings provided the impetus to the government of Peru to change national drug policy regarding treatment of malaria in the Peruvian Amazon . As soon as...feasible, a 13 14 Malaria Emerges in the Amazon Basin of Peru (Department of Loreto) 1992-1997 During the last 10-15 years, malaria has emerged as a major...public health problem in the Amazon basin of South America. In Peru the total number of malaria cases reported annually from the Peruvian Amazon

Hazardous Substance Release Reporting Under CERCLA, EPCR {section}304 and DOE Emergency Management System (EMS) and DOE Occurrence Reporting Requirements. Environmental Guidance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Traceski, T.T.

1994-06-01

Releases of various substances from DOE facilities may be subject to reporting requirements under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the Emergency Planning and Community Right-to-Know Act (EPCRA), as well as DOE`s internal ``Occurrence Reporting and Processing of Operations Information`` and the ``Emergency Management System`` (EMS). CERCLA and EPCPA are Federal laws that require immediate reporting of a release of a Hazardous Substance (HS) and an Extremely Hazardous Substance (EHS), respectively, in a Reportable Quantity (RQ) or more within a 24-hour period. This guidance uses a flowchart, supplemental information, and tables to provide an overview ofmore » the process to be followed, and more detailed explanations of the actions that must be performed, when chemical releases of HSs, EHSs, pollutants, or contaminants occur at DOE facilities. This guidance should be used in conjunction with, rather than in lieu of, applicable laws, regulations, and DOE Orders. Relevant laws, regulations, and DOE Orders are referenced throughout this guidance.« less

10 CFR 73.71 - Reporting of safeguards events.

Code of Federal Regulations, 2011 CFR

2011-01-01

... after discovery of the loss of any shipment of SNM or spent fuel, and within one hour after recovery of... Notification System, if the licensee is party to that system. If the Emergency Notification System is... service or other dedicated telephonic system or any other methods that will ensure that a report is...

10 CFR 73.71 - Reporting of safeguards events.

Code of Federal Regulations, 2010 CFR

2010-01-01

... after discovery of the loss of any shipment of SNM or spent fuel, and within one hour after recovery of... Notification System, if the licensee is party to that system. If the Emergency Notification System is... service or other dedicated telephonic system or any other methods that will ensure that a report is...

Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department.

PubMed

Dahlquist, Robert T; Reyner, Karina; Robinson, Richard D; Farzad, Ali; Laureano-Phillips, Jessica; Garrett, John S; Young, Joseph M; Zenarosa, Nestor R; Wang, Hao

2018-05-01

Emergency department (ED) shift handoffs are potential sources of delay in care. We aimed to determine the impact that using standardized reporting tool and process may have on throughput metrics for patients undergoing a transition of care at shift change. We performed a prospective, pre- and post-intervention quality improvement study from September 1 to November 30, 2015. A handoff procedure intervention, including a mandatory workshop and personnel training on a standard reporting system template, was implemented. The primary endpoint was patient length of stay (LOS). A comparative analysis of differences between patient LOS and various handoff communication methods were assessed pre- and post-intervention. Communication methods were entered a multivariable logistic regression model independently as risk factors for patient LOS. The final analysis included 1,006 patients, with 327 comprising the pre-intervention and 679 comprising the post-intervention populations. Bedside rounding occurred 45% of the time without a standard reporting during pre-intervention and increased to 85% of the time with the use of a standard reporting system in the post-intervention period (P < 0.001). Provider time (provider-initiated care to patient care completed) in the pre-intervention period averaged 297 min, but decreased to 265 min in the post-intervention period (P < 0.001). After adjusting for other communication methods, the use of a standard reporting system during handoff was associated with shortened ED LOS (OR = 0.60, 95% CI 0.40 - 0.90, P < 0.05). Standard reporting system use during emergency physician handoffs at shift change improves ED throughput efficiency and is associated with shorter ED LOS.

Policy implications of emerging vehicle and infrastructure technology.

DOT National Transportation Integrated Search

2014-08-01

This report considers a broad range of emerging transportation technologies that have potential : for enhancing travel on and operations of the Texas transportation system. It provides an : overview of technology classifications and assesses the poli...

Special population planner 4 : an open source release.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuiper, J.; Metz, W.; Tanzman, E.

2008-01-01

Emergencies like Hurricane Katrina and the recent California wildfires underscore the critical need to meet the complex challenge of planning for individuals with special needs and for institutionalized special populations. People with special needs and special populations often have difficulty responding to emergencies or taking protective actions, and emergency responders may be unaware of their existence and situations during a crisis. Special Population Planner (SPP) is an ArcGIS-based emergency planning system released as an open source product. SPP provides for easy production of maps, reports, and analyses to develop and revise emergency response plans. It includes tools to manage amore » voluntary registry of data for people with special needs, integrated links to plans and documents, tools for response planning and analysis, preformatted reports and maps, and data on locations of special populations, facility and resource characteristics, and contacts. The system can be readily adapted for new settings without programming and is broadly applicable. Full documentation and a demonstration database are included in the release.« less

Aircrew Emergency Decision Training: A Conference Report, 28-30 November 1978, San Francisco, California

DTIC Science & Technology

1979-05-01

Reoremnget Aircraft emergencies Emergency training Rsmutrsmngmn Behavioral decision theory Instructional systems Situlatonar mrecytann Decision making ...accidents) should be fed to ISO personnel to update training regularly; (10) special- attention should be paid to teaching difficult component skills...Need to Make Emergency Decisions? Ward Edwards 14 Comment PauZ Slovic 20 * Resource Management in Present and Future Aircraft Operations John Lauber

Increasing Patient Safety Event Reporting in an Emergency Medicine Residency.

PubMed

Steen, Sven; Jaeger, Cassie; Price, Lindsay; Griffen, David

2017-01-01

Patient safety event reporting is an important component for fostering a culture of safety. Our tertiary care hospital utilizes a computerized patient safety event reporting system that has been historically underutilized by residents and faculty, despite encouragement of its use. The objective of this quality project was to increase patient safety event reporting within our Emergency Medicine residency program. Knowledge of event reporting was evaluated with a survey. Eighteen residents and five faculty participated in a formal educational session on event reporting followed by feedback every two months on events reported and actions taken. The educational session included description of which events to report and the logistics of accessing the reporting system. Participants received a survey after the educational intervention to assess resident familiarity and comfort with using the system. The total number of events reported was obtained before and after the educational session. After the educational session, residents reported being more confident in knowing what to report as a patient safety event, knowing how to report events, how to access the reporting tool, and how to enter a patient safety event. In the 14 months preceding the educational session, an average of 0.4 events were reported per month from the residency. In the nine months following the educational session, an average of 3.7 events were reported per month by the residency. In addition, the reported events resulted in meaningful actions taken by the hospital to improve patient safety, which were shared with the residents. Improvement efforts including an educational session, feedback to the residency of events reported, and communication of improvements resulting from reported events successfully increased the frequency of safety event reporting in an Emergency Medicine residency.

47 CFR Appendix A to Part 64 - Telecommunications Service Priority (TSP) System for National Security Emergency Preparedness (NSEP)

Code of Federal Regulations, 2011 CFR

2011-10-01

... service users, or sponsoring Federal government organizations on behalf of service users (e.g., Department of State or Defense on behalf of foreign governments, Federal Emergency Management Agency on behalf... to the FCC and TSP System Oversight Committee a summary report identifying the time and event...

Physician acceptance of the IRIS user interface during a clinical trial at the Ottawa Civic Hospital

NASA Astrophysics Data System (ADS)

Coristine, Marjorie; Beeton, Carolyn; Tombaugh, Jo W.; Ahuja, J.; Belanger, Garry; Dillon, Richard F.; Currie, Shawn; Hind, E.

1990-07-01

During a clinical trial, emergency physicians and radiologists at the Ottawa Civic Hospital used IRIS (Integrated Radiological Information System) to process patients' x-rays, requisitions, and reports, and to have consultations, for 319 active cases. This paper discusses IRIS user interface issues raised during the clinical trial. The IRIS workstation consists of three major system components: 1) an image screen for viewing and enhancing images; 2) a control screen for presenting patient information, selecting images, and executing commands; and 3) a hands-free telephone for reporting activities and consultations. The control screen and hands-free telephone user interface allow physicians to navigate through patient files, select images and access reports, enter new reports, and perform remote consultations. Physicians were observed using the system during the trial and responded to questions about the user interface on an extensive debriefing interview after the trial. Overall, radiologists and emergency physicians were satisfied with IRIS control screen functionality and user interface. In a number of areas radiologists and emergency physicians differed in their user interface needs. Some features were found to be acceptable to one group of physicians but required modification to meet the needs of the other physician group. The data from the interviews, along with the comments from radiologists and emergency physicians provided important information for the revision of some features, and for the evolution of new features.

Emergency Medical Service Information System:the ARES 118 experience.

PubMed

Ientile, D A; Cardinale, M A; Cataldi, S; Parafati, M; Pasquarella, A; Trani, N; Corradi, M P

2017-01-01

In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse. All operations were carried out using open source software. Currently, ARES 118 is equipped with a business information system that enables data collection with its storage, management and processing of the same in fairly and easy way. The system allows the production of specific reports and measures modulated on the user requests in order to highlight the different aspects of the activity. The production of ad hoc reports, with the possibility of developing specific indicators, allows the identification and analysis of critical areas/processes in order to implement any corrective actions and monitor the effectiveness of the sam.

Implementing a national early awareness and alert system for new and emerging health technologies in Italy: the COTE Project.

PubMed

Migliore, Antonio; Perrini, Maria Rosaria; Jefferson, Tom; Cerbo, Marina

2012-07-01

The aim of this study was to establish a national Early Awareness and Alert (EAA) system for the identification and assessment of new and emerging health technologies in Italy. In 2008, Agenas, a public body supporting Regions and the Ministry of Health (MoH) in health services research, started a project named COTE (Observatory of New and Emerging Health Technologies) with the ultimate aim of implementing a national EAA system. The COTE project involved all stakeholders (MoH, Regions, Industry, Universities, technical government bodies, and Scientific Societies), in defining the key characteristics and methods of the EAA system. Agreement with stakeholders was reached using three separate workshops. During the workshops, participants shared and agreed methods for identification of new and emerging health technologies, prioritization, and assessment. The structure of the Horizon Scanning (HS) reports was discussed and defined. The main channels for dissemination of outputs were identified as the EuroScan database, and the stakeholders' Web portals. During the final workshop, Agenas presented the first three HS reports produced at national level and proposed the establishment of a permanent national EAA system. The COTE Project created the basis for a permanent national EAA system in Italy. An infrastructure to enable the stakeholders network to grow was created, methods to submit new and emerging health technologies for possible evaluation were established, methods for assessment of the technologies selected were defined, and the stakeholders involvement was delineated (in the identification, assessment, and dissemination stages).

Evaluation of roadside emergency call box technology : a summary report : technical assistance report.

DOT National Transportation Integrated Search

2003-04-01

Introduction Motorist aid call boxes are used to provide motorist assistance, improve safety, and can serve as an incident detection tool. More recently, Intelligent Transportation Systems (ITS) applications have been added to call box systems to enh...

Standardized Reporting System Use During Handoffs Reduces Patient Length of Stay in the Emergency Department

PubMed Central

Dahlquist, Robert T.; Reyner, Karina; Robinson, Richard D.; Farzad, Ali; Laureano-Phillips, Jessica; Garrett, John S.; Young, Joseph M.; Zenarosa, Nestor R.; Wang, Hao

2018-01-01

Background Emergency department (ED) shift handoffs are potential sources of delay in care. We aimed to determine the impact that using standardized reporting tool and process may have on throughput metrics for patients undergoing a transition of care at shift change. Methods We performed a prospective, pre- and post-intervention quality improvement study from September 1 to November 30, 2015. A handoff procedure intervention, including a mandatory workshop and personnel training on a standard reporting system template, was implemented. The primary endpoint was patient length of stay (LOS). A comparative analysis of differences between patient LOS and various handoff communication methods were assessed pre- and post-intervention. Communication methods were entered a multivariable logistic regression model independently as risk factors for patient LOS. Results The final analysis included 1,006 patients, with 327 comprising the pre-intervention and 679 comprising the post-intervention populations. Bedside rounding occurred 45% of the time without a standard reporting during pre-intervention and increased to 85% of the time with the use of a standard reporting system in the post-intervention period (P < 0.001). Provider time (provider-initiated care to patient care completed) in the pre-intervention period averaged 297 min, but decreased to 265 min in the post-intervention period (P < 0.001). After adjusting for other communication methods, the use of a standard reporting system during handoff was associated with shortened ED LOS (OR = 0.60, 95% CI 0.40 - 0.90, P < 0.05). Conclusions Standard reporting system use during emergency physician handoffs at shift change improves ED throughput efficiency and is associated with shorter ED LOS. PMID:29581808

Prototype development and demonstration for response, emergency staging, communications, uniform management, and evacuation (R.E.S.C.U.M.E.) : R.E.S.C.U.M.E. prototype system design document.

DOT National Transportation Integrated Search

2014-04-01

This report documents the System Design Document (SDD) for the prototype development and demonstration of the Response, Emergency Staging, Communications, Uniform Management, and Evacuation (R.E.S.C.U.M.E.) application bundle, with a focus on the Inc...

Evaluation of the PuSHMe regional mayday system operational test : final report

DOT National Transportation Integrated Search

1997-09-01

This report is an independent evaluation of the Puget Sound Emergency Response Operational Test (PuSHMe), a test of regional mayday systems that allow a driver to signal his or her location and need for assistance to a response center.

[Management of cardiac arrest in a German soccer stadium. Structural, process and outcome quality].

PubMed

Luiz, T; Kumpch, M; Metzger, M; Madler, C

2005-09-01

In Germany there is a lack of data about the quality of emergency medical care in mass gatherings. The following report reflects our experience with management of cardiac arrest events as an example for the most critical medical emergency in a soccer stadium. The Fritz-Walter Stadium is a well-known soccer arena with a crowd capacity of 46,600. Emergency medical care is provided by a 2-tiered system consisting of 3 emergency physicians and 65 ambulance personnel and paramedics. Resuscitation was conducted according to the guidelines of the European Resuscitation Council and American Heart Association. Within 80 months, 13 witnessed cardiac arrests occurred, all in males. In each case the initial rhythm was ventricular fibrillation, 6 patients collapsed before or after the match. Basic life support was usually provided within 2 min, defibrillation and advanced life support within 4 min, 77% regained spontaneous circulation, and 62% survived without neurologic deficits. Cardiac arrest is a relatively frequent event in a soccer stadium. Due to a well organised response system, the survival rate exceeded by far the corresponding figures reported by public health systems.

System Study: Emergency Power System 1998–2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schroeder, John Alton

2015-02-01

This report presents an unreliability evaluation of the emergency power system (EPS) at 104 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2013 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10-year period, while yearly estimates for system unreliability are provided for the entire active period. No statistically significant trends were identified in the EPS results.

A cross-functional service-oriented architecture to support real-time information exchange in emergency medical response.

PubMed

Hauenstein, Logan; Gao, Tia; Sze, Tsz Wo; Crawford, David; Alm, Alex; White, David

2006-01-01

Real-time information communication presents a persistent challenge to the emergency response community. During a medical emergency, various first response disciplines including Emergency Medical Service (EMS), Fire, and Police, and multiple health service facilities including hospitals, auxiliary care centers and public health departments using disparate information technology systems must coordinate their efforts by sharing real-time information. This paper describes a service-oriented architecture (SOA) that uses shared data models of emergency incidents to support the exchange of data between heterogeneous systems. This architecture is employed in the Advanced Health and Disaster Aid Network (AID-N) system, a testbed investigating information technologies to improve interoperation among multiple emergency response organizations in the Washington DC Metropolitan region. This architecture allows us to enable real-time data communication between three deployed systems: 1) a pre-hospital patient care reporting software system used on all ambulances in Arlington County, Virginia (MICHAELS), 2) a syndromic surveillance system used by public health departments in the Washington area (ESSENCE), and 3) a hazardous material reference software system (WISER) developed by the National Library Medicine. Additionally, we have extended our system to communicate with three new data sources: 1) wireless automated vital sign sensors worn by patients, 2) web portals for admitting hospitals, and 3) PDAs used by first responders at emergency scenes to input data (SIRP).

Architecture analysis report.

DOT National Transportation Integrated Search

2007-11-01

The purpose of this document is to provide an Architecture Analysis : for the Next Generation 911 (NG911) System (or system : of systems). The U.S. Department of Transportation (USDOT) : understands that access to emergency services...

14 CFR 121.703 - Service difficulty reports.

Code of Federal Regulations, 2013 CFR

2013-01-01

... system or ability of the system to control overspeed during flight; (11) A fuel or fuel-dumping system..., takeoff, climb, cruise, desent landing, and inspection). (4) The emergency procedure effected (e.g...

14 CFR 121.703 - Service difficulty reports.

Code of Federal Regulations, 2012 CFR

2012-01-01

... system or ability of the system to control overspeed during flight; (11) A fuel or fuel-dumping system..., takeoff, climb, cruise, desent landing, and inspection). (4) The emergency procedure effected (e.g...

14 CFR 121.703 - Service difficulty reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

... system or ability of the system to control overspeed during flight; (11) A fuel or fuel-dumping system..., takeoff, climb, cruise, desent landing, and inspection). (4) The emergency procedure effected (e.g...

14 CFR 121.703 - Service difficulty reports.

Code of Federal Regulations, 2014 CFR

2014-01-01

... system or ability of the system to control overspeed during flight; (11) A fuel or fuel-dumping system..., takeoff, climb, cruise, desent landing, and inspection). (4) The emergency procedure effected (e.g...

[Experience of mismatched blood transfusion for an rh negative patient and reconsideration of emergency blood transfusion manual in the hospital].

PubMed

Yoshimatsu, Aya; Hoshi, Takuo; Nishikawa, Masashi; Aya, Daisuke; Ueda, Hiroshi; Yokouchi, Takako; Tanaka, Makoto

2013-08-01

We report a B Rh negative patient undergoing total pelvic exenteration, who received both ABO and Rh incompatible packed red blood cells in an emergency situation. After this experience, we revised the manual of emergency blood transfusion. We defined level of severity to share information with surgeon, nurses, anesthesiologists and the member of the blood center. We changed anesthesia information management system for showing blood type including Duffy blood group system and checking out whether we can transfuse Rh positive blood to Rh negative patient in an emergency situation at the timeout of surgery.

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations

PubMed Central

Jackson, Brian A.; Faith, Kay Sullivan; Willis, Henry H.

2012-01-01

Abstract The ability to measure emergency preparedness—to predict the likely performance of emergency response systems in future events—is critical for policy analysis in homeland security. Yet it remains difficult to know how prepared a response system is to deal with large-scale incidents, whether it be a natural disaster, terrorist attack, or industrial or transportation accident. This research draws on the fields of systems analysis and engineering to apply the concept of system reliability to the evaluation of emergency response systems. The authors describe a method for modeling an emergency response system; identifying how individual parts of the system might fail; and assessing the likelihood of each failure and the severity of its effects on the overall response effort. The authors walk the reader through two applications of this method: a simplified example in which responders must deliver medical treatment to a certain number of people in a specified time window, and a more complex scenario involving the release of chlorine gas. The authors also describe an exploratory analysis in which they parsed a set of after-action reports describing real-world incidents, to demonstrate how this method can be used to quantitatively analyze data on past response performance. The authors conclude with a discussion of how this method of measuring emergency response system reliability could inform policy discussion of emergency preparedness, how system reliability might be improved, and the costs of doing so. PMID:28083267

Comparison Of Intake Gate Closure Methods At Lower Granite, Little Goose, Lower Monumental, And Mcnary Dams Using Risk-Based Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gore, Bryan F.; Blackburn, Tyrone R.; Heasler, Patrick G.

2001-01-19

The objective of this report is to compare the benefits and costs of modifications proposed for intake gate closure systems at four hydroelectric stations on the Lower Snake and Upper Columbia Rivers in the Walla Walla District that are unable to meet the COE 10-minute closure rule due to the installation of fish screens. The primary benefit of the proposed modifications is to reduce the risk of damage to the station and environs when emergency intake gate closure is required. Consequently, this report presents the results and methodology of an extensive risk analysis performed to assess the reliability of powerhousemore » systems and the costs and timing of potential damages resulting from events requiring emergency intake gate closure. As part of this analysis, the level of protection provided by the nitrogen emergency closure system was also evaluated. The nitrogen system was the basis for the original recommendation to partially disable the intake gate systems. The risk analysis quantifies this protection level.« less

Disabled personnel emergency-heating system. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Dine, N.

1974-12-16

This progress report describes a receiving well for the operating fuel supply (two provided) designed within the unit to permit parasitic heat loss from the system to be captured by the fuel supply. The Zero can housing provides adequate volume to accommodate stowage of the fluid-flow umbilicals for connection of the heater system to the tubulated casualty bag liner.

10 CFR 205.376 - Rates and charges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency Interconnection of Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.376 Rates and charges...

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

Assuring quality health care outcomes: lessons learned from car dealers?

PubMed Central

Dimsdale, Joel E

2017-01-01

Health care systems want quality but struggle to find the right tools because, typically, they track quality in only one or two ways. Because of the complexity of health care, high quality will emerge only when health care systems employ multiple approaches, including, importantly, patient-reported outcome perspectives. Sustained changes are unlikely to emerge in the absence of such multipronged interventions. PMID:28123314

Selecting a dynamic simulation modeling method for health care delivery research-part 2: report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force.

PubMed

Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Crown, William; Padula, William V; Wong, Peter K; Pasupathy, Kalyan S; Higashi, Mitchell K; Osgood, Nathaniel D

2015-03-01

In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling can be used more effectively than other modeling methods. The hierarchical relationship between the health care delivery system, providers, patients, and other stakeholders exhibits a level of complexity that ought to be captured using dynamic simulation modeling methods. As a tool to help researchers decide whether dynamic simulation modeling is an appropriate method for modeling the effects of an intervention on a health care system, we presented the System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence (SIMULATE) checklist consisting of eight elements. This report builds on the previous work, systematically comparing each of the three most commonly used dynamic simulation modeling methods-system dynamics, discrete-event simulation, and agent-based modeling. We review criteria for selecting the most suitable method depending on 1) the purpose-type of problem and research questions being investigated, 2) the object-scope of the model, and 3) the method to model the object to achieve the purpose. Finally, we provide guidance for emerging good practices for dynamic simulation modeling in the health sector, covering all aspects, from the engagement of decision makers in the model design through model maintenance and upkeep. We conclude by providing some recommendations about the application of these methods to add value to informed decision making, with an emphasis on stakeholder engagement, starting with the problem definition. Finally, we identify areas in which further methodological development will likely occur given the growing "volume, velocity and variety" and availability of "big data" to provide empirical evidence and techniques such as machine learning for parameter estimation in dynamic simulation models. Upon reviewing this report in addition to using the SIMULATE checklist, the readers should be able to identify whether dynamic simulation modeling methods are appropriate to address the problem at hand and to recognize the differences of these methods from those of other, more traditional modeling approaches such as Markov models and decision trees. This report provides an overview of these modeling methods and examples of health care system problems in which such methods have been useful. The primary aim of the report was to aid decisions as to whether these simulation methods are appropriate to address specific health systems problems. The report directs readers to other resources for further education on these individual modeling methods for system interventions in the emerging field of health care delivery science and implementation. Copyright © 2015. Published by Elsevier Inc.

Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam.

PubMed

Flemington, Tara; Fraser, Jennifer

2017-09-01

Too many children are brought to hospital emergency departments on numerous occasions before they are recognised as victims of child abuse and neglect. For this reason, improving knowledge and response behaviors of emergency staff at all levels is likely to have a significant impact on better outcomes. An Australian based training programme was the first of its kind to address this issue in a Vietnamese Emergency Department. Titled 'Safe Children Vietnam', the programme aimed to improve knowledge, attitudes and reporting behaviors concerning child abuse in the emergency setting. A pre-post test design was used to evaluate the impact of 'Safe Children Vietnam' on emergency staff knowledge, attitudes and intentions to report child abuse and neglect. Emergency staff including doctors, nurses and healthcare staff (n=116) participated in the clinical training programme. Linear Mixed Model analyses showed that on programme completion, they were more likely to recognise serious cases of all types of abuse. The 'Safe Children Vietnam' programme was effective at improving emergency staff knowledge of child abuse and neglect. A systems wide approach may be necessary to impact on emergency staff attitudes towards reporting cases of abuse. Copyright © 2017 Elsevier Ltd. All rights reserved.

49 CFR 234.109 - Recordkeeping.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.109 - Recordkeeping.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.106 - Partial activation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.101 - Employee notification rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

....101 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at...

49 CFR 234.107 - False activation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.105 - Activation failure.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.101 - Employee notification rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

....101 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at...

49 CFR 234.107 - False activation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.107 - False activation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.106 - Partial activation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.101 - Employee notification rules.

Code of Federal Regulations, 2013 CFR

2013-10-01

....101 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at...

49 CFR 234.105 - Activation failure.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.109 - Recordkeeping.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.106 - Partial activation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

49 CFR 234.105 - Activation failure.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION GRADE CROSSING SAFETY, INCLUDING SIGNAL SYSTEMS, STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Response to Credible Reports of Warning System Malfunction at Highway-Rail...

A new diagnosis grouping system for child emergency department visits.

PubMed

Alessandrini, Evaline A; Alpern, Elizabeth R; Chamberlain, James M; Shea, Judy A; Gorelick, Marc H

2010-02-01

A clinically sensible system of grouping diseases is needed for describing pediatric emergency diagnoses for research and reporting. This project aimed to create an International Classification of Diseases (ICD)-based diagnosis grouping system (DGS) for child emergency department (ED) visits that is 1) clinically sensible with regard to how diagnoses are grouped and 2) comprehensive in accounting for nearly all diagnoses (>95%). The second objective was to assess the construct validity of the DGS by examining variation in the frequency of targeted groups of diagnoses within the concepts of season, age, sex, and hospital type. A panel of general and pediatric emergency physicians used the nominal group technique and Delphi surveys to create the DGS. The primary data source used to develop the DGS was the Pediatric Emergency Care Applied Research Network (PECARN) Core Data Project (PCDP). A total of 3,041 ICD-9 codes, accounting for 98.9% of all diagnoses in the PCDP, served as the basis for creation of the DGS. The expert panel developed a DGS framework representing a clinical approach to the diagnosis and treatment of pediatric emergency patients. The resulting DGS has 21 major groups and 77 subgroups and accounts for 96.5% to 99% of diagnoses when applied to three external data sets. Variations in the frequency of targeted groups of diagnoses related to seasonality, age, sex, and site of care confirm construct validity. The DGS offers a clinically sensible method for describing pediatric ED visits by grouping ICD-9 codes in a consensus-derived classification scheme. This system may be used for research, reporting, needs assessment, and resource planning. (c) 2010 by the Society for Academic Emergency Medicine.

10 CFR 205.377 - Reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Reports. 205.377 Section 205.377 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports... Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.377 Reports. In addition...

EMS helicopter incidents reported to the NASA Aviation Safety Reporting System

NASA Technical Reports Server (NTRS)

Connell, Linda J.; Reynard, William D.

1993-01-01

The objectives of this evaluation were to: Identify the types of safety-related incidents reported to the Aviation Safety Reporting System (ASRS) in Emergency Medical Service (EMS) helicopter operations; Describe the operational conditions surrounding these incidents, such as weather, airspace, flight phase, time of day; and Assess the contribution to these incidents of selected human factors considerations, such as communication, distraction, time pressure, workload, and flight/duty impact.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

PubMed

Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

2016-03-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system.

PubMed

Mortaro, Alberto; Pascu, Diana; Zerman, Tamara; Vallaperta, Enrico; Schönsberg, Alberto; Tardivo, Stefano; Pancheri, Serena; Romano, Gabriele; Moretti, Francesca

2015-07-01

The role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives. An ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010. During the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population. Despite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a "learning organization" and improve both efficacy and safety of first aid care.

Report on the International Conference on Emergency Health Care Development.

PubMed Central

Dines, G B

1990-01-01

Emergency medical services (EMS) provide rescue, field stabilization, transportation to medical facilities, and definitive care for persons experiencing medical emergencies. In order to advance worldwide development and refinement of EMS systems, and their integration with emergency preparedness and response programs, the International Conference on Emergency Health Care Development was held in Crystal City, Arlington, VA, August 15-19, 1989. The conference was supported by the Department of Health and Human Services and its Health Resources and Services Administration; the Department of Transportation and its National Highway Traffic and Safety Administration; and the Pan American Health Organization. Objectives of the conference were to clarify linkages between various levels of emergency response, to present methods for developing or improving EMS systems within societies with different resources, to demonstrate processes by which EMS systems have been developed, and to propose international emergency health care development goals. Topics included development of services in developing nations, case studies of underdeveloped countries' responses to natural disasters, and a method for updating disaster response through use of available medical resources. PMID:1968669

After Action Report: Advanced Test Reactor Complex 2015 Evaluated Drill October 6, 2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Holmes, Forest Howard

2015-11-01

The Advanced Test Reactor (ATR) Complex, operated by Battelle Energy Alliance, LLC, at the Idaho National Laboratory (INL) conducted an evaluated drill on October 6, 2015, to allow the ATR Complex emergency response organization (ERO) to demonstrate the ability to respond to and mitigate an emergency by implementing the requirements of DOE O 151.1C, “Comprehensive Emergency Management System.”

Interactive Voice/Web Response System in clinical research

PubMed Central

Ruikar, Vrishabhsagar

2016-01-01

Emerging technologies in computer and telecommunication industry has eased the access to computer through telephone. An Interactive Voice/Web Response System (IxRS) is one of the user friendly systems for end users, with complex and tailored programs at its backend. The backend programs are specially tailored for easy understanding of users. Clinical research industry has experienced revolution in methodologies of data capture with time. Different systems have evolved toward emerging modern technologies and tools in couple of decades from past, for example, Electronic Data Capture, IxRS, electronic patient reported outcomes, etc. PMID:26952178

Interactive Voice/Web Response System in clinical research.

PubMed

Ruikar, Vrishabhsagar

2016-01-01

Emerging technologies in computer and telecommunication industry has eased the access to computer through telephone. An Interactive Voice/Web Response System (IxRS) is one of the user friendly systems for end users, with complex and tailored programs at its backend. The backend programs are specially tailored for easy understanding of users. Clinical research industry has experienced revolution in methodologies of data capture with time. Different systems have evolved toward emerging modern technologies and tools in couple of decades from past, for example, Electronic Data Capture, IxRS, electronic patient reported outcomes, etc.

Titanium 󈨠: Science and Technology. Volume 3

DTIC Science & Technology

1993-01-01

authors wish to thank Dr. Paul Bania of the Henderson Technical Laboratory. Mr. H.I. Jones conducted the J Integral tests; his assistance is...obtained from a study published in 1983 for the Federal Emergency Management Agency. (5) In 1985. data from all available sources was compiled into a...Emergency Management Agency, 1983) 6. Fisher, R.L., ’An Evaluation of the Titanium Scrap System’, (Report, R&TD Report #689, RMI Company, Unpublished

Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations

DTIC Science & Technology

2010-01-01

for describing response performance or other reliability related measures include Kolesar et al., 1975; Chelst and Jarvis , 1979; Revelle and Hogan...Chemicals,” Journal of Hazardous Materials, Vol. 159, 2008, pp. 2–12. Mason, Steve , Final Report, Incident Name: Teris LLC Explosion and Fire, El Dorado...Arkansas, EPA Region 6, Emergency Readiness Team, Response and Prevention Branch, March 2005. Mason, Steve , Final Report, Incident Name: Union Pacific

Spontaneous Splenic Rupture Following Intravenous Thrombolysis with Alteplase Applied as Stroke Therapy – Case Report and Review of Literature

PubMed Central

Aleksic-Shihabi, Anka; Jadrijevic, Eni; Milekic, Nina; Bulicic, Ana Repic; Titlic, Marina; Suljic, Enra

2016-01-01

Introduction: Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions. Case report: This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture. PMID:26980937

Multitier specification for NSEP (National Security/Emergency Preparedness) enhancement of fiber-optic long-distance telecommunication networks. Volume 1. The multitier specification - an executive summary. Technical Information Bulletin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peach, D.F.

1987-12-01

Fiber optic telecommunication systems are susceptible to both natural and man-made stress. National Security/Emergency Preparedness (NSEP) is a function of how durable these systems are in light of projected levels of stress. Emergency Preparedness in 1987 is not just a matter of--can they deliver food, water, energy and other essentials--but can they deliver the vital information necessary to maintain corporate function of our country. 'Communication stamina' is a function of 'probability of survival' when faced with stress. This report provides an overview of the enhancements to a fiber-optic communication system/installation that will increase durability. These enhancements are grouped, based onmore » their value in protecting the system, such that a Multitier Specification is created that presents multiple levels of hardness. Mitigation of effects due to high-altitude electromagnetic pulse (HEMP) and gamma radiation, and protection from vandalism and weather events are discussed in the report. The report is presented in two volumes. Volume I presents the Multitier Specification in a format that is usable for management review. The attributes of specified physical parameters, and the levels of protection stated in Volume I, are discussed in more detail in Volume II.« less

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

PubMed

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign.

PubMed

Zhang, Lu; Haga, Nobuhiro; Ogawa, Soichiro; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Kataoka, Masao; Ishibashi, Kei; Kojima, Yoshiyuki

2017-11-01

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment. © 2017 The Japanese Urological Association.

Improving the governance of patient safety in emergency care: a systematic review of interventions

PubMed Central

Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

2016-01-01

Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base. PMID:26826151

75 FR 8388 - Agency Information Collection Activities: Submission for OMB Review; Comment Request, OMB No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-24

...; FEMA's Grants Reporting Tool (GRT) AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice; 30... . SUPPLEMENTARY INFORMATION: Collection of Information Title: FEMA's Grants Reporting Tool (GRT). Type of...--None. Abstract: The Grants Reporting Tool (GRT) is a Web-based reporting system designed to help State...

Burden of emergency conditions and emergency care utilization: New estimates from 40 countries

PubMed Central

Chang, Cindy Y.; Abujaber, Samer; Reynolds, Teri A.; Camargo, Carlos A.; Obermeyer, Ziad

2016-01-01

Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care. PMID:27334758

32 CFR 185.5 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... development of an MSCA data base and emergency reporting system, as described in paragraph (j) of this section... parameters of the DoD Resources Data Base (DODRDB) for MSCA, which is described in paragraph (n) of this section. Facilitate use of that data base to support decentralized management of MSCA in time of emergency...

What Curriculum for the 21st Century?

ERIC Educational Resources Information Center

New Things Considered, 1990

1990-01-01

"New Things Considered" reports on emerging trends and issues in education to policymakers and participants in SEDL-SCAN, an emerging issues tracking system being pilot tested by the Southwest Educational Development Laboratory's Policy Information Service and the State of New Mexico. This issue presents brief summaries of the thinking of…

Web-Based Surveillance Systems for Human, Animal, and Plant Diseases.

PubMed

Madoff, Lawrence C; Li, Annie

2014-02-01

The emergence of infectious diseases, caused by novel pathogens or the spread of existing ones to new populations and regions, represents a continuous threat to humans and other species. The early detection of emerging human, animal, and plant diseases is critical to preventing the spread of infection and protecting the health of our species and environment. Today, more than 75% of emerging infectious diseases are estimated to be zoonotic and capable of crossing species barriers and diminishing food supplies. Traditionally, surveillance of diseases has relied on a hierarchy of health professionals that can be costly to build and maintain, leading to a delay or interruption in reporting. However, Internet-based surveillance systems bring another dimension to epidemiology by utilizing technology to collect, organize, and disseminate information in a more timely manner. Partially and fully automated systems allow for earlier detection of disease outbreaks by searching for information from both formal sources (e.g., World Health Organization and government ministry reports) and informal sources (e.g., blogs, online media sources, and social networks). Web-based applications display disparate information online or disperse it through e-mail to subscribers or the general public. Web-based early warning systems, such as ProMED-mail, the Global Public Health Intelligence Network (GPHIN), and Health Map, have been able to recognize emerging infectious diseases earlier than traditional surveillance systems. These systems, which are continuing to evolve, are now widely utilized by individuals, humanitarian organizations, and government health ministries.

Information for Developing Countries: Definitions, Institutions and Issues. A Contribution towards Forming an Understanding of the Potential for Consultancy, Marketing and Training Related Activities. Kingston Polytechnic School of Information Systems Research Report 87-3.

ERIC Educational Resources Information Center

Lindsay, John

This paper reports on the emerging market in information on development-related activities in terms of the European capacity in databases and information networking. The first of its two parts addresses issues that are emerging consequent to the introduction of information technology in developing countries. Problems of definition and interest in…

Emergency and backup power supplies at Department of Energy facilities: Augmented Evaluation Team -- Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This report documents the results of the Defense Programs (DP) Augmented Evaluation Team (AET) review of emergency and backup power supplies (i.e., generator, uninterruptible power supply, and battery systems) at DP facilities. The review was conducted in response to concerns expressed by former Secretary of Energy James D. Watkins over the number of incidents where backup power sources failed to provide electrical power during tests or actual demands. The AET conducted a series of on-site reviews for the purpose of understanding the design, operation, maintenance, and safety significance of emergency and backup power (E&BP) supplies. The AET found that themore » quality of programs related to maintenance of backup power systems varies greatly among the sites visited, and often among facilities at the same site. No major safety issues were identified. However, there are areas where the AET believes the reliability of emergency and backup power systems can and should be improved. Recommendations for improving the performance of E&BP systems are provided in this report. The report also discusses progress made by Management and Operating (M&O) contractors to improve the reliability of backup sources used in safety significant applications. One area that requires further attention is the analysis and understanding of the safety implications of backup power equipment. This understanding is needed for proper graded-approach implementation of Department of Energy (DOE) Orders, and to help ensure that equipment important to the safety of DOE workers, the public, and the environment is identified, classified, recognized, and treated as such by designers, users, and maintainers. Another area considered important for improving E&BP system performance is the assignment of overall ownership responsibility and authority for ensuring that E&BP equipment performs adequately and that reliability and availability are maintained at acceptable levels.« less

An estimate of the effectiveness of an in-vehicle automatic collision notification system in reducing road crash fatalities in South Australia.

PubMed

Ponte, G; Ryan, G A; Anderson, R W G

2016-01-01

The aim of this study was to estimate the potential effectiveness of an in-vehicle automatic collision notification (ACN) system in reducing all road crash fatalities in South Australia (SA). For the years 2008 to 2009, traffic accident reporting system (TARS) data, emergency medical services (EMS) road crash dispatch data, and coroner's reports were matched and examined. This was done to initially determine the extent to which there were differences between the reported time of a fatal road crash in the mass crash data and the time EMS were notified and dispatched. In the subset of fatal crashes where there was a delay, injuries detailed by a forensic pathologist in individual coroner's reports were examined to determine the likelihood of survival had there not been a delay in emergency medical assistance. In 25% (N = 53) of fatalities in SA in the period 2008 to 2009, there was a delay in the notification of the crash event, and hence dispatch of EMS, that exceeded 10 min. In the 2-year crash period, 5 people were likely to have survived through more prompt crash notification enabling quicker emergency medical assistance. Additionally, 3 people potentially would have survived if surgical intervention (or emergency medical assistance to sustain life until surgery) occurred more promptly. The minimum effectiveness rate of an ACN system in SA with full deployment is likely to be in the range of 2.4 to 3.8% of all road crash fatalities involving all vehicle types and all vulnerable road users (pedestrians, cyclists, and motorcyclists) from 2008 to 2009. Considering only passenger vehicle occupants, the benefit is likely to be 2.6 to 4.6%. These fatality reductions could only have been achieved through earlier notification of each crash and their location to enable a quicker medical response. This might be achievable through a fully deployed in-vehicle ACN system.

System Study: Emergency Power System 1998-2014

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schroeder, John Alton

2015-12-01

This report presents an unreliability evaluation of the emergency power system (EPS) at 104 U.S. commercial nuclear power plants. Demand, run hours, and failure data from fiscal year 1998 through 2014 for selected components were obtained from the Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES). The unreliability results are trended for the most recent 10 year period while yearly estimates for system unreliability are provided for the entire active period. An extremely statistically significant increasing trend was observed for EPS system unreliability for an 8-hour mission. A statistically significant increasing trend was observed for EPS system start-onlymore » unreliability.« less

Case report: treatment of subdural hematoma in the emergency department utilizing the subdural evacuating port system.

PubMed

Asfora, Wilson T; Klapper, Hendrik B

2013-08-01

Patients with acute or chronic subdural hematomas may present with rapidly deteriorating neurological function and are at risk for irreversible brainstem injury. In such cases, rapid surgical intervention is required to evacuate the hematoma and reverse critically elevated intracranial pressure. A variety of surgical drainage methods are in existence, none of which are clearly superior to the others. This report presents the case of a 74-year-old woman who suffered an acute-on-chronic subdural hematoma which was evacuated in the emergency department utilizing the subdural evacuating port system (SEPS). The SEPS provides for a minimally invasive technique to drain subdural hematomas and is advantageous in that it can be performed at the bedside. The SEPS is relatively simple to use and may be especially useful to emergency department staff in outlying areas where there is a shortage of neurosurgical coverage.

Northern Shenandoah Valley ITS -- public safety initiative : final report

DOT National Transportation Integrated Search

2002-01-23

This report summarizes the efforts of The Pennsylvania State Universitys Applied Research Laboratory (PSU/ARL) to conduct field tests using a handheld data collection system to enable emergency medical personnel (EMS) to collect and transfer patie...

Using social network analysis to understand Missouri's system of public health emergency planners.

PubMed

Harris, Jenine K; Clements, Bruce

2007-01-01

Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006. The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri. Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/ clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks. While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.

Handheld Multi-Gas Meters Market Survey Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Gustavious; Wald-Hopkins, Mark David; Obrey, Stephen J.

2016-06-23

Handheld multi-gas meters (MGMs) are equipped with sensors to monitor oxygen (O2) levels and additional sensors to detect the presence of combustible or toxic gases in the environment. This report is limited to operational response-type MGMs that include at least four different sensors. These sensors can vary by type and by the chemical monitored. In real time, the sensors report the concentration of monitored gases in the atmosphere near the MGM. To provide emergency responders with information on handheld multi-gas meters, the System Assessment and Validation for Emergency Responders (SAVER) Program conducted a market survey. This market survey report ismore » based on information gathered between November 2015 and February 2016 from vendors, Internet research, industry publications, an emergency responder focus group, and a government issued Request for Information (RFI) that was posted on the Federal Business Opportunities website.« less

Horizon scanning of new and emerging medical technology in Australia: its relevance to Medical Services Advisory Committee health technology assessments and public funding.

