WorldWideScience

Sample records for casualty incidents planning

  1. [Mass casualty incidents - current concepts and developments].

    Science.gov (United States)

    Savinsky, Godo; Stuhr, Markus; Kappus, Stefan; Trümpler, Stefan; Wenderoth, Stephan; Wohlers, Jan-Hauke; Paschen, Hans-Richard; Kerner, Thoralf

    2014-12-01

    Medical concepts and strategies are permanently changing. Due to the emergency response in a mass casualty incident everyone who is involved has to work together with different organisations and public authorities, which are not part of the regular emergency medical service. Within the last 25 years throughout the whole country of Germany the role of a "chief emergency physician" has been implemented and in preparation for the FIFA World Cup 2006 mobile treatment units were set up. In 2007, special units of the "Medical Task Force" - funded by the german state - were introduced and have been established by now. They will be a permanent part of regional plannings for mass casualty incidents. This article highlights current concepts and developments in different parts of Germany. © Georg Thieme Verlag Stuttgart · New York.

  2. Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

    Science.gov (United States)

    Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

    2014-10-01

    At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system.

  3. Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

    Energy Technology Data Exchange (ETDEWEB)

    Greenwalt, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hibbard, W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-08-09

    Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans. These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.

  4. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

    NARCIS (Netherlands)

    Berger, Ferco H.; Körner, Markus; Bernstein, Mark P.; Sodickson, Aaron D.; Beenen, Ludo F.; McLaughlin, Patrick D.; Kool, Digna R.; Bilow, Ronald M.

    2016-01-01

    In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior

  5. Strategies for Improved Hospital Response to Mass Casualty Incidents.

    Science.gov (United States)

    TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas

    2018-03-19

    Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

  6. Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study.

    Science.gov (United States)

    Duncan, Edward A S; Colver, Keith; Dougall, Nadine; Swingler, Kevin; Stephenson, John; Abhyankar, Purva

    2014-02-22

    Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item's importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented. This study is the first to produce an expert consensus on the items and quantities of clinical equipment

  7. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.

    Science.gov (United States)

    Bolster, Ferdia; Linnau, Ken; Mitchell, Steve; Roberge, Eric; Nguyen, Quynh; Robinson, Jeffrey; Lehnert, Bruce; Gross, Joel

    2017-02-01

    The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.

  8. Emergency response to mass casualty incidents in Lebanon.

    Science.gov (United States)

    El Sayed, Mazen J

    2013-08-01

    The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure.

  9. [The role of patient flow and surge capacity for in-hospital response in mass casualty events].

    Science.gov (United States)

    Sefrin, Peter; Kuhnigk, Herbert

    2008-03-01

    Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

  10. Scalable patients tracking framework for mass casualty incidents.

    Science.gov (United States)

    Yu, Xunyi; Ganz, Aura

    2011-01-01

    We introduce a system that tracks patients in a Mass Casualty Incident (MCI) using active RFID triage tags and mobile anchor points (DM-tracks) carried by the paramedics. The system does not involve any fixed deployment of the localization devices while maintaining a low cost triage tag. The localization accuracy is comparable to GPS systems without incurring the cost of providing a GPS based device to every patient in the disaster scene.

  11. Marine Information for Safety and Law Enforcement (MISLE) Casualty and Pollution Incidents, Guam, 2015, US Coast Guard

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  12. Major Incident Hospital: Development of a Permanent Facility for Management of Incident Casualties.

    Science.gov (United States)

    Marres, Geertruid; Bemelman, Michael; van der Eijk, John; Leenen, Luke

    2009-06-01

    . Collaboration with the NVIC and infrastructural adjustments enable us to not only care for patients with physical trauma, but also to provide centralized care of patients under quarantine conditions for, say, MRSA, SARS, smallpox, chemical or biological hazards. Triage plays an important role in medical disaster management and is therefore key to organization and infrastructure. Caps facilitate role distribution and recognizibility. The PBR resulted in more accurate registration and real-time availability of patient and group information. Infrastructure and a plan is not enough; training, research and evaluation are necessary to continuously work on disaster preparedness. The MIH in Utrecht (Netherlands) is a globally unique facility that can provide immediate emergency care for multiple casualties under exceptional circumstances. Resulting from the cooperation between a large academic medical institution, a trauma center, a military hospital and the NVIC, the MIH offers not only a good and complete infrastructure but also the expertise required to provide large-scale emergency care during disasters and major incidents.

  13. Resources planning for radiological incidents management

    Science.gov (United States)

    Hamid, Amy Hamijah binti Ab.; Rozan, Mohd Zaidi Abd; Ibrahim, Roliana; Deris, Safaai; Yunus, Muhd. Noor Muhd.

    2017-01-01

    Disastrous radiation and nuclear meltdown require an intricate scale of emergency health and social care capacity planning framework. In Malaysia, multiple agencies are responsible for implementing radiological and nuclear safety and security. This research project focused on the Radiological Trauma Triage (RTT) System. This system applies patient's classification based on their injury and level of radiation sickness. This classification prioritizes on the diagnostic and treatment of the casualties which include resources estimation of the medical delivery system supply and demand. Also, this system consists of the leading rescue agency organization and disaster coordinator, as well as the technical support and radiological medical response teams. This research implemented and developed the resources planning simulator for radiological incidents management. The objective of the simulator is to assist the authorities in planning their resources while managing the radiological incidents within the Internal Treatment Area (ITA), Reception Area Treatment (RAT) and Hospital Care Treatment (HCT) phases. The majority (75%) of the stakeholders and experts, who had been interviewed, witnessed and accepted that the simulator would be effective to resolve various types of disaster and resources management issues.

  14. Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack.

    Science.gov (United States)

    Bloch, Yuval H; Leiba, Adi; Veaacnin, Nurit; Paizer, Yohanan; Schwartz, Dagan; Kraskas, Ahuva; Weiss, Gali; Goldberg, Avishay; Bar-Dayan, Yaron

    2007-01-01

    Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to

  15. Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

    Science.gov (United States)

    Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

    2009-07-01

    The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

  16. An Interprofessional Approach to Continuing Education With Mass Casualty Simulation: Planning and Execution.

    Science.gov (United States)

    Saber, Deborah A; Strout, Kelley; Caruso, Lisa Swanson; Ingwell-Spolan, Charlene; Koplovsky, Aiden

    2017-10-01

    Many natural and man-made disasters require the assistance from teams of health care professionals. Knowing that continuing education about disaster simulation training is essential to nursing students, nurses, and emergency first responders (e.g., emergency medical technicians, firefighters, police officers), a university in the northeastern United States planned and implemented an interprofessional mass casualty incident (MCI) disaster simulation using the Project Management Body of Knowledge (PMBOK) management framework. The school of nursing and University Volunteer Ambulance Corps (UVAC) worked together to simulate a bus crash with disaster victim actors to provide continued education for community first responders and train nursing students on the MCI process. This article explains the simulation activity, planning process, and achieved outcomes. J Contin Educ Nurs. 2017;48(10):447-453. Copyright 2017, SLACK Incorporated.

  17. [Ethical Debates Related to the Allocation of Medical Resources During the Response to the Mass Casualty Incident at Formosa Fun Coast Water Park].

    Science.gov (United States)

    Tang, Jing-Shia; Chen, Chia-Jung; Huang, Mei-Chih

    2017-02-01

    Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

  18. Decision-support information system to manage mass casualty incidents at a level 1 trauma center.

    Science.gov (United States)

    Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

    2013-12-01

    Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events.

  19. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    Science.gov (United States)

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and

  20. Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

    Science.gov (United States)

    Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

    2008-09-01

    Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

  1. Marine Casualty and Pollution Data for Researchers

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  2. Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident.

    Science.gov (United States)

    Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz

    2016-02-01

    The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.

  3. Exploring the perception of aid organizations' staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study.

    Science.gov (United States)

    Bazeli, Javad; Aryankhesal, Aidin; Khorasani-Zavareh, Davoud

    2017-07-01

    Traffic incidents are of main health issues all around the world and cause countless deaths, heavy casualties, and considerable tangible and intangible damage. In this regard, mass casualty traffic incidents are worthy of special attention as, in addition to all losses and damage, they create challenges in the way of providing health services to the victims. The present study is an attempt to explore the challenges and facilitators in management of mass casualty traffic incidents in Iran. This qualitative grounded theory study was carried out with participation of 14 purposively selected experienced managers, paramedics and staff of aid organizations in different provinces of Iran in 2016. Semi-structured interviews were conducted in order to develop the theory. The transcribed interviews were analyzed through open, axial and selective coding. Despite the recent and relatively good improvements in facilities and management procedure of mass casualty traffic incidents in Iran, several problems such as lack of coordination, lack of centralized and integrated command system, large number of organizations participating in operations, duplicate attempts and parallel operations carried out by different organizations, intervention of lay people, and cultural factors halt provision of effective health services to the victims. It is necessary to improve the theoretical and practical knowledge of the relief personnel and paramedics, provide public with education about first aid and improve driving culture, prohibit laypeople from intervening in aid operations, and increase quality and quantity of aid facilities.

  4. The Significance of Witness Sensors for Mass Casualty Incidents and Epidemic Outbreaks.

    Science.gov (United States)

    Pan, Chih-Long; Lin, Chih-Hao; Lin, Yan-Ren; Wen, Hsin-Yu; Wen, Jet-Chau

    2018-02-02

    Due to the increasing number of natural and man-made disasters, mass casualty incidents occur more often than ever before. As a result, health care providers need to adapt in order to cope with the overwhelming patient surge. To ensure quality and safety in health care, accurate information in pandemic disease control, death reduction, and health quality promotion should be highlighted. However, obtaining precise information in real time is an enormous challenge to all researchers of the field. In this paper, innovative strategies are presented to develop a sound information network using the concept of "witness sensors." To overcome the reliability and quality limitations of information obtained through social media, researchers must focus on developing solutions that secure the authenticity of social media messages, especially for matters related to health. To address this challenge, we introduce a novel concept based on the two elements of "witness" and "sensor." Witness sensors can be key players designated to minimize limitations to quality of information and to distinguish fact from fiction during critical events. In order to enhance health communication practices and deliver valid information to end users, the education and management of witness sensors should be further investigated, especially for implementation during mass casualty incidents and epidemic outbreaks. ©Chih-Long Pan, Chih-Hao Lin, Yan-Ren Lin, Hsin-Yu Wen, Jet-Chau Wen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.02.2018.

  5. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

    Science.gov (United States)

    Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

    2017-01-01

    This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

  6. Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

    Science.gov (United States)

    Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

    2014-10-01

    On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

  7. Human casualties in earthquakes: Modelling and mitigation

    Science.gov (United States)

    Spence, R.J.S.; So, E.K.M.

    2011-01-01

    Earthquake risk modelling is needed for the planning of post-event emergency operations, for the development of insurance schemes, for the planning of mitigation measures in the existing building stock, and for the development of appropriate building regulations; in all of these applications estimates of casualty numbers are essential. But there are many questions about casualty estimation which are still poorly understood. These questions relate to the causes and nature of the injuries and deaths, and the extent to which they can be quantified. This paper looks at the evidence on these questions from recent studies. It then reviews casualty estimation models available, and finally compares the performance of some casualty models in making rapid post-event casualty estimates in recent earthquakes.

  8. Triage and first care of casualties after radiological incidents; Triage en eerste opvang van slachtoffers na radiologische incidenten

    Energy Technology Data Exchange (ETDEWEB)

    De Groot, R.; Van Zoelen, G.A.; Van Riel, A.J.H.P.; Leenders, M.E.C.

    2010-11-15

    The RIVM has prepared an overview of the necessary measures for the first care of casualties of incidents with radiological material, starting at the location of the incident until the hospital. Different groups of casualties are discerned, for which specific measures are necessary to minimise health risk. Subsequently flowcharts are set up for the evaluation, selection and first care of these casualties with concomitant measures. The flowcharts indicate which persons should be directly transported to the hospital and which persons can be sent home after monitoring and, if necessary, removal of radioactive material, for example contaminated clothing (decontamination). Furthermore, there is attention for the persons that are not exposed, but are worried. In time of an incident the flowcharts can be adapted and refined according to the specific nature of the incident. The report is written on request of the 'Medical Planning and Preparedness Office (GHOR)', by order of the Ministry of Health, Welfare and Sport. The report describes the consequences of incidents with a 'dirty bomb' and a hidden radioactive source. A 'dirty bomb' is a conventional explosive that will spread radioactive material after detonation. People in the direct surroundings of the explosion can be perilously injured. They can also become contaminated by scattered shards and radioactive material. During an incident with a hidden (intact) radioactive source, the radioactive material will not spread, because it is located at a specific site. The report also presents a flowchart for these incidents. The report supplies information to explain the flowcharts. The appendices give background information on radioactivity and ionising radiation and the health risks after exposure. Also references are provided to relevant national and international guidelines and handbooks. [Dutch] Het RIVM heeft in kaart gebracht welke maatregelen nodig zijn om slachtoffers op te vangen van

  9. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

    Energy Technology Data Exchange (ETDEWEB)

    Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich [University Hospital Munich, Department of Clinical Radiology, Munich (Germany); Huber-Wagner, Stefan; Kanz, Karl-Georg [University Hospital Munich, Department of Surgery, Munich (Germany)

    2009-08-15

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

  10. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

    International Nuclear Information System (INIS)

    Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich; Huber-Wagner, Stefan; Kanz, Karl-Georg

    2009-01-01

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

  11. Indoor fire in a nursing home : evaluation of the medical response to a mass casualty incident based on a standardized protocol

    NARCIS (Netherlands)

    Koning, S. W.; Ellerbroek, P. M.; Leenen, L. P. H.

    This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent

  12. [Mass maritime casualty incidents in German waters: structures and resources].

    Science.gov (United States)

    Castan, J; Paschen, H-R; Wirtz, S; Dörges, V; Wenderoth, S; Peters, J; Blunk, Y; Bielstein, A; Kerner, T

    2012-07-01

    The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. To face these challenges at sea emergency doctors and firemen have been specially trained. This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe.

  13. Basic Disaster Life Support (BDLS) Training Improves First Responder Confidence to Face Mass-Casualty Incidents in Thailand.

    Science.gov (United States)

    Kuhls, Deborah A; Chestovich, Paul J; Coule, Phillip; Carrison, Dale M; Chua, Charleston M; Wora-Urai, Nopadol; Kanchanarin, Tavatchai

    2017-10-01

    Medical response to mass-casualty incidents (MCIs) requires specialized training and preparation. Basic Disaster Life Support (BDLS) is a course designed to prepare health care workers for a MCI. The purpose of this study was to evaluate the confidence of health care professionals in Thailand to face a MCI after participating in a BDLS course. Basic Disaster Life Support was taught to health care professionals in Thailand in July 2008. Demographics and medical experience were recorded, and participants rated their confidence before and after the course using a five-point Likert scale in 11 pertinent MCI categories. Survey results were compiled and compared with PBasic Disaster Life Support significantly improves confidence to respond to MCI situations, but nurses and active duty military benefit the most from the course. Future courses should focus on these groups to prepare for MCIs. Kuhls DA , Chestovich PJ , Coule P , Carrison DM , Chua CM , Wora-Urai N , Kanchanarin T . Basic Disaster Life Support (BDLS) training improves first responder confidence to face mass-casualty incidents in Thailand. Prehosp Disaster Med. 2017;32(5):492-500 .

  14. The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

    Science.gov (United States)

    Beck-Razi, Nira; Fischer, Doron; Michaelson, Moshe; Engel, Ahuva; Gaitini, Diana

    2007-09-01

    The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.

  15. Preparedness of emergency departments in northwest England for managing chemical incidents: a structured interview survey

    Directory of Open Access Journals (Sweden)

    Walter Darren

    2007-12-01

    Full Text Available Abstract Background A number of significant chemical incidents occur in the UK each year and may require Emergency Departments (EDs to receive and manage contaminated casualties. Previously UK EDs have been found to be under-prepared for this, but since October 2005 acute hospital Trusts have had a statutory responsibility to maintain decontamination capacity. We aimed to evaluate the level of preparedness of Emergency Departments in North West England for managing chemical incidents. Methods A face-to-face semi-structured interview was carried out with the Nurse Manager or a nominated deputy in all 18 Emergency Departments in the Region. Results 16/18 departments had a written chemical incident plan but only 7 had the plan available at interview. All had a designated decontamination area but only 11 felt that they were adequately equipped. 12/18 had a current training programme for chemical incident management and 3 had no staff trained in decontamination. 13/18 could contain contaminated water from casualty decontamination and 6 could provide shelter for casualties before decontamination. Conclusion We have identified major inconsistencies in the preparedness of North West Emergency Departments for managing chemical incidents. Nationally recognized standards on incident planning, facilities, equipment and procedures need to be agreed and implemented with adequate resources. Issues of environmental safety and patient dignity and comfort should also be addressed.

  16. Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents.

    Science.gov (United States)

    Chilcott, Robert P; Mitchell, Hannah; Matar, Hazem

    2018-05-30

    The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as "clinical decontamination") has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography-mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.

  17. Mass casualty triage after an airplane crash near Amsterdam

    NARCIS (Netherlands)

    Postma, Ingri L. E.; Weel, Hanneke; Heetveld, Martin J.; van der Zande, Ineke; Bijlsma, Taco S.; Bloemers, Frank W.; Goslings, J. Carel

    2013-01-01

    Triage is an important aspect of the management of mass casualty incidents. This study describes the triage after the Turkish Airlines Crash near Amsterdam in 2009. The results of the triage and the injuries of P3 casualties were evaluated. In addition, the role of the trauma mechanism and its

  18. Management of In-Field Patient Tracking and Triage by Using Near-Field Communication in Mass Casualty Incidents.

    Science.gov (United States)

    Cheng, Po-Liang; Su, Yung-Cheng; Hou, Chung-Hung; Chang, Po-Lun

    2017-01-01

    Near field communications (NFC) is an emerging technology that may potentialy assist with disaster management. A smartphone-based app was designed to help track patient flow in real time. A table-drill was held as a brief evaluation and it showed significant imporvement in both efficacy and accuracy of patient management. It is feasible to use NFC-embedded smartphones to clarify the ambiguous and chaotic patient flow in a mass casualty incident.

  19. Transfusion-Associated Microchimerism in Combat Casualties

    National Research Council Canada - National Science Library

    Dunne, James R; Lee, Tzong-Hae; Burns, Christopher; Cardo, Lisa J; Curry, Kathleen; Busch, Michael P

    2007-01-01

    ...) in civilian trauma patients receiving allogenic red blood cell (RBC) transfusions. We explored the incidence of TA-MC in combat casualties receiving FrWB compared with patients receiving standard stored RBC transfusions. Methods...

  20. Drones at the service for training on mass casualty incident

    Science.gov (United States)

    Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo

    2017-01-01

    Abstract Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants. PMID:28658106

  1. Occupational safety data and casualty rates for the uranium fuel cycle

    International Nuclear Information System (INIS)

    O'Donnell, F.R.; Hoy, H.C.

    1981-10-01

    Occupational casualty (injuries, illnesses, fatalities, and lost workdays) and production data are presented and used to calculate occupational casualty incidence rates for technologies that make up the uranium fuel cycle, including: mining, milling, conversion, and enrichment of uranium; fabrication of reactor fuel; transportation of uranium and fuel elements; generation of electric power; and transmission of electric power. Each technology is treated in a separate chapter. All data sources are referenced. All steps used to calculate normalized occupational casualty incidence rates from the data are presented. Rates given include fatalities, serious cases, and lost workdays per 100 man-years worked, per 10 12 Btu of energy output, and per other appropriate units of output

  2. How will military/civilian coordination work for reception of mass casualties from overseas?

    Science.gov (United States)

    Mackenzie, Colin; Donohue, John; Wasylina, Philip; Cullum, Woodrow; Hu, Peter; Lam, David M

    2009-01-01

    In Maryland, there have been no military/civilian training exercises of the Medical Mutual Aid Agreement for >20 years. The aims of this paper are to describe the National Disaster Medical System (NDMS), to coordinate military and civilian medical mutual aid in response to arrival of overseas mass casualties, and to evaluate the mass-casualty reception and bed "surge" capacity of Maryland NDMS Hospitals. Three tabletop exercises and a functional exercise were performed using a simulated, overseas, military mass-casualty event. The first tabletop exercise was with military and civilian NMDS partners. The second tested the revised NDMS activation plan. The third exercised the Authorities of State Emergency Medical System and Walter Reed Army Medical Center Directors of Emergency Medicine over Maryland NDMS hospitals, and their Medical Mutual Aid Agreement. The functional exercise used Homeland Security Exercise Evaluation Program tools to evaluate reception, triage, staging, and transportation of 160 notional patients (including 20 live, moulaged "patients") and one canine. The first tabletop exercise identified deficiencies in operational protocols for military/civilian mass-casualty reception, triage, treatment, and problems with sharing a Unified Command. The second found improvements in the revised NDMS activation plan. The third informed expectations for NDMS hospitals. In the functional exercise, all notional patients were received, triaged, dispatched, and accounted in military and five civilian hospitals within two hours. The canine revealed deficiencies in companion/military animal reception, holding, treatment, and evacuation. Three working groups were suggested: (1) to ensure 100% compliance with triage tags, patient accountability, and return of equipment used in mass casualty events and exercises; (2) to investigate making information technology and imaging networks available for Emergency Operation Centers and Incident Command; and (3) to establish NDMS

  3. Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution.

    Science.gov (United States)

    Shartar, Samuel E; Moore, Brooks L; Wood, Lori M

    2017-12-01

    Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care. Working with hospitals within the region, we refined emergency department surge capacity for MCIs and developed a prepopulated tool for EMS providers to use to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to nontrauma hospitals. A mechanism to remove a hospital from the list of available resources, if it is overwhelmed with patients who self-transport to the location, also was put into place. The number of critically injured survivors from an MCI has proven to be consistent, averaging 7% to 10%. Moving critically injured patients to level 1 trauma centers can result in a 25% reduction in mortality, when compared with care at nontrauma hospitals. US cities face major gaps in the surge capacity needed to manage an MCI. Sixty percent of "walking wounded" casualties self-transport to the closest hospital(s) to the incident. Directing critically ill patients to designated trauma centers has the potential to reduce mortality associated with the event. When applied to MCI responses, damage-control principles reduce resource utilization and optimize surge capacity. A universal system for mass casualty triage was identified and incorporated into the region's EMS. Flagship regional coordinating hospitals were designated

  4. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway.

    Science.gov (United States)

    Young, Victoria Solveig; Eggesbø, Heidi B; Gaarder, Christine; Næss, Pål Aksel; Enden, Tone

    2017-07-01

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. • Minimum acceptable care (MAC) should replace normal routines in mass casualty incidents. • MAC implied reduced use of imaging in the emergency department (ED). • CT in ED was restricted to suspected severe head injuries during MAC. • The radiologist should cancel all non-head CTs in the ED during MAC.

  5. Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model.

    Science.gov (United States)

    Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu

    2018-01-01

    Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

  6. Problems associated with the organization and planning of medical aid for radiation accident casualties

    International Nuclear Information System (INIS)

    Jammet, H.P.

    1977-01-01

    Problems associated with the organization and planning of medical treatment for radiation accident casualties are considered for different types of radiation accident: whole-body or partial irradiation, external or internal contamination and small or large numbers of cases. The problems posed are ones of competence, urgency and capacity; on the diagnostic side there is the problem of evaluating the exposure or contamination and assessing the resultant damage, while on the treatment side the questions of first aid, conventional treatment and specialized treatment have to be considered. The solutions envisaged involve organization at the local and national levels and planning of medical treatment by skilled, multidisciplinary medical teams. (author)

  7. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    Science.gov (United States)

    Spano, Susanne J; Campagne, Danielle; Stroh, Geoff; Shalit, Marc

    2015-03-01

    Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  8. Mass Casualty Decontamination in a Chemical or Radiological/ Nuclear Incident: Further Guiding Principles

    Science.gov (United States)

    Carter, Holly; Amlôt, Richard; Williams, Richard; Rubin, G. James; Drury, John

    2016-01-01

    This short report presents a response to an article written by Cibulsky et al. (2016). The paper by Cibulsky et al. presents a useful and timely overview of the evidence surrounding the technical and operational aspects of mass casualty decontamination. It identifies three priority targets for future research, the third of which is how casualties' needs can be met in ways that best support compliance with and effectiveness of casualty decontamination. While further investigation into behavioural, communication and privacy issues during mass decontamination is warranted, there is now a substantial body of research in this area which is not considered in detail in the succinct summary provided by Cibulsky et al. (2016). In this short report, we summarise the available evidence around likely public behaviour during mass decontamination, effective communication strategies, and potential issues resulting from a lack of privacy. Our intention is to help further focus the research needs in this area and highlight topics on which more research is needed. PMID:27790381

  9. Regional coordination in medical emergencies and major incidents; plan, execute and teach

    Directory of Open Access Journals (Sweden)

    Hedelin Annika

    2009-07-01

    Full Text Available Abstract Background Although disasters and major incidents are difficult to predict, the results can be mitigated through planning, training and coordinated management of available resources. Following a fire in a disco in Gothenburg, causing 63 deaths and over 200 casualties, a medical disaster response centre was created. The center was given the task to coordinate risk assessments, disaster planning and training of staff within the region and on an executive level, to be the point of contact (POC with authority to act as "gold control," i.e. to take immediate strategic command over all medical resources within the region if needed. The aim of this study was to find out if the centre had achieved its tasks by analyzing its activities. Methods All details concerning alerts of the regional POC was entered a web-based log by the duty officer. The data registered in this database was analyzed during a 3-year period. Results There was an increase in number of alerts between 2006 and 2008, which resulted in 6293 activities including risk assessments and 4473 contacts with major institutions or key persons to coordinate or initiate actions. Eighty five percent of the missions were completed within 24 h. Twenty eight exercises were performed of which 4 lasted more than 24 h. The centre also offered 145 courses in disaster and emergency medicine and crisis communication. Conclusion The data presented in this study indicates that the center had achieved its primary tasks. Such regional organization with executive, planning, teaching and training responsibilities offers possibilities for planning, teaching and training disaster medicine by giving immediate feed-back based on real incidents.

  10. Drones at the service for training on mass casualty incident: A simulation study.

    Science.gov (United States)

    Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo

    2017-06-01

    Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants.

  11. Management of Multi-Casualty Incidents in Mountain Rescue: Evidence-Based Guidelines of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    Science.gov (United States)

    Blancher, Marc; Albasini, François; Elsensohn, Fidel; Zafren, Ken; Hölzl, Natalie; McLaughlin, Kyle; Wheeler, Albert R; Roy, Steven; Brugger, Hermann; Greene, Mike; Paal, Peter

    2018-02-15

    Blancher, Marc, François Albasini, Fidel Elsensohn, Ken Zafren, Natalie Hölzl, Kyle McLaughlin, Albert R. Wheeler III, Steven Roy, Hermann Brugger, Mike Greene, and Peter Paal. Management of multi-casualty incidents in mountain rescue. High Alt Med Biol. 00:000-000, 2018. Multi-Casualty Incidents (MCI) occur in mountain areas. Little is known about the incidence and character of such events, and the kind of rescue response. Therefore, the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) set out to provide recommendations for the management of MCI in mountain areas. Details of MCI occurring in mountain areas related to mountaineering activities and involving organized mountain rescue were collected. A literature search using (1) PubMed, (2) national mountain rescue registries, and (3) lay press articles on the internet was performed. The results were analyzed with respect to specific aspects of mountain rescue. We identified 198 MCIs that have occurred in mountain areas since 1956: 137 avalanches, 38 ski lift accidents, and 23 other events, including lightning injuries, landslides, volcanic eruptions, lost groups of people, and water-related accidents. General knowledge on MCI management is required. Due to specific aspects of triage and management, the approach to MCIs may differ between those in mountain areas and those in urban settings. Mountain rescue teams should be prepared to manage MCIs. Knowledge should be reviewed and training performed regularly. Cooperation between terrestrial rescue services, avalanche safety authorities, and helicopter crews is critical to successful management of MCIs in mountain areas.

  12. Developing and Organizing a Trauma System and Mass Casualty ...

    African Journals Online (AJOL)

    An effective trauma system may potentially manage mass casualty incidence ... Israel has a unique trauma system of organizing and managing an emergency event, ... Wisdom, motivation and pragmatism of the Israeli model may be useful to ...

  13. Mass-casualty events at schools: a national preparedness survey.

    Science.gov (United States)

    Graham, James; Shirm, Steve; Liggin, Rebecca; Aitken, Mary E; Dick, Rhonda

    2006-01-01

    Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

  14. Patient distribution in a mass casualty event of an airplane crash.

    Science.gov (United States)

    Postma, Ingri L E; Weel, Hanneke; Heetveld, Martin J; van der Zande, Ineke; Bijlsma, Taco S; Bloemers, Frank W; Goslings, J Carel

    2013-11-01

    Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam. Analysis of the patient distribution of 126 surviving casualties of the crash by collecting data on medical treatment capacity, number of patients received per hospital, triage classification, Injury Severity Score (ISS), secondary transfers, distance from the crash site, and the critical mortality rate. The PDP holds ambiguous definitions of medical treatment capacity and was not followed. There were 14 receiving hospitals (distance from crash: 5.8-53.5 km); four hospitals received 133-213% of their treatment capacity, and 5 hospitals received 1 patient. Three hospitals within 20 km of the crash did not receive any casualties. Level I trauma centres received 89% of the 'critical' casualties and 92% of the casualties with ISS ≥ 16. Only 3 casualties were secondarily transferred, and no casualties died in, or on the way to hospital (critical mortality rate=0%). Patient distribution worked out well after the crash as secondary transfers were low and critical mortality rate was zero. However, the regional PDP was not followed in this MCI and casualties were unevenly distributed among hospitals. The PDP is indistinctive, and should be updated in cooperation between Emergency Services, surrounding hospitals, and Schiphol International Airport as a high risk area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Review of On-Scene Management of Mass-Casualty Attacks

    Directory of Open Access Journals (Sweden)

    Annelie Holgersson

    2016-02-01

    Full Text Available Background: The scene of a mass-casualty attack (MCA entails a crime scene, a hazardous space, and a great number of people needing medical assistance. Public transportation has been the target of such attacks and involves a high probability of generating mass casualties. The review aimed to investigate challenges for on-scene responses to MCAs and suggestions made to counter these challenges, with special attention given to attacks on public transportation and associated terminals. Methods: Articles were found through PubMed and Scopus, “relevant articles” as defined by the databases, and a manual search of references. Inclusion criteria were that the article referred to attack(s and/or a public transportation-related incident and issues concerning formal on-scene response. An appraisal of the articles’ scientific quality was conducted based on an evidence hierarchy model developed for the study. Results: One hundred and five articles were reviewed. Challenges for command and coordination on scene included establishing leadership, inter-agency collaboration, multiple incident sites, and logistics. Safety issues entailed knowledge and use of personal protective equipment, risk awareness and expectations, cordons, dynamic risk assessment, defensive versus offensive approaches, and joining forces. Communication concerns were equipment shortfalls, dialoguing, and providing information. Assessment problems were scene layout and interpreting environmental indicators as well as understanding setting-driven needs for specialist skills and resources. Triage and treatment difficulties included differing triage systems, directing casualties, uncommon injuries, field hospitals, level of care, providing psychological and pediatric care. Transportation hardships included scene access, distance to hospitals, and distribution of casualties. Conclusion: Commonly encountered challenges during unintentional incidents were added to during MCAs

  16. Rotorcraft Use in Disaster Relief and Mass Casualty Incidents - Case Studies

    Science.gov (United States)

    1990-06-01

    Disaster Relief and Mass 6. Performing Organization Code C asuallty Incidents- C ase Studies 8._P rfo minOr ani ati nR porNo 7. Author (s) 8...disaster planning process; and 3) produce a color video tape promoting the need for and the use of rotorcraft and heliports in disaster relief. 17...disaster prepaLedness ageicies for use in the integration of local helicopter assets into the disaster planning process; and 3) produce a color video tape

  17. Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.

    Science.gov (United States)

    Dal Ponte, Silvana T; Dornelles, Carlos F D; Arquilla, Bonnie; Bloem, Christina; Roblin, Patricia

    2015-02-01

    On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses.

  18. Casualty data analysis of the world merchant fleet for reported fire and explosion incidents resulting in marine pollution

    Science.gov (United States)

    1995-02-01

    World wide merchant vessel fire and explosion data were analyzed to determine the contribution of these casualties to the marine pollution problem. The source of information is the Lloyd's Casualty Information System Data Base. The major findings of ...

  19. Red Tides: Mass casualty and whole blood at sea Red Tides.

    Science.gov (United States)

    Miller, Benjamin T; Lin, Andrew H; Clark, Susan C; Cap, Andrew P; Dubose, Joseph J

    2018-02-13

    The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP). The blood supply can be augmented with WFWB collected from a "walking blood bank" (WBB). Following a helicopter crash, six patients were transported by MV-22 Osprey to the USS Bataan. Patient 1 had a pelvic fracture, was managed with a pelvic binder, and received 4 units of pRBC, 2 units of FFP, and 6 units of WFWB. Patient 2, with a comminuted tibia and fibula fracture, underwent lower extremity four-compartment fasciotomy, and received 4 units of WFWB. Patient 3 underwent several procedures, including left anterior thoracotomy, aortic cross-clamping, exploratory laparotomy, small bowel resection, and tracheostomy. He received 8 units of pRBC, 8 units of FFP, and 28 units of WFWB. Patients 4 and 5 had suspected spine injuries and were managed non-operatively. Patient 6, with open tibia and fibula fractures, underwent lower extremity four-compartment fasciotomy with tibia external fixation and received 1 unit of WFWB. All patients survived aeromedical evacuation to a Role 4 medical facility and subsequent transfer to local hospitals. Maritime military mass casualty incidents are challenging, but the U.S. Navy's casualty-receiving ships are ready to perform RDCR at sea. Activation of the ship's WBB to transfuse WFWB is essential for hemostatic resuscitations afloat. V STUDY TYPE: Case series.

  20. Patient distribution in a mass casualty event of an airplane crash

    NARCIS (Netherlands)

    Postma, Ingri L. E.; Weel, Hanneke; Heetveld, Martin J.; van der Zande, Ineke; Bijlsma, Taco S.; Bloemers, Frank W.; Goslings, J. Carel

    2013-01-01

    Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam. Analysis of the patient distribution of 126

  1. 78 FR 38878 - Critical Incident Stress Plans

    Science.gov (United States)

    2013-06-28

    ... Institute (API); American Public Transportation Association (APTA); American Short Line and Regional...-0131, Notice No. 1] RIN 2130-AC00 Critical Incident Stress Plans AGENCY: Federal Railroad... incident stress plans that provide for appropriate support services to be offered to their employees who...

  2. The Role of Emergency Medical Service in CBR Incidents

    International Nuclear Information System (INIS)

    Castulik, P.

    2007-01-01

    Majority of Emergency Medical Services (EMS) have daily extensive experience with rescue of casualties having trauma injuries, resulting from conventional incidents. In the case of non-conventional incidents involving chemical, bacteriological or radiological (CBR) hazardous materials operational scene for all responders is begin to be more complicated due contamination of casualties, equipment and environment. Especially EMS personnel and receiving staff at the hospital have to work under very demanding condition due to burden of personal protective equipment (PPE) and awareness to avoiding cross-contamination during handling casualties. Those conditions require significantly different approaches for search and rescue of victims from incident site, through transportation and effective treatment at medical facilities. In cases when chemicals will be major hazard materials, the speed of rescue and treatment of victims is a major challenge. Each minute matter, and any delay of response could seriously complicated saving of lives and successful recovery of exposed victims. Success in rescue victims is finally measured thorough the ability of the first responders to save people... ALIVE..., no matter what surrounding condition is. The presentation is providing a view and suggestions on more rapid immediate medical response during non-conventional incidents. It names basic concept based on preparedness, early identification of CBR hazards through signs and symptoms of casualties, priorities of rescue procedures and care on-site, needs of decontamination, rapid evacuation casualties from a scene and immediate hospital response.(author)

  3. Role of radiology in the study and identification of casualty victims

    International Nuclear Information System (INIS)

    Lichtenstein, J.E.; Madewell, J.E.

    1982-01-01

    Radiology is assuming an increasingly important role in the investigation of casualty victims. Radiographic screening for foreign bodies, personal effects, dental and surgical artifacts and occult skeletal injury has long been an established technique in forensic medicine. Positive radiographic identification of the victims by comparison with antemortem films and records in a more recent, important development. Large scale radiographic investigations may require improvised facilities posing unaccustomed technical and logistical problems. Radiologic experience gained from aviation accident investigation is found to apply in other casualty situations as well as in individual fatality investigations. Radiologic data may aid determination of the cause of incidents, resulting in improved safety procedures and design, as well as serving humanitarian and forensic functions. (orig.)

  4. Manual estimation of fallout casualties. Final report

    International Nuclear Information System (INIS)

    Gant, K.S.; Haaland, C.M.

    1978-08-01

    A method is described for enabling Emergency Operating Centers (EOCs) to estimate nuclear fallout casualties (fatalities and injuries) during and after nuclear attack without the aid of computers. This method is compatible with the current manual method for estimating initial weapons effects. The new technique requires that the EOCs have information on nuclear detonations and upper wind conditions and that they have maps, a protractor, map overlay material, grease pencils, worksheets, and pencils. In addition, they will need two tables of data and a fallout casualty (FC) template, all supplied in this report. Five steps are involved in the estimation of fallout casualties for an area: sketching fallout wind streamlines on a map overlay; plotting locations of nuclear detonations and their fallout streamlines; measuring crosswind and upwind distances to detonation points from the point of interest; reading radiation exposure tables and summing the contributions from different weapons to obtain the exposure at that point; and using the FC template with the protection factor profile for the area to estimate fatalities and injuries. The tables of radiation exposure are based on a modified Weapons Systems Evaluation Group-10 (WSEG-10) fallout model. The table of county protection factor profiles (PFPs) assumes a Community Shelter Plan (CSP) posture

  5. Hospital planning for weapons of mass destruction incidents

    Directory of Open Access Journals (Sweden)

    Perry Ronald

    2006-01-01

    Full Text Available As terrorists attacks increase in frequency, hospital disaster plans need to be scrutinized to ensure that they take into account issues unique to weapons of mass destruction. This paper reports a review of the literature addressing hospital experiences with such incidents and the planning lessons thus learned. Construction of hospital disaster plans is examined as an ongoing process guided by the disaster planning committee. Hospitals are conceived as one of the components of a larger community disaster planning efforts, with specific attention devoted to defining important linkages among response organizations. This includes the public health authorities, political authorities, prehospital care agencies, and emergency management agencies. A review is completed of six special elements of weapons of mass destruction incidents that should be addressed in hospital disaster plans: incident command, hospital security, patient surge, decontamination, mental health consequences, and communications. The paper closes with a discussion of the importance of training and exercises in maintaining and improving the disaster plan.

  6. MiRTE: Mixed Reality Triage and Evacuation game for Mass Casualty information systems design, testing and training.

    Science.gov (United States)

    Yu, Xunyi; Ganz, Aura

    2011-01-01

    In this paper we introduce a Mixed Reality Triage and Evacuation game, MiRTE, that is used in the development, testing and training of Mass Casualty Incident (MCI) information systems for first responders. Using the Source game engine from Valve software, MiRTE creates immersive virtual environments to simulate various incident scenarios, and enables interactions between multiple players/first responders. What distinguishes it from a pure computer simulation game is that it can interface with external mass casualty incident management systems, such as DIORAMA. The game will enable system developers to specify technical requirements of underlying technology, and test different alternatives of design. After the information system hardware and software are completed, the game can simulate various algorithms such as localization technologies, and interface with an actual user interface on PCs and Smartphones. We implemented and tested the game with the DIORAMA system.

  7. Civilian casualties of Iraqi ballistic missile attack to

    Directory of Open Access Journals (Sweden)

    Khaji Ali

    2012-06-01

    Full Text Available 【Abstract】Objective: To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods: Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results: During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile. Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile. During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24% were excluded due to the lack of information. Among the remainders, 179 (55.8% were male and 142 (44.2% were female. The mean age of the victims was 25.3 years±19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded ar-eas is the major cause of high mortality in Tehran. The pres-ence of suitable warning system and shelters could reduce civilian casualties. Conclusion: The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile at-tacks are necessary. Key words: Mortality; War; Mass casualty incidents; Wounds and injuries

  8. [The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report].

    Science.gov (United States)

    Gałazkowski, Robert; Wejnarski, Arkadiusz; Baumberg, Ignacy; Świeżewski, Stanisław; Timler, Dariusz

    2014-01-01

    In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary.

  9. NATO Allied Medical Publication 7.5 (AMedP 7.5) NATO Planning Guide for the Estimation of CBRN Casualties

    Science.gov (United States)

    2016-12-01

    PROMULGATION [ Date ] 1. The enclosed Allied Medical Publication AMedP-7.5, NATO Planning Guide for the Estimation of CBRN Casualties, which has been... radioisotopes modeled are 60Co, 90Sr, 99Mo, 125I, 131I, 137Cs, 192Ir, 226Ra, 238Pu, 241Am, 252Cf. 2) Whole-body irradiation (from cloudshine, groundshine,9... Earth Shelter 16.67 66.67 Exposed/Dismounted 1.00 1.00 Foxhole (nuclear only)† 3.00 10.00 Masonry Building 8.33 6.67 Multi-Story Brick Building 1.33

  10. Tsunami Casualty Model

    Science.gov (United States)

    Yeh, H.

    2007-12-01

    More than 4500 deaths by tsunamis were recorded in the decade of 1990. For example, the 1992 Flores Tsunami in Indonesia took away at least 1712 lives, and more than 2182 people were victimized by the 1998 Papua New Guinea Tsunami. Such staggering death toll has been totally overshadowed by the 2004 Indian Ocean Tsunami that claimed more than 220,000 lives. Unlike hurricanes that are often evaluated by economic losses, death count is the primary measure for tsunami hazard. It is partly because tsunamis kill more people owing to its short lead- time for warning. Although exact death tallies are not available for most of the tsunami events, there exist gender and age discriminations in tsunami casualties. Significant gender difference in the victims of the 2004 Indian Ocean Tsunami was attributed to women's social norms and role behavior, as well as cultural bias toward women's inability to swim. Here we develop a rational casualty model based on humans' limit to withstand the tsunami flows. The application to simple tsunami runup cases demonstrates that biological and physiological disadvantages also make a significant difference in casualty rate. It further demonstrates that the gender and age discriminations in casualties become most pronounced when tsunami is marginally strong and the difference tends to diminish as tsunami strength increases.

  11. [Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery : Presentation of a treatment concept].

    Science.gov (United States)

    Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M

    2017-10-01

    The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a "normal" MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

  12. Population and energy elasticity of tornado casualties

    Science.gov (United States)

    Fricker, Tyler; Elsner, James B.; Jagger, Thomas H.

    2017-04-01

    Tornadoes are capable of catastrophic destruction and mass casualties, but there are yet no estimates of how sensitive the number of casualties are to changes in the number of people in harm's way or to changes in tornado energy. Here the relationship between tornado casualties (deaths and injuries), population, and energy dissipation is quantified using the economic concept of "elasticity." Records of casualties from individual tornadoes over the period 2007-2015 are fit to a regression model. The coefficient on the population term (population elasticity) indicates that a doubling in population increases the casualty rate by 21% [(17, 24)%, 95% credible interval]. The coefficient on the energy term (energy elasticity) indicates that a doubling in energy dissipation leads to a 33% [(30, 35)%, 95% credible interval] increase in the casualty rate. The difference in elasticity values show that on average, changes in energy dissipation have been relatively more important in explaining tornado casualties than changes in population. Assuming no changes in warning effectiveness or mitigation efforts, these elasticity estimates can be used to project changes in casualties given the known population trends and possible trends in tornado activity.

  13. Analysis of performance and stress caused by a simulation of a mass casualty incident.

    Science.gov (United States)

    Nieto Fernández-Pacheco, Antonio; Castro Delgado, Rafael; Arcos González, Pedro; Navarro Fernández, José Luis; Cerón Madrigal, José Joaquín; Juguera Rodriguez, Laura; Perez Alonso, Nuria; Armero-Barranco, David; Lidon López Iborra, María; Damian, Escribano Tortosa; Pardo Rios, Manuel

    2018-03-01

    To determine the stress that is potentially produced in professional health workers due to a mass casualty incident (MCI) simulated exercise, and its relation to prior academic training and the role played in the simulation. Observational study of stress in a MCI. For this work, two MCI drills comprised of 40 victims each were conducted. Two randomized groups of 36 students each were created: Master's Students Group (MSG) and Undergraduate Student Group (USG). The role performed by each student (triage or sectorization) was assessed. The stress level was determined by prior and subsequent measurements of alpha-amylase (αA), HR, SBP and DBP. The percentage of victims that were correctly triaged was 88.6%, 91.84% for MSG and 83.76% for the USG (p=0.004). The basal αA was 97,107.50±72,182.67IU/L and the subsequent αA was 136,195.55±90,176.46±IU/L (pperformed the triage and those who performed sectorization but there were no differences between undergraduate and Masters' students. Conducting a simulated exercise caused stress in personnel involved in the MCI, with a greater impact on participants who performed triage, although it was not influenced by their prior academic level. The stress level in our case did not affect or determine the performance of acquired skills. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI – A case report

    Directory of Open Access Journals (Sweden)

    Robert Gałązkowski

    2014-04-01

    Full Text Available In 2013 a fire broke out in the Nursing Home (NH in the Henryszew village 5 km away from the district hospital in Żyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI. Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. Med Pr 2014;65(2:289–295

  15. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway

    International Nuclear Information System (INIS)

    Young, Victoria Solveig; Eggesboe, Heidi B.; Enden, Tone; Gaarder, Christine; Naess, Paal Aksel

    2017-01-01

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. (orig.)

  16. Radiology response in the emergency department during a mass casualty incident: a retrospective study of the two terrorist attacks on 22 July 2011 in Norway

    Energy Technology Data Exchange (ETDEWEB)

    Young, Victoria Solveig; Eggesboe, Heidi B.; Enden, Tone [Oslo University Hospital, Division of Radiology and Nuclear Medicine, Oslo (Norway); Gaarder, Christine [Oslo University Hospital, Department of Traumatology, Oslo (Norway); Naess, Paal Aksel [Oslo University Hospital, Department of Traumatology, Oslo (Norway); Oslo University Hospital, Department of Paediatric Surgery, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo (Norway)

    2017-07-15

    To describe the use of radiology in the emergency department (ED) in a trauma centre during a mass casualty incident, using a minimum acceptable care (MAC) strategy in which CT was restricted to potentially severe head injuries. We retrospectively studied the initial use of imaging on patients triaged to the trauma centre following the twin terrorist attacks in Norway on 22 July 2011. Nine patients from the explosion and 15 from the shooting were included. Fourteen patients had an Injury Severity Score >15. During the first 15 h, 22/24 patients underwent imaging in the ED. All 15 gunshot patients had plain films taken in the ED, compared to three from the explosion. A CT was performed in 18/24 patients; ten of these were completed in the ED and included five non-head CTs, the latter representing deviations from the MAC strategy. No CT referrals were delayed or declined. Mobilisation of radiology personnel resulted in a tripling of the staff. Plain film and CT capacity was never exceeded despite deviations from the MAC strategy. An updated disaster management plan will require the radiologist to cancel non-head CTs performed in the ED until no additional MCI patients are expected. (orig.)

  17. Difference in First Aid Activity During Mass Casualty Training Based on Having Taken an Educational Course.

    Science.gov (United States)

    Yanagawa, Youichi; Omori, Kazuhiko; Ishikawa, Kouhei; Takeuchi, Ikuto; Jitsuiki, Kei; Yoshizawa, Toshihiko; Sato, Jun; Matsumoto, Hideyuki; Tsuchiya, Masaru; Osaka, Hiromichi

    2017-11-20

    The Japanese Association for Disaster Medicine developed a mass casualty life support (MCLS) course to improve cooperation among medical practitioners during a disaster, which is essential for reducing the rates of preventable disaster death. We investigated whether there was difference in first aid activity among members of the ambulance service during mass casualty training based on having taken the MCLS course. Mass casualty training was held at the fire department of Numazu City. Twenty-one ambulance service parties participated in this training. They first evaluated the mass casualty situation, performed the appropriate services at the scene during the initial period, and then provided START triage for mock wounded patients. Throughout the training, 5 examiners evaluated their performance. Regarding the difference in first aid activity based on MCLS course attendance among the ambulance service members, the cooperative management (scored on a scale of 1 to 5) among the members who had taken the MCLS course was significantly better than that among those who had not taken the course (median [interquartile range]: 5 [0.5] vs. 4 [1.75], P<0.05). Attending an MCLS course may help to improve outcomes in the face of an actual mass casualty incident. (Disaster Med Public Health Preparedness. 2017;page 1 of 4).

  18. Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdullah A. Bin Shalhoub

    2017-03-01

    Full Text Available Objectives: To identify and describe the hospital disaster preparedness (HDP in major private hospitals in Riyadh, Saudi Arabia. Methods: This is an observational cross-sectional survey study performed in Riyadh city, Saudi Arabia between December 2015 and April 2016. Thirteen major private hospitals in Riyadh with more than 100 beds capacity were included in this investigation. Results: The 13 hospitals had HDP plan and reported to have an HDP committee. In 12 (92.3% hospitals, the HDP covered both internal and external disasters and HDP was available in every department of the hospital. There were agreements with other hospitals to accept patients during disasters in 9 facilities (69.2% while 4 (30.8% did not have such agreement. None of the hospitals conducted any unannounced exercises in previous year. Conclusion: Most of the weaknesses were apparent particularly in the education, training and monitoring of the hospital staff to the preparedness for disaster emergency occasion. Few hospitals had conducted an exercise with casualties, few had drilled evacuation of staff and patients in the last 12 months, and none had any unannounced exercise in the last year.

