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PubMed2000

[Post-traumatic stress disorder. After the flood in Saguenay].

OBJECTIVE: To measure the prevalence of posttraumatic stress disorder and emotional distress among victims of the Saguenay flood compared with those who were not affected by the flood. DESIGN: Cross-sectional study using a telephone survey of victims and a control group. SETTING: Chicoutimi, Que. PARTICIPANTS: Sixty-two adults in a flooded area and a control group of 79 volunteers chosen randomly from an adjacent area. MAIN OUTCOME MEASURES: Diagnostic criteria for posttraumatic stress disorder measured using the Post-traumatic Stress Disorder Reaction Index and high scores on the Self-Reporting Questionnaire on emotional distress. RESULTS: Socially and demographically, study group and control group were comparable. Prevalence of posttraumatic stress disorder in the study group was close to 20% (odds ratio [OR] 6.08; 95% confidence interval [CI] 1.63 to 22.64). Prevalence of emotional distress in the study group was 29% (OR 2.42; 95% CI 1.04 to 5.61). CONCLUSION: The Saguenay flood caused psychological distress that was measurable 4 months later. Health care professionals should be aware of the psychological effects of natural disasters.

Adolescent↗
PubMed2005

Toxicological aspects of preparedness and aftercare for chemical-incidents.

The threat of using chemical warfare agents still exists despite the 1993 Chemical Weapons Convention. Preparedness for attacks with chemical agents has become an important issue of national security programs. It can be anticipated that toxicologists will be increasingly involved in preparedness programs of their institutions and of the government, no matter whether they work in agencies, industry or universities. Toxicologists must get prepared to give fast and reliable advice in the case of an attack, a sabotage or an accident with release of toxic chemicals. They should be familiar with the principles of hazard management and with incident command structures and cooperate with first responders of other organizations involved such as fire department and medical emergency teams already in the planning phase. In the emergency planning phase, toxicologists are expected to help identifying possible hazards. Moreover, they consult public health services with regard to toxicosurveillance and advice hospitals regarding antidotes, decontamination procedures and shelters. They may be involved in the procurement of antidotes and of protective equipment and will support qualified analytical laboratories. In the response phase, toxicologists must be ready to gain and to interpret analytical data, to support the medical care of poisoned victims and to provide repeated risk assessment reports. This requires an on-scene access to databases and registries. The aftercare phase includes the identification of exposed persons, mapping of contaminated areas, organization of decontamination measures and the release of areas. A medical study may be initiated to observe long-term health effects. Good cooperation between regulatory and clinical toxicologists, specific education of toxicologist in the field of chemical emergencies and regular trainings are essential elements of good preparedness.

Antidotes↗
PubMed2005

Rapid assessment survey of earthquake affected Bhuj block of Kachchh District, Gujarat, India.

RESEARCH QUESTIONS: How much human loss would have caused by the earthquake in Bhuj block? What is the environmental sanitation status? OBJECTIVES: (1) To assess human loss and injuries after the earthquake in Bhuj block.(2) To study the status of some relief activities.(3) To study the environmental sanitation status of the earthquake affected Bhuj block. STUDY DESIGN: Cross-sectional study. SETTINGS: Bhuj block. PARTICIPANTS: All villages excluding Bhuj city of Bhuj block. STATISTICAL ANALYSIS: Proportions, chi-square test, chi-square for trend. RESULTS: Survey was done in 144 villages; there were total 541 deaths with death rate of 3.18 per 1000 population. Death rate was significantly associated with distance of village from epicenter (chi-square for trend significant, P < 0.001). Among victims, majority were children 171 (45.4%) and women 107 (28.4%). Relief work was significantly associated with accessibility of village (P < 0.001) and few interior pockets were deprived of help. Total 56 (38.9%) villages were entirely dependent on water tanker for water supply and in 61 (42.4%) villages drinking water was used without chlorination. In 142 (98.6%) villages open-air defecation was practiced. Diseases such as URTIs, diarrheal diseases, fever and conjunctivitis were commonly observed in the field area.

Adolescent↗
PubMed2002

Medical management of vulnerable populations and co-morbid conditions of victims of bioterrorism.

