Dougherty, P J
The use of armored vehicles since the First World War has created a subset of casualties with a different epidemiology than infantry soldier casualties. The preponderance of armored fighting vehicles (AFVs) in the world's armies make their use in a future war likely. The purpose of this paper is to review the nature of possible injuries to crewmembers of these vehicles by historical and experimental data. Injuries to armored vehicle crewmembers are characterized by a large number of burn casualties, a larger percentage of fractures and traumatic amputations with extremity wounds, and a higher mortality when compared with infantry footsoldier combat casualty statistics.
Chesser, Susan G
...." A detailed casualty summary that includes data on deaths by cause, as well as statistics on soldiers wounded in action, is available at DoD's web site at http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm.
Chesser, Susan G
...." A detailed casualty summary that includes data on deaths by cause, as well as statistics on soldiers wounded in action, is available at the following DoD website: [http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm].
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.
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...
...." A detailed casualty summary that includes data on deaths by cause, as well as statistics on soldiers wounded in action, is available at the following DoD website: [http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm].
.../]; click on "OIF/OEF Casualty Update." A detailed casualty summary that includes data on deaths by cause, as well as statistics on soldiers wounded in action, is available at the following DoD website: [http://web1.whs.osd.mil/mmid/casualty/OIF-Total.pdf].
universally accepted tool that allows health professionals to achieve this goal in a mass casualty situation. ... Head, Disaster Medicine, Western Cape Department of Health and Division of Emergency Medicine, University of Cape Town and .... This means that a new card has to be filled out with clinical data each time the ...
Smith, H B; Daniel, C S; Verma, S
The combined pressures of the European Working Time Directive, 4 h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London's 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London's two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76 034 patients in 2010/11) and 9.6% per year (to 31 128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel ‘referral pathway' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London's eye casualty services in the future. PMID:23370420
Beekley, Alex C
.... Analysis of multiple and mass casualty events from current conflicts can provide critical lessons learned regarding triage and resource utilization that can potentially be applied to other conflicts...
Fricker, Tyler; Elsner, James B.; Jagger, Thomas H.
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.
Medicine, 1999, 164(8), Supplement. 23. Blood CG, Anderson ME. The Battle for Hue: Casualty and Disease Rates during Urban Warfare, Military Medicine...NAVAL HEALTH RESEARCH CENTER MODELING CASUALTY SUSTAINMENT DURING PEACEKEEPING OPERATIONS G. J. Walker C. G. Bloodl...Report No. 03-21 Approved for public release; distribution unlimited. NAVAL HEALTH RESEARCH
External Defibrillator AF – Assault Force ARS – Acute Radiation Sickness CBRN – Chemical, Biological, Radiological and Nuclear CNS – Casualty...relates to the networking of information flow in combat casualty care. This description will lie out the fundamental concepts of network theory and relate
Spence, R.J.S.; So, E.K.M.
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.
Trendafiloski, G.; Wyss, M.; Wyss, B. M.
When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral
Butler, Frank K
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences. The product of that 3-year research project was TCCC, the first-ever set of battlefield trauma care guidelines designed to combine good medicine with good small-unit tactics. Published by Elsevier Inc.
Dunne, James R; Lee, Tzong-Hae; Burns, Christopher; Cardo, Lisa J; Curry, Kathleen; Busch, Michael P
...) 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...
Cancio, Leopoldo C; Pruitt, Basil A
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...
Ömür Yaşar SAATÇİOĞLU
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.
I N S T I T U T E F O R D E F E N S E A N A L Y S E S Casualty Estimation for Nuclear and Radiological Weapons Carl A. Curling INSTITUTE FOR...S E S IDA Paper P-5220 Casualty Estimation for Nuclear and Radiological Weapons Carl A. Curling This page is intentionally blank. iii Executive... nuclear devices (IND), as well as conventional nuclear weapons .”1 This analysis describes exemplar nuclear and radiological weapon threats; the
... 46 Shipping 7 2010-10-01 2010-10-01 false Written report of casualty. 197.486 Section 197.486... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The person-in-charge of a vessel or facility for which a notice of casualty was made under § 197.484 shall...
.... Because the logistics of shipboard casualty evacuation can be problematic, reliable estimates of the medical resources needed aboard ships are critical to the timely treatment of any battle wounds sustained...
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
Gant, K.S.; Haaland, C.M.
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
Sep 21, 2015 ... Background: 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. Objective: To share our experience in ...
Boa, J. Michael; Gorvett, Rick
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…
their illegal squatting at Bulhoek and the events of 24 May 1921. The second article is entitled: Theprice of fanaticism: the casualties of the Bulhoek massacre. It focuses on the casualties of the massacre on the side of the Israelites and shows that the high number of. Israelites who lost their lives during the incident was due ...
... 46 Shipping 7 2010-10-01 2010-10-01 false Notice of casualty. 197.484 Section 197.484 Shipping... GENERAL PROVISIONS Commercial Diving Operations Records § 197.484 Notice of casualty. (a) In addition to... by this section is not required if the written report required by § 197.486 is submitted within 5...
... 46 Shipping 7 2010-10-01 2010-10-01 false Retention of records after casualty. 197.488 Section 197... HEALTH STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.488 Retention of records... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or...
... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false State casualty reporting system... HOMELAND SECURITY (CONTINUED) BOATING SAFETY STATE NUMBERING AND CASUALTY REPORTING SYSTEMS Casualty Reporting System Requirements § 174.106 State casualty reporting system optional sections. In addition to...
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)
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.
... participant. Applicant submits that the joint arrangement between THC and RCI, which was designed to create...] Riverside Casualty, Inc.; Notice of Application February 8, 2011. AGENCY: Securities and Exchange Commission (``Commission''). [[Page 8789
Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik
The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE.
Patterson, Steven E; Moeller, Bryant; Nagasawa, Herbert T; Vince, Robert; Crankshaw, Daune L; Briggs, Jacquie; Stutelberg, Michael W; Vinnakota, Chakravarthy V; Logue, Brian A
Cyanide is a metabolic poison that inhibits the utilization of oxygen to form ATP. The consequences of acute cyanide exposure are severe; exposure results in loss of consciousness, cardiac and respiratory failure, hypoxic brain injury, and dose-dependent death within minutes to hours. In a mass-casualty scenario, such as an industrial accident or terrorist attack, currently available cyanide antidotes would leave many victims untreated in the short time available for successful administration of a medical countermeasure. This restricted therapeutic window reflects the rate-limiting step of intravenous administration, which requires both time and trained medical personnel. Therefore, there is a need for rapidly acting antidotes that can be quickly administered to large numbers of people. To meet this need, our laboratory is developing sulfanegen, a potential antidote for cyanide poisoning with a novel mechanism based on 3-mercaptopyruvate sulfurtransferase (3-MST) for the detoxification of cyanide. Additionally, sulfanegen can be rapidly administered by intramuscular injection and has shown efficacy in many species of animal models. This article summarizes the journey from concept to clinical leads for this promising cyanide antidote. © 2016 New York Academy of Sciences.
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.
Egan, Joseph R.; Amlôt, Richard
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. PMID:23202768
Blood, Christopher G; Zhang, Jinjin; Walker, G Jay
Projections of the casualties expected during peacekeeping operations allow medical planners to assess in advance the medical resources needed to support such operations. Data detailing fatalities incurred in previous peacekeeping operations were extracted from several U.N. sources. From these data, rates of killed-in-action were computed for the deployed forces. One hundred eighty-eight peacekeeping incidents in which casualties were sustained were also examined to derive wounded-in-action rates. The estimated mean wounded-in-action rate for these operations was 3.16 per 1,000 strength per year; the estimated wounded-in-action rate for individual operations ranged from 0.49 to 12.50. There were an average of 3.8 wounded and 0.86 killed in the 188 casualty incidents examined. Thirty-eight percent of the wounds were described as serious. The casualty incidence derived in this study can provide a basis for estimating the casualties likely in future peacekeeping operations.
Zhang, Guangnan; Yau, Kelvin K W; Zhang, Xun; Li, Yanyan
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.
Greenwalt, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hibbard, W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)
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.
NAVAL HEALTH RESEARCH CENTER AD-A271 748 THE BATTLE FOR HUE: CASUALTY AND DISEASE RATES DURING URBAN WARFARE C. G. Blood M. E. Anderson DTIC...prior to the first casualties being sustained. 2 The Battle for Flue: Casualty and Disease Rates During Urban Warfare Renewed nationalism with the ending...TITLE AND SUBTITLE 5. FUNDING NUMBERS The Battle for Hue: Casualty and Disease Rates Program Element: 63706N During Urban Warfare Work Unit Number: 6
Bingham, C. R.; Shope, J. T.
This study identified casualty crash types for which teen drivers experience excess risk relative to adults. Michigan State Police crash records were used to examine casualty crashes in two statewide populations of drivers who experienced at least one crash from 1989–1996 (pre-graduated driver licensing in Michigan): teens (ages 16–19) and adults (ages 45–65). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two stat...
..., casualty, or act of God. 25.282 Section 25.282 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO... From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid by... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer between...
... reporting system. 174.101 Section 174.101 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) BOATING SAFETY STATE NUMBERING AND CASUALTY REPORTING SYSTEMS Casualty Reporting System Requirements § 174.101 Applicability of State casualty reporting system. (a) A State...
Nov 4, 2012 ... Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. Materials and Methods:A retrospective analysis of the records of patients managed in the Jos civil crisis of September. 2001, in Plateau State, Nigeria. Information extracted included ...
based Casualty Assessment (ORCA) software package contains models which track penetrating fragments and determine the likelihood of injury caused by the...pedestrian and bicycle accidents,” The Institute of Traffic Accident Investigators. Proceedings of the 5th Interantional Conference: 17th and 18th
2006.1 These figures combine two counts: one from the Iraq Ministry of Health, which records deaths reported by hospitals; and one from the Medico ...casualties as well using an IBC-like method of posting media reports of deaths. ICCC, like IBC, is prone to the kind of errors likely when using media
... repairs do not care for more than the damage suffered, and (d) the value of the property after the repairs... 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...
and Mass Casualty Management: Some Useful. Observations from the Israeli Trauma Model ... and websites of trauma organizations. Israel has a unique trauma system of organizing ... on continuous education, manpower training, motivation, team‑work and creation of public volunteers through advocacy is important for ...
Badal, J.; Vázquez-Prada, M.; González, Á.
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...
torso trauma and respiratory distress Sucking chest wounds should be treated by applying a petroleum gauze during expiration, covering it with tape...be treated with a petroleum gauze applied during expiration, covering it with tape or a field dressing, placing the casualty In the sitting...nonsteroidals primarily because it did not inter- fere with platelet function, as aspirin and cyclooxygenase 1 nonsteroidal anti-inflammatory drugs
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.
Rassin, Michal; Avraham, Miri; Nasi-Bashari, Anat; Idelman, Sigalit; Peretz, Yaniv; Morag, Shani; Silner, Dina; Weiss, Gali
In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.
Strommen, Joshua J.; Waterman, Scott M.; Mitchell, Christopher A.; Grogan, Brian F.
On April 2, 2014, in Fort Hood, Texas, an active shooter incident occurred where four active duty soldiers were tragically killed. Active shooter incidents are becoming alarmingly more frequent over the last decade in the USA. The authors provide a detailed account of the events that occurred within the hospital and an evaluation of the triage decisions made on that day. A detailed review of mass casualty preparedness and the general approach to triage processes are also described.
Yu, Xunyi; Ganz, Aura
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.
Weng, Jinxian; Zhu, Jia-Zheng; Yan, Xuedong; Liu, Zhiyuan
Investigation of the casualty crash characteristics and contributory factors is one of the high-priority issues in traffic safety analysis. In this paper, we propose a method based on association rules to analyze the characteristics and contributory factors of work zone crash casualties. A case study is conducted using the Michigan M-94/I-94/I-94BL/I-94BR work zone crash data from 2004 to 2008. The obtained association rules are divided into two parts including rules with high-lift, and rules with high-support for the further analysis. The results show that almost all the high-lift rules contain either environmental or occupant characteristics. The majority of association rules are centered on specific characteristics, such as drinking driving, the highway with more than 4 lanes, speed-limit over 40mph and not use of traffic control devices. It should be pointed out that some stronger associated rules were found in the high-support part. With the network visualization, the association rule method can provide more understandable results for investigating the patterns of work zone crash casualties. Copyright © 2016 Elsevier Ltd. All rights reserved.
Management of radiation mass casualty exposure that may occur as a result of nuclear or radiation accident will depend on the type of accident, and of the knowledge about the actual radiation exposure situation for those who might be involved. Management of the public after an accident in a nuclear or radiation installation will follow existing specific emergency plans, and will take advantage of existing radiation monitoring systems. In other radiation mass casualty exposures, whenever accidental or malevolent use of radiation, there will be a requirement to employ screening programs for indentifying and sorting out exposed people (radiological triage), who will need medical treatment and/or other assistance like decontamination and individual dose assessment. In the later stage after the accident the monitoring for dose assessment purposes for those who will need medical or public health assistance will be required. Demand for dose assessment for large groups of individuals may create the need for international assistance. Prompt and credible public information is vital in all radiation emergencies, and it would be even more important in situations when radiation mass casualties result from exposures to nuclear or radiological material out of regulatory control. In such situations unpredictability of the event creates increase in the risk perception and public communication activities of the authorities will be the key element to prevent unnecessary fear and panic, and the measure to reassure the populace.
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
Jokela, Jorma; Simons, Tomi; Kuronen, Pentti; Tammela, Juha; Jalasvirta, Pertti; Nurmi, Jouni; Harkke, Ville; Castrén, Maaret
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.
Chung, Kevin K; Juncos, , Luis A; Wolf, Steven E; Mann, Elizabeth E; Renz, Evan M; White, Christopher E; Barillo, David J; Clark, Richard A; Jones, John A; Edgecombe, Harcourt P
.... We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria for acute kidney injury. Methods...
Graham, James; Shirm, Steve; Liggin, Rebecca; Aitken, Mary E; Dick, Rhonda
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.
Blakeman, Thomas C; Rodriquez, Dario; Dorlac, Warren C; Hanseman, Dennis J; Hattery, Ellie; Branson, Richard D
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
Fricker, T.; Elsner, J.
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.
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...
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 ...
Postma, Ingri L E; Weel, Hanneke; Heetveld, Martin J; van der Zande, Ineke; Bijlsma, Taco S; Bloemers, Frank W; Goslings, J Carel
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.
... 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...
... 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...
Ebeling, C F
From Kamikaze to Exocet, by learning from history a tool for casualty calculation in modern naval warfare is available, indicating absolute casualty figures per SS guided missile hit. The figures 35 wounded and 30 killed per hit ought to be used.
Ohsaka, Hiromichi; Ishikawa, Kouhei; Omori, Kazuhiko; Jitsuiki, Kei; Yoshizawa, Toshihiko; Yanagawa, Youichi
At approximately 10 o'clock in September 2015, a minibus carrying 18 people accidentally slid backwards because of a malfunctioning brake system while climbing a steep incline on Togasayama Mountain, colliding with a van (Toyota HiAce wagon) carrying 11 people that was situated behind the minibus. Togasayama Mountain is located 1 hour by car and 10 minutes by helicopter from our hospital. The minibus slid off a roadside cliff at a height of 0.5 m and rolled over after colliding with the van. There were 7 victims with yellow tags and 22 with green tags. Two Doctor Helicopters and 1 Doctor Car cooperated with the fire departments by providing medical treatments, selection of medical facilities, and dispersion transportation. In this mass casualty event, there were no mortalities, and all of the victims recovered without sequelae. The coordinated and combined use of Doctor Helicopters and Doctor Cars in addition to the activities of the fire department in response to a mass casualty event resulted in appropriate triage, medical treatments, selection of medical facilities, and dispersion transportation. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
Franke, A; Bieler, D; Friemert, B; Kollig, E; Flohe, S
Due to the recent terrorist attacks in Paris, Brussels, Ansbach, Munich, Berlin and more recently Manchester and London, terrorism is realized as a present threat to our society and social life, as well as a challenge for the health care system. Without fueling anxiety, there is a need for sensitization to this subject and to familiarize all concerned with the special kind of terrorist attack-related injuries, the operational priorities and tactics and the individual basic principles of preclinical and hospital care. There is a need to adapt the known established medical structure for a conventional mass casualty situation to the special requirements that are raised by this new kind of terrorist threat to our social life. It is the aim of this article, from a surgical point of view, to depict the tactics and challenges of preclinical care of the special kind of terrorist attack-related injuries from the site of the incident, via the advanced medical post or casualty collecting point, to the triage point at the hospital. The special needs of medical care and organizational aspects of the primary treatment in the hospital are highlighted and possible decisional options and different approaches are discussed.
Siman-Tov, Maya; Radomislensky, Irina; Peleg, Kobi
The objective of this study was to describe demographic and injury characteristics of hospitalized injured patients involved in e-bike and motorized scooter accidents at a national level in Israel divided by different road user groups: riders and pedestrians. This was a retrospective study based on data from the National Trauma Registry, between January 1, 2013, and December 31, 2015. All hospitalized casualties due to the involvement of an e-bike or motorized scooter were included. The type of hospitalized road user was further categorized and described by different variables. During the study period, the Israel Trauma Registry identified 795 hospitalized patients due to an e-bike or motorized scooter accident, with a dramatic 6-fold increase from 2013 to 2015. Although the majority of the injured patients were riders, 8% were pedestrians. Among the total casualties, 33% were children aged 0-14 years and among pedestrians 42% were children and 33% were seniors (ages 60+). Five persons died in hospital, 3 riders and 2 pedestrians. E-bike and motorized scooter riders represent the majority of patients hospitalized due to related traffic incident. This finding questions the social and economic advantages of electric-powered 2-wheeled vehicles.
Li, Shuang; Yu, Xiaohui; Zhang, Yanjuan; Zhai, Changhai
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.
Evans, Robert G
"There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning." (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare.
Butler, Frank K
The prevailing wisdom for the prehospital fluid resuscitation of trauma victims in hemorrhagic shock in 1992 was to administer 2 L of crystalloid solution as rapidly as possible. A review of the fluid resuscitation literature found that this recommendation was not well supported by the evidence at the time. Prehospital fluid resuscitation strategies were reevaluated in the 1993-1996 Tactical Combat Casualty Care (TCCC) research program. This article reviews the advances in prehospital fluid resuscitation as recommended by the original TCCC Guidelines and modified over the following 2 decades. These advances include hypotensive resuscitation, use of prehospital whole blood or blood components when feasible, and use of Hextend or selected crystalloids when logistical considerations make blood or blood component use not feasible. Published by Elsevier Inc.
Schreiber, Shaul; Yoeli, Naomi; Paz, Gedalia; Barbash, Gabriel I; Varssano, David; Fertel, Nurit; Hassner, Avi; Drory, Margalit; Halpern, Pinchas
Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite
Chen, Jin-Hong; Yang, Jun; Yang, Yu; Zheng, Jing-Chen
Objective: To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China. Data Sources: Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014). The English literature was searched by PubMed (MEDLINE) (1950 to June 2014). We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/), National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/), and China Earthquake Information (http://www.csi.ac.cn/). Study Selection: We included studies associated with mass casualty events related to China, the PT applied in China, guidelines and standards, and application and development of the carding PT method in China. Results: From 3976 potentially relevant articles, 22 met the inclusion criteria, 20 Chinese, and 2 English. These articles included 13 case reports, 3 retrospective analyses of MCI, two methods introductions, three national or sectoral criteria, and one simulated field testing and validation. There were a total of 19 kinds of MCI PT methods that have been reported in China from 1950 to 2014. In addition, there were 15 kinds of PT methods reported in the literature from the instance of the application. Conclusions: The national and sectoral current triage criteria are developed mainly for earthquake relief. Classification is not clear. Vague criteria (especially between moderate and severe injuries) operability are not practical. There are no triage methods and research for children and special populations. There is no data and evidence supported triage method. We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real, practical, and efficient PT method. PMID:26415807
Studer, Nicholas M; Driscoll, Ian R; Daly, Ivonne M; Graybill, John C
Burns are frequently encountered on the modern battlefield, with 5% - 20% of combat casualties expected to sustain some burn injury. Addressing immediate life-threatening conditions in accordance with the MARCH protocol (massive hemorrhage, airway, respirations, circulation, hypothermia/head injury) remains the top priority for burn casualties. Stopping the burning process, total burn surface area (TBSA) calculation, fluid resuscitation, covering the wounds, and hypothermia management are the next steps. If transport to definitive care is delayed and the prolonged field care stage is entered, the provider must be prepared to provide for the complex resuscitation and wound care needs of a critically ill burn casualty. 2015.
Mabry, Robert L; Holcomb, John B; Baker, Andrew M; Cloonan, Clifford C; Uhorchak, John M; Perkins, Denver E; Canfield, Anthony J; Hagmann, John H
.... 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...
Monteith, Raymond G; Pearce, Laurie D R
Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate.
Flynn, Daniel F; Goans, Ronald E
This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism.
Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; Larner, Joanne; Matar, Hazem; Chilcott, Robert P
Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the "ladder-pipe system" for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination.
Davidson, James E., Sr.
A Small Business Innovative Research (SBIR) contract was recently awarded to a start up company for the development of an infrared (IR) image based combat casualty care system. The company, Medical Thermal Diagnostics, or MTD, is developing a light weight, hands free, energy efficient uncooled IR imaging system based upon a Texas Instruments design which will allow emergency medical treatment of wounded soldiers in complete darkness without any type of light enhancement equipment. The principal investigator for this effort, Dr. Gene Luther, DVM, Ph.D., Professor Emeritus, LSU School of Veterinary Medicine, will conduct the development and testing of this system with support from Thermalscan, Inc., a nondestructive testing company experienced in IR thermography applications. Initial research has been done with surgery on a cat for feasibility of the concept as well as forensic research on pigs as a close representation of human physiology to determine time of death. Further such studies will be done later as well as trauma studies. IR images of trauma injuries will be acquired by imaging emergency room patients to create an archive of emergency medical situations seen with an infrared imaging camera. This archived data will then be used to develop training material for medical personnel using the system. This system has potential beyond military applications. Firefighters and emergency medical technicians could directly benefit from the capability to triage and administer medical care to trauma victims in low or no light conditions.
Hanley, Michael E; Bogdan, Gregory M
Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacations. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective.
Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo
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
Adini, B; Bodas, M; Nilsson, H; Peleg, K
Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of >80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents' origin country. 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. Copyright © 2017 Elsevier Ltd. All rights reserved.
Thompson, Shannon N; Wilson, Zachary W; Cole, Christopher B; Kennedy, Andrew R; Aycock, Ryan D
Although lightning strikes are a rare occurrence, their significance cannot be ignored given military operations in the field during all types of weather. With proper medical management, patients with lightning injuries can return to duty. Information for this case report comes from eyewitness account at the 6th Ranger Training Battalion and from review of physician documentation from the 96th Medical Group, Eglin Air Force Base, Florida. A lightning strike injured 44 Ranger School participants during a training exercise on August 12, 2015, at Camp Rudder, Florida. These patients were triaged in the field and transported to emergency department of Eglin Air Force Base. Of the 44 casualties, 20 were admitted. All were returned to duty the following day. One patient had cardiac arrest. This patient, along with two others, was admitted to the intensive care unit. Seventeen other patients were admitted for observation for rhabdomyolysis and/or cardiac arrhythmias. One patient was admitted with suspected acute kidney injury indicated by an elevated creatinine. All patients, including those admitted to the intensive care unit, were released on the day following the lightning strike without restrictions and were allowed to return to duty with increased medical monitoring. This case report highlights the need for proper triage and recognition of lightning strike injury, coordination of care between field operations and emergency department personnel, and close follow-up for patients presenting with lightning injury. Symptoms, physical exam, and laboratory findings from rigorous training can be difficult to distinguish from those resulting from lightning injury. Secondary injuries resulting from blunt trauma from falls may have been prevented by the use of the lightning strike posture. Further analysis of procedures and standard operating protocols to mitigate risk during thunderstorms may be required to prevent lightning's effects on large groups of military personnel
Yanagawa, Youichi; Omori, Kazuhiko; Ishikawa, Kouhei; Takeuchi, Ikuto; Jitsuiki, Kei; Yoshizawa, Toshihiko; Sato, Jun; Matsumoto, Hideyuki; Tsuchiya, Masaru; Osaka, Hiromichi
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).
Safdar, C. A.
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)
O'Donnell, F.R.; Hoy, H.C.
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
Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A
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.
resuscitation and surgery . Inherent in the survival of casualties with such devastating injuries is both the risk for invasive infections and the need for...injured combat casualties receiving far-forward resuscitation, damage control surgery , and rapid evacuation in recent overseas contingency opera- tions...included resuscitative thoracotomy, pelvic external fixation, laparotomy for proximal vascular control and fecal diversion, and debridement of traumatic
Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.
Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the “ladder-pipe system” for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794
Singh, Rita; Bhatnagar, P.K.
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)
Callaway, David W
Combat operations necessitate bold thought and afford the opportunity to rapidly evolve and improve trauma care. The development and maturation of Tactical Combat Casualty Care (TCCC) is an important example of a critical process improvement strategy that reduced mortality in high-threat combat-related trauma. The Committee for Tactical Emergency Casualty Care (C-TECC) adapted the lessons of TCCC to the civilian high-threat environment and provided important all-hazards response principles for austere, dynamic, and resource-limited environments. The Hartford Consensus mobilized the resources of the American College of Surgeons to drive public policy regarding a more singular focus: hemorrhage control. The combined efforts of C-TECC and Hartford Consensus have helped redefine the practice of trauma care in high-threat scenarios across the United States. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
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
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.
... Fiscal Service Surety Companies Acceptable on Federal Bonds: Termination; ULLICO Casualty Company AGENCY... Company (NAIC 37893) under 31 U.S.C. 9305 to qualify as an acceptable surety on Federal bonds is... bonds, including continuous bonds, currently in force with above listed Company, bond-approving officers...
... 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...
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 ...
care 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Patel S., Rasmussen T. E., Gifford S. M., Apodaca A. N...Holcomb JB. The 2004 Fitts Lecture: current perspective on combat casualty care. J Trauma. 2005;59:990. 6. Eastridge BJ, Jenkins D, Flaherty S
Postma, Ingri L. E.; Weel, Hanneke; Heetveld, Martin J.; van der Zande, Ineke; Bijlsma, Taco S.; Bloemers, Frank W.; Goslings, J. Carel
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
Postma, Ingri L. E.; Beenen, L. F. M.; Bijlsma, T. S.; Berger, F. H.; Heetveld, M. J.; Bloemers, F. W.; Goslings, J. C.