  19. Experience in the management of the mass casualty from the January 2010 Jos Crisis.

    Science.gov (United States)

    Ozoilo, K N; Amupitan, I; Peter, S D; Ojo, E O; Ismaila, B O; Ode, M; Adoga, A A; Adoga, A S

    2016-01-01

    On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

  20. Performance of portable ventilators for mass-casualty care.

    Science.gov (United States)

    Blakeman, Thomas C; Rodriquez, Dario; Dorlac, Warren C; Hanseman, Dennis J; Hattery, Ellie; Branson, Richard D

    2011-10-01

    Disasters and mass-casualty scenarios may overwhelm medical resources regardless of the level of preparation. Disaster response requires medical equipment, such as ventilators, that can be operated under adverse circumstances and should be able to provide respiratory support for a variety of patient populations. The objective of this study was to evaluate the performance of three portable ventilators designed to provide ventilatory support outside the hospital setting and in mass-casualty incidents, and their adherence to the Task Force for Mass Critical Care recommendations for mass-casualty care ventilators. Each device was evaluated at minimum and maximum respiratory rate and tidal volume settings to determine the accuracy of set versus delivered VT at lung compliance settings of 0.02, 0.08 and 0.1 L/cm H20 with corresponding resistance settings of 10, 25, and 5 cm H2O/L/sec, to simulate patients with ARDS, severe asthma, and normal lungs. Additionally, different FIO2 settings with each device (if applicable) were evaluated to determine accuracy of FIO2 delivery and evaluate the effect on delivered VT. Ventilators also were tested for duration of battery life. VT decreased with all three devices as compliance decreased. The decrease was more pronounced when the internal compressor was activated. At the 0.65 FIO2 setting on the MCV 200, the measured FIO2 varied widely depending on the set VT. Battery life range was 311-582 minutes with the 73X having the longest battery life. Delivered VT decreased toward the end of battery life with the SAVe having the largest decrease. The respiratory rate on the SAVe also decreased approaching the end of battery life. The 73X and MCV 200 were the closest to satisfying the Task Force for Mass Critical Care requirements for mass casualty ventilators, although neither had the capability to provide PEEP. The 73X provided the most consistent tidal volume delivery across all compliances, had the longest battery duration and the

  1. 49 CFR 225.15 - Accidents/incidents not to be reported.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Accidents/incidents not to be reported. 225.15... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD ACCIDENTS/INCIDENTS: REPORTS CLASSIFICATION, AND INVESTIGATIONS § 225.15 Accidents/incidents not to be reported. A railroad need not report: (a) Casualties which...

  2. Kentucky's highway incident management strategic plan.

    Science.gov (United States)

    2005-06-01

    Kentucky s Highway Incident Management Strategic Plan consists of a mission statement, 4 goals, 16 objectives, and 49 action strategies. The action strategies are arranged by priority and recommended time frame for implementation. When implemented...

  3. Ship Engine Room Casualty Analysis by Using Decision Tree Method

    Directory of Open Access Journals (Sweden)

    Ömür Yaşar SAATÇİOĞLU

    2017-03-01

    Full Text Available Ships may encounter undesirable conditions during operations. In consequence of a casualty, fire, explosion, flooding, grounding, injury even death may occur. Besides, these results can be avoidable with precautions and preventive operating processes. In maritime transportation, casualties depend on various factors. These were listed as misuse of the engine equipment and tools, defective machinery or equipment, inadequacy of operational procedure and measure of safety and force majeure effects. Casualty reports which were published in Australia, New Zealand, United Kingdom, Canada and United States until 2015 were examined and the probable causes and consequences of casualties were determined with their occurrence percentages. In this study, 89 marine investigation reports regarding engine room casualties were analyzed. Casualty factors were analyzed with their frequency percentages and also their main causes were constructed. This study aims to investigate engine room based casualties, frequency of each casualty type and main causes by using decision tree method.

  4. Preparedness for and response to a radiological or nuclear incident

    International Nuclear Information System (INIS)

    Norman Coleman, C.

    2014-01-01

    Public health and medical planning for a nuclear or radiological incident requires a complex, multi-faceted systematic approach involving federal, state and local governments, private sector organizations, academia, industry, international partners and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services in collaboration with other U.S. Departments is the result of efforts from government and non-government experts that connect the available capabilities, resources, guidance tools, underlying concepts and science into the Nuclear Incident Medical Enterprise (NlME). It is a systems approach that can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Experience is gained in exercises specific to radiation but also from other mass casualty incidents as there are many principles and components in common. Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by effective planning, preparation and training, timely response, clear communication, and continuous improvements based on new science, technology, experience and ideas. Recognizing that preparation for a radiological or nuclear incident will be a lower priority for healthcare workers and responders due to other demands, the Radiation Emergency Medical Management website has been developed with the National Library of Medicine. This includes tools for education and training, just-in-time medical management and triage among others. Most of the components of NIME are published in the peer review medical and disaster medicine literature to help ensure high quality and accessibility. While NIME is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is presented. (author)

  5. Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains.

    Science.gov (United States)

    Pennardt, Andre; Callaway, David W; Kamin, Rich; Llewellyn, Craig; Shapiro, Geoff; Carmona, Philip A; Schwartz, Richard B

    2016-01-01

    Tactical emergency medical support (TEMS) is a critical component of the out-of-hospital response to domestic high-threat incidents such as hostage scenarios, warrant service, active shooter or violent incidents, terrorist attacks, and other intentional mass casualty-producing acts. From its grass-roots inception in the form of medical support of select law enforcement special weapons and tactics (SWAT) units in the 1980s, the TEMS subspecialty of prehospital care has rapidly grown and evolved over the past 40 years. The National TEMS Initiative and Council (NTIC) competencies and training objectives are the only published recommendations of their kind and offer the opportunity for national standardization of TEMS training programs and a future accreditation process. Building on the previous work of the NTIC and the creation of acknowledged competency domains for TEMS and the acknowledged civilian translation of TCCC by the Committee for Tactical Emergency Casualty Care (C-TECC), the Joint Review Committee (JRC) has created an opportunity to bring forward the work in a form that could be operationally useful in an all-hazards and whole of community format. 2016.

  6. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2016-04-01

    Full Text Available Background: Psychologically traumatic workplace events (known as critical incidents, which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. Objective: To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. Methods: Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. Results: The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. Conclusion: Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.

  7. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution.

    Science.gov (United States)

    DeFraia, G S

    2016-04-01

    Psychologically traumatic workplace events (known as critical incidents), which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.

  8. Computer Security Incident Response Planning at Nuclear Facilities

    International Nuclear Information System (INIS)

    2016-06-01

    The purpose of this publication is to assist Member States in developing comprehensive contingency plans for computer security incidents with the potential to impact nuclear security and/or nuclear safety. It provides an outline and recommendations for establishing a computer security incident response capability as part of a computer security programme, and considers the roles and responsibilities of the system owner, operator, competent authority, and national technical authority in responding to a computer security incident with possible nuclear security repercussions

  9. Do lower income areas have more pedestrian casualties?

    Science.gov (United States)

    Noland, Robert B; Klein, Nicholas J; Tulach, Nicholas K

    2013-10-01

    Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Agency procedures for the NRC incident response plan. Final report

    International Nuclear Information System (INIS)

    1983-02-01

    The NRC Incident Response Plan, NUREG-0728/MC 0502 describes the functions of the NRC during an incident and the kinds of actions that comprise an NRC response. The NRC response plan will be activated in accordance with threshold criteria described in the plan for incidents occurring at nuclear reactors and fuel facilities involving materials licensees; during transportation of licensed material, and for threats against facilities or licensed material. In contrast to the general overview provided by the Plan, the purpose of these agency procedures is to delineate the manner in which each planned response function is performed; the criteria for making those response decisions which can be preplanned; and the information and other resources needed during a response. An inexperienced but qualified person should be able to perform functions assigned by the Plan and make necessary decisions, given the specified information, by becoming familiar with these procedures. This rule of thumb has been used to determine the amount of detail in which the agency procedures are described. These procedures form a foundation for the training of response personnel both in their normal working environment and during planned emergency exercises. These procedures also form a ready reference or reminder checklist for technical team members and managers during a response

  11. 26 CFR 1.165-7 - Casualty losses.

    Science.gov (United States)

    2010-04-01

    ... where damage by casualty has occurred to a building and ornamental or fruit trees used in a trade or business, the decrease in value shall be measured by taking the building and trees into account separately... building and trees. (ii) In determining a casualty loss involving real property and improvements thereon...

  12. Mass casualty tracking with air traffic control methodologies.

    Science.gov (United States)

    Hoskins, Jason D; Graham, Ross F; Robinson, Duane R; Lutz, Clifford C; Folio, Les R

    2009-06-01

    An intrahospital casualty throughput system modeled after air traffic control (ATC) tracking procedures was tested in mass casualty exercises. ATC uses a simple tactile process involving informational progress strips representing each aircraft, which are held in bays representing each stage of flight to prioritize and manage aircraft. These strips can be reordered within the bays to indicate a change in priority of aircraft sequence. In this study, a similar system was designed for patient tracking. We compared the ATC model and traditional casualty tracking methods of paper and clipboard in 18 four-hour casualty scenarios, each with 5 to 30 mock casualties. The experimental and control groups were alternated to maximize exposure and minimize training effects. Results were analyzed with Mann-Whitney statistical analysis with p value < 0.05 (two-sided). The ATC method had significantly (p = 0.017) fewer errors in critical patient data (eg, name, social security number, diagnosis). Specifically, the ATC method better tracked the mechanism of injury, working diagnosis, and disposition of patients. The ATC method also performed considerably better with patient accountability during mass casualty scenarios. Data strips were comparable with the control method in terms of ease of use. In addition, participants preferred the ATC method to the control (p = 0.003) and preferred using the ATC method (p = 0.003) to traditional methods in the future. The ATC model more effectively tracked patient data with fewer errors when compared with the clipboard method. Application of these principles can enhance trauma management and can have application in civilian and military trauma centers and emergency rooms.

  13. Development of Kentucky's highway incident management strategic plan.

    Science.gov (United States)

    2005-05-01

    ven though Kentucky has undertaken many initiatives to improve specific aspects of incident management, there has never been a plan that establishes an overall framework for a systematic, statewide, multi-agency effort to improve the management of hi...

  14. Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Simon, Erica; Maddry, Joseph K; Carter, Robert; Delorenzo, Robert A

    2017-08-01

    Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included. Data Fifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as "routine." Follow-up data were available for 36 of the subjects and 97% were discharged alive. The most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines. Schauer SG , April MD , Simon E , Maddry JK , Carter R III , Delorenzo RA . Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465-468.

  15. Increased situation awareness in major incidents-radio frequency identification (RFID) technique: a promising tool.

    Science.gov (United States)

    Jokela, Jorma; Rådestad, Monica; Gryth, Dan; Nilsson, Helené; Rüter, Anders; Svensson, Leif; Harkke, Ville; Luoto, Markku; Castrén, Maaret

    2012-02-01

    In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.

  16. The Internet's role in a biodosimetric response to a radiation mass casualty event.

    Science.gov (United States)

    Sugarman, S L; Livingston, G K; Stricklin, D L; Abbott, M G; Wilkins, R C; Romm, H; Oestreicher, U; Yoshida, M A; Miura, T; Moquet, J E; Di Giorgio, M; Ferrarotto, C; Gross, G A; Christiansen, M E; Hart, C L; Christensen, D M

    2014-05-01

    Response to a large-scale radiological incident could require timely medical interventions to minimize radiation casualties. Proper medical care requires knowing the victim's radiation dose. When physical dosimetry is absent, radiation-specific chromosome aberration analysis can serve to estimate the absorbed dose in order to assist physicians in the medical management of radiation injuries. A mock exercise scenario was presented to six participating biodosimetry laboratories as one individual acutely exposed to Co under conditions suggesting whole-body exposure. The individual was not wearing a dosimeter and within 2-3 h of the incident began vomiting. The individual also had other medical symptoms indicating likelihood of a significant dose. Physicians managing the patient requested a dose estimate in order to develop a treatment plan. Participating laboratories in North and South America, Europe, and Asia were asked to evaluate more than 800 electronic images of metaphase cells from the patient to determine the dicentric yield and calculate a dose estimate with 95% confidence limits. All participants were blind to the physical dose until after submitting their estimates based on the dicentric chromosome assay (DCA). The exercise was successful since the mean biological dose estimate was 1.89 Gy whereas the actual physical dose was 2 Gy. This is well within the requirements for guidance of medical management. The exercise demonstrated that the most labor-intensive step in the entire process (visual evaluation of images) can be accelerated by taking advantage of world-wide expertise available on the Internet.

  17. Amputations in natural disasters and mass casualties: staged approach.

    Science.gov (United States)

    Wolfson, Nikolaj

    2012-10-01

    Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.

  18. NAIR: handbook on the national arrangements for incidents involving radioactivity

    International Nuclear Information System (INIS)

    1987-01-01

    A revised handbook on the national arrangements for incidents involving radioactivity (NAIR) has been published. Following brief introductory sections on the administrative aspects and operational aspects, the main part of the handbook is devoted to operational and call-out lists including an index of police forces served by NAIR, an index of establishments providing assistance under NAIR, sources of stage 1 and stage 2 assistance for each police constabulary, hospitals prepared to accept contaminated casualties and to assist with decontamination of personnel, and hospitals prepared to advise on the treatment and admission of casualties exposed to large doses of radiation. Technical appendices are also given on radiological protection in NAIR incidents, instruments and equipment, radionuclide data and a guide to suitable detectors, package and source identification and disposal of radioactive materials involved in NAIR accidents. (U.K.)

  19. Serious gaming technology in major incident triage training: a pragmatic controlled trial.

    Science.gov (United States)

    Knight, James F; Carley, Simon; Tregunna, Bryan; Jarvis, Steve; Smithies, Richard; de Freitas, Sara; Dunwell, Ian; Mackway-Jones, Kevin

    2010-09-01

    By exploiting video games technology, serious games strive to deliver affordable, accessible and usable interactive virtual worlds, supporting applications in training, education, marketing and design. The aim of the present study was to evaluate the effectiveness of such a serious game in the teaching of major incident triage by comparing it with traditional training methods. Pragmatic controlled trial. During Major Incident Medical Management and Support Courses, 91 learners were randomly distributed into one of two training groups: 44 participants practiced triage sieve protocol using a card-sort exercise, whilst the remaining 47 participants used a serious game. Following the training sessions, each participant undertook an evaluation exercise, whereby they were required to triage eight casualties in a simulated live exercise. Performance was assessed in terms of tagging accuracy (assigning the correct triage tag to the casualty), step accuracy (following correct procedure) and time taken to triage all casualties. Additionally, the usability of both the card-sort exercise and video game were measured using a questionnaire. Tagging accuracy by participants who underwent the serious game training was significantly higher than those who undertook the card-sort exercise [Chi2=13.126, p=0.02]. Step accuracy was also higher in the serious game group but only for the numbers of participants that followed correct procedure when triaging all eight casualties [Chi2=5.45, p=0.0196]. There was no significant difference in time to triage all casualties (card-sort=435+/-74 s vs video game=456+/-62 s, p=0.155). Serious game technologies offer the potential to enhance learning and improve subsequent performance when compared to traditional educational methods. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  20. The 43rd Infantry Division: Unit Cohesion and Neuropsychiatric Casualties

    National Research Council Canada - National Science Library

    Fuschak, K

    1999-01-01

    ..., The Solomon Islands, from July to September 1943. The study explores the multiple causes of these casualties, to include ignorance of lessons learned regarding neuropsychiatric casualties in World War I, general unpreparedness, poor training...

  1. The Casualty Actuarial Society: Helping Universities Train Future Actuaries

    Science.gov (United States)

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

    The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

  2. Five years after the accident, whiplash casualties still have poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort.

    Science.gov (United States)

    Tournier, Charlène; Hours, Martine; Charnay, Pierrette; Chossegros, Laetitia; Tardy, Hélène

    2016-01-05

    This study aims to compare health status and quality of life five years after a road accident between casualties with whiplash versus other mild injuries, to compare evolution of quality of life at 1 and 5 years after the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life. The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with "pure" whiplash and a population of 185 casualties with other mild injuries (MAIS-1). All subjects with lesions classified as cervical contusion (AIS code 310402) or neck sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. Whiplash injuries were then classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored by Poisson regression and variance analysis. Between 1 and 5 years, global QoL improved for both whiplash and non-whiplash casualties; but, considering the two whiplash groups separately, improvement in grade 2 was much less than in grade 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4%; p whiplash (24.3%) or grade-1 whiplash casualties (27.0%). Deteriorated quality of life in the mental, social and environmental domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD; unsatisfactory health at 5 years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role. Deteriorated quality of life in the physical domain

  3. Guidelines for Mass Casualty Decontamination During a HAZMAT/Weapon of Mass Destruction Incident. Volumes 1 and 2 (Update)

    Science.gov (United States)

    2013-08-01

    sounds of high-pressure gas leaking and the creaking or popping of expanding and failing metal containers. As previous events have demonstrated, it...different triage categories, affix a commercially available triage tag to each casualty. They are perforated for easy ripping . The bottom-most color of...pupil dilation, and cloudy consciousness. The person may be unable to walk or move his/her arms and legs and may curl up into a fetal position

  4. Public Health and Medical Preparedness for a Nuclear Detonation: The Nuclear Incident Medical Enterprise

    Science.gov (United States)

    Coleman, C. Norman; Sullivan, Julie M.; Bader, Judith L.; Murrain-Hill, Paula; Koerner, John F.; Garrett, Andrew L.; Weinstock, David M.; Case, Cullen; Hrdina, Chad; Adams, Steven A.; Whitcomb, Robert C.; Graeden, Ellie; Shankman, Robert; Lant, Timothy; Maidment, Bert W.; Hatchett, Richard C.

    2014-01-01

    Resilience and the ability to mitigate the consequences of a nuclear incident are enhanced by (1) effective planning, preparation and training; (2) ongoing interaction, formal exercises, and evaluation among the sectors involved; (3) effective and timely response and communication; and (4) continuous improvements based on new science, technology, experience and ideas. Public health and medical planning require a complex, multi-faceted systematic approach involving federal, state, local, tribal and territorial governments, private sector organizations, academia, industry, international partners, and individual experts and volunteers. The approach developed by the U.S. Department of Health and Human Services Nuclear Incident Medical Enterprise (NIME) is the result of efforts from government and nongovernment experts. It is a “bottom-up” systematic approach built on the available and emerging science that considers physical infrastructure damage, the spectrum of injuries, a scarce resources setting, the need for decision making in the face of a rapidly evolving situation with limited information early on, timely communication and the need for tools and just-in-time information for responders who will likely be unfamiliar with radiation medicine and uncertain and overwhelmed in the face of the large number of casualties and the presence of radioactivity. The components of NIME can be used to support planning for, response to, and recovery from the effects of a nuclear incident. Recognizing that it is a continuous work-in-progress, the current status of the public health and medical preparedness and response for a nuclear incident is provided. PMID:25551496

  5. Nuclear and radiological risk: contaminated mass casualties in the hospital

    International Nuclear Information System (INIS)

    Telion, C.; Lejay, M.; Carli, P.

    2006-01-01

    The basic scenario for the medical response organization is the explosion of the dirty bomb in public places spreading radioactive material and contaminating casualties. The French plan gives precise directions for the organization of the emergency room and the simple protective measures for medical staff and equipment to avoid dissemination and contamination into the hospital. Decontamination consists of the undressing of the victims followed by showering. The detection of the contamination can limit the time-consuming unnecessary decontamination procedure and the radioactive waste. Medical and paramedical staff is trained to wear protective disposal paper suits and to direct the procedure of decontamination. (author)

  6. Mathematical models for estimating earthquake casualties and damage cost through regression analysis using matrices

    International Nuclear Information System (INIS)

    Urrutia, J D; Bautista, L A; Baccay, E B

    2014-01-01

    The aim of this study was to develop mathematical models for estimating earthquake casualties such as death, number of injured persons, affected families and total cost of damage. To quantify the direct damages from earthquakes to human beings and properties given the magnitude, intensity, depth of focus, location of epicentre and time duration, the regression models were made. The researchers formulated models through regression analysis using matrices and used α = 0.01. The study considered thirty destructive earthquakes that hit the Philippines from the inclusive years 1968 to 2012. Relevant data about these said earthquakes were obtained from Philippine Institute of Volcanology and Seismology. Data on damages and casualties were gathered from the records of National Disaster Risk Reduction and Management Council. This study will be of great value in emergency planning, initiating and updating programs for earthquake hazard reduction in the Philippines, which is an earthquake-prone country.

  7. Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data

    Directory of Open Access Journals (Sweden)

    Richard Amlôt

    2012-10-01

    Full Text Available In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS. The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit.

  8. Literature review on medical incident command.

    Science.gov (United States)

    Rimstad, Rune; Braut, Geir Sverre

    2015-04-01

    It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published. This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders' performances be measured and assessed? A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis. The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders' tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted

  9. Blood transfusion is associated with infection and increased resource utilization in combat casualties.

    Science.gov (United States)

    Dunne, James R; Riddle, Mark S; Danko, Janine; Hayden, Rich; Petersen, Kyle

    2006-07-01

    Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P blood transfusion as an independent risk factor for ICU admission (P blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

  10. Survey of trauma registry data on tourniquet use in pediatric war casualties.

    Science.gov (United States)

    Kragh, John F; Cooper, Arthur; Aden, James K; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H

    2012-12-01

    Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009. Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use. The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training. Level 4; case series, therapeutic study.

  11. Death on the battlefield (2001-2011): implications for the future of combat casualty care.

    Science.gov (United States)

    Eastridge, Brian J; Mabry, Robert L; Seguin, Peter; Cantrell, Joyce; Tops, Terrill; Uribe, Paul; Mallett, Olga; Zubko, Tamara; Oetjen-Gerdes, Lynne; Rasmussen, Todd E; Butler, Frank K; Kotwal, Russ S; Kotwal, Russell S; Holcomb, John B; Wade, Charles; Champion, Howard; Lawnick, Mimi; Moores, Leon; Blackbourne, Lorne H

    2012-12-01

    Critical evaluation of all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among US combat fatalities, is central to identifying gaps in knowledge, training, equipment, and execution of battlefield trauma care. The impetus to produce this analysis was to develop a comprehensive perspective of battlefield death, concentrating on deaths that occurred in the pre-medical treatment facility (pre-MTF) environment. The Armed Forces Medical Examiner Service Mortality Surveillance Division was used to identify Operation Iraqi Freedom and Operation Enduring Freedom combat casualties from October 2001 to June 2011 who died from injury in the deployed environment. The autopsy records, perimortem records, photographs on file, and Mortality Trauma Registry of the Armed Forces Medical Examiner Service were used to compile mechanism of injury, cause of injury, medical intervention performed, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) on all lethal injuries. All data were used by the expert panel for the conduct of the potential for injury survivability assessment of this study. For the study interval between October 2001 and June 2011, 4,596 battlefield fatalities were reviewed and analyzed. The stratification of mortality demonstrated that 87.3% of all injury mortality occurred in the pre-MTF environment. Of the pre-MTF deaths, 75.7% (n = 3,040) were classified as nonsurvivable, and 24.3% (n = 976) were deemed potentially survivable (PS). The injury/physiologic focus of PS acute mortality was largely associated with hemorrhage (90.9%). The site of lethal hemorrhage was truncal (67.3%), followed by junctional (19.2%) and peripheral-extremity (13.5%) hemorrhage. Most battlefield casualties died of their injuries before ever reaching a surgeon. As most pre-MTF deaths are nonsurvivable, mitigation strategies to impact outcomes in this population need to be directed

  12. Management of Mass Casualty Burn Disasters

    National Research Council Canada - National Science Library

    Cancio, Leopoldo C; Pruitt, Basil A

    2005-01-01

    Mass casualty burn disasters are potentially challenging, in part because the majority of health care providers are inexperienced in the care of thermally injured patients and in part because of the...

  13. Benefits of multidisciplinary collaboration for earthquake casualty estimation models: recent case studies

    Science.gov (United States)

    So, E.

    2010-12-01

    Earthquake casualty loss estimation, which depends primarily on building-specific casualty rates, has long suffered from a lack of cross-disciplinary collaboration in post-earthquake data gathering. An increase in our understanding of what contributes to casualties in earthquakes involve coordinated data-gathering efforts amongst disciplines; these are essential for improved global casualty estimation models. It is evident from examining past casualty loss models and reviewing field data collected from recent events, that generalized casualty rates cannot be applied globally for different building types, even within individual countries. For a particular structure type, regional and topographic building design effects, combined with variable material and workmanship quality all contribute to this multi-variant outcome. In addition, social factors affect building-specific casualty rates, including social status and education levels, and human behaviors in general, in that they modify egress and survivability rates. Without considering complex physical pathways, loss models purely based on historic casualty data, or even worse, rates derived from other countries, will be of very limited value. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from

  14. Level I center triage and mass casualties.

    Science.gov (United States)

    Hoey, Brian A; Schwab, C William

    2004-05-01

    The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.

  15. Traffic accidents involving fatigue driving and their extent of casualties.

    Science.gov (United States)

    Zhang, Guangnan; Yau, Kelvin K W; Zhang, Xun; Li, Yanyan

    2016-02-01

    The rapid progress of motorization has increased the number of traffic-related casualties. Although fatigue driving is a major cause of traffic accidents, the public remains not rather aware of its potential harmfulness. Fatigue driving has been termed as a "silent killer." Thus, a thorough study of traffic accidents and the risk factors associated with fatigue-related casualties is of utmost importance. In this study, we analyze traffic accident data for the period 2006-2010 in Guangdong Province, China. The study data were extracted from the traffic accident database of China's Public Security Department. A logistic regression model is used to assess the effect of driver characteristics, type of vehicles, road conditions, and environmental factors on fatigue-related traffic accident occurrence and severity. On the one hand, male drivers, trucks, driving during midnight to dawn, and morning rush hours are identified as risk factors of fatigue-related crashes but do not necessarily result in severe casualties. Driving at night without street-lights contributes to fatigue-related crashes and severe casualties. On the other hand, while factors such as less experienced drivers, unsafe vehicle status, slippery roads, driving at night with street-lights, and weekends do not have significant effect on fatigue-related crashes, yet accidents associated with these factors are likely to have severe casualties. The empirical results of the present study have important policy implications on the reduction of fatigue-related crashes as well as their severity. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Fires in rooms containing electrical components - incident planning, fire fighting tactics, risks

    International Nuclear Information System (INIS)

    Magnusson, Tommy; Ottosson, Jan; Lindskog, BertiI; Soederquist Bende, Evy; Eriksson, Fredrik; Haffling, Stefan

    2006-12-01

    On July 1, 2005 a fire occurred within an electrical switch room at Forsmark Nuclear Power Plant. At the evaluation of the incident it was identified that the pre-fire plans did not give sufficient information in order to make the appropriate decisions. Questions raised based on the incident are how decisions are made and orders are delegated with respect to the incident command, which fire fighting tactic should be used, which types of extinguishing media should be used, what are the risks with respect to safety of staff and safety of the reactor. Lessons learned from the fire at Forsmark were that pre-incident planning was at hand but the information was not sufficient to make the correct initial decisions that might be critical for life and property. One of the most crucial ingredients in all safety related work is to utilize previous experience in order to maintain a high degree of safety. Lessons learnt are also the foundation on which the ability to construct or create strong barriers against a certain fault phenomena, fault mechanism or type of initial event. In the case of nuclear processes, fire is considered as an important and critical initial event which has to be recognized in a number of cases in order to maintain a safe process. The likelihood for a fire to represent an initial event should not be underestimated and can therefore not be neglected, probabilistically or deterministically, unless the inherent safety systems can not control the event in an acceptable manner. Regardless of safety measures and lessons learnt from previous experiences in the construction and the operation of the nuclear facility, fires can occur. Previous experiences point out that process system, e.g. systems that are part of the turbine, are more frequently subject to fire incidents compared to ordinary safety systems. Fires in electrical components, often electrical cabinets, can be difficult to handle and to extinguish quickly. This report presents the background work

  17. Application of Real-Time Automated Traffic Incident Response Plan Management System: A Web Structure for the Regional Highway Network in China

    Directory of Open Access Journals (Sweden)

    Yongfeng Ma

    2014-01-01

    Full Text Available Traffic incidents, caused by various factors, may lead to heavy traffic delay and be harmful to traffic capacity of downstream sections. Traffic incident management (TIM systems have been developed widely to respond to traffic incidents intelligently and reduce the losses. Traffic incident response plans, as an important component of TIM, can effectively guide responders as to what and how to do in traffic incidents. In the paper, a real-time automated traffic incident response plan management system was developed, which could generate and manage traffic incident response plans timely and automatically. A web application structure and a physical structure were designed to implement and show these functions. A standard framework of data storage was also developed to save information about traffic incidents and generated response plans. Furthermore, a conformation survey and case-based reasoning (CBR were introduced to identify traffic incident and generate traffic incident response plans automatically, respectively. Twenty-three traffic crash-related incidents were selected and three indicators were used to measure the system performance. Results showed that 20 of 23 cases could be retrieved effectively and accurately. The system is practicable to generate traffic incident response plans and has been implemented in China.

  18. Casualty Risk From Tornadoes in the United States is Highest in Urbanized Areas Across the Mid South

    Science.gov (United States)

    Fricker, T.; Elsner, J.

    2017-12-01

    Risk factors for tornado casualties are well known. Less understood is how and to what degree these determinants, after controlling for strength and urban density, vary spatially and temporally. Here we fit models to casualty counts from all casualty-producing tornadoes since 1995 in order to quantify the interactions between urbanization and energy on casualty rates. Results from the models show that the more urbanized areas of the Mid South are substantively and significantly more vulnerable to casualties from tornadoes than elsewhere in the country. Casualty rates are significantly higher on the weekend for tornadoes in this region. Night and day casualty rates are similar regardless of where they occur. Higher vulnerability to casualties from tornadoes occurring in more urbanized areas correspond significantly with greater percentages of elderly people. Many of the micro cities in the Mid South are threatened by tornadoes annually and this threat might potentially be exacerbated by climate change.

  19. A numerical simulation strategy on occupant evacuation behaviors and casualty prediction in a building during earthquakes

    Science.gov (United States)

    Li, Shuang; Yu, Xiaohui; Zhang, Yanjuan; Zhai, Changhai

    2018-01-01

    Casualty prediction in a building during earthquakes benefits to implement the economic loss estimation in the performance-based earthquake engineering methodology. Although after-earthquake observations reveal that the evacuation has effects on the quantity of occupant casualties during earthquakes, few current studies consider occupant movements in the building in casualty prediction procedures. To bridge this knowledge gap, a numerical simulation method using refined cellular automata model is presented, which can describe various occupant dynamic behaviors and building dimensions. The simulation on the occupant evacuation is verified by a recorded evacuation process from a school classroom in real-life 2013 Ya'an earthquake in China. The occupant casualties in the building under earthquakes are evaluated by coupling the building collapse process simulation by finite element method, the occupant evacuation simulation, and the casualty occurrence criteria with time and space synchronization. A case study of casualty prediction in a building during an earthquake is provided to demonstrate the effect of occupant movements on casualty prediction.

  20. Casualties and threshold effects

    International Nuclear Information System (INIS)

    Mays, C.W.; National Cancer Inst., Bethesda

    1988-01-01

    Radiation effects like cancer are denoted as casualties. Other radiation effects occur almost in everyone when the radiation dose is sufficiently high. One then speaks of radiation effects with a threshold dose. In this article the author puts his doubt about this classification of radiation effects. He argues that some effects of exposure to radiation do not fit in this classification. (H.W.). 19 refs.; 2 figs.; 1 tab

  1. Implementing RFID technology in a novel triage system during a simulated mass casualty situation.

    Science.gov (United States)

    Jokela, Jorma; Simons, Tomi; Kuronen, Pentti; Tammela, Juha; Jalasvirta, Pertti; Nurmi, Jouni; Harkke, Ville; Castrén, Maaret

    2008-01-01

    The purpose of this study is to determine the applicability of Radio Frequency Identification (RFID) technology and commercial cellular networks to provide an online triage system for handling mass casualty situations. This was tested by a using a pilot system for a simulated mass casualty situation during a military field exercise. The system proved to be usable. Compared to the currently used system, it also dramatically improves the general view of mass casualty situations and enhances medical emergency readiness in a military medical setting. The system can also be adapted without any difficulties by the civilian sector for the management of mass casualty disasters.

  2. Yale and the Atomic Bomb Casualty Commission

    International Nuclear Information System (INIS)

    Bowers, J.Z.

    1983-01-01

    This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation

  3. Westinghouse GOCO conduct of casualty drills

    International Nuclear Information System (INIS)

    Ames, C.P.

    1996-02-01

    Purpose of this document is to provide Westinghouse Government Owned Contractor Operated (GOCO) Facilities with information that can be used to implement or improve drill programs. Elements of this guide are highly recommended for use when implementing a new drill program or when assessing an existing program. Casualty drills focus on response to abnormal conditions presenting a hazard to personnel, environment, or equipment; they are distinct from Emergency Response Exercises in which the training emphasis is on site, field office, and emergency management team interaction. The DOE documents which require team training and conducting drills in nuclear facilities and should be used as guidance in non-nuclear facilities are: DOE 5480.19 (Chapter 1 of Attachment I) and DOE 5480.20 (Chapter 1, paragraphs 7 a. and d. of continuing training). Casualty drills should be an integral part of the qualification and training program at every DOE facility

  4. Estimating shaking-induced casualties and building damage for global earthquake events: a proposed modelling approach

    Science.gov (United States)

    So, Emily; Spence, Robin

    2013-01-01

    Recent earthquakes such as the Haiti earthquake of 12 January 2010 and the Qinghai earthquake on 14 April 2010 have highlighted the importance of rapid estimation of casualties after the event for humanitarian response. Both of these events resulted in surprisingly high death tolls, casualties and survivors made homeless. In the Mw = 7.0 Haiti earthquake, over 200,000 people perished with more than 300,000 reported injuries and 2 million made homeless. The Mw = 6.9 earthquake in Qinghai resulted in over 2,000 deaths with a further 11,000 people with serious or moderate injuries and 100,000 people have been left homeless in this mountainous region of China. In such events relief efforts can be significantly benefitted by the availability of rapid estimation and mapping of expected casualties. This paper contributes to ongoing global efforts to estimate probable earthquake casualties very rapidly after an earthquake has taken place. The analysis uses the assembled empirical damage and casualty data in the Cambridge Earthquake Impacts Database (CEQID) and explores data by event and across events to test the relationships of building and fatality distributions to the main explanatory variables of building type, building damage level and earthquake intensity. The prototype global casualty estimation model described here uses a semi-empirical approach that estimates damage rates for different classes of buildings present in the local building stock, and then relates fatality rates to the damage rates of each class of buildings. This approach accounts for the effect of the very different types of buildings (by climatic zone, urban or rural location, culture, income level etc), on casualties. The resulting casualty parameters were tested against the overall casualty data from several historical earthquakes in CEQID; a reasonable fit was found.

  5. The 2004 Fitts Lecture: Current Perspective on Combat Casualty Care

    Science.gov (United States)

    2005-07-01

    deliver this lecture, I actually wondered whether he had called the wrong number. Dr. Basil Pruitt described Dr. William P. Fitts in his 1992 Fitts Lecture...in our ability to care for injured casualties in a deployed setting. Dr. Basil Pruitt eloquently described the interaction between the AAST and...ation ( ABA ) verified burn centers (Fig. 3) in proximity to the USAF hubs.11 We anticipated between 500 and 2,500 burn casualties and created a

  6. Management of the mass casualty from the 2001 Jos crisis.

    Science.gov (United States)

    Ozoilo, K N; Kidmas, A T; Nwadiaro, H C; Iya, D; Onche, I I; Misauno, M A; Sule, A Z; Yiltok, S J; Uba, A F; Ramyil, V M; Dakum, N K; Ugwu, B T

    2014-01-01

    We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

  7. A management plan for hospitals and medical centers facing radiation incidents.

    Science.gov (United States)

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

    Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  8. The Casualty Network System Capstone Project

    Science.gov (United States)

    2012-12-01

    described by the Watts and Strogatz model (Watts & Strogatz , 1998). Based on the Watts and Strogatz model, the AF can be viewed as a small world...chemical casualties handbook (Vol. 7). Fort Detrick, MD: U.S. Government Printing Office. Watts, Duncan, & Strogatz , Steven (1998). Collective dynamics of

  9. Radiation protection - Performance criteria for laboratories performing cytogenetic triage for assessment of mass casualties in radiological or nuclear emergencies - General principles and application to dicentric assay

    International Nuclear Information System (INIS)

    2008-01-01

    The potential for nuclear and radiological emergencies involving mass casualties from accidental or malicious acts or terrorism requires generic procedures for emergency dose assessment to help the development of medical response capabilities. A mass-casualties incident is defined here as an event that exceeds the local medical resources. Biological dosimetry, based on cytogenetic analysis using the dicentric assay, typically applied for accidental dose assessment, has been defined in ISO 19238. Cytogenetic triage is the use of chromosome damage to evaluate and assess approximately and rapidly radiation doses received by individuals in order to supplement the clinical categorization of casualties. This International Standard focuses on the use of the dicentric assay for rapid cytogenetic triage involving mass-casualty incidents. The primary purpose of this International Standard is to provide a guideline to all laboratories in order to perform the dicentric-bioassay - cytogenetic triage for dose assessment using documented and validated procedures. Secondly, it can facilitate the application of cytogenetic biodosimetry networks to permit comparison of results obtained in different laboratories. Finally, it is expected that laboratories newly commissioned to carry out the cytogenetic triage conform to this International Standard in order to perform the triage reproducibly and accurately. This International Standard is written in the form of procedures to adopt for dicentric-bioassay - cytogenetic triage biological dosimetry for overexposures involving mass radiological casualties. The criteria required for such measurements usually depend on the application of the results: medical management when appropriate, radiation-protection management, record keeping and medical/legal requirements. For example, selected cases can be analysed to produce a more accurate evaluation of high partial-body exposure; secondly, doses can be estimated for persons exposed below the

  10. 19 CFR 158.21 - Allowance in duties for casualty, loss, or theft while in Customs custody.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Allowance in duties for casualty, loss, or theft... LOST, DAMAGED, ABANDONED, OR EXPORTED Casualty, Loss, or Theft While in Customs Custody § 158.21 Allowance in duties for casualty, loss, or theft while in Customs custody. Section 563(a), Tariff Act of...

  11. Emergency medical consequence planning and management for national special security events after September 11: Boston 2004.

    Science.gov (United States)

    Kade, Kristy A; Brinsfield, Kathryn H; Serino, Richard A; Savoia, Elena; Koh, Howard K

    2008-10-01

    The post-September 11 era has prompted unprecedented attention to medical preparations for national special security events (NSSE), requiring extraordinary planning and coordination among federal, state, and local agencies. For an NSSE, the US Secret Service (USSS) serves as the lead agency for all security operations and coordinates with relevant partners to provide for the safety and welfare of participants. For the 2004 Democratic National Convention (DNC), designated an NSSE, the USSS tasked the Boston Emergency Medical Services (BEMS) of the Boston Public Health Commission with the design and implementation of health services related to the Convention. In this article, we describe the planning and development of BEMS' robust 2004 DNC Medical Consequence Management Plan, addressing the following activities: public health surveillance, on-site medical care, surge capacity in the event of a mass casualty incident, and management of federal response assets. Lessons learned from enhanced medical planning for the 2004 DNC may serve as an effective model for future mass gathering events.

  12. Making the connection: advancing traffic incident management in transportation planning : a primer.

    Science.gov (United States)

    2013-07-01

    "The intent of this primer is to inform and guide traffic incident management (TIM) professionals and transportation planners to initiate and develop collaborative relationships and advance TIM programs through the metropolitan planning process. The ...

  13. Field assessment of a model tuberculosis outbreak response plan for low-incidence areas

    Directory of Open Access Journals (Sweden)

    Pascopella Lisa

    2007-10-01

    Full Text Available Abstract Background For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Prior to dissemination of the plan, a tuberculosis outbreak occurred, presenting an opportunity to perform a field assessment of the plan. The purpose of the assessment was to ensure that the plan included essential elements to help public health professionals recognize and respond to outbreaks. Methods We designed a semi-structured questionnaire and interviewed all key stakeholders involved in the response. We used common themes to assess validity of and identify gaps in the plan. A subset of participants provided structured feedback on the plan. Results We interviewed 11 public health and six community stakeholders. The assessment demonstrated that (1 almost all of the main response activities were reflected in the plan; (2 the plan added value by providing a definition of a tuberculosis outbreak and guidelines for communication and evaluation. These were areas that lacked written protocols during the actual outbreak response; and (3 basic education about tuberculosis and the interpretation and use of genotyping data were important needs. Stakeholders also suggested adding to the plan questions for evaluation and a section for specific steps to take when an outbreak is suspected. Conclusion An interactive field assessment of a programmatic tool revealed the value of a systematic outbreak response plan with a standard definition of a tuberculosis outbreak, guidelines for communication and evaluation, and response steps. The assessment highlighted the importance of education and training for tuberculosis in low-incidence areas.

  14. A management plan for hospitals and medical centers facing radiation incidents

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari

    2015-01-01

    Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  15. 46 CFR 122.220 - Records of a voyage resulting in a marine casualty.

    Science.gov (United States)

    2010-10-01

    ....220 Section 122.220 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER... OPERATIONS Marine Casualties and Voyage Records § 122.220 Records of a voyage resulting in a marine casualty... custody thereof, shall make these records available upon request, to a duly authorized investigating...

  16. War casualties: recent trends in evacuation, triage and the golden hour

    International Nuclear Information System (INIS)

    Safdar, C. A.

    2010-01-01

    Prompt medical treatment and early evacuation is the goal of military medicine in the battlefield. 'Triage' is a process of sorting the casualties according to the severity of injury and the prioritization of treatment. In trauma management 'Golden Hour' is the first sixty minutes or so after injury; this emphasizes that the chances of the victim's survival are the greatest if definitive care is given as early as possible. Our evacuation protocols follow the triage but the time to treatment is beyond sixty minutes. Many Armies have developed evacuation systems which allow the casualty to be seen within this specified time. This has been achieved by streamlining the evacuation chain, extensive incorporation of air transport and training of paramedics in advanced life support measures. In line with the modern trends we need to modernize our own system of casualty evacuation and treatment. (author)

  17. Development and validation of a mass casualty conceptual model.

    Science.gov (United States)

    Culley, Joan M; Effken, Judith A

    2010-03-01

    To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

  18. Pre-hospital management of mass casualty civilian shootings: a systematic literature review.

    Science.gov (United States)

    Turner, Conor D A; Lockey, David J; Rehn, Marius

    2016-11-08

    Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

  19. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR.

    Directory of Open Access Journals (Sweden)

    Richard Amlôt

    Full Text Available Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an "Initial Operational Response" by (1 identifying an appropriate method for performing improvised skin decontamination and (2 providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads. The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate removed from each volunteer's forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and

  20. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR).

    Science.gov (United States)

    Amlôt, Richard; Carter, Holly; Riddle, Lorna; Larner, Joanne; Chilcott, Robert P

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an "Initial Operational Response" by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer's forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised

  1. Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001.

    Science.gov (United States)

    Ozoilo, Kenneth N; Pam, Ishaya C; Yiltok, Simon J; Ramyil, Alice V; Nwadiaro, Hyacinth C

    2013-10-28

    Jos has witnessed a series of civil crises which have generated mass casualties that the Jos University Teaching Hospital has had to respond to from time to time. We review the challenges that we encountered in the management of the victims of the 2001 crisis. We reviewed the findings of our debriefing sessions following the sectarian crisis of September 2001 and identified the challenges and obstacles experienced during these periods. Communication was a major challenge, both within and outside the hospital. In the field, there was poor field triage and no prehospital care. Transportation and evacuation was hazardous, for both injured patients and medical personnel. This was worsened by the imposition of a curfew on the city and its environs. In the hospital, supplies such as fluids, emergency drugs, sterile dressings and instruments, splints, and other consumables, blood and food were soon exhausted. Record keeping was erratic. Staff began to show signs of physical and mental exhaustion as well as features of anxiety and stress. Tensions rose between different religious groups in the hospital and an attempt was made by rioters to attack the hospital. Patients suffered poor subsequent care following resuscitation and/or surgery and there was neglect of patients on admission prior to the crisis as well as non trauma medical emergencies. Mass casualties from disasters that disrupt organized societal mechanisms for days can pose significant challenges to the best of institutional disaster response plans. In the situation that we experienced, our disaster plan was impractical initially because it failed to factor in such a prolongation of both crisis and response. We recommend that institutional disaster response plans should incorporate provisions for the challenges we have enumerated and factor in peculiarities that would emanate from the need for a prolonged response.

  2. Energy systems evaluation of potential for incidents having health or safety impact

    International Nuclear Information System (INIS)

    Speas, I.G.

    1986-01-01

    The paper discusses the results of safety surveys of Martin Marietta Energy Systems - operated nuclear facilities. The purpose was to identify potential incidents that could cause large numbers of casualties, evaluate existing prevention/response actions, and identify possible improvements. The survey findings indicate the potential for an accident with consequences similar to those at Bhopal, India, is essentially non-existent

  3. Net-bottom Cage Inserts for Water Bird Casualties

    Directory of Open Access Journals (Sweden)

    Jackie Belle

    2017-10-01

    Full Text Available My Bright Idea is a net-bottomed cage insert, which is used to support pelagic avian casualties. The idea was designed and modified by the International Bird Rescue in California (Bird Rescue.

  4. Effects of ship casualties on reactor safety and marine reactor design

    International Nuclear Information System (INIS)

    Agena, H.H.

    1978-01-01

    Ship casualties such as collision, grounding, fire and explosions, leakage and partial flooding may severely impair the safety of the nuclear reactor plant and result in nuclear hazards to the crew and the environment. Engineered safeguards are being discussed for protection against such consequences: manoeuvrability, structural (passive) collision and fire protection, protection against external fires and pressure waves, after heat transmission in case of a casualty, and after heat transmission out off the sunk wreck. Existing requirements will be discussed, shortly

  5. Mass casualty events: blood transfusion emergency preparedness across the continuum of care.

    Science.gov (United States)

    Doughty, Heidi; Glasgow, Simon; Kristoffersen, Einar

    2016-04-01

    Transfusion support is a key enabler to the response to mass casualty events (MCEs). Transfusion demand and capability planning should be an integrated part of the medical planning process for emergency system preparedness. Historical reviews have recently supported demand planning for MCEs and mass gatherings; however, computer modeling offers greater insights for resource management. The challenge remains balancing demand and supply especially the demand for universal components such as group O red blood cells. The current prehospital and hospital capability has benefited from investment in the management of massive hemorrhage. The management of massive hemorrhage should address both hemorrhage control and hemostatic support. Labile blood components cannot be stockpiled and a large surge in demand is a challenge for transfusion providers. The use of blood components may need to be triaged and demand managed. Two contrasting models of transfusion planning for MCEs are described. Both illustrate an integrated approach to preparedness where blood transfusion services work closely with health care providers and the donor community. Preparedness includes appropriate stock management and resupply from other centers. However, the introduction of alternative transfusion products, transfusion triage, and the greater use of an emergency donor panel to provide whole blood may permit greater resilience. © 2016 AABB.

  6. Casualties of peace: an analysis of casualties admitted to the intensive care unit during the negotiation of the comprehensive Colombian process of peace.

    Science.gov (United States)

    Ordoñez, Carlos A; Manzano-Nunez, Ramiro; Naranjo, Maria Paula; Foianini, Esteban; Cevallos, Cecibel; Londoño, Maria Alejandra; Sanchez Ortiz, Alvaro I; García, Alberto F; Moore, Ernest E

    2018-01-01

    After 52 years of war in 2012, the Colombian government began the negotiation of a process of peace, and by November 2012, a truce was agreed. We sought to analyze casualties who were admitted to the intensive care unit (ICU) before and during the period of the negotiation of the comprehensive Colombian process of peace. Retrospective study of hostile casualties admitted to the ICU at a Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (November 2012-December 2016). Patients were compared with respect to time periods. Four hundred forty-eight male patients were admitted to the emergency room. Of these, 94 required ICU care. Sixty-five casualties presented before the truce and 29 during the negotiation period. Median injury severity score was significantly higher before the truce. Furthermore, the odds of presenting with severe trauma (ISS > 15) were significantly higher before the truce (OR, 5.4; (95% CI, 2.0-14.2); p  < 0.01). There was a gradual decrease in the admissions to the ICU, and the performance of medical and operative procedures during the period observed. We describe a series of war casualties that required ICU care in a period of peace negotiation. Despite our limitations, our study presents a decline in the occurrence, severity, and consequences of war injuries probably as a result in part of the negotiation of the process of peace. The hysteresis of these results should only be interpreted for their implications in the understanding of the peace-health relationship and must not be overinterpreted and used for any political end.

  7. Towards a national burns disaster plan | Rogers | South African ...

    African Journals Online (AJOL)

    The International Society for Burns Injuries (ISBI) has published guidelines for the management of multiple or mass burns casualties, and recommends that 'each country has or should have a disaster planning system that addresses its own particular needs. The need for a national burns disaster plan integrated with ...

  8. Investigating the Relationship Between Drone Warfare and Civilian Casualties in Gaza

    Directory of Open Access Journals (Sweden)

    Dr. Ann Rogers

    2014-12-01

    Full Text Available Unmanned aerial vehicles (UAVs, better known as drones, are increasingly touted as ‘humanitarian’ weapons that contribute positively to fighting just wars and saving innocent lives. At the same time, civilian casualties have become the most visible and criticized aspect of drone warfare. It is argued here that drones contribute to civilian casualties not in spite of, but because of, their unique attributes. They greatly extend war across time and space, pulling more potential threats and targets into play over long periods, and because they are low-risk and highly accurate, they are more likely to be used. The assumption that drones save lives obscures a new turn in strategic thinking that sees states such as Israel and the US rely on large numbers of small, highly discriminating attacks applied over time to achieve their objectives. This examination of Israel’s 2014 war in Gaza argues that civilian casualties are not an unexpected or unintended consequence of drone warfare, but an entirely predictable outcome.

