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PubMed2001

Chromosome aberrations in lymphocytes of persons exposed to an earthquake in Armenia.

OBJECTIVE: This study attempted to determine the level of chromosome aberrations in lymphocytes of victims of the 1988 earthquake in Armenia. METHODS: Chromosome aberrations were measured in blood samples taken from 41 victims of the earthquake that hit Armenia in 1988 and in samples of 47 reference blood donors. The victims suffered from severe psychoemotional stress but were otherwise healthy. All the samples were taken 2 to 3 weeks after the earthquake. All the subjects were lifetime nonsmokers. The cells were scored blind as to the exposure status. RESULTS: The subjects exposed to the earthquake had a higher proportion of cells with chromosome aberrations [3.1 (SD 2.1)%] than the referents [1.7 (SD 1.3)%, P-value for the difference 0.0009]. The difference persisted when the values were adjusted for age and gender [relative risk (RR) 1.9, 95% confidence interval (95% CI) 1.4-2.5]. The difference was present for double breaks (RR 4.1, 95% CI 2.6-6.4), but not for single breaks (RR 1.1, 95% CI 0.8-1.7). The exposed subjects also had a lower percentage of cells with 46 chromosomes (P=0.03) than the referents. CONCLUSIONS: This study suggests an increase in chromosome aberrations in the lymphocytes of victims of a severe earthquake as compared with the levels of referents. If not due to bias or confounding, the difference may reflect the effect of either environmental exposures related to the earthquake or severe psychogenic stress. The levels of chromosome aberrations found among the earthquake victims in this study are comparable with those found in prospective studies of long-term cancer risk.

Adolescent↗
PubMed1995

The crash of the Partnair Convair 340/580 in the Skagerrak: traumatological aspects.

In September 1989 an aircraft carrying 55 people crashed into the sea north of Denmark. There was no warning of the crash. The medico-legal investigation of the accident concentrated on finding clues to the cause of the accident, and identifying the victims, all of whom perished. These were found in two groups--31 were immediately recovered from the surface of the sea and 19 were collected from the sea or shore during the following months. The injuries in the two groups differed, indicating that the aircraft broke up in mid-air. One group probably fell into the sea after a free fall, while the other probably remained in the wreckage until hitting the surface. The victims' injuries showed no evidence of fire or explosion. The technical investigators concluded that the aircraft broke up due to a structural failure in the tail.

Accidents, Aviation↗
PubMed1997

Sarin poisoning of a rescue team in the Matsumoto sarin incident in Japan.

OBJECTIVES: A nerve agent sarin (isopropyl methyl phosphonofluoridate) was released in Matsumoto city, Japan, on 27 June 1994. About 600 people were affected by the sarin, including seven who died. Fifty two rescuers engaged in helping the victims and 18 were affected. The aim was to investigate how the rescuers were affected by sarin. METHODS: Health examinations and a questionnaire survey were conducted with all rescuers. RESULTS: A rescuer who was one of the first engaged and who worked for about five hours in areas contaminated with sarin was admitted to hospital after poisoning; the others did not consult doctors although they showed slight muscarinic symptoms. The later the rescuers started their work, the less likely they were to experience symptoms of sarin exposure, and no one starting work 270 minutes after the original release of sarin was affected. The symptoms of exposure included ocular pain, darkness of visual field, nausea, vomiting, headache, rhinorrhea, narrowing of visual field, sore throat, fatigue, and dyspnoea, which were similar to those reported by the citizens who were sarin victims. There were no rescuers who had abnormal physical or neurological signs associated with sarin at the time of the physical examination conducted three weeks after the sarin release. A year after the sarin incident, the symptoms of all the rescuers had resolved. CONCLUSIONS: Rescuers should protect themselves with appropriate clothing, gloves, and a mask to prevent a secondary disaster for at least 24 hours after a similar accident.

Hospitalization↗
PubMed2005

A quantitative risk analysis approach to port hydrocarbon logistics.