In mass casualty incidents (MCI) a large number of patients need to be evaluated and treated fast. Well-designed radiological guidelines can save lives. The purpose of this study was to evaluate the Advanced Trauma Life Support (ATLS) radiological guidelines in the MCI of an aeroplane crash. Medical
Jackson, Elizabeth G.
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…
Streckbein, S; Kohlmann, T; Luxen, J; Birkholz, T; Prückner, S
Since the publication of the first mass casualty triage protocol approximately 30 years ago, numerous adaptions and alternatives have been introduced and are currently in use throughout the world. This variety may represent a challenge for the cooperation between emergency medical providers and the interoperability of emergency medical services often required during mass casualty incidents. To enhance cooperation and interoperability a standardization of triage protocols is required. This survey was carried out in order to identify and characterize published triage protocols on national and international levels. Furthermore, evidence for validation of the identified triage algorithms was discussed and recommendations for standardization of triage protocols are given. In a systematic literature search 59 relevant articles were identified and evaluated with respect to the given objectives. A total of 12 triage concepts were identified and characterized which are categorized according to the basic principle. The endpoints of the studies, the chosen observation units and the mode of data collection were discussed with respect to their impact on validation. Furthermore, the impact of the degree and dynamics of system capacity overload, which are pathognomonic for mass casualty incidents, were discussed. There is not sufficient evidence to declare one of the triage protocols superior in all aspects to the others and no triage protocol has been implemented on a comprehensive level in Germany. In order to initialize a national or regional convergence process towards an interoperability of emergency medical services, the model uniform core criteria for mass casualty triage approach has been identified as being appropriate.
... Management Service, Financial Accounting and Services Division, Surety Bond Branch, 3700 East-West Highway... Mutual Casualty Company AGENCY: Financial Management Service, Fiscal Service, Department of the Treasury..., published July 1, 2011, at 76 FR 38892. FOR FURTHER INFORMATION CONTACT: Surety Bond Branch at (202) 874...
... 20782. Dated: September 24, 2010. Laura Carrico, Director, Financial Accounting and Services Division...-- Allegheny Casualty Company AGENCY: Financial Management Service, Fiscal Service, Department of the Treasury..., published July 1, 2010, at 75 FR 38192. FOR FURTHER INFORMATION CONTACT: Surety Bond Branch at (202) 874...
Ünlü, A; Cetinkaya, R A; Ege, T; Ozmen, P; Hurmeric, V; Ozer, M T; Petrone, P
In recent military conflicts, military surgeons encounter more high-energy injuries associated with explosives. Advances in the field care and shorter evacuation time increased survival. However, casualties still incur severe injuries especially to the extremities. We present wound patterns, anatomical distribution and severity of injuries in a Role 2 hospital. Two years data have been retrospectively reviewed. Only explosives and firearms injuries were included in the study. Patient profile, admission details, mechanism of injury, AIS anatomical locations, ISS, surgical and medical treatments have been analyzed. Data revealed 170 male casualties. IEDs and GSW accounted for 133 (78%) and 37 (22%) casualties, respectively. An average of 1.8 IED and 1.2 GSW anatomical locations were exposed to injuries. Regardless of the mechanism, injuries were most commonly located in the extremities. IEDs caused significantly higher soft tissue injuries. Explosives do not necessarily cause more severe injuries than firearms. However, fragments create multiple, complicated soft tissue injuries which constitute more than half of the injuries. Timely wound debridement and excision of contaminated tissue are crucial to manage extremity soft tissue injuries. Casualty care should be assessed within the context of the capabilities present at a hospital and the cause, type and severity of the wounds. The NATO description of Role 2 care only requires an integrated surgical team for damage control surgery with limited diagnostic and infrastructural capabilities.
... 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...
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
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
Recent events involving a significant number of casualties have emphasised the importance of appropriate preparation for receiving hospitals, especially Emergency Departments, during the initial response phase of a major incident. Development of a mass casualty resilience and response framework in the Northern Trauma Network included a review of existing planning assumptions in order to ensure effective resource allocation, both in local receiving hospitals and system-wide.Existing planning assumptions regarding categorisation by triage level are generally stated as a ratio for P1:P2:P3 of 25%:25%:50% of the total number of injured survivors. This may significantly over-, or underestimate, the number in each level of severity in the case of a large-scale incident. A pilot literature review was conducted of the available evidence from historical incidents in order to gather data regarding the confirmed number of overall casualties, 'critical' cases, admitted cases, and non-urgent or discharged cases. This data was collated and grouped by mechanism in order to calculate an appropriate severity ratio for each incident type. 12 articles regarding mass casualty incidents from the last two decades were identified covering three main incident types: (1) Mass transportation crash, (2) Building fire, and (3) Bomb and related terrorist attacks and involving a total of 3615 injured casualties. The overall mortality rate was calculated as 12.3%. Table 1 summarises the available patient casualty data from each of the specific incidents reported and calculated proportions of critical ('P1'), admitted ('P2'), and non-urgent or ambulatory cases ('P3'). Despite the heterogeneity of data and range of incident type there is sufficient evidence to suggest that current planning assumptions are incorrect and a more refined model is required. An important finding is the variation in proportion of critical cases depending upon the mechanism. For example, a greater than expected proportion
Miller, Benjamin T; Lin, Andrew H; Clark, Susan C; Cap, Andrew P; Dubose, Joseph J
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.
Coleman, Liz; Piper, Keith
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
Goldman, Sharon; Siman-Tov, Maya; Bahouth, H; Kessel, B; Klein, Y; Michaelson, M; Miklosh, B; Rivkind, A; Shaked, G; Simon, D; Soffer, D; Stein, M; Peleg, Kobi
According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties. 1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user. A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals. During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths
Plat, Marie-Christine J.; Badloe, John F.; Hess, John R.; Hoencamp, Rigo
Introduction The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties. Materials and Methods Hemovigilance and combat casualties data from Afghanistan 2006–2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1–5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP. Results No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products. Conclusion This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in
Hill, Martin; Galameau, Mike; Pang, Gerry; Konoske, Paula
... to treat victims of biochemical agents on the battlefield. This study reviewed Marine Corps medical supply blocks for biological and chemical warfare casualties - Authorized Medical Allowance Lists (AMALs) 687 and 688...
Cordts, Paul R; Brosch, Laura A; Holcomb, John B
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...
Melnyk, Richard; Schrage, Daniel; Volovoi, Vitali; Jimenez, Hernando
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
Critchley, Eric P; Smirniotopoulos, James G
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.
Urrutia, J D; Bautista, L A; Baccay, E B
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.
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, implying
Spagat, M; Restrepo, J
We develop a new, quantitative approach to the analysis of human security during armed conflict and apply this methodology to the Colombian conflict, 1988-2003. We consider 21 different attack types (unopposed events) plus clashes between pairs of armed groups. For each event type we determine the number of civilian killings and injuries (casualties), the armed group(s) involved and the population density of the municipalities where these events occur. We also study the dynamics of civilian c...
will to resist the enemy. Chaplain support impacts on the soldier’s mo -ale and his combat effective- ness as a fighting force. Inability to provide...uncertainty and fatigue In order to break their will to resist at all echelons. Casualties In the first and second echelons will be inordinately high...210 Pediculosis, Mod 211 Scabies , Mod 212 Pilonial Cyst/Abscess 455 76 213 Pilonial Cyst, Mod 411 59 214 Ingrown Toenails, Severe 43 7 215
Turner, Conor D. A.; Lockey, David J.; Rehn, Marius
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...
Ozoilo, K N; Amupitan, I; Peter, S D; Ojo, E O; Ismaila, B O; Ode, M; Adoga, A A; Adoga, A S
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.
of the grieving family members and less on administrative tasks. Previous Work A considerable amount of previous work was done as part of this...The software did not handle less than perfect data sets, it would break on a missing casualty social security number or badly formed Excel...BE A SYSTEM ADMINISTRATOR OR HAVE ADMINISTRATOR PRIVILEDGES ON YOUR COMPUTER. Installation requires you to: 1. Download the software from either
hemofiltration,56 CVVH, and peritoneal dialysis .57 Given these experiences, medical doctrine has evolved to incorporate RRT in select ech- elon or...identify capability gaps, while researchers at home investigate solutions to fill them. CONCLUSION Advances in trauma care and combat casualty care re...WJ, Morley SW, et al. Respiratory dialysis with an active-mixing extracorporeal carbon dioxide removal system in a chronic sheep study. Intensive Care
pleural space at either the second ICS at the MCL or the fourth or fifth ICS AAL and is not suitable for optimal use in ND. 1, 4 The majority of...Consider chest tube insertion if no improvement and/or long transport is anticipated. c. Most combat casualties do not require supplemental oxygen...JG, Kerr ST, et al.: Needle versus tube thoracostomy in a swine model of traumatic tension hemopneumpothorax Prehosp Emerg Care. 2009; 13:18-27 3
Palmer, Lee E; Maricle, Richard; Brenner, Jo-Anne
Approximately 20% to 25% of trauma-related, prehospital fatalities in humans are due to preventable deaths. Data are lacking, however, on the nature and the prevalence of operational canine (OC) prehospital deaths. It is plausible that OCs engaged in high-threat operations are also at risk for suffering some type of preventable death. Tactical Combat Casualty Care has significantly reduced human fatality rates on the battlefield. Standardized guidelines specifically for prehospital trauma care have not been developed for the OC caregiver. An initiation has been approved by the Committee for Tactical Emergency Casualty Care to form a K9-Tactical Emergency Casualty Care (TECC) working group to develop such guidelines. The intent of the K9-TECC initiative is to form best practice recommendations for the civilian high-risk OC caregiver. These recommendations are to focus on interventions that (1) eliminate the major causes of canine out-of-hospital preventable deaths, (2) are easily learned and applied by any civilian first responder, and (2) minimize resource consumption. 2015.
Dr. Ann Rogers
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.
Vincent, Dale S; Sherstyuk, Andrei; Burgess, Lawrence; Connolly, Kathleen K
Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p learning to be an effective first responder. Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience.
Marla B. Keenan
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.
Jaiswal, Kishor; Wald, David J.; Earle, Paul S.; Porter, Keith A.; Hearne, Mike
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.
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
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
Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J
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
Mackenzie, Colin; Donohue, John; Wasylina, Philip; Cullum, Woodrow; Hu, Peter; Lam, David M
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
Qigen Lin; Ying Wang; Tianxue Liu; Yingqi Zhu; Qi Sui
The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China. 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used t...
Berkenstadt, Haim; Ziv, Amitai; Barsuk, Daphna; Levine, Inbal; Cohen, Amir; Vardi, Amir
Training anesthesiologists to treat nerve gas intoxication in a mass casualty scenario is a complicated task. The scenario is an unfamiliar medical situation involving the need to decontaminate patients before providing definitive medical treatment, and the need for physical protection to the medical team before decontamination. We describe the development of a simulation-based training program. In one site of a virtual hospital, anesthesiologists were trained in initial airway and breathing resuscitation before decontamination while wearing full protective gear. In another site, they were trained in the treatment of critically-ill patients with combined conventional and chemical injuries or severe intoxication. Intubation simulators of newborn, pediatric, and adult patients, advanced full-scale simulators, and actors simulating patients were used. Initial airway, breathing, and antidotal treatment were performed successfully, with or without full protective gear. The gas mask did not interfere with orotracheal intubation, but limited effective communication within the medical team. Chemical protective gloves were the limiting factor in the performance of medical tasks such as fixing the orotracheal tube. Twenty-two participants (88%) pointed out that the simulated cases represented realistic problems in this scenario, and all 25 participants found the simulated-based training superior to previous traditional training they had in this field. Using advanced simulation, we were able to train anesthesiologists to treat nerve gas intoxication casualties and to learn about the limitations of providing medical care in this setting. Advanced medical simulation can be used to train anesthesiologists to treat nonconventional warfare casualties. The limitations of medical performance in full protective gear can be learned from this training.
Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S
Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. Systematic review, level III.
Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L
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
Burgert, James M
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.
Claudius, Ilene; Kaji, Amy; Santillanes, Genevieve; Cicero, Mark; Donofrio, J Joelle; Gausche-Hill, Marianne; Srinivasan, Saranya; Chang, Todd P
Multiple modalities for simulating mass-casualty scenarios exist; however, the ideal modality for education and drilling of mass-casualty incident (MCI) triage is not established. Hypothesis/Problem Medical student triage accuracy and time to triage for computer-based simulated victims and live moulaged actors using the pediatric version of the Simple Triage and Rapid Treatment (JumpSTART) mass-casualty triage tool were compared, anticipating that student performance and experience would be equivalent. The victim scenarios were created from actual trauma records from pediatric high-mechanism trauma presenting to a participating Level 1 trauma center. The student-reported fidelity of the two modalities was also measured. Comparisons were done using nonparametric statistics and regression analysis using generalized estimating equations. Thirty-three students triaged four live patients and seven computerized patients representing a spectrum of minor, immediate, delayed, and expectant victims. Of the live simulated patients, 92.4% were given accurate triage designations versus 81.8% for the computerized scenarios (P=.005). The median time to triage of live actors was 57 seconds (IQR=45-66) versus 80 seconds (IQR=58-106) for the computerized patients (Pactors were felt to offer a more realistic encounter by 88% of the participants, with a higher associated stress level. While potentially easier and more convenient to accomplish, computerized scenarios offered less fidelity than live moulaged actors for the purposes of MCI drilling. Medical students triaged live actors more accurately and more quickly than victims shown in a computerized simulation.
Oliver, Samuel J; Brierley, Jennifer L; Raymond-Barker, Philippa C; Dolci, Alberto; Walsh, Neil P
To compare the effectiveness of a single-layered polyethylene survival bag (P), a single-layered polyethylene survival bag with a hot drink (P+HD), a multi-layered metalized plastic sheeting survival bag (MPS: Blizzard Survival), and a multi-layered MPS survival bag with 4 large chemical heat pads (MPS+HP: Blizzard Heat) to treat cold casualties. Portable cold casualty treatment methods were compared by examining core and skin temperature, metabolic heat production, and thermal comfort during a 3-hour, 0°C cold air exposure in 7 shivering, near-hypothermic men (35.4°C). The hot drink (70°C, ~400 ml, ~28 kJ) was consumed at 0, 1, and 2 hours during the cold air exposure. During the cold air exposure, core rewarming and thermal comfort were similar on all trials (P = .45 and P = .36, respectively). However, skin temperature was higher (10%-13%; P 2.7) and metabolic heat production lower (15%-39%; P .9) on MPS and MPS+HP than P and P+HD. The addition of heat pads further lowered metabolic heat production by 15% (MPS+HP vs MPS; P = .05; large effect size d = .9). The addition of the hot drink to polyethylene survival bag did not increase skin temperature or lower metabolic heat production. Near-hypothermic cold casualties are rewarmed with less peripheral cold stress and shivering thermogenesis using a multi-layered MPS survival bag compared with a polyethylene survival bag. Prehospital rewarming is further aided by large chemical heat pads but not by hot drinks. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
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
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.
Pugh, Harry E J; LeClerc, S; Mclennan, J
Airway compromise is the third leading cause of potentially preventable combat death. Pre-hospital airway management has lower success rates than in hospital. This study reviewed advanced airway management focusing on cricothyroidotomies and supraglottic airway devices in combat casualties prior to admission to a Role 3 Hospital in Afghanistan. This was a retrospective review of all casualties who required advanced airway management prior to arrival at the Role 3 Hospital, Bastion, Helmand Province over a 30-week period identified by the US Joint Theatre Trauma Registry. The notes and relevant X-rays were analysed. The opinions of US and UK clinical Subject Matter Experts (SME) were then sought. Fifty-seven advanced airway interventions were identified. 45 casualties had attempted intubations, 37 (82%) were successful and of those who had failed intubations, one had a King LT Airway (supraglottic device) and seven had a rescue cricothyroidotomy. The other initial advanced airway interventions were five attempted King LT airways and seven attempted cricothyroidotomies. In total, 14 cricothyroidotomies were performed; in this group, there were nine complications/significant events. The SMEs suggested that dedicated surgical airway kits should be used and students in training should be taught to secure the cricothyroidotomy tube as well as how to insert it. This review re-emphasises the need to 'ensure the right person, with the right equipment and the right training, is present at the right time if we are to improve the survival of patients with airway compromise on the battlefield'. The audit reference number is RCDM/Res/Audit/1036/12/0368. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Hatzfeld, Jennifer J; Dukes, Susan; Bridges, Elizabeth
The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status. In addition to institutionalizing these innovations, future efforts are needed to eliminate secondary insults to patients with traumatic brain injuries and technologies to provide closed-loop sedation and ventilation.
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)
Martinoli, S; Quadri, B; Casabianca, A
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.
To assist community planners in allocating scarce resources in a mass casualty event, the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) and the Office of the Assistant Secretary for Preparedness and Response collaborated with leading experts on a series of issue papers on preparedness and response. These papers were presented at an expert meeting in Washington, DC, in June 2006. The papers, revised based on meeting discussions, have been published by AHRQ as Mass Medical Care with Scarce Resources: A Community Planning Guide.
Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi
The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China . 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research.
Full Text Available The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China. 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research.
Born, Christopher T; Briggs, Susan M; Ciraulo, David L; Frykberg, Eric R; Hammond, Jeffrey S; Hirshberg, Asher; Lhowe, David W; O'Neill, Patricia A; Mead, Joann
Terrorists' use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities. Knowledge of blast pathomechanics and patterns of injury allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents, their attendant clinical symptoms, and recommended management strategies is an important prerequisite for optimal preparation and response to these less frequently used agents of mass casualty. Orthopaedic surgeons should be aware of the principles of management of catastrophic events. Stress is less an issue when one is adequately prepared. Decontamination is essential both to manage victims and prevent further spread of toxic agents to first responders and medical personnel. It is important to assess the risk of potential threats, thereby allowing disaster planning and preparation to be proportional and aligned with the actual casualty event.
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.
Kelley, R. L.
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.
Pan, Chih-Long; Lin, Chih-Hao; Lin, Yan-Ren; Wen, Hsin-Yu; Wen, Jet-Chau
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.
Møller, Anders Pape; Erritzøe, Helga; Erritzøe, Johannes
Birds and other animals are frequently killed by cars, causing the death of many million individuals per year. Why some species are killed more often than others has never been investigated. In this work hypothesized that risk taking behavior may affect the probability of certain kinds of individuals being killed disproportionately often. Furthermore, behavior of individuals on roads, abundance, habitat preferences, breeding sociality, and health status may all potentially affect the risk of being killed on roads. We used information on the abundance of road kills and the abundance in the surrounding environment of 50 species of birds obtained during regular censuses in 2001-2006 in a rural site in Denmark to test these predictions. The frequency of road kills increased linearly with abundance, while the proportion of individuals sitting on the road or flying low across the road only explained little additional variation in frequency of road casualties. After having accounted for abundance, we found that species with a short flight distance and hence taking greater risks when approached by a potential cause of danger were killed disproportionately often. In addition, solitary species, species with a high prevalence of Plasmodium infection, and species with a large bursa of Fabricius for their body size had a high susceptibility to being killed by cars. These findings suggest that a range of different factors indicative of risk-taking behavior, visual acuity and health status cause certain bird species to be susceptible to casualties due to cars.
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
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
Ronen, Ohad; Assadi, Nidal; Sela, Eyal
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 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.
Zahran, Sammy; Tavani, Daniele; Weiler, Stephan
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.
Culley, Joan M; Svendsen, Erik
Mass casualty incidents (MCIs) include natural (eg, earthquake) or human (eg, terrorism or technical) events. They produce an imbalance between medical needs and resources necessitating the use of triage strategies. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number. There is limited research on the validation of triage system efficacy in determining the priority of care for victims of MCI, particularly those involving chemicals. To review the literature on the validation of current triage systems to assign on-site treatment status codes to victims of mass casualties, particularly those involving chemicals, using actual patient outcomes. The focus of this article is a systematic review of the literature to describe the influences of MCIs, particularly those involving chemicals, on current triage systems related to the on-site assignment of treatment status codes to a victim and the validation of the assigned code using actual patient outcomes. There is extensive literature published on triage systems used for MCI but only four articles used actual outcome data to validate mass casualty triage outcomes including three for chemical events. Currently, the amount and type of data collected are not consistent or standardized and definitions are not universal. Current literature does not provide needed evidence on the validity of triage systems for MCI in particular those involving chemicals. Well designed studies are needed to validate the reliability, sensitivity, and specificity of triage systems used for MCI including those involving chemicals.
Full Text Available Burn injury continues to be a major cause of morbidity and mortality in modern combat. During the armed combats in Iraq and Afghanistan, the US army put their new five-class medical evacuation system into service with the aim to send back the wounded to duty as soon as possible. This new system indeed increased the efficiency of treatment and evacuation of casualties with extensive burn injury. Though the evacuation time was significantly shortened under the new system, the effective and efficient evacuation of burn patients remains to be rather important problems needing further study. This review summarizes the medical evacuation system of burn casualties and features of burn injuries in US Army in the said conflicts. It may provide some ideas for our burn casualty treatment in future armed conflicts, and it may serve as a reference for treatment of massive casualties caused by catastrophic events in peace time. DOI: 10.11855/j.issn.0577-7402.2015.01.16
Parameters for Estimation of Casualties from Phosgene, Chlorine, Hydrogen Chloride, Cyanide , Hydrogen Sulfide, B. pseudomallei, Eastern and Western Equine...Effects of L Intoxication .............................................................69 1. Mechanism of Action of L Poisoning ...Hydrogen Chloride, Cyanide , Hydrogen Sulfide, B. pseudomallei, Eastern and Western Equine Encephalitis Viruses, Ricin, and T-2 Mycotoxin, IDA Paper P-5140
sharp/pungent, garlic /horseradish, bitter almond, and newly mown hay. Unusual numbers of mass casualties Health problems including nausea, disori...radiation syndrome is generally supportive with blood transfusions and antibiotics . 26 Volume II of II V1.1 2013 Classically acute radiation syndrome
Carter, Holly; Amlôt, Richard
Introduction: Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants. Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols. In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups. Methods: Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination. The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base. Results: Psychosocial aspects of incident management receive limited attention in current decontamination guidance. In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence. For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges. We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination. Conclusions: Effective communication and respect for casualties’ needs are critical in ensuring
Grilo, C.; Bissonette, J.A.; Santos-Reis, M.
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
Koay, S. P.; Tay, L. T.; Fukuoka, H.; Koyama, T.; Sakai, N.; Jamaludin, S. B.; Lateh, H.
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
Musters, C.J.M.; Noordervliet, M.A.W.; Ter Keurs, W.J.
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
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.
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)
Yu, Xunyi; Ganz, Aura
In this paper, we propose an identity aware video analytic system that can assist securing the perimeter of a mass casualty incident scene and generate identity annotated video records for forensics and training purposes. Establishing a secure incident scene perimeter and enforcing access control to different zones is a demanding task for current video surveillance systems which lack the ability to provide the identity of the target and its security clearance. Our system which combines active RFID sensors with video analytic tools recovers the identity of the target enabling the activation of suitable alert policies. The system also enables annotation of incident scene video with identity metadata, facilitating the incident response process reconstruction for forensics analysis and emergency response training.
Saber, Deborah A; Strout, Kelley; Caruso, Lisa Swanson; Ingwell-Spolan, Charlene; Koplovsky, Aiden
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.
Rice, Helen; Mann, Tom M; Armstrong, Stuart J; Price, Matthew E; Green, A Chris; Tattersall, John E H
The provision of effective Medical Countermeasures (MedCM) for all agents and routes of exposure is a strategic goal of defence research and development. In the case of military autoinjector-based therapies for nerve agent poisoning, current treatment effectiveness is limited by the oxime reactivator being effective against only certain agents, by rapid clearance times of the drugs and because the doses may not be optimal for treatment of severe poisoning. Prolonged poisoning by nerve agents entering the body through the skin is also challenging. Since casualty handling timelines have reduced significantly in recent years, it may be sufficient for first aid therapy to provide protection for only a few hours until further medical treatment is available. Therefore, the traditional evaluation of first aid therapy in animal models of survival at 24 h may not be appropriate. At various echelons of medical care, further therapeutic interventions are possible. The current basis for the medical management of nerve-agent poisoned casualties is derived mainly from clinical experience with pesticide poisoning. Adjunct therapy with a bioscavenger (such as human butyrylcholinesterase (huBChE)), could have utility as a delayed intervention by reducing the toxic load. It has previously been demonstrated that huBChE is an effective post-exposure therapy against percutaneous VX poisoning. It is recommended that the scope of animal models of nerve agent MedCM are extended to cover evaluation of both first aid MedCM over significantly reduced timescales, and subsequent supportive therapeutic and medical management strategies over longer timescales. In addition to bioscavengers, these strategies could include repeated combined and individual therapy drugs to alleviate symptoms, other classes of drugs or ventilatory support. Crown Copyright ©  Published by Elsevier Ireland Ltd. This is an open access article under the Open Government Licence (OGL) (http
Edwards, D S; McMenemy, L; Stapley, S A; Patel, H D L; Clasper, J C
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 (Pterrorist attacks. Overall 32 deaths and 180 injuries per incident were seen, however significantly more deaths occurred in explosions associated with a BC. Comparing OS and CS no difference in the deaths per incident was seen, 14.2(SD±17.828) and 15.63 (SD±10.071) respectively. However OS explosions resulted in significantly more injuries, 192.7 (SD±141.147), compared to CS, 79.20 (SD±59.8). Extremity related wounds were the commonest injuries seen (32%). Terrorist bombings continue to be a threat and are increasing particularly in the Middle East. Initial reports, generated immediately at the scene by experienced coordination, on the type of detonation (suicide versus non-suicide), the environment of detonation (confined, open, building collapse) and the number of fatalities, and utilising the Kill:Wounded ratios found in this meta-analysis, can be used to predict the number of casualties and their likely injury profile 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.
Turner, Conor D A; Lockey, David J; Rehn, Marius
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.
Cross, Keith P; Petry, Michael J; Cicero, Mark X
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
Balbus, J. M.; Kirsch, T.; Mitrani-Reiser, J.
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.
Raknes, Guttorm; Morken, Tone; Hunskår, Steinar
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.
Gumanenko, E K; Samokhvalov, I M; Trusov, A A; Severin, V V
Two operational-and-tactical factors had the main influence on organization of the surgical care rendered to the casualties on the Northern Caucasus: the fulminant and maneuverable nature of combat operations at the beginning of both armed conflicts and rather small territory of war theatre. The main special features of organization of surgical care to the casualties were the use of Medical Squads of Special Purpose in the combat conditions and maximal approximation of the specialized surgical care to the wounded by echelonment of medical units and wide use of helicopter evacuation. The structure of sanitary losses was characterized by the increase in the frequency of mechanical traumas, thermal and combined injuries, by the high share of the casualties with head injuries. Besides the number of seriously wounded and critical casualties has increased.
