Prevenzione e Mitigazione delle Emergenze sanitarie: la ...€¦ · program or computer‐based...
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21/06/2010 1 Rome, 14 June 2010 Prevenzione e Mitigazione Prevenzione e Mitigazione delle Emergenze sanitarie: delle Emergenze sanitarie: la nostra esperienza la nostra esperienza PIER LUIGI INGRASSIA MD, PhD, EMDM
Transcript of Prevenzione e Mitigazione delle Emergenze sanitarie: la ...€¦ · program or computer‐based...
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Rome, 14 June 2010
Prevenzione e Mitigazione Prevenzione e Mitigazione delle Emergenze sanitarie:delle Emergenze sanitarie:la nostra esperienzala nostra esperienza
PIER LUIGI INGRASSIAMD, PhD, EMDM
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At a glance
The Interdepartmental Research Centre in Disaster andEmergency Medicine and Informatics applied to didactics andMedical practice (CRIMEDIM) is an institution the Universityof Eastern Piedmont It aims at promoting and fosteringof Eastern Piedmont. It aims at promoting and fosteringresearch and education in emergency and disaster medicinewith particular interest in the application of new informaticstechnologies.
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MissionT i h lth t i d di tTo improve health care system response in emergency and disastersituations increasing knowledge and skills of health care providers basedon scientific literature and on field experience.
ObjectivesObjectivesTo promote and coordinate emergency and disaster research projectsTo foster learning programme in emergency and disaster medicine with
use of new teaching methodologies, especially virtual simulationTo provide scientific and professional consultancy in emergency or
disaster prepadness projectsTo cooperate with different institutions, Universities, public or private
agencies, authorities, companies to reduce disaster vulnerability.
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International Collaborations
Free University of Brussel for the EMDM and the I SEE project
The Division Emergency Medicine, Disaster International Section, Harvard Medical School, USA for the EMDM
The University of Lausanne, Switzerland for the EMDM
The National Center for Emergency Preparedness at Vanderbilt University Medical Center, Nashville, TE, USA for the EMDM USA for the EMDM
The Yale New Haven Center for Emergency Preparedness and Disaster Response. USA for the EMDM
The Centre for Teaching & Research in
The Saint Michael Hospital,
Research Center, Toronto for basic research
The Centre for Teaching & Research in Disaster Medicine and Traumatology, Linkoping, Sweden for the EMDM and the I SEE project
The European Brain Injury Consortium
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Main fields of research
Application of innovative teaching techniques of distance learning,problem‐based learning and partecipatory learning in emergency anddisaster medicine
Design and development of computerized simulators web basedDesign and development of computerized simulators, web‐basedprogram or computer‐based tools for education and training, andfor on‐field management and response in emergency and disastersituations
Application of teaching models for adult education in emergencyApplication of teaching models for adult education in emergencyand disaster management, with particular regard to second levelmasters such as the EuropeanMaster in Disaster Medicine.
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Inter-University Partnership
Università degli Studi del Piemonte Orientale "A. Avogadro" (UPO), Cattedra di Anestesia e Rianimazione, Novara, ItaliaUniversity of Eastern Piedmont "A. Avogadro"Chair of Anesthesiology and Intensive Care, Novara, Italy
Vrije Universiteit Brussels (VUB), Brussels,BelgiumFree University of Brussels,y f ,Belgium
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Associate Institutions and Universities
Centre for Teaching & Research in Disaster Medicine and Traumatology(KMC), Linköping, SwedenOfficial web site (in english): http://www.lio.se/kmc
Centre Hospitalier Universitaire Vaudois(CHUV), Lausanne, Switzerland
Official web site: http://www.chuv.ch/urgences
Yale New Haven Center for Emergency Preparedness and Disaster ResponseYale-New Haven Center for Emergency Preparedness and Disaster ResponseNew Haven, Connecticut - USAOfficial web site: http://yalenewhavenhealth.org/emergency/
National Center for Emergency Preparedness at Vanderbilt University Medical CenterVanderbilt University School of NursingNashville, Tennessee, USAOfficial web site: http://www.ncep.vanderbilt.edu/
University of California, Irvine, Department of Emergency MedicineIrvine, California, USAOfficial web site: http://www.ucihs.uci.edu/emergmed/
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Finland
Austria
BelgiumGermany
IrelandThe Netherlands
Romania
UK
Albania
Greece
Italy
Malta
Portugal
Romania
Serbia
Spain
CroatiaCroatia
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Canada
Ecuador
IndiaAlgeria
EgyptMexico
Saudi ArabiaUSA
Peru
QuatarUAEOman
IsraelTurkey
Nicaragua
South Africa
Peru
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To datea community of 302 members from 5 continents
2010 – 5° anniversaryEducation against Disaster. Stockholm 10‐11 October (in collaboration with Eu.S.E.M. Congress)
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Activities
Action in the fieldResearchEducationEducation
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ACTION IN THE FIELD
National Civil Protection, Presidency of Ministries Council
N ti l H lth I tit tNational Health Institute