  9. Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center.

    Science.gov (United States)

    Abir, Mahshid; Davis, Matthew M; Sankar, Pratap; Wong, Andrew C; Wang, Stewart C

    2013-02-01

    To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims. Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability-number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources-anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability. Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type

  10. Overconfidence, preview, and probability in strategic planning

    Science.gov (United States)

    Wickens, Christopher D.; Pizarro, David; Bell, Brian

    1991-01-01

    The performance of eight subjects in a 'rescue' video game requiring choices as to which node they should fly to in order to rescue the simulated casualties is presently studied with a view to biases and display support criteria in strategic planning. After each choice, the subjects needed to fly a challenging tracking dynamic along a path to reach the next node. The results obtained indicate that the choices of the subjects were less optimal when full preview was offered, perhaps due to subjects' reliance on the simple strategy of choosing routes with the greatest number of casualties.

  11. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S Initial Operational Response (IOR)

    Science.gov (United States)

    Riddle, Lorna; Larner, Joanne

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions

  12. Nurses' requirements for relief and casualty support in disasters: a qualitative study.

    Science.gov (United States)

    Nekooei Moghaddam, Mahmoud; Saeed, Sara; Khanjani, Narges; Arab, Mansour

    2014-04-01

    Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses. In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management. This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes. Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants' comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters. There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives.

  13. 46 CFR 28.80 - Report of casualty.

    Science.gov (United States)

    2010-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... routine duties. (3) Loss of a vessel. (4) Damage to or by a vessel, its cargo, apparel or gear, except for... industry vessel must submit a report of each casualty involving that vessel to an organization listed in...

  14. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile.

    Science.gov (United States)

    Edwards, D S; McMenemy, L; Stapley, S A; Patel, H D L; Clasper, J C

    2016-03-01

    Terrorists have used the explosive device successfully globally, with their effects extending beyond the resulting injuries. Suicide bombings, in particular, are being increasingly deployed due to the devastating effect of a combination of high lethality and target accuracy. The aim of this study was to identify trends and analyse the demographics and casualty figures of terrorist bombings worldwide. Analysis of the Global Terrorism Database (GTD) and a PubMed/Embase literature search (keywords "terrorist", and/or "suicide", and/or "bombing") from 1970 to 2014 was performed. 58,095 terrorist explosions worldwide were identified in the GTD. 5.08% were suicide bombings. Incidents per year are increasing (Pprofile of survivors to guide the immediate response by the medical services and the workload in the coming days. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. 46 CFR 122.210 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Alcohol or drug use by individuals directly involved in... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.210 Alcohol or drug use by individuals... alcohol or drug use by individuals directly involved in the casualty. (b) The owner, agent, master, or...

  16. The use of analgesia in mountain rescue casualties with moderate or severe pain.

    Science.gov (United States)

    Ellerton, John Alexander; Greene, Mike; Paal, Peter

    2013-06-01

    To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR. Prospective, descriptive study. Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010. 92 MR casualties with a pain scoreof 4/10 or greater. 38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover. The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5 ± 2.4 at 15 min and 3.9 ± 2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer. Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.

  17. Emergency planning and preparedness for the deliberate release of toxic industrial chemicals.

    Science.gov (United States)

    Russell, David; Simpson, John

    2010-03-01

    Society in developed and developing countries is hugely dependent upon chemicals for health, wealth, and economic prosperity, with the chemical industry contributing significantly to the global economy. Many chemicals are synthesized, stored, and transported in vast quantities and classified as high production volume chemicals; some are recognized as being toxic industrial chemicals (TICs). Chemical accidents involving chemical installations and transportation are well recognized. Such chemical accidents occur with relative frequency and may result in large numbers of casualties with acute and chronic health effects as well as fatalities. The large-scale production of TICs, the potential for widespread exposure and significant public health impact, together with their relative ease of acquisition, makes deliberate release an area of potential concern. The large numbers of chemicals, together with the large number of potential release scenarios means that the number of possible forms of chemical incident are almost infinite. Therefore, prior to undertaking emergency planning and preparedness, it is necessary to prioritize risk and subsequently mitigate. This is a multi-faceted process, including implementation of industrial protection layers, substitution of hazardous chemicals, and relocation away from communities. Residual risk provides the basis for subsequent planning. Risk-prioritized emergency planning is a tool for identifying gaps, enhancing communication and collaboration, and for policy development. It also serves to enhance preparedness, a necessary prelude to preventing or mitigating the public health risk to deliberate release. Planning is an iterative and on-going process that requires multi-disciplinary agency input, culminating in the formation of a chemical incident plan complimentary to major incident planning. Preparedness is closely related and reflects a state of readiness. It is comprised of several components, including training and exercising

  18. One year after mild injury: comparison of health status and quality of life between casualties with whiplash versus other injuries

    OpenAIRE

    HOURS, Martine; KHATI, Inès; CHARNAY, Pierrette; CHOSSEGROS, Laetitia; TARDY, Hélène; TOURNIER, Charlène; PERRINE, Anne-Laure; LUAUTE, Jacques; LAUMON, Bernard

    2014-01-01

    Objectives: To compare health status, family and occupational impact and quality of life one year after an accident between casualties with whiplash versus other mild injuries, and to explore the relation between initial injury (whiplash vs. other) and quality of life. Design: Prospective cohort study. Subjects: The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 173 casualties with 'pure' whiplash and a population of 207 casualties wi...

  19. Preliminary quantitative assessment of earthquake casualties and damages

    DEFF Research Database (Denmark)

    Badal, J.; Vázquez-Prada, M.; González, Á.

    2005-01-01

    Prognostic estimations of the expected number of killed or injured people and about the approximate cost associated with the damages caused by earthquakes are made following a suitable methodology of wide-ranging application. For the preliminary assessment of human life losses due to the occurrence...... of a relatively strong earthquake we use a quantitative model consisting of a correlation between the number of casualties and the earthquake magnitude as a function of population density. The macroseismic intensity field is determined in accordance with an updated anelastic attenuation law, and the number...... the local social wealth as a function of the gross domestic product of the country. This last step is performed on the basis of the relationship of the macroseismic intensity to the earthquake economic loss in percentage of the wealth. Such an approach to the human casualty and damage levels is carried out...

  20. TIER competency-based training course for the first receivers of CBRN casualties: a European perspective.

    Science.gov (United States)

    Djalali, Ahmadreza; Della Corte, Francesco; Segond, Frederique; Metzger, Marie-Helene; Gabilly, Laurent; Grieger, Fiene; Larrucea, Xabier; Violi, Christian; Lopez, Cédric; Arnod-Prin, Philippe; Ingrassia, Pier L

    2017-10-01

    Education and training are key elements of health system preparedness vis-à-vis chemical, biological, radiological and nuclear (CBRN) emergencies. Medical respondents need sufficient knowledge and skills to manage the human impact of CBRN events. The current study was designed to determine which competencies are needed by hospital staff when responding to CBRN emergencies, define educational needs to develop these competencies, and implement a suitable delivery method. This study was carried out from September 2014 to February 2015, using a three-step modified Delphi method. On the basis of international experiences, publications, and experts' consensus, core competencies for hospital staff - as CBRN casualty receivers - were determined, and training curricula and delivery methods were defined. The course consists of 10 domains. These are as follows: threat identification; health effects of CBRN agents; planning; hospital incident command system; information management; safety, personal protective equipment and decontamination; medical management; essential resources; psychological support; and ethical considerations. Expected competencies for each domain were defined. A blended approach was chosen. By identifying a set of core competencies, this study aimed to provide the specific knowledge and skills required by medical staff to respond to CRBN emergencies. A blended approach may be a suitable delivery method, allowing medical staff to attend the same training sessions despite different time zones and locations. The study output provides a CBRN training scheme that may be adapted and used at the European Union level.

  1. The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sandvik Leiv

    2011-05-01

    Full Text Available Abstract Background Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain measured by the Casualty Chain Inventory (CCI. The purpose of the study was to assess and validate the CCI, and to examine the correlations between the new instrument and stress responses measured by the Impact of Event Scale (IES and the Post-traumatic Stress Scale-10 (PTSS-10 Methods Three hundred and fifteen injured, conscious, hospitalised patients were assessed with a self-report questionnaire. The CCI consists of eight items including sensory impressions and well-known psychological responses to trauma. Results The internal consistency of the CCI was solid (Cronbach's alpha: .83-.85. A factor analysis revealed two components, "perception" and "dissociation". The instrument correlates significantly with the Impact of Event Scale (r = 0.47 - 0.54 and the Posttraumatic Stress Scale-10 (r = 0.32 - 0.50. The explained variance is high both at the scene of injury (61% and in the hospital (65%. Dissociation and perception either used as a two-factor solution or as a sum score measured in the hospital, gave the strongest prediction for later psychological distress. Conclusions The CCI appears to be a useful screening instrument for, at an early state, identifying patients hospitalized after a physical incident at risk for subsequent psychological distress.

  2. Analyzing the Effects of Urban Combat on Daily Casualty Rates

    National Research Council Canada - National Science Library

    Yazilitas, Hakan

    2004-01-01

    .... The available data set contains measurements about the battles like initial strengths, daily casualties, terrain, front width, linear density, attacker's and defender's country, and armor losses...

  3. Importance of banked tissues in the management of mass nuclear casualties

    International Nuclear Information System (INIS)

    Singh, Rita; Bhatnagar, P.K.

    2009-01-01

    Nuclear detonations are the most devastating of the weapons of mass destruction. There will be large number of casualties on detonation of nuclear weapon. Biological tissues like bone, skin, amniotic membrane and other soft tissues can be used for repair or reconstruction of the injured part of the body. Tissues from human donor can be processed and banked for orthopaedic, spinal, trauma and other surgical procedures. Radiation technology is used to sterilize the tissues to make them safe for clinical use. This paper highlights the importance of such banked tissues in the management of the casualties. (author)

  4. Provenancing of unidentified World War II casualties: Application of strontium and oxygen isotope analysis in tooth enamel.

    Science.gov (United States)

    Font, Laura; Jonker, Geert; van Aalderen, Patric A; Schiltmans, Els F; Davies, Gareth R

    2015-01-01

    In 2010 and 2012 two sets of unidentified human remains of two World War II soldiers were recovered in the area where the 1944-1945 Kapelsche Veer bridgehead battle took place in The Netherlands. Soldiers of four Allied nations: British Royal Marine Commandos, Free Norwegian Commandos, Free Poles and Canadians, fought against the German Army in this battle. The identification of these two casualties could not be achieved using dental record information of DNA analysis. The dental records of Missing in Action soldiers of the Allied nations did not match with the dental records of the two casualties. A DNA profile was determined for the casualty found in 2010, but no match was found. Due to the lack of information on the identification of the casualties provided by routine methods, an isotope study was conducted in teeth from the soldiers to constrain their provenance. The isotope study concluded that the tooth enamel isotope composition for both casualties matched with an origin from the United Kingdom. For one of the casualties a probable origin from the United Kingdom was confirmed, after the isotope study was conducted, by the recognition of a characteristic belt buckle derived from a Royal Marine money belt, only issued to British Royal Marines, found with the remains of the soldier. Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

  5. Contents of management plans for incidents and accidents involving the transport of radioactive substances. Guide no. 17, Version of 22/12/2014

    International Nuclear Information System (INIS)

    2014-01-01

    This guide presents the essential topics to be developed in a management plan for incidents and accidents involving the transport of radioactive substances for civil use. It does not aim to be exhaustive and could be added to by each party involved in the transport, who can make the necessary adaptations and additions, taking account of the particularities of its shipments and its organisation, as well as those of the company or group to which it belongs. The radioactive substances transport incident and accident management plan is a document comprising a descriptive part and an operational part. It presents the overall response of the party involved in the transport operation to an incident or accident situation concerning one of its shipments and the steps it intends to make in order to support the authorities in charge of this situation, in the best possible conditions. This response is designed to cover the cases of incidents or accidents whether or not they lead to a radiological emergency situation. The guide exclusively concerns: - road transport; - rail transport; - the 'road' and 'rail' parts of multimodal transport operations. The case of an incident or an accident occurring during a particular stop such as a transit site, in a transhipment area (port, airport, railway station, etc.), or in a transport infrastructure, is also covered by the radioactive substances transport incident and accident management plan, which then supports the entities in charge of managing this situation (operator of the transhipment area or the transport infrastructure and - as applicable - their supervisory authorities). The level of risk associated with transport incidents and accidents varies widely, according to the nature and quantities of the materials being carried, the number of shipments made and the package model used. The incident and accident management plan must therefore be tailored to the specific nature of the shipments by the party concerned. The radioactive

  6. Disaster metrics: quantitative benchmarking of hospital surge capacity in trauma-related multiple casualty events.

    Science.gov (United States)

    Bayram, Jamil D; Zuabi, Shawki; Subbarao, Italo

    2011-06-01

    Hospital surge capacity in multiple casualty events (MCE) is the core of hospital medical response, and an integral part of the total medical capacity of the community affected. To date, however, there has been no consensus regarding the definition or quantification of hospital surge capacity. The first objective of this study was to quantitatively benchmark the various components of hospital surge capacity pertaining to the care of critically and moderately injured patients in trauma-related MCE. The second objective was to illustrate the applications of those quantitative parameters in local, regional, national, and international disaster planning; in the distribution of patients to various hospitals by prehospital medical services; and in the decision-making process for ambulance diversion. A 2-step approach was adopted in the methodology of this study. First, an extensive literature search was performed, followed by mathematical modeling. Quantitative studies on hospital surge capacity for trauma injuries were used as the framework for our model. The North Atlantic Treaty Organization triage categories (T1-T4) were used in the modeling process for simplicity purposes. Hospital Acute Care Surge Capacity (HACSC) was defined as the maximum number of critical (T1) and moderate (T2) casualties a hospital can adequately care for per hour, after recruiting all possible additional medical assets. HACSC was modeled to be equal to the number of emergency department beds (#EDB), divided by the emergency department time (EDT); HACSC = #EDB/EDT. In trauma-related MCE, the EDT was quantitatively benchmarked to be 2.5 (hours). Because most of the critical and moderate casualties arrive at hospitals within a 6-hour period requiring admission (by definition), the hospital bed surge capacity must match the HACSC at 6 hours to ensure coordinated care, and it was mathematically benchmarked to be 18% of the staffed hospital bed capacity. Defining and quantitatively benchmarking the

  7. Is the Australian hospital system adequately prepared for terrorism?

    Science.gov (United States)

    Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

    Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

  8. Military Medical Revolution: Prehospital Combat Casualty Care

    Science.gov (United States)

    2012-01-01

    systems Anesthesia Antisepsis/sanitation (Lister, Pasteur , Koch) Nursing care (Nightingale) World War I and World War II Antibiotics Blood...to preserve the life of casualties in critical conditions. TACEVAC includes evacuation by both designat- ed medical (MEDEVAC) mobility assets and...military experience in Somalia, Afghanistan, and Iraq revitalized the concept of treating hemorrhage with plas- ma to preserve coagulation system

  9. 46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Alcohol or drug use by individuals directly involved in... § 4.05-12 Alcohol or drug use by individuals directly involved in casualties. (a) For each marine... evidence of alcohol or drug use by individuals directly involved in the casualty. (b) The marine employer...

  10. Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

    Science.gov (United States)

    Badiali, Stefano; Giugni, Aimone; Marcis, Lucia

    2017-06-01

    START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients. In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher's exact test for a P valueSTART group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (PSTART group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 "preventable deaths" on 6000 cases because of incorrect triage, whereas the START group had 91. Even a "last-minute" training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305-309).

  11. Evaluation of absorbent materials for use as ad hoc dry decontaminants during mass casualty incidents as part of the UK's Initial Operational Response (IOR.

    Directory of Open Access Journals (Sweden)

    Nick Kassouf

    Full Text Available The UK's Initial Operational Response (IOR is a revised process for the medical management of mass casualties potentially contaminated with hazardous materials. A critical element of the IOR is the introduction of immediate, on-scene disrobing and decontamination of casualties to limit the adverse health effects of exposure. Ad hoc cleansing of the skin with dry absorbent materials has previously been identified as a potential means of facilitating emergency decontamination. The purpose of this study was to evaluate the in vitro oil and water absorbency of a range of materials commonly found in the domestic and clinical environments and to determine the effectiveness of a small, but representative selection of such materials in skin decontamination, using an established ex vivo model. Five contaminants were used in the study: methyl salicylate, parathion, diethyl malonate, phorate and potassium cyanide. In vitro measurements of water and oil absorbency did not correlate with ex vivo measurements of skin decontamination. When measured ex vivo, dry decontamination was consistently more effective than a standard wet decontamination method ("rinse-wipe-rinse" for removing liquid contaminants. However, dry decontamination was ineffective against particulate contamination. Collectively, these data confirm that absorbent materials such as wound dressings and tissue paper provide an effective, generic capability for emergency removal of liquid contaminants from the skin surface, but that wet decontamination should be used for non-liquid contaminants.

  12. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-26... RAILROADS 1 Operating Expenses-Equipment § 1242.41 Other and casualties and insurance (accounts XX-26-99 and... administration (account XX-26-01). freight cars ...

  13. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-51... RAILROADS 1 Operating Expenses-Transportation § 1242.65 Other and casualties and insurance (accounts XX-51... separation of administration (account XX-51-01). yard operations ...

  14. Optimization of Lyophilized Plasma for Use in Combat Casualties

    Science.gov (United States)

    2016-03-01

    ratio of NS infused at a rate of 165 ml/min, minus any given during the controlled hemorrhage to induce acidosis and coagulopathy. This reflects...antioxidant effect suggesting the potential to reduce acute respiratory distress syndrome and multiple organ failure in combat casualties. This model

  15. Management of the mass casualty from the 2001 Jos crisis

    African Journals Online (AJOL)

    2012-11-04

    Nov 4, 2012 ... The complex nature of natural and man‑made disasters poses multidisciplinary ... system [Figure 1] to mobilize staff from outside the hospital. Management of the mass ..... warning before casualties arrived. Transportation to ...

  16. Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana.

    Science.gov (United States)

    Damsere-Derry, James; Palk, Gavan; King, Mark

    2018-02-17

    Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

  17. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-52... RAILROADS 1 Operating Expenses-Transportation § 1242.72 Other and casualties and insurance (accounts XX-52... separation of administration (account XX-52-01). train and yard operations common ...

  18. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-55... RAILROADS 1 Operating Expenses-Transportation § 1242.82 Other and casualties and insurance (accounts XX-55... separation of administration (account XX-55-01). Operating Expenses general and administration ...

  19. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-27... RAILROADS 1 Operating Expenses-Equipment § 1242.54 Other and casualties and insurance (accounts XX-27-99 and... administration (account XX-27-01). Operating Expenses—Transportation train operations ...

  20. Developing a highway emergency response plan for incidents involving hazardous materials, second edition, March 1992

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This provides minimum guidelines for developing an emergency response plan for incidents involving hazardous liquid hydrocarbons, such as gasoline and crude oil, transported in MC 306/DOT 406 and MC 307/DOT 407 aluminum cargo tanks and for coordinating and cooperating with local, state, and federal officials. This publication covers response plan priorities, personnel training, special equipment, media relations, environmental relations, and post-response activities. The apprendixes to this recommended practice outline a highway emergency response plan and suggest a procedure for removing liquid hydrocarbons from overturned cargo tanks and righting the tank vehicles

  1. Planning for the next influenza pandemic: using the science and art of logistics.

    Science.gov (United States)

    Cupp, O Shawn; Predmore, Brad G

    2011-01-01

    The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). The first step in this planning process is the development of specific triage requirements during an influenza pandemic. The second step is identification of logistical resources required during such a pandemic, which are then analyzed within the proposed logistics science and art model for planning purposes. Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.

  2. Computer Simulation as a Tool for Assessing Decision-Making in Pandemic Influenza Response Training

    Directory of Open Access Journals (Sweden)

    James M Leaming

    2013-05-01

    Full Text Available Introduction: We sought to develop and test a computer-based, interactive simulation of a hypothetical pandemic influenza outbreak. Fidelity was enhanced with integrated video and branching decision trees, built upon the 2007 federal planning assumptions. We conducted a before-and-after study of the simulation effectiveness to assess the simulations’ ability to assess participants’ beliefs regarding their own hospitals’ mass casualty incident preparedness.Methods: Development: Using a Delphi process, we finalized a simulation that serves up a minimum of over 50 key decisions to 6 role-players on networked laptops in a conference area. The simulation played out an 8-week scenario, beginning with pre-incident decisions. Testing: Role-players and trainees (N=155 were facilitated to make decisions during the pandemic. Because decision responses vary, the simulation plays out differently, and a casualty counter quantifies hypothetical losses. The facilitator reviews and critiques key factors for casualty control, including effective communications, working with external organizations, development of internal policies and procedures, maintaining supplies and services, technical infrastructure support, public relations and training. Pre- and post-survey data were compared on trainees.Results: Post-simulation trainees indicated a greater likelihood of needing to improve their organization in terms of communications, mass casualty incident planning, public information and training. Participants also recognized which key factors required immediate attention at their own home facilities.Conclusion: The use of a computer-simulation was effective in providing a facilitated environment for determining the perception of preparedness, evaluating general preparedness concepts and introduced participants to critical decisions involved in handling a regional pandemic influenza surge. [West J Emerg Med. 2013;14(3:236–242.

  3. Personal protection during resuscitation of casualties contaminated with chemical or biological warfare agents--a survey of medical first responders.

    Science.gov (United States)

    Brinker, Andrea; Prior, Kate; Schumacher, Jan

    2009-01-01

    The threat of mass casualties caused by an unconventional terrorist attack is a challenge for the public health system, with special implications for emergency medicine, anesthesia, and intensive care. Advanced life support of patients injured by chemical or biological warfare agents requires an adequate level of personal protection. The aim of this study was to evaluate the personal protection knowledge of emergency physicians and anesthetists who would be at the frontline of the initial health response to a chemical/biological warfare agent incident. After institutional review board approval, knowledge of personal protection measures among emergency medicine (n = 28) and anesthetics (n = 47) specialty registrars in the South Thames Region of the United Kingdom was surveyed using a standardized questionnaire. Participants were asked for the recommended level of personal protection if a chemical/biological warfare agent(s) casualty required advanced life support in the designated hospital resuscitation area. The best awareness within both groups was regarding severe acute respiratory syndrome, and fair knowledge was found regarding anthrax, plague, Ebola, and smallpox. In both groups, knowledge about personal protection requirements against chemical warfare agents was limited. Knowledge about personal protection measures for biological agents was acceptable, but was limited for chemical warfare agents. The results highlight the need to improve training and education regarding personal protection measures for medical first receivers.

  4. Management of the mass casualty from the 2001 Jos crisis

    African Journals Online (AJOL)

    2012-11-04

    Nov 4, 2012 ... Management of Jos crisis mass casualty. 437. Nigerian Journal of ... operating and admission registers and their case notes retrieved from the .... of young males in our study was because these were the rioters in the first ...

  5. Post-event reviews: Using a quantitative approach for analysing incident response to demonstrate the value of business continuity programmes and increase planning efficiency.

    Science.gov (United States)

    Vaidyanathan, Karthik

    2017-01-01

    Business continuity management is often thought of as a proactive planning process for minimising impact from large-scale incidents and disasters. While this is true, and it is critical to plan for the worst, consistently validating plan effectiveness against smaller disruptions can enable an organisation to gain key insights about its business continuity readiness, drive programme improvements, reduce costs and provide an opportunity to quantitatively demonstrate the value of the programme to management. This paper describes a post mortem framework which is used as a continuous improvement mechanism for tracking, reviewing and learning from real-world events at Microsoft Customer Service & Support. This approach was developed and adopted because conducting regular business continuity exercises proved difficult and expensive in a complex and distributed operations environment with high availability requirements. Using a quantitative approach to measure response to incidents, and categorising outcomes based on such responses, enables business continuity teams to provide data-driven insights to leadership, change perceptions of incident root cause, and instil a higher level of confidence towards disaster response readiness and incident management. The scope of the framework discussed here is specific to reviewing and driving improvements from operational incidents. However, the concept can be extended to learning and evolving readiness plans for other types of incidents.

  6. The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

    Science.gov (United States)

    Kotwal, Russ S; Howard, Jeffrey T; Orman, Jean A; Tarpey, Bruce W; Bailey, Jeffrey A; Champion, Howard R; Mabry, Robert L; Holcomb, John B; Gross, Kirby R

    2016-01-01

    The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes. A retrospective descriptive analysis of battlefield data examined 21,089 US military casualties that occurred during the Afghanistan conflict from September 11, 2001, to March 31, 2014. Analysis was conducted from September 1, 2014, to January 21, 2015. Data for all casualties were analyzed according to whether they occurred before or after the mandate. Detailed data for those who underwent prehospital helicopter transport were analyzed according to whether they occurred before or after the mandate and whether they occurred in 60 minutes or less vs more than 60 minutes. Casualties with minor wounds were excluded. Mortality and morbidity outcomes and treatment capability-related variables were compared. For the total casualty population, the percentage killed in action (16.0% [386 of 2411] vs 9.9% [964 of 9755]; P mean injury severity score, 17.3; mortality, 10.1% [457 of 4542]) with detailed data, there was a decrease in median transport time after the mandate (90 min vs 43 min; P < .001) and an increase in missions achieving prehospital helicopter transport in 60 minutes or less (24.8% [181 of 731] vs 75.2% [2867 of 3811]; P < .001). When adjusted for injury severity score and time period, the percentage killed in action was lower for those critically injured who received a blood transfusion (6.8% [40 of 589] vs 51.0% [249 of 488]; P < .001) and were transported in 60 minutes or less (25.7% [205 of 799] vs 30.2% [84 of 278]; P < .01), while the percentage died of wounds was lower among those critically injured initially treated by combat

  7. Fires in rooms containing electrical components - incident planning, fire fighting tactics, risks; Braender i driftrum - Insatsplaner, slaeckteknik, risker

    Energy Technology Data Exchange (ETDEWEB)

    Magnusson, Tommy; Ottosson, Jan; Lindskog, BertiI; Soederquist Bende, Evy; Eriksson, Fredrik; Haffling, Stefan

    2006-12-15

    On July 1, 2005 a fire occurred within an electrical switch room at Forsmark Nuclear Power Plant. At the evaluation of the incident it was identified that the pre-fire plans did not give sufficient information in order to make the appropriate decisions. Questions raised based on the incident are how decisions are made and orders are delegated with respect to the incident command, which fire fighting tactic should be used, which types of extinguishing media should be used, what are the risks with respect to safety of staff and safety of the reactor. Lessons learned from the fire at Forsmark were that pre-incident planning was at hand but the information was not sufficient to make the correct initial decisions that might be critical for life and property. One of the most crucial ingredients in all safety related work is to utilize previous experience in order to maintain a high degree of safety. Lessons learnt are also the foundation on which the ability to construct or create strong barriers against a certain fault phenomena, fault mechanism or type of initial event. In the case of nuclear processes, fire is considered as an important and critical initial event which has to be recognized in a number of cases in order to maintain a safe process. The likelihood for a fire to represent an initial event should not be underestimated and can therefore not be neglected, probabilistically or deterministically, unless the inherent safety systems can not control the event in an acceptable manner. Regardless of safety measures and lessons learnt from previous experiences in the construction and the operation of the nuclear facility, fires can occur. Previous experiences point out that process system, e.g. systems that are part of the turbine, are more frequently subject to fire incidents compared to ordinary safety systems. Fires in electrical components, often electrical cabinets, can be difficult to handle and to extinguish quickly. This report presents the background work

  8. Parameters for Estimation of Casualties from Ammonia (NH3), Tabun (GA), Soman (GD),Cyclosarin (GF) and Lewisite (L)

    Science.gov (United States)

    2015-09-01

    untreated casualty estimate, AMedP-7.5 uses the Injury Profile to deter- mine the final outcome for each Injury Profile cohort. For a treated casualty...materially from that of an HD burn. Large, single coalescent blisters with sharply defined margins are filled with cloudy and opales - cent fluid, and the

  9. Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace.

    Science.gov (United States)

    Ordoñez, Carlos A; Manzano Nunez, Ramiro; Parra, Michael W; Herrera, Juan Pablo; Naranjo, Maria Paula; Escobar, Sara Sofia; Badiel, Marisol; Morales, Monica; Cevallos, Cecibel; Bayona, Juan G; Sanchez, Alvaro Ignacio; Puyana, Juan Carlos; García, Alberto F

    2017-12-30

    Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods. A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

  10. Casualties Produced by Impact and Related Topics of People Survivability in a Direct Effects Environment

    Science.gov (United States)

    1974-08-01

    Effects Environment". Lt was per- formed for the Defer se Civil Preparedness Agency under Contract DAHiC20-73-C-0196. rhe study was initiated on Hay...rough examin-ation of field daca , i.e., detailed survey data of existing buildings. The rvJson for this is that in order to be generally applicabli...debris under the action of blast winds. These can inteiracL with people located in their paths producing impact casualtie.s. People locaced in basements

  11. Birds oiled during the Amoco Cadiz incident: an interim report

    Energy Technology Data Exchange (ETDEWEB)

    Jones, P.H.; Monnat, J.Y.; Cadbury, C.J.; Stowe, T.J.

    1978-11-01

    More than 4500 oiled birds were collected from beaches in Northwest France and the Channel Islands following the oil spillage from the super tanker Amoco Cadiz in March 1978. Some 33 bird species were recorded oiled. A notable feature of the incident was the high proportion of puffins among the birds known to have been oiled. In normal years, puffins are considered to be relatively uncommon off Brittany in spring, and so the high proportion of this species among the casualties was unexpected. A relatively large number of shags and divers were also oiled. (1 map, 8 references, 2 tables)

  12. Relation between both oxidative and metabolic-osmotic cell damages and initial injury severity in bombing casualties

    Directory of Open Access Journals (Sweden)

    Vučeljić Marina

    2006-01-01

    Full Text Available Background/Aim. We have recently reported the development of oxidative cell damages in bombing casualties within a very early period after the initial injury. The aim of this study, was to investigate malondialdehyde (MDA, as an indicator of lipid peroxidation, and osmolal gap (OG, as a good indicator of metabolic cell damages and to assess their relationship with the initial severity of the injury in bombing casualties. Methods. The study included the males (n = 52, injured during the bombing with the Injury Severity Score (ISS ranging from 3 to 66. The whole group of casualties was devided into a group of less severely (ISS < 25, n = 24 and a group of severely (ISS ≥ 26, n = 28 injured males. The uninjured volunteers (n = 10 were the controls. Osmolality, MDA, sodium, glucose, urea, creatinine, total bilirubin and total protein levels were measured in the venous blood, sampled daily, within a ten-day period. Results. In both groups of casualties, MDA and OG levels increased, total protein levels decreased, while other parameters were within the control limits. MDA alterations correlated with ISS (r = 0.414, p < 0.01, while a statistically significant correlation between OG and ISS was not obtained. Interestingly, in spite of some differences in MDA and OG trends, at the end of the examined period they were at the similar level in both groups. Conclusion. The initial oxidative damages of the cellular membrane with intracellular metabolic disorders contributed to the gradual development of metabolic-osmotic damages of cells, which, consequently caused the OG increase. In the bombing casualties, oxidative cell damages were dependent on the initial injury severity, while metabolic-osmotic cell damages were not.

  13. 33 CFR 155.1040 - Response plan requirements for unmanned tank barges carrying oil as a primary cargo.

    Science.gov (United States)

    2010-07-01

    ... POLLUTION PREVENTION REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1040 Response plan...-based support or advice; (ii) The individuals who shall be notified of a casualty potentially affecting... coordinator responsible for overseeing or directing those actions. (4) The organizational structure that will...

  14. [HIGH VELOCITY PENETRATING HEAD AND NECK INJURIES OF SYRIAN CIVIL WAR CASUALTIES TREATED IN THE GALILEE MEDICAL CENTER].

    Science.gov (United States)

    Ronen, Ohad; Assadi, Nidal; Sela, Eyal

    2017-05-01

    For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department. Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated. Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p Syria, and 12 died. Of all Syrian injured treated in the ENT department, the vast majority were young men. The main cause of injury was gunshot wounds. It is likely that the lack of protective gear that exist in western armies is a factor in the complex injuries treated at the Galilee Medical Center.

  15. A remotely piloted aircraft system in major incident management: concept and pilot, feasibility study.

    Science.gov (United States)

    Abrahamsen, Håkon B

    2015-06-10

    Major incidents are complex, dynamic and bewildering task environments characterised by simultaneous, rapidly changing events, uncertainty and ill-structured problems. Efficient management, communication, decision-making and allocation of scarce medical resources at the chaotic scene of a major incident is challenging and often relies on sparse information and data. Communication and information sharing is primarily voice-to-voice through phone or radio on specified radio frequencies. Visual cues are abundant and difficult to communicate between teams and team members that are not co-located. The aim was to assess the concept and feasibility of using a remotely piloted aircraft (RPA) system to support remote sensing in simulated major incident exercises. We carried out an experimental, pilot feasibility study. A custom-made, remotely controlled, multirotor unmanned aerial vehicle with vertical take-off and landing was equipped with digital colour- and thermal imaging cameras, a laser beam, a mechanical gripper arm and an avalanche transceiver. We collected data in five simulated exercises: 1) mass casualty traffic accident, 2) mountain rescue, 3) avalanche with buried victims, 4) fisherman through thin ice and 5) search for casualties in the dark. The unmanned aerial vehicle was remotely controlled, with high precision, in close proximity to air space obstacles at very low levels without compromising work on the ground. Payload capacity and tolerance to wind and turbulence were limited. Aerial video, shot from different altitudes, and remote aerial avalanche beacon search were streamed wirelessly in real time to a monitor at a ground base. Electromagnetic interference disturbed signal reception in the ground monitor. A small remotely piloted aircraft can be used as an effective tool carrier, although limited by its payload capacity, wind speed and flight endurance. Remote sensing using already existing remotely piloted aircraft technology in pre

  16. Ocular firework trauma: a systematic review on incidence, severity, outcome and prevention.

    Science.gov (United States)

    Wisse, R P L; Bijlsma, W R; Stilma, J S

    2010-12-01

    To provide a systematic review on ocular firework trauma with emphasis on incidence and patient demographics, the extent of ocular trauma and visual function loss, and firework regulation effects on injury rates. A literature search was performed using predetermined inclusion and exclusion criteria. Demographic characteristics of ocular firework casualties were obtained and incidence rates of sustained trauma and vision loss calculated. Twenty-six relevant articles were suitable for calculation of trauma incidence and patient demographics, of which 17 articles could be used for calculating trauma severity and vision loss. Victims were male (77%), young (82%) and often bystander (47%). Most of the trauma was mild and temporary. Penetrating eye trauma, globe contusions and burns accounted for 18.2%, with a 3.9% enucleation rate. Mean visual acuity was >10/20 in 56.8%, with severe vision loss (firework legislation show 87% less eye trauma (pfirework traumas show severe vision loss, mostly in young males. Bystanders are as frequently injured. Firework traumas are a preventable cause of severe ocular injury and blindness because countries using restrictive firework legislation have remarkable lower trauma incidence rates.

  17. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate... during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from...

  18. Selection, follow-up, and analysis in the Atomic Bomb Casualty Commission Study

    International Nuclear Information System (INIS)

    Jablon, S.

    1985-01-01

    More is known about ionizing radiation as a cause of human cancer than about any other carcinogen. Most of this knowledge is derived from the studies conducted by the Atomic Bomb Casualty Commission and Radiation Effects Research Foundation on about 100,000 Japanese survivors of the atomic bombing in 1945. The importance of these studies is based on the large size of the exposed population and the fact that individual estimates of radiation dose were possible. These factors and the combined excellence of the centralized vital statistics reporting and population registration systems in Japan have made feasible the continuing longitudinal studies of cancer mortality by site in relation to radiation dose over a span of more than 30 years. Excellent voluntary cooperation by the survivors has enabled the continuation of a biennial physical examination program which has made possible the acquisition of blood for studies of radiation-induced chromosomal aberrations and mutations at the level of specific genes. Similarly, with the cooperation of local universities, hospitals, and physicians, tumor and tissue registries necessary for the study of cancer incidence have been developed. An autopsy pathology program has enabled study of the accuracy of cause of death certification

  19. Educational program emergency planning.

    Science.gov (United States)

    Curtis, Tammy

    2009-01-01

    Tragic university shootings have prompted administrators of higher education institutions to re-evaluate their emergency preparedness plans and take appropriate measures for preventing and responding to emergencies. To review the literature and identify key components needed to prevent shootings at higher education institutions in the United States, and in particular, institutions housing radiologic science programs. Twenty-eight emergency preparedness plans were retrieved electronically and reviewed from a convenience sample of accredited radiologic science programs provided by the Joint Review Committee on Education in Radiologic Technology Web site. The review of the 28 emergency preparedness plans confirmed that most colleges are prepared for basic emergencies, but lack the key components needed to successfully address mass-casualty events. Only 5 (18%) of the 28 institutions addressed policies concerning school shootings.

  20. Tracking the daily availability of burn beds for national emergencies.

    Science.gov (United States)

    Barillo, David J; Jordan, Marion H; Jocz, Richard J; Nye, Donna; Cancio, Leopoldo C; Holcomb, John B

    2005-01-01

    Medical planning for Operation Iraqi Freedom included predictive models of expected number of burn casualties. In all but the best-case scenario, casualty estimates exceeded the capacity of the only Department of Defense burn center. Examination of existing federal-civilian disaster plans for military hospital augmentation revealed that bed availability data were neither timely nor accurate. Recognizing the need for accurate knowledge of burn bed availability, the Department of Defense requested assistance from the American Burn Association (ABA). Directors of burn centers in the United States were queried for interest in participation in a mass casualty plan to provide overflow burn bed capacity. A list of 70 participating burn centers was devised based upon proximity to planned military embarkation points. A computer tracking program was developed. Daily automated e-mail messages requesting bed status were sent to burn center directors at 6 am Central time with responses requested before 11 am. The collated list of national overflow burn bed capacity was e-mailed each day to the ABA Central Office and to federal and military agencies involved with burn patient triage and transportation. Once automated, this task required only 1-2 hours a day. Available burn-bed lists were generated daily between March 17 and May 2, 2003 and then every other day until May 9, 2003. A total of 2151 responses were received (mean, 43 burn centers per day). A system to track daily nationwide burn bed availability was successfully implemented. Although intended for military conflict, this system is equally applicable to civilian mass casualty situations. We advocate adoption of this or a similar bed tracking system by the ABA for use during burn mass casualty incidents.

  1. Challenges facing the veterinary profession in Ireland: 3. emergency and casualty slaughter certification.

    Science.gov (United States)

    Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

    2017-01-01

    Veterinarians are faced with significant conflicts of interest when issuing certificates for the transport and slaughter of acutely injured and casualty livestock. In a recent Policy Delphi study, emergency and casualty slaughter certification was a key concern identified by veterinary professionals in Ireland. In this case study (the third in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and the on-farm use of veterinary antimicrobials), we aim to provide a value-based reflection on the constraints and opportunities for best practice in emergency and casualty slaughter certification in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely a representative from the regulatory body, local authority veterinarians with research experience in emergency slaughter, an animal welfare research scientist, official veterinarians from the competent authority, a private veterinary practitioner, and a member of a farming organisation. Results revealed a conflict between the responsibility of private veterinary practitioners (PVPs) to safeguard the welfare of acutely injured bovines on-farm and the client's commercial concerns. As a consequence, some PVPs may feel under pressure to certify, for example, an acutely injured animal for casualty slaughter instead of recommending either on-farm emergency slaughter or disposal by the knackery service. Among Official Veterinarians, there are concerns about the pressure within processing plants to accept acutely injured livestock as casualty animals. Confusion pertaining to legislation and definition of fitness to travel also contribute to these dilemmas. Conflicts of interest arise due to the gap between governance and provision to facilitate on-farm emergency slaughter of livestock. Increased availability and acceptance of on

  2. Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.

    Science.gov (United States)

    Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

    2013-07-01

    Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. © 2012 Society for Risk Analysis.

  3. State propaganda and mental disorders: the issue of psychiatric casualties among Japanese soldiers during the Asia-Pacific War.

    Science.gov (United States)

    Matsumura, Janice

    2004-01-01

    This article explores the politics of Japanese wartime medical policy, demonstrating how state propaganda about the people and their armed forces influenced authoritative views on health and what might endanger it. By focusing on the obstacles faced by psychiatrists trying to promote more official concern for mental health issues, it challenges the validity of figures indicating a low incidence of psychological trauma among the country's soldiers. Civilian psychiatrists had to contend with the threat of censorship and arrest for even discussing war-induced mental disorders; at the same time, army psychiatrists as military insiders were pressured to convince their patients that their conditions were not serious and did not merit compensation. While discussing the neglected topic of Japanese psychiatric casualties, an attempt is made to provide a comparative approach by referring to the state of military psychiatry in other national settings.

  4. Job Stress and Coping in Army Casualty Operations Workers

    Science.gov (United States)

    1991-01-14

    informing survivors, and 2) a masculine culture that denies socioemotional aspects of policework (Hall, 1982; Hendricks, 1984; Eth, 1987). Casualty...assistance environment, requiring a degree of 42 socioemotional investment, social supports of some nature are useful. Overall, the work atmosphere at COC is...in child- protective service workers. _ fly Service Review, 31-44. 52 Hendricks, J.E. (1984). Death notification: The theory and practice of informing

  5. Challenges to Improving Combat Casualty Survivability on the Battlefield

    Science.gov (United States)

    2015-01-01

    Rescue Medic in Mogadishu , Somalia, and Special Forces battalion surgeon during Operation Enduring Freedom. He is currently the Director of the Military...the CoTCCC, an organization born outside the traditional military medical establishment, exposes a void in ownership and expertise in battle - field...serve as bat- talion surgeons responsible for the resuscitation of battle casualties in the battalion aid station. This is reminiscent of how

  6. Retrospection. Uranium mining Wismut und the legal casualty insurance

    International Nuclear Information System (INIS)

    Breuer, Joachim

    2015-01-01

    Although the Wismut uranium mining company in the former DDR had 600.000 employees, the company was not mentioned in the contract on the German reunification. The expenses for the health consequences imposed manifold challenges to the legal casualty insurance. The question of responsibility, the conservation, digitalization and evaluation of data concerning the personnel and health information, partially handwritten is a tremendous amount of work.

  7. A third-party casualty risk model for unmanned aircraft system operations

    International Nuclear Information System (INIS)

    Melnyk, Richard; Schrage, Daniel; Volovoi, Vitali; Jimenez, Hernando

    2014-01-01

    Unmanned Aircraft System (UAS) integration into the National Airspace System (NAS) is an important goal of many members of the Aerospace community including stakeholders such as the military, law enforcement and potential civil users of UAS. However, integration efforts have remained relatively limited due to safety concerns. Due to the nature of UAS, safety predictions must look beyond the system itself and take the operating environment into account. A framework that can link UAS reliability and physical characteristics to the effects on the bystander population is required. This study proposes using a Target Level of Safety approach and an event tree format, populated with data from existing studies that share characteristics of UAS crashes to enable casualty prediction for UAS operations. - Highlights: • A framework for predicting bystander casualties caused by UAS mishaps. • A method to facilitate UAS integration by linking system reliability to system safety. • A tool to help develop UAS certification standards

  8. Radiographic interpretation of the appendicular skeleton: A comparison between casualty officers, nurse practitioners and radiographers

    International Nuclear Information System (INIS)

    Coleman, Liz; Piper, Keith

    2009-01-01

    Aim: To assess how accurately and confidently casualty officers, nurse practitioners and radiographers, practicing within the emergency department (ED), recognize and describe radiographic trauma within an image test bank of 20 appendicular radiographs. Method: The participants consisted of 7 casualty officers, 13 nurse practitioners and 18 radiographers. All 20 radiographic examinations selected for the image test bank had been acquired following trauma and included some subtle, yet clinically significant abnormalities. The test bank score (maximum 40 marks), sensitivity and specificity percentages were calculated against an agreed radiological diagnosis (reference standard). Alternative Free-response Receiver Operating Characteristic (AFROC) analysis was used to assess the overall performance of the diagnostic accuracy of these professional groups. The variation in performance between each group was measured using the analysis of variance (ANOVA) test, to identify any statistical significant differences in the performance in interpretation between these groups. The relationship between the participants' perceived image interpretation accuracy during clinical practice and the actual accuracy of their image test bank score was examined using Pearson's Correlation Coefficient (r). Results: The results revealed that the radiographers gained the highest mean test bank score (28.5/40; 71%). This score was statistically higher than the mean test bank scores attained by the participating nurse practitioners (21/40; 53%) and casualty officers (21.5/40; 54%), with p < 0.01 and p = 0.02, respectively. When compared with each other, the scores from these latter groups showed no significant difference (p = 0.91). The mean 'area under the curve' (AUC) value achieved by the radiographers was also significantly higher (p < 0.01) in comparison to the AUC values demonstrated by the nurse practitioners and casualty officers, whose results, when compared, showed no significant

  9. Conflict Without Casualties: Non-Lethal Weapons in Irregular Warfare

    Science.gov (United States)

    2007-09-01

    the body,” and the Geneva Protocol of 1925, bans the use of chemical and biological weapons .11 On 8 April 1975, President Ford issued Executive...E Funding – PE 63851M) (accessed 15 December 2006). The American Journal of Bioethics . “Medical Ethics and Non-Lethal Weapons .” Bioethics.net...CASUALTIES: NON-LETHAL WEAPONS IN IRREGULAR WARFARE by Richard L. Scott September 2007 Thesis Advisor: Robert McNab Second Reader

  10. Management of the mass casualty from the 2001 Jos crisis | Ozoilo ...

    African Journals Online (AJOL)

    Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. Materials and Methods: Aretrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of ...

  11. Mass casualty drill in a local hospital | Ardill | Nigerian Journal of ...

    African Journals Online (AJOL)

    The stated goals of the mass casualty drill were as follows: evaluate the performance of the hospital staff at every cadre, the communication systems, the adequacy of hospital supplies and equipment and provide immediate feedback to the staff for their educational benefit and improved future performance. The Consultant ...

  12. Eating Order: A 13-Week Trust Model Class for Dieting Casualties

    Science.gov (United States)

    Jackson, Elizabeth G.

    2008-01-01

    Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on…

  13. Development of a subway operation incident delay model using accelerated failure time approaches.

    Science.gov (United States)

    Weng, Jinxian; Zheng, Yang; Yan, Xuedong; Meng, Qiang

    2014-12-01

    This study aims to develop a subway operational incident delay model using the parametric accelerated time failure (AFT) approach. Six parametric AFT models including the log-logistic, lognormal and Weibull models, with fixed and random parameters are built based on the Hong Kong subway operation incident data from 2005 to 2012, respectively. In addition, the Weibull model with gamma heterogeneity is also considered to compare the model performance. The goodness-of-fit test results show that the log-logistic AFT model with random parameters is most suitable for estimating the subway incident delay. First, the results show that a longer subway operation incident delay is highly correlated with the following factors: power cable failure, signal cable failure, turnout communication disruption and crashes involving a casualty. Vehicle failure makes the least impact on the increment of subway operation incident delay. According to these results, several possible measures, such as the use of short-distance and wireless communication technology (e.g., Wifi and Zigbee) are suggested to shorten the delay caused by subway operation incidents. Finally, the temporal transferability test results show that the developed log-logistic AFT model with random parameters is stable over time. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment : Research Summary

    Science.gov (United States)

    2017-12-01

    In designing an effective traffic management plan for non-recurrent congestion, it is critical for responsible highway agencies to have some vital information, such as estimated incident duration, resulting traffic queues, and the expected delays. Ov...

  15. The nuclear medicine department in the emergency management plan: a referent structure for the nuclear and radiological risks

    International Nuclear Information System (INIS)

    Barat, J.L.; Ducassou, D.; Lesgourgues, P.; Zamaron, S.; Boulard, G.

    2006-01-01

    Each french public or private hospital has to establish guidelines for an immediate response to mass casualties (Emergency Management Plan or 'White' Plan). For a nuclear accident or terrorist attack, the staff of the Nuclear Medicine Department may be adequately prepared and equipped. This paper presents the nuclear and radiological risks section of the final draft of the White Plan developed at Bordeaux University Hospital. (author)

  16. Operationalizing Civilian Protection in Mali: The Case for a Civilian Casualty Tracking, Analysis, and Response Cell

    Directory of Open Access Journals (Sweden)

    Marla B. Keenan

    2013-06-01

    Full Text Available This practice note details an emerging best practice of civilian harm mitigation in armed conflict: namely, the creation of civilian casualty tracking, analysis and response processes by a warring party or peace operation force. It asserts that in Iraq, Afghanistan and soon Somalia, these processes to better understand civilian harm and address consequences have positively shaped mission tactics, training, and overall operations. In both Iraq and Afghanistan, tracking and analysis has lead to a marked decrease in civilian casualties and facilitated the making of amends for any civilian losses. The paper argues that for warring parties to achieve their mission—particularly one with a protection of civilians mandate as with the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA—they must fully understand the impact of their actions on the civilian population, positive or negative. For this reason, a Civilian Casualty Tracking, Analysis, and Response Cell should be created for MINUSMA to improve its ability mitigate risk to civilians as required by its Security Council mandate.

  17. Managing the surge in demand for blood following mass casualty events: Early automatic restocking may preserve red cell supply.

