Littérature scientifique sur le sujet « Medicina dei disastri »

AbstractIn recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.Table 1List of Modules and TopicsModuleTopics1. Introduction to disaster medicine and public health during emergencies- Modern taxonomy of disaster and common disaster medicine definitions- Differences between disaster and emergency medicine- Principles of public health during disasters- Different phases of disaster management2. Prehospital disaster management- Mass-casualty disposition, treatment area, and transport issues- Disaster plans and command-and-control chain structure- Functional response roles3. Specific disaster medicine and triage procedures in the- Mass-casualty triage definitions and principlesmanagement of disasters- Different methodologies and protocols- Patient assessment, triage levels and tags4. Hospital disaster preparedness and response- Hospital disaster laws- Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach- Medical management for a massive influx of casualties5. Health consequences of different disasters- Characteristics of different types of disasters- Health impact of natural and man-made disasters- Disaster-related injury after exposure to a different disasters with an all-hazard approach6. Psychosocial care- Techniques to deal with psychic reactions caused by exposure to disaster scenarios- Treatment approaches to acute and delayed critical incident stress reactions7. Presentation of past disasters and public health emergencies, andCase study:review of assistance experiences- Haiti earthquake- Cholera outbreaks in Haiti- National and international disaster response mechanismIngrassiaPL, RagazzoniL, TengattiniM, CarenzoL, Della CorteF. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014;29(5):1-8.

Background Although both disaster management and disaster medicine have been used for decades, their efficiency and effectiveness have been far from perfect. One reason could be the lack of systematic utilization of modern technologies, such as eHealth, in their operations. To address this issue, researchers’ efforts have led to the emergence of the disaster eHealth (DEH) field. DEH’s main objective is to systematically integrate eHealth technologies for health care purposes within the disaster management cycle (DMC). Objective This study aims to identify, map, and define the scope of DEH as a new area of research at the intersection of disaster management, emergency medicine, and eHealth. Methods An extensive scoping review using published materials was carried out in the areas of disaster management, disaster medicine, and eHealth to identify the scope of DEH. This review procedure was iterative and conducted in multiple scientific databases in 2 rounds, one using controlled indexed terms and the other using similar uncontrolled terms. In both rounds, the publications ranged from 1990 to 2016, and all the appropriate research studies discovered were considered, regardless of their research design, methodology, and quality. Information extracted from both rounds was thematically analyzed to define the DEH scope, and the results were evaluated by the field experts through a Delphi method. Results In both rounds of the research, searching for eHealth applications within DMC yielded 404 relevant studies that showed eHealth applications in different disaster types and disaster phases. These applications varied with respect to the eHealth technology types, functions, services, and stakeholders. The results led to the identification of the scope of DEH, including eHealth technologies and their applications, services, and future developments that are applicable to disasters as well as to related stakeholders. Reference to the elements of the DEH scope indicates what, when, and how current eHealth technologies can be used in the DMC. Conclusions Comprehensive data gathering from multiple databases offered a grounded method to define the DEH scope. This scope comprises concepts related to DEH and the boundaries that define it. The scope identifies the eHealth technologies relevant to DEH and the functions and services that can be provided by these technologies. In addition, the scope tells us which groups can use the provided services and functions and in which disaster types or phases. DEH approaches could potentially improve the response to health care demands before, during, and after disasters. DEH takes advantage of eHealth technologies to facilitate DMC tasks and activities, enhance their efficiency and effectiveness, and enhance health care delivery and provide more quality health care services to the wider population regardless of their geographical location or even disaster types and phases.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) è uno dei più promettenti biomarcatori utilizzati nella diagnosi di “Acute Kidney Injury” (AKI), dal momento che il suo incremento è un buon predittore a breve termine dello sviluppo di insufficienza renale acuta in notevole anticipo rispetto all'incremento dei valori della creatinia sierica. Riportiamo la nostra esperienza di un caso di Crush Syndrome di due pazienti vittime dell'alluvione che ha coinvolto Messina. Lo sviluppo di AKI in seguito a Crush Syndrome è la seconda causa più comune di morte in seguito a terremoti o altri disastri naturali ma allo stesso tempo è una complicanza disastro-correlata che può essere reversibile in particolar modo in caso di diagnosi precoce e di altrettanto precoce trattamento. In questo caso, l'NGAL ci ha permesso di fare una diagnosi precoce di AKI preannunciando le alterazioni dei classici marker come la creatinina, inoltre abbiamo notato la correlazione diretta tra i valori di NGAL, l'evoluzione del danno renale e la prognosi per le due pazienti.

