Factors influencing emergency medical competencies of health centers and fire stations in areas that are vulnerable to earthquakes

Objective This study aimed to investigate the factors influencing the emergency medical competency (EMC), perceived by the fire station and health center staff, in the areas where of emergency medical vulnerability where earthquakes had occurred.Methods This study was conducted between December 2019 and February 2020. A proper questionnaire was created to evaluate EMC in disaster situations and administered to the fire station and the health center groups. Descriptive variables of each group were calculated. The Kendall rank correlation analysis was used to measure the relationships between the demographic variables, disaster-related variables, and EMC. The factors influencing the EMC for both groups were investigated in the linear regression analysis.Results For a total of 200 respondents, the mean scores of EMC were 99.85±21.24 and 95.24±20.05 for the fire station (n=96) and the health center (n=104) groups, respectively (P=0.121). EMC was significantly correlated with age, years of service, job position, natural disaster experience, disaster relief service experience, and joint disaster response exercise (P<0.050). Linear regression analysis revealed that the duration of joint disaster response exercise (β=0.640, t=11.696) in Model 1 (F=136.806, P<0.001), the duration of joint disaster response exercise (β=0.627, P<0.001), and disaster rescue service experience (β=0.124, P<0.001) in Model 2 (F=72.431, P<0.001) were independently associated with EMC improvement.Conclusion Our findings indicate that the disaster preparedness program with a longer duration of joint disaster response exercise and more frequent disaster rescue service experience is necessary for improved and systematic response to a disaster.

Making the Most of Volcanic Eruption Responses

Last year, a new collaborative initiative conducted a hypothetical volcano response exercise. A month later, they put the knowledge gained to use during an actual eruption.

Assessment of Right Ventricular Reserve Utilizing Exercise Provocation in Systemic Sclerosis

PurposeRight ventricular (RV) capacity to adapt to increased afterload is the main determinant of outcome in pulmonary hypertension (PH), a common morbidity seen in systemic sclerosis (SSc). We hypothesized that supine bicycle echocardiography (SBE), coupled with RV longitudinal systolic strain (RVLSS), improves detection of limitations in RV reserve in SSc.Methods56 SSc patients were prospectively studied during SBE with RV functional parameters compared at rest and peak stress. We further dichotomized patients based on resting RV systolic pressure (RVSP) to determine the effects of load on contractile response.ResultsOur pooled cohort analysis revealed reduced global RVLSS at rest (-16.2 ± 3.9%) with normal basal contractility (-25.6 ± 7.7%) and relative hypokinesis of the midventricular (-14.1 ± 6.0%) and apical (-8.9 ± 5.1%) segments. With exercise, global RVLSS increased significantly (p=0.0005), however despite normal basal contractility at rest, there was no further augmentation with exercise. Mid and apical RVLSS increased with exercise suggestive of RV contractile reserve. In patients with resting RVSP < 35 mmHg, global and segmental RVLSS increased with exercise. In patients with resting RVSP ≥ 35 mmHg, global and segmental RVLSS did not increase with exercise and there was evidence of exertional RV dilation.ConclusionExercise provocation in conjunction with RVLSS identified differential regional contractile response to exercise in SSc patients. We further demonstrate the effect of increased loading conditions on RV contractile response exercise. These findings suggest subclinical impairments in RV reserve in SSc that may be missed by resting noninvasive 2DE-based assessments alone.

Hydration Does Not Change Postexercise Hypotension and Its Mechanisms

Background: Drinking water is recommended before and after exercise to avoid dehydration. However, water ingestion may mitigate or prevent postexercise hypotension. This study investigated the effects of intentional hydration on postaerobic exercise hemodynamics and autonomic modulation. Methods: A total of 18 young men randomly underwent 4 experimental sessions as follows: (1) control with intentional hydration (1 L of water in the previous night, 500 mL 60 min before the intervention, and 1 mL for each 1 g of body mass lost immediately after the intervention); (2) control without intentional hydration (ad libitum water ingestion before the intervention); (3) exercise (cycle ergometer, 45 min, 50% of VO2peak) with intentional hydration; and (4) exercise without intentional hydration. Hemodynamic and autonomic parameters were measured before and after the interventions and were compared by 3-way analysis of variance. Results: Intentional hydration did not change any postexercise hemodynamic nor autonomic response. Exercise decreased systolic blood pressure and stroke volume (−4.1 [0.8] mm Hg and −4.9 [1.5] mL, P < .05), while increased cardiac sympathovagal balance (0.3 [0.3], P < .05) during the recovery. In addition, it abolished the increase in diastolic blood pressure and the decrease in heart rate observed in the control sessions. Conclusion: Intentional hydration does not modify the hypotensive effect promoted by previous aerobic exercise and did not alter its hemodynamic and autonomic mechanisms.

P793 Is gender a key determinant of exercise tolerance in moderate-to-severe aortic stenosis?

Background Gender-related differences are known about pathophysiology and clinical outcome of aortic stenosis (AS). Nevertheless, the impact due to gender on effort intolerance as well as its mechanisms has not been defined. We sought to assess functional capacity in AS labelling gender differences. Methods Sixty patients [age 69(63-76)years; female 24(40%)] with at least moderate AS (rest Vmax &gt;3 m/s) underwent to rest and exercise echocardiography with simultaneous cardiopulmonary exercise test (CPET) during maximal symptom-limited exercise. Differences on echocardiographic and CPET variables were assessed according to gender. Results Women showed lower effort tolerance [female vs male: workload 51(46.5-72.5) vs 92.5(74-118.5)watts, p&lt;.0001; peakVO2 13.2(12-15.2) vs 17.7(14.2-22-7)mL/kg/min, p=.002; Predicted peakVO2 63.5(53.5-74) vs 76(61.5-101)%, p=.006; anaerobic threshold 11.4(9.8-13.2) vs 12.8(11.4-15-7)mL/kg/min, p=.01; VE/VCO2 29.5(26.1-30.2) vs 26.2(24.3-28.5), p=.008] characterized by lower chronotropic reserve [age-predicted heart rate (HR) reserve 69.5(58.6-78.9) vs 82.8(74.6-89.7)%, p=.003; HR reserve 40.5(33.6-51) vs 47.5(39-67.5), p=.02; HR recovery at 1 min 9(4-12) vs 14(8.5-20), p=.002)], lower cardiac output (CO) response [exercise CO 7.9(6.4-8.8) vs 8.6(7.9-9.9) L/min, p=.01; CO reserve 2.9(2.1-3.6) vs 4.3(3.2-5.4)L, p=.0008] and lower peripheral extraction [C(A-V)VO2 12(9.7-14.2) vs 15.4(13.8-16.6)mL/100mL, p=.0007]. At 12 months follow up, the incidence for AVR was 0.55(0.31-0.73) in women and 0.29(0.15-0.45) in men, while at 60 months it was respectively 0.69(0.44-0.85) and 0.59(0.11-0.35). Conclusions in women, moderate-to-severe AS generates a higher degree of functional limitation compared to men. A lower CO reserve, mainly determined by an impaired chronotropic response and lower C(A-V)O2, plays a central role. This unfavourable phenotype is associated with a less advanced LV remodelling pattern and an earlier incidence of AVR.

Implementation of Periop Disaster Response Exercise Program at Gold Coast Health

Introduction:With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.Aim:This study assesses this model of response and evaluates it within the context of periop disaster exercises.Methods:The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.Results:Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.Discussion:Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.