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PubMedDate not supplied

The incident command system in disasters: evaluation methods for a hospital-based exercise.

OBJECTIVES: No universally accepted methods for objective evaluation of the function of the Incident Command System (ICS) in disaster exercises currently exist. An ICS evaluation method for disaster simulations was derived and piloted. METHODS: A comprehensive variable list for ICS function was created and four distinct ICS evaluation methods (quantitative and qualitative) were derived and piloted prospectively during an exercise. Delay times for key provider-victim interactions were recorded through a system of data collection using participant- and observer-based instruments. Two different post-exercise surveys (commanders, other participants) were used to assess knowledge and perceptions of assigned roles, organization, and communications. Direct observation by trained observers and a structured debriefing session also were employed. RESULTS: A total of 45 volunteers participated in the exercise that included 20 mock victims. First, mean, and last victim delay times (from exercise initiation) were 2.1, 4.0, and 9.3 minutes (min) until triage, and 5.2, 11.9, and 22.0 min for scene evacuation, respectively. First, mean, and last victim delay times to definitive treatment were 6.0, 14.5, and 25.0 min. Mean time to triage (and range) for scene Zones I (nearest entrance), II (intermediate) and III (ground zero) were 2.9 (2.0-4.0), 4.1 (3.0-5.0) and 5.2 (3.0-9.0) min, respectively. The lowest acuity level (Green) victims had the shortest mean times for triage (3.5 min), evacuation (4.0 min), and treatment (10.0 min) while the highest acuity level (Red) victims had the longest mean times for all measures; patterns consistent with independent rather than ICS-directed rescuer activities. Specific ICS problem areas were identified. CONCLUSIONS: A structured, objective, quantitative evaluation of ICS function can identify deficiencies that can become the focus for subsequent improvement efforts.

Communication↗
PubMed1994

A fatal disaster case based on exposure to hydrogen sulfide--an estimation of the hydrogen sulfide concentration at the scene.

Four adult men fell into an artificial lake which was being used to raise flatfish, after a water pipe had been connected to a tube allowing seawater to flow into the lake. Forensic autopsies were carried out on three of the four men, who died soon after the incident. From autopsy findings, the cause of death was diagnosed to be suffocation after aspirating seawater in the three victims. To clarify why the men fell into the lake, a chemical analysis for hydrogen sulfide was carried out using the extractive alkylation technique combined with gas chromatography/mass spectrometry. The sulfide was detected as its derivative, bis(pentafluorobenzyl)sulfide, in body tissues taken from all the victims, and the concentration of hydrogen sulfide gas at the scene was estimated as having been nearly fatal.

Adult↗
PubMed2001

Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey earthquake.

BACKGROUND/PURPOSE: The Marmara earthquake, which destroyed more than 150,000 buildings and caused 15,000 deaths and 40,000 casualties, resembled the Hanshin-Awaji earthquake in many respects. Previous reports from similar disasters from several centres have not addressed trauma in the pediatric age group. The aim of this study was to analyze the clinical and laboratory data of pediatric trauma patients referred to a tertiary center after the 1999 Marmara earthquake. METHODS: The medical records of 33 injured children, aged from 14 days to 16 years, were reviewed retrospectively. The time spent buried under rubble, type of injury, treatment given, complications, laboratory data, and development of acute renal failure (ARF) were noted. Patients in whom ARF developed were treated with a standard regimen of fluid replacement, alkalinization, and diuretics. Limbs with crush injuries were managed as conservatively as possible. RESULTS: All except 3 cases were evacuated from under the debris of collapsed buildings after 1 to 110 (mean, 30.04 +/- 6.48) hours. Seventy-eight percent were transported to our center within the first 3 days. Crush injury (CI) was present in 15 cases, and in 10 of them ARF had already developed by admission. Although serum levels of creatinine were elevated (1.2 to 5 mg/dL) in all cases with ARF, hyperkalemia was observed in only 4. The mean serum creatinine kinase (CK) level of cases with crush syndrome (CS) was 6,040 +/- 4,158 U/L. No significant correlations were detected between the development of CS, age, the time spent under the rubble, the time before admission, or the number of crushed extremities. CONCLUSIONS: CI and CS were the most common entities encountered among our pediatric patients after the 1999 Marmara earthquake. The high incidence of ARF indicates the importance of medical management of this age group during rescue. Because neither laboratory data nor clinical findings predicted CS in our patients, we recommend close observation and monitoring of children with CI for the development of ARF.

Acute Kidney Injury↗
PubMed2006

Estimation of stature from upper extremity.

With the increasing frequency of mass disasters, identification of an isolated upper extremity and determination of the stature of the person it belonged to have created problems for investigation of the identity of some victims. Despite a need for such a study, there is a lack of systematic studies to identify fragmented and dismembered human remains. The purpose of this study was to analyze anthropometric relationships between dimensions of the upper extremity and body height. Analyses were based on a sample of middle class male (n = 202) and female (n = 108) Turks residing in Istanbul, Turkey. Five variables were entered into the analyses. For male subjects, forearm length was selected as the first factor, followed by hand length and finally upper arm length. For female subjects, upper arm length was selected first, followed by forearm length and finally hand length. There were also individually calculated formulae for some of these measurements that provided smaller R2 values. The study suggested that estimation of a living height could be made possible by using various dimensions of the upper extremity. One must consider differences between populations to apply such functions to other populations.

