bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational and Training Systems in Sweden for Prehospital Response to Acts of Terrorism
Authors: Kulling Per E.J. , Holst Jonas E.A. 
Published: August 2016

AbstractSweden has a long tradition in planning for disaster situations in which the National Board of Health and Welfare has a key responsibilty within the health sector. One important part of this disaster preparedness is education and training. Since 11 September 2001, much focus has been placed on the acts of terrorism with special reference to the effects of the use of chemical, biological, or nuclear/radiological (CBNR) agents. In the health sector, the preparedness for such situations is much the same as for other castastrophic events. The National Board of Health and Welfare of Sweden is a national authority under the government, and one of its responsibilities is planning and the provision of supplies for health and medical services, environmental health, and social services in case of war or crises. “Joint Central Disaster Committees” in each County Council/Region in the country are responsible for overseeing major incident planning for their respective counties/regions. The “Disaster Committee” is responsible for ensuring that: (1) plans are established and revised; (2) all personnel involved in planning receive adequate information and training; (3) equipment and supplies are available; and (4) maintenance arrangements are in place.Sweden adopts a “Total Defense” strategy, which means that it places a high value in preparing for peacetime and wartime major incidents. The Swedish Emergency Management Agency coordinates the civilian Total Defense strategy, and provides funding to the relevant responsible authority to this end. The National Board of Health and Welfare takes responsibility in this process. In this area, the main activities of the National Board of Health and Welfare are: (1) the establishment of national guidelines and supervision of standards in emergency and disaster medicine, social welfare, public health, and prevention of infectious diseases; (2) the introduction of new principles, standards, and equipment; (3) the conducting education and training programmes; and (4) the provision of financial support. The budget for National Board of Health and Welfare in this area is approximately 160 million SEK (US$18 million). The National Board of Health and Welfare also provides funding to the County Councils/Regions for the training of healthcare professionals in disaster medicine and crises management by arranging (and financing) courses primarily for teachers and by providing financial support to the County Councils/Regions for providing their own educational and training programmes. The National Board of Health and Welfare provides funding of approximately 20 million SEK (US$2.4 million) to the County Councils/Regions for this training of healthcare professionals in disaster medicine and crises.
The Chemical Disaster Response System in Japan
Authors: Okumura Tetsu , Ninomiya Norifumi , Ohta Muneo 
Published: August 2016

AbstractDuring the last decade, Japan has experienced the largest burden of chemical terrorism-related events in the world, including the: (1) 1994 Matsumoto sarin attack; (2) 1995 Tokyo subway sarin attack; (3) 1998 Wakayama arsenic incident; (4) 1998 Niigata sodium-azide incident; and (5) 1998 Nagano cyanide incident. Two other intentional cyanide releases in To kyo subway and railway station restrooms were thwarted in 1995. These events spurred Japan to improve the following components of its chemical disaster-response system: (1) scene demarcation; (2) emergency medical care; (3) mass decontamination; (4) personal protective equipment; (5) chemical detection; (6) information-sharing and coordination; and (7) education and training. Further advances occurred as result of potential chemical terrorist threats to the 2000 Kyushu-Okinawa G8 Summit, which Japan hosted. Today, Japan has an integrated system of chemical disaster response that involves local fire and police services, local emergency medical services (EMS), local hospitals, Japanese Self-Defense Forces, and the Japanese Poison Information Center.
Decontamination of Mass Casualties — Re-evaluating Existing Dogma
Authors: Levitin Howard W. , Siegelson Henry J. , Dickinson Stanley , Halpern Pinchas , Haraguchi Yoshikura , Nocera Anthony , Turineck David 
Published: August 2016

AbstractThe events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response.This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response.Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.
Future Considerations for the Medical Management of Nerve-Agent Intoxication
Authors: Aas Pål 
Published: August 2016

AbstractThe use of chemical warfare agents against civilians and unprotected troops in international conflicts or by terrorists against civilians is considered to be a real threat, particularly following the terrorist attacks on 11 September 2001 against the World Trade Center in New York and against the Pentagon in Washington, DC. Over the past 10 years, terrorists have been planning to use or have used chemical warfare agents on several occasions around the world, and the attacks in 2001 illustrate their willingness to use any means of warfare to cause death and destruction among civilians. In spite of new international treaties with strong verification measures and with an aim to prohibit and prevent the use of weapons of mass destruction, nevertheless, some countries and terrorist groups have been able to develop, produce, and use such weapons, particularly nerve agents, in domestic terrorist attacks or during warfare in international conflicts. This article reviews current medical therapy for nerve-agent intoxication and discusses possible future improvement of medical therapies.Present medical counter-measures against nerve agents are not sufficiently effective particularly in protecting the brain. Therefore, new and more effective countermeasures must be developed to enable better medical treatment of civilians and military personnel following exposure to nerve agents. Therefore, it is important with an enhanced effort by all countries, to improve and increase research in medical countermeasures, in the development of protective equipment, and in carrying out regular training of medical and emergency personnel as well as of military nuclear, biological, or chemical (NBC) units. Only then will nations be able to reduce the risk from and prevent the use of such weapons of mass destruction (WMD).
The Impact of Terrorism on Children: A Two-Year Experience
Authors: Waisman Yehezkel , Aharonson-Daniel Limor , Mor Meirav , Amir Lisa , Peleg Kobi 
Published: August 2016