Planning for the medical response to bioterrorism has primarily focused around the needs of the population as a whole. There has been little discussion pertaining to certain vulnerable groups such as children, pregnant women, or immunocompromised patients, yet they will likely comprise a significant subset of the exposed population. In addition, they will be at increased risk for morbidity and mortality following an attack. The emergency response to bioterrorism will be more complex as it relates to these vulnerable populations. Careful consideration of their special needs, some of which are presented in this article, may refine our efforts.

Age Factors↗
PubMed2006

Toxinology in Australia's colonial era: a chronology and perspective of human envenomation in 19th century Australia.

The medical management of those envenomed by snakes, spiders and poisonous fish in Australia featured extensively in the writings 19th century doctors, expeditioners and anthropologists. Against the background of this introduced medical doctrine there already existed an extensive tradition of Aboriginal medical lore; techniques of heat treatment, suction, incision and the application of plant-derived pharmacological substances featured extensively in the management of envenomed victims. The application of a hair-string or grass-string ligature, suctioning of the bite-site and incision were practised in a variety of combinations. Such evolved independently of and pre-dated such practices, which were promoted extensively by immigrant European doctors in the late 19th century. Pacific scientific toxinology began in the 17th century with Don Diego de Prado y Tovar's 1606 account of ciguatera. By the end of the 19th century more than 30 papers and books had defined the natural history of Australian elapid poisoning. The medical management of snakebite in Australia was the focus of great controversy from 1860 to 1900. Dogmatic claims of the supposed antidote efficacy of intravenous ammonia by Professor G.B. Halford, and that of strychnine by Dr. Augustus Mueller, claimed mainstream medical attention. This era of potential iatrogenic disaster and dogma was brought to a conclusion by the objective experiments of Joseph Lauterer and Thomas Lane Bancroft in 1890 in Brisbane; and by those of C.J. Martin (from 1893) and Frank Tidswell (from 1898), both of Sydney. The modern era of Australian toxinology developed as a direct consequence of Calmette's discovery, in Paris in 1894, of immune serum, which was protective against snakebite. We review the key contributors and discoveries of toxinology in colonial Australia.

Animals↗
PubMed2003

Acute public health consequences associated with hazardous substances released during transit, 1993-2000.

Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registry's (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.

Disasters↗
PubMed1981

Radiation decontamination unit for the community hospital.

"Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.

Accidents↗
PubMed2001

[Organization of trauma admissions at Norwegian hospitals].

BACKGROUND: Treatment of major trauma is a demanding challenge for most hospitals. The potential benefits of improvement are substantial: it has been calculated that approx. 6,000 person-years are lost each year because of suboptimal treatment of trauma in Norway. Trauma teams, paging criteria, and manuals for appropriate resuscitative and diagnostic interventions are needed for improving the structure and quality of this service. MATERIAL AND METHODS: A telephone survey to Norwegian hospitals. RESULTS: 27 (52%) of all 52 Norwegian hospitals receiving trauma victims had dedicated trauma teams, while 19 (37%) had paging criteria for trauma teams. 22 hospitals (42%) confirmed that they had manuals for the initial treatment of trauma victims. Smaller hospitals tended to have trauma teams and trauma manuals to a lesser extent. An interesting finding was that hospitals that participated in a collaborative project on trauma treatment (the so-called BEST network) were significantly more likely to have trauma teams, paging criteria, and trauma manuals. INTERPRETATION: The results show that structural issues in relation to optimal trauma treatment still need more attention in Norwegian hospitals. Collaborative programmes for training and exchange of experience and procedures seem to be one way to go.

Clinical Competence↗
PubMed2002

Jonestown tragedy revisited: the role of dentistry.

The authors record the contribution of dentistry to the identification of victims of one of the most significant tragedies of the 20th century--the mass suicide of members of a religious cult, which initially resulted in 913 deaths and ultimately in 923. Though forensic dentistry played a significant part in identifying victims, the only report by members of the United States identification team did not examine dentistry's valuable role. Furthermore, the dental-investigation aspects have been mentioned merely in passing by the news media despite an infinite number of stories on the tragedy ranging from factual to expose. The dental team's organization, methodology, and significant contributions to forensic dentistry and a variety of remarkable problems that the team encountered and the lessons learned from them are documented in this paper.

Adolescent↗
PubMed2000

Use of radiographic atlases in a mass fatality.

In May and June of 1996, a forensic anthropology team from the C.A. Pound Human Identification Laboratory at the University of Florida identified 9 of 10 juveniles from the crash of ValuJet 592. The team relied primarily on a radiographic atlas developed and used by clinical practitioners to determine skeletal age. Postmortem radiographs of the juvenile victims were compared with radiographic standards to determine skeletal age. Skeletal age was then compared to a passenger list indicating the sex, weight, height, and chronological age of each individual. Tentative identifications based on the atlas method were organized into an exclusion matrix. Final identifications were based on this assessment in conjunction with other anthropological data such as appearance and fusion of ossification centers and estimation of stature.

Accidents, Aviation↗
PubMed2005

Critical care during epidemics.

We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care capacity, so critical care health care professionals must take the lead for planning and preparing to care for numbers of seriously ill patients that far exceed available ICU beds.

Bioterrorism↗
PubMed2004

Emergency preparedness and response: compensating victims of a nuclear accident.

The 1986 tragedy at the Chernobyl Nuclear Power Plant in Ukraine motivated the entire international nuclear community to ensure that countries would, in the future, be well prepared to manage the physical, psychological and financial consequences of a serious nuclear accident. Since that event, numerous nuclear emergency preparedness and post-emergency management programmes have been established at national and international levels to ensure that appropriate mechanisms will respond to the threat, and the aftermath, of a nuclear accident. The INEX 2000 Workshop on the Indemnification of Nuclear Damage, jointly organised by the OECD/Nuclear Energy Agency and the French Government, was the first ever international programme to address the manner in which victims of a nuclear accident with trans-boundary consequences would be compensated for damage suffered before, during and after the accident. The Workshop results revealed striking differences in the compensation principles and practices implemented in the 30 participating countries, in the co-ordination measures between different public authorities within an affected state, and in the co-operative procedures between the accident state and its neighbours. All participants agreed on the need for improvement in these areas, particularly for maintaining public confidence in governments' ability to properly manage nuclear emergencies.

Compensation and Redress↗
PubMed1990

[Organization of medical services for the victims of the earthquake in the city of Spitak, Armenian S.S.R].

Sanitary losses in the city of Spitak were about 47.8%, injures of the middle and critical degree being diagnosed in 9.5%. During the first period (from December 9 to 14, 1988) patients admitted to the hospitals predominantly had traumas of the head, chest, extremities, vertebral column (86.3%). The crush syndrome and position compressions and their combinations with total cooling during this time were diagnosed in 61 victims (19%), and during the whole period of work--in 63 (7.6%). Success of treatment of the patients with this pathology was promoted by their having obtained qualified surgical and anesthesiological aid before evacuation to medical institutions of the Center in full value in combination with temporary admittance to the hospital at an average for 12-18 hours up to complete arrest of shock. During the first steps of evacuation the amputation of extremities was fulfilled in 3 cases.

Armenia↗
PubMed1990

Mortality estimates of the 1984-85. Ethiopian famine.

A brief summary of famine and drought from a historical perspective is given. In an attempt to estimate the magnitude of deaths due to the 1984-85 famine in Ethiopia, a survey was conducted among the resettled famine victims. The results show that the expected life at birth among the male and female famine victims was 6.2 and 5.7 years, respectively. When compared with the highest mortality rates ever recorded (that is Coale-Demeny, West Model Life Table level 1), the Ethiopian famine induced rate seems to be considerably higher. Regional variations between the two famine affected regions show that mortality in Tigrai was slightly higher than that of Wello. Also prefamine socio-economic differentials between households did not seem to have an effect on mortality. The results suggest that as much as 700,000 excess deaths might have occurred during the 1984-85 famine period in Ethiopia.

Disasters↗
PubMed1992

Hospitalized tornado victims.