Mainstream healthcare has been facing numerous challenges, and it is expected to see that these challenges become more severe and frequent when healthcare is dealing with disasters. This points to the necessity of utilising technologies to support healthcare and disaster managers in making quality decisions during chaotic and rapidly changing conditions in disaster situations. Therefore, in this research, the objective is to identify the role of RFID technology in healthcare-related activities before, during, and after disasters in terms of application areas and phases of the disaster management cycle (DMC). A Delphi approach was used in this research. Two rounds of questionnaires were administered to a panel of experts to evaluate the actual and potential use of RFID applications for healthcare within DMC. The Delphi participants were the field experts in the areas of disaster management, disaster medicine, and information systems. Based on the Delphi results, RFID applications were seen to be most useful in the response and recovery phases of disasters. RFID was seen as being most helpful for health-related supply management and casualty information. There were concerns that privacy and security may be barriers to adoption and use. Other applications identified by this study include identifying and tracking medical resources (including clinicians and first responders) and their accurate coordination in the response missions, determining idle resources, and maximising their utilisation during response activities. In this research, 35 potential scenarios of RFID applications for healthcare purposes within DMC and Disaster e-Health (DEH) were evaluated with the Delphi participants. RFID technologies could play an important role in DMC and DEH to provide more reliable and timely information to support healthcare during disasters. Based on the research results, managing the supply chain emerged as a major RFID application for supporting disaster healthcare.

La tesi sostenuta in questo articolo è che i beni comuni del passato - quelli di sussistenza - possono diventare, se riletti ed aggiornati alla luce del presente, la spina dorsale di un ordine sociale alternativo a quello capitalistico, che domina sul mondo da circa tre secoli. Si ritiene che il "ritorno dei beni comuni", come viene chiamata la proposta presentata in questo elaborato, sia una necessità storica per riuscire a superare la crisi del capitalismo e i problemi da esso creati, specialmente nella sua ultima fase finanziaria: il saccheggio della natura, la privatizzazione dello spazio pubblico, la disoccupazione, le disuguaglianze sociali, i disastri ecologici. Per sostenere la proposta avanzata in questo articolo, prima di tutto vengono identificate le caratteristiche principali dei beni comuni come l'autogoverno da parte delle comunità locali., si ricorda brevemente come i beni comuni siano stati delegittimati dalla Rivoluzione industriale nel passaggio dal Medioevo alla modernità . Terzo: si mettono in evidenza le nuove "recinzioni" di acqua, aria, terra ed dell'energia, così come quella del cambiamento climatico. Quarto: il ritorno ai beni comuni richiede una fase intermedia, cioè la conversione ecologica delle economie che deve essere realizzata dalle comunità locali. Quinto: vengono considerati i motivi che non hanno ancora permesso al ritorno dei beni comuni di diventare il primo tema dell'agenda dei movimenti.

La questione dei beni comuni č in questo momento discussa in ogni angolo del mondo. E l'intensitŕ con cui il tema viene percepita č maggiore, piů acuta e anche culturalmente piů aggiornata in alcuni Paesi che un tempo si sarebbero detti del Sud del mondo. Basti pensare che alcune costituzioni dell'America Latina - per certi aspetti perfino mostruose nelle loro dimensioni (la Costituzione venezuelana ha 444 articoli!) - mettono i beni comuni al centro dell'attenzione e che uno di questi, il cibo, č affrontato con una novitŕ e una fantasia culturale in leggi, norme costituzionali, documenti del Brasile, del Kenya e dell'India. Dunque, se parliamo di beni comuni, dobbiamo guardarli non (solo) dall'angolo di casa nostra, anche perché in alcuni casi sarebbe impossibile. In questo momento uno dei beni comuni principali - la salvaguardia dell'ambiente planetario - č stato messo in grave pericolo dal terremoto di Fukushima e dalle sue conseguenze. Noi ci interroghiamo, ancora in questo momento, fino a che punto gli effetti di quanto č avvenuto rimarranno circoscritti all'area dove quel disastro si č verificato oppure se l'inquinamento atmosferico e del mare determineranno la contaminazione anche dei prodotti alimentari che importiamo dal Giappone. L'attenzione ai beni comuni ormai non puň, dunque, essere legata a un luogo e agli interessi di chi si trova in quel luogo.

È in atto un nuovo interesse nei confronti della smallness che non sia solo l'esito della lettura dei piccoli centri dal binocolo della grande scala. Oggi questi luoghi generano molteplici visioni, anche contrapposte: c'e` una grande attenzione al tema della fragilità e dell'abbandono così come a quello del ritorno ai luoghi. Il piccolo centro di Giampilieri Superiore (ME) rap-presenta una situazione particolare, essendo non abbastanza vicino al mare per rientrare tra gli insediamenti turistici costieri e non abbastanza lontano dal mare per poter rientrare nei progetti destinati alle aree interne (Snai); e se la frana del 2009 non lo avesse riportato alla ribalta nazionale per le 37 vittime sarebbe rimasto nel suo marginale anonimato. Invece, paradossalmente, proprio il disastro lo ha riportato al centro. Ma il totem della ricostruzione attraverso imponenti opere di ingegneria ha prevalso su una idea di sviluppo economico e sociale della comunità.

