RESUMEN
OBJECTIVE: The objective of the present work was to characterize the coping strategies used by first responders to emergencies in the face of exposure to traumatic events. METHODS: A systematic search was performed in the databases MEDLINE (Ovid), EMBASE, LILACS (Latin American and Caribbean Literature in Health Sciences), and the Cochrane Central Registry of Controlled Clinical Trials (CENTRAL) from their inception through February 2022. First responders to emergencies with training in the prehospital area and who used validated measurement instruments for coping strategies were included. RESULTS: First responders to emergencies frequently used nonadaptive coping strategies, with avoidance or disconnection being one of the main strategies, as a tool to avoid confronting difficult situations and to downplay the perceived stressful event. The nonadaptive coping strategies used by these personnel showed a strong relationship with posttraumatic stress disorder (PTSD) symptoms, burnout syndrome, psychiatric morbidity, and chronic stress. As part of the adaptive strategies, active coping was found, which includes acceptance, positive reinterpretation, focusing on the problem, self-efficacy, and emotional support, either social or instrumental, as protective strategies for these personnel. CONCLUSIONS: Developing adaptive coping strategies, whether focused on problems or seeking emotional support, can benefit emergency personnel in coping with stressful situations. These coping strategies should be strengthened to help prevent people from experiencing long-term negative effects that could arise from the traumatic events to which they are exposed. Active coping strategies instead of avoidance strategies should be promoted.
Asunto(s)
Socorristas , Trastornos por Estrés Postraumático , Humanos , Urgencias Médicas , Adaptación Psicológica , Trastornos por Estrés Postraumático/prevención & controlRESUMEN
BACKGROUND: Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs, paramedics, and firefighters) are routinely exposed to potentially traumatic events (PTEs) as part of their regular duties, increasing their risk for a range of adverse mental health outcomes including PTSD symptoms. However, no study to our knowledge has explored the relationship between PTEs, PTSD symptoms, and substance use in this population. In the current study, we examined whether PTSD symptoms were associated with alcohol and drug use in first responders above and beyond demographic variables, job-related characteristics, social support, and cumulative work-related PTE exposure, and whether work-related PTE exposure had an indirect effect on substance use via PTSD symptoms. METHODS: Participants (N = 885; mean age = 37.13; 59.0% male; 91.5% White) were recruited from all 50 U.S. states, the Virgin Islands, and Puerto Rico to complete an online survey. RESULTS: In hierarchical regression analyses, PTSD symptoms were significantly associated with alcohol and drug use above and beyond all the other variables. Work-related PTE exposure was not a significant predictor of either outcome once PTSD symptoms were included, suggesting that PTEs confer risk for substance use via their association with PTSD symptoms. This finding was confirmed by an analysis showing that PTE exposure had a significant indirect effect on both alcohol and drug use via PTSD symptoms. CONCLUSION: Results support the need for periodic assessment of both PTSD symptoms and substance use in first responders.
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Socorristas , Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Adulto , Femenino , Humanos , Masculino , Puerto Rico , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y CuestionariosRESUMEN
ABSTRACT Objective: to compare the knowledge of rescuers before and after training in cardiopulmonary resuscitation with the realistic simulation method. Method: this is a quasi-experimental study carried out with 41 Basic Life Support rescuers covering 8 bases of the 18th Regional Health of Paraná. The rescuers responded to the Instrument for Assessment of Training in Cardiopulmonary Resuscitation applied before and after the realistic simulation. Results: there was a statistically significant difference (p < 0.02) in 6 of the 10 questions, which addressed: the sequence of cardiopulmonary resuscitation maneuvers; the electrical charge of the automatic external defibrillator; the position, depth, and speed of chest compressions; the compression/ventilation ratio; and the handling of the automatic external defibrillator. In the other two questions — recognition of cardiorespiratory arrest and positive pressure ventilation device — there was no change in the answer alternative. There were 60% of correct answers for the questions when assessing prior knowledge and 90% of correct answers after the phases of the realistic simulation. Conclusion: rescuers did not fully complete the pre-test questionnaire; however, after the realistic simulation strategy, there was a significant increase in this knowledge. These results showed an improvement in the cognitive knowledge of rescuers after the simulation, which was confirmed by the increase in knowledge expressed in the post-test. This methodology can also be successfully applied to this professional category.
