WorldWideScience

Sample records for casualty incidents planning

  1. 7 Mass casualty incidents: a review of triage severity planning assumptions.

    Science.gov (United States)

    Hunt, Paul

    2017-12-01

    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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-08-09

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

  4. Mass Casualty Incident Primary Triage Methods in China

    Science.gov (United States)

    Chen, Jin-Hong; Yang, Jun; Yang, Yu; Zheng, Jing-Chen

    2015-01-01

    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

  5. 2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives

    OpenAIRE

    Strommen, Joshua J.; Waterman, Scott M.; Mitchell, Christopher A.; Grogan, Brian F.

    2015-01-01

    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.

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

    Science.gov (United States)

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

    2014-10-01

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

  7. Scalable patients tracking framework for mass casualty incidents.

    Science.gov (United States)

    Yu, Xunyi; Ganz, Aura

    2011-01-01

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

  8. [Preclinical and intrahospital management of mass casualties and terrorist incidents].

    Science.gov (United States)

    Franke, A; Bieler, D; Friemert, B; Kollig, E; Flohe, S

    2017-10-01

    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.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Data.gov (United States)

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

  11. Policies for managing emergency medical services in mass casualty incidents.

    Science.gov (United States)

    Adini, B; Bodas, M; Nilsson, H; Peleg, K

    2017-09-01

    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.

  12. Self-care Decontamination within a Chemical Exposure Mass-casualty Incident.

    Science.gov (United States)

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

    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.

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

    Science.gov (United States)

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

    2012-04-01

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

  14. Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?

    NARCIS (Netherlands)

    Postma, Ingri L. E.; Beenen, L. F. M.; Bijlsma, T. S.; Berger, F. H.; Heetveld, M. J.; Bloemers, F. W.; Goslings, J. C.

    2014-01-01

    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

  15. Coordinating a multiple casualty Critical Incident Stress Management (CISM) response within a medical/surgical hospital setting.

    Science.gov (United States)

    Morrow, H E

    2001-01-01

    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.

  16. An Alternative Health Care Facility: Concept of Operations for the Off-site Triage, Treatment, and Transportation Center (OST3C). Mass Casualty Care Strategy for a Chemical Terrorism Incident

    Science.gov (United States)

    2001-03-01

    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

  17. [Triage protocols for mass casualty incidents : An overview 30 years after START].

    Science.gov (United States)

    Streckbein, S; Kohlmann, T; Luxen, J; Birkholz, T; Prückner, S

    2016-08-01

    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.

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2014-02-22

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

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

    Science.gov (United States)

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

    2017-01-01

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

  1. Mass casualty incident surveillance and monitoring using identity aware video analytics.

    Science.gov (United States)

    Yu, Xunyi; Ganz, Aura

    2010-01-01

    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.

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

    Science.gov (United States)

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

    2018-02-02

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

  3. Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

    Science.gov (United States)

    Carter, Holly; Amlôt, Richard

    2016-01-01

    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

  4. Mass Casualty Incidents in the Underground Mining Industry: Applying the Haddon Matrix on an Integrative Literature Review.

    Science.gov (United States)

    Engström, Karl Gunnar; Angrén, John; Björnstig, Ulf; Saveman, Britt-Inger

    2018-02-01

    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).

  5. A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 Stadium in Durban.

    Science.gov (United States)

    Hardcastle, Timothy C; Samlal, Sanjay; Naidoo, Rajen; Hendrikse, Steven; Gloster, Alex; Ramlal, Melvin; Ngema, Sibongiseni; Rowe, Michael

    2012-10-01

    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.

  6. Can a pediatric trauma center improve the response to a mass casualty incident?

    Science.gov (United States)

    Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S

    2012-10-01

    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.

  7. Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II.

    Science.gov (United States)

    Heinrichs, Wm Leroy; Youngblood, Patricia; Harter, Phillip; Kusumoto, Laura; Dev, Parvati

    2010-01-01

    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

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

    Science.gov (United States)

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

    2015-03-01

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

  9. Using immersive simulation for training first responders for mass casualty incidents.

    Science.gov (United States)

    Wilkerson, William; Avstreih, Dan; Gruppen, Larry; Beier, Klaus-Peter; Woolliscroft, James

    2008-11-01

    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.

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Abdullah A. Bin Shalhoub

    2017-03-01

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

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

    International Nuclear Information System (INIS)

    Jammet, H.P.

    1977-01-01

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

  15. Marine Casualty and Pollution Data for Researchers

    Data.gov (United States)

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

  16. Critical issues in preparing for a mass casualty event: highlights from a new community planning guide.

    Science.gov (United States)

    2007-09-01

    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.

  17. Development of a staff recall system for mass casualty incidents using cell phone text messaging.

    Science.gov (United States)

    Epstein, Richard H; Ekbatani, Ali; Kaplan, Javier; Shechter, Ronen; Grunwald, Zvi

    2010-03-01

    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

  18. 34 A systematic literature review of the pre-hospital lessons identified following mass casualty deliberate bombing incidents.

    Science.gov (United States)

    Cooke, Thomas; Chesters, Adam; Grier, Gareth

    2017-12-01

    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

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

    NARCIS (Netherlands)

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

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

  20. Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system.

    Science.gov (United States)

    Shah, Adil Aijaz; Rehman, Abdul; Sayyed, Raza Hasnain; Haider, Adil Hussain; Bawa, Amber; Zafar, Syed Nabeel; Zia-Ur-Rehman; Ali, Kamran; Zafar, Hasnain

    2015-01-01

    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

  1. Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center.

    Science.gov (United States)

    King, David R; Patel, Mayur B; Feinstein, Ara J; Earle, Steven A; Topp, Raymond F; Proctor, Kenneth G

    2006-10-01

    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.

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

    Science.gov (United States)

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

    2017-07-01

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

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

    Science.gov (United States)

    1995-02-01

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

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

    Science.gov (United States)

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

    2007-09-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2017-10-01

    Medical response to mass-casualty incidents (MCIs) requires specialized training and preparation. Basic Disaster Life Support (BDLS) is a course designed to prepare health care workers for a MCI. The purpose of this study was to evaluate the confidence of health care professionals in Thailand to face a MCI after participating in a BDLS course. Basic Disaster Life Support was taught to health care professionals in Thailand in July 2008. Demographics and medical experience were recorded, and participants rated their confidence before and after the course using a five-point Likert scale in 11 pertinent MCI categories. Survey results were compiled and compared with 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 .

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

    Science.gov (United States)

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

    2017-10-01

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

  8. Data collection in a live mass casualty incident simulation: automated RFID technology versus manually recorded system.

    Science.gov (United States)

    Ingrassia, Pier Luigi; Carenzo, Luca; Barra, Federico Lorenzo; Colombo, Davide; Ragazzoni, Luca; Tengattini, Marco; Prato, Federico; Geddo, Alessandro; Della Corte, Francesco

    2012-02-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-07-15

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

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

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  11. Kentucky's highway incident management strategic plan.

    Science.gov (United States)

    2005-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Huber-Wagner S

    2009-12-01

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

  13. The evaluation of training of hospital staff to respond to casualty incident

    Directory of Open Access Journals (Sweden)

    J Nasl Saraji

    2005-10-01

    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 .

  14. How a major incident plan can be used in an acute healthcare setting.

    Science.gov (United States)

    Makin, Seth; Smith, L; McDevitt, K

    2018-04-06

    All NHS Trusts face a diverse range of potential threats and disruptions that can overwhelm the delivery of their routine healthcare services. Major incidents range from significant infrastructure failure to responding to significant casualty numbers from natural disasters and malicious incidents. Major incident plans are one of the body of documents that support trusts and in this instance acute NHS trusts in emergency preparedness. Major incident plans can be used as a reference point for staff of all disciplines, that is, clinical and non-clinical. Major incident plans incorporate the requirements of the Civil Contingencies Act 2004 for NHS-funded providers to ensure trusts conduct risk assessments, emergency planning, cooperating with other organisations, and internal and external communication. This paper summarises some of the key aspects in the construction and the use of major incident plans in acute care trusts. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

    Science.gov (United States)

    2013-08-01

    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

  16. Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS): development and application of computer modeling to selected National Planning Scenarios for high-consequence events.

    Science.gov (United States)

    Scheulen, James J; Thanner, Meridith H; Hsu, Edbert B; Latimer, Christian K; Brown, Jeffrey; Kelen, Gabor D

    2009-02-01

    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.

  17. Leadership as a component of crowd control in a hospital dealing with a mass-casualty incident: lessons learned from the October 2000 riots in Nazareth.

    Science.gov (United States)

    Pinkert, Moshe; Bloch, Yuval; Schwartz, Dagan; Ashkenazi, Isaac; Nakhleh, Bishara; Massad, Barhoum; Peres, Michal; Bar-Dayan, Yaron

    2007-01-01

    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

  18. Preparing South Carolina Emergency Departments for Mass Casualties with an Emphasis on the Planning Process

    Science.gov (United States)

    2013-03-01

    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

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

    Science.gov (United States)

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

    2015-04-01

    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.

  20. Effect of vacuum spine board immobilization on incidence of pressure ulcers during evacuation of military casualties from theater.

    Science.gov (United States)

    Mok, James M; Jackson, Keith L; Fang, Raymond; Freedman, Brett A

    2013-12-01

    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

  1. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice.

    Science.gov (United States)

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; Larner, Joanne; Matar, Hazem; Chilcott, Robert P

    2016-01-01

    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.

  2. Transfusion-Associated Microchimerism in Combat Casualties

    National Research Council Canada - National Science Library

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

    2007-01-01

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

  3. Hospital planning for weapons of mass destruction incidents

    Directory of Open Access Journals (Sweden)

    Perry Ronald

    2006-01-01

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

  4. Incident Management Organization succession planning stakeholder feedback

    Science.gov (United States)

    Anne E. Black

    2013-01-01

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

  5. Human casualties in earthquakes: Modelling and mitigation

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    Badiali, Stefano; Giugni, Aimone; Marcis, Lucia

    2017-06-01

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

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

    Science.gov (United States)

    2005-05-01

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

  8. Computer Security Incident Response Planning at Nuclear Facilities

    International Nuclear Information System (INIS)

    2016-06-01

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

  9. Retrospective and emergency dosimetry in response to radiological incidents and nuclear mass-casualty events: A review

    International Nuclear Information System (INIS)

    Bailiff, I.K.; Sholom, S.; McKeever, S.W.S.

    2016-01-01

    of a radiation incident. Hence attention has focused on biological or physical materials they may have in their possession that could be used as surrogate dosimeters. For EPR measurements, in particular, this includes material within the body (such as bone or tooth biopsy) requiring invasive procedures, but also materials collected non-invasively (such as clippings taken from finger- or toenails) and artefacts within their personal belongings (such as electronic devices of which smart phones are the most common). For luminescence measurements, attention has also focused on components within electronic devices, including smartphones, and a wide range of other personal belongings such as paper and other polymer-based materials (including currency, clothing, bank cards, etc.). The paper reviews progress made using both EPR and luminescence techniques, along with their current limitations. For the longer-established approach of retrospective dosimetry, luminescence has been the most extensively applied method and, by employing minerals found in construction materials, it consequently is employed in dosimetry using structures within the environment. Recent developments in its application to large-scale radiation releases are discussed, including the atomic bomb detonations at Hiroshima and Nagasaki, fallout from the Chernobyl reactor and atmospheric nuclear bomb tests within the Semipalatinsk Nuclear Test Site and fluvially transported pollution within the Techa River basin due to releases from the Mayak facility. The developments made in applying OSL and TL techniques are discussed in the context of these applications. EPR measurements with teeth have also provided benchmark values to test the dosimetry models used for Chernobyl liquidators (clean-up workers), residents of Semipalatinsk Nuclear Tests Sites and inhabitants of the Techa River basin. For both emergency and retrospective dosimetry applications, computational techniques employing radiation transport

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

    Directory of Open Access Journals (Sweden)

    Hedelin Annika

    2009-07-01

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

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

    International Nuclear Information System (INIS)

    1983-02-01

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

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

    Science.gov (United States)

    2012-09-01

    is the radioactive source material specified in National Planning Scenario #11. Cs-137 has also been involved in several real-world accidents ...including a significant incident in 1987, where scavengers dismantled a metal canister from a radiotherapy machine at an abandoned cancer clinic in...report describing the Cs-137 accident in Goiania, Brazil. Lawrence Livermore National Laboratory September 2012Key Planning Factors for Radiological

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

    Directory of Open Access Journals (Sweden)

    Robert Gałązkowski

    2014-04-01

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

  14. Armored vehicle crew casualties.

    Science.gov (United States)

    Dougherty, P J

    1990-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Richard Amlôt

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

  16. Experience in the management of the mass casualty from the ...

    African Journals Online (AJOL)

    2015-09-21

    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 ...

  17. the bulhoek massacre: origins, casualties, reactions and historical ...

    African Journals Online (AJOL)

    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 ...

  18. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

    Science.gov (United States)

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.

    2016-01-01

    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

  19. Eye casualty services in London

    Science.gov (United States)

    Smith, H B; Daniel, C S; Verma, S

    2013-01-01

    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

  20. Iraq: U.S. Casualties

    National Research Council Canada - National Science Library

    Chesser, Susan G

    2009-01-01

    ...." 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.

  1. Iraq: U.S. Casualties

    National Research Council Canada - National Science Library

    Chesser, Susan G

    2008-01-01

    ...." 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].

  2. Tsunami Casualty Model

    Science.gov (United States)

    Yeh, H.

    2007-12-01

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

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

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2016-04-01

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

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

    Science.gov (United States)

    DeFraia, G S

    2016-04-01

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

  5. Comparison of Unmanned Aerial Vehicle Technology Versus Standard Practice in Identification of Hazards at a Mass Casualty Incident Scenario by Primary Care Paramedic Students.

    Science.gov (United States)

    Jain, Trevor; Sibley, Aaron; Stryhn, Henrik; Hubloue, Ives

    2018-01-31

    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).

  6. Implications for modeling casualty sustainment during peacekeeping operations.

    Science.gov (United States)

    Blood, Christopher G; Zhang, Jinjin; Walker, G Jay

    2002-10-01

    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.

  7. Automated Generation of Traffic Incident Response Plan Based on Case-Based Reasoning and Bayesian Theory

    Directory of Open Access Journals (Sweden)

    Yongfeng Ma

    2014-01-01

    Full Text Available Traffic incident response plan, specifying response agencies and their responsibilities, can guide responders to take actions effectively and timely after traffic incidents. With a reasonable and feasible traffic incident response plan, related agencies will save many losses, such as humans and wealth. In this paper, how to generate traffic incident response plan automatically and specially was solved. Firstly, a well-known and approved method, Case-Based Reasoning (CBR, was introduced. Based on CBR, a detailed case representation and R5-cycle of CBR were developed. To enhance the efficiency of case retrieval, which was an important procedure, Bayesian Theory was introduced. To measure the performance of the proposed method, 23 traffic incidents caused by traffic crashes were selected and three indicators, Precision P, Recall R, and Indicator F, were used. Results showed that 20 of 23 cases could be retrieved effectively and accurately. The method is practicable and accurate to generate traffic incident response plans. The method will promote the intelligent generation and management of traffic incident response plans and also make Traffic Incident Management more scientific and effective.

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

    Science.gov (United States)

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

    2009-01-01

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

  9. Manual estimation of fallout casualties. Final report

    International Nuclear Information System (INIS)

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

    1978-08-01

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

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

    Science.gov (United States)

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

    2013-11-01

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

  11. Iraq: Summary of U.S. Casualties

    National Research Council Canada - National Science Library

    O'Bryant, JoAnne

    2007-01-01

    ...." 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].

  12. Iraq: Summary of U.S. Casualties

    National Research Council Canada - National Science Library

    Fischer, Hannah

    2005-01-01

    .../]; 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].

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

    Directory of Open Access Journals (Sweden)

    Pascopella Lisa

    2007-10-01

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

  14. Triage in mass casualty situations

    African Journals Online (AJOL)

    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 ...

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

    International Nuclear Information System (INIS)

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

    2006-12-01

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

  16. Nuclear terrorism: triage and medical management of radiation and combined-injury casualties.

    Science.gov (United States)

    Flynn, Daniel F; Goans, Ronald E

    2006-06-01

    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.

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

    Science.gov (United States)

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari

    2015-01-01

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

  19. Mass Casualties in Combat: Lessons Learned

    National Research Council Canada - National Science Library

    Beekley, Alex C

    2007-01-01

    .... 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...

  20. RESPONSE PROTOCOL TOOLBOX: PLANNING FOR AND RESPONDING TO DRINKING WATER CONTAMINATION THREATS AND INCIDENTS. MODULE 1: WATER UTILITIES PLANNING GUIDE - INTERIM FINAL - DECEMBER 2003

    Science.gov (United States)

    The interim final Response Protocol Toolbox: Planning for and Responding to Contamination Threats to Drinking Water Systems is designed to help the water sector effectively and appropriately respond to intentional contamination threats and incidents. It was produced by EPA, buil...

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

    Science.gov (United States)

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

    2006-01-01

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

  2. Population and energy elasticity of tornado casualties

    Science.gov (United States)

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

    2017-04-01

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

  3. Modeling Casualty Sustainment During Peacekeeping Operations

    Science.gov (United States)

    2003-10-09

    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

  4. The Casualty Network System Capstone Project

    Science.gov (United States)

    2012-12-01

    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

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

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

    International Nuclear Information System (INIS)

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

    1981-10-01

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

  7. Civilian casualties of Iraqi ballistic missile attack to

    Directory of Open Access Journals (Sweden)

    Khaji Ali

    2012-06-01

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

  8. Predicting casualties implied by TIPs

    Science.gov (United States)

    Trendafiloski, G.; Wyss, M.; Wyss, B. M.

    2009-12-01

    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

  9. Tactical Combat Casualty Care: Beginnings.

    Science.gov (United States)

    Butler, Frank K

    2017-06-01

    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.

  10. Types of radiation mass casualties and their management.

    Science.gov (United States)

    Jaworska, Alicja

    2009-01-01

    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.

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  12. Medical management of toxicological mass casualty events.

    Science.gov (United States)

    Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik

    2008-11-01

    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.

  13. Management of Mass Casualty Burn Disasters

    National Research Council Canada - National Science Library

    Cancio, Leopoldo C; Pruitt, Basil A

    2005-01-01

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

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

    Science.gov (United States)

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

    2017-11-20

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

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

    Directory of Open Access Journals (Sweden)

    Yongfeng Ma

    2014-01-01

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

  16. Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment

    Science.gov (United States)

    2017-12-01

    Traffic incidents have long been recognized as the main contributor to congestion in highway networks. Thus, contending with non-recurrent congestion has been a priority task for most highway agencies over the past decades. Under most incident scenar...

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

    Directory of Open Access Journals (Sweden)

    Ömür Yaşar SAATÇİOĞLU

    2017-03-01

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

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

    Science.gov (United States)

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

    2011-10-01

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

  19. The casualties from electric bike and motorized scooter road accidents.

    Science.gov (United States)

    Siman-Tov, Maya; Radomislensky, Irina; Peleg, Kobi

    2017-04-03

    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.

  20. Casualty Estimation for Nuclear and Radiological Weapons

    Science.gov (United States)

    2016-06-01

    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

  1. 46 CFR 197.486 - Written report of casualty.

    Science.gov (United States)

    2010-10-01

    ... 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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-12-15

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

  3. Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan.

    Science.gov (United States)

    Ward, M A; Xu, Y; Viswanathan, H N; Stolshek, B S; Clay, B; Adams, J L; Kallich, J D; Fine, S; Saag, K G

    2013-04-01

    We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low. We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan. We conducted a retrospective cohort study of MAPD plan members aged≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up. Of the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6%) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR]≥0.8) at 12 months (odds ratio [OR]=1.18) and 24 months (OR=1.13) follow-up. However, overall adherence remained low (MPR=0.59 and 0.51 for the change cohort and MPR=0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR=1.00 at 12 months and OR=0.98 at 24 months) or total direct healthcare costs (p>0.4) in the DID analysis, but was associated with higher pharmacy costs (p<0.004). Osteoporosis treatment change was associated with a small but significant

  4. Using the Shipboard Casualty Projection System (SHIPCAS) to Forecast Ship Hits and Casualty Sustainment

    National Research Council Canada - National Science Library

    Blood, Christopher

    1997-01-01

    .... 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...

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2018-02-13

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

  7. A Water Security Handbook: Planning for and Responding to Drinking Water Contamination Threats and Incidents

    National Research Council Canada - National Science Library

    2006-01-01

    .... This Water Security Handbook was developed by the U.S. EPA to help you, the water utility official, protect your water system and respond effectively to threats and contamination incidents involving your water system...

  8. The Barrow-in-Furness legionnaires' outbreak: qualitative study of the hospital response and the role of the major incident plan.

    Science.gov (United States)

    Smith, A F; Wild, C; Law, J

    2005-04-01

    To document the organisational response of Furness General Hospital to the large outbreak of legionnaire's disease in April 2002 and assess the contribution made by the hospital's major incident plan. Qualitative analysis of interview transcripts and written comments from some staff involved in the management of the incident. Documentary analysis of major incident plan and other written materials. The incident posed considerable managerial and clinical problems and this paper describes how they were overcome. In particular, strategies for dealing with supply (of staff, beds, and resources) and managing demand (by liaising with primary care and the public) seem to have been successful. Many functions necessary for managing the incident were poorly dealt with in the plan, especially procedures for handling the news media and liaison with agencies outside the hospital. Lack of explicit guidance appeared not to hinder the organisational response. There may have been an unspoken high level decision to allow staff to draw on their skills and experience in improvising a response to the initial challenge and learning adaptively as the incident unfolded. There was also evidence that staff disregarded existing job and role boundaries and focused instead on tasks, working flexibly to ensure that these tasks were completed. Protracted major incidents pose particular management challenges and may benefit from an approach different from that set out in typical major incident plans. Staff must be able to act flexibly and responsively. Some form of checklist or toolkit may be preferable to a detailed plan for some types of incident.