AbstractIntroductionThe March 11, 2011 disaster was unparalleled in the disaster history of Japan. There is still enormous effort required in order for Japan to recover from the damage, not only financially, but psychosocially. This paper is a review of the studies that have been undertaken since this disaster, from after the March 11th disaster in 2011 to the end of 2012, and will provide an overview of the disaster-health research literature published during this period.MethodsThe Japanese database Ichushi Ver. 5 was used to review the literature. This database is the most frequently used database in Japanese health-sciences research. The keywords used in the search were “Higashi Nihon Dai-shinsai” (The Great East Japan Earthquake).ResultsA total of 5,889 articles were found. Within this selection, 163 articles were categorized as original research (gencho ronbun). The articles were then sorted and the top four key categories were as follows: medicine (n = 98), mental health (n = 18), nursing (n = 13), and disaster management (n = 10). Additional categories were: nutrition (n = 4), public health (n = 3), radiology, preparedness, and pharmacology (n = 2 for each category). Nine articles appeared with only one category label and were grouped as “others.”ConclusionThis review provides the current status of disaster-health research following the Great East Japan Earthquake. The research focus over the selected period was greatly directed towards medical considerations, especially vascular conditions and renal dialysis. Considering the compounding factors of the cold temperatures at the time of the disaster, the geography, the extensive dislocation of the population, and the demographics of an aging community, it is noteworthy that the immediate and acute impact of the March 11th disaster was substantial compared with other events and their studies on the impact of disaster on chronic and long-term illness. The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management.KakoM, ArbonP, MitaniS. Literature review on disaster health after the 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-6.

ABSTRAK Bencana kebakaran memberikan dampak yang mempengaruhi kehidupan dan harta benda. Besarnya dampak semakin parah di tempat-tempat dengan tingkat kesiapsiagaan bencana kebakaran yang rendah. Kesiapsiagaan bencana salah satu elemen penting dalam pengurangan risiko bencana dan meliputi kesadaran masyarakat, kesiapan memberikan tanggapan yang tepat dan pemulihan yang cepat. Masyarakat memiliki peran dalam mengurangi resiko kebencanaan kebakaran. Komunitas dan masyarakat perlu memperkuat dan meningkatkan kemampuan dalam kesiapsiagaan bencana pada daerah dan tingkat komunitasnya. Tujuan penelitian ini untuk mengetahui kesiapsiagaan masyarakat di Kelurahan Pekauman Banjarmasin dalam menghadapi bencana kebakaran. Penelitian ini menggunakan rancangan deskriptif kuantitatif. Penggumpulan data menggunakan kuesioner. Sampel sebanyak 74 kepala keluarga di Kelurahan Pekauman RT.09 RW.01 yang diambil dengan total sampling. Analisa data menggunakan distribusi frekuensi. Dari hasil penelitian diperoleh kesiapsiagaan masyarakat dalam menghadapi kebakaran mayoritas berada dalam kategori sangat siap sebanyak 44 (59,5%), dan paling sedikit berada di kategori hamper siap sebanyak 7 (9,5%). Pemberdayaan masyarakat dapat mencegah terjadinya bencana dan meningkatkan kesiapsiagaan jika terjadi kebakaran. Kata kunci: kebakaran, kesiapsiagaan, komunitas. DAFTAR PUSTAKA Arismawati, M.D & Wijaya, O. (2019). Analisis Kesiapsiagaan Masyarakat dalam Menghadapi Bencana Kebakaran Pada Kawasan Pemukiman Padat Penduduk (Studi Kasus Kelurahan Prawirodirjan Yogyakarta). Artikel Kesehatan Masyarakat, Universitas Ahmad Dahlan. Badan Nasional Penanggulangan Bencana. (2019). Daftar Bencana Informasi Indonesia (Dibi). Jakarta:BNPB Baker, L. R., & Cormier, L. A. (2012). Disaster Preparedness and Families of Children with Special Needs: A Geographic Comparison. Journal of Community Health, 38(1), 106–112. Chan, E. Y. Y., Kim, J. H., Lin, C., Cheung, E. Y. L., & Lee, P. P. Y. (2012). Is Previous Disaster Experience a Good Predictor for Disaster Preparedness in Extreme Poverty Households in Remote Muslim Minority Based Community in China?. Journal of Immigrant and Minority Health, 