Yu, Xunyi; Ganz, Aura
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.
Beck-Razi, Nira; Fischer, Doron; Michaelson, Moshe; Engel, Ahuva; Gaitini, Diana
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.
Bricknell, M C M
This is the third in a series of papers describing the evolution of the British casualty evacuation chain during the 20th century. This period was dominated by the threat of war between NATO and the Warsaw Pact in Central Europe. The Suez Crisis in 1956, the Falklands War in 1982, the GulfWar in 1991 and events in the Balkans during the 1990s demonstrated the requirement for a flexible system for medical support to the UK Armed Forces.
long-range aero-medical evacuation has adverse effects on brain blood flow and tissue oxygenation, as well as lung function in swine models of...neurotrauma and polytrauma. We plan to investigate the effects of aero-medical evacuation on neurophysiology and lung function in swine models of TBI with...Combat Casualties in a Swine Polytrauma PRINCIPAL INVESTIGATOR: Richard McCarron, PhD CONTRACTING ORGANIZATION: Henry M. Jackson Foundation Bethesda
damage, the effects of the electromagnetic pulse , patients who are internally and externally contaminated with radiation, casualties whose irradiation...N I TOR ’S R E P OR T N O (S ) . 1 2 . D IS T R I B U T IO N / AVA I L A B I L I T Y S TATE M E N T Approved for public release
Heinrichs, Wm Leroy; Youngblood, Patricia; Harter, Phillip; Kusumoto, Laura; Dev, Parvati
Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures. The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs. Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the "game" interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument. Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either "confident" or "very confident", with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical
Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz
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.
Butler, Frank K; Smith, David J; Carmona, Richard H
Thirteen years of continuous combat operations have enabled the US Military and its coalition partners to make a number of major advances in casualty care. The coalition nations have developed a superb combat trauma system and achieved unprecedented casualty survival rates. There remains, however, a need to accelerate the translation of new battlefield trauma care information, training, and equipment to units and individuals deploying in support of combat operations. In addition, the US Military needs to ensure that these advances are sustained during peace intervals and that we continue to build upon our successes as we prepare for future conflicts. This article contains recommendations designed to accomplish those goals. For the proposed actions to benefit all branches of our armed services, the direction will need to come from the Office of the Secretary of Defense in partnership with the Joint Staff. Effective translation of military advances in prehospital trauma care may also increase survival for law enforcement officers wounded in the line of duty and for civilian victims of Active Shooter or terrorist-related mass-casualty incidents.
Alpert, Evan Avraham; Lipsky, Ari M; Elie, Navid Daniel; Jaffe, Eli
To describe the contributions of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel during the Second Intifada. Descriptive study evaluating data obtained from postevent debriefings after 15 terrorist attacks in Israel between 2001 and 2004. An average of 7.9 deaths (median 7.0, interquartile range [IQR] 2.5-12.5) and 53.8 injuries (median 50.0, IQR 34.0-62.0) occurred in each of these attacks. The average number of volunteers responding to each event was 50.3 (median 43.0, IQR 27.5-55.5). The volunteers were involved in extricating victims from imminent danger, and performing emergent tasks such as bag-valve ventilation, tourniquet application, and intravenous line insertion. They were also integral to the rapid evacuation of casualties from the scene. On-call, volunteer first responders are an integral part of Israel's emergency medical response to mass-casualty terrorist attacks. This system may be used as a model for the development of similar services worldwide.
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
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.
Doughty, Heidi; Glasgow, Simon; Kristoffersen, Einar
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.
Martins, N.S.F.; Silva, L.H.C.; Rosa, R.
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)
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
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.
Abdullah A. Bin Shalhoub
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.
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.
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. PMID:26607420
Marano, K.D.; Wald, D.J.; Allen, T.I.
This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and fire for events during the past 40 years. These processes are of great importance to the US Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/significant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER's overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We find that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra-Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our findings, we have built country-specific disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability. ?? Springer Science+Business Media B.V. 2009.
Wald, David J.
This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and ﬁre for events during the past 40 years. These processes are of great importance to the US Geological Survey’s (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/signiﬁcant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER’s overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We ﬁnd that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra–Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our ﬁndings, we have built country-speciﬁc disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability.
Wilkerson, William; Avstreih, Dan; Gruppen, Larry; Beier, Klaus-Peter; Woolliscroft, James
A descriptive study was performed to better understand the possible utility of immersive virtual reality simulation for training first responders in a mass casualty event. Utilizing a virtual reality cave automatic virtual environment (CAVE) and high-fidelity human patient simulator (HPS), a group of experts modeled a football stadium that experienced a terrorist explosion during a football game. Avatars (virtual patients) were developed by expert consensus that demonstrated a spectrum of injuries ranging from death to minor lacerations. A group of paramedics was assessed by observation for decisions made and action taken. A critical action checklist was created and used for direct observation and viewing videotaped recordings. Of the 12 participants, only 35.7% identified the type of incident they encountered. None identified a secondary device that was easily visible. All participants were enthusiastic about the simulation and provided valuable comments and insights. Learner feedback and expert performance review suggests that immersive training in a virtual environment has the potential to be a powerful tool to train first responders for high-acuity, low-frequency events, such as a terrorist attack.
Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo
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.
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
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.
Full Text Available A study of the frequency, intensity, and risk of extreme climatic events or natural hazards is important for assessing the impacts of climate change. Many models have been developed to assess the risk of multiple hazards, however, most of the existing approaches can only model the relative levels of risk. This paper reports the development of a method for the quantitative assessment of the risk of multiple hazards based on information diffusion. This method was used to assess the risks of loss of human lives from 11 types of meteorological hazards in China at the prefectural and provincial levels. Risk curves of multiple hazards were obtained for each province and the risks of 10-year, 20-year, 50-year, and 100-year return periods were mapped. The results show that the provinces (municipalities, autonomous regions in southeastern China are at higher risk of multiple meteorological hazards as a result of their geographical location and topography. The results of this study can be used as references for the management of meteorological disasters in China. The model can be used to quantitatively calculate the risks of casualty, direct economic losses, building collapse, and agricultural losses for any hazards at different spatial scales.
Ingrassia, Pier Luigi; Carenzo, Luca; Barra, Federico Lorenzo; Colombo, Davide; Ragazzoni, Luca; Tengattini, Marco; Prato, Federico; Geddo, Alessandro; Della Corte, Francesco
To demonstrate the applicability and the reliability of a radio frequency identification (RFID) system to collect data during a live exercise. A rooftop collapse of a crowded building was simulated. Fifty-three volunteers were trained to perform as smart victims, simulating clinical conditions, using dynamic data cards, and capturing delay times and triage codes. Every victim was also equipped with a RFID tag. RFID antenna was placed at the entrance of the advanced medical post (AMP) and emergency department (ED) and recorded casualties entering the hospital. A total of 12 victims entered AMP and 31 victims were directly transferred to the ED. 100% (12 of 12 and 31 of 31) of the time cards reported a manually written hospital admission time. No failures occurred in tag reading or data transfers. A correlation analysis was performed between the two methods plotting the paired RFID and manual times and resulted in a r=0.977 for the AMP and r=0.986 for the ED with a P value of less than 0.001. We confirmed the applicability of RFID system to the collection of time delays. Its use should be investigated in every aspect of data collection (triage, treatments) during a disaster exercise.
Jaiswal, K.S.; Wald, D.J.
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.
Spano, Susanne J; Campagne, Danielle; Stroh, Geoff; Shalit, Marc
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.
Oka, Rahul C; Kissel, Marc; Golitko, Mark; Sheridan, Susan Guise; Kim, Nam C; Fuentes, Agustín
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.
Alian, Sahar; Baker, R G V; Wood, Stephen
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.
Penn-Barwell, Jowan G; Sargeant, Ian D
Surgical treatment of high-energy gun-shot wounds (GSWs) to the extremities is challenging. Recent surgical doctrine states that wound tracts from high-energy GSWs should be laid open, however the experience from previous conflicts suggests that some of these injuries can be managed more conservatively. The aim of this study is to firstly characterise the GSW injuries sustained by UK forces, and secondly test the hypothesis that the likely severity of GSWs can be predicted by features of the wound. The UK Military trauma registry was searched for cases injured by GSW in the five years between 01 January 2009 and 31 December 2013: only UK personnel were included. Clinical notes and radiographs were then reviewed. Features associated with energy transfer in extremity wounds in survivors were further examined with number of wound debridements used as a surrogate marker of wound severity. There were 450 cases who met the inclusion criteria. 96 (21%) were fatally injured, with 354 (79%) surviving their injuries. Casualties in the fatality group had a median New Injury Severity Score (NISS) of 75 (IQR 75-75), while the median NISS of the survivors was 12 (IQR 4-48) with 10 survivors having a NISS of 75. In survivors the limbs were most commonly injured (56%). 'Through and through' wounds, where the bullet passes intact through the body, were strongly associated with less requirement for debridement (pwound debridements (p=0.0002), as there was if a bullet fractured a bone (p=0.0006). More complex wounds, as indicated by the requirement for repeated debridements, are associated with injuries where the bullet does not pass straight through the body, or where a bone is fractured. Gunshot wounds should be assessed according to the likely energy transferred, extremity wounds without features of high energy transfer do not require extensive exploration. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
Balajee, A.S.; Dainiak, N.
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
King, David R; Patel, Mayur B; Feinstein, Ara J; Earle, Steven A; Topp, Raymond F; Proctor, Kenneth G
Civilian and military mass casualty incidents (MCI) are an unfortunate reality in the 21st century, but there are few situational training exercises (STX) to prepare for them. To fill this gap, we developed a MCI STX for U.S. Army Forward Surgical Teams (FST) in conjunction with the U.S. Army Trauma Training Center. After a standardized briefing, each FST has 60 minutes to unpack, setup, and organize a standard equipment cache into an emergency room, operating room, and intensive care unit. In an adjacent room, five anesthetized swine are prepared with standardized, combat-relevant injuries. The number and acuity of the total casualties are unknown to the FST and arrive in waves and without warning. A realistic combat environment is simulated by creating resource limitations, power outages, security breaches, and other stressors. The STX concludes when all casualties have died or are successfully treated. FSTs complete a teamwork self-assessment card, while staff and FST surgeons evaluate organization, resource allocation, communication, treatment, and overall performance. Feedback from each FST can be incorporated into an updated design for the next STX. From 2003-2005, 16 FSTs have completed the STX. All FSTs have had collapses in situational triage, primary/ secondary surveys, and/or ATLS principles (basic ABCs), resulting in approximately 20% preventable deaths. We concluded (1) a MCI can overwhelm even combat- experienced FSTs; (2) adherence to basic principles of emergency trauma care by all FST members is essential to effectively and efficiently respond to this MCI; (3) by prospectively identifying deficiencies, future military or civilian performance during an actual MCI may be improved; and (4) this MCI STX could provide a template for similar programs to develop, train, and evaluate civilian surgical disaster response teams.
Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John
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.
Lavon, Ophir; Bentur, Yedidia
Amyl nitrite has been recommended as a cyanide antidote for several decades. Its antidotal properties were initially attributed to induction of methemoglobin and later to a nitric oxide mediated hemodynamic effect. The ease of administration and alleged rapid clinical effect would recommend its wide use in the pre-hospital management of mass casualty cyanide poisoning; yet there are concerns regarding the use of amyl nitrite for this indication. Review the data on amyl nitrite in cyanide poisoning and evaluate its efficacy and safety in mass casualty cyanide poisoning. A literature search utilizing PubMed, Toxnet, textbooks in toxicology and pharmacology, and the bibliographies of the articles retrieved identified 17 experimental studies and human reports on the use of amyl nitrite in cyanide poisoning, and 40 additional articles on amyl nitrite's properties and adverse effects. One paper was excluded as it was a conference abstract with limited data. The antidotal properties of amyl nitrite were attributed initially to induction of methemoglobinemia and later to nitric oxide mediated vasodilation. Animal studies on the use of amyl nitrite in cyanide poisoning are limited, and their results are inconsistent, which makes their extrapolation to humans questionable. Clinical reports are limited in number and the part played by amyl nitrite relative to the other treatments administered (e.g. life support, sodium nitrite, and sodium thiosulfate) is unclear. Amyl nitrite can be associated with potentially serious adverse reactions such as hypotension, syncope, excessive methemoglobinemia, and hemolysis in G6PD deficient patients. These effects are more pronounced in young children, in the elderly, and in patients with cardiac and pulmonary disorders. Dose regimen. The method of administration of amyl nitrite (breaking pearls into gauze or a handkerchief and applying it intermittently to the victim's nose and mouth for a few minutes) is not easily controlled, might result
Waisman, Yehezkel; Goldman, Sharon; Poznanski, Oded; Mor, Meirav; Peleg, Kobi
Children are the most vulnerable sub-population in mass casualty events (MCEs), however, characteristics of MCE related injuries among children have not been well described. The aim of our study was to characterize childhood injuries resulting from MCEs in Israel including parameters such as magnitude, injury mechanism and severity and use of hospital resources. We conducted a descriptive study of MCE related injuries among hospitalized children (0-17 years) between the years 1998-2007 and recorded in the Israel Trauma Registry (ITR). The main outcome measures included: body region, injury severity (ISS) and mortality rates. A total of 267 children (mean age 11.3 years, 52% girls) were hospitalized for injuries caused by 75 (47%) of the 158 MCEs recorded during the study period. The mechanisms of MCE related injury were as follows: terror-related (63%); motor vehicle collision (buses or train) (32%); a collapsed building (3%); and other mechanisms (2%). Injuries among teenagers (ages 10-17 years) were twice as high as those of younger children [ages 0-9 years), (67% and 33%, respectively (p Head and neck (67%) were the most common body regions to be injured, followed by upper and Lower extremities (62%). Most children sustained mild injuries (55% ISS 1-8), however, a significant percentage had severe to fatal injuries (29% ISS > or =16). Severe injuries were significantly more frequent among children injured in MCEs compared to non-MCE injuries: ISS 16 (29% vs. 8%, respectively p < 0.0001), in-hospital mortaLity (3.4% vs. 0.4%, respectively, p < 0.0001), underwent surgical procedures (50% vs. 20%, respectively, p < 0.05), ICU admission rate (31% vs. 6%, p < 0.0001), and longer hospital stay (median LOS 8.9 vs. 3.5 days, respectively p < 0.0001). Morbidity and mortality are significantly higher among children who are injured in MCEs than by other mechanisms. Improved pediatric pre-hospital care and hospital resources as well may enhance future pediatric MCE
Epstein, Richard H; Ekbatani, Ali; Kaplan, Javier; Shechter, Ronen; Grunwald, Zvi
After a mass casualty incident (MCI), rapid mobilization of hospital personnel is required because of an expected surge of victims. Risk assessment of our department's manual phone tree recall system revealed multiple weaknesses that would limit an effective response. Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging. We sent test text messages to anesthesia staff members' cell phone numbers, determined the distance from their home to the hospital, and stored this information in our AIMS. Latency testing for the time from transmission of SMS test messages from the server to return of an e-mail reply was determined at 2 different times on 2 different dates, 1 of which was a busy holiday weekend, using volunteers within the department. Two unannounced simulated disaster recall drills were conducted, with text messages sent asking for the anticipated time to return to the hospital. A timeline of available staff on site was determined. Reasons for failure to respond to the disaster notification message were tabulated. Latency data were fit by a log-normal distribution with an average of 82 seconds from message transmission to e-mail reply. Replies to the simulated disaster alert were received from approximately 50% of staff, with 16 projecting that they would have been able to be back at the hospital within 30 minutes on both dates. There would have been 21 and 23 staff in-house at 30 minutes, and 32 and 37 staff in-house at 60 minutes on the first and second test date, respectively, including in-house staff. Of the nonresponders to the alert, 48% indicated that their cell phone was not with them or was turned off, whereas 22% missed the message. Our SMS staff recall system is likely to be able to rapidly mobilize sufficient numbers of anesthesia personnel in response to an MCI, but actual performance
McGraw, Leigh K; Out, Dorothée; Hammermeister, Jon J; Ohlson, Carl J; Pickering, Michael A; Granger, Douglas A
This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations. Published by Elsevier Ltd.
Knapp, Sabine; Kumar, Shashi; Sakurada, Yuri; Shen, Jiajun
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.
Hardcastle, Timothy C; Samlal, Sanjay; Naidoo, Rajen; Hendrikse, Steven; Gloster, Alex; Ramlal, Melvin; Ngema, Sibongiseni; Rowe, Michael
This report details the background, planning, and establishment of a mass-casualty management area for the Durban Moses Mabhida Stadium at the Natal Mounted Rifles base, by the Department of Health and the eThekwini Fire and Rescue Service, for the Fédération Internationale de Football Association (FIFA) 2010 Soccer World Cup. The report discusses the use of the site during the seven matches played at that stadium, and details the aspects of mass-gathering major incident site planning for football (soccer). The area also was used as a treatment area for other single patient incidents outside of the stadium, but within the exclusion perimeter, and the 22 patients treated by the Casualty Clearing Station (CCS) team are described and briefly discussed. A site-specific patient presentation rate of 0.48 per 10,000 and transport-to-hospital rate (TTHR) of 0.09/10,000 are reported. Lessons learned and implications for future event planning are discussed in the light of the existing literature.
Cooke, Thomas; Chesters, Adam; Grier, Gareth
Since the end of World War II, there has been an emergence of explosives used amongst civilian populations resulting in mass-casualty incidents. The development of pre-hospital medical systems, worldwide, has resulted in an increased response at these incidents. However, information about the pre-hospital medical response is sparse and not collated. This review aimed to collect and appraise the literature on the pre-hospital management of mass-casualty bombing incidents. The primary objective was to identify and discuss the common themes highlighted as problems in the pre-hospital medical response. The secondary objectives reviewed the injury patterns in victims and psychological impacts on pre-hospital responders. A systematic literature search on the PubMed, SCOPUS and Web of Science databases took place. It included literature published from the 1 st of January 2000 to April 3rd 2017, with the last search performed on April 3rd 2017. Literature was included if it offered description, analysis, reflection or review of the bombing incidents.emermed;34/12/A884-a/F1F1F1Figure 1The minimum number of recorded deaths and injuries from 11 deliberate mass casualty bombing incidents (note: two simultaneous marauding terrorist firearm attack and bombing incidents excluded)emermed;34/12/A884-a/F2F2F2Figure 2Percentage of included literature identifying the following themes as problems in the pre-hospitals medical response RESULTS: 1345 articles were found, with 54 included in analysis. 13 mass-casualty bombing incidents were described. Two of these included marauding terrorist firearm attacks (MTFA). In the 11 bombing-only incidents the death of 592-642 people and injury of 3,842-5229 more is described, with a further 301 deaths and 604 injuries from bombings with MTFA attacks. Quality appraisal showed a variation in reporting among incidents and a lack of uniform reporting. Functioning and reliable communication, alongside regular training exercises with other emergency
Broughton, J. Amoros, E. Bos, N.M. Evgenikos, P. Hoeglinger, S. Holló, P. Pérez, C. & Tecl, J.
The objective of Task 1.5 of the SafetyNet IP has been to estimate the actual numbers of road accident casualties in Europe from the CARE database by addressing two issues: • the under-reporting in national accident databases and • the differences between countries of the definitions used to
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
Berger, Ferco H.; Körner, Markus; Bernstein, Mark P.; Sodickson, Aaron D.; Beenen, Ludo F.; McLaughlin, Patrick D.; Kool, Digna R.; Bilow, Ronald M.
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
Morrow, H E
The medical/surgical hospital environment presents numerous challenges to a Critical Incident Stress Management (CISM) Team Coordinator responsible for implementing a psychological crisis intervention. Often this person is responsible for managing a response to a large in-house multiple-casualty incident, sometimes involving fatalities. Many mental health professionals have not had the opportunity to work in a medical/surgical healthcare facility and consequently are not familiar with the environment (and agency culture) that exists within these employment settings. This article will review important factors to be considered during the initial assessment of a critical incident in a hospital setting, logistical concerns that are unique to this setting, and the subsequent planning of the Critical Incident Stress Management Team crisis management response.
Full Text Available Abstract Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters.
Usero-Pérez, Carmen; González Alonso, Valentín; Orbañanos Peiro, Luis; Gómez Crespo, José Manuel; Hossain López, Sheima
Recent terrorist attacks involving active shooters or improvised explosive devices have shown that traditionally sequenced emergency management leads to delays in attending victims and suboptimal outcomes. Tactical medicine, a new concept in prehospital care, emerged from experience attending the wounded in combat zones, where the Tactical Combat Casualty Care (TCCC) recommendations are applied. TCCC targets 3 main causes of preventable death in combat: bleeding from extremities, tension pneumothorax, and airway obstruction. A change in the delivery of emergency care during terrorist attacks is now required if we are to improve survival rates. To that end, strategies based on the TCCC and Hartford Consensus recommendations have been developed. Both these approaches describe procedures for both first responders and medical professionals to apply in areas under threat.
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.
Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu
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.
Kuhls, Deborah A; Chestovich, Paul J; Coule, Phillip; Carrison, Dale M; Chua, Charleston M; Wora-Urai, Nopadol; Kanchanarin, Tavatchai
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 Pconfidence increased among all participants (2.1 to 3.8; +1.7; Pconfidence increases in each measured area (Pconfidence but greater confidence increase, while physicians had higher pre-course confidence but lower confidence increase. Active duty military also had lower pre-course confidence with significantly greater confidence increases, while previous disaster courses or experience increased pre-course confidence but lower increase in confidence. Age and work experience did not influence confidence. Basic 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 .
Steinbach, Rebecca; Perkins, Chloe; Tompson, Lisa; Johnson, Shane; Armstrong, Ben; Green, Judith; Grundy, Chris; Wilkinson, Paul; Edwards, Phil
Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000-2013, and crime within census Middle Super Output Areas during 2010-2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Rodoplu, Ulkümen; Arnold, Jeffrey L; Tokyay, Rifat; Ersoy, Gurkan; Cetiner, Serkan; Yücel, Tayfun
This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response. A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul. On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims. The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.
Duncan, Edward A S; Colver, Keith; Dougall, Nadine; Swingler, Kevin; Stephenson, John; Abhyankar, Purva
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
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
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
TRANSPORTATION CENTER (OST3C) Mass Casualty Care Strategy for a Chemical Terrorism Incident Prepared by: Health & Safety...the Off-site Triage, Treatment, and Transportation Center (OST3C),Mass Casualty Care Strategy for a Chemical Terrorism Incident, Revision 1, Dec 2003...1.4.1 The citizens of the United States are subject to an act of chemical terrorism . 1.4.2 A well-planned chemical agent release is likely to produce a
Beliakin, S A; Dolgikh, R N; Fokin, Iu N
The article is dedicated to the 45-year history of combat casualty care in the Vishnevsky Central Military Clinical Hospital N 3. In the echelon system of medical care the Vishnevsky Central Military Clinical Hospital N 3 ranks the echelon (level) N 3. Specialists of the hospital, along with a medical and preventive activity, practice methodological, educational and innovative activity, participate in different scientific forums. Temporary duty assignment to the combat, human-made disaster and natural disaster areas is a real functional test. 64 physicians have an extreme situation experience. The Vishnevsky Central Military Clinical Hospital N 3 is a clinical base of department of surgery, advanced physician training department, combat casualty care department of the Institute for advanced physician training of Mandryka scientific and educational clinical center. For the purpose of reducing the terms and improving the quality of medical care it was suggested to make the integration connections with leading hospitals of the Ministry of Defense of the Russian Federation.
Stiles, Chad M; Cook, Christopher; Sztajnkrycer, Matthew D
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.
Dhamorikar, Aniruddha H.; Mehta, Prakash; Bargali, Harendra; Gore, Kedar
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 ...
Shah, Adil Aijaz; Rehman, Abdul; Sayyed, Raza Hasnain; Haider, Adil Hussain; Bawa, Amber; Zafar, Syed Nabeel; Zia-Ur-Rehman; Ali, Kamran; Zafar, Hasnain
Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia. We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries. A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived. This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties. Copyright © 2014 Elsevier Ltd
Singleton, James A G; Walker, N M; Gibb, I E; Bull, A M J; Clasper, J C
Analysis of recent UK Armed Forces combat casualty data has highlighted a significant number of through joint traumatic amputations (TAs), most commonly through knee (through knee amputations (TKAs)). Previously, a consensus statement on lower limb amputation from the UK Defence Medical Services reported better outcomes in some patients with TKAs when compared with those with above knee amputations. This study sought to define the proportion of recent combat casualties sustaining severe lower extremity trauma with acute osseous and soft tissue injury anatomy amenable to definitive TKA. The UK Joint Theatre Trauma Registry and post mortem CT (PM-CT) databases were used to identify all UK Armed Forces personnel (survivors and fatalities) sustaining a major extremity TA (through/proximal to wrist or ankle joint) between August 2008 and August 2010. Through knee and all below knee TAs were grouped as 'potential TKAs' (pTKAs), that is, possible candidates for definitive TKA. 146 Cases (75 survivors and 71 fatalities) sustaining 271 TAs (130 in survivors, 141 in fatalities) were identified. The through-joint TA rate was 47/271 (17.3%); 34/47 through-joint injuries (72.3%) were TKAs. Overall, 63/130 TAs in survivors and 66/140 TAs in fatalities merited analysis as the pTKA group. Detailed anatomical data on pre-debridement osseous and soft tissue injury levels were only consistently available for fatalities through PM-CT findings. Further analysis of the soft tissue injury profile revealed that a definitive TKA in the pTKA group (all BKAs as well as TKAs) would have been proximal to the zone of injury (ZOI) in only 3/66 cases. Traumatic TKAs following explosive blast are more common than previously reported. The majority of lower limb TAs are skeletally amenable to a definitive TKA. Maximising residual stump length carries the risks of definitive level amputation within the original ZOI but this study demonstrates that the proximal extent of the soft tissue injury may
Jones, Sarah J; Begg, Dorothy J; Palmer, Stephen R
Crashes involving young drivers (YD) cause significant morbidity and mortality in Great Britain (GB). Graduated Driver Licensing (GDL) is used in some countries to address this. This study assessed potential casualty and cost savings of possible GDL programmes in GB. Police road crash data were analysed to identify YD crashes at night or while carrying passengers. These data were then used to estimate the potential effects of GDL. 314,561 casualties and 3469 fatalities occurred in YD crashes. 25.1% of YD crashes occurred between 9 pm and 6 am and 24.4% occurred with a 15- to 24-year old passenger in the car. A 'strict' form of GDL in GB (night time restriction 9 pm-6 am, no 15-24 year old passengers) with 50% compliance would prevent 114 deaths and 872 serious casualties each year. The estimated value of prevention is £424M pa. A 'less strict' form of GDL (night time restriction 10 pm-5 am, maximum of one 15-19 year old passenger) with 50% compliance would prevent 81 deaths and 538 serious injuries. The estimated value of prevention is £273M pa. Implementing GDL in GB could save significant numbers of lives. Public health organisations have a duty to advocate for such legislation.