PubMed

O'Malley, Sue P; Jordan, Ernest

2009-07-01

In 1998, a formal process using full health technology assessments (HTAs) was implemented to determine the suitability for public subsidy of new and emerging medical technologies in the Australian private healthcare sector. This process is overseen by the Medical Services Advisory Committee (MSAC). In 2004, horizon scanning was introduced in Australia with the stated objective of identifying new and emerging medical technologies into the public healthcare sector, with consideration to the publicly subsidized private healthcare sector. How well horizon scanning works in identifying new and emerging technologies suitable for government subsidized funding in the private healthcare sector is examined in this study. A descriptive evaluation of the impact of horizon scanning as an early alert and awareness system identifying new and emerging technologies before these technologies are submitted to MSAC for a full HTA. All MSAC HTAs commenced after the introduction of horizon scanning in 2004 were cross-checked with the list of Prioritizing Summaries or Horizon Scanning Reports to determine whether a prior Prioritizing Summary or Horizon Scanning Report had been carried out. Of the forty-three technologies that were the subject of a full MSAC HTAs in the time period examined, only eleven had been the subject of either a Prioritizing Summary or Horizon Scanning Report. As a result of a full MSAC HTA, twelve of the technologies that were not the subject of a Prioritizing Summary or Horizon Scanning Report were given positive recommendations for public funding. Horizon scanning was set up to scan the introduction of new and emerging medical technologies into the public healthcare sector, with consideration to the publicly subsidized private healthcare sector. Based on the number of new and emerging technologies that have been the subject of a full MSAC HTA without first being subjected to either a Prioritizing Summary or Horizon Scanning Report, horizon scanning in Australia does not function as an "early alert and awareness system" for funding in the publicly subsidized private healthcare sector in Australia.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

PubMed Central

Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

2016-01-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

Predicting the timing and potential of the spring emergence of overwintered populations of Heliothis spp

NASA Technical Reports Server (NTRS)

Hartstack, A. W.; Witz, J. A.; Lopez, J. D. (Principal Investigator)

1981-01-01

The current state of knowledge dealing with the prediction of the overwintering population and spring emergence of Heliothis spp., a serious pest of numerous crops is surveyed. Current literature is reviewed in detail. Temperature and day length are the primary factors which program H. spp. larva for possible diapause. Although studies on the interaction of temperature and day length are reported, the complete diapause induction process is not identified sufficiently to allow accurate prediction of diapause timing. Mortality during diapause is reported as highly variable. The factors causing mortality are identified, but only a few are quantified. The spring emergence of overwintering H. spp. adults and mathematical models which predict the timing of emergence are reviewed. Timing predictions compare favorably to observed field data; however, prediction of actual numbers of emerging moths is not possible. The potential for use of spring emergence predictions in pest management applications, as an early warning of potential crop damage, are excellent. Research requirements to develop such an early warning system are discussed.

Evaluation of the Emergency Response Dose Assessment System(ERDAS)

NASA Technical Reports Server (NTRS)

Evans, Randolph J.; Lambert, Winifred C.; Manobianco, John T.; Taylor, Gregory E.; Wheeler, Mark M.; Yersavich, Ann M.

1996-01-01

The emergency response dose assessment system (ERDAS) is a protype software and hardware system configured to produce routine mesoscale meteorological forecasts and enhanced dispersion estimates on an operational basis for the Kennedy Space Center (KSC)/Cape Canaveral Air Station (CCAS) region. ERDAS provides emergency response guidance to operations at KSC/CCAS in the case of an accidental hazardous material release or an aborted vehicle launch. This report describes the evaluation of ERDAS including: evaluation of sea breeze predictions, comparison of launch plume location and concentration predictions, case study of a toxic release, evaluation of model sensitivity to varying input parameters, evaluation of the user interface, assessment of ERDA's operational capabilities, and a comparison of ERDAS models to the ocean breeze dry gultch diffusion model.

77 FR 26562 - Mobile Offshore Drilling Unit Dynamic Positioning Guidance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... regarding a draft policy letter on Dynamic Positioning (DP) Systems, Emergency Disconnect Systems, Blowout... Coast Guard, NOSAC issued the report ``Recommendations for Dynamic Positioning System Design and... DEPARTMENT OF HOMELAND SECURITY Coast Guard [USCG-2011-1106] Mobile Offshore Drilling Unit Dynamic...

Design study of arresting gear system for recovery of space shuttle orbiters

NASA Technical Reports Server (NTRS)

1972-01-01

A plan is reported for the design, manufacture, development, test, and production of an emergency arrestment system for the recovery of shuttle orbiters. Time and cost estimates are included. System testing and several optional test programs are discussed.

Using linked data to evaluate collisions with fixed objects in Pennsylvania : Crash Outcome Data Evaluation System (CODES) linked data demonstration project

DOT National Transportation Integrated Search

1998-10-01

This report uses police-reported motor vehicle crash data linked to Emergency Medical Services data and hospital discharge data to evaluate the relative risk of injury posed by specific roadside objects in Pennsylvania. The report focuses primarily o...

Why Clinicians Don't Report Adverse Drug Events: Qualitative Study.

PubMed

Hohl, Corinne M; Small, Serena S; Peddie, David; Badke, Katherin; Bailey, Chantelle; Balka, Ellen

2018-02-27

Adverse drug events are unintended and harmful events related to medications. Adverse drug events are important for patient care, quality improvement, drug safety research, and postmarketing surveillance, but they are vastly underreported. Our objectives were to identify barriers to adverse drug event documentation and factors contributing to underreporting. This qualitative study was conducted in 1 ambulatory center, and the emergency departments and inpatient wards of 3 acute care hospitals in British Columbia between March 2014 and December 2016. We completed workplace observations and focus groups with general practitioners, hospitalists, emergency physicians, and hospital and community pharmacists. We analyzed field notes by coding and iteratively analyzing our data to identify emerging concepts, generate thematic and event summaries, and create workflow diagrams. Clinicians validated emerging concepts by applying them to cases from their clinical practice. We completed 238 hours of observations during which clinicians investigated 65 suspect adverse drug events. The observed events were often complex and diagnosed over time, requiring the input of multiple providers. Providers documented adverse drug events in charts to support continuity of care but never reported them to external agencies. Providers faced time constraints, and reporting would have required duplication of documentation. Existing reporting systems are not suited to capture the complex nature of adverse drug events or adapted to workflow and are simply not used by frontline clinicians. Systems that are integrated into electronic medical records, make use of existing data to avoid duplication of documentation, and generate alerts to improve safety may address the shortcomings of existing systems and generate robust adverse drug event data as a by-product of safer care. ©Corinne M Hohl, Serena S Small, David Peddie, Katherin Badke, Chantelle Bailey, Ellen Balka. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.02.2018.

Mobile Phone–based Infectious Disease Surveillance System, Sri Lanka

PubMed Central

Sawford, Kate; Daniel, Samson L.A.; Nelson, Trisalyn A.; Stephen, Craig

2010-01-01

Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans. We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system. Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation. The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders. PMID:20875276

Satellites for distress alerting and locating: Report by Interagency Committee for Search and Rescue Ad Hoc Working Group

NASA Technical Reports Server (NTRS)

Ehrlich, E.

1976-01-01

The background behind the congressional legislation that led to the requirement for the Emergency Locator Transmitter (ELT) and the Emergency Position-Indicating Radio Beacon (EPIRB) to be installed on certain types of aircraft and inspected marine vessels respectively is discussed. The DAL problem is discussed for existing ELT and EPIRB equipped aircraft and ships. It is recognized that the DAL requirement for CONUS and Alaska and the maritime regions are not identical. In order to address the serious DAL problem which currently exists in CONUS and Alaska, a low orbiting satellite system evolves as the most viable and cost effective alternative that satisfies the overall SAR system design requirements. A satellite system designed to meet the needs of the maritime regions could be either low orbiting or geostationary. The conclusions drawn from this report support the recommendation to proceed with the implementation of a SAR orbiting satellite system.

Expert systems as applied to bridges and pavements : an overview.

DOT National Transportation Integrated Search

1986-01-01

Expert systems is a rapidly emerging new application of computers to aid decision makers in solving problems. This report gives an overview of what expert systems are and of what use they may be to a transportation department. The focus of the applic...

The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism.

PubMed

Barthell, Edward N; Cordell, William H; Moorhead, John C; Handler, Jonathan; Feied, Craig; Smith, Mark S; Cochrane, Dennis G; Felton, Christopher W; Collins, Michael A

2002-04-01

The Frontlines of Medicine Project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, emergency government, law enforcement, and informatics. This collaboration proposes to develop a nonproprietary, "open systems" approach for reporting emergency department patient data. The common element is a standard approach to sending messages from individual EDs to regional oversight entities that could then analyze the data received. ED encounter data could be used for various public health initiatives, including syndromic surveillance for chemical and biological terrorism. The interlinking of these regional systems could also permit public health surveillance at a national level based on ED patient encounter data. Advancements in the Internet and Web-based technologies could allow the deployment of these standardized tools in a rapid time frame.

Setting the vision: applied patient-reported outcomes and smart, connected digital healthcare systems to improve patient-centered outcomes prediction in critical illness.

PubMed

Wysham, Nicholas G; Abernethy, Amy P; Cox, Christopher E

2014-10-01

Prediction models in critical illness are generally limited to short-term mortality and uncommonly include patient-centered outcomes. Current outcome prediction tools are also insensitive to individual context or evolution in healthcare practice, potentially limiting their value over time. Improved prognostication of patient-centered outcomes in critical illness could enhance decision-making quality in the ICU. Patient-reported outcomes have emerged as precise methodological measures of patient-centered variables and have been successfully employed using diverse platforms and technologies, enhancing the value of research in critical illness survivorship and in direct patient care. The learning health system is an emerging ideal characterized by integration of multiple data sources into a smart and interconnected health information technology infrastructure with the goal of rapidly optimizing patient care. We propose a vision of a smart, interconnected learning health system with integrated electronic patient-reported outcomes to optimize patient-centered care, including critical care outcome prediction. A learning health system infrastructure integrating electronic patient-reported outcomes may aid in the management of critical illness-associated conditions and yield tools to improve prognostication of patient-centered outcomes in critical illness.

The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems.

PubMed

Howells, N R; Dunne, N; Reddy, S

2006-07-01

To report the casualty profile of the major incident at the Royal Berkshire Hospital, Reading, following the Ufton Nervet Train crash, November 2004. To make further proposals regarding major incident reporting and implementation of trauma-scoring systems. Retrospective analysis of emergency department and hospital notes. Calculation of index Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS) in all patients. Of 61 casualties, the majority (74%) were seen in the minors area of our emergency department with a mixture of blunt impact and penetrating glass injuries. One died and 16 were admitted. 10% had an ISS >16. All surviving patients had a TRISS predicted probability of survival >90%. We propose mandatory major incident reporting within 6 months of a major incident to aid development of a national database. As previously proposed, this will aid education and facilitate future major incident planning. We further propose the widespread use of trauma scoring systems to facilitate comparative analysis between major incidents, perhaps extrapolating this to develop a major incident score.

A national survey of emergency pharmacy practice in the United States.

PubMed

Thomas, Michael C; Acquisto, Nicole M; Shirk, Mary Beth; Patanwala, Asad E

2016-03-15

The results of a survey to characterize pharmacy practice in emergency department (ED) settings are reported. An electronic survey was sent to all members of the American Society of Health-System Pharmacists' Emergency Medicine Connect group and the American College of Clinical Pharmacy's Emergency Medicine Practice and Research Network. Approximately 400 nontrainee pharmacy practitioners were invited to participate in the survey, which was open for 30 days. Descriptive statistics were used for all analyses. Two hundred thirty-three responses to the survey that were at least partially completed were received. After the removal of duplicate responses and null records, 187 survey responses were retained. The majority of respondents were from community hospitals (59.6%) or academic medical centers (36.1%). A pharmacist's presence in the ED of more than eight hours per day on weekdays and weekends was commonly reported (68.7% of respondents); 49.4% of institutions provided more than eight hours of coverage daily. Nearly one in three institutions (34.8%) provided no weekend ED staffing. The most frequently reported hours of coverage were during the 1 p.m.-midnight time frame. The distribution of ED pharmacist activities, by category, was as follows (data are median reported time commitments): clinical, 25% (interquartile range [IQR], 15-40%); emergency response, 15% (IQR, 10-20%); order processing, 15% (IQR, 5-25%); medication reconciliation/history-taking, 10% (IQR, 5-25%); teaching, 10% (IQR, 5-15%); administrative, 5% (IQR, 3-10%); and scholarly endeavors, 0% (IQR, 0-5%). Pharmacists from academic and community EDs perform a variety of clinical, educational, and administrative activities. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Drug Prices and Emergency Department Mentions for Cocaine and Heroin

PubMed Central

Caulkins, Jonathan P.

2001-01-01

Objectives. In this report, the author illustrates the historic relation between retail drug prices and emergency department mentions for cocaine and heroin. Methods. Price series based on the Drug Enforcement Administration's System to Retrieve Information From Drug Evidence database were correlated with data on emergency department mentions from the Drug Abuse Warning Network for cocaine (1978–1996) and heroin (1981–1996). Results. A simple model in which emergency department mentions are driven by only prices explains more than 95% of the variation in emergency department mentions. Conclusions. Fluctuations in prices are an important determinant of adverse health outcomes associated with drugs. PMID:11527779

The Telecommunications Emergency Decision Support System as a Crisis Management Decision Support System

DTIC Science & Technology

1991-09-01

NAVAL POSTGRADUATE SCHOOL Monterey, California AD-A246 188 7 R DTIC fl ELECTE FEB2 1992 U THESIS THE TELECOMMUNICATIONS EMERGENCY DECISION SUPPORT...ORGANIZATION REPORT NUMBER(S) a. NAME OF PERFORMING ORGANIZATION 6b. OFFICE SYMBOl 7a. NAME OF MONITORING ORGANIZATION Naval Postgraduate School J ""X...s Naval Postgraduate School c. ADDRESS (City, State and ZIP Code) 7b. ADDRESS (City, State, and ZIP Code) Monterey, CA 93943-5000 Monterey, CA 93943

Measures for groundwater security during and after the Hanshin-Awaji earthquake (1995) and the Great East Japan earthquake (2011), Japan

NASA Astrophysics Data System (ADS)

Tanaka, Tadashi

2016-03-01

Many big earthquakes have occurred in the tectonic regions of the world, especially in Japan. Earthquakes often cause damage to crucial life services such as water, gas and electricity supply systems and even the sewage system in urban and rural areas. The most severe problem for people affected by earthquakes is access to water for their drinking/cooking and toilet flushing. Securing safe water for daily life in an earthquake emergency requires the establishment of countermeasures, especially in a mega city like Tokyo. This paper described some examples of groundwater use in earthquake emergencies, with reference to reports, books and newspapers published in Japan. The consensus is that groundwater, as a source of water, plays a major role in earthquake emergencies, especially where the accessibility of wells coincides with the emergency need. It is also important to introduce a registration system for citizen-owned and company wells that can form the basis of a cooperative during a disaster; such a registration system was implemented by many Japanese local governments after the Hanshin-Awaji Earthquake in 1995 and the Great East Japan Earthquake in 2011, and is one of the most effective countermeasures for groundwater use in an earthquake emergency. Emphasis is also placed the importance of establishing of a continuous monitoring system of groundwater conditions for both quantity and quality during non-emergency periods.

Project #138. Coronary Care Education of Health Care Team. Final Report.

ERIC Educational Resources Information Center

Saint Joseph Hospital, MO.

The goal of this project was to develop, establish, and implement a system for the educational development of health care team members of the St. Joseph region in emergency and coronary care. Programs, curricula, and evaluation methodology were devised for four levels of critical care personnel: R.N.s emphasizing emergency and coronary care;…

[New information technologies in the management of emergency health services].

PubMed

Denisov, V N; Vaseneva, L A; Sidorov, A I; Grinkevich, R G; Pogodina, T P

1998-01-01

Novel information computer system introduced at the first aid station of Novosibirsk has improved effectiveness of ambulance transport and emergency teams; quickened the process of reporting information to the head of the station and higher medical institutions as well as responding to requests; facilitated control over continuous education of the staff and planning of relevant educational programs.

TESTING AND PERFORMANCE EVALUATION OF AN INNOVATIVE INTERNAL PIPE SEALING SYSTEM FOR WASTEWATER MAIN REHABILITATION

EPA Science Inventory

Many utilities are seeking emerging and innovative rehabilitation technologies to extend the service life of their infrastructure systems. This report describes the testing and performance evaluation of an internal pipe sealing system, which provides a permanent physical seal fo...

Burden of emergency conditions and emergency care usage: new estimates from 40 countries.

PubMed

Chang, Cindy Y; Abujaber, Samer; Reynolds, Teri A; Camargo, Carlos A; Obermeyer, Ziad

2016-11-01

To estimate the global and national burden of emergency conditions, and compare them to emergency care usage rates. We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care usage rates were obtained from a systematic literature review on emergency care facilities in low-income and middle-income countries (LMICs), supplemented by national health system reports. All 15 leading causes of death and disability-adjusted life years (DALYs) globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency usage. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47 728 per 100 000 population (IQR 45 253-50 085) in low-income, 25 186 (IQR 21 982-40 480) in middle-income and 15 691 (IQR 14 649-16 382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency usage rates were the lowest in low-income countries, with median 8 visits per 1000 population (IQR 6-10), 78 (IQR 25-197) in middle-income and 264 (IQR 177-341) in high-income countries. Despite higher burden of emergency conditions, emergency usage rates are substantially lower in LMICs, likely due to limited access to emergency care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Report: Acquisition Certifications Needed for Managers Overseeing Development of EPA’s Electronic Manifest System

EPA Pesticide Factsheets

Report #17-P-0029, November 7, 2016. Ineffective project oversight could cause project delays that prolong the EPA's ability to provide emergency responders with data about hazardous waste shipped between generators’ sites and waste management facilities.

Conditions of Flexibility: Securing a More Responsive Higher Education System

ERIC Educational Resources Information Center

Barnett, Ronald

2014-01-01

This report is the culmination of the "Flexible Pedagogies: Preparing for the Future" series of reports which have considered flexible learning from a range of perspectives. The report proposes fifteen conditions of flexibility to inject new thinking and new practices into an emerging new age. Flexible provision has the potential to…

[Study on the timeliness of detection and reporting on public health emergency events in China].

PubMed

Li, Ke-Li; Feng, Zi-Jian; Ni, Da-Xin

2009-03-01

To analyze the timeliness of detection and reporting on public health emergency events, and to explore the effective strategies for improving the relative capacity on those issues. We conducted a retrospective survey on 3275 emergency events reported through Public Health Emergency Events Surveillance System from 2005 to the first half of 2006. Developed by county Centers for Disease Control and Prevention, a uniformed self-administrated questionnaire was used to collect data, which would include information on the detection, reporting of the events. For communicable diseases events, the median of time interval between the occurrence of first case and the detection of event was 6 days (P25 = 2, P75 = 13). For food poisoning events and clusters of disease with unknown origin, the medians were 3 hours (P25, P75 = 16) and 1 days (P25 = 0, P75 = 5). 71.54% of the events were reported by the discoverers within 2 hours after the detection. In general, the ranges of time intervals between the occurrence, detection or reporting of the events were different, according to the categories of events. The timeliness of detection and reporting of events could have been improved dramatically if the definition of events, according to their characteristics, had been more reasonable and accessible, as well as the improvement of training program for healthcare staff and teachers.

OEM Emergency Response Information

EPA Pesticide Factsheets

The Office of Emergency Management retains records of all incident responses in which it participates. This data asset includes three major sources of information: (1) records maintained by the Regional Office On-Scene Coordinators, principally at the EPAOSC.org web site, (2) all records of incidents managed at the EPA National Response Center (NRC) at EPA Headquarters in Washington, DC and (3) records of responses to oil spills under the Clean Water Act, for which EPA is the oil spill response lead for inland waters. Regional response information is available through EPAOSC.org, but may also be stored elsewhere if the incident is of national significance. EPAOSC.org is a resource for On-Scene Coordinators to access, track and share information with OSCs throughout the country, but it also contains information open to the public.Incident-related environmental sampling data is maintained by the regional offices in the SCRIBE system.NRC records have been maintained in the Emergency Response Notification System (ERNS). This information is available to the public through the Right to Know Network (RTKnet.ombwatch.org). Incidents reported to NRC range from minor to serious, from an oil-sheen on water to a release of thousands of gallons. NRC reports are extensive, but also known to be incomplete, as many incidents are never reported, and those that are reported generally are not subject to verification.

The development and implementation of a Hospital Emergency Response Team (HERT) for out-of-hospital surgical care.

PubMed

Scott, Christopher; Putnam, Brant; Bricker, Scott; Schneider, Laura; Raby, Stephanie; Koenig, William; Gausche-Hill, Marianne

2012-06-01

Over the past two decades, Los Angeles County has implemented a Hospital Emergency Response Team (HERT) to provide on-scene, advanced surgical care of injured patients as an element of the local Emergency Medical Services (EMS) system. Since 2008, the primary responsibility of the team has been to perform surgical procedures in the austere field setting when prolonged extrication is anticipated. Following the maxim of "life over limb," the team is equipped to provide rapid amputation of an entrapped extremity as well as other procedures and medical care, such as anxiolytics and advanced pain control. This report describes the development and implementation of a local EMS system HERT.

InteractInteraction mechanism of emergency response in geological hazard perception and risk management: a case study in Zhouqu county

NASA Astrophysics Data System (ADS)

Qi, Yuan; Zhao, Hongtao

2017-04-01

China is one of few several natural disaster prone countries, which has complex geological and geographical environment and abnormal climate. On August 8, 2010, a large debris flow disaster happened in Zhouqu Country, Gansu province, resulting in more than 1700 casualties and more than 200 buildings damaged. In order to percept landslide and debris flow, an early warning system was established in the county. Spatial information technologies, such as remote sensing, GIS, and GPS, play core role in the early warning system, due to their functions in observing, analyzing, and locating geological disasters. However, all of these spatial information technologies could play an important role only guided by the emergency response mechanism. This article takes the establishment of Zhouqu Country's Disaster Emergency Response Interaction Mechanism (DERIM) as an example to discuss the risk management of country-level administrative units. The country-level risk management aims to information sharing, resources integration, integrated prevention and unified command. Then, nine subsystems support DERIM, which included disaster prevention and emergency data collection and sharing system, joint duty system, disaster verification and evaluation system, disaster consultation system, emergency warning and information release system, emergency response system, disaster reporting system, plan management system, mass prediction and prevention management system. At last, an emergency command platform in Zhouqu Country built up to realize DERIM. The core mission of the platform consists of daily management of disaster, monitoring and warning, comprehensive analysis, information release, consultation and decision-making, emergency response, etc. Five functional modules, including module of disaster information management, comprehensive monitoring module (geological monitoring, meteorological monitoring, water conservancy and hydrological monitoring), alarm management module, emergency command and disaster dispatching management module are developed on the basis of this platform. Based on the internet technology, an web-based office platform is exploited for the nodes scattered in departments and towns, which includes daily business, monitoring and warning, alarm notification, alarm recording, personnel management and update in disaster region, query and analysis of real-time observation data, etc. The platform experienced 3 years' test of the duty in flood period since 2013, and two typical disaster cases during this period fully illustrates the effectiveness of the DERIM and the emergency command platform.

Evaluation of Emerging Technologies for Traffic Crash Reporting

DOT National Transportation Integrated Search

1998-02-01

A traffic accident records system is a necessity for a cost-effective safety program at any level of government. The more complete the system, the more potential exists for the application of scarce resources to those accident countermeasures that wi...

Vehicle proximity alert system for highway-railroad grade crossings-prototype research

DOT National Transportation Integrated Search

2001-04-01

This report describes testing of prototype vehicle proximity alert system (VPAS) technologies, and presents and evaluates the results. The object was to determine the feasibility of VPAS for possible use in priority vehicles (i.e., emergency vehicles...

An overview of artificial intelligence and robotics. Volume 1: Artificial intelligence. Part B: Applications

NASA Technical Reports Server (NTRS)

Gevarter, W. B.

1983-01-01

Artificial Intelligence (AI) is an emerging technology that has recently attracted considerable attention. Many applications are now under development. This report, Part B of a three part report on AI, presents overviews of the key application areas: Expert Systems, Computer Vision, Natural Language Processing, Speech Interfaces, and Problem Solving and Planning. The basic approaches to such systems, the state-of-the-art, existing systems and future trends and expectations are covered.

Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics.

PubMed

Verhoef, Linda; Depoortere, Evelyn; Boxman, Ingeborg; Duizer, Erwin; van Duynhoven, Yvonne; Harris, John; Johnsen, Christina; Kroneman, Annelies; Le Guyader, Soizick; Lim, Wilina; Maunula, Leena; Meldal, Hege; Ratcliff, Rod; Reuter, Gábor; Schreier, Eckart; Siebenga, Joukje; Vainio, Kirsti; Varela, Carmen; Vennema, Harry; Koopmans, Marion

2008-02-01

In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe.

Emergence of New Norovirus Variants on Spring Cruise Ships and Prediction of Winter Epidemics

PubMed Central

Depoortere, Evelyn; Boxman, Ingeborg; Duizer, Erwin; van Duynhoven, Yvonne; Harris, John; Johnsen, Christina; Kroneman, Annelies; Le Guyader, Soizick; Lim, Wilina; Maunula, Leena; Meldal, Hege; Ratcliff, Rod; Reuter, Gábor; Schreier, Eckart; Siebenga, Joukje; Vainio, Kirsti; Varela, Carmen; Vennema, Harry; Koopmans, Marion

2008-01-01

In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe. PMID:18258116

The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need.

PubMed

Sun, Jared H; Wallis, Lee A

2012-08-01

As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity. A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage. The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately. The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.

Comparison of emergency medical services systems in the pan-Asian resuscitation outcomes study countries: Report from a literature review and survey.

PubMed

Ong, Marcus E H; Cho, Jungheum; Ma, Matthew Huei-Ming; Tanaka, Hideharu; Nishiuchi, Tatsuya; Al Sakaf, Omer; Abdul Karim, Sarah; Khunkhlai, Nalinas; Atilla, Ridvan; Lin, Chih-Hao; Shahidah, Nur; Lie, Desiree; Shin, Sang Do

2013-02-01

Asia-Pacific countries have unique prehospital emergency care or emergency medical services (EMS) systems, which are different from European or Anglo-American models. We aimed to compare the EMS systems of eight Asia-Pacific countries/regions as part of the Pan Asian Resuscitation Outcomes Study (PAROS), to provide a basis for future comparative studies across systems of care. In the first phase, a systematic literature review of EMS system within the eight PAROS countries/regions of interest was conducted. In the second phase, PAROS site directors were surveyed for additional information about the demographics and characteristics of EMS services at their sites. The database and bibliography search identified 25 eligible articles. The survey of EMS systems was completed by seven PAROS directors. By combining information sources from phases 1 and 2, we found that all PAROS EMS systems were single-tiered, and most were public (vs private) and fire-based (Thailand, Malaysia, Singapore, Taiwan, Japan, Korea). Ambulance personnel were primarily emergency medical technicians and paramedics, except for Thailand and Turkey, whose personnel include nurses and physicians. Personnel were trained to use automated external defibrillators and have basic cardiac life support certification. The service capability of each EMS system in terms of dispatch, airway management and medications, for example, varied greatly. We found variation in the EMS systems across the eight Asia-Pacific countries/regions studied. The findings will inform the construction of a multinational Asia-Pacific research network for future comparative studies and could serve as a model for international research networks. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Suggested Guide for Fire Service Standard Operating Procedures.

ERIC Educational Resources Information Center

Gillett, Merl; Hertzler, Simon L.

Suggested guidelines for the development of fire service standard operating procedures are presented in this document. Section topics are as follow: chain of command; communications; emergency response; apparatus; fire service training; disaster response; aircraft fire safety; mutual aid; national reporting system (example reporting forms);…

Oak Ridge Reservation Public Warning Siren System Annual Test Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

R. F. Gee

2000-10-01

The full operational test of the Oak Ridge Reservation (ORR) Public Warning Siren System (PWSS) was successfully conducted on September 27, 2000. The annual test is a full-scale sounding of the individual siren systems around each of the three Department of Energy (DOE) sites in Oak Ridge, Tennessee. The purpose of the annual test is to demonstrate and validate the siren systems' ability to alert personnel outdoors in the Immediate Notification Zones (INZ) (approximately two miles) around each site. The success of this test is based on two critical functions of the siren system. The first function is system operability.more » The system is considered operable if 90% of the sirens are operational. System diagnostics and direct field observations were used to validate the operability of the siren systems. Based on the diagnostic results and field observations, greater than 90% of the sirens were considered operational. The second function is system audibility. The system is considered audible if the siren could be heard in the immediate notification zones around each of the three sites. Direct field observations, along with sound level measurements, were used to validate the audibility of the siren system. Based on the direct field observations and sound level measurements, the siren system was considered audible. The combination of field observations, system diagnostic status reports, and sound level measurements provided a high level of confidence that the system met and would meet operational requirements upon demand. As part of the overall system test, the Tennessee Emergency Management Agency (TEMA) activated the Emergency Alerting System (EAS), which utilized area radio stations to make announcements regarding the test and to remind residents of what to do in the event of an actual emergency.« less

Handheld Multi-Gas Meters Assessment Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Gustavious; Wald-Hopkins, Mark David; Obrey, Stephen J.

2016-06-27

Handheld multi-gas meters (MGMs) are equipped with sensors to monitor oxygen (O2) levels and additional sensors to detect the presence of combustible or toxic gases in the environment. This report is limited to operational response-type MGMs that include at least four different sensors. These sensors can vary by type and by the monitored chemical. In real time, the sensors report the concentration of monitored gases in the atmosphere near the MGM. In April 2016 the System Assessment and Validation for Emergency Responders (SAVER) Program conducted an operationally-oriented assessment of MGMs. Five MGMs were assessed by emergency responders. The criteria andmore » scenarios used in this assessment were derived from the results of a focus group of emergency responders with experience in using MGMs. The assessment addressed 16 evaluation criteria in four SAVER categories: Usability, Capability, Maintainability, and Deployability.« less

Compliance of middle school-aged babysitters in central Pennsylvania with national recommendations for emergency preparedness and safety practices.

PubMed

Hackman, Nicole M; Cass, Katie; Olympia, Robert P

2012-06-01

To determine the compliance of middle school-aged babysitters with national recommendations for emergency preparedness and safety practices. A prospective, self-administered questionnaire-based study was conducted at 3 middle schools in central Pennsylvania. A total of 1364 questionnaires were available for analysis. Responding babysitters (n = 890) reported previous training that included babysitter (21%), first aid (64%), and cardiopulmonary resuscitation (59%) training. Reported unsafe babysitter practices were leaving a child unattended (36%) and opening the door to a stranger (24%). The most common emergency experience encountered by responding babysitters included cut or scrape (83%), burns (28%), and choking (14%). Ten percent of responding babysitters have activated the 911 system. Middle school-aged babysitters will likely encounter common household emergencies and therefore benefit from first aid training; however, very little difference in safety knowledge was found between trained and untrained babysitters, suggesting modifications in babysitter training programs may be required.

Emergence of Life-Like Properties from Dissipative Self-Assembly of Nanoparticles

NASA Astrophysics Data System (ADS)

Ilday, Serim; Makey, Ghaith; Akguc, Gursoy B.; Yavuz, Ozgun; Tokel, Onur; Pavlov, Ihor; Gulseren, Oguz; Ilday, F. Omer

A profoundly fundamental question at the interface between physics and biology remains open: What are the minimum requirements for emergence of life-like properties from non-living systems? Here, we address this question and report emergent complex behavior of tens to thousands of colloidal nanoparticles in a system designed to be as plain as possible: The system is driven far from equilibrium by ultrafast laser pulses, which create spatiotemporal temperature gradients, inducing Marangoni-type flow that drags the particles towards aggregation; strong Brownian motion, used as source of fluctuations, opposes aggregation. Nonlinear feedback mechanisms naturally arise between the flow, the aggregate, and Brownian motion, allowing fast external control with minimal intervention. Consequently, complex behavior, analogous to those commonly seen in living organisms, emerges, whereby the aggregates can self-sustain, self-regulate, self-replicate, self-heal and can be transferred from one location to another, all within seconds. Aggregates can comprise of only one pattern or bifurcated patterns can co-exist, compete, survive or die.

Traffic-Light-Preemption Vehicle-Transponder Software Module

NASA Technical Reports Server (NTRS)

Bachelder, Aaron; Foster, Conrad

2005-01-01

A prototype wireless data-communication and control system automatically modifies the switching of traffic lights to give priority to emergency vehicles. The system, which was reported in several NASA Tech Briefs articles at earlier stages of development, includes a transponder on each emergency vehicle, a monitoring and control unit (an intersection controller) at each intersection equipped with traffic lights, and a central monitoring subsystem. An essential component of the system is a software module executed by a microcontroller in each transponder. This module integrates and broadcasts data on the position, velocity, acceleration, and emergency status of the vehicle. The position, velocity, and acceleration data are derived partly from the Global Positioning System, partly from deductive reckoning, and partly from a diagnostic computer aboard the vehicle. The software module also monitors similar broadcasts from other vehicles and from intersection controllers, informs the driver of which intersections it controls, and generates visible and audible alerts to inform the driver of any other emergency vehicles that are close enough to create a potential hazard. The execution of the software module can be monitored remotely and the module can be upgraded remotely and, hence, automatically

Emergency psychiatric services for individuals with intellectual disabilities: perspectives of hospital staff.

PubMed

Lunsky, Yona; Gracey, Carolyn; Gelfand, Sara

2008-12-01

Strains on the mainstream mental health system can result in inaccessible services that force individuals with intellectual disabilities into the emergency room (ER) when in psychiatric crisis. The purpose of this study was to identify clinical and systemic issues surrounding emergency psychiatry services for people with intellectual disabilities, from the perspective of hospital staff. Focus groups were conducted with emergency psychiatry staff from 6 hospitals in Toronto, Canada. Hospital staff reported a lack of knowledge regarding intellectual disabilities and a shortage of available community resources. Hospital staff argued that caregivers need more community and respite support to feel better equipped to deal with the crisis before it escalates to the ER and that hospital staff feel ill prepared to provide the necessary care when the ER is the last resort. Input from hospital staff pointed to deficiencies in the system that lead caregivers to use the ER when other options have been exhausted. Both staff and caregivers need support and access to appropriate services if the system is to become more effective at serving the psychiatric needs of this complex population.

Framework for Real-Time All-Hazards Global Situational Awareness

DOE Office of Scientific and Technical Information (OSTI.GOV)

Omitaomu, Olufemi A; Fernandez, Steven J; Bhaduri, Budhendra L

Information systems play a pivotal role in emergency response by making consequence analysis models based on up-to-date data available to decision makers. While consequence analysis models have been used for years on local scales, their application on national and global scales has been constrained by lack of non-proprietary data. This chapter describes how this has changed using a framework for real-time all-hazards situational awareness called the Energy Awareness and Resiliency Standardized Services (EARSS) as an example. EARSS is a system of systems developed to collect non-proprietary data from diverse open content sources to develop a geodatabase of critical infrastructures allmore » over the world. The EARSS system shows that it is feasible to provide global disaster alerts by producing valuable information such as texting messages about detected hazards, emailing reports about affected areas, estimating an expected number of impacted people and their demographic characteristics, identifying critical infrastructures that may be affected, and analyzing potential downstream effects. This information is provided in real-time to federal agencies and subscribers all over the world for decision making in humanitarian assistance and emergency response. The system also uses live streams of power outages, weather, and satellite surveillance data as events unfold. This, in turn, is combined with other public domain or open content information, such as media reports and postings on social networking websites, for complete coverage of the situation as events unfold. Working with up-to-date information from the EARSS system, emergency responders on the ground could pre-position their staff and resources, such as emergency generators and ice, where they are most needed.« less

Emerging Communication Technologies (ECT) Phase 2 Report. Volume 1; Main Report

NASA Technical Reports Server (NTRS)

Bastin, Gary L.; Harris, William G.; Chiodini, Robert; Nelson, Richard A.; Huang, PoTien; Kruhm, David A.

2003-01-01

The Emerging Communication Technology (ECT) project investigated three First Mile communication technologies in support of NASA s Second Generation Reusable Launch Vehicle (2nd Gen RLV), Orbital Space Plane, Advanced Range Technology Working Group (ARTWG) and the Advanced Spaceport Technology Working Group (ASTWG). These First Mile technologies have the purpose of interconnecting mobile users with existing Range Communication infrastructures. ECT was a continuation of the Range Information System Management (RISM) task started in 2002. RISM identified the three advance communication technologies investigated under ECT. These were Wireless Ethernet (Wi-Fi), Free Space Optics (FSO), and Ultra Wideband (UWB). Due to the report s size, it has been broken into three volumes: 1) Main Report 2) Appendices 3) UWB.

The Fort McMurray, Alberta wildfires: Emergency and recovery management of healthcare services.

PubMed

Matear, David

2017-01-01

One of the largest wildfires in Canadian history raged through northern Alberta in May to July 2016, and prompted the largest emergency air evacuation in Canadian history. Central to the challenges were the evacuation of a regional hospital, and the emergency and recovery management associated with healthcare services. This paper describes multiple phases of emergency and recovery management, which employed and adapted the Incident Command System to healthcare services. There were no injuries reported throughout the medical evacuation and recovery of medical services. The leadership and management of healthcare services achieved the goals of evacuating patients and staff effectively, supporting emergency first responders and the re-entry of the population to Fort McMurray.

National Antimicrobial Resistance Monitoring System (NARMS) 2010 Report

USDA-ARS?s Scientific Manuscript database

In an effort to prospectively monitor the emergence of antimicrobial resistance in zoonotic pathogens, the National Antimicrobial Resistance Monitoring System (NARMS) was established in 1996 by the Food and Drug Administration’s Center for Veterinary Medicine in collaboration with the Centers for Di...

A Profile of Indian Health Service Emergency Departments.

PubMed

Bernard, Kenneth; Hasegawa, Kohei; Sullivan, Ashley; Camargo, Carlos

2017-06-01

The Indian Health Service provides health care to eligible American Indians and Alaskan Natives. No published data exist on emergency services offered by this unique health care system. We seek to determine the characteristics and capabilities of Indian Health Service emergency departments (EDs). All Indian Health Service EDs were surveyed about demographics and operational characteristics for 2014 with the National Emergency Department Inventory survey (available at http://www.emnet-nedi.org/). Of the forty eligible sites, there were 34 respondents (85% response rate). Respondents reported a total of 637,523 ED encounters, ranging from 521 to 63,200 visits per site. Overall, 85% (95% confidence interval 70% to 94%) had continuous physician coverage. Of all physicians staffing the ED, a median of 13% (interquartile range 0% to 50%) were board certified or board prepared in emergency medicine. Overall, 50% (95% confidence interval 34% to 66%) of respondents reported that their ED was operating over capacity. Indian Health Service EDs varied widely in visit volume, with many operating over capacity. Most were not staffed by board-certified or -prepared emergency physicians. Most lacked access to specialty consultation and telemedicine capabilities. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Integrating pathology and radiology disciplines: an emerging opportunity?

PubMed Central

2012-01-01

Pathology and radiology form the core of cancer diagnosis, yet the workflows of both specialties remain ad hoc and occur in separate "silos," with no direct linkage between their case accessioning and/or reporting systems, even when both departments belong to the same host institution. Because both radiologists' and pathologists' data are essential to making correct diagnoses and appropriate patient management and treatment decisions, this isolation of radiology and pathology workflows can be detrimental to the quality and outcomes of patient care. These detrimental effects underscore the need for pathology and radiology workflow integration and for systems that facilitate the synthesis of all data produced by both specialties. With the enormous technological advances currently occurring in both fields, the opportunity has emerged to develop an integrated diagnostic reporting system that supports both specialties and, therefore, improves the overall quality of patient care. PMID:22950414

Emerging photovoltaic module technologies at PVUSA: A five-year assessment

NASA Astrophysics Data System (ADS)

Townsend, Tim

1995-04-01

The Photovoltaics for Utility Scale Applications (PVUSA) project tests two types of photovoltaic systems: new modules fielded as 20-kW emerging module technology (EMT) arrays, and more mature technologies fielded as 20- to 500-kW turnkey utility scale (US) systems. This report summarizes experiences of the PVUSA project in operating the first six 20-kW EMT photovoltaic systems. Five systems are installed at Davis, California, and one at Kihei, Hawaii. Products selected for testing and demonstration were judged to have potential for significant technical advancement or reduction in manufacturing cost. Features leading to selection of each system and findings over the average 5 years of operation are compared in the report. Factory product qualification test experiences along with field acceptance test results are documented. Evaluation includes a broad range of performance parameters, including long-term efficiency, seasonal generation patterns, and maintenance. While some of the arrays have operated as well as any commercial system, others have fared poorly. Throughout the procurement and operation of these precommercial PV modules, PVUSA has provided feedback to vendors, critical for product improvement. The data and evaluations in this report will be of further benefit to manufacturers and provide general comparative information on a variety of technologies to researchers in utilities, government, and industry alike.

Preparedness and Emergency Response Research Centers: Using a Public Health Systems Approach to Improve All-Hazards Preparedness and Response

PubMed Central

Leinhos, Mary; Williams-Johnson, Mildred

2014-01-01

In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems. PMID:25355970

Yacht Race Monitoring

NASA Technical Reports Server (NTRS)

1981-01-01

Observer Single-handed Transatlantic Race (OSTAR) participants were aided by a French-American space-based monitoring system which reported the yacht's positions throughout the race, and also served as an emergency locator service. Originating from NASA's Nimbus 6 Satellite, use of this system, called ARGOS made the OSTAR competition the most accurately reported sea race ever conducted. Each boat carried a portable transmitter allowing 88 new sources of oceanographic data available during the race.

'Sorting the Wheat from the Chaff': Investigating Overload in Educational Discussion Systems

ERIC Educational Resources Information Center

Kear, Karen; Heap, N.W.

2007-01-01

This paper reports on research to investigate design features of asynchronous discussion systems for higher education. The research aims to identify features that increase the benefits of discussion systems and reduce the problems. The paper focuses on a major theme that emerged from interviews with learners and teachers: information overload.…

Emergency Locator Transmitter Survivability and Reliability Study

NASA Technical Reports Server (NTRS)

Stimson, Chad M.; Littell, Justin D.; Mazzuca, Lisa M.; Foster, Anthony W.; Theodorakos, George J.

2017-01-01

A comprehensive study of Emergency Locator Transmitter (ELT) performance was conducted over a three year period concluding in 2016 in support of the Search and Rescue (SAR) Mission Office at National Aeronautics and Space Administration (NASA) Goddard Space Flight Center (GSFC). The study began with a review of reported performance cited in a collection of works published as early as 1980 as well as analysis of a focused set of contemporary aviation crash reports. Based on initial research findings, a series of subscale and fullscale system tests were performed at NASA Langley Research Center (LaRC) with the goals of investigating ELT system failure modes and developing recommended improvements to the Radio Technical Commission for Aeronautics (RTCA) Minimum Operational Performance Specification (MOPS) that will result in improved system performance. Enhanced performance of ELT systems in aviation accidents will reduce unnecessary loss of human life and make SAR operations safer and less costly by reducing the amount of time required to locate accident sites.

Emerging Communication Technologies (ECT) Phase 3 Final Report

NASA Technical Reports Server (NTRS)

Bastin, Gary L.; Harris, William G.; Bates, Lakesha D.; Nelson, Richard A.

2004-01-01

The Emerging Communication Technology (ECT) project investigated three First Mile communication technologies in support of NASA s Second Generation Reusable Launch Vehicle (2nd Gen RLV), Orbital Space Plane, Advanced Range Technology Working Group (ARTWG) and the Advanced Spaceport Technology Working Group (ASTWG). These First Mile technologies have the purpose of interconnecting mobile users with existing Range Communication infrastructures. ECT was a continuation of the Range Information System Management (RISM) task started in 2002. RISM identified the three advance communication technologies investigated under ECT. These were Wireless Ethernet (Wi-Fi), Free Space Optics (FSO), and Ultra Wideband (UWB). Due to the report s size, it has been broken into three volumes: 1) Main Report 2) Appendices 3) UWB.

Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

PubMed

Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario

2010-01-01

The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

A review of emerging non-volatile memory (NVM) technologies and applications

NASA Astrophysics Data System (ADS)

Chen, An

2016-11-01

This paper will review emerging non-volatile memory (NVM) technologies, with the focus on phase change memory (PCM), spin-transfer-torque random-access-memory (STTRAM), resistive random-access-memory (RRAM), and ferroelectric field-effect-transistor (FeFET) memory. These promising NVM devices are evaluated in terms of their advantages, challenges, and applications. Their performance is compared based on reported parameters of major industrial test chips. Memory selector devices and cell structures are discussed. Changing market trends toward low power (e.g., mobile, IoT) and data-centric applications create opportunities for emerging NVMs. High-performance and low-cost emerging NVMs may simplify memory hierarchy, introduce non-volatility in logic gates and circuits, reduce system power, and enable novel architectures. Storage-class memory (SCM) based on high-density NVMs could fill the performance and density gap between memory and storage. Some unique characteristics of emerging NVMs can be utilized for novel applications beyond the memory space, e.g., neuromorphic computing, hardware security, etc. In the beyond-CMOS era, emerging NVMs have the potential to fulfill more important functions and enable more efficient, intelligent, and secure computing systems.

Improved satellite-based emergency alerting system

NASA Astrophysics Data System (ADS)

Bernard, E. N.; Milburn, H. B.

1991-12-01

Rapid-onset natural hazards have claimed more than 2.8 million lives worldwide in the past 20 years. This category includes such events as earthquakes, landslides, hurricanes, tornadoes, floods, volcanic eruptions, wildfires, and tsunamis. Effective hazard mitigation is particularly difficult in such cases, since the time available to issue warnings can be very short or even nonexistent. A general approach to mitigate the effects of these disasters was demonstrated in 1988 that included preevent emergency planning, real-time hazard assessment, and rapid warning via satellite communication links. This article reports on improvements in this satellite-based emergency alerting communication system that have reduced the response time from 87 to 17 sec and expanded the broadcast coverage from 40 percent to 62 percent of the earth's surface.

Ethics of emergency department triage: SAEM position statement. SAEM Ethics Committee (Society for Academic Emergency Medicine).

PubMed

1995-11-01

Emergency department overcrowding, the growth of managed care, and the high cost of emergency care are creating pressures to triage patients away from U.S. EDs. Paradoxically, this pressure to limit patient access to EDs has increased in spite of federal laws that restrict patient triage and transfer. The latter regulations view EDs as the safety net for the U.S. health care system. The SAEM Ethics Committee evaluated the ethical implications of policies that triage patients out of the ED prior to complete evaluation and treatment. The committee used these implications to develop practical guidelines, which are reported.

Students' Expectations from Technology in Mathematical Tasks: Mathematical Relationships between Objects, Instrumental Genesis and Emergent Goals

ERIC Educational Resources Information Center

Laina, Vasiliki; Monaghan, John

2014-01-01

This paper reports on two students' work on geometry tasks in a dynamic geometry system. It augments prior work on students' instrumental geneses via a consideration of emergent goals that arise in students' work. It offers a way to interpret students' (working with new software) awareness of what software can and cannot do and students'…

Resolve and Resources to Get a Qualified Teacher in Every Classroom. Challenge to Lead Series

ERIC Educational Resources Information Center

Cornett, Lynn M.; Gaines, Gale F.

2004-01-01

This report highlights how key parts of the teacher work force "system" should work together and helps you ask--and answer--questions about emerging solutions that offer promise. Policy-makers in SREB states should focus on five policy areas in which there is now considerable data, plus three emerging policy areas that are growing in importance.…

The first cases of Candida auris candidaemia in Oman.

PubMed

Mohsin, Jalila; Hagen, Ferry; Al-Balushi, Zainab A M; de Hoog, G Sybren; Chowdhary, Anuradha; Meis, Jacques F; Al-Hatmi, Abdullah M S

2017-09-01

Candida auris has been recognised as a problematic healthcare-associated emerging yeast which is often misidentified as Candida haemulonii by commercial systems. Correct early identification of C. auris is important for appropriate antifungal treatment and implementing effective infection control measures. Here we report emergence of the first C. auris cases in Oman, initially misidentified as C. haemulonii. © 2017 Blackwell Verlag GmbH.

A time-motion study of ambulance-to-emergency department radio communications.

PubMed

Penner, Mark S; Cone, David C; MacMillan, Don

2003-01-01

A prospective time-motion study of radio communication between inbound ambulances and emergency department (ED) triage personnel was conducted to assess hospital triage staff time utilized, and how often radio reports result in actions taken in the ED to prepare for patient arrival. The study hypothesis was that reports for "priority 2" (P2, nonemergent) patients rarely provide information that is acted upon in the ED prior to the patient's arrival. The study was conducted at an academic adult ED receiving 22,000 ambulances per year. An observer in the ED monitored and timed (to the second) all radio reports as well as the activities of triage nurses and arriving emergency medical services (EMS) personnel. A convenience sample of 437 reports was collected: 83 priority 1 (P1, emergent) and 354 P2. Average report times (minutes:seconds) with ranges were 0:53 (0:07-1:57) for P1, and 0:44 (0:04-3:50) for P2. Only 16% of the P2 reports resulted in any preparatory action, and 55% of these were requests to have hospital police officers available to receive intoxicated patients, as per local protocol. An in-person report was given in the ED for 61% of the P2 cases, and in 48% of these, the in-person report was longer than the radio report. In the system studied, P2 reports rarely provide information that is acted on prior to the patient's arrival. The time spent giving a radio report is frequently duplicated in the ED. Radio reports for low-priority patients may not be an efficient or productive use of providers' or nurses' time.

77 FR 7171 - Agency Information Collection Activities: Proposed Collection; Comment Request, National Fire...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

..., National Fire Incident Reporting System (NFIRS) v5.0 AGENCY: Federal Emergency Management Agency, DHS... accordance with the Paperwork Reduction Act of 1995, this notice seeks comments concerning National Fire... standardized reporting methods, to collect and analyze fire incident data at the Federal, State, and local...

75 FR 18832 - Agency Information Collection Activities: Existing Collection; Emergency Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

... regulation or order. Accordingly, the EEOC issued regulations prescribing the reporting requirements for... Commission (EEOC or Commission) announces that it submitted to the Office of Management and Budget (OMB) a... and secondary public school systems and districts have been required to submit EEO-5 reports to EEOC...

75 FR 63180 - Agency Information Collection Activities: Existing Collection; Emergency Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-14

... regulation or order. Accordingly, the EEOC issued regulations prescribing the reporting requirements for... Commission (EEOC or Commission) announces that it submitted to the Office of Management and Budget (OMB) a... and secondary public school systems and districts have been required to submit EEO-5 reports to EEOC...

75 FR 6392 - Ageny Information Collection Activities: Existing Collection; Emergency Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... regulation or order. Accordingly, the EEOC issued regulations prescribing the reporting requirements for... Commission (EEOC or Commission) announces that it submitted to the Office of Management and Budget (OMB) a... and secondary public school systems and districts have been required to submit EEO-5 reports to EEOC...

75 FR 40828 - Agency Information Collection Activities: Existing Collection; Emergency Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

... regulation or order. Accordingly, the EEOC issued regulations prescribing the reporting requirements for... Commission (EEOC or Commission) announces that it submitted to the Office of Management and Budget (OMB) a... and secondary public school systems and districts have been required to submit EEO-5 reports to EEOC...

Family Support & Health Care: Working Together for Healthy Families.

ERIC Educational Resources Information Center

Lalley, Jacqueline, Ed.; Ahsan, Nilofer, Ed.

1998-01-01

This report of the Family Resource Coalition of America examines partnerships between family support programs and health care providers, forged to ensure that the comprehensive needs of families are met. The report begins with two articles, "Family Support and the Emerging Health System" and "Social and Economic Issues Affecting…

Sustainability Reporting at Schools: Challenges and Benefits

ERIC Educational Resources Information Center

Carbach, Eva; Fischer, Daniel

2017-01-01

Despite advances made there is still an implementation gap with regard to Education for Sustainable Development (ESD) in formal educational systems at the school level. The present paper focuses on sustainability reporting as a recently emerging practice in the school sector. It presents the approach and findings of an exploratory interview study…

An integrated process and management tools for ranking multiple emerging threats to animal health.

PubMed

Del Rio Vilas, Victor J; Voller, Fay; Montibeller, Gilberto; Franco, L Alberto; Sribhashyam, Sumitra; Watson, Eamon; Hartley, Matt; Gibbens, Jane C

2013-02-01

The UK's Department for Environment, Food and Rural Affairs supports the use of systematic tools for the prioritisation of known and well defined animal diseases to facilitate long and medium term planning of surveillance and disease control activities. The recognition that emerging events were not covered by the existing disease-specific approaches led to the establishment of the Veterinary Risk Group (VRG), constituted of government officials, and supporting structures such as the Risk Management Cycle and the Emerging Threat Highlight Report (ETHiR), to facilitate the identification, reporting and assessment of emerging threats to UK's animal health. Since its inception in November 2009 to the end of February 2011, the VRG reviewed 111 threats and vulnerabilities (T&V) reported through ETHiR. In July 2010 a decision support system (DSS) based on multi-criteria-decision-analysis (MCDA) improved ETHiR to allow the systematic prioritisation of emerging T&V. The DSS allows the regular ranking of emerging T&V by calculating a set of measurement indices related to the actual impact, possible impact on public perception and level of available capabilities associated with every T&V. The systematic characterisation of the processes leading to the assessment of T&V by the VRG has led to a consistent, auditable and transparent approach to the identification and assessment of emerging risks. The regular use of MCDA to manage a portfolio of emerging risks represents a different and novel application of MCDA in a health related context. Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.

Image-based tracking: a new emerging standard

NASA Astrophysics Data System (ADS)

Antonisse, Jim; Randall, Scott

2012-06-01

Automated moving object detection and tracking are increasingly viewed as solutions to the enormous data volumes resulting from emerging wide-area persistent surveillance systems. In a previous paper we described a Motion Imagery Standards Board (MISB) initiative to help address this problem: the specification of a micro-architecture for the automatic extraction of motion indicators and tracks. This paper reports on the development of an extended specification of the plug-and-play tracking micro-architecture, on its status as an emerging standard across DoD, the Intelligence Community, and NATO.

A Coordinated Emergency Response: A Color Dust Explosion at a 2015 Concert in Taiwan

PubMed Central

Yang, Chih-Ching

2016-01-01

In June 2015, nearly 500 concert attendees suffered injuries from smoke inhalation and severe burns following a color-dust explosion at a waterpark in Taiwan. We report on the progressions of the incident and government responses, share cross-departmental mobilization and case management lessons, and reflect on clinical and complex policy issues emerged. The timely and coordinated emergency responses, a high-quality universal health care system, and dedicated clinicians voluntarily working overtime resulted in an unprecedented 2.4% mortality rate (international statistics predicted 26.8%). PMID:27459446

Community Environmental Response Facilitation Act (CERFA) Report, Sacramento Army Depot, Sacramento, California

DTIC Science & Technology

1994-04-01

Response, Compensation, and Liability Information System CERFA Community Environmental Response Facilitation Act CORTESE State-designated hazardous...waste cleanup sites DESCOM U.S. Army Depot Systems Command DTSC Department of Toxic Substance Control EMD Environmental Management Division EPA U.S...Environmental Protection Agency ERNS Emergency Response Notification system FFA Federal Facility Agreement FINDS Facility index system HWCSA Hazardous

Emergency Warning Systems. Part 2. Warning Systems - Evaluation Guidelines.

DTIC Science & Technology

1983-07-01

ELEMENT. PROJECT. TASK AREA A WORK UNIT NUMBERS PRC Voorhees Work Unit 2234G 1500 Planning Research Drive McLean, Virginia 22102 ___ 11. CONTROLLING ...different from Controlling Office) IS. SECURITY CLASS. (of this report) Unclassified 15a. DECLASSIFICATION/DOWNGRADING SCHEDULE 16. DISTRIBUTION...systems that control these warning systems are discussed. Test results of several warning systems are included along with a discussion of sound

Is School Funding Fair? A National Report Card. Third Edition

ERIC Educational Resources Information Center

Baker, Bruce D.; Sciarra, David G.; Farrie, Danielle

2014-01-01

The third edition of the National Report Card examines the condition of states' finance systems as the country emerges from the Great Recession, but is still wrestling with its consequences. As in prior editions, this Third Edition of the National Report Card continues to make the case for states to take immediate and longer-term action to improve…

An Analysis of State Public Health Emergency Declarations

PubMed Central

2014-01-01

Disaster responses often involve coordination among multiple levels of government and public and private sector collaboration. When emergencies raise health concerns, governments must include public health and health care systems in their response. A state government’s declaration of “public health emergency” can provide that state’s health sector with flexibility and guidance about response parameters. Although events including Hurricanes Katrina and Sandy and the H1N1 influenza outbreak provided opportunities for states to deploy their public health emergency powers, little has been reported about how states have used their authority to declare a public health emergency. I present a systematic identification and analysis of states’ public health emergency declarations, examine why these declarations were issued, and discuss their potential value. PMID:25033156

Barriers in detecting elder abuse among emergency medical technicians.

PubMed

Reingle Gonzalez, Jennifer M; Cannell, M Brad; Jetelina, Katelyn K; Radpour, Sepeadeh

2016-09-02

Elder abuse and neglect are highly under-reported in the United States. This may be partially attributed to low incidence of reporting among emergency medical technicians' (EMTs), despite state-mandated reporting of suspected elder abuse. Innovative solutions are needed to address under-reporting. The objective was to describe EMTs' experience detecting and reporting elder abuse. Qualitative data were collected from 11 EMTs and 12 Adult Protective Services (APS) caseworkers that participated in one of five semi-structured focus groups. Focus group data were iteratively coded by two coders. Findings suggest a number of barriers prevent EMTs from reporting elder abuse to APS. Participants suggested that limited training on elder abuse detection or reporting has been provided to them. EMTs suggested that training, creation of an automated reporting system or brief screening tool could be used to enhance EMT's ability to detect and communicate suspected cases of elder abuse to APS. Results from the present study suggest that EMTs may be uniquely situated to serve as elder abuse and neglect surveillance personnel. EMTs are eager to work with APS to address the under-reporting of elder abuse and neglect, but training is minimal and current reporting procedures are time-prohibitive given their primary role as emergency healthcare providers. Future studies should seek to translate these findings into practice by identifying specific indicators predictive of elder abuse and neglect for inclusion on an automated reporting instrument for EMTs.

Real-Time Surveillance of Infectious Diseases: Taiwan's Experience.

PubMed

Jian, Shu-Wan; Chen, Chiu-Mei; Lee, Cheng-Yi; Liu, Ding-Ping

Integration of multiple surveillance systems advances early warning and supports better decision making during infectious disease events. Taiwan has a comprehensive network of laboratory, epidemiologic, and early warning surveillance systems with nationwide representation. Hospitals and clinical laboratories have deployed automatic reporting mechanisms since 2014 and have effectively improved timeliness of infectious disease and laboratory data reporting. In June 2016, the capacity of real-time surveillance in Taiwan was externally assessed and was found to have a demonstrated and sustainable capability. We describe Taiwan's disease surveillance system and use surveillance efforts for influenza and Zika virus as examples of surveillance capability. Timely and integrated influenza information showed a higher level and extended pattern of influenza activity during the 2015-16 season, which ensured prompt information dissemination and the coordination of response operations. Taiwan also has well-developed disease detection systems and was the first country to report imported cases of Zika virus from Miami Beach and Singapore. This illustrates a high level of awareness and willingness among health workers to report emerging infectious diseases, and highlights the robust and sensitive nature of Taiwan's surveillance system. These 2 examples demonstrate the flexibility of the surveillance systems in Taiwan to adapt to emerging infectious diseases and major communicable diseases. Through participation in the GHSA, Taiwan can more actively collaborate with national counterparts and use its expertise to strengthen global and regional surveillance capacity in the Asia Pacific and in Southeast Asia, in order to advance a world safe and secure from infectious disease.

Real-Time Surveillance of Infectious Diseases: Taiwan's Experience

PubMed Central

Jian, Shu-Wan; Chen, Chiu-Mei; Lee, Cheng-Yi

2017-01-01

Integration of multiple surveillance systems advances early warning and supports better decision making during infectious disease events. Taiwan has a comprehensive network of laboratory, epidemiologic, and early warning surveillance systems with nationwide representation. Hospitals and clinical laboratories have deployed automatic reporting mechanisms since 2014 and have effectively improved timeliness of infectious disease and laboratory data reporting. In June 2016, the capacity of real-time surveillance in Taiwan was externally assessed and was found to have a demonstrated and sustainable capability. We describe Taiwan's disease surveillance system and use surveillance efforts for influenza and Zika virus as examples of surveillance capability. Timely and integrated influenza information showed a higher level and extended pattern of influenza activity during the 2015-16 season, which ensured prompt information dissemination and the coordination of response operations. Taiwan also has well-developed disease detection systems and was the first country to report imported cases of Zika virus from Miami Beach and Singapore. This illustrates a high level of awareness and willingness among health workers to report emerging infectious diseases, and highlights the robust and sensitive nature of Taiwan's surveillance system. These 2 examples demonstrate the flexibility of the surveillance systems in Taiwan to adapt to emerging infectious diseases and major communicable diseases. Through participation in the GHSA, Taiwan can more actively collaborate with national counterparts and use its expertise to strengthen global and regional surveillance capacity in the Asia Pacific and in Southeast Asia, in order to advance a world safe and secure from infectious disease. PMID:28418738

The discrepancy rate between preliminary and official reports of emergency radiology studies: a performance indicator and quality improvement method.

PubMed

Issa, Ghada; Taslakian, Bedros; Itani, Malak; Hitti, Eveline; Batley, Nicholas; Saliba, Miriam; El-Merhi, Fadi

2015-05-01

At teaching hospitals, radiology residents give preliminary reports for imaging studies requested from the Emergency Department (ED). Discrepancy rates between preliminary and final reports represent an important performance indicator. To present a system for feedback and follow-up of discrepancies, identify the variables associated with the rate and severity of such discrepancies, target the weaknesses, and suggest the need of a standard reference value for comparison among institutions. A monitoring and communication system between the Department of Diagnostic Radiology and Emergency Department was initiated to mark and follow all studies from the ED for which the official reading was different than the preliminary interpretation. Data analysis was performed on all studies from 1 June 2011 to 31 May 2012, based on the severity of the discrepancy, imaging modality, resident training level, and organ system. The distribution of the number of discrepancies among the different resident levels and imaging modalities was determined, as well as the distribution of three severity scores in correlation with other variables. The overall discrepancy rate was 1.62%. The discrepancy rate was higher for first and second year residents (1.62% and 1.96%) than for third and fourth year residents (1.35% and 1.24%). It was higher for computed tomography (2.13%) than for radiographs (1.29%) and ultrasound (0.8%) (P value < 0.01), and higher for musculoskeletal (1.61%) than non-musculoskeletal (0.99%) radiographs (P value = 0.0003). Discrepancies with severity score one constituted 35.5% of the total discrepancies, those with severity scores two and three constituted 22.9% and 41.6%, respectively. We have demonstrated a system for follow-up of discrepancy in interpreting emergency radiology studies, and recorded the discrepancy rate, with further analysis based on different variables. In terms of quality assurance, a periodical analysis might help to reduce the number of discrepant reports by targeted intervention. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An Analysis of Adverse Events in the Rehabilitation Department: Using the Veterans Affairs Root Cause Analysis System.

PubMed

Hagley, Gregory W; Mills, Peter D; Shiner, Brian; Hemphill, Robin R

2018-04-01

Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists. The objective of this study was to determine the types of AEs, root causes, and action plans for risk mitigation that exist within the disciplines of rehabilitation medicine. This study is a retrospective, cross-sectional review. A national search of the Veterans Health Administration RCA database was conducted to identify reports describing AEs associated with physical therapy, occupational therapy, or speech and language pathology services between 2009 and May 2016. Twenty-five reports met the inclusion requirements. The reports were classified by the event type, root cause, action plans, and strength of action plans. Delays in care (32.0%) and falls (28.0%) were the most common type of AE. Three AEs resulted in death. RCA teams identified deficits regarding policy and procedures as the most common root cause. Eighty-eight percent of RCA reports included strong or intermediate action plans to mitigate risk. Strong action plans included standardizing emergency terminology and implementing a dedicated line to call for an emergency response. These data are self-reported and only AEs that are scored as a safety assessment code 3 in the system receive a full RCA, so there are likely AEs that were not captured in this study. In addition, the RCA reports are deidentified and so do not include all patient characteristics. As the Veterans Health Administration system services mostly men, the data might not generalize to non-Veterans Health Administration systems with a different patient mix. Care provided by rehabilitation professionals is generally safe, but AEs do occur. Based on this RCA review, the safety of rehabilitation services can be improved by implementing strong practices to mitigate risk to patients. Checklists should be considered to aid timely decision making when initiating an emergency response.

Implementing the Hospital Emergency Incident Command System: an integrated delivery system's experience.

PubMed

Zane, Richard D; Prestipino, Ann L

2004-01-01

Hospital disaster manuals and response plans often lack formal command structure; instead, they rely on the presence of key individuals who are familiar with hospital operations, or who are in leadership positions during routine, day-to-day operations. Although this structure occasionally may prove to be successful, it is unreliable, as this leadership may be unavailable at the time of the crisis, and may not be sustainable during a prolonged event. The Hospital Emergency Incident Command System (HEICS) provides a command structure that does not rely on specific individuals, is flexible and expandable, and is ubiquitous in the fire service, emergency medical services, military, and police agencies, thus allowing for ease of communication during event management. A descriptive report of the implementation of the HEICS throughout a large healthcare network is reviewed. Implementation of the HEICS provides a consistent command structure for hospitals that enables consistency and commonality with other hospitals and disaster response entities.

Managing aging in nuclear power plants: Insights from NRC maintenance team inspection reports

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fresco, A.; Subudhi, M.; Gunther, W.

1993-12-01

A plant`s maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of 67 of the reports issued on these in-depth team inspections were reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant systems, structures, and components. Relevant information was extracted from these inspection reports and sorted into several categories, including Specific Aging Insights, Preventive Maintenance,more » Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified. The information also was sorted according to systems and components, including: Auxiliary Feedwater, Main Feedwater, High Pressure Injection for both BWRs and PWRs, Service Water, Instrument Air, and Emergency Diesel Generator Air Start Systems, and Emergency Diesel Generators Air Start Systems, emergency diesel generators, electrical components such as switchgear, breakers, relays, and motor control centers, motor operated valves and check valves. This information was compared to insights gained from the Nuclear Plant Aging Research (NPAR) Program. Attributes of plant maintenance programs where the NRC inspectors felt that improvement was needed to properly address the aging issue also are discussed.« less

21 CFR Appendix E to Subpart A of... - Elements To Be Considered in Developing a Two-Way Alert System

Code of Federal Regulations, 2010 CFR

2010-04-01

... hazards evaluation and classification —Language of communication and transmission of information 2. Crisis Management System —Crisis analysis and communication mechanisms —Establishment of contact points —Reporting... Considered in Developing a Two-Way Alert System 1. Documentation —Definition of a crisis/emergency and under...

Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

PubMed

Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

2015-11-01

Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group.

PubMed

Nichol, Graham; Rumsfeld, John; Eigel, Brian; Abella, Benjamin S; Labarthe, Darwin; Hong, Yuling; O'Connor, Robert E; Mosesso, Vincent N; Berg, Robert A; Leeper, Barbara Bobbi; Weisfeldt, Myron L

2008-04-29

The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

PubMed Central

Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

2017-01-01

Objectives To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. Design A cross-sectional study using a community-based survey. Setting Yaoundé, Cameroon. Participants All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Primary outcome measures Unmet needs for emergency care. Results Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Conclusions Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. PMID:28167749

Remote sensing of multimodal transportation systems.

DOT National Transportation Integrated Search

2016-09-01

Hyperspectral remote sensing is an emerging field with many potential applications in the observation, management, and maintenance of the global transportation infrastructure. This report describes the development of an affordable framework to captur...

The User Interface: A Hypertext Model Linking Art Objects and Related Information.

ERIC Educational Resources Information Center

Moline, Judi

This report presents a model combining the emerging technologies of hypertext and expert systems. Hypertext is relatively unexplored but promises an innovative approach to information retrieval. In contrast, expert systems have been used experimentally in many different application areas ranging from medical diagnosis to oil exploration. The…

CDC's Emergency Management Program activities - worldwide, 2003-2012.

PubMed

2013-09-06

In 2003, recognizing the increasing frequency and complexity of disease outbreaks and disasters and a greater risk for terrorism, CDC established the Emergency Operations Center (EOC), bringing together CDC staff members who respond to public health emergencies to enhance communication and coordination. To complement the physical EOC environment, CDC implemented the Incident Management System (IMS), a staffing structure and set of standard operational protocols and services to support and monitor CDC program-led responses to complex public health emergencies. The EOC and IMS are key components of CDC's Emergency Management Program (EMP), which applies emergency management principles to public health practice. To enumerate activities conducted by the EMP during 2003-2012, CDC analyzed data from daily reports and activity logs. The results of this analysis determined that, during 2003-2012, the EMP fully activated the EOC and IMS on 55 occasions to support responses to infectious disease outbreaks, natural disasters, national security events (e.g., conventions, presidential addresses, and international summits), mass gatherings (e.g., large sports and social events), and man-made disasters. On 109 other occasions, the EMP was used to support emergency responses that did not require full EOC activation, and the EMP also conducted 30 exercises and drills. This report provides an overview of those 194 EMP activities.

National programmes for validating physician competence and fitness for practice: a scoping review.

PubMed

Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

2016-04-15

To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Scoping review. MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000-2014). Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin--defined as that of the primary author--included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build on current evidence or theory. Terminology is highly variable across programmes for validating physician competence and fitness for practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

National programmes for validating physician competence and fitness for practice: a scoping review

PubMed Central

Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

2016-01-01

Objective To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Design Scoping review. Data sources MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000–2014). Selection Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Data extraction Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. Results 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin—defined as that of the primary author—included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. Conclusions There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build on current evidence or theory. Terminology is highly variable across programmes for validating physician competence and fitness for practice. PMID:27084276

Trends in Facility Management Technology: The Emergence of the Internet, GIS, and Facility Assessment Decision Support.

ERIC Educational Resources Information Center

Teicholz, Eric

1997-01-01

Reports research on trends in computer-aided facilities management using the Internet and geographic information system (GIS) technology for space utilization research. Proposes that facility assessment software holds promise for supporting facility management decision making, and outlines four areas for its use: inventory; evaluation; reporting;…

76 FR 3628 - Agency Information Collection Activities: Existing Collection; Emergency Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... records, and to produce reports as the Commission prescribes by regulation or order. Accordingly, the EEOC... Commission (EEOC or Commission) announces that it submitted to the Office of Management and Budget (OMB) a... secondary public school systems and districts have been required to submit EEO-5 reports to EEOC since 1974...

Smart Desktops for Teachers. ECS Issue Paper: Technology.

ERIC Educational Resources Information Center

Palaich, Robert M.; Good, Dixie Griffin; Stout, Connie; Vickery, Emily

This report presents the results of a study of how emerging technologies can help educators deliver standards-based education to K-12 students. The first section of the report provides background on the new technology offerings and defines smart desktop systems. The second section lists critical questions for decisionmakers related to general…

Physicochemical Requirements Inferred for Chemical Self-Organization Hardly Support an Emergence of Life in the Deep Oceans of Icy Moons

NASA Astrophysics Data System (ADS)

Pascal, Robert

2016-05-01

An approach to the origin of life, focused on the property of entities capable of reproducing themselves far from equilibrium, has been developed recently. Independently, the possibility of the emergence of life in the hydrothermal systems possibly present in the deep oceans below the frozen crust of some of the moons of Jupiter and Saturn has been raised. The present report is aimed at investigating the mutual compatibility of these alternative views. In this approach, the habitability concept deduced from the limits of life on Earth is considered to be inappropriate with regard to emerging life due to the requirement for an energy source of sufficient potential (equivalent to the potential of visible light). For these icy moons, no driving force would have been present to assist the process of emergence, which would then have had to rely exclusively on highly improbable events, thereby making the presence of life unlikely on these Solar System bodies, that is, unless additional processes are introduced for feeding chemical systems undergoing a transition toward life and the early living organisms.

Actinobaculum schaalii, a new cause of knee prosthetic joint infection in elderly.

PubMed

Jacquier, H; Benmansour, H; Zadegan, F; Hannouche, D; Micaelo, M; Mongiat-Artus, P; Salomon, E; Cambau, E; Berçot, B

2016-08-01

Actinobaculum schaalii is an emerging pathogen particularly involved in urinary tract infection of elderly people and/or patient with urological risk factors of urinary tract infection. This microorganism is a difficult-to-diagnose pathogen and is rarely involved in systemic or deep infections. Here, we report the first case of prosthetic joint infection due to A. schaalii in an 84-year-old man with a benign prostatic hyperplasia associated with chronic retention of urine. This case underlines the importance to optimize the diagnosis of emerging uropathogens as A. schaalii, to prevent systemic infections, particularly in patients with orthopaedic implants.

Emerging Communication Technologies (ECT) Phase 2 Report. Volume 2; Appendices

NASA Technical Reports Server (NTRS)

Bastin, Gary L.; Harris, William G.; Chiodini, Robert; Nelson, Richard A.; Huang, PoTien; Kruhm, David A.

2003-01-01

The Emerging Communication Technology (ECT) project investigated three First Mile communication technologies in support of NASA s Second Generation Reusable Launch Vehicle (2nd Gen RLV), Orbital Space Plane, Advanced Range Technology Working Group (ARTWG) and the Advanced Spaceport Technology Working Group (ASTWG). These First Mile technologies have the purpose of interconnecting mobile users with existing Range Communication infrastructures. ECT was a continuation of the Range Information System Management (RISM) task started in 2002. RISM identified the three advance communication technologies investigated under ECT. These were Wireless Ethernet (Wi-Fi), Free Space Optics (FSO), and Ultra Wideband (UWB). Due to the report s size, it has been broken into three volumes: 1) Main Report 2) Appendices 3) UWB

Emerging Communication Technologies (ECT) Phase 2 Report. Volume 3; Ultra Wideband (UWB) Technology

NASA Technical Reports Server (NTRS)

Bastin, Gary L.; Harris, William G.; Chiodini, Robert; Nelson, Richard A.; Huang, PoTien; Kruhm, David A.

2003-01-01

The Emerging Communication Technology (ECT) project investigated three First Mile communication technologies in support of NASA s Second Generation Reusable Launch Vehicle (2nd Gen RLV), Orbital Space Plane, Advanced Range Technology Working Group (ARTWG) and the Advanced Spaceport Technology Working Group (ASTWG). These First Mile technologies have the purpose of interconnecting mobile users with existing Range Communication infrastructures. ECT was a continuation of the Range Information System Management (RISM) task started in 2002. RISM identified the three advance communication technologies investigated under ECT. These were Wireless Ethernet (Wi-Fi), Free Space Optics (FSO), and Ultra Wideband (UWB). Due to the report s size, it has been broken into three volumes: 1) Main Report 2) Appendices 3) UWB

Design certification tests: High Pressure Oxygen Filter (HPOF) program. Summary report

NASA Technical Reports Server (NTRS)

Smith, I. D.

1976-01-01

Design and acceptance certification test procedures and results are presented for a high pressure oxygen filter developed to protect the sealing surfaces in emergency oxygen systems. Equipment specifications are included.

Local-regional anesthesia in the management of stingray stings: Experience of the Bouffard medical-surgical hospital in Djibouti.

PubMed

Vanoye, C; Lacroix, G; Le Gonidec, E; Couret, A; Benois, A; Peigne, V

2017-02-01

Stingray injuries are very painful. Systemic analgesics are ineffective, and the use of local-regional anesthesia has been reported. This retrospective descriptive study reviewed all cases of stingray injuries seen at the emergency department of the Bouffard Hospital (Djbouti, Africa) between 2011 and 2014. The study included 35 patients. Most of the injuries (n= 31, 89%) concerned the lower limbs. Median pain intensity was 6 [5-8] on a visual analog scale of 0 (no pain) to 10. The following systemic medications were administered: acetaminophen to 13 (27%) patients, morphine to 8 (23%), and tramadol to 6 (17%). In all, 25 (71%) patients received local-regional anesthesia, 15 (60%) by injections at the ankle. All procedures were successful, and no adverse event was reported. This study reports clinical data about stingray injuries in the Red Sea area and highlights the interest of local-regional anesthesia in their management. Most of the procedures were distal and could be performed by trained emergency physicians.

Performance management of the public healthcare services in Ireland: a review.

PubMed

Mesabbah, Mohammed; Arisha, Amr

2016-01-01

Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

Opportunistic immunisation in the emergency department: a survey of staff knowledge, opinion and practices.

PubMed

Philips, Leanne; Young, Jeanine; Williams, Lesley A; Cooke, Marie; Rickard, Claire

2014-05-01

The aim of this study was to identify (a) emergency department staff knowledge, opinion and practices in relation to childhood vaccines and opportunistic immunisation in the emergency department and (b) differences between nursing and medical staff knowledge, opinion and self reported practices. A self-administered, cross-sectional survey was offered to a convenience sample of medical and nursing staff (n=86) working in a tertiary paediatric emergency department. Variables of interest were described using frequencies and odds ratios to report differences between medical and nursing staff responses. An 87% survey response was achieved. The majority of staff agreed that childhood vaccines were safe (96%), effective (99%) and necessary (97%). Less than half (45%) of the staff correctly identified that there is no association between measles, mumps and rubella (MMR) vaccine and autism. Medical staff were more likely than nurses to disagree that giving multiple vaccines overloads the immune system (p<0.01), or that complementary therapies reduced the need for a child to be vaccinated (p<0.006). These knowledge deficits exist despite a reported awareness of immunisation resources. The majority (96%) of those surveyed reported that the Australian Immunisation Handbook was as a useful resource. Overall, the majority of staff agreed vaccines are safe, effective and necessary. This study highlighted that staff knowledge deficits and misconceptions about vaccines and vaccine management may be barriers to promoting opportunistic immunisation practices in ED. Copyright © 2014 College of Emergency Nursing Australasia Ltd. All rights reserved.

A Method for Evaluating the Safety Impacts of Air Traffic Automation

NASA Technical Reports Server (NTRS)

Kostiuk, Peter; Shapiro, Gerald; Hanson, Dave; Kolitz, Stephan; Leong, Frank; Rosch, Gene; Bonesteel, Charles

1998-01-01

This report describes a methodology for analyzing the safety and operational impacts of emerging air traffic technologies. The approach integrates traditional reliability models of the system infrastructure with models that analyze the environment within which the system operates, and models of how the system responds to different scenarios. Products of the analysis include safety measures such as predicted incident rates, predicted accident statistics, and false alarm rates; and operational availability data. The report demonstrates the methodology with an analysis of the operation of the Center-TRACON Automation System at Dallas-Fort Worth International Airport.

Design of an eMonitor system to transport electronic patient care report (ePCR) information in unstable MobileIP wireless environment.

PubMed

Giovanni, Mazza G; Shenvi, Rohit; Battles, Marcie; Orthner, Helmuth F

2008-11-06

The eMonitor is a component of the ePatient system; a prototype system used by emergency medical services (EMS) personnel in the field to record and transmits electronic patient care report (ePCR) information interactively. The eMonitor component allows each Mobile Data Terminal (MDT) on an unreliable Cisco MobileIP wireless network to securely send and received XML messages used to update patient information to and from the MDT before, during and after the transport of a patient.

EPs welcome new focus on reducing diagnostic errors.

PubMed

2015-12-01

Emergency medicine leaders welcome a major new report from the Institute of Medicine (IOM) calling on providers, policy makers, and government agencies to institute changes to reduce the incidence of diagnostic errors. The 369-page report, "Improving Diagnosis in Health Care," states that the rate of diagnostic errors in this country is unacceptably high and offers a long list of recommendations aimed at addressing the problem. These include large, systemic changes that involve improvements in multiple areas, including health information technology (HIT), professional education, teamwork, and payment reform. Further, of particular interest to emergency physicians are recommended changes to the liability system. The authors of the IOM report state that while most people will likely experience a significant diagnostic error in their lifetime, the importance of this problem is under-appreciated. According to conservative estimates, the report says 5% of adults who seek outpatient care each year experience a diagnostic error. The report also notes that research over many decades shows diagnostic errors contribute to roughly 10% of all.deaths. The report says more steps need to be taken to facilitate inter-professional and intra-professional teamwork throughout the diagnostic process. Experts concur with the report's finding that mechanisms need to be developed so that providers receive ongoing feedback on their diagnostic performance.

International recommendations for outpatient palliative care and prehospital palliative emergencies – a prospective questionnaire-based investigation

PubMed Central

2013-01-01

Background To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. Methods One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical . Results The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics). Conclusions This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system. PMID:23432905

Automated Reporting of Trainee Metrics Using Electronic Clinical Systems.

PubMed

Levin, Jonathan C; Hron, Jonathan

2017-06-01

The Accreditation Council for Graduate Medical Education has called for increased emphasis on reporting objective performance measures to trainees and programs. However, reporting of objective measures, including clinical volume, is largely omitted from training programs. To use automated electronic medical systems at a tertiary pediatric care hospital to create a dashboard that reports objective trainee and program metrics, including clinical volume and diagnoses in a pediatrics residency. We queried an enterprise data warehouse that aggregates data daily from multiple hospital systems to identify patient encounters during which senior pediatrics residents at Boston Children's Hospital had entered documentation over a 9-month period. From this query, we created a filterable dashboard to display clinical volume and diagnosis data by individual resident and in aggregate. A total of 44 of 45 senior residents (98%) in the program were included in analysis. We identified 12 198 patient encounters during which a senior pediatrics resident had entered documentation; these included a median of 332 inpatient encounters per resident, 122 emergency department encounters, and 84 outpatient encounters. The most common diagnoses stratified by clinical site were: inpatient - dehydration (median = 61); emergency department - long-term/current drug therapy (median = 16); and outpatient - encounter for immunization (median = 48). We used electronic health record systems to generate performance dashboards for trainees in a pediatrics residency across different sites of care with reported volume by diagnosis. Our dashboards provide feedback to program leadership regarding individual and aggregate trainee experience and allow individual trainees to compare their clinical exposure to peers.

Completeness of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection Reporting From Outpatient Hemodialysis Facilities to the National Healthcare Safety Network, 2013.

PubMed

Nguyen, Duc B; See, Isaac; Gualandi, Nicole; Shugart, Alicia; Lines, Christi; Bamberg, Wendy; Dumyati, Ghinwa; Harrison, Lee H; Lesher, Lindsey; Nadle, Joelle; Petit, Susan; Ray, Susan M; Schaffner, William; Townes, John; Njord, Levi; Sievert, Dawn; Thompson, Nicola D; Patel, Priti R

2016-02-01

Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event.

Validation of the new diagnosis grouping system for pediatric emergency department visits using the International Classification of Diseases, 10th Revision.

PubMed

Lee, Jin Hee; Hong, Ki Jeong; Kim, Do Kyun; Kwak, Young Ho; Jang, Hye Young; Kim, Hahn Bom; Noh, Hyun; Park, Jungho; Song, Bongkyu; Jung, Jae Yun

2013-12-01

A clinically sensible diagnosis grouping system (DGS) is needed for describing pediatric emergency diagnoses for research, medical resource preparedness, and making national policy for pediatric emergency medical care. The Pediatric Emergency Care Applied Research Network (PECARN) developed the DGS successfully. We developed the modified PECARN DGS based on the different pediatric population of South Korea and validated the system to obtain the accurate and comparable epidemiologic data of pediatric emergent conditions of the selected population. The data source used to develop and validate the modified PECARN DGS was the National Emergency Department Information System of South Korea, which was coded by the International Classification of Diseases, 10th Revision (ICD-10) code system. To develop the modified DGS based on ICD-10 code, we matched the selected ICD-10 codes with those of the PECARN DGS by the General Equivalence Mappings (GEMs). After converting ICD-10 codes to ICD-9 codes by GEMs, we matched ICD-9 codes into PECARN DGS categories using the matrix developed by PECARN group. Lastly, we conducted the expert panel survey using Delphi method for the remaining diagnosis codes that were not matched. A total of 1879 ICD-10 codes were used in development of the modified DGS. After 1078 (57.4%) of 1879 ICD-10 codes were assigned to the modified DGS by GEM and PECARN conversion tools, investigators assigned each of the remaining 801 codes (42.6%) to DGS subgroups by 2 rounds of electronic Delphi surveys. And we assigned the remaining 29 codes (4%) into the modified DGS at the second expert consensus meeting. The modified DGS accounts for 98.7% and 95.2% of diagnoses of the 2008 and 2009 National Emergency Department Information System data set. This modified DGS also exhibited strong construct validity using the concepts of age, sex, site of care, and seasons. This also reflected the 2009 outbreak of H1N1 influenza in Korea. We developed and validated clinically feasible and sensible DGS system for describing pediatric emergent conditions in Korea. The modified PECARN DGS showed good comprehensiveness and demonstrated reliable construct validity. This modified DGS based on PECARN DGS framework may be effectively implemented for research, reporting, and resource planning in pediatric emergency system of South Korea.

Distributed virtual environment for emergency medical training

NASA Astrophysics Data System (ADS)

Stytz, Martin R.; Banks, Sheila B.; Garcia, Brian W.; Godsell-Stytz, Gayl M.

1997-07-01

In many professions where individuals must work in a team in a high stress environment to accomplish a time-critical task, individual and team performance can benefit from joint training using distributed virtual environments (DVEs). One professional field that lacks but needs a high-fidelity team training environment is the field of emergency medicine. Currently, emergency department (ED) medical personnel train by using words to create a metal picture of a situation for the physician and staff, who then cooperate to solve the problems portrayed by the word picture. The need in emergency medicine for realistic virtual team training is critical because ED staff typically encounter rarely occurring but life threatening situations only once in their careers and because ED teams currently have no realistic environment in which to practice their team skills. The resulting lack of experience and teamwork makes diagnosis and treatment more difficult. Virtual environment based training has the potential to redress these shortfalls. The objective of our research is to develop a state-of-the-art virtual environment for emergency medicine team training. The virtual emergency room (VER) allows ED physicians and medical staff to realistically prepare for emergency medical situations by performing triage, diagnosis, and treatment on virtual patients within an environment that provides them with the tools they require and the team environment they need to realistically perform these three tasks. There are several issues that must be addressed before this vision is realized. The key issues deal with distribution of computations; the doctor and staff interface to the virtual patient and ED equipment; the accurate simulation of individual patient organs' response to injury, medication, and treatment; and an accurate modeling of the symptoms and appearance of the patient while maintaining a real-time interaction capability. Our ongoing work addresses all of these issues. In this paper we report on our prototype VER system and its distributed system architecture for an emergency department distributed virtual environment for emergency medical staff training. The virtual environment enables emergency department physicians and staff to develop their diagnostic and treatment skills using the virtual tools they need to perform diagnostic and treatment tasks. Virtual human imagery, and real-time virtual human response are used to create the virtual patient and present a scenario. Patient vital signs are available to the emergency department team as they manage the virtual case. The work reported here consists of the system architectures we developed for the distributed components of the virtual emergency room. The architectures we describe consist of the network level architecture as well as the software architecture for each actor within the virtual emergency room. We describe the role of distributed interactive simulation and other enabling technologies within the virtual emergency room project.

