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PubMed2001

[The analysis of traumatized patients who were admitted to the Uludag University Medical School Hospital after the Marmara earthquake].

The aim of this study was to analyze the victims of the Marmara earthquake who injured, especially had the crush syndrome. Our hospital received a total of 645 victims after the earthquake and admitted 330. Victims were classified into five different groups according to their diagnosis (crush syndrome, vital organ injury, vertebral and pelvic injuries, others and unknown) and their mortality rates were determined. Mortality was highest (21%) in the crush syndrome group. Second and third highest mortality were in the unknown (20%) and vital organ injury (20%) groups. The overall mortality rate was 8%. In conclusion the earthquake victims with crush syndrome and vital organ injury had the highest mortality and morbidity rates. Because of that so many departments (General Surgery, Emergency Medicine, Orthopedics Surgery, Plastic Surgery, Nephrology, Infection Disease etc.) had to be study in a great harmonious.

Crush Syndrome↗
PubMed1994

The Helderberg air disaster--forensic odontological investigations.

A Boeing 747-224B Combi of the South African Airways, the "Helderberg", crashed into the sea near Mauritius on 28 November 1987. All 159 people on board died and dental tissues were present in only eight of the 15 lots of human remains recovered. Ante-mortem dental records were collected by a team in Johannesburg while the post-mortem examinations were conducted in Mauritius. The special circumstances surrounding an accident at sea resulted in the low number of bodies available for identification procedures. Of the eight remains which included dental tissues, five were identified by means of simple dental restorations, advanced dentistry, anatomical features of teeth and stages of development of teeth. One of the victims was identified by a process of exclusion and radiographic evidence played a decisive role in the identification process. (J Forensic Odontostomatol 1994; 12: 15-18) The variety of record-keeping styles and abbreviations used in different countries posed a major problem during the process and it is concluded that international standardization in record-keeping requires urgent attention.

Accidents, Aviation↗
PubMed2003

[Avalanche emergency and accidental hypothermia].

The importance of emergency medical treatment for avalanche victims in the pre-clinical and clinical sector is still real. Based on new investigations, guidelines for triage have been endorsed by the International Commission of the Alpine Rescue Services (ICAR) to reduce secondary deaths following the successful extrication of victims from the avalanche mass. Although hypothermia plays a secondary role in the total mortality of avalanche victims, the most important task if extrication lasts 35 min or more is the professional treatment of hypothermia. Avalanche emergencies in the southern part of the Black Forest are quite rare. In February 2002 one avalanche victim in this region survived despite a statistically bad prognosis. Based on the current literature, we provide an algorithm which conforms with the ICAR guidelines for emergency personnel and describe the possibilities and standard stage dependent treatment in cases of accidental hypothermia.

Accidents↗
PubMedDate not supplied

Mass-casualty terrorist bombings in Istanbul, Turkey, November 2003: report of the events and the prehospital emergency response.

BACKGROUND: This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting pre-hospital emergency response. METHODS: A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul. RESULTS: On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims. CONCLUSION: The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.

Ambulances↗
PubMed1996

The revised Civilian Mississippi Scale for PTSD: reliability, validity, and cross-language stability.

Examined in two studies the psychometric properties of a revised 30-item version of the civilian form of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (PTSD) developed by Keane, Caddell, and Taylor (1988). Study 1, whose sample was composed of 37 bilingual adults who had experienced a variety of traumatic events, was undertaken primarily to examine the linguistic equivalence of a Spanish translation of the scale. High cross-language stability was demonstrated, and both English and Spanish versions showed high internal consistency. Study 2, which used a sample of 404 victims of Hurricane Andrew, provided additional evidence of scale reliability and also showed that the scale correlates in meaningful ways with known traumatic stressors. Together the results indicate that the scale is applicable to different populations and events and constitutes a valid and reliable self-report, measure of PTSD.

