bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects on Local Emergency Departments of Large-Scale Urban Chemical Fire
With Hazardous Materials Spill
Authors: Hsu Edbert B. , Grabowski Jurek G. , Chotani Rashid A. , Winslow Jason A. , Alves Donald W. , VanRooyen Michael J. 
Published: August 2016

Abstract

Introduction:

On 18 July 2001, a train hauling hazardous materials, including
hydrochloric acid, hydrofluoric acid, and acetic acid, derailed in the
city of Baltimore, Maryland, resulting in a fire that burned under a
downtown street for five days. Firefighters were stymied in their
efforts to extinguish the fire, and the city was subjected to thick
smoke for several days.

Objectives:

To determine whether an urban chemical fire with a hazardous
materials spill resulted in a detectable public health impact, and to
demo-graphically describe the at-risk population for potential smoke and
chemical exposure.

Methods:

The United States Centers for Disease Control and Prevention (CDC)
was consulted about possible side effects from chemical exposure. Total
numbers of emergency department (ED) patients and admissions from 15:00
hours (h), 15 July 2001 to 15:00 h, 21 July 2001 were collected from
five local hospitals. Patient encounters citing specified chief
complaints from 15:00 h, 15 July to 15:00 h, 18 July (pre-accident) were
compared with the period from 15:00 h, July 18 to 15:00 h, 21 July
(post-accident). Data were analyzed using Fisher's exact test. The
United States Census Bureau's Topologically Integrated Geographic
Encoding and Referencing (TIGER) digital database of geographic features
and ArcView Geographic Information Systems (GIS) were used to create
maps of Baltimore and to identify populations at-risk using attribute
census data. Results: There were 62,808 people residing in the
immediate, affected area. The mean of the values for age was 33.7 ±3.2
years (standard deviation; range = 16 yrs) with 49% (30,927) males and
51% (31,881) females. A total of 2,922 ED patient encounters were
screened. Chief complaints included shortness of breath, pre-event = 109
vs. post-event = 148; chest complaints = 90 vs. 113; burns and/or skin
irritation = 45 vs. 42; eye irritation 26 vs. 34; throat irritation = 33
vs. 27; and smoke exposure = 0 vs. 15. There was a statistically
significant increase (p <0.05) for
shortness of breath and smoke exposure-related complaints. No
statistically significant increase in numbers of admitted patients with
these complaints was found.

Conclusions:

In the setting of a large-scale urban chemical fire, local EDs can
expect a significant increase in the number of patients presenting to
EDs with shortness of breath and/or smoke inhalation. Most do not
require inpatient hospitalization. Careful assessment of impact on local
EDs should be considered in future city-accident planning. Some official
warnings were widely misinterpreted or ignored. Public education on
potential hazards and disaster preparedness targeted to populations
at-risk should receive a high priority. Geographic information systems
(GIS) may serve as useful tools for identifying demographics of
populations at-risk for disaster planning and responses.
Multimodal Assessment of the Primary Healthcare System of Serbia: A Model for Evaluating Post-Conflict Health Systems
Authors: Nelson Brett D. , Simic Snezana , Beste Lauren , Vukovic Dejana , Bjegovic Vesna , VanRooyen Michael J. 
Published: August 2016

AbstractIntroduction:Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia.Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods:Integrated quantitative and qualitative methodologies—system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology—were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results:Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions:This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings.
Cost: Benefit of Point-of-Care Blood Gas Analysis vs. Laboratory Measurement During Stabilization Prior to Transport
Authors: Macnab Andrew J , Grant Greg , Stevens Kyle , Gagnon Faith , Noble Robert , Sun Charles 
Published: August 2016