  9. Recovery from a chemical weapons accident or incident: A concept paper on planning

    Energy Technology Data Exchange (ETDEWEB)

    Herzenberg, C.L.; Haffenden, R.; Lerner, K.; Meleski, S.A.; Tanzman, E.A. [Argonne National Lab., IL (United States); Lewis, L.M. [US Dept. of Agriculture (United States); Hemphill, R.C. [Niagara Mohawk Power Corporation (United States); Adams, J.D. [US Environmental Protection Agency (United States)

    1994-04-01

    Emergency planning for an unintended release of chemical agent from the nation`s chemical weapons stockpile should include preparation for. the period following implementation of immediate emergency response. That period -- the recovery, reentry, and restoration stage -- is the subject of this report. The report provides an overview of the role of recovery, reentry, and restoration planning in the Chemical Stockpile Emergency Preparedness Program (CSEPP), describes the transition from immediate emergency response to restoration, and analyzes the legal framework that would govern restoration activities. Social, economic, and administrative issues, as well as technical ones, need to be considered in the planning effort. Because of possible jurisdictional conflicts, appropriate federal, state, and local agencies need to be included in a coordinated planning process. Advance consideration should be given to the pertinent federal and state statutes and regulations. On the federal level, the principal statutes and regulations to be considered are those associated with the Comprehensive Environmental Response, Compensation, and Liability Act; the Resource Conservation and Recovery Act; and the National Environmental Policy Act. This report recommends that extensive preaccident planning be undertaken for the recovery, reentry, and restoration stage and outlines several key issues that should be considered in that planning. The need for interagency cooperation and coordination at all levels of the planning process is emphasized.

  10. Towards comprehensive malaria planning: the effect of government capacity, health policy, and land use variables on malaria incidence in India.

    Science.gov (United States)

    Boussalis, Constantine; Nelson, Hal T; Swaminathan, Siddharth

    2012-10-01

    We present what we believe is the first empirical research that accounts for subnational government capacity in estimating malaria incidence. After controlling for relevant extrinsic factors, we find evidence of a negative effect of state government capacity on reported malaria cases in Indian states over the period 1993-2002. Government capacity is more successful in predicting malaria incidence than potentially more direct indicators such as state public health expenditures and economic development levels. We find that high government capacity can moderate the deleterious health effects of malaria in rice producing regions. Our research also suggests that government capacity may have exacerbated the effectiveness of the World Bank Malaria Control Project in India over the period studied. We conclude by proposing the integration of government capacity measures into existing planning efforts, including vulnerability mapping tools and disease surveillance efforts. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Annelie Holgersson

    2016-02-01

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

  12. Westinghouse GOCO conduct of casualty drills

    International Nuclear Information System (INIS)

    Ames, C.P.

    1996-02-01

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

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

    Science.gov (United States)

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

    2018-04-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Yu, Xunyi; Ganz, Aura

    2011-01-01

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

  16. Hospital preparedness for possible nonconventional casualties: an Israeli experience.

    Science.gov (United States)

    Schreiber, Shaul; Yoeli, Naomi; Paz, Gedalia; Barbash, Gabriel I; Varssano, David; Fertel, Nurit; Hassner, Avi; Drory, Margalit; Halpern, Pinchas

    2004-01-01

    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

  17. Pushing up smoking incidence: plans for a privatised tobacco industry in Moldova.

    Science.gov (United States)

    Gilmore, Anna B; Radu-Loghin, Cornel; Zatushevski, Irina; McKee, Martin

    Moldova, one of the former Soviet republics and Europe's poorest country, has so far resisted pressure to privatise its tobacco industry. This paper examines the policies pursued by the transnational tobacco companies in Moldova in order to inform the ongoing debate about tobacco industry privatisation. We analysed relevant internal industry documents made public through litigation. The documents suggest that although a competitive tender for the state owned monopoly was later announced, British American Tobacco (BAT) and the German manufacturer Reemtsma each initially sought to secure a closed deal, with BAT accusing Reemtsma of underhand tactics. Imperial Tobacco, which now owns Reemstma, was unable to comment on these allegations as it only acquired Reemstma after the events in question. BAT sought to acquire a monopoly position, bolstered by excise rules developed by the company that would uniquely favour its products. Despite hoping to establish a monopoly, it planned intensive marketing, as if in a competitive market, aiming to target young urban dwellers, particularly opinion leaders. In so doing it predicted that smoking uptake would increase, especially among women. The documents also suggest that BAT was aware of the sensitive nature of its plans to cull the processing workforce and aimed to present "sanitised" information on future employment levels to the Moldovans. The potential for tobacco industry privatisation to undermine tobacco control and promote cigarette consumption is highlighted and is consistent with economic theory. Countries planning tobacco industry privatisation should ensure a transparent and competitive privatisation process, seek to prevent the predicted increase in consumption by implementing effective tobacco control policies and consider the impacts on employment. Multilateral financial organisations promoting tobacco industry privatisation could ensure their loan conditions protect public health by making the implementation of

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

    Science.gov (United States)

    Vaidyanathan, Karthik

    2017-01-01

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

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

    Science.gov (United States)

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

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

  20. 46 CFR 197.484 - Notice of casualty.

    Science.gov (United States)

    2010-10-01

    ... 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...

  1. 46 CFR 197.488 - Retention of records after casualty.

    Science.gov (United States)

    2010-10-01

    ... 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...

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  3. Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.

    Science.gov (United States)

    Hanley, Michael E; Bogdan, Gregory M

    2008-02-01

    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.

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

    International Nuclear Information System (INIS)

    Norman Coleman, C.

    2014-01-01

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

  5. Enhanced Chemical Incident Response Plan (ECIRP). Appendix F, remediation analysis with Decision Support Tools (DSTs) for wide-area chemical hazards.

    Energy Technology Data Exchange (ETDEWEB)

    Hassig, Nancy L. (Pacific Northwest National Laboratory, Richland, WA); Pulsipher, Brent A. (Pacific Northwest National Laboratory, Richland, WA); Foltz, Greg W.; Hoette, Trisha Marie

    2011-07-01

    The Defense Threat Reduction Agency (DTRA) commissioned an assessment of the Consequence Management (CM) plans in place on military bases for response to a chemical attack. The effectiveness of the CM plans for recovering from chemical incidents was modeled using a multiple Decision Support Tools (DSTs). First, a scenario was developed based on an aerial dispersion of a chemical agent over a wide-area of land. The extent of contamination was modeled with the Hazard Prediction and Assessment Capability (HPAC) tool. Subsequently, the Analyzer for Wide Area Restoration Effectiveness (AWARE) tool was used to estimate the cost and time demands for remediation based on input of contamination maps, sampling and decontamination resources, strategies, rates and costs. The sampling strategies incorporated in the calculation were designed using the Visual Sample Plan (VSP) tool. Based on a gaps assessment and the DST remediation analysis, an Enhanced Chemical Incident Response Plan (ECIRP) was developed.

  6. 33 CFR 174.106 - State casualty reporting system optional sections.

    Science.gov (United States)

    2010-07-01

    ... 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...

  7. Protective measures while treating CWA casualties

    International Nuclear Information System (INIS)

    Medema, J.

    2009-01-01

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

  8. A review of the literature on the validity of mass casualty triage systems with a focus on chemical exposures.

    Science.gov (United States)

    Culley, Joan M; Svendsen, Erik

    2014-01-01

    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.

  9. Net-bottom Cage Inserts for Water Bird Casualties

    Directory of Open Access Journals (Sweden)

    Jackie Belle

    2017-10-01

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

  10. 76 FR 8788 - Riverside Casualty, Inc.; Notice of Application

    Science.gov (United States)

    2011-02-15

    ... 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

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

    Science.gov (United States)

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

    2012-12-01

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

  12. Early Atomic Bomb Casualty Commission perceptions and planning

    International Nuclear Information System (INIS)

    Friedell, H.L.

    1982-01-01

    A description of the kind of research carried on by the Manhattan Project during World War II is presented. At that time scientists were trying to identify acceptable radiation levels, and to ascertain whether any immediate research was needed to support such levels. The author briefly outlines activities to determine any immediate effects of radiation that occurred after the nuclear strikes in Hiroshima and Nagasaki

  13. NATO Planning Guide for the Estimation of CBRN Casualties

    Science.gov (United States)

    2014-11-01

    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

  14. The Role of Emergency Medical Service in CBR Incidents

    International Nuclear Information System (INIS)

    Castulik, P.

    2007-01-01

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

  15. [Incidence of occupational diseases in a province of China during the period of "Twelfth Five-Year Plan" and its trend].

    Science.gov (United States)

    Gao, Q Q; Zhang, H D; Bai, Y; Han, L; Shen, H; Zhang, J; Zhu, B L

    2017-12-20

    Objective: To investigate the incidence of occupational diseases in a province of China during the period of "Twelfth Five-Year Plan" , and to analyze the features of disease spectrum, the characteristics of regional and industrial distribution, and incidence trend. Methods: Data (2011-2015) were collected from the Information System of Occupational Diseases and Occupational Health to analyze the reported cases of occupational diseases during the period of "Twelfth Five-Year Plan". A statistical analysis was performed to identify the characteristics of the disease distribution in terms of sex, age, working years, enterprise type, enterprise scale, and region, as well as the incidence trend. Results: The overall incidence of occupational diseases in this province fluctuated and decreased gradually. There were a total of 5036 new cases of occupational diseases during the period of "Twelfth Five-Year Plan" ; 89.45% of them were male, and 69.78% of them were aged 40-69 years; the most frequently seen occupational diseases were pneumoconiosis (72.48%) and ear, nose, throat, and oral diseases (7.23%). Most cases of pneumoconiosis occurred after 5-10 years of exposure, and other occupational diseases usually developed within 10 years of exposure. New cases of occupational diseases were often seen in small and micro enterprises, as well as Wuxi, Suzhou, and Yancheng. Conclusion: During the period of "Twelfth Five-Year Plan" , the incidence of occupational diseases in this province decreased gradually, indicating improved control of occupational diseases, but we still need to pay attention to the high-risk population (male, aged over 40 years) , as well as the prevention of occupational noise-induced hearing loss, and to strengthen the supervision of small and micro enterprises.

  16. Development of sulfanegen for mass cyanide casualties.

    Science.gov (United States)

    Patterson, Steven E; Moeller, Bryant; Nagasawa, Herbert T; Vince, Robert; Crankshaw, Daune L; Briggs, Jacquie; Stutelberg, Michael W; Vinnakota, Chakravarthy V; Logue, Brian A

    2016-06-01

    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.

  17. Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma

    Science.gov (United States)

    2017-02-01

    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

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

    NARCIS (Netherlands)

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

    2009-01-01

    HIV incidence estimation is increasingly being incorporated into HIV/AIDS surveillance activities in both resource-rich and developing countries. We conducted a systematic review to assess the availability of HIV incidence data from sub-Saharan Africa. We examined peer-reviewed articles, conference

  19. Comparison of Computerized Patients versus Live Moulaged Actors for a Mass-casualty Drill.

    Science.gov (United States)

    Claudius, Ilene; Kaji, Amy; Santillanes, Genevieve; Cicero, Mark; Donofrio, J Joelle; Gausche-Hill, Marianne; Srinivasan, Saranya; Chang, Todd P

    2015-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Richard Amlôt

    2012-10-01

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

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

    Science.gov (United States)

    Egan, Joseph R.; Amlôt, Richard

    2012-01-01

    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

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  4. Public health and medical preparedness for a nuclear detonation: the nuclear incident medical enterprise.

    Science.gov (United States)

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

    2015-02-01

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

  5. Literature review on medical incident command.

    Science.gov (United States)

    Rimstad, Rune; Braut, Geir Sverre

    2015-04-01

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

  6. The Battle for Hue: Casualty and Disease Rates during Urban Warfare

    Science.gov (United States)

    1993-08-01

    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

  7. Casualty Crash Types for which Teens are at Excess Risk

    OpenAIRE

    Bingham, C. R.; Shope, J. T.

    2007-01-01

    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...

  8. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile.

    Science.gov (United States)

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

    2016-03-01

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

  9. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Science.gov (United States)

    2010-04-01

    ..., 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...

  10. 33 CFR 174.101 - Applicability of State casualty reporting system.

    Science.gov (United States)

    2010-07-01

    ... 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...

  11. Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US Military.

    Science.gov (United States)

    Butler, Frank K; Smith, David J; Carmona, Richard H

    2015-08-01

    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.

  12. Acute incident rapid response at a mass-gathering event through comprehensive planning systems: a case report from the 2013 Shamrock Shuffle.

    Science.gov (United States)

    Başdere, Mehmet; Ross, Colleen; Chan, Jennifer L; Mehrotra, Sanjay; Smilowitz, Karen; Chiampas, George

    2014-06-01

    Planning and execution of mass-gathering events involves various challenges. In this case report, the Chicago Model (CM), which was designed to organize and operate such events and to maintain the health and wellbeing of both runners and the public in a more effective way, is described. The Chicago Model also was designed to prepare for unexpected incidents, including disasters, during the marathon event. The model has been used successfully in the planning and execution stages of the Bank of America Shamrock Shuffle and the Bank of America Chicago Marathon since 2008. The key components of the CM are organizational structure, information systems, and communication. This case report describes how the organizers at the 2013 Shamrock Shuffle used the key components of the CM approach in order to respond to an acute incident caused by a man who was threatening to jump off the State Street Bridge. The course route was changed to accommodate this unexpected event, while maintaining access to key health care facilities. The lessons learned from the incident are presented and further improvements to the existing model are proposed.

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

    African Journals Online (AJOL)

    2012-11-04

    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 ...

  14. Updates to Blast Injury Criteria Models for Nuclear Casualty Estimation

    Science.gov (United States)

    2015-12-01

    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

  15. Iraqi Civilian: Police, and Security Forces Casualty Estimates

    Science.gov (United States)

    2006-09-14

    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

  16. 26 CFR 1.165-7 - Casualty losses.

    Science.gov (United States)

    2010-04-01

    ... 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...

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

    African Journals Online (AJOL)

    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 ...

  18. Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents.

    Science.gov (United States)

    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

    2007-08-01

    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.

  19. Spinal injuries in United States military personnel deployed to Iraq and Afghanistan: an epidemiological investigation involving 7877 combat casualties from 2005 to 2009.

    Science.gov (United States)

    Schoenfeld, Andrew J; Laughlin, Matthew D; McCriskin, Brendan J; Bader, Julia O; Waterman, Brian R; Belmont, Philip J

    2013-09-15

    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

  20. Allocation of scarce resources during mass casualty events.

    Science.gov (United States)

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

    2012-06-01

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

  1. Preliminary quantitative assessment of earthquake casualties and damages

    DEFF Research Database (Denmark)

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

    2005-01-01

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

  2. Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience

    Science.gov (United States)

    2007-11-01

    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

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

    International Nuclear Information System (INIS)

    Breuer, Joachim

    2015-01-01

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

  4. Emergency department staff preparedness for mass casualty events involving children.

    Science.gov (United States)

    Rassin, Michal; Avraham, Miri; Nasi-Bashari, Anat; Idelman, Sigalit; Peretz, Yaniv; Morag, Shani; Silner, Dina; Weiss, Gali

    2007-01-01

    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.

  5. Investigation of work zone crash casualty patterns using association rules.

    Science.gov (United States)

    Weng, Jinxian; Zhu, Jia-Zheng; Yan, Xuedong; Liu, Zhiyuan

    2016-07-01

    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.

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

    Science.gov (United States)

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

    2016-11-08

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

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

    Science.gov (United States)

    Doughty, Heidi; Glasgow, Simon; Kristoffersen, Einar

    2016-04-01

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

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

    International Nuclear Information System (INIS)

    2008-01-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

  10. Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury

    National Research Council Canada - National Science Library

    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

    2007-01-01

    .... 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...

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

    Science.gov (United States)

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

    2017-12-11

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

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

    Science.gov (United States)

    Fricker, T.; Elsner, J.

    2017-12-01

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

  13. 46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

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

  14. 46 CFR 122.210 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

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

  15. Casualties from guided missile impact in warships from another point of view.

    Science.gov (United States)

    Ebeling, C F

    1991-06-01

    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.

  16. Does amyl nitrite have a role in the management of pre-hospital mass casualty cyanide poisoning?

    Science.gov (United States)

    Lavon, Ophir; Bentur, Yedidia

    2010-07-01

    in under- or over-dosing, can prevent the caregiver from administering life support, and possibly expose him/her to amyl nitrite's adverse effects. Administration of amyl nitrite in mass casualty cyanide poisoning can result in unnecessary morbidity and may interfere with the proper management of the incident and the required supportive treatment and rapid evacuation. In the authors' opinion these drawbacks make the use of amyl nitrite in pre-hospital mass casualty cyanide poisoning unwarranted.

  17. Management of Mass Casualties Using Doctor Helicopters and Doctor Cars.

    Science.gov (United States)

    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.

  18. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de; Villeirs, G.M.; Delrue, L.J.

    2004-01-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  19. The incidence of inclusion of the sigmoid colon and small bowel in the planning target volume in radiotherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Meerleer, G.O. de; Vakaet, L.; Neve, W.J. de [Dept. of Radiation Oncology, Gent Univ. Hospital, Gent (Belgium); Villeirs, G.M.; Delrue, L.J. [Dept. of Radiology, Gent Univ. Hospital, Gent (Belgium)

    2004-09-01

    Background and purpose: in radiotherapy for prostate cancer, the rectum is considered the dose-limiting organ. The incidence of overlap between the sigmoid colon and/or small bowel and the planning target volume (PTV) as well as the dose to sigmoid colon and small bowel were investigated. Patients and methods: the CT data of 75 prostate cancer patients were analyzed. The clinical target volume (CTV) consisted of prostate and seminal vesicles. The PTV was defined as a three-dimensional expansion of the CTV with a 10-mm margin in craniocaudal and a 7-mm margin in the other directions. All patients were planned to a mean CTV dose of at least 76 Gy. Minimum CTV dose was set at 70 Gy. Dose inhomogeneity within the CTV was kept between 12% and 17%. Sigmoid colon was defined upward from the level where the rectum turned in a transverse plane. Contrast-filled small bowel was contoured on all slices where it was visible. The presence of sigmoid colon and/or small bowel in close vicinity to or overlapping with the PTV was recorded. For each case, the dose to the sigmoid colon and small bowel was calculated. Results: the PTV was found to overlap with the sigmoid colon in 60% and with the small bowel in 19% of the cases. In these patients, mean maximum dose to the sigmoid colon was 76.2 Gy (5th-95th percentile: 70.0-80.7 Gy). Mean maximum dose to the small bowel was 74.9 Gy (5th-95th percentile: 68.0-80.0 Gy). Conclusion: when systematically investigating the anatomic position of sigmoid colon and small bowel in patients accepted for prostate irradiation, parts of both organs were often observed in close vicinity to the PTV. Apart from the rectum, these organs may be dose-limiting in prostate radiotherapy. (orig.)

  20. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Science.gov (United States)

    2012-08-30

    ... 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...

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

    Science.gov (United States)

    1990-06-01

    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

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

    International Nuclear Information System (INIS)

    1987-01-01

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

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

    International Nuclear Information System (INIS)

    Jablon, S.

    1985-01-01

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

  4. Incident Management: Process into Practice

    Science.gov (United States)

    Isaac, Gayle; Moore, Brian

    2011-01-01

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

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

    Science.gov (United States)

    Matsumura, Janice

    2004-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

  7. A Casualty in the Class War: Canada's Medicare.

    Science.gov (United States)

    Evans, Robert G

    2012-02-01

    "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.

  8. Fluid Resuscitation in Tactical Combat Casualty Care: Yesterday and Today.

    Science.gov (United States)

    Butler, Frank K

    2017-06-01

    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.

  9. Care of the Burn Casualty in the Prolonged Field Care Environment.

    Science.gov (United States)

    Studer, Nicholas M; Driscoll, Ian R; Daly, Ivonne M; Graybill, John C

    2015-01-01

    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.

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

    Science.gov (United States)

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

    2016-10-01

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

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

    National Research Council Canada - National Science Library

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

    2000-01-01

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2012-02-01

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

  14. Infrared imaging-based combat casualty care system

    Science.gov (United States)

    Davidson, James E., Sr.

    1997-08-01

    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.

  15. Wheelchair incidents

    NARCIS (Netherlands)

    Drongelen AW van; Roszek B; Hilbers-Modderman ESM; Kallewaard M; Wassenaar C; LGM

    2002-01-01

    This RIVM study was performed to gain insight into wheelchair-related incidents with powered and manual wheelchairs reported to the USA FDA, the British MDA and the Dutch Center for Quality and Usability Research of Technical Aids (KBOH). The data in the databases do not indicate that incidents with

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

    International Nuclear Information System (INIS)

    Balajee, A.S.; Dainiak, N.

    2016-01-01

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

  17. The Use of Restorative Justice Practices in a School Community Traumatized by an Incident of Planned School Violence: A Case Study

    Science.gov (United States)

    Mateer, Susan Carol

    2010-01-01

    In 2001, less than two years after the Columbine High School shootings, a plan to copycat the Columbine shooting in a junior high school was interrupted by police. This was one of the first documented cases of interrupted school violence and the school where this was to occur was traumatized both by the fact that students were planning violence…

  18. Case Report: Mass Casualty Lightning Strike at Ranger Training Camp.

    Science.gov (United States)

    Thompson, Shannon N; Wilson, Zachary W; Cole, Christopher B; Kennedy, Andrew R; Aycock, Ryan D

    2017-05-01

    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

  19. Rough terrain motion planning for actively reconfigurable mobile robots

    Energy Technology Data Exchange (ETDEWEB)

    Brunner, Michael

    2015-02-05

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

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

    International Nuclear Information System (INIS)

    Safdar, C. A.