Ansari, Armin; Harper, Frederick Taylor; Smith, James M.
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.
Folio, Les R; Fischer, Tatjana; Shogan, Paul; Frew, Michael; Dwyer, Andrew; Provenzale, James M
The purpose of this study is to determine the agreement with which radiologists identify wound paths in vivo on MDCT and calculate missile trajectories on the basis of Cartesian coordinates using a Cartesian positioning system (CPS). Three radiologists retrospectively identified 25 trajectories on MDCT in 19 casualties who sustained penetrating trauma in Iraq. Trajectories were described qualitatively in terms of directional path descriptors and quantitatively as trajectory vectors. Directional descriptors, trajectory angles, and angles between trajectories were calculated based on Cartesian coordinates of entrance and terminus or exit recorded in x, y image and table space (z) using a Trajectory Calculator created using spreadsheet software. The consistency of qualitative descriptor determinations was assessed in terms of frequency of observer agreement and multirater kappa statistics. Consistency of trajectory vectors was evaluated in terms of distribution of magnitude of the angles between vectors and the differences between their paraaxial and parasagittal angles. In 68% of trajectories, the observers' visual assessment of qualitative descriptors was congruent. Calculated descriptors agreed across observers in 60% of the trajectories. Estimated kappa also showed good agreement (0.65-0.79, p trajectory vectors were within 20° across observers. Results show agreement of visually assessed and calculated qualitative descriptors and trajectory angles among observers. The Trajectory Calculator describes trajectories qualitatively similar to radiologists' visual assessment, showing the potential feasibility of automated trajectory analysis.
Full Text Available Although its socio-economic disaster pattern was obvious, the March 4, 1977 Vrancea, Romania earthquake was studied mainly in seismological and earthquake engineering terms. In 1977, the loss data released in Romania, referred to 32,900 collapsed or heavily damaged dwellings, 35,000 homeless families, thousands of damaged buildings, many other damages and destructions in industry and economy, 1,578 people killed, 11,321 people injured (with 90% of the killed and 67% of the injured being in the city of Bucharest. The Romanian government reported the economic losses from this event in December 1977, as being US$ 2 billion. For a long time, the evaluation of human casualties vs. collapse pattern of buildings in 1977 was not addressed and we still miss integral data. The recovery and reevaluation of economic and social impacts of the 1977 disaster was a concern of the authors, with the intent to better understand its consequences and prepare a new strategy of seismic risk reduction in view of future earthquakes in Romania, and in order to fill that gap the authors recovered many unpublished and obscure data.
Matar, H; Larner, J; Kansagra, S; Atkinson, K L; Skamarauskas, J T; Amlot, R; Chilcott, R P
The efficient removal of contaminants from the outer surfaces of the body can provide an effective means of reducing adverse health effects associated with incidents involving the accidental or deliberate release of hazardous materials. Showering with water is frequently used by first responders as a rapid method of mass casualty decontamination (MCD). However, there is a paucity of data on the generic effectiveness and safety of aqueous decontamination systems. To address these issues, we have developed a new in vitro skin diffusion cell system to model the conditions of a common MCD procedure ("ladder pipe system"). The new diffusion cell design incorporates a showering nozzle, an air sampling port for measurement of vapour loss and/aerosolisation, adjustable (horizontal to vertical) skin orientation and a circulating manifold system (to maintain a specified flow rate, temperature and pressure of shower water). The dermal absorption characteristics of several simulants (Invisible Red S, curcumin and methyl salicylate) measured with the new in vitro model were in good agreement with previous in vitro and in vivo studies. Moreover, these initial studies have indicated that whilst flow rate and water temperature are important factors for MCD, the presence of clothing during showering may (under certain circumstances) cause transfer and spreading of contaminants to the skin surface. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bukoski, Alex; Uhlich, Rindi; Tucker, Johnny; Cooper, Chris; Barnes, Steve
Changes in electrodermal activity (EDA) correlate with arousal and stress during stimulating experiences. We hypothesized that associations exist between short-term performance gains and changes in EDA. A total of 187 combat medics were randomly assigned to simulation (S), live tissue (L), or video (V) based training in the recognition and treatment of nerve agent casualties. Change in EDA from baseline to training was quantified for tonic and phasic responses and was categorized as positive (>+10%), no change (±10%), or negative ( S ∼ V) were observed. Notably, larger proportions of trainees experienced negative changes in tonic (67%) and phasic (21%) EDA measures in the V group when compared to the L and S groups. Regardless of training modality, negative tonic and phasic EDA responses were associated with lower psychomotor performance gains and this finding approached statistical significance (tonic: p = 0.056, phasic: p = 0.08). No significant differences were noted in pre- to post-training cognitive performance between EDA response categories. As quantified by EDA response to training, reduced arousal was associated with lower short-term psychomotor, but not cognitive, performance gains. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.
Dragoș C. Tudose
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.
Engström, Karl Gunnar; Angrén, John; Björnstig, Ulf; Saveman, Britt-Inger
Underground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review. A literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing. Most of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission. Evaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations. (Disaster Med Public Health Preparedness. 2018;12:138-146).
Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M
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.
Schoenfeld, Andrew J; Laughlin, Matthew D; McCriskin, Brendan J; Bader, Julia O; Waterman, Brian R; Belmont, Philip J
Retrospective analysis of a prospective data set. Determine the incidence and epidemiology of combat-related spinal injuries for the wars in Afghanistan and Iraq. Recent studies have identified a marked increase in the rate of combat-related spine trauma among casualties in Afghanistan and Iraq. Limitations in these previous works, however, limit their capacity for generalization. A manual search of casualty records stored in the Department of Defense Trauma Registry was performed for the years 2005 to 2009. Demographic information, nature of spinal wounding, injury mechanism, concomitant injuries, year, and location of injury were recorded for all soldiers identified as having sustained combat-related spine trauma. Incidence rates were constructed by comparing the frequencies of spine casualties against defense manpower deployment data. Multivariate Poisson regression was used to identify statistically significant factors associated with spinal injury. In the years 2005 to 2009, 872 (11.1%) casualties with spine injuries were identified among a total of 7877 combat wounded. The mean age of spine casualties was 26.6 years. Spine fractures were the most common injury morphology, comprising 83% of all spinal wounds. The incidence of combat-related spinal trauma was 4.4 per 10,000, whereas that of spine fractures was 4.0 per 10,000. Spinal cord injuries occurred at a rate of 4.0 per 100,000. Spinal cord injuries were most likely to occur in Afghanistan (incident rate ratio: 1.96; 95% confidence interval: 1.68-2.28), among Army personnel (incident rate ratio: 16.85; 95% confidence interval: 8.39-33.84), and in the year 2007 (incident rate ratio: 1.90; 95% confidence interval: 1.55-2.32). Spinal injuries from gunshot were significantly more likely to occur in Iraq (17%) than in Afghanistan (10%, P = 0.02). The incidence of spine trauma in modern warfare exceeds reported rates from earlier conflicts. The study design and population size may enhance the capacity for
Vincent, Dale S; Berg, Benjamin W; Ikegami, Keiichi
More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought. A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed). There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition. Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment. Simulation training represents an opportunity to engage learners regardless of language and cultural barriers
Maqsood, Rasikh; Rasikh, Alia; Abbasi, Tariq; Shukr, Irfan
As a front line state in war against terror, Pakistan has been a victim of terrorism, for the last many years & Baluchistan has been the hub of all such terror activities. The objective of this study was to determine the incidence and type of injuries in mass casualties in terrorist activities in Baluchistan. The study was done by the review of the record of all patients of terrorist attacks who were admitted in Combined Military Hospital (CMH) Quetta from 27th Aug 2012 to 31st Jul 2015. The final injuries sustained by the victims were documented in the patient charts after repeated examination. The data was collected from these patient charts. Data was analysed using SPSS-21. Frequency & percentages of different injuries was calculated to determine the injury pattern. A total of 3034 patients reported to the hospital (n-3034), 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. Sex ratio was M/F=5.7: 1 Mean hospital stay was 6.31 days. Majority of the injured had multisystem injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the subspecialties' should include orthopaedics, vascular, thoracic and neurosurgery.
Toltzis, Philip; Soto-Campos, Gerardo; Shelton, Christian R; Kuhn, Evelyn M; Hahn, Ryan; Kanter, Robert K; Wetzel, Randall C
ICU resources may be overwhelmed by a mass casualty event, triggering a conversion to Crisis Standards of Care in which critical care support is diverted away from patients least likely to benefit, with the goal of improving population survival. We aimed to devise a Crisis Standards of Care triage allocation scheme specifically for children. A triage scheme is proposed in which patients would be divided into those requiring mechanical ventilation at PICU presentation and those not, and then each group would be evaluated for probability of death and for predicted duration of resource consumption, specifically, duration of PICU length of stay and mechanical ventilation. Children will be excluded from PICU admission if their mortality or resource utilization is predicted to exceed predetermined levels ("high risk"), or if they have a low likelihood of requiring ICU support ("low risk"). Children entered into the Virtual PICU Performance Systems database were employed to develop prediction equations to assign children to the exclusion categories using logistic and linear regression. Machine Learning provided an alternative strategy to develop a triage scheme independent from this process. One hundred ten American PICUs : One hundred fifty thousand records from the Virtual PICU database. None. The prediction equations for probability of death had an area under the receiver operating characteristic curve more than 0.87. The prediction equation for belonging to the low-risk category had lower discrimination. R for the prediction equations for PICU length of stay and days of mechanical ventilation ranged from 0.10 to 0.18. Machine learning recommended initially dividing children into those mechanically ventilated versus those not and had strong predictive power for mortality, thus independently verifying the triage sequence and broadly verifying the algorithm. An evidence-based predictive tool for children is presented to guide resource allocation during Crisis Standards
Scheulen, James J; Thanner, Meridith H; Hsu, Edbert B; Latimer, Christian K; Brown, Jeffrey; Kelen, Gabor D
Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS), developed to have broad application across emergency management and public health fields as part of a catastrophic events preparedness planning process. As a scalable, flexible tool, EMCAPS is intended to support emergency preparedness planning efforts at multiple levels ranging from local health systems to regional and state public health departments to Metropolitan Medical Response System jurisdictions. Designed around the subset of the National Planning Scenarios with health effects, advanced by the US Department of Homeland Security, the tool's platform is supported by the detailed descriptions and readily retrievable evidence-based assumptions of each scenario. The EMCAPS program allows the user to manipulate key scenario-based input variables that would best reflect the region or locale of interest. Inputs include population density, vulnerabilities, event size, and potency, as applicable. Using these inputs, EMCAPS generates the anticipated population-based health surge influence of the hazard scenario. Casualty estimates are stratified by injury severity/types where appropriate. Outputs are graph and table tabulations of surge estimates. The data can then be used to assess and tailor response capabilities for specific jurisdictions, organizations, and health care systems. EMCAPS may be downloaded without cost from http://www.hopkins-cepar.org/EMCAPS/EMCAPS.html as shareware.
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
Pinkert, Moshe; Bloch, Yuval; Schwartz, Dagan; Ashkenazi, Isaac; Nakhleh, Bishara; Massad, Barhoum; Peres, Michal; Bar-Dayan, Yaron
Crowd control is essential to the handling of mass-casualty incidents (MCIs). This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals. Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered. The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed. During 10 days of riots (01-10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the "immediate care"location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control. During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management
Full Text Available Peter Doyle. World War II in Numbers: An Infographic Guide to the Conflict, Its Conduct, and Its Casualties, illustrated by Lindsey Johns (Buffalo NY: Firefly Books, 2013. 224 pp. ISBN: 177085195X. Doyle’s book contains dozens of graphs of statistical data dealing with World War II. Many of these graphs are visually striking. However, they often violate fundamental graphing principles, in that they distort quantitative relationships, use unidentified scales, and often make it difficult to compare quantities. Graphic software makes it easy to create imaginative images, but these can fail to communicate the very information that is the graph’s purpose.
NF ISO 21243, September 2009. 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
This international standard is to give an overview of the minimum requirements of process and quality-control components of the cytogenetic response for triage of mass casualties. Cytogenetic triage is the use of chromosome damage to evaluate approximately and rapidly radiation doses received by individuals in order to supplement the early clinical categorization of casualties. This standard concentrates on organizational aspects of applying the dicentric assay for operation in a triage mode. The technical aspects of the dicentric assay can be found in the ISO 19238. This international standard is applicable either to an experienced biological dosimetry laboratory working alone or to a network of collaborating laboratories
In this report we compare two measures of driver risks: fatality risk per vehicle registration-year, and casualty (fatality plus serious injury) risk per police-reported crash. Our analysis is based on three sets of data from five states (Florida, Illinois, Maryland, Missouri, and Pennsylvania): data on all police-reported crashes involving model year 2000 to 2004 vehicles; 2005 county-level vehicle registration data by vehicle model year and make/model; and odometer readings from vehicle emission inspection and maintenance (I/M) programs conducted in urban areas of four of the five states (Florida does not have an I/M program). The two measures of risk could differ for three reasons: casualty risks are different from fatality risk; risks per vehicle registration-year are different from risks per crash; and risks estimated from national data are different from risks from the five states analyzed here. We also examined the effect of driver behavior, crash location, and general vehicle design on risk, as well as sources of potential bias in using the crash data from five states.
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600,000, Study Says,” New York Times, October 11, 2006, p. A16. 10 Steven E. Moore, “655,000 War Dead?,” Wall Street Journal , October 18, 2006, p. A.20. 11...International, objected to the methods used by the researchers, commenting in the Wall Street Journal that the Lancet article lacked some of the hallmarks of
Raknes, Guttorm; Hunskaar, Steinar
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.
Young, Victoria Solveig; Eggesbø, Heidi B; Gaarder, Christine; Næss, Pål Aksel; Enden, Tone
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.
Pasquier, Pierre; Mérat, Stéphane; Malgras, Brice; Petit, Ludovic; Queran, Xavier; Bay, Christian; Boutonnet, Mathieu; Jault, Patrick; Ausset, Sylvain; Auroy, Yves; Perez, Jean Paul; Tesnière, Antoine; Pons, François; Mignon, Alexandre
The French Military Health Service has standardized its military prehospital care policy in a ''Sauvetage au Combat'' (SC) program (Forward Combat Casualty Care). A major part of the SC training program relies on simulations, which are challenging and costly when dealing with more than 80,000 soldiers. In 2014, the French Military Health Service decided to develop and deploy 3D-SC1, a serious game (SG) intended to train and assess soldiers managing the early steps of SC. The purpose of this paper is to describe the creation and production of 3D-SC1 and to present its deployment. A group of 10 experts and the Paris Descartes University Medical Simulation Department spin-off, Medusims, coproduced 3D-SC1. Medusims are virtual medical experiences using 3D real-time videogame technology (creation of an environment and avatars in different scenarios) designed for educational purposes (training and assessment) to simulate medical situations. These virtual situations have been created based on real cases and tested on mannequins by experts. Trainees are asked to manage specific situations according to best practices recommended by SC, and receive a score and a personalized feedback regarding their performance. The scenario simulated in the SG is an attack on a patrol of 3 soldiers with an improvised explosive device explosion as a result of which one soldier dies, one soldier is slightly stunned, and the third soldier experiences a leg amputation and other injuries. This scenario was first tested with mannequins in military simulation centers, before being transformed into a virtual 3D real-time scenario using a multi-support, multi-operating system platform, Unity. Processes of gamification and scoring were applied, with 2 levels of difficulty. A personalized debriefing was integrated at the end of the simulations. The design and production of the SG took 9 months. The deployment, performed in 3 months, has reached 84 of 96 (88%) French Army units, with a total of 818
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)
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.)
Young, Victoria Solveig; Eggesboe, Heidi B.; Enden, Tone; Gaarder, Christine; Naess, Paal Aksel
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.)
Binder, L S; Willoughby, P J; Matkaitis, L
This article describes the planning, development, and execution of a unique, decentralized, and flexible medical response capability that was developed for the 1996 Democratic National Convention in Chicago. Concerns for coordinated acts of violence, terrorism, toxicologic exposures, and logistic problems posed by the United Center prompted the development of a decentralized and flexible rapid-response plan. Contingency planning for the remote possibility of a full-scale disaster led to the additional development of a contingency mass-casualty field hospital on site. The plans for this mass-gathering response are described in considerable detail. Forty-four patient encounters across the four days of the convention were recorded, with a combination of minor injuries and potentially serious medical presentations. The 1.46 EMS encounters per 1,000 attendees at the Democratic National Convention is comparable to other utilization rates for mass gatherings in the literature. Proactive attention to comprehensive contingency planning for equipment, supplies, personnel, and organizational needs, especially when multiagency response and cooperation are required, is essential.
Dhamorikar, Aniruddha H; Mehta, Prakash; Bargali, Harendra; Gore, Kedar
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 during the collection of Non-Timber Forest Produce (NTFP), 15% during the collection of fuelwood and 13% during grazing of livestock. The remainder took place at forest edges or in agricultural fields (19%), most occurring when person(s) were working in fields (7%), defecating (5%), or engaged in construction work (3%). Most victims were between the ages of 31 to 50 (57%) and most (54%) were members of the Gond tribe. The majority of attacks occurred in summer (40%) followed by monsoon (35%) and winter (25%). Forty-four percent of victims were rescued by people, while 43% of the time bears retreated by themselves. In 60% of attacks, a single bear was involved, whereas 25% involved adult females with dependent cubs and the remainder (15%) of the cases involved a pair of bears. We discuss the compensation program for attack victims as well as other governmental programs which can help reduce conflict. Finally, we recommend short-term mitigation measures for forest-dependent communities.
Aniruddha H Dhamorikar
Full Text Available 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 during the collection of Non-Timber Forest Produce (NTFP, 15% during the collection of fuelwood and 13% during grazing of livestock. The remainder took place at forest edges or in agricultural fields (19%, most occurring when person(s were working in fields (7%, defecating (5%, or engaged in construction work (3%. Most victims were between the ages of 31 to 50 (57% and most (54% were members of the Gond tribe. The majority of attacks occurred in summer (40% followed by monsoon (35% and winter (25%. Forty-four percent of victims were rescued by people, while 43% of the time bears retreated by themselves. In 60% of attacks, a single bear was involved, whereas 25% involved adult females with dependent cubs and the remainder (15% of the cases involved a pair of bears. We discuss the compensation program for attack victims as well as other governmental programs which can help reduce conflict. Finally, we recommend short-term mitigation measures for forest-dependent communities.
Ajimi, Yasuhiko; Sasaki, Masaru; Uchida, Yasuyuki; Kaneko, Ichiro; Nakahara, Shinya; Sakamoto, Tetsuya
Introduction Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon's Information Theory to triage. Hypothesis Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon's entropy evaluates the degree of informational confusion quantitatively and improves primary triage. The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 - all 32 patients in the triage area at commencement of triage; Case 2 - 16 randomly imported patients to join 16 post-triage patients; Case 3 - eight patients imported randomly and another eight grouped separately; Case 4 - 16 patients grouped separately; Case 5 - random placement of all 32 post-triage patients; Case 6 - isolation of eight patients of minor priority level; Case 7 - division of all patients into two groups of 16; and Case 8 - separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A - triage conducted in random manner; and System B - triage arranged into four categories). In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3
Sheppard, Forest R; Mitchell, Thomas A; Macko, Antoni R; Fryer, Darren M; Schaub, Leasha J; Ozuna, Kassandra M; Glaser, Jacob J
Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development. In the non-human primate, a poly-trauma model was utilized, consisting of a musculoskeletal injury (femur fracture), soft tissue injury (15cm laparotomy), and controlled hemorrhage to a mean arterial pressure of 20 mmHg, demarcating the beginning of the shock period. Animals were randomized to pre-hospital interventions of whole blood or Hextend at T=0 minutes, and at T=90 minutes definitive surgical interventions and balanced sanguineous damage control resuscitation could be implemented. All animals were euthanized at T=480 minutes. Data are expressed as mean±SEM; significance, p<0.05. No significant differences in survival, 83% vs. 100%, p=0.3), tissue perfusion (EtCO2 & StO2) or endpoints of resuscitation (base deficit, lactate, pH) between Hextend and whole blood were identified. Secondly, whole blood compared to Hextend demonstrated significantly earlier normalization of clot formation time, maximal clot firmness, and α angle. A future multi-functional resuscitative fluid including an asanguineous, oncotic, non-oxygen carrying component to facilitate intra-vascular volume expansion and a component with synthetic coagulation factors and fibrinogen to deter coagulopathy may show equivalence to whole blood. Translational animal model LEVEL OF EVIDENCE: N/A.
Badiali, Stefano; Giugni, Aimone; Marcis, Lucia
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).
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 research institute were used. The protocol for reports from major accidents and disaster was used to standardize the reporting [Lennquist, in Int J Disaster Med 1(1):79-86, 2003]. The emergency services were quickly at the scene. The different levels of pre-hospital management performed a tight coordination. However, miscommunication led to confusion in the registration and tracking of patients. In total, 49 persons needed medical treatment, 46 were treated in the MIH. Because of (possible) inhalation injury nine patients needed mechanical ventilation and nine patients were hospitalized to exclude delayed onset of pulmonary symptoms. No incident related deaths occurred. The intensive care unit of the MIH was initially understaffed despite the efforts of the automated calling system and switchboard operators. The handwritten registration of incoming staff was incomplete and should be performed digitally. Some staff members were unfamiliar with the MIH procedures. The medical chart appeared too extensive. Miscommunication between chain partners resulted in the delayed sharing of (semi) medical information. The different levels of incident managers performed a tight coordination. The MIH demonstrated its potency to provide emergency care for 46 patients and 9 intubated patients. No deaths or persistent disabilities occurred. Areas of improvement were recognized both in the pre-hospital as the hospital phase.
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
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
Turcan, Romeo V.
In this essay I will expand my thoughts on universities as ‘late globalizers’ and the impact ‘being late’ has on university internationalization or globalization activities. In my earlier essay I viewed universities as ‘late globalizers’ and briefly introduced the impact of being ‘late’, e...
Full Text Available Human factors play an important role in the origin of accidents,and it is commonly claimed that between seventy andninety-five percent of industrial and transport accidents involvehuman factors, see Figure 1.Some authorities, however, claim that ultimately, all accidentsinvolve human factors.
Thirty seven years ago, 6 August 1945 marks the date of the first atomic bombing never experienced in human history. It was dropped on Hiroshima and this was followed by a second bombing three days later on Nagasaki. The total deaths following exposure to the bomb by the end of 1945 totalled 140,000 (+/- 10,000) in Hiroshima and 70,000 (+/- 10,000) in Nagasaki. The present article described and outline of the physical effects of the atomic bomb and injury to the human body by exposure to the bomb.
Cadman, Kate; Clack, Elaine; Lethbridge, Zena; Millward, Jennifer; Morris, Jenny; Redwood, Rachel
A cross-sectional survey of 54 nursing lecturers and 244 students using modularized curriculum and analysis of curriculum documentation indicated that only 3 of 13 modules refer explicitly to reflective practice. Students identified lectures and group work as strategies for learning reflection; lecturers cited tutorials, groups, and cases. Most…
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
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.
assuming a glomerular filtration rate of 75 mL/min per 1.73 m2.25 The lower value of this estimated creatinine or the admission creatinine was used as...baseline, and a baseline creatinine was derived from either a back-calculated value (assuming a glomerular filtration rate of 75 mL/min) or the admission...creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247Y254. 26
of Transportation Statistics: Average Emergency Medical Service (EMS) ResponseTime for Rural and Urban Fatal Crashes: 1998 34. Stearley HE. Patients...UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Arizant Healthcare University of Minnesota 10393 W...Prescribed by ANSI-Std Z39-18 This page is intentionally left blank. Arizant Healthcare – STTR Phase I Final Report Navy STTR
Although the Common Core standards do not prescribe pedagogy or forbid playful learning, kindergarten teachers will find it challenging to maintain a playful classroom under this reform. Kindergarten teachers have to cover a more rigorous and accelerated curriculum now, and they are doing so in a context that rewards procedural teaching.
Intervention Inte rvention Group Higher group cohesion Highe r problem solving coping scores Higher per ceived socia l support Lower a nger expression...44 Media Reports Managing Stress in Military Personnel with a Web-Enhanced Behavioral Self- Management Program. Cognitive Behavior Therapy for
Other groups within the Department of De- fense (DOD) and Department of Vet- erans Affairs ( DVA ) are already ex- amining issues such as improving...kins Bloomberg School of Public Health. Finally, the panel recognized the continued need for data integra- tion across the DOD and DVA to fa- cilitate
The bio-terrorism threat has become the ''poor man's'' nuclear weapon. The ease of manufacture and dissemination has allowed an organization with only rudimentary skills and equipment to pose a significant threat with high consequences. This report will analyze some of the most likely agents that would be used, the ease of manufacture, the ease of dissemination and what characteristics of the public health response that are particularly important to the successful characterization of a high consequence event to prevent excessive causalities.
Çelikel, Adnan; Karbeyaz, Kenan; Kararslan, Bekir; Arslan, M Mustafa; Zeren, Cem
In war areas a lot of children die as well as adults. According to UNICEF, almost 2 million children have died in the wars took place in the last 10 years. In this study, we aimed to evaluate demographical data and injury characteristics of Syrian children who were wounded in Syria Civil War and died while being treated in Turkey. Postmortem examination and autopsy reports of 985 forensic deaths from Hatay -a Syrian neighborhood city of Turkey-between January 2012 and August 2014 were analyzed retrospectively. Among 763 Syrian people who were wounded in the war and died while being treated in Turkey, 140 cases (18.3%) who were younger than 18 years of age were taken into the scope of this study. Among those cases 77.9% (n = 109) were male and 22.1% were female. Median ages of female cases are 14 (min-max: 2-18) and median age of female cases are 9 (min-max: 1-18). Frequency distribution is highest between 13 and 18 years of age (n: 71, 50.7%). In 70% (n: 98) of cases, cause of death is bombing and shrapnel injuries, 13.6% (19) of them were killed by gunshot wounds. According to injury sites most of the injuries were reported to be on multiple body parts (54.3%, n: 76) and only head and neck injuries (%30). Cause of death was intracranial bleeding and cerebral parenchymal injury in most of the cases (n: 66, %47.1) followed by vascular damage with external bleeding (n: 15, %10.7) and internal organ damage with internal bleeding (n: 15, %10.7). The cases had very high level Abbreviated Injury Scales and Injury Severity Sores. In conclusion, a lot of children have died in the Civil War of Syria. Their average abbreviated injury scale and injury severity score values reported very high. Children that we evaluated were mostly died of head and neck injuries predominantly caused by bombing attacks and Autopsies of them revealed fatal intracranial hemorrhages and parenchymal injuries. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
The classification recognises a category called “regional disaster” and attempts to enunciate a principle of initiation, mobilisation and co-ordination of management of such disasters among hospitals and human and material resources within the region. It is envisaged that coalescence of “regional disaster preparedness” ...
