bluuebunny/crossref_metadata_2025 huggingface dataset:
Get Off the Bus: Sound Strategy for Injury Prevention During a Tornado?
Authors: Comstock R. Dawn , Mallonee Sue
Published: August 2016

Introduction:

On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the “F Scale”) struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris.

Methods:

A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck.

Results:

Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate= 79.2%).While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were lesssevere (median injury severity score (ISS) 1 versus 4).

Conclusion:

For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.
Lessons Learned from Cross-border Medical Response to the Terrorist Bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004
Authors: Leiba Adi , Blumenfeld Amir , Hourvitz Ariel , Weiss Gali , Peres Michal , Laor Dani , Schwartz Dagan , Arad Jacob , Goldberg Avishay , Levi Yeheskel , Bar-Dayan Yaron
Published: August 2016

Introduction:

Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario.

Methods:

Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response.

Results:

A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation “staging hospital”. Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter.

Conclusion:

Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an “evacuation hospital”, and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.
KAMEDO Report No. 75 Fire Catastrophe in Gothenburg 29–30 October 1998
Authors: Riddez Louis , Dellgar Uno
Published: August 2016

A fire developed in a facility being used as a discotheque that resulted in death for 63 young people. The rescue operations, ambulance responses, medical care provided at the scene, hospital operations, and psychosocial responses are described. Bodies blocked the exit and many survivors had to evacuate by leaping from windows. A total of 16 ambulances were used. Survivors and people not directly involved in the incident created disturbances and some even attacked responders. Many of those who escaped early suffered mild inhalation injuries and those who escaped later, sustained more severe inhalation injuries. High levels of both carbon-monoxide and cyanide were detected at autopsy. A total of 213 persons were transported to hospitals, 85 by ambulance. Most who died at the scene had severe burn injuries, were unconscious, or suffered from fire-gas injuries. A total of 150 victims were admitted to a hospital, of which 74 (49.3%) required intensive care. Only one of the four hospitals actuated a disaster alert. Psychosocial support was complicated due the multicultural characteristics of those involved. Support to the survivors and relatives of the victims was provided by representatives of various religious organization, non-profit organizations, and by the government of Gothenburg. Many recommendations are provided to better prepare for future events.
KAMEDO Report No. 76 Floods in Poland in 1997 and in Sweden in 2000
Authors: Riddez Louis , Dellgar Uno
Published: August 2016

Extensive flooding occurred in Poland in 1997 and in Sweden in 2000. These events and their management are reviewed in this Report. The floods in Poland were more extensive than in Sweden as they covered some 10% of Poland's landmass. An estimated 55 persons died as a direct result of the floods in Poland and none were reported due to the flood in Sweden. No epidemics were encountered in either country, presumably related to the extensive use of bottled water and radio instructions to boil all water before its use. The water supply was interrupted and untreated water was taken into the water distribution systems. Chlorination of the water supplies was added in Sweden. Sewage and refuse management was problematic. The heathcare system was impacted profoundly in Poland both by direct damage to hospitals and/or loss of essential services such as electricity and water supplies. Government responses are described with the needs in Poland being extensive including the need for outside assistance. Some pathways used for obtaining aid were outside of government coordination. Comprehensive conclusions and recommendations derived from the observations are provided.
Session 1.5: Health Policy and Coordination: A Critical Review of Experiences
Authors: Procacci Pasqualino , Doran Rodger , Chunkath Sheela Rani , Garfield Richard , Briceno Salvano , Fric Anton
Published: August 2016

This is a summary of the presentations and discussion of Session 1.5 on Health Policy and Coordination: A Critical Review of Experiences during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened bythe World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to health policy and coordination as pertain to the responses to the damage created by the Tsunami. Key questions were answered in this session, and recommendations were made.
Panel 2.5: Mass-Casualty Management and Hospital Care
Authors: Borra Agostino , Perez Luis Jorge , Min Tin , Puavilai Wilai , Seo Norimasa , Tipsunthonsak Nakhon
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.5, Mass-Casualty Management and Hospital Care of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to mass-casualty management and hospital care as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: wing (1) key questions; (2) recommendations; and (3) conclusions. Subsections of the conclusion section include: (1) lessons learned; (2) what was done well?; and (3) what could have been done better?.
Panel 2.7: First 30 Days: Organizing Rapid Responses
Authors: Emerson Natacha , Pesigan Arturo , Sarana Lita , Motus Nenette , Buriak Dan , Randall Tim
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.7, First 30 Days: Organizing Rapid Response of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed inc included issues related to organizingrapid responses as pertain to the responses to the damage created by the created Tsunami. It is presented in the following major sections: (1) issues; (2) key questions; and (3) recommendations.
Panel 2.8: Water, Sanitation, Food Safety, and Environmental Health
Authors: Islam Md Shafiqul , Heijnen Han Antonius , Sumanasekera Deepthi , Walden Vivien , Roulet Michel , Yoosuf Abdul Sattar
Published: August 2016