    Science.gov (United States)

    Glasgow, Simon; Vasilakis, Christos; Perkins, Zane; Brundage, Susan; Tai, Nigel; Brohi, Karim

    2016-07-01

    Traumatic hemorrhage is a leading preventable cause of mortality following mass casualty events (MCEs). Improving outcomes requires adequate in-hospital provision of high-volume red blood cell (RBC) transfusions. This study investigated strategies for optimizing RBC provision to casualties in MCEs using simulation modeling. A computerized simulation model of a UK major trauma center (TC) transfusion system was developed. The model used input data from past MCEs and civilian and military trauma registries. We simulated the effect of varying on-shelf RBC stock hold and the timing of externally restocking RBC supplies on TC treatment capacity across increasing loads of priority one (P1) and two (P2) casualties from an event. Thirty-five thousand simulations were performed. A casualty load of 20 P1s and P2s under standard TC RBC stock conditions left 35% (95% confidence interval, 32-38%) of P1s and 7% (4-10%) of P2s inadequately treated for hemorrhage. Additionally, exhaustion of type O emergency RBC stocks (a surrogate for reaching surge capacity) occurred in a median of 10 hours (IQR, 5 to >12 hours). Doubling casualty load increased this to 60% (57-63%) and 30% (26-34%), respectively, with capacity reached in 2 hours (1-3 hours). The model identified a minimum requirement of 12 U of on-shelf RBCs per P1/P2 casualty received to prevent surge capacity being reached. Restocking supplies in an MCE versus greater permanent on-shelf RBC stock holds was considered at increasing hourly intervals. T-test analysis showed no difference between stock hold versus supply restocking with regard to overall outcomes for MCEs up to 80 P1s and P2s in size (p < 0.05), provided the restock occurred within 6 hours. Even limited-sized MCEs threaten to overwhelm TC transfusion systems. An early-automated push approach to restocking RBCs initiated by central suppliers can produce equivocal outcomes compared with holding excess stock permanently at TCs. Therapeutic/care management study

  18. Phenomenological modelling of second cancer incidence for radiation treatment planning

    International Nuclear Information System (INIS)

    Pfaffenberger, Asja; Oelfke, Uwe; Schneider, Uwe; Poppe, Bjoern

    2009-01-01

    It is still an unanswered question whether a relatively low dose of radiation to a large volume or a higher dose to a small volume produces the higher cancer incidence. This is of interest in view of modalities like IMRT or rotation therapy where high conformity to the target volume is achieved at the cost of a large volume of normal tissue exposed to radiation. Knowledge of the shape of the dose response for radiation-induced cancer is essential to answer the question of what risk of second cancer incidence is implied by which treatment modality. This study therefore models the dose response for radiation-induced second cancer after radiation therapy of which the exact mechanisms are still unknown. A second cancer risk estimation tool for treatment planning is presented which has the potential to be used for comparison of different treatment modalities, and risk is estimated on a voxel basis for different organs in two case studies. The presented phenomenological model summarises the impact of microscopic biological processes into effective parameters of mutation and cell sterilisation. In contrast to other models, the effective radiosensitivities of mutated and non-mutated cells are allowed to differ. Based on the number of mutated cells present after irradiation, the model is then linked to macroscopic incidence by summarising model parameters and modifying factors into natural cancer incidence and the dose response in the lower-dose region. It was found that all principal dose-response functions discussed in the literature can be derived from the model. However, from the investigation and due to scarcity of adequate data, rather vague statements about likelihood of dose-response functions can be made than a definite decision for one response. Based on the predicted model parameters, the linear response can probably be rejected using the dynamics described, but both a flattening response and a decrease appear likely, depending strongly on the effective cell

  19. Tactical and operational response to major incidents: feasibility and reliability of skills assessment using novel virtual environments.

    Science.gov (United States)

    Cohen, Daniel; Sevdalis, Nick; Patel, Vishal; Taylor, Michael; Lee, Henry; Vokes, Mick; Heys, Mick; Taylor, David; Batrick, Nicola; Darzi, Ara

    2013-07-01

    To determine feasibility and reliability of skills assessment in a multi-agency, triple-site major incident response exercise carried out in a virtual world environment. Skills assessment was carried out across three scenarios. The pre-hospital scenario required paramedics to triage and treat casualties at the site of an explosion. Technical skills assessment forms were developed using training syllabus competencies and national guidelines identified by pre-hospital response experts. Non-technical skills were assessed using a seven-point scale previously developed for use by pre-hospital paramedics. The two in-hospital scenarios, focusing on a trauma team leader and a silver/clinical major incident co-ordinator, utilised the validated Trauma-NOTECHS scale to assess five domains of performance. Technical competencies were assessed using an ATLS-style competency scale for the trauma scenario. For the silver scenario, the assessment document was developed using competencies described from a similar role description in a real-life hospital major incident plan. The technical and non-technical performance of all participants was assessed live by two experts in each of the three scenarios and inter-assessor reliability was computed. Participants also self-assessed their performance using identical proformas immediately after the scenarios were completed. Self and expert assessments were correlated (assessment cross-validation). Twenty-three participants underwent all scenarios and assessments. Performance assessments were feasible for both experts as well as the participants. Non-technical performance was generally scored higher than technical performance. Very good inter-rater reliability was obtained between expert raters across all scenarios and both technical and non-technical aspects of performance (reliability range 0.59-0.90, Psassessment in technical skills across all three scenarios (correlation range 0.52-0.84, Psskills. This study establishes feasibility and

  20. Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

    Science.gov (United States)

    Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

    2015-04-01

    This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (PVirtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

  1. Internet-accessible radiographic database of Vietnam War casualties for medical student education.

    Science.gov (United States)

    Critchley, Eric P; Smirniotopoulos, James G

    2003-04-01

    The purpose of this study was to determine the feasibility of archiving radiographic images from Vietnam era conflict casualties into a personal computer-based electronic database of text and images and displaying the data using an Internet-accessible database for preservation and educational purposes. Thirty-two patient cases were selected at random from a pool of 1,000 autopsy reports in which radiographs were available. A total of 74 radiographs from these cases were digitized using a commercial image scanner and then uploaded into an Internet accessible database. The quality of the digitized images was assessed by administering an image-based test to a group of 12 medical students. No statistically significant (p > 0.05) differences were found between test scores when using the original radiographs versus using the digitized radiographs on the Internet-accessible database. An Internet-accessible database is capable of effectively archiving Vietnam era casualty radiographs for educational purposes.

  2. Guidance on accidents involving radioactivity

    International Nuclear Information System (INIS)

    1989-01-01

    This annex contains advice to Health Authorities on their response to accidents involving radioactivity. The guidance is in six parts:-(1) planning the response required to nuclear accidents overseas, (2) planning the response required to UK nuclear accidents a) emergency plans for nuclear installations b) nuclear powered satellites, (3) the handling of casualties contaminated with radioactive substances, (4) background information for dealing with queries from the public in the event of an accident, (5) the national arrangements for incident involving radioactivity (NAIR), (6) administrative arrangements. (author)

  3. Modification of Measures of Acute Kidney Injury to Risk Stratify Combat Casualties

    Science.gov (United States)

    2017-08-26

    REPORT TYPE 08/26/2017 Poster 4. TJTLE AND SUBTITLE t\\.1odification of l’vfeasures,of Acute Kidney Injury to Risk Stratify Cotnbat Casualties 6...profiles and potential future conflicts , identifying acute kidney injury (AKI) early can help us determine the need for rapidity of evacuation

  4. Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system

    International Nuclear Information System (INIS)

    Novak, Avrey; Nyflot, Matthew J.; Ermoian, Ralph P.; Jordan, Loucille E.; Sponseller, Patricia A.; Kane, Gabrielle M.; Ford, Eric C.; Zeng, Jing

    2016-01-01

    Purpose: Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. Methods: From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Results: Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically

  5. Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system

    Energy Technology Data Exchange (ETDEWEB)

    Novak, Avrey; Nyflot, Matthew J.; Ermoian, Ralph P.; Jordan, Loucille E.; Sponseller, Patricia A.; Kane, Gabrielle M.; Ford, Eric C.; Zeng, Jing, E-mail: jzeng13@uw.edu [Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific Street, Campus Box 356043, Seattle, Washington 98195 (United States)

    2016-05-15

    Purpose: Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. Methods: From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Results: Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically

  6. Earthquake casualty models within the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system

    Science.gov (United States)

    Jaiswal, Kishor; Wald, David J.; Earle, Paul S.; Porter, Keith A.; Hearne, Mike

    2011-01-01

    Since the launch of the USGS’s Prompt Assessment of Global Earthquakes for Response (PAGER) system in fall of 2007, the time needed for the U.S. Geological Survey (USGS) to determine and comprehend the scope of any major earthquake disaster anywhere in the world has been dramatically reduced to less than 30 min. PAGER alerts consist of estimated shaking hazard from the ShakeMap system, estimates of population exposure at various shaking intensities, and a list of the most severely shaken cities in the epicentral area. These estimates help government, scientific, and relief agencies to guide their responses in the immediate aftermath of a significant earthquake. To account for wide variability and uncertainty associated with inventory, structural vulnerability and casualty data, PAGER employs three different global earthquake fatality/loss computation models. This article describes the development of the models and demonstrates the loss estimation capability for earthquakes that have occurred since 2007. The empirical model relies on country-specific earthquake loss data from past earthquakes and makes use of calibrated casualty rates for future prediction. The semi-empirical and analytical models are engineering-based and rely on complex datasets including building inventories, time-dependent population distributions within different occupancies, the vulnerability of regional building stocks, and casualty rates given structural collapse.

  7. Medical treatment of radiation damages and medical emergency planning in case of nuclear power plant incidents and accidents

    International Nuclear Information System (INIS)

    Ohlenschlaeger, L.

    1981-03-01

    Medical measures in case of radiation damages are discussed on the basis of five potential categories of radiation incidents and accidents, respectively, viz. contaminations, incorporations, external local and general radiation over-exposures, contaminated wounds, and combinations of radiation damages and conventional injuries. Considerations are made for diagnostic and therapeutic initial measures especially in case of minor and moderate radiation accidents. The medical emergency planning is reviewed by means of definations used in the practical handling of incidents or accidents. The parameters are: extent of the incident or accident, number of persons involved, severity of radiation damage. Based on guiding symptoms the criteria for the classification into minor, moderate or severe radiation accidents are discussed. Reference is made to the Medical Radiation Protection Centers existing in the Federal Republic of Germany and the possibility of getting advices in case of radiation incidents and accidents. (orig.) [de

  8. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident.

    Science.gov (United States)

    Lee, James S; Franc, Jeffrey M

    2015-08-01

    A high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise. Hypothesis/Problem It was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone. Physicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes. There were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar

  9. Two incidents that changed quality management in the Australian livestock export industry

    Directory of Open Access Journals (Sweden)

    Peter R. Stinson

    2008-03-01

    Full Text Available Quality assurance in Australia's livestock export industry arose from a need to address animal welfare concerns. It was initially instigated by industry in the form of an accreditation scheme which contained standards, auditing requirements and training requirements. Two major incidents in long haul shipping of livestock demonstrated that risk management in the industry cannot be achieved through compliance with standards alone. A thorough investigation of the first incident recommended the introduction of formal risk management to complement a standards regime. This approach is applicable to the management of major risks, such as heat stress and disease. It is also especially suited to commercial risks, such as the rejection of cargo and where voyage or market specific treatments are needed and depend upon the expertise of the exporter. However, before these recommendations on risk management could be fully implemented, a significant public incident occurred which altered the direction of quality assurance in industry. The Australian response was to transfer authority to government regulators with a tightening of standards. This focuses on the need to ensure ownership of quality assurance programmes by the exporter. Formal risk management has been a casualty of the second incident and, unfortunately, has not been introduced.

  10. Rough terrain motion planning for actively reconfigurable mobile robots

    International Nuclear Information System (INIS)

    Brunner, Michael

    2015-01-01

    In the aftermath of the Tohoku earthquake and the nuclear meltdown at the power plant of Fukushima Daiichi in 2011, reconfigurable robots like the iRobot Packbot were deployed. Instead of humans, the robots were used to investigate contaminated areas. Other incidents are the two major earthquakes in Northern Italy in May 2012. Besides many casualties, a large number of historical buildings was severely damaged. Due to the imminent danger of collapse, it was too dangerous for rescue personnel to enter many of the buildings. Therefore, the sites were inspected by reconfigurable robots, which are able to traverse the rubble and debris of the partially destroyed buildings. This thesis develops a navigation system enabling wheeled and tracked robots to safely traverse rough terrain and challenging structures. It consists of a planning mechanism and a controller. The focus of this thesis, however, is on the contribution to motion planning. The planning scheme employs a hierarchical approach to motion planning for actively reconfigurable robots in rough environments. Using a map of the environment the algorithm estimates the traversability under the consideration of uncertainties. Based on this analysis, an initial path search determines an approximate solution with respect to the robot's operating limits.Subsequently, a detailed planning step refines the initial path where it is required. The refinement step considers the robot's actuators and stability in addition to the quantities of the first search. Determining the robot-terrain interaction is very important in rough terrain. This thesis presents two path refinement approaches: a deterministic and a randomized approach. The experimental evaluation investigates the separate components of the planning scheme, the robot-terrain interaction for instance.In simulation as well as in real world experiments the evaluation demonstrates the necessity of such a planning algorithm in rough terrain and it provides

  11. Rough terrain motion planning for actively reconfigurable mobile robots

    Energy Technology Data Exchange (ETDEWEB)

    Brunner, Michael

    2015-02-05

    In the aftermath of the Tohoku earthquake and the nuclear meltdown at the power plant of Fukushima Daiichi in 2011, reconfigurable robots like the iRobot Packbot were deployed. Instead of humans, the robots were used to investigate contaminated areas. Other incidents are the two major earthquakes in Northern Italy in May 2012. Besides many casualties, a large number of historical buildings was severely damaged. Due to the imminent danger of collapse, it was too dangerous for rescue personnel to enter many of the buildings. Therefore, the sites were inspected by reconfigurable robots, which are able to traverse the rubble and debris of the partially destroyed buildings. This thesis develops a navigation system enabling wheeled and tracked robots to safely traverse rough terrain and challenging structures. It consists of a planning mechanism and a controller. The focus of this thesis, however, is on the contribution to motion planning. The planning scheme employs a hierarchical approach to motion planning for actively reconfigurable robots in rough environments. Using a map of the environment the algorithm estimates the traversability under the consideration of uncertainties. Based on this analysis, an initial path search determines an approximate solution with respect to the robot's operating limits.Subsequently, a detailed planning step refines the initial path where it is required. The refinement step considers the robot's actuators and stability in addition to the quantities of the first search. Determining the robot-terrain interaction is very important in rough terrain. This thesis presents two path refinement approaches: a deterministic and a randomized approach. The experimental evaluation investigates the separate components of the planning scheme, the robot-terrain interaction for instance.In simulation as well as in real world experiments the evaluation demonstrates the necessity of such a planning algorithm in rough terrain and it provides

  12. Amendment to the Decree of the Slovak Nuclear Regulatory Authority on details concerning emergency planning in case of nuclear incident or accident

    International Nuclear Information System (INIS)

    Biharyová, Michaela

    2018-01-01

    Following up amendment to the Slovak Atomic Act, the Decree No. 55/2006 on details concerning emergency planning in case of nuclear incident or accident has also been amended now. Following a short introductory text by the author, the entire text of the ‘Decree of the Nuclear Regulatory Authority of the Slovak Republic No 9/2018 Coll. of 2 January 2018 amending Decree of the Nuclear Regulatory Authority of the Slovak Republic No 55/2006 Coll. on details in emergency planning in case of nuclear incident or accident as amended by Decree No. 35/2012 Coll.’ is reproduced. The Amendment entered into force 1 February 2018. (orig.)

  13. Evaluating the Joint Theater Trauma Registry as a data source to benchmark casualty care.

    Science.gov (United States)

    O'Connell, Karen M; Littleton-Kearney, Marguerite T; Bridges, Elizabeth; Bibb, Sandra C

    2012-05-01

    Just as data from civilian trauma registries have been used to benchmark and evaluate civilian trauma care, data contained within the Joint Theater Trauma Registry (JTTR) present a unique opportunity to benchmark combat care. Using the iterative steps of the benchmarking process, we evaluated data in the JTTR for suitability and established benchmarks for 24-hour mortality in casualties with polytrauma and a moderate or severe blunt traumatic brain injury (TBI). Mortality at 24 hours was greatest in those with polytrauma and a severe blunt TBI. No mortality was seen in casualties with polytrauma and a moderate blunt TBI. Secondary insults after TBI, especially hypothermia and hypoxemia, increased the odds of 24-hour mortality. Data contained in the JTTR were found to be suitable for establishing benchmarks. JTTR data may be useful in establishing benchmarks for other outcomes and types of combat injuries.

  14. Incident Management: Process into Practice

    Science.gov (United States)

    Isaac, Gayle; Moore, Brian

    2011-01-01

    Tornados, shootings, fires--these are emergencies that require fast action by school district personnel, but they are not the only incidents that require risk management. The authors have introduced the National Incident Management System (NIMS) and the Incident Command System (ICS) and assured that these systems can help educators plan for and…

  15. United States Army Rangers in Somalia: An Analysis of Combat Casualties on an Urban Battlefield

    National Research Council Canada - National Science Library

    Mabry, Robert L; Holcomb, John B; Baker, Andrew M; Cloonan, Clifford C; Uhorchak, John M; Perkins, Denver E; Canfield, Anthony J; Hagmann, John H

    2000-01-01

    .... From July 1998 to March 1999 data were collected for a retrospective analysis of all combat casualties sustained by United States military forces in Mogadishu, Somalia, on October 3 and 4, 1993...

  16. 46 CFR 185.220 - Records of a voyage resulting in a marine casualty.

    Science.gov (United States)

    2010-10-01

    ....220 Section 185.220 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.220 Records of a... officer, or person responsible for the custody thereof, shall make these records available upon request...

  17. Rural casualty crashes on the Kings Highway: A new approach for road safety studies.

    Science.gov (United States)

    Alian, Sahar; Baker, R G V; Wood, Stephen

    2016-10-01

    This paper will consider the contribution that changes in road geometry and driver visual information make to the incidence and distribution of road casualties in different driving environments. This relationship will be explored specifically for the Kings Highway, a major arterial road connecting Queanbeyan with coastal southern New South Wales, Australia. It introduces and suggests a new empirical approach of plotting crashes with road segmentation, calculating sinuosity indices and grades as key features of road geometry, and critical visual points as a behavioural component of road curvature, within a GIS context. It is an approach that might be used when detailed road geometry data is not available. The visualisation and segmentation approach in this research might be used for summarising crash rates and road geometry factors, and for comparing day/night and eastbound/westbound driving conditions. The results suggest some early interpretations for detailed road safety studies that might be considered at local or national levels. The rate of crashes increases according to changes in road geometry factors during the day and for eastbound travel. This is not the case for night driving where the incidence of crashes is similar on both straight and curved roads segments due to the headlight effect and limited background visual field. Crash clusters at day-time may be due to the stronger effect of road geometry (e.g. combination of curvature and vertical grade) on driver behaviour travelling eastbound. The outcomes suggest that it might be essential to consider the effect of environmental factors in any road safety and crash analysis studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Incidents with hazardous radiation sources

    International Nuclear Information System (INIS)

    Schoenhacker, Stefan

    2016-01-01

    Incidents with hazardous radiation sources can occur in any country, even those without nuclear facilities. Preparedness for such incidents is supposed to fulfill globally agreed minimum standards. Incidents are categorized in incidents with licensed handling of radiation sources as for material testing, transport accidents of hazardous radiation sources, incidents with radionuclide batteries, incidents with satellites containing radioactive inventory, incidents wit not licensed handling of illegally acquired hazardous radiation sources. The emergency planning in Austria includes a differentiation according to the consequences: incidents with release of radioactive materials resulting in restricted contamination, incidents with release of radioactive materials resulting in local contamination, and incidents with the hazard of e@nhanced exposure due to the radiation source.

  19. Systematic review of strategies to manage and allocate scarce resources during mass casualty events.

    Science.gov (United States)

    Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Pillemer, Francesca; Waxman, Daniel A; Moore, Melinda; Hansen, Cynthia K; Knebel, Ann R; Ricciardi, Richard; Kellermann, Arthur L

    2013-06-01

    Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of

  20. 75 FR 38188 - Surety Companies Acceptable on Federal Bonds-Termination: Stonebridge Casualty Insurance Company

    Science.gov (United States)

    2010-07-01

    ... should be accepted from this company, and bonds that are continuous in nature should not be renewed. The... DEPARTMENT OF THE TREASURY Fiscal Service [NAIC 10952] Surety Companies Acceptable on Federal Bonds--Termination: Stonebridge Casualty Insurance Company AGENCY: Financial Management Service, Fiscal...

  1. Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb.

    Science.gov (United States)

    Fox, Charles J; Perkins, Jeremy G; Kragh, John F; Singh, Niten N; Patel, Bhavin; Ficke, James R

    2010-07-01

    Popliteal artery war wounds can bleed severely and historically have high rates of amputation associated with ligation (72%) and repair (32%). More than before, casualties are now surviving the initial medical evacuation and presenting with severely injured limbs that prompt immediate limb salvage decisions in the midst of life-saving maneuvers. A modern analysis of current results may show important changes because previous limb salvage strategies were limited by the resuscitation and surgical techniques of their eras. Because exact comparisons between wars are difficult, the objective of this study was to calculate a worst-case (a pulseless, fractured limb with massive hemorrhage from popliteal artery injury) amputation-free survival rate for the most severely wounded soldiers undergoing immediate reconstruction to save both life and limb. We performed a retrospective study of trauma casualties admitted to the combat support hospital at Ibn Sina Hospital in Baghdad, Iraq, between 2003 and 2007. US military casualties requiring a massive transfusion (> or = 10 blood units transfused within 24 hours of injury) were identified. We extracted data on the subset of casualties with a penetrating supra or infrageniculate popliteal arterial vascular injury. Demographics, injury mechanism, Injury Severity Score, tourniquet use, physiologic parameters, damage control adjuncts, surgical repair techniques, operative time, and outcomes (all-cause 30-day mortality, amputation rates, limb salvage failure, and graft patency) were investigated. Forty-six massively transfused male casualties, median age 24 years (range, 19-54 years; mean Injury Severity Score, 19 +/- 8.0), underwent immediate orthopedic stabilization and vascular reconstruction. There was one early death. The median operative time for the vascular repairs was 217 minutes (range, 94-630 minutes) and included all damage control procedures. Combined arterial and venous injuries occurred in 17 (37%). Ligation was

  2. Protective measures while treating CWA casualties

    International Nuclear Information System (INIS)

    Medema, J.

    2009-01-01

    When Chemical Warfare agent casualties are brought into a medical facility they are usually decontaminated before receiving treatment. The decontamination can range from simply undressing to complex entry/exit procedures for a collective protection medical shelter. It is expected that the decontamination has reduced the contamination to such a degree that there is no more hazard for the medical personnel from emanating CWA vapors. However there is quite some evidence that this is usually not the case and additional protective measures are required in order to have the medical staff operating unhindered and not endangered by albeit low but still hazardous CWA vapor concentrations that at the end of the day would have adverse effects on the capabilities of the medical staff. In the paper some simple but effective means will be described that will reduce the exposure of the medical staff to.(author)

  3. Research issues in preparedness for mass casualty events, disaster, war, and terrorism.

    Science.gov (United States)

    Hinton Walker, Patricia; Garmon Bibb, Sandra C; Elberson, Karen L

    2005-09-01

    This article provides a perspective on the types of research questions that might be explored and strategies used in relation to disaster,terrorism, and mass casualty events. Research is addressed in the context of three areas of focus: issues related to the health care provider; issues affecting the patient, individual, family, and community; and issues related to the health care system.

  4. HIV incidence in sub-Saharan Africa: a review of available data with implications for surveillance and prevention planning.

    Science.gov (United States)

    Braunstein, Sarah L; van de Wijgert, Janneke H H M; Nash, Denis

    2009-01-01

    HIV incidence estimation is increasingly being incorporated into HIV/AIDS surveillance activities in both resource-rich and developing countries. We conducted a systematic review to assess the availability of HIV incidence data from sub-Saharan Africa. We examined peer-reviewed articles, conference proceedings and technical reports published from 1987-2008. Incidence estimates were classified by country, year, population group, and estimation method (prospective study or the serologic testing algorithm for recent HIV seroconversion; STARHS). Our search yielded HIV incidence estimates for 15 of 44 sub-Saharan African countries, with 57 studies generating 264 unique estimates. Of these, 239 (91%) were obtained via prospective studies, and 25 (9%) via the STARHS method (24 using the BED-CEIA assay). Only five countries reported population-based estimates, and less than two-thirds of studies reported risk factor information. STARHS use increased over time, comprising 20% of estimates since 2006. However, studies that compared STARHS estimates with prospectively observed or modeled estimates often found substantial levels of disagreement, with STARHS often overestimating HIV incidence. Population-based HIV incidence estimates and risk factor information in sub-Saharan Africa remain scant but increasingly available. Regional STARHS data suggest a need for further validation prior to widespread use and incorporation into routine surveillance activities. In the meantime, prevalence and behavioral risk factor data remain important for HIV prevention planning.

  5. Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

    Science.gov (United States)

    Stewart, Ian J; Faulk, Tarra I; Sosnov, Jonathan A; Clemens, Michael S; Elterman, Joel; Ross, James D; Howard, Jeffrey T; Fang, Raymond; Zonies, David H; Chung, Kevin K

    2016-03-01

    Rhabdomyolysis has been associated with poor outcomes in patients with traumatic injury, especially in the setting of acute kidney injury (AKI). However, rhabdomyolysis has not been systematically examined in a large cohort of combat casualties injured in the wars in Iraq and Afghanistan. We conducted a retrospective study of casualties injured during combat operations in Iraq and Afghanistan who were initially admitted to the intensive care unit from February 1, 2002, to February 1, 2011. Information on age, sex, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), mechanism of injury, shock index, creatine kinase, and serum creatinine were collected. These variables were examined via multivariate logistic and Cox regression analyses to determine factors independently associated with rhabdomyolysis, AKI, and death. Of 6,011 admissions identified, a total of 2,109 patients met inclusion criteria and were included for analysis. Rhabdomyolysis, defined as creatine kinase greater than 5,000 U/L, was present in 656 subjects (31.1%). Risk factors for rhabdomyolysis identified on multivariable analysis included injuries to the abdomen and extremities, increased ISS, male sex, explosive mechanism of injury, and shock index greater than 0.9. After adjustment, patients with rhabdomyolysis had a greater than twofold increase in the odds of AKI. In the analysis for mortality, rhabdomyolysis was significantly associated with death until AKI was added, at which point it lost statistical significance. We found that rhabdomyolysis is associated with the development of AKI in combat casualties. While rhabdomyolysis was strongly associated with mortality on the univariate model and in conjunction with both ISS and age, it was not associated with mortality after the inclusion of AKI. This suggests that the effect of rhabdomyolysis on mortality may be mediated by AKI. Prognostic and epidemiologic study, level III.

  6. The influence of car registration year on driver casualty rates in Great Britain.

    Science.gov (United States)

    Broughton, Jeremy

    2012-03-01

    A previous paper analysed data from the British national road accident reporting system to investigate the influence upon car driver casualty rates of the general type of car being driven and its year of first registration. A statistical model was fitted to accident data from 2001 to 2005, and this paper updates the principal results using accident data from 2003 to 2007. Attention focuses upon the role of year of first registration since this allows the influence of developments in car design upon occupant casualty numbers to be evaluated. Three additional topics are also examined with these accident data. Changes over time in frontal and side impacts are compared. Changes in the combined risk for the two drivers involved in a car-car collision are investigated, being the net result of changes in secondary safety and aggressivity. Finally, the results of the new model relating to occupant protection are related to an index that had been developed previously to analyse changes over time in the secondary safety of the car fleet. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Intraosseous vascular access in disasters and mass casualty events: A review of the literature.

    Science.gov (United States)

    Burgert, James M

    2016-01-01

    The intraosseous (IO) route of vascular access has been increasingly used to administer resuscitative fluids and drugs to patients in whom reliable intravenous (IV) access could not be rapidly or easily obtained. It is unknown that to what extent the IO route has been used to gain vascular access during disasters and mass casualty events. The purpose of this review was to examine the existing literature to answer the research question, "What is the utility of the IO route compared to other routes for establishing vascular access in patients resulting from disasters and mass casualty events?" Keyword-based online database search of PubMed, CINAHL, and the Cochrane Database of Systematic Reviews. University-based academic research cell. Included evidence were randomized and nonrandomized trials, systematic reviews with and without meta-analysis, case series, and case reports. Excluded evidence included narrative reviews and expert opinion. Not applicable. Of 297 evidence sources located, 22 met inclusion criteria. Located evidence was organized into four categories including chemical agent poisoning, IO placement, while wearing chemical protective clothing (PPE), military trauma, and infectious disease outbreak. Evidence indicates that the IO route of infusion is pharmacokinetically equal to the IV route and superior to the intramuscular (IM) and endotracheal routes for the administration of antidotal drugs in animal models of chemical agent poisoning while wearing full chemical PPE. The IO route is superior to the IM route for antidote administration during hypovolemic shock. Civilian casualties of explosive attacks and mass shootings would likely benefit from expanded use of the IO route and military resuscitation strategies. The IO route is useful for fluid resuscitation in the management of diarrheal and hemorrhagic infectious disease outbreaks.

  8. Bird casualties and wind turbines near the Kreekrak sluices of Zeeland

    International Nuclear Information System (INIS)

    Musters, C.J.M.; Noordervliet, M.A.W.; Ter Keurs, W.J.

    1995-03-01

    The impact of wind turbines on birds was investigated for an estuary, situated near the North Sea coast in the Dutch province of Zeeland, with large amount of bird migration. Five 250 kW, three-bladed 25m, 40 rpm turbines were installed on the western side of a dike. The distance between the turbines is 125 m. Since 1 April 1990 the turbines have been in action almost continuously. The study on the title subject was set up to investigate the number of bird casualties caused by the five wind turbines near the sluices of Kreekrak and the number that may be expected to be caused by a total of 20 turbines. The study also focused on the number of casualties among rare birds in relation to those among the common birds as a result of the wind turbines in the Kreekrak area. An area of 125 x 125 m around each wind turbine, consisting partly of land and partly of water, was searched for dead birds every other day during a period of one year (28 April 1990 - 29 April 1991). During this one-year period, the bodies of 26 birds of 17 different species were found; six birds were certainly or almost certainly killed by the turbines. In three other cases, the birds may have died because of the turbines, while in the case of eight birds, it was not possible to determine the cause of death. The remaining nine birds were not killed by the wind turbines. The annual number of bird victims expected following the installation of 20 wind turbines was estimated at a minimum of 7 and a maximum of 142. For each species a correlation was found between the number of victims and the estimated number of visitors to the area. This suggests that the rare species among the birds were not excessively endangered by the turbines. The number of bird casualties per turbine was low in comparison with the results of other Dutch investigations. On the basis of these results, it is concluded that there is no reason to advise against increasing the number of wind turbines near the sluices of Kreekrak to 20. 3

  9. Addressing the gap between public health emergency planning and incident response

    Science.gov (United States)

    Freedman, Ariela M; Mindlin, Michele; Morley, Christopher; Griffin, Meghan; Wooten, Wilma; Miner, Kathleen

    2013-01-01

    Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods: This study was conducted using critical case study methodology consisting of document review and 18 key-informant interviews with individuals who played key roles in planning and response. Thematic analysis was used to analyze data. Results: Several broad elements emerged as key to ensuring effective and efficient public health response: 1) developing a plan for emergency response; 2) establishing the framework for an ICS; 3) creating the infrastructure to support response; 4) supporting a workforce trained on emergency response roles, responsibilities, and equipment; and 5) conducting regular preparedness exercises. Conclusions: This research demonstrates the value of investments made and that effective emergency preparedness requires sustained efforts to maintain personnel and material resources. By having the infrastructure and experience based on ICS and EOC, the public health system had the capability to surge-up: to expand its day-to-day operation in a systematic and prolonged manner. None of these critical actions are possible without sustained funding for the public health infrastructure. Ultimately, this case study illustrates the importance of public health as a key leader in emergency response. PMID:28228983

  10. Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room.

    Science.gov (United States)

    Shaw, Subhash Chandra; Devgan, Amit; Anila, Sushila; Anushree, Neha; Debnath, Himadri

    2018-04-01

    Body temperature of a neonate continues to be under-documented, under-recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We aimed to reduce neonatal hypothermia (body temperature improvement (QI) initiative using the rapid-cycle Plan-Do-Study-Act approach (PDSA) improvement model and the project was conducted from 15 Jan 2017 to 25 Feb 2017. All singleton neonates with gestational ages above 34 completed weeks born by vaginal delivery were targeted. Exclusion criteria included neonates needing any form of resuscitation, those developing respiratory distress after birth needing any form of respiratory support or observation in NICU. We ran PDSA cycles (including pre-warmed cloths, skin to skin care with mother, early breast feeding, delaying weight check by 1 h and checklist of planned steps), every week, after taking the baseline data in the first week. A total of 46 neonates were studied. After 4 PDSA cycles, incidence of neonatal hypothermia at 1 h of birth dropped to zero from 50% at baseline and we were able to sustain 100% normal temperature (36.5-37.5 °C) since then. This QI project has significantly reduced the incidence of hypothermia in term and late preterm neonates born by vaginal delivery in our institute.

  11. The pros and cons of vaious optical media for the soldier's interfacility radiographic record (SIRR) in the combat casualty care system

    International Nuclear Information System (INIS)

    Kerlin, B.D.; Johnson, W.P.

    1989-01-01

    Ongoing research and evaluation projects sponsored by the Army Medical Research and Development Command are leading towards filmless radiography in the combat casualty care system of the 1990s. With the elimination of film, the question arises as to the most appropriate medium for archiving and transporting X-ray images and related patient data with the wounded between facilities. This paper considers the pros and cons of the various candidate media in relation to their specifications, availability, and appropriateness under simulated combat casualty care conditions

  12. The Pros And Cons Of Various Optical Media For The Soldier's Interfacility Radiographic Record (SIRR) In The Combat Casualty Care System

    Science.gov (United States)

    Kerlin, Barbara D.; Johnson, William P.

    1989-05-01

    Ongoing research and evaluation projects sponsored by the Army Medical Research and Development Command are leading towards filmless radiography in the combat casualty care system of the 1990s. With the elimination of film, the question arises as to the most appropriate medium for archiving and transporting x-ray images and related patient data with the wounded between facilities. This paper considers the pros and cons of the various candidate media in relation to their specifications, availability, and appropriateness under simulated combat casualty care conditions.

  13. Pre-hospital management of mass casualty civilian shootings: a systematic literature review

    OpenAIRE

    Turner, Conor D. A.; Lockey, David J.; Rehn, Marius

    2016-01-01

    Background Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future p...

  14. Analysis of the Causes of Maritime Casualties

    Directory of Open Access Journals (Sweden)

    Jelenko Švetak

    2003-01-01

    Full Text Available A survey of total loss accidents in merchant shipping over aperiod of 30 years shows that these can be arranged in the followingorder: stranding, fire, water-leaks, gales and collision;other accidents are also taken into consideration. The analysisconsiders ships over 500 GT of different flags, plying any routeof navigation.Initially, a sample of 500 merchant ships- of different typesand tonnage- and under 15 different flags is analyzed to determineage and type of ship, and the causes of accidents.In the second analysis, the same 15 flags are considered,but now over a wider range on a sample totalling 1,500 merchantships. The results of both analyses are compared. It isshown that all collisions together with gale amount to 25% ofmaritime casualty returns -in the total loss lists- while strandingand collision take more than 40% of the toll.

  15. A quantification of the effectiveness of EPID dosimetry and software-based plan verification systems in detecting incidents in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bojechko, Casey; Phillps, Mark; Kalet, Alan; Ford, Eric C., E-mail: eford@uw.edu [Department of Radiation Oncology, University of Washington, 1959 N. E. Pacific Street, Seattle, Washington 98195 (United States)

    2015-09-15

    Purpose: Complex treatments in radiation therapy require robust verification in order to prevent errors that can adversely affect the patient. For this purpose, the authors estimate the effectiveness of detecting errors with a “defense in depth” system composed of electronic portal imaging device (EPID) based dosimetry and a software-based system composed of rules-based and Bayesian network verifications. Methods: The authors analyzed incidents with a high potential severity score, scored as a 3 or 4 on a 4 point scale, recorded in an in-house voluntary incident reporting system, collected from February 2012 to August 2014. The incidents were categorized into different failure modes. The detectability, defined as the number of incidents that are detectable divided total number of incidents, was calculated for each failure mode. Results: In total, 343 incidents were used in this study. Of the incidents 67% were related to photon external beam therapy (EBRT). The majority of the EBRT incidents were related to patient positioning and only a small number of these could be detected by EPID dosimetry when performed prior to treatment (6%). A large fraction could be detected by in vivo dosimetry performed during the first fraction (74%). Rules-based and Bayesian network verifications were found to be complimentary to EPID dosimetry, able to detect errors related to patient prescriptions and documentation, and errors unrelated to photon EBRT. Combining all of the verification steps together, 91% of all EBRT incidents could be detected. Conclusions: This study shows that the defense in depth system is potentially able to detect a large majority of incidents. The most effective EPID-based dosimetry verification is in vivo measurements during the first fraction and is complemented by rules-based and Bayesian network plan checking.

  16. A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015.

    Science.gov (United States)

    Stiles, Chad M; Cook, Christopher; Sztajnkrycer, Matthew D

    2017-06-01

    Introduction Based upon military experience, law enforcement has developed guidelines for medical care during high-threat conditions. The purpose of the current study was to provide a descriptive analysis of reported outcomes of law enforcement medical interventions. This was a descriptive analysis of a convenience sample of cases submitted to the Wisconsin Tactical Medicine Initiative (Wisconsin USA), after the provision of successful patient care, between January 2010 and December 2015. The study was reviewed by the Mayo Foundation Institutional Review Board (Rochester, Minnesota USA) and deemed exempt. Nineteen agencies submitted information during the study period. Of the 56 episodes of care reported, four (7.1%) cases involved care provided to injured officers while 52 (92.9%) involved care to injured civilians, including suspects. In at least two cases, on-going threats existed during the provision of medical care to an injured civilian. Law enforcement rendered care prior to Emergency Medical Services (EMS) arrival in all but two cases. The current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current Tactical Combat Casualty Care (TCCC)/ Committee on Tactical Emergency Casualty Care (C-TECC) tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training appears more likely to save victims rather than law enforcement personnel. Stiles CM , Cook C , Sztajnkrycer MD . A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the State of Wisconsin, 2010-2015. Prehosp Disaster Med. 2017;32(3):284-288.

  17. 46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Alcohol or drug use by individuals directly involved in... whether there is any evidence of alcohol or drug use by individuals directly involved in the casualty. (b... evidence of drug or alcohol use, or evidence of intoxication, has been obtained; and (2) Specifies the...

  18. USCG Vessel Events

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  19. USCG Other Events

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  20. USCG Vessel Pollution

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  1. USCG Facility Pollution

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  2. USCG Vessel

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  3. USCG Injury

    Data.gov (United States)

    Department of Homeland Security — The Marine Casualty and Pollution Data files provide details about marine casualty and pollution incidents investigated by Coast Guard Offices throughout the United...

  4. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid by...

  5. Spatial-temporal patterns in Mediterranean carnivore road casualties: Consequences for mitigation

    Science.gov (United States)

    Grilo, C.; Bissonette, J.A.; Santos-Reis, M.

    2009-01-01

    Many carnivores have been seriously impacted by the expansion of transportation systems and networks; however we know little about carnivore response to the extent and magnitude of road mortality, or which age classes may be disproportionately impacted. Recent research has demonstrated that wildlife-vehicle-collisions (WVC) involving carnivores are modulated by temporal and spatial factors. Thus, we investigated road mortality on a guild of small and medium-sized carnivores in southern Portugal using road-kill data obtained from a systematic 36 months monitoring period along highways (260 km) and national roads (314 km) by addressing the following questions: (a) which species and age class are most vulnerable to WVC? (b) are there temporal and/or spatial patterns in road-kill? and (c) which life-history and/or spatial factors influence the likelihood of collisions? We recorded a total of 806 carnivore casualties, which represented an average of 47 ind./100 km/year. Red fox and stone marten had the highest mortality rates. Our findings highlight three key messages: (1) the majority of road-killed individuals were adults of common species; (2) all carnivores, except genets, were more vulnerable during specific life-history phenological periods: higher casualties were observed when red fox and stone marten were provisioning young, Eurasian badger casualties occurred more frequently during dispersal, and higher Egyptian mongoose mortality occurred during the breeding period; and (3) modeling demonstrated that favorable habitat, curves in the road, and low human disturbance were major contributors to the deadliest road segments. Red fox carcasses were more likely to be found on road sections with passages distant from urban areas. Conversely, stone marten mortalities were found more often on national roads with high of cork oak woodland cover; Egyptian mongoose and genet road-kills were found more often on road segments close to curves. Based on our results, two key

  6. A Planning Tool for Estimating Waste Generated by a Radiological Incident and Subsequent Decontamination Efforts - 13569

    International Nuclear Information System (INIS)

    Boe, Timothy; Lemieux, Paul; Schultheisz, Daniel; Peake, Tom; Hayes, Colin

    2013-01-01

    Management of debris and waste from a wide-area radiological incident would probably constitute a significant percentage of the total remediation cost and effort. The U.S. Environmental Protection Agency's (EPA's) Waste Estimation Support Tool (WEST) is a unique planning tool for estimating the potential volume and radioactivity levels of waste generated by a radiological incident and subsequent decontamination efforts. The WEST was developed to support planners and decision makers by generating a first-order estimate of the quantity and characteristics of waste resulting from a radiological incident. The tool then allows the user to evaluate the impact of various decontamination/demolition strategies on the waste types and volumes generated. WEST consists of a suite of standalone applications and Esri R ArcGIS R scripts for rapidly estimating waste inventories and levels of radioactivity generated from a radiological contamination incident as a function of user-defined decontamination and demolition approaches. WEST accepts Geographic Information System (GIS) shape-files defining contaminated areas and extent of contamination. Building stock information, including square footage, building counts, and building composition estimates are then generated using the Federal Emergency Management Agency's (FEMA's) Hazus R -MH software. WEST then identifies outdoor surfaces based on the application of pattern recognition to overhead aerial imagery. The results from the GIS calculations are then fed into a Microsoft Excel R 2007 spreadsheet with a custom graphical user interface where the user can examine the impact of various decontamination/demolition scenarios on the quantity, characteristics, and residual radioactivity of the resulting waste streams. (authors)

  7. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

    Directory of Open Access Journals (Sweden)

    Huber-Wagner S

    2009-12-01

    Full Text Available Abstract Background Hospitals have a critically important role in the management of mass causality incidents (MCI, yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%, pelvic injuries (11.5%, thoracic injuries (5.0% and major amputations (3.1%. The mean cut to suture time was 130 min (IQR 65-165 min. Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00, ISS ≥ 35 (OR 2,94, hemoglobin level ≤ 8 mg/dL (OR 1,40, pulse rate on hospital admission 120/min (OR 1,39, blood pressure on hospital admission Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

  8. EMS Response to Mass Casualty Incidents: The Critical Importance of Automatic Statewide Mutual Aid and MCI Training

    Science.gov (United States)

    2008-09-01

    incidents, dam failure, earthquakes, fires and wild fires, thunderstorms, tsunamis, volcanoes , winter storms, heat, landslides , nuclear power plant...President Bush reorganized the federal government and created the U.S. Department of Homeland Security, which produced the National Strategy for...to produce the best outcome and ensure personnel safety. This discipline prevented units from treating the first victim they came upon and ensured

  9. Incident Management Organization succession planning stakeholder feedback

    Science.gov (United States)

    Anne E. Black

    2013-01-01

    This report presents complete results of a 2011 stakeholder feedback effort conducted for the National Wildfire Coordination Group (NWCG) Executive Board concerning how best to organize and manage national wildland fire Incident Management Teams in the future to meet the needs of the public, agencies, fire service and Team members. Feedback was collected from 858...

  10. A Planning Tool for Estimating Waste Generated by a Radiological Incident and Subsequent Decontamination Efforts - 13569

    Energy Technology Data Exchange (ETDEWEB)

    Boe, Timothy [Oak Ridge Institute for Science and Education, Research Triangle Park, NC 27711 (United States); Lemieux, Paul [U.S. Environmental Protection Agency, Research Triangle Park, NC 27711 (United States); Schultheisz, Daniel; Peake, Tom [U.S. Environmental Protection Agency, Washington, DC 20460 (United States); Hayes, Colin [Eastern Research Group, Inc, Morrisville, NC 26560 (United States)

    2013-07-01

    Management of debris and waste from a wide-area radiological incident would probably constitute a significant percentage of the total remediation cost and effort. The U.S. Environmental Protection Agency's (EPA's) Waste Estimation Support Tool (WEST) is a unique planning tool for estimating the potential volume and radioactivity levels of waste generated by a radiological incident and subsequent decontamination efforts. The WEST was developed to support planners and decision makers by generating a first-order estimate of the quantity and characteristics of waste resulting from a radiological incident. The tool then allows the user to evaluate the impact of various decontamination/demolition strategies on the waste types and volumes generated. WEST consists of a suite of standalone applications and Esri{sup R} ArcGIS{sup R} scripts for rapidly estimating waste inventories and levels of radioactivity generated from a radiological contamination incident as a function of user-defined decontamination and demolition approaches. WEST accepts Geographic Information System (GIS) shape-files defining contaminated areas and extent of contamination. Building stock information, including square footage, building counts, and building composition estimates are then generated using the Federal Emergency Management Agency's (FEMA's) Hazus{sup R}-MH software. WEST then identifies outdoor surfaces based on the application of pattern recognition to overhead aerial imagery. The results from the GIS calculations are then fed into a Microsoft Excel{sup R} 2007 spreadsheet with a custom graphical user interface where the user can examine the impact of various decontamination/demolition scenarios on the quantity, characteristics, and residual radioactivity of the resulting waste streams. (authors)

  11. Now and Then: Combat Casualty Care Policies for Operation Iraqi Freedom and Operation Enduring Freedom Compared With Those of Vietnam

    National Research Council Canada - National Science Library

    Cordts, Paul R; Brosch, Laura A; Holcomb, John B

    2008-01-01

    Between December 2004 and June 2007, 13 key Operation Iraqi Freedom/ Operation Enduring Freedom combat casualty care policies were published to inform medical practice in the combat theater of operations...

  12. Minimizing casualties in biological and chemical threats (war and terrorism): the importance of information to the public in a prevention program.

    Science.gov (United States)

    Noy, Shabtai

    2004-01-01

    The most effective means of defending against biological or chemical warfare, whether in war or as a result of terror, is the use of primary prevention. The main goal of such a prevention program is to minimize the human loss by reducing the number of casualties (fatalities, physical wounds, and psychological injury). A secondary objective is to prevent the widespread sense of helplessness in the general population. These two aims complement each other. The more the public is active in defending itself, rather than viewing itself as helpless, the lesser the expected number of casualties of any kind. In order to achieve these two goals, educating the civilian population about risk factors and pointing out appropriate defensive strategies is critical. In the absence of an effective prevention program and active participation by the public, there is a high risk for massive numbers of physical and psychological casualties. An essential ingredient of any preventive program, which ultimately may determine the success or failure of all other protective actions, is early, gradual dissemination of information and guidance to the public, so that citizens can become active participants in the program. The public needs to be given information concerning the nature of the threat and effective methods of coping with it, should an unconventional attack occur. Lack of such adaptive behavior (such as wearing protective gear) is likely to bring about vast numbers of physical and psychological casualties. These large numbers may burden the medical, political, and public safety systems beyond their ability to manage. Failure to provide reasonable prevention and effective interventions can lead to a destruction of the social and emotional fabric of individuals and the society. Furthermore, inadequate preparation, education, and communication can result in the development of damaging mistrust of the political and military leadership, disintegration of social and political structures

  13. Managing Materials and Wastes for Homeland Security Incidents

    Science.gov (United States)

    To provide information on waste management planning and preparedness before a homeland security incident, including preparing for the large amounts of waste that would need to be managed when an incident occurs, such as a large-scale natural disaster.

  14. Using the Design for Demise Philosophy to Reduce Casualty Risk Due to Reentering Spacecraft

    Science.gov (United States)

    Kelley, R. L.

    2012-01-01

    Recently the reentry of a number of vehicles has garnered public attention due to their risk of human casualty due to fragments surviving reentry. In order to minimize this risk for their vehicles, a number of NASA programs have actively sought to minimize the number of components likely to survive reentry at the end of their spacecraft's life in order to meet and/or exceed NASA safety standards for controlled and uncontrolled reentering vehicles. This philosophy, referred to as "Design for Demise" or D4D, has steadily been adopted, to at least some degree, by numerous programs. The result is that many programs are requesting evaluations of components at the early stages of vehicle design, as they strive to find ways to reduce the number surviving components while ensuring that the components meet the performance requirements of their mission. This paper will discuss some of the methods that have been employed to ensure that the consequences of the vehicle s end-of-life are considered at the beginning of the design process. In addition this paper will discuss the technical challenges overcome, as well as some of the more creative solutions which have been utilized to reduce casualty risk.

  15. Incident command linkup: the vital key for CBRN response

    International Nuclear Information System (INIS)

    Smith, D.

    2009-01-01

    , what are the Incident Commander's objectives, are there any casualties and what are their signs and symptoms, and what are the current weather conditions. This is a lot of information for CBRN responders to digest, but any experienced specialized unit knows to delegate the tasks among its members. Once onsite, the CBRN Commander needs to locate the Incident Command Post (ICP) and coordinate with the Incident Commander. After a quick introduction, the CBRN Commander should relay his team's composition, capabilities, limitations, specific support requirements, necessary security measures, and long term operations requirements. A handout of the CBRN assets composition should accompany the Commander and be handed to the IC so that it is available for future reference. The CBRN Commander should bring a representative from his organization to take notes and should seek a quick question and answer session with the IC or designated representative upon initial link up or as soon as time permits. Members of the CBRN organization may be incorporated into the NIMS structure to fill various positions such as a group under the operations section, technical specialist under the planning section, or as a technical unit. The CBRN organization should utilize a checklist or standard operating procedure (SOP) when conducting the link up and this should be incorporated into the standard operating guidance (SOG). This ensures that all questions that need to be answered are covered initially and that you do not have to track down members of the incident command for follow up questions. This facilitates effective time management and streamlines the response. Once the IC is located and ready to integrate the CBRN assets into the response, the link up and interview process can be organized into the CBRN Commander questioning first, his operations representative second, downrange representative third, medical representative fourth, and any other representative last. The operations representative

  16. [Travel time and distances to Norwegian out-of-hours casualty clinics].