AbstractObjectives:To review and analyze the cumulative two-year, Israeli experience with medical care for children victims of terrorism during the prehospital and hospital phases.Methods:Data were collected from the: (1) Magen David Adom National Emergency Medical System Registry (prehospital phase); (2) medical records from the authors’ institutions (pediatric triage); and (3) Israel Tr auma Registry (injury characteristics and utilization of in-hospital resources). Statistical analyses were performed as appropriate.Introduction:During the recent wave of violence in Israel and the surrounding region, hundreds of children have been exposed to and injured by terrorist attacks. There is a paucity of data on the epidemiology and management of terror-related trauma in the pediatric population and its effects on the healthcare system. This study focuses on four aspects of terrorism-related injuries: (1) tending to victims in the prehospital phase; (2) triage, with a description of a modified, pediatric triage algorithm; (3) characteristics of trauma-related injuries in children; and (4) utilization of in-hospital resources.Results:During the study period, 41 mass-casualty events (MCEs) were managed by Magen David Adom. Each event involved on average, 32 regular and nine mobile intensive care unit ambulances with 93 medics, 19 paramedics, and four physicians. Evacuation time was 5–10 minutes in urban areas and 15–20 minutes in rural areas. In most cases, victims were evacuated to multiple facilities. To improve efficiency and speed, the Magen David Adom introduced the use of well-trained “first-responders” and volunteer, off-duty professionals, in addition to “scoop and run” on-the-scene management. Because of differences in physiology and response between children and adults, a pediatric triage algorithm was developed using four categories instead of the usual three. Analysis of the injuries sustained by the 160 children hospitalized after these events indicates that most were caused by blasts and penetration by foreign objects. Sixty-five percent of the children had multiple injuries, and the proportion of critical to fatal injuries was high (18%). Compared to children with non-terrorism-related injuries, the terrorism-related group had a higher rate of surgical interventions, longer hospital stays, and greater needs for rehabilitation services.Conclusion:Terrorism-related injuries in children are severe and increase the demand for acute care. The modifications in the management of pedi-atric casualties from terrorism in Israel may contribute to the level of preparedness of medical and paramedical personnel to cope with future events. Further studies of other aspects of traumatic injuries, such as its short- and long-term psychological consequences, will provide a more comprehensive picture of the damage inflicted on children by acts of terrorism.
Case Report: Penetrating Cardiac Injury Secondary to a Terrorism-Related Nail Bomb Explosion
Authors: Asai Yasufumi , Yoshida Masashi , Kurimoto Yoshihiko , Arnold Jeffrey L. 
Published: August 2016

AbstractPenetrating cardiac injuries commonly occur secondary to gunshot or stab wounds. This is a report an unusual case of a patient who sustained a penetrating cardiac injury due to a nail from a terrorism-related, nail-bomb explosion. Associated problems included pericardial tamponade, penetrating cardiac injuries, acute, traumatic, myocardial infarction, and a penetrating lung injury. Prompt diagnosis and aggressive surgical intervention resulted in full recovery of the patient.
The Spectrum of Human Reactions to Terrorist Attacks with Weapons of Mass Destruction: Early Management Considerations
Authors: DiGiovanni Cleto 
Published: August 2016