RESUMEN Objetivo: comparar el conocimiento de los socorristas antes y después de la capacitación de la reanimación cardiopulmonar con el método de la simulación real. Método: estudio cuasi-experimental, realizado con 41 socorristas del Soporte Vital Básico cubriendo 8 bases de la 18 Regional de Salud de Paraná. Los socorristas respondieron al Instrumento para la Evaluación de la Formación en Reanimación Cardiopulmonar, aplicado antes y después de la simulación real. Resultados: se encontraron diferencias estadísticamente significativas (p < 0,02) en 6 de las 10 preguntas, que abordaban: la secuencia de maniobras de reanimación cardiopulmonar; la carga eléctrica del desfibrilador externo automático; la posición, profundidad y velocidad de las compresiones torácicas; la relación compresión/ventilación; y el manejo del desfibrilador externo automático. En dos preguntas -reconocimiento de la parada cardíaca y dispositivo de ventilación con presión positiva- no hubo cambios en la respuesta alternativa. Hubo un 60% de respuestas correctas para las preguntas al evaluar los conocimientos previos y un 90% de respuestas correctas después de las fases de la simulación real. Conclusión: los socorristas no responden totalmente a la cuestión de la prueba previa, mientras que, tras la estrategia de simulación realista, se produjo un aumento significativo de este conocimiento. Estos resultados demostraron una mejora en el conocimiento cognitivo de los socorristas después de la simulación, comprobada por el aumento del conocimiento expreso en el post-test, que esta metodología también puede ser aplicada con éxito a esta categoría profesional.
RESUMO Objetivo: comparar o conhecimento de socorristas antes e depois da capacitação de reanimação cardiopulmonar com o método da simulação realística. Método: estudo quase-experimental realizado com 41 socorristas do Suporte Básico de Vida que contemplam 8 bases da 18° Regional de Saúde do Paraná. Os socorristas responderam ao Instrumento para Avaliação da capacitação em Ressuscitação Cardiopulmonar aplicado antes e depois da simulação realística. Resultados: obteve-se diferença estatisticamente significativa (p < 0,02) em 6 das 10 questões, as quais abordaram: a sequência das manobras de reanimação cardiopulmonar; a carga elétrica do desfibrilador externo automático; a posição, a profundidade e a velocidade das compressões torácicas; a relação compressão/ventilação; e o manuseio do desfibrilador externo automático. Já em outras duas questões — reconhecimento da parada cardiorrespiratória e dispositivo de ventilação com pressão positiva — não houve mudança quanto à alternativa de resposta. Encontraram-se 60% de acertos das questões quando avaliado o conhecimento prévio e 90% de acertos após as fases da simulação realística. Conclusão: os socorristas não atingiram com totalidade o questionário de pré-teste; entretanto, após a estratégia da simulação realística, houve um aumento significativo desse conhecimento. Esses resultados demonstraram melhoria no conhecimento cognitivo dos socorristas após simulação, o que foi comprovado pelo aumento de conhecimento expresso no pós-teste. Essa metodologia também pode ser aplicada com sucesso a essa categoria profissional.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Reanimación Cardiopulmonar , Socorristas/educación , Entrenamiento Simulado/métodos , Estrategias de Salud , Ejercicio de Simulación , Desfibriladores , Paro Cardíaco/prevención & controlRESUMEN
BACKGROUND: The aim of this study is to assess the efficacy of the TRUE-Bolivia (Trauma Responders Unifying to Empower Communities Bolivia) trauma first responder course at improving participant confidence in first responder abilities and increasing knowledge of trauma response skills. METHODS: Participants attended the 4-h TRUE-Bolivia course at the municipal department of urban transportation and universities and medical schools in Santa Cruz, Bolivia and completed a demographic survey and pre- and post-course knowledge assessments. All participants who attended the full course and completed both knowledge assessments were included in the study, with 453 people attending at least one portion of the course and 329 completing the full course and assessments. RESULTS: A majority of participants were men, had completed high school or attended university, and worked or trained in the fields of transportation or medicine. Participant ratings of confidence on a 5-point Likert scale improved from a median of 3 (interquartile range [IQR] 2) before the course to 5 (IQR 1) after the course (P < 0.01). The median number of correct answers on the pre-course nine-question knowledge assessment was 3 (IQR 3), improving to 7 (IQR 3) on the post-course assessment (P < 0.01). All demographic groups demonstrated improvements in scores from the pre- to post-test. Female gender, higher education level, a background in medicine, and prior training in first aid were associated with higher pre- and post-test scores. CONCLUSIONS: The TRUE-Bolivia course increased knowledge of first responder skills and improved confidence in these abilities in participants from a variety of backgrounds. Further study is needed to determine the long-term skill utilization by participants and the course's impact on local trauma morbidity and mortality.