    2010-01-01

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

  1. Experience with Proctectomy to Manage Combat Casualties Sustaining Catastrophic Perineal Blast Injury Complicated by Invasive Mucor Soft-Tissue Infections

    Science.gov (United States)

    2014-03-01

    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

  2. Incidents analysis

    International Nuclear Information System (INIS)

    Francois, P.

    1996-01-01

    We undertook a study programme at the end of 1991. To start with, we performed some exploratory studies aimed at learning some preliminary lessons on this type of analysis: Assessment of the interest of probabilistic incident analysis; possibility of using PSA scenarios; skills and resources required. At the same time, EPN created a working group whose assignment was to define a new approach for analysis of incidents on NPPs. This working group gave thought to both aspects of Operating Feedback that EPN wished to improve: Analysis of significant incidents; analysis of potential consequences. We took part in the work of this group, and for the second aspects, we proposed a method based on an adaptation of the event-tree method in order to establish a link between existing PSA models and actual incidents. Since PSA provides an exhaustive database of accident scenarios applicable to the two most common types of units in France, they are obviously of interest for this sort of analysis. With this method we performed some incident analyses, and at the same time explores some methods employed abroad, particularly ASP (Accident Sequence Precursor, a method used by the NRC). Early in 1994 EDF began a systematic analysis programme. The first, transient phase will set up methods and an organizational structure. 7 figs

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

    International Nuclear Information System (INIS)

    Singh, Rita; Bhatnagar, P.K.

    2009-01-01

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

  4. Regulation No. 55/2006 Coll. of the Nuclear Regulatory Authority of the Slovak Republic dated as of January 12, 2006 on details concerning emergency planning in case of nuclear incident or accident

    International Nuclear Information System (INIS)

    2006-01-01

    This Regulation provides details on (a) the content of emergency plans, procedure for their submission and approval; (b) the measures, procedures and activities including degrees of severity of the events according to international criteria; (c) informing the Authority and the public; (d) contents of the documents necessary for application approval of the size of the area at risk, the size of the common area at risk, including the date of its submission; (e) monitoring systems; (f) training, practicing and updating emergency plans; (g) provided data and time during an incident or accident to nuclear installations and the transport of radioactive materials; (h) notification of operational events and events during shipment. This Regulation came into force on March 1, 2006.

  5. Translating Tactical Combat Casualty Care Lessons Learned to the High-Threat Civilian Setting: Tactical Emergency Casualty Care and the Hartford Consensus.

    Science.gov (United States)

    Callaway, David W

    2017-06-01

    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.

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

    Science.gov (United States)

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

    2018-01-01

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

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

    International Nuclear Information System (INIS)

    Smith, D.

    2009-01-01

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

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

    Science.gov (United States)

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

    2010-09-01

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

  9. Educational program emergency planning.

    Science.gov (United States)

    Curtis, Tammy

    2009-01-01

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

  10. 77 FR 75263 - Surety Companies Acceptable on Federal Bonds: Termination; ULLICO Casualty Company

    Science.gov (United States)

    2012-12-19

    ... 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...

  11. 75 FR 38188 - Surety Companies Acceptable on Federal Bonds-Termination: Stonebridge Casualty Insurance Company

    Science.gov (United States)

    2010-07-01

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

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

    African Journals Online (AJOL)

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

  13. Interpreting Comparative Died of Wounds Rates as a Quality Benchmark of Combat Casualty Care

    Science.gov (United States)

    2012-01-01

    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

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

    Science.gov (United States)

    Jackson, Elizabeth G.

    2008-01-01

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

  15. 77 FR 8956 - Surety Companies Acceptable on Federal Bonds: Grange Mutual Casualty Company

    Science.gov (United States)

    2012-02-15

    ... 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...

  16. 75 FR 60865 - Surety Companies Acceptable on Federal Bonds: Amendment-Allegheny Casualty Company

    Science.gov (United States)

    2010-10-01

    ... 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...

  17. Role 2 military hospitals: results of a new trauma care concept on 170 casualties.

    Science.gov (United States)

    Ünlü, A; Cetinkaya, R A; Ege, T; Ozmen, P; Hurmeric, V; Ozer, M T; Petrone, P

    2015-04-01

    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.

  18. 46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.

    Science.gov (United States)

    2010-10-01

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

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

    Science.gov (United States)

    Cupp, O Shawn; Predmore, Brad G

    2011-01-01

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

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

  1. Design and characterisation of a novel in vitro skin diffusion cell system for assessing mass casualty decontamination systems.

    Science.gov (United States)

    Matar, H; Larner, J; Kansagra, S; Atkinson, K L; Skamarauskas, J T; Amlot, R; Chilcott, R P

    2014-06-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1978-11-01

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

  3. Disaster and mass casualty events in the pediatric population.

    Science.gov (United States)

    Burke, Rita V; Iverson, Ellen; Goodhue, Catherine J; Neches, Robert; Upperman, Jeffrey S

    2010-11-01

    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.

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

    African Journals Online (AJOL)

    2012-11-04

    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 ...

  5. Concurrent eruptions at Etna, Stromboli, and Vulcano: casualty or causality?

    Directory of Open Access Journals (Sweden)

    R. Funiciello

    2008-06-01

    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.

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

    International Nuclear Information System (INIS)

    Coleman, Liz; Piper, Keith

    2009-01-01

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

  7. The contribution of the Israeli trauma system to the survival of road traffic casualties.

    Science.gov (United States)

    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

    2015-01-01

    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

  8. Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care

    Science.gov (United States)

    Plat, Marie-Christine J.; Badloe, John F.; Hess, John R.; Hoencamp, Rigo

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Dragoș C. Tudose

    2016-07-01

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

  10. Marine Corps NBC Warfare: Determining Clinical Supply Requirements for Treatment of Battlefield Casualties from Chemical and Biological Warfare

    National Research Council Canada - National Science Library

    Hill, Martin; Galameau, Mike; Pang, Gerry; Konoske, Paula

    2003-01-01

    ... 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...

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

    National Research Council Canada - National Science Library

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

    2008-01-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

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

    Science.gov (United States)

    Critchley, Eric P; Smirniotopoulos, James G

    2003-04-01

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

  14. Development of a unique decentralized rapid-response capability and contingency mass-casualty field hospital for the 1996 Democratic National Convention.

    Science.gov (United States)

    Binder, L S; Willoughby, P J; Matkaitis, L

    1997-01-01

    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.

  15. Civilian Casualties in the Colombian Conflict: A New Approach to Human Security

    OpenAIRE

    Spagat, M; Restrepo, J

    2006-01-01

    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...

  16. Unit Ministry Team Religious Support to Casualties on the Airland Battlefield

    Science.gov (United States)

    1987-10-28

    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

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

    OpenAIRE

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

    2016-01-01

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

  18. The Armed Forces Casualty Assistance Readiness Enhancement System (AF-CARES), Version 1.0

    Science.gov (United States)

    2007-06-08

    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

  19. Extracorporeal Organ Support following Trauma: The Dawn of a New Era in Combat Casualty Critical Care

    Science.gov (United States)

    2013-01-01

    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

  20. Needle Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations

    Science.gov (United States)

    2012-07-06

    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

  1. The Operational Canine and K9 Tactical Emergency Casualty Care Initiative.

    Science.gov (United States)

    Palmer, Lee E; Maricle, Richard; Brenner, Jo-Anne

    2015-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Dr. Ann Rogers

    2014-12-01

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

  3. Teaching mass casualty triage skills using immersive three-dimensional virtual reality.

    Science.gov (United States)

    Vincent, Dale S; Sherstyuk, Andrei; Burgess, Lawrence; Connolly, Kathleen K

    2008-11-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Marla B. Keenan

    2013-06-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    2008-09-01

    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

  7. Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents in Iran: a qualitative study.

    Science.gov (United States)

    Kiani, Mehrzad; Fadavi, Mohsen; Khankeh, Hamidreza; Borhani, Fariba

    2017-09-01

    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.

  8. Guidelines for Mass Casualty Decontamination During a HAZMAT/Weapon of Mass Destruction Incident. Volumes 1 and 2

    Science.gov (United States)

    2009-04-01

    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

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

    Science.gov (United States)

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

    2017-01-01

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

  10. The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China

    OpenAIRE

    Qigen Lin; Ying Wang; Tianxue Liu; Yingqi Zhu; Qi Sui

    2017-01-01

    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...

  11. PATTERN OF INJURIES SEEN IN MASS CASUALTIES IN TERRORIST ATTACKS IN BALUCHISTAN, PAKISTAN--A THREE YEARS EXPERIENCE.

    Science.gov (United States)

    Maqsood, Rasikh; Rasikh, Alia; Abbasi, Tariq; Shukr, Irfan

    2015-01-01

    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.

  12. Estimating Casualties for Large Earthquakes Worldwide Using an Empirical Approach

    Science.gov (United States)

    Jaiswal, Kishor; Wald, David J.; Hearne, Mike

    2009-01-01

    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.

  13. 78 FR 38878 - Critical Incident Stress Plans

    Science.gov (United States)

    2013-06-28

    ... reported no such exposure. Their symptoms included musculoskeletal, gastrointestinal, and sleep pattern..., and immune systems, which have been linked to adverse changes in overall health.\\3\\ These changes and... treated and the different locations and systems involved in railroad employees' identification and care...

  14. A Knowledge-based System for Estimating Incident Clearance Duration for Maryland : I-95 a Case Study for the Project of MD-17-SHA/UM/4-19 : “Development of a Traffic Management Decision Support Tool for Freeway Incident Traffic Management (FITM) Plan Deployment”

    Science.gov (United States)

    2017-12-01

    For the incident response operations to be appreciated by the general public, it is essential that responsible highway agencies be capable of providing the estimated clearance duration of a detected incident at the level sufficiently reliable for mot...

  15. The use of advanced simulation in the training of anesthesiologists to treat chemical warfare casualties.

    Science.gov (United States)

    Berkenstadt, Haim; Ziv, Amitai; Barsuk, Daphna; Levine, Inbal; Cohen, Amir; Vardi, Amir

    2003-06-01

    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.

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

    Science.gov (United States)

    Burgert, James M

    2016-01-01

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

  17. Portable Prehospital Methods to Treat Near-Hypothermic Shivering Cold Casualties.

    Science.gov (United States)

    Oliver, Samuel J; Brierley, Jennifer L; Raymond-Barker, Philippa C; Dolci, Alberto; Walsh, Neil P

    2016-03-01

    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.

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

    Science.gov (United States)

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

    2016-03-01

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

  19. A review of pre-admission advanced airway management in combat casualties, Helmand Province 2013.

    Science.gov (United States)

    Pugh, Harry E J; LeClerc, S; Mclennan, J

    2015-06-01

    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.

  20. Mass-casualty triage training for international healthcare workers in the Asia-Pacific region using manikin-based simulations.

    Science.gov (United States)

    Vincent, Dale S; Berg, Benjamin W; Ikegami, Keiichi

    2009-01-01

    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

  1. Chapter 3 innovations in the en route care of combat casualties.

    Science.gov (United States)

    Hatzfeld, Jennifer J; Dukes, Susan; Bridges, Elizabeth

    2014-01-01

    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.

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

    Science.gov (United States)

    Martinoli, S; Quadri, B; Casabianca, A

    1993-01-01

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

  3. The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China.

    Science.gov (United States)

    Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi

    2017-02-21

    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.

  4. The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China

    Directory of Open Access Journals (Sweden)

    Qigen Lin

    2017-02-01

    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.

  5. Impact of local circumstances on outcome of renal casualties in major disasters.

    Science.gov (United States)

    van der Tol, Arjan; Hussain, Asrar; Sever, Memhet Sukru; Claus, Stefaan; Van Biesen, Wim; Hoste, Eric; Khan, Samuel; Vanholder, Raymond

    2009-03-01

    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.

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

    Science.gov (United States)

    Broughton, Jeremy

    2012-03-01

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

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

    Science.gov (United States)

    Kelley, R. L.

    2012-01-01

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

  8. A behavioral ecology approach to traffic accidents: interspecific variation in causes of traffic casualties among birds.

    Science.gov (United States)

    Møller, Anders Pape; Erritzøe, Helga; Erritzøe, Johannes

    2011-04-01

    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.

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

    Science.gov (United States)

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

    2013-06-01

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

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

    Science.gov (United States)

    Ronen, Ohad; Assadi, Nidal; Sela, Eyal

    2017-05-01

    For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department. Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated. Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p 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.

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

    Science.gov (United States)

    Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

    2013-07-01

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

  12. Medical evacuation system of burn casualties and characteristics of burn injuries in US Army in Iraqi War and Afghanistan War

    Directory of Open Access Journals (Sweden)

    Xiao-ming FAN

    2015-04-01

    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

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

    Science.gov (United States)

    2015-09-01

    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

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    International Nuclear Information System (INIS)

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

    1995-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Vučeljić Marina

    2006-01-01

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

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

    International Nuclear Information System (INIS)

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

    2006-01-01

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

  19. Blast overpressure and fallout radiation dose models for casualty assessment and other purposes. Rev. ed.

    International Nuclear Information System (INIS)

    Bentley, P.R.

    1981-12-01

    The determination of blast overpressures and fallout radiation doses at points on a sufficiently fine grid, for any part or for the whole of the UK, and for any postulated attack, is an essential element in the systematic assessment of casualties, the estimation of numbers of homeless, and the evaluation of life-saving measures generally. Models are described which provide the required blast and dose values and which are intended to supersede existing models which were introduced in 1971. The factors which affect blast and, more particularly, dose values are discussed, and the way in which various factors are modelled is described. The models are incorporated into separate computer programs which are described, the outputs of which are stored on magnetic tape for subsequent use as required. (author)

  20. The potential role of bioscavenger in the medical management of nerve-agent poisoned casualties.

    Science.gov (United States)

    Rice, Helen; Mann, Tom M; Armstrong, Stuart J; Price, Matthew E; Green, A Chris; Tattersall, John E H

    2016-11-25

    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 © [2016] Published by Elsevier Ireland Ltd. This is an open access article under the Open Government Licence (OGL) (http

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

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

    Science.gov (United States)

    Raknes, Guttorm; Morken, Tone; Hunskår, Steinar

    2014-11-01

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

  4. Defense Technology Area Plan.

    Science.gov (United States)

    1996-05-01

    evacuation , missile defense, reconnaissance and surveillance, sea lane control, search and rescue, special operations, strategic and theater airlift...decontamination technology advances. Recently, novel types of polymeric support termed “ starburst ” dendrimer polymers have been developed. The ability to...threats • Optimize military performance; survival and stabilization of combat casualties • Provide the world’s best casualty evacuation and medical

  5. Urgent medical response in CBR incidents

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  6. MCFRS Incidents by Station

    Data.gov (United States)

    Montgomery County of Maryland — This dataset contains the monthly summary data indicating incident occurred in each fire station response area. The summary data is the incident count broken down by...

  7. Police Incident Reports Written

    Data.gov (United States)

    Town of Chapel Hill, North Carolina — This table contains incident reports filed with the Chapel Hill Police Department. Multiple incidents may have been reported at the same time. The most serious...

  8. Incident Information Management Tool

    CERN Document Server

    Pejovic, Vladimir

    2015-01-01

    Flaws of\tcurrent incident information management at CMS and CERN\tare discussed. A new data\tmodel for future incident database is\tproposed and briefly described. Recently developed draft version of GIS-­‐based tool for incident tracking is presented.

  9. Internet plan and planning

    Directory of Open Access Journals (Sweden)

    Kahriman Emina

    2008-01-01

    Full Text Available Paper discuss specific features of internet plan as well as planning as management process in general in the contemporary environment. No need to stress out that marketing plan and marketing planning is core activity in approaching to market. At the same time, there are a lot specific c request in preparing marketing plan comparing to business planning due to marketing plan is an essential part. The importance of internet plan and planning rely on specific features of the internet network but as a part of general corporate as well as marketing strategy.

  10. A generative model for predicting terrorist incidents

    Science.gov (United States)

    Verma, Dinesh C.; Verma, Archit; Felmlee, Diane; Pearson, Gavin; Whitaker, Roger

    2017-05-01

    A major concern in coalition peace-support operations is the incidence of terrorist activity. In this paper, we propose a generative model for the occurrence of the terrorist incidents, and illustrate that an increase in diversity, as measured by the number of different social groups to which that an individual belongs, is inversely correlated with the likelihood of a terrorist incident in the society. A generative model is one that can predict the likelihood of events in new contexts, as opposed to statistical models which are used to predict the future incidents based on the history of the incidents in an existing context. Generative models can be useful in planning for persistent Information Surveillance and Reconnaissance (ISR) since they allow an estimation of regions in the theater of operation where terrorist incidents may arise, and thus can be used to better allocate the assignment and deployment of ISR assets. In this paper, we present a taxonomy of terrorist incidents, identify factors related to occurrence of terrorist incidents, and provide a mathematical analysis calculating the likelihood of occurrence of terrorist incidents in three common real-life scenarios arising in peace-keeping operations

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

    Science.gov (United States)

    Wagner, U; Fälker, A; Wenzel, V

    2013-01-01

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

  12. [Principles of surgical care organization and structural characteristics of sanitary casualties in counter-terrorist operations in the Northern Caucasus (Report I)].

    Science.gov (United States)

    Gumanenko, E K; Samokhvalov, I M; Trusov, A A; Severin, V V

    2005-01-01

    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.

  13. VOYAGE PLANNING

    Directory of Open Access Journals (Sweden)

    Kazimierz SKÓRA

    2016-09-01

    Full Text Available A sea voyage can be divided into three parts with varying degrees of risk: - from the berth at the port of departure to the pilot disembarkation point - from the pilot disembarkation to another pilot embarkation point near the port of call/destination - from the pilot embarkation point to the berth Results of statistical research into ship accidents at sea point to an increased number of incidents and accidents, including groundings, especially in restricted areas. Such areas are often narrow and have limited depths, while their short straight sections require frequent course alterations, often in varying hydrometeorological conditions. Due to all these factors, the voyage has to be carefully planned and all watchkeeping officers have to be well prepared to conduct the ship safely. The article presents the objectives, scope, legal basis and stages in the process of voyage planning. The compliance with the outlined principles will reduce the level of risk in maritime transport.

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

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2015-07-01

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

  15. The evolution of casualty evacuation in the British Army in the 20th century (Part 3)--1945 to present.

    Science.gov (United States)

    Bricknell, M C M

    2003-03-01

    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.

  16. Putting the Puzzle Together: A Proposal for a Comprehensive Study of the Military Medical Management of Nuclear Casualties

    Science.gov (United States)

    2011-07-01

    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

  17. Performance indicators for initial regional medical response to major incidents: a possible quality control tool

    Directory of Open Access Journals (Sweden)

    Nilsson Heléne

    2012-12-01

    Full Text Available Abstract Background Timely decisions concerning mobilization and allocation of resources and distribution of casualties are crucial in medical management of major incidents. The aim of this study was to evaluate documented initial regional medical responses to major incidents by applying a set of 11 measurable performance indicators for regional medical command and control and test the feasibility of the indicators. Methods Retrospective data were collected from documentation from regional medical command and control at major incidents that occurred in two Swedish County Councils. Each incident was assigned to one of nine different categories and 11 measurable performance indicators for initial regional medical command and control were systematically applied. Two-way analysis of variance with one observation per cell was used for statistical analysis and the post hoc Tukey test was used for pairwise comparisons. Results The set of indicators for regional medical command and control could be applied in 102 of the130 major incidents (78%, but 36 incidents had to be excluded due to incomplete documentation. The indicators were not applicable as a set for 28 incidents (21.5% due to different characteristics and time frames. Based on the indicators studied in 66 major incidents, the results demonstrate that the regional medical management performed according to the standard in the early phases (1–10 min after alert, but there were weaknesses in the secondary phase (10–30 min after alert. The significantly lowest scores were found for Indicator 8 (formulate general guidelines for response and Indicator 10 (decide whether or not resources in own organization are adequate. Conclusions Measurable performance indicators for regional medical command and control can be applied to incidents that directly or indirectly involve casualties provided there is sufficient documentation available. Measurable performance indicators can enhance follow- up and be

  18. The contribution of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel.

    Science.gov (United States)

    Alpert, Evan Avraham; Lipsky, Ari M; Elie, Navid Daniel; Jaffe, Eli

    2015-01-01

    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.

  19. Grazing Incidence Optics Technology

    Science.gov (United States)

    Ramsey, Brian; Smith, W. Scott; Gubarev, Mikhail; McCracken, Jeff

    2015-01-01

    This project is to demonstrate the capability to directly fabricate lightweight, high-resolution, grazing-incidence x-ray optics using a commercially available robotic polishing machine. Typical x-ray optics production at NASA Marshall Space Flight Center (MSFC) uses a replication process in which metal mirrors are electroformed on to figured and polished mandrels from which they are later removed. The attraction of this process is that multiple copies can be made from a single master. The drawback is that the replication process limits the angular resolution that can be attained. By directly fabricating each shell, errors inherent in the replication process are removed. The principal challenge now becomes how to support the mirror shell during all aspects of fabrication, including the necessary metrology to converge on the required mirror performance specifications. This program makes use of a Zeeko seven-axis computer-controlled polishing machine (see fig. 1) and supporting fabrication, metrology, and test equipment at MSFC. The overall development plan calls for proof-of-concept demonstration with relatively thick mirror shells (5-6 mm, fig. 2) which are straightforward to support and then a transition to much thinner shells (2-3 mm), which are an order of magnitude thinner than those used for Chandra. Both glass and metal substrates are being investigated. Currently, a thick glass shell is being figured. This has enabled experience to be gained with programming and operating the polishing machine without worrying about shell distortions or breakage. It has also allowed time for more complex support mechanisms for figuring/ polishing and metrology to be designed for the more challenging thinner shells. These are now in fabrication. Figure 1: Zeeko polishing machine.

