The Integrated Medical Response protocol (IMP) is a new protocol of medical response during the response phase of a flood disaster in Kelantan, Malaysia. It integrates response workflows of various rescue agencies involved in patient care during response phase of flood disaster. Traditionally, health care services in this region used either an all-hazard protocol or those not specific to Kelantan. The present study is aimed to test the effectiveness of IMP on knowledge, attitude and practice of healthcare providers (HCP) involved in managing patients during flood disaster in Kelantan. This study was a prospective parallel group, single blinded, randomized controlled trial. The unit of randomization was the district within Kelantan on a 1:1 basis into either the control or intervention group using cluster randomized method. The hospitals within the district were subsequently assigned to the allocated group. Investigators were blinded to the assignments. The knowledge, attitude and practice scores of HCP were assessed by FloodDMQ-BM© and was evaluated 2 weeks before and immediately after a flood disaster table-top exercise. Data was analyzed using two-way repeated measure ANOVA. Our findings showed that intervention was essential to improve the knowledge [F (1,100) = 6.947, p-value 0.010 (<0.05)] and attitude scores [F (1,100) = 31.56, p-value 0.001]. Meanwhile, practice score was improved in both control and intervention group with time [F (1,100) = 226.56, p-value 0.001]. Thus, our localized IMP specific to response phase of flood disaster was crucial to further enhance the knowledge and attitude levels among HCP while practice level showed similar improvement in both control and intervention group post table-top exercise.

This study is to determine the prevalence and the associated factors of low-back pain (LBP), which has multifactorial causes, among ambulance workers in Kelantan, Malaysia. The cross-sectional study involved ambulance workers in the emergency department in all government hospitals in Kelantan. Those who did not consent, complete or return the questionnaire as well as having rheumatic diseases were excluded from the study. The participants were asked to answer a self-administered questionnaire in English. Descriptive analyses and Chi-square test were used. A total of 168 respondents had completed the questionnaires with a response rate of 85.0%. Questionnaires with more than 95.0% items completed were included in the analysis (n=143). The respondents had a higher proportion of male than female (63.6% versus 36.4%). Assistant Medical Officer comprised of 60.0% of all respondents and the rest were nurses. The respondents’ age ranged between 23 to 58 years old with a mean age of 38.27 and standard deviation (SD) of 7.27. The mean duration of involvement in ambulance service was 9.68 years (SD 6.97). The majority (98.5%) of the respondents were Malay. Gender, smoking status and hobbies were the associated factors of LBP among ambulance workers. The modifiable risk factors should be emphasized to the ambulance workers as a measure to prevent the development of LBP.

Hand grenade explosion is a rare occasion in our local community. Most of us have seen or heard about the injuries only from the TV news or newspaper. We report two cases of bomb blast injury that occurred in an army camp in September 2000. These case studies illustrate the clinical presentations of hand grenade blast injures that present with multiple organ involvement. We would like to share our experience in managing such cases in a busy emergency department and highlight the outcome of those two cases. Certain issues pertaining to the complexity of the injuries and mass casualty management are also highlighted.
Physical trauma ; Hand ; experience ; Malaysia ; Hospitals

Ambulance response time is one of the key performance of ambulances services. The objective of this study is to determine the factors associated with delayed ambulance response time in Hospital Universiti Sains Malaysia (HUSM). This was a cross sectional study conducted in Department of Emergency Medicine, Hospital Universiti Sains Malaysia (EDHUSM) between January 2016 to January 2017. A total of 300 ambulance calls were included in our analysis. Data were collected by ambulance paramedic using validated ambulance form. All ambulance forms with missing data were excluded from this study. Of the 300 ambulance calls within the study periods, 254 cases (84.7%) were determined to have delayed ambulance response time. Current ambulance response time is 14 minutes with interquartile range of 5 minutes. Factors which showed significant association delayed ambulance response time include distance from hospital, location, type of emergency and ambulance mechanism. The odd of delayed ambulance response time by every increase in distance unit was 1.59 (95% CI, 1.37 to 1.85). For location type, the odd of delayed ambulance response time for public location as compared to road was 0.13 (95% CI, 0.04 to 0.45). For ambulance mechanism, the odd of delayed ambulance response time for beacon type as compared to siren type was 0.22 (95% CI, 0.01 to 0.69). Further intervention should be initiated based on our findings to improve current ambulance response time.

Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a ‘tsunami-like disaster’. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.

Disaster is a sudden event that associated with ecological changes, disruption of normal daily activities, destruction of infrastructures, loss of properties, and medical disabilities. In disaster, there is a mismatch between available resources and patients need for healthcare service. During flood disaster, the victims were predisposed to different type of illnesses for various reasons such as inadequate supply of clean water, poor sanitation or drainage system, unhealthy foods, and over-crowded relief centers. Mobile clinic is an option for delivering medical care for the disaster victims who often have a difficulty to access to the medical facilities. In this article we would like to share our experiences during the provision of humanitarian services for flood victims at District of Muar Johor. Common illnesses among the flood victims at visited relief centers and advantages of Mobile Medical Relief Team were also highlighted and discussed.

Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.
Acute Coronary Syndrome ; Emergency Service, Hospital

Background: Maintaining good quality CPR while transporting out-of-hospital cardiac arrest patients is very challenging. We aim to determine how different ambulance speed can affect the quality of chest compression performed either manually or mechanically. Methods: This was an observational manikin-based study. A total of 96 participants as well as two types of mechanical compression devices: Lucas-2 and AutoPulse, performed one minute of continuous chest compression on BT-CPEA programmed manikin while the ambulance travelled at different speeds, i.e., idle state, 30km/hr and 60km/hr. Seven outcome variables of chest compression were measured. Performance data of different groups of compressor were compared and analysed using repeated measures analysis of variance (ANOVA). Results: In manual chest compression, significant variation were noted among different speeds in term of average compression rate (p<0.001), average compression depth (p=0.007), fraction of adequate/insufficient compression depth and fraction of normal hands positioning with p=0.018, 0.022 and 0.034 respectively. Overall, AutoPulse and Lucas-2 were not affected by ambulance speed. Lucas2 showed more consistent average compression rate, higher fraction of adequate compression depth and reduced fraction of insufficient compression depth as compared to manual compression with p<0.001, 0.001 and 0.043 respectively. Conclusion: In this study we found that ambulance speed significantly affected certain aspects of manual chest compression most notably compression depth, rate and hand positioning. AutoPulse and Lucas-2 can improve these aspects by providing more consistent compression rate, depth and fraction of adequate compression depth during transport.