[Prehospital cardiac resuscitation in Queretaro, Mexico. Report of 3 cases. Importance of an integral emergency medical care system].

PubMed

Fraga-Sastrías, Juan Manuel; Aguilera-Campos, Andrea; Barinagarrementería-Aldatz, Fernando; Ortíz-Mondragón, Claudio; Asensio-Lafuente, Enrique

2014-01-01

In Mexico, out-of-hospital cardiac arrest is a health problem that represents 33,000 to 150,000 or more deaths per year. The few existent reports show mortality as high as 100% in contrast to some international reports that show higher survival rates. In Queretaro, during the last 5 years there were no successful resuscitation cases. However, in 2012 some patients were reported to have return of spontaneous circulation. We report in this article 3 cases with return of spontaneous circulation and pulse at arrival to the hospital. Two of the patients were discharged alive, one of them with poor cerebral performance category. Community cardiopulmonary resuscitation, early defibrillation and better emergency medical system response times, are related with survival. This poorly explored health problem in Queretaro could be increased with quality and good public education, bystander assisted cardiopulmonary resuscitation, police involvement in cardiopulmonary resuscitation and defibrillation, public access defibrillation programs and measurement of indicators and feedback for better results. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

A statewide model program to improve emergency department readiness for pediatric care.

PubMed

Cichon, Mark E; Fuchs, Susan; Lyons, Evelyn; Leonard, Daniel

2009-08-01

Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. Since 1985, federally funded Emergency Medical Services for Children (EMSC) programs in each state have been working to improve the quality of pediatric emergency care. The Health Resources and Services Administration now requires that all EMSC grantees report on specific performance measures. This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.

The Spacecraft Emergency Response System (SERS) for Autonomous Mission Operations

NASA Technical Reports Server (NTRS)

Breed, Julia; Chu, Kai-Dee; Baker, Paul; Starr, Cynthia; Fox, Jeffrey; Baitinger, Mick

1998-01-01

Today, most mission operations are geared toward lowering cost through unmanned operations. 7-day/24-hour operations are reduced to either 5-day/8-hour operations or become totally autonomous, especially for deep-space missions. Proper and effective notification during a spacecraft emergency could mean success or failure for an entire mission. The Spacecraft Emergency Response System (SERS) is a tool designed for autonomous mission operations. The SERS automatically contacts on-call personnel as needed when crises occur, either on-board the spacecraft or within the automated ground systems. Plus, the SERS provides a group-ware solution to facilitate the work of the person(s) contacted. The SERS is independent of the spacecraft's automated ground system. It receives and catalogues reports for various ground system components in near real-time. Then, based on easily configurable parameters, the SERS determines whom, if anyone, should be alerted. Alerts may be issued via Sky-Tel 2-way pager, Telehony, or e-mail. The alerted personnel can then review and respond to the spacecraft anomalies through the Netscape Internet Web Browser, or directly review and respond from the Sky-Tel 2-way pager.

Online Monitoring Technical Basis and Analysis Framework for Emergency Diesel Generators - Interim Report for FY 2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Binh T. Pham; Nancy J. Lybeck; Vivek Agarwal

The Light Water Reactor Sustainability program at Idaho National Laboratory is actively conducting research to develop and demonstrate online monitoring capabilities for active components in existing nuclear power plants. Idaho National Laboratory and the Electric Power Research Institute are working jointly to implement a pilot project to apply these capabilities to emergency diesel generators and generator step-up transformers. The Electric Power Research Institute Fleet-Wide Prognostic and Health Management Software Suite will be used to implement monitoring in conjunction with utility partners: Braidwood Generating Station (owned by Exelon Corporation) for emergency diesel generators, and Shearon Harris Nuclear Generating Station (owned bymore » Duke Energy Progress) for generator step-up transformers. This report presents monitoring techniques, fault signatures, and diagnostic and prognostic models for emergency diesel generators. Emergency diesel generators provide backup power to the nuclear power plant, allowing operation of essential equipment such as pumps in the emergency core coolant system during catastrophic events, including loss of offsite power. Technical experts from Braidwood are assisting Idaho National Laboratory and Electric Power Research Institute in identifying critical faults and defining fault signatures associated with each fault. The resulting diagnostic models will be implemented in the Fleet-Wide Prognostic and Health Management Software Suite and tested using data from Braidwood. Parallel research on generator step-up transformers was summarized in an interim report during the fourth quarter of fiscal year 2012.« less

Secondary traumatic stress among emergency nurses: a cross-sectional study.

PubMed

Duffy, Emer; Avalos, Gloria; Dowling, Maura

2015-04-01

Emergency department nurses are required to deal with emotional trauma issues on a daily basis, which may result in them experiencing symptoms of secondary traumatic stress, a consequence of stress experienced when helping or wanting to help a person traumatised or suffering. This study measured emergency department nurses' self-reported levels of secondary traumatic stress. Registered nurses (n = 117) working at three emergency departments in the Western geographical region of Ireland were invited to complete the secondary traumatic stress scale (STSS). A response rate of 90% (n = 105) was achieved. Most participants (n = 67/64%) met the criteria for secondary traumatic stress. A statistically significant finding was that the highest proportion (82%) of secondary traumatic stress existed in the staff nurse group (p = 0.042). Moreover, for those nurses reporting secondary traumatic stress, statistical significance was found for the variables 'change of career considered' (p = 0.017) and 'finds alcohol helpful in alleviating work-related stress' (p = 0.004), when compared with nurses not reporting secondary traumatic stress. The findings suggest the need to examine current crisis management interventions and to introduce new systems to support nurses in Irish emergency departments. Moreover, because different types of traumatic events in the ED require different types of interventions, the prevention and management of STS among emergency department nurses must be tackled using a variety of approaches. Copyright © 2014 Elsevier Ltd. All rights reserved.

A comparison between digital images viewed on a picture archiving and communication system diagnostic workstation and on a PC-based remote viewing system by emergency physicians.

PubMed

Parasyn, A; Hanson, R M; Peat, J K; De Silva, M

1998-02-01

Picture Archiving and Communication Systems (PACS) make possible the viewing of radiographic images on computer workstations located where clinical care is delivered. By the nature of their work this feature is particularly useful for emergency physicians who view radiographic studies for information and use them to explain results to patients and their families. However, the high cost of PACS diagnostic workstations with fuller functionality places limits on the number of and therefore the accessibility to workstations in the emergency department. This study was undertaken to establish how well less expensive personal computer-based workstations would work to support these needs of emergency physicians. The study compared the outcome of observations by 5 emergency physicians on a series of radiographic studies containing subtle abnormalities displayed on both a PACS diagnostic workstation and on a PC-based workstation. The 73 digitized radiographic studies were randomly arranged on both types of workstation over four separate viewing sessions for each emergency physician. There was no statistical difference between a PACS diagnostic workstation and a PC-based workstation in this trial. The mean correct ratings were 59% on the PACS diagnostic workstations and 61% on the PC-based workstations. These findings also emphasize the need for prompt reporting by a radiologist.

A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.

PubMed

Lovett, Paris B; Illg, Megan L; Sweeney, Brian E

2016-05-01

This article reports on an innovative approach to managing patient flow at a multicampus academic health system, integrating multiple services into a single, centralized Patient Flow Management Center that manages supply and demand for inpatient services across the system. Control of bed management was centralized across 3 campuses and key services were integrated, including bed management, case management, environmental services, patient transport, ambulance and helicopter dispatch, and transfer center. A single technology platform was introduced, as was providing round-the-clock patient placement by critical care nurses, and adding medical directors. Daily bed meetings with nurse managers and charge nurses drive action plans. This article reports immediate improvements in the first year of operations in emergency department walkouts, emergency department boarding, ambulance diversion, growth in transfer volume, reduction in lost transfers, reduction in time to bed assignment, and bed turnover time. The authors believe theirs is the first institution to integrate services and centralize bed management so comprehensively. © The Author(s) 2014.

Community-based first aid: a program report on the intersection of community-based participatory research and first aid education in a remote Canadian Aboriginal community.

PubMed

VanderBurgh, D; Jamieson, R; Beardy, J; Ritchie, S D; Orkin, A

2014-01-01

Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course participants and the people they help are relevant and important; (3) curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings.

Emergency vehicle alert system (EVAS)

NASA Technical Reports Server (NTRS)

Reed, Bill; Crump, Roger; Harper, Warren; Myneni, Krishna

1995-01-01

The Emergency Vehicle Alert System (EVAS) program is sponsored by the NASA/MSFC Technology Utilization (TU) office. The program was conceived to support the needs of hearing impaired drivers. The objective of the program is to develop a low-cost, small device which can be located in a personal vehicle and warn the driver, via a visual means, of the approach of an emergency vehicle. Many different technologies might be developed for this purpose and each has its own advantages and drawbacks. The requirements for an acoustic detection system, appear to be pretty stringent and may not allow the development of a reliable, low-cost device in the near future. The problems include variations in the sirens between various types of emergency vehicles, distortions due to wind and surrounding objects, competing background noise, sophisticated signal processing requirements, and omni-directional coverage requirements. Another approach is to use a Radio Frequency (RF) signal between the Emergency Vehicle (EV) and the Personal Vehicle (PV). This approach requires a transmitter on each EV and a receiver in each PV, however it is virtually assured that a system can be developed which works. With this approach, the real technology issue is how to make a system work as inexpensively as possible. This report gives a brief summary of the EVAS program from its inception and concentrates on describing the activities that occurred during Phase 4. References 1-3 describe activities under Phases 1-3. In the fourth phase of the program, the major effort to be expended was in development of the microcontroller system for the PV, refinement of some system elements and packaging for demonstration purposes. An EVAS system was developed and demonstrated which used standard spread spectrum modems with minor modifications.

Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline.

PubMed

Jollis, James G; Granger, Christopher B; Henry, Timothy D; Antman, Elliott M; Berger, Peter B; Moyer, Peter H; Pratt, Franklin D; Rokos, Ivan C; Acuña, Anna R; Roettig, Mayme Lou; Jacobs, Alice K

2012-07-01

National guidelines call for participation in systems to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States. A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association Mission: Lifeline website. Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%). This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI.

Real-time incident detection using social media data.

DOT National Transportation Integrated Search

2016-05-09

The effectiveness of traditional incident detection is often limited by sparse sensor coverage, and reporting incidents to emergency response systems : is labor-intensive. This research project mines tweet texts to extract incident information on bot...

Worldwide Emerging Environmental Issues Affecting the U.S. Military. November 2005 Report

DTIC Science & Technology

2005-11-01

rapid development. At the program’s launch festivity, the need for developing an international e- waste recycling systems along with transparent...electronic equipment. Sources: Roadmap Set for the Environmentally Sound Management of Electronic Waste in Asia-Pacific under the Basel Convention...34 Tom Dunne, of the agency’s Office of Solid Waste and Emergency Response, wrote in an e-mail message. 4.5 Sunk Weapons Represent a Growing

Practical Guide for Emergency Crime Prevention and Penal System Alternatives in Crisis Relocation Planning.

DTIC Science & Technology

1982-09-01

93117____________ 11. CONTROLLING OFFICE NAMIE AND ADDRESS 12. REPORT DATE Federal Emergency Management Agency 21 September 1982 13. NUMBER OF...relocation is the controlled , orderly evacuation of a community that is a possible target for attack by a foreign power. The concept of crisis...SI s Relocation? Crisis relocation is the controlled , orderly evacuation of a comunity which is considered a possible target for foreign attack

The value of necropsy reports for animal health surveillance.

PubMed

Küker, Susanne; Faverjon, Celine; Furrer, Lenz; Berezowski, John; Posthaus, Horst; Rinaldi, Fabio; Vial, Flavie

2018-06-18

Animal health data recorded in free text, such as in necropsy reports, can have valuable information for national surveillance systems. However, these data are rarely utilized because the text format requires labor-intensive classification of records before they can be analyzed with using statistical or other software. In a previous study, we designed a text-mining tool to extract data from text in necropsy reports. In the current study, we used the tool to extract data from the reports from pig and cattle necropsies performed between 2000 and 2011 at the Institute of Animal Pathology (ITPA), University of Bern, Switzerland. We evaluated data quality in terms of credibility, completeness and representativeness of the Swiss pig and cattle populations. Data was easily extracted from necropsy reports. Data quality in terms of completeness and validity varied a lot depending on the type of data reported. Diseases of the gastrointestinal system were reported most frequently (54.6% of pig submissions and 40.8% of cattle submissions). Diseases affecting serous membranes were reported in 16.0% of necropsied pigs and 27.6% of cattle. Respiratory diseases were reported in 18.3% of pigs and 21.6% of cattle submissions. This study suggests that extracting data from necropsy reports can provide information of value for animal health surveillance. This data has potential value for monitoring endemic disease syndromes in different age and production groups, or for early detection of emerging or re-emerging diseases. The study identified data entry and other errors that could be corrected to improve the quality and validity of the data. Submissions to veterinary diagnostic laboratories have selection biases and these should be considered when designing surveillance systems that include necropsy reports.

Specialist availability in emergencies: contributions of response times and the use of ad hoc coverage in New York State.

PubMed

Rabin, Elaine; Patrick, Lisa

2016-04-01

Nationwide, hospitals struggle to maintain specialist on-call coverage for emergencies. We seek to further understand the issue by examining reliability of scheduled coverage and the role of ad hoc coverage when none is scheduled. An anonymous electronic survey of all emergency department (ED) directors of a large state. Overall and for 10 specialties, respondents were asked to estimate on-call coverage extent and "reliability" (frequency of emergency response in a clinically useful time frame: 2 hours), and use and effect of ad hoc emergency coverage to fill gaps. Descriptive statistics were performed using Fisher exact and Wilcoxon sign rank tests for significance. Contact information was obtained for 125 of 167 ED directors. Sixty responded (48%), representing 36% of EDs. Forty-six percent reported full on-call coverage scheduled for all specialties. Forty-six percent reported consistent reliability. Coverage and reliability were strongly related (P<.01; 33% reported both), and larger ED volume correlated with both (P<.01). Ninety percent of hospitals that had gaps in either employed ad hoc coverage, significantly improving coverage for 8 of 10 specialties. For all but 1 specialty, more than 20% of hospitals reported that specialists are "Never", "Rarely" or "Sometimes" reliable (more than 50% for cardiovascular surgery, hand surgery and ophthalmology). Significant holes in scheduled on-call specialist coverage are compounded by frequent unreliability of on-call specialists, but partially ameliorated by ad hoc specialist coverage. Regionalization may help because a 2-tiered system may exist: larger hospitals have more complete, reliable coverage. Better understanding of specialists' willingness to treat emergencies ad hoc without taking formal call will suggest additional remedies. Copyright © 2015 Elsevier Inc. All rights reserved.

Update: New Federal Financial Accounting for State and Local School Systems Due Out Soon.

ERIC Educational Resources Information Center

Sielke, Catherine C.

2002-01-01

Reports on several changes in the 2002 edition (forthcoming) of the federal government accounting handbook "Federal Financial Accounting for State and Local School Systems." Includes brief summary of "Emerging Issues" section of the handbook that addresses issues such as alternative revenues, charter schools, school safety and security,…

Quantitative Synthesis and Component Analysis of Single-Participant Studies on the Picture Exchange Communication System

ERIC Educational Resources Information Center

Tincani, Matt; Devis, Kathryn

2011-01-01

The "Picture Exchange Communication System" (PECS) has emerged as the augmentative communication intervention of choice for individuals with autism spectrum disorder (ASD), with a supporting body of single-participant studies. This report describes a meta-analysis of 16 single-participant studies on PECS with percentage of nonoverlapping data…

Ontology-Based e-Assessment for Accounting Education

ERIC Educational Resources Information Center

Litherland, Kate; Carmichael, Patrick; Martínez-García, Agustina

2013-01-01

This summary reports on a pilot of a novel, ontology-based e-assessment system in accounting. The system, OeLe, uses emerging semantic technologies to offer an online assessment environment capable of marking students' free text answers to questions of a conceptual nature. It does this by matching their response with a "concept map" or…

[Introduction and some problems of the rapid time series laboratory reporting system].

PubMed

Kanao, M; Yamashita, K; Kuwajima, M

1999-09-01

We introduced an on-line system of biochemical, hematological, serological, urinary, bacteriological, and emergency examinations and associated office work using a client server system NEC PC-LACS based on a system consisting of concentration of outpatient blood collection, concentration of outpatient reception, and outpatient examination by reservation. Using this on-line system, results of 71 items in chemical serological, hematological, and urinary examinations are rapidly reported within 1 hour. Since the ordering system at our hospital has not been completed yet, we constructed a rapid time series reporting system in which time series data obtained on 5 serial occasions are printed on 2 sheets of A4 paper at the time of the final report. In each consultation room of the medical outpatient clinic, at the neuromedical outpatient clinic, and at the kidney center where examinations are frequently performed, terminal equipment and a printer for inquiry were established for real-time output of time series reports. Results are reported by FAX to the other outpatient clinics and wards, and subsequently, time series reports are output at the clinical laboratory department. This system allowed rapid examination, especially preconsultation examination. This system was also useful for reducing office work and effectively utilize examination data.

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study.

PubMed

Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

2017-02-06

To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. A cross-sectional study using a community-based survey. Yaoundé, Cameroon. All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Unmet needs for emergency care. Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The crisis in United States hospital emergency services.

PubMed

Harrison, Jeffrey P; Ferguson, Emily D

2011-01-01

Emergency services are critical for high-quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (U.S.) acute care hospital staffs ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers. Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities. U.S. acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, U.S. emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staffs ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state-of-the-art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement. This research uses the AHA annual surveys,which represent self-reported data by individual hospital staff. However, the AHA expendssignificant resources to validate reported information and the annual survey data are widely used for hospital research. The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure. This article has important information on US emergency service availability in the hospital industry.

Measuring and Reporting Physician's Performance in a University Medical Center.

ERIC Educational Resources Information Center

Kazan-Fishman, Ana Lucia

This paper describes a Patient Satisfaction survey and database used to measure and report on physician performance at the Ohio State University Health System (OSUHS). The OSUHS averages 6,000 inpatients in any given month, and more than 7,000 emergency patients and 70,000 outpatient encounters. Data from the Patient Satisfaction measures are…

Re-emerging schistosomiasis in hilly and mountainous areas of Sichuan, China.

PubMed Central

Liang, Song; Yang, Changhong; Zhong, Bo; Qiu, Dongchuan

2006-01-01

Despite great strides in schistosomiasis control over the past several decades in Sichuan Province, China the disease has re-emerged in areas where it was previously controlled. We reviewed historical records and found that schistosomiasis had re-emerged in eight counties by the end of 2004 - seven of 21 counties with transmission control and one of 25 with transmission interruption as reported in 2001 were confirmed to have local disease transmission. The average "return time" (from control to re-emergence) was about eight years. The onset of re-emergence was commonly signalled by the occurrence of acute infections. Our survey results suggest that environmental and sociopolitical factors play an important role in re-emergence. The main challenge would be to consolidate and maintain effective control in the longer term until "real" eradication is achieved. This would be possible only by the formulation of a sustainable surveillance and control system. PMID:16501732

Incident reporting in one UK accident and emergency department.

PubMed

Tighe, Catherine M; Woloshynowych, Maria; Brown, Ruth; Wears, Bob; Vincent, Charles

2006-01-01

Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme for reporting and discussing the incidents internally. There appeared to be a mismatch between the recorded events and the category allocated to the incident in the historical record. In addition the database did not contain complete information for every incident, contributory factors were rarely recorded and relatively large numbers of incidents were recorded as "other" in the type of incident. There was also observed difficulty in updating the system as there is at least a months time lag between reporting or an incident and discussion/resolution of issues at the local departmental clinical risk management committee meetings. We used Leape's model for assessing the reporting system as a whole and found the system in the department to be relatively safe, fairly easy to use and moderately effective. Recommendations as a result of this study include the introduction of an electronic reporting system, limiting the number of staff who categorise the incidents--using clear definitions for classifications including a structured framework for contributory factors, and a process that allows incidents to be updated on the database locally after the discussion. This research may have implications for the incident reporting process in other specialities as well as in other hospitals.

44 CFR 327.5 - Reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Reports. 327.5 Section 327.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... Reports. Such reports of operations under this order as may be required by the Federal Emergency...

44 CFR 327.5 - Reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reports. 327.5 Section 327.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... Reports. Such reports of operations under this order as may be required by the Federal Emergency...

44 CFR 327.5 - Reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Reports. 327.5 Section 327.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... Reports. Such reports of operations under this order as may be required by the Federal Emergency...

44 CFR 327.5 - Reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Reports. 327.5 Section 327.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... Reports. Such reports of operations under this order as may be required by the Federal Emergency...

44 CFR 327.5 - Reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Reports. 327.5 Section 327.5 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY... Reports. Such reports of operations under this order as may be required by the Federal Emergency...

Wearable system-on-a-chip UWB radar for health care and its application to the safety improvement of emergency operators.

PubMed

Zito, Domenico; Pepe, Domenico; Neri, Bruno; De Rossi, Danilo; Lanatà, Antonio; Tognetti, Alessandro; Scilingo, Enzo Pasquale

2007-01-01

A new wearable system-on-a-chip UWB radar for health care systems is presented. The idea and its applications to the safety improvement of emergency operators are discussed. The system consists of a wearable wireless interface including a fully integrated UWB radar for the detection of the heart beat and breath rates, and a IEEE 802.15.4 ZigBee radio interface. The principle of operation of the UWB radar for the monitoring of the heart wall is explained hereinafter. The results obtained by the feasibility study regarding its implementation on a modern standard silicon technology (CMOS 90 nm) are reported, demonstrating (at simulation level) the effectiveness of such an approach and enabling the standard silicon technology for new generations of wireless sensors for heath care and safeguard wearable systems.

[Development of an index system for the comprehensive evaluation on public health emergency events surveillance system in China].

PubMed

Hong, Zhiheng; Ni, Daxin; Cao, Yang; Meng, Ling; Tu, Wenxiao; Li, Leilei; Li, Qun; Jin, Lianmei

2015-06-01

To establish a comprehensive evaluation index system for the China Public Health Emergency Events Surveillance System (CPHEESS). A draft index system was built through literature review and under the consideration of the characteristics on CPHEESS. Delphi method was adapted to determine the final index system. The index system was divided into primary, secondary and tertiary levels. There were 4 primary indicators: System structure, Network platform, Surveillance implementation reports with Data analysis and utilization. There were 16 secondary and 70 tertiary indicators being set, with System structure including 14 tertiary indicators (accounted for 20.00%), 21 Network platforms (accounted for 30.00%). Twenty-four Surveillance implementation reports (accounted for 34.29%), 11 Data analysis and utilization (accounted for 15.71%). The average score of importance of each indicators was 4.29 (3.77-4.94), with an average coefficient variation as 0.14 (0.12-0.16). The mean Chronbach's α index was 0.84 (0.81-0.89). The adaptability of each related facilities indicator was specified. The primary indicators were set in accordance with the characteristics and goals of the surveillance systems. Secondary indicators provided key elements in the management and control of the system while the tertiary indicators were available and operative. The agreement rate of experts was high with good validity and reliability. This index system could be used for CPHEESS in future.

Surveillance for pneumonic plague in the United States during an international emergency: a model for control of imported emerging diseases.

PubMed Central

Fritz, C. L.; Dennis, D. T.; Tipple, M. A.; Campbell, G. L.; McCance, C. R.; Gubler, D. J.

1996-01-01

In September 1994, in response to a reported epidemic of plague in India, the Centers for Disease Control and Prevention (CDC) enhanced surveillance in the United States for imported pneumonic plague. Plague information materials were rapidly developed and distributed to U.S. public health officials by electronic mail, facsimile, and expedited publication. Information was also provided to medical practitioners and the public by recorded telephone messages and facsimile transmission. Existing quarantine protocols were modified to effect active surveillance for imported plague cases at U.S. airports. Private physicians and state and local health departments were relied on in a passive surveillance system to identify travelers with suspected plague not detected at airports. From September 27 to October 27, the surveillance system identified 13 persons with suspected plague; no case was confirmed. This coordinated response to an international health emergency may serve as a model for detecting other emerging diseases and preventing their importation. PMID:8964057

Surveillance for pneumonic plague in the United States during an international emergency: a model for control of imported emerging diseases.

PubMed

Fritz, C L; Dennis, D T; Tipple, M A; Campbell, G L; McCance, C R; Gubler, D J

1996-01-01

In September 1994, in response to a reported epidemic of plague in India, the Centers for Disease Control and Prevention (CDC) enhanced surveillance in the United States for imported pneumonic plague. Plague information materials were rapidly developed and distributed to U.S. public health officials by electronic mail, facsimile, and expedited publication. Information was also provided to medical practitioners and the public by recorded telephone messages and facsimile transmission. Existing quarantine protocols were modified to effect active surveillance for imported plague cases at U.S. airports. Private physicians and state and local health departments were relied on in a passive surveillance system to identify travelers with suspected plague not detected at airports. From September 27 to October 27, the surveillance system identified 13 persons with suspected plague; no case was confirmed. This coordinated response to an international health emergency may serve as a model for detecting other emerging diseases and preventing their importation.

Neural network model for automatic traffic incident detection : final report, August 2001.

DOT National Transportation Integrated Search

2001-08-01

Automatic freeway incident detection is an important component of advanced transportation management systems (ATMS) that provides information for emergency relief and traffic control and management purposes. In this research, a multi-paradigm intelli...

Implementation plan and cost analysis for Oregon's online crash reporting system.

DOT National Transportation Integrated Search

2011-07-01

Federal, state and local transportation agencies, law enforcement, the legislature, consulting firms, safety advocates and the : public use crash data to quantify emerging traffic safety issues and problems, determine priorities, support decision-mak...

Smart call box field operational test evaluation : subtest reports

DOT National Transportation Integrated Search

1997-05-01

Smart call boxes are an enhanced version of devices used as emergency call boxes in California. The overall system consists of a microprocessor, a cellular communications transceiver, solar power sources, data collection devices, maintenance computer...

Metropolitan Model Deployment Initiative : Seattle evaluation report

DOT National Transportation Integrated Search

2000-05-30

The Washington State Department of Transportation (WSDOT) and others in the public and private sectors are looking to emerging technologies to help improve the performance of the Seattle regions existing transportation system. Their goal is to app...

Smart call box field operational test evaluation : summary report

DOT National Transportation Integrated Search

1997-05-01

Smart call boxes are an enhanced version of devices used as emergency call boxes in California. The overall system consists of a microprocessor, a cellular communications transceiver, solar power sources, data collection devices, maintenance computer...

2015 OST-R Transportation Technology Scan : A Look Ahead.

DOT National Transportation Integrated Search

2015-12-01

This report identifies emerging technologies and innovative applications that may begin to have significant impact on our transportation systems within three to five years. They represent several industries and disciplines and could affect all major ...

Inflight medical emergencies.

PubMed

Lyznicki, J M; Williams, M A; Deitchman, S D; Howe, J P

2000-08-01

This report responds to resolutions asking the American Medical Association (AMA) to develop recommendations for the use of medical equipment and technology onboard commercial airlines. Information for the report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with experts in aerospace and emergency medicine. Based on this information, the AMA Council on Scientific Affairs determined that, while inflight morbidity and mortality are uncommon, serious events do occur, which require immediate emergency care. Management of serious problems requires an integrated emergency response system that ensures rapid notification of medical personnel on the ground, assistance from appropriately trained flight crews and passenger volunteers (if available), and adequate medical supplies and equipment to stabilize the victim. Physicians have an important role in the preflight evaluation and counseling of potential passengers who are at risk of inflight medical complications, and in providing inflight medical assistance. Some U.S. and foreign air carriers are upgrading inflight emergency medical kits and placing automated external defibrillators aboard aircraft. Few data are available regarding the effectiveness of such improvements in improving health or survival outcomes. Recent federal legislation requires assessment of the extent of inflight medical emergencies, including the adequacy of emergency medical supplies and equipment carried onboard commercial airliners. This legislation also should alleviate liability concerns by providing immunity for physicians and others who render inflight medical assistance.

Primary care access barriers as reported by nonurgent emergency department users: implications for the US primary care infrastructure.

PubMed

Hefner, Jennifer L; Wexler, Randy; McAlearney, Ann Scheck

2015-01-01

The objective was to explore variation by insurance status in patient-reported barriers to accessing primary care. The authors fielded a brief, anonymous, voluntary survey of nonurgent emergency department (ED) visits at a large academic medical center and conducted descriptive analysis and thematic coding of 349 open-ended survey responses. The privately insured predominantly reported primary care infrastructure barriers-wait time in clinic and for an appointment, constraints related to conventional business hours, and difficulty finding a primary care provider (because of geography or lack of new patient openings). Half of those insured by Medicaid and/or Medicare also reported these infrastructure barriers. In contrast, the uninsured predominantly reported insurance, income, and transportation barriers. Given that insured nonurgent ED users frequently report infrastructure barriers, these should be the focus of patient-level interventions to reduce nonurgent ED use and of health system-level policies to enhance the capacity of the US primary care infrastructure. © 2014 by the American College of Medical Quality.

Shaping Collective Functions in Privatized Agricultural Knowledge and Information Systems: The Positioning and Embedding of a Network Broker in the Dutch Dairy Sector

ERIC Educational Resources Information Center

Klerkx, Laurens; Leeuwis, Cees

2009-01-01

This paper examines new organizational arrangements that have emerged in the context of a privatized extension system. It investigates the positioning and embedding of a network broker aimed at enhancing interaction in the privatized agricultural knowledge and information system (AKIS), to assess whether tensions reported in other sectors also…

Systems engineering technology for networks

NASA Technical Reports Server (NTRS)

1994-01-01

The report summarizes research pursued within the Systems Engineering Design Laboratory at Virginia Polytechnic Institute and State University between May 16, 1993 and January 31, 1994. The project was proposed in cooperation with the Computational Science and Engineering Research Center at Howard University. Its purpose was to investigate emerging systems engineering tools and their applicability in analyzing the NASA Network Control Center (NCC) on the basis of metrics and measures.

Failure of the MicroScan WalkAway System To Detect Heteroresistance to Carbapenems in a Patient with Enterobacter aerogenes Bacteremia▿

PubMed Central

Gordon, N. C.; Wareham, D. W.

2009-01-01

We report the failure of the automated MicroScan WalkAway system to detect carbapenem heteroresistance in Enterobacter aerogenes. Carbapenem resistance has become an increasing concern in recent years, and robust surveillance is required to prevent dissemination of resistant strains. Reliance on automated systems may delay the detection of emerging resistance. PMID:19641071

Biosensing and environmental sensing for emergency and protection e-Textiles.

PubMed

Magenes, G; Curone, D; Secco, E L; Bonfiglio, A

2011-01-01

The ProeTEX project introduced for the first time a complete set of smart garments integrating sensors for the physiological and environmental monitoring of emergency operators. These "smart" garments have been deeply tested in emergency-like contexts by professional rescuers, in order to assess real-time acquisition, processing and transmission of data from moving subjects while operating in harsh conditions. Here we report an overview of the main results obtained during field trials performed in 2010 by Italian and French professional firefighters, in specialized training centers, while dressing the ProeTEX prototypes. Results clearly demonstrate the benefit and step forward of such a system in order to monitor and coordinate rescuers even during intervention far away from the emergency headquarter.

[Cardiovascular complications of hypertensive crisis].

PubMed

Rosas-Peralta, Martín; Borrayo-Sánchez, Gabriela; Madrid-Miller, Alejandra; Ramírez-Arias, Erick; Pérez-Rodríguez, Gilberto

2016-01-01

It is inexorable that a proportion of patients with systemic arterial hypertension will develop a hypertensive crisis at some point in their lives. The hypertensive crises can be divided in hypertensive patients with emergency or hypertensive emergency, according to the presence or absence of acute end-organ damage. In this review, we discuss the cardiovascular hypertensive emergencies, including acute coronary syndrome, congestive heart failure, aortic dissection and sympathomimetic hypertensive crises (those caused by cocaine use included). Each is presented in a unique way, although some patients with hypertensive emergency report non-specific symptoms. Treatment includes multiple medications for quick and effective action with security to reduce blood pressure, protect the function of organs remaining, relieve symptoms, minimize the risk of complications and improve patient outcomes.

Feasibility of blind aortic catheter placement in the prehospital environment to guide resuscitation in cardiac arrest.

PubMed

Manning, James E

2013-08-01

Aortic catheter-based resuscitation therapies are emerging with laboratory investigations showing benefit in models of trauma-related noncompressible torso hemorrhage and nontraumatic cardiac arrest. For these investigational aortic catheter-based therapies to reach their greatest potential clinical benefit, the ability to initiate them in the prehospital setting will be important. Feasibility of prehospital aortic catheterization without imaging capability supports this potential and is described in this report. A physician prehospital response system was created in cooperation with the local emergency medical services system to provide invasive hemodynamic monitoring during cardiac arrest. Physicians were dispatched to all known or suspected prehospital cardiac arrests covered by the emergency medical services system. Physicians responded with a specialized vascular catheterization pack and a monitor with invasive pressure monitoring capability. The physicians performed blind thoracic aortic and central venous catheterizations in cardiac arrest patients in the prehospital setting to measure coronary perfusion pressure, to optimize closed-chest cardiopulmonary resuscitation technique, and to administer intra-aortic epinephrine. During a 2-year period, 22 medical cardiac arrest patients underwent prehospital invasive hemodynamic monitoring to guide resuscitation. Most patients had both aortic and central venous catheters inserted. The combination of intra-aortic epinephrine and adjustments in closed-chest cardiopulmonary resuscitation technique resulted in improved coronary perfusion pressure. Return of spontaneous circulation with survival to hospital admission was achieved in 50% (11 of 22) of these patients. This report demonstrates the feasibility of successful blind aortic and central venous catheterizations in the prehospital environment and supports the potential feasibility of other emerging aortic catheter-based resuscitation therapies.

Multi-Agent Simulation of Allocating and Routing Ambulances Under Condition of Street Blockage after Natural Disaster

NASA Astrophysics Data System (ADS)

Azimi, S.; Delavar, M. R.; Rajabifard, A.

2017-09-01

In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.

Hydrodynamic interactions of cilia on a spherical body

NASA Astrophysics Data System (ADS)

Nasouri, Babak; Elfring, Gwynn J.

2015-11-01

The emergence of metachronal waves in ciliated microorganisms can arise solely from the hydrodynamic interactions between the cilia. For a chain of cilia attached to a flat ciliate, it was observed that fluid forces can lead the system to form a metachronal wave. However, several microorganisms such as paramecium and volvox possess a curved shaped ciliate body. To understand the effect of this geometry on the formation of metachronal waves, we evaluate the hydrodynamic interactions of cilia near a large spherical body. Using a minimal model, we show that for a chain of cilia around the sphere, the embedded periodicity in the geometry leads the system to synchronize. We also report an emergent wave-like behavior when an asymmetry is introduced to the system.

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.

PubMed

Georgiou, Andrew; Prgomet, Mirela; Paoloni, Richard; Creswick, Nerida; Hordern, Antonia; Walter, Scott; Westbrook, Johanna

2013-06-01

We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Emerging Communication Technologies (ECT) Phase 4 Report

NASA Technical Reports Server (NTRS)

Bastin, Gary L.; Harris, William G.; Marin, Jose A.; Nelson, Richard A.

2005-01-01

The Emerging Communication Technology (ECT) project investigated three First Mile communication technologies in support of NASA s Crew Exploration Vehicle (CEV), Advanced Range Technology Working Group (ARTWG), and the Advanced Spaceport Technology Working Group (ASTWG). These First Mile technologies have the purpose of interconnecting mobile users with existing Range Communication infrastructures on a 24/7 basis. ECT is a continuation of the Range Information System Management (RISM) task started in 2002. This is the fourth year of the project.

Development and evaluation of a leadership training program for public health emergency response: results from a Chinese study.

PubMed

Wang, Chongjian; Wei, Sheng; Xiang, Hao; Wu, Jing; Xu, Yihua; Liu, Li; Nie, Shaofa

2008-10-30

Since the 9/11 attack and severe acute respiratory syndrome (SARS), the development of qualified and able public health leaders has become a new urgency in building the infrastructure needed to address public health emergencies. Although previous studies have reported that the training of individual leaders is an important approach, the systemic and scientific training model need further improvement and development. The purpose of this study was to develop, deliver, and evaluate a participatory leadership training program for emergency response. Forty-one public health leaders (N = 41) from five provinces completed the entire emergency preparedness training program in China. The program was evaluated by anonymous questionnaires and semi-structured interviews held prior to training, immediately post-training and 12-month after training (Follow-up). The emergency preparedness training resulted in positive shifts in knowledge, self-assessment of skills for public health leaders. More than ninety-five percent of participants reported that the training model was scientific and feasible. Moreover, the response of participants in the program to the avian influenza outbreak, as well as the planned evaluations for this leadership training program, further demonstrated both the successful approaches and methods and the positive impact of this integrated leadership training initiative. The emergency preparedness training program met its aims and objectives satisfactorily, and improved the emergency capability of public health leaders. This suggests that the leadership training model was effective and feasible in improving the emergency preparedness capability.

China's research status in emergency medicine: a 15-year survey of literature.

PubMed

Wang, Weiwei; Jiang, Ting; Li, Chunyu; Chen, Jun; Cao, Kejiang; Qi, Lian-wen; Li, Ping; Zhu, Wei; Zhu, Baoli; Chen, Yan

2016-03-01

To investigate the research status of emergency medicine in China through literature search of international emergency medicine journals and retrospectively compare the outputs of emergency medicine articles of the 3 major regions of China-Mainland (ML), Taiwan (TW), and Hong Kong (HK). Emergency medicine journals were selected category from Science Citation Index Expand. Articles from the ML, TW, and HK were retrieved from PubMed database. The total number of articles, publication types, research contents, impact factors (IF), and articles published in each journal were conducted for quantity and quality comparisons. A total of 1760 articles from 19 emergency medicine journals were searched, of which 395 were from ML, 1210 from TW, and 155 from HK. Accumulated IF of articles from TW (2451.109) was much higher than that of ML (851.832) and HK (328.579), whereas the average IF of articles from TW (2.02) was the lowest. The number of case reports was the highest, which was, 69 from ML, 637 from TW, and 25 from HK, respectively. Although emergency medicine was involved with multiple organs and multiple systems, the reports of trauma accounted for 25% of the research contents. The total number of articles from both China and the rest of the world increased significantly from 2000 to 2014, especially ML. The total number of articles from TW was still much more than that of ML and HK, whereas the quality of articles from TW was not as good as ML and HK. Case report had the highest share of publication types, whereas the proportions of meta-analysis and observational study were the lowest. As for research contents, the proportion of trauma was still the highest. Copyright © 2015 Elsevier Inc. All rights reserved.

Hydrodynamic Equations for Flocking Models without Velocity Alignment

NASA Astrophysics Data System (ADS)

Peruani, Fernando

2017-10-01

The spontaneous emergence of collective motion patterns is usually associated with the presence of a velocity alignment mechanism that mediates the interactions among the moving individuals. Despite of this widespread view, it has been shown recently that several flocking behaviors can emerge in the absence of velocity alignment and as a result of short-range, position-based, attractive forces that act inside a vision cone. Here, we derive the corresponding hydrodynamic equations of a microscopic position-based flocking model, reviewing and extending previous reported results. In particular, we show that three distinct macroscopic collective behaviors can be observed: i) the coarsening of aggregates with no orientational order, ii) the emergence of static, elongated nematic bands, and iii) the formation of moving, locally polar structures, which we call worms. The derived hydrodynamic equations indicate that active particles interacting via position-based interactions belong to a distinct class of active systems fundamentally different from other active systems, including velocity-alignment-based flocking systems.

Critical incidents during prehospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about?

PubMed

Hohenstein, Christian; Rupp, Peter; Fleischmann, Thomas

2011-02-01

We wanted to identify incidents that led or could have led to patient harm during prehospital cardiopulmonary resuscitation. A nationwide anonymous and Internet-based critical incident reporting system gave the data. During a 4-year period we received 548 reports of which 74 occurred during cardiopulmonary resuscitation. Human error was responsible for 85% of the incidents, whereas equipment failure contributed to 15% of the reports. Equipment failure was considered to be preventable in 61% of all the cases, whereas incidents because of human error could have been prevented in almost all the cases. In most cases, prevention can be accomplished by simple strategies with the Poka-Yoke technique. Insufficient training of emergency medical service physicians in Germany requires special attention. The critical incident reports raise concerns regarding the level of expertize provided by emergency medical service doctors.

Important historical efforts at emergency department categorization in the United States and implications for regionalization.

PubMed

Mehrotra, Abhishek; Sklar, David P; Tayal, Vivek S; Kocher, Keith E; Handel, Daniel A; Myles Riner, R

2010-12-01

This article is drawn from a report created for the American College of Emergency Physicians (ACEP) Emergency Department (ED) Categorization Task Force and also reflects the proceedings of a breakout session, "Beyond ED Categorization-Matching Networks to Patient Needs," at the 2010 Academic Emergency Medicine consensus conference, "Beyond Regionalization: Integrated Networks of Emergency Care." The authors describe a brief history of the significant national and state efforts at categorization and suggest reasons why many of these efforts failed to persevere or gain wider implementation. The history of efforts to categorize hospital (and ED) emergency services demonstrates recognition of the potential benefits of categorization, but reflects repeated failures to implement full categorization systems or limited excursions into categorization through licensing of EDs or designation of receiving and referral facilities. An understanding of the history of hospital and ED categorization could better inform current efforts to develop categorization schemes and processes. 2010 by the Society for Academic Emergency Medicine.

Icon and user interface design for emergency medical information systems: a case study.

PubMed

Salman, Y Batu; Cheng, Hong-In; Patterson, Patrick E

2012-01-01

A usable medical information system should allow for reliable and accurate interaction between users and the system in emergencies. A participatory design approach was used to develop a medical information system in two Turkish hospitals. The process consisted of task and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons. We observed work sites to note working processes and tasks related to the information system and interviewed medical personnel. Emergency personnel then participated in the design process to develop a usable graphical user interface, by drawing icon sketches for 23 selected tasks. Similar sketches were requested for specific tasks such as family medical history, contact information, translation, addiction, required inspections, requests and applications, and nurse observations. The sketches were analyzed and redesigned into computer icons by professional designers and the research team. A second group of physicians and nurses then tested the understandability of the icons. The user interface layout was examined and evaluated by system users, followed by the system's installation. Medical personnel reported the participatory design process was interesting and believed the resulting designs would be more familiar and friendlier. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The implementation of a national trauma registry in Greece. Methodology and preliminary results.

PubMed

Katsaragakis, Stylianos; Theodoraki, Maria E; Toutouzas, Kostas; Drimousis, Panagiotis G; Larentzakis, Antreas; Stergiopoulos, Spiros; Aggelakis, Christos; Lapidakis, George; Massalis, Ioannis; Theodorou, Dimitrios

2009-12-01

Trauma is a leading cause of death worldwide and a major health problem of the modern society. Trauma systems are considered the gold standard of managing patients with trauma. An integral part of any trauma system is a trauma registry. In Europe, and particularly in Greece, trauma registries and systems are in an embryonic stage. In this study, we present an attempt to record trauma in Greece. The Hellenic Society of Trauma and Emergency Surgery invited all the official representatives of the society throughout the country to participate in the study. In succeeding meetings of the representatives, the reporting form was developed and the inclusion criteria were defined meticulously. Inclusion criteria were defined as patients with trauma requiring admission, transfer to a higher level center, or arrived dead or died in the emergency department of the reporting hospital. All reports were accumulated by the Hellenic Trauma society, imported in an electronic database, and analyzed. Thirty-two hospitals receiving patients with trauma participated in the country, representing 40% of the country's healthcare facilities and serving 40% of the country's population. In 12 months time, (October 2005 to September 2006), 8,862 patients were included in the study. Of them, 66.9% were men and 31.3% were women. The compilation rate of the reporting forms was surprisingly high, considering that the final reporting form included 150 data points and that there were no independent personnel in charge of filling the forms. Trauma registries are feasible even in health care systems where funding of medical research is sparse.