Terrien’s degeneration, Mooren’s ulcer, keratoconus , and pel- lucid marginal degeneration,16–18 as well as with dis- orders of collagen metabolism...Ingraham HJ, Donnenfeld ED, Perry HD. Keratoconus with spontaneous perforation of the cornea. Arch Ophthalmol. 1991;109:1651–1652. 19. Izquierdo L Jr...Au YK, Collins WP, Patel JS, Asamoah A. Spontaneous corneal rupture in Noonan syndrome: A case report. Ophthalmic Genet . 1997;18:39–41. 21. Topping
Kimble, C.W. Witherspoon, ’Endophthalmitis due to Sporothrix schenckll after penetrating ocular injury," Annals of Ophthalmology 22:385- 388, (1990). F...car- oxygen saturation in human subjects by photographic means. diac output, systemic vascular resistance , and brain blood Circulation. 1963;27:275...configuration used for this study, the systemic vascular resistance , blood volume, and EOX is capable of analyzing vessels ranging from brain blood flow
PHYSICIAN. In moving and transporting the patient, keep him lying in the head down position at all times and do not interrupt resuscitation. The worker...or paralysis (usually with a definite nerve distribution); b. vertigo (staggers); c. visual disturbances (tunnel vision, flashing lights, partial or...may have involvement of the cardio-respiratory - system (chokes) such as: a. dry, harsh cough, possibly paroxysmal ; b. wheezing; c. dyspnoea; d
Doherty, William J.; Walker, Brian J.
Investigated the relationship between participation in Marriage Encounter and subsequent marital or family distress. An analysis of 13 case reports suggested that Marriage Encounter weekends can cause marital or family deterioration through increased marital conflict, avoidance of constructive problem solving, or marital enmeshment at the expense…
Sawka, M. N; Wenger, C. B; Montain, S. J; Kolka, M. A; Bettencourt, B; Flinn, S; Gardner, J; Matthew, W. T; Lovell, M; Scott, C
.... Understand the effect of fluid and electrolyte imbalances (para 4-7); h. Understand the methodology, needed equipment, use of, and correction procedures for the wet bulb globe temperature (WBGT) index (appendix P...
factor in determining the outcome in a medium-scale conflict .21 The massacre of 45 ethnic Albanian civilians in the village of Racak on January... SCHOOL OF ADVANCED AIR AND SPACE STUDIES FOR COMPLETION OF GRADUATION REQUIREMENTS SCHOOL OF ADVANCED AIR AND SPACE STUDIES AIR...thesis suggests that war’s nature and the requirement for efficiency in conflict influences airpower innovation. This thesis proposes that the
Same Daughter Mr. Thomas (NMI) Edison 5222 Lightbulb Dr, Arkon, OH 4 4 Father(3) ,Ii 10. REMARKS (CoUnvo on mpau# shEoot If nemw’y) *Item 5d continued...i, . : .j - .- .4. Department of Defense . S INSTRUCTIONAD-A269 412 111111 4 December 27, 1991 NUMBER 1300.18 ASD(FM&P) SUBJECT: Military Personnel...and Associated S P b Terms," December A, 1989 (d) DoD Directive 5010.38, "Internal Management Control Program," April 14, 1987 (e) through (m), see
Jonathan J. Bryson Heidi Keller-Glaze ICF International Christopher L. Vowels U.S. Army Research Institute February 2015 United...Christopher L. Vowels 5c. PROJECT NUMBER A790 5d. TASK NUMBER 5e. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES...Contracting Officer’s Representative and Subject Matter POC: Dr. Christopher L. Vowels 14. ABSTRACT (Maximum 200 words): This report
Hall, Katharine; Stahl, Dale
The problem of measuring the number of civilian fatalities in Iraq gained widespread media coverage when the Lancet published a study in October 2004 claiming that more than 100,000 Iraqi civilians...
Carpaij, W.J.M.; Keverling Buisman, A.S.
All routine procedures taken by the Occupational Health Service of the Health Protection Department of ECN in case of a personal contamination with radioactive materials and/or overexposure with ionising radiation are described in detail. The appendices contain information concerning limits of intake and all forms and registration-charts used in these procedures
Cutter, S L
The author posits that women and children bear a disproportionate burden of environmental degradation and are in the worst position to mitigate the consequences of deteriorating environmental conditions. This article discusses the concept of environmental equity or fairness and its sociospatial impacts and the different adjustments made by women and children. Environmental equity is both an outcome and a process. Process equity includes the underlying causes of uneven distributions of resources. The 1992 Rio Declaration on Environment and Development defines 27 specific principles that broadly follow three forms of equity: social equity, generational equity, and procedural equity. Social equity is defined as the role of social, economic, and political forces in resource consumption and environmental degradation. Environmental risk is related to locational criteria such as cheap land and transportation access and by the social geography of places. Hazardous waste dumping is used to illustrate inequitable waste disposal in developing countries such as Brazil, Mexico, Nigeria, Lebanon, Syria, Venezuela, Zimbabwe, and South Korea. Generational equity is defined as fairness over time. The issue of permanent radioactive waste disposal is a current issue that has implications for future generations. Three strategies are important in assuring generational equity: the maintenance of natural and cultural diversity; a reduction in environmental degradation; and the provision of equal access to resources. Preservation of parkland is a positive strategy and lack of access to health services and reproductive health care is a negative strategy. Procedural equity is defined as the extent to which regulations are applied fairly. The example is given of higher fines for dumping waste in "nice White communities" compared to minority ones. Environmental law regulating hazardous waste exports has been minimally effective. Women and children are affected by particulate pollution and environmental toxins (lead and pesticides) in the air and water of urban areas and by a composite of poverty, development, and urbanization.
Martineau, Lucie; Shek, Pang N
... dressing to address key requirements for treating external war wounds. In the present report, we assessed our dressing's bactericidal efficacy, wound healing properties, and skin-cooling characteristics using various pre-clinical models...
Social Security Administration — SSA initiated this agreement with the Department of Defense (DOD) to transmit to SSA information that will identify military personnel injured or taken ill while in...
Bulhoek to carry out the Government's instructions at Bulhoek.3. Following the fight, the medical per- sonnel awaited orders from Colonel Truter. After ... quested the Automobile Club of Queenstown to help transport the wounded Israelites from the dressing station at Enoch's house to the Frontier HospitaLS. A total of 157 ...
Mahoney, Robert T
.... Other disciplines such as philosophy, theology, bioethics, and the military, etc. have examined principles that are involved in the concept of accepting loss of life and have identified theoretical circumstances under which acceptance...
0 0.0 0.00000 1 0.0 0.00001 121 DESCRIPTION MENSTRUATION DISORDERS OF FEMALE GENITAL ORGANS OTHER DISEASES ECTOPIC PREGNANCY ABORTION...unexploded RPG to chest (KIA) 4. Helicopter crash followed by gunshot wound to back/neck (KIA) 5. Gunshot wound to upper back through soft body armor...chest") 16. Gunshot wound to head (KIA) 17. RPG to abdomen (DOW) (hospital report reads "GSW to hip") 18. Gunshot wound to head (KIA) Wounded in
Glover, Derek; Gleeson, Denis; Johnson, Mike; Spencer, Pat; Watson, Ray
Study of the introduction of generic Key Skills in two local education authorities in Britain found limited implementation. Results suggested the need for strategic district- and school-level management, clear aims and objectives, ownership by school staff, and cross-curricular application. (SK)
This study has several findings. First, the constant values of the prediction model are relatively close to the average number of accident which implies that the mere compliance to current standard cannot warrant the safeness of Indoensian highways. Second, the number of median opening per unit length and disturbance level to pedestrian and road reserve area are the features that having positive relationships with total accident count. Meanwhile, the ROW disturbance, conformance of intersection and of road marking also show significant value but negative relationship with total accident count. Third, significant variables for each type of crash may have different sign. For example, in right angle crash, median width has positive relation with the number of accident, while in run off and rear end crash, median width compliance is shown to have negative relation.
The author uses an autoethnographic account of a close friend's emergency cardiac surgery, and its disastrous outcome, to explore and critique the contemporary search for medical "miracles" and the patchwork and inequitable system of medical reimbursement in the United States.
Young drivers and riders aged 15-25 are more likely to be killed on Europe’s roads than their older counterparts, despite continued improvements in road safety. Road collisions remain one of the highest external causes of death for young people. The risks are especially high for young males and for
Holcomb, John B
.... Basil Pruitt described Dr. William P. Fitts in his 1992 Fitts Lecture as a physician soldier in World War II, an author, a chairman, an editor of the Journal of Trauma, and a past President of our association...
.... The period covered is from 7 December 1941 through 31 December 1946 -- from the unprovoked attack on Pearl Harbor to the day hostilities were declared terminated by Presidential Proclamation No. 2714...
Nigerian Quarterly Journal of Hospital Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 10, No 3 (2000) >. Log in or Register to get access to full text downloads.
An increasing number of states have legalized marijuana for recreational use. Though marijuana is still illegal at the Federal level, the administration will not seek to enforce the law in states that have legalized its use, consistent with a majority of Americans who indicate that they do not want Federal resources used to arrest and convict marijuana smokers in states that have legalized the substance (Ferner, 2012). With the legalization of marijuana comes interesting implications for the ...
.... Hypothesis tests are used to find if the DCR is different in urban operations. A linear regression model is constructed to predict outcomes of similar engagements and to see the effect of each variable...
Contact of the gate with the power lines caused production of sparks and electrocution of the patients. Results: There were 2 instant mortalities, varying levels of electrical shock in 7 and burns in 3 patients. The hall mark of treatment was resuscitation, and management of the burn wounds. No obvious gross internal organ ...
Burke, Rita V; Iverson, Ellen; Goodhue, Catherine J; Neches, Robert; Upperman, Jeffrey S
Recent disasters involving pediatric victims have highlighted the need for pediatric hospital disaster preparedness. Although children represent 25% of the U.S. population, there are significant gaps in pediatric disaster preparedness across the country. Disaster planners and others tend to overlook pediatric needs, and therefore plans are often inadequate. To establish an effective hospital and community-based pediatric disaster management system, administrative and hospital leadership are key. Disaster planners and hospital leadership should establish and improve their management of pediatric victims in the event of a disaster through staff training, family reunification planning, and use of available pediatric disaster management tools. Copyright © 2010 Elsevier Inc. All rights reserved.
carcinogenesis. The maximum permissi- ble dose to the fetus during gestation is 5 mSv, which treats the unborn child as a member of the general public...counts q6h in first few days if possible for prognosis. Moderate loss of granulocytes and platelets. Hair loss after 14 d. Thrombocytopenic purpura ...d 0-7 d 0-2 d None Manifest illness Signs, symptoms None Moderate leukopenia Severe leukopenia, purpura , hemorrhage, pneumonia, hair loss after 300
to the fetus during gestation is 5 mSv, which treats the unborn child as a member of the general public brought involuntarily into controlled areas...Thrombocytopenic mised No further 5 wk purpura appears after 3piese Nraditon 5wwk. Consider cytokine therapy and biologic (follow exposure No further
Martineau, Lucie; Shek, Pang N
.... Biopsies taken from full-thickness, pig wounds infected with Ps. aeruginosa and Staph. epidermidis showed a 2- to 5-log reduction in the bacterial load of antiseptic-treated wounds compared to those of control wounds...
Jaiswal, Kishor; Wald, David J.; Hearne, Mike
We developed an empirical country- and region-specific earthquake vulnerability model to be used as a candidate for post-earthquake fatality estimation by the U.S. Geological Survey's Prompt Assessment of Global Earthquakes for Response (PAGER) system. The earthquake fatality rate is based on past fatal earthquakes (earthquakes causing one or more deaths) in individual countries where at least four fatal earthquakes occurred during the catalog period (since 1973). Because only a few dozen countries have experienced four or more fatal earthquakes since 1973, we propose a new global regionalization scheme based on idealization of countries that are expected to have similar susceptibility to future earthquake losses given the existing building stock, its vulnerability, and other socioeconomic characteristics. The fatality estimates obtained using an empirical country- or region-specific model will be used along with other selected engineering risk-based loss models for generation of automated earthquake alerts. These alerts could potentially benefit the rapid-earthquake-response agencies and governments for better response to reduce earthquake fatalities. Fatality estimates are also useful to stimulate earthquake preparedness planning and disaster mitigation. The proposed model has several advantages as compared with other candidate methods, and the country- or region-specific fatality rates can be readily updated when new data become available.
The most extensive and detailed study of the health effects of a nuclear attack on a major urban centre has been recently made of London. Not only hospitals, physicians, nurses, all other health professionals and technicians would be in short supply, but antibiotics, parenteral fluids, bandages, surgical equipment and all the sophisticated medical technology would be similarly lacking. Disrupting of communications, locally and nationally, would contribute to the general chaos following a nuclear attack. 13 refs, 2 tabs
anesthesia (12); (c) internal hemorrhage or fluid extravasation such as coagulopathy and intramuscular hematoma (13, 14), false aneurysm (15), hamstring ...clinical signs and symptoms alone (27, 28). These signs include pain out of proportion, weakness and passive pain on stretch of the muscles in the...thigh. J. Orthop. Trauma 16:436–438, 2002. 6. Rooser, B., Bengtson, S., Hagglund, G. Acute compartment syndrome from anterior thigh muscle contusion: a
BHS and S. aureus showed 100% sensitivity to cefuroxine, azithromycin, ceftazidine and genticin. All the isolates had little or no sensitivity to ampicillin and cotrimoxazole. BHS is a significant cause of pharyngitis and tonsillitis in our environment and therefore poses a potential danger of rheumatic fever and rheumatic heart ...
Conclusion: While the respiratory complaint was perceived as being the most detrimental of all presenting complaints, there was an overall non-threatening outcome in all patients. The presenting respiratory complaints were mostly subjective with benign outcome. Although various risk factors associated with severity increase of respiratory status, were present in a few of the index cases patients, their affect was negligible with a resultant benign outcome.
to the United States in military transport aircraft provides a unique environment in which patient pain management is crucial. Patients enter into...Anesthesiologists in the military have met to institute changes to address pain needs of trauma patients (Carter, 2010). Innovative pain care strategies have been...treat pain in the ERC environment are also being pursued. Battlefi eld acupuncture is one such intervention that has been evaluated in the ERC envi
Underwriting cycles are unexpected in a structurally competitive industry where financial capital is the major determinant of output capacity. "Arbitrage" theories explain underwriting cycles as largely an artifact of institutional lags and reporting practices; "capacity-constraint" theories view insurance markets as characterized by real frictions that cause underwriting cycles by temporarily reducing the industry's capacity to insure risks. Arbitrage theories imply no systematic relationshi...
Department, for ex- ample, brigadier generals lead veterinary medicine and warrior transition care. Dentistry and nursing are both led by major generals...Active duty. By comparison, the Army has roughly the same number of radiation oncologists and nearly three times the number of pediatric psychia
cells ultimately leading to cellular death. If untreated, this can progress toward organ failure, and eventually death of the patient ( Guyton & Hall...eds.), Handbook of Workplace Assessment (pp. 165-196). San Francisco: Jossey-Bass Guyton , A., & Hall, J. (2006). Chapter 24: Circulatory Shock
2 996.66 Infection joint prosthesis 2 996.67 Infection orthopaedic device 12 Central nervous system 320.89 Meningitis other bacteria 1 320.9...Abrasion hip /leg infected 3 916.3 Blister hip /leg infected 2 917.3 Blister foot and toes-infected 2 958.3 Post-trauma wound infection 35 997.62 Infection...451.89 Thrombophlebitis other 6 451.9 Thrombophlebitis not otherwise stated 3 519.2 Mediastinitis 4 910.5 Infection bite head 5 916.5 Infection bite hip
Cevik, Yunsur; Onay, Meral; Akmaz, Ibrahim; Sezigen, Sermet
Chlorine gas is a potent pulmonary irritant that affects the mucous membranes and induces severe disturbances of pulmonary gas exchange within minutes of inhalation. The present study evaluated an extraordinary type of mass inhalational exposure. Clinical reports of 25 soldiers who were admitted to the emergency department of Maresal Cakmak Military Hospital, Erzurum were retrospectively evaluated. All patients were exposed to chlorine gas as a result of mixing sodium hypochlorite with hydrochloric acid during cleaning activities. All patients were male and the mean age of patients was 22.04+/-2.98 years. The main symptoms were coughing and dyspnea in 18 patients (72%). Forced expiratory volume in 1 second (FEV1) and FEV1/forced volume capacity (FVC) ratio were found to be normal in all patients but FVC and peak expiratory flow (PEF) were below the normal range (80%) in 9 patients (36%). All patients received warmed humidified oxygen combined with nebulized salbutamol. Inhaled budesonide and nebulized sodium bicarbonate were ordered additionally for 19 patients (76%). Thirteen patients (52%) were discharged from the emergency department and 12 patients (48%) were hospitalized. No mortality was observed. Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract. We suggest that inhaled steroids combined with nebulized sodium bicarbonate could be a safe and effective alternative for the treatment of symptomatic patients. Education of the public about the dangers of mixing of hypochlorite bleach with acidic cleaning agents is also very important.
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
of Sole Parenting and Pregnancy on Deployment P004 079 Male and Female Performance on Military Related Tasks "P004 080 Some Human Dimensions of...lability, increased libido , paresthesis, visual hallbcinations and tremor, along with EEG changes. This was the first suchi repcrt about EEG. However
Using our novel animal models of severe hemorrhage, focusing on evaluation of outcome to 3-10 days, the following strategies were found superior in terms of intact survival compared to standard resuscitation...
Full Text Available Marine Accident investigation multidimensional and complex, so this study aimed to provide a systematic approach to determining the degree of the most influential parameters (dimensions in accident occurrence in order to improve marine safety in the direction of good governance. In this paper, two-phase procedures are proposed. The first stage utilizes the fuzzy Delphi method (FDM to determine the critical factors of Marine Accident Investigation by interviewing the pertinent authorities. In the second stage, the fuzzy analytic hierarchy process (FAHP is applied to pair fuzzy numbers as measurable indices and finally to rank by degree each influential criterion within accident investigation. This study considers 1 goal, 4 aspects, and 31 criteria (parameters and establishes a ranking model that allows decision-makers to assess the prior ordering of reasons and sort by the most effective parameters involved in marine accident occurrence. The empirical study indicated that People, working and living conditions, effect is considered the highest ranking aspect, and Ability, skills, and knowledge of workers is considered the most important evaluation criterion overall by experts. These results were derived from fuzzy Delphi analytical hierarchy processing (FDAHP. A demonstration of the prior ordering of accident-causing parameters by authorities was addressed as well. Therefore, ranking the priority of every influential criterion (parameter will help marine transportation decision makers emphasize the areas in which to improve in order to prevent future marine accidents.
Martineau, Lucie; Shek, Pang N
.... Considering that commercially available dressings are not designed to meet the challenges of treating combat burn wounds, DRDC-Toronto has designed a novel, absorbent and medicated bi-layer wound...
Martineau, Lucie; Shek, Pang N
.... Considering that commercially available dressings are not designed to meet the challenges of treating combat burn wounds, DRDC Toronto has designed a novel, absorbent and medicated bi-layer wound...
mustard (HD), two pulmonary agents, phosgene (CG) and chlorine (Cl2), and three blood agents, hydrogen cyanide (AC), cyanogen chloride (CK), and hydrogen...must wear certain IPE because of the assessed threat. 2) Donning IPE or taking shelter in response to observing nerve agent poisoning symptoms in...Administration Publication AC Hydrogen cyanide ACH Air changes per hour AJP Allied Joint Publication AMedP Allied Medical Publication BDO Battle dress
Nov 4, 2012 ... exhaustion of supplies, poor communication and security threats both within the hospital and outside. Conclusion: 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 ...
strontium therapy. Sulfur (S) Consider sodium thiosulfate. Technetium (Tc) Potassium perchlorate Thallium (Tl) Prussian blue Thorium (Th...Zinc (Zn) DTPA*, EDTA, zinc sulfate as a diluting agent Zirconium (Zr) DTPA*, EDTA KI Blockage of the Thyroid Children are particularly...Nebulized inhalation: 1 g in 1:1 dilution with sterile water or NS. Children under 12 years: 14 mg kg–1 IV as above, not to exceed 1 g. IM: 1
unclear from the report if VTC was aware of the outages. 6349 7/14/76 The /V NOPAL VEGA was inbound the HSC when it passed the Steel Enterprises Inc...dock where the barge U.IC 730 was moored. The speed at which the NOPAL VEGA was travel- ing caused the U.IC 730 to break its mooringsstrike the dock...and cause damage to the barge and the dock. From the bell book of the NOPAL VEGA its speed was approximately 12.2 knots. CONCLUSION: If VTS had
After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites ...
which is reconstituted in water containing vitamin C to normalize the pH . We are currently reconstituting the plasma to its original volume and we...anesthetic maintenance in 50% oxygen. Tidal volume was fixed at 10 ml/kg with a rate of 10 breaths per minute. An esophageal stethoscope, gastric tube and...was hyperosmolar with significantly higher osmolarity 8 compared to the 100%LP solution. The pH of the two study fluids following reconstitution using
Roy, Nobhojit; Kapil, Vikas; Subbarao, Italo; Ashkenazi, Isaac
The November 26-29, 2008, terrorist attacks on Mumbai were unique in its international media attention, multiple strategies of attack, and the disproportionate national fear they triggered. Everyone was a target: random members of the general population, iconic targets, and foreigners alike were under attack by the terrorists. A retrospective, descriptive study of the distribution of terror victims to various city hospitals, critical radius, surge capacity, and the nature of specialized medical interventions was gathered through police, legal reports, and interviews with key informants. Among the 172 killed and 304 injured people, about four-fifths were men (average age, 33 years) and 12% were foreign nationals. The case-fatality ratio for this event was 2.75:1, and the mortality rate among those who were critically injured was 12%. A total of 38.5% of patients arriving at the hospitals required major surgical intervention. Emergency surgical operations were mainly orthopedic (external fixation for compound fractures) and general surgical interventions (abdominal explorations for penetrating bullet/shrapnel injuries). The use of heavy-duty automatic weapons, explosives, hostages, and arson in these terrorist attacks alerts us to new challenges to medical counterterrorism response. The need for building central medical control for a coordinated response and for strengthening public hospital capacity are lessons learned for future attacks. These particular terrorist attacks had global consequences, in terms of increased security checks and alerts for and fears of further similar "Mumbai-style" attacks. The resilience of the citizens of Mumbai is a critical measure of the long-term effects of terror attacks.
Full Text Available Anecdotes of concurrent eruptions at Etna, Stromboli, and Vulcano (Southern Italy have persisted for more than 2000 years and volcanologists in recent and past times have hypothesized a causal link among these volcanoes. Here this hypothesis is tested. To introduce the problem and provide examples of the type of expected volcanic phenomena, narratives of the most notable examples of concurrent eruptions are provided. Then the frequency of eruptions at each individual volcano is analysed for about the last 300 years and the expected probability of concurrent eruptions is calculated to compare it to the observed probability. Results show that the occurrence of concurrent eruptions is often more frequent than a random probability, particularly for the Stromboli-Vulcano pair. These results are integrated with a statistical analysis of the earthquake catalogue to find evidence of linked seismicity in the Etnean and Aeolian areas. Results suggest a moderate incidence of non-random concurrent eruptions, but available data are temporally limited and do not allow an unequivocal identification of plausible triggers; our results, however, are the first attempt to quantify a more-than-2000-years-old curious observation and constitute a starting point for more sophisticated analyses of new data in the future. We look forward to our prediction of a moderate incidence of concurrent eruptions being confirmed or refuted with the passage of time and occurrence of new events.
occurred despite the relatively poor protection and level of medical care available at that time (e.g., no antibiotics ). Mustard rapidly penetrates...could affect the eyes and respiratory tract. DETECTION Mustard received its name because of its garlic , horseradish, or mustard odor and can...follows: • The out of place smell of mustard, garlic , or onion. • Color change in M9 detector tape. • Overt indications such as enemy helicopters
Martineau, Lucie; Shek, Pang N
... dressing to address key requirements for treating external war wounds. In the present report, we assess our dressing's bactericidal efficacy, wound healing properties, and skin-cooling characteristics using various pre-clinical models...
.... Volunteers, their argument goes, may be more easily committed to combat situations by our nation's civilian leadership than their drafted brethren were a generation ago, since a voluntary career...
all involved tissue; thus, excision to fascia is frequently required. When infection is suspected, samples of the de- brided tissue should be sent for...phaeohyphomycosis due to Curvularia lunata involving skin and subcutaneous tissue after an explosion at a chemical plant . Am J Med Sci. 1993;305:387–389
... and would like to know that they reached the Facility, please enclose a stamped, self-addressed...). ``Bodysurfing'' means swimming or floating on one's stomach or on one's back on or in the wake directly behind a...
histopathological analysis obtained from animal experiments and prepare reports; interpret data and make adequate changes for subsequent experimental design...evacuation standards. In animal models of combat trauma, we will address the effects of timing, altitude, and oxygen supplementation during...7 9. Appendices…………………………………………………………… 7 DM 167040 “The Effects of Aero-medical Evacuation on Militarily Relevant Animal Models of Trauma”; PI: Dr
Early identification of AKI can also assist in aeroevacuation priorities for Role Ill to Role IV facility transfers. • Creatinine is easily available...as point of care testing and as part of serum chemistries in Role I to Ill, depending on deployment equipment. • But, creatinine has both false...9.8) Yts 8 (12.0) BMI 28.8(5.4) Dool> No 48(98.0) v .. 2(4.0) Conti nod No 42 (84.D) Y• 8118.’" "Modien (!QA) Table 2. Logistic Regression
Fábio Lucio Tavares
Full Text Available Objetivo: caracterizar a gravidade de homens acidentados de motocicleta, atendidos no serviço móvel pré-hospitalar. Método: estudo descritivo, transversal, com abordagem quantitativa. Foram analisados 901 Boletins de Ocorrência do Serviço de Atendimento Móvel de Urgência do Espírito Santo/Brasil, no período de janeiro a março de 2012. Resultados: A escoriação (44,66%, o ferimento corto-contuso (21,94%, a fratura e a amputação traumática (12,45% constituíram os tipos mais frequentes de lesão; os membros inferiores (40%, o crânio e a coluna cervical (9,41% foram os segmentos do corpo mais atingidos; ocorreram 6 óbitos no local do acidente (0,66%. Conclusão: os acidentes motociclísticos representam importante problema de saúde do homem, não apenas pela frequência com que ocorrem, mas principalmente pela gravidade das lesões geradas por esse tipo de acidente, confirmando a importância do preparo dos profissionais de saúde envolvidos no atendimento e na adoção de medidas preventivas
eds., Reorganizing the Military Health System (Santa Monica, CA: RAND, 2001), 57. 115 Ibid. 116 Ibid., 58-61. 117 Tom Philpott, “Military Update...armedforcesjournal.com/unified- medical-command-an-old-idea-whose-time-has-come/ June 1, 2013, (accessed June 19, 2017). 121 Tom Philpott, Healthcare to be single...accessed June 12, 2017). 122 Tom Philpott, Military Update: Merger of three services’ medical bureaucracies is rejected. 123 Ibid. 124 Hosek and
Umesh, Achary; Gowda, Guru S; Kumar, Channaveerachari Naveen; Srinivas, Dwarakanath; Dawn, Bharath Rose; Botta, Ragasudha; Yadav, Ravi; Math, Suresh Bada
A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients. We did retrospective chart review of all "Unknown" patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7%) were males with the mean age of 43.8 ± 14.8 years and 95 (63%) were aged >40 years. Among them, 147 (97.4%) were from the urban vicinity, 126 (83.6%) were brought by police and 75 (49.7%) were registered as medico-legal cases. Out of these, only 3 (2%) patients had normal sensorium, whereas 101 (66.9%) presented with loss of consciousness. Forty-one (27.2%) unknown patients had a seizure disorder, 37 (24.5%) had metabolic encephalopathy, 26 (17.2%) had a stroke, 9 (6%) had neuro-infection, and 17 (11.3%) had a head injury. Deranged liver functions were seen in 65 (43%), renal derangement in 37 (24.5%), dyselectrolytemia in 42 (27.8%), and abnormal brain imaging finding in 95 (62.9%) patients. Furthermore, there were 14 (9.3%) deaths. Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India.