16(3), 466–472. Dantzler, D. (2013). Basic household disaster preparedness decisionalInfluences among male federal employees in the national Capital region. Dissertation Doctor of Philosophy Capella University. ProQuest LLC. UMI Number:3559889. Farisa, F.C. (2018). BNPB: Selama 2018, Ada 1.999 Kejadian Bencana Kebakaran. Kompas.com. Retrieved 5 November 2020 at 13:20 WITA From Https://Nasional.Kompas.Com/Read/2018/10/25/22572321/Bnpb-Selama-2018ada-1999-Kejadian-Bencana Gowing, J. R., Walker, K. N., Elmer, S. L., & Cummings, E. A. (2017). Disaster Preparedness among Health Professionals and Support Staff: What is Effective? An Integrative Literature Review. Prehospital and Disaster Medicine, 32(03), 321–328. Haswar, Andi. M. (2021). Ada 45 Kasus Kebakaran dalam 5 Bulan di Banjarmasin, 2 Orang Meninggal Dunia. Retrieved from https://regional.kompas.com/read/2021/05/20/215702278/ada-45-kasus-kebakaran-dalam-5-bulan-di-banjarmasin-2-orang-meninggal-dunia. Hermon, Dedi. (2015). Geografi Bencana Alam. Jakarta Jaslow, D., Ufberg, J., Yoon, R., McQueen, C., Zecher, D., & Jakubowski, G. (2005). Fire Safety Knowledge and Practices Among Residents of an Assisted Living Facility. Prehospital and Disaster Medicine, 20(02), 134–138. Kuntoro, C. (2017). Implementasi Manajemen Risiko Kebakaran Berdasarkan (Is) ISO 31000 PT Apac. Inti Corpora. HIGEIA, 1(4), pp. 109-119 Martanto, C., Aji, A., & Parman, S. (2017). Kajian Kesiapsiagaan Masyarakat dalam menghadapi Bencana Kebakaran di Kelurahan Kembangsari Kecamatan Semarang Tengah. Edu Geography,2LIPI-UNESCO/ISDR. (2006). Kajian Kesiapsiagaan Masyarakat dalam mengantisipasi Bencana Gempa Bumi dan Tsunami. Nakao, R., Kawasaki, R., & Ohnishi, M. (2019). Disaster preparedness of hillside residential area in Nagasaki city, Japan: evaluations regarding experiences related to a fire. Journal of Rural Medicine, 14(1), 95–102. National Fire Protection Association (NFPA). (2018). Standar for Portable Fire Extinguisherts. USA Nugroho. (2015). Preparedness Assessment Tools For Indonesia. Jakarta: Humanitarian Forum Indonesia & MDM. Pahriannoor, Fauzan, A., & Hadi, Z. (2020). Relationship Of Knowlage And Nurse Attitude With Fire Prevention And Management Of Fire Ar RSUD Ulin Banjarmasin In 2020. Artikel Kesehatan Masyarakat. pdf Thomas, Tracy N., Griffith, Michelle Leander ., Harp, Victoria., Joan P. Cioffi. (2015). Influences of Preparedness Knowledge and Beliefs on Household Disaster Preparedness. 64(35); 965-971 Yulia, F. C. (2020). Kesiapsiagaan Masyarakat Dalam Menghadapi Bencana Kebakaran di Kampung Pelangi Kota Semarang Tahun 2020. Retrived 7 Mei 2021, from http://lib.unnes.ac.id/41191/1/3201416048.

By definition, hospitals should be among the places with the highest safety index (1). But often, on these premises, we have occasional accidents which may be dangerous and which illustrate the way hospitals are exposed to various and often undervalued risks.The incidences of unforeseen, dangerous situations involving sudden accidents, of uncontrollable emergency conditions and also of larger catastrophes are awful. Recent accidents proved inadequate safety inside hospitals. In Parma (2) escaping gas was followed by an explosion that destroyed a division of the hospital and resulted in wounded and dead. In Mondovi, an explosion in the central heating system of the hospital caused the death of an employee. A fire that broke out in an old people's home in Southern Italy brought about the death of three persons. The first shocks of the earthquake in 1980 caused the death of many patients and staff (including six physicians) in the so called “safe” hospital of San Angelo Dei Lombardi. In the earthquake in 1976 many patients and some personnel of the hospital staff in Gemona, Friuli lost their lives (3)Apparently these facts are not closely linked together. Some were caused by human error, others by inadequacy of buildings, age of structures, even where the disaster was due to natural causes. However all these events show the presence of the common denominator of “high risk,” typical of hospital structures (4,5). The principle dangerous situations are: (a) risks coming from the structures of the premises (no earthquake-proof principles of modular structure); and (b) risks connected with the working activities (6,7).