Adult↗
PubMed1986

Airport emergency medical services.

To obtain improved emergency medical services at the Minneapolis/St. Paul International Airport, a combination of utilization of existing fire, police, and medical services and improved technology was adopted. Exemplified by the use of EMT and an automatic cardiac defibrillator/pacer (Heart Aide), this system resulted in increased survival for victims of cardiac arrest at the Twin Cities airport. Furthermore, this system allowed for improved triage efficiency and breadth of services that complemented the already existing aircraft crash disaster program.

Aerospace Medicine↗
PubMed1985

[Medicolegal identification by the dental system].

Bodies found in acts of war or natural disasters are sometimes impossible to identify for police or legal purposes, notably because of calcination or putrefaction. Teeth, which are particularly resistant to destruction by fire, bacteria or other agents, can be used to evaluate the victim's dental age by the Gustafson method with a margin of error of plus or minus 4,6 years. Blood group has also been established with more than 85% concordant results by determination of the A. B. O antigens which are present in dental tissue and pulp. These techniques were tested on 257 teeth from subjects of known dental age and blood group. They provide additional evidence of the identity of deceased persons.

Accidents, Aviation↗
PubMed2003

Bioterrorism and critical care.

A bioterrorist attack of any kind has the potential to overwhelm a community and, indeed, in the case of smallpox, an entire nation. During such an attack the number of patients requiring hospitalization and specifically critical care is likely to be enormous. Intensivists will be at the forefront of this war and will play an important role in dealing with mass casualties in an attempt to heal the community. A high degree of suspicion and prompt recognition of an event will be required to contain it. Specific knowledge of the possible agents that can be used will be key in managing patients and in estimating the needs of a health care facility and community to deal with the future course of events. Intensivists play various roles aside from the delivery of critical care to the patient in the ICU. These roles include making triage decisions regarding the appropriate use of critical care beds (which automatically dictates how other non-ICU beds are used and managed) and serving as a team member of ethics committees (on such issues as dying, futility, and withdrawal of care). Indeed, intensivists are no strangers to disaster management and have served on the forefront of many. A biologic weapons attack, however, is likely to push this multidimensional nature of the intensivist to the maximum, because such an attack is likely to result in a more homogeneous critically ill population where the number of critical care staff and supplies to treat the victims may be limited. One hopes that such an event will not occur. Sadly, however the events of September 11, 2001, have only heightened the awareness of such a possibility.

Anthrax↗
PubMed2005

Mass casualty triage in the chemical, biological, radiological, or nuclear environment.

Field trauma triage systems currently used by emergency responders at mass casualty incidents and disasters do not adequately account for the possibility of contamination of patients with chemical, biological, radiological, or nuclear material. Following a discussion of background issues regarding mass casualty triage schemes, this paper proposes chemical, biological, radiological, or nuclear-compatible trauma triage algorithms, based on a review of the literature and the input of recognized content experts. A basic trauma triage template is first proposed, with patient assessment limited to ability to walk, presence of breathing, and ability to follow commands. This template is then modified for use in chemical, biological, and radiation/nuclear situations in which the exposed or contaminated victims have also sustained conventional trauma. The proposed algorithms will need further refinement and testing.

Algorithms↗
PubMed1986

Childhood sibling loss. A family tragedy.

The loss of a significant object, the loss of a home (security, personal possessions, familiar space that has emotional meaning), the dislocation from one's home or land as occurs in wars or disasters, gives rise to stress-strain responses that may have short-term or long-term effects, eg, post-traumatic stress disorder. The hidden or neglected victims of such occurrences frequently are children--be they siblings or direct descendants. In childhood sibling loss, the effects of the loss are mediated through different members of the family. The acute stressors can give rise to later adversity unless it is recognized that there is a social context in which life and death events occur. Recognizing these individual responses in the family can lead to interventions that may prevent later difficulty. Understanding the meaning of the events to the child, appreciating the fact that events are not just single occurrences, but interact with what existed before as well as with other concomitant events, helps in our therapeutic recommendations and interventions. Sibling loss, though initially related to the death of a sibling, can now be expanded to include the loss of a sibling through chronic illness (emotional, medical, surgical, long-term hospitalization), birth injuries, disabled children (accidents or illness with body changes), chronic illness with visible as well as non-visible changes that require special parental and nursing care, medication on an ongoing basis, and restrictions in diet and activities. The impacts of these losses without death can have devastating effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Telematics equipment for poison control surveillance. Its applications in the health management of relevant chemical incidents].