  20. The Internet's effect on personality traits: An important casualty of the "Internet addiction" paradigm.

    Science.gov (United States)

    Aboujaoude, Elias

    2017-03-01

    Background and aims The "Internet addiction" paradigm has been criticized for several shortcomings, including inattention to specific online behaviors, not distinguishing the Internet from other media, insufficient focus on comorbidities, and definitions that do not take into account the constant access now possible. The paradigm's biggest casualty, however, may be that it has diverted attention away from subtle personality changes that seem to occur online, including in users who cannot be considered "addicted" under any definition. Methods A narrative assessment of the literature was conducted, focusing on the Internet's effects on personality traits as revealed in studies of Internet users. Results Impulsivity, narcissism, and aggression are some of the personality traits that seem to be nurtured by the Internet, with possible negative offline consequences. Discussion Ignoring the Internet's subtle effects on personality as we embrace an addiction model that implies severe pathology makes the majority of Internet users feel deceptively immune to the psychological effects of new technologies. It also limits our understanding of the big cultural shifts that are happening as a result. Conclusion The Internet's potentially negative effect on personality, and by extension on society at large, is a fundamental part of online psychology, one well worthy of further investigation.

  1. Radiation protection measures applied during the autopsies on the casualties of the Goiania accident

    International Nuclear Information System (INIS)

    Martins, N.S.F.; Silva, L.H.C.; Rosa, R.

    1998-01-01

    The most seriously affected casualties of the radiological accident caused by the opening of a 137 Cs source capsule in Goiania were treated at the Marcilio Dias Naval Hospital (HNMD) in Rio de Janeiro in the period from October to December 1987. Four of the injured died in October. The autopsies were performed at this institution. Due to the external and internal contamination presented by these victims, specific radiation protection procedures were adopted to enable the medical team to perform their duties. The radiation protection staff, under the co-ordination of technicians of the Brazilian Nuclear Energy Commission (CNEN), were responsible for the preparation of the autopsy room and for advising the professionals on duty during these events. The radiation protection staff took specific measures to prevent the spread of contamination throughout the hospital, the contamination of persons attending the autopsies and to minimize any radiation dose to the medical and professional team. The measures aimed at personal control and the preparation of the autopsy room are described as well as the radiation protection steps applied in connection with the performance of the autopsies, the emplacement of the bodies into the coffins and their transport back to Goiania. (author)

  2. Epidemiology and Antimicrobial Susceptibilities of Wound Isolates of Obligate Anaerobes from Combat Casualties

    Science.gov (United States)

    White, Brian K.; Mende, Katrin; Weintrob, Amy C.; Beckius, Miriam L.; Zera, Wendy C.; Lu, Dan; Bradley, William; Tribble, David R.; Schnaubelt, Elizabeth R.; Murray, Clinton K.

    2015-01-01

    Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009–12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested. Overall, 59 patients had 119 obligate anaerobes identified (83 were first isolates). Obligate anaerobes were isolated 7–13 days post-injury, primarily from lower extremity wounds (43%), and were largely Bacteroides spp. (42%) and Clostridium spp. (19%). Patients with pelvic wounds were more likely to have Bacteroides spp. and concomitant resistant gram-negative aerobes. Seventy-three percent of isolates were resistant to ≥1 antimicrobials. Bacteroides spp. demonstrated the most resistance (16% of first isolates). Patients with resistant isolates had similar outcomes to those with susceptible strains. Serial recovery of isolates occurred in 15% of patients and was significantly associated with isolation of Bacteroides spp., along with resistant gram-negative aerobes. PMID:26607420

  3. Global earthquake casualties due to secondary effects: A quantitative analysis for improving rapid loss analyses

    Science.gov (United States)

    Marano, K.D.; Wald, D.J.; Allen, T.I.

    2010-01-01

    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.

  4. Global earthquake casualties due to secondary effects: A quantitative analysis for improving PAGER losses

    Science.gov (United States)

    Wald, David J.

    2010-01-01

    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.

  5. Assessment of the Casualty Risk of Multiple Meteorological Hazards in China

    Directory of Open Access Journals (Sweden)

    Wei Xu

    2016-02-01

    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.

  6. Improving PAGER's real-time earthquake casualty and loss estimation toolkit: a challenge

    Science.gov (United States)

    Jaiswal, K.S.; Wald, D.J.

    2012-01-01

    We describe the on-going developments of PAGER’s loss estimation models, and discuss value-added web content that can be generated related to exposure, damage and loss outputs for a variety of PAGER users. These developments include identifying vulnerable building types in any given area, estimating earthquake-induced damage and loss statistics by building type, and developing visualization aids that help locate areas of concern for improving post-earthquake response efforts. While detailed exposure and damage information is highly useful and desirable, significant improvements are still necessary in order to improve underlying building stock and vulnerability data at a global scale. Existing efforts with the GEM’s GED4GEM and GVC consortia will help achieve some of these objectives. This will benefit PAGER especially in regions where PAGER’s empirical model is less-well constrained; there, the semi-empirical and analytical models will provide robust estimates of damage and losses. Finally, we outline some of the challenges associated with rapid casualty and loss estimation that we experienced while responding to recent large earthquakes worldwide.

  7. Acute incidents during anaesthesia

    African Journals Online (AJOL)

    Incidents can occur during induction, maintenance and emergence from anaesthesia. The following acute critical incidents are discussed in this article: • Anaphylaxis. • Aspiration ..... Already used in South Africa and Malawi, a scale-up of the technique is under way in Tanzania, Rwanda and Ghana. The report found that.

  8. Radiological incidents in radiotherapy

    International Nuclear Information System (INIS)

    Hobzova, L.; Novotny, J.

    2008-01-01

    In many countries a reporting system of radiological incidents to national regulatory body exists and providers of radiotherapy treatment are obliged to report all major and/or in some countries all incidents occurring in institution. State Office for Nuclear Safety (SONS) is providing a systematic guidance for radiotherapy departments from 1997 by requiring inclusion of radiation safety problems into Quality assurance manual, which is the basic document for obtaining a license of SONS for handling with sources of ionizing radiation. For that purpose SONS also issued the recommendation 'Introduction of QA system for important sources in radiotherapy-radiological incidents' in which the radiological incidents are defined and the basic guidance for their classification (category A, B, C, D), investigation and reporting are given. At regular periods the SONS in co-operation with radiotherapy centers is making a survey of all radiological incidents occurring in institutions and it is presenting obtained information in synoptic communication (2003 Motolske dny, 2005 Novy Jicin). This presentation is another summary report of radiological incidents that occurred in our radiotherapy institutions during last 3 years. Emphasis is given not only to survey and statistics, but also to analysis of reasons of the radiological incidents and to their detection and prevention. Analyses of incidents in radiotherapy have led to a much broader understanding of incident causation. Information about the error should be shared as early as possible during or after investigation by all radiotherapy centers. Learning from incidents, errors and near misses should be a part of improvement of the QA system in institutions. Generally, it is recommended that all radiotherapy facilities should participate in the reporting, analyzing and learning system to facilitate the dissemination of knowledge throughout the whole country to prevent errors in radiotherapy.(authors)

  9. Population is the main driver of war group size and conflict casualties.

    Science.gov (United States)

    Oka, Rahul C; Kissel, Marc; Golitko, Mark; Sheridan, Susan Guise; Kim, Nam C; Fuentes, Agustín

    2017-12-26

    The proportions of individuals involved in intergroup coalitional conflict, measured by war group size (W), conflict casualties (C), and overall group conflict deaths (G), have declined with respect to growing populations, implying that states are less violent than small-scale societies. We argue that these trends are better explained by scaling laws shared by both past and contemporary societies regardless of social organization, where group population (P) directly determines W and indirectly determines C and G. W is shown to be a power law function of P with scaling exponent X [demographic conflict investment (DCI)]. C is shown to be a power law function of W with scaling exponent Y [conflict lethality (CL)]. G is shown to be a power law function of P with scaling exponent Z [group conflict mortality (GCM)]. Results show that, while W/P and G/P decrease as expected with increasing P, C/W increases with growing W. Small-scale societies show higher but more variance in DCI and CL than contemporary states. We find no significant differences in DCI or CL between small-scale societies and contemporary states undergoing drafts or conflict, after accounting for variance and scale. We calculate relative measures of DCI and CL applicable to all societies that can be tracked over time for one or multiple actors. In light of the recent global emergence of populist, nationalist, and sectarian violence, our comparison-focused approach to DCI and CL will enable better models and analysis of the landscapes of violence in the 21st century. Copyright © 2017 the Author(s). Published by PNAS.

  10. Gun-shot injuries in UK military casualties - Features associated with wound severity.

    Science.gov (United States)

    Penn-Barwell, Jowan G; Sargeant, Ian D

    2016-05-01

    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.

  11. Critical incident stress management.

    Science.gov (United States)

    Lim, J J; Childs, J; Gonsalves, K

    2000-10-01

    Recent studies have indicated implementation of the CISM Program has impacted and reduced the cost of workers' compensation claims for stress related conditions and the number of lost work days (Ott, 1997; Western Management Consultants, 1996). Occupational health professionals need to be ready to develop and implement a comprehensive critical incident stress management process in anticipation of a major event. The ability to organize, lead, or administer critical incident stress debriefings for affected employees is a key role for the occupational health professional. Familiarity with these concepts and the ability to identify a critical incident enhances value to the business by mitigating the stress and impact to the workplace. Critical Incident Stress Management Systems have the potential for decreasing stress and restoring employees to normal life function--a win/win situation for both the employees and the organization.

  12. Marine Animal Incident Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Large whale stranding, death, ship strike and entanglement incidents are all recorded to monitor the health of each population and track anthropogenic factors that...

  13. Police Incident Blotter (Archive)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The Police Blotter Archive contains crime incident data after it has been validated and processed to meet Uniform Crime Reporting (UCR) standards, published on a...

  14. Prediction of Safety Incidents

    Data.gov (United States)

    National Aeronautics and Space Administration — Safety incidents, including injuries, property damage and mission failures, cost NASA and contractors thousands of dollars in direct and indirect costs. This project...

  15. 2011 Japanese Nuclear Incident

    Science.gov (United States)

    EPA’s RadNet system monitored the environmental radiation levels in the United States and parts of the Pacific following the Japanese Nuclear Incident. Learn about EPA’s response and view historical laboratory data and news releases.

  16. Information Security Incident Management

    Directory of Open Access Journals (Sweden)

    D. I. Persanov

    2010-03-01

    Full Text Available The present report highlights the points of information security incident management in an enterprise. Some aspects of the incident and event classification are given. The author presents his view of the process scheme over the monitoring and processing information security events. Also, the report determines a few critical points of the listed process and gives the practical recommendations over its development and optimization.

  17. [Pediatric injuries from mass casualty events in Israel: a ten-year summary].

    Science.gov (United States)

    Waisman, Yehezkel; Goldman, Sharon; Poznanski, Oded; Mor, Meirav; Peleg, Kobi

    2010-07-01

    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

  18. Radiation incidents in dentistry

    International Nuclear Information System (INIS)

    Lovelock, D.J.

    1996-01-01

    Most dental practitioners act as their own radiographer and radiologist, unlike their medical colleagues. Virtually all dental surgeons have a dental X-ray machine for intraoral radiography available to them and 40% of dental practices have equipment for dental panoramic tomography. Because of the low energy of X-ray equipment used in dentistry, radiation incidents tend to be less serious than those associated with other aspects of patient care. Details of 47 known incidents are given. The advent of the 1985 and 1988 Ionising Radiation Regulations has made dental surgeons more aware of the hazards of radiation. These regulations, and general health and safety legislation, have led to a few dental surgeons facing legal action. Because of the publicity associated with these court cases, it is expected that there will be a decrease in radiation incidents arising from the practice of dentistry. (author)

  19. Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.

    Science.gov (United States)

    McGraw, Leigh K; Out, Dorothée; Hammermeister, Jon J; Ohlson, Carl J; Pickering, Michael A; Granger, Douglas A

    2013-01-01

    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.

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

    Science.gov (United States)

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

    2011-05-01

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

  1. 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

    Science.gov (United States)

    2010-11-01

    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

  2. Anesthesia department preparedness for a multiple-casualty incident: lessons learned from the Fukushima earthquake and the Japanese nuclear power disaster.

    Science.gov (United States)

    Murakawa, Masahiro

    2013-03-01

    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.

  3. Incidents in nuclear installations

    International Nuclear Information System (INIS)

    Franzen, L.F.; Wienhold, W.

    1976-09-01

    With reference to the incident list of the Ministry for the period 1971-74, Prof. Bechert has expressed a lot of questions and statements in a letter to the Government. The letter is quoted in full. Inadequate conclusions drawn by Prof. Bechert in connection with quotations from daily newspapers and other documents are put right. (HP) [de

  4. Lightning incidents in Mongolia

    Directory of Open Access Journals (Sweden)

    Myagmar Doljinsuren

    2015-11-01

    Full Text Available This is one of the first studies that has been conducted in Mongolia on the distribution of lightning incidents. The study covers a 10-year period from 2004 to 2013. The country records a human death rate of 15.4 deaths per 10 million people per year, which is much higher than that of many countries with similar isokeraunic level. The reason may be the low-grown vegetation observed in most rural areas of Mongolia, a surface topography, typical to steppe climate. We suggest modifications to Gomes–Kadir equation for such countries, as it predicts a much lower annual death rate for Mongolia. The lightning incidents spread over the period from May to August with the peak of the number of incidents occurring in July. The worst lightning affected region in the country is the central part. Compared with impacts of other convective disasters such as squalls, thunderstorms and hail, lightning stands as the second highest in the number of incidents, human deaths and animal deaths. Economic losses due to lightning is only about 1% of the total losses due to the four extreme weather phenomena. However, unless precautionary measures are not promoted among the public, this figure of losses may significantly increase with time as the country is undergoing rapid industrialization at present.

  5. Fire Incident Reporting Manual

    Science.gov (United States)

    1984-02-01

    the result of an incident that requires (or should require) treatment by a practitioner of medicine , a registered emergency medical technician, or a...UNANNOUNCED AIRCRAFT EMERGENCYS ~~PRIOR TO TAKE OFF OR AFTERLADN 5 FUEL OPERATIONS REQUIRING 1AREING G A FIRE10 ARRESTING GEAR’BARRIER FR . ENGAGEMENTS AND

  6. Strategic considerations in planning a counterevacuation

    International Nuclear Information System (INIS)

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

    1975-12-01

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

  7. Estimation real number of road accident casualties. SafetyNet, Building the European Road Safety Observatory, Deliverable D.1.15 : final report on task 1.5.

    NARCIS (Netherlands)

    Broughton, J. Amoros, E. Bos, N.M. Evgenikos, P. Hoeglinger, S. Holló, P. Pérez, C. & Tecl, J.

    2009-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Peter R. Stinson

    2008-03-01

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

  9. Investigation of Collapsed Building Incidents on Soft Marine Deposit: Both from Social and Technical Perspectives

    Directory of Open Access Journals (Sweden)

    Hai-Min Lyu

    2018-02-01

    Full Text Available A collapsed incident occurred on 10 October 2016 in Wenzhou City, China, which resulted in 22 casualties and 6 injuries. Most of victims were migrant laborers (rural dwellers who move to urban for a temporary work, who rented apartments in these residential buildings, which were originally constructed by local rural residents. This case report investigates the collapsed incident as well as other similar previous incidents. From the perspectives of both social and technical aspects, this report analyzed the Chinese rural land use policy with relevant technical factors. These incidents reveal social problems of the existing dual structure land-use policy in China. Chinese dual structure land-use policy caused deficiencies in the supervision of the construction market in rural area so that the following technical factors were not well supervised by the various quality control departments: (1 poorly quality of residential buildings, (2 unauthorized rooftop additions, and (3 differential settlement caused by the uneven distribution of underlying Wenzhou clay under creep conditions. Mandatory regulation by the government for any construction in China, particularly for the construction of self-constructed house building sites in rural areas, was recommended to minimize the resettlement issue of migrant workers.

  10. Constipation and Incident CKD.

    Science.gov (United States)

    Sumida, Keiichi; Molnar, Miklos Z; Potukuchi, Praveen K; Thomas, Fridtjof; Lu, Jun Ling; Matsushita, Kunihiro; Yamagata, Kunihiro; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

    2017-04-01

    Constipation is one of the most prevalent conditions in primary care settings and increases the risk of cardiovascular disease, potentially through processes mediated by altered gut microbiota. However, little is known about the association of constipation with CKD. In a nationwide cohort of 3,504,732 United States veterans with an eGFR ≥60 ml/min per 1.73 m 2 , we examined the association of constipation status and severity (absent, mild, or moderate/severe), defined using diagnostic codes and laxative use, with incident CKD, incident ESRD, and change in eGFR in Cox models (for time-to-event analyses) and multinomial logistic regression models (for change in eGFR). Among patients, the mean (SD) age was 60.0 (14.1) years old; 93.2% of patients were men, and 24.7% were diabetic. After multivariable adjustments, compared with patients without constipation, patients with constipation had higher incidence rates of CKD (hazard ratio, 1.13; 95% confidence interval [95% CI], 1.11 to 1.14) and ESRD (hazard ratio, 1.09; 95% CI, 1.01 to 1.18) and faster eGFR decline (multinomial odds ratios for eGFR slope constipation associated with an incrementally higher risk for each renal outcome. In conclusion, constipation status and severity associate with higher risk of incident CKD and ESRD and with progressive eGFR decline, independent of known risk factors. Further studies should elucidate the underlying mechanisms. Copyright © 2017 by the American Society of Nephrology.

  11. Cancer incidence among firefighters

    DEFF Research Database (Denmark)

    Pukkala, Eero; Martinsen, Jan Ivar; Weiderpass, Elisabete

    2014-01-01

    .51), adenocarcinoma of the lung (SIR=1.90, 95% CI 1.34 to 2.62), and mesothelioma (SIR=2.59, 95% CI 1.24 to 4.77). By contrast with earlier studies, the incidence of testicular cancer was decreased (SIR=0.51, 95% CI 0.23 to 0.98). CONCLUSIONS: Some of these associations have been observed previously, and potential...

  12. Cancer incidence among waiters

    DEFF Research Database (Denmark)

    Reijula, Jere; Kjaerheim, Kristina; Lynge, Elsebeth

    2015-01-01

    AIMS: To study cancer risk patterns among waiters in the Nordic countries. METHODS: We identified a cohort of 16,134 male and 81,838 female waiters from Denmark, Finland, Iceland, Norway and Sweden. During the follow-up period from 1961 to 2005, we found that 19,388 incident cancer cases were...... diagnosed. Standardised incidence ratio (SIR) was defined as the observed number of cancer cases divided by the expected number, based on national age, time period and gender-specific cancer incidence rates in the general population. RESULTS: The SIR of all cancers in waiters, in the five countries combined......, was 1.46 (95% CI 1.41-1.51) in men and 1.09 (1.07-1.11) in women. In male waiters, the SIR decreased from 1.79 (1.63-1.96) in 1961-1975, to 1.33 (1.26-1.40) in 1991-2005, but remained stable among women. The SIR among male waiters was highest for cancers in the pharynx (6.11; 95% CI 5.02-7.37), oral...

  13. Contaminated Mexican steel incident

    International Nuclear Information System (INIS)

    1985-01-01

    This report documents the circumstances contributing to the inadvertent melting of cobalt 60 (Co-60) contaminated scrap metal in two Mexican steel foundries and the subsequent distribution of contaminated steel products into the United States. The report addresses mainly those actions taken by US Federal and state agencies to protect the US population from radiation risks associated with the incident. Mexico had much more serious radiation exposure and contamination problems to manage. The United States Government maintained a standing offer to provide technical and medical assistance to the Mexican Government. The report covers the tracing of the source to its origin, response actions to recover radioactive steel in the United States, and return of the contaminated materials to Mexico. The incident resulted in significant radiation exposures within Mexico, but no known significant exposure within the United States. Response to the incident required the combined efforts of the Nuclear Regulatory Commission (NRC), Department of Energy, Department of Transportation, Department of State, and US Customs Service (Department of Treasury) personnel at the Federal level and representatives of all 50 State Radiation Control Programs and, in some instances, local and county government personnel. The response also required a diplomatic interface with the Mexican Government and cooperation of numerous commercial establishments and members of the general public. The report describes the factual information associated with the event and may serve as information for subsequent recommendations and actions by the NRC. 8 figures

  14. Computerized radiation treatment planning

    International Nuclear Information System (INIS)

    Laarse, R. van der.

    1981-01-01

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

  15. A Tool for the Concise Analysis of Patient Safety Incidents.

    Science.gov (United States)

    Pham, Julius Cuong; Hoffman, Carolyn; Popescu, Ioana; Ijagbemi, O Mayowa; Carson, Kathryn A

    2016-01-01

    Patient safety incidents, sometimes referred to as adverse events, incidents, or patient safety events, are too common an occurrence in health care. Most methods for incident analysis are time and labor intensive. Given the significant resource requirements of a root cause analysis, for example, there is a need for a more targeted and efficient method of analyzing a larger number of incidents. Although several concise incident analysis tools are in existence, there are no published studies regarding their usability or effectiveness. Building on previous efforts, a Concise Incident Analysis (CIA) methodology and tool were developed to facilitate analysis of no- or low-harm incidents. Staff from 11 hospitals in five countries-Australia, Canada, Hong Kong, India, and the United States-pilot tested the tool in two phases. The tool was evaluated and refined after each phase on the basis of user perceptions of usability and effectiveness. From September 2013 through January 2014, 52 patient safety incidents were analyzed. A broad variety of incident types were investigated, the most frequent being patient falls (25%). Incidents came from a variety of hospital work areas, the most frequent being from the medical ward (37%). Most incidents investigated resulted in temporary harm or no harm (94%). All or most sites found the tool "understandable" (100%), "easy to use" (89%), and "effective" (89%). Some 95% of participants planned to continue to use all or some parts of the tool after the pilot. Qualitative feedback suggested that the tool allowed analysis of incidents that were not currently being analyzed because of insufficient resources. The tool was described as simple to use, easy to document, and aligned with the flow of the incident analysis. A concise tool for the investigation of patient safety incidents with low or no harm was well accepted across a select group of hospitals from five countries.