This is a summary of the presentations and discussion by the panel that addressed issues with Water, Sanitation, Food Safety, and Environmental Health during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to water, sanitation, food safety, and environmental health as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessments; (2) institutional capacity and coordination; (3) what was done wel well, and what could have been done better?; and (4) capacity building and preparedness. Topics discussed in the needs assessment section included: (1) water supply; (2) hygiene; and (3) lessons learned. Topics discussed realated to capacity building and preparedness included: (1) waste and vector-bor borne diseases; (2) food safety; (3) nutrition; and (4) environmental health.
Panel 2.16: Forensic Aspects of Disaster Fatality Management
Authors: Tun Kan , Butcher Barbara , Sribanditmongkol Pongruk , Brondolo Tom , Caragine Theresa , Perera Clifford , Kent Karl
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.16, Forensic Aspects of Disaster Fatality Management of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to forensic aspects that pertain to the responses to the deaths created by the Earthquake and Tsunami. It is presented in the following major sections: (1) overview of victim identification; (2) resource factors in mass-fatality management; (3) mass-fatality management in protecting public health; and (4) reasons to use deoyxribose nucleic acid (DNA) to identify the deceased.
Panel 2.17: Private Commercial Sector Partnerships for Health Action in Crises
Authors: Sundnes Knut Ole , Sannerkvist Milan , Hedger Philip , Woodworth Brent , Hyre Anne , Cuddyre Terrence , Waldman Ronald
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.17, Private Commercial Sector Partnerships for Health Action in Crises of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to private sector partnerships for health action in crises as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) key questions; (2) issues and challenges; (3) lessons learned; (4) what was done well?; (5) what could have been done better?; and (6) conclusions and recommendations.
Panel 2.18: Logistics, Information Technology (IT), and Telecommunications in Crisis Management
Authors: De Silva Terrence , Chikersal Jyotsna , Snoad Nigel , Woodworth Brent , Ghaly Cherif , Catterall Martin
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.18, Logistics, Information Technology, and Telecommunication in crisis Management of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to logistics, information Technology (IT), and crisis communication pertaining to the responses to the damage created by the Tsunami. It iss presented in the following major sections: (1) issues; (2) lessons learned; (3)what was done well; (4)what could have been done better; and (5)conclusions and recommendations. Each major section is presented in four sub-sections: (1) needs assessments; (2) coordination; (3) filling the gaps; and (4) capacity building.
What Have We Learned? Capacity Building for Health Responses in Disasters
Authors: Guha-Sapir Debarati
Published: August 2016

This is a synthesis of the presentations and discussions pertaining to Capacity Building for Health Responses in Disasters of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04–06 May 2005. The topics discussed included: (1) Specific goals; (2)Main focal areas, including available training programs, country-specific training programs, targeted technical assistance for training programs, certified training programs, and ensuring that funding is available for training; (3) What has been achieved in building capacity; (4) Challenges; (5) Where capacity building is needed; and (6) Conclusions and recommendations.
Putting It Together: Stronger Public Health Capacity within Disaster Management Systems
Authors: Nabarro David
Published: August 2016

This is a summary of the agreement reached during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. There are 12elements to this agreement: (1) risk management and vulnerability capacities; (2) needs assessments and programmed management; (3) best public health practices; (4) benchmarks, standards, and codes of practice; (5) management and coordination; (6) supply systems, communication, and logistics; (7) volunteers; (8) demonstrated leadership; (9) military and commercial private sectors; (10) media; (11) accountability and ethics; and (12) preparedness.
Collegiate-Based Emergency Medical Services (EMS): A Survey of EMS Systems on College Campuses
Authors: Fisher Jonathan , Ray Adam , Savett Scott C. , Milliron Mark E. , Koenig George J.
Published: August 2016

Introduction:

Collegiate-based emergency medical systems (CBEMS) are a unique model for the delivery of prehospital care. The National Collegiate Emergency Medical Services Foundation (NCEMSF) was founded to serve as a resource for CBEMS groups. The purpose of this investigation is to describe the current state of CBEMS organizations.

