Disaster Medical Assistance Teams Members Research Articles

Evaluating the Effect of Brief Disaster Education on Emergency Department Staff: Can Short, Low-cost Education Improve Disaster Readiness of Non-DMAT Healthcare Personnel?

Introduction:Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.Method:This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.Results:Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p<0.001), DMAT personnel (26.7% to 94.3%, p<0.001), DMAT-designated equipment (23.8% to 60.0%, p<0.001), initial response (27.6% to 69.5%, p<0.001) and patient transport priority (74.3% to 94.3%, p<0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p<0.001).Conclusion:Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.

The Participation of Disaster Medical Assistance Team Members in Response to Disasters and Related Factors

Background: The purpose of this study was to assess the presence of Disaster Medical Assistance Team (DMAT) members at the site of disasters and related factors
 Methods: This quasi-experimental study was conducted on all 178 DMAT members in Iran in 2020. A researcher-made questionnaire was used to collect data, which consisted of 20 questions. On a preappointed time, DMAT members were called for disaster by receiving a text message and asked to come to a pre-appointed place. Data analysis was performed using descriptive and inferential statistics, included chi-square test.
 Results: Only 29% of the members responded to the call and showed up at the place. There were significant relationships between being a clinical member, membership in similar organizations, experience of work in disasters, worries about the health of the child, responsibility for taking care of an old family member, believing the disaster site’s safety and security and the availability of personal protective equipment in the disaster site with the status of response to disaster call.
 Conclusion: Overall, the response rate to call was very low, which indicates the need to take measures to improve it. Continuing training and providing safety at disaster areas and support for family members will increase the presence at work in disasters

Increasing Disaster Medical Assistance Teams' Intent to Engage with Specific Hazards.

To ensure human resource availability for a smooth response during various types of disasters, there is a need to improve the intent of those involved in responding to each hazard type. However, Disaster Medical Assistance Team personnel’s intent to engage with specific hazards has yet to be clarified. This study therefore aimed to clarify the factors affecting Disaster Medical Assistance Team members’ (n = 178) intent to engage with each type of hazard through an anonymous web questionnaire survey containing 20 questions. Our results show that the intent to engage in disaster response activities was significantly lower for chemical (50), biological (47), radiological/nuclear (58), and explosive (52) incidents compared with natural (82) and man-made hazards (82) (p < 0.01). Multiple regression analysis showed that incentives were the most common factor affecting responders’ intent to engage with all hazard types, followed by self-confidence. Thus, creating a system that provides generous incentives could effectively improve disaster responders’ intent to engage with specific hazards. Another approach could be education and training to increase disaster responders’ confidence. We believe that the successful implementation of these measures would improve the intent of responders to engage with hazards and promote the recruitment of sufficient human resources.

Survey about Intention to Engage in Specific Disaster Activities among Disaster Medical Assistance Team Members.

Different disaster activities should be performed smoothly. In relation to this, human resources for disaster activities must be secured. To achieve a stable supply of human resources, it is essential to improve the intentions of individuals responding to each type of disaster. However, the current intention of Disaster Medical Assistance Team (DMAT) members has not yet been assessed. To facilitate a smooth disaster response, this survey aimed to assess the intention to engage in each type of disaster activity among DMAT members. An anonymous web questionnaire survey was conducted. Japanese DMAT members in the nuclear disaster-affected area (Group A; n = 79) and the non-affected area (Group N; n = 99) were included in the analysis. The outcome was the answer to the following question: "Will you actively engage in activities during natural, human-made, and chemical (C), biological (B), radiological/nuclear (R/N), and explosive (E) (CBRNE) disasters?" Then, questionnaire responses were compared according to disaster type. The intention to engage in C (50), B (47), R/N (58), and E (52) disasters was significantly lower than that in natural (82) and human-made (82) disasters (P <.001). The intention to engage in CBRNE disasters among younger participants (age ≤39 years) was significantly higher in Group A than in Group N. By contrast, the intention to engage in R/N disasters alone among older participants (age ≥40 years) was higher in Group A than in Group N. However, there was no difference between the two groups in terms of intention to engage in C, B, and E disasters. Moreover, the intention to engage in all disasters between younger and older participants in Group A did not differ. In Group N, older participants had a significantly higher intention to engage in B and R/N disasters. Experience with a specific type of calamity at a young age may improve intention to engage in not only disasters encountered, but also other types. In addition, the intention to engage in CBRNE disasters improved with age in the non-experienced population. To respond smoothly to specific disasters in the future, measures must be taken to improve the intention to engage in CBRNE disasters among DMAT members.