Response, Emergency Staging, Communications, Uniform Management, and Evacuation (R.E.S.C.U.M.E.) : report on functional and performance requirements, and high-level data and communication needs.

DOT National Transportation Integrated Search

1995-06-01

INTELLIGENT VEHICLE INITIATIVE OR IVI ABSTRACT THE GOAL OF THE TRAVTEK CAMERA CAR STUDY WAS TO FURNISH A DETAILED EVALUATION OF DRIVING AND NAVIGATION PERFORMANCE, SYSTEM USABILITY, AND SAFETY FOR THE TRAVTEK SYSTEM. TO ACHIEVE THIS GOAL, AN INSTRUME...

Colorado School Finance Partnership: Report and Recommendations. Financing Colorado's Future: Assessing Our School Finance System

ERIC Educational Resources Information Center

Colorado Children's Campaign, 2012

2012-01-01

Over the last decade, Colorado has emerged as a national leader in crafting innovative solutions for challenges facing its public school system. From implementing the Colorado Student Assessment Program (CSAP) and No Child Left Behind (NCLB) reforms to more recent legislation including standards and assessments for a preschool-through-college…

The Impacts of Agile Development Methodology Use on Project Success: A Contingency View

ERIC Educational Resources Information Center

Tripp, John F.

2012-01-01

Agile Information Systems Development Methods have emerged in the past decade as an alternative manner of managing the work and delivery of information systems development teams, with a large number of organizations reporting the adoption & use of agile methods. The practitioners of these methods make broad claims as to the benefits of their…

Physicochemical Requirements Inferred for Chemical Self-Organization Hardly Support an Emergence of Life in the Deep Oceans of Icy Moons.

PubMed

Pascal, Robert

2016-05-01

An approach to the origin of life, focused on the property of entities capable of reproducing themselves far from equilibrium, has been developed recently. Independently, the possibility of the emergence of life in the hydrothermal systems possibly present in the deep oceans below the frozen crust of some of the moons of Jupiter and Saturn has been raised. The present report is aimed at investigating the mutual compatibility of these alternative views. In this approach, the habitability concept deduced from the limits of life on Earth is considered to be inappropriate with regard to emerging life due to the requirement for an energy source of sufficient potential (equivalent to the potential of visible light). For these icy moons, no driving force would have been present to assist the process of emergence, which would then have had to rely exclusively on highly improbable events, thereby making the presence of life unlikely on these Solar System bodies, that is, unless additional processes are introduced for feeding chemical systems undergoing a transition toward life and the early living organisms. Icy moon-Bioenergetics-Chemical evolution-Habitability-Origin of life. Astrobiology 16, 328-334.

On-time reliability impacts of advanced traveler information services (ATIS) : Washington, DC case study

DOT National Transportation Integrated Search

1998-09-01

Emissions Management Using ITS Technology report summarizes and interprets the results of three Intelligent Transportation Systems (ITS) Field Operational Tests (FOTs) that evaluated the use of emerging technologies to help authorities measure emissi...

Report on the emergency response to the event on May 14, 1997, at the plutonuim reclamation facility, Hanford Site, Richland,Washington

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shoop, D.S.

1997-08-20

On the evening of May 14,1997, a chemical explosion Occurred at the Plutonium Reclamation Facility (PRF) in the 200 West Area(200-W) of the Hanford Site. The event warranted the declaration of an Alert emergency, activation of the Hanford Emergency Response Organization (BRO), and notification of offsite agencies. As a result of the emergency declaration, a subsequent evaluation was conducted to assess: 9 the performance of the emergency response organization o the occupational health response related to emergency activities o event notifications to offsite and environmental agencies. Additionally, the evaluation was designed to: 9 document the chronology of emergency and occupationalmore » health responses and environmental notifications connected with the explosion at the facility 0 assess the adequacy of the Hanford Site emergency preparedness activities; response readiness; and emergency management actions, occupational health, and environmental actions 0 provide an analysis of the causes of the deficiencies and weaknesses in the preparedness and response system that have been identified in the evaluation of the response a assign organizational responsibility to correct deficiencies and weaknesses a improve future performance 0 adjust elements of emergency implementing procedures and emergency preparedness activities.« less

Childhood Emergencies

MedlinePlus

... In A Medical Emergency Childhood Emergencies Careers in Emergency Medicine Seconds Save Lives Be Prepared Safe Citizen Day ... case report was reported online in Annals of Emergency Medicine. More Than 200,000 Kids Treated in ERs ...

Development and use of a population based injury surveillance system: the All Wales Injury Surveillance System (AWISS)

PubMed Central

Lyons, R; Jones, S; Kemp, A; Sibert, J; Shepherd, J; Richmond, P; Bartlett, C; Palmer, S

2002-01-01

This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives. PMID:11928983

A Knock-in Reporter for a Novel AR-Targeted Therapy

DTIC Science & Technology

2016-05-01

of this research is to explore a possibility whether the CRISPR -Cas9 technology, an emerging genome-editing approach, could be applied to develop a...in this report that the CRISPR -Cas9 system could indeed mediate high-efficient insertion of a selection gene into a site immediately downstream of...inhibitory for AR expression. 15. SUBJECT TERMS Androgen receptor, high-throughput drug screening assay, reporter gene assay, CRISPR -Cas9, genome editing

Paradigm shift: contribution of field epidemiology training in advancing the “One Health” approach to strengthen disease surveillance and outbreak investigations in Africa

PubMed Central

Monday, Busuulwa; Gitta, Sheba Nakacubo; Wasswa, Peter; Namusisi, Olivia; Bingi, Aloysius; Musenero, Monica; Mukanga, David

2011-01-01

The occurrence of major zoonotic disease outbreaks in Sub-Saharan Africa has had a significant impact on the already constrained public health systems. This has, as a result, justified the need to identify creative strategies to address threats from emerging and re-emerging infectious diseases at the human-animal-environmental interface, and implement robust multi-disease public health surveillance systems that will enhance early detection and response. Additionally, enhanced reporting and timely investigation of all suspected notifiable infectious disease threats within the health system is vital. Field epidemiology and laboratory training programs (FELTPs) have made significant contributions to public health systems for more than 10 years by producing highly skilled field epidemiologists. These epidemiologists have not only improved disease surveillance and response to outbreaks, but also improved management of health systems. Furthermore, the FETPs/FELTPs have laid an excellent foundation that brings clinicians, veterinarians, and environmental health professionals drawn from different governmental sectors, to work with a common purpose of disease control and prevention. The emergence of the One Health approach in the last decade has coincided with the present, paradigm, shift that calls for multi-sectoral and cross-sectoral collaboration towards disease surveillance, detection, reporting and timely response. The positive impact from the integration of FETP/FELTP and the One Health approach by selected programs in Africa has demonstrated the importance of multi-sectoral collaboration in addressing threats from infectious and non- infectious causes to man, animals and the environment. PMID:22359701

Predictors of Intention of Reporting Child Abuse among Emergency Nurses.

PubMed

Lee, Hye-Mi; Kim, Ji-Soo

The current study investigates predictors of intention of reporting child abuse among emergency nurses in Korea. A descriptive cross-sectional design was used. Data were collected from 200 emergency nurses in eight general hospitals in Korea through a questionnaire that asked about their general characteristics, knowledge about child abuse, perceived behavioral control, experiences of child abuse cases and reporting, and attitude toward child abuse. Multiple regression analysis indicated that attitude toward child abuse was the most influential predictor of the intention of reporting child abuse among Korea's emergency nurses. Knowledge about child abuse, and perceived behavioral control were also significant influencing predictors of reporting intention. These variables explained 22.1% of the variances in the intention of reporting child abuse among emergency nurses. Reporting child abuse has not yet been established as a professional responsibility among Korea's emergency nurses. Increasing the level of awareness of the characteristics of child abuse and encouraging communication among nurses about the responsibility to report suspected child abuse will increase nurses' confidence to report. Training for reporting child abuse should be implemented in the near future to improve emergency nurses' understanding of child abuse. A support program is also needed to help emergency nurses build confidence in reporting child abuse as a professional responsibility. Copyright © 2017 Elsevier Inc. All rights reserved.

Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing "One Health" community surveillance and emergency response practice.

PubMed

Tambo, Ernest; Adetunde, Oluwasegun T; Olalubi, Oluwasogo A

2018-04-28

We evaluated the impact of man-made conflict events and climate change impact in guiding evidence-based community "One Health" epidemiology and emergency response practice against re-/emerging epidemics. Increasing evidence of emerging and re-emerging zoonotic diseases including recent Lassa fever outbreaks in almost 20 states in Nigeria led to 101 deaths and 175 suspected and confirmed cases since August 2015. Of the 75 laboratory confirmed cases, 90 deaths occurred representing 120% laboratory-confirmed case fatality. The outbreak has been imported into neighbouring country such as Benin, where 23 deaths out of 68 cases has also been reported. This study assesses the current trends in re-emerging Lassa fever outbreak in understanding spatio-geographical reservoir(s), risk factors pattern and Lassa virus incidence mapping, inherent gaps and raising challenges in health systems. It is shown that Lassa fever peak endemicity incidence and prevalence overlap the dry season (within January to March) and reduced during the wet season (of May to November) annually in Sierra Leone, Senegal to Eastern Nigeria. We documented a scarcity of consistent data on rodent (reservoirs)-linked Lassa fever outbreak, weak culturally and socio-behavioural effective prevention and control measures integration, weak or limited community knowledge and awareness to inadequate preparedness capacity and access to affordable case management in affected countries. Hence, robust sub/regional leadership commitment and investment in Lassa fever is urgently needed in building integrated and effective community "One Health" surveillance and rapid response approach practice coupled with pest management and phytosanitation measures against Lassa fever epidemic. This offers new opportunities in understanding human-animal interactions in strengthening Lassa fever outbreak early detection and surveillance, warning alerts and rapid response implementation in vulnerable settings. Leveraging on Africa CDC centre, advances in cloud-sourcing and social media tools and solutions is core in developing and integrating evidence-based and timely risk communication, and reporting systems in improving contextual community-based immunization and control decision making policy to effectively defeat Lassa fever outbreak and other emerging pandemics public health emergencies in Africa and worldwide.

The use of a contextual, modal and psychological classification of medication errors in the emergency department: a retrospective descriptive study.

PubMed

Cabilan, C J; Hughes, James A; Shannon, Carl

2017-12-01

To describe the contextual, modal and psychological classification of medication errors in the emergency department to know the factors associated with the reported medication errors. The causes of medication errors are unique in every clinical setting; hence, error minimisation strategies are not always effective. For this reason, it is fundamental to understand the causes specific to the emergency department so that targeted strategies can be implemented. Retrospective analysis of reported medication errors in the emergency department. All voluntarily staff-reported medication-related incidents from 2010-2015 from the hospital's electronic incident management system were retrieved for analysis. Contextual classification involved the time, place and the type of medications involved. Modal classification pertained to the stage and issue (e.g. wrong medication, wrong patient). Psychological classification categorised the errors in planning (knowledge-based and rule-based errors) and skill (slips and lapses). There were 405 errors reported. Most errors occurred in the acute care area, short-stay unit and resuscitation area, during the busiest shifts (0800-1559, 1600-2259). Half of the errors involved high-alert medications. Many of the errors occurred during administration (62·7%), prescribing (28·6%) and commonly during both stages (18·5%). Wrong dose, wrong medication and omission were the issues that dominated. Knowledge-based errors characterised the errors that occurred in prescribing and administration. The highest proportion of slips (79·5%) and lapses (76·1%) occurred during medication administration. It is likely that some of the errors occurred due to the lack of adherence to safety protocols. Technology such as computerised prescribing, barcode medication administration and reminder systems could potentially decrease the medication errors in the emergency department. There was a possibility that some of the errors could be prevented if safety protocols were adhered to, which highlights the need to also address clinicians' attitudes towards safety. Technology can be implemented to help minimise errors in the ED, but this must be coupled with efforts to enhance the culture of safety. © 2017 John Wiley & Sons Ltd.

Use of emergency care services by immigrants—a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic.

PubMed

Ruud, Sven Eirik; Aga, Ruth; Natvig, Bård; Hjortdahl, Per

2015-10-07

The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5-6% annual increase in patient visits between 2005 and 2011, which was significantly higher than the 2-3% annual increase among registered Oslo residents. This study explored immigrant walk-in patients' use of both the general emergency and trauma clinics of the OAEOC and their concomitant use of regular general practitioners (RGPs) in Oslo. A cross-sectional survey of walk-in patients attending the OAEOC during 2 weeks in September 2009. We analysed demographic data, patients' self-reported affiliation with the RGP scheme, self-reported number of OAEOC and RGP consultations during the preceding 12 months. The first approach used Poisson regression models to study visit frequency. The second approach compared the proportions of first- and second-generation immigrants and those from the four most frequently represented countries (Sweden, Pakistan, Somalia and Poland) among the patient population, with their respective proportions within the general Oslo population. The analysis included 3864 patients: 1821 attended the Department of Emergency General Practice ("general emergency clinic"); 2043 attended the Section for Orthopaedic Emergency ("trauma clinic"). Both first- and second-generation immigrants reported a significantly higher OAEOC visit frequency compared with Norwegians. Norwegians, representing 73% of the city population accounted for 65% of OAEOC visits. In contrast, first- and second-generation immigrants made up 27% of the city population but accounted for 35% of OAEOC visits. This proportional increase in use was primarily observed in the general emergency clinic (42% of visits). Their proportional use of the trauma clinic (29%) was similar to their proportion in the city. Among first-generation immigrants only 71% were affiliated with the RGP system, in contrast to 96% of Norwegians. Similar finding were obtained when immigrants were grouped by nationality. Compared to Norwegians, immigrants from Sweden, Pakistan and Somalia reported using the OAEOC significantly more often. Immigrants from Sweden, Poland and Somalia were over-represented at both clinics. The least frequent RGP affiliation was among immigrants from Sweden (32%) and Poland (65%). In Norway, immigrant subgroups use emergency health care services in different ways. Understanding these patterns of health-seeking behaviour may be important when designing emergency health services.

Public Health System Research in Public Health Emergency Preparedness in the United States (2009–2015): Actionable Knowledge Base

PubMed Central

Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P.; Guicciardi, Stefano

2017-01-01

Background. In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. Objectives. To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. Data Collection and Analysis. We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Main Results. Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. Conclusions: In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts. PMID:28892437

Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

PubMed

Savoia, Elena; Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P; Guicciardi, Stefano

2017-09-01

In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics. To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies. We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool. Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.

Research and Development Annual Report, 1992

NASA Technical Reports Server (NTRS)

1993-01-01

Issued as a companion to Johnson Space Center's Research and Technology Annual Report, which reports JSC accomplishments under NASA Research and Technology Operating Plan (RTOP) funding, this report describes 42 additional JSC projects that are funded through sources other than the RTOP. Emerging technologies in four major disciplines are summarized: space systems technology, medical and life sciences, mission operations, and computer systems. Although these projects focus on support of human spacecraft design, development, and safety, most have wide civil and commercial applications in areas such as advanced materials, superconductors, advanced semiconductors, digital imaging, high density data storage, high performance computers, optoelectronics, artificial intelligence, robotics and automation, sensors, biotechnology, medical devices and diagnosis, and human factors engineering.

The JSC Research and Development Annual Report 1993

NASA Technical Reports Server (NTRS)

1994-01-01

Issued as a companion to Johnson Space Center's Research and Technology Annual Report, which reports JSC accomplishments under NASA Research and Technology Operating Plan (RTOP) funding, this report describes 47 additional projects that are funded through sources other than the RTOP. Emerging technologies in four major disciplines are summarized: space systems technology, medical and life sciences, mission operations, and computer systems. Although these projects focus on support of human spacecraft design, development, and safety, most have wide civil and commercial applications in areas such as advanced materials, superconductors, advanced semiconductors, digital imaging, high density data storage, high performance computers, optoelectronics, artificial intelligence, robotics and automation, sensors, biotechnology, medical devices and diagnosis, and human factors engineering.

Quality and Safety Implications of Emergency Department Information Systems

PubMed Central

Farley, Heather L.; Baumlin, Kevin M.; Hamedani, Azita G.; Cheung, Dickson S.; Edwards, Michael R.; Fuller, Drew C.; Genes, Nicholas; Griffey, Richard T.; Kelly, John J.; McClay, James C.; Nielson, Jeff; Phelan, Michael P.; Shapiro, Jason S.; Stone-Griffith, Suzanne; Pines, Jesse M.

2013-01-01

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue. Case studies are presented that illustrate the potential harm that could befall patients from an inferior EDIS product or suboptimal execution of such a product in the clinical environment. The authors have developed 7 recommendations to improve patient safety with respect to the deployment of EDISs. These include ensuring that emergency providers actively participate in selection of the EDIS product, in the design of processes related to EDIS implementation and optimization, and in the monitoring of the system’s ongoing success or failure. Our recommendations apply to emergency departments using any type of EDIS: custom-developed systems, best-of-breed vendor systems, or enterprise systems. PMID:23796627

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee report on electronic brachytherapy.

PubMed

Park, Catherine C; Yom, Sue S; Podgorsak, Matthew B; Harris, Eleanor; Price, Robert A; Bevan, Alison; Pouliot, Jean; Konski, Andre A; Wallner, Paul E

2010-03-15

The development of novel technologies for the safe and effective delivery of radiation is critical to advancing the field of radiation oncology. The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for, or are already in, clinical use. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft, Inc. (Fremont, CA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany). These devices are designed to deliver electronically generated radiation, and because of their relatively low energy output, they do not fall under existing regulatory scrutiny of radioactive sources that are used for conventional radioisotope brachytherapy. This report provides a descriptive overview of the technologies, current and future projected applications, comparison of competing technologies, potential impact, and potential safety issues. The full Emerging Technology Committee report is available on the American Society for Therapeutic Radiology and Oncology Web site. Copyright 2010. Published by Elsevier Inc.

American Society for Therapeutic Radiology and Oncology (ASTRO) Emerging Technology Committee Report on Electronic Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, Catherine C., E-mail: cpark@radonc.ucsf.ed; Yom, Sue S.; Podgorsak, Matthew B.

The development of novel technologies for the safe and effective delivery of radiation is critical to advancing the field of radiation oncology. The Emerging Technology Committee of the American Society for Therapeutic Radiology and Oncology appointed a Task Group within its Evaluation Subcommittee to evaluate new electronic brachytherapy methods that are being developed for, or are already in, clinical use. The Task Group evaluated two devices, the Axxent Electronic Brachytherapy System by Xoft, Inc. (Fremont, CA), and the Intrabeam Photon Radiosurgery Device by Carl Zeiss Surgical (Oberkochen, Germany). These devices are designed to deliver electronically generated radiation, and because ofmore » their relatively low energy output, they do not fall under existing regulatory scrutiny of radioactive sources that are used for conventional radioisotope brachytherapy. This report provides a descriptive overview of the technologies, current and future projected applications, comparison of competing technologies, potential impact, and potential safety issues. The full Emerging Technology Committee report is available on the American Society for Therapeutic Radiology and Oncology Web site.« less

Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect.

PubMed

Rosen, Tony; Lien, Cynthia; Stern, Michael E; Bloemen, Elizabeth M; Mysliwiec, Regina; McCarthy, Thomas J; Clark, Sunday; Mulcare, Mary R; Ribaudo, Daniel S; Lachs, Mark S; Pillemer, Karl; Flomenbaum, Neal E

2017-10-01

Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities. To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment. Five semi-structured focus groups with 27 EMS providers. Participants reported believing they frequently encountered and were able to identify potential elder mistreatment victims. Many reported infrequently discussing their concerns with other health care providers or social workers and not reporting them to the authorities due to barriers: 1) lack of EMS protocols or training specific to vulnerable elders; 2) challenges in communication with emergency department providers, including social workers, who are often unavailable or not receptive; 3) time limitations; and 4) lack of follow-up when EMS providers do report concerns. Many participants reported interest in adopting protocols to assist in elder protection. Additional strategies included photographically documenting the home environment, additional training, improved direct communication with social workers, a dedicated location on existing forms or new form to document concerns, a reporting hotline, a system to provide feedback to EMS, and community paramedicine. EMS providers frequently identify potential victims of elder abuse, neglect, and self-neglect, but significant barriers to reporting exist. Strategies to empower EMS providers and improve reporting were identified. Copyright © 2017 Elsevier Inc. All rights reserved.

An Integrated Computerized Triage System in the Emergency Department

PubMed Central

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients. PMID:18999190

Emergency physician perspectives on central venous catheterization in the emergency department: a survey-based study.

PubMed

Ballard, Dustin W; Reed, Mary E; Rauchwerger, Adina S; Chettipally, Uli K; Offerman, Steven R; Mark, Dustin G; Vinson, David R

2014-06-01

The objective was to assess clinician experience, training, and attitudes toward central venous catheterization (CVC) in adult emergency department (ED) patients in a health system promoting increased utilization of CVC for severely septic ED patients. The authors surveyed all emergency physicians (EPs) within a 21-hospital integrated health care delivery system that had recently instituted a modified Rivers protocol for providing early goal-directed therapy (EGDT) to patients with severe sepsis or septic shock, including CVC if indicated. This initiative was accompanied by a structured, but optional, systemwide hands-on training for EPs in real-time ultrasound-guided CVC (US CVC). EPs' responses to questions regarding self-reported experience with CVC in the ED are reported. Data included frequency of CVC (by type) and US CVC training opportunities: both during and after residency and informal ("on-the-job training involving actual ED patients under the oversight of someone more experienced than yourself") and formal ("off-the-job training not involving actual ED patients"). The survey also asked respondents to report their comfort levels with different types of CVC as well as their agreement with possible barriers (philosophical, time-related, equipment-related, and complication-related) to CVC in the ED. Multivariable ordinal logistic regression was used to identify provider characteristics and responses associated with higher yearly CVC volumes. The survey response rate among eligible participants was 365 of 465 (78%). Overall, 154 of 365 (42%) respondents reported performing 11 or more CVCs a year, while 46 of 365 (13%) reported doing two or fewer. Concerning CVC techniques, 271 of 358 (76%) of respondents reported being comfortable with the internal jugular approach with US guidance, compared to 200 of 345 (58%) with the subclavian approach without US. Training rates were reported as 1) in residency, formal 167 of 358 (47%) and informal 189 of 364 (52%); and 2) postresidency, formal 236 of 359 (66%) and informal 260 of 365 (71%). The most commonly self-reported barriers to CVC were procedural time (56%) and complication risk (61%). After multivariate adjustment, the following were significantly associated with greater self-reported CVC use (p < 0.01): 1) informal bedside CVC training after residency, 2) male sex, 3) disagreement with complication-related barrier questions, and 4) self-reported comfort with placing US-guided internal jugular catheters. In this cross-sectional survey-based study, EPs reported varying experience with CVC in the ED and reported high comfort with the US CVC technique. Postresidency informal training experience, male sex, negative responses to complication-related barrier questions, and comfort with placing US-guided internal jugular catheters were associated with yearly CVC volume. These results suggest that higher rates of CVC in eligible patients might be achieved by informal training programs in US and/or by disseminating existing evidence about the low risk of complications associated with the procedure. © 2014 by the Society for Academic Emergency Medicine.

Prototype development and demonstration for response, emergency staging, communications, uniform management, and evacuation (R.E.S.C.U.M.E.) : R.E.S.C.U.M.E. prototype system architecture.

DOT National Transportation Integrated Search

2014-01-01

This document provides the high-level system architecture for the Prototype Development and Demonstration of a R.E.S.C.U.M.E. system. The requirements addressed in this document are based upon those that can be found in previous R.E.S.C.U.M.E. report...

Real-time monitoring, prognosis, and resilient control for wind turbine systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gao, Zhiwei; Sheng, Shuangwen

This special issue aims to provide a platform for academic and industrial communities to report recent results and emerging research in real-time monitoring, fault diagnosis, prognosis, and resilient control and design of wind turbine systems. After a strict peer-review process, 20 papers were selected, which represent the most recent progress of the real-time monitoring, diagnosis, prognosis, and resilient control methods/techniques in wind turbine systems.

Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK.

PubMed

Rönn, Minttu; Hughes, Gwenda; Simms, Ian; Ison, Cathy; Alexander, Sarah; White, Peter J; Ward, Helen

2014-08-01

United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection. We described laboratory data on samples and surveillance data from case reports for LGV from 2004-2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections. LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8). The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.

Challenges Presented by Re-Emerging Sexually Transmitted Infections in HIV Positive Men who have Sex with Men: An Observational Study of Lymphogranuloma Venereum in the UK

PubMed Central

Rönn, Minttu; Hughes, Gwenda; Simms, Ian; Ison, Cathy; Alexander, Sarah; White, Peter J; Ward, Helen

2015-01-01

Background United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection. Methods We described laboratory data on samples and surveillance data from case reports for LGV from 2004-2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections. Results LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8). Conclusion The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases. PMID:26301124

The impact of OCR accuracy on automated cancer classification of pathology reports.

PubMed

Zuccon, Guido; Nguyen, Anthony N; Bergheim, Anton; Wickman, Sandra; Grayson, Narelle

2012-01-01

To evaluate the effects of Optical Character Recognition (OCR) on the automatic cancer classification of pathology reports. Scanned images of pathology reports were converted to electronic free-text using a commercial OCR system. A state-of-the-art cancer classification system, the Medical Text Extraction (MEDTEX) system, was used to automatically classify the OCR reports. Classifications produced by MEDTEX on the OCR versions of the reports were compared with the classification from a human amended version of the OCR reports. The employed OCR system was found to recognise scanned pathology reports with up to 99.12% character accuracy and up to 98.95% word accuracy. Errors in the OCR processing were found to minimally impact on the automatic classification of scanned pathology reports into notifiable groups. However, the impact of OCR errors is not negligible when considering the extraction of cancer notification items, such as primary site, histological type, etc. The automatic cancer classification system used in this work, MEDTEX, has proven to be robust to errors produced by the acquisition of freetext pathology reports from scanned images through OCR software. However, issues emerge when considering the extraction of cancer notification items.

Local Public Health System Response to the Tsunami Threat in Coastal California following the Tōhoku Earthquake

PubMed Central

Hunter, Jennifer C.; Crawley, Adam W.; Petrie, Michael; Yang, Jane E.; Aragón, Tomás J.

2012-01-01

Background On Friday March 11, 2011 a 9.0 magnitude earthquake triggered a tsunami off the eastern coast of Japan, resulting in thousands of lives lost and billions of dollars in damage around the Pacific Rim. The tsunami first reached the California coast on Friday, March 11th, causing more than $70 million in damage and at least one death. While the tsunami’s impact on California pales in comparison to the destruction caused in Japan and other areas of the Pacific, the event tested emergency responders’ ability to rapidly communicate and coordinate a response to a potential threat. Methods To evaluate the local public health system emergency response to the tsunami threat in California, we surveyed all local public health, emergency medical services (EMS), and emergency management agencies in coastal or floodplain counties about several domains related to the tsunami threat in California, including: (1) the extent to which their community was affected by the tsunami, (2) when and how they received notification of the event, (3) which public health response activities were carried out to address the tsunami threat in their community, and (4) which organizations contributed to the response. Public health activities were characterized using the Centers for Disease Control and Prevention (CDC) Public Health Preparedness Capabilities (PHEP) framework. Findings The tsunami's impact on coastal communities in California ranged widely, both in terms of the economic consequences and the response activities. Based on estimates from the National Oceanic and Atmospheric Administration (NOAA), ten jurisdictions in California reported tsunami-related damage, which ranged from $15,000 to $35 million. Respondents first became aware of the tsunami threat in California between the hours of 10:00pm Pacific Standard Time (PST) on Thursday March 10th and 2:00pm PST on Friday March 11th, a range of 16 hours, with notification occurring through both formal and informal channels. In response to this threat, the activities most commonly reported by the local government agencies included in this study were: emergency public information and warning, emergency operations coordination, and inter-organizational information sharing, which were reported by 86%, 75%, and 65% of all respondents, respectively. When looking at the distribution of responsibility, emergency management agencies were the most likely to report assuming a lead role in these common activities as well as those related to evacuation and community recovery. While activated less frequently, public health agencies carried out emergency response functions related to surveillance and epidemiology, environmental health, and mental health/psychological support. Both local public health and EMS agencies took part in mass care and medical material management activities. A large network of organizations contributed to response activities, with emergency management, law enforcement, fire, public health, public works, EMS, and media cited by more than half of respondents. Conclusions In response to the tsunami threat in California, we found that emergency management agencies assumed a lead role in the local response efforts. While public health and medical agencies played a supporting role in the response, they uniquely contributed to a number of specific activities. If the response to the recent tsunami is any indication, these support activities can be anticipated in planning for future events with similar characteristics to the tsunami threat. Additionally, we found that many respondents first learned of the tsunami through the media, rather than through rapid notification systems, which suggests that government agencies must continue to develop and maintain the ability to rapidly aggregate and analyze information in order to provide accurate assessments and guidance to a potentially well-informed public. Citation: Hunter JC, Crawley AW, Petrie M, Yang JE, Aragón TJ. Local Public Health System Response to the Tsunami Threat in Coastal California following the Tōhoku Earthquake. PLoS Currents Disasters. 2012 Jul 16 PMID:22953236

Local Public Health System Response to the Tsunami Threat in Coastal California following the Tōhoku Earthquake.

PubMed

Hunter, Jennifer C; Crawley, Adam W; Petrie, Michael; Yang, Jane E; Aragón, Tomás J

2012-07-16

Background On Friday March 11, 2011 a 9.0 magnitude earthquake triggered a tsunami off the eastern coast of Japan, resulting in thousands of lives lost and billions of dollars in damage around the Pacific Rim. The tsunami first reached the California coast on Friday, March 11th, causing more than $70 million in damage and at least one death. While the tsunami's impact on California pales in comparison to the destruction caused in Japan and other areas of the Pacific, the event tested emergency responders' ability to rapidly communicate and coordinate a response to a potential threat. Methods To evaluate the local public health system emergency response to the tsunami threat in California, we surveyed all local public health, emergency medical services (EMS), and emergency management agencies in coastal or floodplain counties about several domains related to the tsunami threat in California, including: (1) the extent to which their community was affected by the tsunami, (2) when and how they received notification of the event, (3) which public health response activities were carried out to address the tsunami threat in their community, and (4) which organizations contributed to the response. Public health activities were characterized using the Centers for Disease Control and Prevention (CDC) Public Health Preparedness Capabilities (PHEP) framework. Findings The tsunami's impact on coastal communities in California ranged widely, both in terms of the economic consequences and the response activities. Based on estimates from the National Oceanic and Atmospheric Administration (NOAA), ten jurisdictions in California reported tsunami-related damage, which ranged from $15,000 to $35 million. Respondents first became aware of the tsunami threat in California between the hours of 10:00pm Pacific Standard Time (PST) on Thursday March 10th and 2:00pm PST on Friday March 11th, a range of 16 hours, with notification occurring through both formal and informal channels. In response to this threat, the activities most commonly reported by the local government agencies included in this study were: emergency public information and warning, emergency operations coordination, and inter-organizational information sharing, which were reported by 86%, 75%, and 65% of all respondents, respectively. When looking at the distribution of responsibility, emergency management agencies were the most likely to report assuming a lead role in these common activities as well as those related to evacuation and community recovery. While activated less frequently, public health agencies carried out emergency response functions related to surveillance and epidemiology, environmental health, and mental health/psychological support. Both local public health and EMS agencies took part in mass care and medical material management activities. A large network of organizations contributed to response activities, with emergency management, law enforcement, fire, public health, public works, EMS, and media cited by more than half of respondents. Conclusions In response to the tsunami threat in California, we found that emergency management agencies assumed a lead role in the local response efforts. While public health and medical agencies played a supporting role in the response, they uniquely contributed to a number of specific activities. If the response to the recent tsunami is any indication, these support activities can be anticipated in planning for future events with similar characteristics to the tsunami threat. Additionally, we found that many respondents first learned of the tsunami through the media, rather than through rapid notification systems, which suggests that government agencies must continue to develop and maintain the ability to rapidly aggregate and analyze information in order to provide accurate assessments and guidance to a potentially well-informed public. Hunter JC, Crawley AW, Petrie M, Yang JE, Aragón TJ. Local Public Health System Response to the Tsunami Threat in Coastal California following the Tōhoku Earthquake. PLoS Currents Disasters. 2012 Jul 16.

Emergency motorcycle: has it a place in a medical emergency system?

PubMed

Soares-Oliveira, Miguel; Egipto, Paula; Costa, Isabel; Cunha-Ribeiro, Luis Manuel

2007-07-01

In an emergency medical service system, response time is an important factor in determining the prognosis of a victim. There are well-documented increases in response time in urban areas, mainly during rush hour. Because prehospital emergency care is required to be efficient and swift, alternative measures to achieve this goal should be addressed. We report our experience with a medical emergency motorcycle (MEM) and propose major criteria for dispatching it. This work presents a prospective analysis of the data relating to MEM calls from July 2004 to December 2005. The analyzed parameters were age, sex, reason for call, action, and need for subsequent transport. A comparison was made of the need to activate more means and, if so, whether the MEM was the first to arrive. There were 1972 calls. The average time of arrival at destination was 4.4 +/- 2.5 minutes. The main action consisted of administration of oxygen (n = 626), immobilization (n = 118), and control of hemorrhage (n = 101). In 63% of cases, MEM arrived before other emergency vehicles. In 355 cases (18%), there was no need for transport. The MEM can intervene in a wide variety of clinical situations and a quick response is guaranteed. Moreover, in specific situations, MEM safely and efficiently permits better management of emergency vehicles. We propose that it should be dispatched mainly in the following situations: true life-threatening cases and uncertain need for an ambulance.

Emergency Situation Prediction Mechanism: A Novel Approach for Intelligent Transportation System Using Vehicular Ad Hoc Networks

PubMed Central

Gokulakrishnan, P.

2015-01-01

In Indian four-lane express highway, millions of vehicles are travelling every day. Accidents are unfortunate and frequently occurring in these highways causing deaths, increase in death toll, and damage to infrastructure. A mechanism is required to avoid such road accidents at the maximum to reduce the death toll. An Emergency Situation Prediction Mechanism, a novel and proactive approach, is proposed in this paper for achieving the best of Intelligent Transportation System using Vehicular Ad Hoc Network. ESPM intends to predict the possibility of occurrence of an accident in an Indian four-lane express highway. In ESPM, the emergency situation prediction is done by the Road Side Unit based on (i) the Status Report sent by the vehicles in the range of RSU and (ii) the road traffic flow analysis done by the RSU. Once the emergency situation or accident is predicted in advance, an Emergency Warning Message is constructed and disseminated to all vehicles in the area of RSU to alert and prevent the vehicles from accidents. ESPM performs well in emergency situation prediction in advance to the occurrence of an accident. ESPM predicts the emergency situation within 0.20 seconds which is comparatively less than the statistical value. The prediction accuracy of ESPM against vehicle density is found better in different traffic scenarios. PMID:26065014

Intrahospital teleradiology from the emergency room

NASA Astrophysics Data System (ADS)

Fuhrman, Carl R.; Slasky, B. S.; Gur, David; Lattner, Stefanie; Herron, John M.; Plunkett, Michael B.; Towers, Jeffrey D.; Thaete, F. Leland

1993-09-01

Off-hour operations of the modern emergency room presents a challenge to conventional image management systems. To assess the utility of intrahospital teleradiology systems from the emergency room (ER), we installed a high-resolution film digitizer which was interfaced to a central archive and to a workstation at the main reading room. The system was designed to allow for digitization of images as soon as the films were processed. Digitized images were autorouted to both destinations, and digitized images could be laser printed (if desired). Almost real time interpretations of nonselected cases were performed at both locations (conventional film in the ER and a workstation in the main reading room), and an analysis of disagreements was performed. Our results demonstrate that in spite of a `significant' difference in reporting, `clinically significant differences' were found in less than 5% of cases. Folder management issues, preprocessing, image orientation, and setting reasonable lookup tables for display were identified as the main limitations to the systems' routine use in a busy environment. The main limitation of the conventional film was the identification of subtle abnormalities in the bright regions of the film. Once identified on either system (conventional film or soft display), all abnormalities were visible and detectable on both display modalities.

Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern.

PubMed

Al-Tayyib, Alia; Koester, Stephen; Langegger, Sig; Raville, Lisa

2017-07-03

We sought to describe an emerging drug use pattern characterized by injection of both methamphetamine and heroin. We examined differences in drug injection patterns by demographics, injection behaviors, HIV and HCV status, and overdose. Persons who inject drugs (PWID) were recruited as part of the National HIV Behavioral Surveillance (NHBS) system in Denver, Colorado. We used chi-square statistics to assess differences between those who reported only heroin injection, only methamphetamine injection, and combined heroin and methamphetamine injection. We used generalized linear models to estimate unadjusted and adjusted prevalence ratios to describe the association between drug injection pattern and reported nonfatal overdose in 2015. We also examined changes in the drug reported as most frequently injected across previous NHBS cycles from 2005, 2009, and 2012. Of 592 participants who completed the survey in 2015, 173 (29.2%) reported only injecting heroin, 123 (20.8%) reported only injecting methamphetamine, and 296 (50.0%) reported injecting both drugs during the past 12 months. Injecting both heroin and methamphetamine was associated with a 2.8 (95% confidence interval: 1.7, 4.5) fold increase in reported overdose in the past 12 months compared with only injecting heroin. The proportion of those reporting methamphetamine as the most frequently injected drug increased from 2.1% in 2005 to 29.6% in 2015 (p < 0.001). The rapid increase in methamphetamine injection, and the emergence of combining methamphetamine with heroin, may have serious public health implications.

Self-reported preparedness of New Zealand acute care providers to mass emergencies before the Canterbury Earthquakes: a national survey.

PubMed

Al-Shaqsi, Sultan; Gauld, Robin; McBride, David; Al-Kashmiri, Ammar; Al-Harthy, Abdullah

2015-02-01

Disasters occur more frequently. Acute care providers are the first to respond to mass emergencies from the healthcare sector. The preparedness of acute care providers in New Zealand to respond to mass emergencies has not been previously studied. To assess the self-reported training and experience of New Zealand acute care providers to respond to mass emergencies and the factors associated with strong preparedness. A cross-sectional national survey of 1500 acute care providers in New Zealand carried out between 2009 and 2010. The survey assessed experience, training and self-reported preparedness. It also determined the factors associated with strong perceived preparedness. The response rate to this survey was 60.7%. Nurses had a higher response rate than doctors or paramedics. Only 29.2% of acute care providers reported responding to a previous mass emergency event. There were 53.5% of acute care providers who reported having formal training in how to deal with mass emergencies, whereas 58.1% of participants reported that they were aware of their role during a healthcare mass emergency response. The factors associated with self-reported strong preparedness to deal with mass emergencies included: being a paramedic, previous training, participation in a drill, willingness to report to work during an infection or man-made emergency, ability to triage and general awareness of the role during a mass emergency. Almost half of New Zealand acute healthcare providers have no training in dealing with mass emergency events. Training and general awareness of the role during a mass emergency response were the main factors associated with strong self-reported preparedness of acute care providers. The apparent efficacy of training allied to lack of availability means that it should be a national priority. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

A multi-disciplinary approach to the removal of emerging contaminants in municipal wastewater treatment plants in New York state (2003-2004)

USGS Publications Warehouse

Philips, Patrick J.; Stinson, Beverley; Zaugg, Steven D.; Furlong, Edward T.; Kolpin, Dana W.; Esposito, Kathleen; Bodniewicz, B.; Pape, R.; Anderson, J.

2008-01-01

Across the United States, there is a rapidly growing awareness of the occurrence and the toxicological impacts of natural and synthetic trace compounds in the environment. These trace compounds, referred to as emerging contaminants (ECs), are reported to cause a range of negative impacts in the environment, such as adverse effects on biota in receiving streams and interference with the normal functions of the endocrine system, which controls growth and development in living organisms.

Preventing the next 'SARS' - European healthcare workers' attitudes towards monitoring their health for the surveillance of newly emerging infections: qualitative study

PubMed Central

2011-01-01

Background Hospitals are often the epicentres of newly circulating infections. Healthcare workers (HCWs) are at high risk of acquiring infectious diseases and may be among the first to contract emerging infections. This study aims to explore European HCWs' perceptions and attitudes towards monitoring their absence and symptom reports for surveillance of newly circulating infections. Methods A qualitative study with thematic analysis was conducted using focus group methodology. Forty-nine hospital-based HCWs from 12 hospitals were recruited to six focus groups; two each in England and Hungary and one each in Germany and Greece. Results HCWs perceived risk factors for occupationally acquired infectious diseases to be 1.) exposure to patients with undiagnosed infections 2.) break-down in infection control procedures 3.) immuno-naïvety and 4.) symptomatic colleagues. They were concerned that a lack of monitoring and guidelines for infectious HCWs posed a risk to staff and patients and felt employers failed to take a positive interest in their health. Staffing demands and loss of income were noted as pressures to attend work when unwell. In the UK, Hungary and Greece participants felt monitoring staff absence and the routine disclosure of symptoms could be appropriate provided the effectiveness and efficiency of such a system were demonstrable. In Germany, legislation, privacy and confidentiality were identified as barriers. All HCWs highlighted the need for knowledge and structural improvements for timelier recognition of emerging infections. These included increased suspicion and awareness among staff and standardised, homogenous absence reporting systems. Conclusions Monitoring absence and infectious disease symptom reports among HCWs may be a feasible means of surveillance for emerging infections in some settings. A pre-requisite will be tackling the drivers for symptomatic HCWs to attend work. PMID:21740552

Human melioidosis reported by ProMED.

PubMed

Nasner-Posso, Katherinn Melissa; Cruz-Calderón, Stefania; Montúfar-Andrade, Franco E; Dance, David A B; Rodriguez-Morales, Alfonso J

2015-06-01

There are limited sources describing the global burden of emerging diseases. A review of human melioidosis reported by ProMED was performed and the reliability of the data retrieved assessed in comparison to published reports. The effectiveness of ProMED was evaluated as a source of epidemiological data by focusing on melioidosis. Using the keyword 'melioidosis' in the ProMED search engine, all of the information from the reports and collected data was reviewed using a structured form, including the year, country, gender, occupation, number of infected individuals, and number of fatal cases. One hundred and twenty-four entries reported between January 1995 and October 2014 were identified. A total of 4630 cases were reported, with death reported in 505 cases, suggesting a misleadingly low overall case fatality rate (CFR) of 11%. Of 20 cases for which the gender was reported, 12 (60%) were male. Most of the cases were reported from Australia, Thailand, Singapore, Vietnam, and Malaysia, with sporadic reports from other countries. Internet-based reporting systems such as ProMED are useful to gather information and synthesize knowledge on emerging infections. Although certain areas need to be improved, ProMED provided good information about melioidosis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

77 FR 26358 - Petition for Waiver of Compliance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... parts of 49 CFR (Parts 216, Special Notice and Emergency Order Procedures: Railroad Track, Locomotive and Equipment; Part 217, Railroad Operating Rules; Part 218, Railroad Operating Practices; Part 229, Railroad Locomotive Safety Standards; Part 233, Signal Systems Reporting Requirements; Part 235...