    Science.gov (United States)

    Raknes, Guttorm; Morken, Tone; Hunskår, Steinar

    2014-11-01

    Geographical factors have an impact on the utilisation of out-of-hours services. In this study we have investigated the travel distance to out-of-hours casualty clinics in Norwegian municipalities in 2011 and the number of municipalities covered by the proposed recommendations for secondary on-call arrangements due to long distances. We estimated the average maximum travel times and distances in Norwegian municipalities using a postcode-based method. Separate analyses were performed for municipalities with a single, permanently located casualty clinic. Altogether 417 out of 430 municipalities were included. We present the median value of the maximum travel times and distances for the included municipalities. The median maximum average travel distance for the municipalities was 19 km. The median maximum average travel time was 22 minutes. In 40 of the municipalities (10 %) the median maximum average travel time exceeded 60 minutes, and in 97 municipalities (23 %) the median maximum average travel time exceeded 40 minutes. The population of these groups comprised 2 % and 5 % of the country's total population respectively. For municipalities with permanent emergency facilities(N = 316), the median average flight time 16 minutes and median average distance 13 km.. In many municipalities, the inhabitants have a long average journey to out-of-hours emergency health services, but seen as a whole, the inhabitants of these municipalities account for a very small proportion of the Norwegian population. The results indicate that the proposed recommendations for secondary on-call duty based on long distances apply to only a small number of inhabitants. The recommendations should therefore be adjusted and reformulated to become more relevant.

  17. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device (RDD)

    International Nuclear Information System (INIS)

    Ansari, Armin; Harper, Frederick Taylor; Smith, James M.

    2005-01-01

    One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event.

  18. Urgent medical response in CBR incidents

    International Nuclear Information System (INIS)

    Castulik, P.; Slabotinsky, J.; Kralik, L.; Bradka, S.

    2009-01-01

    During CBR incidents with releases of hazardous materials (HazMat), there is extremely urgent aim of first rescuing responders to safe the life for as much as possible victims and reducing health consequences from the exposure of the HazMat. Highest priority of the response is to be applied, if victims are exposed with chemicals through their airways and/or mucous membranes. There is general approach in the emergency medical services (EMS) stated that the victims being in critical status have to receive emergency medical care on-site even prior the transportation to a medical facility. However, in a case of CBR events the EMS prefer to provide the First Aid for victims to be already decontaminated as mass casualties, e.g. by the firemen and transferred to a safe zone. This approach is to be time consuming and thus creating delays in medical care not in the favor of a victim's successful survival. In order to overcome this approach, there are needs for eminent ceasing of the victims exposure, protection of breathing tract/ventilation support and administration of antidotes, if available. All this have to be done in shortest time since HazMat incident/accident occurs. This presentation is focusing on emergency provisions for saving victims directly in contaminated environment through the assistance by responders, concentrating on search and rescue of victims, their emergency decontamination, breathing protection, clothing removal, ventilation support, antidote administration, fixing and bandage of trauma injuries prior transportation and/or mass decontamination. This experience is shared based on a field exercise with the EMS volunteers (Red Cross), fire brigade volunteers and university's students.(author)

  19. National health and medical services response to incidents of chemical and biological terrorism.

    Science.gov (United States)

    Tucker, J B

    1997-08-06

    In response to the growing threat of terrorism with chemical and biological weapons, the US government has developed a national concept of operations for emergency health and medical services response. This capability was developed and tested for the first time during the Atlanta Olympic Games in the summer of 1996. In the event of a chemical or biological terrorist incident that exceeded local and state-level response capabilities, federal agencies would provide specialized teams and equipment to help manage the consequences of the attack and treat, decontaminate, and evacuate casualties. The US Congress has also established a Domestic Preparedness Program that provides for enhanced training of local first-responders and the formation of metropolitan medical strike teams in major cities around the country. While these national response capabilities are promising, their implementation to date has been problematic and their ultimate effectiveness is uncertain.

  20. Incidents with hazardous radiation sources; Zwischenfaelle mit gefaehrlichen Strahlenquellen

    Energy Technology Data Exchange (ETDEWEB)

    Schoenhacker, Stefan [Bundesministerium fuer Inneres, Traiskirchen (Austria). Abt. 1/9 - Zivilschutzschule

    2016-07-01

    Incidents with hazardous radiation sources can occur in any country, even those without nuclear facilities. Preparedness for such incidents is supposed to fulfill globally agreed minimum standards. Incidents are categorized in incidents with licensed handling of radiation sources as for material testing, transport accidents of hazardous radiation sources, incidents with radionuclide batteries, incidents with satellites containing radioactive inventory, incidents wit not licensed handling of illegally acquired hazardous radiation sources. The emergency planning in Austria includes a differentiation according to the consequences: incidents with release of radioactive materials resulting in restricted contamination, incidents with release of radioactive materials resulting in local contamination, and incidents with the hazard of e@nhanced exposure due to the radiation source.

  1. Slope Failure Prediction and Early Warning Awareness Education for Reducing Landslides Casualty in Malaysia

    Science.gov (United States)

    Koay, S. P.; Tay, L. T.; Fukuoka, H.; Koyama, T.; Sakai, N.; Jamaludin, S. B.; Lateh, H.

    2015-12-01

    Northeast monsoon causes heavy rain in east coast of Peninsular Malaysia from November to March, every year. During this monsoon period, besides the happening of flood along east coast, landslides also causes millions of Malaysian Ringgit economical losses. Hence, it is essential to study the prediction of slope failure to prevent the casualty of landslides happening. In our study, we introduce prediction method of the accumulated rainfall affecting the stability of the slope. If the curve, in the graph, which is presented by rainfall intensity versus accumulated rainfall, crosses over the critical line, the condition of the slope is considered in high risk where the data are calculated and sent from rain gauge in the site via internet. If the possibility of slope failure is going high, the alert message will be sent out to the authorities for decision making on road block or setting the warning light at the road side. Besides road block and warning light, we propose to disseminate short message, to pre-registered mobile phone user, to notify the public for easing the traffic jam and avoiding unnecessary public panic. Prediction is not enough to prevent the casualty. Early warning awareness of the public is very important to reduce the casualty of landslides happening. IT technology does not only play a main role in disseminating information, early warning awareness education, by using IT technology, should be conducted, in schools, to give early warning awareness on natural hazard since childhood. Knowing the pass history on landslides occurrence will gain experience on the landslides happening. Landslides historical events with coordinate information are stored in database. The public can browse these historical events via internet. By referring to such historical landslides events, the public may know where did landslides happen before and the possibility of slope failure occurrence again is considered high. Simulation of rainfall induced slope failure mechanism

  2. [Traffic casualties and injuries: a problem of costs, too. A Swiss survey].

    Science.gov (United States)

    Martinoli, S; Quadri, B; Casabianca, A

    1993-01-01

    Based on an epidemiological observation in Ticino 1985, following statement is possible: in Switzerland every year 900 people dye in traffic casualties. Many victims of tragic accidents get lifetime disabled. Direct and indirect costs of traffic injuries are yearly 3 billions of swiss francs. Only a small percentage (6%) is devoted to medical treatment. The most part is due to compensation of income, disability with its allocations and lost productivity. Among "avoidable" deaths, traffic victims are an essential portion because the are young. More efforts should be undertaken to lower road mortality because she erodes the swiss population pyramid in a significant manner.

  3. The Impact of 10 Years of War on Combat Casualty Care Research: A Citation Analysis

    Science.gov (United States)

    2012-01-01

    Crommett JW, et al. Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. J Trauma. 2002;52:1078Y1085...transection model to compare nine hemostatic dressings. They concluded that the use of a zeolite hemostatic agent controlled hemorrhage and significantly...review of the scientific literature published during this period can be used to evaluate the research on combat casualty care conducted during the recent

  4. Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents.

    Science.gov (United States)

    DeFraia, G S

    2015-07-01

    Psychologically traumatic workplace events (known as critical incidents) occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.

  5. Stardust Entry: Landing and Population Hazards in Mission Planning and Operations

    Science.gov (United States)

    Desai, P.; Wawrzyniak, G.

    2006-01-01

    The 385 kg Stardust mission was launched on Feb 7, 1999 on a mission to collect samples from the tail of comet Wild 2 and from interplanetary space. Stardust returned to Earth in the early morning of January 15, 2006. The sample return capsule landed in the Utah Test and Training Range (UTTR) southwest of Salt Lake City. Because Stardust was landing on Earth, hazard analysis was required by the National Aeronautics and Space Administration, UTTR, and the Stardust Project to ensure the safe return of the landing capsule along with the safety of people, ground assets, and aircraft. This paper focuses on the requirements affecting safe return of the capsule and safety of people on the ground by investigating parameters such as probability of impacting on UTTR, casualty expectation, and probability of casualty. This paper introduces the methods for the calculation of these requirements and shows how they affected mission planning, site selection, and mission operations. By analyzing these requirements before and during entry it allowed for the selection of a robust landing point that met all of the requirements during the actual landing event.

  6. Strategic considerations in planning a counterevacuation

    International Nuclear Information System (INIS)

    Chester, C.V.; Cristy, G.A.; Haaland, C.M.

    1975-12-01

    The Soviet Union has highly developed plans to evacuate their population centers in a nuclear confrontation. Their plans include construction of expedient shelters in the outlying areas and continued operation of their essential industry by commuting workers. If they should successfully implement their plan, a subsequent nuclear exchange with the United States would cost them far fewer casualties than they suffered in World War II. Without a corresponding evacuation, the US could lose from 50 to 70 percent of its population. This asymmetry in vulnerability, if allowed to persist, would seriously weaken the bargaining position of the US President. To restore the balance, a great reduction in vulnerability can be achieved most economically by planning a US counterevacuation as a response to a Soviet evacuation. Russian historical experience with murderous invaders, most recently in World War II, has made authoritarian defense measures involving civilians and property in peacetime quite acceptable in their culture. In the US, widescale use of private property and civilian participation in defense activity are not feasible until the development of a grave crisis. Hence US evacuation plans must differ in several important respects from the Soviet plans. However, this preliminary study indicates that the US has ample material resources to move and shelter its population at least as effectively as the Soviet Union. Perhaps the most critical disadvantage of the US is in morale, as evidenced by the widespread misconception that effective survival measures are not possible

  7. Extending injury prevention methodology to chemical terrorism preparedness: the Haddon Matrix and sarin.

    Science.gov (United States)

    Varney, Shawn; Hirshon, Jon Mark; Dischinger, Patricia; Mackenzie, Colin

    2006-01-01

    The Haddon Matrix offers a classic epidemiological model for studying injury prevention. This methodology places the public health concepts of agent, host, and environment within the three sequential phases of an injury-producing incident-pre-event, event, and postevent. This study uses this methodology to illustrate how it could be applied in systematically preparing for a mass casualty disaster such as an unconventional sarin attack in a major urban setting. Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feedback in the data review session. Four injury prevention strategies (education, engineering, enforcement, and economics) were applied to the individual factors and event phases of the Haddon Matrix. The majority of factors identified in all phases were modifiable, primarily through educational interventions focused on individual healthcare providers and first responders. The Haddon Matrix provides a viable means of studying an unconventional problem, allowing for the identification of modifiable factors to decrease the type and severity of injuries following a mass casualty disaster such as a sarin release. This strategy could be successfully incorporated into disaster planning for other weapons attacks that could potentially cause mass casualties.

  8. Improvised explosive devices: pathophysiology, injury profiles and current medical management.

    Science.gov (United States)

    Ramasamy, A; Hill, A M; Clasper, J C

    2009-12-01

    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

  9. Assessment of Evacuation Protective Action Strategies For Emergency Preparedness Plan

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joomyung; Jae, Moosung [Hanyang Univ., Seoul (Korea, Republic of); Ahn, Kwangil [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2013-10-15

    This report which studies about evacuation formation suggests some considerable factors to reduce damage of radiological accidents. Additional details would be required to study in depth and more elements should be considered for updating emergency preparedness. However, this methodology with sensitivity analysis could adapt to specific plant which has total information such as geological data, weather data and population data. In this point of view the evacuation study could be contribute to set up emergency preparedness plan and propose the direction to enhance protective action strategies. In radiological emergency, residents nearby nuclear power plant should perform protective action that is suggested by emergency preparedness plan. The objective of emergency preparedness plan is that damages, such as casualties and environmental damages, due to radioactive accident should be minimized. The recent PAR study includes a number of subjects to improve the quality of protective action strategies. For enhancing protective action strategies, researches that evaluate many factors related with emergency response scenario are essential parts to update emergency preparedness plan. Evacuation is very important response action as protective action strategy.

  10. Assessment of Evacuation Protective Action Strategies For Emergency Preparedness Plan

    International Nuclear Information System (INIS)

    Lee, Joomyung; Jae, Moosung; Ahn, Kwangil

    2013-01-01

    This report which studies about evacuation formation suggests some considerable factors to reduce damage of radiological accidents. Additional details would be required to study in depth and more elements should be considered for updating emergency preparedness. However, this methodology with sensitivity analysis could adapt to specific plant which has total information such as geological data, weather data and population data. In this point of view the evacuation study could be contribute to set up emergency preparedness plan and propose the direction to enhance protective action strategies. In radiological emergency, residents nearby nuclear power plant should perform protective action that is suggested by emergency preparedness plan. The objective of emergency preparedness plan is that damages, such as casualties and environmental damages, due to radioactive accident should be minimized. The recent PAR study includes a number of subjects to improve the quality of protective action strategies. For enhancing protective action strategies, researches that evaluate many factors related with emergency response scenario are essential parts to update emergency preparedness plan. Evacuation is very important response action as protective action strategy

  11. Emergency response planning in hospitals, United States: 2003-2004.

    Science.gov (United States)

    Niska, Richard W; Burt, Catharine W

    2007-08-20

    This study presents baseline data to determine which hospital characteristics are associated with preparedness for terrorism and natural disaster in the areas of emergency response planning and availability of equipment and specialized care units. Information from the Bioterrorism and Mass Casualty Preparedness Supplements to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in hospital emergency response plans and resources by residency and medical school affiliation, hospital size, ownership, metropolitan statistical area status, and Joint Commission accreditation. Of 874 sampled hospitals with emergency or outpatient departments, 739 responded for an 84.6 percent response rate. Estimates are presented with 95 percent confidence intervals. About 92 percent of hospitals had revised their emergency response plans since September 11, 2001, but only about 63 percent had addressed natural disasters and biological, chemical, radiological, and explosive terrorism in those plans. Only about 9 percent of hospitals had provided for all 10 of the response plan components studied. Hospitals had a mean of about 14 personal protective suits, 21 critical care beds, 12 mechanical ventilators, 7 negative pressure isolation rooms, and 2 decontamination showers each. Hospital bed capacity was the factor most consistently associated with emergency response planning and availability of resources.

  12. [Fatal incidents by crowd crush during mass events. (Un)preventable phenomenon?].

    Science.gov (United States)

    Wagner, U; Fälker, A; Wenzel, V

    2013-01-01

    Crowd crushes with dozens or even hundreds of casualties have occurred several times at the Hajj in Saudi Arabia and also in soccer stadiums in Western Europe. As fatal accidents after human stampedes during mass events occur very rarely and are usually accompanied by many years of criminal court proceedings in order to identify underlying responsible mechanisms and culprits, it is very difficult to draw conclusions and formulate precautions from an emergency medical point of view. This study analyzed a fatal crowd crush which occurred on 4 December 1999 following the "Air & Style" snowboard contest with approximately 22,000 people attending in the Bergisel stadium in Innsbruck, Austria. Firstly, focused interviews were conducted with professional rescuers, police and physicians and secondly publicly available court records dealing with this incident in the district court of Innsbruck, Austria were analyzed. During the snowboard contest 87 emergency medical technicians, 6 emergency physicians, 1 leading emergency physician, 21 policemen and 140 security personnel were present. Following the accident additionally some 100 emergency medical technicians, 36 emergency medical service vehicles and 4 physician-staffed emergency medical service vehicles responded to the scene. The deadly crowd crush resulting in 6 fatalities, 4 patients still in a vegetative state and 38 injured, was due to a severe crowd accumulation at one stadium exit, which was not recognized and dispersed in time. Construction of the exit in line with darkness, steep slope and slippery surface contributed adversely to this dangerous situation, although panic did not occur at any time. Unfortunately, there is no patent remedy to completely prevent fatal accidents by a crowd crush at mass events. If planning is initiated early, sufficient material and personnel reserves are kept in reserve and despite conflicting interests of the organizers, the host community, security, police and emergency medical

  13. Yampa River Valley sub-area contingency plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    The Yampa River Valley sub-area contingency plan (Contingency Plan) has been prepared for two counties in northwestern Colorado: Moffat County and Routt County. The Contingency Plan is provided in two parts, the Contingency Plan and the Emergency Response Action Plan (ERAP). The Contingency Plan provides information that should be helpful in planning to minimize the impact of an oil spill or hazardous material incident. It contains discussions of planning and response role, hazards identification, vulnerability analysis, risk analysis, cleanup, cost recovery, training, and health and safety. It includes information on the incident command system, notifications, response capabilities, emergency response organizations, evacuation and shelter-in-place, and immediate actions.

  14. High Reliability Organization and Applicability to the Battlefield to Reduce Errors Associated with Combat Casualty Care

    Science.gov (United States)

    2016-06-10

    use different terminology depending on which sister service they are from. Every service has various medical capabilities for each role of medical ... Medical Errors, Combat Casualty Care, Culture of Safety 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a...Army) AE Adverse event AHRQ Agency for Healthcare Research and Quality AHS Army Health System AMEDD Army Medical Department CPQ Clinical Practice

  15. Retrospection. Uranium mining Wismut und the legal casualty insurance; Erinnerungen. Uranerzbergbau Wismut und die gesetzliche Unfallversicherung

    Energy Technology Data Exchange (ETDEWEB)

    Breuer, Joachim [Deutsche Gesetzliche Unfallversicherung (DGUV), Berlin (Germany)

    2015-07-01

    Although the Wismut uranium mining company in the former DDR had 600.000 employees, the company was not mentioned in the contract on the German reunification. The expenses for the health consequences imposed manifold challenges to the legal casualty insurance. The question of responsibility, the conservation, digitalization and evaluation of data concerning the personnel and health information, partially handwritten is a tremendous amount of work.

  16. Simulating traffic for incident management and ITS investment decisions

    Science.gov (United States)

    1998-08-01

    UTPS-type models were designed to adequately support planning activities typical of the 1960s and 1970s. However, these packages were not designed to model intelligent transportation systems (ITS) and support incident management planning. To ov...

  17. Psychological Trauma in the Workplace: Variation of Incident Severity among Industry Settings and between Recurring vs Isolated Incidents

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2015-07-01

    Full Text Available Background: Psychologically traumatic workplace events (known as critical incidents occur within various work environments, with workgroups in certain industries vulnerable to multiple incidents. With the increasing prevalence of incidents in the USA, incident response is a growing practice area within occupational medicine, industrial psychology, occupational social work and other occupational health professions. Objective: To analyze a measure of incident severity based on level of disruption to the workplace and explore whether incident severity varied among different industry settings or between workgroups experiencing multiple vs single traumatic incidents. Methods: Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring incident severity level varied among industry settings or between workgroups impacted by multiple vs isolated events. Results: Incident severity level differed among various industry settings. Banks, retail stores and fast food restaurants accounted for the most severe incidents, while industrial and manufacturing sites reported less severe incidents. Workgroups experiencing multiple incidents reported more severe incidents than workgroups experiencing a single incident. Conclusion: Occupational health practitioners should be alert to industry differences in several areas: pre-incident resiliency training, the content of business recovery plans, assessing worker characteristics, strategies to assist continuous operations and assisting workgroups impacted by multiple or severe incidents.

  18. Reducing the Consequences of a Nuclear Detonation.

    Energy Technology Data Exchange (ETDEWEB)

    Buddemeier, B R

    2007-11-09

    The 2002 National Strategy to Combat Weapons of Mass Destruction states that 'the United States must be prepared to respond to the use of WMD against our citizens, our military forces, and those of friends and allies'. Scenario No.1 of the 15 Department of Homeland Security national planning scenarios is an improvised nuclear detonation in the national capitol region. An effective response involves managing large-scale incident response, mass casualty, mass evacuation, and mass decontamination issues. Preparedness planning activities based on this scenario provided difficult challenges in time critical decision making and managing a large number of casualties within the hazard area. Perhaps even more challenging is the need to coordinate a large scale response across multiple jurisdictions and effectively responding with limited infrastructure and resources. Federal response planning continues to make improvements in coordination and recommending protective actions, but much work remains. The most critical life-saving activity depends on actions taken in the first few minutes and hours of an event. The most effective way to reduce the enormous national and international social and economic disruptions from a domestic nuclear explosion is through planning and rapid action, from the individual to the federal response. Anticipating response resources for survivors based on predicted types and distributions of injuries needs to be addressed.

  19. Allocation of scarce resources during mass casualty events.

    Science.gov (United States)

    Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Waxman, Daniel A; Pillemer, Francesca; Carey, Christine; Moore, Melinda; Karir, Veena; Johnson, Tiffani J; Iyer, Neema; Hu, Jianhui; Shanman, Roberta; Larkin, Jody Wozar; Timmer, Martha; Motala, Aneesa; Perry, Tanja R; Newberry, Sydne; Kellermann, Arthur L

    2012-06-01

    This systematic review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs). Specifically, the review addresses the following questions: (1) What strategies are available to policymakers to optimize the allocation of scarce resources during MCEs? (2) What strategies are available to providers to optimize the allocation of scarce resources during MCEs? (3) What are the public's key perceptions and concerns regarding the implementation of strategies to allocate scarce resources during MCEs? (4) What methods are available to engage providers in discussions regarding the development and implementation of strategies to allocate scarce resources during MCEs? We searched Medline, Scopus, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science®, and the Cochrane Database of Systematic Reviews from 1990 through 2011. To identify relevant non-peer-reviewed reports, we searched the New York Academy of Medicine's Grey Literature Report. We also reviewed relevant State and Federal plans, peer-reviewed reports and papers by nongovernmental organizations, and consensus statements published by professional societies. We included both English- and foreign-language studies. Our review included studies that evaluated tested strategies in real-world MCEs as well as strategies tested in drills, exercises, or computer simulations, all of which included a comparison group. We reviewed separately studies that lacked a comparison group but nonetheless evaluated promising strategies. We also identified consensus recommendations developed by professional societies or government panels. We reviewed existing State plans to examine the current state of planning for scarce resource allocation during MCEs. Two investigators independently reviewed each article, abstracted data, and assessed study quality. We considered 5,716 reports for this comparative effectiveness

  20. GIS and Geodatabase Disaster Risk for Spatial Planning

    Science.gov (United States)

    Hendriawan Nur, Wawan; Kumoro, Yugo; Susilowati, Yuliana

    2018-02-01

    The spatial planning in Indonesia needs to consider the information on the potential disaster. That is because disaster is a serious and detrimental problem that often occurs and causes casualties in some areas in Indonesia as well as inhibits the development. Various models and research were developed to calculate disaster risk assessment. GIS is a system for assembling, storing, analyzing, and displaying geographically referenced disaster. The information can be collaborated with geodatabases to model and to estimate disaster risk in an automated way. It also offers the possibility to customize most of the parameters used in the models. This paper describes a framework which can improve GIS and Geodatabase for the vulnerability, capacity or disaster risk assessment to support the spatial planning activities so they can be more adaptable. By using this framework, GIS application can be used in any location by adjusting variables or calculation methods without changing or rebuilding system from scratch.

  1. [Notification of incidents related to patient safety in hospitals in Catalonia, Spain during the period 2010-2013].

    Science.gov (United States)

    Oliva, Glòria; Alava, Fernando; Navarro, Laura; Esquerra, Miquel; Lushchenkova, Oksana; Davins, Josep; Vallès, Roser

    2014-07-01

    The aim of this paper is to discover the aggregated results of a general notification system for incidents related to patient safety implemented in Catalan hospitals from 2010 to 2013. Observational study describing the incidents notified from January 2010 to December 2013 from all hospitals in Catalonia forming part of the project to create operational patient safety management units. The Patient Safety Notification and Learning System (SiNASP) was used. This makes it possible to classify incidents depending on the area where they occur, the type of incident notified, the consequences, the seriousness according to the Severity Assessment Code (SAC) and the profession of the notifying party, as the principal variables. The system was accessed via the Internet (SiNASP portal). Access was voluntary and anonymous or with a name given and later removed. During the study period, notification of a total of 5,948 incidents came from 22-29 hospitals. 5,244 of the incidents were handled by the centres and these are the ones analysed in the study. 64% (3,380) affected patients, 18% (950) created a situation capable of causing an incident and 18% (914) did not affect patients. 26% of incidents that affected patients (864) caused some kind of harm. Most incidents occurred during hospitalisation (54%) and in casualty (15%), followed by the ICU (9%) and the surgical block (8%). The most frequent notifying parties were nurses (71%) followed by doctors (15%) and pharmacists (9%). In terms of severity, most incidents were classified as low-risk (37%) or incidents that did not affect the patient (36%). However, 40 cases (0.76%) of extreme risk should be highlighted. In terms of the types of incident notified, most were due to a medication error (26.8%), followed by falls (16.3%) and patient identification (10.6%). The majority of notifications were incidents that affected patients and, of these, 26% caused harm. In general, they occurred in hospitalisation units and notification was

  2. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

    Science.gov (United States)

    Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

    2013-01-01

    During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. 2013.

  3. Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries

    Science.gov (United States)

    2017-11-13

    Airway Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries...Consumer Style Comparison Table of Suction Pump Devices ............................. 103 Appendix H – Web Links for Images for Consumer- Style ...0022 pg. 6 Executive Summary Suction is a critical component of airway management , which is the second leading cause of preventable

  4. Incidence of emergency contacts (red responses to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

    Directory of Open Access Journals (Sweden)

    Hansen Elisabeth

    2009-07-01

    Full Text Available Abstract Background The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC. The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses to the emergency primary health care service. Methods A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis. Results During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3% were defined as emergency contacts (red responses, corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway. Conclusion The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics

  5. Epidemiology, Incidence and Mortality of Breast Cancer in Asia.

    Science.gov (United States)

    Ghoncheh, Mahshid; Momenimovahed, Zohre; Salehiniya, Hamid

    2016-01-01

    Breast cancer is the most common malignancy in women around the world. Information on the incidence and mortality of breast cancer is essential for planning health measures. This study aimed to investigate the incidence and mortality of breast cancer in the world using age-specific incidence and mortality rates for the year 2012 acquired from the global cancer project (GLOBOCAN 2012) as well as data about incidence and mortality of the cancer based on national reports. It was estimated that 1,671,149 new cases of breast cancer were identified and 521,907 cases of deaths due to breast cancer occurred in the world in 2012. According to GLOBOCAN, it is the most common cancer in women, accounting for 25.1% of all cancers. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries. Education of women is suggested in all countries for early detection and treatment. Plans for the control and prevention of this cancer must be a high priority for health policy makers; also, it is necessary to increase awareness of risk factors and early detection in less developed countries.

  6. From the incident command center oil spills from Hurricanes Katrina and Rita

    Energy Technology Data Exchange (ETDEWEB)

    Guidry, R.J. [Lousiana Oil Spill Coordinator' s Office, Baton Rouge, LA (United States)

    2006-07-01

    Approximately 30.2 million litres of oil were discharged during Hurricanes Katrina and Rita. A total of 230 incidents were reported to the state's spill response community, including ruptured pipelines, damaged and moved storage tanks, refineries, and sunken vessels. By January 2006, industry had reported the recovery of 14.7 million litres of oil. After Hurricane Rita, a further 234 off- and onshore incidents were reported. This paper presented a chronology from August 26 2005 through to June 2006 of clean-up activities for both hurricanes, with specific reference to logistic and communications issues associated with working in environments that are difficult to access due to damaged transportation infrastructure. An outline of the Louisiana Oil Spill Coordinator's Office's role in the incidents was presented, as well as an overview of the Louisiana State Contingency Plan. It was noted that the lack of communications systems caused considerable difficulties for responders. It was concluded that responses to hurricanes can be made more effective by having all response communities incident command structure (ICS)-trained with a thorough knowledge of the National Response Plan as it relates to the National Contingency Plan. Ensuring that plans are operational, having clear lines of authority on all hurricane-related issues, and having a robust communications plan were recommended, as well as the ability to respond without communications.

  7. From the incident command center oil spills from Hurricanes Katrina and Rita

    International Nuclear Information System (INIS)

    Guidry, R.J.

    2006-01-01

    Approximately 30.2 million litres of oil were discharged during Hurricanes Katrina and Rita. A total of 230 incidents were reported to the state's spill response community, including ruptured pipelines, damaged and moved storage tanks, refineries, and sunken vessels. By January 2006, industry had reported the recovery of 14.7 million litres of oil. After Hurricane Rita, a further 234 off- and onshore incidents were reported. This paper presented a chronology from August 26 2005 through to June 2006 of clean-up activities for both hurricanes, with specific reference to logistic and communications issues associated with working in environments that are difficult to access due to damaged transportation infrastructure. An outline of the Louisiana Oil Spill Coordinator's Office's role in the incidents was presented, as well as an overview of the Louisiana State Contingency Plan. It was noted that the lack of communications systems caused considerable difficulties for responders. It was concluded that responses to hurricanes can be made more effective by having all response communities incident command structure (ICS)-trained with a thorough knowledge of the National Response Plan as it relates to the National Contingency Plan. Ensuring that plans are operational, having clear lines of authority on all hurricane-related issues, and having a robust communications plan were recommended, as well as the ability to respond without communications

  8. Thyroid cancer incidence among atomic bomb survivors, 1958-79

    International Nuclear Information System (INIS)

    Akiba, Suminori; Ezaki, Haruo; Ron, E.; Ishimaru, Toranosuke; Shimizu, Yukiko; Kato, Hiroo; Lubin, J.; Asano, Masahide.

    1992-06-01

    One hundred and twelve cases of thyroid cancer diagnosed during the period 1958-79 among the extended Life Span Study cohort in Hiroshima and Nagasaki were studied. There was a statistically significant association between thyroid cancer incidence and exposure to atomic bomb radiation. The adjusted excess relative risk (ERR) per gray was 1.1 (95% confidence interval=0.3-2.5) and the adjusted absolute risk per 10 4 PYGy was 0.59 (95% confidence interval=0.2-1.7). Based on a comparison of the deviances obtained from relative and absolute risk models, a simple linear relative risk model appeared to fit the data better than an absolute risk model; however, it would not be appropriate to conclude that the data conform strictly to a relative risk pattern. The incidence of thyroid cancer among the members of the Adult Health Study (AHS) population, who have received biennial medical examinations at the Atomic Bomb Casualty Commission and its successor the Radiation Effects Research Foundation, since 1958, was 70% higher than that among the rest of the extended LSS cohort after adjustments for city, sex, log age, calendar year, and Dosimetry System 1986 dose. There was no significant difference between the slope of the dose-response curve for AHS and non-AHS participants, although the estimated ERRs at 1 Gy for the AHS and non-AHS population were 1.6 and 0.3, respectively. The elevated risk appeared to be confined to women, and there was an increasing risk with decreasing attained age and age at exposure. (J.P.N.)

  9. 76 FR 3648 - NIMS Training Plan

    Science.gov (United States)

    2011-01-20

    ...] NIMS Training Plan AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice of availability... comments on the NIMS Training Plan. This plan defines National Incident Management System (NIMS) national... sustaining NIMS training. In addition to delineating responsibilities and actions, the NIMS Training Plan...

  10. A five-year history of hazardous materials incidents in Chester County, PA

    International Nuclear Information System (INIS)

    Shorten, C.V.; McNamara, J.

    1993-01-01

    The Emergency Planning and Community Right-to-Know Act (EPCRA) of 1986 established Local Emergency Planning Committees (LEPCs) to oversee emergency response planning at the community level. In Pennsylvania, each county was assigned its own LEPC, and Chester County held its first LEPC meeting on October 15, 1987. From the data of that meeting through September 1992, 300 hazardous materials incidents have been reported. The majority of these incidents were met with fire department response, but several warranted response by hazardous materials teams. This report presents an analysis of the database of reported hazardous materials incidents in Chester County, including chemical identification, amount released, type of response, location, and trends. Over 235 of the reported spills were either gasoline, diesel fuel, home heating oil, or kerosene, often in five to 50 gallon amounts from transportation accidents. A number of extremely hazardous substance (EHS) incidents were reported, however, including sulfuric acid, chlorine, ammonia, phosphorus, formaldehyde, bromine, methyl mercaptan, and hydrofluoric acid. The most commonly released EHS's were ammonia and chlorine. The number of hazardous materials incidents reported in Chester County increased from only 14 in 1988 to 95 in 1991, with 67 in 1992 through September. This dramatic increase is attributable to both increased reporting and an increased number of incidents. This database clearly indicates both the success of EPCRA reporting system and the magnitude of hazardous materials incidents in this part of Pennsylvania

  11. Role of cytogenetic biodosimetry in meeting the needs of a mass casualty radiological/nuclear event

    International Nuclear Information System (INIS)

    Balajee, A.S.; Dainiak, N.

    2016-01-01

    Radiological/nuclear (R/N) terrorism constitutes a potential threat to all nations that can result in significant morbidity and mortality among hundreds of thousands individuals. In addition to the timing and severity of clinical signs and symptoms, individual radiation dose informs risk assessment and mitigation of radiation-associated injuries. The 'gold standard' for individual whole-body radiation dosimetry is the dicentric chromosome assay. The Cytogenetics Biodosimetry Laboratory at REAC/TS is a WHO Collaborating Centre and member of IAEA's RANET that employs DCA, as well as fluorescence in situ hybridization, premature chromosome condensation, and micronuclei assays to assess radiation dose. The quality of dose estimates and standard operating procedures for DCA at REAC/TS have been validated in multiple inter-comparison studies involving CBLs in Asia, Europe, North America and South America. DCA is scalable to meet the needs of a mass casualty R/N incident. The CBL at REAC/TS has made seminal contributions to augment surge capacity for DCA and develop CBLs worldwide through initiatives such as modification of 'Share Point' in 2010 to transmit images of metaphases for simultaneous telescoring; (2) development of an on-line training program for metaphase scoring; (3) proactive participation as a WCC to create ISO standards; and (4) guidance of regulatory agencies to monitor quality of results and SOPs. The precision of dose estimates by DCA can be vastly improved by using a universal calibration curve. With this view, REAC/TS has organized a collaboration with CBLs at Health Canada and Yale University to construct and validate a common calibration curve for gamma rays

  12. Prototyping and validating requirements of radiation and nuclear emergency plan simulator

    Science.gov (United States)

    Hamid, AHA.; Rozan, MZA.; Ibrahim, R.; Deris, S.; Selamat, A.

    2015-04-01

    Organizational incapability in developing unrealistic, impractical, inadequate and ambiguous mechanisms of radiological and nuclear emergency preparedness and response plan (EPR) causing emergency plan disorder and severe disasters. These situations resulting from 65.6% of poor definition and unidentified roles and duties of the disaster coordinator. Those unexpected conditions brought huge aftermath to the first responders, operators, workers, patients and community at large. Hence, in this report, we discuss prototyping and validating of Malaysia radiation and nuclear emergency preparedness and response plan simulation model (EPRM). A prototyping technique was required to formalize the simulation model requirements. Prototyping as systems requirements validation was carried on to endorse the correctness of the model itself against the stakeholder's intensions in resolving those organizational incapability. We have made assumptions for the proposed emergency preparedness and response model (EPRM) through the simulation software. Those assumptions provided a twofold of expected mechanisms, planning and handling of the respective emergency plan as well as in bringing off the hazard involved. This model called RANEPF (Radiation and Nuclear Emergency Planning Framework) simulator demonstrated the training emergency response perquisites rather than the intervention principles alone. The demonstrations involved the determination of the casualties' absorbed dose range screening and the coordination of the capacity planning of the expected trauma triage. Through user-centred design and sociotechnical approach, RANEPF simulator was strategized and simplified, though certainly it is equally complex.

  13. The national response plan and radioactive incident monitoring network (RIMNET)

    International Nuclear Information System (INIS)

    Jones, M.W.

    1989-01-01

    The Department of the Environment is responsible through Her Majesty's Inspectorate of Pollution for co-ordination of the Government's response to overseas nuclear incidents. This paper describes the contingency arrangements that have been set up for this purpose. (author)

  14. Drowning in the bible and contemporary society: responsibilities of religious caregivers.

    Science.gov (United States)

    Avramidis, Stathis

    2010-06-01

    The aim of this study was to research drowning incidents and rescues that are included in the Bible and provide recommendations for how religious caregivers can support psychologically affected victims. Results confirm that the Bible contains six aquatic emergencies. Persons threatened with drowning were saved by an act of God, a human act and acts of human/divine interaction, when, for example, a person was ordered by God to perform an action which resulted in saving people on the threshold of drowning. The drowning casualties were largely individual males and some cases with multiple victims (male and female) as well. The outcomes of the drowning incidents were the survival of most of the casualties whose stories are told in the Bible. One person is reported to have drowned. Drowning incidents occurred at sea and on earth. The types of rescues used were reach-rescue and rescue and survival. The drowning casualties were rescued from land and from ships and boats by human rescuers. Some rescues were achieved by divine miracles.

  15. Computerized radiation treatment planning

    International Nuclear Information System (INIS)

    Laarse, R. van der.

    1981-01-01

    Following a general introduction, a chain consisting of three computer programs which has been developed for treatment planning of external beam radiotherapy without manual intervention is described. New score functions used for determination of optimal incidence directions are presented and the calculation of the position of the isocentre for each optimum combination of incidence directions is explained. A description of how a set of applicators, covering fields with dimensions of 4 to 20 cm, for the 6 to 20 MeV electron beams of a MEL SL75-20 linear accelerator was developed, is given. A computer program for three dimensional electron beam treatment planning is presented. A microprocessor based treatment planning system for the Selectron remote controlled afterloading system for intracavitary radiotherapy is described. The main differences in treatment planning procedures for external beam therapy with neutrons instead of photons is discussed. A microprocessor based densitometer for plotting isodensity lines in film dosimetry is described. A computer program for dose planning of brachytherapy is presented. Finally a general discussion about the different aspects of computerized treatment planning as presented in this thesis is given. (Auth.)

  16. The application of seismic risk-benefit analysis to land use planning in Taipei City.

    Science.gov (United States)

    Hung, Hung-Chih; Chen, Liang-Chun

    2007-09-01

    In the developing countries of Asia local authorities rarely use risk analysis instruments as a decision-making support mechanism during planning and development procedures. The main purpose of this paper is to provide a methodology to enable planners to undertake such analyses. We illustrate a case study of seismic risk-benefit analysis for the city of Taipei, Taiwan, using available land use maps and surveys as well as a new tool developed by the National Science Council in Taiwan--the HAZ-Taiwan earthquake loss estimation system. We use three hypothetical earthquakes to estimate casualties and total and annualised direct economic losses, and to show their spatial distribution. We also characterise the distribution of vulnerability over the study area using cluster analysis. A risk-benefit ratio is calculated to express the levels of seismic risk attached to alternative land use plans. This paper suggests ways to perform earthquake risk evaluations and the authors intend to assist city planners to evaluate the appropriateness of their planning decisions.

  17. Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties

    Science.gov (United States)

    2014-03-01

    area under the curve (ROC AUC ) values. (ROC AUC values range from 0 and 1 and indicate the probability of correct detection/discrimination...training set of the human LBNP data. Values are receiver operating characteristic area under the curves (ROC AUCs ) comparing the relative SV change...detection of hemorrhage is crucial for managing combat casualties. However, mean arterial blood pressure (ABP) and other vital signs are late indicators of

  18. Lesson learned from two radiological incidents in industrial radiography in Iran

    International Nuclear Information System (INIS)

    Samimi, Bijan; Deevband Mohammad, Reza; Kardan Mohammad, Reza; Eshraghi, Ahmad

    2006-01-01

    This paper discussed two incidents occurred in Iran, follow-up investigations as well as lessons learned. Two Industrial Gamma Radiography Projectors (I.G.R.P.) included Ir-192 source with activities 24 and 30 Curies respectively were stolen. One of them was stolen in an industrial area with high security provision and the other one has been stolen at the home town without any security provision. The lessons learned from these incidents are discussed and the results are proposed as recommendations. Investigations show that the reasons for these incidents are as follows: 1. Insufficient training programs for radiographers. 2. Lack of specific emergency procedure for this type of incident in the company. 3. Not efficient National Emergency Plan for this type of threat. 4. Lack of technical and administrative measures to separate radioactive sources from unauthorized persons. 5. Lack of security plan in the company. 6. Insufficient supervision of Radiation Protection Officer (R.P.O.) or responsible person at the site. (authors)

  19. Lesson learned from two radiological incidents in industrial radiography in Iran

    Energy Technology Data Exchange (ETDEWEB)

    Samimi, Bijan; Deevband Mohammad, Reza; Kardan Mohammad, Reza; Eshraghi, Ahmad [National Radiation Protection Department (NRPD) Atomic Energy Organization of Iran (AEOI) (Iran, Islamic Republic of)

    2006-07-01

    This paper discussed two incidents occurred in Iran, follow-up investigations as well as lessons learned. Two Industrial Gamma Radiography Projectors (I.G.R.P.) included Ir-192 source with activities 24 and 30 Curies respectively were stolen. One of them was stolen in an industrial area with high security provision and the other one has been stolen at the home town without any security provision. The lessons learned from these incidents are discussed and the results are proposed as recommendations. Investigations show that the reasons for these incidents are as follows: 1. Insufficient training programs for radiographers. 2. Lack of specific emergency procedure for this type of incident in the company. 3. Not efficient National Emergency Plan for this type of threat. 4. Lack of technical and administrative measures to separate radioactive sources from unauthorized persons. 5. Lack of security plan in the company. 6. Insufficient supervision of Radiation Protection Officer (R.P.O.) or responsible person at the site. (authors)

  20. A comparative study of depression, anxiety, stress and their relationships with smoking pattern in caregivers of patients of casualty and outpatient departments

    Directory of Open Access Journals (Sweden)

    Purushottam

    2016-01-01

    Full Text Available Background: Smoking is prohibited in India at all the public places including hospital premises, but people with habit of smoking are not able to abide the rules strictly. Somehow, level of dependence and stress along with other psychological variables like anxiety and depression play key roles in smoking in the hospital premises. Methodology: Present study aimed to know the level of dependence and other psychological variables like depression, anxiety, and stress in the caregivers of patients of casualty and outpatients departments. Seventy five participants were recruited purposively from the hospital premises. The Fagerström Test for Nicotine Dependence and the Depression Anxiety Stress Scales (DASS- Hindi were administered. Result: Participants reported nicotine dependence was associated with psychological variables like mild to moderate level of depression, anxiety, and stress. Caregivers of casualty patients were having high level of stress than caregivers of outpatients. Conclusion: It can be concluded that psychological variables play a significant role in nicotine dependence.

  1. EAP-based critical incident stress management: utilization of a practice-based assessment of incident severity level in responding to workplace trauma.

    Science.gov (United States)

    DeFraia, Gary S

    2013-01-01

    Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.

  2. Family emergency preparedness plans in severe tornadoes.

    Science.gov (United States)

    Cong, Zhen; Liang, Daan; Luo, Jianjun

    2014-01-01

    Tornadoes, with warnings usually issued just minutes before their touchdowns, pose great threats to properties and people's physical and mental health. Few studies have empirically investigated the association of family emergency preparedness planning and observed protective behaviors in the context of tornadoes. The purpose of this study was to examine predictors for the action of taking shelter at the time of tornadoes. Specifically, this study investigated whether having a family emergency preparedness plan was associated with higher likelihood of taking shelter upon receiving tornado warnings. This study also examined the effects of socioeconomic status and functional limitations on taking such actions. A telephone survey based on random sampling was conducted in 2012 with residents in Tuscaloosa AL and Joplin MO. Each city experienced considerable damages, injuries, and casualties after severe tornadoes (EF-4 and EF-5) in 2011. The working sample included 892 respondents. Analysis was conducted in early 2013. Logistic regression identified emergency preparedness planning as the only shared factor that increased the likelihood of taking shelter in both cities and the only significant factor in Joplin. In Tuscaloosa, being female and white also increased the likelihood of taking shelter. Disability was not found to have an effect. This study provided empirical evidence on the importance of having a family emergency preparedness plan in mitigating the risk of tornadoes. The findings could be applied to other rapid-onset disasters. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

  3. Statistical aspects of the program of the Atomic Bomb Casualty Commission

    Energy Technology Data Exchange (ETDEWEB)

    Beebe, G W

    1961-02-24

    The Atomic Bomb Casualty Commission (ABCC) is a medical research institute in Hiroshima and Nagasaki devoted to long term study of the late effects of nuclear radiation upon man. The work draws its great interest from the paucity of existing information on the effect of radiation on man; from the unique radiation experience of the atomic bomb survivors; from the increasing utilization of nuclear energy in modern technology; and from humanitarian concern for the survivors of the bombs. The ABCC program provides the statistician with an important opportunity to apply the tools and concepts of statistics, for the inferences to be drawn are largely statistical inferences growing out of the comparison of samples defined as to radiation exposure. The work is of international as well as statistical interest by virtue of its subject matter and as a meeting-ground for statisticians trained in different countries.

  4. Incidence and Mortality and Epidemiology of Breast Cancer in the World.

    Science.gov (United States)

    Ghoncheh, Mahshid; Pournamdar, Zahra; Salehiniya, Hamid

    2016-01-01

    Breast cancer is the most common malignancy in women around the world. Information on the incidence and mortality of breast cancer is essential for planning health measures. This study aimed to investigate the incidence and mortality of breast cancer in the world using age-specific incidence and mortality rates for the year 2012 acquired from the global cancer project (GLOBOCAN 2012) as well as data about incidence and mortality of the cancer based on national reports. It was estimated that 1,671,149 new cases of breast cancer were identified and 521,907 cases of deaths due to breast cancer occurred in the world in 2012. According to GLOBOCAN, it is the most common cancer in women, accounting for 25.1% of all cancers. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries. Education of women is suggested in all countries for early detection and treatment. Plans for the control and prevention of this cancer must be a high priority for health policy makers; also, it is necessary to increase awareness of risk factors and early detection in less developed countries.

  5. Surgical resource utilization in urban terrorist bombing: a computer simulation.

    Science.gov (United States)

    Hirshberg, A; Stein, M; Walden, R

    1999-09-01

    The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

  6. 2 Major incident triage and the implementation of a new triage tool, the MPTT-24.

    Science.gov (United States)

    Vassallo, James; Smith, Jason

    2017-12-01

    Over the last decade, a number of European cities including London, have witnessed high profile terrorist attacks resulting in major incidents with large numbers of casualties. Triage, the process of categorising casualties on the basis of their clinical acuity, is a key principle in the effective management of major incidents.The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool which in comparison to existing triage tools, including the 2013 UK NARU Sieve, demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations.To improve the applicability and usability of the MPTT we increased the upper respiratory rate threshold to 24 breaths per minute (MPTT-24), to make it divisible by four, and included an assessment of external catastrophic haemorrhage. The aim of this study was to conduct a feasibility analysis of the proposed MPTT-24 (figure 1).emermed;34/12/A860-b/F1F1F1Figure 1MPTT-24 METHODS: A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult ( > 18 years) patients presenting between 2006-2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they had received one or more life-saving interventions.Using first recorded hospital physiology, patients were categorised as P1 or not-P1 by existing triage tools and both MPTT and MPTT-24. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage with a McNemar test to determine statistical significance. Basic study characteristics are shown in Table 1. Both the MPTT and MPTT-24 outperformed all existing triage methods with a statistically significant (p<0.001) absolute reduction of between 25.5%-29.5% in under-triage when compared to existing UK civilian methods (NARU Sieve). In both populations the MPTT-24 demonstrated an absolute reduction in sensitivity

  7. Integrating Urban Infrastructure and Health System Impact Modeling for Disasters and Mass-Casualty Events

    Science.gov (United States)

    Balbus, J. M.; Kirsch, T.; Mitrani-Reiser, J.

    2017-12-01

    Over recent decades, natural disasters and mass-casualty events in United States have repeatedly revealed the serious consequences of health care facility vulnerability and the subsequent ability to deliver care for the affected people. Advances in predictive modeling and vulnerability assessment for health care facility failure, integrated infrastructure, and extreme weather events have now enabled a more rigorous scientific approach to evaluating health care system vulnerability and assessing impacts of natural and human disasters as well as the value of specific interventions. Concurrent advances in computing capacity also allow, for the first time, full integration of these multiple individual models, along with the modeling of population behaviors and mass casualty responses during a disaster. A team of federal and academic investigators led by the National Center for Disaster Medicine and Public Health (NCDMPH) is develoing a platform for integrating extreme event forecasts, health risk/impact assessment and population simulations, critical infrastructure (electrical, water, transportation, communication) impact and response models, health care facility-specific vulnerability and failure assessments, and health system/patient flow responses. The integration of these models is intended to develop much greater understanding of critical tipping points in the vulnerability of health systems during natural and human disasters and build an evidence base for specific interventions. Development of such a modeling platform will greatly facilitate the assessment of potential concurrent or sequential catastrophic events, such as a terrorism act following a severe heat wave or hurricane. This presentation will highlight the development of this modeling platform as well as applications not just for the US health system, but also for international science-based disaster risk reduction efforts, such as the Sendai Framework and the WHO SMART hospital project.