World Health Organization
United Nation Development Program
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Italian Humanitarian Mission in HaitiARES Field Hospital in l’Aquila, ItalyItalian Humanitarian Mission in Jojacarta,
Indonesia
Italian Field Hospital Mansehra, Pakistanp ,
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Capacity Building Project for the M t f Di t d C l Management of Disasters and Complex Emergencies
Istituto Superiore di Sanità (ISS) e Ministry of H lth f S i L k d th N ti l I tit t f Health of Sri Lanka and the National Institute of Health Sciences (NIHS)
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B ildi C it f th Mi i t fBuilding Capacity of the Ministry of Health in reforming the Emergency Medical Services in Albania
World Health Organization Regional Office for Europe e Ministry of Health, Albania
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RESEARCH
I‐SEE ® (Interactive Simulation Exercise for Emergencies, www.iseeproject.org)
(eDISTRICT‐CiPro ® (European Distance Training Interactive and Collaborative Tools for the Civil Protection, www.edcipro.org)
HDPnetS ® (Hospital Disaster Preparedness Networked Simulator, www.virtualengine.it)
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Interactive
Simulation
Development of scenario models for simulation
Design of simulation of disaster Simulation
Exercise on
Emergencies
event
Problem-based learning
Financilly supported by the EU – Leonardo Da Vinci Programme
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Free University of Brussel, Belgium
Interactive
Simulation
Interactive simulation systems for training, the Netherlands
Empresa Publuca de Emergencias Sanitarias,Andalucia, SpainSimulation
Exercise on
Emergencies
, p
Consorzio Scuola Comunità Impresa, Novara, Italy
Centre for teaching and research in disaster medicine and traumatology, disaster medicine and traumatology, Linkoping, Sweden
Romanian Society for Emergency and Disaster Medicine, Romania
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Riceland©
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University General General EMSNational Health y
Hospital Hospital HospitalHealth
Authority
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Paramedic Emergency
Emergency Room nurse
Dispatch Center
Paramedic Room doctor
OR doctor
Exercise Management
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H-Treatment
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Riceland ‐ HDPnetS
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Main Field of Research
Developmen of methods for assessment of medical performanceduring funcional real-size exercises with maxiemergency scenario
Application of new technologies into the implementation of real-pp g psize exercise in pre- and in-hospital setting
Application of new teaching methodologies for adult learning in Disaster Medicine
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DISASTER SIMULATION SUITE©
SIMULATIOSUITESUITE©
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DISASTER SIMULATION SUITE©
Ch th i (t it d i )• Chose the scenario (type, severity and size)• Creation of a set of victims which include:
– Dynamic Casualty Cards– Guidelines for figurants– Instruction for make-up tema– Laboratory and Radiology tests (according to no-treatment delay or
performed treatments)– Forms for data collection (key times e key treatments)– Access to a online data collector
• Access to data analysis module for After Action Aeview
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DISASTER SIMULATION SUITE©DESIGN
TIPOLOGIA N. DI VITTIME
N. DI AMBULANZE
N. DI POSTI LETTO
LIVELLO DEA
N. DI OPERATORI
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DISASTER SIMULATION SUITE©DEVELOPMENT
TYPE OF SCENARIO N. OF VICTIMS
Subgroup Immediate mortality Early mortality Late mortality ED Utilization Hospital admission
Median Best worst Median Best worst Median Best worst Median Best worst Median Best worst
open‐air 1 0 4 0 0 0 0 0 1 73 70 75 10 8 20
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DISASTER SIMULATION SUITE©DEVELOPMENT
N
TYPE OF SCENARIO N. OF VICTIMS
N
N
N
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DISASTER SIMULATION SUITE©IMPLEMENTATION
Dynamic Casualty Card* Victim Story Board Maquillage instructions
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DISASTER SIMULATION SUITE©IMPLEMENTATION
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DISASTER SIMULATION SUITE©IMPLEMENTATION
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DISASTER SIMULATION SUITE©ASSESSMENT
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DISASTER SIMULATION SUITE©VALUTAZIONE
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Conventional Explosion in confined setting: 120 victims
CasalvoloneMay 13th 2005
120 victimsEMDM118Vigili del FuocoPolizia UrbanaArma dei CarabinieriProtezione Civile, NovaraMay, 13th 2005 ,
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Multi car crash in the tunnel: 107 victimsEMDM
St. ChristopheMay, 19th 2006
EMDM118Vigili del FuocoPolizia UrbanaArma dei CarabinieriProtezione Civile, Valle d’Aosta
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Open-air bombing:75 i ti75 victimsEMDM118Vigili del FuocoPolizia Urbana
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IEMO‐MEPS System
The IEMO Medical Emergency Preparedness The IEMO Medical Emergency Preparedness System (MEPS) represents an innovative procedure for the voluntary recruitment of pratictioners and students of Medical Schools to support the normal medical staff during disaster situations and health crises.