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Socorristas , Primeros Auxilios , Bolivia/epidemiología , Femenino , Humanos , MasculinoRESUMEN
Soaring summer temperatures, systematic urban and political violence, unreliable infrastructure-power outages, water shortages, sporadic transportation and interruption of other basic services-plus the illness, death and economic straits wrought by COVID-19, are what Haitians awake to every day. On the morning of August 14, 2021, they also woke to the earth in the throes of violent, lethal convulsions caused by a 7.2-magnitude earthquake, along the same fault line responsible for the devastating 2010 disaster and stronger still. As if this weren't enough, Tropical Storm Grace was bearing down on the nation, about to dump biblical amounts of rain on the heels of Tropical Storm Fred. When the Haitian President was assassinated on July 7, Haiti still had not received a single dose of any COVID-19 vaccine-indeed, it was the last country in the Americas to receive vaccines. Later that month, 500,000 doses arrived in the country, donated by the United States via COVAX, the WHO-led initiative to assure at least some vaccines reached low- and middle-income countries. In Haiti, getting those vaccines into the arms of the population is beset by cold chain, distribution and bureaucratic problems, and compounded by widespread vaccine hesitancy; when the earthquake struck, only 14,074 of those doses had been administered.[1,2] Suddenly there was a new, more urgent tragedy, the earthquake leaving thousands of dead, injured and displaced-perhaps hundreds of thousands once the real tally emerges. As in the 2010 quake, the doctors, nurses and technicians comprising Cuba's medical team in Haiti-a commitment Cuba has maintained with its Caribbean neighbor since 1998-were among the first responders. The 2010 relief effort included an additional 1500 health professionals and specialists from Cuba's Henry Reeve Emergency Medical Contingent. Just 24 hours after the August 14th quake, MEDICC Review spoke by phone with Dr Luis Orlando Oliveros-Serrano in Port-au-Prince, where he coordinates Cuba's medical team in Haiti. His disaster response experience had already taken him to Haiti twice before and to Pakistan, Bolivia and beyond.
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COVID-19 , Socorristas , Vacunas contra la COVID-19 , Cuba , Haití , Humanos , Masculino , SARS-CoV-2 , Estados UnidosRESUMEN
Resumen. Objetivo. Analizar la eficacia del personal voluntario y profesional que asiste en emergencias (Bomberos Voluntarios, Defensa Civil, Cruz Roja) en un programa de entrenamiento en la Primera Ayuda Psicológica y su relación con indicadores de empatía y estrategias de afrontamiento. Método. Se realizó un estudio cuantitativo, comparativo correlacional, con una muestra de 198 voluntarios que pertenecen a instituciones que intervienen en emergencias. Se utilizó un programa de simulación sobre respuestas a víctimas de catástrofes (Sistema Interactivo de Primera Ayuda Psicológica y el Inventario de Valoración y Afrontamiento). Resultados. Los voluntarios que expresan que manejan mejor una situación estresante lograban un rendimiento más eficaz en el programa de simulación. La valoración del contexto como amenazante o indiferente, perjudicaba la ejecución del protocolo de PAP propuesto en la ejercitación mediante software.