The Effectiveness of Functional Exercises for Teaching Method Disaster Medicine to Medical Students.

IntroductionFunctional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise.ObjectiveThe study objective is to investigate whether functional exercise is effective for teaching disaster medicine.MethodsStudents who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise.ResultsNinety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students’ willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise.ConclusionDisaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.

Resilience, post‐traumatic growth, and work engagement among health care professionals after the Great East Japan Earthquake: A 4‐year prospective follow‐up study

Although attention has been paid to post-traumatic stress disorder (PTSD) among health care professionals after disasters, the impact of traumatic events on their work has not been elucidated. The aim of this study was to examine whether disaster-related distress, resilience, and post-traumatic growth (PTG) affect work engagement among health care professionals who had been deployed to the areas affected by the Great East Japan Earthquake that occurred on March 11, 2011. We recruited disaster medical assistance team members who were engaged in rescue activities after the earthquake. The short version of the Resilience Scale (RS-14) and Peritraumatic Distress Inventory (PDI) were administered one month after the earthquake, and the short form of Posttraumatic Growth Inventory (SF-PTGI) and Utrecht Work Engagement Scale (UWES) were administered four years after the earthquake. Work engagement is composed of vigor, dedication, and absorption. Regression analyses were used to examine the relationship of UWES with RS-14, PDI, and SF-PTGI. We obtained baseline data of 254 participants in April 2011, and 191 (75.2%) completed the follow-up assessment between December 2014 and March 2015. The results showed that RS-14 predicted vigor, dedication, and absorption; in addition, SF-PTGI was positively related with these three parameters (p<0.01 for all). Resilience at baseline and PTG after rescue activities may increase work engagement among health care professionals after disasters. These findings could be useful for establishing a support system after rescue activities during a large-scale disaster and for managing work-related stress among health care professionals.

Nonclinical Core Competencies and Effects of Interprofessional Teamwork in Disaster and Emergency Response Training and Practice: A Pilot Study

To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration. In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis. Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration. The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1-8).

Lessons Learned from the Aeromedical Disaster Relief Activities Following the Great East Japan Earthquake

Since 2001, a Japanese national project has developed a helicopter emergency medical service (HEMS) system ("doctor-helicopter") and a central Disaster Medical Assistance Team (DMAT) composed of mobile and trained medical teams for rapid deployment during the response phase of a disaster. In Japan, the DMAT Research Group has focused on command and control of doctor-helicopters in future disasters. The objective of this study was to investigate the effectiveness of such planning, as well as the problems encountered in deploying the doctor-helicopter fleet with DMAT members following the March 11, 2011 Great East Japan Earthquake. This study was undertaken to examine the effectiveness of aeromedical disaster relief activities following the Great East Japan Earthquake and to evaluate the assembly and operations of 15 doctor-helicopter teams dispatched for patient evacuation with medical support. Fifteen DMATs from across Japan were deployed from March 11th through March 13th to work out of two doctor-helicopter base hospitals. The dispatch center at each base hospital directed its own doctor-helicopter fleet under the command of DMAT headquarters to transport seriously injured or ill patients out of hospitals located in the disaster area. Disaster Medical Assistance Teams transported 149 patients using the doctor-helicopters during the first five days after the earthquake. The experiences and problems encountered point to the need for DMATs to maintain direct control over 1) communication between DMAT headquarters and dispatch centers; 2) information management concerning patient transportation; and 3) operation of the doctor-helicopter fleet during relief activities. As there is no rule of prioritization for doctor-helicopters to refuel ahead of other rotorcraft, many doctor-helicopters had to wait in line to refuel. The "doctor-helicopter fleet" concept was vital to Japan's disaster medical assistance and rescue activities. The smooth and immediate dispatch of the doctor-helicopter fleet must occur under the direct control of the DMAT, independent from local government authority. Such a command and control system for dispatching the doctor-helicopter fleet is strongly recommended, and collaboration with local government authorities concerning refueling priority should be addressed.