Lovric, Z; Mihaljevic, J; Martinac, M
The purpose of this article is to present medical results of mobile surgical teams (MST) supporting units of Croatian Special Police Forces in three attack combat actions. The rate of injury was from 2.0 to 1.3%, Whereas the combat mortality rate was between 0.20 and 0.17%. No postoperative mortality occurred. Heavy injuries were found in 45% of all injured, among them 57% caused by shell fragments. Extremities were involved in 92% of all injuries, whereas 50% were injuries of the calf. All the injured were surgically managed by MST at the site of deployment or in mobile surgical hospitals and evacuated to general hospitals within 12 hours, where 80% of all heavily injured patients underwent additional operations with no postoperative mortality. Eight to 36 months after injury, we found major functional disability in 2% of all injured. NATO schemes served as a basis for the formation of the Croatian war surgical care system with certain modifications dictated by specific situations at the beginning of the aggression against Croatia. MST of Croatian Special Police Force presented second- and third--echelon staged management of the wounded, which was adequate for this type of attack combat situation.
BACKGROUND: Human Immune Deficiency Virus Infection and Acquired Immune Deficiency Syndrome is prevalent in our population and in emergency situations. Hospital staffs (particularly the accident/emergency staff and traumatologists) are at high risk of contracting this deadly disease. BODY: 1434 of surgical ...
Guelcher, S. A; Sriniwasan, A; Hollinger, J. O
A family of biocompatible, biodegradable poly(ester urethane)urea (PEUUR) biomaterials has been developed that degrade to non-toxic by-products and support the attachment and proliferation of cells...
Hannon, Matthew; Tadlock, Matthew D; Melcer, Ted; Walker, Jay; Bandle, Jesse; Nieses, Kameran; Galarneau, Michael
We sought to determine the incidence, risk factors, and time course for deep vein thrombosis and pulmonary embolism (DVT/PE) after combat-related major limb amputations. Patients with amputation in Iraq or Afghanistan from 2009 through 2011 were eligible. Details of postinjury care, date of diagnosis of DVT/PE, and injury specific data were collected. Military databases and chart reviews were used. In 366 patients, 103 (28%) had DVT/PE; PE was diagnosed in 59 (16%) and DVT in 59 (16%). Most DVT (69%) and PE (66%) occurred within 10 days. Increasing ventilator days (odds ratio [OR], 1.97; 95% CI, 1.16 to 3.37) and units of blood transfused (OR, 1.72; 95% CI, 1.11 to 2.68) were associated with DVT. Increasing units of fresh-frozen plasma were associated with PE (OR, 1.31; 95% CI, 1.10 to 1.55). The incidence of DVT/PE is high after combat-related amputation. Most DVT/PE occur early and prophylaxis is indicated. Published by Elsevier Inc.
The drill enabled the hospital administration to evaluate and make improvements in the adequacy of hospital, equipment and supplies such as stretchers and wheelchairs. The attitudes of the staff toward the actor patients and real patients who were observing provided valuable feedback. The roles of the support services ...
la to r da ys , m ed ia n (r an ge ) N 15 ,9 12 0 (0 –4 05 ) 0 (0 –3 4) 0 (0 –7 5...ia n (r an ge ) 6 (0 –7 4) 5 (0 –2 2) 5 (0 –4 1) 5 (0 –6 9) 6 (0 –7 0) 7 (0 –6 6) 7 (1 –7 4) 8 (1 –3 4) P la te le t, m ed ia n (r an ge ) 0 (0 –3 4) 0...postoperative infection 88 Skin/wound 519.01 Tracheostomy infection 1 528.3 Cellulitis /abscess mouth 1 566 Anal/rectal abscess 1 682 Cellulitis
Cardoso, I.; Pinto, O.; Pinto, I. R. C. A.; Holle, R.
A 10-year study of lightning fatalities in Brazil is presented. It is the most complete study undertaken in South America. The study indicates the death rates in the country sorted by season, state, city, type of region, age, gender and circumstances. Ten years of data were collected from the Federal Civil Defense Agency, the Ministry of Health and the media press. The circumstances of lightning fatalities in Brazil were compared with other countries that have this information available. It also includes an analysis of the differences involved in lightning deaths in each region of Brazil. The results suggest that specific actions should be adopted in terms of lightning protection to minimize risks. Finally, this study provides useful information in order to identify the most important lightning safety rules for the country.
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.
Maybritt Jill Alpes
Full Text Available This article analyzes what can happen to forced returnees upon arrival in their country of nationality. Subjective configurations of state agents in the Global South have created return risks, which in turn transform subjectivities of post-colonial citizens. The article contributes to this Special Issue by tracing repercussions of the externalization and internalization of border controls. In the case of Cameroon, these connections have resulted in the criminalization of emigration. Aspiring migrants are prosecuted if their departure projects fail to respect the entry requirements of countries in the Global North. The article is based on research conducted in Douala, Cameroon, in the form of discussions with control agents at the international airport, investigations at a prison, a review of related case law, police registers and interviews with Cameroonians returnees (November 2013–January 2014. Border controls and connected anti-fraud programs suppress family-based forms of solidarity and allow only for subjectivities rooted in state-managed forms of national identity. The article illustrates how efforts to combat fraud fuel corruption in returnees’ social networks, whereby, instead of receiving remittances, families in emigration countries have to mobilize financial resources in order to liberate returnees from police stations or prison complexes. Migration related detention of nationals in the Global South highlights the growing significance of exit controls in migration management.
211 Scabies all cases 0.08% 0.08% 216 Herpes simplex and zoster without encephalitis all types all cases 0.30% 0.28% 219 Hyperhidrosis all cases...disorders with nerve root compression resistant to bed rest/traction 0.74% 1.07% 32 Intervertebral disc disorders with nerve root compression responding
technologies to reduce the number of convoys transporting drinking water such as Expeditionary Water Bottling Plants and Water-from-Air Systems. To... palettes 50% contractor 50% military 40% 100 MRAP Leg 2: BSB to Consuming Unit 8,400 1 liter bottles on palettes 100% military 40% 50...distance is 200 miles 14. Bottled drinking water is supplied by a commercial plant in theater (Anaconda); continuous operation of plant at peak load
Razavi, Seyed M; Salamati, Payman; Harandi, Ali Amini; Ghanei, Mostafa
About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict (1980-88). After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes.
Kiely, Denis O.; Swift, Lisa
The experience of the combat soldier and the road back to civilian life are recurrent themes in American literature and cinema. Whether the treatment is tragic (Stephen Crane's "Red Badge of Courage", Tim O'Brien's "The Things They Carried", or Tony Scott's "Blackhawk Down"), satirical (Joseph Heller's "Catch Twenty-Two" and Robert Altman's…
Full Text Available Objectives: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of “unknown” patients. Materials and Methods: We did retrospective chart review of all “Unknown” patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. Results: A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7% were males with the mean age of 43.8 ± 14.8 years and 95 (63% were aged >40 years. Among them, 147 (97.4% were from the urban vicinity, 126 (83.6% were brought by police and 75 (49.7% were registered as medico-legal cases. Out of these, only 3 (2% patients had normal sensorium, whereas 101 (66.9% presented with loss of consciousness. Forty-one (27.2% unknown patients had a seizure disorder, 37 (24.5% had metabolic encephalopathy, 26 (17.2% had a stroke, 9 (6% had neuro-infection, and 17 (11.3% had a head injury. Deranged liver functions were seen in 65 (43%, renal derangement in 37 (24.5%, dyselectrolytemia in 42 (27.8%, and abnormal brain imaging finding in 95 (62.9% patients. Furthermore, there were 14 (9.3% deaths. Conclusions: Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India.
seemingly diverse peptides from arthropods such as bee venom , or melittin (FIGURE 7) . In fact, both ß-endorphin and melittin inter- act...based therapies p-4]. However, pep- tides and proteins do offer distinct advantages for developing efficacious and well-tolerated treatments for
... 1 Information included in audited financial statements, including other schedules, need not be...%-or-less-owned equity investors that file this information as registrants in their own right exceeds... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Supplemental information (for...
Webster, J.M.; Clague, D.A.; Riker-Coleman, K.; Gallup, C.; Braga, J.C.; Potts, D.; Moore, J.G.; Winterer, E.L.; Paull, C.K.
We present evidence that the drowning of the - 150 m coral reef around Hawaii was caused by rapid sea-level rise associated with meltwater pulse 1A (MWP-1A) during the last deglaciation. New U/Th and 14C accelerator mass spectrometry dates, combined with reinterpretation of existing radiometric dates, constrain the age of the coral reef to 15.2-14.7 ka (U/Th age), indicating that reef growth persisted for 4.3 k.y. following the end of the Last Glacial Maximum at 19 ka. The drowning age of the reef is roughly synchronous with the onset of MWP-1A between 14.7 and 14.2 ka. Dates from coralline algal material range from 14 to 10 cal ka (calibrated radiocarbon age), 1-4 k.y. younger than the coral ages. A paleoenvironmental reconstruction incorporating all available radiometric dates, high-resolution bathymetry, dive observations, and coralgal paleobathymetry data indicates a dramatic rise in sea level around Hawaii ca. 14.7 ka. Paleowater depths over the reef crest increased rapidly above a critical depth (30-40 m), drowning the shallow reef-building Porites corals and causing a shift to deepwater coralline algal growth, preserved as a crust on the drowned reef crest. ?? 2004 Geological Society of America.
such as anticoagulation or vena caval interruption. CONCLUSION: This report is the first to characterize acute, peritraumatic pulmonary thrombus in...anticoagulation or vena cava filter devices. (J Trauma Acute Care Surg. 2013;75: S215YS220. Copyright * 2013 by Lippincott Williams & Wilkins) LEVEL OF...traumatic brain, spinal cord, or severe pelvic injury. Certain situations result in the placement of a vena cava filter adding to the risk of com
Seyed M Razavi
Full Text Available Background: About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict (1980-88. After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. Methods: For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. Results: There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. Conclusions: Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes.
The UNHCR estimated that 1,462 civilians were killed in Gaza and six civilians were killed in Israel during the conflict of 2104. This article uses Discursive Psychology to examine how Israeli spokespeople described the conflict, and Israel’s actions, in ways that denied responsibility for civilian deaths. They did this using a number of discursive strategies. These included: a) using passive and noun constructions which minimized reference to civilian deaths and erased Israeli involvement in...
contact. Wear protective eyeglasses or chemical safety goggles, per OSHA eye- and face- protection regulations (29 CFR 1910.133). Contact lenses are...Hydrochloric Acid and Phosphoric Acid CERCLA Reportable Quantity (RQ): 5000 lb Section 8 - Exposure Controls / Personal Protection Engineering...Administrative Controls: None Respiratory Protection : Not required under normal conditions. If necessary, follow OSHA respirator regulations (29 CFR
or both. Some pain may occur in the lower thorax and salivation increases. Secretions may be thick, sticky, and persistent. If postural drainage...often with fever, chills, and cyanosis, may develop two to six weeks after the initial exposure. Crackles are present; chest radiography may
van der Tol, Arjan; Hussain, Asrar; Sever, Memhet Sukru; Claus, Stefaan; Van Biesen, Wim; Hoste, Eric; Khan, Samuel; Vanholder, Raymond
In the aftermath of earthquakes, the cumulative incidence of crush-induced acute kidney injury (AKI) is difficult to predict. Insight into factors determining this risk is indispensable to allow adequate logistical planning, which is a prerogative for success in disaster management. Data of 88 crush-related AKI patients in the aftermath of the Kashmir earthquake were collected and outcome measures were analysed. Then the findings were compared with the data of 596 crush-related AKI patients of the Marmara earthquake. The earthquake in Kashmir occurred in a rural area with lack of medical facilities and difficult transportation conditions while the earthquake in Marmara occurred in an urban area with more efficient transport possibilities. In Kashmir we reported fewer patients with treated AKI (1.2 AKI per 1000 deaths, 1.3 AKI per 1000 victims) than in Marmara (34.1 AKI per 1000 deaths; P earthquake and admission to hospitals was longer in Kashmir (5.8 +/- 5.8 days) than in Marmara (3.5 +/- 3.7 days; P frequencies of fasciotomies (P earthquakes. Many factors may affect the frequency of AKI: hampered rescue and transport possibilities; destroyed medical facilities on the spot; availability or not of sophisticated therapeutic possibilities and structure of the buildings might all have impacted on different cumulative incidence between Kashmir and Marmara.
Sen- tinel) in a simulated chest-wound model, volunteers were sprayed with a mixture of construction sand and canned evaporated/condensed milk ...Institute of Surgical Research, where his research interests include transfusion medicine, IV hemo- static agents, coagulation , and trauma. CDR
with brain injuries, belly wounds, and missing genitals . I could see the morgue and hundreds of bodies strewn haphazardly; the faces of 22 eighteen...are: physical (e.g., food, shelter, rest); psychosocial (e.g., interpersonal relatedness); and sociocultural (e.g., societal values and structure
Weiner, 1992) suggest that previous experience and training potentially moderate the psychobiology of the stress response in these types of...integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex...pilot study raise important questions regarding the degree to which individual differences in the psychobiology of the stress response moderate how Army
The relationships between forests and climate change are complex and multidimensional. Deforestation and forest degradation are now recognised to be a globally significant source of greenhouse gas emissions, and it is asserted that reduction of forest-based emissions may be among the least expensive mitigation options. However, decades of unsuccessful efforts to reverse high rates of deforestation and degradation in the tropics have revealed the fundamental failures of markets, governance and...
Full Text Available Financial disasters to hedge funds, bank trading departments and individual speculative traders and investors seem to always occur because of non-diversification in all possible scenarios, being overbet and being hit by a bad scenario. Black swans are the worst type of bad scenario: unexpected and extreme. The Swiss National Bank decision on 15 January 2015 to abandon the 1.20 peg against the Euro was a tremendous blow for many Swiss exporters, but also Swiss and international investors, hedge funds, global macro funds, banks, as well as the Swiss central bank. In this paper, we discuss the causes for this action, the money losers and the few winners, what it means for Switzerland, Europe and the rest of the world, what kinds of trades were lost and how they have been prevented.
Calosevic, Srdjan; Lovric, Zvonimir
Fatal triad and ipsilateral dyad are patterns of pedestrian injuries related to significant mortality in traffic-related accidents. The aim of this research was to investigate the correlation between specific injury patterns and fatal outcome in other participants of traffic-related accidents. This was a retrospective study of traffic-related accidents in the broader area of the city of Osijek in a five-year period from 1995 to 1999. Autopsy results from the Institute of Pathology and Forensic Medicine of the Clinical Hospital Centre Osijek were analysed of individuals who died after their accident. The total severity of injuries was measured using the ISS. Logistic regression analysis was used for assessing the correlation between specific injury patterns and an early outcome from the severe injury. There were 213 individuals included in the study: 72 pedestrians and 141 other participants (drivers, assistant drivers, passengers, cyclists and motorcyclists). A total of129 individuals died on the spot and 84 died in the hospital during the first 48h. Femoral and pelvic fracture, fatal triad and both variants of ipsilateral dyad were related to higher ISS values. Ipsilateral fracture of upper and lower extremities (ipsilateral dyad 1) was associated with a 4.59 times higher risk of an immediate fatal outcome in the total sample. In pedestrians, the risk was 5.99 higher, and in other participants, the risk was 4.11 times higher. Specific skeletal injuries and injury patterns are a significant indicator for total injury severity and related poor prognosis for all participants of traffic-related injuries, not only for pedestrians. In this study, the ipsilateral fracture of upper and lower extremity was related to the largest total severity of injuries and the poorest prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.
Emergency department leaders at DCH Regional Medical Center in Tuscaloosa, AL, and Cullman Regional Medical Center in Cullman, AL, credit their regular practice drills with helping them deal with unprecedented demand when deadly tornadoes swept through the South this past April. Both facilities used the hospital instant command structure (HICS) to mobilize the resources needed to care for the surge in patients, and say the approach worked well in helping them meet the needs of their communities. However, the crises also showcased opportunities for improvement. The ED at DCH Regional Medical Center saw more than 600 patients on the day of the storm, a three-fold increase in the hospital's typical volume. CRMC treated 99 patients in the seven hours immediately following the storm when it usually treats 114 patients per day. In addition to a big surge in patients, both hospitals dealt with power outages that limited access to some services such as radiology. Triage proved particularly challenging at DCH Regional Medical Center, as patients flowed into the hospital from numerous access points. The hospital plans to assign coordinators to each area of the hospital to better manage the influx in the future. When reviewing emergency operations plans, Joint Commission reviewers often find deficiencies in hazard vulnerability analyses as well as the processes used to determine the emergency credentials of licensed independent practitioners.
In the twenty-first century, many music education scholars seek to reconceptualize music education toward social justice. Critical pedagogy is at the forefront of this shift. However, as teachers aim toward equity through employing critical pedagogy, some undesired effects of using this teaching approach may arise. In this paper, I consider the…
operational stressors are prolonged exposure to extreme temperatures, sleep deprivation , boredom, reduced quality of life, prolonged separation from family...increase of proximity meant “small unit leaders identified more with their men than with their superiors” which caused several unexpected ...possibly recycling or failing a course (Grossman 1995, 254). Although this example explains how to essentially make soldiers 60 more efficient killers
kind of de facto medical service of soldier- medici —soldiers in the ranks specially detailed for the post who gathered their craft within the legion...of the Principate (27 B.C.–284 A.D.), a medical unit con- sisted of a trained medical officer ( medici ) and a supporting staff of orderlies, stretcher...bearers, and dressers (medicus).25 While the medici took the military oath as soldiers, they “ranked with the ‘immunes,’ those who receive freedom
7 Table 2. Small Satellite Categories by Wet Mass ........................................ 27 Table 3. NPSAT1 Material Properties... Small Satellite Categories by Wet Mass Satellite Class Qualifying Wet Mass (kg) Minisatellite 100 kg to 500 kg Microsatellite 10 kg to 100 kg...Earth. This thesis addresses both the survivability of the soon-to-be-launched NPSAT1 satellite on its eventual reentry into the earth’s atmosphere
Effects of intraosseous erythropoietin during hemorrhagic shock in swine. Borovnik-Lesjak V; Whitehouse K; Baetiong A; Miao Y ; Currie B; Velmurugan S...Resuscitation. Universidad Católica de la Santísima Concepción, Facultad de Ciencias de la Salud. May 7-8. Concepción, Chile. 1997 Advances in CPR...2. 2012 Targeting Mitochondria during CPR (lecture, September 9); State-of-the- Art in Critical Care (panel, September 8); Quality of CPR (panel
r’q din.- 3 thi, in str , mt O or s, ir ;pitl ut th’S. - t f , ’ a’,,•,lr•* I10’l ’ ’"’ I, ,, ’,,, I ’ l I ’i ŕ , t, r’- I- I. -n’I f,- n ttl *•p...bunch." 0 "I think about my wife to maintain my morale." 48 USNS Comfort " Chocolate maintains my morale!" "I play Dungeons and Dragons to maintain my
malaise, and painful lymph nodes (buboes) may progress spontaneously to the septicemic form (septic shock, thrombosis , DIC) or to the pneumonic form...citrated blood for bacterial cultures. Pathology samples: routinely include liver, lung, spleen, and regional or mesenteric lymph nodes
distress syndrome 4.4 (1,535) 7.3‡ (504) Renal failure 2.9 (1,534) 7.5§ (504) Mesenteric thrombosis 0 (1,533) 0 (503) Overall complications 15 (1,539...embolism, deep vein thrombosis , stroke, myocardial infarction, acute respiratory distress syndrome, and renal failure. Statistical Analysis Admission...TABLE 6. Complication Rates for Patients Treated With and Without rFVIIa Complication No rFVIIa (n 1,544) rFVIIa (n 506) Deep vein thrombosis 6.1
creatinine kinase, myoglobin (serum and urine ), lactate, prealbumin, C-reactive protein , and erythrocyte sedimentation rate Injury Severity Score GCS at...of injury Laboratories: serum creatinine , complete blood counts, cultures (wound, blood, urine , sputum, CSF, or other bodily fluid culture
begin treatment in a medical facility, but later die due to those same injuries.4 Unfortunately, DOW is most accurately measured at the hospital, or...intensive, or nursing services. However, the addition of a patient hold section, xray diagnostics, and minimal laboratory equipment allow Role 2...fracture.28 Currently, the standard of medicine requires an xray to confirm a fracture before it is treated. An additional xray is required after
Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Current antidotes for cyanide poisoning must be administered by intravenous... Cyanide Poisoning ; Intramuscular Injection; Intraosseous Injection; Inhalational Delivery 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...required in cyanide - poisoned victims, since they may be hypotensive with collapsed peripheral veins. Thus, intravenous antidote administration would not
distributed by government and community leaders via the media (i.e., public service announcements, radio bulletins, television “ crawlers ,” Emergency Alert...volunteers while maintaining a database of volunteers. The Hampshire County MRC provides web - based registration and hard-copy applications. It does not...the web to assist hospitals and public health agencies integrate volunteer support into hospital inpatient, emergency department, and incident
seconds. The vasoconstrictor effects of catecholamines are mediated via postsynaptic -1 and extrasynaptic -2 receptors. The stim- ulation of...such as H and lactate. It is interesting to note that the vasoconstrictor action of AVP is thought to result in part from an action at this site
Terti, G.; Ruin, I.; Anquetin, S.; Gourley, J. J.
In the United States (U.S.) flash flooding (FF hereafter) is one of the leading cause of weather-related deaths. Because FF events can be distinguished from riverine floods by their fast response to rainfall and resulting impacts signature, analyzing FF-specific impact datasets seems a good way to identify the juxtaposition of social and physical circumstances leading to those impacts. This communication focuses on conceptual and methodological developments allowing testing hypotheses on FF-specific vulnerability factors through the analysis of human impact datasets. We hypothesize that the intersection of the spatio-temporal context of the FF phenomena with the distribution of people and their characteristics across space and time reveals various paths of vulnerability through the expression of different accidents' circumstances (i.e., vehicle-related, inside buildings, open-air, campsites). We argue that vulnerability and the resulting impacts vary dynamically throughout the day according to the location/situation under concern. In order to test FF-specific contextual vulnerability factors at the scale of the continental US, 1075 fatalities reported between 1996 and 2014 in the Storm Data publication of the U.S. National Climatic Data Center (NCDC) are analyzed to statistically explore the timing, the duration and the location of the FF event, and the age and gender of the victims and the circumstance (i.e. location/activity) of their death. In this objective, a re-classification of the individual fatality circumstances and a discretization of the time in qualitative time-steps are performed to obtain possible trends and patterns in the occurrence of fatalities in certain circumstances and time (e.g., day vs night). The findings highlight the importance of situation-specific assessment of FF fatalities to guide the development of FF-specific vulnerability and impacts prediction modeling. Such analysis can provide valuable knowledge when the National Weather Service issues FF warning and emergencies. This is because targeted warnings can be communicated when we can relate the location of risky incidents in space (e.g., roads, campsites, mobile homes) with specific vulnerable groups (e.g., certain age groups, gender).
Umesh, Achary; Gowda, Guru S; Kumar, Channaveerachari Naveen; Srinivas, Dwarakanath; Dawn, Bharath Rose; Botta, Ragasudha; Yadav, Ravi; Math, Suresh Bada
Objectives: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of “unknown” patients. Materials and Methods: We did retrospective chart review of all “Unknown” patients from January 2002 to December 2011, who was admitted under Neurology Emergency Service at a Tertiary Care Neuropsychiatry Center in South Indian Metropolitan City. Clinical and sociodemographic characteristics and clinical outcome of the sample were analyzed. Results: A total of 151 unknown patients were admitted during the 10 years. Out of these, 134 (88.7%) were males with the mean age of 43.8 ± 14.8 years and 95 (63%) were aged >40 years. Among them, 147 (97.4%) were from the urban vicinity, 126 (83.6%) were brought by police and 75 (49.7%) were registered as medico-legal cases. Out of these, only 3 (2%) patients had normal sensorium, whereas 101 (66.9%) presented with loss of consciousness. Forty-one (27.2%) unknown patients had a seizure disorder, 37 (24.5%) had metabolic encephalopathy, 26 (17.2%) had a stroke, 9 (6%) had neuro-infection, and 17 (11.3%) had a head injury. Deranged liver functions were seen in 65 (43%), renal derangement in 37 (24.5%), dyselectrolytemia in 42 (27.8%), and abnormal brain imaging finding in 95 (62.9%) patients. Furthermore, there were 14 (9.3%) deaths. Conclusions: Our findings demonstrate seizures, metabolic causes, and neuro-infections were the primary reasons for admission of unknown patients to neuro-emergency service. This novel Indian study data show the common causes of admission of unknown patients in neurology. This pattern can be useful to guide the approach of healthcare providers in India. PMID:28615894
often extremely fragmented in patients with a chronic pain history and opioid addiction. Before hospital discharge, both nonopioid adjunct treat...116. 12. Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia- assisted vs buprenorphine - or clonidine-assisted heroin detoxification and
number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 10-06-2016 2. REPORT TYPE Master’s Thesis 3. DATES...Guideline CQM Clinical Quality Management CRM Crew Resource Management CSH Combat Support Hospital DOD Department of Defense DOW Died of Wounds...latest advancements in medicine to promote a culture of safety, quality initiatives, and leveraging technology to improve patient care, the U.S
Chatfield-Ball, Catherine; Boyle, Peter; Autier, Philippe; van Wees, Sibylle Herzig; Sullivan, Richard
According to the Global Burden of Disease, trauma is now responsible for five million deaths each year. High-income countries have made great strides in reducing trauma-related mortality figures but low-middle-income countries have been left behind with high trauma-related fatality rates, primarily in the younger population. Much of the progress high-income countries have made in managing trauma rests on advances developed in their armed forces. This analysis looks at the recent advances in high-income military trauma systems and the potential transferability of those developments to the civilian health systems particularly in low-middle-income countries. It also evaluates some potential lifesaving trauma management techniques, proven effective in the military, and the barriers preventing these from being implemented in civilian settings. © The Royal Society of Medicine.
