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At least 919 records · Page 51Linked to original sources
PubMed1998

Management of casualties from the bombing at the centennial olympics.

BACKGROUND: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 AM on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and care of the victims, emphasizing those with significant injuries. METHODS: Retrospective review of triage and care of injured patients. RESULTS: Ninety-six of the 111 victims of the blast were triaged in the first half hour to four hospitals within 3 miles of the bombing. Only four minor operations were performed in 61 patients evaluated at community hospitals. Ten of 35 patients evaluated at the regional trauma center underwent emergency or urgent operations, and all who were seriously injured did well. CONCLUSIONS: Although overtriage to the regional trauma center occurred, outcome was excellent in all seriously injured victims treated there.

Disaster Planning↗
PubMed1999

Psychological trauma and posttraumatic stress disorder: a review.

This paper presents a concise, fully-referenced, state-of-the-art review of psychological trauma and Posttraumatic Stress Disorder (PTSD) for emergency mental health practitioners. The nature of traumatic events, their common symptomatology, their disruptions to normal psychological and biological functioning, and the negative health consequences of untreated incidents are presented. Implications for the treatment of victims of traumatic events within the context of a Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) approach are discussed.

Crisis Intervention↗
PubMed2002

Pediatric triage. A system to JumpSTART your triage of young patients at MCIs.

No matter how well we plan and train, every MCI is an exercise in gaining control over chaos. Emotions can sometimes get in the way. An MCI with pediatric victims is an additional emotional challenge that must be met by using objective tools so we can avoid needless mistakes in medical judgment. JumpSTART, used in conjunction with an adult triage tool such as START, can help to ensure that we not only meet the needs of all our MCI victims, but also address our own needs to provide the very best care for the children we encounter.

Algorithms↗
PubMed1994

Emergency department response to hazardous materials incidents.

Emergency physicians must stay alert to situations that involve toxic chemical exposures. An appropriate response to victims of chemical contamination is important for the victim's outcome and the safety of hospital personnel. Successful management of such a situation requires managing information, resources, and patients with complex medical conditions. Chemical contamination may affect one or hundreds of victims. Community planning is essential for an effective response to toxic chemical accidents (Haz-Mat).

Decontamination↗
PubMed2006

Hospital disaster preparedness in Los Angeles County.

BACKGROUND: There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." OBJECTIVES: To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. METHODS: This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. RESULTS: Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services-compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. CONCLUSIONS: Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies.

Cross-Sectional Studies↗
PubMed2003

[Afyon sultandagi earthquake].

BACKGROUND: Ninety-six percent of Turkey's land is in the earthquake zone. Consequently the results of every earthquake should be presented and discussed. The aim of this study was to evaluate the results of Afyon Sultandagi Earthquake. METHODS: The records from Governorship of Afyon, local hospitals and Public Work Directorate have been evaluated retrospectively and compared with current literature. RESULTS: An earthquake was detected with the magnitude of 6.0 at 9:11 A.M. at February 3rd, 2002, in the Sultandagi town, which is localized in Afyon city of Turkey. Bolvadin and Cay towns were also affected from the disaster. This earthquake, caused 39 deaths (23 of them were older than 65 year-old; 15 male and 24 female), 325 injured persons; 315 cows and water buffaloes and 3,176 sheep, 14,328 poultry were dead, and 15,032 buildings were damaged. The causes of deaths in human beings were: myocardial infarction in three patients and traumatic cerebral hematoma in one; the others expired from respiratory insufficiency due to dust inhalation because of the traditional architecture of the rural area. Health professionals reached the victims in about four hours, 35 of the injured patients were treated with hospital care and the remaining did not require health support.

Adolescent↗
PubMed2000

Revisiting the concept of 'vulnerability'.