AbstractIntroduction:This study was conducted to determine whether point-of-care testing, using the iSTAT Portable Clinical Analyzer, would reduce time at the referring hospital required to stabilize ventilated pediatric patients prior to interfacility, air-medical transport.Methods:The following data were collected prospectively: (1) When a blood gas analysis was ordered; (2) If it was necessary to call in a technician; (3) Waiting time for blood to be drawn; and (4) Waiting time for results. The cost-efficacy of point-of-care testing was calculated based on: (1) Three minutes for a transport team member to draw a sample and obtain a result using the iSTAT (unit cost $CDN8,000); (2) Lab technician call-back (minimum two hours at $90); (3) Paramedic overtime (by the minute at $49/hour); and (4) Cost of charter aircraft wait time ($200 per hour) for every hour beyond four hours.Results:Data were collected on 46 ventilated patients over a three month period. A blood gas analysis was ordered on 35 patients. Laboratory technicians were called in for 17 (49%). For 12 (34%) patients, there was a wait for the sample to be drawn, and for 23 (66%), there was a wait for results to become available. Total time waiting to obtain laboratory gases was 526 minutes compared with a calculated 105 minutes using point-of-care testing. An iSTAT cartridge cost of $420 would not have been different from laboratory costs. Cost-saving on technician callback ($1,530), paramedic overtime ($690) and aircraft time waiting charges ($2,000) would have totaled ($4,220). From this study, the cost of point-of-care equipment could be recouped in 101 patients if aircraft charges apply or 192 patients if no aircraft costs are involved. For 11 cases, ventilator adjustments were made subsequently during transport, and for six patients, point-of-care testing, if in place, would have been used to optimize transport care.Conclusion:The data from the present study indicate significant cost-efficacy from use of this technology to reduce stabilization times, and support the potential to improve quality of care during air medical interfacility transport.
Terrorism in Colombia
Authors: Zapata Gabriel Darío Paredes 
Published: August 2016

Abstract
Colombia is a poor country that has been plagued by ongoing violence for
more than 120 years. During the 1940s, subversive terrorist groups emerged
in rural areas of the country when criminal groups came under the influence
of Communism, and were later transformed into contemporary groups, such as
the Ejercito de Liberacion Nacional (ELN) or
National Liberation Army and Fuerzas Armadas Revolucionares de
Colombia (FARC) or Revolutionary Armed Forces of
Colombia). Paramilitary terrorist groups emerged in response to subversive
groups and were later transformed into contemporary groups, such as the
Autodefensas Unidas de Colombia (AUC) or
United Self-Defense Forces of Colombia.
Terrorism has placed an enormous burden on modern Colombia. From 1995 to
2002, 9,435 people were killed by terrorism-related events, of which 5,864
were killed by subversive terrorist activities and 3,571 were killed by
paramilitary terrorist activities. In 2002, at least nineteen attacks
produced 10 or more casualties, of which 18 were bombings. In 2002,
terrorists killed at least 12 mayors, 71 legislators, and internally
displaced 300,000 persons from their homes. Since terrorist groups in
Colombia are typically supported by drug manufacturing and trafficking, it
has been difficult at times to distinguish violence due to terrorism from
violence due to illicit drug trafficking. Terrorism has also had a major
adverse effect on the economy, with restricted travel, loss of economic
resources, and lack of economic investment. In addition to political,
military, and commercial targets, terrorists have specifically targeted
healthcare infrastructure and personnel.
At the national and local levels, much emergency planning and
preparedness has taken place for terrorism-related events. The Centro
Regulador de Urgencias (CRU) or Emergency Regulation Center in Bogota plays
a major role in coordinating local prehospital and hospital emergency
response in the capital city and the national level where
necessary.
Terrorism in France
Authors: Carli Pierre , Telion Caroline , Baker David 
Published: August 2016

Abstract
France has experienced two waves of major terrorist bombings since 1980.
In the first wave (1985–1986), eight bombings occurred in Paris, killing 13
and injuring 281. In the second wave (1995–1996), six bombings occurred in
Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during
these events, France has developed and improved a sophisticated national
system for prehospital emergency response to conventional terrorist attacks
based on its national emergency medical services (EMS) system,
Service d' Aide Medicale Urgente (SAMU).
According to the national plan for the emergency medical response to
mass-casualty events (White Plan), the major phases of EMS response are: (1)
alert; (2) search and rescue; (3) triage of victims and provision of
critical care to first priority victims; (4) regulated dispatch of victims
to hospitals; and (5) psychological assistance.
Following the 1995 Tokyo subway sarin attack, a national plan for the
emergency response to chemical and biological events (PIRATOX) was
implemented. In 2002, the Ministries of Health and the Interior collaborated
to produce a comprehensive national plan (BIOTOX) for the emergency response
to chemical, biological, radiological, and nuclear events. Key aspects of
BIOTOX are the prehospital provision of specialized advance life support for
toxic injuries and the protection of responders in contaminated
environments. BIOTOX was successfully used during the 2003 Severe Acute
Respiratory Syndrome (SARS) outbreak in France.
Terrorism in Mexico
Authors: Nordin Yannick , Cruz-Vega Felipe , Roman Fernando 
Published: August 2016

