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Get off the bus: sound strategy for injury prevention during a tornado?

INTRODUCTION: On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the "F Scale") struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris. METHODS: A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck. RESULTS: Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate = 79.2%). While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were less severe (median injury severity score (ISS) 1 versus 4). CONCLUSION: For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.

Adolescent↗
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Health aspects of the Tsunami disaster in Asia.

This is a summary of the proceedings of the Conference on the Health Aspects of the Tsunami Disaster in Asia that was convened by the World Health Organization in Phuket, Thailand from 04-06 May 2005. It contains reviews of the experiences of the health sector and early recovery following the Earthquake and Tsunami with emphasis on what was done well and what could have been done better and the lessons learned that can be incorporated into actions that will mitigate the damage created by future events. It outlines the national and international responses and recovery and the actions taken and not taken by the international community in support of the countries affected. Specific issues addressed include: (1) needs assessments; (2) coordination; (3) filling gaps in essential services, and (4) capacity building at the country level. Each of these aspects is analyzed as to its: (1) appropriateness; (2) adequacy; (3) effectiveness; (4) efficiency; and (5) connectedness. Much of what occurred provided benefits to the stricken population, but there is substantial room for improvement through implementation of the lessons learned. These lessons must be converted into actions in order to mitigate the damage sustained and to enhance our responses to the damage from future events.

Disaster Planning↗
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Panel 2.9: repair and recovery of health systems.

This is a summary of the presentations and discussion of Panel 2.9, Repair and Recovery of Health Systems 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 the repair and recovery of health systems as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessment; (2) coordination; (3) filling gaps; (4) capacity building; (5) what was done well, and what should have been done better; (6) lessons learned; and (7) recommendations. Recommendations included: (1) how to make health systems better prepared for coping with disasters; and (2) how to support preparedness in local communities.

Delivery of Health Care↗
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Putting it together: stronger public health capacity within disaster management systems.

This is a summary of the agreement reached during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. There are 12 elements to this agreement: (1) risk management and vulnerability capacities; (2) needs assessments and programmed management; (3) best public health practices; (4) benchmarks, standards, and codes of practice; (5) management and coordination; (6) supply systems, communication, and logistics; (7) volunteers; (8) demonstrated leadership; (9) military and commercial private sectors; (10) media; (11) accountability and ethics; and (12) preparedness.

Disaster Planning↗
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Surviving collapsed structure entrapment after earthquakes: a "time-to-rescue" analysis.

INTRODUCTION: Massive earthquakes often cause structures to collapse, trapping victims under dense rubble for long periods of time. Commonly, this spurs resource intensive, dangerous, and frustrating attempts to find and extricate live victims. The search and rescue phase usually is maintained for many days beyond the last "save," potentially diverting critical attention and resources away from the pressing needs of non-trapped survivors and the devastated community. This recurring phenomenon is driven by the often-unanswered question "Can anyone still be alive under there?" The maximum survival time in entrapment is an important issue for responders, yet little formal research has been conducted on this issue. Knowing the maximum survival time in entrapment helps responders: (1) decide whether or not they should continue to assign limited resources to search and rescue activities; (2) assess the safety risks versus the benefits; (3) determine when search and rescue activities no longer are indicated; and (4) time and pace the important transition to community recovery efforts. METHODS: The time period of 1985-2004 was selected for investigation. Medline and Lexis-Nexis databases were searched for earthquake events that occurred within this timeframe. Medical literature articles providing time-torescue data for victims of earthquakes were identified. Lexis-Nexis reports were scanned to select those with time-to-rescue data for victims of earthquakes. Reports from both databases were examined for information that might contribute to prolonged survival of entrapped individuals. RESULTS: A total of 34 different earthquake events met study criteria. Forty-eight medical articles containing time-to-rescue data were identified. Of these, the longest time to rescue was "13-19 days" post-event (secondhand data and the author is not specific). The second longest time to rescue in the medical articles was 8.7 days (209 hours). Twenty-five medical articles report multiple rescues that occurred after two days (48 hours). Media reports describe rescues occurring beyond Day 2 in 18 of 34 earthquakes. Of these, the longest reliably reported survival is 14 days after impact, with the next closest having survived 13 days. The average maximum times reported from these 18 earthquakes was 6.8 days (median = 5.75 days). The event with the most media reports of distinct rescue events was the 1999 Marmara, Turkey earthquake (43 victims). Times range from 0.5 days (12 hours) to 6.2 days (146 hours) for this event. Both databases provide little formal data to develop detailed insight into factors affecting survivability during entrapment. CONCLUSIONS: A thorough search of the English-language medical literature and media accounts provides a provocative picture of numerous survivors beyond 48 hours of entrapment under rubble, with a few successfully enduring entrapment of 13-14 days. These data are not necessarily applicable to non-earthquake collapsed-structure events. For incident managers and their medical advisors, the study findings and discussion may be useful for post-impact decision-making and in establishing and/or revising incident priorities as the response evolves.

Confined Spaces↗
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Precision of in-hospital triage in mass-casualty incidents after terror attacks.

INTRODUCTION: Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan. OBJECTIVE: [corrected] The objective of this study was to assess the precision of triage in mass-casualty incidents. METHODS: The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS). RESULTS: Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 < or = ISS < 16), and 11 severe (ISS <16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%). CONCLUSION: Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.

Efficiency, Organizational↗
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Transient modeling in simulation of hospital operations for emergency response.