Adolescent↗
PubMed2003

Medical management of biological warfare and bioterrorism: place of the immunoprevention and the immunotherapy.

Biological weapons are considered as mass destruction and terror weapons. Terrorism including bioterrorism is the major threat in the future conflicts for our nations. The aim of bioterrorism is more related to the potential disorganisation of the society than to the lethal effects of the agents used. The dramatic consequences cannot be discarded, especially if contagious agents such viral are used. The preparation of specific defence measures is a major challenge for our countries. The knowledge acquired from the struggle against natural infectious diseases and recent events are essential to improve behaviours to face the biological weapon threats. The defence attitude is based on the anticipation of the threat, the management of the victims, and the restoration of the operational capabilities. This global defence attitude implies six important functions: (i) alert, (ii) detection and diagnosis, (iii) availability of pharmaceutical countermeasures such as vaccine, sera and anti-infectious medicine and products, (iv) medical management of victims, (v) training and information, (vi) research and development. Passive and active immunoprevention and immuntherapy belong to the approaches discussed in the context of bioterrorism countermeasures. Further researches might be focused on these topics.

Animals↗
PubMed1987

The libidinal cocoon: a nurturing retreat for the families of plane crash victims.

In 1985 the families of 137 passengers killed when a Delta Airlines jet crashed at Dallas-Fort Worth International Airport stayed in a secluded hotel while waiting for the victims' bodies to be retrieved and identified. In this protected environment, which the author calls the "libidinal cocoon," the families received intensive nurturing from the author, a Dallas psychiatrist; a team of Red Cross nurses; hotel staff; airline representatives; clergy; and each other. The supportive environment allowed the families to regress safely and to satisfy the basic yearning, intensified in times of personal loss, for an idealized caretaker who will meet all one's needs. The author believes this kind of intervention may be useful in future disasters with massive casualties.

Aircraft↗
PubMedDate not supplied

Biological, chemical, and nuclear terrorism readiness: major concerns and preparedness of future nurses.

INTRODUCTION: The nursing profession is developing educational resources to improve their response to victims of nuclear, biological, and chemical terrorism. Future nurses may differ from practicing nurses in their perspective of what is critical information. The purpose of this study was to identify student nurses' major concerns in relation to working with victims of terrorism. METHOD: A descriptive study was used to identify how future nurses might practice as caregivers for victims of terrorism. The study population consisted of a convenience sample of 95 junior and senior baccalaureate nursing students at a mid-south state university. The students were given an anonymous questionnaire regarding their concerns and how their lives had changed after September 11, 2001. The questionnaire consisted of 19 major items that identified demographics and perceptions and concerns regarding preparedness, willingness to work, expectation of future terrorism events, effect on lifestyle, and other fears related to terrorism or caring for victims of terrorism. A Cronbach alpha coefficient of reliability on standardized items was .745. RESULTS: Students' primary concern was for the safety of themselves and their families. They were primarily concerned about having adequate protection for all types of terrorist agents and indicated they would not be willing to care for victims if there was a lack of protection for both themselves and family. Although the nursing school faculty had provided self-education information about terrorism, students did not demonstrate an accurate understanding of the pathogenic nature of many agents.

Adolescent↗
PubMed1991

Child, adolescent, and adult victims of residential fire. Psychosocial consequences.

Behavior of children, adolescents, and adults during and after a residential fire was objectively assessed. Antecedents, behaviors, and consequences of the nighttime residential fire immediately and 1 month following the fire were obtained. Also, the extent of agreement between children/adolescent and adult functioning was determined. Eight children and adolescents and 12 adults were individually interviewed. Results showed that individuals' reactions to residential fire could be assessed, and several PTSD-related symptoms were expressed. A follow-up study in which 25 adolescent boys whose dormitory had been totally destroyed by fire were compared to 13 boys who had not experienced the fire showed similar findings. These findings add to the dearth of literature concerning children and adolescents in fire-related disasters.