Abstract
Even though Mexico is considered internationally as a pacifist country,
its economic, social, and geopolitical characteristics during the last half
of the 20th century have resulted in internal events that can be considered
acts of terrorism.
Most of the acts of terrorism during the last 15 years have had to do
either with political movements or drug-dealing actions. After the 11
September 2001 attacks in the United States, Mexican Health Authorities have
strengthened the epidemiological surveillance system. More than 1,372 calls
asking for information or reporting suspicious envelopes were received
between 16 October and 21 October 2001.
Following the earthquake in 1985 that caused great damage and many
deaths in Mexico, the National Civil Protection System was created in 1986.
This protection system is led by the President and the Secretary of
Government. It was developed to improve preparedness for disaster
coordination more than for terrorism responses. In addition, the emergency
medical systems continue to lack organization, even though some states have
shown significant progress in their emergency medical system.
Terrorism in Taiwan, Republic of China
Authors: Tsai Ming-Che , Chuang Chia-Chang , Arnold Jeffrey , Lee Mau-Hwa , Hsu Sun-Chieh , Chi Chih-Hsien 
Published: August 2016

Abstract
The Republic of China on the island of Taiwan has experienced at least
20 terrorist events since 1979, including 13 aircraft hijackings and five
bombings. Factors responsible for the relatively small burden of terrorism
on Taiwan in the past include tight military control over political dissent
until 1987, a warming relationship with the People's Republic of China in
the 1990s, political inclusion of major internal cultural groups, geographic
isolation, and a lack of other significant international enemies.
Nevertheless, today Taiwan faces a new prospect of terrorism by adversaries
of the United States and its allies and by an international paradigm shift
in the types of weapons used by terrorists.
National emergency management has been enhanced significantly since the
Ji Ji earthquake in 1999, including the assignment of lead government
agencies to the planning and preparedness for specific types of terrorist
events involving nuclear, biological, and/or chemical releases. Other
significant improvements at the operations level, include the establishment
of two national disaster medical assistance teams, four urban search and
rescue teams, 13 local disaster medical assistance teams, and eight chemical
emergency response hospitals. Future challenges include improving the
coordination of inter-agency response at the national level and the quantity
and quality of local disaster response assets.
Terrorism in South Africa
Authors: MacFarlane Campbell 
Published: August 2016

Abstract
The Republic of South Africa lies at the southern tip of the African
continent. The population encompasses a variety of races, ethnic groups,
religions, and cultural identities. The country has had a turbulent history
from early tribal conflicts, colonialisation, the apartheid period, and
postapartheid readjustment.
Modern terrorism developed mainly during the apartheid period, both by
activities of the state and by the liberation movements that continued to
the time of the first democratic elections in 1994, which saw South Africa
evolve into a fully representative democratic state with equal rights for
all.
Since 1994, terrorist acts have been criminal-based, evolving in the
Cape Town area to political acts, largely laid at the feet of a
predominantly Muslim organisation, People against Gangsterism and Drugs, a
vigilant organisation allegedly infiltrated by Muslim fundamentalists. Along
with this, has been terrorist activities, mainly bombings by disaffected
members of white, right-wing groups.
In the apartheid era, a Draconian series of laws was enacted to suppress
liberation activities. After 1994, most of these were repealed and new
legislation was enacted, particularly after the events of 11 September 2001;
this legislation allows the government to act against terrorism within the
constraints of a democratic system. Disaster management in South Africa has
been largely local authority-based, with input from provincial authorities
and Civil Defence. After 1994, attempts were made to improve this situation,
and national direction was provided. After 11 September 2001, activity was
increased and the Disaster Management Act 2002 was brought into effect. This
standardized disaster management system at national, provincial, and local
levels, also facilites risk assessment and limitation as well as disaster
mitigation.
The potential still exists for terrorism, mainly from right wing and
Muslim fundamentalist groups, but the new legislation should stimulate
disaster management in South Africa to new and improved levels.
Introduction: Consequences of Terrorism
Authors: Noji Eric K. 
Published: August 2016

AbstractRecent acts of terrorism have ranged from the dissemination of anthrax spores to intentional contamination of food to the release of chemical weapons to suicide attacks using explosives. The prediction of such events is difficult, if not impossible. The recent attacks that have generated massive numbers of injured and dead may signal the crossing of a new threshold from multi-casualty events to the use of weapons of mass destruction. Consequently, the medical and healthcare infrastructure must be able to prevent and treat illness and injury resulting from such events. Thus, a first step in improving the preparation for and responses to such events must include a sustained commitment to training physicians, nurses, identification specialists, pathologists, and other first responders. The rapid spread of SARS gives reason to believe that the distribution of such agents has potential advantages over the use of other weapons. Investments in the public health and healthcare systems provide the best defense against terrorism.
Terrorism, Disasters, and Security
Authors: Alexander David 
Published: August 2016