A method is presented that allows quantitative risk analysis to be performed on marine hydrocarbon terminals sited in ports. A significant gap was identified in the technical literature on QRA for the handling of hazardous materials in harbours published prior to this work. The analysis is extended to tanker navigation through port waters and loading and unloading facilities. The steps of the method are discussed, beginning with data collecting. As to accident scenario identification, an approach is proposed that takes into account minor and massive spills due to loading arm failures and tank rupture. Frequency estimation is thoroughly reviewed and a shortcut approach is proposed for frequency calculation. This allows for the two-fold possibility of a tanker colliding/grounding at/near the berth or while navigating to/from the berth. A number of probability data defining the possibility of a cargo spill after an external impact on a tanker are discussed. As to consequence and vulnerability estimates, a scheme is proposed for the use of ratios between the numbers of fatal victims, injured and evacuated people. Finally, an example application is given, based on a pilot study conducted in the Port of Barcelona, where the method was tested.

Accidents, Occupational↗
PubMed2004

Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes.

This study analyzes the effects of fluid resuscitation in the crush victims of the Bingol earthquake, which occurred in May 2003 in southeastern Turkey. Questionnaires asking about demographic, clinical, laboratory, and therapeutic features of 16 crush victims were filled in retrospectively. Mean duration under the rubble was 10.3 +/- 7 h, and all patients had severe rhabdomyolysis. Fourteen patients were receiving isotonic saline at admission, which was followed by mannitol-alkaline fluid resuscitation. All but two patients were polyuric. Admission serum creatinine level was lower than and higher than 1.5 mg/dl in 11 and 5 patients, respectively. Marked elevations were noted in muscle enzymes in all patients. During the clinical course, hypokalemia was observed in nine patients, all of whom needed energetic potassium chloride replacement. Four (25%) of 16 victims required hemodialysis. Duration between rescue and initiation of fluids was significantly longer in the dialyzed victims as compared with nondialyzed ones (9.3 +/- 1.7 versus 3.7 +/- 3.3 h, P < 0.03). Sixteen fasciotomies were performed in 11 patients (68%), nine of which were complicated by wound infections. All patients survived and were discharged from the hospital with good renal function. Early and vigorous fluid resuscitation followed by mannitol-alkaline diuresis prevents acute renal failure in crush victims, resulting in a more favorable outcome.

Acute Kidney Injury↗
PubMed1991

Crisis debriefing of a jury after a murder trial.

The importance of crisis debriefing for those involved in major accidents, violent crimes, and natural disasters has been demonstrated. Similar debriefing may be warranted for jurors exposed to disturbing material in criminal cases. The authors describe a debriefing session for jurors after the murder trial of a man whose truck had collided with a school bus, killing 27 people. The graphic evidence of the accident, the high levels of emotion of the survivors and the victims' relatives, and the intense community and national attention to the trial placed the jurors under considerable stress. The debriefing enabled the jurors to express their feelings of anger, guilt, and frustration and to begin to accept their role in the event.

Crisis Intervention↗
PubMed2005

A psychosocial risk assessment and management framework to enhance response to CBRN terrorism threats and attacks.

Evidence in the disaster mental health literature indicates that psychosocial consequences of terrorism are a critical component of chemical, biological, radiological, and nuclear (CBRN) events, both at the clinical level and the normal behavioral and emotional levels. Planning for such psychosocial aspects should be an integral part of emergency preparedness. As Canada and other countries build the capacity to prevent, mitigate, and manage CBRN threats and events, it is important to recognize the range of social, psychological, emotional, spiritual, behavioral, and cognitive factors that may affect victims and their families, communities, children, the elderly, responders, decision makers, and others at all phases of terrorism, from threat to post-impact recovery. A structured process to assist CBRN emergency planners, decision makers, and responders in identifying psychosocial risks, vulnerable populations, resources, and interventions at various phases of a CBRN event to limit negative psychosocial impacts and promote resilience and adaptive responses is the essence of our psychosocial risk assessment and management (P-RAM) framework. This article presents the evidence base and conceptual underpinnings of the framework, the principles underlying its design, its key elements, and its use in the development of decision tools for responders, planners, decision makers, and the general public to better assess and manage psychosocial aspects of CBRN threats or attacks.

