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PubMed2003

The presentation and management of victims of chemical and biological agents: a survey of knowledge of UK clinicians.

A survey was conducted among acute specialty clinicians in four centres in the UK to determine their levels of knowledge of the presentation and subsequent management of victims following deliberate release of chemical or biological agents. This revealed significant gaps in knowledge and training. Of the 102 respondents, more than half did not understand the decontamination process. More than a third were unsure of the presenting features of nerve agent release. Only a minority knew the recommended treatment and only one in five have participated in relevant exercises.

Bioterrorism↗
PubMed2002

Biological terrorism: understanding the threat, preparation, and medical response.

The thought of an outbreak of disease caused by the intentional release of a pathogen or toxin in an American city was alien just 10 years ago. Many people believed that biological warfare was only in the military's imagination, perhaps to be faced by soldiers on a far-away battlefield, if at all. The "anthrax letters" and the resulting deaths from inhalation anthrax have changed that perception. The national, state, and local governments in the United States are preparing for what is now called "not if, but when and how extensive" biological terrorism. In contrast to the acute onset and first-responder focus with a chemical attack, in a bioterrorist attack, the physician and the hospital will be at the center of the fray. Whether the attack is a hoax, a small food-borne outbreak, a lethal aerosol cloud moving silently through a city at night, or the introduction of contagious disease, the physician who understands threat agent characteristics and diagnostic and treatment options and who thinks like an epidemiologist will have the greatest success in limiting the impact of the attack. As individual health care providers, we must add the exotic agents to our diagnostic differentials. Hospital administrators must consider augmenting diagnostic capabilities and surveillance programs and even making infrastructure modifications in preparation for the treatment of victims of bioterrorism. Above all, we must all educate ourselves. If done correctly, preparation for a biological attack will be as "dual use" as the facility that produced the weapon. A sound public health infrastructure, which includes all of us and our resources, will serve this nation well for the control of the disease, no matter what the cause of the disease.

Biological Warfare↗
PubMed2004

[Expert work during technogenic extreme situations (Report II)].

The article is devoted to the organizational principles of work of expert institutions and its subdivisions with reference to technogenic catastrophes with mass victims. The problems of interactions of representatives from different structures and departments made busy with the work at the place of event are discussed in terms of forensic medicine. Special attention is paid to the problems of expert institution readiness for work under conditions of extreme situations depending on the medical-and-tactical characteristics of damage focus.

Disaster Planning↗
PubMed2003

Two New York City hospitals' surgical response to the September 11, 2001, terrorist attack in New York City.

BACKGROUND: We describe the surgical response of two affiliated hospitals during the day of, and week following, the September 11th, 2001 terrorist attack at the World Trade Center in New York City. The city of New York has 18 state designated regional trauma centers that receive major trauma victims. The southern half of Manhattan is served by a burn center, two regional trauma centers, and a community hospital that is an affiliate of one of the regional trauma centers. This report accounts for the surgical response by a regional trauma center (Hospital A, located 2.5 miles from the World Trade Center) and its affiliate hospital (Hospital B, located 5 city blocks from the World Trade Center) on September 11th when two commercial jets crashed into the Twin Towers at the World Trade Center mall. METHODS: Hospital A maintained a concurrent log of patients received during the first 5 hours, the first day, and the first week after the disaster which was kept by the Surgical Triage Officer. The trauma registry completed and verified this data by September 18th. Hospital B collected its data by hand counting and verification by chart review. Both hospitals, A and B, had established disaster plans that were implemented. RESULTS: Nine hundred eleven patients were received by two affiliated hospitals from the World Trade Center attack. Seven hundred seventy six patients (85%) were walking wounded, sustaining mild inhalation and eye irritant injuries. One hundred thirty five (15%) were admitted with 18 (13%) of these undergoing surgery. Twenty two of the 23 transfers were from the community hospital to specialized orthopedic or burn centers. Of the 109 patients admitted to Hospital A, 30 were to the surgical service. The mean ISS score of these patients was 12. There were 4 deaths (within minutes of arrival at the hospital) and 6 delayed deaths (day 1-14). Excluding walking wounded and DOAs, the critical mortality rate was 37.5% overall. CONCLUSION: The September 11th, 2001, terrorist attack in New York City, involving two commercial airliners crashing into the World Trade Center, led to 911 patients received at two affiliated hospitals in lower Manhattan. One hospital is a regional trauma center and one was an affiliate community hospital. Eighty five percent of the patients received were walking wounded. Of the rest, 13% underwent surgical procedures with an overall critical mortality rate of 37.5%.