Abstract. Objective. To analyze the effectiveness of volunteer and professional personnel who assist in emergencies (Volunteer Firefighters, Civil Defense, Red Cross) in a Psychological First Aid training program and its relationship with indicators of empathy and coping strategies. Method. A quantitative, comparative, and co-relational study was carried out with a sample of 198 volunteers belonging to institutions that intervene in emergencies. A simulation program on responses to victims of catastrophes was used, Interactive System in Psychological First Aid and the Coping Strategies Inventory. Results. Volunteers, who state that handle better stressful situations, achieve a more effective performance in the simulation program. The assessment of the context as threatening or indifferent impaired the execution of the proposed PFA protocol using software.
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Humanos , Masculino , Femenino , Voluntarios/psicología , Adaptación Psicológica , Socorristas , Argentina , Capacitación en ServicioRESUMEN
BACKGROUND: Given the demonstrated success of programs that bolster informal Emergency Medical Service (EMS) systems in other low- and middle-income counties (LMICs), this study aimed to explore formal and informal systems, practices, customs, and structures for emergency response and medical transport in Colca Valley, Perú while identifying possible opportunities for future intervention. METHODS: Twenty-two interviews with first responders and community members were conducted in three mountain villages throughout rural Andean Colca Valley of Perú. Subjects were recruited based on profession and experience with medical emergencies in the area. Transcripts were entered into Dedoose, coded, and analyzed to identify themes. RESULTS: Providers and community members shared similar perceptions on the most common barriers to emergency care and transport. Challenges experienced equally by both groups were identified as "structural problems," such as lack of infrastructure, lack of structured care delivery, and unclear protocols.Incongruities of responses between groups emerged with regard to certain barriers to care. Providers perceived baseline health education and use of home remedies as significant barriers to seeking care, which was not proportionally corroborated by community members. In contrast, 86% of community members cited lack of trust in health providers as a major barrier.Community members often noted witnessing a high frequency of emergency events, their personal experiences of helping, and the formal utilization of lay providers. When specifically questioned on their willingness to engage in first aid training, all participants were in agreement. CONCLUSION: While structural changes such as increased infrastructure would likely be the most durable improvement, future interventions focused on both empowering community members and improving the relationship between the health center and the community would be beneficial in this community. Additionally, these interview data suggest that a layperson first aid training program would be feasible and well-received.
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Servicios Médicos de Urgencia , Socorristas , Primeros Auxilios , Humanos , Perú , Población RuralRESUMEN
Los trastornos del sueño son frecuentes en la población y una causa importante de morbilidad. El objetivo de esta revisión es evaluar las alteraciones del sueño en periodos de emergencia y desastres. A lo largo de la historia, la esfera biopsicosocial y el sueño de las personas ha sido abrumada por múltiples eventos a gran escala, tales como desastres naturales, tragedias provocadas por el hombre, conflictos bélicos, crisis sociales y pandemias, cuya experiencia puede derivar en problemas de salud a corto, mediano y/o largo plazo. En los estudios analizados, se ha observado el impacto negativo de las emergencias y desastres en el sueño, por lo que ha cobrado gran relevancia la difusión y promoción de medidas que incentiven el buen dormir. Debido a la llegada del COVID-19 y a la situación de confinamiento por periodos prolongados en el hogar para prevenir su propagación, han surgido importantes consecuencias a nivel social. Ciertos factores ocupacionales y características de los desastres se asocian a mayor comorbilidad, un alto riesgo de experimentar agotamiento físico, trastornos psicológicos e insomnio en grupos altamente vulnerables, como lo son los profesionales de la salud, rescatistas y socorristas. El insomnio es el trastorno de sueño más frecuente en la población general y su empeoramiento en el contexto de pandemia por COVID-19 representa un nuevo problema en salud pública. Es por ello, que es indispensable promover campañas de prevención de salud física y mental orientados a la pesquisa precoz y manejo de patologías de la esfera psicosocial, dentro de las posibilidades socioeconómicas.
Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and/or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.