  16. INCIDENCE OF AMPUTATION IN EMERGENCY

    Directory of Open Access Journals (Sweden)

    K. Rojaramani Kumbha

    2016-08-01

    Full Text Available Advanced Technology and early detection of disease by recent improvements in investigation modalities lead to decreased incidents of amputations while Road Traffic Accidents (RTA increase. Furthermore, it leads to variation and decreased morbidity, mortality and accidents (crush injuries, and better equipped and trained staff, specialist services, diabetic food, rehabilitation centres, and giving good support physically and psychologically for Amputated patients. OBJECTIVE To know incidence rates of Emergency Amputation who attended causality with advanced disease and severe Trauma. METHODOLOGY The study is done over a period of one year i.e. between June 2015 to June 2016 who attended causality with advanced and severe disease affecting the limbs either due to diabetes, trauma or vascular diseases. RESULTS During one-year period, total 6,371 patients attended for general surgery OP. In those, 187 patients needed emergency surgery which included both major and minor operations. Among those, 81 patients were amputated. CONCLUSION As per our available records and observation, even though there is increased literacy and access to advanced technology, there is still increased incidence of patients undergoing amputations due to diseases. Therefore, there is a need to improve awareness and importance of early detection of diabetes, hazards of smoking, and regular general health checkups for patients at root level. With that we can treat diabetes and/or any disease in time. So there must be awareness in peripheral health staff i.e. PHC, subcentres, and community health centres about early detection of disease which in turn improves the quality of life of the patient. Due to diabetes slight injury to the glucose laden tissue may cause chronic infection and ulcer formation.(1 The tumours are seen commonly in the age group of 20-40 years after bone fusion, bones affected commonly are those around the knee (lower end of knee, upper end of tibia. A lytic

  17. 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

    Science.gov (United States)

    2011-01-01

    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

  18. 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

    Science.gov (United States)

    2013-05-01

    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

  19. Book review of "The Ethics of Coercion in Mass Casualty Medicine" by Griffin Trotter MD, PhD

    Directory of Open Access Journals (Sweden)

    Singh Sonal

    2007-10-01

    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.

  20. [Implementation of the Hartford Consensus and Tactical Combat Casualty Care recommendations in emergency services: a review of the literature].

    Science.gov (United States)

    Usero-Pérez, Carmen; González Alonso, Valentín; Orbañanos Peiro, Luis; Gómez Crespo, José Manuel; Hossain López, Sheima

    2017-01-01

    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.

  1. The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis.

    Science.gov (United States)

    Steinbach, Rebecca; Perkins, Chloe; Tompson, Lisa; Johnson, Shane; Armstrong, Ben; Green, Judith; Grundy, Chris; Wilkinson, Paul; Edwards, Phil

    2015-11-01

    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.

  2. Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.

    Science.gov (United States)

    Rodoplu, Ulkümen; Arnold, Jeffrey L; Tokyay, Rifat; Ersoy, Gurkan; Cetiner, Serkan; Yücel, Tayfun

    2004-01-01

    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.

  3. Medication incidents reported to an online incident reporting system.

    LENUS (Irish Health Repository)

    Alrwisan, Adel

    2011-01-15

    AIMS: Approximately 20% of deaths from adverse events are related to medication incidents, costing the NHS an additional £500 million annually. Less than 5% of adverse events are reported. This study aims to assess the reporting rate of medication incidents in NHS facilities in the north east of Scotland, and to describe the types and outcomes of reported incidents among different services. Furthermore, we wished to quantify the proportion of reported incidents according to the reporters\\' profession. METHODS: A retrospective description was made of medication incidents reported to an online reporting system (DATIX) over a 46-month-period (July 2005 to April 2009). Reports originated from acute and community hospitals, mental health, and primary care facilities. RESULTS: Over the study period there were 2,666 incidents reported with a mean monthly reporting rate of 78.2\\/month (SD±16.9). 6.1% of all incidents resulted in harm, with insulin being the most commonly implicated medication. Nearly three-quarters (74.2%, n=1,978) of total incidents originated from acute hospitals. Administration incidents were implicated in the majority of the reported medication incidents (59%), followed by prescribing (10.8%) and dispensing (9.9%), while the nondescript "other medication incidents" accounted for 20.3% of total incidents. The majority of reports were made by nursing and midwifery staff (80%), with medical and dental professionals reporting the lowest number of incidents (n=56, 2%). CONCLUSIONS: The majority of medication incidents in this study were reported by nursing and midwifery staff, and were due to administration incidents. There is a clear need to elucidate the reasons for the limited contribution of the medical and dental professionals to reporting medication incidents.

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

    Directory of Open Access Journals (Sweden)

    Hansen Elisabeth

    2009-07-01

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

  5. Yampa River Valley sub-area contingency plan

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

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

  6. Incident users of antipsychotics

    DEFF Research Database (Denmark)

    Baandrup, Lone; Kruse, Marie

    2016-01-01

    PURPOSE: In Denmark, as well as in many other countries, consumption of antipsychotics is on the rise, partly due to increasing off-label use. The aim of this study was to analyze and quantify the extent of off-label use and polypharmacy in incident users of antipsychotic medication, and to examine...... initial antipsychotic prescribing patterns and associated use of mental health care services. METHOD: Population-based cohort study linking the following Danish national registers: the Central Psychiatric Research Register, the Register of Medicinal Product Statistics, and Statistics Denmark. RESULTS...

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

    Science.gov (United States)

    Abrahamsen, Håkon B

    2015-06-10

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

  8. Improving freight crash incident management.

    Science.gov (United States)

    2015-06-01

    The objective of this study was to determine the most effective way to mitigate the effect of freight : crash incidents on Louisiana freeways. Candidate incident management strategies were reviewed from : practice in other states and from those publi...

  9. Common Causes of Pesticide Incidents

    Science.gov (United States)

    There are many types of pesticide incidents. EPA staff analyze pesticide incident reports involving people (including children and farm workers), pets, domestic animals, wildlife including bees and other pollinators, and the environment.

  10. Increasing incidence of pyogenic spondylodiscitis

    DEFF Research Database (Denmark)

    Kehrer, Michala; Pedersen, Court; Jensen, Thøger G

    2014-01-01

    Smaller studies indicate that the incidence of pyogenic spondylodiscitis is increasing, possible related to a growing elderly population. Data supporting this is sparse, and we therefore studied patient characteristics and changes in spondylodiscitis incidence 1995-2008.......Smaller studies indicate that the incidence of pyogenic spondylodiscitis is increasing, possible related to a growing elderly population. Data supporting this is sparse, and we therefore studied patient characteristics and changes in spondylodiscitis incidence 1995-2008....

  11. Venous thromboembolism after traumatic amputation: an analysis of 366 combat casualties.

    Science.gov (United States)

    Hannon, Matthew; Tadlock, Matthew D; Melcer, Ted; Walker, Jay; Bandle, Jesse; Nieses, Kameran; Galarneau, Michael

    2016-08-01

    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.

  12. Family emergency preparedness plans in severe tornadoes.

    Science.gov (United States)

    Cong, Zhen; Liang, Daan; Luo, Jianjun

    2014-01-01

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

  13. Grazing incidence beam expander

    Energy Technology Data Exchange (ETDEWEB)

    Akkapeddi, P.R.; Glenn, P.; Fuschetto, A.; Appert, Q.; Viswanathan, V.K.

    1985-01-01

    A Grazing Incidence Beam Expander (GIBE) telescope is being designed and fabricated to be used as an equivalent end mirror in a long laser resonator cavity. The design requirements for this GIBE flow down from a generic Free Electron Laser (FEL) resonator. The nature of the FEL gain volume (a thin, pencil-like, on-axis region) dictates that the output beam be very small. Such a thin beam with the high power levels characteristic of FELs would have to travel perhaps hundreds of meters or more before expanding enough to allow reflection from cooled mirrors. A GIBE, on the other hand, would allow placing these optics closer to the gain region and thus reduces the cavity lengths substantially. Results are presented relating to optical and mechanical design, alignment sensitivity analysis, radius of curvature analysis, laser cavity stability analysis of a linear stable concentric laser cavity with a GIBE. Fabrication details of the GIBE are also given.

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

    International Nuclear Information System (INIS)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-05-15

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

  16. [Contribution of the Vishnevsky Central Military Clinical Hospital N 3 to the history of combat casualty care and delivery of care to the injured soldiers].

    Science.gov (United States)

    Beliakin, S A; Dolgikh, R N; Fokin, Iu N

    2013-05-01

    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.

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

    Science.gov (United States)

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

    2017-06-01

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

  18. Characteristics of human - sloth bear (Melursus ursinus) encounters and the resulting human casualties in the Kanha-Pench corridor, Madhya Pradesh, India

    OpenAIRE

    Dhamorikar, Aniruddha H.; Mehta, Prakash; Bargali, Harendra; Gore, Kedar

    2017-01-01

    Sloth bears (Melursus ursinus) caused the highest number of human deaths between 2001 and 2015 and ranked second compared to other wild animals in causing human casualties in the Kanha-Pench corridor area. We studied the patterns of sloth bear attacks in the region to understand the reasons for conflict. We interviewed 166 victims of sloth bear attacks which occurred between 2004 and 2016 and found that most attacks occurred in forests (81%), with the greatest number of those (42%) occurring ...

  19. Case suitability for definitive through knee amputation following lower extremity blast trauma: analysis of 146 combat casualties, 2008-2010.

    Science.gov (United States)

    Singleton, James A G; Walker, N M; Gibb, I E; Bull, A M J; Clasper, J C

    2014-06-01

    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

  20. Proposed key elements of a critical incident intervention program for reducing the effects of potentially traumatic exposure on train crews to grade crossing and trespasser incidents.

    Science.gov (United States)

    2014-04-01

    This independent report presents work conducted regarding project FR-RDD-0024-11-01 to advise and support the formulation of : regulations and supporting materials concerning critical incident response plans for rail carriers covered by the Rai...

  1. Reducing young driver crash casualties in Great Britain - use of routine police crash data to estimate the potential benefits of graduated driver licensing.

    Science.gov (United States)

    Jones, Sarah J; Begg, Dorothy J; Palmer, Stephen R

    2013-01-01

    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.

  2. EDs credit drills, community engagement with helping them manage casualties from tornado crises.

    Science.gov (United States)

    2011-07-01

    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.

  3. GIS and Geodatabase Disaster Risk for Spatial Planning

    Science.gov (United States)

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

    2018-02-01

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

  4. Planned inguinal herniorrhaphy but no hernia sac?

    DEFF Research Database (Denmark)

    Jensen, P; Bay-Nielsen, M; Kehlet, H

    2004-01-01

    Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention.......Planned inguinal herniorrhaphy may present a clinical dilemma when no hernia is found. No large-scale data are available on the incidence of this problem, and, therefore, no recommendations exist for choice of surgical intervention....

  5. Flood action plans

    International Nuclear Information System (INIS)

    Slopek, R.J.

    1995-01-01

    Safe operating procedures developed by TransAlta Utilities for dealing with flooding, resulting from upstream dam failures or extreme rainfalls, were presented. Several operating curves developed by Monenco AGRA were described, among them the No Overtopping Curve (NOC), the Safe Filling Curve (SFC), the No Spill Curve (NSC) and the Guaranteed Fill Curve (GFC). The concept of an operational comfort zone was developed and defined. A flood action plan for all operating staff was created as a guide in case of a flooding incident. Staging of a flood action plan workshop was described. Dam break scenarios pertinent to the Bow River were developed for subsequent incorporation into a Flood Action Plan Manual. Evaluation of the technical presentations made during workshops were found them to have been effective in providing operating staff with a better understanding of the procedures that they would perform in an emergency. 8 figs

  6. Blast and ballistic trajectories in combat casualties: a preliminary analysis using a cartesian positioning system with MDCT.

    Science.gov (United States)

    Folio, Les R; Fischer, Tatjana; Shogan, Paul; Frew, Michael; Dwyer, Andrew; Provenzale, James M

    2011-08-01

    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.

  7. A Review of Socio-Economic Consequences, Losses and Human Casualties of the 1977 Vrancea, Romania Earthquake

    Directory of Open Access Journals (Sweden)

    Emil-Sever GEORGESCU

    2011-01-01

    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.

  8. Recognition and Treatment of Nerve Agent Casualties: Evidence of Reduced Learner Engagement During Video-based Training.

    Science.gov (United States)

    Bukoski, Alex; Uhlich, Rindi; Tucker, Johnny; Cooper, Chris; Barnes, Steve

    2016-05-01

    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.

  9. Goiania incident case study

    International Nuclear Information System (INIS)

    Petterson, J.S.

    1988-06-01

    The reasons for wanting to document this case study and present the findings are simple. According to USDOE technical risk assessments (and our own initial work on the Hanford socioeconomic study), the likelihood of a major accident involving exposure to radioactive materials in the process of site characterization, construction, operation, and closure of a high-level waste repository is extremely remote. Most would agree, however, that there is a relatively high probability that a minor accident involving radiological contamination will occur sometime during the lifetime of the repository -- for example, during transport, at an MRS site or at the permanent site itself during repacking and deposition. Thus, one of the major concerns of the Yucca Mountain Socioeconomic Study is the potential impact of a relatively minor radiation-related accident. A large number of potential impact of a relatively minor radiation-related accident. A large number of potential accident scenarios have been under consideration (such as a transportation or other surface accident which results in a significant decline in tourism, the number of conventions, or the selection of Nevada as a retirement residence). The results of the work in Goiania make it clear, however, that such a significant shift in established social patterns and trends is not likely to occur as a direct outcome of a single nuclear-related accident (even, perhaps, a relatively major one), but rather, are likely to occur as a result of the enduring social interpretations of such an accident -- that is, as a result of the process of understanding, communicating, and socially sustaining a particular set of associations with respect to the initial incident

  10. Radiation incident in oil well logging

    International Nuclear Information System (INIS)

    Lozada, J.A.

    1998-01-01

    On June 4th 1997 equipment failure and violation of approved procedures by a crew of workers initiated a series of events that resulted in the unnecessary exposure to neutron and gamma radiation, from a 666 GBq Am 241 Be source, of forty two workers from a well logging company in Venezuela. Due to the presence of dry mud or drilling fluids inside the logging tool, the nosepiece was screwed off the rest of the source holder; this piece was mistaken for the entire source holder thus leaving the source inside the tool. The tool was labelled for maintenance and electronic laboratory personal worked near the source for seven hours before they identify its presence. As soon as the incident was detected a contingency plan was implemented and the source could be retrieved from the tool and placed in its shipping container. The TLD badges indicate doses well below the annual limit of 20 mSv, and none of the workers involved in the incident seem to show serious health consequences from it. After the incident, in order to avoid the occurrence of similar situations, a better source and tool maintenance program was implemented, all the workers were re-trained, and area monitors were installed in all operations bases. (author)

  11. Human Q fever incidence is associated to spatiotemporal environmental conditions

    Directory of Open Access Journals (Sweden)

    J.P.G. Van Leuken

    2016-12-01

    We conclude that environmental conditions are correlated to human Q fever incidence rate. Similar research with data from other outbreaks would be needed to more firmly establish our findings. This could lead to better estimations of the public health risk of a C. burnetii outbreak, and to more detailed and accurate hazard maps that could be used for spatial planning of livestock operations.

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

    Science.gov (United States)

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

    2014-07-01

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

  13. Real time freeway incident detection.

    Science.gov (United States)

    2014-04-01

    The US Department of Transportation (US-DOT) estimates that over half of all congestion : events are caused by highway incidents rather than by rush-hour traffic in big cities. Real-time : incident detection on freeways is an important part of any mo...

  14. Epistemic Planning

    DEFF Research Database (Denmark)

    Baral, Chitta; Bolander, Thomas; van Ditmarsch, Hans

    investigates the formal semantics of communication and communicative actions, knowledge representation and reasoning focuses on theories of action and change, and automated planning investigates computational techniques and tools to generate plans. The original goals of the seminar were to develop benchmarks......The seminar Epistemic Planning brought together the research communities of Dynamic Epistemic Logic, Knowledge Representation and Reasoning, and Automated Planning to address fundamental problems on the topic of epistemic planning. In the context of this seminar, dynamic epistemic logic...... for epistemic planning, to explore the relationship between knowledge and belief in multi-agent epistemic planning, to develop models of agency and capability in epistemic planning and to explore action types and their representations (these originally separate goals were merged during the seminar), and finally...

  15. Business plan

    OpenAIRE

    Monakov, Victor

    2011-01-01

    The aim of this bachelor's thesis is to prepare a business plan for web design courses in Prague and feasibility & efficiency evaluation of this type of business. In the theoretical part of my bachelor's thesis, I focus on important terms, structure and aspects of a business plan. In the practical part, I apply theoretical knowledge and create a real business plan.

  16. Vulnerability Situations associated with Flash Flood Casualties in the United States

    Science.gov (United States)

    Terti, G.; Ruin, I.; Anquetin, S.; Gourley, J. J.

    2015-12-01

    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).

  17. Medical planning for very large events: Special Olympics World Games Los Angeles 2015.

    Science.gov (United States)

    Vasquez, Marissa S; Fong, Michael K; Patel, Leena J; Kurose, Brian; Tierney, John; Gardner, Imani; Yazdani-Arazi, Arash; Su, John K

    2015-01-01

    Mass gathering events that involve special populations have challenges that require unique medical planning. The key to a successful mass event is in the preparation, planning, and communication. Concerns in communication such as language barriers, age of participants, and intellectual disability should be addressed early in the planning. In the event of a mass casualty disaster, there should be a clear chain of command and escalation policy. The primary concern of the sports medicine team is to ensure safety for the participation of an athlete. The risk of injury to an athlete varies depending on the event and venue. The sporting venue may require special consideration for access to athletes, crowd control, and ingress/egress of medical personnel and transports. In order to ensure safety and efficient care, it is paramount to have the necessary medical planning and preparedness to manage a large-scale sporting event.

  18. Planning for Change: Comprehensive Planning.

    Science.gov (United States)

    Temkin, Sanford

    This speech draws a distinction between a priori and a posteriori planning, and relates these two types of planning in coping with the various problems faced by local school districts. The author describes the comprehensive planning process, the development of information required by the process, and how this process is supported in the local…

  19. National Emergency Preparedness and Response: Improving for Incidents of National Significance

    National Research Council Canada - National Science Library

    Clayton, Christopher M

    2006-01-01

    .... More appropriately, the Department of Defense (DoD), the Department of Homeland Security (DHS), and the states need to become better partners in planning for, exercising for, and responding to Incidents of National Significance...

  20. Decreasing incidence rates of bacteremia

    DEFF Research Database (Denmark)

    Nielsen, Stig Lønberg; Pedersen, C; Jensen, T G

    2014-01-01

    BACKGROUND: Numerous studies have shown that the incidence rate of bacteremia has been increasing over time. However, few studies have distinguished between community-acquired, healthcare-associated and nosocomial bacteremia. METHODS: We conducted a population-based study among adults with first......-acquired, 50.0 for healthcare-associated and 66.7 for nosocomial bacteremia. During 2000-2008, the overall incidence rate decreased by 23.3% from 254.1 to 198.8 (3.3% annually, p ...) and the incidence rate of nosocomial bacteremia decreased by 28.9% from 82.2 to 56.0 (4.2% annually, p

  1. Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event.

    Science.gov (United States)

    Toltzis, Philip; Soto-Campos, Gerardo; Shelton, Christian R; Kuhn, Evelyn M; Hahn, Ryan; Kanter, Robert K; Wetzel, Randall C

    2015-09-01

    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

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

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  3. Traffic incident management resource management.

    Science.gov (United States)

    2009-01-01

    The necessity of a multi-disciplinary approach involving law enforcement, fire and rescue, transportation, towing and recovery, and others has been well-recognized and integrated into incident management operations. This same multidisciplinar...

  4. Police Incident Blotter (30 Day)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The 30 Day Police Blotter contains the most recent initial crime incident data, updated on a nightly basis. All data is reported at the block/intersection level,...

  5. Regional comparison of cancer incidence

    International Nuclear Information System (INIS)

    Obralic, N.; Gavrankapetanovic, F.; Dizdarevic, Z.; Duric, O.; Sisic, F.; Selak, I.; Balta, S.; Nakas, B.

    2004-01-01

    Background. Due to specific war and post-war situation in Balkan region, differences in the number, type, development, biological course, treatment of malignant tumours and its outcome are possible. In order to perceive the situation realistically, it is necessary to gather continuously exact data about malignant tumours and compare them with the data from other European and world countries.The aim of the study was to collect and analyse the data on cancer incidence in the region of Sarajevo city, which represents a symbol of difficult times in the recent past, and to compare it to the incidence in the neighbouring countries. Patients and methods. Data on all newly diagnosed cancer cases, permanent residents of Sarajevo Canton, in the years 1999 and 2000 were collected. Crude incidence rate has been calculated according to the years observed, gender and localizations of the disease The data were compared to the cancer registries of Slovenia and Croatia and were observed in the light of specific local situation. Results. The crude cancer incidence of all sites but skin was the highest in both years and by both genders in Croatia. The incidence of the most common tumours (lung and breast cancer) was similar in all three countries. The differences in the incidence between both genders in the Sarajevo canton were registered in laryngeal and urinary bladder cancer, as well as in bone and cartilage sarcoma. Cervical cancer had extremely high incidence and was high up on the incidence list in the Sarajevo canton, which correlates with the data in developing countries. The incidence of other tumours in the post-war period is reaching expected numbers. Conclusions. It is difficult to identify whether the war and post-war stress, irregular and insufficient nutrition during and after the siege of the city of Sarajevo or some other factor influenced the cancer incidence among exposed population. The prevalence of smoking in the whole region is extremely high, in Bosnia and

  6. Asymptotics for incidence matrix classes

    OpenAIRE

    Cameron, Peter; Prellberg, Thomas; Stark, Dudley

    2005-01-01

    We define {\\em incidence matrices} to be zero-one matrices with no zero rows or columns. A classification of incidence matrices is considered for which conditions of symmetry by transposition, having no repeated rows/columns, or identification by permutation of rows/columns are imposed. We find asymptotics and relationships for the number of matrices with $n$ ones in these classes as $n\\to\\infty$.