AbstractResidents of a community who are intentionally exposed to a hazardous biological, chemical, or radiological agent (including medical first-responders and other civil defense personnel who live in that community) will exhibit a spectrum of psychological reactions that will impact the management of the incident. These reactions will range from a variety of behaviors of normal people under abnormal circumstances that either will help or hinder efforts to contain the threatening agent, deliver medical care, and reduce the morbidity, mortality, and costs associated with the disaster, to the development of new, or exacerbation of preexisting, mental disorders.Anticipating the decisions that people will make and actions they will take as the crisis develops is hindered by the limited number of previous disasters that bear crucial similarities to a terrorist attack with a weapon of mass destruction. Such actions, therefore, could serve as models to predict community reactions. One result of a study that attempted to fill in these gaps suggested that medical first-responders and their spouses/significant others may require separately crafted information and advice to reduce the potential for disharmony within the family that could affect job performance during the crisis.For those persons who exhibit emotional lability or cognitive deficits, evaluation of their psychiatric signs and symptoms may be more difficult than imagined, especially with exposure to nerve agents. Appreciation of these difficulties, and possession of the skill to sort through them, will be required of those assigned to triage stations. The allocation and utilization of mental health resources as the incident unfolds will be the responsibility of local consequence managers; these managers should be aware of the results of a recently-held workshop that attempted to reach consensus among experts in disaster mental health, based on the peer-reviewed literature, on the efficacy and safety of various approaches to early psychological interventions for victims of mass trauma and disasters.Thus, psychological factors are likely to be significant in the management of a terrorist incident that involves an agent of mass destruction. Emergency medical workers with managerial responsibilities, whether limited in scope or community-wide, should be aware of these factors, and should train to handle them through effective risk communication as part of their planning and preparation.
Measures of Effectiveness in Large-scale Bioterrorism Events
Authors: Burkle Frederick M. 
Published: August 2016

AbstractMeasures of effectiveness (MOEs) are defined as operationally quantifiable management tools that provide a means for measuring effectiveness, outcome, and performance. No clear MOEs exist for determining success or failure of the management of a bioterrorism response. This is especially critical because management requires a multi-agency and multi-disciplinary decision-making and evaluation process. It is suggested that the minimum MOEs required to operationally measure outcome must contain a measuring response capacity for: (1) real-time public health surveillance system; (2) full coverage health information system; (3) capacity to measure variance across management timelines; (4) demonstrated decline in mortality and morbidity; (5) control of transmission rates of communicable agents; and (6) resource distribution across the entire population.
From Complex Emergencies to Terrorism — New Tools for Health-Sector Coordination in Conflict-Associated Disasters
Authors: Bradt David A. , Drummond Christina M. 
Published: August 2016

AbstractInter-agency coordination in humanitarian assistance dates as a discipline from the 1960s. The United Nations, Red Cross, governmental, and nongovernmental agencies have evolved different mechanisms to achieve it. Present practices in field-based, inter-agency coordination of the health sector remain variable and non-standardized. International experiences in coordination of humanitarian assistance reveal numerous issues of jurisdiction, authority, capacity, and competency. New tools to help overcome these issues in the health-sector coordination include binding principles of engagement, protocols for the assumption of responsibilities, standardized minimum essential data sets, and health-sector component summaries.
Israeli Defense Forces Medical Corps Humanitarian Mission for Kosovo's
Refugees
Authors: Amital Howard , Alkan Michael L , Adler Jakov , Kriess Iyzhak , Levi Yehezkel 
Published: August 2016

Abstract
In April 1999, during the crisis in Kosovo, the Israeli government
launched a medical, field hospital in order to provide humanitarian aid to
the Albanian refugees that fled from their homes in Kosovo. This facility
was set up by the Medical Corps of the Israeli Defense Forces, in a refugee
camp located in Northern Macedonia. During the 16 days during which the
hospital functioned, the medical staff treated 1,560 patients and
hospitalized >100. The field hospital served as a referral center for all
of the other primary clinics that were hastily erected in the camp and its
surroundings. This communication elaborates on the various aspects of the
humanitarian medical aid that were provided by this medical facility and the
conclusions that learned from such a mission.
Standardized Emergency Management System and Response to a Smallpox
Emergency
Authors: Kim-Farley Robert J. , Celentano John T. , Gunter Carol , Jones Jessica W. , Stone Rogelio A. , Aller Raymond D. , Mascola Laurene , Grigsby Sharon F. , Fielding Jonathan E. 
Published: August 2016