Methods:

The NCEMSF maintains a Web-based, data collection system to gather data on CBEMS organizations. Collegiate-based emergency medical services are defined as emergency medical services in a university or college campus setting. The abstracted data from the NCEMSF registry were analyzed using descriptive statistics.

Results:

The NCEMSF registry contained data on 175 groups, and 145 groups were identified as providing CBEMS. The levels of service provided by the groups were: (1) first responder, 8.3%; (2) basic life support (BLS) 66.2%; (3) intermediate life support (ILS) 4.8%; (4) advanced life support (ALS), 9.7%; and (5) combination BLS/ALS, 8.3%. Transport capabilities were provided by 31.7% of the CBEMS. The average response time was estimated at 2.6 minutes (95% confidence interval (CI), 2.35–2.91 minutes). Early defibrillation using a automated external defibrillator (AED) or ALS was available by 75.9% (95% CI, 68.8–83.0) of CBEMS. Service to the community beyond the campus was provided by 21.3% of CBEMS groups. Forty-eight percent of the services operate 24 hours/day, seven days/week. The average call volume per year was 568 responses (95% CI, 315–820), and the groups averaged 29 (95% CI, 25–34) members. During the past five years, an average of 4.3 new CBEMS groups were formed per year. Eleven of the CBEMS are based at international schools.
KAMEDO Report No. 79 Train Accident in Germany, 1998
Authors: Iselius Lennart , Nilsson Per-Åke , Riddez Louis
Published: August 2016

A train traveling at 200 kilometers per hour carrying 300 passengers crashed into a bridge. At leaset 85 doctors and 1,889 persons were involved in the emergency response. A total of 101 persons were killed, 108 were injured, and 87 were transported to a hospital (27 by helicopter; 60 by land ambulance). Eighty percent of the severely injured were trasported to a hosptial within two hours of the crash. Coordination of the activities of the hoards of responders was an issue, as was the lack of a formal organization to provide psychosocial support. Preparedness plans should include management of the dead and for the provision of psychosocial support.
Frequency of Post-Traumatic Stress Disorder among Relief Force Workers after the Tsunami in Asia: Do Rescuers Become Victims?
Authors: Armagan Erol , Engindeniz Zulfi , Devay Ali Onder , Erdur Bulent , Ozcakir Alis
Published: August 2016

Objective:

The objective of this study was to evaluate the frequency of posttraumatic stress disorder (PTSD) among the participants of the Turkish Red Crescent Disaster Relief Team after the Tsunami in Asia.

Methods:

The Clinician Administered PTSD Scale-1 (CAPS-1) was administered to 33 of 36 team members one month after their Disaster Relief Team duty. Along with the CAPS-1 interview, demographic features, profession, previous professional experience, previous experience with traumatic events and disasters also were recorded. To be classified as present, a symptom must have a frequency score of “1” and an intensity score of “2” at the CAPS-1 interview. For a diagnosis of PTSD, at least one re-experiencing, three avoidance and numbing, and two increased arousal symptoms should be present.

Results:

The PTSD was diagnosed in eight of the 33 (24.2%) participants. No significant difference was detected in the distribution of PTSD diagnosis according to gender, age, profession, professional experience, previous disaster experience, and/or previous experience of traumatic events. However, the severity of PTSD symptoms as measured by the CAPS-1 score was significantly higher in women, nurses, and participants with <3 previous disaster duty experiences.

Conclusion:

Post-traumatic stress disorder is prevalent within disaster teams and healthcare workers, and measures should be taken to prevent PTSD within this group.
Changes in Level of Consciousness and Association with Hyperglycemia as Tool for Predicting and Preventing Re-bleeding after Spontaneous Subarachnoid Hemorrhage
Authors: Kitsuta Yoichi , Suzuki Noriyuki , Sugiyama Mitsugi , Yamamoto Isao
Published: August 2016

Introduction:

It is crucial to predict and prevent re-bleeding from ruptured intracranial aneurysms in patients with subarachnoid hemorrhage (SAH). During the prehospital period and on arrival to the hospital, blood glucose and serum potassium levels, as well as changes in levels of consciousness were assessed in patients in the acute stage of spontaneous subarachnoid hemorrhage. These assessments were analyzed as possible risk factors for re-bleeding and as potential contributors to the prevention of re-bleeding, both in prehospital care and after hospital admission.