  8. A better START for low-acuity victims: data-driven refinement of mass casualty triage.

    Science.gov (United States)

    Cross, Keith P; Petry, Michael J; Cicero, Mark X

    2015-01-01

    Methods currently used to triage patients from mass casualty events have a sparse evidence basis. The objective of this project was to assess gaps of the widely used Simple Triage and Rapid Transport (START) algorithm using a large database when it is used to triage low-acuity patients. Subsequently, we developed and tested evidenced-based improvements to START. Using the National Trauma Database (NTDB), a large set of trauma victims were assigned START triage levels, which were then compared to recorded patient mortality outcomes using area under the receiver-operator curve (AUC). Subjects assigned to the "Minor/Green" level who nevertheless died prior to hospital discharge were considered mistriaged. Recursive partitioning identified factors associated with of these mistriaged patients. These factors were then used to develop candidate START models of improved triage, whose overall performance was then re-evaluated using data from the NTDB. This process of evaluating performance, identifying errors, and further adjusting candidate models was repeated iteratively. The study included 322,162 subjects assigned to "Minor/Green" of which 2,046 died before hospital discharge. Age was the primary predictor of under-triage by START. Candidate models which re-assigned patients from the "Minor/Green" triage level to the "Delayed/Yellow" triage level based on age (either for patients >60 or >75), reduced mortality in the "Minor/Green" group from 0.6% to 0.1% and 0.3%, respectively. These candidate START models also showed net improvement in the AUC for predicting mortality overall and in select subgroups. In this research model using trauma registry data, most START under-triage errors occurred in elderly patients. Overall START accuracy was improved by placing elderly but otherwise minimally injured-mass casualty victims into a higher risk triage level. Alternatively, such patients would be candidates for closer monitoring at the scene or expedited transport ahead of other

  9. Implementation of the National Incident Management System (NIMS)/Incident Command System (ICS) in the Federal Radiological Monitoring and Assessment Center(FRMAC) - Emergency Phase

    International Nuclear Information System (INIS)

    NSTec Environmental Restoration

    2007-01-01

    Homeland Security Presidential Directive HSPD-5 requires all federal departments and agencies to adopt a National Incident Management System (NIMS)/Incident Command System (ICS) and use it in their individual domestic incident management and emergency prevention, preparedness, response, recovery, and mitigation programs and activities, as well as in support of those actions taken to assist state and local entities. This system provides a consistent nationwide template to enable federal, state, local, and tribal governments, private-sector, and nongovernmental organizations to work together effectively and efficiently to prepare for, prevent, respond to, and recover from domestic incidents, regardless of cause, size, or complexity, including acts of catastrophic terrorism. This document identifies the operational concepts of the Federal Radiological Monitoring and Assessment Center's (FRMAC) implementation of the NIMS/ICS response structure under the National Response Plan (NRP). The construct identified here defines the basic response template to be tailored to the incident-specific response requirements. FRMAC's mission to facilitate interagency environmental data management, monitoring, sampling, analysis, and assessment and link this information to the planning and decision staff clearly places the FRMAC in the Planning Section. FRMAC is not a mitigating resource for radiological contamination but is present to conduct radiological impact assessment for public dose avoidance. Field monitoring is a fact-finding mission to support this effort directly. Decisions based on the assessed data will drive public protection and operational requirements. This organizational structure under NIMS is focused by the mission responsibilities and interface requirements following the premise to provide emergency responders with a flexible yet standardized structure for incident response activities. The coordination responsibilities outlined in the NRP are based on the NIMS

  10. Risk factors for radiotherapy incidents and impact of an online electronic reporting system

    International Nuclear Information System (INIS)

    Chang, David W.; Cheetham, Lynn; Marvelde, Luc te; Bressel, Mathias; Kron, Tomas; Gill, Suki; Tai, Keen Hun; Ball, David; Rose, William; Silva, Linas; Foroudi, Farshad

    2014-01-01

    Background and purpose: To ascertain the rate, type, significance, trends and the potential risk factors associated with radiotherapy incidents in a large academic department. Materials and methods: Data for all radiotherapy activities from July 2001 to January 2011 were reviewed from radiotherapy incident reporting forms. Patient and treatment data were obtained from the radiotherapy record and verification database (MOSAIQ) and the patient database (HOSPRO). Logistic regression analyses were performed to determine variables associated with radiotherapy incidents. Results: In that time, 65,376 courses of radiotherapy were delivered with a reported incident rate of 2.64 per 100 courses. The rate of incidents per course increased (1.96 per 100 courses to 3.52 per 100 courses, p < 0.001) whereas the proportion of reported incidents resulting in >5% deviation in dose (10.50 to 2.75%, p < 0.001) had decreased after the introduction of an online electronic reporting system. The following variables were associated with an increased rate of incidents: afternoon treatment time, paediatric patients, males, inpatients, palliative plans, head-and-neck, skin, sarcoma and haematological malignancies. In general, complex plans were associated with higher incidence rates. Conclusion: Radiotherapy incidents were infrequent and most did not result in significant dose deviation. A number of risk factors were identified and these could be used to highlight high-risk cases in the future. Introduction of an online electronic reporting system resulted in a significant increase in the number of incidents being reported

  11. Triage in mass casualty situations

    African Journals Online (AJOL)

    A recent Oxfam report highlights a four-fold increase in the occurrence of ... A disaster, by definition, overwhelms the response capacity of the community. However ... or the location of the incident in such a place that it warrants the response of ...

  12. The Equivalent Uniform Dose as a severity metric for radiation treatment incidents

    International Nuclear Information System (INIS)

    Dunscombe, Peter B.; Iftody, Sandra; Ploquin, Nicolas; Ekaette, Edidiong U.; Lee, Robert C.

    2007-01-01

    In allocating resources within a risk management program, ideally we would like to know both the probabilities and consequences of potential incidents. We simulate, on a treatment planning computer, several commonly reported incidents in radiation treatment and explore their consequences for the EUDs of targets and organs at risk

  13. Air MEDEVAC in case of multiple casualties – The experience of civilian-military cooperation in RoAF

    Directory of Open Access Journals (Sweden)

    Dragoș C. Tudose

    2016-07-01

    Full Text Available Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.

  14. Hazardous materials incidents on major highways -- A case study

    International Nuclear Information System (INIS)

    McElhaney, M.S.

    1995-01-01

    Personnel from both the public and private sectors have been involved for many years in pre-planning for hazardous materials releases at fixed installations all over the world. As a result of several major petroleum releases during marine transportation, oil companies, private contractors and government agencies have been preparing contingency plans for oil spills and other petroleum product releases in marine settings. Various industry groups have also developed plans for railway and pipeline disasters. These response plans are of varying quality, complexity and usefulness. Organizations such as plant emergency response teams, government agencies, contract response and clean-up crews and fire departments use these plans as a basis for training and resource allocation, hopefully becoming familiar enough with them that the plans are truly useful when product releases occur. Planners and emergency responders to hazardous materials releases must overcome some of the deficiencies which have long stood in the way of efficient and effective response and mitigation efforts. Specifically they must recognize and involve all resources with which they may respond or interact during an incident. This involvement should begin with the planning stages and carry through to training and emergency response and recovery efforts. They must ensure that they adopt and utilize a common command and control system and that all potential resources know this system thoroughly and train together before the incident occurs. It is only through incorporating these two factors that may successfully combat the ever growing number of unwanted product releases occurring in the more difficult realm of transportation

  15. Care planning for aggression management in a specialist secure mental health service: An audit of user involvement.

    Science.gov (United States)

    Hallett, Nutmeg; Huber, Jörg W; Sixsmith, Judith; Dickens, Geoffrey L

    2016-12-01

    This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation. © 2016 Australian College of Mental Health Nurses Inc.

  16. Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study.

    Science.gov (United States)

    Li, Wen-Yi; Wang, Yi-Cheng; Hwang, Shang-Jyh; Lin, Shih-Hua; Wu, Kwan-Dun; Chen, Yung-Ming

    2017-12-11

    The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD. This was a 2-year prospective observational study. We enrolled 507 incident ESRD patients, among them 111 chose PD (43 planned-start, 68 emergent-start) and 396 chose HD (116 planned-start, 280 emergent-start) as the long-term dialysis modality. The logistic regression model was used to identify variables associated with emergent-start dialysis. The Kaplan-Meier survival analysis was used to determine patient survival and technique failure. The propensity score-adjusted Cox regression model was used to identify factors associated with patient outcomes. During the 2-year follow-up, we observed 5 (4.5%) deaths, 15 (13.5%) death-censored technique failures (transfer to HD) and 3 (2.7%) renal transplantations occurring in the PD population. Lack of predialysis education, lower predialysis estimated glomerular filtration rate and serum albumin were predictors of being assigned to emergent dialysis initiation. The emergent starters of PD displayed similar risks of patient survival, technique failure and overall hospitalization, compared with the planned-start counterparts. By contrast, the concurrent planned-start and emergent-start HD patients with an arteriovenous fistula or graft were protected from early overall death and access infection-related mortality, compared with the emergent HD starters using a central venous catheter. In late-referred chronic kidney disease patients who have initiated emergent dialysis via a temporary HD catheter, post-initiation PD can be a safe and effective long-term treatment option. Nevertheless, due to the potential complications

  17. Risk Assessment Using The Homeland-Defense Operational Planning System (HOPS)

    International Nuclear Information System (INIS)

    Price, D E; Durling, R L

    2005-01-01

    The Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging Lawrence Livermore National Laboratory's expertise in weapons systems and in sparse information analysis to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors, HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities will be presented

  18. Key Planning Factors for Recovery from a Radiological Terrorism Incident

    Science.gov (United States)

    2012-09-01

    measurements are made, these are collected electronically4 and automatically exported to local operation centers and incident command posts where the...economic, natural and built environments and a move to self-sufficiency, sustainability and resilience.” As can be seen in Figure 3-11, some long-term...Transportation and access routes Bridges Streets and thoroughfares Sidewalks and walkways Release of property from radiologically controlled areas

  19. Developing a hazmat incident evaluation program

    International Nuclear Information System (INIS)

    Williams, D.L.; Kaikumba, F.

    1991-01-01

    This paper reports that all communities are at risk of experiencing a hazardous materials incident, whether in transportation or at a fixed facility (such as petroleum refineries, oil fields, processing plants, etc.). However, many communities are unprepared to cope with this emergency. Administrators of state agencies and local response organizations often face fierce competition for tax dollars in support of their hazardous materials emergency response programs. Historically, little statistical information has been available to support their call for additional budget dollars in the areas of personnel, training, and equipment. It is difficult to plan for an emergency when you have little understanding of the risks, the frequency of incidents, the type of chemicals generally involved, and other vital information. The Illinois Hazardous Materials Incident Evaluation Program was designed to address the state and local needs, and position government and industry in a more responsive and proactive mode. The result is a program that works

  20. Risk Assessment Using The Homeland-Defense Operational Planning System (HOPS)

    International Nuclear Information System (INIS)

    Durling, R L; Price, D E; Spero, K K

    2005-01-01

    For over ten years, the Counterproliferation Analysis and Planning System (CAPS) at Lawrence Livermore National Laboratory (LLNL) has been a planning tool used by U.S. combatant commands for mission support planning against foreign programs engaged in the manufacture of weapons of mass destruction (WMD). CAPS is endorsed by the Secretary of Defense as the preferred counterproliferation tool to be used by the nation's armed services. A sister system, the Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging CAPS expertise designed to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors, HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities will be presented

  1. Key Planning Factors for Recovery from a Chemical Warfare Agent Incident

    Science.gov (United States)

    2012-07-01

    challenges that may arise in such an incident. Audiences for this document include local, regional, state, and federal stakeholders within the...the Denver Mint, Coors Field, Pepsi Center, the Metropolitan State College of Denver, and Mile High Field. In parallel, members of the population

  2. Crippling Violence: Conflict and Incident Polio in Afghanistan.

    Science.gov (United States)

    Norris, Alison; Hachey, Kevin; Curtis, Andrew; Bourdeaux, Margaret

    2016-01-01

    Designing effective public health campaigns in areas of armed conflict requires a nuanced understanding of how violence impacts the epidemiology of the disease in question. We examine the geographical relationship between violence (represented by the location of detonated Improvised Explosive Devices) and polio incidence by generating maps of IEDs and polio incidence during 2010, and by comparing the mean number of IED detonations in polio high-risk districts with non polio high-risk districts during 2004-2009. We demonstrate a geographic relationship between IED violence and incident polio. Districts that have high-risk for polio have highly statistically significantly greater mean numbers of IEDs than non polio high-risk districts (p-values 0.0010-0.0404). The geographic relationship between armed conflict and polio incidence provides valuable insights as to how to plan a vaccination campaign in violent contexts, and allows us to anticipate incident polio in the regions of armed conflict. Such information permits vaccination planners to engage interested armed combatants to co-develop strategies to mitigate the effects of violence on polio.

  3. Crippling Violence: Conflict and Incident Polio in Afghanistan.

    Directory of Open Access Journals (Sweden)

    Alison Norris

    Full Text Available Designing effective public health campaigns in areas of armed conflict requires a nuanced understanding of how violence impacts the epidemiology of the disease in question.We examine the geographical relationship between violence (represented by the location of detonated Improvised Explosive Devices and polio incidence by generating maps of IEDs and polio incidence during 2010, and by comparing the mean number of IED detonations in polio high-risk districts with non polio high-risk districts during 2004-2009.We demonstrate a geographic relationship between IED violence and incident polio. Districts that have high-risk for polio have highly statistically significantly greater mean numbers of IEDs than non polio high-risk districts (p-values 0.0010-0.0404.The geographic relationship between armed conflict and polio incidence provides valuable insights as to how to plan a vaccination campaign in violent contexts, and allows us to anticipate incident polio in the regions of armed conflict. Such information permits vaccination planners to engage interested armed combatants to co-develop strategies to mitigate the effects of violence on polio.

  4. WE-G-BRA-01: Patient Safety and Treatment Quality Improvement Through Incident Learning: Experience of a Non-Academic Proton Therapy Center

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Y; Johnson, R; Zhao, L; Ramirez, E; Rana, S; Singh, H; Chacko, M [Procure Proton Therapy Center, Oklahoma City, OK (United States)

    2015-06-15

    Purpose: Incident learning has been proven to improve patient safety and treatment quality in conventional radiation therapy. However, its application in proton therapy has not been reported yet to our knowledge. In this study, we report our experience in developing and implementation of an in-house incident learning system. Methods: An incident learning system was developed based on published principles and tailored for our clinical practice and available resource about 18 months ago. The system includes four layers of error detection and report: 1) dosimetry peer review; 2) physicist plan quality assurance (QA); 3) treatment delivery issue on call and record; and 4) other incident report. The first two layers of QA and report were mandatory for each treatment plan through easy-to-use spreadsheets that are only accessible by the dosimetry and physicist departments. The treatment delivery issues were recorded case by case by the on call physicist. All other incidents were reported through an online incident report system, which can be anonymous. The incident report includes near misses on planning and delivery, process deviation, machine issues, work flow and documentation. Periodic incident reviews were performed. Results: In total, about 116 errors were reported through dosimetry review, 137 errors through plan QA, 83 treatment issues through physics on call record, and 30 through the online incident report. Only 8 incidents (2.2%) were considered to have a clinical impact to patients, and the rest of errors were either detected before reaching patients or had negligible dosimetric impact (<5% dose variance). Personnel training & process improvements were implemented upon periodic incident review. Conclusion: An incident learning system can be helpful in personnel training, error reduction, and patient safety and treatment quality improvement. The system needs to be catered for each clinic’s practice and available resources. Incident and knowledge sharing among

  5. WE-G-BRA-01: Patient Safety and Treatment Quality Improvement Through Incident Learning: Experience of a Non-Academic Proton Therapy Center

    International Nuclear Information System (INIS)

    Zheng, Y; Johnson, R; Zhao, L; Ramirez, E; Rana, S; Singh, H; Chacko, M

    2015-01-01

    Purpose: Incident learning has been proven to improve patient safety and treatment quality in conventional radiation therapy. However, its application in proton therapy has not been reported yet to our knowledge. In this study, we report our experience in developing and implementation of an in-house incident learning system. Methods: An incident learning system was developed based on published principles and tailored for our clinical practice and available resource about 18 months ago. The system includes four layers of error detection and report: 1) dosimetry peer review; 2) physicist plan quality assurance (QA); 3) treatment delivery issue on call and record; and 4) other incident report. The first two layers of QA and report were mandatory for each treatment plan through easy-to-use spreadsheets that are only accessible by the dosimetry and physicist departments. The treatment delivery issues were recorded case by case by the on call physicist. All other incidents were reported through an online incident report system, which can be anonymous. The incident report includes near misses on planning and delivery, process deviation, machine issues, work flow and documentation. Periodic incident reviews were performed. Results: In total, about 116 errors were reported through dosimetry review, 137 errors through plan QA, 83 treatment issues through physics on call record, and 30 through the online incident report. Only 8 incidents (2.2%) were considered to have a clinical impact to patients, and the rest of errors were either detected before reaching patients or had negligible dosimetric impact (<5% dose variance). Personnel training & process improvements were implemented upon periodic incident review. Conclusion: An incident learning system can be helpful in personnel training, error reduction, and patient safety and treatment quality improvement. The system needs to be catered for each clinic’s practice and available resources. Incident and knowledge sharing among

  6. Econometric analysis of the changing effects in wind strength and significant wave height on the probability of casualty in shipping.

    Science.gov (United States)

    Knapp, Sabine; Kumar, Shashi; Sakurada, Yuri; Shen, Jiajun

    2011-05-01

    This study uses econometric models to measure the effect of significant wave height and wind strength on the probability of casualty and tests whether these effects changed. While both effects are in particular relevant for stability and strength calculations of vessels, it is also helpful for the development of ship construction standards in general to counteract increased risk resulting from changing oceanographic conditions. The authors analyzed a unique dataset of 3.2 million observations from 20,729 individual vessels in the North Atlantic and Arctic regions gathered during the period 1979-2007. The results show that although there is a seasonal pattern in the probability of casualty especially during the winter months, the effect of wind strength and significant wave height do not follow the same seasonal pattern. Additionally, over time, significant wave height shows an increasing effect in January, March, May and October while wind strength shows a decreasing effect, especially in January, March and May. The models can be used to simulate relationships and help understand the relationships. This is of particular interest to naval architects and ship designers as well as multilateral agencies such as the International Maritime Organization (IMO) that establish global standards in ship design and construction. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups.

    Science.gov (United States)

    Schneider, S; Seither, B; Tönges, S; Schmitt, H

    2006-04-01

    To generate national representative data on the incidence, diagnosis, severity, and nature of medically treated sports injuries and to identify high risk groups. The first national health survey for the Federal Republic of Germany, conducted in the format of a standardised, written, cross sectional survey in the period October 1997 to March 1999, gathered data on the incidence of accident and injury and information on social demographics, injury related disability/time off work, and injury location/setting. The net sample comprised 7124 people aged 18-79. 3.1% of adult Germans said they sustained a sports injury during the previous year, corresponding to an annual injury rate of 5.6% among those engaging in regular recreational physical activity and ranking sports injuries as the second most common type of accident. About 62% of all sports injuries result in time taken off work. The period of occupational disability is 14 days or less in around two thirds of these cases. The occupational disability rate after occupational and traffic accidents is much higher by comparison. Dislocations, distortions, and/or torn ligaments make up 60% of all sports injuries, followed by fractures (18%), contusions, surface wounds, or open wounds (12%). Three out of four sports injury casualties are male. The incidence declines noticeably in higher age groups. Future injury prevention measures should focus on the high risk group of young male recreational athletes. The data indicate that the fear of damage to health and injury, believed to be significant internal psychological barriers to participation in sports, is largely unwarranted for the female population and/or older age groups. Sporting injuries are a marginal phenomenon among the female population and mobile seniors actively engaged in sports.

  8. Major incidents in Kenya: the case for emergency services development and training.

    Science.gov (United States)

    Wachira, Benjamin W; Smith, Wayne

    2013-04-01

    Kenya's major incidents profile is dominated by droughts, floods, fires, terrorism, poisoning, collapsed buildings, accidents in the transport sector and disease/epidemics. With no integrated emergency services and a lack of resources, many incidents in Kenya escalate to such an extent that they become major incidents. Lack of specific training of emergency services personnel to respond to major incidents, poor coordination of major incident management activities, and a lack of standard operational procedures and emergency operation plans have all been shown to expose victims to increased morbidity and mortality. This report provides a review of some of the major incidents in Kenya for the period 2000-2012, with the hope of highlighting the importance of developing an integrated and well-trained Ambulance and Fire and Rescue service appropriate for the local health care system.

  9. Radio-contaminated casualties treatment: an unusual application of technical shelters used on the Ile Longue site

    International Nuclear Information System (INIS)

    Laroche, P.; Rousset, J.; Abiliou, R.; Roe, H.; Berthelot, B.; Lemaire, L.

    2002-01-01

    While the radio-contaminated casualties treatment center (CTBRC) of the military hospital of Brest is reconstructed an unusual structure has been built on the Ile Longue site. Technical shelters (ETM) of the French military health service have been put together in order to constitute the CTBRC/ETM. This structure is adapted to the necessities of the nuclear site of Brest. First we explain the organization of the medical intervention in case of a nuclear accident; then we describe the functions of the CTBRC. People from hospital and medical teams of the nuclear oceanic French forces (FOST) take part in utilization, maintenance, training according to a particular protocol. (author)

  10. Manipulating the Geometric Computer-aided Design of the Operational Requirements-based Casualty Assessment Model within BRL-CAD

    Science.gov (United States)

    2018-03-30

    aided Design of the Operational Requirements-based Casualty Assessment Model within BRL-CAD 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ...upper_arm_r.s upper_arm_r.s-bool r upper_leg_l.r - lower_leg_l.s-bool r upper_leg_r.r - lower_leg_r.s-bool r upper_arm_r.r - lower_arm_r.s-bool r ...upper_arm_l.r - lower_arm_l.s-bool r pelvis.r - hip_l.s-bool - hip_r.s-bool - upper_leg_l.s-bool - upper_leg_r.s-bool r thorax.r - shoulder_l.s-bool

  11. Sneller veiliger : inleiding op het Nationaal Verkeersveiligheidscongres NVVC, Amsterdam, 18 april 2002.

    NARCIS (Netherlands)

    Wegman, F.C.M.

    2003-01-01

    In the Dutch Second Transport Structure Plan (SVV-2), the 2000 target was formulated as 25% less casualties than in 1986. This reduction was achieved for the road deaths, but not for the number injured: only half the target percentage was realised. In order to reduce the number of casualties

  12. Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters.

    Science.gov (United States)

    Lennquist Montán, K; Hreckovski, B; Dobson, B; Örtenwall, P; Montán, C; Khorram-Manesh, A; Lennquist, S

    2014-08-01

    The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of

  13. Validating FMEA output against incident learning data: A study in stereotactic body radiation therapy.

    Science.gov (United States)

    Yang, F; Cao, N; Young, L; Howard, J; Logan, W; Arbuckle, T; Sponseller, P; Korssjoen, T; Meyer, J; Ford, E

    2015-06-01

    Though failure mode and effects analysis (FMEA) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge, its output has never been validated against data on errors that actually occur. The objective of this study was to perform FMEA of a stereotactic body radiation therapy (SBRT) treatment planning process and validate the results against data recorded within an incident learning system. FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, dosimetrists, and IT technologists. Potential failure modes were identified through a systematic review of the process map. Failure modes were rated for severity, occurrence, and detectability on a scale of one to ten and risk priority number (RPN) was computed. Failure modes were then compared with historical reports identified as relevant to SBRT planning within a departmental incident learning system that has been active for two and a half years. Differences between FMEA anticipated failure modes and existing incidents were identified. FMEA identified 63 failure modes. RPN values for the top 25% of failure modes ranged from 60 to 336. Analysis of the incident learning database identified 33 reported near-miss events related to SBRT planning. Combining both methods yielded a total of 76 possible process failures, of which 13 (17%) were missed by FMEA while 43 (57%) identified by FMEA only. When scored for RPN, the 13 events missed by FMEA ranked within the lower half of all failure modes and exhibited significantly lower severity relative to those identified by FMEA (p = 0.02). FMEA, though valuable, is subject to certain limitations. In this study, FMEA failed to identify 17% of actual failure modes, though these were of lower risk. Similarly, an incident learning system alone fails to identify a large number of potentially high-severity process errors. Using FMEA in combination with incident learning may

  14. Radiological incident preparedness for community hospitals: a demonstration project.

    Science.gov (United States)

    Jafari, Mary Ellen

    2010-08-01

    In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

  15. Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.

    Science.gov (United States)

    Leatherman, Matthew L; Held, Jenny M; Fluke, Laura M; McEvoy, Christian S; Inaba, Kenji; Grabo, Daniel; Martin, Matthew J; Earley, Angela S; Ricca, Robert L; Polk, Travis M

    2017-07-01

    Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current prehospital standard of care for tPTX is immediate decompression with a 14-gauge 8-cm angiocatheter; however, failure rates may be as high as 17% to 60%. Alternative devices, such as 10-gauge angiocatheter, modified Veress needle, and laparoscopic trocar, have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement. Seven soft-embalmed cadavers were intubated and mechanically ventilated. Chest wall thickness was measured at the second intercostal space at the midclavicular line (2MCL) and the fifth intercostal space along the anterior axillary line (5AAL). CO2 insufflation created a PTX, and needle decompression was then performed with a randomized device. Insertional depth was measured between hub and skin before and after simulated casualty transport. Thoracoscopy was used to evaluate for intrapleural placement and/or injury during insertion and after movement. Cadaver demographics, device displacement, device dislodgment, and injuries were recorded. Three decompressions were performed at each site (2MCL/5AAL), totaling 12 events per cadaver. Eighty-four decompressions were performed. Average cadaver age was 59 years, and body mass index was 24 kg/m. The CWT varied between cadavers because of subcutaneous emphysema, but the average was 39 mm at the 2MCL and 31 mm at the 5AAL. Following movement, the 2MCL site was more likely to become dislodged than the 5AAL (67% vs. 17%, p = 0.001). Median displacement also differed between 2MCL and 5AAL (23 vs. 2 mm, p = 0.001). No significant differences were noted in dislodgement or displacement between devices. Five minor lung injuries were noted at the 5AAL position. Preliminary results from this human cadaver study suggest the 5AAL position is a more stable and reliable location

  16. [National preparedness for biological mass casualty event: between the devil and the deep blue sea].

    Science.gov (United States)

    Eldad, Arieh

    2002-05-01

    Species of plants and animals, as well as nations of human beings were extinguished throughout the prehistory and history of this planet. One of the possible explanations for this phenomenon is a large scale epidemic of viral, bacterial or fungal infections. One well-documented example was the smallpox epidemic among native Indians of South America following the European invasion. Deliberate dissemination of disease was used as a weapon during the Middle Ages when corpses of plague casualties were thrown over the walls and into the besieged towns. The Book of Kings II, of the Bible, in chapter 19 recalls the story of 185,000 soldiers of Sennacherib that died in one night, near the walls of Jerusalem. The possibility of causing mass casualty by dissemination of infectious disease has driven countries and terrorist organizations to produce and store large quantities of bacteria or viruses. The death of thousands in the USA on September 11, 2001, demonstrated that terror has no moral prohibitions, only technical limitations. Terror organizations will not hesitate to use weapons for mass destruction to kill many, and if only few will die, it will still serve the purpose of these evil organizations: to strew panic, to destroy normal life and to increase fear and instability. Any government that faces decisions about how to be better prepared against biological warfare is pushed between the devil and the deep blue sea. On the one hand: the better we will be prepared, equipped with antibiotics and vaccines--the more lives of casualties we will be able to save. Better public education will help to reduce the damage, but, on the other hand--in order to cause more people to make the effort to equip themselves or to refresh their protective kit--we will have to increase their level of concern. In order to improve the medical education of all members of the medical teams we will have to start a broad and intense campaign, thereby taking the risk of increasing stress in the

  17. 49 CFR 1242.33 - Other expenses and casualties and insurance (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50...

    Science.gov (United States)

    2010-10-01

    ... (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50-18-00, and 50-19-00). 1242.33 Section 1242.33....33 Other expenses and casualties and insurance (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50... separation of administrative—other (account XX-19-06). Operating Expenses—Equipment locomotives ...

  18. Factors Associated with Incidence of Induced Abortion in Hamedan, Iran.

    Science.gov (United States)

    Hosseini, Hatam; Erfani, Amir; Nojomi, Marzieh

    2017-05-01

    There is limited reliable information on abortion in Iran, where abortion is illegal and many women of reproductive age seek clandestine abortion to end their unintended pregnancy. This study aims to examine the determinants of induced abortion in the city of Hamedan, Iran. The study utilizes recent data from the 2015 Hamedan Survey of Fertility, conducted in a representative sample of 3,000 married women aged 15-49 years in the city of Hamedan, Iran. Binary logistic regression models are used to examine factors associated with the incidence of abortion. Overall, 3.8% of respondents reported having had an induced abortion in their life. Multivariate results showed that the incidence of abortion was strongly associated with women's education, type of contraceptive and family income level, after controlling for confounding factors. Women using long-acting contraceptive methods, those educated under high school diploma or postsecondary education, and those with high level of income were more likely to report having an induced abortion. The high incidence of abortion among less or more educated women and those with high income level signifies unmet family planning needs among these women, which must be addressed by focused reproductive health and family planning programs.

  19. Use of the Homeland-Defense Operational Planning System (HOPS) for Emergency Management

    International Nuclear Information System (INIS)

    Durling, Jr. R.L.; Price, D.E.

    2005-01-01

    The Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging Lawrence Livermore National Laboratory's expertise in weapons systems and in sparse information analysis to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors, HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities will be presented

  20. IDAS-RR: an incident data base system for research reactors

    International Nuclear Information System (INIS)

    Matsumoto, Kiyoshi; Kohsaka, Atsuo; Kaminaga, Masanori; Murayama, Youji; Ohnishi, Nobuaki; Maniwa, Masaki.

    1990-03-01

    An Incident Data Base System for Research Reactors, IDAS-RR, has been developed. IDAS-RR has information about abnormal incidents (failures, transients, accidents, etc.) of research reactors in the world. Data reference, input, editing and other functions of IDAS-RR are menu driven. The routine processing and data base management functions are performed by the system software and hardware. PC-9801 equipment was selected as the hardware because of its portability and popularity. IDAS-RR provides effective reference information for the following activities. 1) Analysis of abnormal incident of research reactors, 2) Detail analysis of research reactor behavior in the abnormal incident for building the knowledge base of the reactor emergency diagnostic system for research reactor, 3) Planning counter-measure for emergency situation in the research reactor. This report is a user's manual of IDAS-RR. (author)

  1. Vulnerability And Risk Assessment Using The Homeland-Defense Operational Planning System (HOPS)

    International Nuclear Information System (INIS)

    Durling, R.L. Jr.; Price, D.E.; Spero, K.K.

    2005-01-01

    For over ten years, the Counterproliferation Analysis and Planning System (CAPS) at Lawrence Livermore National Laboratory (LLNL) has been a planning tool used by U.S. combatant commands for mission support planning against foreign programs engaged in the manufacture of weapons of mass destruction (WMD). CAPS is endorsed by the Secretary of Defense as the preferred counterproliferation tool to be used by the nation's armed services. A sister system, the Homeland-Defense Operational Planning System (HOPS), is a new operational planning tool leveraging CAPS expertise designed to support the defense of the U.S. homeland. HOPS provides planners with a basis to make decisions to protect against acts of terrorism, focusing on the defense of facilities critical to U.S. infrastructure. Criticality of facilities, structures, and systems is evaluated on a composite matrix of specific projected casualty, economic, and sociopolitical impact bins. Based on these criteria, significant unidentified vulnerabilities are identified and secured. To provide insight into potential successes by malevolent actors, HOPS analysts strive to base their efforts mainly on unclassified open-source data. However, more cooperation is needed between HOPS analysts and facility representatives to provide an advantage to those whose task is to defend these facilities. Evaluated facilities include: refineries, major ports, nuclear power plants and other nuclear licensees, dams, government installations, convention centers, sports stadiums, tourist venues, and public and freight transportation systems. A generalized summary of analyses of U.S. infrastructure facilities is presented

  2. Legal preparedness: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

    Science.gov (United States)

    Courtney, Brooke; Hodge, James G; Toner, Eric S; Roxland, Beth E; Penn, Matthew S; Devereaux, Asha V; Dichter, Jeffrey R; Kissoon, Niranjan; Christian, Michael D; Powell, Tia

    2014-10-01

    Significant legal challenges arise when health-care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. Following the CHEST Guidelines Oversight Committee's methodology, the Legal Panel developed 35 key questions for which specific literature searches were then conducted. The literature in this field is not suitable to provide support for evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process resulting in seven final suggestions. Acceptance is widespread for the health-care community's duty to appropriately plan for and respond to severe disasters and pandemics. Hospitals, public health entities, and clinicians have an obligation to develop comprehensive, vetted plans for mass casualty incidents involving critically ill or injured patients. Such plans should address processes for evacuation and limited appeals and reviews of care decisions. To legitimize responses, deter independent actions, and trigger liability protections, mass critical care (MCC) plans should be formally activated when facilities and practitioners shift to providing MCC. Adherence to official MCC plans should contribute to protecting

  3. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

    Directory of Open Access Journals (Sweden)

    K Asish

    2016-01-01

    Full Text Available Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs, presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected.The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI, separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians.

  4. An incident command system in practice and reality

    International Nuclear Information System (INIS)

    Spitzer, J.D.

    1992-01-01

    The basic organizational problems and options for forming a pollution response organization are described. Problems with multi-agency response organizations include poor coordination and lack of accountability. Alternatives to autonomous organizations operating with minimal coordination are the multi-agency/organization teams working under a controlling organization, and organizations formed into a single response organization (the incident command system or ICS). Design criteria for an ICS include flexibility as to the jurisdiction and agency, adaptable organizational structure, capability to expand in a logical manner, and uniform elements in terminology, organization, and procedures. ICS in practice is illustrated both by the CANUSLAK exercise undertaken in August 1990 and a real incident that occurred several days after the exercise was finished. CANUSLAK involved the US Coast Guard and its Canadian and Michigan counterparts in a simulated incident in the St. Clair river. The real incident was the explosion of the gasoline-carrying tank vessel Jupiter in the Saginaw River. In both instances, ICS combined many organizations into one team with a single incident commander. The eight basic components of ICS are common terminology, modular organization, integrated communications, unified command structure, consolidated action plan, manageable span of control, designated incident facilities, and comprehensive resource management. ICS has been tailored to a wide range of applications and is not only used in major disasters but as a part of routine operations. 18 refs., 5 figs

  5. SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

    2014-06-15

    Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, including 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy.

  6. SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

    International Nuclear Information System (INIS)

    Yang, R; Wang, J

    2014-01-01

    Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, including 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy

  7. Recovery from a chemical weapons accident or incident: A concept paper on planning

    Energy Technology Data Exchange (ETDEWEB)

    Herzenberg, C.L.; Haffenden, R.; Lerner, K.; Meleski, S.A.; Tanzman, E.A. [Argonne National Lab., IL (United States); Lewis, L.M. [US Dept. of Agriculture (United States); Hemphill, R.C. [Niagara Mohawk Power Corporation (United States); Adams, J.D. [US Environmental Protection Agency (United States)

    1994-04-01

    Emergency planning for an unintended release of chemical agent from the nation`s chemical weapons stockpile should include preparation for. the period following implementation of immediate emergency response. That period -- the recovery, reentry, and restoration stage -- is the subject of this report. The report provides an overview of the role of recovery, reentry, and restoration planning in the Chemical Stockpile Emergency Preparedness Program (CSEPP), describes the transition from immediate emergency response to restoration, and analyzes the legal framework that would govern restoration activities. Social, economic, and administrative issues, as well as technical ones, need to be considered in the planning effort. Because of possible jurisdictional conflicts, appropriate federal, state, and local agencies need to be included in a coordinated planning process. Advance consideration should be given to the pertinent federal and state statutes and regulations. On the federal level, the principal statutes and regulations to be considered are those associated with the Comprehensive Environmental Response, Compensation, and Liability Act; the Resource Conservation and Recovery Act; and the National Environmental Policy Act. This report recommends that extensive preaccident planning be undertaken for the recovery, reentry, and restoration stage and outlines several key issues that should be considered in that planning. The need for interagency cooperation and coordination at all levels of the planning process is emphasized.

  8. An Investigation of Operational Decision Making in Situ: Incident Command in the U.K. Fire and Rescue Service.

    Science.gov (United States)

    Cohen-Hatton, Sabrina R; Butler, Philip C; Honey, Robert C

    2015-08-01

    The aim of this study was to better understand the nature of decision making at operational incidents in order to inform operational guidance and training. Normative models of decision making have been adopted in the guidance and training for emergency services. In these models, it is assumed that decision makers assess the current situation, formulate plans, and then execute the plans. However, our understanding of how decision making unfolds at operational incidents remains limited. Incident commanders, attending 33 incidents across six U.K. Fire and Rescue Services, were fitted with helmet-mounted cameras, and the resulting video footage was later independently coded and used to prompt participants to provide a running commentary concerning their decisions. The analysis revealed that assessment of the operational situation was most often followed by plan execution rather than plan formulation, and there was little evidence of prospection about the potential consequences of actions. This pattern of results was consistent across different types of incident, characterized by level of risk and time pressure, but was affected by the operational experience of the participants. Decision making did not follow the sequence of phases assumed by normative models and conveyed in current operational guidance but instead was influenced by both reflective and reflexive processes. These results have clear implications for understanding operational decision making as it occurs in situ and suggest a need for future guidance and training to acknowledge the role of reflexive processes. © 2015, Human Factors and Ergonomics Society.

  9. Retrospective and emergency dosimetry in response to radiological incidents and nuclear mass-casualty events: A review

    International Nuclear Information System (INIS)

    Bailiff, I.K.; Sholom, S.; McKeever, S.W.S.

    2016-01-01

    of a radiation incident. Hence attention has focused on biological or physical materials they may have in their possession that could be used as surrogate dosimeters. For EPR measurements, in particular, this includes material within the body (such as bone or tooth biopsy) requiring invasive procedures, but also materials collected non-invasively (such as clippings taken from finger- or toenails) and artefacts within their personal belongings (such as electronic devices of which smart phones are the most common). For luminescence measurements, attention has also focused on components within electronic devices, including smartphones, and a wide range of other personal belongings such as paper and other polymer-based materials (including currency, clothing, bank cards, etc.). The paper reviews progress made using both EPR and luminescence techniques, along with their current limitations. For the longer-established approach of retrospective dosimetry, luminescence has been the most extensively applied method and, by employing minerals found in construction materials, it consequently is employed in dosimetry using structures within the environment. Recent developments in its application to large-scale radiation releases are discussed, including the atomic bomb detonations at Hiroshima and Nagasaki, fallout from the Chernobyl reactor and atmospheric nuclear bomb tests within the Semipalatinsk Nuclear Test Site and fluvially transported pollution within the Techa River basin due to releases from the Mayak facility. The developments made in applying OSL and TL techniques are discussed in the context of these applications. EPR measurements with teeth have also provided benchmark values to test the dosimetry models used for Chernobyl liquidators (clean-up workers), residents of Semipalatinsk Nuclear Tests Sites and inhabitants of the Techa River basin. For both emergency and retrospective dosimetry applications, computational techniques employing radiation transport

  10. Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment

    Science.gov (United States)

    2017-12-01

    Traffic incidents have long been recognized as the main contributor to congestion in highway networks. Thus, contending with non-recurrent congestion has been a priority task for most highway agencies over the past decades. Under most incident scenar...

  11. MO-G-BRE-09: Validating FMEA Against Incident Learning Data: A Study in Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Yang, F; Cao, N; Young, L; Howard, J; Sponseller, P; Logan, W; Arbuckle, T; Korssjoen, T; Meyer, J; Ford, E

    2014-01-01

    Purpose: Though FMEA (Failure Mode and Effects Analysis) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge it has never been validated against actual incident learning data. The objective of this study was to perform an FMEA analysis of an SBRT (Stereotactic Body Radiation Therapy) treatment planning process and validate this against data recorded within an incident learning system. Methods: FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, and dosimetrists. Potential failure modes were identified through a systematic review of the workflow process. Failure modes were rated for severity, occurrence, and detectability on a scale of 1 to 10 and RPN (Risk Priority Number) was computed. Failure modes were then compared with historical reports identified as relevant to SBRT planning within a departmental incident learning system that had been active for two years. Differences were identified. Results: FMEA identified 63 failure modes. RPN values for the top 25% of failure modes ranged from 60 to 336. Analysis of the incident learning database identified 33 reported near-miss events related to SBRT planning. FMEA failed to anticipate 13 of these events, among which 3 were registered with severity ratings of severe or critical in the incident learning system. Combining both methods yielded a total of 76 failure modes, and when scored for RPN the 13 events missed by FMEA ranked within the middle half of all failure modes. Conclusion: FMEA, though valuable, is subject to certain limitations, among them the limited ability to anticipate all potential errors for a given process. This FMEA exercise failed to identify a significant number of possible errors (17%). Integration of FMEA with retrospective incident data may be able to render an improved overview of risks within a process

  12. A consensus process on management of major burns accidents: lessons learned from the café fire in Volendam, The Netherlands

    NARCIS (Netherlands)

    Welling, L.; Boers, M.; Mackie, D. P.; Patka, P.; Bierens, J. J. L. M.; Luitse, J. S. K.; Kreis, R. W.

    2006-01-01

    PURPOSE: The optimum response to the different stages of a major burns incident is still not established. The fire in a café in Volendam on New Year's Eve 2000 was the worst incident in recent Dutch history and resulted in mass burn casualties. The fire has been the subject of several investigations

  13. Brace for impact! A thesis on medical care following an airplane crash

    NARCIS (Netherlands)

    Postma, I.L.E.

    2014-01-01

    In this thesis the events and management of a mass casualty incident (MCI) of an airplane crash are studied from a medical point of view. The incident is broken down into areas that are applicable to other MCIs. it is believed that the detailed study of an exceptional event can provide vital

  14. Estimating the global incidence of traumatic spinal cord injury.

    Science.gov (United States)

    Fitzharris, M; Cripps, R A; Lee, B B

    2014-02-01

    Population modelling--forecasting. To estimate the global incidence of traumatic spinal cord injury (TSCI). An initiative of the International Spinal Cord Society (ISCoS) Prevention Committee. Regression techniques were used to derive regional and global estimates of TSCI incidence. Using the findings of 31 published studies, a regression model was fitted using a known number of TSCI cases as the dependent variable and the population at risk as the single independent variable. In the process of deriving TSCI incidence, an alternative TSCI model was specified in an attempt to arrive at an optimal way of estimating the global incidence of TSCI. The global incidence of TSCI was estimated to be 23 cases per 1,000,000 persons in 2007 (179,312 cases per annum). World Health Organization's regional results are provided. Understanding the incidence of TSCI is important for health service planning and for the determination of injury prevention priorities. In the absence of high-quality epidemiological studies of TSCI in each country, the estimation of TSCI obtained through population modelling can be used to overcome known deficits in global spinal cord injury (SCI) data. The incidence of TSCI is context specific, and an alternative regression model demonstrated how TSCI incidence estimates could be improved with additional data. The results highlight the need for data standardisation and comprehensive reporting of national level TSCI data. A step-wise approach from the collation of conventional epidemiological data through to population modelling is suggested.

  15. Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties.

    Science.gov (United States)

    White, Brian K; Mende, Katrin; Weintrob, Amy C; Beckius, Miriam L; Zera, Wendy C; Lu, Dan; Bradley, William; Tribble, David R; Schnaubelt, Elizabeth R; Murray, Clinton K

    2016-02-01

    Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009-12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested. Overall, 59 patients had 119 obligate anaerobes identified (83 were first isolates). Obligate anaerobes were isolated 7-13 days post-injury, primarily from lower extremity wounds (43%), and were largely Bacteroides spp. (42%) and Clostridium spp. (19%). Patients with pelvic wounds were more likely to have Bacteroides spp. and concomitant resistant gram-negative aerobes. Seventy-three percent of isolates were resistant to ≥1 antimicrobials. Bacteroides spp. demonstrated the most resistance (16% of first isolates). Patients with resistant isolates had similar outcomes to those with susceptible strains. Serial recovery of isolates occurred in 15% of patients and was significantly associated with isolation of Bacteroides spp., along with resistant gram-negative aerobes. Published by Elsevier Inc.

  16. Anaesthesia for trauma patients

    African Journals Online (AJOL)

    casualty incident, or a natural disaster. ... Exposure/environmental control: completely undress the ... E. Figure 1: Advance Trauma Life Support® management priorities ..... requiring operative intervention: the patient too sick to anesthetize.

  17. Improving PAGER's real-time earthquake casualty and loss estimation toolkit: a challenge

    Science.gov (United States)

    Jaiswal, K.S.; Wald, D.J.

    2012-01-01

    We describe the on-going developments of PAGER’s loss estimation models, and discuss value-added web content that can be generated related to exposure, damage and loss outputs for a variety of PAGER users. These developments include identifying vulnerable building types in any given area, estimating earthquake-induced damage and loss statistics by building type, and developing visualization aids that help locate areas of concern for improving post-earthquake response efforts. While detailed exposure and damage information is highly useful and desirable, significant improvements are still necessary in order to improve underlying building stock and vulnerability data at a global scale. Existing efforts with the GEM’s GED4GEM and GVC consortia will help achieve some of these objectives. This will benefit PAGER especially in regions where PAGER’s empirical model is less-well constrained; there, the semi-empirical and analytical models will provide robust estimates of damage and losses. Finally, we outline some of the challenges associated with rapid casualty and loss estimation that we experienced while responding to recent large earthquakes worldwide.

  18. Blast overpressure and fallout radiation dose models for casualty assessment and other purposes. Rev. ed.

    International Nuclear Information System (INIS)

    Bentley, P.R.

    1981-12-01

    The determination of blast overpressures and fallout radiation doses at points on a sufficiently fine grid, for any part or for the whole of the UK, and for any postulated attack, is an essential element in the systematic assessment of casualties, the estimation of numbers of homeless, and the evaluation of life-saving measures generally. Models are described which provide the required blast and dose values and which are intended to supersede existing models which were introduced in 1971. The factors which affect blast and, more particularly, dose values are discussed, and the way in which various factors are modelled is described. The models are incorporated into separate computer programs which are described, the outputs of which are stored on magnetic tape for subsequent use as required. (author)

  19. Incidence of invasive Haemophilus influenzae type b disease in Italian children

    International Nuclear Information System (INIS)

    Tozzi, Alberto E.; Salmaso, Stefania; Atti, Marta L. Ciofi degli; Panei, Pietro; Anemona, Alessandra; Scuderi, Gabriella; Wassilak, Steven G.F.

    1997-01-01

    To estimate the incidence of Haemophilus influenzae type b (Hib) invasive disease in Italian infants we performed a prospective study in a cohort of newborns enrolled for a randomized trial on safety and efficacy of three pertussis vaccines and followed for onset of serious disease or pertussis. The overall cumulative incidence observed in 15,601 children was 51.3/100,000 for all invasive Hib infections and 38.4/100,000 for Hib meningitis, over 27 months of observation. The incidence density of all invasive Hib diseases was 28.7/100,000 person-years, while meningitis occurred with an incidence of 21.5/100,000 person-years. Among the eight cases detected, six were meningitis, one sepsis, and one cellulitis. The child with sepsis died. The incidence and epidemiology of invasive Hib disease in Italy are comparable to those reported from other European countries. Cost-benefit analyses are needed for planning Italian vaccination policy

  20. Effective operational oil spill response planning

    International Nuclear Information System (INIS)

    Meyers, R.J.

    1991-01-01

    An operational Contingency Plan is one of the single most important aspects of effective oil spill response operations. It is a spill control game plan. A thorough contingency plan provides a set of guidelines that can be used to help direct all phases of spill response activities. More than simple a compilation of lists and rosters, the contingency plan reflects strategic and philosophical elements of spill response that help to ensure a viable response to any spill incident. Facilities and oil carrying vessels should have well maintained contingency plans with these features. This paper describes the requirement for effective oil spill response pans and the training required to exercise them

  1. Characteristics of human - sloth bear (Melursus ursinus) encounters and the resulting human casualties in the Kanha-Pench corridor, Madhya Pradesh, India

    OpenAIRE

    Dhamorikar, Aniruddha H.; Mehta, Prakash; Bargali, Harendra; Gore, Kedar

    2017-01-01

    Sloth bears (Melursus ursinus) caused the highest number of human deaths between 2001 and 2015 and ranked second compared to other wild animals in causing human casualties in the Kanha-Pench corridor area. We studied the patterns of sloth bear attacks in the region to understand the reasons for conflict. We interviewed 166 victims of sloth bear attacks which occurred between 2004 and 2016 and found that most attacks occurred in forests (81%), with the greatest number of those (42%) occurring ...

  2. 78 FR 42071 - Updates to Protective Action Guides Manual: Protective Action Guides (PAGs) and Planning Guidance...

    Science.gov (United States)

    2013-07-15

    ... Guides Manual: Protective Action Guides (PAGs) and Planning Guidance for Radiological Incidents AGENCY... guidance ``PAG Manual: Protective Action Guides (PAGs) and Planning Guidance for Radiological Incidents... ``anonymous access'' system, which means the EPA will not know your identity or contact information unless you...

  3. Growth and development studies Hiroshima and Nagasaki: research plan

    Energy Technology Data Exchange (ETDEWEB)

    Finch, S C; Jablon, S; Hrubec, Zdenek

    1962-03-21

    This report summarizes the research plan for prospective evaluation of growth and development in those exposed to varying amounts of ionizing radiation during childhood or while in utero in Hiroshima or Nagasaki. Some experimental observations are briefly presented to provide background information, and the results of previous studies of growth and development at the Atomic Bomb Casualty Commission (ABCC) are reviewed. Procedures have been described for determining the top of the growth curve for the in utero exposed and the maximum growth and development of those exposed during childhood in comparison to their nonexposed counterparts. Differences in growth and development found between exposed and nonexposed individuals will be analysed in relation to radiation dose, age at time of exposure, sex, and socioeconomic factors. Attempts will be made to determine whether or not abnormalities in visual acuity are increased in those exposed while in utero or during childhood as compared to nonexposed or comparable ages. 23 references, 2 tables.

