bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prehospital Management and Fluid Resuscitation in Hypotensive Trauma Patients Admitted to Karolinska University Hospital in Stockholm
Authors: Talving Peep , Pålstedt Joakim , Riddez Louis 
Published: August 2016

AbstractIntroduction:Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated.Methods:This is a retrospective, descriptive study on consecutive, hypotensivetrauma patients (systolic blood pressure ≤90 mmHg on the scene of injury) admitted to Karolinska University Hospital in Stockholm, Sweden, during 2001–2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model.Results:In 102 (71 male) adult patients (age ≥15 years) recruited, the median age was 35.5 years (range: 27–55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16–50). The on-scene time interval was 19 minutes (range: 12–24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0–20; 21–40; 41–75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21–40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact logistic regression analysis.Conclusion:The time interval at the scene of injury exceeded PHTLS guidelines. The vast majority of the hypotensive trauma patients were fluid-resuscitated on-scene regardless of the type, mechanism, or severity of injury. A predefined fluid resuscitation regimen is not employed in hypotensive trauma victims with different types of injuries. The outcome was worsened by male gender, progressive age, and ISS >20 in the exact multiple regression analysis.
Strategies in Evaluation and Management of Bam Earthquake Victims
Authors: Emami Mohammad J. , Tavakoli Ali R. , Alemzadeh Hossein , Abdinejad Farzad , Shahcheraghi Gholamhossain , Erfani Mohammad A. , Mozafarian Kamran , Solooki Saeed , Rezazadeh Sorena , Ensafdaran Ahmad , Nouraie Hormoz , Jaberi Feriedoon M. , Sharifian Maryam 
Published: August 2016

AbstractBackground:On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, >43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals werecreated and large numbers of patients were evacuated from their homes and transported to hospitals throughoutIran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake.Methods:This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation.Results:Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months–70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of theleg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death.Conclusion:A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.
Session 1.4: Health Services Delivery: A Critical Review of Experience
Authors: Smith Jack , Fink Sheri , Hansch Steve , Yoosuf Abdul Azeez , Keng K.O.H. Peng , van Alphen Dana 
Published: August 2016

AbstractThis is a summary of the presentations and discussion of Session 1.4, Health Services Delivery: A CriticalReview of Experience, 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 health services delivery as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessment; (2) coordination; (3) filling of gaps; (4) capacity building; and (5) lessons learned.
Panel 2.1: Assessing Impact and Needs
Authors: Aldis William , Rockenschaub Gerald , Gorokhovich Yuri , Doocy Shannon , Lumbiganon Pisake , Grunewald Francois 
Published: August 2016

AbstractThis is a summary of the presentations and discussion of Panel 2.1 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 assessing needs and measuring impact as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) assessing needs; (3) measuring impact; and (4) lessons learned and recommendations.
Panel 2.9: Repair and Recovery of Health Systems
Authors: Melgaard Bjorn , Profili Maria Cristina , Heimann Peter , Pusponegoro Aryono , O'Rourke Edward , Kolokathis Antonia , Romisch-Diouf Marie-Andrée 
Published: August 2016

AbstractThis is a summary of the presentations and discussion of Panel 2.9, Repair and Recovery of Health Systemsof 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 the repair and recovery of health systems as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessment; (2) coordination; (3) filling gaps; (4) capacity building; (5) what was done well, and what should have been done better; (6) lessons learned; and (7) recommendations. Recommendations included: (1) how to make health systems better prepared for coping with disasters; and (2) how to support preparedness in local communities.
Panel 2.13: The Role of Media and Communication
Authors: Habayeb Salim , Bolton Samantha , Jones Mark , Surapaneni Naveen , Dietz Robert , Pandey Harsaran Bir Kaur 
Published: August 2016

AbstractThis is a summary of the presentations and discussion of Panel 2.13, The Role of Media and Communication, 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 the role of media and communication as pertain to the responses to the damage created by the Tsunami of 26 December 2004.
Panel 2.15: Civil-Military Cooperation in Humanitarian Health Action
Authors: Gunnarsson David , Hyer Randy , Hufstader R.D. , Hidayat Archmad , Peake James , Banerjee Anshu 
Published: August 2016

AbstractThis is a summary of the presentations and discussion of Panel 2.15, Civil-Military Cooperation in Humanitarian Health Action 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 civil-military collaboration in humanitarian health actions as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) how effective civil-military cooperation can help health responses, including; (a) needs assessment; (b) coordination; (c) filling gaps; and (d) capacity (2) what was done well, and what could have been done better better; and (3) conclusions and recommendations. Conclusions and recommendations included: (1) the best coordination mechanisms for civil-military cooperation; and (2) suggested additions and improvements.
Enhancing Local Health Department Disaster Response Capacity with Rapid Community Needs Assessments: Validation of a Computerized Program for Binary Attribute Cluster Sampling
Authors: Groenewold Matthew R. 
Published: August 2016