Methods:

Upon the arrival of 202 patients with spontaneous subarachnoid hemorrhage, the following indications were examined retrospectively: (1) presence/absence of re-bleeding; (2) time interval between the onset of SAH and re-bleeding; (3) level of consciousness using the Glasgow Coma Scale (GCS) score before and on arrival; (4) amount and distribution of subarachnoid blood using Fisher's Computerized Tomography Classification; (5) blood pressure; (6) blood glucose concentration; and (7) serum potassium concentration. The patients were hospitalized in the Yokohama City University Critical Care and Emergency Center (Yokohama, Japan) between January 1991 and December 2000. The re-bleeding rate was analyzed using the chi-square ([X]2 test, and the averages and standard deviations of hematological data were compared using the Mann-Whitney U-test. The level of statistical significance was set at p <0.05.

Results:

The overall re-bleeding rate was 20.8%. Among 119 patients with a GCS score of 3–7 before arrival, 42 (35.3%) had re-bleeding, but none of the 83 patients with a GCS score of 8–15 before arrival had re-bleeding. Of 105 patients with a GCS score of 13–15 on arrival, 14 (51.8%) of 27 patients whose consciousness level was a GCS score of 3–7 before arrival experienced re-bleeding. The re-bleeding rate of this group was high. Moreover, this rebleeding group had a significantly higher blood glucose concentration than did the patients whose GCS score was 13–15 both before and on arrival. Between the patients with or without re-bleeding, there was no significant difference in the blood pressure on arrival or in distribution according to Fisher's Computerized Tomography Classification

Conclusion:

Since the re-bleeding rate is high in patients who have hyperglycemia and a history of a level of consciousness as low as a GCS score of 3–7, a detailed assessment of level of consciousness and blood glucose tests performed on arrival provide important information that will contribute to predicting and preventing re-bleeding. This may be extended to the prehospital phase, because blood glucose tests are simple and safe when performed by paramedics.
Medical Support for Emergency Relief Workers After Typhoon Sudal in Yap, Micronesia
Authors: Partridge Robert , King Kevin , Proano Lawrence
Published: August 2016

Introduction:

On 09 April 2004, Typhoon Sudal struck the Island of Yap in the Federated States of Micronesia (FSM). Over 90% of homes, public utilities, and public property were damaged or destroyed. Nearly 10% of the population was displaced to shelters, and the majority of the population was without drinking water or power. United States disaster workers were deployed to Yap for three months to assist in the recovery and relief efforts.

Objective:

The objective of this study was to evaluate the acute healthcare needs of the US disaster relief population serving in a remote setting with limited medical resources.

Methods:

A retrospective chart review of all disaster relief workers presenting to an emergency clinic in Yap during the disaster relief effort from April 2004–July 2004 was performed. Investigators extracted demographic data, chief complaints, medical histories, medical management, disposition, and outcome data from the clinic charts.

Results:

Together, the 60 disaster workers present on Yap during the relief effort made 163 patient contacts in the disaster emergency clinic. A total of 92% of patient contacts were for minor medical complaints or minor trauma, 13% were for upper-respiratory infections, 9% were for gastrointestinal illness, and 9% were for dermatological problems. Eight percent of visits were for serious medical problems or trauma. Life-threatening illnesses or injuries did not occur.

Conclusions:

Disaster relief workers on Yap frequently utilized the disaster relief clinic. In general, disaster workers remained healthy during the relief effort in Yap, and most injuries and illnesses were minor. On-site medical providers resulted in rapid care and stabilization, and after treatment, disaster workers were able to return to duty.
Anti-personnel Landmine Injuries during Peace: Experience in a European Country
Authors: Papadakis Stamatios A. , Babourda Eleni C. , Mitsitskas Thomas C. , Markakidis Sotirios , Bachtis Costas , Koukouvis Dimitrios , Tentes Apostolos A.
Published: August 2016

Introduction:

The purpose of this study is to report the incidence of landmine injuries during peacetime in a European country.

Methods:

Forty victims of landmine explosions were admitted to Didimoticho General Hospital in Greece, from December 1988 to March 2003. A total of 19 people survived (47.5%) these events; all of the others were dead upon admission to the hospital. All of the victims were men, either suspected smugglers or migrants entering the country illegally, with an aver- age of 30 years (range: 15–56 years).

Results:

Most victims presented in groups, with multiple traumatic injuries, including lower extremity wounds. The mortality rate in the minefield prior to hospital admission was 52.5%, and the amputation rate for the survivors was 37%. There were no deaths of the patients admitted to the hospital.

Conclusions:

Landmines cause highenergy injuries with high mortality and amputation rates. Illegal migrants are the main victims of landmine explosions in Greece.
Reanimation Unit Experience of a Second-Level Hospital in Mexico City
Authors: Loria-Castellanos Jorge , Rocha-Luna Juan Manuel , Márquez-Ávila Guadalupe
Published: August 2016

Objectives:

The objectives of this study were to determine the clinical characteristics of patients who presented to the Reanimation Unit (RU) of a second-level hospital during one year, and the number and type of emergency procedures performed.