Aviation↗
PubMedDate not supplied

KAMEDO report no. 77: sinking of the MS Sleipner, 26 November 1999.

The catamaran HS Sleipner struck a rock and sunk in bad weather and heavy seas on 26 November 1999. Rescue efforts were provided by helicopters and other ships. A total of 68 victims were rescued alive and 16 died, mostly by drowning. Problems were encountered with evacuation, life jackets, and life rafts. Most of those rescued alive suffered from hypothermia. Response times for rescue helicopters should be improved. Emphasis should be placed on correct manifest lists of passengers and crew. Special emphasis must be placed on media relations and cross-boundary issues. Exercises should focus on cooperation and coordination.

Disasters↗
PubMed1997

Can hazard risk be communicated through a virtual experience?

Cyberspace, defined by William Gibson as a consensual hallucination, now refers to all computer-generated interactive environments. Virtual reality, one of a class of interactive cyberspaces, allows us to create and interact directly with objects not available in the everyday world. Despite successes in the entertainment and aviation industries, this technology has been called a 'solution in search of a problem'. The purpose of this commentary is to suggest such a problem: the inability to acquire experience with a hazard to motivate mitigation. Direct experience with a hazard has been demonstrated as a powerful incentive to adopt mitigation measures. While we lack the ability to summon hazard events at will in order to gain access to that experience, a virtual environment can provide an arena where potential victims are exposed to a hazard's effects. Immersion as an active participant within the hazard event through virtual reality may stimulate users to undertake mitigation steps that might otherwise remain undone. This paper details the possible direction in which virtual reality may be applied to hazards mitigation through a discussion of the technology, the role of hazard experience, the creation of a hazard stimulation and the issues constraining implementation.

Computer Simulation↗
PubMed2005

The impact of Bam earthquake on substance users in the first 2 weeks: a rapid assessment.

In the final days of the year 2003, an earthquake in the city of Bam, Iran, led to the death of some 35,000 of its inhabitants. The rate of opium abuse, which had been high among the male population in this city, caused problems after the earthquake. The aim of the following study was to examine the status of substance abusers during the first 2 weeks after the earthquake. The study was carried out in the city of Bam, one of its nearby villages and eight hospitals admitting earthquake victims. One hundred and sixty-three individuals were interviewed, including substance abusers, their family members, people living in Bam, service providers, and the authorities. During the first 2 weeks after the earthquake, about half of drug-dependent interviewees suffered from withdrawal symptoms. About half reported their problems to health care providers and asked for morphine or other analgesics. Around one third had used opium on the first day and two thirds in the course of the second day to the end of the second week after the earthquake. Although smoking had been the most common means of abuse before the earthquake, oral intake has become the most prevalent route after the disaster. Almost all obtained their opium from inhabitants of other cities as gifts. Members of rescue and health delivery systems had a lot of encounters with opium abusers, especially in the first 3 days after the earthquake, and had prescribed morphine and other analgesics. In societies with a considerable prevalence of substance abuse, this issue becomes a matter of utmost health care and social importance at times of disasters, and the necessary arrangements to deal with it should be present beforehand.

Adult↗
PubMed2004

Radiation disaster response: preparation and simulation experience at an academic medical center.

