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PubMed1990

[The organization of care for burn victims in catastrophes].

The experience in medical care and treatment of burned patients showed that adequate anti-shock infusion therapy can be established only 4-6 hours after the sustained trauma. However, even despite such a delay, many burned patients (75-80%) get well, due to the later adequate complex treatment controlled by experienced burn specialists [correction of combustiologists] in hospital units specially organized and equipped for this category of patients. Within the first 2-4 days after the trauma, it is recommended to distribute major accident victims between different specialized burn units, using specially equipped air and motor transportation vehicles.

Burn Units↗
PubMed2005

Identification and posttraumatic stress disorder symptoms in rescue workers in the Marmara, Turkey, earthquake.

After the 1999 Marmara Turkey earthquake, 434 volunteer rescue workers and 154 soldiers who were control subjects completed the Questionnaire for Identification with Deceased Victims and the Impact of Event Scale-Revised (IES-R). Identification with the Deceased as Oneself, Identification with the Deceased as a Friend, Identification with the Deceased as a Family Member, and IES-R Intrusion, Avoidance, and Hyperarousal subscale scores were significantly higher in rescue workers. Identification-Self, Identification-Friend, and Identification-Family correlated with the IES-R subscale and total scores. The set of identification variables was significantly associated with group membership before, but not after, IES-R scores were controlled. Findings suggest that identification with deceased victims, not rescue work per se, is the risk factor of concern for posttraumatic stress disorder in rescue workers.

Adult↗
PubMed1997

Interhospital patient transfer: a quality improvement indicator for prehospital triage in mass casualties.

The need for interhospital patient transfer after mass casualties may be a consequence of triage errors. Indications for interhospital patient transfer following seven suicidal bus bombings in Israel were reviewed to identify possible errors in triage at the scene. Medical records of victims arriving to hospitals were analyzed for age, injury description, injury Severity Score (ISS), and indication and destination of interhospital transfer. A total of 473 victims were involved, 74 of whom died at the scene (15.6%). Mean victim age was 29 +/- 16 (SD) years. Interhospital transfer was necessary for 29 patients. Indications for transfer included (1) mandatory lifesaving procedures on route to trauma center (n = 14), (2) underdiagnosis at the scene (n = 1), (3) insufficient local resources (n = 9), and (4) triage-related errors (n = 5). The ratio between interhospital transfer due to triage errors and the victim population who may need to be transferred is suggested as quality assurance (QA/QI) indicator for triage.

Adolescent↗
PubMed2001

Posttraumatic stress symptoms and salivary cortisol levels.

OBJECTIVE: This study assessed the relationship between posttraumatic stress symptoms and salivary cortisol levels after a severe ice storm. METHOD: Posttraumatic stress symptoms (Impact of Event Scale scores) and salivary cortisol levels were determined in 115 victims of an ice storm and in 27 healthy comparison subjects 1 month and approximately 1 year after the ice storm. RESULTS: One month after the storm, Impact of Event Scale scores for the victims (mean=20.31, SD=15.23) exceeded those of the comparison subjects (mean=5.30, SD=9.78) but were reduced approximately 1 year later (mean=14.01, SD=13.68). A quadratic relation was found to exist between Impact of Event Scale scores and cortisol levels. CONCLUSIONS: One month after the storm, cortisol levels were found to be elevated among the victims but were diminished among those with the highest Impact of Event Scale scores. This relationship was found not to exist approximately 1 year later.

Disasters↗
PubMed2004

Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol.

UNLABELLED: Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

Chemical Warfare↗
PubMed2001

Avalanche trauma and closed head injury: adding insult to injury.