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Humanos , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/psicología , Trastornos del Sueño-Vigilia/prevención & control , Emergencias en Desastres , Cuarentena , Personal de Salud/psicología , Desastres , Pandemias , Socorristas/psicología , COVID-19 , Trastornos del Inicio y del Mantenimiento del Sueño/clasificación , Trastornos del Inicio y del Mantenimiento del Sueño/diagnósticoRESUMEN
BACKGROUND: Battlefield first responders (BFR) are the first non-medical personnel to render critical lifesaving interventions for combat casualties, especially for massive hemorrhage where rapid control will improve survival. Soldiers receive medical instruction during initial entry training (IET) and unit-dependent medical training, and by attending the Combat Lifesaver (CLS) course. We seek to describe the interventions performed by BFRs on casualties with only BFRs listed in their chain of care within the Prehospital Trauma Registry (PHTR). METHODS: This is a secondary analysis of a dataset from the PHTR from 2003-2019. We excluded encounters with a documented medical officer, medic, or unknown prehospital provider at any time in their chain of care during the Role 1 phase to isolate only casualties with BFR medical care. RESULTS: Of the 1,357 encounters in our initial dataset, we identified 29 casualties that met inclusion criteria. Pressure dressing was the most common intervention (n=12), followed by limb tourniquets (n=4), IV fluids (n=3), hemostatic gauze (n=2), and wound packing (n=2). Bag-valve-masks, chest seals, extremity splints, and nasopharyngeal airways (NPA) were also used (n=1 each). Notably absent were backboards, blizzard blankets, cervical collars, eye shields, pelvic splints, hypothermia kits, chest tubes, supraglottic airways (SGA), intraosseous (I/O) lines, and needle decompression (NDC). CONCLUSIONS: Despite limited training, BFRs employ vital medical skills in the prehospital setting. Our data show that BFRs largely perform medical interventions within the scope of their medical knowledge and training. Better datasets with efficacy and complication data are needed.
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Servicios Médicos de Urgencia , Socorristas , Medicina Militar , Hemorragia/terapia , Humanos , TorniquetesRESUMEN
OBJECTIVE: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders. METHOD: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine. RESULTS: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment. CONCLUSION: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.
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Socorristas , Trastornos por Estrés Postraumático , Humanos , Psicoterapia , Trastornos por Estrés Postraumático/terapiaRESUMEN
Improving access to safe, effective, and quality medicines and other health technologies is a critical public health priority and a fundamental requisite for universal health. National regulatory systems play a key part in a country’s health system by overseeing the safety, quality, and efficacy of all health technologies, including pharmaceuticals, vaccines, blood and blood products, and medical devices, among others. The aim of this document is to better understand the regulatory landscape of the Americas, with an emphasis on Latin American National Regulatory Authorities of Reference. This report presents data and analysis corresponding to essential regulatory functions and systems foundations to understand current practices, identify critical issues, and present a series of recommendations for action. The report also includes an overview of the market outlook and economic integration mechanisms in the Americas and their influence on regulatory policy and pharmaceutical trade. In addition, the report includes a supplement to describe salient regulatory emergency responses to the COVID-19 pandemic in the Americas. Through this report, the Pan American Health Organization aims to increase the understanding of national regulatory remits and capacity in the Americas, raise awareness and appreciation of the regional regulatory progress and challenges, identify the regulatory issues emerging markets will bring, and highlight opportunities for evidence-based regulatory system strengthening.
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Acceso a Medicamentos Esenciales y Tecnologías Sanitarias , Calidad de la Atención de Salud , Salud Pública , COVID-19 , Infecciones por Coronavirus , Pandemias , Socorristas , Urgencias Médicas , Farmacovigilancia , Betacoronavirus , Sistemas de Salud , Servicios de SaludRESUMEN
ABSTRACT Objective: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders. Method: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine. Results: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment. Conclusion: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.
RESUMEN Objetivo: Identificar las terapias no farmacológicas utilizadas para tratamiento del trastorno de estrés postraumático en profesionales emergencistas. Método: Revisión de alcance conforme indicaciones del Instituto Joanna Briggs y del protocolo PRISMA-ScR. Búsqueda realizada en nueve bases de datos, portales de tesis y disertaciones, y mediante buscador electrónico. Resultados: Fueron seleccionados y caracterizados 23 estudios, categorizados en seis ejes temáticos, a saber: terapia con suplemento alimentario de omega 3; arteterapia, terapia con ejercicios físicos, terapia con técnica de mindfulness, terapia con elementos de la naturaleza y psicoterapia, todos ellos destacados como tratamientos no farmacológicos para esta patología en profesionales emergencistas, así como el recurso de la psicoterapia vía telesalud como alternativa de tratamiento. Conclusión: Se necesita mayor cantidad de evidencias respaldando la terapia alimentaria, mientras que las demás alternativas terapéuticas encontradas demostraron resultados positivos, hallando respaldo en recomendaciones nacionales e internacionales de tratamiento y práctica clínica.
