At the point of injury, critical medical tasks include locating and identifying an injury as well as applying the appropriate initial care. Over the past decade, to increase the fidelity of wound representation and ultimately the quality of medical care, a considerable amount of research and development has occurred to improve simulated wounds during training, primarily at the point of injury. As material and techniques mature and as more relevant data is collected on tissue properties, examining what fidelity is required for training at the point of injury is crucial. The main objective of this effort was to assess a three dimensional silicone wound versus a two dimensional tattoo wound for training and to examine differences in user perceptions and treatment time. This was accomplished with a test population of 158 City of Orlando Fire Department First Responders which were randomly assigned to each group (three dimensional silicone wound group versus a two dimensional tattoo wound group). The data analyses incorporated the use of non-parametric statistics (Mann-Whitney U Test) to compare the differences between the two groups on depth perception, sense of urgency, immersion, and time on task. Other factors that were examined included the costs for the average tattoo wound and silicone wound as well as the number of uses before the synthetic wound is visibly damaged. The data results indicated that at the point of injury, there were relatively few statistically significant differences in the survey data or time on task between the silicone and tattoo wounds. Additionally, the cost analysis revealed that the silicone wound is significantly more expensive than the tattoo wound. Supporting the military and civilian first responder communities, the results of this study provides statistically reliable data on the use of trauma tattoos as a tool for mastering point of injury treatment during training exercises.

In the event of large scale public radiation exposures, a means of rapid personal radiation dosimetry would provide a valuable tool for environmental and human health protection as well as for possible criminal investigations (in the event of terrorist dirty bombs). This thesis describes a method of sensitizing synthetic quartz oscillators, found in many timekeeping devices such as watches and cellular phones, to function as radiation dosimeters. Experiments on the sensitization of synthetic quartz crystals from watch oscillators were performed by subjecting the quartz to thermal treatments in the range of 200°C to 800°C. The lengths of treatments ranged from numerous one hour cycles to week-long single anneal treatments and combinations of the two. All treatments were designed to mimic factors that are known to cause sensitization in geologic quartz grains (Botter-Jensen, Larsen et al., 1995). The greatest sensitization was observed in crystals treated to 800°C for one week and then subjected to two series of heating, irradiation, and optical exposures. These crystals were able to recover doses as low as 0.5 Gray at an error within 10% of the delivered dose. This work is the first stage of development for creating dual purpose quartz oscillator-dosimeters which could be used in watches, cellular phones, clocks, and nearly all equipment requiring a timekeeping component. In the future, experiments should be conducted to show definitively that crystals still function as 32.768 kHz oscillators after annealing and that oscillators trap charge while in operation. / Thesis / Master of Science (MSc)

As a quintessential role of government, emergency and crisis management requires coordination between levels of government and private and nonprofit sector organizations. Hurricane Irma in 2017 was used as the context in examining interorganizational network effectiveness. Effective and efficient policy implementation and service delivery can be key indicators of collaborative networks; however, it was equally important to understand what factors determine the effectiveness of those collaborative networks. Using network theory and network governance as the theoretical foundations, this study measured and compared the designed versus implemented networks during disaster response. The guiding research for this study was: What factors facilitate effective implementation of interorganizational networks in response to disasters? Using a mixed-method approach, this research surveyed Florida emergency managers on their use and reliance on plan and policy documents to make decisions, analyzed the policies and plans and After-Action Reports of seven (7) Central Florida counties, utilized Twitter data to understand how social media demonstrates interorganizational networks, and employed focus group interviews to gain clarification about the differences between designed and implemented disaster response networks. This research will demonstrate the practical need to examine the interorganizational network differences between designed and implemented for disasters and crises, how policy change and adaptation can reflect the lessons learned from disaster response.

This research discusses developing a FLy-Away-Kit (FLAK) to support the forming of Hastily Formed Networks (HFNs) in remote areas in support of Humanitarian Assistance and Disaster Relief (HA/DR) operations. The initial focus will be on the requirements, situation, area of operations and mission. Different definitions and perspectives emerge when an individual mentions HFNs, HA/DR and Complex Humanitarian Disasters (CHDs). It is the author's intention to define and describe both a HFN and a CHD, in order to justify the need for the FLAK. This process will also define the requirements for the FLAK as well as facilitate processes for ensuring those requirements are met. The personnel responding to the attacks of September 11, 2001 and the December 26, 2004 Southeast Asia Tsunami suffered Command and Control (C2) and information challenges. Even more challenges are being currently addressed by Homeland Defense, Maritime Domain Awareness, and Non-Governmental Organizations (NGOs) abroad. From the top down, levels of administration are developing new plans, procedures, and organizations that will improve the security and communication processes of our nation. A global, broadband, rapidly deployable network node complete with Internet reachback, voice, data, and video capability is of the utmost importance to enable C2 and Network Centric Operations (NCO). Undoubtedly, commercial and military organizations, traditional or new, will greatly benefit from this capability. The U.S. DoD is particularly interested in improving interaction, coordination, communications, and operations when DoD and other entities respond simultaneously to natural or man-made CHD's.