OBJECTIVE: The incidence of fatal closed head injury (CHI) and nonfatal CHI causing an altered level of consciousness in avalanche victims is unknown. The purpose of this study was to assess the incidence and potential significance of CHI in avalanche-related deaths. METHODS: The records of the state medical examiner and hospital records of all victims killed in avalanches in the state of Utah from October 1, 1992 through April 30, 1999 were reviewed for a cause of death and for the presence of CHI. Closed head injury was described as "present" or "severe," depending on whether the degree of CHI was sufficient to have caused or directly contributed to death, as determined by the medical examiner. RESULTS: In this review, 28 avalanche-related deaths were identified, of which 22 (79%) were due to asphyxia. Seventeen victims (61%) had evidence of some degree of CHI. Six victims (21%) had evidence of severe CHI. One of 7 snowmobile riders sustained a severe CHI, whereas 4 of 16 skiers or snowboarders sustained a severe CHI (P = not significant). CONCLUSION: Although asphyxiation was the cause of death in most avalanche victims, evidence of CHI was present in 61% of the cases studied. While avalanche-associated CHI may not be sufficient to cause death in many cases, a depressed level of consciousness might render a victim incapable of self-rescue and predispose to asphyxia. Helmet use may help prevent avalanche-associated CHI and thus be a useful safety adjunct.

Asphyxia↗
PubMed2006

College students' perceived risk and anxiety after reading airplane crash news.

328 college students in midwest and west coast regions read one of five news stories (four airplane crash and one irrelevant) or none. They estimated the likelihood of their victimization in an airplane crash and indicated the maximum amount of time that they would be willing to spend driving in lieu of flying. Analysis showed those who read one of the airplane crash stories reported higher perceived risk of victimization than did those who read the irrelevant story or none. Reading airplane crash news was not related to the number of hours reported for driving instead of flying.

Adult↗
PubMed1997

Posttraumatic stress symptoms in nonexposed, victims, and spontaneous rescuers after an avalanche.

A company from the Norwegian Army was investigated 2 weeks and 4 months after they were hit by an avalanche during a winter exercise. The subjects were divided into victims, spontaneous rescuers, and nonexposed subjects. The results showed that exposed subjects (victims and rescuers) reported higher levels of symptoms compared to nonexposed subjects. No differences were found among exposed subjects. The level of symptoms was also higher than comparable previous research both on victims and professional rescuers or nonprofessionals assigned a role as rescuers. All groups showed decrement in symptoms on the 4-month follow-up.

Case-Control Studies↗
PubMed2000

Bioterrorism threats: learning from inappropriate responses.

Between April 1997 and June 1999, some 200 mailed or telephoned bioterrorism threats were received at a variety of locations. Usually claiming that anthrax had been released, the threats all proved to be hoaxes. In many instances, local emergency responders treated the more than 13,000 potential victims inappropriately, in particular requiring victims to strip and undergo decontamination with bleach solutions. Narratives of several incidents indicated that many victims were distressed and embarrassed by their treatment. Their experiences underscore the need for improved local response actions and the formulation of a uniform response protocol for public health agencies.

Anthrax↗
PubMed1990

The 1988 earthquake in Soviet Armenia: a case study.

A major earthquake devastated the Armenian Republic of the Soviet Union on December 7, 1988, resulting in thousands of deaths and injuries. In a postearthquake investigation of three towns seriously affected by the earthquake, we studied earthquake-related injury patterns, made observations on rescue and medical efforts, and postulated certain factors associated with increased morbidity and mortality. Information was obtained from official Soviet documents, interviews with survivors of the earthquake, and interviews with local, regional, and national government officials. Figures were based on assessments made by these officials in the field in the immediate postearthquake period. Out of a population of 8,500, there were 4,202 (49.4%) deaths and 1,244 (14.6%) injured (casualty rate, 64.0%). Deaths and injuries were 67 and 11 times higher, respectively, among trapped than nontrapped victims. Being outside at the time of the earthquake or having escaped to the outside from the collapsing structure was crucial for survival. Among persons found alive, 89% were rescued during the first 24 hours, mostly without the use of heavy equipment. This observation underscores the importance of swift rescuer response. As with all field surveys after disasters, there were methodological limitations to this study due to chaotic postearthquake conditions. Accordingly, results must be approached with caution. Nonetheless, these preliminary observations are striking and have generated several new hypotheses for further investigations using more sophisticated analytic methods.

Armenia↗
PubMed2001

Role of the dental team in mass fatality incidents.