RESUMO Objetivo: Identificar as terapias não farmacológicas utilizadas no tratamento do transtorno de estresse pós-traumático em profissionais emergencistas. Método: Revisão de escopo conforme orientações do Instituto Joanna Briggs e do protocolo PRISMA-ScR. A busca foi realizada em nove bases de dados, portais de teses e dissertações e por meio de buscador eletrônico. Resultados: Foram selecionados e caracterizados 23 estudos, que foram categorizados em seis eixos temáticos, sendo eles: terapia com suplementação alimentar com ômega 3, arteterapia, terapia com exercícios físicos, terapia envolvendo a técnica mindfulness, terapia com elementos da natureza e psicoterapia, que foram apontados como tratamentos não farmacológicos para esta psicopatologia em profissionais emergencistas e, ainda, o recurso da psicoterapia via telessaúde como uma alternativa no tratamento. Conclusão: É necessário maior número de evidências que suportem a terapia dietética, enquanto as demais alternativas terapêuticas encontradas apresentaram resultados positivos, encontrando suporte nas recomendações nacionais e internacionais de tratamento e prática clínica.
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Trastornos por Estrés Postraumático , Terapias Complementarias , Revisión , Enfermería de Urgencia , SocorristasRESUMEN
Recomendações aos gestores e trabalhadores da Segurança pública (policiais federais, rodoviários, militares, civis, municipais, bombeiros, agentes penitenciários e socioeducativos) para discussão coletiva sobre medidas que amenizem os riscos à saúde dos trabalhadores e pessoas privadas de liberdade, como também, reduzam a disseminação do COVID-19 para seus familiares e a população em geral.
Recommendations to the managers and workers of public security (police federais, rodoviários, military, civis, municipais, bombeiros, penitentiary and socio-educational agents) for collective discussion on measures that mitigate the risks to the health of two workers and people deprived of freedom, as also, also, a dissemination of COVID-19 for family members and general population.
Recomendaciones a los gerentes y trabajadores de seguridad pública (federal, vial, militar, civil, municipal, bomberos, agentes penitenciarios y socioeducativos) para la discusión colectiva sobre medidas para mitigar los riesgos para la salud de los trabajadores y personas privadas de libertad, así como reducir la difusión del COVID-19 a sus familias y población en general.
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Humanos , Administración de la Seguridad/normas , Prisiones/organización & administración , Higiene Militar/organización & administración , Salud Laboral/normas , Lugar de Trabajo/organización & administración , Auxiliares de Urgencia/organización & administración , Socorristas/clasificación , Personal Militar/clasificaciónRESUMEN
INTRODUCTION: Countries most affected by disasters are often those with limited local capacity to respond. When local capacity is overwhelmed, international humanitarian response often provides needs-based emergency response. Despite global progress in education and the development of international humanitarian response standards, access to training and integration of local actors in response mechanisms remains limited. In May 2017, the Haiti Humanitarian Response Course (HHRC) was implemented in Mirebalais, Haiti to increase local capacity and allow for effective future engagement with international humanitarian actors in a country prone to disasters. REPORT: In collaboration with the Hôpital Universitaire de Mirebalais' (HUM; Mirebalais, Haiti) Department of Medical Education and Emergency Medicine (EM) residency program, four physicians from the Division of Global Emergency Care and Humanitarian Studies at Brigham and Women's Hospital (Boston, Massachusetts USA) facilitated the course, which included 53 local physicians and staff. Following 15 hours of online pre-course preparation, through didactics and practical small-group exercises, the course focused on key components of international humanitarian response, minimum standards for effective response, and the roles of key response players. The course was free to participants and taught in English and French. DISCUSSION: The HHRC reduced the barriers often faced by local actors who seek training in international humanitarian response by offering free training in their own community. It presents a novel approach to narrow critical gaps in training local populations in international humanitarian response, especially in environments prone to crises and disasters. This approach can help local responders better access international humanitarian response mechanisms when the local response capacity is exhausted or overwhelmed. CONCLUSION: The HHRC demonstrates a potential new model for humanitarian and disaster training and offers a model for similar programs in other disaster-prone countries. Ultimately, local capacity building could lead to more efficient resource utilization, improved knowledge sharing, and better disaster response.