Abstract
The smallpox virus is a high-priority, Category-A agent that poses a
global, terrorism security risk because it: (1) easily can be disseminated
and transmitted from person to person; (2) results in high mortality rates
and has the potential for a major public health impact; (3) might cause
public panic and social disruption; and (4) requires special action for
public health preparedness. In recognition of this risk, the Los Angeles
County Department of Health Services (LAC-DHS) developed the Smallpox
Preparedness, Response, and Recovery Plan for LAC to prepare for the
possibility of an outbreak of smallpox.
A unique feature of the LAC-DHS plan is its explicit use of the
Standardized Emergency Management System (SEMS) framework for detailing the
functions needed to respond to a smallpox emergency. The SEMS includes the
Incident Command System (ICS) structure (management, operations,
planning/intelligence, logistics, and finance/administration), the
mutual-aid system, and the multi/interagency coordination required during a
smallpox emergency. Management for incident command includes setting
objectives and priorities, information (risk communications), safety, and
liaison. Operations includes control and containment of a smallpox outbreak
including ring vaccination, mass vaccination, adverse events monitoring and
assessment, management of confirmed and suspected smallpox cases, contact
tracing, active surveillance teams and enhanced hospital-based surveillance,
and decontamination. Planning/intelligence functions include developing the
incident action plan, epidemiological investigation and analysis of smallpox
cases, and epidemiological assessment of the vaccination coverage status of
populations at risk. Logistics functions include receiving, handling,
inventorying, and distributing smallpox vaccine and vaccination clinic
supplies; personnel; transportation; communications; and health care of
personnel. Finally, finance/administration functions include monitoring
costs related to the smallpox emergency, procurement, and administrative
aspects that are not handled by other functional divisions of incident
command systems.
The plan was developed and is under frequent review by the LAC-DHS
Smallpox Planning Working Group, and is reviewed periodically by the LAC
Bioterrorism Advisory Committee, and draws upon the Smallpox Response Plan
and Guidelines of the Centers for Disease Control and Prevention (CDC) and
recommendations of the Advisory Committee on Immunization Practices (ACIP).
The Smallpox Preparedness, Response, and Recovery Plan, with its SEMS
framework and ICS structure, now is serving as a model for the development
of LAC-DHS plans for responses to other terrorist or natural-outbreak
responses.
Homeland Security and Public Health: Role of the Department of Veterans
Affairs, the US Department of Homeland Security, and Implications for the
Public Health Community
Authors: Koenig Kristi L. 
Published: August 2016

Abstract
The terrorist attacks of 11 September 2001 led to the largest US
Government transformation since the formation of the Department of Defense
following World War II. More than 22 different agencies, in whole or in
part, and >170,000 employees were reorganized to form a new Cabinet-level
Department of Homeland Security (DHS), with the primary mission to protect
the American homeland. Legislation enacted in November 2002 transferred the
entire Federal Emergency Management Agency and several Department of Health
and Human Services (HHS) assets to DHS, including the Office of Emergency
Response, and oversight for the National Disaster Medical System, Strategic
National Stockpile, and Metropolitan Medical Response System. This created a
potential separation of “health” and “medical” assets between the DHS and
HHS. A subsequent presidential directive mandated the development of a
National Incident Management System and an all-hazard National Response
Plan.
While no Department of Veterans Affairs (VA) assets were targeted for
transfer, the VA remains the largest integrated healthcare system in the
nation with important support roles in homeland security that complement its
primary mission to provide care to veterans. The Emergency Management
Strategic Healthcare Group (EMSHG) within the VA's medical component, the
Veteran Health Administration (VHA), is the executive agent for the VA's
Fourth Mission, emergency management. In addition to providing comprehensive
emergency management services to the VA, the EMSHG coordinates medical
back-up to the Department of Defense, and assists the public via the
National Disaster Medical System and the National Response Plan.
This article describes the VA's role in homeland security and disasters,
and provides an overview of the ongoing organizational and operational
changes introduced by the formation of the new DHS. Challenges and
opportunities for public health are highlighted.
Use and Analysis of Field Triage Criteria for Mass Gatherings
Authors: Salhanick Steven D. , Sheahan William , Bazarian Jeffrey J. 
Published: August 2016

Abstract

Introduction:

Mass gatherings may result in an acute increase in the number of
people seeking medical care potentially causing undue stress to local
emergencymedical services (EMS) and hospitals. Often, temporary medical
facilities are established within the mass gathering venue. Emergency
Medical Services providers encountering patients in the field should be
equipped with effective protocols to determine transport destination
(venue facility vs. hospital).

Hypothesis:

Paramedics are capable of appropriately using triage criteria
written specifically for a particular mass gathering. The use of triage
criteria, when appliedcorrectly, decreases over-triage to the venue
facility and under-triage to the hospital.

Methods:

Paramedics triaged patients at a mass gathering to a temporary venue
facility or to a single emergency department using criteria specific for
the event. Cases were reviewed to determine if the patients transported
went to an appropriate facility and if the triage criteria were applied
appropriately. Results: Transport destination was consistent with that
dictated by the criteria for 78% of cases. Analysis of these cases shows
that the criteria had a sensitivity of 100% (95% CI = 58–100%) and a
specificity of 90% (95% CI = 73–98%) for predicting which patients
needed hospital services and which could be cared for safely in the
temporary clinic setting.

Conclusions:

Triage by paramedics at the point of patient contact may reduce
transporting of patients to hospitals unnecessarily. Patients in need of
hospital services were identified. Point-of-contact triage should be
applied in mass gatherings.