  7. Incidence Handling and Response System

    OpenAIRE

    Kalbande, Prof. Dhananjay R.; Thampi, Dr. G. T.; Singh, Mr. Manish

    2009-01-01

    A computer network can be attacked in a number of ways. The security-related threats have become not only numerous but also diverse and they may also come in the form of blended attacks. It becomes difficult for any security system to block all types of attacks. This gives rise to the need of an incidence handling capability which is necessary for rapidly detecting incidents, minimizing loss and destruction, mitigating the weaknesses that were exploited and restoring the computing services. I...

  8. Cancer incidence in Spain, 2015.

    Science.gov (United States)

    Galceran, J; Ameijide, A; Carulla, M; Mateos, A; Quirós, J R; Rojas, D; Alemán, A; Torrella, A; Chico, M; Vicente, M; Díaz, J M; Larrañaga, N; Marcos-Gragera, R; Sánchez, M J; Perucha, J; Franch, P; Navarro, C; Ardanaz, E; Bigorra, J; Rodrigo, P; Bonet, R Peris

    2017-07-01

    Periodic cancer incidence estimates of Spain from all existing population-based cancer registries at any given time are required. The objective of this study was to present the current situation of cancer incidence in Spain. The Spanish Network of Cancer Registries (REDECAN) estimated the numbers of new cancer cases occurred in Spain in 2015 by applying the incidence-mortality ratios method. In the calculus, incidence data from population-based cancer registries and mortality data of all Spain were used. In 2015, nearly a quarter of a million new invasive cancer cases were diagnosed in Spain, almost 149,000 in men (60.0%) and 99,000 in women. Globally, the five most common cancers were those of colon-rectum, prostate, lung, breast and urinary bladder. By gender, the four most common cancers in men were those of prostate (22.4%), colon-rectum (16.6%), lung (15.1%) and urinary bladder (11.7%). In women, the most common ones were those of breast (28.0%), colon-rectum (16.9%), corpus uteri (6.2%) and lung (6.0%). In recent years, cancer incidence in men seems to have stabilized due to the fact that the decrease in tobacco-related cancers compensates for the increase in other types of cancer like those of colon and prostate. In women, despite the stabilization of breast cancer incidence, increased incidence is due, above all, to the rise of colorectal and tobacco-related cancers. To reduce these incident cancer cases, improvement of smoking control policies and extension of colorectal cancer screening should be the two priorities in cancer prevention for the next years.

  9. Major incident response: collecting ante-mortem data.

    Science.gov (United States)

    De Valck, Eddy

    2006-05-15

    The Asian tsunami of 26 December 2004, which devastated coastal parts of more than 10 countries in and around the Indian Ocean caused over 200,000 casualties. People from more than 58 nationalities were amongst the victims and subsequently an international effort for disaster victim identification (DVI) was set up, coordinated by Interpol. DVI teams from more than 20 countries took part in the identification process which, because of the complexity of the situation, had to be conducted in an internationally agreed upon procedure. Standard operating protocols of post-mortem (PM) procedures were established for fingerprinting, forensic pathology, forensic odontology and DNA profiling and were crucial in the quality of the entire DVI process of the quickly decomposing bodies. A very important and underestimated part of the DVI process is the gathering of the ante-mortem (AM) data of the persons reported missing in their home countries. In the wake of this tsunami event it appeared to be even more problematic as entire families had died and information was difficult to obtain. As dentistry proved to be the most valuable identification mean--up to 85% of the cases--the AM dental records proved to be crucial elements for DVI. Standard operating protocols (SOP) were again established as to who, where, when and what information had to be collected by the dentists by the AM teams abroad. Transcribing the AM dental information by experienced forensic odontologists was another crucial element in the whole identification procedure as the information had to be loaded into the DVI System International (Plass Data, Holbaek, Denmark) for comparison with incoming PM data. The Interpol DVI Standing Committee thus recommends that forward planning, adequate funding, international cooperation and standardisation are essential to guarantee an effective response to any major mass disaster of this kind in the future.

  10. Inspection planning

    International Nuclear Information System (INIS)

    Korosec, D.; Levstek, M.F.

    2001-01-01

    Slovenian Nuclear Safety Administration (SNSA) division of nuclear and radiological safety inspection has developed systematic approach to their inspections. To be efficient in their efforts regarding regular and other types of inspections, in past years, the inspection plan has been developed. It is yearly based and organized on a such systematic way, that all areas of nuclear safety important activities of the licensee are covered. The inspection plan assures appropriate preparation for conducting the inspections, allows the overview of the progress regarding the areas to be covered during the year. Depending on the licensee activities and nature of facility (nuclear power plant, research reactor, radioactive waste storage, others), the plan has different levels of intensity of inspections and also their frequency. One of the basic approaches of the plan is to cover all nuclear and radiological important activities on such way, that all regulatory requests are fulfilled. In addition, the inspection plan is a good tool to improve inspection effectiveness based on previous experience and allows to have the oversight of the current status of fulfillment of planned inspections. Future improvement of the plan is necessary in the light of newest achievements on this field in the nuclear world, that means, new types of inspections are planned and will be incorporated into plan in next year.(author)

  11. Cyber Incidents Involving Control Systems

    Energy Technology Data Exchange (ETDEWEB)

    Robert J. Turk

    2005-10-01

    The Analysis Function of the US-CERT Control Systems Security Center (CSSC) at the Idaho National Laboratory (INL) has prepared this report to document cyber security incidents for use by the CSSC. The description and analysis of incidents reported herein support three CSSC tasks: establishing a business case; increasing security awareness and private and corporate participation related to enhanced cyber security of control systems; and providing informational material to support model development and prioritize activities for CSSC. The stated mission of CSSC is to reduce vulnerability of critical infrastructure to cyber attack on control systems. As stated in the Incident Management Tool Requirements (August 2005) ''Vulnerability reduction is promoted by risk analysis that tracks actual risk, emphasizes high risk, determines risk reduction as a function of countermeasures, tracks increase of risk due to external influence, and measures success of the vulnerability reduction program''. Process control and Supervisory Control and Data Acquisition (SCADA) systems, with their reliance on proprietary networks and hardware, have long been considered immune to the network attacks that have wreaked so much havoc on corporate information systems. New research indicates this confidence is misplaced--the move to open standards such as Ethernet, Transmission Control Protocol/Internet Protocol, and Web technologies is allowing hackers to take advantage of the control industry's unawareness. Much of the available information about cyber incidents represents a characterization as opposed to an analysis of events. The lack of good analyses reflects an overall weakness in reporting requirements as well as the fact that to date there have been very few serious cyber attacks on control systems. Most companies prefer not to share cyber attack incident data because of potential financial repercussions. Uniform reporting requirements will do much to make this

  12. Infographics as Eye Candy: Review of World War II in Numbers: An Infographic Guide to the Conflict, Its Conduct, and Its Casualties by Peter Doyle (2013

    Directory of Open Access Journals (Sweden)

    Joel Best

    2016-01-01

    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.

  13. Breast cancer incidence in Mongolia

    Science.gov (United States)

    Altantsetseg, Dalkhjav; Davaasambuu, Ganmaa; Rich-Edwards, Janet; Davaalkham, Dambadarjaa; Tretli, Steinar; Hoover, Robert N.; Frazier, A. Lindsay

    2013-01-01

    Purpose Data on international variation in breast cancer incidence may help to identify additional risk factors. Substantially lower breast cancer rates in Asia than in North America and Western Europe are established, but differences within Asia have been largely ignored despite heterogeneity in lifestyles and environments. Mongolia’s breast cancer experience is of interest because of its shared genetics but vastly different diet compared with other parts of Asia. Methods Age-standardized breast cancer incidence and mortality rates obtained from the International Association of Cancer Registries are presented for several Asian countries. Mongolian incidence rates obtained from its cancer registry describe incidence within the country. Results Breast cancer incidence in Mongolia (age standardized 8.0/100,000) is almost a third of rates in China (21.6/100,000), and over five times that of Japan (42.7/100,000) and Russia (43.2/100,000). Rates within Mongolia appear to have increased slightly over the last decade and are higher in urban than rural areas (annual percentage increase of age-standardized rates from 1998 to 2005 was 3.60 and 2.57%, respectively). The increase in breast cancer incidence with age plateaus at menopause, as in other Asian populations. Conclusions Mongolia’s low breast cancer incidence is of particular interest because of their unusual diet (primarily red meat and dairy) compared with other Asian countries. More intensive study of potential dietary, reproductive and lifestyle factors in Mongolia with comparison to other Asian populations may provide more clarity in what drives the international breast cancer rate differences. PMID:22543542

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  15. Test plan :

    Energy Technology Data Exchange (ETDEWEB)

    Dwyer, Stephen F.

    2013-05-01

    This test plan is a document that provides a systematic approach to the planned testing of rooftop structures to determine their actual load carrying capacity. This document identifies typical tests to be performed, the responsible parties for testing, the general feature of the tests, the testing approach, test deliverables, testing schedule, monitoring requirements, and environmental and safety compliance.

  16. Regional Planning.

    Science.gov (United States)

    Bang, Bryan

    1987-01-01

    Explores ideas about regional planning and provides a framework for developing a secondary level course on regional planning. Claims that such a course can help students understand more about the world around them and improve their attitude toward contributing to the management of change. (BR)

  17. Information sharing for traffic incident management.

    Science.gov (United States)

    2009-01-01

    Traffic incident management focuses on developing procedures, implementing policies, and deploying technologies to more quickly identify incidents, improve response times, and more effectively and efficiently manage the incident scene. Because so man...

  18. Systemic Planning

    DEFF Research Database (Denmark)

    Leleur, Steen

    This book presents principles and methodology for planning in a complex world. It sets out a so-called systemic approach to planning, among other things, by applying “hard” and “soft” methodologies and methods in combination. The book is written for Ph.D and graduate students in engineering......, business and other fields, and it is useful for all professionals, across a wide range of employment areas, who share an interest in renewing planning practice. Such an endeavour is seen as both important and timely, recognising that many complex planning tasks necessitate organisations – be they public...... or private – to engage in planning to prepare proactive decision-making....

  19. Technical Reference Manual to Allied Medical Publication 7.5 (AMedP 7.5) NATO Planning Guide for the Estimation of CBRN Casualties

    Science.gov (United States)

    2016-10-01

    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

  20. NATO Allied Medical Publication 7.5 Study Draft 3 (AMedP 7.5 SD.3), NATO Planning Guide for the Estimation of CBRN Casualties

    Science.gov (United States)

    2015-12-01

    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

  1. Technical Reference Manual: NATO Planning Guide for the Estimation of Chemical, Biological, Radiological, and Nuclear (CBRN), Casualties, Allied Medical Publication-8(C)

    Science.gov (United States)

    2010-08-01

    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

  2. LAND USE PLANNING AND URBAN PLANS: TERRITORIAL BALANCE AS ETHICS

    Directory of Open Access Journals (Sweden)

    Eunice Helena Sguizzardi Abascal

    2012-07-01

    Full Text Available The article suggests a necessary link between urban planning and territorial organization, in order to, through the synergistic relationship between planning tools and their application to planning, implementing a policy of urban and regional management. By linking the development plan for territorial development plans and categories of land use, this methodology helps to streamline operations at multiple scales. The establishment of this network of instruments and shapes the actions of government action against the rapid and intense increase of only economic forces that shape the territory today, suggesting that it is possible to regulate the action of the housing market through planned interventions, valuing the regional balance, social and environmental - ethical by definition. It is suggested that the possible effects predatory natural and built environment can be reversed or prevented by an action articulating these planning instruments are linked to the development and implementation of plans (and projects at multiple scales, approaching from the regional to the local and metropolitan, from regional policies to sectors, that are incidents in the municipal territory. However, the speed and magnitude of the occupation and transformation of soil occur mainly in periods of heating housing, often jeopardize the balance and environmental quality, natural heritage, urban and landscape. It assumes the argument that the overcoming of undesirable environmental effects, triggered by occupation of the ground guided by the real estate sector fast action can be successful with the articulation of levels of planning and intervention. It is proposed that the complexity of contemporary urban and metropolitan requires the articulation of different scales through the use of innovative urban instruments. By articulating these different scales, at the municipal and other levels supra, contributes to, through a network plan to overcome the undesirable dichotomy

  3. Investigating the association between weather conditions, calendar events and socio-economic patterns with trends in fire incidence: an Australian case study

    Science.gov (United States)

    Corcoran, Jonathan; Higgs, Gary; Rohde, David; Chhetri, Prem

    2011-06-01

    Fires in urban areas can cause significant economic, physical and psychological damage. Despite this, there has been a comparative lack of research into the spatial and temporal analysis of fire incidence in urban contexts. In this paper, we redress this gap through an exploration of the association of fire incidence to weather, calendar events and socio-economic characteristics in South-East Queensland, Australia using innovative technique termed the quad plot. Analysing trends in five fire incident types, including malicious false alarms (hoax calls), residential buildings, secondary (outdoor), vehicle and suspicious fires, results suggest that risk associated with all is greatly increased during school holidays and during long weekends. For all fire types the lowest risk of incidence was found to occur between one and six a.m. It was also found that there was a higher fire incidence in socially disadvantaged neighbourhoods and there was some evidence to suggest that there may be a compounding impact of high temperatures in such areas. We suggest that these findings may be used to guide the operations of fire services through spatial and temporal targeting to better utilise finite resources, help mitigate risk and reduce casualties.

  4. 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

    International Nuclear Information System (INIS)

    2009-01-01

    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

  5. PROPOSAL FOR THE CREATION OF SECURITY PLANS FOR THE ROAD TRANSPORTATION OF HIGH CONSEQUENCE DANGEROUS GOODS

    Directory of Open Access Journals (Sweden)

    Karolina KOŁDYS

    2016-12-01

    Full Text Available In the list of dangerous goods, there are materials and articles, which, due to particular criteria stated in the European Agreement Concerning the International Carriage of Goods by Road (ADR, are treated as high consequence goods. High consequence dangerous goods are those whose misuse may lead to a terrorist event and therefore pose a serious threat of mass casualties, destruction or socio-economic disruption. All personnel responsible for the carriage of high consequence dangerous goods should comply with ADR requirements, as appropriate. Basic ADR requirements, which should lead to the elimination of potential safety violations hazards, is to acknowledge, implement and respect security plans. The ADR reflects overall security plan regulations, describing the elements of which such plans should be created. The ADR itself does not prescribe methods for preparing documentation, nor implementation details. This article is to elaborate on these aspects.

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

    Science.gov (United States)

    DeFraia, Gary S

    2013-01-01

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

  7. Incidence of scabies in Belgium

    Science.gov (United States)

    LAPEERE, H.; NAEYAERT, J.-M.; De WEERT, J.; De MAESENEER, J.; BROCHEZ, L.

    2008-01-01

    SUMMARY A prospective survey on scabies in Ghent, Belgium was performed in 2004. Sixty-four individual cases were reported, corresponding to a crude incidence rate of 28/100 000 inhabitants. The incidence was higher in the elderly (51/100 000 in persons aged >75 years) and a higher incidence was also found in immigrants (88/100 000). More than 40% of the registered scabies patients had symptoms for more than 4 weeks at the time of presentation. In 54% of the consultations, the patient had already consulted a physician for his/her skin problem. Of this group, 44% had not yet received any scabicidal treatment, indicating that scabies was not yet diagnosed or that an inappropriate treatment was prescribed. The observations suggest that the diagnosis and/or treatment of scabies in this region can still be improved. PMID:17506916

  8. Incidence of hyperthyroidism in Slovenia since improved iodine supply

    International Nuclear Information System (INIS)

    Zaletel, K.; Gaberscek, S.; Pirnat, E.; Hojker, S.

    2002-01-01

    Full text: Since the year 1953, when iodine prophylaxis was introduced in Slovenia, several epidemiological studies confirmed the existence of mild iodine deficiency on the whole territory of Slovenia. In January 1999 the implementation of higher iodine content (25 mg of KI or 32 mg of KIO 3 ) was recommended and since then the increased incidence of thyrotoxicosis was observed. Here we present 5-year follow-up data of the incidence of hyperthyroidism due to thyroid autonomy and Graves' disease. We estimated incidence rates from 1997 to 2001 for hyperthyroidism due to thyroid autonomy and Graves' disease among 1000000 people, living in the area of Ljubljana. We assumed that most cases were seen and treated in the Outpatient Department for thyroid diseases of Department for Nuclear Medicine of University Medical Centre Ljubljana. Immediately after correction of iodine deficiency, the incidence of hyperthyroidism due to thyroid autonomy rose almost twice in 1999 (320 cases in 1999 compared to 173 cases in 1997), but afterwards the incidence slightly decreased (240 cases in 2000). Similarly, the incidence of Graves' disease rose in 1999 (267 cases in 1999 compared to 237 in 1997) and in contrast to thyroid autonomy the incidence further increased in the following years (337 in 2000 and 246 in the first half of 2001). The increased incidence of hyperthyroidism due to thyroid autonomy and Graves' disease after elevation of iodine prophylaxis in Slovenia is comparable with data in some other endemic areas. Those data indicate that stepwise supplementation is preferable to immediate corrections. However, we believe that iodine prophylaxis is reasonable and justified and to reassess the iodine nutrition status we plan a follow up evaluation in year 2002. (author)

  9. Statement of nuclear incidents at nuclear installations

    International Nuclear Information System (INIS)

    2002-01-01

    The Health and Safety Executive (HSE) presents the statement of nuclear incidents at nuclear installations published under the Health and Safety Commission's powers derived from section 11 of the Health and Safety at Work, etc. Act 1974. INCIDENT 02/4/1. Harwell (United Kingdom Atomic Energy Authority) On 6 November 2002 during operations in a glove box in B220, the over pressure alarm sounded. The operators evacuated and shortly afterwards the airborne activity monitors also sounded. The building emergency arrangements for airborne activity alarms was initiated to ascertain the source and to manage the operations. An investigation by UKAEA confirmed that a release of Americium 241 into the working area had occurred at a quantity in excess of Schedule 8 column 4 of the Ionising Radiations Regulations 1999 (IRRs). A number of personnel have received intakes including the two operators and the health physics personnel who attended the event. The highest dose (up to 6 mSv.) was received by the Health Physics charge hand. UKAEA placed an embargo on the use of similar systems and have completed their own management investigation and produced an internal report. It concludes that the likely cause of the event was over-pressurisation of the vacuum equipment used in the process. The report also highlights improvements required to the ventilation system in the laboratory and adjoining areas. An action plan has been developed for this work and progress is being made. NIl has followed the UKAEA investigation and carried out its own study including a visit by a ventilation specialist. This has confirmed the problems with the ventilation system. It is a complex issue that may have a wider impact across the building. A letter has been sent to UKAEA detailing a series of short-term requirements and the need to review implications and produce a longer-term action plan. UKAEA is cooperating fully with these requirements. INCIDENT 02/4/2. Dounreay (United Kingdom Atomic Energy

  10. Analysis of Casualty Risk per Police-Reported Crash for Model Year 2000 to 2004 Vehicles, using Crash Data from Five States

    Energy Technology Data Exchange (ETDEWEB)

    Wenzel, Tom

    2011-03-20

    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.

  11. Metabolic Syndrome and Incident Diabetes

    OpenAIRE

    Ford, Earl S.; Li, Chaoyang; Sattar, Naveed

    2008-01-01

    OBJECTIVE?Our objective was to perform a quantitative review of prospective studies examining the association between the metabolic syndrome and incident diabetes. RESEARCH DESIGN AND METHODS?Using the title terms ?diabetes? and ?metabolic syndrome? in PubMed, we searched for articles published since 1998. RESULTS?Based on the results from 16 cohorts, we performed a meta-analysis of estimates of relative risk (RR) and incident diabetes. The random-effects summary RRs were 5.17 (95% CI 3.99?6....

  12. Cardiovascular disease incidence and survival

    DEFF Research Database (Denmark)

    Byberg, Stine; Agyemang, Charles; Zwisler, Ann-Dorthe

    2016-01-01

    Studies on cardiovascular disease (CVD) incidence and survival show varying results between different ethnic groups. Our aim was to add a new dimension by exploring the role of migrant status in combination with ethnic background on incidence of-and survival from-CVD and more specifically acute...... of some types of cardiovascular disease compared to Danish-born. Family-reunified migrants on the other hand had lower rates of CVD. All migrants had better survival than Danish-born indicating that migrants may not always be disadvantaged in health....

  13. Radiological incident preparedness for community hospitals: a demonstration project.

    Science.gov (United States)

    Jafari, Mary Ellen

    2010-08-01

    In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

  14. The World Trade Center attack. Helping the helpers: the role of critical incident stress management.

    Science.gov (United States)

    Hammond, J; Brooks, J

    2001-12-01

    Healthcare and prehospital workers involved in disaster response are susceptible to a variety of stress-related psychological and physical sequelae. Critical incident stress management, of which critical incident stress debriefing is a component, can mitigate the response to these stressors. Critical incident stress debriefing is a peer-driven, therapist-guided, structured, group intervention designed to accelerate the recovery of personnel. The attack on the World Trade Center, and the impact it may have on rescue, prehospital, and healthcare workers, should urge us to incorporate critical incident stress management into disaster management plans.