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Planificación en Desastres , Desastres , Socorristas/educación , Creación de Capacidad , Haití , Humanos , Capacitación en Servicio , Cooperación InternacionalRESUMEN
Many first responders are outfitted with electronic personal dosimeters to recognize and be alerted to radiological hazards during their response operations. These dosimeters provide invaluable measurement data for force protection, allowing the first responder to assess a response situation and take protective measures for themselves and other individuals involved based on instrument readings of dose rate or cumulative dose. However, capabilities of common electronic personal dosimeters to identify and distinguish various contributions to the instrument reading, in particular from natural radiological sources, are rather limited. An algorithm has been developed for two-channel electronic personal dosimeters that quantifies the signal contribution from radon progeny and allows for background subtraction from radon and radon progeny in the instrument reading. This algorithm will be particularly useful in operational scenarios where first responders may be subject to rapidly changing levels of natural background radiation, which could mimic the presence of anthropogenic sources of ionizing radiation.
Asunto(s)
Equipos y Suministros Eléctricos , Dosímetros de Radiación , Radiometría/instrumentación , Radiometría/métodos , Hijas del Radón/química , Algoritmos , Radiación de Fondo , Socorristas , Diseño de Equipo , Humanos , Modelos Químicos , Dosis de RadiaciónRESUMEN
O objetivo deste estudo foi apresentar uma revisão narrativa do atendimento à parada cardiorrespiratória, baseada nas diretrizes mais atuais e, também, uma análise crítica de informações de literatura recente, que vão além das recomendações gerais das diretrizes vigentes. A parada cardiorrespiratória, quando ocorre de forma inesperada, abrupta, em indivíduo que se encontrava estável horas antes do evento, é chamada de morte súbita. Essa condição é a principal causa de óbito extra-hospitalar não traumático e, dentre suas diversas causas, a síndrome coronariana aguda é a mais comum em adultos. Uma vez que a frequência de síndrome coronariana aguda tende a aumentar com o aumento da expectativa de vida e de prevalência de outros fatores de risco na população, a ocorrência de morte súbita também tende a aumentar nesse cenário. No intuito de orientar o atendimento de pacientes em parada cardiorrespiratória, há mais de quatro décadas foram criadas diretrizes internacionais, que evoluíram com o surgimento de novas evidências, especialmente nos últimos 20 anos. Todo médico deve estar preparado para atender uma situação de parada cardiorrespiratória, pois ele pode ser chamado para atender tais casos em diferentes cenários (emergência, unidade de internação ou em ambiente extra-hospitalar). Entretanto, apesar da importância da incorporação de novas evidências nessas diretrizes, mudanças frequentes nas recomendações representam grande desafio para os clínicos se manterem atualizados. Além da dificuldade na atualização permanente, há recomendações feitas pelas diretrizes de sociedades médicas que divergem entre si e são questionadas por especialistas, o que gera dúvida na tomada de decisão do clínico. Conforme pormenorizado neste artigo de atualização, as etapas do algoritmo de Suportes Básico e Avançado de Vida são apresentadas como uma sequência, para facilitar para o socorrista que atua sozinho a oferecer intervenções com impacto na sobrevivência do paciente, devendo priorizar a reanimação cardiopulmonar de qualidade e a desfibrilação precoce, se indicada.