Peritraumatic Distress, Watching Television, and Posttraumatic Stress Symptoms among Rescue Workers after the Great East Japan Earthquake

BackgroundThe Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.Methodology/Principal FindingsIn this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.Conclusions/SignificanceThe PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.

Leadership and Use of Standards by Australian Disaster Medical Assistance Teams: Results of a National Survey of Team Members

It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters. As part of a national survey, the present study was designed to evaluate leadership issues and use of standards in Australian DMATs. Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster. The response rate for this survey was estimated to be approximately 50% (59/118). Most of the personnel had deployed to the Asian Tsunami affected areas. The DMAT members were quite experienced, with 53% (31/59) of personnel in the 45-55 years of age group. Seventy-five percent (44/59) of the respondents were male. Fifty-eight percent (34/59) of the survey participants had significant experience in international disasters, although few felt they had previous experience in disaster management (5%, 3/59). There was unanimous support for a clear command structure (100%, 59/59), with strong support for leadership training for DMAT commanders (85%, 50/59). However only 34% (20/59) felt that their roles were clearly defined pre-deployment, and 59% (35/59) felt that team members could be identified easily. Leadership was identified by two team members as one of the biggest personal hardships faced during their deployment. While no respondents disagreed with the need for meaningful, evidence-based standards to be developed, only 51% (30/59) stated that indicators of effectiveness were used for the deployment. In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.

Human resources issues and Australian Disaster Medical Assistance Teams: results of a national survey of team members.

BackgroundCalls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, this study was designed to evaluate Australian DMAT experience in relation to the human resources issues associated with deployment.MethodsData was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster.ResultsThe response rate for this survey was 50% (59/118). Most personnel had deployed to the Asian Tsunami affected areas with DMAT members having significant clinical and international experience. While all except one respondent stated they received a full orientation prior to deployment, only 34% of respondents (20/59) felt their role was clearly defined pre deployment. Approximately 56% (33/59) felt their actual role matched their intended role and that their clinical background was well suited to their tasks. Most respondents were prepared to be available for deployment for 1 month (34%, 20/59). The most common period of notice needed to deploy was 6–12 hours for 29% (17/59) followed by 12–24 hours for 24% (14/59). The preferred period of overseas deployment was 14–21 days (46%, 27/59) followed by 1 month (25%, 15/59) and the optimum shift period was felt to be 12 hours by 66% (39/59). The majority felt that there was both adequate pay (71%, 42/59) and adequate indemnity (66%, 39/59). Almost half (49%, 29/59) stated it was better to work with people from the same hospital and, while most felt their deployment could be easily covered by staff from their workplace (56%, 33/59) and caused an inconvenience to their colleagues (51%, 30/59), it was less likely to interrupt service delivery in their workplace (10%, 6/59) or cause an inconvenience to patients (9%, 5/59). Deployment was felt to benefit the affected community by nearly all (95%, 56/59) while less (42%, 25/59) felt that there was a benefit for their own local community. Nearly all felt their role was recognised on return (93%, 55/59) and an identical number (93%, 55/59) enjoyed the experience. All stated they would volunteer again, with 88% strongly agreeing with this statement.ConclusionsThis study of Australian DMAT members provides significant insights into a number of human resources issues and should help guide future deployments. The preferred ‘on call’ arrangements, notice to deploy, period of overseas deployment and shift length are all identified. This extended period of operations needs to be supported by planning and provision of rest cycles, food, temporary accommodation and rest areas for staff. The study also suggests that more emphasis should be placed on team selection and clarification of roles. While the majority felt that there was both adequate pay and adequate indemnity, further work clarifying this, based on national conditions of service should be, and are, being explored currently by the state based teams in Australia. Importantly, the deployment was viewed positively by team members who all stated they would volunteer again, which allows the development of an experienced cohort of team members.

Logistic support provided to Australian disaster medical assistance teams: results of a national survey of team members.

BackgroundIt is likely that calls for disaster medical assistance teams (DMATs) continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the Australian DMAT experience and the need for logistic support.MethodsData were collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster.ResultsThe response rate for this survey was 50% (59/118). Most of the personnel had deployed to the South East Asian Tsunami affected areas. The DMAT members had significant clinical and international experience. There was unanimous support for dedicated logistic support with 80% (47/59) strongly agreeing. Only one respondent (2%) disagreed with teams being self sufficient for a minimum of 72 hours. Most felt that transport around the site was not a problem (59%; 35/59), however, 34% (20/59) felt that transport to the site itself was problematic. Only 37% (22/59) felt that pre-deployment information was accurate. Communication with local health providers and other agencies was felt to be adequate by 53% (31/59) and 47% (28/59) respectively, while only 28% (17/59) felt that documentation methods were easy to use and reliable. Less than half (47%; 28/59) felt that equipment could be moved easily between areas by team members and 37% (22/59) that packaging enabled materials to be found easily. The maximum safe container weight was felt to be between 20 and 40 kg by 58% (34/59).ConclusionsThis study emphasises the importance of dedicated logistic support for DMAT and the need for teams to be self sufficient for a minimum period of 72 hours. There is a need for accurate pre deployment information to guide resource prioritisation with clearly labelled pre packaging to assist access on site. Container weights should be restricted to between 20 and 40 kg, which would assist transport around the site, while transport to the site was seen as problematic. There was also support for training of all team members in use of basic equipment such as communications equipment, tents and shelters and water purification systems.

Attenuating posttraumatic distress with omega-3 polyunsaturated fatty acids among disaster medical assistance team members after the Great East Japan Earthquake: The APOP randomized controlled trial

BackgroundOn March 11, 2011, a magnitude 9.0 earthquake, the most powerful ever recorded in Japan, and a massive tsunami struck off the coast of the Sanriku region. A Disaster Medical Assistance Team, a mobile medical team with specialized training that is deployed during the acute phase of a disaster, was dispatched to areas with large-scale destruction and multiple injured and sick casualties. Previous studies have reported critical incident stress (i.e. posttraumatic stress disorder symptoms and depressive symptoms) among rescue workers as well as the need for screening and prevention for posttraumatic stress disorder. So far we have shown in an open trial that posttraumatic stress disorder symptoms in critically injured patients can be reduced by taking omega-3 fatty acids intended to stimulate hippocampal neurogenesis.Method/DesignThis study is designed to determine the effectiveness of attenuating posttraumatic distress with omega-3 polyunsaturated fatty acids among Disaster Medical Assistance Team members after the Great East Japan Earthquake, and is named the APOP randomized controlled trial which is currently ongoing. First, we will provide psycho-education on posttraumatic distress, which is common in responders to the Disaster Medical Assistance Team members deployed to the disaster area. Second, observational research will be conducted to evaluate critical incident stress following the completion of medical activities. Third, team members who provide consent to participate in the intervention research will be randomly divided into a group given an omega-3 fatty acid supplement and a group not given the supplements. Outcome will be evaluated at 12 weeks after the supplements are shipped to the team members.DiscussionMeasures that address critical incident stress in disaster responders are important, but there is no substantial evidence that links such measures with prevention of posttraumatic stress disorder. Thus, any confirmation through this study that the intake of omega-3 fatty acid supplements serves as a simple preventative measure for critical incident stress will be of great significance.Trial registrationUMIN Clinical Trials Registry, UMIN000005367

Education and Training of Australian Disaster Medical Assistance Team Members: Results of a National Survey

Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, the present study was designed to evaluate the education and training of Australian DMATs. Data were collected via an anonymous, mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Southeast Asia tsunami disaster. The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami-affected areas. The DMAT members were quite experienced, with 53% of personnel in the 45-55-year age group (31/59). Seventy-six percent of the respondents were male (44/58). While most respondents had not participated in any specific training or educationalprogram, any kind of relevant training was regarded as important in preparing personnel for deployment. The majority of respondents had experience in disasters, ranging from hypothetical exercises (58%, 34/59) to actual military (41%, 24/49) and non-governmental organization (32%, 19/59) deployments. Only 27% of respondents felt that existing training programs had adequately prepared them for deployment. Thirty-four percent of respondents (20/59) indicated that they had not received cultural awareness training prior to deployment, and 42% (25/59) received no communication equipment training. Most respondents felt that DMAT members needed to be able to handle practical aspects of deployments, such as training as a team (68%, 40/59), use of communications equipment (93%, 55/59), ability to erect tents/shelters (90%, 53/59), and use of water purification equipment (86%, 51/59). Most respondents (85%, 50/59) felt leadership training was essential for DMAT commanders. Most (88%, 52/59) agreed that teams need to be adequately trained prior to deployment, and that a specific DMAT training program should be developed (86%, 51/59). This study of Australian DMAT members suggests that more emphasis should be placed on the education and training. Prior planning is required to ensure the success of DMAT deployments and training should include practical aspects of deployment. Leadership training was seen as essential for DMAT commanders, as was team-based training. While any kind of relevant training was regarded as important for preparing personnel for deployment, Australian DMAT members, who generally are a highly experienced group of health professionals, have identified the need for specific DMAT training.

Characteristics and triage of a maritime disaster: an accidental passenger ship collision in Korea

The aim of this study was to analyze the characteristics of and responses to a maritime disaster, by reviewing the events surrounding the accidental collision of a high-speed passenger ship in South Korea. Of the 215 boarded passengers on a high-speed passenger ship sailing from Fukuoka to Busan, we retrospectively examined information of 114 victims of the ship's collision with a whale on 12 April 2007. We referenced reports from the on-site disaster medical assistance team members; recorded notifications to the Busan 1339 Emergency Medical Information Centre, from the scene of the accident and data from the ship's insurer. The 114 victims were transported to 20 different hospitals. Many patients were transported to nearby local hospitals from the scene of the accident; other patients were transported to more distant hospitals. Eighty-five patients were transported to hospitals through mobile emergency support units, whereas the other patients were transported directly by fire officers from the 119 Fire Officer Centre. One patient died in the transport. In conclusion, our national emergency medical service and disaster response system each suffer from many problems - especially a lack of cooperation among related departments and insufficient communication therein. The onboard planning and practice of a disaster plan is required, and a reliable information system between the scene of a maritime disaster and our emergency medical service system should be developed.

CONCERNS OF DISASTER MEDICAL ASSISTANCE TEAM (DMAT) MEMBERS ABOUT TROUBLES AT THE NUCLEAR POWER PLANT: EXPERIENCE FROM THE NIIGATA CHUETSU-OKI EARTHQUAKE, 16 JULY 2007, IN JAPAN

An earthquake measuring 6.8 on the Richter scale struck the Niigata-Chuetsu region of Japan at 10:13 on 16 July 2007. The earthquake was followed by the sustained occurrence of numerous aftershocks, delaying the reconstruction of community lifelines. The earthquake affected the Kashiwazaki-Kariwa nuclear power plants (NPPs), the biggest NPP site in the world. The earthquake caused damage to NPPs, resulting in a small amount of radioactive materials being released into the air and the sea. However, no significant effects were detected in the public and the environment. As medical response to this earthquake, 42 Disaster Medical Assistance Teams (DMATs) were sent to hospitals and first-aid care centers at the NPP site. In order to evaluate the perceptions of the deployed DMAT personnel regarding concerns about the health effects of radiation and information about the damage to NPPs, questionnaires were sent to 40 facilities that dispatched DMATs to the earthquake area. Most of them were concerned with the effects of radiation, and adequate information about the problems at the NPPs was not communicated to them. This preliminary study suggests that communication of information is extremely important for DMAT members in the case of disasters, in particular if there exists a possibility of radiation exposure, since radiation cannot be detected by our senses. DMAT members are critical to any mass casualty incident, whether caused by humans or nature. We have learned from this earthquake that there is urgent need for an all-hazards approach, including a "combined disaster" strategy, which should be emphasized for current disaster planning and response. This is the first report on DMATs deployed to an earthquake site with damage to NPPs.

Health and safety aspects of deployment of Australian Disaster Medical Assistance Team members: Results of a national survey

Disaster medical assistance teams (DMATs) have responded to numerous international disasters in recent years. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to health and safety aspects of actual deployment. Data were collected via an anonymous mailed survey distributed by State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the time of the 2004 South East Asian tsunami disaster. The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59) and a mean level of clinical experience of 21 years. 76% of the respondents were male (44/58). Once deployed, most felt that their basic health needs were adequately met. Almost all stated there were adequate shelter (95%, 56/59), adequate food (93%, 55/59) and adequate water (97%, 57/59). A clear majority, felt there were adequate toilet facilities (80%, 47/59), adequate shower facilities (64%, 37/59); adequate hand washing facilities (68%, 40/59) and adequate personal protective equipment (69%, 41/59). While most felt that there were adequate security briefings (73%, 43/59), fewer felt that security itself was adequate (64%, 38/59). 30% (18/59) felt that team members could not be easily identified. The optimum shift period was identified as 12h (66%, 39/59) or possibly 8h (22%, 13/59) with the optimum period of overseas deployment as 14-21 days (46%, 27/59). Missing essential items were just as likely to be related to personal comfort (28%) as clinical care (36%) or logistic support (36%). The most frequently nominated personal items recommended were: suitable clothes (49%, 29/59); toiletries (36%, 22/59); mobile phone (24%, 14/59); insect repellent (17%, 10/59) and a camera (14%, 8/59). The most common personal hardship reported during their deployment was being away from home/problems at home (24%, 14/59); however, most felt that their family was adequately informed of their whereabouts and health status (73%, 43/59). This study of Australian DMAT members suggests that, in the field, attention should be given to basics, such as adequate food, water, shelter and personal hygiene as well as appropriate clothing, sunscreen and vector protection. The inclusion of appropriate personal items can be assisted by provision of a minimum suggested personal equipment list, with local conditions and the nature of the deployment being taken into account. A personal survival kit should also be recommended. There should be medical and psychological support for team members themselves, including the provision of a dedicated team member medical cache. Concern for their own health and ability to communicate with family members at home are major issues for deployed team members and need to be addressed in mission planning. This should also recognise security issues, including briefings, evacuation plans and exit strategies. The team members concerns about adequate security and the risk profile of humanitarian intervention in natural disasters compared with complex humanitarian emergencies may help determine future deployment of civilian or defence based teams.

Pre- and post-deployment health support provided to Australian Disaster Medical Assistance Team members: Results of a national survey

Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to pre- and post-deployment health care. Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 South East Asian Tsunami disaster. The response rate for this survey was estimated to be around 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59). Seventy-six percent of the respondents were male (44/58). Only 42% (25/59) received a medical check prior to departure and only 15% (9/59) received a psychological assessment prior to deployment. Most respondents indicated that both medical and psychological screening of personnel would be desirable. Most DMAT personnel received some vaccinations (83%, 49/59) before departure and most felt that they were adequately immunised. While nearly all DMAT members participated in formal debriefing post-deployment (93%, 55/59), far less received psychological debriefing (44%, 26/59), or a medical examination upon return (10%, 6/59). Three respondents reported experiencing physical ill health resulting in time off work following their return. While only one reportedly experienced any adjustment problems post-deployment that needed time off work, 32% (19/59) found it somewhat difficult to return to work. There were multiple agencies involved in the post-deployment debriefing (formal and psychological) and medical examination process including Emergency Management Australia (EMA), Australian Government, State/Territory Health Departments, District Health services and others. This study of Australian DMAT members suggests that more emphasis should be placed on health of personnel prior to deployment with pre-deployment medical examinations and psychological assessment. Following the return home, and in addition to mission and psychological debriefing, there should be a post-deployment medical examination and ongoing support and follow-up of DMAT members. More research is needed to examine deployment health support issues.

Needs assessment of current pediatric guidelines for use by disaster medical assistance teams members in response to disasters and shelter care

Study objectives: We evaluate the needs of disaster medical assistance teams (DMAT) about personnel recruitment/retention/training, curriculum, and equipment with regard to pediatric patients. Methods: A written survey was mailed to all DMAT teams in the United States in July 2003, with a follow-up mailing in November 2003. Responses were entered into a computerized database and analyzed by SPSS software. Results: Responses were obtained from 38 DMAT team leaders (88.3%, 38/43). Team levels were 1 (77.8%), 2 (11.1%), and 3 (11.1%); 28.9% were members of DMAT specialty teams, including pediatric, burn, cold weather, International Medical Surgical Response Team (IMSuRT), National Medical Response Team (NMRT), NMRT-Hazmat, surgical, and surgical pediatric burn. Responses (mean±SEM) are listed according to a Likert scale of 1 to 6 (1=not at all to 6=a great degree). Responses were as follows. Use Web-based National Disaster Medical Systems (NDMS) curriculum: 4.44 (±0.24). NDMS curriculum meets needs of pediatric patients: 4.71 (±0.30). Team uses standardized curriculum: yes 57.9%. Standardized curriculum meets needs of pediatric patients: 3.33 (±0.25). Include pediatric patients in disaster drill scenarios: 68.6%. Team's preparedness for pediatric patients: 3.91 (±0.22). Medical providers work with pediatric patients daily: 86.1%. How well team responds to a disaster with pediatric patients: 3.94 (±0.31). How well equipped to respond to a disaster with pediatric patients: 3.22 (±0.24). How well is pediatric equipment organized: 3.08 (±0.29). Agree that system needs more pediatric specialty teams: 3.37 (±0.31). Agree that current teams need more pediatric training: 3.68 (±0.34). Pediatric protocols in addition to Jump START (simple triage and rapid treatment): yes 36.1%. How well are pediatric guidelines developed: 3.69 (±0.33). Percentage of providers working with children daily: physicians 44.1% (±6.4), nurses 40.0% (±4.7), midlevel providers (nurse practitioners, physician assistants) 44.1% (±6.4), paramedics 59.2% (±6.1), respiratory therapists 51.9% (±7.3). Additional responses are listed in Tables 1 through 5. Conclusion: Emergency physicians compose about three quarters of all the DMAT physicians. Most DMAT team leaders and DMAT teams use the NDMS curriculum but believe that the curriculum in regard to pediatrics could be improved. Recruitment of medical personnel at all levels is difficult, although once they are involved, retention is still a concern but somewhat less of a problem. Although most DMAT providers work with pediatric patients daily (86.1%) and include pediatric patients in disaster drill scenarios (68.6%), some pediatric topics are missing from the curriculum (are included only 27.8% to 41.7% of the time), and there are needs for various pediatric equipment with some equipment (eg, pediatric backboards) only available 37.8% of the time.Table 1, abstract 112.Difficulty in recruitment of DMAT team membersMedical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians4.31 (±0.28)4.29 (±0.30)Nurses3.53 (±0.24)3.74 (±0.25)Midlevel providers3.77 (±0.26)4.15 (±0.23)Paramedics2.72 (±0.27)3.85 (±0.27)Respiratory therapists3.75 (±0.24)4.00 (±0.30) Table 2, abstract 112.Difficulty in retention of DMAT team members.Medical Staff in General, Mean (±SEM)Medical Staff With Pediatric Experience, Mean (±SEM)Physicians3.94 (±0.31)3.94 (±0.31)Nurses3.29 (±0.27)4.00 (±0.30)Midlevel providers3.41 (±0.28)3.50 (±0.30)Paramedics3.10 (±0.29)3.10 (±0.29)Respiratory therapists3.63 (±0.31)3.63 (±0.31) Table 3, abstract 112.Physician specialization of DMAT physicians.Field% of Physicians Specialized in the Following Fields, Mean (±SEM)RangeEmergency medicine74.2 (±3.9)(0–100)Pediatric emergency medicine35.1 (±7.3)(0–100)Pediatrics25.5 (±9.8)(0–100)Family medicine19.5 (±5.1)(0–100)General surgery26.9 (±7.4)(0–100)Pediatric surgery30.7 (±8.6)(0–100)Orthopedics15.4 (±7.1)(0–100)Pediatric psychiatry22.2 (±7.6)(0–100)Anesthesiology with pediatric experience20.8 (±8.6)(0–100)Pediatric intensivist14.4 (±7.7)(0–100) Table 4, abstract 112.Pediatric equipment that the DMAT team has.EquipmentYes, %No, %Airway/intubation83.816.2Backboard37.862.2Cervical collars62.237.8Pediatric IV73.027.0Interosseous devices73.027.0Pediatric medications62.237.8Broslow tape54.145.9 Table 5, abstract 112.Pediatric topics missing from the DMAT team's curriculum.^∗TopicYes, %No, %Pediatric airway and respiratory issues27.882.2Pediatric trauma and shock33.366.7Disaster triage for pediatrics36.173.9Pediatric burn management41.768.3Pediatric pain management41.768.3Psychosocial/mental health issues41.768.3Pediatric mock code practice41.768.3∗Other: General pediatric medicine, developmental milestones.