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PubMed2004

Triage and management of mass casualties in a train accident.

OBJECTIVE: The purpose of this study was to assess the practicality and usefulness of different scoring systems of triage process in mass casualty management. DESIGN: Descriptive/observational. PLACE AND DURATION OF STUDY: An experience of management of train accident in Balochistan in the year 2003. SUBJECTS AND METHODS: One hundred and twenty-two patients injured in train accident of Quetta Express were included in the study. A trauma team reached the site of the accident. Triage was done at three levels. "Triage sieve" scoring system was used at the site of accident, "field categories of trauma patients" at Primary Health Care Centre, and "ATLS (Advanced Trauma Life Support) secondary survey" at tertiary referral centre. Helicopters and ambulances were used for evacuation of patients. RESULTS: There were 122 injured patients. " Triage sieve " system scored 14(11.47%) patients in priority I, 21(17.21%) patients in priority II, 80(65.57%) patients in priority III and 7(5.73%) dead individuals in priority IV at the site of accident. Casualties clearing time was three and half hours. By utilizing "field categories of trauma patients" at primary health care centre, 7(5.7%) patients were placed in category I who were air lifted, 19(15.57%) patients in category II, 89(72.95%) patients in category III and 7(5.73%) dead remained in category IV. Application of ATLS secondary survey in CMH, Quetta triaged 4(57.14) patients in priority I and 3(42.85) patients in priority II. There was only one death after the triage process started. CONCLUSION: Proper triage, appropriate resuscitation, and timely evacuation definitively decrease morbidity and mortality in trauma patients, and facilitates utilization of the available resources appropriately.

Accidents↗
PubMed1993

Railway surgery. Traumatology and managed health care in 19th-century United States.

Railway surgery was an organized movement in the late 19th century that had as its primary goal the systematic study of accident or trauma surgery. Railway surgeons, although often regarded with contempt by their fellow physicians, fostered such revolutionary concepts in health care provision as private inpatient hospitals and rudimentary managed care plans. Railway surgery and its proponents are a long-forgotten chapter in the history of US surgery, but they serve as an apt example of how studying and understanding the past can enable us to be better prepared to cope with the present and the future.

History, 19th Century↗
PubMed1999

Lung cancer risk in male workers occupationally exposed to diesel motor emissions in Germany.

BACKGROUND: Although in several epidemiological studies exposure to diesel motor emissions (DME) shows an elevated lung cancer risk, it is still controversial whether DME is a human carcinogen. METHODS: In a pooled analysis of two case-control studies on lung cancer in Germany a total of 3498 male cases with histologically or cytologically ascertained lung cancer and 3541 male population controls were included. Information about lifelong occupational and smoking history was obtained by questionnaire. Drivers of lorries, buses, taxies, diesel locomotives and forklift trucks, bulldozers, graders, excavators, and tractors, were considered as exposed to DME and their cumulative exposure was estimated. All odds ratios were adjusted for smoking and asbestos exposure. RESULTS: The evaluation of lung cancer risk for all jobs with DME-exposure combined showed an odds ratio of OR=1.43 (95%-CI: 1.23-1.67). Most pronounced was the increase in lung cancer risk in heavy equipment operators (OR=2. 31 95%-CI: 1.44-3.70). The risk of tractor drivers increased with length of employment and reached statistical significance for exposures longer than 30 years (OR=6.81, 95%-CI: 1.17-39.51). The group of professional drivers (e.g., trucks, buses, and taxies), showed an increased risk only in West Germany (OR=1.44, 95%-CI: 1. 18-1.76), but not in East Germany (OR=0.83, 95%-CI: 0.60-1.14). DME-exposure in other traffic related jobs (e.g., diesel engine locomotive drivers, switchmen, forklift operators) was associated with an odds ratio of OR=1.53 (95%-CI: 1.04-2.24). CONCLUSIONS: The study provides further evidence that occupational exposure to diesel motor emissions is associated with an increased lung cancer risk.

Aged↗
PubMed2000

A lantern color vision test for the rail industry.

BACKGROUND: Correct identification of wayside signal colors is critical for safe operation of railway equipment. However, evaluating color discrimination using just a screening test may not be occupationally relevant. METHODS: A lantern test (CNLAN) was designed to provide a functional assessment of color discrimination for the rail industry. It was validated against a simulated field trial. 81 individuals with normal color vision and 74 individuals with congenital red-green defects participated. Color vision was classified using the Nagel Anomaloscope. RESULTS: Using a criterion based on the worst-normal performance, 97% of the individuals with a color vision defect failed both the CNLAN and simulation trial. This value is slightly lower than the 100% who failed both the Ishihara test and simulation. However, the Ishihara test also failed 3.7% of the color-normals who passed both the simulation and lantern, whereas by definition none of the color-normals failed the lantern. CONCLUSIONS: This lantern test provides a reasonable functional assessment of one's ability to identify rail signal colors; especially when a strict failing criterion is applied to screening tests.