  4. Addressing the gap between public health emergency planning and incident response

    OpenAIRE

    Freedman, Ariela M; Mindlin, Michele; Morley, Christopher; Griffin, Meghan; Wooten, Wilma; Miner, Kathleen

    2013-01-01

    Objectives: Since 9/11, Incident Command System (ICS) and Emergency Operations Center (EOC) are relatively new concepts to public health, which typically operates using less hierarchical and more collaborative approaches to organizing staff. This paper describes the 2009 H1N1 influenza outbreak in San Diego County to explore the use of ICS and EOC in public health emergency response. Methods:?This study was conducted using critical case study methodology consisting of document review and 18 k...

  5. Lessons learned from recent safety related incidents at A Canadian uranium conversion facility

    International Nuclear Information System (INIS)

    Jaferi, Jafir

    2013-01-01

    This paper presents the Canadian Nuclear Safety Commission's (CNSC) regulatory requirements for nuclear fuel facility licensees to report any situation or incident that results or is likely to result in a hazard to the health or safety of any person or the environment and to submit its incident investigation report with cause(s) of the incident and corrective actions taken or planned. In addition, the paper presents two recent safety-related incidents that occurred at a uranium conversion facility in Canada along with their consequences, causes, corrective actions and any lessons learned. The first incident resulted in a release of uranium hexafluoride (UF6) inside the UF6 cylinder filling station and the second one resulted in a spill of uranium tetrafluoride (UF 4 ) slurry inside the UF6 plant. Both incidents had no impact on the workers or the environment. (authors)

  6. Perioperative incidents associated with internal maxillary distraction osteogenesis: a retrospective study of 20 patients.

    Science.gov (United States)

    Kristian, Andersen; Erik, Nørholt Sven; Annelise, Küseler; John, Jensen; Klit, Pedersen Thomas

    2012-12-01

    This retrospective study aimed to assess the frequency and distribution of incidents encountered during the perioperative period of maxillary distraction with internal devices. The perioperative period was defined as the period between device placement and removal. Records of 20 patients treated during 2004-2011 with internal maxillary distraction osteogenesis were examined. Incidents were registered in terms of severity and need of intervention. Eighty percent of the patients experienced minor incidents, of which the most frequent were pain during activation and infections; 80% of these experienced ≥1 hard and soft tissue-related incidents, and 20% ≥1 device-related incidents. All incidents were solved with minimal or no intervention. Maxillary distraction using internal devices is a safe treatment with only minor incidents in the perioperative period. Preoperative planning and good cooperation are essential for preventing postoperative incidents. Prophylactic antibiotic treatment during the distraction period may be indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Developing disaster management modules: a collaborative approach.

    Science.gov (United States)

    Douglas, Valerie

    Disasters, whether natural or human induced, can strike when least expected. The events of 9/11 in the US, the 7/7 bombings in the UK, and the anthrax incident in the US on 10th October 2001 indicate that there is a need to have a nursing workforce who is able to respond effectively to mass casualty events and incidents involving chemical, biological, radiological and nuclear substances. Multi-agency collaboration is one of the fundamental principles of disaster preparedness and response. It was therefore necessary to take a similar multi-agency collaborative approach to develop modules on the management of mass casualty events and incidents involving hazardous substances. The modules are offered to registered nurses and registered paramedics. They can be taken independently or as part of a BSc in nursing or health pathway, on a part-time basis. Since the commencement of the modules in September 2004, registered paramedics and registered nurses who work in a wide range of specialties have accessed them.

  8. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

  9. Margins for treatment planning of proton therapy

    International Nuclear Information System (INIS)

    Thomas, Simon J

    2006-01-01

    For protons and other charged particles, the effect of set-up errors on the position of isodoses is considerably less in the direction of the incident beam than it is laterally. Therefore, the margins required between the clinical target volume (CTV) and planning target volume (PTV) can be less in the direction of the incident beam than laterally. Margins have been calculated for a typical head plan and a typical prostate plan, for a single field, a parallel opposed and a four-field arrangement of protons, and compared with margins calculated for photons, assuming identical geometrical uncertainties for each modality. In the head plan, where internal motion was assumed negligible, the CTV-PTV margin reduced from approximately 10 mm to 3 mm in the axial direction for the single field and parallel opposed plans. For a prostate plan, where internal motion cannot be ignored, the corresponding reduction in margin was from 11 mm to 7 mm. The planning organ at risk (PRV) margin in the axial direction reduced from 6 mm to 2 mm for the head plan, and from 7 mm to 4 mm for the prostate plan. No reduction was seen on the other axes, or for any axis of the four-field plans. Owing to the shape of proton dose distributions, there are many clinical cases in which good dose distributions can be obtained with one or two fields. When this is done, it is possible to use smaller PTV and PRV margins. This has the potential to convert untreatable cases, in which the PTV and PRV overlap, into cases with a gap between PTV and PRV of adequate size for treatment planning

  10. In 'big bang' major incidents do triage tools accurately predict clinical priority?: a systematic review of the literature.

    Science.gov (United States)

    Kilner, T M; Brace, S J; Cooke, M W; Stallard, N; Bleetman, A; Perkins, G D

    2011-05-01

    practicalities, training implications, performance characteristics and reliance on computer technology during a mass casualty incident require further evaluation. 2010 Elsevier Ltd. All rights reserved.

  11. 75 FR 68861 - Miscellaneous Amendments to the Federal Railroad Administration's Accident/Incident Reporting...

    Science.gov (United States)

    2010-11-09

    ... regulation, FRA challenged the railroads to develop a Total Quality Management (TQM) system to have zero... the quality of information available for railroad casualty analysis. In addition, FRA has revised the... regulations in order to clarify ambiguous regulations and to enhance the quality of information available for...

  12. Technical Program of The 4th World Congress on Chemical, Biological and Radiological Terrorism

    International Nuclear Information System (INIS)

    2007-01-01

    Many countries worldwide were interested in the part that CBMTS industry played in the overall protection schemes required of all nations. It was idea to develop a baseline of information on antidotes and planned medical treatment for military and civilian medical casualties, in both peace and war. Based on actual incidents that affected their chemical, petrochemical and pharmaceutical industries during their recent war, countries highlighted a danger that every country could face in the event of military actions, sabotage and especially terrorist actions, as well as major incidents or accidents involving these industries. It is great importance of CBMTS approach at bringing together the world's very best professionals in science and medicine to explore at the outer edges of science and technology, the most important issue facing the international community. Participants put big efforts towards defining the issues, surfacing the problems across the NBC science and medical spectrum and applying the best efforts at developing solutions that would most benefit our world community

  13. Technical Program of The 4th World Congress on Chemical, Biological and Radiological Terrorism

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    Many countries worldwide were interested in the part that CBMTS industry played in the overall protection schemes required of all nations. It was idea to develop a baseline of information on antidotes and planned medical treatment for military and civilian medical casualties, in both peace and war. Based on actual incidents that affected their chemical, petrochemical and pharmaceutical industries during their recent war, countries highlighted a danger that every country could face in the event of military actions, sabotage and especially terrorist actions, as well as major incidents or accidents involving these industries. It is great importance of CBMTS approach at bringing together the world's very best professionals in science and medicine to explore at the outer edges of science and technology, the most important issue facing the international community. Participants put big efforts towards defining the issues, surfacing the problems across the NBC science and medical spectrum and applying the best efforts at developing solutions that would most benefit our world community.

  14. Sex Differences in Stroke Incidence, Prevalence, Mortality and Disability-Adjusted Life Years

    DEFF Research Database (Denmark)

    Barker-Collo, Suzanne; Bennett, Derrick A; Krishnamurthi, Rita V

    2015-01-01

    BACKGROUND: Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality...... incidence, prevalence, mortality, disability-adjusted life years (DALYs) and healthy years lost due to disability were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Data inputs included all available information on stroke incidence, prevalence and death and case fatality rates...... ischemic stroke (IS) and hemorrhagic stroke (HS) incidence (per 100,000) in men (IS 132.77 (95% UI 125.34-142.77); HS 64.89 (95% UI 59.82-68.85)) exceeded those of women (IS 98.85 (95% UI 92.11-106.62); HS 45.48 (95% UI 42.43-48.53)). IS incidence rates were lower in 2013 compared with 1990 rates for both...

  15. Medical examination of A-bomb survivors on Nagasaki A-bomb Casualty

    International Nuclear Information System (INIS)

    Tagawa, Masuko

    1996-01-01

    Medical examination of A-bomb survivors was described and discussed on history, time change of examinee number, action for subjects not examined, change of prevalence, cancer examination, examination for the second generation, and education and enlightenment. Free examination of the survivors was begun in 1953 and the present casualty was made in 1958 on the law for medical care for the survivors. Systematic examination started from 1967 and the examination for the 2nd generation, from 1974. Cancer examination was from 1988. The number of the survivors was the maximum of 82,439 in 1974 and decreased to 61,388 in 1994, when the actual number of examinees, which being rather settled recently, was 32,294 and their average age was 64 y. The examination is done by tour or at the Center. Subjects receive the information of the examination twice by mail. Hematopoietic diseases like anemia, hepatic ones, metabolic and endocrinic ones like diabetes, renal impairment and others (mostly hyperlipidemia) are increasing recently. The number of examinees for cancer is increasing. Lung cancer is examined by the direct roentgenography, gastric cancer by transillumination, and other cancers like myeloma, those in large bowel, uterus and mammary gland, by the respective suitable methods. Health education and enlightenment have been conceivably effective. (H.O.)

  16. Incidence and mortality of kidney cancers, and human development index in Asia; a matter of concern

    OpenAIRE

    Arabsalmani, Masoumeh; Mohammadian-Hafshejani, Abdollah; Ghoncheh, Mahshid; Hadadian, Fatemeh; Towhidi, Farhad; Vafaee, Kamran; Salehiniya, Hamid

    2016-01-01

    Background The incidence and mortality of kidney cancer have steadily increased by 2%- 3% per decade worldwide, and an increased risk of kidney cancer has been observed in many Asian countries. The information on the incidence and mortality of a disease and its distribution is essential for better planning for prevention and further studies. Objectives This study aimed to assess the incidence and mortality of kidney cancer and their correlation with the human development index (HDI) in Asia. ...

  17. Radiation incident in oil well logging

    International Nuclear Information System (INIS)

    Lozada, J.A.

    1998-01-01

    On June 4th 1997 equipment failure and violation of approved procedures by a crew of workers initiated a series of events that resulted in the unnecessary exposure to neutron and gamma radiation, from a 666 GBq Am 241 Be source, of forty two workers from a well logging company in Venezuela. Due to the presence of dry mud or drilling fluids inside the logging tool, the nosepiece was screwed off the rest of the source holder; this piece was mistaken for the entire source holder thus leaving the source inside the tool. The tool was labelled for maintenance and electronic laboratory personal worked near the source for seven hours before they identify its presence. As soon as the incident was detected a contingency plan was implemented and the source could be retrieved from the tool and placed in its shipping container. The TLD badges indicate doses well below the annual limit of 20 mSv, and none of the workers involved in the incident seem to show serious health consequences from it. After the incident, in order to avoid the occurrence of similar situations, a better source and tool maintenance program was implemented, all the workers were re-trained, and area monitors were installed in all operations bases. (author)

  18. British Columbia inland oil spill response plan

    International Nuclear Information System (INIS)

    2005-01-01

    This paper presents an outline of the organization, procedures and duties of the provincial government in response to inland oil spills stemming from pipeline or tank-farm rupture, train derailment and vehicle accidents in British Columbia. Provincial response strategies were reviewed, along with their relationships to various policies and standards. Public, infrastructure and environmental protection were identified as key factors. Incident notification procedures were detailed, including outlines of roles, event criteria and call for incident management teams. Agreements and cost recovery issues were examined. The characteristics of site response were reviewed, including details of communications, tactical planning, and unified command among local and federal governments. The role of First Nations and responsible parties was also addressed. Details of shore cleanup, wildlife rescue, decontamination, and waste handling strategies were presented. The organization, missions and duties for an incident management team were outlined, along with a summary of operational guidelines and information on team positions and the establishment of joint information centres. The involvement of cooperating agencies was examined. An incident command system was also presented, including details of planning, operations, logistics, and organization. A checklist of individual duties was provided, with details of responsibilities, safety issues and general instructions for all team members. tabs., figs

  19. 33 CFR 151.26 - Shipboard oil pollution emergency plans.

    Science.gov (United States)

    2010-07-01

    ... pollution incident has occurred or is likely to occur. The plan contains all information and operational... the plan must contain a discussion of procedures to address the following scenarios: (i) Operational... transferring cargo or bunkers to empty or slack tanks, or readying pumps to transfer the excess ashore; (C...

  20. Incidence, epidemiology and clinical features of Kawasaki disease in Catalonia, Spain.

    Science.gov (United States)

    Sánchez-Manubens, Judith; Antón, Jordi; Bou, Rosa; Iglesias, Estíbaliz; Calzada-Hernandez, Joan

    2016-01-01

    To assess the incidence, epidemiology and clinical features of Kawasaki disease (KD) in Catalonia (northeast region of Spain). This was an observational population-based study including all Paediatric Units in Catalonia, under both public and private management. Retrospective data retrieval was performed for 10 years (2004-2013). A 12-month (March 2013 to March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. Data from 399 patients over the 10-year study period was analysed, revealing that 233 (58.4%) had complete KD, 159 (39.8) incomplete KD and 7 (1.7%) were considered atypical KD. Mean annual incidence was 3.5/105 children 10(th) day of illness, ages 8 yo and the presence of sterile piuria, aseptic meningitis, abdominal pain and uveitis at diagnosis were found to have higher risk of coronary aneurisms (CAA) (pIncidence, clinical features and treatment plans in our cohort are similar to those described in other European studies.

  1. Combination of Extracorporeal Life Support and Mesenchymal Stem Cell Therapy for Treatment of ARDS in Combat Casualties and Evacuation of Service Members with ARDS

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-15-2-0072 TITLE: Combination of Extracorporeal Life Support and Mesenchymal Stem Cell Therapy for Treatment of ARDS in...Mesenchymal Stem Cell Therapy for Treatment of ARDS in Combat Casualties and Evacuation of Service Members with ARDS 5b. GRANT NUMBER W81XWH-15...Figure 4. Mitochondrial activity is mostly preserved on the animals that were supported with ventilator devices and mesenchymal stem cells . Using a

  2. Neurorehabilitation of cerebral disorders following lightning and electrical trauma.

    Science.gov (United States)

    Yarnell, Philip R

    2005-01-01

    The most devastating casualties in lightning and electrical trauma patients are the result of lesions of the nervous system, and especially lesions of the brain. The brain injuries can be divided into three categories: global dysfunction; focal brain injuries; and behavioral-cognitive sequelae without gross physical signs. Lightning injuries are usually the result of outdoor sports and leisure activities. Most electrical trauma cases are the result of workplace accidents. Rehabilitation planning should begin early after the incident and often needs to be continued for a long time. The goal of the rehabilitation team is to maximize functional return in patients with deficits related to brain lesions. The neurorehabilitation team includes the neurorehabilitation physician, physical therapists, occupational therapists, psychologists, speech therapists, and case managers.

  3. Putting Action Back into Action Planning: Experiences of Career Clients

    Science.gov (United States)

    Borgen, William A.; Maglio, Asa-Sophia T.

    2007-01-01

    This study used the critical incident technique to investigate what helped and hindered unemployed and career-changing people in implementing the action plans they developed while participating in career or employment counseling. Information from interviews with 23 women and 16 men generated 9 categories of helping incidents and 9 categories of…

  4. Incident involving radioactive material in steel scrap

    International Nuclear Information System (INIS)

    Drabova, D.; Matzner, J.; Prouza, Z.

    1998-01-01

    In early March of 1996, a wagon with steel scrap heading from the Czech Republic to Italy was returned as a strongly contaminated material. Based on the integral dose (dose rate 650 mGy/h in front of the wagon) and spectrometric measurement and evaluation, it was concluded that an unshielded cobalt-60 source (1.6 TBq) was present. The history of the event (notification, assessment, intervention planning, intervention) is highlighted and the lesson learned from the incident is discussed. (P.A.)

  5. Hospital-Based Coalition to Improve Regional Surge Capacity

    Directory of Open Access Journals (Sweden)

    James M. Learning

    2012-12-01

    Full Text Available Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors.Methods: Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP¬SCPA to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1 increase awareness of capabilities and assets, (2 develop and pilot test advanced planning and exercising of plans in the region, (3 augment written medical mutual aid agreements, (4 develop and strengthen partnership relationships, (5 ensure National Incident Management System compliance, and (6 develop and test a plan for effective utilization of volunteer healthcare professionals.Results: In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents.Conclusion: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.

  6. Incidence of hyperthyroidism in Slovenia since improved iodine supply

    International Nuclear Information System (INIS)

    Zaletel, K.; Gaberscek, S.; Pirnat, E.; Hojker, S.

    2002-01-01

    Full text: Since the year 1953, when iodine prophylaxis was introduced in Slovenia, several epidemiological studies confirmed the existence of mild iodine deficiency on the whole territory of Slovenia. In January 1999 the implementation of higher iodine content (25 mg of KI or 32 mg of KIO 3 ) was recommended and since then the increased incidence of thyrotoxicosis was observed. Here we present 5-year follow-up data of the incidence of hyperthyroidism due to thyroid autonomy and Graves' disease. We estimated incidence rates from 1997 to 2001 for hyperthyroidism due to thyroid autonomy and Graves' disease among 1000000 people, living in the area of Ljubljana. We assumed that most cases were seen and treated in the Outpatient Department for thyroid diseases of Department for Nuclear Medicine of University Medical Centre Ljubljana. Immediately after correction of iodine deficiency, the incidence of hyperthyroidism due to thyroid autonomy rose almost twice in 1999 (320 cases in 1999 compared to 173 cases in 1997), but afterwards the incidence slightly decreased (240 cases in 2000). Similarly, the incidence of Graves' disease rose in 1999 (267 cases in 1999 compared to 237 in 1997) and in contrast to thyroid autonomy the incidence further increased in the following years (337 in 2000 and 246 in the first half of 2001). The increased incidence of hyperthyroidism due to thyroid autonomy and Graves' disease after elevation of iodine prophylaxis in Slovenia is comparable with data in some other endemic areas. Those data indicate that stepwise supplementation is preferable to immediate corrections. However, we believe that iodine prophylaxis is reasonable and justified and to reassess the iodine nutrition status we plan a follow up evaluation in year 2002. (author)

  7. THE GLOBALIZED WORLD AND GENDER RIGHTS IN NIGERIA ...

    African Journals Online (AJOL)

    Mofasony

    human, and how the incidence of gender has affected the exercise of their fundamental freedoms. The 1999 ... programme, women are most often the casualties due to the inbuilt bias in SAP ... Where family financial resources are scarce, the.

  8. Early Atomic Bomb Casualty Commission perceptions and planning

    International Nuclear Information System (INIS)

    Friedell, H.L.

    1982-01-01

    A description of the kind of research carried on by the Manhattan Project during World War II is presented. At that time scientists were trying to identify acceptable radiation levels, and to ascertain whether any immediate research was needed to support such levels. The author briefly outlines activities to determine any immediate effects of radiation that occurred after the nuclear strikes in Hiroshima and Nagasaki

  9. Decoding incident-to and provider-based billing: ensuring payment and avoiding liability.

    Science.gov (United States)

    Hofstra, Patricia S; Hart, Elinor L

    2012-01-01

    In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.

  10. Regulation No. 55/2006 Coll. of the Nuclear Regulatory Authority of the Slovak Republic dated as of January 12, 2006 on details concerning emergency planning in case of nuclear incident or accident

    International Nuclear Information System (INIS)

    2006-01-01

    This Regulation provides details on (a) the content of emergency plans, procedure for their submission and approval; (b) the measures, procedures and activities including degrees of severity of the events according to international criteria; (c) informing the Authority and the public; (d) contents of the documents necessary for application approval of the size of the area at risk, the size of the common area at risk, including the date of its submission; (e) monitoring systems; (f) training, practicing and updating emergency plans; (g) provided data and time during an incident or accident to nuclear installations and the transport of radioactive materials; (h) notification of operational events and events during shipment. This Regulation came into force on March 1, 2006.

  11. The causes and circumstances of drinking water incidents impact consumer behaviour: Comparison of a routine versus a natural disaster incident.

    Science.gov (United States)

    Rundblad, Gabriella; Knapton, Olivia; Hunter, Paul R

    2014-11-18

    When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two "Boil Water" notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine "Boil Water" notice. Findings were then compared to a previous study that explored drinking water behaviour during a "Boil Water" notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.

  12. The Causes and Circumstances of Drinking Water Incidents Impact Consumer Behaviour: Comparison of a Routine versus a Natural Disaster Incident

    Directory of Open Access Journals (Sweden)

    Gabriella Rundblad

    2014-11-01

    Full Text Available When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3% than the routine incident (35.4%. For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.

  13. The Causes and Circumstances of Drinking Water Incidents Impact Consumer Behaviour: Comparison of a Routine versus a Natural Disaster Incident

    Science.gov (United States)

    Rundblad, Gabriella; Knapton, Olivia; Hunter, Paul R.

    2014-01-01

    When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food. PMID:25411725

  14. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Montgomery, Logan; Kildea, John [McGill University Health Centre (Canada)

    2016-08-15

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  15. Sci-Fri AM: Quality, Safety, and Professional Issues 06: An Evaluation of Incident Reporting and Learning using the Canadian National System for Incident Reporting – Radiation Treatment

    International Nuclear Information System (INIS)

    Montgomery, Logan; Kildea, John

    2016-01-01

    We report on the development and clinical deployment of an in-house incident reporting and learning system that implements the taxonomy of the Canadian National System for Incident Reporting – Radiation Treatment (NSIR-RT). In producing our new system, we aimed to: Analyze actual incidents, as well as potentially dangerous latent conditions. Produce recommendations on the NSIR-RT taxonomy. Incorporate features to divide reporting responsibility among clinical staff and expedite incident categorization within the NSIR-RT framework. Share anonymized incident data with the national database. Our multistep incident reporting workflow is focused around an initial report and a detailed follow-up investigation. An investigator, chosen at the time of reporting, is tasked with performing the investigation. The investigation feature is connected to our electronic medical records database to allow automatic field population and quick reference of patient and treatment information. Additional features include a robust visualization suite, as well as the ability to flag incidents for discussion at monthly Risk Management meetings and task ameliorating actions to staff. Our system was deployed into clinical use in January 2016. Over the first three months of use, 45 valid incidents were reported; 31 of which were reported as actual incidents as opposed to near-misses or reportable circumstances. However, we suspect there is ambiguity within our centre in determining the appropriate event type, which may be arising from the taxonomy itself. Preliminary trending analysis aided in revealing workflow issues pertaining to storage of treatment accessories and treatment planning delays. Extensive analysis will be undertaken as more data are accrued.

  16. Surface Movement Incidents Reported to the NASA Aviation Safety Reporting System

    Science.gov (United States)

    Connell, Linda J.; Hubener, Simone

    1997-01-01

    Increasing numbers of aircraft are operating on the surface of airports throughout the world. Airport operations are forecast to grow by more that 50%, by the year 2005. Airport surface movement traffic would therefore be expected to become increasingly congested. Safety of these surface operations will become a focus as airport capacity planning efforts proceed toward the future. Several past events highlight the prevailing risks experienced while moving aircraft during ground operations on runways, taxiways, and other areas at terminal, gates, and ramps. The 1994 St. Louis accident between a taxiing Cessna crossing an active runway and colliding with a landing MD-80 emphasizes the importance of a fail-safe system for airport operations. The following study explores reports of incidents occurring on an airport surface that did not escalate to an accident event. The Aviation Safety Reporting System has collected data on surface movement incidents since 1976. This study sampled the reporting data from June, 1993 through June, 1994. The coding of the data was accomplished in several categories. The categories include location of airport, phase of ground operation, weather /lighting conditions, ground conflicts, flight crew characteristics, human factor considerations, and airport environment. These comparisons and distributions of variables contributing to surface movement incidents can be invaluable to future airport planning, accident prevention efforts, and system-wide improvements.

  17. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study

    DEFF Research Database (Denmark)

    Patterson, Christopher C; Dahlquist, Gisela G; Gyürüs, Eva

    2009-01-01

    BACKGROUND: The incidence of type 1 diabetes in children younger than 15 years is increasing. Prediction of future incidence of this disease will enable adequate fund allocation for delivery of care to be planned. We aimed to establish 15-year incidence trends for childhood type 1 diabetes in Eur...

  18. Flood action plans

    International Nuclear Information System (INIS)

    Slopek, R.J.

    1995-01-01

    Safe operating procedures developed by TransAlta Utilities for dealing with flooding, resulting from upstream dam failures or extreme rainfalls, were presented. Several operating curves developed by Monenco AGRA were described, among them the No Overtopping Curve (NOC), the Safe Filling Curve (SFC), the No Spill Curve (NSC) and the Guaranteed Fill Curve (GFC). The concept of an operational comfort zone was developed and defined. A flood action plan for all operating staff was created as a guide in case of a flooding incident. Staging of a flood action plan workshop was described. Dam break scenarios pertinent to the Bow River were developed for subsequent incorporation into a Flood Action Plan Manual. Evaluation of the technical presentations made during workshops were found them to have been effective in providing operating staff with a better understanding of the procedures that they would perform in an emergency. 8 figs

  19. Design of neutral particle incident heating apparatus for large scale helical apparatus

    Energy Technology Data Exchange (ETDEWEB)

    Kaneko, Osamu; Oka, Yoshihide; Osakabe, Masaki; Takeiri, Yasuhiko; Tsumori, Katsuyoshi; Akiyama, Ryuichi; Asano, Eiji; Kawamoto, Toshikazu; Kuroda, Tsutomu [National Inst. for Fusion Science, Nagoya (Japan)

    1997-02-01

    In the Institute of Nuclear Fusion Science, construction of the large scale helical apparatus has been progressed favorably, and constructions of the heating apparatus as well as of electron resonance apparatus were begun in their orders under predetermined manner since 1994 fiscal year. And, on 1995 fiscal year, construction of neutral particle incident heating apparatus, leading heat apparatus, was begun under 3 years planning. The plasma heating study system adopted the study results developed in this institute through the large scale hydrogen negative ion source and also adopted thereafter development on nuclear fusion study by modifying the original specification set at the beginning of the research plan before 7 years. As a result, system design was changed from initial 125 KeV to 180 KeV in the beam energy and to execute 15 MW incidence using two sets beam lines, to begin its manufacturing. Here is described on its new design with reason of its modifications. (G.K.)

  20. CitizenAID.

    Science.gov (United States)

    2017-01-25

    CitizenAID is an easy-to-use app that informs users how to provide care in mass casualty situations, including shootings, knife attacks and bomb incidents. The authors are well known and respected specialists in trauma care and disaster management.

  1. LAND USE PLANNING AND URBAN PLANS: TERRITORIAL BALANCE AS ETHICS

    Directory of Open Access Journals (Sweden)

    Eunice Helena Sguizzardi Abascal

    2012-07-01

    Full Text Available The article suggests a necessary link between urban planning and territorial organization, in order to, through the synergistic relationship between planning tools and their application to planning, implementing a policy of urban and regional management. By linking the development plan for territorial development plans and categories of land use, this methodology helps to streamline operations at multiple scales. The establishment of this network of instruments and shapes the actions of government action against the rapid and intense increase of only economic forces that shape the territory today, suggesting that it is possible to regulate the action of the housing market through planned interventions, valuing the regional balance, social and environmental - ethical by definition. It is suggested that the possible effects predatory natural and built environment can be reversed or prevented by an action articulating these planning instruments are linked to the development and implementation of plans (and projects at multiple scales, approaching from the regional to the local and metropolitan, from regional policies to sectors, that are incidents in the municipal territory. However, the speed and magnitude of the occupation and transformation of soil occur mainly in periods of heating housing, often jeopardize the balance and environmental quality, natural heritage, urban and landscape. It assumes the argument that the overcoming of undesirable environmental effects, triggered by occupation of the ground guided by the real estate sector fast action can be successful with the articulation of levels of planning and intervention. It is proposed that the complexity of contemporary urban and metropolitan requires the articulation of different scales through the use of innovative urban instruments. By articulating these different scales, at the municipal and other levels supra, contributes to, through a network plan to overcome the undesirable dichotomy

  2. Human Q fever incidence is associated to spatiotemporal environmental conditions

    Directory of Open Access Journals (Sweden)

    J.P.G. Van Leuken

    2016-12-01

    We conclude that environmental conditions are correlated to human Q fever incidence rate. Similar research with data from other outbreaks would be needed to more firmly establish our findings. This could lead to better estimations of the public health risk of a C. burnetii outbreak, and to more detailed and accurate hazard maps that could be used for spatial planning of livestock operations.

  3. HIV incidence in sub-Saharan Africa: a review of available data with implications for surveillance and prevention planning

    NARCIS (Netherlands)

    Braunstein, Sarah L.; van de Wijgert, Janneke H. H. M.; Nash, Denis

    2009-01-01

    HIV incidence estimation is increasingly being incorporated into HIV/AIDS surveillance activities in both resource-rich and developing countries. We conducted a systematic review to assess the availability of HIV incidence data from sub-Saharan Africa. We examined peer-reviewed articles, conference

  4. Incidence and cost of medications dispensed despite electronic medical record discontinuation.

    Science.gov (United States)

    Baranowski, Patrick J; Peterson, Kristin L; Statz-Paynter, Jamie L; Zorek, Joseph A

    2015-01-01

    To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization. Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company. Pharmacist-led quality improvement project using retrospective chart review. Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD. Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event. 7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74. Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.

  5. Prediction of cancer incidence in Tyrol/Austria for year of diagnosis 2020.

    Science.gov (United States)

    Oberaigner, Willi; Geiger-Gritsch, Sabine

    2014-10-01

    Prediction of the number of incident cancer cases is very relevant for health planning purposes and allocation of resources. The shift towards elder age groups in central European populations in the next decades is likely to contribute to an increase in cancer incidence for many cancer sites. In Tyrol, cancer incidence data have been registered on a high level of completeness for more than 20 years. We therefore aimed to compute well-founded predictions of cancer incidence for Tyrol for the year 2020 for all frequent cancer sites and for all cancer sites combined. After defining a prediction base range for every cancer site, we extrapolated the age-specific time trends in the prediction base range following a linear model for increasing and a log-linear model for decreasing time trends. The extrapolated time trends were evaluated for the year 2020 applying population figures supplied by Statistics Austria. Compared with the number of annual incident cases for the year 2009 for all cancer sites combined except non-melanoma skin cancer, we predicted an increase of 235 (15 %) and 362 (21 %) for females and males, respectively. For both sexes, more than 90 % of the increase is attributable to the shift toward older age groups in the next decade. The biggest increase in absolute numbers is seen for females in breast cancer (92, 21 %), lung cancer (64, 52 %), colorectal cancer (40, 24 %), melanoma (38, 30 %) and the haematopoietic system (37, 35 %) and for males in prostate cancer (105, 25 %), colorectal cancer (91, 45 %), the haematopoietic system (71, 55 %), bladder cancer (69, 100 %) and melanoma (64, 52 %). The increase in the number of incident cancer cases of 15 % in females and 21 % in males in the next decade is very relevant for planning purposes. However, external factors cause uncertainty in the prediction of some cancer sites (mainly prostate cancer and colorectal cancer) and the prediction intervals are still broad. Therefore

  6. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Elnahal, Shereef M., E-mail: selnaha1@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Blackford, Amanda [Department of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A. [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2016-04-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  7. Identifying Predictive Factors for Incident Reports in Patients Receiving Radiation Therapy

    International Nuclear Information System (INIS)

    Elnahal, Shereef M.; Blackford, Amanda; Smith, Koren; Souranis, Annette N.; Briner, Valerie; McNutt, Todd R.; DeWeese, Theodore L.; Wright, Jean L.; Terezakis, Stephanie A.

    2016-01-01

    Purpose: To describe radiation therapy cases during which voluntary incident reporting occurred; and identify patient- or treatment-specific factors that place patients at higher risk for incidents. Methods and Materials: We used our institution's incident learning system to build a database of patients with incident reports filed between January 2011 and December 2013. Patient- and treatment-specific data were reviewed for all patients with reported incidents, which were classified by step in the process and root cause. A control group of patients without events was generated for comparison. Summary statistics, likelihood ratios, and mixed-effect logistic regression models were used for group comparisons. Results: The incident and control groups comprised 794 and 499 patients, respectively. Common root causes included documentation errors (26.5%), communication (22.5%), technical treatment planning (37.5%), and technical treatment delivery (13.5%). Incidents were more frequently reported in minors (age <18 years) than in adult patients (37.7% vs 0.4%, P<.001). Patients with head and neck (16% vs 8%, P<.001) and breast (20% vs 15%, P=.03) primaries more frequently had incidents, whereas brain (18% vs 24%, P=.008) primaries were less frequent. Larger tumors (17% vs 10% had T4 lesions, P=.02), and cases on protocol (9% vs 5%, P=.005) or with intensity modulated radiation therapy/image guided intensity modulated radiation therapy (52% vs 43%, P=.001) were more likely to have incidents. Conclusions: We found several treatment- and patient-specific variables associated with incidents. These factors should be considered by treatment teams at the time of peer review to identify patients at higher risk. Larger datasets are required to recommend changes in care process standards, to minimize safety risks.

  8. Epidemiology and Inequality in the Incidence and Mortality of Nasopharynx Cancer in Asia

    OpenAIRE

    Mahdavifar, Neda; Ghoncheh, Mahshid; Mohammadian-Hafshejani, Abdollah; Khosravi, Bahman; Salehiniya, Hamid

    2016-01-01

    Objectives One of the most common head and neck cancers is nasopharynx cancer. Knowledge about the incidence and mortality of this disease and its distribution in terms of geographical areas is necessary for further study and better planning. Therefore, this study was conducted with the aim of determining the incidence and mortality rates of nasopharynx cancer and its relationship with the Human Development Index (HDI) in Asia in 2012. Methods The aim of this ecologic study was to assess the ...

  9. Critical incident monitoring in anaesthesia.

    Science.gov (United States)

    Choy, Y C

    2006-12-01

    Critical incident monitoring in anaesthesia is an important tool for quality improvement and maintenance of high safety standards in anaesthetic services. It is now widely accepted as a useful quality improvement technique for reducing morbidity and mortality in anaesthesia and has become part of the many quality assurance programmes of many general hospitals under the Ministry of Health. Despite wide-spread reservations about its value, critical incident monitoring is a classical qualitative research technique which is particularly useful where problems are complex, contextual and influenced by the interaction of physical, psychological and social factors. Thus, it is well suited to be used in probing the complex factors behind human error and system failure. Human error has significant contributions to morbidities and mortalities in anaesthesia. Understanding the relationships between, errors, incidents and accidents is important for prevention and risk management to reduce harm to patients. Cardiac arrests in the operating theatre (OT) and prolonged stay in recovery, constituted the bulk of reported incidents. Cardiac arrests in OT resulted in significant mortality and involved mostly de-compensated patients and those with unstable cardiovascular functions, presenting for emergency operations. Prolonged-stay in the recovery extended period of observation for ill patients. Prolonged stay in recovery was justifiable in some cases, as these patients needed a longer period of post-operative observation until they were stable enough to return to the ward. The advantages of the relatively low cost, and the ability to provide a comprehensive body of detailed qualitative information, which can be used to develop strategies to prevent and manage existing problems and to plan further initiatives for patient safety makes critical incident monitoring a valuable tool in ensuring patient safety. The contribution of critical incident reporting to the issue of patient safety is

  10. [Incidence of fetal macrosomia: maternal and fetal morbidity].

    Science.gov (United States)

    Rodríguez-Rojas, R R; Cantú-Esquivel, M G; Benavides-de la Garza, L; Benavides-de Anda, L

    1996-06-01

    The macrosomia is an obstetric eventuality associated to high maternal-fetal morbidity-mortality. This assay was planned in order to know the incidence of macrosomia in our institution, the relation between vaginal and abdominal deliveries and the fetal-maternal morbidity we reviewed 3590 records and we found 5.6% incidence of macrosomia in the global obstetric population. There was 58% of vaginal deliveries, 68% of the newborn were male. The main complications were in the C. sections, 2 laceration of the hysterectomy, and 2 peroperative atonias. In the vaginal deliveries, the lacerations of III and IV grade were 9 of each grade. The main fetal complications were 5 slight to severe asphyxia and 4 shoulder dystocias. This assay concludes that the macrosomia in our service is similar to the already published ones, a 42% were C. section and the maternal-fetal morbidity was low.

  11. Monte Carlo Treatment Planning for Advanced Radiotherapy

    DEFF Research Database (Denmark)

    Cronholm, Rickard

    This Ph.d. project describes the development of a workflow for Monte Carlo Treatment Planning for clinical radiotherapy plans. The workflow may be utilized to perform an independent dose verification of treatment plans. Modern radiotherapy treatment delivery is often conducted by dynamically...... modulating the intensity of the field during the irradiation. The workflow described has the potential to fully model the dynamic delivery, including gantry rotation during irradiation, of modern radiotherapy. Three corner stones of Monte Carlo Treatment Planning are identified: Building, commissioning...... and validation of a Monte Carlo model of a medical linear accelerator (i), converting a CT scan of a patient to a Monte Carlo compliant phantom (ii) and translating the treatment plan parameters (including beam energy, angles of incidence, collimator settings etc) to a Monte Carlo input file (iii). A protocol...

  12. Recent operating experience in Europe and the Soviet Union with fire resistant turbine lubricants

    International Nuclear Information System (INIS)

    Vilyanskaya, G.D.; Lysko, V.V.; Phillips, W.D.

    1990-01-01

    Power station fires are of continuing concern to the electricity generation industry. Statistics on their frequency and severity are however difficult to obtain and it is suspected that many fires are not officially reported unless they result in a forced outage or casualties are involved. It is well known that fires in power stations can be extremely expensive incidents. Not only is the cost of repairing equipment very high but outage costs can amount to millions of dollars. A recent publication listed the financial cost (where known) of seven major fires in the USA occurring between 1985--89. The author of the article commented that In many cases fixed fire suppression systems were non-existent, incomplete or inaccessible. The fire emergency planning proved to be generally ineffective and in some cases non-existent

  13. War casualties on the home front

    Energy Technology Data Exchange (ETDEWEB)

    Brenda J. Flinn

    2005-11-01

    On May 12, 1942, at Christopher coal mine No. 3 in Osage, West Virginia, a continent away from the frontlines of World War II, Superintendent Ed O'Neil saw the mine ventilation fan suddenly run backwards, propelled by a strong gust of air that tore the belt off the huge blower. The second shift mantrip of 115 coal miners, traversing the drift mouth for the 3:00 p.m. shift, ground to an uneasy halt. The article recounts the tragic consequences of this incident. It also tells of other events affecting coal miners during World War I and World War II.

  14. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Science.gov (United States)

    2012-08-30

    ... Building 1 where routine security check procedures will be performed. For parking and security information... telephone number. Those without Internet access should contact Suzanne Schwartz to register (see Contact... Internet at http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/default.htm . (Select this...

  15. Bomb blast mass casualty incidents: initial triage and management of injuries.

    Science.gov (United States)

    Goh, S H

    2009-01-01

    Bomb blast injuries are no longer confined to battlefields. With the ever present threat of terrorism, we should always be prepared for bomb blasts. Bomb blast injuries tend to affect air-containing organs more, as the blast wave tends to exert a shearing force on air-tissue interfaces. Commonly-injured organs include the tympanic membranes, the sinuses, the lungs and the bowel. Of these, blast lung injury is the most challenging to treat. The clinical picture is a mix of acute respiratory distress syndrome and air embolism, and the institution of positive pressure ventilation in the presence of low venous pressures could cause systemic arterial air embolism. The presence of a tympanic membrane perforation is not a reliable indicator of the presence of a blast injury in the other air-containing organs elsewhere. Radiological imaging of the head, chest and abdomen help with the early identification of blast lung injury, head injury, abdominal injury, eye and sinus injuries, as well as any penetration by foreign bodies. In addition, it must be borne in mind that bomb blasts could also be used to disperse radiological and chemical agents.

  16. Environmental surveillance: An integral part of the spill contingency plan

    International Nuclear Information System (INIS)

    Salinas, J.; Bozzo, W.

    1993-01-01

    Typically, the initial response to spills is directed at containing, controlling, and stopping the flow of spilled materials. The primary goal of such a response is to limit the spread and further impact of spilled material, and to initiate timely cleanup and recovery of affected areas. Surveillance of actual spill impacts has often followed an after the fact approach, using only immediately available resources. Surveillance may occur quickly after a spill, but in most incidents its occurs as a follow-up action after initial response and containment have been achieved. Insufficient planning may produce spill surveillance that inadequately assesses impacts, fails to incorporate baseline data, and does not clearly identify a cleanup recovery and endpoint. The management and operations contractor for the US Dept. of Energy's Strategic Petroleum Reserve (SPR) conducts environmental surveillance activities in response to spill incidents when they occur at these facilities. These surveillance activities, when conducted as part of the response, are useful instruments in the initial assessment of spill incidents, management of spill response, containment, and cleanup activities, and for monitoring and documenting postspill impacts and recovery. An Environmental Surveillance Plan (ESP) incorporated in the SPR Spill Contingency Plan provides for initiation of environmental surveillance as part of the spill response. The ESP outlines, through alogic tree, conditions for activating the plan, key indicator parameters for evaluation, detailed methods for establishing surveillance stations, lists of key personnel, locations of equipment necessary to perform surveillance, and conditions for termination of environmental surveillance

  17. CEGB nuclear power stations basic emergency plan

    International Nuclear Information System (INIS)

    1978-03-01

    The introduction states that this is a typical emergency plan for a nuclear power station employing about 500 people, having two reactors and a total electrical output of 500 Megawatts in an intensively farmed rural area. The document has the following headings: definitions ('site incident', etc); functions of the site emergency organization; conditions for taking emergency action; persons empowered to declare or cancel a site incident or an emergency; emergency actions by staff; control centres; communication; collaboration with other bodies; warnings; transport; house rules; public information centre. (U.K.)

  18. 24 CFR 1000.139 - What are the standards for insurance entities owned and controlled by recipients?

    Science.gov (United States)

    2010-04-01

    ...) The plan maintains internal controls and cost containment measures, as shown by the annual budget; (6... designation of a chartered property/casualty underwriter (CPCU), associate in risk management (ARM), or... entity, tribal self-insurance plan, tribal risk retention group, or Indian housing self-insurance risk...

  19. Creation of inpatient capacity during a major hospital relocation: lessons for disaster planning.

    Science.gov (United States)

    Jen, Howard C; Shew, Stephen B; Atkinson, James B; Rosenthal, J Thomas; Hiatt, Jonathan R

    2009-09-01

    To identify tools to aid the creation of disaster surge capacity using a model of planned inpatient census reduction prior to relocation of a university hospital. Prospective analysis of hospital operations for 1-week periods beginning 2 weeks (baseline) and 1 week (transition) prior to move day; analysis of regional hospital and emergency department capacity. Large metropolitan university teaching hospital. Hospital census figures and patient outcomes. Census was reduced by 36% from 537 at baseline to 345 on move day, a rate of 18 patients/d (P emergency operations was unchanged. Hospital admissions were decreased by 42%, and the adjusted discharges per occupied bed were increased by 8% (both P capacity to absorb new patients was limited. During a period in which southern California population grew by 8.5%, acute care beds fell by 3.3%, while Los Angeles County emergency departments experienced a 13% diversion rate due to overcrowding. Local or regional disasters of any size can overwhelm the system's ability to respond. Our strategy produced a surge capacity of 36% without interruption of emergency department and trauma services but required 3 to 4 days for implementation, making it applicable to disasters and mass casualty events with longer lead times. These principles may aid in disaster preparedness and planning.

  20. Key Response Planning Factors for the Aftermath of Nuclear Terrorism

    Energy Technology Data Exchange (ETDEWEB)

    Buddemeier, B R; Dillon, M B

    2009-01-21

    Despite hundreds of above-ground nuclear tests and data gathered from Hiroshima and Nagasaki, the effects of a ground-level, low-yield nuclear detonation in a modern urban environment are still the subject of considerable scientific debate. Extensive review of nuclear weapon effects studies and discussions with nuclear weapon effects experts from various federal agencies, national laboratories, and technical organizations have identified key issues and bounded some of the unknowns required to support response planning for a low-yield, ground-level nuclear detonation in a modern U.S. city. This study, which is focused primarily upon the hazards posed by radioactive fallout, used detailed fallout predictions from the advanced suite of three-dimensional (3-D) meteorology and plume/fallout models developed at Lawrence Livermore National Laboratory (LLNL), including extensive global Key Response Planning Factors for the Aftermath of Nuclear Terrorism geographical and real-time meteorological databases to support model calculations. This 3-D modeling system provides detailed simulations that account for complex meteorology and terrain effects. The results of initial modeling and analysis were presented to federal, state, and local working groups to obtain critical, broad-based review and feedback on strategy and messaging. This effort involved a diverse set of communities, including New York City, National Capitol Regions, Charlotte, Houston, Portland, and Los Angeles. The largest potential for reducing casualties during the post-detonation response phase comes from reducing exposure to fallout radiation. This can be accomplished through early, adequate sheltering followed by informed, delayed evacuation.B The response challenges to a nuclear detonation must be solved through multiple approaches of public education, planning, and rapid response actions. Because the successful response will require extensive coordination of a large number of organizations, supplemented by

  1. Prevention of a wrong-location misadministration through the use of an intradepartmental incident learning system

    International Nuclear Information System (INIS)

    Ford, Eric C.; Smith, Koren; Harris, Kendra; Terezakis, Stephanie

    2012-01-01

    Purpose: A series of examples are presented in which potential errors in the delivery of radiation therapy were prevented through use of incident learning. These examples underscore the value of reporting near miss incidents. Methods: Using a departmental incident learning system, eight incidents were noted over a two-year period in which fields were treated “out-of-sequence,” that is, fields from a boost phase were treated, while the patient was still in the initial phase of treatment. As a result, an error-prevention policy was instituted in which radiation treatment fields are “hidden” within the oncology information system (OIS) when they are not in current use. In this way, fields are only available to be treated in the intended sequence and, importantly, old fields cannot be activated at the linear accelerator control console. Results: No out-of-sequence treatments have been reported in more than two years since the policy change. Furthermore, at least three near-miss incidents were detected and corrected as a result of the policy change. In the first two, the policy operated as intended to directly prevent an error in field scheduling. In the third near-miss, the policy operated “off target” to prevent a type of error scenario that it was not directly intended to prevent. In this incident, an incorrect digitally reconstructed radiograph (DRR) was scheduled in the OIS for a patient receiving lung cancer treatment. The incorrect DRR had an isocenter which was misplaced by approximately two centimeters. The error was a result of a field from an old plan being scheduled instead of the intended new plan. As a result of the policy described above, the DRR field could not be activated for treatment however and the error was discovered and corrected. Other quality control barriers in place would have been unlikely to have detected this error. Conclusions: In these examples, a policy was adopted based on incident learning, which prevented several errors

  2. How to maintain a business continuity despite cyber incidents?

    OpenAIRE

    Đekić Milica D.

    2015-01-01

    Modern IT systems can bring a lot of advantages in terms of electronic commerce and governance as well as an automatic process control within industry, traffic and the other ways of classical and critical infrastructure. However, beside many advantages regarding technological development, there are also some drawbacks in sense of cyber risks, threats and the real hacker's attacks. In this article, we plan to deal with all these cyber risks caused by IT incidents and emergency situations that ...

  3. Survey of state and tribal emergency response capabilities for radiological transportation incidents

    Energy Technology Data Exchange (ETDEWEB)

    Vilardo, F J; Mitter, E L; Palmer, J A; Briggs, H C; Fesenmaier, J [Indiana Univ., Bloomington, IN (USA). School of Public and Environmental Affairs

    1990-05-01

    This publication is the final report of a project to survey the fifty states, the District of Columbia, Puerto Rico, and selected Indian Tribal jurisdictions to ascertain their emergency-preparedness planning and capabilities for responding to transportation incidents involving radioactive materials. The survey was conducted to provide the Nuclear Regulatory Commission and other federal agencies with information concerning the current level of emergency-response preparedness of the states and selected tribes and an assessment of the changes that have occurred since 1980. There have been no major changes in the states' emergency-response planning strategies and field tactics. The changes noted included an increased availability of dedicated emergency-response vehicles, wider availability of specialized radiation-detection instruments, and higher proportions of police and fire personnel with training in the handling of suspected radiation threats. Most Indian tribes have no capability to evaluate suspected radiation threats and have no formal relations with emergency-response personnel in adjacent states. For the nation as a whole, the incidence of suspected radiation threats declined substantially from 1980 to 1988. 58 tabs.

  4. HASCAL -- A system for estimating contamination and doses from incidents at worldwide nuclear facilities

    International Nuclear Information System (INIS)

    Sjoreen, A.L.

    1995-01-01

    The Hazard Assessment System for Consequence Analysis (HASCAL) is being developed to support the analysis of radiological incidents anywhere in the world for the Defense Nuclear Agency (DNA). HASCAL is a component of the Hazard Prediction and Assessment Capability (HPAC), which is a comprehensive nuclear, biological, and chemical hazard effects planning and forecasting modeling system that is being developed by DNA. HASCAL computes best-guess estimates of the consequences of radiological incidents. HASCAL estimates the amount of radioactivity released, its atmospheric transport and deposition, and the resulting radiological doses

  5. Oblique incidence of electron beams - comparisons between calculated and measured dose distributions

    International Nuclear Information System (INIS)

    Karcher, J.; Paulsen, F.; Christ, G.