Canada↗
PubMed1989

Medical planning for toxic releases into the community: the example of chlorine gas.

Emergency planning for a major accidental release of chlorine gas from industrial installations into the community is outlined for emergency services and hospitals. Realistic planning has been made possible with the advent of computer models for gas dispersion which may be used to estimate the numbers of deaths and casualties, according to their severity. For most purposes sufficient accuracy may be obtained by using a small number of computer analyses for the most serious reasonably foreseeable events under typical day and night weather conditions, and allowing for the emergency response to be scaled up or down according to the size of an actual release. In highly populated areas triage should be preplanned to deal with a large number of victims; field stations will be needed for the treatment and observation of minor casualties. The management and treatment of casualties is summarised. The best protection against a gas cloud is afforded by buildings whose windows, doors, and ventilation systems have been closed. Hospitals in the vicinity of an installation should draw up plans to protect patients and staff. Coordination in a disaster will require toxicological and epidemiological expertise and hospital plans should allow for this.

Accidents, Occupational↗
PubMed1982

Pyroclastic flow injury. Mount St. Helens, May 18, 1980.

Three patients who were on the periphery of the pyroclastic flow of the Mount St. Helens eruption on May 18, 1980 were treated for severe thermal and inhalation injuries. Although exposed in identical manner, two patients arrived with heavily colonized burn wounds and developed adult respiratory distress syndrome leading directly to their death, whereas the third patient, with a noncolonized burn wound and little evidence of adult respiratory distress syndrome, survived. Evidence of inhaled ash complicating various stages of adult respiratory distress syndrome was confirmed by energy dispersive roentgenographic analysis. In the Pacific Northwest, Alaska, and the Aleutian Islands, potential for further injuries of this type in even larger numbers exists. Should these occur, those who treat the victims should be aware of the potential for severe inhalation problems in addition to the obvious burns.

Adult↗
PubMed2003

The challenges of deliberate chemical/biological attack.

Major incident plans in many countries have recently been updated to address the issues surrounding the deliberate release of chemical and biological agents. Despite this, many 'front line' doctors who would be responsible for treating victims of such incidents are poorly integrated into the plans. This article examines some of the challenges that face clinicians in the pre-hospital and hospital phases of a deliberate release incident.

Bioterrorism↗
PubMed2006

Hospital planning ahead for bird flu pandemic.

In preparing your department's response to a pandemic, it's best to plot out worst-case scenarios. Once the scenarios have been created, explore all possible solutions to equipment and staffing shortages. Since existing capacity will be insufficient, identify in advance alternative sites for treating victims. Stay abreast of new equipment developments, such as multiple ventilators, that may help deal with the added volume of immune compromised patients. Recognize that the level of care will be reduced, and adjust your emergency preparedness protocols accordingly.

Animals↗
PubMedDate not supplied

L.A. County plans its disaster response.

The Los Angeles County Fire Department is one of many agencies making great strides in the development of urban search and rescue programs. Much of the department's USAR training, equipment, and strategies have been tested on real incidents. Each incident presents new challenges and teaches new lessons. Before the establishment of the three-tiered USAR system, those personnel nearest an incident handled it. Many never saw a similar incident again. The lessons they learned were often lost because there was no system to collect their experiences, retrieve the information, and make it available to other emergency responders in the form of training programs. A major advantage of tiered response is the system's ability to ensure rapid response by trained, experienced, and well-equipped personnel. Rather than repeating mistakes and forgetting successful rescue methods, the system allows the retrieval of the experiences of personnel and their use in the development of training materials. Urban search and rescue specialists have the ability to build on earlier experiences to raise the overall level of skills. The net result is more effective training, increased efficiency, and enhanced safety for rescuers and victims. The field of urban search and rescue is still in its infancy. Many new and innovative strategies, techniques, and tools are on the horizon. In recent years, there has been growing interest in this specialty across the nation. We expect this trend to continue as breakthroughs occur. More than ever, it is important for all concerned agencies to share information and to work together to improve our ability to save lives.

Disaster Planning↗
PubMed2004

Mass casualties in the Oklahoma City bombing.

