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PubMed1997

Method for the analysis of the methylphosphonic acid metabolites of sarin and its ethanol-substituted analogue in urine as applied to the victims of the Tokyo sarin disaster.

An analysis method for the methylphosphonic acid metabolites of sarin in urine using trimethylsilyl derivatization and flame photometric detection is described in this report. Authentic reference standards of isopropyl methylphosphonic acid (IMPA) and ethyl methylphosphonic acid (EMPA) as well as methylphosphonic acid were employed to estimate the concentration in human urine. A sample pretreatment procedure was developed for urine using a column of cation-loaded ion-exchange resins (Ag+ -, Ba2+ - or H+ -Dowex) and adjusting the pH of the eluate from the column to 3.75-3.85 improved recovery of the target compounds. The eluate was evaporated to dryness under vacuum prior to trimethylsilylation, to remove water and any hydroxy- or amino-carrying volatile substances. The sarin metabolites, because of their low volatility, were concentrated and could be derivatized for analysis. The use of synthesized authentic sarin and ethylsarin metabolites, i.e., IMPA and EMPA, made it possible to establish the necessary sample pretreatment procedures for derivatization and gas chromatography-flame photometric detection (GC-FPD) analysis. The detection limits were 0.025 ppm both for EMPA and [MPA, and 0.625 microM for MPA, respectively. This method can be useful for estimating the exposure level to sarin by assaying the metabolites in urine and it is applicable to a large numbers of samples.

Chemical Warfare Agents↗
PubMed1991

Intensive care of the crush victim. Part 1.

The victims of disasters, accidents and many forms of trauma are often trapped or wedged under and within rubble which can lead to crush injury. Prolonged immobility can also cause crush injury if the weight of a person's body compresses muscle and soft tissue for an extended period of time. Extensive muscular tissue pathology can result from the crush injury itself and once the pressure, or compressive force, is removed a predictable sequence of events can cause widespread haemodynamic and metabolic disturbances--the crush syndrome. Part one includes the mechanism of crush injury and the pathophysiology underlying the clinical manifestations of the crush syndrome. The aims of assessment and management are discussed as well as a brief review of the literature related to management of the local crush site and the potential problem of compartment syndrome. Part two involves a case study of a person who was trapped for 10-12 hours following a motor vehicle accident. This patient was transported to 2 country centres and then transferred to a major teaching hospital in Sydney. Discussions will centre on the classic nature of the case, and the findings and management strategies will be correlated with the literature. The implications for nursing practice are explored and include the need for astute assessment and monitoring based on a thorough understanding of the sequelae of crush. Interventions are aimed at minimising discomfort and reducing complications both at the local crush site and generalised systemic level. Close monitoring and interpretation of the patient's response to interventions is essential for the continuation of definitive care.

Critical Care↗
PubMedDate not supplied

Benchmarking for hospital evacuation: a critical data collection tool.

In events such as earthquakes or terrorist attacks, hospitals may be victims of disasters. They may need to transfer patients to outside facilities rather than continue to provide on-site care. Following the Northridge earthquake, eight hospitals in the damaged area were the foci of a United States National Science Foundation study that examined the status of the hospitals' pre-event planning, post-event evacuation decision-making, and internal and external evacuation processes. Building on this experience, this paper offers a standardized data collection tool, which will enable researchers to record hospital evacuation information in a systematic manner so that comparable data can be accumulated, evacuation research methods can be improved, and consensus on methods can be reached. The study's principal subjects include: (1) hospital demographics; (2) description of existing disaster response plans; (3) an event's impacts on hospital operations; (4) decision-making and incident command; (5) movement of patients within the facility; (6) movement of patients to off-site institutions; and (7) hospital recovery.

Benchmarking↗
PubMed1996

Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma.

OBJECTIVE: A century of clinical research has noted a range of trauma-related psychological problems that are not captured in the DSM-IV framework of posttraumatic stress disorder (PTSD). This study investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with "hysteria," which can be understood as problems with stimulus discrimination, self-regulation, and cognitive integration of experience. METHOD: The DSM-IV field trial for PTSD studied 395 traumatized treatment-seeking subjects and 125 non-treatment-seeking subjects who had also been exposed to traumatic experiences. Data on age at onset, the nature of the trauma, PTSD, dissociation, somatization, and affect dysregulation were collected. RESULTS: PTSD, dissociation, somatization, and affect dysregulation were highly interrelated. The subjects meeting the criteria for lifetime (but not current) PTSD scored significantly lower on these disorders than those with current PTSD, but significantly higher than those who never had PTSD. Subjects who developed PTSD after interpersonal trauma as adults had significantly fewer symptoms than those with childhood trauma, but significantly more than victims of disasters. CONCLUSIONS: PTSD, dissociation, somatization, and affect dysregulation represent a spectrum of adaptations to trauma. They often occur together, but traumatized individuals may suffer from various combinations of symptoms over time. In treating these patients, it is critical to attend to the relative contributions of loss of stimulus discrimination, self-regulation, and cognitive integration of experience to overall impairment and provide systematic treatment that addresses both unbidden intrusive recollections and these other symptoms associated with having been overwhelmed by exposure to traumatic experiences.