  15. Living conditions in the districts of Oslo and poisonings by substances of abuse treated at casualty clinic level.

    Science.gov (United States)

    Akopian, Maja; Vallersnes, Odd Martin; Jacobsen, Dag; Ekeberg, Øivind; Brekke, Mette

    2015-11-17

    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.

  16. How to maintain a business continuity despite cyber incidents?

    OpenAIRE

    Đekić Milica D.

    2015-01-01

    Modern IT systems can bring a lot of advantages in terms of electronic commerce and governance as well as an automatic process control within industry, traffic and the other ways of classical and critical infrastructure. However, beside many advantages regarding technological development, there are also some drawbacks in sense of cyber risks, threats and the real hacker's attacks. In this article, we plan to deal with all these cyber risks caused by IT incidents and emergency situations that ...

  17. business plan

    OpenAIRE

    Luzan, Dmitrij

    2009-01-01

    My thesis is dedicated to the business plan of the gastronomic facility. The thesis describes foundation of the company, analyses demand for the gastronomic services. The financial plan is being presented as well. The thesis includes the analysis of the company's environment, suppliers and customers. SWOT analysis, net present value analysis, index of the net present value and other ratio indexes are the parts of this thesis.

  18. Statistics of Casualties, 1979.

    Science.gov (United States)

    1980-12-01

    46 III 7 Othe r-oknoC.- foren.............. . ... . , . I . .. 4 I ............... l i I . .. 3..2 .I .... ... . Stteor cSpacity4 .,1 ve ::o1 I...8 1 12 20 1 1 0 3 0, 4 2 0 l 2 01 Uninspected ve -ssels: Fishing ---------------------------- 068 53 13 24 104 0 21 0 602 113 M7 259 7 0’ ’ _0, 7 1...C (I (’𔃺 0 26 PsyctaIugica-inimnaturity, insanity --------- ---- 0 5 16 1 0 0 0 0 3 1 0 0 IF 0 0 0 0 itF 0 F 0~ 2 0 28 C nmte practice

  19. Iraqi Civilian Casualties Estimates

    Science.gov (United States)

    2008-03-13

    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

  20. Scenario planning.

    Science.gov (United States)

    Enzmann, Dieter R; Beauchamp, Norman J; Norbash, Alexander

    2011-03-01

    In facing future developments in health care, scenario planning offers a complementary approach to traditional strategic planning. Whereas traditional strategic planning typically consists of predicting the future at a single point on a chosen time horizon and mapping the preferred plans to address such a future, scenario planning creates stories about multiple likely potential futures on a given time horizon and maps the preferred plans to address the multiple described potential futures. Each scenario is purposefully different and specifically not a consensus worst-case, average, or best-case forecast; nor is scenario planning a process in probabilistic prediction. Scenario planning focuses on high-impact, uncertain driving forces that in the authors' example affect the field of radiology. Uncertainty is the key concept as these forces are mapped onto axes of uncertainty, the poles of which have opposed effects on radiology. One chosen axis was "market focus," with poles of centralized health care (government control) vs a decentralized private market. Another axis was "radiology's business model," with one pole being a unified, single specialty vs a splintered, disaggregated subspecialty. The third axis was "technology and science," with one pole representing technology enabling to radiology vs technology threatening to radiology. Selected poles of these axes were then combined to create 3 scenarios. One scenario, termed "entrepreneurialism," consisted of a decentralized private market, a disaggregated business model, and threatening technology and science. A second scenario, termed "socialized medicine," had a centralized market focus, a unified specialty business model, and enabling technology and science. A third scenario, termed "freefall," had a centralized market focus, a disaggregated business model, and threatening technology and science. These scenarios provide a range of futures that ultimately allow the identification of defined "signposts" that can

  1. Detecting Terrorism Incidence Type from News Summary

    DEFF Research Database (Denmark)

    Nizamani, Sarwat; Memon, Nasrullah

    2012-01-01

    The paper presents the experiments to detect terrorism incidence type from news summary data. We have applied classification techniques on news summary data to analyze the incidence and detect the type of incidence. A number of experiments are conducted using various classification algorithms...... and results show that a simple decision tree classifier can learn incidence type with satisfactory results from news data....

  2. Energy planning and management plan

    International Nuclear Information System (INIS)

    1996-01-01

    This paper contains printed copies of 60FR 53181, October 12, 1995 and 60 FR 54151. This is a record of decision concerning the Western Area Power Administration's final draft and environmental impact statement, and Energy Planning and Management Program

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

    Directory of Open Access Journals (Sweden)

    Alison Norris

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

  4. Lessons learned from recent safety related incidents at A Canadian uranium conversion facility

    International Nuclear Information System (INIS)

    Jaferi, Jafir

    2013-01-01

    This paper presents the Canadian Nuclear Safety Commission's (CNSC) regulatory requirements for nuclear fuel facility licensees to report any situation or incident that results or is likely to result in a hazard to the health or safety of any person or the environment and to submit its incident investigation report with cause(s) of the incident and corrective actions taken or planned. In addition, the paper presents two recent safety-related incidents that occurred at a uranium conversion facility in Canada along with their consequences, causes, corrective actions and any lessons learned. The first incident resulted in a release of uranium hexafluoride (UF6) inside the UF6 cylinder filling station and the second one resulted in a spill of uranium tetrafluoride (UF 4 ) slurry inside the UF6 plant. Both incidents had no impact on the workers or the environment. (authors)

  5. Partial scram incident in FBTR

    International Nuclear Information System (INIS)

    Usha, S.; Pillai, C.P.; Muralikrishna, G.

    1989-01-01

    Evaluation of a partial scram incident occurred at the Fast Breeder Test Reactor at Kalpakkam was carried out. Based on the observations of the experiments it was ascertained that the nonpersistant order was due to superimposed noise component on the channel that was close to the threshold and had resulted in intermittent supply to electro-magnetic (EM) coils. Owing to a larger discharge time and a smaller charge time, the EM coils got progressively discharged. It was confirmed that during the incident, partial scram took place since the charging and discharging patterns of the EM coils are dissimilar and EM coils of rods A, E and F had discharged faster than others for noise component of a particular duty cycle. However, nonlatching of scram order was because of the fact that noise pulse duration was less than latching time. (author)

  6. Dissociative Tendencies and Traffic Incidents

    Directory of Open Access Journals (Sweden)

    Valle, Virginia

    2012-01-01

    Full Text Available This paper analyses the relationship between dissociative experiences and road traffic incidents (crashes and traffic tickets in drivers (n=295 from Mar del Plata (Argentina city. A self-report questionnaire was applied to assess traffic crash involvement and sociodemographic variables. Dissociative tendencies were assessed by a modified version of the DES scale. To examine differences in DES scores tests of the difference of means were applied. Drivers who reported to be previously involved in traffic incidents obtained higher puntuations in the dissociative experiences scale than drivers who did not report such events. This result is observed for the total scale and for the three sub-scales (absorption, amnesia and depersonalization. However, differences appeared mainly for minor damage collisions. Further studies are needed to evaluate the role of dissociative tendencies as a risk factor in road traffic safety.

  7. 2 Major incident triage and the implementation of a new triage tool, the MPTT-24.

    Science.gov (United States)

    Vassallo, James; Smith, Jason

    2017-12-01

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

  8. Incidents malignant neoplasias maxillofacial area.

    Science.gov (United States)

    Goiato, Marcelo Coelho; Haddad, Marcela Filié; dos Santos, Daniela Micheline; Pesqueira, Aldiéres Alves; Filho, Humberto Gennari; Pellizzer, Eduardo Piza

    2009-07-01

    Cancer is regarded as abnormal cellular multiplication; it is not controlled by the organism, and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratory examinations. When tumors are present in the maxillofacial area, the carrier can lose structures in this area, resulting to the carrier's social environment exclusion. This article aims to show incidences and causes of malignant neoplasias in the maxillofacial area.

  9. [Familial incidence of Crohn disease].

    Science.gov (United States)

    Bürger, L; Karoff, C; Wagner, H

    1981-03-12

    This study reports about the frequent incidence of Crohn's disease in four families. This evidence in confirmed by literature. Relatives of patients with Crohn's disease are ten times more likely to suffer from that disease than those of healthy families. Familial accumulation of Crohn's disease can possibly be explained by genetic factors. Other factors like autoimmunological processes, infections, overnutrition and deficient composition of alimentation with refined carbohydrates might start Crohn's diseases in these families.

  10. Incidence of respiratory distress syndrome

    International Nuclear Information System (INIS)

    Ghafoor, T.; Mahmud, S.; Ali, S.; Dogar, S.A.

    2003-01-01

    Objective: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies. Subjects and Methods: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study. Results: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births. 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%). Conclusion: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world. (author)

  11. [Skin cancer incidence in Zacatecas].

    Science.gov (United States)

    Pinedo-Vega, José Luis; Castañeda-López, Rosalba; Dávila-Rangel, J Ignacio; Mireles-García, Fernando; Ríos-Martínez, Carlos; López-Saucedo, Adrián

    2014-01-01

    Skin cancer is the most frequent cancer related to ultraviolet radiation. The aim was to estimate the incidence of skin cancer type, melanoma and non-melanoma in Zacatecas, Mexico. An epidemiological study was carried out during the period from 2008 to 2012. The data were obtained from the Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Secretaría de Salud de Zacatecas (SSZ) and a private source, the Centro Médico Alameda. The incidence and the global prevalence were estimated. We studied 958 skin cancer cases, histopathologically confirmed. The cases were distributed as: 63.6 % basal cell carcinomas, 25.8 % squamous cell carcinomas, and 10.6 % melanoma. Significantly higher proportions were observed in women in the basal cell carcinomas (60.4 %) and squamous cell carcinomas (53.4 %). However, in the case of melanoma, the major proportion was observed in men (55.9 %). The more frequent skin cancer location was the face and for basal cell carcinoma was the nose (53 %); for squamous cell carcinomas were the lips (36 %), and for melanoma it was also the nose (40 %). The skin cancer incidence was estimated in 20 cases for each 100 000 inhabitants. Linear regression analysis showed that the skin cancer is increasing at an annual rate of 10.5 %. The anatomical location indicates that solar UV radiation is a risk factor, since the face is the zone with major exposure to solar radiation.

  12. [Burns care following a nuclear incident].

    Science.gov (United States)

    Bargues, L; Donat, N; Jault, P; Leclerc, T

    2010-09-30

    Radiation injuries are usually caused by radioactive isotopes in industry. Detonations of nuclear reactors, the use of military nuclear weapons, and terrorist attacks represent a risk of mass burn casualties. Ionizing radiation creates thermal burns, acute radiation syndrome with pancytopenia, and a delayed cutaneous syndrome. After a latency period, skin symptoms appear and the depth of tissue damages increase with dose exposure. The usual burn resuscitation protocols have to be applied. Care of these victims also requires assessment of the level of radiation, plus decontamination by an experienced team. In nuclear disasters, the priority is to optimize the available resources and reserve treatment to patients with the highest probability of survival. After localized nuclear injury, assessment of burn depth and surgical techniques of skin coverage are the main difficulties in a burn centre. Training in medical facilities and burn centres is necessary in the preparation for management of the different types of burn injuries.

  13. Spatio-seasonal modeling of the incidence rate of malaria in Mozambique

    Directory of Open Access Journals (Sweden)

    Nhalungo Delino

    2008-10-01

    Full Text Available Abstract Background The objective was to study the seasonal effect on the spatial distribution of the incidence of malaria in children under 10 years old living in the Manhiça district, Mozambique. Methods The data of the clinical malaria incidence were obtained from a study of two cohorts of children followed from December 1996 to July 1999. The cases were obtained by the active detection method. Hierarchical Bayesian models were used to model the incidence of malaria, including spatial correlation nested to climatic season. The models were compared with the deviance information criterion. The age and gender of the children were also taken into account. Results The incidence of malaria is associated with age, period and climate season. The incidence presents a clear spatial pattern, with a higher incidence in the neighbourhoods situated in the north and northeast of the Manhiça area. The transmission of malaria is highest during the wet season but the spatial pattern of malaria does not differ from that during the dry season. Conclusion The incidence of malaria in Manhiça presents a spatial pattern which is independent of the seasonal climatic conditions. The climate modifies the incidence of malaria in the entire region but does not change the spatial pattern of the incidence of this disease. These findings may be useful for the planning of malaria control activities. These activities can be performed taking account that the neighbourhoods with more incidence of malaria do not change over the annual climate seasons.

  14. Conference Planning.

    Science.gov (United States)

    Burke, W. Warner, Ed.; Beckhard, Richard, Ed.

    This book, written to instruct in the use of a conference as a medium of social intercourse, is divided into four sections. Section I, which contains five articles, deals with factors to be considered in planning a conference. Specific techniques one can employ to improve a conference and several different techniques for evaluating the…

  15. Method paper--distance and travel time to casualty clinics in Norway based on crowdsourced postcode coordinates: a comparison with other methods.

    Science.gov (United States)

    Raknes, Guttorm; Hunskaar, Steinar

    2014-01-01

    We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times.

  16. Data on incident solar energy

    Science.gov (United States)

    Thekaekara, M. P.

    1974-01-01

    Instrumentation for solar irradiance monitoring, and radiation scales are discussed in a survey of incident solar energy data. The absolute accuracy and intrinsic reliability of the values of the solar constant and zero air mass solar spectrum proposed by the Institute of Environmental Sciences as an ASTM standard are evaluated. Extraterrestrial observations are used for deriving solar irradiance data at ground level for widely varying atmospheric parameters, with special reference to air pollution. The effects of diffuse sky radiance and those of varying slopes of the solar energy collecting surface are examined. Average values of solar energy available at different locations in the United States are included.

  17. Grazing incidence diffraction : A review

    Energy Technology Data Exchange (ETDEWEB)

    Gilles, B. [LTPCM, ENSEEG. St. Martin d`Heres. (France)

    1996-09-01

    Different Grazing Incidence Diffraction (GID) methods for the analysis of thin films and multilayer structures are reviewed in three sections: the reflectivity is developed in the first one, which includes the non-specular diffuse scattering. The second one is devoted to the extremely asymmetric Bragg diffraction and the third one to the in-plane Bragg diffraction. Analytical formulations of the scattered intensities are developed for each geometry, in the framework of the kinetical analysis as well as the dynamical theory. Experimental examples are given to illustrate the quantitative possibility of the GID techniques.

  18. Factors Associated with Incidence of Induced Abortion in Hamedan, Iran.

    Science.gov (United States)

    Hosseini, Hatam; Erfani, Amir; Nojomi, Marzieh

    2017-05-01

    There is limited reliable information on abortion in Iran, where abortion is illegal and many women of reproductive age seek clandestine abortion to end their unintended pregnancy. This study aims to examine the determinants of induced abortion in the city of Hamedan, Iran. The study utilizes recent data from the 2015 Hamedan Survey of Fertility, conducted in a representative sample of 3,000 married women aged 15-49 years in the city of Hamedan, Iran. Binary logistic regression models are used to examine factors associated with the incidence of abortion. Overall, 3.8% of respondents reported having had an induced abortion in their life. Multivariate results showed that the incidence of abortion was strongly associated with women's education, type of contraceptive and family income level, after controlling for confounding factors. Women using long-acting contraceptive methods, those educated under high school diploma or postsecondary education, and those with high level of income were more likely to report having an induced abortion. The high incidence of abortion among less or more educated women and those with high income level signifies unmet family planning needs among these women, which must be addressed by focused reproductive health and family planning programs.

  19. Incident investigation team report: K-reactor D20 spill

    Energy Technology Data Exchange (ETDEWEB)

    Enis, E.

    1990-12-31

    This report discusses a spill of approximately 20 gallons of D2O (moderator) which occurred on February 7, 1990, at 0008 hours. The spill occurred while construction was removing process water lines from the 5B heat exchanger at a location referred to as a Rams Horn to allow the heat exchanger to be realigned. The heat exchangers in the other systems (loops) had been successfully disconnected (lines broken) during the previous two months and had been realigned without incident under the control of job plans similar to the System 5 job plan. Construction personnel reacted positively at the time the spill and successfully rebolted and tightened the leaking flanges on 5B and later on the 5A heat exchangers. This initial reaction stopped the leak and prevented a more severe incident. The spill incident resulted in a Site Alert declaration by the Shift Manager at 0220 hours when the Stack Tritium Monitor indicated a tritium release which exceeded the limits specified. After the event it was determined that a Temporary Procedure Change (TPC) to this DPSOL, had been approved and issued in April 1989. Had this TPC been available to the Shift Manager, the alert would not have been declared. Although the environmental impact of this event was negligible with no real radiological consequences minimal, the causal factors and programmatic deficiencies identified by this investigation show significant weakness in some critical areas.

  20. Incident investigation team report: K-reactor D20 spill

    Energy Technology Data Exchange (ETDEWEB)

    Enis, E.

    1990-01-01

    This report discusses a spill of approximately 20 gallons of D2O (moderator) which occurred on February 7, 1990, at 0008 hours. The spill occurred while construction was removing process water lines from the 5B heat exchanger at a location referred to as a Rams Horn to allow the heat exchanger to be realigned. The heat exchangers in the other systems (loops) had been successfully disconnected (lines broken) during the previous two months and had been realigned without incident under the control of job plans similar to the System 5 job plan. Construction personnel reacted positively at the time the spill and successfully rebolted and tightened the leaking flanges on 5B and later on the 5A heat exchangers. This initial reaction stopped the leak and prevented a more severe incident. The spill incident resulted in a Site Alert declaration by the Shift Manager at 0220 hours when the Stack Tritium Monitor indicated a tritium release which exceeded the limits specified. After the event it was determined that a Temporary Procedure Change (TPC) to this DPSOL, had been approved and issued in April 1989. Had this TPC been available to the Shift Manager, the alert would not have been declared. Although the environmental impact of this event was negligible with no real radiological consequences minimal, the causal factors and programmatic deficiencies identified by this investigation show significant weakness in some critical areas.

  1. Planning Inequality

    DEFF Research Database (Denmark)

    Mandersheid, Katharina; Richardson, Tim

    2011-01-01

    While traces and techniques of power and contestation around the understanding and production of spaces are clearly recognized in the sociological and planning research literature, there has been little rigorous attention to how socio-spatial inequality is put at stake in strategic mobilization...... around particular spatial imaginaries. In an analysis of the German Spatial Planning Report, the paper examines how inequalities are represented in relation to space and movement in spatial strategy. The analysis shows how, in the report, the spatial dimension of the social is represented...... as a territorial container, in which the social merges into regional and national entities. Correspondingly, movement is only interpreted as a derived demand, ignoring its integrative aspect as precondition of participation and part of network capital. On the other hand, the spatiality of the economy...

  2. USFA NFIRS 2013 Fire Incident & Cause Data

    Data.gov (United States)

    Department of Homeland Security — The 2013 Fire Causes & Incident data was provided by the U.S. Fire Administration’s (USFA) National Fire Data Center’s (NFDC’s) National Fire Incident Reporting...

  3. Increasing incidence of diabetes after gestational diabetes

    DEFF Research Database (Denmark)

    Lauenborg, Jeannet; Hansen, Torben; Jensen, Dorte Møller

    2004-01-01

    To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes....

  4. Ionospheric Oblique Incidence Soundings by Satellites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The oblique incidence sweep-frequency ionospheric sounding technique uses the same principle of operation as the vertical incidence sounder. The primary difference...

  5. Big plans.

    Science.gov (United States)

    Fitch, Kevin F; Doyle, James F

    2005-09-01

    In Elmhurst Memorial Healthcare's capital planning method: Future replacement costs of assets are estimated by inflating their historical cost over their lives. A balanced model is created initially based on the assumption that rates of revenue growth, inflation, investment income, and interest expense are all equal. Numbers then can be adjusted to account for possible variations, such as excesses or shortages in investment or debt balances.

  6. Strategic plan

    International Nuclear Information System (INIS)

    1993-01-01

    In November 1989, the Office of Environmental Restoration and Waste Management (EM) was formed within the US Department of Energy (DOE). The EM Program was born of the recognition that a significant national effort was necessary to clean up over 45 years' worth of environmental pollution from DOE operations, including the design and manufacture of nuclear materials and weapons. Within EM, the Deputy Assistant Secretary for Environmental Restoration (EM-40) has been assigned responsibility for the assessment and cleanup of areas and facilities that are no longer a part of active DOE operations, but may be contaminated with varying levels and quantifies of hazardous, radioactive, and n-mixed waste. Decontamination and decommissioning (D ampersand D) activities are managed as an integral part of Envirorunental Restoration cleanup efforts. The Office of Environmental Restoration ensures that risks to the environment and to human health and safety are either eliminated or reduced to prescribed, acceptable levels. This Strategic Plan has been developed to articulate the vision of the Deputy Assistant Secretary for Environmental Restoration and to crystallize the specific objectives of the Environmental Restoration Program. The document summarizes the key planning assumptions that guide or constrain the strategic planning effort, outlines the Environmental Restoration Program's specific objectives, and identifies barriers that could limit the Program's success

  7. Increasing incidence of diabetes after gestational diabetes

    DEFF Research Database (Denmark)

    Lauenborg, Jeannet; Hansen, Torben; Jensen, Dorte Møller

    2004-01-01

    To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes.......To study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes....