Rapid estimates of hospital capacity after an event that may cause a disaster can assist disaster-relief efforts. Due to the dynamics of hospitals, following such an event, it is necessary to accurately model the behavior of the system. A transient modeling approach using simulation and exponential functions is presented, along with its applications in an earthquake situation. The parameters of the exponential model are regressed using outputs from designed simulation experiments. The developed model is capable of representing transient, patient waiting times during a disaster. Most importantly, the modeling approach allows real-time capacity estimation of hospitals of various sizes and capabilities. Further, this research is an analysis of the effects of priority-based routing of patients within the hospital and the effects on patient waiting times determined using various patient mixes. The model guides the patients based on the severity of injuries and queues the patients requiring critical care depending on their remaining survivability time. The model also accounts the impact of prehospital transport time on patient waiting time.

California↗
PubMedDate not supplied

Analysis of medical needs on day 7 after the tsunami disaster in Papua New Guinea.

INTRODUCTION: Because of great intervening distances, international medical relief activities in catastrophic, sudden-onset disasters often do not begin until days 5-7 after the precipitating event. The medical needs of those affected and what public health problems exist in the community in the week after the tsunami disaster in Papua New Guinea(PNG) were investigated. METHODS: The Japan Medical Team for Disaster Relief (JMTDR) conducted investigative hearings at the District Office responsible for the management of the disaster, the Care Center, and the Hospitals in Aitape, Vanimo, and Wewak in PNG. RESULTS: The numbers of in-patients in the Aitape, Vanimo, and Wewak Hospitals, and in the Care Center in Aitape were 291, > 300, 68, and 104, respectively. The exact number of people affected was unknown at the Aitape District Office. There was no lack of medical supplies and drugs in the hospital, but the Care Center in Aitape did not have sufficient quantities of antibiotics. No outbreak of communicable disease occurred, despite the presence of risk factors such as the dense concentration of affected people and the constant prevalence of malaria and diarrhea. The water at Wewak General Hospital contained chlorine and was suitable for drinking, but that elsewhere contained bacteria. CONCLUSIONS: On about the 7th day after the event, the available information still was incomplete, and it was a time to shift from initial emergency activities to specialized medical care. Although no outbreak of communicable disease actually occurred, there was much anxiety about it because of the risk factors present. For effective medical care at this stage, it is essential to conduct a survey of actual medical needs that also include epidemiological factors.

Anti-Bacterial Agents↗
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The concept of assisted management of large-scale disasters by horizontal organizations.

Management of large-scale disasters is impeded by inadequately designed organizational infrastructure. The vertical organizational structures of most agencies responding to disasters contribute to a poorly integrated response, especially when collaboration, information sharing, and coordination are required. Horizontal (or lateral) organizations have assisted traditionally vertical civilian and military agencies by enhancing their capacity to operate successfully in complex human emergencies and large-scale natural disasters. Because of the multiagency and highly technical multidisciplinary requirements for decision-making in chemical and biological disasters, similar horizontal management options must be considered.

Disaster Planning↗
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Guidelines for rescue training of the lay public.

The fundamental goal of emergency medical response in disaster is to save lives and reduce injury and permanent disability. It has been observed that urgent emergency medical care of seriously injured earthquake casualties trapped under building rubble, cannot be provided unless the victims have been extricated and transported to medical facilities by friends or relatives, or are accessible to field rescue and medical teams. Equally important is the fact that extrication of seriously injured, trapped victims by laypersons is hazardous, unless the following conditions are met: 1) the rescuer has basic knowledge of extrication, and; 2) there is early application of effective life-supporting first-aid (LSFA) and/or advanced trauma life support (ATLS) at the scene. Time is the critical factor in such an effort. In previous studies of death and dying in earthquakes, it was noted that extrication of trapped victims will be attempted by survivors. Therefore, it is suggested that citizens living in regions of high seismic risk and trained in basic search and rescue and in LSFA are the most immediate resource for early response after an earthquake. An accompanying paper addresses the issue of citizen LSFA training. This paper focuses on the basic concepts of search and rescue training for the lay public.

Disaster Planning↗
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The 1989 Loma Prieta earthquake: issues in medical control.

INTRODUCTION: The role of the base-hospital and on-line medical control in a disaster has not been investigated previously. This study assesses the roles of base-hospitals and the value and feasibility of on-line medical control during the 1989 Loma Prieta earthquake. METHODS: The researchers studied five Bay Area counties most affected by the earthquake: San Francisco, Alameda, San Mateo, Santa Clara, and Santa Cruz. Researchers sent questionnaires to all 1,498 registered EMTs and paramedics in these counties; 620 were returned (41.4%). Respondents answered questions about activities performed, contacts with base-hospitals and other agencies, and problems encountered the night of the earthquake. Researchers selected 63 paramedics for in-depth interviews based on their performance of significant advanced life support (ALS) activities performed during the disaster. The coordinators of the 13 base-hospitals (BHCs) in the region also received and returned questionnaires about medical control, base-hospital roles during the disaster, and problems encountered. Researchers interviewed all five county emergency medical services (EMS) agency directors. RESULTS: The surveys of EMS directors, base-hospital coordinators, and paramedics indicate that confusion existed over the status of medical control after the earthquake. There was general agreement among base-hospital coordinators (BHCs) that suspension of medical control is appropriate in a major disaster. Three bases had appropriate equipment to function as back-up dispatch centers. Eight bases had adequate personnel, but only one BHC felt his personnel had adequate training to function in a dispatch capacity. Nine paramedics did not start or continue resuscitation on patients whom they ordinarily would have begun resuscitation. CONCLUSION: Emergency medical services should suspend medical control immediately following a major disaster and ensure that all prehospital and base personnel are notified. Disrupted communications protocols for prehospital personnel should reflect the skill and knowledge level of paramedics and the need for rapid, advanced practice in a disaster. Disaster planners should consider other roles for base hospitals in major disasters.

Decision Making↗