OBJECTIVES: A mass casualty disaster drill involving the simulated explosion of a radiation dispersal device (dirty bomb) was performed with the participation of multiple hospitals, emergency responders, and governmental agencies. The exercise was designed to stress trauma service capacities, communications, safety, and logistic functions. We report our experience and critique of the planning, training, and execution of the exercise, with special attention to the integrated response of the Departments of Nuclear Medicine, Health Physics, and Emergency Medicine. METHODS: The Health Physics Department presented multiple training sessions to the Emergency Medicine Department, Operating Room, and ancillary staff; reviewing basics of radiation biology and risk, protection standards, and detection of radiocontamination. Competency-based simulations using Geiger-Müller detectors and sealed sources were performed. Two nuclear medicine technologists played an important role in radiation discrimination-that is, assessment of radioactive contamination with survey meters and radionuclide identification based on gamma-spectroscopy of wipe smears from patients' clothing, skin, and orifices. Three Health Physics personnel and one senior Nuclear Medicine staff member were designated the radiation control officers for assigned teams triaging or treating patients. Patients were triaged and, when indicated, decontaminated. RESULTS: Within a 2-h period, 21 simulated victims arrived at our institution's Emergency Room. Of these, 11 were randomized as noncontaminated, with 10 as contaminated. Decontamination procedures were implemented in a hazardous materials (HAZMAT) decontamination trailer and, for the 5 patients with simulated serious injuries, in a designated trauma room. A full debriefing took place at the conclusion of the exercise. Staff largely complied with appropriate radiation protection protocols, although decontamination areas were not effectively controlled. The encountered limitations included significant lapses in communications and logistics, lack of coordination in the flow of patients through the HAZMAT trailer, insufficient staff to treat acute patients in a radiation control area, additional personnel needed for transport, and insufficient radiation safety personnel to control each decontamination room. CONCLUSION: Nuclear Medicine personnel are particularly well qualified to assist Health Physics and Emergency Medicine personnel in the preparation for, and management of, mass casualty radiation emergencies. Simulation exercises, though resource intensive, are essential to an institution's determination of response capability, performance, and coordination with outside agencies.

Academic Medical Centers↗
PubMed2004

Autopsy findings from 111 deaths in the 1999 Athens earthquake as a basis for auditing the emergency response.

BACKGROUND: The aim of the study was to assess the emergency response to an earthquake. METHODS: This retrospective study, based on formal autopsy findings from 111 earthquake-related deaths, evaluated demographic data, circumstances of death, rescue time, mechanisms of injury, causes of death, Abbreviated Injury Scale (AIS 90) and Injury Severity Score (ISS) values, vital functions, co-morbidity and preventable deaths. RESULTS: The median extrication time for 99 of 102 victims buried or trapped in collapsed buildings was 2.1 (range 0.1-7.8) days. Deaths were cause by blunt injuries, asphyxia and myocardial infarction. Injuries impaired the airway, breathing, circulation, and brain or spinal functions in 10.5, 61.9, 46.6 and 57.1 per cent of the victims respectively. The 105 injured victims were classified into three main categories. The first comprised 36 victims (34.3 per cent) with injuries not compatible with life (ISS 75), the second included 38 victims (36.2 per cent) who suffered life-threatening injuries (ISS 9-74) but had no evidence of asphyxia, and the third category contained 31 victims (29.5 per cent) with findings of asphyxia and an ISS of 1-18. The reviewers concluded that 13 trauma-related deaths and 31 deaths from asphyxia were potentially preventable. CONCLUSION: A method based on detailed evaluation of deaths provided information with which to audit the emergency response to an earthquake.

Adolescent↗
PubMedDate not supplied

Interactive computer-aided training of emergency care tactics: an experimental study with medical students.

