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The problems and errors in personal identifications in rescue work after accidents with a large number of human victims are considered. The order of actions of forensic medical experts in personal identification in emergency situation is proposed.
Fires, their consequences and their investigations, continue to provide forensic scientists, especially those involved in medicolegal investigation (the medical examiner or forensic pathologist), with constant work and variations in problems. The recent history of mass disasters involving high-rise buildings, transport accidents, and arson-related accidents in nightclubs and prisons has emphasized the necessity for corrective and preventive means to ensure safety to the occupants of any of these areas. Problems presented by fires include the determination of the cause of the fire, the identification of the victims, and the cause and manner of their deaths. The motivation of the fire setter and the settlement by the insurance company or legal means are also aspects to be considered. The imperceptible effects of the fires include many other aspects, among which loss of loved ones and family providers and loss of industrial revenue and job potential are all felt. The most frightening development of all, however, is the insidious surfacing of arson as a possible factor in many major fires. The most recent tragedies involving the Stouffer Inn fire and the Hilton International Hotel fire were both related to arsonous acts. The scope of this article is to review the subject as it affects the forensic medical practitioner directly or indirectly so that his or her investigation may be brought to completion in conjunction with other authorities involved in the case.
The study describes New York area social workers' experiences of nine different stressors on 9/11. It also examines their reports of working with clients within the 6 months after 9/11. These variables are then analyzed for their relationship with symptomology 6 months after 9/11. Proximity to the WTC on 9/11, knowing someone who was a primary victim, and talking with clients about events related to 9/11 were all related to symptom levels; however, these experiences differentially impacted levels of depressive, anxiety, and somatic symptoms. Sex and race differences were found among the variables.
OBJECTIVES: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyan and similar social-cultural situations. DESIGN: Cross-Sectional quantitative study. SETTING: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up. SUBJECTS: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members. RESULTS: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL-90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54 to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733. Other item statistics and correlations of the scale are discussed. CONCLUSION: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victims of all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive.
A terrorism movement has been active in Spain during the last 20 years, with a painful number of victims. Civil Defense is in charge of the coordination of all the structures that are implicated in a terrorist incident. There are three typical patterns of attacks: (1) individual attacks; (2) group attacks; and (3) mass attacks. The individual attacks are done with guns, usually 9 mm, fired from a short distance; victims die from serious intracranial damage. Collective attacks are done using explosives under vehicles, tramp bombs, or "bomb vehicles;" victims are of different severity with wounds, burns, and blast injuries. With mass attacks with "bomb vehicles" in buildings or crowded public places, the numbers of victims are elevated and produce brutal social consequences. Emergency Medical Services integrated in to "Civil Defense" try to minimize the damage by initializing treatment on-scene and with the rapid provision of definitive care. During the last year, post-traumatic stress disorder treatment groups have been providing care to the victims and personnel. Chemical or biological weapons have not been used, although this is a great concern to the authorities.
INTRODUCTION: In the early morning of Friday 25th Dec. 2003, the ancient and historical city of Bam in Southern East of Iran was vibrated by a big and horrible earthquake for 6.4 degree of Richter. About 30,000 people were died and about 30,000 victims and injured persons were the initial results of the earthquake. Almost all of the buildings were destroyed and all the people became houseless. In this study, 156 patients with peripheral nerve lesion (PNL) were assessed for their injuries. MATERIALS AND METHODS: In a cross sectional study since the second week after the quake until 6 months later, we examined 506 patients with the symptoms and signs of motor/sensory and performed the Electrodiagnostic study for all of the patients who had obvious or suspected lesion of peripheral nerves. There were 156 patients (31.2%) afflicted with peripheral nerve lesion. We performed NCS/EMG for upper limb and face at least 2 weeks and for lower limb, at least 3 weeks after injury in 156 of the victims that had PNL. FINDINGS: Of 156 patients, 75 (48%) were female and 81 (52%) were male. The average of age was 29.2 +/- 12.9 years, about 87.2% were between 15 to 50 yrs old. The frequency of injuries was 88 nerves, 53 neural plexuses and 5 cauda equina lesions. The most frequent injured nerve was sciatic nerve (24.8%) and the next was Radial nerve (15.5%) and the less frequent nerve was axillary which observed just in 1 patient. 21.6% of patients had the brachial plexus and/or lumbosacral plexus injuries. There were more involvements in lower limbs comparing upper limbs and face (p < 0.01). CONCLUSION: Peripheral nerve injury is one of the most frequent injuries in earthquake victims. These lesions may cause temporary or lifelong disabilities in patients. In this study, the more frequent involvement of sciatic and radial nerve seems to be related to their anatomic location and also the position of victims when earthquake happened and the involvement of brachial and lumbosacral plexus could be due to inappropriate evacuation of the victims from the loads and also due to incorrect transportation.