Methods:

A cross-sectional study was designed that enrolled all patients >15 years of age who presented to the RU from 01 January through 31 December 2003. The age, gender, diagnosis, site of origin, and disposition of each patient was recorded, as well as the distribution by time of day, the number and type of emergency procedures performed, complications, and mortality rate.

Results:

Of the 3,741 patients enrolled in the study, 57.0% were male; predominantly 41–50 years old (20%). Most patients presented to the RU from their homes during the afternoon.There were 60 different admission diagnoses: more of the emergencies were for medical than for traumatic emergencies. The predominant pathologies were bronchospasm, hypertensive crisis, and upper gastrointestinal bleeding. Initially, patients either were admitted to the observation unit, the consulting office for the emergency department, or the intensive care unit. There were a total of 2,753 emergency procedures performed: orotracheal intubations were the most common, followed by installation of a catheter into the central venous circulation. Of all of the patients admitted to the RU, 31% were not insured.

Conclusions:

There exists a remarkable combination between medical and traumatic emergencies, which is not encountered frequently in other second level-hospitals in Mexico City. A high proportion of the patients who received medical attention were not insured and there were a large number of emergency invasive procedures performed.
Using Innovative Simulation Modalities for Civilian-based, Chemical, Biological, Radiological, Nuclear, and Explosive Training in the Acute Management of Terrorist Victims: A Pilot Study
Authors: Subbarao Italo , Bond William F. , Johnson Christopher , Hsu Edbert B. , Wasser Thomas E.
Published: August 2016

Objectives:

Chemical, biological, radiological, nuclear, and explosive (CBRNE) incidents are low frequency, high impact events that require specialized train-ing outside of usual clinical practice. Educational modalities must recreate these clinical scenarios in order to provide realistic first responder/receiver training.

Methods:

High fidelity, mannequin-based (HFMB) simulation and video clinical vignettes were used to create a simulation-based CBRNE course directed at the recognition, triage, and resuscitation of contaminated victims. The course participants, who consisted of first responders and receivers, were evaluated using a 43-question pre- and post-test that employed 12 video clinical vignettes as scenarios for the test questions. The results of the pre-test were analyzed according to the various medical training backgrounds of the participants to identify differences in baseline performance. A Scheffe posthoc test and an ANOVA were used to determine differences between the medical training backgrounds of the participants. For those participants who completed both the pre-course and post-course test, the results were compared using a paired Student's t-test.

Results:

A total of 54 first responders/receivers including physicians, nurses, and paramedics completed the course. Pre-course and post-course test results are listed by learner category. For all participants who took the pre-course test (n = 67), the mean value of the test scores was 53.5 ±12.7%. For all participants who took the post-course test (n = 54), the mean value of the test scores was 78.3 ±10.9%. The change in score for those who took both the pre- and post-test (n = 54) achieved statistical significance at all levels of learner.

Conclusions:

The results suggest that video clinical vignettes and HFMB simulation are effective methods of CBRNE training and evaluation. Future studies should be conducted to determine the educational and cost-effectiveness of the use of these modalities.
Medical Support during the European Union Summit in Gothenburg, Sweden, June 2001
Authors: Johnsson Kristina M.C. , Örtenwall Per A. , Kivi Anne-Lii H. , Hedelin Annika H.E.
Published: August 2016

Introduction:

Several factors are important for the number and severity of medical emergencies during mass-gatherings. The risk of violence, the size and mobility of the crowd, the type of event, weather, and duration of the event all influence the outcome. During the European Union (EU) Summit, from 15–16 June 2001 in Gothenburg, Sweden, approximately 50,000 people participated in 43 protest marches, some which included 15,000 participants. Clashes between police and the protesters occurred.

Objective:

The objective of this study was to analyze the amount and character of injuries as well as the medical complaints in relation to the EU Summit. In addition, the aim of this study was to describe the organization and function of the healthcare services provided during the meeting.

Methods:

This study is based on the medical records of patients presenting with injuries and other types of medical emergencies at the healthcare stations during the Summit.

Results:

In total, 143 patients sought medical care. Fifty-three (37.1%) were police officers. Most patients had minor complaints, but a few were seriously injured.The Patient Presentation Rate (PPR) was 2.7. Nine victims were hospitalized as high priority.