The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources.

Blast Injuries↗
PubMed1996

[Manifestation of the symptoms in demented patients after the Great Hanshin Earthquake in Japan].

On Jan. 17, 1995, at 5:46 a.m., an earthquake measuring 7.2 on the Richter scale shook southern area of Hyogo prefecture of Japan, including Kobe city. By this earthquake referred as the Great Hanshin Earthquake later, over 6,000 people were killed, 150,000 buildings and houses were destroyed and more than 300,000 people were temporally evacuated. Over a half of victims were reported to be elderly. We reported five survivors with senile dementia of the Alzheimer's type, who showed exacerbation or manifestation of their dementia symptoms after the quake. None of them had been injured and none of their close relatives had been killed or injured. They had been living in the downtown of Kobe for over 30 years before the disaster. Most of them had lived by themselves. Their severity of dementation were mild to moderate. They had been living without any problems and functioning fairly well. Their sons and daughters did not realize that their fathers or mothers had dementia before the earthquake. They had to move to and live with their son's or daughter's families, since their residences were destroyed by the earthquake. Shortly after that, they showed exacerbation or manifestation of their symptoms and developed delusion that their money and valuables were stolen by their daughters or daughters-in-law. We concluded that: they had been living without any problems and functioning fairly well, although they had had mild dementia symptoms; their living by themselves in communities familiar to them prevented manifestation of dementia symptoms; living together with son's or daughter's family easily promoted the development of delusion that their property was stolen by their close relatives, especially daughters or daughters-in-law in demented people.

Aged↗
PubMed2001

Public health risks of railroad hazardous substance emergency events.

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.

Accidents↗
PubMed2002

Considerations for selecting personal protective equipment for hazardous materials decontamination.

PPE is necessary to protect staff and to deliver rapid and efficient care to patients contaminated with HAZMAT chemicals. Planning for HAZMAT cases includes learning about the common chemicals in the area, what resources are available to care for victims, identifying a decontamination area, and providing PPE to protect employees and other patients. A customized service can be used to meet OSHA standards and reduce costs. Ongoing training will be an important part of any HAZMAT program.

Air↗
PubMed2006

Anesthesia for Indian Ocean tsunami-affected patients at a southern Thailand provincial hospital.

BACKGROUND: On 26 December 2004, a giant earthquake shook South-East Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. The Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand joined the Thai Red Cross Society to provide relief in southern Thailand. The objective of this article is to characterize the emergency surgical patients and anesthesia profiles of tsunami victims at Phang-Nga Provincial Hospital. METHODS: Available records from the operating room and anesthesia unit of Phang-Nga Provincial Hospital, together with laboratory and administrative data, during the period 26-31 December 2004 were collected and analyzed using descriptive statistics. RESULTS: Thai Red Cross teams provided surgical emergency services for 107 cases during 28-30 December 2004. Ninety-three cases (86%) were Caucasian, one (0.9%) was Japanese and nine (8.4%) were Thai. ASA physical status classifications of 1, 2 and 3 were present in 87.8%, 8.4% and 0.4%, respectively. The majority of injuries comprised multiple soft tissue wounds with severe infection. Eighty-five per cent of cases received debridement and 14.0% tendon or nerve repair or fixation of bone. The anesthesia choices were general endotracheal with rapid sequence induction and intubation (69.2%), general under mask (19.6%), total intravenous anesthesia (4.7%), spinal anesthesia (3.7%) and local anesthesia (2.8%). Anesthesia-related problems included a lack of pre-operative laboratory investigation, hypovolemia, severe wound infection with early sepsis and aspiration pneumonia. Common intra-operative complications included hypotension and oxygen desaturation from pulmonary aspiration or lung contusion. There was one case of post-operative reintubation and no peri-operative mortality. CONCLUSION: Anesthesia-related problems in tsunami victims included pulmonary aspiration, hypovolemia, sepsis and lack of pre-operative laboratory investigation. General anesthesia was the most common anesthetic technique. Common intra-operative complications included hypotension and oxygen desaturation.

Anesthesia↗