The objective of this study was to present a narrative review of cardiac arrest care based on the most current guidelines, and also a critical analysis of recent literature information that goes beyond the general recommendations of the current guidelines. Cardiac arrest, when occurring unexpectedly, abruptly, in an individual who was stable hours before the event, is called sudden death. This condition is the leading cause of non-traumatic out-of-hospital death and, among its many causes, acute coronary syndrome is the most common in adults. Since the frequency of acute coronary syndrome tends to increase with increasing life expectancy and the prevalence of other risk factors in the population, sudden death also tends to increase in this scenario. In order to guide the care of patients with cardiopulmonary arrest, for over 4 decades, international guidelines have been created and have evolved with the emergence of new evidence, especially in the last 20 years. Every physician should be prepared to deal with a cardiac arrest situation as he or she may be called upon to treat such cases in different scenarios (emergency, inpatient unit or out-of-hospital setting). However, despite the importance of incorporating new evidence into these guidelines, frequent changes to the recommendations pose a major challenge for clinicians to update their knowledge. In addition to the difficulty of constantly updating, there are recommendations made by the guidelines of medical societies that differ from each other and are questioned by specialists, which creates doubt in the process of decision making among clinicians. As detailed in this update article, the stages of the algorithm of Basic and Advanced Life Support are presented in a sequence to help the rescuer who works alone to provide interventions that impact the patient's survival, and prioritize quality cardiopulmonary resuscitation and early defibrillation, if required.
Asunto(s)
Humanos , Atención Médica/normas , Médicos Generales/educación , Paro Cardíaco/terapia , Reanimación Cardiopulmonar/normas , Socorristas , Primeros Auxilios/métodos , Paro Cardíaco/diagnóstico , Cuidados para Prolongación de la Vida/normasRESUMEN
Every year, natural or people-generated disasters disrupt the functioning of society, causing human, and material loses, which lead to an increase in the demand for medical attention. In the morning of September 19, 2017, a 7.1-magnitude earthquake struck Mexico City and four other cities, leaving around 19 million people affected and 331 dead. Although the medical response was timely, most of the efforts fell short because demand exceeded responsiveness. This incident evidenced the challenges that we have as caregivers with mass medical emergency, and the need for direct and well-structured interventions of professional-medical associations in the immediate response, on both in-site and in-hospital settings. The aim of this paper is to analyze how we respond to these medical emergencies and what new strategies have been proposed in order to identify the weaknesses and areas of improvement, as well as to restructure our methods of emergency intervention. We searched all the information in both official institutional and social media with a public sanitary scope. We submitted this information to a descriptive qualitative analysis and compared with official information and management. We found an important role for social media as a means of communication and civil organization. Collegiate medical societies, such as neurosurgeons, showed a limited reach, little on-site intervention, and poor use of social media and other strategies to improve the response. Finally, we propose how we may approach these mass medical emergencies in a better way, taking advantage of new technologies and strategies.
Asunto(s)
Desastres , Terremotos , Urgencias Médicas/epidemiología , Procedimientos Neuroquirúrgicos/tendencias , Socorristas , Humanos , México/epidemiología , Neurocirugia , Procedimientos Neuroquirúrgicos/métodosRESUMEN
OBJECTIVE: The aim of this study was the construction and validation of a novel research instrument to quantify the degree of post-hurricane trauma and distress in an affected population. The Post-Hurricane Distress Scale (PHDS) has quantitative measures of both acute and prolonged distress, attributable to meteorological and hydrological disasters. METHODS: A careful evaluation of existing questionnaires, as well as extensive canvasing of the post-Maria population of Puerto Rico, availed the construction of the PHDS. The PHDS consists of 20 items, organized into 4 subscales. The PHDS was pre-validated (n=79), revised, and then distributed to a broad sampling of the post-Hurricane Maria Puerto Rican population (n=597). Validation, including factor analysis, analyses of concurrent validity, discriminant validity, and internal reliability, was performed. RESULTS: After comparing various scales, factor loading profiles, concurrent validities, and models of fit, we show that the PHDS is best scored as a single 0-6 distress scale. When compared with the Traumatic Exposure Severity Scale, the PHDS shows superior concurrent validity, more accurately predicting scores for the Peritraumatic Distress Inventory, Impact of Event Scale - Revised, and Generalized Anxiety Disorder 7 Scale. The PHDS shows good internal reliability and discriminant validity. CONCLUSIONS: The PHDS represents a novel, useful instrument for disaster first-responders and researchers. The prompt identification of high-risk populations is possible using this instrument. (Disaster Med Public Health Preparedness. 2019;13:82-89).