Conclusion:

The PPR for the EU Summit was 2.7, which is in the same range as previously reported from other mass-gatherings.
Fear, Panic, and Bio-events: A Population-Based Approach
Authors: Greenough P. Gregg
Published: August 2016

Reading the Bracha and Burkle article gave me a flashback to a military course I took early in my career:the Combat Casualty Care Course (C4), an exercise of mass-casualty triage and management. Triaging and treating the severely injured–all types of blunt and penetrating injuries–proved relatively manageable with practice. However, what I distinctly remember as the most challenging, were those cases of stress-induced psychosis that the course leaders periodically threw at us. Dazed “soldiers” with the “hundred mile stares” and predictably unpredictable thoughts and behaviors, drained our valuable resourcesas they required constant vigilance in addition to their “three hots and a cot” (three meals and a place to sleep).
Impact of London's Terrorist Attacks on a Major Trauma Center in London
Authors: Mohammed Aso B. , Mann Haroon A. , Nawabi Danyal H. , Goodier Davis W. , Ang Swee C.
Published: August 2016

During the morning rush hour on Thursday, 07 July 2005, a series of four bombs exploded, affecting London's public transport system.These terrorist attacks killed 52 people and injured >700.A majorincident was declared, and the Royal London Hospital (RLH) was a primary receiving hospital.

A total of 194 patients presented to the RLH.Twenty-seven patients required admission. A total of 11 amputations were performed on eight patients. One patient died intra-operatively.Another patient died on Day 6 due to complications related to a head injury.

Coordination is vital to the implementation of the hospital's Major Incident Plan in such an emergency. Subsequent internal reviews of the response of the RLH on 07 July 2005 highlighted problems with communication and documentation, as well as the need for extra staffing.These areas should be improved for the management of future major incidents.
Percutaneous Transtracheal Ventilation: Resuscitation Bags Do Not Provide Adequate Ventilation
Authors: Hooker Edmond A. , Danzl Daniel F. , O'Brien Daniel , Presley Michael , Whitaker Ginger , Sharp M. Keith
Published: August 2016

Introduction:

Percutaneous, transtracheal jet ventilation (percutaneous transtracheal jet ventilation) is an effective way to ventilate both adults and children. However, some authors suggest that a resuscitation bag can be utilized to ventilate through a cannula placed into the trachea.

Hypothesis:

Percutaneous transtracheal ventilation (percutaneous transtracheal ventilation) through a 14-gauge catheter is ineffective when attempted using a resuscitation bag.

Methods:

Eight insufflation methods were studied. A 14-gauge intravenous catheter was attached to an adult resuscitation bag, a pediatric resuscitation bag, wall-source (wall) oxygen, portable-tank oxygen with a regulator, and a jet ventilator (JV) at two flow rates. The resuscitation bags were connected to the 14-gauge catheter using a 7 mm adult endotracheal tube adaptor connected to a 3 cc syringe barrel. The wall and tank oxygen were connected to he 14-gauge catheter using a three-way stopcock. The wall oxygen was tested with the regulator set at 15 liters per minute (LPM) and with the regulator wide open. The tank was tested with the regulator set at 15 and 25 LPM. The JV was connected directly to the 14-gauge catheter using JV tubing supplied by the manufacturer. Flow was measured using an Ohmeda 5420 Volume Monitor. A total of 30 measurements were taken, each during four seconds of insufflation, and the results averaged (milliliters (ml) per second (sec)) for each device.

Results:

Flow rates obtained using both resuscitation bags, tank oxygen, and regulated wall oxygen were extremely low (adult 215 ±20 ml/sec; pediatric 195 ±19 ml/sec; tank 358 ±13 ml/sec; wall at 15 l/min 346 ±20 ml/sec). Flow rates of 1,394 ±13 ml were obtained using wall oxygen with the regulator wide open. Using the JV with the regulator set at 50 pounds per square inch (psi), a flow rate of 1,759 ±40 was obtained.These were the only two methods that produced flow rates high enough to provide an adequate tidal volume to an adult.

Conclusions:

Resuscitation bags should not be used to ventilate adult patients through a 14-gauge, transtracheal catheter. Jet ventilation is needed when percutaneous transtracheal ventilation is attempted. If jet ventilation is attempted using oxygen supply tubing, it must be connected to an unregulated oxygen source of at least 50 psi.
Seen but Not Heard: Injuries and Deaths from Landmines and Unexploded Ordnance in Chechnya, 1994–2005
Authors: Bilukha Oleg O. , Brennan Muireann , Anderson Mark , Tsitsaev Zaur , Murtazaeva Eliza , Ibragimov Ramzan
Published: August 2016

Introduction:

Due to more than a decade of armed conflict and civil unrest, Chechnya is among the regions most affected by landmines and unexploded ordnance worldwide.

Hypothesis:

The study was performed to assess the magnitude of injuries and deaths due to landmines and unexploded ordnance in Chechnya between 1994 and 2005 and to describe epidemiologic patterns and risk factors for these events.

Methods:

Surveillance data that included 3,021 civilian non-combatants injured by landmines and unexploded ordnance in Chechnya during 1994–2005 were analyzed. Local non-governmental organizations in collaboration with the United Nations Children's Fund conducted victim data collection using trained staff to interview victims or their families. Surveillance data were used to describe injury trends, victim demographics, injury types, risk behaviors, and types of explosives related to landmine and unexploded ordnance events.

Results:

The largest number of injuries occurred in 2000 (716, injury rate 6.6 per 10,000) and 2001 (640, injury rate 5.9 per 10,000). One-quarter of all victims were younger than 18 years, and 19% were females. The case-fatality rate was 23%. Approximately 40% of victims were injured by landmines, 30% by unexploded ordnance, and 7% by booby traps. A large proportion of children and adults were injured while traveling or performing activities of economic necessity; 29% of children were injured while tampering with explosives or playing in a contaminated area. The proportion of victims with lower limb amputations was similar among children and adults (14% and 17%, respectively), whereas the proportion of victims with upper limb amputations was three times higher in children than in adults (12% and 4%, respectively). Most accidents that occurred while the victim was traveling or performing activities of economic necessity were caused by landmines, while most accidents that occurred while the victim was playing near an explosive device or tampering with it were caused by unexploded ordnance.

Conclusions:

Civilians in Chechnya experienced the highest rates of injury from landmines and unexploded ordnance ever documented, 10 times higher than injury rates reported from such highly affected countries as Afghanistan, Angola, or Cambodia. Urgent efforts to identify, mark, and clear mined areas and/or areas contaminated with unexploded ordnance are needed to prevent further civilian injuries and deaths.
Hospital Strategic Preparedness Planning: The New Imperative
Authors: Ginter Peter M. , Duncan W. Jack , Abdolrasulnia Maziar
Published: August 2016

Strategic preparedness planning is an important new imperative for many hospitals. Strategic preparedness planning goes beyond traditional product/ market strategic planning by focusing on disaster prevention, containment, and response roles. Hospitals, because of their unique mission, size, complexity, the types of materials they handle, and the types of patients they encounter, are especially vulnerable to natural and human-initiated disasters. In addition, when disasters occur, hospitals must develop well-conceived first responder (receiver) strategies. This paper argues the case for strategic preparedness planning for hospitals and proposes a process for this relatively new and much needed type of planning.
Ability of Regional Hospitals to Meet Projected Avian Flu Pandemic Surge Capacity Requirements
Authors: Ten Eyck Raymond P.
Published: August 2016

Introduction:

Hospital surge capacity is a crucial part of community disaster preparedness planning, which focuses on the requirements for additional beds, equipment, personnel, and special capabilities.The scope and urgency of these requirements must be balanced with a practical approach addressing cost and space concerns. Renewed concerns for infectious disease threats, particularly from a potential avian flu pandemic perspective, have emphasized the need to be prepared for a prolonged surge that could last six to eight weeks.

Null Hypothesis:

The surge capacity that realistically would be generated by the cumulative Greater Dayton Area Hospital Association (GDAHA) plan is sufficient to meet the demands of an avian influenza pandemic as predicted by the [US] Centers for Disease Control and Prevention (CDC) models.

Methods:

Using a standardized data form, surge response plans for each hospital in the GDAHA were assessed.The cumulative results were compared to the demand projected for an avian influenza pandemic using the CDC's FluAid and FluSurge models.

Results:

The cumulative GDAHA capacity is sufficient to meet the projected demand for bed space, intensive care unit beds, ventilators, morgue space, and initial personal protective equipment (PPE) use. There is a shortage of negative pressure rooms, some basic equipment, and neuraminidase inhibitors. Many facilities lack a complete set of written surge policies, including screening plans to segregate contaminated patients and staff prior to entering the hospital. Few hospitals have agreements with nursing homes or home healthcare agencies to provide care for patients discharged in order to clear surge beds. If some of the assumptions in the CDC's models are changed to match the morbidity and mortality rates reported from the 1918 pandemic, the surge capacity of GDAHA facilities would not meet the projected demand.

