Important Directions for Future Inquiry in Disaster Medicine and - - PowerPoint PPT Presentation

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Important Directions for Future Inquiry in Disaster Medicine and - - PowerPoint PPT Presentation

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So Many Questions: Important Directions for Future Inquiry in Disaster Medicine and Mass Gathering Medicine WADEM 2012 Adam Lund , BSc, MD, MEd, FRCPC (ED) Sheila Turris , PhD, NP (Family) October 15 th , 2012 Acknowledgements WADEM

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SLIDE 1

So Many Questions: Important Directions for Future Inquiry in Disaster Medicine and Mass Gathering Medicine

WADEM 2012 Adam Lund, BSc, MD, MEd, FRCPC (ED) Sheila Turris, PhD, NP (Family)

October 15th, 2012

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SLIDE 2

Acknowledgements

  • WADEM Conference Organizers
  • Ms. Kerrie Lewis & Dr. Samuel Gutman
  • Research Support

– Pre-UBC Department of Emergency Medicine – Columbian Emergency Physicians’ Association – Vancouver Coastal Health Research Institute – Justice Institute of British Columbia – Fraser Health Authority – Michael Smith Foundation for Health Research/MITACS – BC Ambulance Service – Special Operations

  • Team members too numerous to mention
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SLIDE 3

Conflicts of Interest

None to declare.

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SLIDE 4

Objectives

  • 1. Outline status quo in Canadian Mass

Gathering Medicine (MGM)

  • 2. Briefly acknowledge linkages between

MGM and Disaster Medicine (DM)

  • 3. Highlight present research priorities to

strengthen the sciences of MGM and DM

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SLIDE 5

Objective 1

  • 1. Outline status quo in Canadian Mass

Gathering Medicine (MGM)

  • 2. Briefly acknowledge linkages between

MGM and Disaster Medicine (DM)

  • 3. Highlight present research priorities to

strengthen the sciences of MGM and DM

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SLIDE 6

Canada

  • 2nd largest country in world
  • Longest border with USA to

south and north (Alaska)

  • Population of 34,940,270*

6

  • Statistics Canada. (2012). Accessed: October 6, 2012. Available at: http://www.statcan.gc.ca/pub/91-215-x/2012000/t002-eng.pdf
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SLIDE 7

Canadian Mass Gatherings

  • Majority live along

49th parallel in south of the country

  • Most events in

areas of greatest population density

  • Event “season”

runs April to September

7

* statcan.gc.ca Oct 6, 2012

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SLIDE 8

MGs – What do we host?

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SLIDE 9

Canadian MGM Scope

  • Mega/Compound – 3 x Olympics hosts

– 1976 Summer - Montreal – 1988 Winter - Calgary – 2010 Winter – Vancouver/Whistler – 1986 World Fair and Exposition – 2009 World Police & Fire Games

  • Large (50,000-500,000)

Fireworks, parades, fun runs

  • Medium (5000-50,000)

Festivals, concerts, air shows, adventure races

  • Small (500-5000)

Ubiquitous in all Canadian communities

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SLIDE 10

Canadian MGM Standards

  • There are no national, provincial (BC), or

municipal standards for medical planning for MGM events.

  • The lack of standards impacts event safety as

medical planning is left to the conscience of event organizers. POTENTIAL CONFLICT OF INTEREST.

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SLIDE 11

MG First Aid/Medical Teams

  • Legacy committees
  • Volunteer organizations (St. John’s

Ambulance, event driven)

  • Contracted providers (few, variable)
  • Provincial ambulance services
  • Or EVENT DRIVEN external standards

– i.e. IOC, WPFG, World Cup events

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SLIDE 12

Mass Gathering Medicine Interest Group

4 Pillars

  • Research
  • Education
  • Clinical
  • Advocacy
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SLIDE 13

Objective 2

  • 1. Outline status quo in Canadian Mass

Gathering Medicine (MGM)

  • 2. Briefly acknowledge linkages between

MGM and Disaster Medicine (DM)

  • 3. Highlight present research priorities to

strengthen the sciences of MGM and DM

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SLIDE 14
  • Site
  • Infrastructure
  • Logistics/Transport
  • Communication
  • Liability
  • Documentation
  • Personnel & Equipment
  • Patients
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SLIDE 15

MGM, Disasters & Capacity: The Perfect Storm

  • Even comprehensive disaster plans that include

simulation and rehearsal lack a practical component or simulation experience that reproduces the chaos and

the variable logistical leadership and medical needs of a real event.