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IEMO‐MEPS System
Functional lack of personnel during large emergenciesDiscepancy between health needs and
avialable resources
NOTE: In‐bound emegensis not overseas
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IEMO‐MEPS System
ONLINE ROSTERVoluntary enrollment of GP or doctors in trainingRosters are divided by Nation and subdivided byDistrict/ Provinces/ Local Communities.Hosted on www iemo int international websiteHosted on www.iemo.int international websitePeople appartaining to the Roster receive by SMS alogin and password to set their profile (cell numberor geographic location)Automatically assignment of most suitablegeographic locations, based on the Postal (ZIP) codeof anyone
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IEMO‐MEPS System
ONLINE ROSTERvisible by all National Registered Members endowedwith login and passweord, and by RespectiveNational AuthoritiesRoster members provisionally ranked in level 1, 2 or 3Roster members provisionally ranked in level 1, 2 or 3according to the level of specialization (basic,advanced, trained) and advanced auto‐evaluationprocess.
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IEMO‐MEPS System
ONLINE ROSTERSelection of key candidates, based on curriculum andfield of competence carried out by NationalEvaulation CommissionAdditional e‐Learning training provided by IEMOAdditional e Learning training provided by IEMOCentral Training CommissionAfter 1 year definition of definitive members‘ ranking(level 1,2, and 3)
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IEMO‐MEPS System
ROSTER FUNCTIONINGAutomatic SMS alert according to level of emergencyand magnitudo
• generic alertlimited request of intervention• limited request of intervention
• massive support requested
National Authorities shall have clear Map of avaliablepsubsidiary medical forces to support ordinary localmedical teams during health crises in a modularmanner
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t ti l l l
EDUCATIONat national level
Aosta Region (Terre de glace, 2007)Novara Province (Riceland for Eastern Piedmont, 2008)University Hospital “Maggiore della Carità”, Novara (BLSD, ACLS and
Advanced Airway management, 2008‐10; Hospital strategies for management of pandemic influenza A H1N1, 2009)g p 9)District Hospital, Borgomanero (NO) (Hospital management of
pandemic influenza A H1N1, 2009)National Medical Student Association (S.I.S.M.) (Basic principles of
Disaster Medicine, 2008‐09)Faculty of Civil Protection, Foligno (Health management of disasters,
2009)2009)District Health Authority, Bologna (EmergoTrain System Courses ‐
www.emergotrain.com – 2009‐10)University Hospital “Policlinico‐Vittorio Emanuele”, Catania (Hospital
disaster management, 2010)
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EDUCATION
at international levelAzzorre Islands Health Authority, Portugal (PLESCAMAC, 2008)World Health Organization, Country Office in Albania (Medical
Management of Climate Change‐related Health Emergencies, 2009)United Nation Medical Emergency Response Team, Italy (UNMERT
Mass Casualty Course 2008)Mass Casualty Course, 2008)Algarve Health Authority, Portugal (Health management of health
crises, 2010)
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UNDERGRADUATE COMPLEMENTARY COURSE IN DISASTER MEDICINE
4th, 5th, and 6th‐year medical d ll d 2 hstudents enrolled in a 24‐hr
complementary course on basic principles of disaster medicine at the University of Eastern Piedmont and University of Palermo
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A web page for distance learning was created: text files and .ppt presentations were available for students. Fora were also available to promote interaction
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45 d d lsix 45‐minute didactic lectures discussing principle of mass‐casualty incident MCI and disaster management were designedg
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Disastermed.Ca emergency department simulation was used either as training instrument and assessment tool for practical attitudes too o p act ca att tudesand skills
Franc‐Law JM, Bullard MJ, Della Corte F. Hospital disaster plan simulation using the Disastermed.ca patient database and an existing, computerized patient tracking system: a virtual live exercise. Prehosp Dis Med. 2007;s172‐3
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RESULTSWh lWhole
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16
est S
core
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Test
Sco
re
ControlIntervention
p 0.0028
d 1.9
10
12
Pre Post
Te
0
2
4
Pre Post
T
d (post-pre)IV 1 77IV 1,77V 1.454VI 2,166FC 4,666
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RESULTS12
14
16
0
2
4
6
8
10
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Pre Post
Test
Sco
re
ControlIntervention d 2.76 0.159 Grp”I” – 3.43 preB – 0,0059 AR – 0,165 SI – 0.0846 VV
0,248 SG
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RESULTS
p 0.001
p 0.98
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1st Ph.D. Programme in Disaster Medicine
Analysis, evaluation and assessment of learning process in”blendedlearning” education in Disaster Medicineborsa nell’ambito di indagine prioritario “Sistemi di telecomunicazioneinnovativi a larga banda anche con impiego di satelliti per utenzedifferenziate in materia di sicurezza prevenzione e intervento in caso didifferenziate in materia di sicurezza, prevenzione e intervento in caso dicatastrofi naturali”