Conclusions:

The GDAHA hospitals should test their regional distributors' ability to resupply PPE for multiple facilities simultaneously. Facilities should retrofit current air exchange systems to increase the number of potential negative pressure rooms and include such designs in all future construction. Neuraminidase inhibitor supplies should be increased to provide treatment for healthcare workers exposed in the course of their duties. Each hospital should have a complete set of policies to address the special considerations for a prolonged surge. Additional capacity is required to meet the predicted demands of a threat similar to the 1918 pandemic.
Bridging the Gap: Building Local Resilience and Competencies in Remote Communities
Authors: Gilbert Mads
Published: August 2016

This keynote address will focus on the potential to reduce the increasing gap between rich and poor countries. This critical gap only can be bridged if we systematically replace the expensive and reactive international disaster post-hoc operations by systematic, long-term, proactive efforts to increase the local capacity to master everyday accidents and emergencies as well as empower the local preparedness for major events such as natural and technological events. If we really wish to strengthen local preparedness and competencies in remote communities in lowand middle-income countries (LMIC, “the South”), we must systematically share knowledge and skills through scientifically proven training programs aimed at such impoverished, still densely populated regions in the South. Such local training represents a sustainable, long-term action to build emergency medical capacity into the local population and the health workers, as opposed to only relying on expensive foreign relief that arrive too late, is cost ineffective, and most often responds to spectacular disasters. Building local competence also strengthens local resilience (Table 1).
International Collaboration in Disaster Medicine—It is Time for the “Big Step” in Disaster Preparedness
Authors: Bar-Dayan Yaron
Published: August 2016

In the last few decades, we have witnessed global disasters that rendered national medical systems helpless. A few examples are the tsunami in southeast Asia, and earthquakes in Turkey, Pakistan, Indonesia, Iran, and India.
Fostering Disaster Resilient Communities across the Globe through the Incorporation of Safe and Resilient Hospitals for Community-Integrated Disaster Responses
Authors: Albanese Joseph , Birnbaum Marvin , Cannon Christopher , Cappiello Joseph , Chapman Elaine , Paturas James , Smith Stewart
Published: August 2016

Events due to natural and technological hazards result in damage to living beings and the natural and built environment. The high urban population density, level of development, and extent of poverty in many disaster-prone areas further exacerbate the cumulative impact of such catastrophes. Also, crises, including those created by earthquakes, hurricanes, landslides, and tsunamis, have underscored the inability of hospitals to provide uninterrupted, urgently needed health services and maintain structural integrity. In many instances, deaths of hospital occupants were the direct result of collapsing physical infrastructure. In response and recognition of the need for collaborative efforts to mitigate the damages and loss of function, international public health, humanitarian, and relief organizations such as the Pan-American Health Organization (WHO/PAHO), the International Strategy for Disaster Reduction (ISDR) of the United Nations, the World Bank, the Joint Commission International (JCI), and the World Association for Disaster and Emergency Medicine (WADEM) have sponsored a series of global forums intent on developing guidelines for designing, constructing, and evaluating “safe and resilient” hospitals. The underlying goals of these guidelines are to protect the lives of patients, staff, and other hospital occupants, and ensure that hospitals continue to function during and after a catastrophic event.
Acquiring and Maintaining Competence in the Application of Extrication Cervical Collars by a Group of First Responders
Authors: Ireland Colin J. , Zeitz Kathryn M. , Bridgewater Franklin H.G.
Published: August 2016

Introduction:

Research on skill acquisition and retention in the prehospital setting has focused primarily on resuscitation and defibrillation. Investigation into other first aid skills is required in order to validate practices and support training regimes. No studies have investigated competency using an extrication cervical collar for cervical spine immobilization.

Objective:

This study was conducted to confirm that a group of first responders could acquire and maintain competency in the application of an extrication cervical collar over a 12-month period.

Methods:

Participants attended a standardized training session that addressed the theory of application of an extrication cervical collar followed by hands-on practice. The training was presented by the same instructor and covered the nine key elements necessary in order to be deemed competent in extraction cervical collar application. Following the practical session, the competency of the participants was assessed. Participants were requested not to practice the skill during the 12-month period. Following the 12-month period, their skills were re-assessed by the same assessor.

Results:

Of the 64 subjects who participated in the study, 100% were competent after the initial first assessment. Forty-one participants (64%) were available for the second assessment (12 months later); of these, 25 (61%) maintained competence.

Conclusions:

Although the sample size was small, this research demonstrates that first responders are able to acquire competence in applying an extrication cervical collar. However, skill retention in the absence of usage or re-training is poor. Larger studies should be conducted to validate these results. In addition, there is a need for research on the clinical practice and outcomes associated with spinal immobilization in the prehospital setting.