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

    Science.gov (United States)

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

    2015-04-01

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

  9. Parkinson's disease incidence: magnitude, comparability, time trends.

    Science.gov (United States)

    de Pedro-Cuesta, J; Stawiarz, L

    1991-11-01

    In this study, we reviewed incidence surveys of Parkinson's Disease (PD) from all over the world, published during the period 1945-1989, using reported quality criteria. In addition, we compared age-specific PD incidences from selected observations by stratified analysis. Crude incidences were described for 11 populations, and age-specific incidences for three of them: Iceland, Rochester (Minn, USA), and Turku (Finland). Effect modification by age was detected: a) by comparing incidences by age at diagnosis with incidence by age at clinical disease onset; and b) when only data on onset of disease was computed. For disease onsets, the incidences in Rochester for the period 1955-1966, and in Turku (Finland) during the interval 1968-1970, were lower than that in Iceland for the period 1958-1960: RR = 0.58 95% CI (0.41, 0.83), and RR = 0.67 95% CI (0.51, 0.87), respectively. For the Rochester population aged 40-69 years, a statistically significant 56% decrease in the incidences of Parkinsonism onsets during the period 1945-1966 was found. Validity problems in comparing PD incidences and the role of PD underdiagnosis were emphasized. We concluded that: a) stratified analysis is more suitable than standardization when comparing incidences for etiological purposes; b) the incidence of PD was highest in Iceland; and c) in Rochester, PD incidence under the age of 70 decreased with time.

  10. The psychosocial work environment and incident diabetes in Ontario, Canada.

    Science.gov (United States)

    Smith, P M; Glazier, R H; Lu, H; Mustard, C A

    2012-09-01

    Relatively few longitudinal studies have explored the relationship between psychosocial work conditions and diabetes incidence. Given the increasing global burden of diabetes this is an important area for public health research. To examine the relationships between dimensions of the psychosocial work environment on the subsequent incidence of diabetes among men and women in Ontario, Canada over a 9 year period. We used data from Ontario respondents (35 to 60 years of age) to the 2000-01 Canadian Community Health Survey linked to the Ontario Health Insurance Plan database for physician services and the Canadian Institute for Health Information Discharge Abstract Database for hospital admissions. Our sample of actively employed labour market participants with no previous diagnoses for diabetes was followed for a 9 year period to ascertain incident diabetes. There were 7443 participants. Low levels of job control were associated with an increased risk of diabetes among women, but not among men. Counter to our hypotheses high levels of social support were also associated with increased diabetes risk among women, but not among men. No relationship was found between any psychosocial work measure and risk of diabetes among men. Given the increasing prevalence of diabetes worldwide, job control could potentially be an import ant modifiable risk factor to reduce the incidence of diabetes among female, but not among male, workers. More research is needed to understand the pathways through which low social support may protect against the development of diabetes.

  11. TB incidence in an adolescent cohort in South Africa.

    Directory of Open Access Journals (Sweden)

    Hassan Mahomed

    Full Text Available BACKGROUND: Tuberculosis (TB is a major public health problem globally. Little is known about TB incidence in adolescents who are a proposed target group for new TB vaccines. We conducted a study to determine the TB incidence rates and risk factors for TB disease in a cohort of school-going adolescents in a high TB burden area in South Africa. METHODS: We recruited adolescents aged 12 to 18 years from high schools in Worcester, South Africa. Demographic and clinical information was collected, a tuberculin skin test (TST performed and blood drawn for a QuantiFERON TB Gold assay at baseline. Screening for TB cases occurred at follow up visits and by surveillance of registers at public sector TB clinics over a period of up to 3.8 years after enrolment. RESULTS: A total of 6,363 adolescents were enrolled (58% of the school population targeted. During follow up, 67 cases of bacteriologically confirmed TB were detected giving an overall incidence rate of 0.45 per 100 person years (95% confidence interval 0.29-0.72. Black or mixed race, maternal education of primary school or less or unknown, a positive baseline QuantiFERON assay and a positive baseline TST were significant predictors of TB disease on adjusted analysis. CONCLUSION: The adolescent TB incidence found in a high burden setting will help TB vaccine developers plan clinical trials in this population. Latent TB infection and low socio-economic status were predictors of TB disease.

  12. The causes and circumstances of drinking water incidents impact consumer behaviour: Comparison of a routine versus a natural disaster incident.

    Science.gov (United States)

    Rundblad, Gabriella; Knapton, Olivia; Hunter, Paul R

    2014-11-18

    When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two "Boil Water" notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine "Boil Water" notice. Findings were then compared to a previous study that explored drinking water behaviour during a "Boil Water" notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.

  13. The Causes and Circumstances of Drinking Water Incidents Impact Consumer Behaviour: Comparison of a Routine versus a Natural Disaster Incident

    Science.gov (United States)

    Rundblad, Gabriella; Knapton, Olivia; Hunter, Paul R.

    2014-01-01

    When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3%) than the routine incident (35.4%). For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food. PMID:25411725

  14. The Causes and Circumstances of Drinking Water Incidents Impact Consumer Behaviour: Comparison of a Routine versus a Natural Disaster Incident

    Directory of Open Access Journals (Sweden)

    Gabriella Rundblad

    2014-11-01

    Full Text Available When public health is endangered, the general public can only protect themselves if timely messages are received and understood. Previous research has shown that the cause of threats to public health can affect risk perception and behaviours. This study compares compliance to public health advice and consumer behaviour during two “Boil Water” notices issued in the UK due to a routine incident versus a natural disaster incident. A postal questionnaire was sent to 1000 randomly selected households issued a routine “Boil Water” notice. Findings were then compared to a previous study that explored drinking water behaviour during a “Boil Water” notice issued after serious floods. Consumers affected by the routine incident showed a significant preference for official water company information, whereas consumers affected by the natural disaster preferred local information sources. Confusion over which notice was in place was found for both incidents. Non-compliance was significantly higher for the natural disaster (48.3% than the routine incident (35.4%. For the routine incident, compliance with advice on drinking as well as preparing/cooking food and brushing teeth was positively associated with receiving advice from the local radio, while the opposite was true for those receiving advice from the water company/leaflet through the post; we suggest this may largely be due to confusion over needing boiled tap water for brushing teeth. No associations were found for demographic factors. We conclude that information dissemination plans should be tailored to the circumstances under which the advice is issued. Water companies should seek to educate the general public about water notices and which actions are safe and unsafe during which notice, as well as construct and disseminate clearer advice on brushing teeth and preparing/cooking food.

  15. Disparities in the incidence of acute myocardial infarction: long-term trends from the Hunter region.

    Science.gov (United States)

    Davies, Allan J; Naudin, Crystal; Al-Omary, Mohammed; Khan, Arshad; Oldmeadow, Chris; Jones, Mark; Bastian, Bruce; Bhagwandeen, Rohan; Fletcher, Peter; Leitch, James; Boyle, Andrew

    2017-05-01

    Trends in the incidence of acute myocardial infarction (AMI) provide important information for healthcare providers and can allow for accurate planning of future health needs and targeted interventions in areas with an excess burden of cardiovascular disease. To investigate the regional variations in AMI incidence in the Hunter region. Incident cases of AMI identified between 1996 and 2013 from the Hunter New England Health Cardiac and Stroke Outcomes Unit were prospectively collected for this study. We calculated crude and age-adjusted incidence of AMI over an 18-year period and explored differences in remoteness, age, sex and indigenous status. During 1996-2013, a total of 15 480 cases of AMI were identified. There was a significantly higher incidence of AMI in patients from regional areas compared to patients from metropolitan areas. More importantly, while rates of AMI declined by 28% in metropolitan patients, they increased by 8% in regional patients. Males had higher rates of AMI throughout the study period than females, however there was trend over time towards a reduction in AMI incidence in males that was not seen in females. The age-adjusted incidence of AMI for indigenous patients increased by 48% from 2007 to 2013, compared to a 23% decrease in non-indigenous patients. Between 1996 and 2013 in the Hunter region, the adjusted incidence of AMI increased for regional patients compared to metropolitan patients with a trend towards a higher adjusted incidence of AMI in the indigenous population. © 2017 Royal Australasian College of Physicians.

  16. Geographical Variations and Trends in Major Cancer Incidences throughout Korea during 1999-2013.

    Science.gov (United States)

    Won, Young-Joo; Jung, Kyu-Won; Oh, Chang-Mo; Park, Eun-Hye; Kong, Hyun-Joo; Lee, Duk Hyoung; Lee, Kang Hyun

    2018-01-04

    We aimed to describe the temporal trends and district-level geographical variations in cancer incidences throughout Korea during 1999-2013. Data were obtained from the Korean National Cancer Incidence Database. We calculated the age-standardized cumulative cancer incidences according to sex and geographical region (metropolitan cities, provinces, and districts) for three 5-year periods (1999-2003, 2004-2008, and 2009-2013). Each quintile interval contained the same number of regions. Disease maps were created to visualize regional differences in the cancer incidences. Substantial differences in cancer incidences were observed according to district and cancer type. The largest variations between geographical regions were found for thyroid cancer among both men and women. There was little variation in the incidences of stomach, colorectal, and lung cancer according to geographical region. Substantially elevated incidences of specific cancers were observed in Jeollanam-do (thyroid); Daejeon (colorectum); Jeollanam-do, Gyeongsangbuk-do, and Chungcheongbuk-do (lung); Seocho-gu, Gangnam-gu, and Seongnam, Bundang-gu (breast and prostate); Chungcheong and Gyeongsang provinces (stomach); Ulleung-gun and the southern districts of Gyeongsangnam-do and Jeollanam-do (liver); and along the Nakdonggang River (gallbladder and biliary tract). Mapping regional cancer incidences in Korea allowed us to compare the results according to geographical region. Our results may facilitate the development of infrastructure for systematic cancer incidence monitoring, which could promote the planning and implementation of region-specific cancer management programs.

  17. Plan Repair using a Plan Library

    NARCIS (Netherlands)

    Van der Krogt, R.P.J.; De Weerdt, M.M.

    2005-01-01

    Plan library's have proven their added value to the efficiency of planning. In this paper, we present results on the use of a plan library to plan repair. We show that using a relatively simple library, we can already obtain significant improvements in efficiency compared to plan repair without a

  18. Incidence of invasive Haemophilus influenzae type b disease in Italian children

    International Nuclear Information System (INIS)

    Tozzi, Alberto E.; Salmaso, Stefania; Atti, Marta L. Ciofi degli; Panei, Pietro; Anemona, Alessandra; Scuderi, Gabriella; Wassilak, Steven G.F.

    1997-01-01

    To estimate the incidence of Haemophilus influenzae type b (Hib) invasive disease in Italian infants we performed a prospective study in a cohort of newborns enrolled for a randomized trial on safety and efficacy of three pertussis vaccines and followed for onset of serious disease or pertussis. The overall cumulative incidence observed in 15,601 children was 51.3/100,000 for all invasive Hib infections and 38.4/100,000 for Hib meningitis, over 27 months of observation. The incidence density of all invasive Hib diseases was 28.7/100,000 person-years, while meningitis occurred with an incidence of 21.5/100,000 person-years. Among the eight cases detected, six were meningitis, one sepsis, and one cellulitis. The child with sepsis died. The incidence and epidemiology of invasive Hib disease in Italy are comparable to those reported from other European countries. Cost-benefit analyses are needed for planning Italian vaccination policy

  19. USCG Injury

    Data.gov (United States)

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

  20. USCG Other Events

    Data.gov (United States)

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

  1. USCG Vessel Events

    Data.gov (United States)

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

  2. USCG Vessel Pollution

    Data.gov (United States)

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

  3. USCG Facility Pollution

    Data.gov (United States)

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

  4. USCG Vessel

    Data.gov (United States)

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

  5. Responding to a biological incident

    Energy Technology Data Exchange (ETDEWEB)

    Campagna, P.R. [U.S. Environmental Response Team, Office of Superfund Remediation and Technology Innovation, Edison, NJ (United States)

    2005-07-01

    The U.S. Environmental Protection Agency's Environmental Response Team (ERT) was established in October 1978 to provide technical assistance to a variety of governmental agencies in the area of environmental emergency issues such as chemical spills, uncontrolled hazardous waste site and terrorist incidents. This paper describes responses to a biological incident that occurred on July 29 2004, when the United States Department of Agriculture (USDA) received an anonymous e-mail identifying 3 containers on board the M/V Rio Puelo, one of which was said to contain a harmful biological substance. The containers were part of a 5 container shipment of Argentinian lemons bound for Canada. The vessel had a total of 2204 containers, of which 260 were loaded at the same port as the lemons. The containers were to be off-loaded at the Port of Newark and transported via truck to Canada. The federal On-Scene Coordinator (OSC) was responsible for managing this incident, as well as assessing the creditability of the threat. In accordance with federal authorities under the Public Water Safety Act, the Captain of the Port of New York ordered the vessel to anchor off shore. A tactical security operations team was dispatched to assess vessel security. It was determined that none of the crew, who had been exposed to the potential agent 10 days earlier, had shown any symptoms of biological warfare agents. A multi-agency unified command was set up, consisting of state, federal and local agencies. Various options were evaluated, including treatment of the containers on board due to the possibility of a dispersal device which could cause wide-spread contamination; the off loading and disposal of the cargo into the sea; and off loading of containers on shore with subsequent treatment. The following safety precautions were taken: cooling units were shut off 48 hours before sailing; the vents were sealed and closed; and the drains were plugged. At the port, trained dogs were used, and

  6. A Case Study in the Identification of Critical Factors Leading to Successful Implementation of the Hospital Incident Command System

    Science.gov (United States)

    2015-06-01

    Industrial Hygienist  Industrial Hygienist  Infectious Disease Specialist  Infection Control  Epidemiology  Chief of Staff  Chief of...0 Receive briefing from Casualty Care Unit Leader 0 Establish Minor Care in Cafeteria -Obtain Minor Casualty Care Cache 0 Organize and lead medical

  7. Incidence of sialolithiasis in Denmark

    DEFF Research Database (Denmark)

    Schrøder, Stine Attrup; Andersson, Mikael; Wohlfahrt, Jan

    2017-01-01

    Sialolithiasis is a frequent disorder affecting the salivary glands. The incidence rate (IR) has been reported to be 2.9-5.5 per 100,000 person-years, but all previous studies have been based on selected hospital data. In this study, we conducted a population-based study evaluating the IR...... of sialolithiasis and the IR variation according to age, gender and geography in Denmark. We included data from hospitals as well as from private ear, nose and throat (ENT) clinics. The study was based on registry data on all sialolithiasis cases in Denmark between 2003 and 2009 extracted from the Danish National...... Patient Registry (hospital cohort) and the Danish Regions Centre for Healthcare Statistics (private ENT clinic cohort). To validate the diagnosis, the proportion of visually confirmed cases was estimated based on patient records from subsamples of the two cohorts. The IR was 7.27 and 14.10 per 100...

  8. An introduction to incidence geometry

    CERN Document Server

    De Bruyn, Bart

    2016-01-01

    This book gives an introduction to the field of Incidence Geometry by discussing the basic families of point-line geometries and introducing some of the mathematical techniques that are essential for their study. The families of geometries covered in this book include among others the generalized polygons, near polygons, polar spaces, dual polar spaces and designs. Also the various relationships between these geometries are investigated. Ovals and ovoids of projective spaces are studied and some applications to particular geometries will be given. A separate chapter introduces the necessary mathematical tools and techniques from graph theory. This chapter itself can be regarded as a self-contained introduction to strongly regular and distance-regular graphs. This book is essentially self-contained, only assuming the knowledge of basic notions from (linear) algebra and projective and affine geometry. Almost all theorems are accompanied with proofs and a list of exercises with full solutions is given at the end...

  9. RADIATION CONTAMINATION INCIDENT AT ISOLDE

    CERN Multimedia

    2000-01-01

    On 27 June 2000 three specialists were investigating a problem with the extraction electrode of the high-resolution separator (HRS) in Isolde. Whilst using an endoscope in order to have a closer look at the interior, they came into contact with radioactive dust and became contaminated. The level of contamination was low and the radiation dose received by the 3 persons was far below the effective dose limit given in the CERN Radiation Safety Manual and in the regulations of the Host States.According to the usual procedure, the Director General has set up a Fact-Finding Group and an Accident Board in order to advise him on the steps and decisions tobe taken following this incident and in particular to avoid a recurrence.

  10. The Jarvis gas release incident

    International Nuclear Information System (INIS)

    Manocha, J.

    1992-01-01

    On 26 September, 1991, large volumes of natural gas were observed to be leaking from two water wells in the Town of Jarvis. Gas and water were being ejected from a drilled water well, at which a subsequent gas explosion occurred. Measurements of gas concentrations indicated levels far in excess of the lower flammability limit at several locations. Electrical power and natural gas services were cut off, and residents were evacuated. A state of emergency was declared, and gas was found to be flowing from water wells, around building foundations, and through other fractures in the ground. By 27 September the volumes of gas had reduced substantially, and by 30 September all residents had returned to their homes and the state of emergency was cancelled. The emergency response, possible pathways of natural gas into the aquifer, and public relations are discussed. It is felt that the likelihood of a similar incident occurring in the future is high. 11 figs

  11. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical?

    DEFF Research Database (Denmark)

    Maaløe, R; la Cour, M; Hansen, A

    2006-01-01

    The purpose of the present study was to measure the incidence and type of incidents that occurred in relation to anaesthesia and surgery during a 1-year period in six Danish hospitals. Furthermore, we wanted to identify risk factors for incidents, as well as risk factors for incidents being deemed...

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

    International Nuclear Information System (INIS)

    Guidry, R.J.

    2006-01-01

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

  13. Incidence of Stingers in Young Rugby Players.

    Science.gov (United States)

    Kawasaki, Takayuki; Ota, Chihiro; Yoneda, Takeshi; Maki, Nobukazu; Urayama, Shingo; Nagao, Masashi; Nagayama, Masataka; Kaketa, Takefumi; Takazawa, Yuji; Kaneko, Kazuo

    2015-11-01

    A stinger is a type of neurapraxia of the cervical roots or brachial plexus and represents a reversible peripheral nerve injury. The incidence of and major risk factors for stingers among young rugby players remain uninvestigated. To investigate the incidence, symptoms, and intrinsic risk factors for stingers in elite rugby union teams of young players. Descriptive epidemiology study. A total of 569 male rugby players, including 358 players from 7 high school teams and 211 players from 2 university teams, were investigated using self-administered preseason and postseason questionnaires. The prevalence of a history of stingers was 33.9% (95% CI, 30.3-37.9), and 20.9% (119/569) of players experienced at least 1 episode of a stinger during the season (34.2 [95% CI, 26.2-42.1] events per 1000 player-hours of match exposure). The reinjury rate for stingers per season was 37.3% (95% CI, 30.4-44.2). Using the multivariate Poisson regression method, a history of stingers in the previous season and the grade and position of the player were found to be risk factors for stingers during the current season. The mean severity of injury was 2.9 days, with 79.3% (191/241) of the players not losing any time from playing after sustaining a stinger injury and 5.8% (14/241) of the players recovering within more than 14 days. The most frequent symptom was numbness in the unilateral upper extremity, and the most severe symptom was weakness of grasping (mean severity, 6 days). A logistic regression analysis indicated that a history of stingers in the previous season and an injury with more than 3 symptoms, especially motor weakness, were correlated with the severity of injury. Young rugby players with a history of stingers have a significantly high rate of repeat injuries. Although nearly 80% of the players experienced only minimal (0-1 day) time loss injuries, neurological deficits sometimes last beyond 1 month. A history of stingers was identified to be the strongest risk factor for

  14. Multiemployer Pension Plans

    Data.gov (United States)

    Pension Benefit Guaranty Corporation — This spreadsheet lists the active multiemployer pensions plans insured by PBGC. Plans are identified by name, employer identification number (EIN) and plan number...

  15. The Local Agenda 21 Planning Guide: An Introduction to ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Couverture du livre The Local Agenda 21 Planning Guide: An Introduction to Sustainable Development Planning. Auteur(s) : International Council for Local ... La recherche sur les incidences et les impacts des technologies de l'information et de la communication (TIC) sur le développement social et humain est ...

  16. How to maintain a business continuity despite cyber incidents?

    Directory of Open Access Journals (Sweden)

    Đekić Milica D.

    2015-01-01

    Full Text Available Modern IT systems can bring a lot of advantages in terms of electronic commerce and governance as well as an automatic process control within industry, traffic and the other ways of classical and critical infrastructure. However, beside many advantages regarding technological development, there are also some drawbacks in sense of cyber risks, threats and the real hacker's attacks. In this article, we plan to deal with all these cyber risks caused by IT incidents and emergency situations that are capable to threaten a business continuity within big companies as well as medium and small enterprises.

  17. Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters.

    Science.gov (United States)

    Lennquist Montán, K; Hreckovski, B; Dobson, B; Örtenwall, P; Montán, C; Khorram-Manesh, A; Lennquist, S

    2014-08-01

    The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of

  18. A Serious Game for Massive Training and Assessment of French Soldiers Involved in Forward Combat Casualty Care (3D-SC1): Development and Deployment.

    Science.gov (United States)

    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

    2016-05-18

    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

  19. An Inter-regional US Blood Supply Simulation Model to Evaluate Blood Availability to Support Planning for Emergency Preparedness and Medical Countermeasures.

    Science.gov (United States)

    Simonetti, Arianna; Ezzeldin, Hussein; Walderhaug, Mark; Anderson, Steven A; Forshee, Richard A

    2017-08-23

    Planning for a response to threats like pandemics or mass casualty events is a national priority. The US blood supply system can be particularly vulnerable to such events. It is important to understand the impacts of emergency situations on blood availability and the resiliency of the US blood supply system. On the basis of the Stock-and-Flow simulation model of the US blood supply system, we developed an inter-regional blood transfer system representing the action of multiple blood collectors and distributors to enable effective planning of strategies to minimize collection and donation disruptions to the blood supply system in the event of a national emergency. We simulated a pandemic or mass casualty event on both a national and an inter-regional blood supply system. Differences in the estimated impacts demonstrated the importance of incorporating spatial and temporal variations of blood collection and utilization across US regions. The absence of blood shortage in both emergency scenarios highlighted the resilience of the inter-regional system to meet the potential associated blood demand. Our inter-regional model considered complex factors and can be a valuable tool to assist regulatory decision-making and strategic planning for emergency preparedness to avoid and mitigate associated adverse health consequences. (Disaster Med Public Health Preparedness. 2017;page 1 of 10).

  20. SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

    2014-06-15

    Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, including 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy.