bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locations of Cardiac Arrest: Affirmation for Community Public Access
Defibrillation (PAD) Program
Authors: Fedoruk J.C. , Currie Wayne L. , Gobet Meikel 
Published: August 2016

Abstract

Background:

The purpose of this study was to describe the regional locations of
cardiac arrest, and to identify public locations and the annual
incidence of arrests within the identified locations, in order to help
to determine optimal placement of Automatic External Defibrillators
(AEDs) under the regional Public Access Defibrillation (PAD) Program.
This is a retrospective study.

Methods:

The locations of cardiac arrest were abstracted from Ambulance Call
Reports (ACRs) collected by the Essex-Kent Base Hospital Centre from
regional ambulance services throughout the City of Windsor, and the
Counties of Essex and Kent, Ontario, Canada, from 01 January 1994
through 31 December 2000. Arrest locations were grouped into five
categories, and then the number of public venues was determined. Public
sites were grouped into 28 Public Locations. Also included in the Public
Sites were both General Industry and Outdoors categories. Categories
identified but excluded from Public Sites were Institutions and Private
Residences.

Results:

During the study, 2,295 arrests occurred, 152 cases were excluded,
2,142 arrests were categorized, (average annual incidence of 306 ±50.4
cardiac arrests), 329 (15.4%) of which were in Public Sites. Nineteen
public venues had an average of >1 arrest/year, and nine public
venues had an average of ≤1 arrest/year during the study, period.
Calculations of the annual incidence of arrests for each public location
were completed.

Conclusions:

These findings have significant prehospital emergency cardiac care
implications for communities that wish to strengthen/improve their
responses to out-of-hospital cardiac arrests. Public Access
Defibrillation Programs should identify the site-specific incidence of
arrest within their communities in order to provide legitimacy for
funding and planning of programs. Training and availability of AEDs will
reduce the time to first shock, thus strengthening the chain-of-survival
and will save more lives.
Prehospital Hyperventilation After Brain Injury: A Prospective Analysis of Prehospital and Early Hospital Hyperventilation of the Brain-Injured Patient
Authors: Lal Dave , Weiland Steve , Newton Monica , Flaten Anne , Schurr Michael 
Published: August 2016

AbstractBackground:The Brain Trauma Foundation's Guidelines for the Management of Severe Head Injury state that the use of prophylactic hyperventilation after traumatic brain injury (TBI) should be avoided because it can compromise cerebral perfusion. The objective of this study was to assess the prevalence of unintentional hyperventilation.Methods:A prospective evaluation of all intubated trauma patients with a diagnosis of TBI was performed. Patients with signs of impending hernia-tion were excluded.Results:Forty patients were included in the study. The average Glasgow Coma Scale (GCS) was 6.3. Of these, 28 patients (70%) were unintentionally hyperventilated. Eleven (39%) of the hyperventilated patients died or were discharged in a persistent vegetative state. Of the remaining 12 patients who experienced normal ventilation, three patients (25%) died or were discharged in a vegetative state (p = ns) (Table 1).Conclusion:Hyperventilation was common after TBI. However, patients ventilated to a normal PaCO2 were significantly more acidotic. Prehospital personnel should undergo educational training after development of strict ventilation protocols for patients suffering TBI.
Terrorism in Bulgaria
Authors: Shanduorkov George 
Published: August 2016

Abstract
The Republic of Bulgaria is one of the smallest countries in
southeastern Europe and has little experience with terrorist acts. During
the past 20 years, only nine terrorism-related events have been recorded in
Bulgaria, and no unconventional weapons have been used. Factors contributing
to terrorism in Bulgaria have been: (1) Communist Party domination of the
government and political process from 1944 to 1989; (2) ethnic and religious
conflicts between the Bulgarian Orthodox Christian majority and the Turkish
Muslim minority from 1983 to 1987; and (3) the relatively high level of
organized crime after the Communist regime ended in 1990.
The structure and function of the Disaster Relief System in Bulgaria not
only are focused on the prevention of terrorism, but also on preparedness
for the emergency response to terrorism-related events. Institutional
components of the Disaster Relief System structure responsible for the
emergency response to terrorism-related events include: (1) the Government
of Bulgaria; (2) the State Agency for Civil Protection with 28 regional
directorates; (3) the Ministry of Health with five national hospitals, 28
regional hospitals, and 28 EMS systems; (4) the Ministry of Defense with
special military units for response to unconventional terrorist events,
including nuclear, biological, and chemical weapons; (5) the Ministry of
Internal Affairs with 28 police departments, 28 fire departments, and
specialized anti-terrorist units; and (6) the Bulgarian Red Cross.
A major future challenge in Bulgaria is the prevention of terrorism
through political stability, economic prosperity, ethnic and religious
tolerance, and more effective measures against organized criminal
activities. A related challenge will be to improve the level of preparedness
of all components of Disaster Relief.
Terrorism in Canada
Authors: Kollek Daniel 
Published: August 2016

AbstractThis paper reviews terrorism in Canada, assessing the incidence and nature of terrorist activity, the potential targets of terrorist attacks, risk factors to Canadian nationals and institutions, and the responses of the Canadian government in dealing with the threat and the effectiveness of those responses.Despite the fact that there have been no recent high-profile terrorist events in Canada, this country has a serious terrorism problem, the key manifestation of which is the multitude of terrorist organizations that have designated Canada as a base of operations. In addition, Canadians have been attacked overseas and Canadian organizations, both local and abroad, are potential targets of terrorist activity. Canadian attempts to deal with terrorism through foreign and domestic policy have been ineffective, primarily because the policies have been poorly enforced. Until recently, terrorist organizations legally could raise funds in Canada, in direct contravention of international treaties signed by Canada. It is possible that the ineffectiveness in enforcing the anti-terrorism legislation stems from hope that placating terrorist organizations, and the countries that support them, will prevent Canada from becoming a target. Unfortunately evidence from other countries has shown this strategy to be ineffective.
Terrorism in Indonesia
Authors: Pusponegoro Aryono D. 
Published: August 2016

Abstract
Indonesia has had its share of natural and manmade disasters. From 1997
to 2002, Indonesia has experienced 90 incidents of terrorist bomb attacks.
In 13 (14.4%) of the terrorist attacks, the bombs did not explode. A total
of 224 persons have been killed, and 340 persons have been injured. Most of
those killed or injured were the result of the bombings in Jakarta and Bali.
Besides bombings, there have been riots, especially in Jakarta. The
Indonesian Surgeons Association established the 1–1–8 Emergency Ambulance
Service Foundation to develop the Prehospital Emergency Medical Services in
Indonesia. Despite difficulties, this service has been implemented in 18
cities. The occurrence of disasters, riots, ethnic conflicts, terrorist
attacks, and the introduction of the Advanced Trauma Life Support (ATLS)
course in 1995, have helped to convince the people and the government that
it was important to develop this 1–1–8 Emergency Ambulance Services system,
and agreed to accept a Safe Community Program. With the Safe Community
Program, Jakarta with its Integrated 1–1–8 Emergency Ambulance Service
managed to provide proper emergency medical care to the casualties caused by
terrorist bombings, riots, and in the three weeks of floods during which 75%
of Jakarta was submerged.
Terrorism in Peru
Authors: Hernandez Dora H. Barrientos , Church Adam L. 
Published: August 2016

Abstract
Two major domestic terrorist groups have plagued Peru over the past 20
years, the Sendero Luminoso or “Shining Path” (SL) and the Revolutionary
Movement Túpac Amaru (MRTA). On 28 August 2003, the Peruvian Truth and
Reconciliation Commission reported that an estimated 69,280 persons were
killed in the internal conflict in Peru from 1980 to 2000. Most of the
victims were farmers (56%), most attacks occurred in rural settings (79%),
and the SL was responsible for mostof the deaths (54%). Aggressive
anti-terrorism efforts by police and military during this period, often at
the expense of basic human rights, also contributed to this large burden of
terrorism on Peru. During the 1990s, terrorist attacks in Peru had spread to
its urban areas. On 17 December 1996, 22 members of MRTA took over the
Japanese ambassador's residence in Lima, holding 72 hostages until the
grounds were stormed by Peruvian special forces on 23 April 1997.
Until recently, emergency planning and preparedness for
terrorism-related events in Peru were largely underdeveloped. In the last
five years, Peru has taken two key steps towards developing a mature
emergency response system, with the establishment of the country's first
emergency medicine residency training program and the construction of the
first dedicated trauma center in Lima.
Ethical Considerations in Emergency Planning, Preparedness, and Response to Acts of Terrorism
Authors: Larkin Gregory Luke , Arnold Jeffrey 
Published: August 2016

AbstractThroughout the globe, healthcare providers are increasingly challenged with the specter of terrorism and the fallout from weapons of mass destruction. Preparing for and responding to such manmade emergencies, however, threatens the ethical underpinnings of routine, individualized, patient-centered, emergency healthcare. The exigency of a critical incident can instantly transform resource rich environs, to those of austerity. Healthcare workers, who only moments earlier may have been seeing two to three patients per hour, are instantly thrust into a sea of casualties and more basic lifeboat issues of quarantine, system overload and the thornier determinations of who will be given every chance to live and who will be allowed to die. Beyond the tribulations of triage, surge capacity, and the allocation of scarce resources, terrorism creates a parallel need for a host of virtues not commonly required in daily medical practice, including prudence, courage, justice, stewardship, vigilance, resilience, and charity. As a polyvalent counterpoint to the vices of apathy, cowardice, profligacy, recklessness, inflexibility, and narcissism, the virtues empower providers at all levels to vertically integrate principles of safety, public health, utility, and medical ethics at the micro, meso, and macro levels. Over time, virtuous behavior can be modeled, mentored, practiced, and institutionalized to become one of our more useful vaccines against the threat of terrorism in the new millennium.
Mass-Casualty, Terrorist Bombings: Epidemiological Outcomes, Resource Utilization, and Time Course of Emergency Needs (Part I)
Authors: Arnold Jeffrey L. , Tsai Ming-Che , Halpern Pinchas , Smithline Howard , Stok Edita , Ersoy Gurkan 
Published: August 2016

AbstractIntroduction:This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties.Methods:Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela.Results:Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1–25%); terrorist-suicide, 19% (7–44%); confined-space 4% (1–11%); open-air, 1% (0–5%); structural-collapse, 18% (5–26%); structural fire 17% (1–17%); and overall, 3% (1–14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14–50%); terrorist-suicide, 58% (38–77%); confined-space, 52% (36–71%); open-air, 13% (11–27%); structural-collapse, 41% (23–74%); structural-fire, 34% (25–44%); and overall, 34% (14–53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours.Conclusion:Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the characteristics of the event.
Guidelines for the Use of Foreign Field Hospitals in the Aftermath of
Sudden-Impact Disaster
Authors:   Department of Emergency
                        and Humanitarian Action,   World Health
                        Organization,   Area on Emergency
                        Preparedness and Disaster Relief,   Pan-American
                        Health Organization
Published: August 2016

Abstract
Natural and complex disasters can cause a dramatic increase in the
demand for emergency medical care. Local health services can be overwhelmed,
and damage to clinics and hospitals can render them useless. Many countries
maintain mobile field hospitals for defense or humanitarian purposes.
Dispatching these facilities to disaster-affected countries would seem an
ideal response to emergency medical needs. Unfortunately, experience has
shown that in the case of natural disasters, field hospitals often have not
met the expectations of recipients and donor institutions.
In July 2003, the World Health Organization and Pan American Health
Organization sponsored a workshop in El Salvador to discuss the pros and
cons of using foreign fieldhospitals in the aftermath of natural disasters.
These guidelines are the result of that workshop. The workshop participants
identified different phases when foreign field hospitals and specialized
medical personnel are most useful. They can provide advanced trauma care and
life support if at the disaster site within 48 hours of the impact of an
event; they would provide follow-up care for trauma victims and resumption
of routine medical care in the two weeks following the event; during
rehabilitation and reconstruction phases (from two months to two or more
years), a field hospital might serve as a temporary replacement for damaged
health facilities. These guidelines propose conditions that field hospitals
and their staff should meet for each ofthese phases. The guidelines also
outline issues that authorities in donor countriesand disaster-affected
countries should discuss before mobilizing a field hospital.
The Threat of Mid-Spectrum Chemical Warfare Agents
Authors: Aas Pål 
Published: August 2016

Abstract
There is a spectrum of several threat agents, ranging from nerve agents
and mustard agents to natural substances, such as biotoxins and new,
synthetic, bioactive molecules produced by the chemical industry, to the
classical biological warfare agents. The new, emerging threat agents are
biotoxins produced by animals, plants, fungi, and bacteria. Examples of such
biotoxins are botulinum toxin, tetanus toxin, and ricin. Several bioactive
molecules produced by the pharmaceutical industry can be even more toxic
than are the classical chemical warfare agents. Such new agents, like the
biotoxins and bioregulators, often are called mid-spectrum agents. The
threat to humans from agents developed by modern chemical synthesis and by
genetic engineering also must be considered, since such agents may be more
toxic or more effective in causing death or incapacitation than classical
warfare agents. By developing effective medical protection and treatment
against the most likely chemical and mid-spectrum threat agents, the effects
of such agents in a war scenario or following a terrorist attack can be
reduced.
The San Diego East County School Shootings: A Qualitative Study of Community-Level Post-traumatic Stress
Authors: Palinkas Lawrence A. , Prussing Erica , Reznik Vivian M. , Landsverk John A. 
Published: August 2016

AbstractIntroduction:Within one month (March 2001), two separate incidents of school shootings occurred at two different high schools within the same school district in San Diego's East County.Objective:To examine community-wide expressions of post-traumatic distress resulting from the shootings that may or may not fulfill DSM-IV criteria for post-traumatic stress disorder (PTSD), but which might interfere with treatment and the prevention of youth violence.Methods:A qualitative study was undertaken using Rapid Assessment Procedures (RAP) in four East San Diego County communities over a six-month period following the two events. Semi-structured interviews were conducted with 85 community residents identified through a maximum variation sampling technique. Interview transcripts were analyzed by coding consensus, co-occurrence, and comparison, using text analysis software.Results:Three community-wide patterns of response to the two events were identified: (1) 52.9% of respondents reported intrusive reminders of the trauma associated with intense media coverage and subsequent rumors, hoaxes, and threats of additional acts of school violence; (2) 44.7% reported efforts to avoid thoughts, feelings, conversations, or places (i.e., schools) associated with the events; negative assessment of media coverage; and belief that such events in general cannot be prevented; and (3) 30.6% reported anger, hyper-vigilance, and other forms of increased arousal. Twenty-three (27.1%) respondents reported symptoms of fear, anxiety, depression, drug use, and psychosomatic symptoms in themselves or others.Conclusions:School shootings can precipitate symptoms of post-traumatic stress disorder at the community level. Such symptoms hinder the treatment of individuals with PTSD and the implementation of effective prevention strategies and programs.
Mass-Casualty Terrorist Bombings In Istanbul, Turkey, November 2003: Report of the Events and the Prehospital Emergency Response
Authors: Rodoplu Ülkümen , Arnold Jeffrey L. , Tokyay Rifat , Ersoy Gurkan , Cetiner Serkan , Yücel Tayfun 
Published: August 2016

AbstractBackground:This paper describes the two mass-casualty, terrorist attacks that occurred in Istanbul, Turkey in November 2003, and the resulting prehospital emergency response.Methods:A complex, retrospective, descriptive study was performed, using open source reports, interviews, direct measurements of street distances, and hospital records from the American Hospital (AH) and Taksim Education and Research State Hospital (TERSH) in Istanbul.Results:On 15 November, improvised explosive devices (IEDs) in trucks were detonated outside the Neve Shalom and Beth Israel Synagogues, killing 30 persons and injuring an estimated additional 300. Victims were maldistributed to 16 medical facilities. For example, AH, a private hospital located six km from both synagogues, received 69 injured survivors, of which 86% had secondary blast injuries and 13% were admitted to the hospital. The TERSH, a government hospital located 1 km from both synagogues, received 48 injured survivors. On 20 November, IEDs in trucks were detonated outside the Hong Kong Shanghai Banking Corporation (HSBC) headquarters and the British Consulate (BC), killing 33 and injuring an estimated additional 450. Victims were maldistributed to 16 medical facilities. For example, TERSH, located 18 km from the HSBC site and 2 km from the the BC received 184 injured survivors, of which 93% had secondary blast injuries and 15% were hospitalized. The AH, located 9 km from the HSBC site and 6 km from the BC, received 16 victims.Conclusion:The twin suicide truck bombings on 15 and 20 November 2003 were the two largest terrorist attacks in modern Turkish history, collectively killing 63 persons and injuring an estimated 750 others. The vast majority of victims had secondary blast injuries, which did not require hospitalization. Factors associated with the maldistribution of casualties to medical facilities appeared to include the distance from each bombing site, the type of medical facility, and the personal preference of injured survivors.
Efficacy of Critical Incident Monitoring for Evaluating Disaster Medical Readiness and Response During the Sydney 2000 Olympic Games
Authors: Flabouris Arthas , Nocera Antony , Garner Alan 
Published: August 2016

AbstractIntroduction:Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI.Objective:To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents.Methods:Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings.Results:A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communicationrelated issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Predeployment planning was the most important factor for future incident impact minimization.Conclusions:Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.