INTRODUCTION: It is important to know which level of tactical preparedness is reached after completing lectures and training included in a medical curriculum. A computer-based interactive programme aimed for tactical training of emergency care tactics at the scene (Matimed, Matimed Ltd, Kuopio, Finland) was used in testing the skills of 20 medical students. METHOD: In this standardised test, every student first received guided introduction on the technical use of the programme. The test included four severely injured victims. The traumas used were hepatic rupture, flail chest, haemothorax, and femoral fracture. The students were tested in making decisions on the priority of care and transportation and in keeping the patients alive with appropriate emergency care until they were transported to a trauma centre. RESULTS: Only five of 20 (25%) succeeded in this task, 50% lost one victim and 25% lost two. The results show that the tactical preparedness of medical students is far from what is presumed. A more detailed analysis shows serious deficiencies in decision-making, priority order of actions, and in the use of available resources. CONCLUSIONS: This type of interactive computer-aided training of tactics appropriately supplements theoretical lectures, and partially fills the need for practical training.

Adult↗
PubMed1999

Telemedical support of prehospital emergency care in mass casualty incidents.

In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation.

Allied Health Personnel↗
PubMed2002

Observations from Ground Zero at the World Trade Center in New York City, Part II: Theoretical and clinical considerations.

Part I of this series discussed our observations of Ground Zero of the World Trade Center (WTC) immediately after the attack on September 11, 2001, as well as the stress-response of police officers on site. This paper offers a variety of clinical techniques for emergency mental health practitioners and first responders for use with victims of critical incidents. The suggested interventions are based on the theory and clinical practice of Emergency Medical Hypnosis, Neuro-Linguistic Programming, and Ericksonian Psychotherapy. Specific examples of how they were applied with police personnel following the World Trade Center attack are provided along with specific clinical guidelines. These interventions are designed to augment and enhance standard CISM, mental health, and medical practice in the field.

Aircraft↗
PubMed1993

[The characteristics of mental disorders in older persons who were earthquake victims].

To investigate mental disorders in elderly patients, victims to the earthquake, 30 patients aged 50 to 68 years were examined. Somatic complaints played the leading part in the disease clinical picture. The basic group comprised 14 patients, victims to the earthquake, and the control group was made up of 16 patients with analogous disorders but they had not been exposed to the earthquake. The disease lasted 6 and more months. It has been shown that the basic group patients seen over time manifest depressive forms of reaction to the extreme situation whereas in the control group patients, somatic disorders turned out dominant.

Aged↗
PubMed2005

Crush syndrome.

The assessment, management, and treatment of the entrapped victim are critical skills needed to ensure a successful outcome. Individuals have been trapped in the "rubble" for even short periods of time only to succumb to predictable consequences of muscle compression injury. The clinician should be prepared to address issues of crush syndrome (including compartment syndrome) proactively and aggressively. The history of this disease is clear and well documented both in the military literature and in the earthquake rescue reviews. The key to management is managing and predicting clinical conditions before they present themselves. The potential exists in the urban environment (with the potential of building collapses) to have patients with crush syndrome that far exceed local medical capabilities should be part of modern disaster planning. This article reviews the various body systems and presents management and assessment strategies for the clinician.

Adult↗
PubMed1999

An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard.

BACKGROUND: The purpose of this study was to create a system of mass casualty incident triage that provides a common language platform for both ambulance and hospital personnel based upon standard daily operating procedures for both groups. METHODS: An annotated literature review was conducted. RESULTS: The Homebush Triage Standard taxonomy consists of five categories: immediate, urgent, not urgent, dying and dead, which are given the phonetic alphabet designations of Alpha, Bravo, Charlie, Delta and Echo, respectively, to facilitate radio voice communications. Colours are assigned to each category: red (Homebush Red), yellow (Homebush Gold), green (Homebush Green), white and black comply with Standards Australia AS-2700 1996 Colour Standard for General Purposes, to ensure triage materials have consistent production standards. Numbers are reserved to either quantify or stratify individuals within a particular triage category. The Homebush Triage Standard methodology is based on START (Simple Triage Assessment and Rapid Transport) and SAVE (Secondary Assessment of Victim Endpoint) and documents triage priority using geographic triage with triage flags, instead of triage tags. CONCLUSION: The Homebush Triage Standard provides a basis for both seamless patient reassessment at all points along the casualty evacuation chain and the audit of the medical response to mass casualty incidents. It allows hospital and ambulance staff to keep working using familiar routines and removes fundamental barriers to good communication during a time of crisis.