AbstractThe purpose of this editorial is to explore the relationship between the new global emphasis on terrorism and the developing academic and practical fields of disaster management. It includes an appraisal of the place of terrorism among the various forms of disaster, a consideration of its relationship to risk assessment and its place in the practical handling of risks and incidents, and some reflections on the role of the private sector in security management. The influence on the current attitude toward managing the terrorism threat by the evolution of the disaster management field is considered and some of the problems with defining scenarios for counter-terrorism planning also are discussed.
Lack of Hospital Preparedness for Chemical Terrorism in a Major US City: 1996–2000
Authors: Keim Mark E. , Pesik Nicki , Twum-Danso Nana A.Y. 
Published: August 2016

AbstractIntroduction:The [US] Nunn-Lugar-Domenici Defense Against Weapons of Mass Destruction (WMD) Act (the WMD Act of 1996) heralded a new wave of spending by the federal government on counter-terrorism efforts. Between 1996 and 2000, the United States of America (US) federal government allocated large sums of funding to the States for bioterrorism preparedness. Distribution of these funds between institutions involved in first-responder care (e.g., fire and safety departments) and hospitals was uneven. It is unknown whether these additional funds had an impact on the level of hospital preparedness for managing mass casualties involving hazardous materials at the local level, including potential terrorist attacks with chemical agents.Objectives:(1) To compare 1996 and 2000 measures of preparedness among hospitals of a major US metropolitan area for dealing with hazardous material casualties, including terrorism that involved the use of weapons of mass destruction; and (2) To provide guidance for the improvement of emergency preparedness and response in US hospitals.Methods:In July 1996 and again in July 2000, 21 hospitals in one major US city were surveyed by questionnaire. A survey was used to assess the amounts of antidote stocks held available for treatment of casualties caused by toxic chemical agents and institutional response capabilities including the number of showers for decontaminating patients, the level of worker protection, and the number of staff trained to decontaminate patients.Results:Hospital preparedness for treating and decontaminating patients exposed to toxic chemical agents was inadequate in 1996 and in 2000. From 1996 to 2000, there was no statistically significant change in the lack of hospital preparedness for stocking of nerve agent and cyanide antidotes. Capacity for decontamination of patients, which included appropriate hazardous material infrastructure and trained staff, generally was unimproved from 1996 to 2000 with the exception of an increase of nearly 30% in hospitals with at least one decontamination shower facility.Conclusion:Hospitals surveyed in this study were poorly prepared to manage chemical emergency incidents, including terrorism. This lack of hospital preparedness did not change significantly between 1996 and 2000 despite increased funds allocated to bioterrorism preparedness at the local level.
Public Health Response Actions and the Use of Emergency Operations Centers
Authors: Mignone A. Thomas , Davidson Robert 
Published: August 2016

AbstractIn the wake of 11 September 2001, many public health agencies are reassessing their institutional capabilities and procedures to respond to mass-casualty incidents involving weapons of mass destruction. Prior to the fall of 2001, planning by the public health and other sectors addressed more conventional or naturally occurring events such as earthquakes, hurricanes, tornados, and chemical spills, although attacks with weapons of mass destruction were a growing concern. While the nature of natural versus intentional events differs, the management and coordination of response activities to them follows the same incident command system.A major lesson learned during the response operations to the 11 September 2001 attacks in New York City was the value of disaster planning, conducting exercises, and developing relationships among the various response agencies. Although New York City's physical Emergency Operations Center (EOC) at 7 World Trade Center was destroyed in the attack, the medical and health response community was able to react effectively to the possibility of mass casualties as well as to the more usual needs. This was enabled by the pre-existing relationships that had been developed between city, state, federal, and non-governmental agencies while planning and exercising for such events and their aftermaths.
Mass-Casualty, Terrorist Bombings: Implications for Emergency Department and Hospital Emergency Response (Part II)
Authors: Halpern Pinchas , Tsai Ming-Che , Arnold Jeffrey L. , Stok Edita , Ersoy Gurkan 
Published: August 2016

AbstractThis article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.