Predicting Positive Education Outcomes for Emerging Adults in Mental Health Systems of Care.

PubMed

Brennan, Eileen M; Nygren, Peggy; Stephens, Robert L; Croskey, Adrienne

2016-10-01

Emerging adults who receive services based on positive youth development models have shown an ability to shape their own life course to achieve positive goals. This paper reports secondary data analysis from the Longitudinal Child and Family Outcome Study including 248 culturally diverse youth ages 17 through 22 receiving mental health services in systems of care. After 12 months of services, school performance was positively related to youth ratings of school functioning and service participation and satisfaction. Regression analysis revealed ratings of young peoples' perceptions of school functioning, and their experience in services added to the significant prediction of satisfactory school performance, even controlling for sex and attendance. Finally, in addition to expected predictors, participation in planning their own services significantly predicted enrollment in higher education for those who finished high school. Findings suggest that programs and practices based on positive youth development approaches can improve educational outcomes for emerging adults.

Communicating with the workforce during emergencies: developing an employee text messaging program in a local public health setting.

PubMed

Karasz, Hilary N; Bogan, Sharon; Bosslet, Lindsay

2014-01-01

Short message service (SMS) text messaging can be useful for communicating information to public health employees and improving workforce situational awareness during emergencies. We sought to understand how the 1,500 employees at Public Health--Seattle & King County, Washington, perceived barriers to and benefits of participation in a voluntary, employer-based SMS program. Based on employee feedback, we developed the system, marketed it, and invited employees to opt in. The system was tested during an ice storm in January 2012. Employee concerns about opting into an SMS program included possible work encroachment during non-work time and receiving excessive irrelevant messages. Employees who received messages during the weather event reported high levels of satisfaction and perceived utility from the program. We conclude that text messaging is a feasible form of communication with employees during emergencies. Care should be taken to design and deploy a program that maximizes employee satisfaction.

Engineering risk assessment for emergency disposal projects of sudden water pollution incidents.

PubMed

Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng

2017-06-01

Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.

The preparedness of schools to respond to emergencies in children: a national survey of school nurses.

PubMed

Olympia, Robert P; Wan, Eric; Avner, Jeffrey R

2005-12-01

Because children spend a significant proportion of their day in school, pediatric emergencies such as the exacerbation of medical conditions, behavioral crises, and accidental/intentional injuries are likely to occur. Recently, both the American Academy of Pediatrics and the American Heart Association have published guidelines stressing the need for school leaders to establish emergency-response plans to deal with life-threatening medical emergencies in children. The goals include developing an efficient and effective campus-wide communication system for each school with local emergency medical services (EMS); establishing and practicing a medical emergency-response plan (MERP) involving school nurses, physicians, athletic trainers, and the EMS system; identifying students at risk for life-threatening emergencies and ensuring the presence of individual emergency care plans; training staff and students in first aid and cardiopulmonary resuscitation (CPR); equipping the school for potential life-threatening emergencies; and implementing lay rescuer automated external defibrillator (AED) programs. The objective of this study was to use published guidelines by the American Academy of Pediatrics and the American Heart Association to examine the preparedness of schools to respond to pediatric emergencies, including those involving children with special care needs, and potential mass disasters. A 2-part questionnaire was mailed to 1000 randomly selected members of the National Association of School Nurses. The first part included 20 questions focusing on: (1) the clinical background of the school nurse (highest level of education, years practicing as a school health provider, CPR training); (2) demographic features of the school (student attendance, grades represented, inner-city or rural/suburban setting, private or public funding, presence of children with special needs); (3) self-reported frequency of medical and psychiatric emergencies (most common reported school emergencies encountered over the past school year, weekly number of visits to school nurses, annual number of "life-threatening" emergencies requiring activation of EMS); and (4) the preparedness of schools to manage life-threatening emergencies (presence of an MERP, presence of emergency care plans for asthmatics, diabetics, and children with special needs, presence of a school nurse during all school hours, CPR training of staff and students, availability of athletic trainers during all athletic events, presence of an MERP for potential mass disasters). The second part included 10 clinical scenarios measuring the availability of emergency equipment and the confidence level of the school nurse to manage potential life-threatening emergencies. Of the 675 questionnaires returned, 573 were eligible for analysis. A majority of responses were from registered nurses who have been practicing for >5 years in a rural or suburban setting. The most common reported school emergencies were extremity sprains and shortness of breath. Sixty-eight percent (391 of 573 [95% confidence interval (CI): 64-72%]) of school nurses have managed a life-threatening emergency requiring EMS activation during the past school year. Eighty-six percent (95% CI: 84-90%) of schools have an MERP, although 35% (95% CI: 31-39%) of schools do not practice the plan. Thirteen percent (95% CI: 10-16%) of schools do not identify authorized personnel to make emergency medical decisions. When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP did not differ significantly. Of the 205 schools that do not have a school nurse present on campus during all school hours, 17% (95% CI: 12-23%) do not have an MERP, 17% (95% CI: 12-23%) do not identify an authorized person to make medical decisions when faced with a life-threatening emergency, and 72% (95% CI: 65-78%) do not have an effective campus-wide communication system. CPR training is offered to 76% (95% CI: 70-81%) of the teachers, 68% (95% CI: 61-74%) of the administrative staff, and 28% (95% CI: 22-35%) of the students. School nurses reported the availability of a bronchodilator meter-dosed inhaler (78% [95% CI: 74-81%]), AED (32% [95% CI: 28-36%]), and epinephrine autoinjector (76% [95% CI: 68-79%]) in their school. When stratified by inner-city and rural/suburban school setting, the availability of emergency equipment did not differ significantly except for the availability of an oxygen source, which was higher in rural/suburban schools (15% vs 5%). School-nurse responders self-reported more confidence in managing respiratory distress, airway obstruction, profuse bleeding/extremity fracture, anaphylaxis, and shock in a diabetic child and comparatively less confidence in managing cardiac arrest, overdose, seizure, heat illness, and head injury. When analyzing schools with at least 1 child with special care needs, 90% (95% CI: 86-93%) have an MERP, 64% (95% CI: 58-69%) have a nurse available during all school hours, and 32% (95% CI: 27-38%) have an efficient and effective campus-wide communication system linked with EMS. There are no identified authorized personnel to make medical decisions when the school nurse is not present on campus in 12% (95% CI: 9-16%) of the schools with children with special care needs. When analyzing the confidence level of school nurses to respond to common potential life-threatening emergencies in children with special care needs, 67% (95% CI: 61-72%) of school nurses felt confident in managing seizures, 88% (95% CI: 84-91%) felt confident in managing respiratory distress, and 83% (95% CI: 78-87%) felt confident in managing airway obstruction. School nurses reported having the following emergency equipment available in the event of an emergency in a child with special care needs: glucose source (94% [95% CI: 91-96%]), bronchodilator (79% [95% CI: 74-83%]), suction (22% [95% CI: 18-27%]), bag-valve-mask device (16% [95% CI: 12-21%]), and oxygen (12% [95% CI: 9-16%]). An MERP designed specifically for potential mass disasters was present in 418 (74%) of 573 schools (95% CI: 70-77%). When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP for mass disasters did not differ significantly. Although schools are in compliance with many of the recommendations for emergency preparedness, specific areas for improvement include practicing the MERP several times per year, linking all areas of the school directly with EMS, identifying authorized personnel to make emergency medical decisions, and increasing the availability of AED in schools. Efforts should be made to increase the education of school nurses in the assessment and management of life-threatening emergencies for which they have less confidence, particularly cardiac arrest, overdose, seizures, heat illness, and head injury.

Mass spectrometry: a revolution in clinical microbiology?

PubMed

Lavigne, Jean-Philippe; Espinal, Paula; Dunyach-Remy, Catherine; Messad, Nourredine; Pantel, Alix; Sotto, Albert

2013-02-01

Recently, different bacteriological laboratory interventions that decrease reporting time have been developed. These promising new broad-based techniques have merit, based on their ability to identify rapidly many bacteria, organisms difficult to grow or newly emerging strains, as well as their capacity to track disease transmission. The benefit of rapid reporting of identification and/or resistance of bacteria can greatly impact patient outcomes, with an improvement in the use of antibiotics, in the reduction of the emergence of multidrug resistant bacteria and in mortality rates. Different techniques revolve around mass spectrometry (MS) technology: matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), PCR combined with electrospray ionization-mass spectrometry (PCR/ESIMS), iPLEX MassArray system and other new evolutions combining different techniques. This report emphasizes the (r)evolution of these technologies in clinical microbiology.

Symptom Burden among Latino Patients with End-Stage Renal Disease and Access to Standard or Emergency-Only Hemodialysis.

PubMed

Cervantes, Lilia; Hull, Madelyne; Keniston, Angela; Chonchol, Michel; Hasnain-Wynia, Romana; Fischer, Stacy

2018-05-30

Patients with end-stage renal disease (ESRD) have a high symptom burden and this negatively impacts health-related quality of life. Little is known about the symptom burden of Latinos with ESRD and variable access to hemodialysis. To estimate the symptom burden of Latinos with ESRD and access to standard or emergency-only hemodialysis. Observational descriptive study of Latino adults with ESRD receiving standard or emergency-only hemodialysis. Patients completed the Edmonton Symptom Assessment System Revised: Renal (ESAS-r:Renal). We used descriptive statistics and propensity score adjustment to conduct the analysis. ESAS-r:Renal. Participants (N = 67) had a mean age of 58 years (standard deviation [SD] ±13) and a mean Charlson Comorbidity Index of 6.6 ± 2.5, and had been on hemodialysis a mean of 42 months (SD ±43). On average, Latinos with ESRD experienced 7 (SD ±3) symptoms with a mean of 5 ± 3 symptoms reported as moderate or severe. After adjusting for propensity score, emergency-only hemodialysis patients reported experiencing more nausea compared to standard hemodialysis patients (odds ratio 8.95, 95% confidence interval: 1.17-68.31, p = 0.03). Latinos with ESRD have a high symptom burden and compared to patients with standard hemodialysis, patients who rely on emergency-only hemodialysis report more nausea. A national treatment strategy that provides standard hemodialysis for undocumented immigrants with ESRD is an important next step.

Avian predation pressure as a potential driver of periodical cicada cycle length.

PubMed

Koenig, Walter D; Liebhold, Andrew M

2013-01-01

The extraordinarily long life cycles, synchronous emergences at 13- or 17-year intervals, and complex geographic distribution of periodical cicadas (Magicicada spp.) in eastern North America are a long-standing evolutionary enigma. Although a variety of factors, including satiation of aboveground predators and avoidance of interbrood hybridization, have been hypothesized to shape the evolution of this system, no empirical support for these mechanisms has previously been reported, beyond the observation that bird predation can extirpate small, experimentally mistimed emergences. Here we show that periodical cicada emergences appear to set populations of potential avian predators on numerical trajectories that result in significantly lower potential predation pressure during the subsequent emergence. This result provides new support for the importance of predators in shaping periodical cicada life history, offers an ecological rationale for why emergences are synchronized at the observed multiyear intervals, and may explain some of the developmental plasticity observed in these unique insects.

Bilateral simultaneous acute angle closure glaucoma precipitated by non-prescription cold and flu medication.

PubMed

Rudkin, Adam K; Gray, Tim L; Awadalla, Mona; Craig, Jamie E

2010-10-01

We present a case of a 63-year-old woman who presented to an ED with bifrontal headache, nausea and vomiting and reduced visual acuity. Examination revealed bilateral elevated intraocular pressures, corneal haze, shallow anterior chambers and poorly reactive, mid-dilated pupils. Diagnosis was made of simultaneous bilateral acute angle closure glaucoma. A complete drug history revealed that she had been using an over-the-counter cold and flu remedy whose active ingredients included atropa belladonna, an herb with anticholinergic properties. It is likely that drug-induced dilatation of the individual's pupils precipitated this angle closure emergency. In the report we discuss the risk factors for angle closure glaucoma, and review the local and systemic drugs known to trigger this sight-threatening emergency. © 2010 The Authors. Emergency Medicine Australasia © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

A pilot asthma incidence surveillance system and case definition: lessons learned.

PubMed

Trepka, Mary Jo; Martin, Pilar; Mavunda, Kunjana; Rodriguez, Diana; Zhang, Guoyan; Brown, Clive

2009-01-01

Surveillance for incident asthma in the general population could provide timely information about asthma trends and new, emerging etiologic factors. We sought to determine the feasibility of an asthma incidence surveillance system using voluntary reporting of asthma by outpatient clinics and emergency departments (EDs). Voluntary reporting occurred from July 2002 through June 2006. We classified reported asthma based on a case definition adapted from one developed by the Council of State and Territorial Epidemiologists. We validated the case definition by having pulmonologists review data from participant interviews, medical record abstractions, and pulmonary function test (PFT) results. The positive predictive value (PPV) of meeting any of the case definition criteria for asthma was 80% to 82%. The criterion of taking at least one rescue and one controller medication had the highest PPV (97% to 100%). Only 7% of people meeting the incident case definition had a PFT documented in their medical record, limiting the usefulness of PFT results for case classification. Compared with pediatric participants, adult participants were more likely to be uninsured and to obtain asthma care at EDs. The surveillance system cost $5129 per enrolled person meeting the incident case definition and was difficult to implement in participating clinics and EDs because asthma reporting was not mandatory and informed consent was necessary. The project was useful in evaluating the case definition's validity and in describing the participants' characteristics and health-care use patterns. However, without mandatory reporting laws, reporting of incident asthma in the general population by clinicians is not likely to be a feasible method for asthma surveillance.

Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India – A Systematic Review

PubMed Central

Singh, Samiksha; Doyle, Pat; Campbell, Oona M.; Mathew, Manu; Murthy, G. V. S.

2016-01-01

Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication and low compliance, is likely to contribute to gaps and delays in the provision of emergency obstetric care. PMID:27486745

Safety of Medical Abortion Provided Through Telemedicine Compared With In Person.

PubMed

Grossman, Daniel; Grindlay, Kate

2017-10-01

To compare the proportion of medical abortions with a clinically significant adverse event among telemedicine and in-person patients at a clinic system in Iowa during the first 7 years of the service. We conducted a retrospective cohort study. We analyzed data on clinically significant adverse events (hospital admission, surgery, blood transfusion, emergency department treatment, and death) for all medical abortions performed by telemedicine or in person at a clinic system in Iowa between July 1, 2008, and June 30, 2015. Data on adverse events came from required reporting forms submitted to the mifepristone distributor. We calculated the prevalence of adverse events and 95% CIs comparing telemedicine with in-person patients. The analysis was designed as a noninferiority study. Assuming the prevalence of adverse events to be 0.3%, telemedicine provision was considered to be inferior to in-person provision if the prevalence were 0.6% or higher. The required sample size was 6,984 in each group (one-sided α=0.025, power 90%). To explore whether patients with adverse events presented to emergency departments and were not reported, we conducted a survey of the 119 emergency departments in Iowa, asking whether they had treated a woman with an adverse event in the prior year. During the study period, 8,765 telemedicine and 10,405 in-person medical abortions were performed. Forty-nine clinically significant adverse events were reported (no deaths or surgery; 0.18% of telemedicine patients with any adverse event [95% CI 0.11-0.29%] and 0.32% of in-person patients [95% CI 0.23-0.45%]). The difference in adverse event prevalence was 0.13% (95% CI -0.01% to 0.28%, P=.07). Forty-two emergency departments responded to the survey (35% response rate); none reported treating a woman with an adverse event after medical abortion. Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant adverse events.

Strengthening global health security capacity--Vietnam demonstration project, 2013.

PubMed

Tran, Phu Dac; Vu, Long Ngoc; Nguyen, Hien Tran; Phan, Lan Trong; Lowe, Wayne; McConnell, Michelle S; Iademarco, Michael F; Partridge, Jeffrey M; Kile, James C; Do, Trang; Nadol, Patrick J; Bui, Hien; Vu, Diep; Bond, Kyle; Nelson, David B; Anderson, Lauren; Hunt, Kenneth V; Smith, Nicole; Giannone, Paul; Klena, John; Beauvais, Denise; Becknell, Kristi; Tappero, Jordan W; Dowell, Scott F; Rzeszotarski, Peter; Chu, May; Kinkade, Carl

2014-01-31

Over the past decade, Vietnam has successfully responded to global health security (GHS) challenges, including domestic elimination of severe acute respiratory syndrome (SARS) and rapid public health responses to human infections with influenza A(H5N1) virus. However, new threats such as Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza A(H7N9) present continued challenges, reinforcing the need to improve the global capacity to prevent, detect, and respond to public health threats. In June 2012, Vietnam, along with many other nations, obtained a 2-year extension for meeting core surveillance and response requirements of the 2005 International Health Regulations (IHR). During March-September 2013, CDC and the Vietnamese Ministry of Health (MoH) collaborated on a GHS demonstration project to improve public health emergency detection and response capacity. The project aimed to demonstrate, in a short period, that enhancements to Vietnam's health system in surveillance and early detection of and response to diseases and outbreaks could contribute to meeting the IHR core capacities, consistent with the Asia Pacific Strategy for Emerging Diseases. Work focused on enhancements to three interrelated priority areas and included achievements in 1) establishing an emergency operations center (EOC) at the General Department of Preventive Medicine with training of personnel for public health emergency management; 2) improving the nationwide laboratory system, including enhanced testing capability for several priority pathogens (i.e., those in Vietnam most likely to contribute to public health emergencies of international concern); and 3) creating an emergency response information systems platform, including a demonstration of real-time reporting capability. Lessons learned included awareness that integrated functions within the health system for GHS require careful planning, stakeholder buy-in, and intradepartmental and interdepartmental coordination and communication.

Fact Sheet: EPCRA Amendments to Emergency Planning and Notification; Emergency Release Notification and Hazardous Chemical Reporting

EPA Pesticide Factsheets

2008 minor revisions to the emergency planning and emergency release notification sections; as well as the revisions to hazardous chemical reporting regulations covering the Tier I and Tier II forms, and how to report hazardous chemicals in a mixture.

The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017.

PubMed

Neal, Joseph M; Barrington, Michael J; Fettiplace, Michael R; Gitman, Marina; Memtsoudis, Stavros G; Mörwald, Eva E; Rubin, Daniel S; Weinberg, Guy

2018-02-01

The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity. WHAT'S NEW IN THIS UPDATE?: This interim update summarizes recent scientific findings that have enhanced our understanding of the mechanisms that lead to lipid emulsion reversal of LAST, including rapid partitioning, direct inotropy, and post-conditioning. Since the previous practice advisory, epidemiological data have emerged that suggest a lower frequency of LAST as reported by single institutions and some registries, nevertheless a considerable number of events still occur within the general community. Contemporary case reports suggest a trend toward delayed presentation, which may mirror the increased use of ultrasound guidance (fewer intravascular injections), local infiltration techniques (slower systemic uptake), and continuous local anesthetic infusions. Small patient size and sarcopenia are additional factors that increase potential risk for LAST. An increasing number of reported events occur outside of the traditional hospital setting and involve non-anesthesiologists.

Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

PubMed Central

2012-01-01

Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES) program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations. PMID:22950686

The Challenge of Declining Enrolments. Critical Emerging Problems and Recommendations for Immediate Action. Interim Report No. 2. [La Baisse des Effectifs Scolaires. Problemes Critiques et Recommandations pour une Action Immediate. Rapport Preliminaire No. 2].

ERIC Educational Resources Information Center

Jackson, Robert W. B.

This second interim report on declining enrollment in Ontario identifies the major implications of the several factors associated with declining enrollments and makes recommendations for immediate action to contribute to the stability of the system while preparing and initiating long-term policies. The first part of the report deals with…

Computer-Aided Design of Drugs on Emerging Hybrid High Performance Computers

DTIC Science & Technology

2013-09-01

solutions to virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a...virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a specific version of...Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA, 22202-4302

The Emerging Role of the Data Base Manager. Report No. R-1253-PR.

ERIC Educational Resources Information Center

Sawtelle, Thomas K.

The Air Force Logistics Command (AFLC) is revising and enhancing its data-processing capabilities with the development of a large-scale, multi-site, on-line, integrated data base information system known as the Advanced Logistics System (ALS). A data integrity program is to be built around a Data Base Manager (DBM), an individual or a group of…

Synthetic Aperture Acoustic Imaging of Non-Metallic Cords

DTIC Science & Technology

2012-04-01

Washington Headquarters Services , Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA, 22202-4302...collected with a research prototype synthetic aperture acoustic ( SAA ) imaging system. SAA imaging is an emerging technique that can serve as an...inexpensive alternative or logical complement to synthetic aperture radar (SAR). The SAA imaging system uses an acoustic transceiver (speaker and

SSRL Emergency Response Shore Tool

NASA Technical Reports Server (NTRS)

Mah, Robert W.; Papasin, Richard; McIntosh, Dawn M.; Denham, Douglas; Jorgensen, Charles; Betts, Bradley J.; Del Mundo, Rommel

2006-01-01

The SSRL Emergency Response Shore Tool (wherein SSRL signifies Smart Systems Research Laboratory ) is a computer program within a system of communication and mobile-computing software and hardware being developed to increase the situational awareness of first responders at building collapses. This program is intended for use mainly in planning and constructing shores to stabilize partially collapsed structures. The program consists of client and server components, runs in the Windows operating system on commercial off-the-shelf portable computers, and can utilize such additional hardware as digital cameras and Global Positioning System devices. A first responder can enter directly, into a portable computer running this program, the dimensions of a required shore. The shore dimensions, plus an optional digital photograph of the shore site, can then be uploaded via a wireless network to a server. Once on the server, the shore report is time-stamped and made available on similarly equipped portable computers carried by other first responders, including shore wood cutters and an incident commander. The staff in a command center can use the shore reports and photographs to monitor progress and to consult with structural engineers to assess whether a building is in imminent danger of further collapse.

Biomimicry, Biofabrication, and Biohybrid Systems: The Emergence and Evolution of Biological Design.

PubMed

Raman, Ritu; Bashir, Rashid

2017-10-01

The discipline of biological design has a relatively short history, but has undergone very rapid expansion and development over that time. This Progress Report outlines the evolution of this field from biomimicry to biofabrication to biohybrid systems' design, showcasing how each subfield incorporates bioinspired dynamic adaptation into engineered systems. Ethical implications of biological design are discussed, with an emphasis on establishing responsible practices for engineering non-natural or hypernatural functional behaviors in biohybrid systems. This report concludes with recommendations for implementing biological design into educational curricula, ensuring effective and responsible practices for the next generation of engineers and scientists. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Use of Pneumococcal Disease Epidemiology to Set Policy and Prevent Disease during 20 Years of the Emerging Infections Program.

PubMed

Moore, Matthew R; Whitney, Cynthia G

2015-09-01

Two decades ago, the Emerging Infections Program of the US Centers for Disease Control and Prevention implemented what seemed like a simple yet novel idea: a population- and laboratory-based surveillance system designed to identify and characterize invasive bacterial infections, including those caused by Streptococcus pneumoniae. This system, known as Active Bacterial Core surveillance, has since served as a flexible platform for following trends in invasive pneumococcal disease and studying vaccination as the most effective method for prevention. We report the contributions of Active Bacterial Core surveillance to every pneumococcal vaccine policy decision in the United States during the past 20 years.

Real time alert system: a disease management system leveraging health information exchange.

PubMed

Anand, Vibha; Sheley, Meena E; Xu, Shawn; Downs, Stephen M

2012-01-01

Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA's performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. Our results show that RTA was successfully able to deliver "just in time" patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient's asthma related emergency room admission so further follow up can happen in near real time.

Community exposures to chemical incidents: development and evaluation of the first environmental public health surveillance system in europe.

PubMed

Bowen, H J; Palmer, S R; Fielder, H M; Coleman, G; Routledge, P A; Fone, D L

2000-11-01

To describe the frequency, nature and location of acute chemical incidents in Wales, and the morbidity in employees, emergency responders and the general public who were exposed. Active multi-agency community-based surveillance system. Wales, 1993-5. Frequency, nature and location of incidents, populations potentially exposed and with symptoms. Most of the 402 incidents identified were not associated with sites governed by the Control of Industrial Major Accident Hazard Regulations but with smaller industrial sites and commercial premises. About two in every thousand of the estimated 236 000 members of the public considered to be at risk from exposure reported symptoms, which were mainly nausea, headaches, and irritation of the eye, skin and respiratory tract. The most commonly reported chemicals that members of the public were exposed to were smoke toxins, miscellaneous organics, toxic gases and flammable gases. A health authority was reported to be involved in only 34 (8%) of the incidents and in only 3 of the 29 incidents where more than 100 members of the public were exposed. A geographically defined, multi-agency surveillance system can identify high risk locations and types of incidents, together with the chemicals most likely to be involved. Such ongoing surveillance information is essential for appropriate policy making, emergency planning, operational management and training.

Measuring Outcomes of Clinical Care: Victorian Emergency Laparotomy Audit Using Quality Investigator.

PubMed

Stevens, Claire L; Brown, Christopher; Watters, David A K

2018-07-01

The Australian and New Zealand Audit of Surgical Mortality (ANZASM) National Report 2015 found that within the cohort of audited deaths, 85% were emergencies with acute life-threatening conditions, and by far, the most common procedures were laparotomy and colorectal procedures. Emergency laparotomy outcomes have shown improvement through audit and reporting in the UK. The purpose of this study was to determine the outcome of emergency laparotomy in the state of Victoria, Australia. The Dr Foster Quality Investigator (DFQI) database was interrogated for a set of Australian Classification of Health Intervention (ACHI) codes defined by the authors as representing an emergency laparotomy. The dataset included patients who underwent emergency laparotomy from July 2007 to July 2016 in all Victorian hospitals. There were 23,115 emergency laparotomies conducted over 9 years in 66 hospitals. Inpatient mortality was 2036/23,115 (8.8%). Mortality in the adult population increased with age and reached 18.1% in those patients that were 80 years or older. 51.3% were females, and there was no significant difference in survival between genders. Patients with no recorded comorbidities had a mortality of 4.3%, whereas those with > 5 comorbidities had 19.3% mortality. Administrative data accessed via a tool such as DFQI can provide useful population data to guide further evidence-based improvement strategies. The mortality for emergency laparotomy within Victorian hospitals is comparable, if not better than that seen in overseas studies. There is a need to continue routine audit of mortality rates and implement systems improvement where necessary.

A concept for routine emergency-care data-based syndromic surveillance in Europe.

PubMed

Ziemann, A; Rosenkötter, N; Garcia-Castrillo Riesgo, L; Schrell, S; Kauhl, B; Vergeiner, G; Fischer, M; Lippert, F K; Krämer, A; Brand, H; Krafft, T

2014-11-01

We developed a syndromic surveillance (SyS) concept using emergency dispatch, ambulance and emergency-department data from different European countries. Based on an inventory of sub-national emergency data availability in 12 countries, we propose framework definitions for specific syndromes and a SyS system design. We tested the concept by retrospectively applying cumulative sum and spatio-temporal cluster analyses for the detection of local gastrointestinal outbreaks in four countries and comparing the results with notifiable disease reporting. Routine emergency data was available daily and electronically in 11 regions, following a common structure. We identified two gastrointestinal outbreaks in two countries; one was confirmed as a norovirus outbreak. We detected 1/147 notified outbreaks. Emergency-care data-based SyS can supplement local surveillance with near real-time information on gastrointestinal patients, especially in special circumstances, e.g. foreign tourists. It most likely cannot detect the majority of local gastrointestinal outbreaks with few, mild or dispersed cases.

Developing an electronic system to manage and track emergency medications.

PubMed

Hamm, Mark W; Calabrese, Samuel V; Knoer, Scott J; Duty, Ashley M

2018-03-01

The development of a Web-based program to track and manage emergency medications with radio frequency identification (RFID) is described. At the Cleveland Clinic, medication kit restocking records and dispense locations were historically documented using a paper record-keeping system. The Cleveland Clinic investigated options to replace the paper-based tracking logs with a Web-based program that could track the real-time location and inventory of emergency medication kits. Vendor collaboration with a board of pharmacy (BOP) compliance inspector and pharmacy personnel resulted in the creation of a dual barcoding system using medication and pocket labels. The Web-based program was integrated with a Cleveland Clinic-developed asset tracking system using active RFID tags to give the real-time location of the medication kit. The Web-based program and the asset tracking system allowed identification of kits nearing expiration or containing recalled medications. Conversion from a paper-based system to a Web-based program began in October 2013. After 119 days, data were evaluated to assess the success of the conversion. Pharmacists spent an average of 27 minutes per day approving medication kits during the postimplementation period versus 102 minutes daily using the paper-based system, representing a 74% decrease in pharmacist time spent on this task. Prospective reports are generated monthly to allow the manager to assess the expected workload and adjust staffing for the next month. Implementation of a BOP-approved Web-based system for managing and tracking emergency medications with RFID integration decreased pharmacist review time, minimized compliance risk, and increased access to real-time data. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A framework for developing and integrating effective routing strategies within the emergency management decision-support system.

DOT National Transportation Integrated Search

2012-05-01

This report describes the modeling, calibration, and validation of a VISSIM traffic-flow simulation of the San Jos, California, downtown network and examines various evacuation scenarios and first-responder routings to assess strategies that would ...

Fiber Optic Communications Technology. A Status Report.

ERIC Educational Resources Information Center

Hull, Joseph A.

Fiber optic communications (communications over very pure glass transmission channels of diameter comparable to a human hair) is an emerging technology which promises most improvements in communications capacity at reasonable cost. The fiber transmission system offers many desirable characteristics representing improvements over conventional…

A remote sensing and GIS-enabled highway asset management system : final report.

DOT National Transportation Integrated Search

2016-04-01

The objective of this project is to validate the use of commercial remote sensing and spatial information : (CRS&SI) technologies, including emerging 3D line laser imaging technology, mobile LiDAR, image : processing algorithms, and GPS/GIS technolog...

Integrating Emerging Data Sources into Operational Practice : State of the Practice Review

DOT National Transportation Integrated Search

2016-12-01

The purpose of this report is provide agencies responsible for Transportation Systems Management and Operations (TSM&O) with an introduction to successful Big Data tools and technologies that can be used to aggregate, store, and analyze new forms of ...

Member Takes Action Against Violence.

ERIC Educational Resources Information Center

Bertholf, Deedrick

1999-01-01

An ASBO member and chair of New York's School Emergency Response to Violent Events (SERVE) explains how this program tackles violence and teen suicide. SERVE teaches the basic principles of hostage situations, uses a confidential reporting system, and advocates safety audits and risk-reduction strategies. (MLH)

77 FR 14525 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... maintains the CDC Computer Security Incident Response Team; (4) performs cyber security incident reporting... systems planning and support; internal security and emergency preparedness; and management analysis and... security; education, training, and workforce development in information and IT disciplines; development and...

Nuclear Misinformation

ERIC Educational Resources Information Center

Ford, Daniel F.; Kendall, Henry W.

1975-01-01

Many scientists feel that research into nuclear safety has been diverted or distorted, and the results of the research concealed or inaccurately reported on a large number of occasions. Of particular concern have been the emergency cooling systems which have not, as yet, been adequately tested. (Author/MA)

Satellite communications systems and technology. Executive Summary

NASA Technical Reports Server (NTRS)

Edelson, Burton I.; Pelton, Joseph N.; Bostian, Charles W.; Brandon, William T.; Chan, Vincent W. S.; Hager, E. Paul; Helm, Neil R.; Jennings, Raymond D.; Kwan, Robert; Mahle, Christoph E.

1993-01-01

NASA and the National Science Foundation (NSF) commissioned a panel of US experts to study the international status of satellite communications systems and technology. The study covers emerging systems concepts, applications, services, and the attendant technologies. The panel members travelled to Europe, Japan, and Russia to gather information first-hand. They visited 17 sites in Europe, 20 sites in Japan, and four in Russia. These included major manufacturers, government organizations, service providers, and associated R&D facilities. The panel's report was reviewed by the sites visited, by the panel, and by representatives of US industry. The report details the information collected and compares it to US activities.

Thrombus-in-Transit: A Case for a Multidisciplinary Hospital-Based Pulmonary Embolism System of Care.

PubMed

Pappas, Anthony J; Knight, Stephen W; McLean, Katherine Zanyk; Bork, Susan; Kurz, Michael C; Sawyer, Kelly N

2016-09-01

Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death. In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen. We present a case of a 49-year-old man diagnosed with an acute saddle PE who was incidentally found to have a thrombus-in-transit and patent foramen ovale and required open thrombectomy. Identification of these additional potentially life-threatening features was possible only due to our availability of risk-stratification resources, specifically bedside echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit rare, with a reported incidence estimated at 4%, the presence of thrombus-in-transit may change emergent clinical management. A multidisciplinary team of resources should be considered emergently as part of a hospital-based PE system of care. Copyright © 2016 Elsevier Inc. All rights reserved.

The Interaction Between Punishment Sensitivity and Effortful Control for Emerging Adults' Substance Use Behaviors.

PubMed

Kahn, Rachel E; Chiu, Pearl H; Deater-Deckard, Kirby; Hochgraf, Anna K; King-Casas, Brooks; Kim-Spoon, Jungmeen

2018-01-08

Within the dual systems perspective, high reward sensitivity and low punishment sensitivity in conjunction with deficits in cognitive control may contribute to high levels of risk taking, such as substance use. The current study examined whether the individual components of effortful control (inhibitory control, attentional control, and activation control) serve as regulators and moderate the association between reward or punishment sensitivity and substance use behaviors. A total of 1,808 emerging adults from a university setting (Mean age = 19.48; 72% female) completed self-report measures of reward and punishment sensitivity, effortful control, and substance use. Findings indicated significant two-way interactions for punishment sensitivity and inhibitory control for alcohol and marijuana use. The form of these interactions revealed a significant negative association between punishment sensitivity and alcohol and marijuana use at low levels of inhibitory control. No significant interactions emerged for reward sensitivity or other components of effortful control. The current findings provide preliminary evidence suggesting the dual systems theorized to influence risk taking behavior interact to make joint contributions to health risk behaviors such as substance use in emerging adults.

The Pediatric Emergency Care Applied Research Network Registry: A Multicenter Electronic Health Record Registry of Pediatric Emergency Care.

PubMed

Deakyne Davies, Sara J; Grundmeier, Robert W; Campos, Diego A; Hayes, Katie L; Bell, Jamie; Alessandrini, Evaline A; Bajaj, Lalit; Chamberlain, James M; Gorelick, Marc H; Enriquez, Rene; Casper, T Charles; Scheid, Beth; Kittick, Marlena; Dean, J Michael; Alpern, Elizabeth R

2018-04-01

 Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes.  A data dictionary, and subsequent data model, were developed describing EHR data sources to include all processes of care within the emergency department (ED). ED visit data were deidentified and XML files were created and submitted to a central data coordinating center for inclusion in the registry. Automated data quality control occurred prior to submission through an application created for this project. Data quality reports were created for manual data quality review.  The Pediatric Emergency Care Applied Research Network (PECARN) Registry, representing four hospital systems and seven EDs, demonstrates that ED data from disparate health systems and EHR vendors can be harmonized for use in a single registry with a common data model. The current PECARN Registry represents data from 2,019,461 pediatric ED visits, 894,503 distinct patients, more than 12.5 million narrative reports, and 12,469,754 laboratory tests and continues to accrue data monthly.  The Registry is a robust harmonized clinical registry that includes data from diverse patients, sites, and EHR vendors derived via data extraction, deidentification, and secure submission to a central data coordinating center. The data provided may be used for benchmarking, clinical quality improvement, and comparative effectiveness research. Schattauer.

Establishing a publicly available national database of US news articles reporting agriculture-related injuries and fatalities.

PubMed

Weichelt, Bryan; Salzwedel, Marsha; Heiberger, Scott; Lee, Barbara C

2018-05-22

The AgInjuryNews system and dataset are a news report repository and information source for agricultural safety professionals, policymakers, journalists, and law enforcement officials. AgInjuryNews was designed as a primary storage and retrieval system that allows users to: identify agricultural injury/fatality events; identify injury agents and emerging issues; provide safety messages for media in anticipation of trends; and raise awareness and knowledge of agricultural injuries and prevention strategies. Data are primarily collected through Google Alerts and a digital media subscription service. Articles are screened, reviewed, coded, and entered into the system. As of January 1, 2018, the system contained 3028 unique incidents. Of those, 650 involved youth, and 1807 were fatalities. The system also had registered 329 users from 39 countries. AgInjuryNews combines injury reports into one dataset and may be the most current and comprehensive publicly available collection of news reports on agricultural injuries and deaths. © 2018 Wiley Periodicals, Inc.

Applying dynamic simulation modeling methods in health care delivery research-the SIMULATE checklist: report of the ISPOR simulation modeling emerging good practices task force.

PubMed

Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Osgood, Nathaniel D; Padula, William V; Higashi, Mitchell K; Wong, Peter K; Pasupathy, Kalyan S; Crown, William

2015-01-01

Health care delivery systems are inherently complex, consisting of multiple tiers of interdependent subsystems and processes that are adaptive to changes in the environment and behave in a nonlinear fashion. Traditional health technology assessment and modeling methods often neglect the wider health system impacts that can be critical for achieving desired health system goals and are often of limited usefulness when applied to complex health systems. Researchers and health care decision makers can either underestimate or fail to consider the interactions among the people, processes, technology, and facility designs. Health care delivery system interventions need to incorporate the dynamics and complexities of the health care system context in which the intervention is delivered. This report provides an overview of common dynamic simulation modeling methods and examples of health care system interventions in which such methods could be useful. Three dynamic simulation modeling methods are presented to evaluate system interventions for health care delivery: system dynamics, discrete event simulation, and agent-based modeling. In contrast to conventional evaluations, a dynamic systems approach incorporates the complexity of the system and anticipates the upstream and downstream consequences of changes in complex health care delivery systems. This report assists researchers and decision makers in deciding whether these simulation methods are appropriate to address specific health system problems through an eight-point checklist referred to as the SIMULATE (System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence) tool. It is a primer for researchers and decision makers working in health care delivery and implementation sciences who face complex challenges in delivering effective and efficient care that can be addressed with system interventions. On reviewing this report, the readers should be able to identify whether these simulation modeling methods are appropriate to answer the problem they are addressing and to recognize the differences of these methods from other modeling approaches used typically in health technology assessment applications. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the VR Tool).

PubMed

Manganas, A; Tsiknakis, M; Leisch, E; Ponder, M; Molet, T; Herbelin, B; Magnetat-Thalmann, N; Thalmann, D; Fato, M; Schenone, A

2004-01-01

This paper reports the results of the second of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.

Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015.

PubMed

Bemis, Kelley; Frias, Mabel; Patel, Megan Toth; Christiansen, Demian

Mandatory reporting of potential rabies exposures and initiation of postexposure prophylaxis (PEP) allow local health authorities to monitor PEP administration for errors. Our objectives were to use an emergency department (ED) syndromic surveillance system to (1) estimate reporting compliance for exposure to rabies in suburban Cook County, Illinois, and (2) initiate interventions to improve reporting and reassess compliance. We queried ED records from 45 acute care hospitals in Cook County and surrounding areas from January 1, 2013, through June 30, 2015, for chief complaints or discharge diagnoses pertaining to rabies, PEP, or contact with a wild mammal (eg, bat, raccoon, skunk, fox, or coyote). We matched patients with ≥1 ED visit for potential rabies exposure to people with potential rabies exposure reported to the Cook County Department of Public Health. We considered nonmatches to have unreported exposures. We then initiated active surveillance in July 2015, disseminated education on reporting requirements in August and September 2015, and reassessed reporting completeness from July 2015 through February 2016. Of 248 patients with rabies-related ED visits from January 2013 through June 2015, 63 (25.4%) were reported. After interventions were implemented to increase reporting compliance, 53 of 98 (54.1%) patients with rabies-related ED visits from July 2015 through February 2016 were reported. Patients with ED visits for potential rabies exposure were twice as likely to be reported postintervention than preintervention (risk ratio = 2.1; 95% CI, 1.6-2.8). The volume of potential rabies exposure cases reported to the health department from July 2015 through February 2016 increased by 252% versus the previous year. Potential rabies exposures and PEP initiation are underreported in suburban Cook County. ED syndromic surveillance records can be used to estimate reporting compliance and conduct active surveillance.

Urban caregiver empowerment: Caregiver nativity, child asthma symptoms and emergency department use

PubMed Central

Coutinho, Maria Teresa; Kopel, Sheryl J.; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-01-01

Introduction This study examines the associations between caregiver empowerment, child asthma symptoms, and emergency department use in a sample of school aged urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child asthma symptoms, and emergency department use as a function of caregiver nativity. Methods Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7–9; N=130). Caregiver empowerment was assessed within family, asthma services, and community domains. Results Children whose caregivers reported greater empowerment within the family (knowledge and ability to care for their family) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (ability to collaborate with asthma providers and healthcare system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, while US-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child asthma symptoms. For US-born caregivers, higher levels of empowerment in asthma services were associated with more child asthma symptoms. Discussion Results suggest that caregivers who feel more confident and better able to manage problems within their family may better manage their child's asthma more effectively navigate the asthma healthcare system and manage their child's asthma. PMID:27632543

Part II: preparing and assessing first-year radiology resident on-call readiness technical implementation.

PubMed

Yam, Chun-Shan; Kruskal, Jonathan; Pedrosa, Ivan; Kressel, Herbert

2006-06-01

The effectiveness of using a Digital Imaging and Communications in Medicine (DICOM)-based interactive examination system in evaluating the readiness of first year radiology residents before taking overnight call in the emergency department (ED) was reported in part I of this article. This report describes technical aspects for the design and implementation of this system. The examination system consists of two modules: Data Collection and Image Viewing. The Data Collection module was a personal computer (PC)-based DICOM storage server based on a free public domain software package, the Mallinckrodt Central Test Node. The Image Viewing module was a Java-based DICOM viewer created using another freeware package: zDicom ActiveX component. The examination takes place once a year at the end of the first 6-month rotation. Cases selected for the examination were actual clinical cases according to the American Society of Emergency Radiology core curriculum. In the 3-hour timed examination, each resident was required to read the cases and provide clinical findings and recommendations. Upper-level residents also participated in the examination to serve as a control. Answers were scored by two staff radiologists. We have been using this examination system successfully in our institution since 2003 to evaluate the readiness of the first-year residents before they take overnight call in the ED. This report describes a step-by-step procedure for implementing this system into a PC-based platform. This DICOM viewing software is available as freeware to other academic radiology institutions. The total cost for implementing this system is approximately 2000 US dollars.

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments

PubMed Central

2011-01-01

Background Injuries represent a significant and growing public health concern in China. This Review was conducted to document the characteristics of injured patients presenting to the emergency department of Chinese hospitals and to assess of the nature of information collected and reported in published surveillance studies. Methods A systematic search of MEDLINE and China Academic Journals supplemented with a hand search of journals was performed. Studies published in the period 1997 to 2007 were included and research published in Chinese was the focus. Search terms included emergency, injury, medical care. Results Of the 268 studies identified, 13 were injury surveillance studies set in the emergency department. Nine were collaborative studies of which eight were prospective studies. Of the five single centre studies only one was of a prospective design. Transport, falls and industrial injuries were common mechanisms of injury. Study strengths were large patient sample sizes and for the collaborative studies a large number of participating hospitals. There was however limited use of internationally recognised injury classification and severity coding indices. Conclusion Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy. PMID:22029774

Ebola Surveillance - Guinea, Liberia, and Sierra Leone.