Il progetto ha indagato l importanza delle competenze infermieristiche avanzate in medicina dei disastri prendendo in considerazione una formazione standardizzata finalizzata alla costituzione di un percorso formativo dedicato La medicina delle catastrofi si è imposta all’attenzione del mondo culturale e scientifico negli ultimi vent’anni, per gli addetti ai lavori l’interesse per l’argomento ha conosciuto un crescendo esponenziale in ragione del contesto politico e sociale dei nostri giorni. Gli attentati verificatisi a New York, Madrid e Londra hanno rappresentato la spinta propulsiva verso un argomento fino ad allora ritenuto di scarso interesse per coloro, che nella quotidianità, erano deputati alla gestione dell’emergenza sanitaria sia in ambito ospedaliero che extraospedaliero. Dopo la tragedia dell'11 settembre 2001, sono stati ideati e realizzati un gran numero di corsi di istruzione e formazione in Medicina dei Disastri . In Italia il Ministero della Salute e la Prefettura ( Ministero della Difesa ) si rivolgono al Servizio di Emergenza Territoriale 118 per intervenire in caso di “Disastro”. In Italia gli infermieri che lavorano presso i Servizi di Emergenza Territoriale 118, spesso, non possiedono competenze certificate ma si avvalgono dell’esperienza per affrontare tali emergenze. Da questo quesito nasce l’idea di un progetto formativo dedicato, che fornisca agli infermieri competenze avanzate e standardizzate in materia di medicina dei disastri Formazione e organizzazione rappresentano i cardini della medicina dei disastri e si pongono come obiettivi primari su cui investire risorse umane e materiali. OBIETTIVO GENERALE: costituire, attraverso un metodo validato, una “nurse core competencies” standardizzata, relativa alla Medicina dei Disastri, su cui progettare un percorso didattico professionalizzante per infermieri, relativo, alla Medicina dei Disastri OBIETTIVI SPECIFICI: - Valutare, utilizzando il Dreyfus ' Ability Scale / livelli di competenza di P. Benner (11), la percezione degli infermieri dei servizi di emergenza territoriale 118 in Italia relativa alle competenze possedute per rispondere ai disastri e agli incidenti casuali di massa facendo riferimento al “National Standardized All-Hazard Disaster Core Competencies Task Force” di Shultz e Koenig (1° Survey) (12). - Attribuire un valore di importanza, in base alle competenze certificate possedute e all’esperienza nel campo della medicina dei disastri, alle attività contenute nella core competence “National Standardized All-Hazard Disaster Core Competencies Task Force” di Shultz e Koenig (2°Survey). - L’ obiettivo del focus group è quello di indagare l’importanza di una formazione specifica in medicina dei disastri ed individuare possibili criticità dovute ad una ipotetica carenza di percorsi didattici dedicati e l’eventuale gap formativo. Contesto e popolazione L’indagine multicentrica si è rivolta ai Servizi di emergenza 118. Per quanto riguarda la prima indagine agli infermieri era richiesta l’appartanenza ad un Servizio di Area Critica, per quanto concerne la seconda survey,la popolazione è stata selezionata in base a requisiti specifici: prestare Servizio presso il Servizio di emergenza territoriale 118, possedere competenze certificate in medicina dei disastri ed esperienza nel campo Materiali e metodi Lo studio del progetto prevede una ricerca di tipo quantitativo attraverso la somministrazione di due survey , costruite sulla base degli strumenti validati elencati sopra e compilati in tempi diversi ed una ricerca di tipo qualitativo attraverso il focus group. Strumenti - Standardized National All-Hazard Disaster Core Competencies of Koenig and Schultz - Dreyfus' Ability Scale - Scala Likert - Griglia di osservazione di Bales (20) (scala degli atteggiamenti IPA- Interaction Process Analysis Per lavorare al questionario da somministrare agli infermieri dei servizi territoriali 118 in Italia è stato necessario tradurre dall’inglese all’italiano il primo strumento. Il processo di traduzione1 si è svolto secondo le linee guida del QCER (Quadro Comune Europeo di Riferimento per le Lingue) e a tal proposito è stato costituito un gruppo di lavoro multidisciplinare. L’obiettivo generale del progetto di dottorato era quello di costruire, attraverso un metodo validato, una “nurse core competencies” relativa alla medicina dei Disastri, su cui costruire un percorso didattico, professionalizzante, per infermieri. Il lavoro è iniziato conducendo una revisione della letteratura internazionale finalizzata alla ricerca di uno strumento validato, pertinente, all’ipotesi di ricerca. Lo stato dell’arte ha confermato una carente offerta di percorsi didattici, completi, fruibili da infermieri, tranne corsi di pochi giorni che non forniscono sufficienti competenze in merito. E’ emerso, inoltre, un gap formativo che spesso viene colmato dall’esperienza sul campo ma non supportata da competenze certificate ed inoltre, alla luce della nuova normativa, inerente le competenze avanzate dell’infermiere, è necessario istituire percorsi formativi specialistici. Per il progetto di studio è stata condotta una ricerca di tipo quantitativo e qualitativo e rispettivamente sono state somministrate due survey, attraverso uno studio multicentrico, ed è stato organizzato un focus group. Per quanto concerne i dati statistici è stata svolta un’analisi monovariata e bivariata con il software SPSS: l’attendibilità dei questionari è stata valutata calcolando il livello di coerenza interna, relativa od ogni costrutto, ossia l’alpha di Cronbach che ha dato un risultato di 0,98 e 0.99, pertanto molto soddisfacente; per il focus group è stata individuata la posizione di massima efficacia della dinamica di gruppo attraverso la griglia osservazionale di Bales (scala degli atteggiamenti IPA- Interaction Process Analysis. Dal primo questionario emerge, tra i rispondenti. un’anzianità di servizio molto elevata pertanto l’esperienza è molta e sarebbe utile poiché l’80% non è mai intervenuto in disastri ma il 70% non possiede formazione in materia di medicina dei disastri pertanto è fondamentale avere competenze