This dissertation used an organizational structure framework to examine the current status of hazard mitigation from the perspective of emergency managers from four organizational structure categories. This study addressed three primary research questions: (1) What is the role of the local emergency management office in hazard mitigation and what is the function of other stakeholders as perceived by local emergency managers? (2) What are the challenges to achieving hazard mitigation objectives and what are the strategies used to overcome them? and (3) How do local emergency managers define hazard mitigation success? Thirty North Central Texas emergency managers were recruited for participation in this study, and data was collected through telephone interviews and an internet survey. A mixed methodology was used to triangulate qualitative and quantitative findings. Qualitative analyses consisted of inductive grounded theory, and quantitative data analyses consisted of independent samples t-test analyses, correlation analyses, and Chi-square analyses. Findings indicate that emergency managers from the different emergency management office categories have six self-identified roles in hazard mitigation planning and strategy implementation; have a similar reported level of involvement in different hazard mitigation-related activities; and perceive stakeholders as having four key functions in hazard mitigation planning and strategy implementation. Second, participants describe five obstacles that are categorized as internal organizational challenges and two obstacles that are categorized as outside organizational challenges. The Disinterested Stakeholders Challenge is rated as a more significant obstacle by participants from the Non-Fire emergency management office category. Emergency managers describe the use of four strategies for overcoming hazard mitigation challenges, and the ability to master these strategies has implications for achieving hazard mitigation success. Third, emergency managers define a tangible and intangible category of hazard mitigation success, and each category is comprised of distinct indicators. Lastly, the organizational characteristics of emergency management offices had significant relationships with their reported level of involvement in select hazard mitigation activities; the rating assigned to select hazard mitigation challenges; and the rating assigned to select hazard mitigation success measures. For integrated emergency management offices, their parent agency is found to be an asset for achieving hazard mitigation objectives.

Sepsis and its manifestation as a shock state in “septic shock” have long caused medical issues and death worldwide. The disease requires quick identification, diagnosis, and intervention with very high mortality rates prevalent otherwise. Historically this has been due to limited awareness of the disease and misclassification of its prevalence, severity, and incidence. Luckily in the past decade there has been increased interest and therefore resources devoted towards improving care and further understanding a disease that is one of the leading causes of mortality in hospitals worldwide. Over the past handful of years novel interventions and diagnostic techniques have become available. Unfortunately, in many cases these new discoveries have not yet trickled down to many of the providers on the frontline and a large amount of variation in care exists across the country. Because of the time sensitivity of sepsis, it is imperative that individuals working in the areas of healthcare who first come in contact with these patients have a clear understanding of the newest advances and resources available. In this thesis the goal is to first analyze the current protocols and standards of care for sepsis and then secondly consider new developments available both in the hospital and in prehospital emergency medical services (EMS). From the current information, strategies and protocols based on improvement of patient outcomes, can be streamlined and optimized moving forward. As predicted, there is currently an incredibly large amount of variation and knowledge on the subject with some areas implementing very progressive protocols while others still lack a sepsis protocol all together. In general, the current consensus in the field is that rapid identification and initiation of treatment is the most important component to long term survival. Improvement of outcomes therefore relies on standardization of protocols with incorporation of education components for healthcare providers. This aims to raise awareness and encourage utilization of the newest information and suggestions available. Increased interdisciplinary cooperation between prehospital providers in EMS and care providers in the hospital can also lead to improvement of recognition and treatment times for these patients. Future considerations were also examined that may potentially be applicable moving forward to improve these standards even further. There is a much opportunity available in each of these areas currently and progress is key to improving outcomes.

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.

Thesis (Master of Emergency Medical Care)--Cape Peninsula University of Technology, 2018. / Physical injury is a major cause of premature death and disability worldwide (WHO, 2015). Mortality statistics for South Africa indicate that approximately half of all injury-related deaths were intentionally inflicted, often as a result of sharp-force injuries (Donson 2009). Cape Town is reputed to be a violent city (Nicol et al., 2014). Pre-hospital emergency care providers are often the first medical contact for injured patients. Previously, it was understood that high volume crystalloid administration would improve survival and was standardised in the management of shock (Santry & Alam 2010). However, over-administration of crystalloid fluid can cause patient harm by potentially worsening injuries and can be detrimental to a patients survival. Current evidence supports the practice of lower volume crystalloid intravenous fluid administration- permissive hypotension. Little is known about pre-hospital emergency care providers intravenous fluid management practices for penetrating injury. Injury surveillance data for victims of penetrating injury is also scarce with the majority of current data taken from mortality sources. Surveilling pre-hospital cases may yield opportunities for prevention from premature mortality and morbidity. The aim of this study is to undertake surveillance of penetrating injury and related intravenous fluid resuscitation in the pre-hospital emergency care environment. A prospective observational descriptive survey was conducted in the Cape Metropole1. Over three consecutive months, emergency care providers documented parameters related to mechanism of injury, scene vital signs, hospital vital signs, intravenous fluid resuscitation and basic patient demographic information for patients with penetrating injury. A predetermined inclusion and exclusion criteria was used to sample patients.

Discharge instructions provided to patients discharged from the emergency department (ED) are often provided in a way that is neither clear nor concise. Patients are often discharged home without a clear understanding of their diagnosis, medications, reasons to return to the ED, follow-up instructions, or how to manage their care at home during their illness. Therefore, a guideline needed to be developed in order to help the ED staff provide clear and concise discharge instructions to patients discharged from the ED. The Ace Star Model of Knowledge Transformation was the foundation for the development of the evidence-based guideline. A formative group of 7 individuals was created to critique the initial draft of the guideline, and a final version of the guideline was then distributed to 10 medical professionals to aid in the approval and determination of the quality of the guideline. The data analysis from the formative group questionnaire, and the appraisal of guidelines for research and evaluation tool led to the recommendations for a guideline on the delivery of evidence-based discharge instructions. This project has implications for social change in practice by (a) increasing the awareness among medical professionals about the importance of their communication style on patient discharge and (b) allowing for more efficient communication to occur between them and their patients. The use of an evidence-based practice guideline for providing discharge instructions to patients discharged from the ED will allow improved quality of care to patients, efficient communication between the healthcare providers and patients, a positive impact for social change in practice, and a consistent and reliable method for patients to understand their discharge instructions in a way that is clear and concise.