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 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
Conflicts of Interest None to declare.
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
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
Canada • 2 nd 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
Canadian Mass Gatherings • Majority live along 49 th 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
MGs – What do we host?
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) 9 Ubiquitous in all Canadian communities
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 . 10
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 11
Mass Gathering Medicine Interest Group 4 Pillars • Research • Education • Clinical • Advocacy
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
• Site • Infrastructure • Logistics/Transport • Communication • Liability • Documentation • Personnel & Equipment • Patients
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.
MGM & DM – Great Opportunity • Mass gatherings are “live fire exercises” that run in most cities, most of the year • Improve training, test systems, support event safety 16
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
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
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 19
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 20
Grand Collaborations 21
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. 22
Thank you for your attention! Questions and Discussion
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
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.
Gaps in MG Literature • Minimal focus on • No robust theory for events of small to estimation of patient medium size with presentation rates or selective publication for estimating the size of high profile (mega) of a medical team events required for a specific event • Lack of standardized data collection • Lack of a Canadian – Documentation context – Variables of interest
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. 27
MGMIG Interests • Research – theory to predict workload at a given event (PPR, TTHR, & ATR) ing there is time during the question period for Adam to talk about a projec – 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
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