The terms 'vulnerable' and 'vulnerability' are used more and more frequently in the areas of both social science research into and prevention of HIV/AIDS, but certain difficulties arise when it comes to applying this concept to actual situations at the heart of which individuals or groups are more exposed to HIV. The concept of vulnerability must thus be clarified to reinforce its heuristic capacity and political and practical relevancy. The first part of this paper is devoted to presenting a heuristic matrix of vulnerability, used in previous research among people living with HIV/AIDS (PWHAs) and to extracting three levels of intelligibility, that is to say, first the social trajectory level, then the level on which two or more trajectories intersect, and finally that of the social context. Each of the elements belonging to these three levels must be described both objectively and subjectively. The identity construction processes are then proposed as particular observation and 'gelling' points for these various levels taken as a whole. In the second part of the paper, we have reviewed how the concept of 'vulnerability' has been defined and used in other fields, notably disaster, famine, and mental health, paying special attention to the crucial points in the debates that are raging in these fields. We have also shed light on a few concepts that are frequently associated with vulnerability, such as victimization, insecurity, and risk. In the third part, we have summarized our approach to vulnerability as a relevant concept for elucidating risk-taking processes and designing intervention programmes. The importance of analysing the inter-individual differences, the variability in time and the relational dimension of all social vulnerability has been stressed.

Crime↗
PubMed1995

Raising the dead: war, reparation, and the politics of memory.

All societies attach a different range of meanings to war than to natural disasters, and questions of societal recognition, reparation, and justice are generally central. Most modern conflict has been grounded in the use of terror to control and silence whole populations. Those abusing power typically refuse to acknowledge their dead victims, as if they had never existed and were mere wraiths in the memories of those left behind. This denial, and the impunity of those who maintain it, must be challenged if survivors are to make sense of their losses and the social fabric is to mend. For the names and fate of the dead to be properly lodged in the public record of their times also illuminates the costs that may flow from the philosophies and practices of the Western led world order, ones which health workers should be in a position to influence.

Human Rights↗
PubMed2001

Understanding the chaplain's role in an age of weapons of mass destruction.

The possibility and/or use of weapons of mass destruction (WMD), in the same manner as disasters, terrorism, and other large-scale events, will trigger a huge response from the military services, government organizations, and community groups. Deploying a systematic, coordinated, and timely response is the challenge of all crisis response management teams. Victims and rescuers will have different issues and need different types of support at different times before, during, and after such a threat. Spiritual reactions of survivors as a result of WMD will impact diagnosis and treatment of psychological casualties. The chaplain, as the team pastoral care provider, contributes to the design and implementation of an effective, multi-disciplinary, and cohesive intervention strategy to meet today's realization of WMD threat.

Humans↗
PubMed2002

[Psychiatric aspects of terrorism].

The violence is systematized here in five types. The violence of terrorism is described as a modality of organized criminality elaborated for dominating other people in the field of politics, religion, economics or nationalism by means of terror. The terrorist action produces more important pathological effects on the mental health than the war and the natural or technological disaster. The terrorist is a fanatic ready to fight somehow for his ideals, deprivated of own freedom and sense of reality. There are many people mentally affected for each person killed or imprisoned. Finally, the early treatment of victims is distributed into psychological intervention and psychotropic drugs.

Humans↗
PubMed1993

Disaster preparation and the functioning of a hospital social work department during the Gulf War.

The nature of the Gulf War and its consequences for the public at the personal and community levels, called for considerable alterations in organization and management at the Chaim Sheba Medical Center, the largest government general hospital in Israel, with constant adaptation to the changing situation. The preparations and exercises preceding the state of emergency, combined with the knowledge and experience gained in similar situations in the past, equipped the staff of the Social Work Department to function adequately and to make appropriate decisions and changes in the face of moral and ethical dilemmas, as well as immediate physical threat. This article presents the rationale for the model of intervention that guided the hospital during the Gulf War in offering services to casualty victims and their families. Also discussed are the process of developing an organizational framework and its content that meets wartime demands, and the implications for social work practice in dealing with a war crisis.

Adult↗
PubMedDate not supplied

Response of Thai hospitals to the tsunami disaster.

The disaster caused by the tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters. The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients. Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims. Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed. Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system.

Disaster Planning↗
PubMed1995

Mass disasters: rapid molecular screening of human remains by means of short tandem repeats typing.