Accidents, Occupational↗
PubMed1985

Occupational deafness: the continuing challenge of early German and Scottish research.

Systematic studies in occupational deafness were first carried out in the late 19th century, in America, Germany, Russia, and Scotland. The studies by Gottstein and Kayser, in 1881 in Germany, and by Barr, in 1886 in Scotland, are identified as the two principal landmarks. The physicians who carried them out should be seen as occupying a place in the mainstream of development of industrial medicine. Gottstein and Kayser's study of personnel in a railway works reflected a contemporary concern about railway safety; Barr's, of boilermakers, a feeling for the difficulties in hearing in the everyday world experienced by the victims of occupational deafness. Barr's evaluation of such difficulties through self-report, we argue, reveals more of the quality of hearing handicap than the present century's apparently objective tests. Both studies relied on occupation-based epidemiology, which was able to identify occupational deafness, distinguish its etiology, and locate the site of its pathology. We argue that occupation-based epidemiology has since been neglected in favour of dose-response epidemiology to the detriment of research in occupational deafness and in industrial medicine generally. Dose-response epidemiology seems the more scientific but, in practice, it is afflicted by even more uncertainty than occupation-based epidemiology. To compound the uncertainty, there are two incompatible mathematical expressions for the dose-response relation for noise, both separately enshrined in legislation in various parts of the world. We conclude by advocating more secondary research in industrial medicine. Barr points us to a further topic for such research, the place of temporary threshold shift in the development of knowledge about occupational deafness as a problem for industrial medicine.

Germany↗
PubMed1986

A health examination of railway high-voltage substation workers exposed to ELF electromagnetic fields.

This is a cross-sectional survey on the health conditions of railways workers active in 258 interconnection and conversion substations all over Italy. Measurements performed in both kinds of substations operating at 220 kV have shown that maximum levels of the electric field strength and of the magnetic flux density at 50 Hz are of the order of 5 kV/m and 15 microT, respectively. Three subject groups, differently exposed (1, 10, 20 h/week), and an unexposed control group, for a total number of 627 workers, constitute the population at study. All subjects underwent a general medical examination, laboratory investigations, and a series of selected examinations relative to three systems (nervous, cardiovascular, and haematopoietic) considered at higher risk. No differences have been found between the exposed and the control groups. It is concluded that workers exposed to ELF electromagnetic fields of moderate strength do not show the presence of clear effects on their state of health.

Electromagnetic Fields↗
PubMed2003

Waveform magnetic field survey in Russian DC and Swiss AC powered trains: a basis for biologically relevant exposure assessment.

Recent epidemiological studies suggest a link between transport magnetic fields (MF) and certain adverse health effects. We performed measurements in workplaces of engineers on Russian DC and Swiss AC powered (16.67 Hz) electric trains using a computer based waveform capture system with a 200 Hz sampling rate. MF in DC and AC trains show complex combinations of static and varying components. The most probable levels of quasistatic MF (0.001-0.03 Hz) were in the range 40 microT. Maximum levels of 120 microT were found in DC powered locomotives. These levels are much higher than the geomagnetic field at the site of measurements. MF encountered both in DC and AC powered rail systems showed irregular temporal variability in frequency composition and amplitude characteristics across the whole frequency range studied (0-50 Hz); however, more than 90% of the magnetic field power was concentrated in frequencies </=16.67 Hz. In AC locomotives, such as the most popular engine Re 4/4 II, the major energy falls around the fundamental frequency 16.67 Hz, with an average magnetic field intensity of about 44 microT; moreover, a significant contribution (about 15%) is due to components below the fundamental frequency. In Russian DC powered trains amplitudes of field variations sharply decrease from static to approximately 3-4 Hz fields; for higher frequencies a tendency of slow decrease is observed up to 50 Hz. For frequencies higher than 1 Hz average amplitudes of magnetic field variations are less than 1 microT; maximum levels reach tens of microtesla. At frequencies lower than 15 Hz, the average magnetic field generated by Swiss AC powered locomotives was approximately 10 times greater than fields observed in Russian DC powered trains.

Electric Power Supplies↗