PubMed

McNamara, Lucy A; Schafer, Ilana J; Nolen, Leisha D; Gorina, Yelena; Redd, John T; Lo, Terrence; Ervin, Elizabeth; Henao, Olga; Dahl, Benjamin A; Morgan, Oliver; Hersey, Sara; Knust, Barbara

2016-07-08

Developing a surveillance system during a public health emergency is always challenging but is especially so in countries with limited public health infrastructure. Surveillance for Ebola virus disease (Ebola) in the West African countries heavily affected by Ebola (Guinea, Liberia, and Sierra Leone) faced numerous impediments, including insufficient numbers of trained staff, community reticence to report cases and contacts, limited information technology resources, limited telephone and Internet service, and overwhelming numbers of infected persons. Through the work of CDC and numerous partners, including the countries' ministries of health, the World Health Organization, and other government and nongovernment organizations, functional Ebola surveillance was established and maintained in these countries. CDC staff were heavily involved in implementing case-based surveillance systems, sustaining case surveillance and contact tracing, and interpreting surveillance data. In addition to helping the ministries of health and other partners understand and manage the epidemic, CDC's activities strengthened epidemiologic and data management capacity to improve routine surveillance in the countries affected, even after the Ebola epidemic ended, and enhanced local capacity to respond quickly to future public health emergencies. However, the many obstacles overcome during development of these Ebola surveillance systems highlight the need to have strong public health, surveillance, and information technology infrastructure in place before a public health emergency occurs. Intense, long-term focus on strengthening public health surveillance systems in developing countries, as described in the Global Health Security Agenda, is needed.The activities summarized in this report would not have been possible without collaboration with many U.S and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

The use of technology to transform the home into a safe-haven.

PubMed

Kun, Luis

2007-01-01

On June 14, 2006 three reports were published by the Institute of Medicine (IOM) in regards to "THE FUTURE OF EMERGENCY CARE IN THE UNITED STATES HEALTH SYSTEM". The three combined reports: Hospital-Based Emergency Care at the Breaking Point, Emergency Medical Services at the Crossroads and Emergency Care for Children Growing Pains, are a clear reflection of the state we currently face, even without a major disaster. Some key findings drawn from all three reports showed that the emergency care system is ill-prepared to handle a major one. For example, many of the 41 million citizens who do not have medical insurance end up using the Emergency Departments (ED) as their source of "regular" care and many of these EDs are at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack. If we had during the major disaster event, a "contagion" element, i.e. pandemic flu, then the problem would be even more complicated, since the "regular" hospital patient population would need to be isolated from these patients. If we add to this equation the length of time involved in the "current" process of vaccine creation and production (i.e. the volume of vaccines that would be required to be provided to the citizens of the world), the scenario does not look to promising. A new model is needed then to address these requirements. In the developed world we have a number of devices (e.g., radio, TV, Computers, telephones, mobile devices, etc.) and infrastructure (e.g., cable, wireless networks, etc.) that are already supplying the homes and the individuals with a large number of independent applications and different types of information. These stovepipes or independently developed family that include: tele-banking, Telehealth, tele-education, e-commerce, entertainment on demand, etc. when "connected" as an integrated set, may provide an ideal environment, where families may stay at home for a long period of time (quarantine) and would have all the mechanisms in place for getting food and water from supermarkets, drugs from the pharmacy, the children would be able to go to school from home (in turn their school grounds may become temporary hospitals), adults could telecommute to work and minor conditions could be consulted and treated through these systems (with the help of a Telehealth platform that would include electronic health records), etc.

BEARS: a multi-mission anomaly response system

NASA Astrophysics Data System (ADS)

Roberts, Bryce A.

2009-05-01

The Mission Operations Group at UC Berkeley's Space Sciences Laboratory operates a highly automated ground station and presently a fleet of seven satellites, each with its own associated command and control console. However, the requirement for prompt anomaly detection and resolution is shared commonly between the ground segment and all spacecraft. The efficient, low-cost operation and "lights-out" staffing of the Mission Operations Group requires that controllers and engineers be notified of spacecraft and ground system problems around the clock. The Berkeley Emergency Anomaly and Response System (BEARS) is an in-house developed web- and paging-based software system that meets this need. BEARS was developed as a replacement for an existing emergency reporting software system that was too closedsource, platform-specific, expensive, and antiquated to expand or maintain. To avoid these limitations, the new system design leverages cross-platform, open-source software products such as MySQL, PHP, and Qt. Anomaly notifications and responses make use of the two-way paging capabilities of modern smart phones.

Intelligent Pilot Aids for Flight Re-Planning in Emergencies

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2002-01-01

Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions necessary to safely land the plane. However, there is still the potential problem of brittleness. This study examined the impact of contextual information in presentations of emergency descent procedures to see if they might impact the pilot's evaluation of the feasibility of the presented procedure. The study and its results are described in detail.

10 CFR 205.373 - Application procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... power. (k) A showing that, to the best of the applicant's knowledge, the requested relief will not... DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports... Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power § 205.373 Application...

Passenger train emergency systems : single-level commuter rail car egress experiments

DOT National Transportation Integrated Search

2015-04-01

Under FRA sponsorship, a series of three experimental egress trials was conducted in 2005 and 2006 to obtain human factors data relating to the amount of time necessary for individuals to exit from a passenger rail car. This final report describes th...

Highway safety performance metrics and emergency response in an advanced transportation environment : final report.

DOT National Transportation Integrated Search

2016-06-01

Traditional highway safety performance metrics have been largely based on fatal crashes and more recently serious injury crashes. In the near future however, there may be less severe motor vehicle crashes due to advances in driver assistance systems,...

Johnson Space Center Research and Technology 1997 Annual Report

NASA Technical Reports Server (NTRS)

1998-01-01

This report highlights key projects and technologies at Johnson Space Center for 1997. The report focuses on the commercial potential of the projects and technologies and is arranged by CorpTech Major Products Groups. Emerging technologies in these major disciplines we summarized: solar system sciences, life sciences, technology transfer, computer sciences, space technology, and human support technology. Them NASA advances have a range of potential commercial applications, from a school internet manager for networks to a liquid metal mirror for optical measurements.

Enhanced Component Performance Study. Emergency Diesel Generators 1998–2013

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schroeder, John Alton

2014-11-01

This report presents an enhanced performance evaluation of emergency diesel generators (EDGs) at U.S. commercial nuclear power plants. This report evaluates component performance over time using Institute of Nuclear Power Operations (INPO) Consolidated Events Database (ICES) data from 1998 through 2013 and maintenance unavailability (UA) performance data using Mitigating Systems Performance Index (MSPI) Basis Document data from 2002 through 2013. The objective is to present an analysis of factors that could influence the system and component trends in addition to annual performance trends of failure rates and probabilities. The factors analyzed for the EDG component are the differences in failuresmore » between all demands and actual unplanned engineered safety feature (ESF) demands, differences among manufacturers, and differences among EDG ratings. Statistical analyses of these differences are performed and results showing whether pooling is acceptable across these factors. In addition, engineering analyses were performed with respect to time period and failure mode. The factors analyzed are: sub-component, failure cause, detection method, recovery, manufacturer, and EDG rating.« less

Providers Fear Immigration Proposals May Cause Some Patients to Nix Care.

PubMed

Hacker, Karen; Hurwitz, Alisheba; Shy, Bradley

2017-05-01

With high-profile travel bans and well-publicized Immigration and Customs Enforcement (ICE) activities, frontline providers have noticed changes in the behavior of immigrant patients. Some emergency providers report there is more fear and a reluctance to share key information. Also, providers are concerned that worries about deportation will cause immigrant patients to refrain from accessing needed care. Investigators note that such concerns are valid, considering how heightened ICE activities previously have affected immigrant health. •Emergency providers who see a high number of immigrant patients report patients are very guarded about providing identifying information and recent travel history. They are concerned that medical staff will report them to ICE authorities. •Some emergency providers are wearing "safety pin" symbols to try to let patients know that they are safe in their care. Others are thinking about posting signs in multiple languages to inform immigrant patients that information about travel history only will be used for medical purposes. •Experts worry that restrictions on foreign-born physicians and medical students only will exacerbate anticipated shortages, particularly in rural areas. •In a previous period of increased immigration enforcement, researchers found that more than 40% of frontline providers reported that ICE activities produced negative health effects on their immigrant patients, including stress, anxiety, and avoidance of the healthcare system.

Identifying pneumonia outbreaks of public health importance: can emergency department data assist in earlier identification?

PubMed

Hope, Kirsty; Durrheim, David N; Muscatello, David; Merritt, Tony; Zheng, Wei; Massey, Peter; Cashman, Patrick; Eastwood, Keith

2008-08-01

To retrospectively review the performance of a near real-time Emergency Department (ED) Syndromic Surveillance System operating in New South Wales for identifying pneumonia outbreaks of public health importance. Retrospective data was obtained from the NSW Emergency Department data collection for a rural hospital that has experienced a cluster of pneumonia diagnoses among teenage males in August 2006. ED standard reports were examined for signals in the overall count for each respiratory syndrome, and for elevated counts in individual subgroups including; age, sex and admission to hospital status. Using the current thresholds, the ED syndromic surveillance system would have trigged a signal for pneumonia syndrome in children aged 5-16 years four days earlier than the notification by a paediatrician and this signal was maintained for 14 days. If the ED syndromic surveillance system had been operating it could have identified the outbreak earlier than the paediatrician's notification. This may have permitted an earlier public health response. By understanding the behaviour of syndromes during outbreaks of public health importance, response protocols could be developed to facilitate earlier implementation of control measures.

Using off-the-shelf medical devices for biomedical signal monitoring in a telemedicine system for emergency medical services.

PubMed

Thelen, Sebastian; Czaplik, Michael; Meisen, Philipp; Schilberg, Daniel; Jeschke, Sabina

2015-01-01

In order to study new methods of telemedicine usage in the context of emergency medical services, researchers need to prototype integrated telemedicine systems. To conduct a one-year trial phase-intended to study a new application of telemedicine in German emergency medical services-we used off-the-shelf medical devices and software to realize real-time patient monitoring within an integrated telemedicine system prototype. We demonstrate its feasibility by presenting the integrated real-time patient monitoring solution, by studying signal delay and transmission robustness regarding changing communication channel characteristics, and by evaluating issues reported by the physicians during the trial phase. Where standards like HL7 and the IEEE 11073 family are intended to enable interoperability of product grade medical devices, we show that research prototypes benefit from the use of web technologies and simple device interfaces, as they simplify product development for a manufacturer and ease integration efforts for research teams. Embracing this approach for the development of new medical devices eases the constraint to use off-the-shelf products for research trials investigating innovative use of telemedicine.

Severe gastric variceal bleeding successfully treated by emergency splenic artery embolization.

PubMed

Sankararaman, Senthilkumar; Velayuthan, Sujithra; Vea, Romulo; Herbst, John

2013-06-01

Bleeding from gastric varices due to splenic vein obstruction is extremely rare in children, but it can be catastrophic. Reported herein is the case of a teenager with splenic vein thrombosis and chronic decompensated liver disease from autoimmune hepatitis who presented with massive gastric variceal bleeding. Standard medical management did not control the bleeding. Due to decompensated liver disease and continuous active bleeding, emergency partial splenic artery embolization was preferred over splenectomy or a shunt procedure. Bleeding was successfully controlled by partial splenic artery embolization by decreasing the inflow of blood into the portal system. It is concluded that emergency partial splenic artery embolization is a safer alternative life-saving procedure to manage severe gastric variceal bleeding due to splenic vein obstruction in a patient with high surgical risk. To our knowledge, only one other patient with similar management has been reported in the pediatric age group. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

Tumefactive multiple sclerosis requiring emergency craniotomy: case report and literature review.

PubMed

Munarriz, Pablo M; Castaño-Leon, Ana M; Martinez-Perez, Rafael; Hernandez-Lain, Aurelio; Ramos, Ana; Lagares, Alfonso

2013-01-01

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by focal neurological dysfunction with a relapsing and remitting course. Tumor-like presentation of MS (or "tumefactive"/"pseudotumoral" presentation) has been described before with a certain frequency; it consists of a large single plaque (>2cm) with presence of edema and mass effect and it is hard to distinguish from a brain tumor. However, we present a very rare case of a 53-year-old woman with a right temporal mass that turned out to be a MS plaque, who deteriorated within hours (brain herniation with loss of consciousness and unilateral mydriasis) and required an emergency craniotomy. We also present a review of the literature. It appears that only 4 cases of emergency craniotomy/craniectomy required in a patient with a tumor-like MS plaque have been reported before. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

New program for identification of child maltreatment in emergency department: preliminary data.

PubMed

Milani, Gregorio P; Vianello, Federica A; Cantoni, Barbara; Agostoni, Carlo; Fossali, Emilio F

2016-07-13

Early detection of child maltreatment in pediatric emergency department is one of the most important challenges for the Italian and European medical care system. Several interventions have been proposed, but results are often unquantifiable or inadequate to face this problem. We promoted an educational program and built up an interdisciplinary team to improve the identification and management of maltreated children. Aim of this study is to report preliminary results of these interventions. Meetings structured with lecture-based teaching and case-based lessons were focused on identification and management of maltreatment cases. An interdisciplinary team with forensic physicians, dermatologists, orthopedics, radiologists, gynecologists, oculists, psychologists and psychiatrics, was created to manage children with suspected diagnosis of maltreatment. We analysed the characteristics of subjects diagnosed after these interventions and their number was compared with the one in the two previous years. An increased rate of diagnoses of 16.9 % was found. Results of the reported program are encouraging, but many efforts are still mandatory to improve the child maltreatment identification in emergency departments.

Unexpected nerve gas exposure in the city of Matsumoto: report of rescue activity in the first sarin gas terrorism.

PubMed

Okudera, H; Morita, H; Iwashita, T; Shibata, T; Otagiri, T; Kobayashi, S; Yanagisawa, N

1997-09-01

This report describes the rescue activities and the exposure of rescue and hospital personnel from the first unexpected nerve gas terrorist attack using sarin (isopropyl methylphophonofluoridate) in the city of Matsumoto at midnight on June 27, 1994. The details of the emergency activities in the disaster were studied based on the records from emergency departments of the affiliated hospitals and records from the firehouse. About 600 people, including residents and rescue staff, were exposed to sarin gas. Fifty-eight residents were admitted to hospitals, and 7 died. Among 95 rescuers and the duty doctor from the doctor car, 8 had mild symptoms of poisoning. All the rescue activity took place without gas masks or decontamination procedures. In this case of unexpected mass exposure to sarin gas, the emergency rescue system for a large disaster in Matsumoto city, which had been established for a conflagration or a local earthquake, was effective.

Use of after action reports (AARs) to promote organizational and systems learning in emergency preparedness.

PubMed

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D

2012-08-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The "lessons-learned" approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the "Lessons Learned Information Sharing (LLIS.gov)" system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strove to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.

Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness

PubMed Central

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D.

2012-01-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The “lessons-learned” approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the “Lessons Learned Information Sharing (LLIS.gov)” system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strived to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed. PMID:23066408

The Impact of Geographic Information Systems on Emergency Management Decision Making at the U.S. Department of Homeland Security

ERIC Educational Resources Information Center

King, Steven Gray

2012-01-01

Geographic information systems (GIS) reveal relationships and patterns from large quantities of diverse data in the form of maps and reports. The United States spends billions of dollars to use GIS to improve decisions made during responses to natural disasters and terrorist attacks, but precisely how GIS improves or impairs decision making is not…

Advances in Thrust-Based Emergency Control of an Airplane

NASA Technical Reports Server (NTRS)

Creech, Gray; Burken, John J.; Burcham, Bill

2003-01-01

Engineers at NASA's Dryden Flight Research Center have received a patent on an emergency flight-control method implemented by a propulsion-controlled aircraft (PCA) system. Utilizing the preexisting auto-throttle and engine-pressure-ratio trim controls of the airplane, the PCA system provides pitch and roll control for landing an airplane safely without using aerodynamic control surfaces that have ceased to function because of a primary-flight-control-system failure. The installation of the PCA does not entail any changes in pre-existing engine hardware or software. [Aspects of the method and system at previous stages of development were reported in Thrust-Control System for Emergency Control of an Airplane (DRC-96-07), NASA Tech Briefs, Vol. 25, No. 3 (March 2001), page 68 and Emergency Landing Using Thrust Control and Shift of Weight (DRC-96-55), NASA Tech Briefs, Vol. 26, No. 5 (May 2002), page 58.]. Aircraft flight-control systems are designed with extensive redundancy to ensure low probabilities of failure. During recent years, however, several airplanes have exhibited major flight-control-system failures, leaving engine thrust as the last mode of flight control. In some of these emergency situations, engine thrusts were successfully modulated by the pilots to maintain flight paths or pitch angles, but in other situations, lateral control was also needed. In the majority of such control-system failures, crashes resulted and over 1,200 people died. The challenge lay in creating a means of sufficient degree of thrust-modulation control to safely fly and land a stricken airplane. A thrust-modulation control system designed for this purpose was flight-tested in a PCA an MD-11 airplane. The results of the flight test showed that without any operational control surfaces, a pilot can land a crippled airplane (U.S. Patent 5,330,131). The installation of the original PCA system entailed modifications not only of the flight-control computer (FCC) of the airplane but also of each engine-control computer. Inasmuch as engine-manufacturer warranties do not apply to modified engines, the challenge became one of creating a PCA system that does not entail modifications of the engine computers.

Techniques for Improving Pilot Recovery from System Failures

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2001-01-01

This project examined the application of intelligent cockpit systems to aid air transport pilots at the tasks of reacting to in-flight system failures and of planning and then following a safe four dimensional trajectory to the runway threshold during emergencies. Two studies were conducted. The first examined pilot performance with a prototype awareness/alerting system in reacting to on-board system failures. In a full-motion, high-fidelity simulator, Army helicopter pilots were asked to fly a mission during which, without warning or briefing, 14 different failures were triggered at random times. Results suggest that the amount of information pilots require from such diagnostic systems is strongly dependent on their training; for failures they are commonly trained to react to with a procedural response, they needed only an indication of which failure to follow, while for 'un-trained' failures, they benefited from more intelligent and informative systems. Pilots were also found to over-rely on the system in conditions were it provided false or mis-leading information. In the second study, a proof-of-concept system was designed suitable for helping pilots replan their flights in emergency situations for quick, safe trajectory generation. This system is described in this report, including: the use of embedded fast-time simulation to predict the trajectory defined by a series of discrete actions; the models of aircraft and pilot dynamics required by the system; and the pilot interface. Then, results of a flight simulator evaluation with airline pilots are detailed. In 6 of 72 simulator runs, pilots were not able to establish a stable flight path on localizer and glideslope, suggesting a need for cockpit aids. However, results also suggest that, to be operationally feasible, such an aid must be capable of suggesting safe trajectories to the pilot; an aid that only verified plans entered by the pilot was found to have significantly detrimental effects on performance and pilot workload. Results also highlight that the trajectories suggested by the aid must capture the context of the emergency; for example, in some emergencies pilots were willing to violate flight envelope limits to reduce time in flight - in other emergencies the opposite was found.

Major incidents in Kenya: the case for emergency services development and training.

PubMed

Wachira, Benjamin W; Smith, Wayne

2013-04-01

Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in Kenya for the period 2000-2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

An intelligent IoT emergency vehicle warning system using RFID and Wi-Fi technologies for emergency medical services.

PubMed

Lai, Yeong-Lin; Chou, Yung-Hua; Chang, Li-Chih

2018-01-01

Collisions between emergency vehicles for emergency medical services (EMS) and public road users have been a serious problem, impacting on the safety of road users, emergency medical technicians (EMTs), and the patients on board. The aim of this study is to develop a novel intelligent emergency vehicle warning system for EMS applications. The intelligent emergency vehicle warning system is developed by Internet of Things (IoT), radio-frequency identification (RFID), and Wi-Fi technologies. The system consists of three major parts: a system trigger tag, an RFID system in an emergency vehicle, and an RFID system at an intersection. The RFID system either in an emergency vehicle or at an intersection contains a controller, an ultrahigh-frequency (UHF) RFID reader module, a Wi-Fi module, and a 2.4-GHz antenna. In addition, a UHF ID antenna is especially designed for the RFID system in an emergency vehicle. The IoT system provides real-time visual warning at an intersection and siren warning from an emergency vehicle in order to effectively inform road users about an emergency vehicle approaching. The developed intelligent IoT emergency vehicle warning system demonstrates the capabilities of real-time visual and siren warnings for EMS safety.

Measuring Coverage in MNCH: Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic

PubMed Central

Tunçalp, Özge; Stanton, Cynthia; Castro, Arachu; Adanu, Richard; Heymann, Marilyn; Adu-Bonsaffoh, Kwame; Lattof, Samantha R.; Blanc, Ann; Langer, Ana

2013-01-01

Background Cesarean section is the only surgery for which we have nearly global population-based data. However, few surveys provide additional data related to cesarean sections. Given weaknesses in many health information systems, health planners in developing countries will likely rely on nationally representative surveys for the foreseeable future. The objective is to validate self-reported data on the emergency status of cesarean sections among women delivering in teaching hospitals in the capitals of two contrasting countries: Accra, Ghana and Santo Domingo, Dominican Republic (DR). Methods and Findings This study compares hospital-based data, considered the reference standard, against women’s self-report for two definitions of emergency cesarean section based on the timing of the decision to operate and the timing of the cesarean section relative to onset of labor. Hospital data were abstracted from individual medical records, and hospital discharge interviews were conducted with women who had undergone cesarean section in two hospitals. The study assessed sensitivity, specificity, and positive predictive value of responses to questions regarding emergency versus non-emergency cesarean section and estimated the percent of emergency cesarean sections that would be obtained from a survey, given the observed prevalence, sensitivity, and specificity from this study. Hospital data were matched with exit interviews for 659 women delivered via cesarean section for Ghana and 1,531 for the Dominican Republic. In Ghana and the Dominican Republic, sensitivity and specificity for emergency cesarean section defined by decision time were 79% and 82%, and 50% and 80%, respectively. The validity of emergency cesarean defined by operation time showed less favorable results than decision time in Ghana and slightly more favorable results in the Dominican Republic. Conclusions Questions used in this study to identify emergency cesarean section are promising but insufficient to promote for inclusion in international survey questionnaires. Additional studies which confirm the accuracy of key facility-based indicators in advance of data collection and which use a longer recall period are warranted. PMID:23667428

Keep calm and carry on: the 2009 NEHA sabbatical exchange ambassador report.

PubMed

Barnett, Marcy

2011-06-01

Sabbatical goal as an environmental health specialist working with the California Department of Public Health as an emergency planner, I was interested in the NEHA sabbatical exchange program for the opportunity it affords its awardees to see how Canada and the United Kingdom utilize their environmental health workforce. Specifically, I wanted to examine the role environmental health has in the preparations being made for the 2012 Olympic Games to be held in London. I had a special interest in the emergency preparedness efforts related to the games as my work involves promoting the integration of environmental health into the emergency response structure. In California, environmental health services are delivered by several state agencies as well as 62 local jurisdictions. This multifaceted system tends to diminish the important role environmental health plays in disaster response and recovery operations due to the lack of a central focus, and as a result, environmental health is often an overlooked resource. This situation is not unique to California, as the emergency management system in the U.S. has traditionally focused primarily on "blue light" first responders: police, fire, and emergency medical services. After an article caught my eye on involving environmental health in emergency planning, posted on the Chartered Institute of Environmental Health (CIEH) (NEHA's counterpart in the UK) Web site, I became intrigued and used it to form the basis of my sabbatical mission.

A survey of Oregon emergency physicians to assess mandatory reporting knowledge and reporting patterns regarding intoxicated drivers in the state of Oregon.

PubMed

McManus, John; Magaret, Nathan D; Hedges, Jerris R; Rayner, Nicolas B; Rice, Matthew

2005-09-01

To assess emergency physician reporting patterns in Oregon before and after the passage of a mandatory intoxicated driving reporting law. A one-page survey was mailed to 504 emergency physicians in Oregon in April 2004. Data on reporting frequency were collected using a four-point ordinal scale regarding motor vehicle crash-involved drivers (MIDs) and intoxicated persons attempting to drive away from the emergency department (DAEDs). Paired observations were assessed for a stated increase in reporting activity following passage of the law using the Wilcoxon signed-rank test. Associations of postlaw reporting and demographic and knowledge factors were sought using Spearman rank correlation analysis. Of the 504 surveys mailed, 298 (59%) were adequate for analysis. Many respondents (57%) were already aware of the law. Most (92%) agreed that physicians should be mandated to report some crimes. MIDs were always reported by 18% of physicians before the law and by 47% afterward, whereas DAEDs were always reported by 56% of physicians before the law and by 69% afterward. Emergency medicine-trained physicians, higher emergency department census, and increased years of experience were associated with a significantly higher increase in reporting pattern after passage of the law for both MIDs and DAEDs. Although 44% of responding emergency physicians in Oregon were unaware of a mandated reporting law for intoxicated drivers presenting to the ED, most physicians stated an increase in their reporting practice.

Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation

PubMed Central

Driscoll, David L.; Hiratsuka, Vanessa; Johnston, Janet M.; Norman, Sara; Reilly, Katie M.; Shaw, Jennifer; Smith, Julia; Szafran, Quenna N.; Dillard, Denise

2013-01-01

PURPOSE This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. METHODS We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. RESULTS Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. CONCLUSIONS All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments. PMID:23690385

Major emerging and re-emerging zoonoses in China: a matter of global health and socioeconomic development for 1.3 billion.

PubMed

Liu, Quan; Cao, Lili; Zhu, Xing-Quan

2014-08-01

Emerging and re-emerging zoonoses are a significant public health concern and cause considerable socioeconomic problems globally. The emergence of severe acute respiratory syndrome (SARS), highly pathogenic avian influenza (HPAI) H5N1, avian influenza H7N9, and severe fever with thrombocytopenia syndrome (SFTS), and the re-emergence of rabies, brucellosis, and other zoonoses have had a significant effect on the national economy and public health in China, and have affected other countries. Contributing factors that continue to affect emerging and re-emerging zoonoses in China include social and environmental factors and microbial evolution, such as population growth, urbanization, deforestation, livestock production, food safety, climate change, and pathogen mutation. The Chinese government has devised new strategies and has taken measures to deal with the challenges of these diseases, including the issuing of laws and regulations, establishment of disease reporting systems, implementation of special projects for major infectious diseases, interdisciplinary and international cooperation, exotic disease surveillance, and health education. These strategies and measures can serve as models for the surveillance and response to continuing threats from emerging and re-emerging zoonoses in other countries. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Development and application of emergency medical information management system].

PubMed

Wang, Fang; Zhu, Baofeng; Chen, Jianrong; Wang, Jian; Gu, Chaoli; Liu, Buyun

2011-03-01

To meet the needs of clinical practice of rescuing critical illness and develop the information management system of the emergency medicine. Microsoft Visual FoxPro, which is one of Microsoft's visual programming tool, is used to develop computer-aided system included the information management system of the emergency medicine. The system mainly consists of the module of statistic analysis, the module of quality control of emergency rescue, the module of flow path of emergency rescue, the module of nursing care in emergency rescue, and the module of rescue training. It can realize the system management of emergency medicine and,process and analyze the emergency statistical data. This system is practical. It can optimize emergency clinical pathway, and meet the needs of clinical rescue.

Pediatric and adolescent mental health emergencies in the emergency medical services system.

PubMed

Dolan, Margaret A; Fein, Joel A

2011-05-01

Emergency department (ED) health care professionals often care for patients with previously diagnosed psychiatric illnesses who are ill, injured, or having a behavioral crisis. In addition, ED personnel encounter children with psychiatric illnesses who may not present to the ED with overt mental health symptoms. Staff education and training regarding identification and management of pediatric mental health illness can help EDs overcome the perceived limitations of the setting that influence timely and comprehensive evaluation. In addition, ED physicians can inform and advocate for policy changes at local, state, and national levels that are needed to ensure comprehensive care of children with mental health illnesses. This report addresses the roles that the ED and ED health care professionals play in emergency mental health care of children and adolescents in the United States, which includes the stabilization and management of patients in mental health crisis, the discovery of mental illnesses and suicidal ideation in ED patients, and approaches to advocating for improved recognition and treatment of mental illnesses in children. The report also addresses special issues related to mental illness in the ED, such as minority populations, children with special health care needs, and children's mental health during and after disasters and trauma.

The Trauma Patient Tracking System: implementing a wireless monitoring infrastructure for emergency response.

PubMed

Maltz, Jonathan; C Ng, Thomas; Li, Dustin; Wang, Jian; Wang, Kang; Bergeron, William; Martin, Ron; Budinger, Thomas

2005-01-01

In mass trauma situations, emergency personnel are challenged with the task of prioritizing the care of many injured victims. We propose a trauma patient tracking system (TPTS) where first-responders tag all patients with a wireless monitoring device that continuously reports the location of each patient. The system can be used not only to prioritize patient care, but also to determine the time taken for each patient to receive treatment. This is important in training emergency personnel and in identifying bottlenecks in the disaster response process. In situations where biochemical agents are involved, a TPTS may be employed to determine sites of cross-contamination. In order to track patient location in both outdoor and indoor environments, we employ both Global Positioning System (GPS) and Television/ Radio Frequency (TVRF) technologies. Each patient tag employs IEEE 802.11 (Wi-Fi)/TCP/IP networking to communicate with a central server via any available Wi-Fi basestation. A key component to increase TPTS fault-tolerance is a mobile Wi-Fi basestation that employs redundant Internet connectivity to ensure that tags at the disaster scene can send information to the central server even when local infrastructure is unavailable for use. We demonstrate the robustness of the system in tracking multiple patients in a simulated trauma situation in an urban environment.

Real-time notification and improved situational awareness in fire emergencies using geospatial-based publish/subscribe

NASA Astrophysics Data System (ADS)

Kassab, Ala'; Liang, Steve; Gao, Yang

2010-12-01

Emergency agencies seek to maintain situational awareness and effective decision making through continuous monitoring of, and real-time alerting about, sources of information regarding current incidents and developing fire hazards. The nature of this goal requires integrating different, potentially numerous, sources of dynamic geospatial information on the one side, and a large number of clients having heterogeneous and specific interests in data on the other side. In such scenarios, the traditional request/reply communication style may function inefficiently, as it is based on point-to-point, synchronous, and pulling mode interaction between consumer clients and information providers/services. In this work, we propose Geospatial-based Publish/ Subscribe, an interaction framework that serves as a middleware for real-time transacting of spatially related information of interest, termed geospatial events, in distributed systems. Expressive data models, including geospatial event and geospatial subscription, as well as an efficient matching approach for fast dissemination of geospatial events to interested clients, are introduced. The proposed interaction framework is realized through the development of a Real-Time Fire Emergency Response System (RFERS) prototype. The prototype is designed for transacting several topics of geospatial events that are crucial within the context of fire emergencies, including GPS locations of emergency assets, meteorological observations of wireless sensors, fire incidents reports, and temporal sequences of remote sensing images of active wildfires. The performance of the system prototype has been evaluated in order to demonstrate its efficiency.

Medical students' perceptions of a novel institutional incident reporting system : A thematic analysis.

PubMed

Gordon, Morris; Parakh, Dillan

2017-10-01

Errors in healthcare are a major patient safety issue, with incident reporting a key solution. The incident reporting system has been integrated within a new medical curriculum, encouraging medical students to take part in this key safety process. The aim of this study was to describe the system and assess how students perceived the reporting system with regards to its role in enhancing safety. Employing a thematic analysis, this study used interviews with medical students at the end of the first year. Thematic indices were developed according to the information emerging from the data. Through open, axial and then selective stages of coding, an understanding of how the system was perceived was established. Analysis of the interview specified five core themes: (1) Aims of the incident reporting system; (2) internalized cognition of the system; (3) the impact of the reporting system; (4) threshold for reporting; (5) feedback on the systems operation. Selective analysis revealed three overriding findings: lack of error awareness and error wisdom as underpinned by key theoretical constructs, student support of the principle of safety, and perceptions of a blame culture. Students did not interpret reporting as a manner to support institutional learning and safety, rather many perceived it as a tool for a blame culture. The impact reporting had on students was unexpected and may give insight into how other undergraduates and early graduates interpret such a system. Future studies should aim to produce interventions that can support a reporting culture.

An intensive assessment of alcohol use and emergency department utilization in homeless alcohol-dependent adults.

PubMed

Holtyn, August F; Jarvis, Brantley P; Subramaniam, Shrinidhi; Wong, Conrad J; Fingerhood, Michael; Bigelow, George E; Silverman, Kenneth

2017-09-01

Excessive alcohol use among the homeless may contribute to their high rates of emergency department use. Survey-based studies have provided some information on the relation between alcohol and emergency department use among the homeless. This study used an intensive schedule of random breath collections and self-report assessments to examine the relation between emergency department utilization and alcohol use in homeless alcohol-dependent adults. Data were from homeless alcohol-dependent adults (N=116) who were participating in a therapeutic workplace that provided job-skills training every weekday for 26 weeks. Breath-sample collections and assessments of self-reported alcohol use were scheduled each week, an average of twice per week per participant, at random times between 9:00 A.M. and 5:00 P.M. Participants received $35 for each breath sample collected. Self-reports of emergency department use were assessed throughout the study. Thirty-four percent of participants reported attending an emergency department and reported an average of 2.2 emergency department visits (range 1-10 visits). Alcohol intoxication was the most common reason for emergency department use. Participants who used the emergency department had significantly more alcohol-positive breath samples and more self-reported heavy alcohol use than participants who did not use the emergency department. This study provided a rare intensive assessment of alcohol and emergency department use in homeless alcohol-dependent adults over an extended period. Emergency department use was high and was significantly related to indices of alcohol use. Copyright © 2017 Elsevier B.V. All rights reserved.

2007 motor vehicle occupant safety survey : use of and support for emergency medical services systems.

DOT National Transportation Integrated Search

2009-09-01

The Motor Vehicle Occupant Safety Survey (MVOSS) is a national telephone survey administered by NHTSA on a periodic basis to obtain data on attitudes, knowledge, and self-reported behavior primarily in areas of occupant protection. The sample is comp...

The Training of Teacher-Librarians--Paving the Way.

ERIC Educational Resources Information Center

Meder, Marylouise D.

This report traces the emerging relationships between the school and library systems during the colonial era until the late nineteenth century. It examines the public library's influence on early educational methodologies, describes the beginnings of the cooperative movement between teachers and librarians, and the new interrelationship which…

Human Factors of Remotely Piloted Aircraft Systems: Lessons from Incident Reports

NASA Technical Reports Server (NTRS)

Hobbs, Alan; Null, Cynthia

2016-01-01

An exploratory study is being conducted to examine the feasibility of collecting voluntary critical incident reports from RPAS pilots. Twenty-three experienced RPAS pilots volunteered to participate in focus groups in which they described critical incidents from their own experience. Participants were asked to recall (1) incidents that revealed a system flaw, or (2) highlighted a case where the human operator contributed to system resilience or mission success. Participants were asked to only report incidents that could be included in a public document. A total of 90 incidents were reported. Human factor issues included the impact of reduced sensory cues, traffic separation in the absence of an out-the-window view, control latencies, vigilance during monotonous and ultra-long endurance flights, control station design considerations, transfer of control between control stations, the management of lost link procedures, and decision-making during emergencies.

The Potential of Social Media and Internet-Based Data in Preventing and Fighting Infectious Diseases: From Internet to Twitter.

PubMed

Al-Surimi, Khaled; Khalifa, Mohammed; Bahkali, Salwa; El-Metwally, Ashraf; Househ, Mowafa

2017-01-01

Health threats due to infectious diseases used to be a major public health concerns around the globe till mid of twentieth century when effective public health interventions helped in eradicating a number of infectious diseases around the world. Over the past 15 years, there has been a rise in the number of emerging and reemerging infectious diseases being reported such as the Acute Respiratory Syndrome (SARS) in 2002, HINI in 2009, Middle East Respiratory Syndrome (MERS) in 2012, Ebola in 2014, and Zika in 2016. These emerging viral infectious diseases have led to serious public health concerns leading to death and causing fear and anxiety among the public. More importantly, at the moment, the prevention and control of viral infectious diseases is difficult due to a lack of effective vaccines. Thus having real-time reporting tools are paramount to alert relevant public health surveillance systems and authorities about taking the right and necessary actions to control and minimize the potential harmful effects of viral infectious diseases. Social media and Internet-based data can play a major role in real-time reporting to empower active public health surveillance systems for controlling and fighting infectious diseases.

Violence and aggression in the emergency department is under-reported and under-appreciated.

PubMed

Richardson, Sandra K; Grainger, Paula C; Ardagh, Michael W; Morrison, Russell

2018-06-08

To examine levels of reporting of violence and aggression within a tertiary level emergency department in New Zealand, and to explore staff attitudes to violence and reporting. A one-month intensive, prospective audit of the emergency department's violence and aggression reporting was undertaken and compared with previously reported data. There was a significant mismatch between the number of events identified during the campaign month and previously reported instances of violence and aggression. The findings identified that failure to report acts of violence was common. Reports of violence and aggression in the emergency department underestimate the true incidence. Failure to report has potential impacts on organisational recognition of risk and the ability to develop appropriate policy responses.

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data

PubMed Central

2015-01-01

Background Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Methods Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. Results A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Conclusion Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging. PMID:26692453

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data.

PubMed

Khan, Irum; Khan, Nadeem; Naeem, Rubaba; Kerai, Salima; Allen, Kate; Zia, Nukhba; Shahbaz, Sana; Afridi, Shiraz; Siddiqui, Emaduddin; Khan, Uzma; Hyder, Adnan A; Razzak, Junaid A

2015-01-01

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging.

44 CFR 12.16 - Reports about the advisory committees.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Reports about the advisory committees. 12.16 Section 12.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL ADVISORY COMMITTEES § 12.16 Reports about the advisory committees. (a) The Agency will furnish a report of...

Disseminated cytomegalovirus infection complicating active treatment of systemic lupus erythematosus: an emerging problem.

PubMed

Berman, N; Belmont, H M

2017-04-01

Patients with systemic lupus erythematosus (SLE) often require immunosuppression to induce remission of active disease exacerbations. Over the past two decades, treatment modalities for this condition have emerged leading to improved morbidity from disease related outcomes. However, as a result, infection risks and patterns have changed, leading to higher rates of opportunistic infections among this population. We report four cases of cytomegalovirus (CMV) in patients with SLE who received immunosuppressive therapy, including pulse steroids, antimetabolites such as mycophenolate mofetil, and alkylating agents such as cyclophosphamide. We propose that given the rise in prevalence of CMV, there is a need for appropriate screening for this opportunistic pathogen and studies to determine the risks and benefits of prophylactic or preemptive treatment for this virus.

Versatile microbial surface-display for environmental remediation and biofuels production

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Cindy H.; Mulchandani, Ashok; Chen, wilfred

2008-02-14

Surface display is a powerful technique that utilizes natural microbial functional components to express proteins or peptides on the cell exterior. Since the reporting of the first surface-display system in the mid-1980s, a variety of new systems have been reported for yeast, Gram-positive and Gram-negative bacteria. Non-conventional display methods are emerging, eliminating the generation of genetically modified microorganisms. Cells with surface display are used as biocatalysts, biosorbents and biostimulants. Microbial cell-surface display has proven to be extremely important for numerous applications ranging from combinatorial library screening and protein engineering to bioremediation and biofuels production.

Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana.

PubMed

Egmann, Gérald; Tattevin, Pierre; Palancade, Renaud; Nacher, Matthieu

2018-03-01

Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients' legal status. Data were extracted from the SAMU 973 notebook registry (1998-2000) or the SAMU 973 computerized database (2008-2010) and werre collected using a standardized questionnaire. Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%). Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Emergency nurses' and department preparedness for an ebola outbreak: A (narrative) literature review.

PubMed

Pincha Baduge, Mihirika Sds; Morphet, Julia; Moss, Cheryle

2018-05-01

The 2014 Ebola Virus Disease outbreak in West Africa triggered a public health emergency of international concern. Emergency departments worldwide responded with Ebola containment and preparation measures. This paper reports a literature inquiry into how emergency departments and emergency nurses prepared to manage the Ebola risk. Narrative review was the method used. Guidelines (n = 5) for organisational and emergency department preparedness were retrieved from relevant websites. Searches for primary studies and case reports were undertaken in the MEDLINE and CINAHL databases. After screening and quality appraisal, 20 papers were included in the review. Research and case reports identified 17 different preparedness strategies, and practical interventions for containment undertaken in emergency departments. These included a requirement for surveillance and reporting, Ebola case management, inventory and logistic management, laboratory management, and communication and education. Emergency nurses' personal preparedness was influenced by the emotional readiness, their willingness to care for people at risk of Ebola, and the provision of psychological support. The preparation efforts reported internationally were generally consistent in strategy and intervention. The findings provide guidance for future preparedness strategies by emergency departments in response to threats like Ebola. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

What can Parents' Self-report of Reading Difficulties Tell Us about Their Children's Emergent Literacy at School Entry?

PubMed

Esmaeeli, Zahra; Lundetrae, Kjersti; Kyle, Fiona E

2018-02-01

Research has linked family risk (FR) of reading difficulties (RD) with children's difficulties in emergent literacy development. This study is the first to apply parents' self-report of RD as a proxy for FR in a large sample (n = 1171) in order to test group differences in children's emergent literacy. Emergent literacy, the home literacy environment and children's interest in literacy and letters were compared across different groups of FR children around the school entry. The FR children performed lower in emergent literacy compared with not-FR children. Furthermore, when comparing FR children with one parent reporting RD and children with both parents reporting RD, moderate group differences were found in Emergent Literacy. Finally, parents' self-report of RD was a significant contributor of emergent literacy after controlling for the home literacy environment, children's gender, their interest in literacy and letters, months in kindergarten, vocabulary and parents' education. Our findings suggest that schools should monitor the reading development of children with parents self-reporting RD closely - especially if both parents self-report RD. © 2017 The Authors. Dyslexia published by John Wiley & Sons Ltd. © 2017 The Authors. Dyslexia published by John Wiley & Sons Ltd.

What can Parents' Self‐report of Reading Difficulties Tell Us about Their Children's Emergent Literacy at School Entry?

PubMed Central

Lundetræ, Kjersti; Kyle, Fiona E.

2017-01-01

Research has linked family risk (FR) of reading difficulties (RD) with children's difficulties in emergent literacy development. This study is the first to apply parents' self‐report of RD as a proxy for FR in a large sample (n = 1171) in order to test group differences in children's emergent literacy. Emergent literacy, the home literacy environment and children's interest in literacy and letters were compared across different groups of FR children around the school entry. The FR children performed lower in emergent literacy compared with not‐FR children. Furthermore, when comparing FR children with one parent reporting RD and children with both parents reporting RD, moderate group differences were found in Emergent Literacy. Finally, parents' self‐report of RD was a significant contributor of emergent literacy after controlling for the home literacy environment, children's gender, their interest in literacy and letters, months in kindergarten, vocabulary and parents' education. Our findings suggest that schools should monitor the reading development of children with parents self‐reporting RD closely – especially if both parents self‐report RD. © 2017 The Authors. Dyslexia published by John Wiley & Sons Ltd. PMID:28921775

Terrorism in Mexico.