Human remains identification represents a challenging situation and constitutes a difficult task associated with mass disasters. The only highly efficient means for individual and family group reconstruction is that based on DNA typing. On July 18, 1994 an explosion destroyed the A.M.I.A. (Argentine Israeli Association). Over 100 people died; however, the exact number of victims is still being investigated. Our Service received over 70 remains to be characterized by DNA typing in order to determine the number of victims and to try to reconstruct the family groups to which they belonged. DNA was extracted by a cetyltrimethylammonium bromide (CTAB) based protocol, a rapid molecular screening of all samples was carried out by multiplex STR amplifications including HUMTH01, HUMFABP, HUMHPRTB, HUMRENA4, HUMVWA, HUMFES/FPS and Y27H39LR. Samples with identical genotypes were HaeIII-digested. Southern blotted and probed with YNH-24 (D2S44). PH-30 (D4S139). LH-1 (D5S110) and MS-1 (D1S7) for variable number of tandem repeats (VNTR) evaluation. The minisatellite variant repeat (MVR) approach was used in those cases in which band or profile shift were detected in Southern blot assays. Kinship between victims and putative relatives was initially evaluated by comparison of short tandem repeat (STR) profiles and then confirmed by VNTR with the above probes. The high identification efficiency attained in this case is, in part, supported by a previous experience, the DNA-based molecular characterization of human remains caused by the explosion of the Israeli Embassy in Buenos Aires, March 1992.

Blotting, Southern↗
PubMed2001

Hazardous materials events: evaluation of transport to health care facility and evacuation decisions.

The study objective was to analyze hazardous materials event and victim factors associated with transportation of victims to a health care facility, and evacuation or shelter-in-place of nearby populations. A retrospective review was conducted on hazardous materials events in Washington State from 1993 to 1997. Bivariate and multiple logistic regression were used to identify risk factors for transportation, evacuation, and shelter-in-place. Over five years, 2,654 victims from 457 events were reported, with 1,859 (70%) transported to a health care facility. Evacuation occurred in 279 (61%) events and shelter-in-place in 14 (3%) events. After excluding 14 deaths, regression analysis indicated that victims with trauma (OR 5.87, 95% CI 1.41-24.5), thermal burns (6.90, 1.15-41.3), dizziness/other CNS symptoms (1.59, 1.00-2.54), and headache (1.54, 1.01-2.35) were most likely to be transported. Chemical releases inside buildings (2.09, 1.06-4.10, compared with transportation events), and involving 3-5 victims (2.86, 1.54-5.31, compared to 1 victim) or > or =6 victims (8.74, 4.01-19.0), were most likely to involve evacuation or shelter-in-place. Events involving sulfuric acid (0.15, 0.05-0.49) and sodium hydroxide (0.19, 0.04-0.94) were least likely to involve evacuation or shelter-in-place. Prehospital decisions to transport victims to a health care facility and evacuate or shelter-in-place nearby populations are associated with event and victim factors. Further research is needed to determine if these factors also predict need for medical care or removal from exposure, and to develop evidence-based prehospital care protocols for hazardous materials exposure victims.

Adolescent↗
PubMed2002

Posttraumatic stress disorder among adolescent earthquake victims in Taiwan.

OBJECTIVE: To assess the exposure experience and prevalence of posttraumatic stress disorder (PTSD) among adolescent victims in the worst-affected region (Chungliao) near the epicenter of a severe earthquake (7.3 on the Richter scale) that occurred on September 21, 1999, in Taiwan. METHOD: The experience of exposure to the earthquake and subjective symptoms of junior high school students aged 12 to 14 who remained in the area were assessed with self-rated questionnaires. Psychiatrists made independent diagnoses for PTSD by using the Children's Interview for Psychiatric Syndromes. RESULTS: Six weeks after the earthquake, 21.7% of 323 students demonstrated PTSD. Those with PTSD showed significantly more psychiatric symptoms than did those without PTSD. Being physically injured and experiencing the death of a close family member with whom they had lived were the 2 major risk factors for PTSD. CONCLUSIONS: This study demonstrates that PTSD among adolescent victims of a severe earthquake in Taiwan is not as high as that reported in other studies. Methodological differences in the investigations are discussed, along with differences in symptom manifestations. However, long-term follow-up of these victims is recommended to prevent the development of other psychiatric complications.

Adolescent↗
PubMed1981

Patient vital signs cards.

In the context of developing a mass casualty evaluation methodology and in the pursuit of increased realism in the field, a system of casualty time cards has been developed. These cards capture most elements of the physician evaluation and free decision-making from the ambiguity that necessarily accompanies having a doctor 'evaluate' mock victims. They manifest the deterioration or death of the victim as time goes by and condition the risks and outcomes to depend upon treatment.

Blood Pressure↗