Klausner, J M; Lelcuk, S; Gutman, M; Khazam, A; Rozin, R R
Practical experience in the initial treatment of injured patients is not easily available to the medical student. The small number of injured patients available for observation in a short time, the fact that the patients do not necessarily arrive in regular teaching hours, and the large number of students present in teaching groups compound this difficulty. Specialized instruction in these subjects is therefore important. The acquisition and use of teaching aids facilitate precise and efficient presentation of the material. We present teaching aids specifically prepared for instruction in the initial management of the injured and in resuscitation procedures. These aids include a library of video recordings documenting important emergency procedures, a TV camera used for filming these procedures, a collection of slides on the subject of emergency medicine and recent injuries, mannequins for instruction in cardiopulmonary resuscitation (CPR), utilization of the hospital's animal research laboratory for instruction in critical procedures such as venous cutdown, chest drainage, etc., and simulated computer programs.
Ewy GA (1994) The efficacy of an ACLS train - ing program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med 23: 56–59. PMID...between vasopressin and baroreflex control of the sympathetic nervous system. Clin Exp Pharmacol Physiol 24: 102–108. PMID: 9043814 25. Nunez TC, Young...OR who provided training to Kasen Whitehouse in the swine model of liver laceration. Support Acknowledgement This research was supported by the
Gorman, H.A.; Park, J.J.
A list of four recent gas marketing bankruptcies in Canada and their current status was reviewed. In 1996 and in early 1997 some gas marketers found themselves with an open position as a result of insolvency of their suppliers. Consequently, they faced huge losses in a market where commodity prices were rising significantly. A number of practical suggestions to deal with the losses and forestall receivership and/or bankruptcy have been discussed. One of the most important considerations is to protect oneself from the outset, i.e. to arrange for satisfactory security for performance. Dealing only with reputable parties and contracting for short term deals are some of the other measures that a marketer can take in advance. Security for performance was described as the most important issue in gas contracting today. It was seen as the only way to ensure that a company would not have to deal with insolvency problems. The legal implications of bankruptcy and insolvency were also discussed
Rodger, M.; Boland, B.; Brooks, J.; Edwards, K.; Strickland, D.
A discussion of Ontario's energy marketplace in transition was presented. The current monopolistic marketplace is characterized by cost based rates, homogenous product offering, and an obligation to service. The post-2000 marketplace will be characterized by competitive prices, customer choices and innovations. In the new marketplace, customers will be able to articulate their needs, will be inundated by new providers and will have the choice of value adding services. As far as suppliers are concerned, they will have to become more creative and offer better service to survive
currently FDA-approved for the treatment of urea cycle disorders, and it can be administered orally and is stored at room temperature.102 Phenylbutyrate can...in Figure 5. No DRF was calculated from the filgrastim NHP study. However, MacVittie, Farese, and Jackson performed a study in canines where they...Treatment of Canine Cyclic Hematopoiesis with Recombinant Human Granulocyte-Macrophage Colony-Macrophage Stimulating Factor (GM-CSF), Interleukin-3, and
J Nasl Saraji
Full Text Available Background and Aims:Hospital disaster drills, Computer Simulations , and tabletop and otherexercises are designated to test the hospital's disaster plan and to allow employees to becomefamiliar with disaster procedures.Method: Based on the review of literature , discussion with experts, and analysis of disasterresponse plans , there are several aspects of hospital disaster that may be useful to evaluate . Mostof the lessons learned relate to one or more of the following aspects of disaster response are :1. Communications (both internal and external2. Clinical care , including triage , patient care , patient flow , and patient tracking.3. Security4. Materials and resources.5. DecontaminationResults :Evidence also indicated that computer simulations and table top and other exercises mayhelp to train key decisionmakers in disaster response. The studies demonstrate that different typesof training exercises may have different roles to play in educating hospital staff in disasterresponse.Conclusion:The evidence are insufficient to support firm conclusions about the effectiveness ofspecific training methods because of marked heterogeneity of studies, weakness in study design ,and the limited number of exercises that have been reported . Future disaster preparedness effortswould benefit from incased reporting of hospitals experiences in disaster response training .
We proposed to follow changes in the bone mineral content of medullary damage cases by measuring the attenuation of a monoenergetic gamma ray according to the Cameron and Sorenson technique. Apart from their high cost, existing instruments are not designed for this bedside observation of patients. Our aim was therefore to design and develop an easily portable, inexpensive apparatus. The γ radiation is supplied by a sealed 125 I source fitted with a narrow collimator. The battery-operated scintillation detector is that used to detect post-operative phlebites after injection of radio-fibrinogen. The source-detector unit can move to allow a transverse bone mineral content measurement. Data from the detector are processed electronically and the results given: - either graphically on a tracing board which gives an area proportional to the bone mineral content, - or numerically by means of an integrator computing this area and supplying the linear bone density directly. Experiments carried out in vivo showed the apparatus to be sensitive and the measurements reproducible, the results obtained being comparable with those of other authors. Using pieces of embalmed bone moreover an excellent correlation was observed between the bone mineral content obtained after incineration and the results displayed by our apparatus, which can therefore be calibrated [fr
... attendees on the concept of medical utilization and response integration. The overall goal is to engage... Oak Campus, 10903 New Hampshire Ave., Building 31 Conference Center, the Great Room (rm. 1503A), Silver Spring, MD 20993. Entrance for the public meeting participants (non-FDA-employees) is through...
federal medical center for a psychiatric interview, administration of the MMPI and Personal Orientation Inventory (P01), and dental/neurological examination...scale elevations. This represents 43% of the total subjects with valid MMPI profiles. Seven subjects reported a borderline level of symptomatology...the items on the MMPI Depression scale tended to endorse POI items associ- ated with liking oneself as a person and relying on internal motivation to
ground-level complex comprised of a casino, showrooms , convention facilities, jai alai fronton, and mercantile complex. The hotel was partially...horrifying: at least half a dozen cars and trucks on the northbound span had their rooftops virtually crushed to seat level or sheared off completely... virtually the only rescue vehicle able to quickly reach and rescue the survivors. It would have taken an ice-breaker several hours to plow its way
NATO Planning Guide for the Estimation of Chemical, Biological, Radiological, and Nuclear (CBRN) Casualties (AMedP-8(C)) - Parameters for Estimation of Casualties from Exposure to Specified Biological Agents. Addenda to Allied Medical Publication 8
no. 66 (1854): 309–12; Frederick Mason, “Case of Glanders in Man,” Association Medical Journal 4, no. 168 (1856): 232–34; J. Clark Stewart, “Pyæmic...Commission on Epidemiological Survey, ed. H. G. Dangerfield, No. 65-FDS-1662 (Ft. Detrick, Frederick , MD, April 1965): 25–52. 24 Rusnak et al...Organization 30, no. 5 (1964): 693–99. Elberg, Sanford S., D. W. Henderson, M. Herzberg , and S. Peacock. “Immunization against Brucella Infection IV
Addenda to Allied Medical Publication 8, NATO Planning Guide for the Estimation of Chemical, Biological, Radiological, and Nuclear (CBRN) Casualties (AMedP-8(C)) to Consider the Impact of Medical Treatment on Casualty Estimation
Botulism Survivor Injury Profile Stage 1 Stage 2 Stage 3 Signs and Symptoms (S/S) Fatigue; dry mouth; ptosis; diplopia (blurred or double vision ...signs and symptoms provided in Table C-50 should be changed to read: Fatigue; dry mouth; ptosis; diplopia (blurred or double vision ); photophobia...Interactions 175, no. 1–3 (2008): 261–66. Marrs , Timothy C., Paul Rice, and J. Allister Vale. “The Role of Oximes in the Treatment of Nerve Agent
... with the values of x. ER19Oc00.117 (v) An applicant shall calculate the probability of impact (Pi) for...)-(vii). (A) Assume that Px and Py have a value of 1.0 for all populated areas. (B) Combine populated... areas equal to the most densely populated area. (C) For any given populated area, assume Px has a value...
Evolving Concepts and Battlefield Experience. Mil Med. 2007; 172:S1-S19. 29. Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, Pearse...ischemia/reperfusion. J Vasc Surg. 2011;53:1052-1062. 54. Malinoski DJ, Slater MS, Mullins RJ. Crush injury and rhabdomyolysis. Crit Care Clin
The issue of Malaysian graduates' unemployment, attributed largely to their flawed English language competence, has been a major concern in the country for many years. The study reported in this paper sought to better comprehend future graduates' perspectives and practices in dealing with the English language literacies prior to graduation. This…
stres waves? The Abdomen Lung has another distinctive biophvsical property; it is perhaps the only organ in the body in which the Intraabdtominal... immunoglobulin , 250 burn patients in the first 24-48 hours after they are or more units, at separate sites and complete the casu- injured, all based upon
Hertzberg, Frederick . The Motivation to Work. http://www.netmba.com/mgmt/ob/motivation/ herzberg /. Hertzberg, Frederick . Work and the nature of man. NY...participation needs of a coalition—active involvement. In the book Work and the Nature of Man, Frederick Hertzberg details his “two-factor theory” in...59 Frederick Hertzberg; Work and the Nature of Man; 1973; Mentor Books, New York; Two-factor Theory Pp. 149-158 60 Hertzberg’s
by a fit test (Ref. 93). Flaccid Weak, lax, and soft. Fomites Inanimate objects such as linens, towels, clothing, books, and utensils, which...111, 114, 115, B-10 Flaccid, 7, 16, 17, 18, A-17 Fomites , A-17 GA, 14, 15 Gamma, 24, 26, 29, 32, 53, 57, 96, A-21 Garments, 38, 40, 42, 43
resistance (vasoconstriction/dilation), cardiogenic shock, and changes in stroke volume. Currently, CO measurement is measured invasively, which... OPAMP GP R-R CMOS 1MHZ 8MSOP 14 1 DLED-660/940-LLS-3 DLED-660/940-LLS-3 Duel Emitter LED IR/RED 15 2 MCP4801-E/MC-ND MCP4801-E/MC DAC 8BIT SGL SPI/VREF
... for all active duty military Worldwide U.S. Active Duty sources: For the public: Director National Technical 5285 Port Royal, Springfield, For the Federal Government Administration Defense Technical Information Center (BR...
final reading. A monograph based on historical sources is not possible without the invaluable support of librarians and archivists. I wish to thank...distinction between them merely academic , although the US Army Air Forces still 48 Headquarters, US Army
measured from distinct arterial sites. Then, by applying the fundamental properties of convolution to the single-input, multioutput model of Fig. 1 (dark...outputs and showed its feasibility in a single swine. Fig. 1 (all blocks) il- lustrates the single input, multioutput model upon which their technique
Gun mounts, * Steel , Mechanical properties, Welds, Welding, Notch toughness, Charpy impact tests , Brittleness, Fracture(Mechanics), Subarctic regions, Low temperature, Test methods, Tension, Flanges
Lemoine, Patrick; Stahl, Stephen M
Between 1940 and 1944, an estimated 48,588 patients resident in French psychiatric hospitals died of starvation. Standard prisons, while facing similar problems, did not experience the same number of deaths by starvation, partly due to their ability to develop a black market for food and rations. Patients in psychiatric hospitals, on the other hand, were completely at the mercy of their doctors and the personnel in charge. At Hôpital du Vinatier, a psychiatric facility in Lyon, the mortality rate increased sharply from 1940 to 1944. In 1942, the worst year, 42% of patients died of hunger and exposure. In the end, more than 2,000 patients died at Vinatier. Was this due to a supposed lack of rations, or was it something more sinister? In Germany at the same time, tens of thousands of psychiatric patients died of purposeful starvation in psychiatric hospitals as part of the Nazi program of psychiatric euthanasia. Was the same thing occurring in Lyon?
Jordan, F B
To describe the events that shaped the investigation by the Oklahoma Office of the Chief Medical Examiner with regard to the terrorist bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995 and to provide lessons learned for reinforcement and future planning. All persons known to have been killed by the blast. Standard forensic techniques with regard to crime scene investigation, documentation, body identification and cause of death determinations were followed. Fatality injury and related evidence documentation. A total of 168 people died principally from secondary and tertiary injuries caused by projectiles, victim displacement, and crushing. Emphasis is placed on the methods of operation required to find, remove, identify, and determine cause of death in these individuals. Simultaneously, evidence must be identified and preserved in a homicide investigation of this type. Close cooperation must exist among multiple varied agencies and disciplines to accomplish the task and to prepare for subsequent analysis and courtroom testimony required by the criminal justice system. Terrorism, both foreign and domestic, is a current fact and will be a problem in many forms in the 21st century. No one is immune. The key to success is to plan ahead and be aware of available resources. Preplanning for short comings and difficult issues, and most importantly, relying on team work will allow future participants to successfully meet and complete the challenge. The investigation developed detailed injury data and mechanisms that were available for subsequent judicial proceedings and for in-depth epidemiological studies spearheaded by the Injury Prevention Service of the Oklahoma State Department of Health.
rescue dummies and live individuals) that were placed at the Amphitheatre.61 Upon explosion of the bomb and radiological dispersal device from concert...automatic mutual aid organization serving the state of Illinois and singed on jurisdictions within Wisconsin, Indiana, and Missouri and several cities
because its physical properties are similar to dD and because it is easily analyzed at very low cor.centrations by UV spectroscopy . The foil was covered...analyzed by UV for methyl salicylate . No attempt was made to insure that the laminates had reached equilibrium. The results were used as a means of...sorptive capacity and all registered greater than 95% removal’ of thickened methyl salicylate during simulated decontaminations. At the conclusion of
Kiani, Mehrzad; Fadavi, Mohsen; Khankeh, Hamidreza; Borhani, Fariba
In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers.
2.48% 3.12% 198 Inguinal hernia complicated direct or indirect sliding incarceration of bowel 1.40% 1.76% 199 Inguinal hernia uncomplicated direct...symptoms 0.04% 0.09% 245 Diarrheal disease severe 0.14% 0.34% 246 Diarrheal disease moderate 0.80% 1.88% 248 Gastritis acute all cases 1.69% 4.00...Sexually transmitted diseases complicated 0.00% 0.01% 0.22% 0.35% Patient Condition Code Distributions 21 Appendix A. Estimated Distributions
Bailiff, I.K.; Sholom, S.; McKeever, S.W.S.
This paper reviews recent research on the application of the physical dosimetry techniques of electron paramagnetic resonance (EPR) and luminescence (optically stimulated luminescence, OSL, and thermoluminescence, TL) to determine radiation dose following catastrophic, large-scale radiological events. Such data are used in dose reconstruction to obtain estimates of dose due to the exposure to external sources of radiation, primarily gamma radiation, by individual members of the public and by populations. The EPR and luminescence techniques have been applied to a wide range of radiological studies, including nuclear bomb detonation (e.g., Hiroshima and Nagasaki), nuclear power plant accidents (e.g., Chernobyl), radioactive pollution (e.g., Mayak plutonium facility), and in the future could include terrorist events involving the dispersal of radioactive materials. In this review we examine the application of these techniques in ‘emergency’ and ‘retrospective’ modes of operation that are conducted on two distinct timescales. For emergency dosimetry immediate action to evaluate dose to individuals following radiation exposure is required to assess deterministic biological effects and to enable rapid medical triage. Retrospective dosimetry, on the other hand, contributes to the reconstruction of doses to populations and individuals following external exposure, and contributes to the long-term study of stochastic processes and the consequential epidemiological effects. Although internal exposure, via ingestion of radionuclides for example, can be a potentially significant contributor to dose, this review is confined to those dose components arising from exposure to external radiation, which in most studies is gamma radiation. The nascent emergency dosimetry measurement techniques aim to perform direct dose evaluations for individuals who, as members of the public, are most unlikely to be carrying a dosimeter issued for radiation monitoring purposes in the event 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 simulations based on Monte Carlo code form an essential component in the application of dose determinations by EPR and OSL to dose reconstruction problems. We include in the review examples where the translation from the physical quantity of cumulative dose determined in the sampled medium to a dose quantity that can be applied in the reconstruction of dose to individuals and/or populations; these take into account the source terms, release patterns and the movements of people in the affected areas. One role for retrospective luminescence dosimetry has been to provide benchmark dose determinations for testing the models employed in dose reconstruction for exposed populations, notably at Hiroshima and Nagasaki. The discussion is framed within the context of the well-known radiation incidents mentioned above. - Highlights: • Review of luminescence and EPR in retrospective and emergency dosimetry. • OSL, TL, and EPR results on biological and physical materials. • Use in emergency and retrospective dosimetry for large-scale radiological events.
radioactive substance in the Brazilian city of Goiania in 1987 and the aftermath of the sarin attack on the Tokyo subway in 1995, people sought...Walter Reich, ed., Origins of Terrorism: Psychologies, Ideologies, Theologies , States of Mind (Washington, DC: Woodrow Wilson Center Press, 1998), p
Jorm, Christine; Roberts, Chris; Lim, Renee; Roper, Josephine; Skinner, Clare; Robertson, Jeremy; Gentilcore, Stacey; Osomanski, Adam
There is little research on large-scale complex health care simulations designed to facilitate student learning of non-technical skills in a team-working environment. We evaluated the acceptability and effectiveness of a novel natural disaster simulation that enabled medical students to demonstrate their achievement of the non-technical skills of collaboration, negotiation and communication. In a mixed methods approach, survey data were available from 117 students and a thematic analysis undertaken of both student qualitative comments and tutor observer participation data. Ninety three per cent of students found the activity engaging for their learning. Three themes emerged from the qualitative data: the impact of fidelity on student learning, reflexivity on the importance of non-technical skills in clinical care, and opportunities for collaborative teamwork. Physical fidelity was sufficient for good levels of student engagement, as was sociological fidelity. We demonstrated the effectiveness of the simulation in allowing students to reflect upon and evidence their acquisition of skills in collaboration, negotiation and communication, as well as situational awareness and attending to their emotions. Students readily identified emerging learning opportunities though critical reflection. The scenarios challenged students to work together collaboratively to solve clinical problems, using a range of resources including interacting with clinical experts. A large class teaching activity, framed as a simulation of a natural disaster is an acceptable and effective activity for medical students to develop the non-technical skills of collaboration, negotiation and communication, which are essential to team working. The design could be of value in medical schools in disaster prone areas, including within low resource countries, and as a feasible intervention for learning the non-technical skills that are needed for patient safety.
Adverse Effects ................................................................................................................................. 33...hospital suctioning of primarily mechanically ventilated patients. There were no high-quality reports focusing on prehospital or emergency care in the...the adverse effects of suction and related safety concerns. There are no randomized controlled trials or other high-quality evidence that addresses
Dual Gigabit Network Adapter • DVD Drive: 16x DVD+/-RW, Internal SATA • System Documentation: Electronic System Documentation • Chassis ...Configuration: Chassis with Hot Plug Hard Drive and Redundant Power Supply • Hardware Support Services: 3 Year ProSupport for IT and NBD On-site Service...26 — 3D rendering of Critical Care Treatment areas ICU ICU CONTROL ROOM RETRACTABLE WALL • LSTAT • Wireless Monitoring • Oxygen Generator • Ability
Akopian, Maja; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind; Brekke, Mette
Use of and acute poisoning by substances of abuse represent a major health problem and are often linked to social destitution. We describe associations between place of residence, living conditions and the incidence of poisoning by substances of abuse in Oslo. All patients who were 12 years of age or older and resident in Oslo and who were treated for acute poisoning by substances of abuse at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) were included prospectively for a continuous period of one year, from October 2011 to September 2012. The 15 districts of Oslo were categorised into three groups of living conditions, from the best (I) to the poorest (III) living conditions, based on the City of Oslo's living conditions index. Homeless people were grouped separately. The incidence of poisoning by substances of abuse treated in the OAEOC was estimated. Of a total of 1,560 poisonings by substances of abuse, 1,094 cases (70%) affected men. The median age was 41 years. The most frequent toxic agents were ethanol, with 915 cases (59%), and heroin, with 249 cases (16%). The incidence of poisoning by substances of abuse treated in the OAEOC per year per 1,000 inhabitants amounted to 1.75 in living conditions group I, to 2.76 in living conditions group II and 3.41 in living conditions group III. Living conditions group III had a significantly higher incidence than living conditions group II (p < 0.001), and living conditions group II had a significantly higher incidence than living conditions group I (p < 0.001). The incidence of acute poisoning by substances of abuse was higher, the poorer the living conditions in the district.
Vedsted, Peter; Christensen, Morten Bondo
OBJECTIVE: A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect...
Stewart, Ian J.; Glass, Kristen R.; Howard, Jeffrey T.; Morrow, Benjamin D.; Sosnov, Jonathan A.; Siew, Edward D.; Wickersham, Nancy; Latack, Wayne; Kwan, Hana K.; Heegard, Kelly D.; Diaz, Christina; Henderson, Aaron T.; Saenz, Kristin K.; Ikizler, T. Alp; Chung, Kevin K.
Introduction Traditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy. Methods We conducted a prospective, observational study in United States Military personnel with tr...
Convertino, Victor A; Ryan, Kathy L; Richards, Caroline A; Holcomb, John B; Cooke, William H; Idris, Ahamed H; Metzger, Anja; Lurie, Keith G; Adams, Bruce D
.... An impedance threshold device (ITD) has recently been developed that acutely increases central blood volume by forcing the thoracic muscles to develop increased negative pressure, thus drawing venous blood from extrathoracic cavities...
White Phosphorus Injury, Skin Exposure B-1 APPENDIX B NBC Tasks and Supplies First Responder B-2 Appendix B NBC Tasks and...6630015008737 Analyzer Blood Hand-Held 1 EA 6550015008742 Cartridge Analyzer Blood Cc Combo 25S 1 EA 599 SERUM CREATININE 6630014151593 Analyzer...Hospital Field 1 EA 6530000756636 Specimen Kit Urine 500S 1 EA 7520002815895 Stapler Paper Fastening Office Desk Gray 1 EA 7510002729662
average of the first 2 hours of urine output. Both creatinine (OR 55.99, 95 % CI 4.59, 682.57; p = 0.002) and urine output (OR 1.04, 95 % CI 1.01, 1.07; p...pg/mg creatinine . CyC cystatin C, IL-18 interleukin-18, KIM-1 kidney injury molecule-1, L-FABP liver-type fatty acid-binding protein , NGAL neutrophil...Eighty nine patients with urine samples drawn at admission to the intensive care unit were studied. Twelve patients subsequently died or needed renal
SUMMARY ...............................................................................15 II. LITERATURE REVIEW...referenced earlier in this chapter, one aspect of TECC is the creation of rescue task forces.20 In the RTF archetype , firefighter-paramedics train with...dynamic approach modeled after TCCC doctrine. TECC provides the framework for this archetypal transformation. Although esteemed public safety advocacy
reprints: Philip C. Spinella, MD, Connecticut Children’s Medical Center, Pediatric Intensive Care Unit, 282 Washington Street, Hart - ford, CT 06106; email...for these differences. Despite similar ISS in the RCT by Boffard et al. and the patients we studied, the ISS underestimates the se- verity of injury in
the body surface • Radiation - heat exchange between two objects not in direct contact Most people are unaware of all four heat transfer mechanisms...days (mustard agents). • Nerve agents: Miosis: Contracting of the pupils. Rapid effect that becomes more acute over time Headache Twitching of... Pneumonic is more fatal (nearly 100% if untreated) than bubonic (50% fatality). Protection and Precautions • Protective equipment with
8217 The change in the increased emphasis was seen in the So% iet litera- MN blood-group antigen occurs in the stem cells ture on fluorescent and...further abrade the damaged strual cycle."’ skin. An illness like diabetes 43 or a genetic disease like ataxia telangiectasia’,41,-" may also make the skin...dimycolate Diabetes Copit’nebiacterihon parulmn, 259 and its effect on skin radiosensitivity, 177 Cosmic radiation. Set’ Extraterrestrial radiation
shock; it also included patients with diagnostic descriptors such as sepsis, burns, “ ICU patients ,” and “post-cardiac ar- rest” as well as trauma...protocols in place during the study period.” The conclusion from this study was: “Because of the detrimental association with renal function and mortality...adverse events, including pru- ritus, skin rash, and renal replacement therapy.141 Most of the patients in this study were sepsis rather than hem
further examination of the literature, the theory that there is a linear relationship between over-triage rates and critical mortality rates is further...staffed with either two EMTs or one EMT and one volunteer and contain basic equipment and defibrillator . They are primarily used for patient...assess airway, B for breaths or ventilation, C for circulation or chest compressions and D for definitive care, defibrillation , and drugs. TCCC
disease (Groll and Walsh 2001). Sepsis is the physiological reaction to the infectious agent in an overactive, inflammatory response. The precursor...in small amounts by thyroid C cells as a precursor to the hormone calcitonin. It is also produced by the neuroendocrine cells of the lung and...sciences 71: 3241-3255; 2014. Aitken C, Jeffries DJ. Nosocomial spread of viral disease . Clinical microbiology reviews 14: 528-546; 2001. Anguige K
2001. 33. Hinkelbein J, Floss F, Denz C, et al. Accuracy and precision of three different methods to determine PCO2 (PaCO2 vs PETCO2 vs PTCCO2... dental care. Conventional medics are only partially trained for these mission requirements. Civilian helicopter EMS has advanced tremendously since...integrating medical research, advocating for resources, directing process improvements, and developing training standards: veterinary care, dental care
Hornez, E; Ramiara, P; Mocellin, N; Bajard, X; Legoudeveze, S; Charpail, C; Ollat, D
In August 2012, the Zaatari refugee camp was opened in Jordan under the auspices of the United Nations High Commissioner for Refugees. France deployed there a surgical facility to treat victims of war trauma. After a phase of intensive care and resuscitation, surgical management meeting the current standards of war surgery was conducted. Then, patients were transferred to a Jordanian civilian hospital or stayed in the Zaatari camp. A retrospective analysis of patient data was performed. From January to March 2013, 95 patients were managed: 85% of patients were male with a median age of 27 years (4-65); 5% of patients were <18 years of age. All patients were Syrian, civilian or members of the "Free Syrian Army." Penetrating trauma accounted for 95% of lesions. A total of 105 surgeries were performed, including: 33 external fixators, 8 laparotomies, 8 nerve repairs, 6 cover flaps, 4 direct arterial repairs, 2 reversed saphenous vein bypass grafts, and 1 amputation. The median length of stay on the wards was 3.71 days; 43% of patients were transferred to Jordanian civilian hospitals. The presence at the Zaatari camp of a surgical facility, which is experienced and specialized in war surgery, is essential, as long as battles are ongoing. Many victims will later require long-term surgical care for the management of the sequelae associated with these traumas.