The process of dental identification for a mass fatality incident has unique aspects in comparison with that of a routine dental identification, outside of the obvious increase in the number of victims and responders. The dental team is a small part of a large effort to resolve the incident. Incident command structure applies to the dental team as a unit as well as to the entire organization of the response. Teamwork and planning are essential on all levels. Discussing the casework is limited to the public information officer; only the public information officer is authorized to talk to anyone outside the medical examiner's office. For the team, communication is essential between the team members and between the team and other morgue sections. Daily meetings not only update progress, but also identify and solve problems as they arise. Redundancy and cross-checking occur each step in each section. A core team of trained individuals provides a framework for the use of less experienced members. Use of a dental identification computer program is extremely beneficial, especially as the amount of fragmentation or number of victims increases. Because of the magnitude of the response, the physical and mental stresses require critical incident stress debriefing for all responders, regardless of their experience. The past and future service of the dental profession to the victims of mass fatality incidents and their families is an excellent example of the ideal of service on which the profession is based.

Accidents, Aviation↗
PubMedDate not supplied

1999 Marmara earthquake; peripheral nerve injuries--electrophysiologic evaluation.

This study evaluated the clinical, demographic and electromyographic (EMG) findings of 75 patients referred to our EMG laboratory with the preliminary diagnosis of peripheral nerve injury (PNI) during the 1999 Marmara earthquake. Forty-two patients had single and 33 had serial EMGs. Seventy-nine percent of the patients were found to have PNI. Eighty-six percent of these had PNI of the extremities and 23.7% had brachial plexus injury. PNI were detected in the upper extremities in 39% of patients, in the lower extremities in 47.5% of patients and in both extremities in 13.5% of patients. It was observed that brachial plexus degeneration was at a higher rate in patients with compartment and crush syndromes (35.70% and 42.9%) and peripheral nerve (PN) degeneration was higher in patients remaining under the debris (37%). In control EMG examinations, regeneration findings were observed at a rate of 79.2% in the upper extremities and 55.3% in the lower extremities (mean 64.5%) in the patients with PNI of the extremities and 90.9% in the patients with brachial plexus injury. In conclusion, after a mean EMG follow-up of 4 months in 75 earthquake victims a reasonably high level of regeneration findings shows that prognosis will be good in the majority of patients.

Adolescent↗
PubMed1985

The Cincinnati DC-9 experience: lessons in aircraft and airport safety.

Twenty-three passengers died on June 2, 1983, when a McDonnell Douglas DC-9 experienced an inflight rear lavatory fire near Cincinnati, OH. Evidence of toxic fume inhalation was developed by investigators, demonstrating lethal levels of carbon monoxide and cyanide in the victims' blood. An analysis of the inflight progression of fire and smoke, and the subsequent extension of this following the emergency landing at Greater Cincinnati Airport has been accomplished. This data is augmented by other data from previous accidents of this type. Data from interviews with survivors was collected, including inflight experiences, emergency escape processes and airport disaster management during the emergency. Several practical means of respiratory protection both inflight and during emergency evacuation are documented. Onboard preventive measures in regard to this type of emergency have been identified. Emergency evacuation and modern airport disaster management techniques are codified and described. This recent accident provides information for future adoption by the responsible authorities so that inflight and postflight fires do not continue to cause significant numbers of fatalities. Modified lightweight passenger breathing apparatus, upgraded flight attendant and aircrew portable breathing apparatus, floor level guidance to exits, less flammable and toxic interior materials, improved passenger evacuation information, tailored airport emergency response procedures, and upgraded toilet smoke detector equipment are examples.

Accidents, Aviation↗
PubMed1985

The use of medical and dental radiographs in identification.

Following mass disasters and individual deaths, dentists with special training and experience in forensic odontology are frequently called upon to assist in the identification of badly mutilated or decomposed bodies. Teeth and dental restorations are resistant to destruction by fire and the elements and are, therefore, useful in identification. The forensic odontologist makes use of dental radiographs taken of the victim before death. These are compared to dental data from the remains to assist in making the identification. Many features of the teeth and numerous characteristics of dental treatment are quite unique. This permits accurate and legally acceptable identification of the remains. The cases described illustrate the procedures and techniques of identification using ante-mortem and post-mortem radiographs.

Adult↗
PubMed1993

Issues of rescue and medical care following the 1988 Armenian earthquake.