Adaptation, Psychological↗
PubMed2000

The challenge of identification following the tragedy of the Solar Temple (Cheiry/Salvan, Switzerland).

On October 5, 1994, 48 members of the Sect of the Solar Temple were found dead at two different locations in Switzerland: 23 victims in Cheiry and 25 victims in Salvan. Our Institute was commissioned to solve the forensic problems presented by this tragedy. Our goals were to establish the time of death, determine its causes, help elucidate the surrounding circumstances and identify the victims. This work presented us with the following challenges. This catastrophe was of an 'open' type: there was no list of 'passengers'; the victims were of five different nationalities and many had just arrived in Switzerland to participate in this event; family ties were very complex within this group; half of the victims were burned and sometimes charred; the exceptionally intense media converage of the story put a lot of pressure on the investigators and our Institute. In spite of these difficulties, all the victims were positively identified within 1 month. In the present report, we describe the steps realized to progress in our work. A special section describes our relationship with the journalists and their invaluable help in our investigations. The importance of being prepared for such an event is discussed.

Disasters↗
PubMed2004

Health impacts of flooding in Lewes: a comparison of reported gastrointestinal and other illness and mental health in flooded and non-flooded households.

Severe flooding may become more frequent due to global warming. A historical cohort study was conducted by telephone interview for new episodes of illness in all age groups, and for psychological distress in adults, following severe river flooding on 12 October 2000 in the town of Lewes in Southern England. Two hundred and twenty-seven residents of 103 flooded households and 240 residents of 104 non-flooded households in the same postal district were recruited by random selection of addresses from a post flooding survey and a commercial database respectively. Having been flooded was associated with earache (RR 2.2 [1.1,4.1] p = 0.02), and a significant increase in risk of gastroenteritis with depth of flooding (RR 1.7 [0.9,3.0] p = 0.09, p for trend by flood depth = 0.04). Adults had a four-times higher risk of psychological distress defined as a score of > or = 4 in response to the 12-item General Health Questionnaire (GHQ-12) (RR 4.1 [2.6, 6.4] p < 0.0005, p for trend by flood depth = 0.01). Associations between flooding and new episodes of physical illness in adults diminished after adjustment for psychological distress. Flooding remained highly significantly associated with psychological distress after adjustment for physical illnesses. Psychological distress may explain some of the excess physical illness reported by flooded adults and possibly by children as well. Policies to promote population resilience to flooding where flood prevention has failed must include practical support for flood victims and provision of appropriate psychological support. Associations with physical illnesses affirm the need for advice and assistance with individual, household and environmental hygiene and access to medical services.

Adolescent↗
PubMed2001

Curricular and extracurricular activities of medical students during war, Zagreb University School of Medicine, 1991-1995.

War, as a major human disaster, affects many aspects of life, including medical education. This report describes curricular and extracurricular activities of the students at the Zagreb University School of Medicine during the wars in Croatia and neighboring Bosnia and Herzegovina. Although condensed versions of the curricula were prepared in case of a major breakdown in civilian life, the school maintained the continuity and quality of its curriculum throughout the war. Students engaged in extracurricular activities related to medical aspects of the war, including organization of resuscitation and first aid courses, collecting medical documentation on war victims, humanitarian help to refugees, and peace-promoting activities. Some students joined mobile surgical teams on the battlefronts. After army service, most of them returned to the school and successfully continued with their studies. The school also accepted guest-students from other new states emerged from former Yugoslavia. The authors found that the students' engagement in extracurricular activities related to medicine was enormously beneficial both to the psychological well-being of the students and to the region's peace-building efforts.

Bosnia and Herzegovina↗
PubMed2000

Chemical-biological terrorism and its impact on children: a subject review. American Academy of Pediatrics. Committee on Environmental Health and Committee on Infectious Diseases.