Australia↗
PubMed2006

Chemical-biological terrorism and its impact on children.

Children remain potential victims of chemical or biological terrorism. In recent years, children have even been specific targets of terrorist acts. Consequently, it is necessary to address the needs that children would face after a terrorist incident. A broad range of public health initiatives have occurred since September 11, 2001. Although the needs of children have been addressed in many of them, in many cases, these initiatives have been inadequate in ensuring the protection of children. In addition, public health and health care system preparedness for terrorism has been broadened to the so-called all-hazards approach, in which response plans for terrorism are blended with plans for a public health or health care system response to unintentional disasters (eg, natural events such as earthquakes or pandemic flu or manmade catastrophes such as a hazardous-materials spill). In response to new principles and programs that have appeared over the last 5 years, this policy statement provides an update of the 2000 policy statement. The roles of both the pediatrician and public health agencies continue to be emphasized; only a coordinated effort by pediatricians and public health can ensure that the needs of children, including emergency protocols in schools or child care centers, decontamination protocols, and mental health interventions, will be successful.

Bioterrorism↗
PubMed2006

Muscoid fly populations in tsunami-devastated villages of southern India.

Several coastal villages of southern India were affected by the 26 December 2004 tsunami, and 10,749 people were killed. Investigation carried out in the affected villages during fourth, fifth, and sixth weeks posttsunami showed that the fly density was in the range of 12-91.8 flies per sweep net. In total, 3,259 flies belonging to eight species, namely, Musca domestica L., Musca vicina Macquart, Musca sorbens Wiedemann, Calliphora erythrocephala Robineau-Desvody, Sarcophaga ruficornis F., Chrysomyia sp. Robineau-Desvody, Chlorops sp., and Fannia sp. Robineau-Desvody, were recorded. M. domestica was the predominant species constituting 78.2% of the total flies collected. Density of flies was the highest in temporary shelters constructed for the victims, followed by centralized kitchens and devastated human settlements. Lack of waste control at centralized kitchens nearer to the shelters might be the reason for the high fly density in relief shelters. Under these circumstances, outbreak of fly-borne diseases is likely to be aggravated. Therefore, it is suggested that the ongoing space spraying be supplemented with effective waste control measures to reduce the high density of flies.

Animals↗
PubMed2003

Food aid in emergencies and public health nutrition.

HUNGER LEAVES SCARS: The visible kind may be born by the survivors of famine. Less visible, but all the more damaging, are the long-term effects of hunger that run through families through generations. Hunger passed from mother to child represents a ruinous inheritance. It marks a cycle of hunger that transcends generations, unless the cycle is broken. Food aid provided at crucial times in the lives of women and infants represents an investment for future. Thus, in contrast to former conceptions of food aid as an exclusively life-saving vehicle, modern aims of food aid also include preventing increases in the prevalence of malnutrition and asset depletion. Mass migration and food shortages have been responsible for most deaths following civil conflicts around the world. The most visible form of migration occurs when people cross international borders. The reasons for the flight of refugees and internally displaced persons are generally same; war, civil strife, and persecution. "NUTRITIONAL GATEWAYS": Finally, the importance of timely and sustained delivery of adequate food aid adequate in quality and quantity to people in dire need during the emergency is paramount. Food aid is the most direct means for conveying nutritional benefits: the time frame is often limited, sustainability is not an issue. However, in the case of drought victims, refugees or displaced people, the nutritional situation and the actions needed are more complex. In many situations people arrive are often in very bad state. While high prevalence of malnutrition is associated with inadequate food rations, in some situation malnutrition developed primarily because of the high incidence of diarrhoeal diseases. The synergism between high malnutrition and increased incidence of communicable diseases explains much of excess mortality seen in refugee and displaced persons.

Disasters↗