On-site emergency care and rescue efforts may be critical in preventing disability and other serious consequences of disasters. In this report we compare efforts used in the rescue and emergency medical care of 189 people (case subjects) from Kumairy (Leninakan), Armenia, who were hospitalized with serious injuries following the Armenian earthquake of 7 December 1988, with efforts used in helping 68 people (controls) from Kumairy with mild injuries who were not hospitalized. We used a standardized interview questionnaire to ascertain the circumstances of entrapment, the rescue process used, the injuries the victims sustained, and the medical care they received. Case and control subjects shared similar social and demographic characteristics; however, case subjects waited longer to be rescued and to receive medical care than did control subjects. Of the people who said they were trapped, 66.2% of the case subjects and 41.2% of the control subjects said that they were trapped for > 1 hour (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.52-5.13) whilst the OR for > 6 hours of entrapment was 3.88 (95% CI: 1.69-9.10). Of those requiring medical care, 28.6% of people who were hospitalized waited > 1 hour after rescue to receive medical care, compared with only 14.7% of the control subjects (OR = 2.32, 95% CI: 1.05-5.23). In addition to the case-control study, we collected data on general characteristics of the rescue and emergency medical care process. We found that most of the trapped people were rescued by untrained local inhabitants who most often used their hands or simple tools.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

Postdisaster morbidity of the bereaved. A possible role for preventive psychiatry?

Immediately following a rail disaster in Sydney, Australia, on January 18, 1977, in which 83 people were killed, an attempt was made to organize a preventive psychiatry outreach program for the relatives of the bereaved and the survivors. Bereavement counseling was offered to all families considered to be at risk for development of postbereavement morbidity. A follow-up study was performed 15 to 18 months later to assess the level of functioning of the bereaved relatives. The next of kin of 36 victims (43 per cent of the total number killed) were interviewed and filled in questionnaires (general health, Goldberg's General Health Questionnaire, loss, and social support). They included 15 widows, nine widowers, 11 mothers, and eight fathers who had lost children. The trends were for the bereaved spouses to have done better than bereaved parents; the widowers to have done better than the widows; those with a supportive network to have done better than those without one; those who saw the body to have done better than those who did not; and, in addition, there was a tendency for those who had bereavement counseling to do better than those who had no such intervention. Examples are given of several types of outcome, and conclusions are drawn about the results and the difficulties of implementing and evaluating such a program.

Accidents↗
PubMed1996

Kobe earthquake and reduced sperm motility.

We investigated a possible relationship between the Kobe earthquake (January 17, 1995) and the quality of semen. We assessed sperm concentration and motility of 27 male patients who had a concentration of more than 30 million/ml and >40% sperm motility within 5 months before the earthquake. Twelve male patients from districts with a magnitude of <4 on the Richter scale showed no difference in sperm concentration and motility before and after the earthquake. Of 15 male patients from districts with a magnitude of >6, five patients whose houses received no damage showed no distinct changes in sperm concentration and motility. In contrast, 10 patients whose houses were partially or completely destroyed showed significantly (P < 0.001) lower sperm motility after the earthquake than before, although no significant difference of sperm concentration could be observed. Of these latter 10 patients, seven could be followed. In six patients, sperm motility was restored between 2 and 9 months after the earthquake; the sperm motility in one patient, whose father died a victim of the house crash, has not yet recovered. Thus, the acute stress resulting from such a catastrophic earthquake could be a possible cause of reduced sperm motility.

Adult↗
PubMed2005

Preparedness of hospitals to respond to a radiological terrorism event as assessed by a full-scale exercise.

Hospitals and healthcare workers face the challenge of being prepared to manage victims of acts of terrorism that involve chemical, biological, and radiological agents that they do not commonly encounter. One example that is often cited as a potential terrorism scenario is the use of a conventional explosive that is mixed with radioactive material. On November 10, 2004, we conducted a regional multihospital full-scale exercise involving 11 hospitals and 358 victim-observers to evaluate hospital preparedness for such an event. Our results demonstrate that hospitals are not adequately prepared to manage mass casualties with associated radiological contamination.

Disaster Planning↗