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Around 1750 society grows aware of the high mortality of abandoned infants: enlightened physicians and administrators attempt to remedy this disaster and put the blame on the country wet nurses who took in the foundlings. A large number of contemporary historians have incritically contented themselves with repeating these reproaches. This article constitutes an attempt to rehabilitate country wet nurses. According to the authors, the infants were victims of the circumstances of being abandoned. An analysis based on a list of names does show that the most obvious causes for the high mortality rate of the foundlings were the close incidents surrounding the fact of being abandoned whereas it can rarely be explained by the living conditions at a wet nurse's. In the background, an original rural society emerges in a poor country taking in infants constitutes a real business. This study represents but one stage at the core of a developing research.
Shortly after 09:00 h on 19 April 1995, the Alfred P. Murrah Federal Building, located in downtown Oklahoma City, was devastated with a bomb blast of such gigantic proportions that it was heard 60 miles away in neighbouring Norman, Oklahoma. Oklahomans routinely commuting to work on that sunny Wednesday morning went about their business as usual. A crude bomb chemically comprised of various organic compounds, chemical fertilizer, ammonium nitrate and diesel fuel, weighing an estimated 4800 pounds or more, was transported in a vehicle the size of a truck. It blew open a crater 6-8 ft deep in the street floor. The Murrah Federal Building was impacted immediately; floors, windows, communication equipment and almost all the innocent victims inside were razed to the ground. Outside the building, as far as 10 blocks away or more, hundreds of victims lay hurt, seriously injured or dead from shards of glass that flew from office windows hundreds of feet above the street floor. Without warning, the initial impact of the bomb immediately devastated the entire city. People were in a state of shock, disbelief and denial; acute symptoms of post traumatic stress disorder (PTSD) were commonplace. Oklahomans, 'numb' from the impact of the critical incident and ill-equipped to handle the chaos of such catastrophic proportions, struggled to regain control of their lives as friends, family and loved ones went unaccounted for or were found critically injured, dying or already dead. The critical incident on 19 April demanded the immediate attention of the nation, to come to the aid of the Oklahomans who were in desperate need. By 1 June, the exhaustive investigations revealed that 30 office buildings in downtown Oklahoma City had to be condemned, and as many as 300 others were damaged. In addition, 168 people had been found dead including 19 children and one nurse working as an emergency services rescue worker. Approximately 490 other victims had been reported injured from the blast. Countless others have been traumatised by the critical event and will need professional attention and care for weeks, months and years to come. The final extent of the impact on Oklahoma City is yet unknown and may never realistically be estimated in terms of personal trauma, loss and grief.
Disaster medicine is an extension of emergency medicine involving mass casualties and use of the best available techniques in search and rescue. To achieve the best results extensive predisaster preparedness is mandatory. Earthquakes have caused the loss of more than 1 million lives in the 20th century. Evidence-based medicine confirms that these deaths were mostly preventable based on experience in developed countries. The key to success is implementing building codes and structural reinforcement. In earthquakes as well as in collapse of buildings in bomb blasts, loss of life is either because of the direct effect of trauma or to the metabolic consequences of rhabdomyolysis and complications of its management. Hyperkalemia and infection are the commonest causes of death in victims who survive the direct effect of trauma. Acute renal failure, a grave complication of rhabdomyolysis, is mostly preventable by timely rehydration and bicarbonate therapy. Mannitol therapy can be very efficient in reducing the severity of muscle damage and its sequelae. Fasciotomy can be limb saving if it is done in the early hours, although a firm guideline is still lacking. Although each country is responsible for improving the structure of buildings and organizing an efficient disaster response, national and international organizations in developed countries should give high priority to communicating with developing countries to encourage their preparedness.
Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. The fundamental difference between high voltage electrical injury and lightning is the duration of exposure to current. Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.