PubMed

Nordin, Yannick; Cruz-Vega, Felipe; Roman, Fernando

2003-01-01

Even though Mexico is considered internationally as a pacifist country, its economic, social, and geopolitical characteristics during the last half of the 20th century have resulted in internal events that can be considered acts of terrorism. Most of the acts of terrorism during the last 15 years have had to do either with political movements or drug-dealing actions. After the 11 September 2001 attacks in the United States, Mexican Health Authorities have strengthened the epidemiological surveillance system. More than 1,372 calls asking for information or reporting suspicious envelopes were received between 16 October and 21 October 2001. Following the earthquake in 1985 that caused great damage and many deaths in Mexico, the National Civil Protection System was created in 1986. This protection system is led by the President and the Secretary of Government. It was developed to improve preparedness for disaster coordination more than for terrorism responses. In addition, the emergency medical systems continue to lack organization, even though some states have shown significant progress in their emergency medical system.

Epidemiologic Comparison of Injured High School Basketball Athletes Reporting to Emergency Departments and the Athletic Training Setting

PubMed Central

Fletcher, Erica N.; McKenzie, Lara B.; Comstock, R. Dawn

2014-01-01

Context: Basketball is a popular US high school sport with more than 1 million participants annually. Objective: To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005–2011 seasons. Design: Descriptive epidemiology study. Setting: Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database. Main Outcome Measure(s): Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison. Patients or Other Participants: Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball. Results: Nationally, an estimated 1 514 957 (95% confidence interval = 1 337 441, 1 692 474) athletes with basketball-related injuries reported to the emergency department and 1 064 551 (95% confidence interval = 1 055 482, 1 073 620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001). Conclusions: Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department. PMID:24758246

76 FR 41273 - National Emergency Communications Plan (NECP) Tribal Report

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... DEPARTMENT OF HOMELAND SECURITY [Docket No. DHS-2011-0025] National Emergency Communications Plan... Communications (CS&C), Office of Emergency Communications (OEC), will submit the following information collection... concerning New Information Collection Request, National Emergency Communications Plan Tribal Report. DHS...

Multi-material classification of dry recyclables from municipal solid waste based on thermal imaging.

PubMed

Gundupalli, Sathish Paulraj; Hait, Subrata; Thakur, Atul

2017-12-01

There has been a significant rise in municipal solid waste (MSW) generation in the last few decades due to rapid urbanization and industrialization. Due to the lack of source segregation practice, a need for automated segregation of recyclables from MSW exists in the developing countries. This paper reports a thermal imaging based system for classifying useful recyclables from simulated MSW sample. Experimental results have demonstrated the possibility to use thermal imaging technique for classification and a robotic system for sorting of recyclables in a single process step. The reported classification system yields an accuracy in the range of 85-96% and is comparable with the existing single-material recyclable classification techniques. We believe that the reported thermal imaging based system can emerge as a viable and inexpensive large-scale classification-cum-sorting technology in recycling plants for processing MSW in developing countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

Power Systems of the Future: A 21st Century Power Partnership Thought Leadership Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zinaman, Owen; Miller, Mackay; Adil, Ali

This report summarizes key forces driving transformation in the power sector around the world, presents a framework for evaluating decisions regarding extent and pace of change, and defines pathways for transformation. Powerful trends in technology, policy environments, financing, and business models are driving change in power sectors globally. In light of these trends, the question is no longer whether power systems will be transformed, but rather how these transformations will occur. Three approaches to policy and technology decision-making can guide these transformations: adaptive, reconstructive, and evolutionary. Within these approaches, we explore the five pathways that have emerged as viable modelsmore » for power system transformation.« less

Emerging adults' perspectives on their relationships with mothers with mental illness: implications for caregiving.

PubMed

Abraham, Kristen M; Stein, Catherine H

2012-10-01

Guided by a life course perspective, the current study examined whether emerging adults with and without mothers with affective disorders viewed their relationships with their mothers differently, and whether aspects of the emerging adult-mother relationship were associated with reports of caregiving for mothers. Reports from emerging adults with mothers with affective disorders (n = 46) were compared to reports from emerging adults with mothers without mental illness (n = 64). Results indicated that emerging adults with mothers with affective disorders reported significantly lower levels of affection, felt obligation, reciprocity, and future caregiving intentions, and significantly higher levels of role reversal in their relationships with their mothers. Reported current caregiving levels did not differ between emerging adults with and without mothers with affective disorders. Hierarchical multiple regression analyses generally indicated higher levels of felt obligation were associated with higher levels of caregiving, regardless of maternal mental health status. Results and future research directions are discussed from a life course perspective. © 2012 American Orthopsychiatric Association.

Evaluating the Emergency Notification Systems of the NASA White Sands Test

NASA Technical Reports Server (NTRS)

Chavez, Alfred Paul

2004-01-01

The problem was that the NASA Fire and Emergency Services did not know if the current emergency notification systems on the NASA White Sands Test Facility were appropriate for alerting the employees of an emergency. The purpose of this Applied Research Project was to determine if the current emergency notification systems of the White Sands Test Facility are appropriate for alerting the employees of an emergency. This was a descriptive research project. The research questions were: 1) What are similar facilities using to alert the employees of an emergency?; 2) Are the current emergency notification systems suitable for the community hazards on the NASA White Sands Test Facility?; 3) What is the NASA Fire and Emergency Services currently using to measure the effectiveness of the emergency notification systems?; and 4) What are the current training methods used to train personnel to the emergency notification systems at the NASA White Sands Test Facility? The procedures involved were to research other established facilities, research published material from credible sources, survey the facility to determine the facility perception of the emergency notification systems, and evaluate the operating elements of the established emergency notification systems for the facility. The results were that the current systems are suitable for the type of hazards the facility may endure. The emergency notification systems are tested frequently to ensure effectiveness in the event of an emergency. Personnel are trained and participate in a yearly drill to make certain personnel are educated on the established systems. The recommendations based on the results were to operationally improve the existing systems by developing and implementing one system that can overall notify the facility of a hazard. Existing procedures and training should also be improved to ensure that all personnel are educated on what to do when the emergency notification systems are activated.

Special population planner, version 4.0.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuiper, J.; Tanzman, E.; Metz, W.

2007-03-26

Emergencies happen every day. Many are caused by storms or auto accidents and can be planned for, if not predicted. Emergencies resulting from natural hazards often affect a large number of people, and planning for them can be difficult, since knowledge of the needs of the people involved is generally unavailable. Emergencies resulting from accidents at industrial and military facilities can also be large scale in nature if people must be evacuated or sheltered in place. Federal planning for large scale emergencies is the responsibility of the Federal Emergency Management Agency (FEMA), which provides assistance to various emergency management agenciesmore » at the national, state and local level. More information about FEMA is available at http://www.fema.gov/. The purpose of the Special Population Planner (SPP) is to help emergency planners address the needs of persons with special needs. The exact definition of 'special population' is a policy decision. Policymakers have included a variety of groups in this term, such as persons with disabilities, those who do not have vehicles with which to evacuate, children who are unattended at times (latchkey children), and many others. The SPP was developed initially for the Alabama Emergency Management Agency as part of its Chemical Stockpile Emergency Preparedness Program (CSEPP), which aids emergency planning and preparedness in communities surrounding military installations across the United States where chemical weapons are stored pending their destruction under federal law. Like that specialized application, this open-source version contains a set of specialized Geographic Information System (GIS) tools to facilitate emergency planning on behalf of persons with special needs, regardless of how the term is defined. While the original SPP system was developed for emergency planning relating to chemical hazards, it can be applied to other threats as well. It is apparent from Hurricane Katrina and other natural and man-made disasters that many of the problems posed by emergency planning for a chemical weapons agent release are shared by other hazards as well. The notion that emergency planning shares common functions underlies the decision by FEMA to include the Chemical Stockpile Emergency Preparedness Program (CSEPP) in its 'all-hazards' planning approach. The CSEPP's official planning guidance operationalizes this approach by suggesting that state and local CSEPP emergency plans 'should be appended to the existing all-hazards emergency plan.' The SPP is programmed as a set of tools within an ESRI ArcMap 9.1 project. ArcMap is a component of both ESRI ArcGIS 9.1 and ESRI ArcView 9.1, and it provides a rich GIS user interface for viewing spatial and tabular data, analyzing it, and producing output reports and maps. This GIS interface has been augmented with the SPP tools for a user interface that provides custom functionality for emergency planning. The system as released also includes some hypothetical example records for special needs populations, facilities, resources, control points and sirens sufficient for showing how the system would work with real information. A GIS database is included with some publicly available example layers. The SPP is designed to support emergency planners as they address emergency management issues, and includes capabilities that support the collection and importing of data, the review of data in a spatial context, and GIS tools for emergency planning. The SPP system allows for the identification and categorization of response zones to allow for multiple levels of preparedness. An Immediate Response Zone (IRZ) might be designated as the area 0 to 10 miles from a facility where the response would be the most urgent. SPP can support more than one set of planning zones to accommodate different types of emergencies or the different jurisdictions of emergency response organizations. These areas can be delineated by any number of criteria that make sense for the area. An area like New Orleans might designate response zones based on the depth above/below sea level, or an urban area may categorize an IRZ as the 'central business district' with the PAZ encompassing the larger outlying area. Many of the sites involved in the CSEPP currently use an integrated emergency response information system to support their emergency management planning. The D2-Puff system (including or WebPuff 2.1) by Innovative Emergency Management, Inc. is the main software serving this purpose. More information on D2-Puff can be found at www.ieminc.com. SPP differs from D2-Puff in that it is designed for planning, not response to assist those with special needs, is programmed within a popular commercial GIS software system, and can be loaded with large amounts of data to support all hazards emergency planning.« less

Real Time Alert System: A Disease Management System Leveraging Health Information Exchange

PubMed Central

Anand, Vibha; Sheley, Meena E.; Xu, Shawn; Downs, Stephen M.

2012-01-01

Background Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. Methods: Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA’s performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. Results: Our results show that RTA was successfully able to deliver “just in time” patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. Conclusions: We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient’s asthma related emergency room admission so further follow up can happen in near real time. PMID:23569648

46 CFR 112.15-10 - Loads on systems without a temporary emergency power source.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Loads § 112.15-10 Loads on systems without a temporary emergency power source. If there is no temporary emergency power source, the loads... 46 Shipping 4 2013-10-01 2013-10-01 false Loads on systems without a temporary emergency power...

46 CFR 112.15-10 - Loads on systems without a temporary emergency power source.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Loads § 112.15-10 Loads on systems without a temporary emergency power source. If there is no temporary emergency power source, the loads... 46 Shipping 4 2014-10-01 2014-10-01 false Loads on systems without a temporary emergency power...

46 CFR 112.15-10 - Loads on systems without a temporary emergency power source.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Loads § 112.15-10 Loads on systems without a temporary emergency power source. If there is no temporary emergency power source, the loads... 46 Shipping 4 2012-10-01 2012-10-01 false Loads on systems without a temporary emergency power...

46 CFR 112.15-10 - Loads on systems without a temporary emergency power source.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Loads § 112.15-10 Loads on systems without a temporary emergency power source. If there is no temporary emergency power source, the loads... 46 Shipping 4 2011-10-01 2011-10-01 false Loads on systems without a temporary emergency power...

46 CFR 112.15-10 - Loads on systems without a temporary emergency power source.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) ELECTRICAL ENGINEERING EMERGENCY LIGHTING AND POWER SYSTEMS Emergency Loads § 112.15-10 Loads on systems without a temporary emergency power source. If there is no temporary emergency power source, the loads... 46 Shipping 4 2010-10-01 2010-10-01 false Loads on systems without a temporary emergency power...

Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

PubMed

Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

2014-10-01

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.

Applications of Emerging Parallel Optical Link Technology to High Energy Physics Experiments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chramowicz, J.; Kwan, S.; Prosser, A.

2011-09-01

Modern particle detectors depend upon optical fiber links to deliver event data to upstream trigger and data processing systems. Future detector systems can benefit from the development of dense arrangements of high speed optical links emerging from the telecommunications and storage area network market segments. These links support data transfers in each direction at rates up to 120 Gbps in packages that minimize or even eliminate edge connector requirements. Emerging products include a class of devices known as optical engines which permit assembly of the optical transceivers in close proximity to the electrical interfaces of ASICs and FPGAs which handlemore » the data in parallel electrical format. Such assemblies will reduce required printed circuit board area and minimize electromagnetic interference and susceptibility. We will present test results of some of these parallel components and report on the development of pluggable FPGA Mezzanine Cards equipped with optical engines to provide to collaborators on the Versatile Link Common Project for the HI-LHC at CERN.« less

Emergency Medicine: On the Frontlines of Medical Education Transformation.

PubMed

Holmboe, Eric S

2015-11-01

Emergency medicine (EM) has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment.

Communicating with the Workforce During Emergencies: Developing an Employee Text Messaging Program in a Local Public Health Setting

PubMed Central

Bogan, Sharon; Bosslet, Lindsay

2014-01-01

Short message service (SMS) text messaging can be useful for communicating information to public health employees and improving workforce situational awareness during emergencies. We sought to understand how the 1,500 employees at Public Health – Seattle & King County, Washington, perceived barriers to and benefits of participation in a voluntary, employer-based SMS program. Based on employee feedback, we developed the system, marketed it, and invited employees to opt in. The system was tested during an ice storm in January 2012. Employee concerns about opting into an SMS program included possible work encroachment during non-work time and receiving excessive irrelevant messages. Employees who received messages during the weather event reported high levels of satisfaction and perceived utility from the program. We conclude that text messaging is a feasible form of communication with employees during emergencies. Care should be taken to design and deploy a program that maximizes employee satisfaction. PMID:25355976

Enhancing Public Helicopter Safety as a Component of Homeland Security

DTIC Science & Technology

2016-12-01

Risk Assessment Tool GPS Global Positioning System IFR instrument flight rules ILS instrument landing system IMC instrument meteorological...flight rules ( IFR ) flying and the lack of a pre-flight risk assessment. Pilot fatigue is a factor that appeared in two of the accident reports (New...three common factors that emerged from the qualitative analysis of coding: inadequate proficiency of IFR flying, lack of a pre- flight risk assessment

Integrated System Safety Program for the MX Weapon System.

DTIC Science & Technology

1979-09-25

Quantitative AnalIsis Of Specified Undesired Events Nuclr Safey Anisis Reports ISARI Contractor Inpu To AFWL Technical Nucler Sa An. Is FIGURE 1...Launch Includes all functions from initiation of launch se- quence to missile first motion, such as transfer from ground power to airborne power ...all credible contingency or emergency condi- tions, such as Toxic gases/fluid release, inadvertently armed ordnance, electric power loss, and destruct

44 CFR 334.7 - Reporting.

Code of Federal Regulations, 2010 CFR

2010-10-01

... implementation of the national security emergency preparedness policy. Pursuant to section 201(15) of Executive... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reporting. 334.7 Section 334.7 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND...

Emergency communications within the limited English proficient Chinese community.

PubMed

Yip, Mei-Po; Calhoun, Rebecca E; Painter, Ian S; Meischke, Hendrika W; Tu, Shin-Ping

2014-08-01

Limited English speaking communities face communication challenges during emergencies. Our objective was to investigate Chinese limited English proficiency individuals' perceptions of and inclination to interact with emergency communication systems. A telephone survey was conducted in Mandarin or Cantonese with 250 ethnic Chinese individuals who spoke little or no English. Respondents who spoke no English were less likely to name 9-1-1 as their first source of help for a medical emergency than those who spoke some English (p < 0.01). Those reporting higher levels of confidence in handling the situation were more likely to name 9-1-1 as their first source of help, as were those who listed 9-1-1 as their most trusted source of help (p < 0.01). For this group, the results indicate that calling 9-1-1 may require a sense of self-efficacy. Not calling 9-1-1 in a medical emergency can have serious health consequences, thus interventions are needed to increase confidence in accessing 9-1-1.

Summary of data reported to CDC's national automated biosurveillance system, 2008

PubMed Central

2010-01-01

Background BioSense is the US national automated biosurveillance system. Data regarding chief complaints and diagnoses are automatically pre-processed into 11 broader syndromes (e.g., respiratory) and 78 narrower sub-syndromes (e.g., asthma). The objectives of this report are to present the types of illness and injury that can be studied using these data and the frequency of visits for the syndromes and sub-syndromes in the various data types; this information will facilitate use of the system and comparison with other systems. Methods For each major data source, we summarized information on the facilities, timeliness, patient demographics, and rates of visits for each syndrome and sub-syndrome. Results In 2008, the primary data sources were the 333 US Department of Defense, 770 US Veterans Affairs, and 532 civilian hospital emergency department facilities. Median times from patient visit to record receipt at CDC were 2.2 days, 2.0 days, and 4 hours for these sources respectively. Among sub-syndromes, we summarize mean 2008 visit rates in 45 infectious disease categories, 11 injury categories, 7 chronic disease categories, and 15 other categories. Conclusions We present a systematic summary of data that is automatically available to public health departments for monitoring and responding to emergencies. PMID:20500863

OLEM Performance Assessment Information

EPA Pesticide Factsheets

This asset includes a variety of data sets that measure the performance of Office of Land and Emergency Management (OLEM) programs in support of the Office of the Chief Financial Officer's Annual Commitment System (ACS) and Performance Evaluation Reporting System (PERS). Information is drawn from OLEM's ACRES, RCRAInfo, CERCLIS/SEMS, ICIS, and LUST4 systems, as well as input manually by authorized individuals in OLEM's program offices. Information is reviewed by OLEM program staff prior to being pushed to ACS and entered into PERS. This data asset also pulls in certain performance information input directly by Regional Office staff into ACS. Information is managed by the Performance Assessment Tool (PAT) and displayed in the PAT Dashboard.Information in this asset include:--Government Performance and Results Act (GPRA) of 1993: Measures reported for Innovations, Partnerships and Communications Office (IPCO), the Office of Brownfields and Land Revitalization (OBLR), the Office of Emergency Management (OEM), the Office of Resource Conservation and Recovery (ORCR), the Office of Superfund Remediation and Technology Innovation (OSRTI), and the Office of Underground Storage Tanks (OUST).-- Performance and Environmental Results System (PERS): Includes OLEM's information on performance results and baselines for the EPA Annual Plan and Budget.--Key Performance Indicators: OLEM has identified five KPIs that are tracked annually.--Integrated Cleanup Initiative: A pilot pe

49 CFR 234.7 - Accidents involving grade crossing signal failure.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Accidents involving grade crossing signal failure..., STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Reports and Plans § 234.7 Accidents involving... railroad equipment and an automobile, bus, truck, motorcycle, bicycle, farm vehicle, or pedestrian at a...

49 CFR 234.7 - Accidents involving grade crossing signal failure.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Accidents involving grade crossing signal failure..., STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Reports and Plans § 234.7 Accidents involving... railroad equipment and an automobile, bus, truck, motorcycle, bicycle, farm vehicle, or pedestrian at a...

49 CFR 234.7 - Accidents involving grade crossing signal failure.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Accidents involving grade crossing signal failure..., STATE ACTION PLANS, AND EMERGENCY NOTIFICATION SYSTEMS Reports and Plans § 234.7 Accidents involving... railroad equipment and an automobile, bus, truck, motorcycle, bicycle, farm vehicle, or pedestrian at a...

76 FR 42590 - Retrospective Review Under E.O. 13563; Improving Common Acreage Reporting Processes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... solutions to preserve and strengthen the economic stability of America's agricultural producers. RMA..., commodity, credit, conservation, disaster, and emergency assistance programs that help improve the stability... management system. To implement ACRSI in an economical manner, we plan to the extent possible to utilize CIMS...

Homeland security and the non-federal healthcare sector: evaluation of your incident command system (ICS).

PubMed

Blair, James D

2005-01-01

Healthcare and other private sector industries have lagged behind federal agencies in fulfilling their security readiness mission, according to the author. A comprehensive and timely resource is now available, he reports, to help healthcare officials in improving emergency response and preparedness.

The Typology of Organizational Effectiveness in Australian Higher Education.

ERIC Educational Resources Information Center

Lysons, Art

1993-01-01

New developments emerging from a study of organizational effectiveness in Australia's system of higher education are reported, and a second study is also described. The results have established a four-group typology of institutions: classical universities, institutes of technology, colleges of advanced education, and other institutions.…

Preventing and managing aggression and violence in the NHS.

PubMed

Bleetman, Anthony; Fayeye, Oloruntoba O

2003-12-01

Streaming in emergency departments reduces waiting times and stress, and removes the causes of most violent attacks against staff. In spite of this some people will still attack staff. Staff must be protected by a sound trust policy and effective and realistic training, monitored by a good reporting system.

10 CFR 205.374 - Responses from “entities” designated in the application.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Emergency... appropriate Regional Electric Reliability Council. Pursuant to section 202(c) of the Federal Power Act, DOE... Electric Power § 205.374 Responses from “entities” designated in the application. Each “entity” designated...

10 CFR 205.372 - Filing procedures; number of copies.

Code of Federal Regulations, 2010 CFR

2010-01-01

....372 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power... and reports required under §§ 205.370 through 205.379 shall be filed with the Division of Power Supply...

10 CFR 205.372 - Filing procedures; number of copies.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and reports required under §§ 205.370 through 205.379 shall be filed with the Division of Power Supply....372 Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System... Electric Facilities and the Transfer of Electricity to Alleviate An Emergency Shortage of Electric Power...

NANOTECHNOLOGY AND LIFE CYCLE ASSESSMENT: A SYSTEMS APPROACH TO NANOTECHNOLOGY AND THE ENVIRONMENT

EPA Science Inventory

This report summarizes the results of a two-day workshop jointly convened by the Woodrow Wilson Center Project on Emerging Nanotechnologies; the US Environmental Protection Agency¿s Office of Research and Development; and the European Commission. Held in October 2006, the worksh...

Taxonomic Proposal: Create sixteen new species in existing genera of the families Alphaflexiviridae and Betaflexiviridae

USDA-ARS?s Scientific Manuscript database

A transparent and functional system for virus classification is essential to allow scientists to correctly identify and report on viruses detected in different hosts or locations without ambiguity. New research into relationships between previously characterized and newly-emerging viruses may requir...

3 new species in a proposed new genus Deltaflexivirus and new family Deltaflexiviridae in the order Tymovirales

USDA-ARS?s Scientific Manuscript database

A transparent and functional system for virus classification is essential to allow scientists to correctly identify and report on viruses detected in different hosts or locations without ambiguity. New research into relationships between previously characterized and newly-emerging viruses may requir...

34. VIEW OF THREE MONITORS LOCATED IMMEDIATELY WEST OF THOSE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

34. VIEW OF THREE MONITORS LOCATED IMMEDIATELY WEST OF THOSE IN PHOTO A-33. TELEPHONE BELOW THE CENTER MONITOR IS LABLED 'ACCIDENT REPORTING EMERGENCY NOTIFICATION SYSTEM ONLY.' - Vandenberg Air Force Base, Space Launch Complex 3, Launch Operations Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

The intelligent transportation aystems public safety program : opportunities for technological advancement in detecting, responding and recovering from community emergencies

DOT National Transportation Integrated Search

1993-08-01

This report is the third in a series produced for the Federal Transit Administration (FTA) and the Federal Highway Administration (FHWA) by the Volpe National Transportation Systems Center (Volpe Center). This formal, comprehensive review of the plan...

Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.

PubMed

Okafor, Nnaemeka; Payne, Velma L; Chathampally, Yashwant; Miller, Sara; Doshi, Pratik; Singh, Hardeep

2016-04-01

Diagnostic errors are common in the emergency department (ED), but few studies have comprehensively evaluated their types and origins. We analysed incidents reported by ED physicians to determine disease conditions, contributory factors and patient harm associated with ED-related diagnostic errors. Between 1 March 2009 and 31 December 2013, ED physicians reported 509 incidents using a department-specific voluntary incident-reporting system that we implemented at two large academic hospital-affiliated EDs. For this study, we analysed 209 incidents related to diagnosis. A quality assurance team led by an ED physician champion reviewed each incident and interviewed physicians when necessary to confirm the presence/absence of diagnostic error and to determine the contributory factors. We generated descriptive statistics quantifying disease conditions involved, contributory factors and patient harm from errors. Among the 209 incidents, we identified 214 diagnostic errors associated with 65 unique diseases/conditions, including sepsis (9.6%), acute coronary syndrome (9.1%), fractures (8.6%) and vascular injuries (8.6%). Contributory factors included cognitive (n=317), system related (n=192) and non-remedial (n=106). Cognitive factors included faulty information verification (41.3%) and faulty information processing (30.6%) whereas system factors included high workload (34.4%) and inefficient ED processes (40.1%). Non-remediable factors included atypical presentation (31.3%) and the patients' inability to provide a history (31.3%). Most errors (75%) involved multiple factors. Major harm was associated with 34/209 (16.3%) of reported incidents. Most diagnostic errors in ED appeared to relate to common disease conditions. While sustaining diagnostic error reporting programmes might be challenging, our analysis reveals the potential value of such systems in identifying targets for improving patient safety in the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Ambulatory Care Workload Management System for Nursing Reference Manual

DTIC Science & Technology

1991-05-31

MEDICAL DATA SERVICES CENTER BETHESDA, MARYLAND 2088Q-506. 91-03029 SECuRItY CLASSIFICATION OF THIS PAGEr REPORT DOCUMENTATION PAGE Ia. REPORT SECURITY...ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION Naval Medical Data Servics (If applicable) Center 6c. ADDRESS (City, State, and ZIPCode) 7b...staffing methodology developed for emergency and ambulatory care departments in naval medical treatment facilities . The staffing model translates varying

Emergence of Fundamental Limits in Spatially Distributed Dynamical Networks and Their Tradeoffs

DTIC Science & Technology

2017-05-01

It is shown that the resulting non -convex optimization problem can be equivalently reformulated into a rank-constrained problem. We then...display a current ly valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM- YYYY) ,2. REPORT TYPE 3...robustness in distributed control and dynamical systems. Our research re- sults are highly relevant for analysis and synthesis of engineered and natural

Enzyme cascades activated on topologically programmed DNA scaffolds

NASA Astrophysics Data System (ADS)

Wilner, Ofer I.; Weizmann, Yossi; Gill, Ron; Lioubashevski, Oleg; Freeman, Ronit; Willner, Itamar

2009-04-01

The ability of DNA to self-assemble into one-, two- and three-dimensional nanostructures, combined with the precision that is now possible when positioning nanoparticles or proteins on DNA scaffolds, provide a promising approach for the self-organization of composite nanostructures. Predicting and controlling the functions that emerge in self-organized biomolecular nanostructures is a major challenge in systems biology, and although a number of innovative examples have been reported, the emergent properties of systems in which enzymes are coupled together have not been fully explored. Here, we report the self-assembly of a DNA scaffold made of DNA strips that include `hinges' to which biomolecules can be tethered. We attach either two enzymes or a cofactor-enzyme pair to the scaffold, and show that enzyme cascades or cofactor-mediated biocatalysis can proceed effectively; similar processes are not observed in diffusion-controlled homogeneous mixtures of the same components. Furthermore, because the relative position of the two enzymes or the cofactor-enzyme pair is determined by the topology of the DNA scaffold, it is possible to control the reactivity of the system through the design of the individual DNA strips. This method could lead to the self-organization of complex multi-enzyme cascades.

Emerging Regenerative Approaches for Periodontal Reconstruction: A Consensus Report From the AAP Regeneration Workshop

PubMed Central

Cochran, David L.; Cobb, Charles M.; Bashutski, Jill D.; Chun, Yong-Hee Patricia; Lin, Zhao; Mandelaris, George A.; McAllister, Bradley S.; Murakami, Shinya; Rios, Hector F.

2015-01-01

Background Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session. Methods The review paper was sent to all the consensus group participants in advance of the consensus conference. In addition and also before the conference, individual consensus group members submitted additional material for consideration by the group. At the conference, each consensus group participant introduced themselves and provided disclosure of any potential conflicts of interest. The review paper was briefly presented by two of the authors and discussed by the consensus group. A discussion of each of the following topics then occurred based on the content of the review: a general summary of the topic, implications for patient-reported outcomes, and suggested research priorities for the future. As each topic was discussed based on the review article, supplemental information was then added that the consensus group agreed on. Last, an updated reference list was created. Results The application of protein and peptide therapy, cell-based therapy, genetic therapy, application of scaffolds, bone anabolics, and lasers were found to be emerging technologies for periodontal regeneration. Other approaches included the following: 1) therapies directed at the resolution of inflammation; 2) therapies that took into account the influence of the microbiome; 3) therapies involving the local regulation of phosphate and pyrophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient-related outcomes were typically not addressed in the literature. Numerous recommendations can bemade for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost-to-benefit ratio were also identified as key factors for emerging technologies. Conclusions A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost-to-benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations. PMID:25317603

Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: A retrospective cohort study.

PubMed

Park, Hyun Oh; Kim, Jong Woo; Kim, Sung Hwan; Moon, Seong Ho; Byun, Joung Hun; Kim, Ki Nyun; Yang, Jun Ho; Lee, Chung Eun; Jang, In Seok; Kang, Dong Hun; Kim, Seong Chun; Kang, Changwoo; Choi, Jun Young

2017-11-01

Early estimation of mortality risk in patients with trauma is essential. In this study, we evaluate the validity of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) for predicting in-hospital mortality in patients with trauma. Furthermore, we compared the REMS and the EMTRAS with 2 other scoring systems: the Revised Trauma Score (RTS) and Injury Severity score (ISS).We performed a retrospective chart review of 6905 patients with trauma reported between July 2011 and June 2016 at a large national university hospital in South Korea. We analyzed the associations between patient characteristics, treatment course, and injury severity scoring systems (ISS, RTS, EMTRAS, and REMS) with in-hospital mortality. Discriminating power was compared between scoring systems using the areas under the curve (AUC) of receiver operating characteristic (ROC) curves.The overall in-hospital mortality rate was 3.1%. Higher EMTRAS and REMS scores were associated with hospital mortality (P < .001). The ROC curve demonstrated adequate discrimination (AUC = 0.957 for EMTRAS and 0.9 for REMS). After performing AUC analysis followed by Bonferroni correction for multiple comparisons, EMTRAS was significantly superior to REMS and ISS in predicting in-hospital mortality (P < .001), but not significantly different from the RTS (P = .057). The other scoring systems were not significantly different from each other.The EMTRAS and the REMS are simple, accurate predictors of in-hospital mortality in patients with trauma.

Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

PubMed Central

Bevan, Gwyn; Hamblin, Richard

2009-01-01

Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

After-action review of the 2009-10 H1N1 Influenza Outbreak Response: Ohio's Public Health System's performance.

PubMed

Mase, William A; Bickford, Beth; Thomas, Casey L; Jones, Shamika D; Bisesi, Michael

In early 2009, H1N1 influenza was identified within the human population. Centers for Disease Control and Prevention (CDC) officials responded with focused assessment, policy development, and assurances. The response was mobilized through efforts including procurement of adequate vaccine supply, local area span of control, materials acquisition, and facilities and resource identification. Qualitative evaluation of the assurance functions specific to the system's ability to assure safe and healthy conditions are reported. The methodology mirrors the Homeland Security Exercise and Evaluation Program used to assess system capability. Findings demonstrate the effectiveness of community responsive disease prevention efforts in partnership with the public health systems mission to unify traditional public sector systems, for-profit systems, and local area systems was accomplished. As a result of this response pharmaceutical industries, healthcare providers, healthcare agencies, police/safety, colleges, and health and human service agencies were united. Findings demonstrate the effectiveness of community response strategies utilizing feedback from system stakeholders. After-action review processes are critical in all-hazards preparedness. This analysis of local health district response to the H1N1 influenza outbreak informs future public health service delivery. Results provide a synthesis of local health department's emergency response strategies, challenges encountered, and future-focused emergency response strategy implementation. A synthesis is provided as to policy and practice developments which have emerged over the past seven years with regard to lessons learned from the 2009-10 H1N1 influenza outbreak and response.

Foundational Report Series. Advanced Distribution management Systems for Grid Modernization (Importance of DMS for Distribution Grid Modernization)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jianhui

2015-09-01

Grid modernization is transforming the operation and management of electric distribution systems from manual, paper-driven business processes to electronic, computer-assisted decisionmaking. At the center of this business transformation is the distribution management system (DMS), which provides a foundation from which optimal levels of performance can be achieved in an increasingly complex business and operating environment. Electric distribution utilities are facing many new challenges that are dramatically increasing the complexity of operating and managing the electric distribution system: growing customer expectations for service reliability and power quality, pressure to achieve better efficiency and utilization of existing distribution system assets, and reductionmore » of greenhouse gas emissions by accommodating high penetration levels of distributed generating resources powered by renewable energy sources (wind, solar, etc.). Recent “storm of the century” events in the northeastern United States and the lengthy power outages and customer hardships that followed have greatly elevated the need to make power delivery systems more resilient to major storm events and to provide a more effective electric utility response during such regional power grid emergencies. Despite these newly emerging challenges for electric distribution system operators, only a small percentage of electric utilities have actually implemented a DMS. This paper discusses reasons why a DMS is needed and why the DMS may emerge as a mission-critical system that will soon be considered essential as electric utilities roll out their grid modernization strategies.« less

Multimodality imaging of foreign bodies of the musculoskeletal system.

PubMed

Jarraya, Mohamed; Hayashi, Daichi; de Villiers, Richard V; Roemer, Frank W; Murakami, Akira M; Cossi, Alda; Guermazi, Ali

2014-07-01

The purpose of this article is to clarify the most relevant points in managing suspected foreign bodies of the musculoskeletal system on the basis of a literature review and published reports with cases to illustrate each type on different imaging modalities. Foreign bodies of the musculoskeletal system are a common problem in emergency departments, with more than a third missed in the initial clinical evaluation. These retained objects may result in various complications and also offer fertile ground for litigation.

[Adverse drug reaction reporting in emergency medicine].

PubMed

Milojevic, Kolia; Chassagnol, Isabelle; Brion, Nathalie; Cléro, Joël; Degrèze, Nathalie; Lambert, Yves

2004-01-01

A regional survey was performed between June and September 2002, to evaluate knowledge and attitudes of emergency physicians regarding adverse drug reaction (ADR) reporting in a French district. 100 questionnaires completed by physicians working in emergency departments and/or mobile intensive care units were analysed. The frequency of ADRs encountered by emergency practitioners was estimated at > or = 0.73 per year and per physician. The ADR notification rate in emergency medicine was estimated at < or = 6%. A minority of physicians were responsible for the majority of ADR reporting. Sixty-four percent of emergency physicians underestimated the conditions required for ADR notification: 28% thought that certain causality was an absolute necessary condition for notification, while 37% considered that notification was required only for ADRs that were both severe and unexpected. Interventions focused on advertising ADR reporting procedures could help to improve the notification rate in emergency medicine.

Patient- and family-centered care of children in the emergency department.

PubMed

O'Malley, Patricia J; Brown, Kathleen; Krug, Steven E

2008-08-01

Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in a mutually beneficial partnership among patients, families, and health care professionals. Providing patient- and family-centered care to children in the emergency department setting presents many opportunities and challenges. This technical report draws on previously published policy statements and reports, reviews the current literature, and describes the present state of practice and research regarding patient- and family-centered care for children in the emergency department setting as well as some of the complexities of providing such care. This technical report has been endorsed by the Academic Pediatric Association (formerly the Ambulatory Pediatric Association), the American College of Osteopathic Emergency Physicians, the National Association of Emergency Medical Technicians, the Institute for Family-Centered Care, and the American College of Emergency Physicians. This report is also supported by the Emergency Nurses Association.

A national survey of emergency nurses and avian influenza threat.

PubMed

Bell, Mary Ann; Dake, Joseph A; Price, James H; Jordan, Timothy R; Rega, Paul

2014-05-01

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. A descriptive, nonexperimental, cross-sectional survey of emergency nurses within the United States. A total of 332 nurses (46%) responded. Most emergency nurses (84%) reported they would report to work (1 in 6 would not). The likelihood of reporting to work differed by education level, nurses' avian influenza information sources, and nurses who had family living with them. Of the nurses who decided not to report to work, the majority were willing to provide health information (90%), administer vaccinations (82%), and triage (74%) neighbors/friends from home. One third of nurses had not attended a disaster-preparedness drill within the past year. Only 20% identified formal training while on the job as a source of avian influenza information. A third of emergency nurses would be worried about getting an avian influenza vaccination because of potential adverse effects. Protection Motivation Theory accounted for almost 40% of the variance of likelihood to report to work, with response costs being the largest predictor. Disaster drills, avian influenza job training, and vaccination education are necessary to prepare emergency nurses for an outbreak. The findings support emergency nurses' willingness to work from home if they are unable to report to work. This finding is new and may have implications for disaster planning, staffing, and ED operations. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

1996-1997 TEMA/DOE oversite annual report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-01-01

The Tennessee Emergency Management Agency (TEMA) has entered into a five-year agreement with the Department of Energy (DOE) to provide emergency response activities associated with the Oak Ridge Reservation (ORR). The Agreement in Principle (AIP) delineates the duties and responsibilities of the parties. The agreement tasked TEMA with the following responsibilities: develop offsite emergency plans; conduct emergency management training; develop offsite emergency organizations; develop emergency communications; develop emergency facilities; conduct exercises and drills; provide detection and protection equipment; and develop an emergency staff. This document reports on progress on these tasks during the past year.

1996--1997 TEMA/DOE oversight annual report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-06-01

The Tennessee Emergency Management Agency (TEMA) has entered into a five-year agreement with the Department of Energy (DOE) to provide emergency response activities associated with the Oak Ridge Reservation (ORR). The Agreement in Principle (AIP) delineates the duties and responsibilities of the parties. The agreement tasked TEMA with the following responsibilities: develop offsite emergency plans; conduct emergency management training; develop offsite emergency organizations; develop emergency communications; develop emergency facilities; conduct exercises and drills; provide detection and protection equipment; and develop an emergency staff. This report describes progress on the 14 deliverables connected with this contract.

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil.

PubMed

Tallo, Fernando Sabia; Campos Vieira Abib, Simone de; Baitello, André Luciano; Lopes, Renato Delascio

2014-09-01

To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.

Emerging literature in the Microbiota-Brain Axis and Perinatal Mood and Anxiety Disorders.

PubMed

Rackers, Hannah S; Thomas, Stephanie; Williamson, Kelsey; Posey, Rachael; Kimmel, Mary C

2018-05-17

Perinatal Mood and Anxiety Disorders (PMAD) are common and can cause significant morbidity and mortality for mother and child. A healthy perinatal period requires significant adaptations; however, systems can become imbalanced resulting in depressive and anxiety symptoms. The interface between the microbiome, the immune system, and the stress system may be a model for understanding mechanisms underlying PMAD. Emerging literature from general populations regarding immune, hormone, and HPA axis changes in relation to the microbiome combined with literature on immune, gonadotropin, and stress systems in the perinatal period provides a background. We systematically investigated literature in the developing field of the microbiome in relation to PMAD. Our inclusion criteria were 1) reporting measure of maternal mood, stress, or anxious or depressed behavior; 2) in the perinatal period, defined as pregnancy through one year postpartum; and 3) reporting measure of maternal microbiome including manipulations of the microbiome through prebiotics, probiotics, or interventions with microbial byproducts. The review identified research studying associations between stress and maternal microbiome; dietary impacts on microbial composition, mood, and stress; and the relationship between the microbiome and the immune system through immunoregulatory mechanisms. Important themes identified include: the importance of studying the maternal microbiome and measures of stress, anxiety, and depression and that multi-hit models will be needed as research strives to determine the effects of multiple mechanisms working in concert. Copyright © 2018 Elsevier Ltd. All rights reserved.

Sex differences in physiological reactivity to acute psychosocial stress in adolescence.

PubMed

Ordaz, Sarah; Luna, Beatriz

2012-08-01

Females begin to demonstrate greater negative affective responses to stress than males in adolescence. This may reflect the concurrent emergence of underlying differences in physiological response systems, including corticolimbic circuitries, the hypothalamic-pituitary-adrenal axis (HPAA), and the autonomic nervous system (ANS). This review examines when sex differences in physiological reactivity to acute psychosocial stress emerge and the directionality of these differences over development. Indeed, the literature indicates that sex differences emerge during adolescence and persist into adulthood for all three physiological response systems. However, the directionality of the differences varies by system. The emerging corticolimbic reactivity literature suggests greater female reactivity, particularly in limbic regions densely innervated by gonadal hormone receptors. In contrast, males generally show higher levels of HPAA and ANS reactivity. We argue that the contrasting directionality of corticolimbic and peripheral physiological responses may reflect specific effects of gonadal hormones on distinct systems and also sex differences in evolved behavioral responses that demand different levels of peripheral physiological activation. Studies that examine both subjective reports of negative affect and physiological responses indicate that beginning in adolescence, females respond to acute stressors with more intense negative affect than males despite their comparatively lower peripheral physiological responses. This dissociation is not clearly explained by sex differences in the strength of the relationship between physiological and subjective responses. We suggest that females' greater subjective responsivity may instead arise from a greater activity in brain regions that translate stress responses to subjective awareness in adolescence. Future research directions include investigations of the role of pubertal hormones in physiological reactivity across all systems, examining the relationship of corticolimbic reactivity and negative affect, and sex differences in emotion regulation processes. Copyright © 2012 Elsevier Ltd. All rights reserved.

Sex differences in physiological reactivity to acute psychosocial stress in adolescence

PubMed Central

Ordaz, Sarah; Luna, Beatriz

2012-01-01

Summary Females begin to demonstrate greater negative affective responses to stress than males in adolescence. This may reflect the concurrent emergence of underlying differences in physiological response systems, including corticolimbic circuitries, the hypothalamic—pituitary— adrenal axis (HPAA), and the autonomic nervous system (ANS). This review examines when sex differences in physiological reactivity to acute psychosocial stress emerge and the directionality of these differences over development. Indeed, the literature indicates that sex differences emerge during adolescence and persist into adulthood for all three physiological response systems. However, the directionality of the differences varies by system. The emerging corti-colimbic reactivity literature suggests greater female reactivity, particularly in limbic regions densely innervated by gonadal hormone receptors. In contrast, males generally show higher levels of HPAA and ANS reactivity. We argue that the contrasting directionality of corticolimbic and peripheral physiological responses may reflect specific effects of gonadal hormones on distinct systems and also sex differences in evolved behavioral responses that demand different levels of peripheral physiological activation. Studies that examine both subjective reports of negative affect and physiological responses indicate that beginning in adolescence, females respond to acute stressors with more intense negative affect than males despite their comparatively lower peripheral physiological responses. This dissociation is not clearly explained by sex differences in the strength of the relationship between physiological and subjective responses. We suggest that females' greater subjective responsivity may instead arise from a greater activity in brain regions that translate stress responses to subjective awareness in adolescence. Future research directions include investigations of the role of pubertal hormones in physiological reactivity across all systems, examining the relationship of corticolimbic reactivity and negative affect, and sex differences in emotion regulation processes. PMID:22281210

Emerging Technologies Program Integration Report. Volume 2. Background, Delphi and Workshop Data. Appendices

DTIC Science & Technology

1987-05-04

FTIILE COP’ AD-A196 840 EMERGING TECHNOLOGIES PROGRAM INTEGRATION REPORT VOLUME II BACKGROUND, DELPHI AND WORKSHOP DATA, APPENDICES . -- PREPARED...Security Classification) Emerging Technologies Program Integration Report Volume II: Background, Delphi and Workshop Data; Appendices (U) 12 PERSONAL...volumes of this integration report assess and synthesize information gathered through a Delphi survey, defense needs prioritization workshops, and