Adaptation, Psychological↗
PubMed2006

Venomous adversaries: a reference to snake identification, field safety, and bite-victim first aid for disaster-response personnel deploying into the hurricane-prone regions of North America.

Each hurricane season, emergency-preparedness deployment teams including but not limited to the Office of Force Readiness and Deployment of the US Public Health Service, Federal Emergency Management Agency, Deployment Medical Assistance Teams, Veterinary Medical Assistance Teams, and the US Army and Air Force National Guard are at risk for deploying into hurricane-stricken areas that harbor indigenous hazards, including those posed by venomous snakes. North America is home to 2 distinct families of venomous snakes: 1) Viperidae, which includes the rattlesnakes, copperheads, and cottonmouths; and 2) Elapidae, in which the only native species are the coral snakes. Although some of these snakes are easily identified, some are not, and many rank among the most feared and misunderstood animals. This article specifically addresses all the native species of venomous snakes that inhabit the hurricane-prone regions of North America and is intended to serve as a reference to snake identification, basic field safety procedures, and the currently recommended first-aid measures for snakebite casualties.

Animals↗
PubMed1998

Worst tornadoes in years: how hospitals fared; critical lessons learned.

Tornado warnings have not been uncommon in many areas of the country this year and when twisters touch down, they can be extremely deadly. When tornadoes swept through Florida's Osceola County in late February, they caused 38 deaths and wide-spread damage. In April, tornadoes caused a number of deaths and considerable damage in Nashville, TN; Birmingham, AL; and Gainesville, GA. Hospitals in those areas that bore the brunt of treatment of victims activated disaster plans. This report relates their experiences and the lessons learned from them.

Communication↗
PubMed2000

[Temporary work disability among firemen employed in rescue and fire brigades].

Workers of rescue and fire brigades participating in actions are exposed to harmful effect of toxic substances, chemicals or physical factors. They also experience enormous emotional shock evoked by direct threat or contact with victims of disasters and fires. The aim of the study was to define the pathology which increases the risk of temporary work disability among firemen. The study covered 150 firemen employed during the years 1994-97 in rescue and fire brigades selected at random. The data on the number of days and cases of work disability during the period of four years for each firemen covered by the study were analysed. In the group under study a mean annual number of work disability due to sickness accounted for 1443 days per 100 employed. The major causes of work disability were as follows: diseases of the respiratory system (22% of total sickness absenteeism); diseases of the nervous system and sense organs (19%); diseases of the musculoskeletal system (18%), diseases of the circulatory system (13%); mental disorders (8%); and diseases of digestive system (7%). Sickness absenteeism among workers of rescue and fire brigades was lower by 30% on average than that among men employed in the national economy. But in the 50-59 age group, it was higher by 68%. In this age group, the highest level of sickness absenteeism was associated with mental disorders (15 times higher than in other male occupational groups); diseases of the musculoskeletal system (higher by 53%); diseases of the respiratory system (2 times higher); neoplasms (7 times higher); diseases of the nervous system (higher by 46%). It should be stressed that the study revealed increased work disability due to lung (by 33%), bladder (6 times higher) and brain (over 3 times higher) cancers. The results of this study find their confirmation in many other epidemiological studies of this occupational group.

Adult↗
PubMedDate not supplied

[Issues related to the identification process of catastrophes victims].

Catastrophes on an international scale with an increasingly pronounced terrorist factor (for example, the terrorist attacks in the United States of America on September 11, 2001) are occurring with increasing frequency. This fact compels the international forensic medical community--especially at the present moment--to undertake coordinated and rapid measures in the area, closely related to our profession, of issues connected with problems of identifying the victims of catastrophes. To date organizational issues have not been harmonized to the required at an international level degree. The subject has been raised frequently at congresses and symposiums of forensic medicine. The real and present danger of catastrophes at a national and regional level demands the adoption of rapid organizational activities at these levels too. Because the victims of such catastrophes are often of various nationalities, these activities also demand urgent organizational harmonization in keeping with established international norms. The following article addresses this issue. It contains propositions in outline with the aim of presenting them to discussion. These suggestions refer solely to organizational activities on the regional, national, and international levels, connected with the issue of identification in the broad sense of the word.