There is an increasing threat that chemical and biological weapons will be used on a civilian population in an act of domestic terrorism. Casualties among adults and children could be significant in such an event. Federal, state, and local authorities have begun extensive planning to meet a chemical-biological incident by developing methods of rapid identification of potential agents and protocols for management of victims without injury to health care personnel. Because children would be disproportionately affected by a chemical or biological weapons release, pediatricians must assist in planning for a domestic chemical-biological incident. Government agencies should seek input from pediatricians and pediatric subspecialists to ensure that the situations created by multiple pediatric casualties after a chemical-biological incident are considered. This statement reviews key aspects of chemical-biological agents, the consequences of their use, the potential impact of a chemical-biological attack on children, and issues to consider in disaster planning and management for pediatric patients.

Adolescent↗
PubMed2002

[Epidemiological surveillance during humanitarian emergencies].

Humanitarian emergencies are complex situations that usually occur after warfare or social upheavals. They result in a dramatic increase in morbidity and mortality in the affected population. Organizations that undertake management of humanitarian emergencies must be prepared to provide comprehensive services covering all aspects of public health including preliminary evaluation, mass vaccination, water and sanitation, food supply and nutrition, shelter, medical care, control of communicable diseases, personnel training, and logistic coordination. Epidemiological surveillance is an integral part of a full-service approach to humanitarian action that should be included in the preliminary evaluation. Epidemiology is a powerful tool for detecting any health problems that might further jeopardize the victim population. By allowing measurement of the impact of humanitarian action, epidemiological data also provides a means of verifying that the victims are benefiting from aid operations. Implementation of a surveillance system should be given high priority during the start-up of a humanitarian operation. The system must have the simplicity and flexibility necessary to adapt changing, unstable situations as well as high sensitivity necessary for early detection of epidemic outbreaks.

Altruism↗
PubMed2003

Organization of a health-system pharmacy team to respond to episodes of terrorism.

The role of a pharmacy emergency response team (PERT) trained to respond to episodes of terrorism involving chemical, biological, radiological, and nuclear (CBRN) agents is described. Pharmacists must be prepared to support their health systems in responding to episodes of terrorism by detecting exposure to CBRN agents and mitigating, treating, and preventing casualties resulting from exposure to those agents. Maimonides Medical Center, whose pharmacists responded to the medical and pharmaceutical needs of victims of the World Trade Center attacks and anthrax exposures, has developed the PERT, modeled after the Health Emergency Incident Command System, to standardize the response of their pharmacists in the event of such an attack. Each team member has a specific role and can assume any other team member's role, if needed. Key players in the PERT include the pharmacy administrator, drug information pharmacist, intensive care unit pharmacist, infectious diseases pharmacist, nuclear pharmacist, management-information-system pharmacist, hazardous materials pharmacist, and auxiliary-site pharmacist. The most important features of this disaster response model include activating the PERT to establish command and control in the pharmacy department, conducting a disaster-needs analysis, deploying PERT members in support of the medical center during a public health emergency involving CBRN agents while maintaining normal operations in the pharmacy, and maintaining, mobilizing, distributing, and receiving a pharmaceutical stockpile while ensuring that timely antidotes are available and used appropriately when distributed. The PERT allows for a comprehensive pharmacy response within a health system to episodes of terrorism involving CBRN agents.

Disaster Planning↗
PubMed2001

[Local and regional in-hospital trauma care following fireworks depot explosion in Enschede].

