Prehospital & Disaster Medicine
Volume 29 – Issue 05 – October 2014
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

Special Report
Health Care Workers in Danger Zones: A Special Report on Safety and Security in a Changing Environment
Lynda J. Redwood-Campbella1 c1, Sharonya N. Sekhara2 and Christine R. Persauda2
a1 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
a2 Canadian Red Cross, Ottawa, Ontario, Canada
Abstract
Introduction Violence against humanitarian health care workers and facilities in situations of armed conflict is a serious humanitarian problem. Targeting health care workers and destroying or looting medical facilities directly or indirectly impacts the delivery of emergency and life-saving medical assistance, often at a time when it is most needed.
Problem Attacks may be intentional or unintentional and can take a range of forms from road blockades and check points which delay or block transport, to the direct targeting of hospitals, attacks against medical personnel, suppliers, patients, and armed entry into health facilities. Lack of access to vital health care services weakens the entire health system and exacerbates existing vulnerabilities, particularly among communities of women, children, the elderly, and the disabled, or anyone else in need of urgent or chronic care. Health care workers, especially local workers, are often the target.
Methods This report reviews the work being spearheaded by the Red Cross and Red Crescent Movement on the Health Care in Danger initiative, which aims to strengthen the protections for health care workers and facilities in armed conflicts and ensure safe access for patients. This includes a review of internal reports generated from the expert workshops on a number of topics as well as a number of public sources documenting innovative coping mechanisms adopted by National Red Cross and Red Crescent Societies. The work of other organizations is also briefly examined. This is followed by a review of security mechanisms within the humanitarian sector to ensure the safety and security of health care personnel operating in armed conflicts.
Results From the existing literature, a number of gaps have been identified with current security frameworks that need to be addressed to improve the safety of health care workers and ensure the protection and access of vulnerable populations requiring assistance. A way forward for policy, research, and practice is proposed for consideration.
Conclusion While there is work being done to improve conditions for health care personnel and patients, there need to be concerted actions to stigmatize attacks against workers, facilities, and patients to protect the neutrality of the medical mission.

Comprehensive Review
Child Disaster Mental Health Interventions: Therapy Components
Betty Pfefferbauma1 c1, Jennifer L. Sweetona2, Pascal Nitiémaa1, Mary A. Noffsingera3, Vandana Varmaa1, Summer D. Nelsona4 and Elana Newmana4
a1 Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma USA
a2 Veterans Affairs Medical Center, Oklahoma City, Oklahoma USA
a3 Courtroom Sciences, Inc., Irving, Texas USA
a4 Department of Psychology, Tulsa Institute of Trauma, Adversity, and Injustice, University of Tulsa, Tulsa, Oklahoma USA
Abstract
Children face innumerable challenges following exposure to disasters. To address trauma sequelae, researchers and clinicians have developed a variety of mental health interventions. While the overall effectiveness of multiple interventions has been examined, few studies have focused on the individual components of these interventions. As a preliminary step to advancing intervention development and research, this literature review identifies and describes nine common components that comprise child disaster mental health interventions. This review concluded that future research should clearly define the constituent components included in available interventions. This will require that future studies dismantle interventions to examine the effectiveness of specific components and identify common therapeutic elements. Issues related to populations studied (eg, disaster exposure, demographic and cultural influences) and to intervention delivery (eg, timing and optimal sequencing of components) also warrant attention.

Original Research
Making Disaster Care Count: Consensus Formulation of Measures of Effectiveness for Natural Disaster Acute Phase Medical Response
Rajesh K. Daftarya1a2 c1, Andrea T. Cruza1, Erik J. Reavesa3, Frederick M. Burklea4, Michael D. Christiana5a6a7, Daniel B. Fagbuyia2, Andrew L. Garretta8, G. Bobby Kapura9 and Paul E. Sirbaugha1a10
a1 Baylor College of Medicine, Department of Pediatrics, Section of Emergency Medicine, Houston, Texas USA
a2 The George Washington University School of Medicine and Health Sciences, Department of Pediatrics and Emergency Medicine, Washington, D.C. USA
a3 US Naval Medical Research Unit No. 6, Lima, Peru
a4 Harvard Humanitarian Initiative, Harvard School of Public Health, Cambridge, Massachusetts USA
a5 Critical Care & Infectious Diseases Mount Sinai Hospital & University Health Network, Toronto, Ontario Canada
a6 Royal Canadian Air Force, National Defence, Canada
a7 Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario Canada
a8 Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response, Washington, DC USA
a9 Baylor College of Medicine, Department of Emergency Medicine, Houston, Texas USA
a10 City of Houston, Emergency Medical Services, Texas USA
Abstract
Introduction
No standard exists for provision of care following catastrophic natural disasters. Host nations, funders, and overseeing agencies need a method to identify the most effective interventions when allocating finite resources. Measures of effectiveness are real-time indicators that can be used to link early action with downstream impact.
Hypothesis
Group consensus methods can be used to develop measures of effectiveness detailing the major functions of post natural disaster acute phase medical response.
Methods
A review of peer-reviewed disaster response publications (2001-2011) identified potential measures describing domestic and international medical response. A steering committee comprised of six persons with publications pertaining to disaster response, and those serving in leadership capacity for a disaster response organization, was assembled. The committee determined which measures identified in the literature review had the best potential to gauge effectiveness during post-disaster acute-phase medical response. Using a modified Delphi technique, a second, larger group (Expert Panel) evaluated these measures and novel measures suggested (or “free-texted”) by participants for importance, validity, usability, and feasibility. After three iterations, the highest rated measures were selected.
Results
The literature review identified 397 measures. The steering committee approved 116 (29.2%) of these measures for advancement to the Delphi process. In Round 1, 25 (22%) measures attained >75% approval and, accompanied by 77 free-text measures, graduated to Round 2. There, 56 (50%) measures achieved >75% approval. In Round 3, 37 (66%) measures achieved median scores of 4 or higher (on a 5-point ordinal scale). These selected measures describe major aspects of disaster response, including: Evaluation, Treatment, Disposition, Public Health, and Team Logistics. Of participants from the Expert Panel, 24/39 (63%) completed all rounds. Thirty-three percent of these experts represented international agencies; 42% represented US government agencies.
Conclusion
Experts identified response measures that reflect major functions of an acute medical response. Measures of effectiveness facilitate real-time assessment of performance and can signal where practices should be improved to better aid community preparedness and response. These measures can promote unification of medical assistance, allow for comparison of responses, and bring accountability to post-disaster acute-phase medical care. This is the first consensus-developed reporting tool constructed using objective measures to describe the functions of acute phase disaster medical response. It should be evaluated by agencies providing medical response during the next major natural disaster.