    2005-01-01

    Clinical applications of high-energy electron beams, for example for the irradiation of internal mammary lymph nodes, can lead to oblique incidence of the beams. It is well known that oblique incidence of electron beams can alter the depth dose distribution as well as the specific dose per monitor unit. The dose per monitor unit is the absorbed dose in a point of interest of a beam, which is reached with a specific dose monitor value (DIN 6814-8[5]). Dose distribution and dose per monitor unit at oblique incidence were measured with a small-volume thimble chamber in a water phantom, and compared to both normal incidence and calculations of the Helax TMS 6.1 treatment planning system. At 4 MeV and 60 degrees, the maximum measured dose per monitor unit at oblique incidence was decreased up to 11%, whereas at 18MeV and 60 degrees this was increased up to 15% compared to normal incidence. Comparisons of measured and calculated dose distributions showed that the predicted dose at shallow depths is usually higher than the measured one, whereas it is smaller at depths beyond the depth of maximum dose. On the basis of the results of these comparisons, normalization depths and correction factors for the dose monitor value were suggested to correct the calculations of the dose per monitor unit. (orig.)

  6. Twelve cases of multiple myeloma in Nagasaki (especially seven atomic bombing casualty cases). [In Japanese

    Energy Technology Data Exchange (ETDEWEB)

    Ichimaru, M; Yasuhi, S; Ouchuru, S

    1963-12-01

    Since 1958, there have been 12 cases of multiple myeloma in Nagasaki, and among them were 7 cases representing atomic bombing casualties, with 3 cases being with 2 km distance from the hypocenter. The age of onset was between 51 and 69 years, and the sex ratio was 8:4, it occurring mostly in males. Symptoms were predominantly low back pain and chest pain caused by the bone changes in 8 cases. Two cases complained of general malaise and palpitation which resulted from anemia. One developed persistent epistaris, and another complained of diplopia caused by the paralysis of the oculomotor nerve. Peripheral blood in all cases showed anemia, 9 with hyperchromic and 3 with normochromic or hypochromic anemia. Low platelet counts were seen in 3 cases. All showed leukopenia. All cases showed typical ..gamma..-globulin change with a myeloma peak, and in 4 cases showed an increase of ..beta..-globulin. Bence-Jones proteinuria was present in 5 cases. Average course was 1 year 4 months. Among complications, myeloma nephrosis, aplastic anemia, and pneumonia were the most important ones.

  7. The Marshall Grazing Incidence X-ray Spectrometer

    Science.gov (United States)

    Kobayashi, Ken; Winebarger, Amy R.; Savage, Sabrina; Champey, Patrick; Cheimets, Peter N.; Hertz, Edward; Bruccoleri, Alexander R.; Golub, Leon; Ramsey, Brian; Ranganathan, Jaganathan; Marquez, Vanessa; Allured, Ryan; Parker, Theodore; Heilmann, Ralf K.; Schattenburg, Mark L.

    2017-08-01

    The Marshall Grazing Incidence X-ray Spectrometer (MaGIXS) is a NASA sounding rocket instrument designed to obtain spatially resolved soft X-ray spectra of the solar atmosphere in the 6-24 Å (0.5-2.0 keV) range. The instrument consists of a single shell Wolter Type-I telescope, a slit, and a spectrometer comprising a matched pair of grazing incidence parabolic mirrors and a planar varied-line space diffraction grating. The instrument is designed to achieve a 50 mÅ spectral resolution and 5 arcsecond spatial resolution along a +/-4-arcminute long slit, and launch is planned for 2019. We report on the status and our approaches for fabrication and alignment for this novel optical system. The telescope and spectrometer mirrors are replicated nickel shells, and are currently being fabricated at the NASA Marshall Space Flight Center. The diffraction grating is currently under development by the Massachusetts Institute of Technology (MIT); because of the strong line spacing variation across the grating, it will be fabricated through e-beam lithography.

  8. Hospital-related incidents; causes and its impact on disaster preparedness and prehospital organisations

    Directory of Open Access Journals (Sweden)

    Khorram-Manesh Amir

    2009-06-01

    Full Text Available Abstract Background A hospital's capacity and preparedness is one of the important parts of disaster planning. Hospital-related incidents, a new phenomenon in Swedish healthcare, may lead to ambulance diversions, increased waiting time at emergency departments and treatment delay along with deterioration of disaster management and surge capacity. We aimed to identify the causes and impacts of hospital-related incidents in Region Västra Götaland (western region of Sweden. Methods The regional registry at the Prehospital and Disaster Medicine Center was reviewed (2006–2008. The number of hospital-related incidents and its causes were analyzed. Results There were an increasing number of hospital-related incidents mainly caused by emergency department's overcrowdings, the lack of beds at ordinary wards and/or intensive care units and technical problems at the radiology departments. These incidents resulted in ambulance diversions and reduced the prehospital capacity as well as endangering the patient safety. Conclusion Besides emergency department overcrowdings, ambulance diversions, endangering patient s safety and increasing risk for in-hospital mortality, hospital-related incidents reduces and limits the regional preparedness by minimizing the surge capacity. In order to prevent a future irreversible disaster, this problem should be avoided and addressed properly by further regional studies.

  9. Optimal multi-agent path planning for fast inverse modeling in UAV-based flood sensing applications

    KAUST Repository

    Abdelkader, Mohamed

    2014-05-01

    Floods are the most common natural disasters, causing thousands of casualties every year in the world. In particular, flash flood events are particularly deadly because of the short timescales on which they occur. Unmanned air vehicles equipped with mobile microsensors could be capable of sensing flash floods in real time, saving lives and greatly improving the efficiency of the emergency response. However, of the main issues arising with sensing floods is the difficulty of planning the path of the sensing agents in advance so as to obtain meaningful data as fast as possible. In this particle, we present a fast numerical scheme to quickly compute the trajectories of a set of UAVs in order to maximize the accuracy of model parameter estimation over a time horizon. Simulation results are presented, a preliminary testbed is briefly described, and future research directions and problems are discussed. © 2014 IEEE.

  10. Radiation protection measures applied during the autopsies on the casualties of the Goiania accident

    International Nuclear Information System (INIS)

    Martins, N.S.F.; Silva, L.H.C.; Rosa, R.

    1998-01-01

    The most seriously affected casualties of the radiological accident caused by the opening of a 137 Cs source capsule in Goiania were treated at the Marcilio Dias Naval Hospital (HNMD) in Rio de Janeiro in the period from October to December 1987. Four of the injured died in October. The autopsies were performed at this institution. Due to the external and internal contamination presented by these victims, specific radiation protection procedures were adopted to enable the medical team to perform their duties. The radiation protection staff, under the co-ordination of technicians of the Brazilian Nuclear Energy Commission (CNEN), were responsible for the preparation of the autopsy room and for advising the professionals on duty during these events. The radiation protection staff took specific measures to prevent the spread of contamination throughout the hospital, the contamination of persons attending the autopsies and to minimize any radiation dose to the medical and professional team. The measures aimed at personal control and the preparation of the autopsy room are described as well as the radiation protection steps applied in connection with the performance of the autopsies, the emplacement of the bodies into the coffins and their transport back to Goiania. (author)

  11. Turning Chaos into Order : Preparedness, Concepts and Lessons Learned in Disaster Medicine

    NARCIS (Netherlands)

    Haverkort, J. J Mark

    2016-01-01

    Optimal care for a sudden, unexpected large number of victims from a mass casualty incident (MCI) is demanding and challenging for every healthcare system. It requires paradigm shift from regular trauma care. Instead of focusing on the individual patient with unlimited resources the focus of care

  12. Medical management after indoor fires: A review

    NARCIS (Netherlands)

    Welling, L.; van Harten, S. M.; Patka, P.; Bierens, J. J. L. M.; Boers, M.; Luitse, J. S. K.; Mackie, D. P.; Trouwborst, A.; Gouma, D. J.; Kreis, R. W.

    2005-01-01

    Fires involving mass burn casualties require extreme efforts and flexibility from the regular health care system. The cafe fire in Volendam, which occurred shortly after midnight on the first of January 2001, resulted in the worst indoor mass burns incident in Dutch history. During the extensive

  13. Evanescent wave scattering at off-axis incidence on multiple cylinders located near a surface

    International Nuclear Information System (INIS)

    Lee, Siu-Chun

    2015-01-01

    The scattering characteristics of an infinite cylinder are strongly influenced by the incidence angle relative to its axis. If the incident wave propagates in the plane normal to the axis of the cylinder, the polarization of the scattered wave remains unchanged and the scattered wave propagates in the same plan as the incident wave. At off-axis incidence such that the incident direction makes an oblique angle with the cylinder axis, the scattered wave is depolarized, and its spatial distribution becomes three-dimensional. This paper presents the scattering solution for oblique incidence on multiple parallel cylinders located near a planar interface by an evanescent wave that is generated by total internal reflection of the source wave propagating in the higher refractive index substrate. Hertz potentials are utilized to formulate the interaction of inhomogeneous waves with the cylinders, scattering at the substrate interface, and near field scattering between the cylinders. Analytic formulas are derived for the electromagnetic fields and Poynting vector of scattered radiation in the near-field and their asymptotic forms in the far-field. Numerical examples are shown to illustrate scattering of evanescent wave by multiple cylinders at off-axis incidence. - Highlights: • Developed an exact solution for off-axis incidence on multiple cylinders. • Included depolarization, near-field scattering, and Fresnel effect in theory. • Derived analytic formulas for scattered radiation in the far field. • Illustrated evanescent scattering at off-axis incidence by numerical data

  14. Computer incident response and forensics team management conducting a successful incident response

    CERN Document Server

    Johnson, Leighton

    2013-01-01

    Computer Incident Response and Forensics Team Management provides security professionals with a complete handbook of computer incident response from the perspective of forensics team management. This unique approach teaches readers the concepts and principles they need to conduct a successful incident response investigation, ensuring that proven policies and procedures are established and followed by all team members. Leighton R. Johnson III describes the processes within an incident response event and shows the crucial importance of skillful forensics team management, including when and where the transition to forensics investigation should occur during an incident response event. The book also provides discussions of key incident response components. Provides readers with a complete handbook on computer incident response from the perspective of forensics team management Identify the key steps to completing a successful computer incident response investigation Defines the qualities necessary to become a succ...

  15. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012.

    Science.gov (United States)

    Zhang, Xingyu; Zhang, Tao; Pei, Jiao; Liu, Yuanyuan; Li, Xiaosong; Medrano-Gracia, Pau

    2016-01-01

    The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis.

  16. Business continuity in blood services: two case studies from events with potentially catastrophic effect on the national provision of blood components.

    Science.gov (United States)

    Morgan, S J; Rackham, R A; Penny, S; Lawson, J R; Walsh, R J; Ismay, S L

    2015-02-01

    NHS Blood and Transplant (NHSBT) and the Australian Red Cross Blood Service (ARCBS) are national blood establishments providing blood components to England and North Wales, and Australia, respectively. In 2012, both services experienced potentially catastrophic challenges to key assets. NHSBT suffered a flood that closed the largest blood-manufacturing centre in Europe, whilst ARCBS experienced the failure of a data centre network switch that rendered the national blood management system inaccessible for 42 h. This paper describes both crisis events, including the immediate actions, recovery procedures and lessons learned. Both incidents triggered emergency response plans. These included hospital reprovisioning and recovery from the incident. Once normal services had been restored, both events were subjected to root cause analysis (RCA) and production of 'lessons learned' reports. In both scenarios, the key enablers of rapid recovery were established emergency plans, clear leadership and the support of a flexible workforce. Product issues to hospitals were unaffected, and there were no abnormal trends in hospital complaints. RCA identified the importance of risk mitigations that require co-operation with external organizations. Reviews of both events identified opportunities to enhance business resilience through prior identification of external risks and improvements to contingency plans, for example by implementing mass messaging to staff and other stakeholders. Blood establishment emergency plans tend to focus on responding to mass casualty events. However, consolidation of manufacturing to fewer sites combined with a reliance on national IT systems increases the impact of loss of function. Blood services should develop business continuity plans which include prevention of such losses, and the maintenance of services and disaster recovery. © 2014 International Society of Blood Transfusion.

  17. The incidence and mortality of ovarian cancer and their relationship with the Human Development Index in Asia

    OpenAIRE

    Razi, Saeid; Ghoncheh, Mahshid; Mohammadian-Hafshejani, Abdollah; Aziznejhad, Hojjat; Mohammadian, Mahdi; Salehiniya, Hamid

    2016-01-01

    Background The incidence and mortality estimates of ovarian cancer based on human development are essential for planning by policy makers. This study is aimed at investigating the standardised incidence rates (SIR) and standardised mortality rates (SMR) of ovarian cancer and their relationship with the Human Development Index (HDI) in Asian countries. Methods This study was an ecologic study in Asia for assessment of the correlation between SIR, age standardised rates (ASR), and HDI and their...

  18. Los Alamos National Laboratory emergency management plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Ramsey, G.F.

    1998-07-15

    The Laboratory has developed this Emergency Management Plan (EMP) to assist in emergency planning, preparedness, and response to anticipated and actual emergencies. The Plan establishes guidance for ensuring safe Laboratory operation, protection of the environment, and safeguarding Department of Energy (DOE) property. Detailed information and specific instructions required by emergency response personnel to implement the EMP are contained in the Emergency Management Plan Implementing Procedure (EMPIP) document, which consists of individual EMPIPs. The EMP and EMPIPs may be used to assist in resolving emergencies including but not limited to fires, high-energy accidents, hazardous material releases (radioactive and nonradioactive), security incidents, transportation accidents, electrical accidents, and natural disasters.

  19. 49 CFR 225.33 - Internal Control Plans.

    Science.gov (United States)

    2010-10-01

    ... official business. Each railroad shall amend its Internal Control Plan, as necessary, to reflect any..., incident, injury or illness will not be permitted or tolerated and will result in some stated disciplinary... paragraph (a)(1). Each railroad shall have procedures to process complaints from any person about the policy...

  20. Spatial-Temporal Hotspot Pattern Analysis of Provincial Environmental Pollution Incidents and Related Regional Sustainable Management in China in the Period 1995–2012

    Directory of Open Access Journals (Sweden)

    Lei Ding

    2015-10-01

    Full Text Available Spatial-temporal hotspot pattern analysis of environmental pollution incidents provides an indispensable source of information for the further development of incident prevention measures. In this study, the spatial-temporal patterns of environmental pollution incidents in China in the period of 1995–2012 were analyzed, using the Spatial Getis-Ord statistic and an Improved Prediction Accuracy Index (IAPI. The results show that, in this period, the occurrence of environmental incidents exhibited a dynamic growth pattern but then dropped and continued to drop after the year 2006, which was considered a crucial turning point. Not coincidentally, this corresponds to the year when the State Council issued its National Environmental Emergency Plan, and following the examination of major incidents, special actions were taken to strengthen the control of incidents and emergency responses. The results from Getis-Ord General G statistical analysis show that the spatial agglomeration phenomenon was statistically significant after 1999 and that the level of spatial agglomeration was rising, while the Getis-Ord Gi* statistical analysis reveals that environmental pollution incidents were mainly agglomerated in the Pan Yangtze River Delta and Pan Pearl River Delta regions. Accordingly, the spatial-temporal hotspot pattern based on the IAPI values at the provincial scale could be categorized into: stable hotspots, unstable hotspots, and cold-spot areas. The stable hotspots category was further divided into three subtypes: industrial distribution type, industrial transfer type, and extensive economic growth type. Finally, the corresponding measures for sustainable management were proposed: stable hotspots were classified as essential regions requiring the immediate prevention and control of environmental pollution incidents; unstable hotspots were characterized by their need for ongoing and continual prevention measures, and cold-spots were those areas that

  1. HIV incidence in Asia: a review of available data and assessment of the epidemic.

    Science.gov (United States)

    Dokubo, E Kainne; Kim, Andrea A; Le, Linh-Vi; Nadol, Patrick J; Prybylski, Dimitri; Wolfe, Mitchell I

    2013-01-01

    Rates of new HIV infections in Asia are poorly characterized, likely resulting in knowledge gaps about infection trends and the most important areas to target for interventions. We conducted a systematic review of peer-reviewed English language publications and conference abstracts on HIV incidence in thirteen countries - Bangladesh, Cambodia, China, India, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Taiwan, Thailand, and Vietnam. We obtained data on HIV incidence rate, incidence estimation method, population, and risk factors for incident infection. Our search yielded 338 unique incidence estimates from 70 published articles and 41 conference abstracts for eight countries. A total of 138 (41%) were obtained from prospective cohort studies and 106 (31%) were from antibody-based tests for recent infection. High HIV incidence rates were observed among commercial sex workers (0.4-27.8 per 100 person-years), people who inject drugs (0.0-43.6 per 100 person-years) and men who have sex with men (0.7-15.0 per 100 person-years). Risk factors for incident HIV infection include brothel-based sex work and cervicitis among commercial sex workers; young age, frequent injection use and sharing needles or syringes among people who inject drugs; multiple male sexual partners, receptive anal intercourse and syphilis infection among men who have sex with men. In the countries with available data, incidence rates were highest in key populations and varied widely by incidence estimation method. Established surveillance systems that routinely monitor trends in HIV incidence are needed to inform prevention planning, prioritize resources, measure impact, and improve the HIV response in Asia.

  2. Method paper--distance and travel time to casualty clinics in Norway based on crowdsourced postcode coordinates: a comparison with other methods.

    Science.gov (United States)

    Raknes, Guttorm; Hunskaar, Steinar

    2014-01-01

    We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times.

  3. Method paper--distance and travel time to casualty clinics in Norway based on crowdsourced postcode coordinates: a comparison with other methods.

    Directory of Open Access Journals (Sweden)

    Guttorm Raknes

    Full Text Available We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times.

  4. Physical treatment planning by several approaches

    International Nuclear Information System (INIS)

    Burger, G.; Morhart, A.; Wittmann, A.

    1985-01-01

    Neutron isodose planning may be performed by commercial treatment planning systems for photons, providing that certain modifications are applied. All geometry-related corrections such as for nonregular surfaces and oblique incidence remain unchanged. The main modifications concern the tissue-air-ratio, containing essentially the attenuation correction function. We have as a first step applied this modified commercial system to a few regular exposure situations in a homogenious water phantom and compared the generated isodose charts with those derived by direct Monte Carlo calculations of the neutron transport for the corresponding fields. As expected the commercial methods do not incorporate the necessary corrections for the change of scatter conditions in case of oblique incidence or wedged fields. For this reason we developed another approach, based upon the numerical superposition of dose matrices for pencil beams. These matrices were again Monte Carlo calculated. From it build-up functions can be derived by partial radial integration. The isodose charts generated by superposition of pencil beam dose distributions agree much better with directly Monte Carlo calculated ones, than those from the commercial treatment planning system. Based upon these results the method was finally applied to real patients cross sections, as derived from CT or MR-tomography. In the latter case one can even perform a pixelwise attenuation correction, if spin density images are available

  5. VOYAGE PLANNING

    Directory of Open Access Journals (Sweden)

    Kazimierz SKÓRA

    2016-09-01

    Full Text Available A sea voyage can be divided into three parts with varying degrees of risk: - from the berth at the port of departure to the pilot disembarkation point - from the pilot disembarkation to another pilot embarkation point near the port of call/destination - from the pilot embarkation point to the berth Results of statistical research into ship accidents at sea point to an increased number of incidents and accidents, including groundings, especially in restricted areas. Such areas are often narrow and have limited depths, while their short straight sections require frequent course alterations, often in varying hydrometeorological conditions. Due to all these factors, the voyage has to be carefully planned and all watchkeeping officers have to be well prepared to conduct the ship safely. The article presents the objectives, scope, legal basis and stages in the process of voyage planning. The compliance with the outlined principles will reduce the level of risk in maritime transport.

  6. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical?

    DEFF Research Database (Denmark)

    Maaløe, R; la Cour, M; Hansen, A

    2006-01-01

    The purpose of the present study was to measure the incidence and type of incidents that occurred in relation to anaesthesia and surgery during a 1-year period in six Danish hospitals. Furthermore, we wanted to identify risk factors for incidents, as well as risk factors for incidents being deeme...... critical....

  7. Project of Particular intervention plan of the Belleville-sur-Loire NPP. Special provisions of the ORSEC plan

    International Nuclear Information System (INIS)

    2015-01-01

    The Particular intervention plan (PPI in French) is an emergency plan which foresees the measures and means to be implemented to address the potential risks of the presence and operation of a nuclear facility. This plan is implemented and developed by the Prefect in case of nuclear accident (or incident leading to a potential accident), the impact of which extending beyond the facility perimeter. It represents a special section of the organisation plan for civil protection response (ORSEC plan). The PPI foresees the necessary measures and means for crisis management during the first hours following the accident and is triggered by the Department Prefect according to the information provided by the facility operator. Its aim is to protect the populations leaving within 10 km of the facility against a potential radiological hazard. The PPI describes: the facility, the intervention area, the protection measures for the population, the conditions of emergency plan triggering, the crisis organisation, the action forms of the different services, and the post-accident stage. This document is the project of Particular intervention plan for the Belleville-sur-Loire Nuclear Power Plant (Cher, France)

  8. On-ground casualty risk reduction by structural design for demise

    Science.gov (United States)

    Lemmens, Stijn; Funke, Quirin; Krag, Holger

    2015-06-01

    In recent years, awareness concerning the on-ground risk posed by un-controlled re-entering space systems has increased. On average over the past decade, an object with mass above 800 kg re-enters every week from which only a few, e.g. ESA's GOCE in 2013 and NASA's UARS in 2011, appeared prominent in international media. Space agencies and nations have discussed requirements to limit the on-ground risk for future missions. To meet the requirements, the amount of debris falling back on Earth has to be limited in number, mass and size. Design for demise (D4D) refers to all measures taken in the design of a space object to increase the potential for demise of the object and its components during re-entry. SCARAB (Spacecraft Atmospheric Re-entry and Break-Up) is ESA's high-fidelity tool which analyses the thermal and structural effects of atmospheric re-entry on spacecraft with a finite-element approach. For this study, a model of a representative satellite is developed in SCARAB to serve as test-bed for D4D analyses on a structural level. The model is used as starting point for different D4D approaches based on increasing the exposure of the satellite components to the aero-thermal environment, as a way to speed up the demise. Statistical bootstrapping is applied to the resulting on-ground fragment lists in order to compare the different re-entry scenarios and to determine the uncertainties of the results. Moreover, the bootstrap results can be used to analyse the casualty risk estimator from a theoretical point of view. The risk reductions for the analysed D4D techniques are presented with respect to the reference scenario for the modelled representative satellite.

  9. NATO Planning Guide for the Estimation of CBRN Casualties

    Science.gov (United States)

    2014-11-01

    of icon movement, changes in breathing rate (e.g. due to sprinting to cover), and changing defensive postures (e.g. due to warning and response...4 300 0 1 2 4 400 0 0 1 4 700 0 0 0 4 * According to the default value for Tdeath-CN-SL4, death would be modeled at this point. Table 4-46...SD.2 KIA Killed in action kg Kilogram kJ/m2 Kilojoule per square meter kPa Kilopascal LD50 Median lethal dose; dose resulting in lethality for 50

  10. DOE Region 6 Radiological Assistance Program plan. Revision 1

    International Nuclear Information System (INIS)

    Jakubowski, F.M.

    1995-11-01

    The US Department of Energy (DOE) has sponsored a Radiological Assistance Program (RAP) since the 1950's. The RAP is designed to make DOE resources available to other DOE facilities, state, tribal, local, private businesses, and individuals for the explicit purpose of assisting during radiological incidents. The DOE has an obligation, through the Atomic Energy Act of 1954, as amended, to provide resources through the Federal Radiological Emergency Response Plan (FRERP, Nov. 1985) in the event of a radiological incident. Toward this end, the RAP program is implemented on a regional basis, and has planned for an incremental response capability with regional coordination between states and DOE response elements. This regional coordination is intended to foster a working relationship between DOE radiological assistance elements and those state, tribal, and local agencies responsible for first response to protect public health and safety

  11. SU-E-T-310: Targeting Safety Improvements Through Analysis of Near-Miss Error Detection Points in An Incident Learning Database

    International Nuclear Information System (INIS)

    Novak, A; Nyflot, M; Sponseller, P; Howard, J; Logan, W; Holland, L; Jordan, L; Carlson, J; Ermoian, R; Kane, G; Ford, E; Zeng, J

    2014-01-01

    Purpose: Radiation treatment planning involves a complex workflow that can make safety improvement efforts challenging. This study utilizes an incident reporting system to identify detection points of near-miss errors, in order to guide our departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or their patterns. Methods: 1377 incidents were analyzed from a departmental nearmiss error reporting system from 3/2012–10/2013. All incidents were prospectively reviewed weekly by a multi-disciplinary team, and assigned a near-miss severity score ranging from 0–4 reflecting potential harm (no harm to critical). A 98-step consensus workflow was used to determine origination and detection points of near-miss errors, categorized into 7 major steps (patient assessment/orders, simulation, contouring/treatment planning, pre-treatment plan checks, therapist/on-treatment review, post-treatment checks, and equipment issues). Categories were compared using ANOVA. Results: In the 7-step workflow, 23% of near-miss errors were detected within the same step in the workflow, while an additional 37% were detected by the next step in the workflow, and 23% were detected two steps downstream. Errors detected further from origination were more severe (p<.001; Figure 1). The most common source of near-miss errors was treatment planning/contouring, with 476 near misses (35%). Of those 476, only 72(15%) were found before leaving treatment planning, 213(45%) were found at physics plan checks, and 191(40%) were caught at the therapist pre-treatment chart review or on portal imaging. Errors that passed through physics plan checks and were detected by therapists were more severe than other errors originating in contouring/treatment planning (1.81 vs 1.33, p<0.001). Conclusion: Errors caught by radiation treatment therapists tend to be more severe than errors caught earlier in the workflow, highlighting the importance of safety

  12. Prediction of injuries caused by explosive events: A case study of a hand grenade incident in South Africa

    CSIR Research Space (South Africa)

    Whyte, TN

    2008-11-01

    Full Text Available An M26 hand grenade was accidentally detonated by a group of eight children, six of whom were killed, in the Mthatha area of South Africa. The M26 grenade is designed to produce casualties through the high velocity fragments that it expels. However...

  13. Emergency planning and preparedness of the Dalat Nuclear Research Institute

    International Nuclear Information System (INIS)

    Luong, B.V.

    2001-01-01

    The effectiveness of measures taken in case of accident or emergency to protect the site personnel, the general public and the environment will depend heavily on the adequacy of the emergency plan prepared in advance. For this reason, an emergency plan of the operating organization shall cover all activities planned to be carried out in the event of an emergency, allow for determining the level of the emergency and corresponding level of response according to the severity of the accident condition, and be based on the accidents analysed in the SAR as well as those additionally postulated for emergency planning purposes. The purpose of this paper is to present the practice of the emergency planning and preparedness in the Dalat Nuclear Research Institute (DNRI) for responding to accidents/incidents that may occur at the DNRI. The DNRI emergency plan and emergency procedures developed by the DNRI will be discussed. The information in the DNRI emergency plan such as the emergency organization, classification and identification of emergencies; intervention measures; the co-ordination with off-site organizations; and emergency training and drills will be described in detail. The emergency procedures in the form of documents and instructions for responding to accidents/incidents such as accidents in the reactor, accidents out of the reactor but with significant radioactive contamination, and fire and explosion accidents will be mentioned briefly. As analysed in the Safety Analysis Report for the DNRI, only the in-site actions are presented in the paper and no off-site emergency measures are required. (author)

  14. Integrating an incident management system within a continuity of operations programme: case study of the Bank of Canada.

    Science.gov (United States)

    Loop, Carole

    2013-01-01

    Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.

  15. Space-time variability of citrus leprosis as strategic planning for crop management.

    Science.gov (United States)

    Andrade, Daniel J; Lorençon, José R; Siqueira, Diego S; Novelli, Valdenice M; Bassanezi, Renato B

    2018-01-31

    Citrus leprosis is the most important viral disease of citrus. Knowledge of its spatiotemporal structure is fundamental to a representative sampling plan focused on the disease control approach. Such a well-crafted sampling design helps to reduce pesticide use in agriculture to control pests and diseases. Despite the use of acaricides to control citrus leprosis vector (Brevipalpus spp.) populations, the disease has spread rapidly through experimental areas. Citrus leprosis has an aggregate spatial distribution, with high dependence among symptomatic plants. Temporal variation in disease incidence increased among symptomatic plants by 4% per month. Use of acaricides alone to control the vector of leprosis is insufficient to avoid its incidence in healthy plants. Preliminary investigation into the time and space variation in the incidence of the disease is fundamental to select a sampling plan and determine effective strategies for disease management. © 2018 Society of Chemical Industry. © 2018 Society of Chemical Industry.

  16. A multi-layered risk estimation routine for strategic planning and operations for the maritime industry

    NARCIS (Netherlands)

    S. Knapp (Sabine); S. Vander Hoorn (Stephen)

    2017-01-01

    textabstractMaritime regulators and port authorities require the ability to predict risk exposure for strategic planning aspects to optimize asset allocation, mitigate and prevent incidents. This article builds on previous work to develop the strategic planning component and introduces the concept

  17. Formal analysis of empirical traces in incident management

    International Nuclear Information System (INIS)

    Hoogendoorn, Mark; Jonker, Catholijn M.; Maanen, Peter-Paul van; Sharpanskykh, Alexei

    2008-01-01

    Within the field of incident management split second decisions have to be made, usually on the basis of incomplete and partially incorrect information. As a result of these conditions, errors occur in such decision processes. In order to avoid repetition of such errors, historic cases, disaster plans, and training logs need to be thoroughly analysed. This paper presents a formal approach for such an analysis that pays special attention to spatial and temporal aspects, to information exchange, and to organisational structure. The formal nature of the approach enables automation of analysis, which is illustrated by case studies of two disasters

  18. Time Series Modelling of Syphilis Incidence in China from 2005 to 2012

    Science.gov (United States)

    Zhang, Xingyu; Zhang, Tao; Pei, Jiao; Liu, Yuanyuan; Li, Xiaosong; Medrano-Gracia, Pau

    2016-01-01

    Background The infection rate of syphilis in China has increased dramatically in recent decades, becoming a serious public health concern. Early prediction of syphilis is therefore of great importance for heath planning and management. Methods In this paper, we analyzed surveillance time series data for primary, secondary, tertiary, congenital and latent syphilis in mainland China from 2005 to 2012. Seasonality and long-term trend were explored with decomposition methods. Autoregressive integrated moving average (ARIMA) was used to fit a univariate time series model of syphilis incidence. A separate multi-variable time series for each syphilis type was also tested using an autoregressive integrated moving average model with exogenous variables (ARIMAX). Results The syphilis incidence rates have increased three-fold from 2005 to 2012. All syphilis time series showed strong seasonality and increasing long-term trend. Both ARIMA and ARIMAX models fitted and estimated syphilis incidence well. All univariate time series showed highest goodness-of-fit results with the ARIMA(0,0,1)×(0,1,1) model. Conclusion Time series analysis was an effective tool for modelling the historical and future incidence of syphilis in China. The ARIMAX model showed superior performance than the ARIMA model for the modelling of syphilis incidence. Time series correlations existed between the models for primary, secondary, tertiary, congenital and latent syphilis. PMID:26901682

  19. Incidence and prognosis of stroke in young adults: a population-based study in Ferrara, Italy.

    Science.gov (United States)

    Groppo, Elisabetta; De Gennaro, Riccardo; Granieri, Gino; Fazio, Patrik; Cesnik, Edward; Granieri, Enrico; Casetta, Ilaria

    2012-02-01

    The reported annual incidence of juvenile stroke ranges from 9 to 47 cases per 100,000 inhabitants. We sought to estimate the incidence of first-ever stroke in young adults through a population-based stroke registry in a well-defined and stable population. We planned to collect all cases of new stroke in people aged 15-44 years in Ferrara, Italy, over the period 2002-2007. During the surveillance period, a first-ever stroke was diagnosed in 39 patients, giving a mean annual crude incidence rate of 12.1 cases per 100,000 person-years (95% CI 8.6-16.5), 9.1 when adjusted to the European population. The overall 30-day case fatality rate was 7.7, 21.4% for hemorrhagic stroke. The incidence rate was in the range of estimates detected in western countries. The case-fatality rate was lower than that reported in less recent studies. The stroke subtype predicted the probability of death and the outcome.

  20. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

  1. Incidents analysis

    Energy Technology Data Exchange (ETDEWEB)

    Francois, P

    1997-12-31

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs.

  2. The Internet's effect on personality traits: An important casualty of the "Internet addiction" paradigm.

    Science.gov (United States)

    Aboujaoude, Elias

    2017-03-01

    Background and aims The "Internet addiction" paradigm has been criticized for several shortcomings, including inattention to specific online behaviors, not distinguishing the Internet from other media, insufficient focus on comorbidities, and definitions that do not take into account the constant access now possible. The paradigm's biggest casualty, however, may be that it has diverted attention away from subtle personality changes that seem to occur online, including in users who cannot be considered "addicted" under any definition. Methods A narrative assessment of the literature was conducted, focusing on the Internet's effects on personality traits as revealed in studies of Internet users. Results Impulsivity, narcissism, and aggression are some of the personality traits that seem to be nurtured by the Internet, with possible negative offline consequences. Discussion Ignoring the Internet's subtle effects on personality as we embrace an addiction model that implies severe pathology makes the majority of Internet users feel deceptively immune to the psychological effects of new technologies. It also limits our understanding of the big cultural shifts that are happening as a result. Conclusion The Internet's potentially negative effect on personality, and by extension on society at large, is a fundamental part of online psychology, one well worthy of further investigation.

  3. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de; Villeirs, G.M.; Delrue, L.J.

    2004-01-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  4. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de [Dept. of Radiation Oncology, Gent Univ. Hospital, Gent (Belgium); Villeirs, G.M.; Delrue, L.J. [Dept. of Radiology, Gent Univ. Hospital, Gent (Belgium)

    2004-09-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  5. Factors affecting the organization and management of emergency ...

    African Journals Online (AJOL)

    Factors affecting the organization and management of emergency mass casualty ... service all under a unified command of leadership with a specified job description. Factors identified were: Political will, human resource planning, appropriate ...

  6. Wheelchair incidents

    NARCIS (Netherlands)

    Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM

    2002-01-01

    This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with

  7. Incident reporting: Its role in aviation safety and the acquisition of human error data

    Science.gov (United States)

    Reynard, W. D.

    1983-01-01

    The rationale for aviation incident reporting systems is presented and contrasted to some of the shortcomings of accident investigation procedures. The history of the United State's Aviation Safety Reporting System (ASRS) is outlined and the program's character explained. The planning elements that resulted in the ASRS program's voluntary, confidential, and non-punitive design are discussed. Immunity, from enforcement action and misuse of the volunteered data, is explained and evaluated. Report generation techniques and the ASRS data analysis process are described; in addition, examples of the ASRS program's output and accomplishments are detailed. Finally, the value of incident reporting for the acquisition of safety information, particularly human error data, is explored.

  8. The grave is wide: the Hibakusha of Hiroshima and Nagasaki and the legacy of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation.

    Science.gov (United States)

    O'Malley, Gerald F

    2016-07-01

    Following the atomic bomb attacks on Japan in 1945, scientists from the United States and Japan joined together to study the Hibakusha - the bomb affected people in what was advertised as a bipartisan and cooperative effort. In reality, despite the best efforts of some very dedicated and earnest scientists, the early years of the collaboration were characterized by political friction, censorship, controversy, tension, hostility, and racism. The 70-year history, scientific output and cultural impact of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation are described in the context of the development of Occupied Japan.

  9. Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva Short-term effectiveness of brief interventions in alcohol-positive traffic casualties

    Directory of Open Access Journals (Sweden)

    Alicia Rodríguez-Martos

    2005-02-01

    Full Text Available Objetivos: Investigar la efectividad de las intervenciones breves para reducir el consumo de alcohol en los pacientes lesionados por accidente de tráfico con alcoholemia positiva. Métodos: Se cribó la presencia de alcohol en 948 lesionados en accidente de tráfico (el 97,6% de los elegibles de un universo de 1.106, con 126 (13,3% positivos. Se intervino en 85 individuos, aleatoriamente distribuidos en intervención mínima (consejo simple e intervención breve (intervención de tipo motivacional, y se programó un seguimiento telefónico a los 3, 6 y 12 meses. En este trabajo se presentan los resultados del seguimiento a los 3 meses. Resultados: A los 3 meses se ha seguido a 57 pacientes (67%. EL 73,7% ha reducido el consumo, porcentaje que fue mayor en el grupo intervención breve (p = 0,06; tamaño del efecto, 0,5 y en los incluidos en la categoría de los bebedores de riesgo (p Objectives: To investigate the effectiveness of brief interventions to reduce alcohol intake in traffic casualties with a positive blood alcohol concentration. Methods: Nine hundred forty-eight eligible casualties (97.6% of eligible casualties within a universe of 1106 were screened for alcohol and 126 (13.3% were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice or a brief intervention (motivational intervention. Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. Results: Fifty-seven patients (67% were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5 and among heavy drinkers (p < 0.05. Conclusions: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn.

  10. Selected Spiritual, Religious, and Family Factors in the Prevention of School Violence

    Science.gov (United States)

    Windham, R. Craig; Hooper, Lisa M.; Hudson, Patricia E.

    2005-01-01

    The mass-casualty school shooting incidents in recent years have heightened concern about the safety of U.S. schools and prompted responses that, in many cases, have centered mainly on bolstering security on school campuses. Some researchers have concluded, however, that the most effective prevention efforts are those that are more comprehensive…

  11. The incidence and mortality of lung cancer and their relationship to development in Asia.

    Science.gov (United States)

    Pakzad, Reza; Mohammadian-Hafshejani, Abdollah; Ghoncheh, Mahshid; Pakzad, Iraj; Salehiniya, Hamid

    2015-12-01

    Lung cancer is the deadliest cancer worldwide and the most common cancer in Asia. It is necessary to get information on epidemiology and inequalities related to incidence and mortality of the cancer to use for planning and further research. This study aimed to investigate epidemiology and inequality of incidence and mortality from lung cancer in Asia. The study was conducted based on data from the world data of cancer and the World Bank [including the Human Development Index (HDI) and its components]. The incidence and mortality rates, and cancer distribution maps were drawn for Asian countries. To analyze data, correlation test between incidence and death rates, and HDI and its components at significant was used in the significant level of 0.05 using SPSS software. A total of 1,033,881 incidence (71.13% were males and 28.87% were females. Sex ratio was 2.46) and 936,051 death (71.45% in men and 28.55% in women. The sex ratio was 2.50) recorded in Asian countries in 2012. Five countries with the highest standardized incidence and mortality rates of lung cancer were Democratic Republic of Korea, China, Armenia, Turkey, and Timor-Leste, respectively. Correlation between HDI and standardized incidence rate was 0.345 (P=0.019), in men 0.301 (P=0.042) and in women 0.3 (P=0.043); also between HDI and standardized mortality rate 0.289 (P=0.052), in men 0.265 (P=0.075) and in women 0.200 (P=0.182). The incidence of lung cancer has been increasing in Asia. It is high in men. Along with development, the incidence and mortality from lung cancer increases. It seems necessary to study reasons and factors of increasing the incidence and mortality of lung cancer in Asian countries.

  12. Why do organizations not learn from incidents? Bottlenecks, causes and conditions for a failure to effectively learn

    DEFF Research Database (Denmark)

    Drupsteen, Linda; Hasle, Peter

    2014-01-01

    be studied.Difficulties were identified in multiple steps of the learning process, but most difficulties became visiblewhen planning actions, which is the phase that bridges the gap from incident investigation to actions forimprovement. The main causes for learning difficulties, which were identified...... learn. In sevenorganizations focus groups were held to discuss factors that according to employees contributed to thefailure to learn. By use of a model of the learning from incidents process, the steps, where difficulties forlearning arose, became visible, and the causes for these difficulties could...

  13. Emergency planning and operating experience

    International Nuclear Information System (INIS)

    Halpern, O.; Breniere, J.

    1984-01-01

    The purpose of this paper is to derive lessons from operating experience for the planning of emergency measures. This operating experience has two facets: it is obtained not only from the various incidents and accidents which have occurred in countries with nuclear power programmes and from the resulting application of emergency plans but also from the different exercises and simulations carried out in France and in other countries. Experience generally confirms the main approaches selected for emergency plans. The lessons to be derived are of three types: first, it appears necessary to set forth precisely the responsibilities of each person involved in order to prevent a watering-down of decisions in the event of an accident; secondly, considerable improvements need to be made in the different communication networks to be used; and thirdly, small accidents with minor radiological consequences deserve as systematic and thorough an approach as large and more improbable accidents. (author)

  14. Population is the main driver of war group size and conflict casualties.

    Science.gov (United States)

    Oka, Rahul C; Kissel, Marc; Golitko, Mark; Sheridan, Susan Guise; Kim, Nam C; Fuentes, Agustín

    2017-12-26

    The proportions of individuals involved in intergroup coalitional conflict, measured by war group size (W), conflict casualties (C), and overall group conflict deaths (G), have declined with respect to growing populations, implying that states are less violent than small-scale societies. We argue that these trends are better explained by scaling laws shared by both past and contemporary societies regardless of social organization, where group population (P) directly determines W and indirectly determines C and G. W is shown to be a power law function of P with scaling exponent X [demographic conflict investment (DCI)]. C is shown to be a power law function of W with scaling exponent Y [conflict lethality (CL)]. G is shown to be a power law function of P with scaling exponent Z [group conflict mortality (GCM)]. Results show that, while W/P and G/P decrease as expected with increasing P, C/W increases with growing W. Small-scale societies show higher but more variance in DCI and CL than contemporary states. We find no significant differences in DCI or CL between small-scale societies and contemporary states undergoing drafts or conflict, after accounting for variance and scale. We calculate relative measures of DCI and CL applicable to all societies that can be tracked over time for one or multiple actors. In light of the recent global emergence of populist, nationalist, and sectarian violence, our comparison-focused approach to DCI and CL will enable better models and analysis of the landscapes of violence in the 21st century. Copyright © 2017 the Author(s). Published by PNAS.

  15. Experience in the management of the mass casualty from the ...

    African Journals Online (AJOL)

    2015-09-21

    Sep 21, 2015 ... mainly from road traffic collisions[5] until September 9,. 2001,[6,7] when ... highlighted, analyzed, and possible solutions proffered. Other areas that .... incidence of exhaustion of supplies, drugs, blood, or other consumables.

  16. Incidence Trend and Epidemiology of Common Cancers in the Center of Iran.

    Science.gov (United States)

    Rafiemanesh, Hosein; Rajaei-Behbahani, Narjes; Khani, Yousef; Hosseini, Sayedehafagh; Pournamdar, Zahra; Mohammadian-Hafshejani, Abdollah; Soltani, Shahin; Hosseini, Seyedeh Akram; Khazaei, Salman; Salehiniya, Hamid

    2015-07-13

    Cancer is a major public health problem in Iran and many other parts of the world. The cancer incidence is different in various countries and in country provinces. Geographical differences in the cancer incidence lead to be important to conduct an epidemiological study of the disease. This study aimed to investigate cancer epidemiology and trend in the province of Qom, located in center of Iran. This is an analytical cross-sectional study carried out based on re-analysis cancer registry report and the disease management center of health ministry from 2004 to 2008 in the province of Qom. To describe incidence time trends, we carried out join point regression analysis using the software Join point Regression Program, Version 4.1.1.1. There were 3,029 registered cases of cancer during 5 years studied. Sex ratio was 1.32 (male to female). Considering the frequency and mean standardized incidence, the most common cancer in women were breast, skin, colorectal, stomach, and esophagus, respectively while in men the most common cancers included skin, stomach, colorectal, bladder, and prostate, respectively. There was an increasing and significant trend, according to the annual percentage change (APC) equal to 8.08% (CI: 5.1-11.1) for all site cancer in women. The incidence trend of all cancers was increasing in this area. Hence, planning for identifying risk factors and performing programs for dealing with the disease are essential.

  17. Statement of nuclear incidents at nuclear installations

    International Nuclear Information System (INIS)

    2002-01-01

    The Health and Safety Executive (HSE) presents the statement of nuclear incidents at nuclear installations published under the Health and Safety Commission's powers derived from section 11 of the Health and Safety at Work, etc. Act 1974. INCIDENT 02/4/1. Harwell (United Kingdom Atomic Energy Authority) On 6 November 2002 during operations in a glove box in B220, the over pressure alarm sounded. The operators evacuated and shortly afterwards the airborne activity monitors also sounded. The building emergency arrangements for airborne activity alarms was initiated to ascertain the source and to manage the operations. An investigation by UKAEA confirmed that a release of Americium 241 into the working area had occurred at a quantity in excess of Schedule 8 column 4 of the Ionising Radiations Regulations 1999 (IRRs). A number of personnel have received intakes including the two operators and the health physics personnel who attended the event. The highest dose (up to 6 mSv.) was received by the Health Physics charge hand. UKAEA placed an embargo on the use of similar systems and have completed their own management investigation and produced an internal report. It concludes that the likely cause of the event was over-pressurisation of the vacuum equipment used in the process. The report also highlights improvements required to the ventilation system in the laboratory and adjoining areas. An action plan has been developed for this work and progress is being made. NIl has followed the UKAEA investigation and carried out its own study including a visit by a ventilation specialist. This has confirmed the problems with the ventilation system. It is a complex issue that may have a wider impact across the building. A letter has been sent to UKAEA detailing a series of short-term requirements and the need to review implications and produce a longer-term action plan. UKAEA is cooperating fully with these requirements. INCIDENT 02/4/2. Dounreay (United Kingdom Atomic Energy

  18. Spatial Interaction Modeling to Identify Potentially Exposed Populations during RDD or IND Terrorism Incidents

    International Nuclear Information System (INIS)

    Regens, J.L.; Gunter, J.T.; Gupta, S.

    2009-01-01

    Homeland Security Presidential Directive no.5 (HSPD-5) Management of Domestic Incidents and Department of Homeland Security (DHS) Planning Guidance for Protection and Recovery Following Radiological Dispersal Device (RDD) and Improvised Nuclear Device (IND) Incidents underscore the need to delineate radiological emergency guidance applicable to remedial action and recovery following an RDD or IND incident. Rapid delineation of the population potentially exposed to ionizing radiation from fallout during terrorist incidents involving RDDs or low-yield nuclear devices (≤ 20 KT) is necessary for effective medical response and incident management as part of the recovery process. This paper illustrates the application of spatial interaction models to allocate population data for a representative U.S. urban area (≅1.3M people; 1,612.27 km 2 area) at a geographical scale relevant for accurately estimating risk given dose concentrations. Estimated total dose equivalents (TEDE) are calculated for isopleths moving away from the detonation point for typical release scenarios. Population is estimated within the TEDE zones using Euclidean distances between zip code polygon centroids generated in ArcGIS version 9.1 with distance decay determined by regression analysis to apportion origin-destination pairs to a population count and density matrix on a spatial basis for daytime and night-time release scenarios. (authors)

  19. A simple approach to measure transmissibility and forecast incidence.

    Science.gov (United States)

    Nouvellet, Pierre; Cori, Anne; Garske, Tini; Blake, Isobel M; Dorigatti, Ilaria; Hinsley, Wes; Jombart, Thibaut; Mills, Harriet L; Nedjati-Gilani, Gemma; Van Kerkhove, Maria D; Fraser, Christophe; Donnelly, Christl A; Ferguson, Neil M; Riley, Steven

    2018-03-01

    Outbreaks of novel pathogens such as SARS, pandemic influenza and Ebola require substantial investments in reactive interventions, with consequent implementation plans sometimes revised on a weekly basis. Therefore, short-term forecasts of incidence are often of high priority. In light of the recent Ebola epidemic in West Africa, a forecasting exercise was convened by a network of infectious disease modellers. The challenge was to forecast unseen "future" simulated data for four different scenarios at five different time points. In a similar method to that used during the recent Ebola epidemic, we estimated current levels of transmissibility, over variable time-windows chosen in an ad hoc way. Current estimated transmissibility was then used to forecast near-future incidence. We performed well within the challenge and often produced accurate forecasts. A retrospective analysis showed that our subjective method for deciding on the window of time with which to estimate transmissibility often resulted in the optimal choice. However, when near-future trends deviated substantially from exponential patterns, the accuracy of our forecasts was reduced. This exercise highlights the urgent need for infectious disease modellers to develop more robust descriptions of processes - other than the widespread depletion of susceptible individuals - that produce non-exponential patterns of incidence. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Risk assessment of major hazards and its application in urban planning: a case study.

    Science.gov (United States)

    Zhou, Yafei; Liu, Mao

    2012-03-01

    With the rapid development of industry in China, the number of establishments that are proposed or under construction is increasing year by year, and many are industries that handle flammable, explosive, toxic, harmful, and dangerous substances. Accidents such as fire, explosion, and toxic diffusion inevitably happen. Accidents resulting from these major hazards in cities cause a large number of casualties and property losses. It is increasingly important to analyze the risk of major hazards in cities realistically and to suitably plan and utilize the surrounding land based on the risk analysis results, thereby reducing the hazards. A theoretical system for risk assessment of major hazards in cities is proposed in this article, and the major hazard risk for the entire city is analyzed quantitatively. Risks of various major accidents are considered together, superposition effect is analyzed, individual risk contours of the entire city are drawn out, and the level of risk in the city is assessed using "as low as reasonably practicable" guidelines. After the entire city's individual risk distribution is obtained, risk zones are divided according to corresponding individual risk value of HSE, and land-use planning suggestions are proposed. Finally, a city in China is used as an example to illustrate the risk assessment process of the city's major hazard and its application in urban land-use planning. The proposed method has a certain theoretical and practical significance in establishing and improving risk analysis of major hazard and urban land-use planning. On the one hand, major urban public risk is avoided; further, the land is utilized in the best possible way in order to obtain the maximum benefit from its use. © 2011 Society for Risk Analysis.