certificate e una formazione che comprenda simulazioni in scala reale. Le competenze maggiori sono possedute in materia di Triage e una minore conoscenza invece è emersa, nei confronti di impianti e sistemi sanitari in grado di fronteggiare rapidamente un disastro e l'aumento spropositato della domanda di soccorso rispetto alle risorse disponibili: personale adeguato, forniture, attrezzature, strutture e spazi adeguati per la cura del paziente. Questi argomenti riassunti in surge capacity e surge capability sono i cardini della medicina dei disastri, è rilevante che sia emerso questo dato come competenza maggiormente carente. Ma soprattutto una carenza formativa si è evidenziata per quanto concerne i principi etici e problemi psicosociali, in medicina dei disastri che hanno un impatto, non da poco, sulla popolazione colpita ed il personale chiamato ad intervenire. In un disastro è fondamentale avere anche una preparazione in merito, basti pensare agli aspetti etici del Triage: “non tutti possono essere salvati” e ai problemi psicosociali che ne derivano: traumi psicologici in bambini, anziani, disabili, donne in gravidanza ma anche tra gli operatori chiamati ad intervenire. Gli input psicologici negativi sono molteplici. La motivazione dei rispondenti è stata molto elevata poiché il lavoro è stato ritenuto molto rilevante per il 45% e rilevante/mediamente rilevante il 49,2%, un dato molto significativo che evidenzia una cultura intellettuale sull’argomento La seconda intervista ha preso in considerazione, come contesto, i Servizi di emergenza territoriale, per quanto concerne la popolazione, sono stati fissati due requisiti di reclutamento: esperienza sul campo e competenze certificate in materia di medicina dei disastri. Lo strumento utilizzato è lo stesso inserito nella prima survey ma in questo caso è stato richiesto ai rispondenti di esprimere un parere di inclusione o esclusione sugli obiettivi di performance estrapolati dall’elenco di competenze della core presa in considerazione, nell’ottica di inserirli o meno in un programma didattico, specifico, in medicina dei disastri. Nonostante la survey fosse impegnativa dal punto di vista della compilazione (circa 10 minuti circa per l’intera compilazione), i questionari sono stati compilati per intero ed inoltre sono state inserite numerose osservazioni, tutte positive e costruttive. Si percepiscono pertanto motivazione ed interesse per l’argomento proposto ed è proprio stato specificato che il lavoro e l’argomento sono molto interessanti ed è forte e sentita la necessità di formazione specifica, nell’ambito della medicina dei disastri. Il triage è emerso nuovamente come prima attività riconosciuta dagli infermieri come la più importante, nel primo questionario era ritenuta la competenza posseduta maggiormente. Dalle annotazioni libere, predisposte nel questionario, viene evidenziata carenza di formazione e la necessità che vengano istituiti corsi completi. Viene inoltre annotato l’importanza di argomenti etici e psicologici nonché l’importanza di una formazione multi professionale e in collaborazione con altri enti. Anche questi dati concordano con il primo questionario dove veniva espresso il bisogno di formazione in tal senso. Il focus group è stato organizzato con l’obiettivo di indagare l’importanza di una formazione specifica in medicina dei disastri ed individuare possibili criticità dovute ad una ipotetica carenza di percorsi didattici dedicati e l’eventuale gap formativo. La posizione di massima efficacia della dinamica di gruppo ha trovato collocazione nell’area dei comportamenti socio emozionali positivi e nell’area di orientamento al compito (ambito conoscitivo). Nel corso della conversazione non sono mai emersi comportamenti e atteggiamenti socio emozionali negativi.E’ indubbio che il focus abbia messo in evidenza il bisogno di formazione e la necessità di istituire un corso completo e multidisciplinare che conferisca agli infermieri competenze avanzate certificate e quindi riconoscibili, a livello formale, in ambito lavorativo e didattico. In ultimo, ma non meno importante, è emersa la carenza di una cultura intellettuale di base. relativa alla medicina dei disastri. A tal proposito si auspica che questo lavoro abbia contribuito ad accrescere questa cultura, e continui a farlo, attraverso gli infermieri che hanno partecipato a questa indagine, con il loro preziosissimo contributo, poiché hanno dimostrato molto interesse e motivazione sull’argomento. Questo progetto di dottorato non può considerarsi terminato e lascia spazio quindi ad altre ipotesi future e ad approfondimenti, come del resto il lavoro di ricerca prevede. Sicuramente i limiti maggiori sono dovuti al numero del campione che può risultare rappresentativo ma sicuramente può essere ampliato, inoltre si sono incontrati molti ostacoli per reperire indirizzi per diffondere i questionari: la situazione dei Servizi 118 in Italia è disomogenea e sempre soggetta a cambiamenti strutturali, organizzativi ed economici derivanti da disposizioni normative . Le prospettive future sono rivolte essenzialmente all’implementazione di un programma educativo ed innovativo inerente la medicina dei disastri; per quanto concerne le risorse economiche è possibile sottoporre progetti didattici all’Ente di Protezione Civile che può disporre di finanziamenti europei erogabili, per iniziative che includono anche corsi di formazione, specifici in materia di medicina delle catastrofi. The project investigated the importance of advanced nursing skills in disaster medicine by considering a standardized training aimed at creating a dedicated training path Disaster medicine has attracted attention to the cultural and scientific world in the last twenty years, for the insiders interest in the subject has experienced an exponential growth due to the political and social context of our days. The attacks in New York, Madrid and London represented the driving force towards a topic that until then was considered of little interest to those who, in their daily life, were deputies to the management of the health emergency both in hospital and outside the