OBJECTIVE: Mental health impact of severe earthquakes on survivors has attracted considerable attention. Suicide represents a terminal outcome of the spectrum of potential major mental health issues spawned by severe earthquakes. This study used time-series analysis to examine the time trends of increased suicide rates after the Chi-Chi earthquake of 1999 in Taiwan in the affected counties. METHOD: Adult cause of death data were used to study monthly suicide rates per 100,000 adult population in the study and control counties, during January 1995 to December 2001. Box and Tiao's event intervention analysis was used to examine changes in monthly suicide rates before and after the Chi-Chi earthquake. RESULTS: During the post-quake period, October 1999 to December 2001, the mean monthly suicide rate in the affected counties was 1.567 per 100,000, compared with the control counties' rate of 1.297 per 100,000. Mean monthly suicide rate among the high-exposure group was 42% higher during the 26 months following the earthquake than the average for the entire observation period. Examined by time trends, the increased suicide rate registered in the first month following the quake began a monthly gradual decline by 0.7/100,000 thereafter, accounting for a total reduction of 98% in quake-related suicides by the end of 10 months. Suicide rates fell to the baseline level after 10 months. CONCLUSION: We found that the mean monthly suicide rate for earthquake victims was higher while the low-exposure group remained stable and consistent throughout the observation period, indicating that the impact on the high-exposure group was attributable to the earthquake. This indicates the need for providing strengthened psychiatric services during the first year following major disasters.
The first hours after a mass casualty event (MCE) are critical for the care of injured patients, especially for those with major burns. Burn patients are best treated in a specialized unit, however, transfer may not always be practical or possible. If transfer is not an option, hospitals need to find another solution to provide safe, effective, and efficient care. A critical element in providing burn care is to have a sufficient number of capable trained nurses. The Rambam Medical Center in Haifa, Israel evaluated past experience and has developed an innovative and comprehensive plan to provide treatment for a large influx of burn patients. The plan allows the 15-bed burn unit to expand and treat up to 136 burn victims, uses supplementary personnel, and allocates hospital beds and equipment as needed. This article describes the educational program that is used to prepare supplemental nurses.
A series of radioactive catastrophes (from 1948 to 1967) in the Southern Urals in the USSR led to intensive environmental contamination. Radioactive wastes were dispersed over the 20000 km(2) territory of four provinces-Chelyabinsk, Sverdlovsk, Tyumen' and Kurgan-due to the activity of the military facility that was built in 1948 for the production of nuclear bomb plutonium. The results of 50 years of investigations into the consequences of these disasters allow a general picture of the events that occurred to be reconstructed and allow the medical consequences of the irradiation of about half a million residents to be depicted. However, due to the atmosphere of secrecy and inadequate medical procedures, the results of medical studies of radiation victims are scant. The current protocols present a unique opportunity to study the DNA damage at the nucleotide resolution level in the genome of inhabitants of the given region, who presumably received chronic doses of irradiation. Studies were conducted through the direct sequencing of genes after their PCR-amplification and preselection of allegedly mutated DNA molecules. The regions of two genes have been sequenced: D1 dopamine receptor gene (subfamily of the G-protein coupled receptor L-DOPA genes) and the intron 12 of the gene for phenylalanine hydroxylase (PAH) responsible for phenylketonuria or hyperphenylalaninemia. Six point mutations (four presumably new) were found in the D1 gene of 42 persons and five polymorphic loci (two of which are widespread and three are unique) were revealed in the PAH gene. One of two widespread mutations is a deletion, and the other four are substitutions. Mutations in the controls were not found.
Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the PPE level must be increased and attempts must be made to identify and eliminate the source of the contamination. Finally, if the victims were exposed through ingestion, then consider the possibility that secondary exposure will occur during gastric lavage.
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On the basis of the method worked out by the author, scientific prognosis was provided of medico-tactical situation in disastrous flooding of a large city. Ways in which the city health service can deliver first aid and medical care to the victims were outlined. Measures aimed at perfection of urgent pre-hospital medical care were suggested.
STUDY OBJECTIVE: We examine the mortality and morbidity associated with earthquakes in the Chi-Chi earthquake in Taiwan in 1999. METHODS: Crude casualty data were collected from the reports of the government, local health bureaus, and 97 hospitals. The demographic data from the annual report of the Department of Interior were also employed for data analysis. Cross tables showing incidence of deaths and injuries by age, sex, time, and geographic distribution were generated to compare the mortality among different subgroups. Multiple regression models were established to explore the risk factors related to the mortality caused by earthquakes. RESULTS: The following results were found: the mortality rate increased with proximity to the epicenter, mortality was higher among the elderly than among young people, 30% of the victims died from head injuries caused by the collapse of dwellings, and the peak of medical demand was 12 hours after the earthquake and significantly increased demand for care lasted as long as 3 days. Furthermore, the regression model indicated that 78.5% of the variation of locality-age-sex-specific mortality was explained by the intensity of the earthquake, age, population density, distance to epicenter, medical beds per 10,000 people, and physicians per 10,000 people. CONCLUSION: The results implied that fragile minorities, specifically the elderly and children, require special consideration and attention in regard to disaster rescue and emergency medical care allocation. Epidemiologic analysis can guide disaster response and preparation.