Community Networks↗
PubMed1996

Hazardous materials. Disaster medical planning and response.

Hazardous materials offer a variety of unique challenges to emergency personnel. These agents have immense economic impact, but when mishandled, they become notorious for turning contained accidents into disasters involving the entire community. During a hazmat accident, the victims often ignore the rules of the disaster plan by seeking out the nearest hospital for medical care, regardless of that institution's capabilities. Health care workers rushing to the aid of contaminated individuals, without taking appropriate precautions (i.e., donning PPE), potentially make themselves victims. Disaster preparedness requires planning, policy, and procedure development, hazard analysis, training, and the availability of personal protective equipment for all responding personnel. Presently, the level of hazmat preparedness varies greatly among different hospitals, EMS and fire services, and disaster response teams. These differences in hazmat preparedness can be linked to a variety of factors (lack of awareness, funding, and support) and controversies (types of PPE and level of training required) which have prevented the establishment of a national hazmat policy for most of these organizations. Despite these difficulties, emergency departments continue to be the primary provider of care to contaminated individuals. As a result, emergency physicians must work with their hospital to implement a hazmat decontamination program in order to appropriately care for these individuals. The appendix to this article presents a list of recommendations for hospital hazmat preparedness. It is modeled after existing CDC and OSHA guidelines.

Decontamination↗
PubMed1980

An organizational concept for pathologic identification in mass disasters.

The process of identifying the victims of a mass disaster can be simplified if approached in a logical manner. The organizational concept used by the Armed Forces Institute of Pathology divides the process into four phases--preliminary evaluation, data collection, data analysis, and conclusion. Much flexibility is retained within each of these phases to enable general application, but major emphasis centers upon quality control. This control consists of multiple checks during the phases of data collection and analysis and confirmation of each identification by all available methods. An intensive effort must be made to obtain complete antemortem records and descriptions as soon as possible, for no identification will be possible without this comparison data. The values of a logical organizational flow are increased efficiency and accuracy of identification.

Accidents, Aviation↗
PubMedDate not supplied

[Post-traumatic stress disorder in survivors of the Agadir earthquake (Morocco) in 1960].

INTRODUCTION: Agadir City is geologically located on a seismic line. This city witnessed an earthquake in February 1960 with a magnitude of 6 degrees in Richter scale. During this disaster more than 17,000 people died and 60% of the town was destroyed. OBJECTIVES: Forty years later, the objective of this study was to assess post-traumatic stress disorders at the time of the disaster and currently among this population. METHODS: Two groups, matched by gender and age were included: 1) a group (G 1) of 80 earthquake survivors with an age varying from 45 to 70 years ; 2) a control group (G2) with 80 people who experienced accidental events other than the earthquake. The instruments used were: a questionnaire concerning socio-demographic data, and the Post-traumatic Stress Diagnosis Scale-Edna Foa-1995 for the diagnosis of PTSD which was translated in Moroccan Arabic language. The epidemiological survey was conducted in two steps during 13 months. The first step consisted in the inclusion of the first group: victims of the disaster. One hundred and two survivors were contacted and 80 accepted to participate in the study. The second step, concentrated on the inclusion of the other group, according to gender and age of the survivors group. All interviews were conducted in the homes of the participants. Data analysis was performed on a PC microcomputer using Epi info 6.04 French version (Center for disease control and prevention CDC, Atlanta, USA). The statistical analysis was based on the descriptive techniques of statistics. RESULTS: The main results were: 1) after the traumatic events and retrospectively, survivors from the earthquake had statistically more PTSD than G2: 38.8% vs 20%; 2) at the time of the study, the prevalence of PTSD between the two groups was not significantly different: 10% for the survivors of the earthquake vs 7.5% for G2 (victims of accidents) while the dates of trauma differed; 3) forty years later, the socio-professional life of the survivors was still perturbed. DISCUSSION: These results are in accordance with the literature, even if the methodological differences constitute a limiting factor for the comparison. Nevertheless, the persistence of symptoms of PTSD many years later might be explained by the severity of the trauma, the existence of external stimuli, such as the frequent tremors felt in Agadir, the noise, the storms, the earthquake happening in other cities...create a persistent state of hyper-vigilance which maintains and/or worsens the symptoms of PTSD. CONCLUSION: In conclusion, 40 years later, survivors are in need of care to overcome symptoms of PTSD. Preventive measures for victims of disasters should perhaps be developed.

Aged↗