hospital. After the tragedy of 11 September 2001, a large number of education and training courses in Disaster Medicine have been designed and implemented. In Italy, the Ministry of Health and the Prefecture (Ministry of Defense) turn to the 118 Territorial Emergency Service to intervene in the event of a "disaster". In Italy nurses working at Territorial Emergency Services 118 often do not have certified skills but use the experience to deal with such emergencies. From this question arises the idea of ​​a dedicated training project, which provides nurses with advanced and standardized skills in disaster medicine. Training and organization are the cornerstones of disaster medicine and are set as primary objectives on which to invest human and material resources. GENERAL OBJECTIVE: to establish, through a validated method, a standardized "nurse core competencies", related to Disaster Medicine, on which to plan a professional training course for nurses, relative, to Disaster Medicine SPECIFIC OBJECTIVES: - Evaluate, by using the Dreyfus' Ability Scale / levels of competence of P. Benner (11), the perception of nurses of the territorial emergency services 118 in Italy concerning the skills possessed to respond to disasters and mass casual incidents referring to the "National Standardized All-Hazard Disaster Core Competencies Task Force" by Shultz and Koenig (1st Survey) (12). - Assign a value of importance, based on the certified skills possessed and experience in the field of disaster medicine, to the activities contained in the core competence of the "National Standardized All-Hazard Disaster Core Competencies Task Force" by Shultz and Koenig (2nd Survey ). - The objective of the focus group is to investigate the importance of specific training in disasters and to identify possible critical issues due to a hypothetical lack of dedicated didactic paths and the possible training gap. Context and population The multi-center survey focused on the 118 emergency services. Regarding the first survey of the nurses, the need for a Critical Area Service was required, with regard to the second survey, the population was selected according to specific requirements. : provide service at the Territorial Emergency Service 118, possess certified skills in disaster medicine and experience in the field Materials and methods The study of the project involves a quantitative research through the administration of two surveys, built on the basis of the validated tools listed above and compiled at different times and a qualitative research through the focus group. Instruments - Standardized National All-Hazard Disaster Core Competencies of Koenig and Schultz - Dreyfus' Ability Scale - Likert scale - Bales observation grid (20) (IPA-Interaction Process Analysis attitudes scale) In order to work on the questionnaire to be administered to the nurses of territorial services 118 in Italy, it was necessary to translate the first tool from English into Italian. The translation process1 took place according to the guidelines of the CEFR (Common European Framework of Reference for Languages) and a multidisciplinary working group was set up for this purpose. The general objective of the doctoral project was to build, through a validated method, a "nurse core competencies" related to Disaster medicine, on which to build a didactic, professionalizing path for nurses. The work began by conducting a review of the international literature aimed at finding a validated tool, relevant to the research hypothesis. The state of the art has confirmed a lack of offer of didactic paths, complete, usable by nurses, except courses of a few days that do not provide sufficient skills in this regard. In addition, a training gap has emerged that is often filled by experience in the field but not supported by certified skills and furthermore, in the light of the new legislation, inherent in the advanced skills of the nurse, it is necessary to establish specialized training courses. For the study project a quantitative and qualitative research was conducted and two surveys were administered, through a multicentric study, and a focus group was organized. With regard to the statistical data, a monovariate and bivariate analysis was carried out with the SPSS software: the reliability of the questionnaires was assessed by calculating the level of internal, relative or each construct, ie the Cronbach alpha which gave a result of 0.98 and 0.99, therefore very satisfactory; for the focus group the position of maximum effectiveness of the group dynamics was identified through the observational grid of Bales (IPA-Interaction Process Analysis attitude scale) From the first questionnaire emerges, among the respondents, a very high level of service therefore experience is great and it would be useful as 80% have never intervened in disasters but 70% have no training in disaster medicine so it is essential to have certified skills and training that includes full-scale simulations. they are owned in the field of Triage and less knowledge has instead emerged, with regard to systems and health systems able to cope rapidly with a disaster and the disproportionate increase in the demand for assistance compared to the available resources: adequate personnel, supplies, equipment, facilities and adequate space for patient care. These arguments summarized in surge capacity and surge capability are the cornerstones of disaster medicine, it is important that this data emerged as the most lacking competence. But above all, a lack of training has been highlighted with regard to ethical principles and psychosocial problems, in medicine of disasters that have an impact, not a little, on the population affected and the staff called to intervene. In a disaster it is also important to have a preparation on this, just think of the ethical aspects of the Triage: "not everyone can be saved" and the psychosocial problems that derive: psychological trauma in children, the elderly, the disabled, pregnant women but also between the operators called to intervene. There are many negative psychological inputs. The motivation of the respondents was very high because the work was considered very relevant for 45% and 49.2% is relevant / significant, a very significant figure that highlights an intellectual culture on the subject. The second interview took into account, as context, the Territorial Emergency Services, with regard to the population, two recruitment requirements were set: field experience and certified skills in disaster medicine. The instrument used is the same as in the first survey but in this case respondents were asked to express an opinion of inclusion or exclusion on performance targets extrapolated from the list of core competencies taken into consideration, with a view to inserting them or not in a specific educational program in disasters medicine. Although the survey was demanding from the compilation point of view (about 10 minutes for the entire compilation), the questionnaires were completed in full and also many comments were included, all positive and constructive. We therefore perceive motivation and interest in the proposed topic and it has been specified that the work and the topic are very interesting and the need for specific training in the field of disasters is strong and felt. . The triage has emerged again as the first activity recognized by nurses as the most important, in the first questionnaire was considered the most widely owned competence. From the free annotations, prepared in the questionnaire, there is a lack of training and the need for complete courses to be established. It is also noted the importance of ethical and psychological topics as well as the importance of a multi professional training and in collaboration with other bodies. These data also agree with the first questionnaire where the need for training in this sense was expressed. The focus group was organized with the aim of investigating the importance of specific training in disaster medicine and identifying possible critical issues due to a hypothetical lack of dedicated didactic paths and the possible training gap. The position of maximum effectiveness of the group dynamics has found a place in the area of ​​positive social and emotional behaviors and in the area of ​​orientation to the task (cognitive field). During the conversation, negative social and emotional behaviors and attitudes have never emerged. It is undoubted that the focus highlighted the need for training and the need to establish a complete and multidisciplinary course that gives nurses advanced skills certified and therefore recognizable, at the formal level, in the workplace and teaching. Last but not least, the lack of a basic intellectual culture has emerged. relating to Disaster Medicine. In this regard it is hoped that this work has contributed to increasing this culture, and continues to do so, through the nurses who participated in this survey, with their invaluable contribution, since they have shown much interest and motivation on the subject. This doctoral project can not be considered finished and therefore leaves room for other future hypotheses and in-depth analyzes, as the research work provides. Surely the biggest limits are due to the number of the sample that can be representative but surely it can be expanded, moreover many obstacles have been encountered to find addresses to spread the questionnaires: the situation of the 118 Services in Italy is inhomogeneous and always subject to structural changes, organizational and economic results deriving from regulatory provisions. The future perspectives are essentially aimed at the implementation of an educational and innovative program concerning disaster medicine; as far as economic resources are concerned, it is possible to submit educational projects to the Civil Protection Agency, which may dispose of European funding, for initiatives that also include training courses specific to disaster medicine.

The case of Linda Loerch and her son Peter presented to the Minnesota Supreme Court raises the question of whether legal liability can extend beyond the second generation. During the pregnancy leading to Linda's birth, her mother had taken the synthetic hormone diethylstilbestrol, commonly known as DES. Linda herself has a deformed uterus, and her son Peter, born twelve weeks prematurely, is a quadriplegic afflicted with cerebral palsy. The family is seeking damages for the child's condition from Abbott Laboratories, the manufacturer of the drug taken forty years earlier by his grandmother (MacNeil/Lehrer 1988). The claims of this lawsuit hinge on the evidence available when the drug was prescribed. The case illustrates, with some new ramifications, the interrelated issues of ethics and evidence surrounding the practice of medicine, a major theme of this chapter. The DES story first became national news at a time that marked the rise of the new field of bioethics. The Food and Drug Administration (FDA) issued a drug alert in 1971 to all physicians concerning the use of DES by pregnant women, as an association had been found between the occurrence of a rare form of cancer of the vagina in young women and their mothers' exposure to DES. The drug had been prescribed widely since the 1940s for a variety of medical conditions, including the prevention of miscarriages. It is estimated that during this period four to six million individuals, mothers and their offspring, were exposed to DES during the mothers' pregnancy. The full dimensions of the medical disaster, the subject of continued controversy, have yet to be firmly established. DES daughters are at risk of developing clear cell adenocarcinoma of the vagina, the risk estimated to be one per one thousand by age twenty-four. Ninety percent have a benign vaginal condition called adenosis, and many have other genital abnormalities. They are at higher risk of pregnancy loss and infertility. DES mothers also may be at a higher risk for breast and gynecological cancers, and DES sons may be at an increased risk of genitourinary abnormalities, infertility, and testicular cancer. DES may, as well, have affected fetal brain development, leading to behavioral problems and learning disabilities.