UNLABELLED: On Saturday 13 May, 2000 at about 15:30 h, the Dutch city of Enschede was struck by the explosion of a midtown firework depot. Twenty-two people were killed and almost 1,000 people were wounded. A complete district with 1,000 houses was destroyed. In total, 527 victims were treated in one of the regional hospitals, 76 (14%) of whom were admitted and 451 (84%) were treated as outpatients. Of the clinically treated victims, 11 patients were triaged as T1 and needed immediate intervention, 63 patients were triaged as T2 where treatment within six hours was indicated, and two T3 patients did not need urgent treatment. The outpatients mainly suffered secondary blast injuries to the head and extremities due to flying debris. Of the 11 T1 patients, 10 underwent acute surgery; intervention radiology was performed in one patient. The injuries of the severely wounded T1 patients consisted of penetrating thoracic, abdominal and skull injuries, as well as blunt abdominal trauma and compound fractures. Two patients from the disaster area underwent acute vascular surgery for acutely burst aortic aneurysms. The in-hospital trauma care was characterised by the spontaneous arrival of a large number of extra medical personnel. The regional distribution of the trauma patients was adequate. The regional capacity of the emergency rooms, IC-units and operating facilities proved to be sufficient. Routing of lightly-wounded patients was found to be important. The communication in all phases of the disaster management appeared to be poorly structured. CONCLUSION: During the initial trauma care, the routing of vast numbers of ambulant, lightly-wounded patient, as well as extra doctors and nurses, needs careful planning.

Adolescent↗
PubMed1999

Emergency department impact of the Oklahoma City terrorist bombing.

STUDY OBJECTIVE: To collect descriptive epidemiologic injury data on patients who suffered acute injuries after the April 19, 1995, Oklahoma City bombing and to describe the effect on metropolitan emergency departments. METHODS: A retrospective review of the medical records of victims seen for injury or illness related to the bombing at 1 of the 13 study hospitals from 9:02 AM to midnight April 19, 1995. Rescue workers and nontransported fatalities were excluded. RESULTS: Three hundred eighty-eight patients met inclusion criteria; 72 (18.6%) were admitted, 312 (80.4%) were treated and released, 3 (.7%) were dead on arrival, and 1 had undocumented disposition. Patients requiring admission took longer to arrive to EDs than patients treated and released (P =.0065). The EDs geographically closest to the blast site (1.5 radial miles) received significantly more victims than more distant EDs (P <.0001). Among the 90 patients with documented prehospital care, the most common interventions were spinal immobilization (964/90, 71.1%), field dressings (40/90, 44.4%), and intravenous fluids (32/90, 35.5%). No patients requiring prehospital CPR survived. Patients transported by EMS had higher admission rates than those arriving by any other mode (P <.0001). The most common procedures performed were wound care and intravenous infusion lines. The most common diagnoses were lacerations/contusion, fractures, strains, head injury, abrasions, and soft tissue foreign bodies. Tetanus toxoid, antibiotics, and analgesics were the most common pharmaceutical agents used. Plain radiology, computed tomographic radiology, and the hospital laboratory were the most significantly utilized ancillary services. CONCLUSION: EMS providers tended to transport the more seriously injured patients, who tended to arrive in a second wave at EDs. The closest hospitals received the greatest number of victims by all transport methods. The effects on pharmaceutical use and ancillary service were consistent with the care of penetrating and blunt trauma. The diagnoses in the ED support previous reports of the complex but often nonlethal nature of bombing injuries.

Adolescent↗
PubMed2005

Preliminary DNA identification for the tsunami victims in Thailand.

The 2004 Southeast Asia Tsunami killed nearly 5,400 people in Southern Thailand, including foreign tourists and local residents. To recover DNA evidence as much as possible from the seriously decomposed bodies, we explored procedures of sample preparation from both bone and tooth samples as well as both mitochondrial and nuclear markers. Despite having failed to recover enough DNA for nuclear marker typing, we succeeded in obtaining fully informative results for mitochondrial markers (HV1 and HV2) from 258 tooth samples with a success rate of 51% (258/507). Using an organic DNA extraction method coupled with an ultrafiltration step, we obtained 16 STR (including 13 CODIS loci, one sex discrimination locus, and two Identifiler loci) profiles for 834 samples with a success rate of 79% (834/1,062). In addition, by comparing the allelic frequencies between the typed samples as a group and other index populations, we conclude that the Thai tsunami victims are a combined group of several populations. Our results provide valuable evidence and protocols for the future forensic practice.

Bone and Bones↗