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SLIDE 16

MGM & DM – Great Opportunity

  • Mass gatherings

are “live fire exercises” that run in most cities, most

  • f the year
  • Improve training,

test systems, support event safety

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SLIDE 17

Objective 3

  • 1. Outline status quo in Canadian Mass

Gathering Medicine (MGM)

  • 2. Briefly acknowledge linkages between

MGM and Disaster Medicine (DM)

  • 3. Highlight present research priorities to

strengthen the sciences of MGM and DM

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SLIDE 18

Three Areas for Priority Action

Create:

  • 1. strong linkages between the DM and

MGM communities

  • 2. a common language and conceptual

definitions

  • 3. research infrastructure for use by an

international community of researchers and clinicians

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SLIDE 19

Aligning Research Priorities

  • collaborations between DM and MG groups may

build disaster management capacity

  • shared terminology and conceptual definitions

will allow comparisons across categories and types of event

  • theory development will support decisions

around medical and logistical team composition and operations

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SLIDE 20

Technology in the Field

  • Supporting medical teams in collection of

data, and standardized reporting, will positively influence patient, provider and community outcomes.

  • Smart phone/tablet technology will enable

time/geo/personnel real-time tracking of encounters

  • Local/sync-able app-based charting

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SLIDE 21

Grand Collaborations

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SLIDE 22

Conclusions

  • Consensus on research priorities by the MG and

DM communities will permit synergy in advancing the science underlying the management of mass casualty incidents.

  • In order to support systematic inquiry and to

further develop the underlying science of both MGM and DM, international collaborations and infrastructure will support clinicians and researchers.

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SLIDE 23

Thank you for your attention!

Questions and Discussion

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SLIDE 24

For more information, please contact:

  • Dr. Adam Lund, BSc, MD, MEd, FRCPC (Emergency)

Clinical Associate Professor, Department of Emergency Medicine, University of British Columbia Research Associate, Justice Institute of British Columbia Founder, Lead, Mass Gathering Medicine Interest Group, UBC | www.ubcmgm.ca Emergency Physician, Royal Columbian, Eagle Ridge, Vancouver General and BC Children’s Hospitals

604-315-8013 (m) | 1-888-298-8013 (f) | adam.lund@ubc.ca

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SLIDE 25

Bibliography

  • Arbon P, Bridgewater FH, Smith C. Mass gathering medicine: A predictive model for

patient presentation and transport rates. Prehosp Disaster Med. 2001 Jul- Sep;16(3):150-8.

  • Brady (Ed). Prehospital Emergency Care Sixth Edition; 2009. Mistovich, Joseph J. et

al pg, 866

  • Lund A, Gutman SJ, Turris SA: Mass gathering medicine: a practical means of

enhancing disaster preparedness in Canada.CJEM 2011 Jul; 13(4):231-6.

  • Lund A, Turris SA, Amiri N, Lewis K, Carson M. Mass-gathering medicine: creation of

an online event and patient registry. Prehosp Disaster Med. 2012;27(6):1-11.

  • Molloy, M., Sherif, Z., Natin, S., McDonnell, J. (2010). Management of Mass
  • Gatherings. In K. Koenig & C. Schultz, Koenig and Schultz’s Disaster Medicine:

Comprehensive Principles and Practices (228-252). New York: Cambridge University Press.

  • Ranse J, Hutton A. Minimum data set for mass-gathering health research and

evaluation: a 41 discussion paper. Prehosp Disaster Med. 2012;27(5):1-8.

  • Teich JM, Wagner MM, MacKenzie CF, et al. The informatics response in disaster,

terrorism, and war. JAMIA 2002;9:97-104, doi:10.1197/jamia.M1055.

  • Zeitz KM, Zeitz C, Arbon P. Forecasting medical work at mass-gathering events:

Predictive model versus retrospective review. Prehospital and Disaster Medicine. 2005;20(3):164,165-168.

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SLIDE 26

Gaps in MG Literature

  • Minimal focus on

events of small to medium size with selective publication

  • f high profile (mega)

events

  • Lack of standardized

data collection

– Documentation – Variables of interest

  • No robust theory for

estimation of patient presentation rates or for estimating the size

  • f a medical team

required for a specific event

  • Lack of a Canadian

context

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SLIDE 27

MGM & DM Future Goals

  • Develop further theory and conceptual

modeling in both MGM and DM.

  • Establish consensus with regard to

terminology.

  • Advance MGM and DM research beyond

case reports.

  • Leverage case reports to shape future

inquiry so that questions can be asked and answered.

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SLIDE 28

MGMIG Interests

  • Research

– theory to predict workload at a given event (PPR, TTHR, & ATR) – develop an international event and patient registry – measuring the IMPACT of events on local service levels in community – new communication technology for MG and disasters – measuring the reliability and validity of a triage scale for MG’s – case reporting within event types such as marathons, parades, cycling events (e.g., Vancouver International Marathon, Ride to Conquer Cancer, Sun Run, World Police & Fire Games) and across event categories

ing there is time during the question period for Adam to talk about a projec