Health management of major chemical incidents requires a close collaboration between rescuers (on the disaster site and in the emergency department) and the poison center. The study tested telematic technologies allowing telepresence and teleconsulting, a real time and continuous connection among health care personnel and toxicologists involved in the management of the emergency. The link between the poison center (PC) and the emergency department in the local hospital is provided by a ISDN operating video conferencing system, while the data transmission from the site of the accident to the PC is achieved with a personal computer and GSM cellular data transmission. Toxicological databases and risk assessment software are integrated in the system, to support information sharing. To test such instruments in operative nearly realistic conditions, the main phase of the study has implemented simulated chemical disasters in different locations in Italy. Instruments for telepresence and teleconsulting have been effectively utilized to evaluate from a remote location the scenario and the severity of the accident, by inspecting either specific details or the whole scene, to enable PC guiding the triage of the victims before and after hospitalization, to utilize and share data, such as intervention protocols or patient records, and to document all the activities. In summary, this experience shows that the telematic link allows the toxicologists of the poison center to rapidly understand the situation, and to correctly learn about the conditions of patients with the help of images. The results of this study indicate the valuable benefits of telematic instruments for the health care in case of major chemical disasters occurring in a remote geographical location or in an area which lacks local toxicological experts, where specialized expertise can be achieved by the use of telematic technologies.

Emergency Service, Hospital↗
PubMedDate not supplied

Panel 2.16: forensic aspects of disaster fatality management.

This is a summary of the presentations and discussion of Panel 2.16, Forensic Aspects of Disaster Fatality Management of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to forensic aspects that pertain to the responses to the deaths created by the Earthquake and Tsunami. It is presented in the following major sections: (1) overview of victim identification; (2) resource factors in mass-fatality management; (3) mass-fatality management in protecting public health; and (4) reasons to use deoyxribose nucleic acid (DNA) to identify the deceased.

Disasters↗
PubMedDate not supplied

Children who lost a parent as a result of the terrorist attacks of September 11, 2001: registry construction and population description.

Children who experience traumatic bereavement in the context of catastrophic disasters are at increased risk for developing post-disaster problems. Despite massive loss of life on September 11th, 2001, no public data were collected on those children who lost a parent in the multiple terrorist attacks. Such a registry would be an important public health tool to help mitigate the consequences of traumatic bereavement and to guide health surveillance efforts. As information about affected individuals was fragmented and difficult to congregate, we constructed our registry by conducting systematic public record searches and data exchanges with key stakeholders to identify, locate, and characterize all the 9/11 bereaved children. We identified 1,363 victims who were parents of minor children, and 2,752 bereaved children below age 18. In addition to reporting important identifying data on these children, this study also demonstrates the feasibility and the potential usefulness of such a registry to support post-disaster service provision and advocacy efforts. The construction of registries of severely affected people post-disaster should become government policy to obviate the need to use ad hoc methods to construct lists of high-risk individuals.

Bereavement↗
PubMed2006

Health problems in children and adolescents before and after a man-made disaster.

OBJECTIVE: The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems. METHOD: Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N=1,628) and controls (N=2,856) was possible. Health problems were classified according to the International Classification of Primary Care. RESULTS: Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status. CONCLUSIONS: Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems.

Adolescent↗
PubMedDate not supplied

The aftermath of violence: children, disaster, and posttraumatic stress disorder.

Terrorist attacks, situations of armed conflict, and all forms of catastrophe tax our abilities to cope, understand, and respond. Because of their developmental status, children are even more emotionally vulnerable to the devastating effects of a disaster. When tragedy strikes a family, community, or the nation, helping children cope and regain a sense of safety is critical. A child with posttraumatic stress disorder (PTSD) develops symptoms such as intense fear, disorganized and agitated behavior, emotional numbness, anxiety, or depression after being directly exposed to or witnessing an extreme traumatic situation involving threatened death or serious injury. Victims of repeated abuse or children who live in violent neighborhoods or war zones, or who have witnessed extensive media coverage of violent events, may experience PTSD.

Adolescent↗
PubMed2003

Estimation of stature from body parts.

Anthropometric technique commonly used by anthropologists and adopted by medical scientists has been employed to estimate body size for over a hundred years. With the increasing frequency of mass disasters, the identification of an isolated lower extremity and the stature of the person it belonged to has created problems for the investigation of the identity of some of the victims. In spite of a need for such a study, there is a lack of systematic studies to identify fragmented and dismembered human remains. The purpose of the paper is to analyze anthropometric relationships between dimensions of the lower extremity and body height. Analysis is based on a sample of middle class male (N=203) and female (N=108) adult Turks residing in Istanbul. The participants are mostly students and staff members of a medical school, and military personnel. Measurements taken are stature, trochanteric height, thigh length, lower leg length, leg length, and foot height, breadth, and length. Of the five variables entered into the regression analysis, all but foot breadth participate in the analysis with leg length as the first and followed by thigh and foot lengths, and finally foot height in males (R(2)). There were also individually calculated formulae for some of these measurements which provided smaller R(2)-values. Student's t-test to assess if there was any intraobserver error in measurements take by individual anthropometrist did not show such any statistically significant difference. In conclusion, the study suggested that estimation of a living height can be made possible using various dimensions of the lower extremity. One must consider differences between populations in order to apply functions as such to others.

Adult↗