psychological warfare” or “special propaganda,” there does not seem to be a Soviet-era equivalent that conceptually encompasses both Active Measures and...extensive use of proxies are made, including private and state-sponsored or controlled media outlets as well as non-state actors, such as labour unions...2) Maskirovka, or military deception (see Annex A). Active Measures can be understood or loosely interpreted as a cross between psychological and
experienced sleep deprivation . The commander would have to decide whether the Service members should be allowed to sleep or be awakened to take the...Theater validation identification descriptors ........................................................ G-3 Table G-4. Definitive identification...This publication uses joint terms where applicable. Selected joint and Army terms and definitions appear in both the glossary and the text. Terms
Gabriel, Allen; Gialich, Shelby; Kirk, Julie; Edwards, Sheriden; Beck, Brooke; Sorocéanu, Alexandra; Nelson, Scott; Gabriel, Cassie; Gupta, Subhas
Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed.
injury to admission and to death. They died more frequently of infection (notably fungus , Pseudomonas, and Klebsiella) and gastrointestinal...baumannii calcoaceticus complex 2 0 Serratia marcescens 2 0 Enterobacter cloacae 0 1 Aeromonas spp 1 0 Stenotrophomonas 0 1 Staphylococcus aureus 0 2 Fungus ...in the burn unit, infections still play a major role in attributable mortality. This is all the more concerning with rising antimicrobial resistance
Mok, James M; Jackson, Keith L; Fang, Raymond; Freedman, Brett A
In the summer of 2009, the vacuum spine board (VSB) was designated by the US Air Force as the preferred method of external spinal immobilization during aeromedical transport of patients with suspected unstable thoracolumbar spine fractures. One purported advantage of the VSB is that, by distributing weight over a larger surface area, it decreases the risk of skin pressure ulceration. To examine whether the rate of pressure ulcers has changed since the introduction of the VSB. Retrospective cohorts. Injured US service members undergoing spinal immobilization during evacuation from the Iraq and Afghanistan theaters to Landstuhl, Germany. Presence and stage of pressure ulceration, and deterioration in neurologic status. Records of the initial 60 patients medically evacuated on the VSB to Landstuhl Regional Medical Center were retrospectively analyzed for patient demographics, injury characteristics, and incidence of pressure injury. The incidence of pressure ulcers after the use of VSB was compared with that in a historical control consisting of 30 patients with unstable spinal injuries evacuated before the introduction of the VSB. No sources of external funding were used for this investigation. The combined cohort had a mean age of 28.8 years and mean Injury Severity Score (ISS) of 20.63 and comprised 96% men. Most injury mechanisms were blunt (58%). The rate of neurological injury was 19%. There were no cases of progressive neurological deficit or deformity in either cohort. In the VSB group, using a broad definition of pressure ulcer, incidence was 13 of 60 patients (22%). Using a strict definition, incidence was eight of 60 (13%): five Stage I and three Stage II. In the non-VSB group, incidence of pressure ulcers was three of 30 (10%), using either definition, all Stage II. Difference in incidence between the groups was not statistically significant. Intubated patients had a significantly higher incidence of pressure ulcers. Both the VSB and historic means (non-VSB) of spinal immobilization appear to be safe and produce only transient morbidity despite an average of 9 to 10 hours of transport. Intubated status was identified as the most important risk factor for the development of a pressure ulcer. Published by Elsevier Inc.
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...
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...
genes or fragments as needed. GEO-CENTERS, INC. GC-PR-2728-003 June 25, 1998 Page 5 Summary Of Work Performed During Current Reporting Period...the T cell receptor (TCR), p53 exon 8, and HPV - L1 . Little evidence for presence of significant HPV DNA was found. The new position for a Scientist I...Reporting Period • Continue in primer and probe synthesis, automated sequencing analysis, cloning genes of interest, and development of rapid
and better coordination of the experimental team, consequently the quality of our data had improved. On the ALung group two animals , numbers 9 and 15...deterioration in patient status. Cell based therapy with adult bone marrow-derived mesenchymal stromal cells (MSC) in experimental models of ARDS data...adjunct to current supportive measures for lung failure. Our objective is to complete a series of preclinical studies in large animal models using
Preparedness for the Evaluation and Management of Mass Casualty Incidents Involving Anticholinesterase Compounds: A Survey of Emergency Department Directors in the 12 Largest Cities in the United States
weakness, and paralysis; and muscarinic receptor- mediated effects such as miosis, bronchospasm , hyper- peristalsis, the production of copious secretions...settings and that the clinical presentation of such poi- sonings may be atypical in special populations such as children " may make initial ED diagnosis... children . MCN Am J Matern Child Nurs. 1995; 20(5): 261-268. 19. Lewn JB, Thomas RG, Walter FG, et a1.: A review of nerve agent exposure for the
8217between 0 &D4 100% oaaual tl•• la open to aerioua o’bjeotion eapeolall7 tor the hiper peroentagea. ID extenuation it •Y ’be aald that reliable qd...1104erateq hip T&por oonoen• trt.tioa OD the tarpt area. !he groUAd t_,.rature ftl about 20°F. hiper thaD the air t.peratltre howe’Yer, 10 that OOD’Yeo’tion
algorithm enable this direct quantification. Three basic steps characterize each Monte Carlo trial. First, obtain a random incubation or latent period...18-3 3. Incubation /Latent Period...3. Incubation Period .................................................................................... 19-4 4. Injury Profile
Baker, Michael S
This article is a primer to understand the medical advances and the future health care consequences of the current conflicts in the Middle East and Southwest Asia, known as the Global War on Terror. There have been significant advances in health care learned in caring for those injured by the conflict--often a polytrauma blast victim, but there are also very high incidence rates of the hidden injuries of war--traumatic brain injury, post-traumatic stress disorder, suicide, and depression. These lead to disruptive behaviors, homelessness, and family violence. Global War on Terror returnees are using medical services and applying for disability at higher rates than in previous conflicts. The costs for veterans' care may peak 30 to 40 years or longer following the conflict, and will inflict an enormous burden on services and resources. The effects of the war will linger for years and impact across generations because of the stress on families and children. We must mobilize government agencies, create public-private partnerships, and invest our resources now to mitigate the approaching tsunami of veterans' health care needs, the impact on our social services, and the devastating costs to society. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.
Magnusson, Skuli; Baldursson, Baldur Tumi; Kjartansson, Hilmar; Rolfsson, Ottar; Sigurjonsson, Gudmundur Fertram
Improvised explosive devices and new directed energy weapons are changing warfare injuries from penetrating wounds to large surface area thermal and blast injuries. Acellular fish skin is used for tissue repair and during manufacturing subjected to gentle processing compared to biologic materials derived from mammals. This is due to the absence of viral and prion disease transmission risk, preserving natural structure and composition of the fish skin graft. The aim of this study was to assess properties of acellular fish skin relevant for severe battlefield injuries and to compare those properties with those of dehydrated human amnion/chorion membrane. We evaluated cell ingrowth capabilities of the biological materials with microscopy techniques. Bacterial barrier properties were tested with a 2-chamber model. The microstructure of the acellular fish skin is highly porous, whereas the microstructure of dehydrated human amnion/chorion membrane is mostly nonporous. The fish skin grafts show superior ability to support 3-dimensional ingrowth of cells compared to dehydrated human amnion/chorion membrane (p skin is a bacterial barrier for 24 to 48 hours. The unique biomechanical properties of the acellular fish skin graft make it ideal to be used as a conformal cover for severe trauma and burn wounds in the battlefield. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Both vessels were moored at Coast Guard Base San Francisco, California, located on Yerba Buena Island. Both vessels were in Bravo 24 status (ready to get...0551 on October 31, 1984. The USCGC CAPE CROSS returned to Yerba Buena Island, San Francisco on the afternoon of October 31, 1984 to bring out...formed part of the upper and lower edges of the hole and had a matte , etched 62 46 2 *’ ". lj . -. .. - . - .. appearance similar to surrounding welds
many years of chi- tosan- based hemostatic dressing use (HemCon® Ban- dage [HemCon Medical Technologies; http://www .hemcon.com/ products /] and Celox...Gauze products will add a radi- opaque strip starting in 2014. Chitosan- Based Agents and Dressings Chitosans have widespread applications, have been...series of polymers derived from crustacean chitin and is a complex carbohydrate that is Table 1 First-, Second-, and Third-Generation Chitosan- Based
servicemember’s designee(s) or next of kin, which include the surviving spouses, children, parents, siblings, estate executor or administrator, or other...some Navy installations cover all five modules in 1 day. • Air Force. The Air Force splits notification, mortuary affairs, and benefits assistance...organizational results. The fourth level is sometimes split into two levels, with the fifth level representing a comparison of costs and benefits
In the Great East Japan Earthquake, which occurred on March 11, 2011, many lives were lost in the accompanying giant tsunami. Fukushima prefecture was widely contaminated with radioactive substances emitted by the accident at the nuclear power plant. Only a few trauma and emergency patients were brought to our hospital by ambulance, and an unexpectedly small number of emergency surgeries performed. There were patients with radiation-induced sickness and injury, but no cases of severe exposure requiring surgery or intensive care. As a logistic support hospital, we should prepare for and simulate these cases to respond to any such future occurrence. Copyright © 2013 Elsevier Inc. All rights reserved.
Page, Yves; Hermitte, Thierry; Cuny, Sophie
In France, over the last 10 years, road fatalities have decreased dramatically by 48%. This reduction is somewhat close to the target fixed by the European Commision in 2001 for the whole of Europe (-50 %). According to the French govnerment, 75% of this reduction was due to the implementation of automatic speed cameras on the roadsides from 2003 onwards. Yet, during this period, there was also a significantly increase in safety technology, new regulations in front and side impacts, and developments in Euro NCAP to improve passive safety in the vehicles. This paper set out to estimate the extent that vehicle safety technologies contributed to the road safety benefits over this decade. Using a combination of databases and fitment rates, the number of fatalities and hospitalized injuries saved in passenger car crashes was estimated for a number of safety technologies, individually and as a package including a 5 star EuroNCAP rating. The additional benefits from other public safety measures were also similarly estimated. The results showed that overall safety measures during this decade saved 240,676 fatalities + serious injuries, of which 173,663 were car occupants. Of these, 27,365 car occupants and 1,083 pedestrian savings could be attributed directly to vehicle safety improvements (11% overall). It was concluded that while public safety measures were responsible for the majority of the savings, enhanced vehicle safety technologies also made a significant improvement in the road toll in France during the last decade. As the take-up rate for these technologies improves, is expected to continue to provide even more benefits in the next 10-year period.
Eisenscher, A.; Jaquemord, P.; Jeandeau, M.; Schweg-Toffler, E.; Murrmann, J.
Due to the adjustment problems with the traditional overhead support, repeatedly the conventional radiation systems applied until today in emergency departments resulted to be disadvantageous. Another disadvantage is that the patient's position has often to be changed in order to photograph the individual sections to be examined. With a stirrup system attached to the overhead support and a patient table board with a thin plate vertically adjustable, these disadvantages can be eliminated. Since the system works with a fixed raster cassette with a high camera shaft ratio, a lighter constructional design and an easier operation without an impairment of image quality are rendered possible. This study describes the applicability of a new unit especially designed for emergency diagnostics, which is supplemented with a previously programmed generator, a table board with vertical adjustment and an exchangeable mobile sliding mattress. (orig.) [de
Wenzel, Tom [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division. Building Technology and Urban Systems Dept.
NHTSA recently completed a logistic regression analysis (Kahane 2012) updating its 2003 and 2010 studies of the relationship between vehicle mass and US fatality risk per vehicle mile traveled (VMT). The new study updates the previous analyses in several ways: updated FARS data for 2002 to 2008 involving MY00 to MY07 vehicles are used; induced exposure data from police reported crashes in several additional states are added; a new vehicle category for car-based crossover utility vehicles (CUVs) and minivans is created; crashes with other light-duty vehicles are divided into two groups based on the crash partner vehicle’s weight, and a category for all other fatal crashes is added; and new control variables for new safety technologies and designs, such as electronic stability controls (ESC), side airbags, and methods to meet voluntary agreement to improve light truck compatibility with cars, are included.
Milliken, Michael S
In today s world, the United States is the dominant naval power. World powers are trading naval dominance in favor of naval defense, creating fleets of smaller ships to protect their littoral waters...
Plunkett, Anthony; Turabi, Ali; Wilkinson, Indy
SUMMARY Battlefield analgesia and post-injury pain management is a high priority within the military medical community. The combined military services of the USA have developed a Pain Task Force and clinical practice guidelines to ensure that adequate analgesia is provided to our wounded soldiers as far forward as the point of injury on the battlefield. As a result of this emphasis, novel analgesic techniques and equipment have led to improved pain management. Continuous peripheral nerve blocks, intranasal ketamine, battlefield acupuncture and other adjuncts have all been utilized safely and successfully. The ability to provide rapid analgesia as early in the course of injury as possible not only helps with the immediate pain of the soldier, but potentially minimizes the risk of developing chronic postinjury pain. During the long medical evacuation system the risks of both undertreatment and overtreatment of pain are very real. Future studies and observation will help to delineate best treatment regimens and pave the way for the next generation of medical providers to positively impact a soldier's recovery. This article is written from the perspective of the USA with a focus on the conflicts in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom).
... burden in accounting expense, the carrier may request relief from such rules by letter to the Director... (CONTINUED) ACCOUNTS, RECORDS AND REPORTS SEPARATION OF COMMON OPERATING EXPENSES BETWEEN FREIGHT SERVICE AND PASSENGER SERVICE FOR RAILROADS 1 Operating Expenses § 1242.87 Joint facility—debit and credit and...
multiples rôles et il semble évident que les UAV à capacité logistique capables de transporter des blessés seront présents sur le champ de bataille ...leur apparition sur le champ de bataille , avec ou sans orientation basée sur une doctrine. L’OTAN et les forces d’opérations spéciales – ainsi que les...Captain George Gossman, a U.S. Army medical officer, joined with Lieutenant Albert Rhodes of the Coast Artillery Corps in designing and building an
The “Bikini Incident,” a large scale radiation exposure event caused by a US H-bomb test conducted in the Pacific Ocean, March 1954, shocked the world and, eventually, brought a serious debate on the risk assessment of effects of radiation on living bodies to the international arena, like the United Nations Scientific Committee on the Effects of Atomic Radiation in the second half of 1950s. As one of the reaction to the “Bikini Incident,” a scientific conference, “International Scientific Rou...
Background The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Methods Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. Results For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. Conclusions The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed. PMID:25214310
Jain, Trevor; Sibley, Aaron; Stryhn, Henrik; Hubloue, Ives
Introduction The proliferation of unmanned aerial vehicles (UAV) has the potential to change the situational awareness of incident commanders allowing greater scene safety. The aim of this study was to compare UAV technology to standard practice (SP) in hazard identification during a simulated multi-vehicle motor collision (MVC) in terms of time to identification, accuracy and the order of hazard identification. A prospective observational cohort study was conducted with 21 students randomized into UAV or SP group, based on a MVC with 7 hazards. The UAV group remained at the UAV ground station while the SP group approached the scene. After identifying hazards the time and order was recorded. The mean time (SD, range) to identify the hazards were 3 minutes 41 seconds (1 minute 37 seconds, 1 minute 48 seconds-6 minutes 51 seconds) and 2 minutes 43 seconds (55 seconds, 1 minute 43 seconds-4 minutes 38 seconds) in UAV and SP groups corresponding to a mean difference of 58 seconds (P=0.11). A non-parametric permutation test showed a significant (P=0.04) difference in identification order. Both groups had 100% accuracy in hazard identification with no statistical difference in time for hazard identification. A difference was found in the identification order of hazards. (Disaster Med Public Health Preparedness. 2018;page 1 of 4).
Cl2), ammonia (NH3), hydrogen cyanide (AC), cyanogen chloride (CK), and hydrogen sulfide (H2S). Table 1-1: Chemical Agent Challenge Types Agent...agent poisoning symptoms in some personnel. 3) Donning IPE or taking shelter in response to a detector alarm. AMedP-7.5 2-3 SD.3 2.1.2...LIST OF ACRONYMS AND ABBREVIATIONS AAP Allied Administration Publication AC Hydrogen cyanide ACH Air changes per hour AJP Allied Joint Publication
Ut:IVI:I... I 11:111VI:> Hydroxocobalamin, hypotension, cyanide , poisoning , intraosseous, Vitamin B 12a, Vitamin B 12 I 1:). :>CI...U I111 T L.L~:>:>II...Il l Ll:. ~IIIU :>Utili I Ll: :>a. I...UIIIII1~1... I IIIVIVItll:l1 lntraosseous hydroxocobalamin in the treatment of acute, severe cyanide induced...between 2 groups of swine in acute cyanide toxicity and treated with IV HOC or 10 HOC. We also compared blood cyanide , lactate, pH, nitrotyrosine levels
Randy D. Kearns
Full Text Available Disasters which include countless killed and many more injured, have occurred throughout recorded history. Many of the same reports of disaster also include numerous accounts of individuals attempting to rescue those in great peril and render aid to the injured and infirmed. The purpose of this paper is to briefly discuss the transition through several periods of time with managing a surge of many patients. This review will focus on the triggering event, injury and illness, location where the care is provided and specifically discuss where the science is today.
Pelaez (ed) Public Law and Comparative Politics. Trabajos en Homenaje a Ferran Vallis i Taberner, Vol XVII, Barcelona, Spain; Facultad de Derecho de...increase rather than decrease the likelihood of war. (7) The notion that sexual frustration increases the likelihood of war is not supported by the
Wenzel, Tom P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
The Department of Energy’s (DOE) Vehicle Technologies Office funds research on development of technologies to improve the fuel economy of both light- and heavy-duty vehicles, including advanced combustion systems, improved batteries and electric drive systems, and new lightweight materials. Of these approaches to increase fuel economy and reduce fuel consumption, reducing vehicle mass through more extensive use of strong lightweight materials is perhaps the easiest and least expensive method; however, there is a concern that reducing vehicle mass may lead to more fatalities. Lawrence Berkeley National Laboratory (LBNL) has conducted several analyses to better understand the relationship between vehicle mass, size and safety, in order to ameliorate concerns that down-weighting vehicles will inherently lead to more fatalities. These analyses include recreating the regression analyses conducted by the National Highway Traffic Safety Administration (NHTSA) that estimate the relationship between mass reduction and U.S. societal fatality risk per vehicle mile of travel (VMT), while holding vehicle size (i.e. footprint, wheelbase times track width) constant; these analyses are referred to as LBNL Phase 1 analysis. In addition, LBNL has conducted additional analysis of the relationship between mass and the two components of risk per VMT, crash frequency (crashes per VMT) and risk once a crash has occurred (risk per crash); these analyses are referred to as LBNL Phase 2 analysis.
more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness, and brain injury...The polytraumatic nature of blast injuries is evidence of their effectiveness, and brain injury is a frequent and debilitating form of this trauma...injury in OIF (Hoge et al., eration Iraqi Freedom (OIF). Soon after the invasion of Iraq in 2008), and they were multifocal and polytraumatic . The
.... This past year the source of he defects was determined to be the freeze-drying process. Ongoing efforts toward process optimization and design modifications that will provide undamaged tissue grafts are presented in this report...
acetylcholine, ending the stimulation trigger and allowing the muscle to relax . Nerve agents inhibit acetylcholinesterase function by binding to the enzyme’s...intensifies, as acetylcholine builds up in the system, the muscles remain constantly stimulated and prevented from relaxing . This effect can...dysphagia; dysarthria; dysphonia ; facial paralysis. Acute symmetrical descending flaccid paralysis: progressive muscle weakness in the head and neck
biopsy during the first week postinjury were E faecium (3.3% ), A species (3.3% ), P stutzeri (2.2%), E cloacae (2.2%), and of lesser incidence E coli...as fol- lows: A baumannii, 14.3% (n = 4); S aureus, 3.6% (n = 1); C freundii, 3.6% (n = 1); E faecium , 3.6% (n = I); and Achromobacter, 3.6% (n = 1
Israeli families of terrorist victims have undertaken initiatives to include their dearest in the national pantheon. The objections opposed the penetration of "second-class loss" into the symbolic closure of heroic national bereavement. The "hierarchy of bereavement" is examined through the lens of political culture organized around the veneration held for the army fallen and their families, which has symbolic as well as rehabilitative outcomes. Families of civilian terror victims claims for similar status and treatment had to frame their loss as national in the eyes of the social policy. The article claimed linkage between collective memory and rehabilitation.
Wolf, Philipp; Bigalke, Marc; Graf, Bernhard M; Birkholz, Torsten; Dittmar, Michael S
The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed.
Items 101 - 144 of 144 ... M D Belgore. Vol 7, No 2 (2006): Mass Casualty, The role of genetics professionals in the aftermath of Hurricane Katrina, Abstract. T Sellers. Vol 7, No 2 (2006): Mass Casualty, The role of pathology in trauma and mass casualties, Abstract. A O Osunkoya. Vol 7, No 2 (2006): Mass Casualty, The training ...
Hoencamp, Rigo; Idenburg, Floris J.; Vermetten, Eric; Tan, Edward; Plat, Marie Christine; Hoencamp, Erik; Leenen, Luke P H; Hamming, Jaap F.
Introduction Care for battle casualties demands special skills from medics, nurses, and tactical commanders. To date, no inventory has been performed evaluating the first responders (medics, nurses and tactical commanders) around battle casualties. Method This observational cohort study was
.... Such exposure can significantly contribute to the casualty rate. To reduce casualties, physiological markers are required to characterize training programs relative to their capacity to impart resistance to the lethal effects of stress...
.... It consists of networked realistic casualty generators, patient simulators and computer-based casualty simulations, virtual patients and equipment, data and sensor recorders, and an After- Action Review System...
Catagnus, Jr., Earl J; Edison, Brad Z; Keeling, James D; Moon, David A
.... The casualties in MOUT present a significant challenge to small unit leaders. Casualties in Fallujah hit Marine infantry squads and fire teams extremely hard because the squads were already under table of organization standards...
Pavel A. Yakovlev
Despite the trend toward fewer armed conflicts and war deaths, dramatic variations in conflict casualties exist across countries. This article examines what factors affect casualties in civil as well as interstate wars and finds that conflict casualties are directly influenced by geography and military expenditure per soldier. The latter proxies for military capital intensity and is of concern to policymakers because it affects the level of conflict casualties. Specifically, the article finds...
Serious road injuries in the Netherlands in 1993-2008: road casualties admitted to hospital with a MAIS score of at least 2; Description and justification of the estimation method. Until 2009 the term 'seriously injured road casualty' was generally used to indicate an inpatient. This is a casualty
on a barqe at Portsmouth, Va, on 31 October 1^78. Kmpresa Lineas Maritimas Arqentinas S.A., as owner of M/v SANTA CRUZ II, and Captain Abelardo...Clearance Unit Two, based at Little Creek, Va. CUYAHOGA was lifted by tandem heavy lift derrick barqes on 30 October 1978, in...conditions of deteriorating weather. The vessel was secured on a barqe durinq the hours ot darkness. The Board and representatives
Keneally, Sean K; Robbins, Matthew J; Lunday, Brian J
We develop a Markov decision process (MDP) model to examine aerial military medical evacuation (MEDEVAC) dispatch policies in a combat environment. The problem of deciding which aeromedical asset to dispatch to each service request is complicated by the threat conditions at the service locations and the priority class of each casualty event. We assume requests for MEDEVAC support arrive sequentially, with the location and the priority of each casualty known upon initiation of the request. The United States military uses a 9-line MEDEVAC request system to classify casualties as being one of three priority levels: urgent, priority, and routine. Multiple casualties can be present at a single casualty event, with the highest priority casualty determining the priority level for the casualty event. Moreover, an armed escort may be required depending on the threat level indicated by the 9-line MEDEVAC request. The proposed MDP model indicates how to optimally dispatch MEDEVAC helicopters to casualty events in order to maximize steady-state system utility. The utility gained from servicing a specific request depends on the number of casualties, the priority class for each of the casualties, and the locations of both the servicing ambulatory helicopter and casualty event. Instances of the dispatching problem are solved using a relative value iteration dynamic programming algorithm. Computational examples are used to investigate optimal dispatch policies under different threat situations and armed escort delays; the examples are based on combat scenarios in which United States Army MEDEVAC units support ground operations in Afghanistan.
observed the Soldiers. Quantifiable task details were recorded, including quantity and weights of loads being moved or lifted, distances traveled ...battery (11), Soldiers also performed the task once solo , with the bag weighted at 103.5 lb. Army Standard: Casualty removed from vehicle in 2...than males for the carry phase of a fighting position. Of the strength tasks, females took longer to complete the casualty drag, solo casualty
Information on the SAREF Reactor experiment handling system is presented concerning functions and design requirements, design description, operation, casualty events and recovery procedures, and maintenance
..., design, engineering, and blueprint costs insofar as they are allocable to the specific merchandise; and... merchandise, such as administrative salaries, casualty and liability insurance, advertising, and salesmen's...
... Business Address and Redomestication: American Fire and Casualty Company (NAIC 24066) and The Ohio Casualty... companies formally changed their ``BUSINESS ADDRESS'' to ``62 Maple Avenue, Keene, NH 03431'' effective..., Financial Accounting and Services Division, Surety Bond Branch, 3700 East-West Highway, Room 6F01...
Foreign Vessels 183 • 4. Fault Tree Analysis 184 B. Hazard Ranking 194 1. Ranking By Vessel Casualty Data 194 2. Auxiliar y Casualty Information 201 3...hydraulic system — 2. a. Piping — 1. 5. Steering gear: pumps -- 2. a. Auxiliar y system turbines and gears: governing system -- 1. b. Hull - general -- 1