We reviewed the clinical findings of 59 patients admitted to Huntsville's three hospitals during the first 24 hours after the November 15, 1989, tornado and as a result of injury caused by the tornado. Fracture of a bone was the most common injury followed by soft tissue trauma and infection. A variety of non-traumatic conditions also were encountered. Fractures were more frequent above the waist than below and five fractures became infected resulting in osteomyelitis. Infections most often involved the urinary tract and bone and were caused primarily by aerobic gram-negative bacilli. The hospital mortality rate was 7%.

Adolescent↗
PubMed1991

[The use of aviation transport in providing medical care to the victims in an earthquake focus].

2584 wounded were evacuated by helicopters during Armenian earthquake, December, 1988--that was 20% of all hospital cases. But, practically, the possibilities of aviation in Spitak and Leninakan regions were far more extensive. The more effective employment of air transportation for evacuation could be attained by the following measures: organization of a sole command and action coordination between medical service, air command and rescue teams, preliminary rescue planning, efficient organization of triage and evacuation of wounded, special training of medical staff in air evacuation. The extreme conditions of flights in emergency situation of catastrophe or calamity need high working capacity and firm professional skill of flight crews.

Aircraft↗
PubMed2005

Epidemiology of burn injuries in Singapore from 1997 to 2003.

The Singapore General Hospital (SGH) Burn Centre receives more than 93% of burn cases occurring in Singapore. The Centre also received patients from the Southeast Asian region. The collection and analysis of burn epidemiology data in recent years from Singapore would provide insights into new prevention/management strategies in terms of population profile and economic activities. Data pertaining to burn patients admitted to SGH Burn Centre between January 1997 and December 2003 were studied retrospectively in terms of admissions' demographics, extent of burn (TBSA), causes of burns, length of hospital stay (LOS) and mortality. A total of 2019 burn patients were admitted with an annual admission of 288. This presented an incidence rate for burn injury (with admission) of 0.07 per 1000 general population. The male to female ratio is 2.2:1 and the mean age of admission is 32.5years. The mean extent of burn was 11.5% and patients with burn size 10% TBSA and less made up the majority of admissions at 70.7% while patients with burn size 30% TBSA and more made up 8.2%. The most common cause of burn injury is scald at 45.6% followed by flame at 35.2%. The overall mean LOS and mortality are 10.8days and 4.61%, respectively. An annual trend of falling mortality rate for admissions with burn size >30% TBSA was observed-60% in year 2000 to 30% in 2003. This is a result of massive early excision and grafting of severe burn patients. 17.6% of patients were children of 12years and below, showing a 11.9% reduction from previous study in the 80s. This is consistent with the city's demographics of falling fertility rate and improved living and social conditions. Occupational burn admissions account for 33.4% of total admissions, a reduction of 11.6% from a study in the early 90s. Occurrence of occupational flame burns decreased by 9.5% due to an improvement in fire prevention and management of the industrial sectors. However, chemical burns increased by 12.6% as the chemical sector in Singapore grew at a rate of 10% from year 1995 to 2000. Singapore has also derived much experience from the management of mass casualties resulting from SQ006 plane crash and bomb blasts in Bali as well as in Jakarta. In total, 315 victims were treated (4 from SQ006, 16 from Bali and 15 from Jakarta) with 1 mortality. The burns admissions in Singapore has a profile consistent with population demographics. Scald is the major cause of burns and most of these injuries are preventable. While the industries have made inroads into good fire prevention and management, management of chemical burns and other occupational hazards will continue to be scrutinized and advice given in terms of regulations, work processes and personal protective gears.

Adolescent↗
PubMed1989

[Functional methods of examination of the victims of the earthquake with crush syndrome in the Armenian S.S.R].

The authors have developed a complex of measures including the known (tetrapolar rheoplethysmography, liver and kidney radiography) and the new tests (soft tissue scintigraphy) that have been used for the first time in this condition. Employment of these tests for the examination and monitoring the treatment of patients who were injured in the earthquake in Armenia has helped quantitatively assess the structural and functional shifts in the vital organs and injured limbs in the crush syndrome, thus being valuable for the organization and monitoring the efficacy of therapy and for predicting the outcome of injury.

Acute Kidney Injury↗