AbstractIntroduction:Local health departments are among the first agencies to respond to disasters or other mass emergencies. However, they often lack the ability to handle large-scale events. Plans including locally developed and deployed tools may enhance local response. Simplified cluster sampling methods can be useful in assessing community needs after a sudden-onset, short duration event.Methods:Using an adaptation of the methodology used by the World Health Organization Expanded Programme on Immunization (EPI), a Microsoft Access-based application for two-stage cluster sampling of residential addresses in Louisville/Jefferson County Metro, Kentucky was developed. The sampling frame was derived from geographically referenced data on residential addresses and political districts available through the Louisville/Jefferson County Information Consortium (LOJIC). The program randomly selected 30 clusters, defined as election precincts, from within the area of interest, and then, randomly selected 10 residential addresses from each cluster.The program, called the Rapid Assessment Tools Package (RATP), was tested in terms of accuracy and precision using data on a dichotomous characteristic of residential addresses available from the local tax assessor database. A series of 30 samples were produced and analyzed with respect to their precision and accuracy in estimating the prevalence of the study attribute. Point estimates with 95% confidence intervals were calculated by determining the proportion of the study attribute values in each of the samples and compared with the population proportion. To estimate the design effect, corresponding simple random samples of 300 addresses were taken after each of the 30 cluster samples.Results:The sample proportion fell within ±10 absolute percentage points of the true proportion in 80% of the samples. In 93.3% of the samples, the point estimate fell within ±12.5%, and 96.7% fell within ±15%. All of the point estimates fell within ±20% of the true proportion. Estimates of the design effect ranged from 0.926 to 1.436 (mean = 1.157, median = 1.170) for the 30 samples.Conclusions:Although prospective evaluation of its performance in field trials or a real emergency is required to confirm its utility, this study suggests that the Rapid Assessment Tools Package, a locally designed and deployed tool, may provide populationbased estimates of community needs or the extent of event-related consequences that are precise enough to serve as the basis for the initial post-event decisions regarding relief efforts.
Back to Where It Happened: Self-Reported Symptom Improvement of Tsunami Survivors who Returned to the Disaster Area
Authors: Heir Trond , Weisæth Lars 
Published: August 2016

AbstractBackground:During October and November 2005, the National Norwegian Tsunami Support Association organized a journey to the disaster area for survivors. The aim of this study was to investigate whether the Tsunami affected the participants' psychological problems.Methods:Twenty-nine adults and 19 children made the journey. Steps were taken to enable each individual to acquire an overall understanding of the catastrophic event. Various forms of antiphobic training were provided. At the end of the stay, 28 adults replied to a questionnaire. The questions concerned: (1) motives for traveling; (2) benefits experienced; (3) psychological problems before departure; and (4) problems at the end of the stay. Parents with children were asked to assess their children's psychological problems at the same points in time.Results:Considerable improvements in anxiety symptoms were reported and observed in both the adults and children. No certain cases of retraumatization occurred.Discussion:The improvements can be understood in the light of psychodynamic, cognitive, and behavioral theory approaches. The duration of the improvement in symptoms remains to be documented. There appears to be grounds for encouraging traumatized patients to return to a disaster area as part of the treatment process if they so wish.
KAMEDO Report No. 77 Sinking of the MS Sleipner, 26 November 1999
Authors: Brändström Helge , Sedig Karin , Lundälv Jörgen 
Published: August 2016

AbstractThe catamaran HS Sleipner struck a rock and sunk in bad weather and heavy seas on 26 November 1999. Rescue efforts were provided by helicopters and other ships. A total of 68 victims were rescued alive and 16 died, mostly by drowning. Problems were encountered with evacuation, life jackets, and life rafts. Most of those rescued alive suffered from hypothermia. Response times for rescue helicopters should be improved. Emphasis should be placed on correct manifest lists of passengers and crew. Special emphasis must be placed on media relations and cross-boundary issues. Exercises should focus on cooperation and coordination.
KAMEDO Report No. 78 Nuclear Accident in Japan,1999
Authors: Joussineau Siegfried , Riddez Louis 
Published: August 2016

AbstractA break in safety locks resulted in the release of high quantities of gamma and neutron radiation directly exposed three workers and indirectly exposed as many as 310,000 other persons. The two persons who received the highest doses ultimatley succumbed due to the latent effects of the radiation on the skin and mucous membranes. Improved protection of workers and responders as well as dosimeters are needed in areas where such events may occur. Careful attention must be paid to providing accurate information to the media and to the provision of competent psychosocial support.
KAMEDO Report No. 80 Train Accident in England, 1999
Authors: Hedelin Annika , Örtenwall Per , Ortgren Per-Olof , Riddez Louis 
Published: August 2016

AbstractThe train crash that occurred in London in 1999 resulted in 31 dead and almost 300 injured persons. Mobilized resources allowed for the application of normal treatment principles. Available resources were in excess of what was needed. The procedures implemented were judged as adequate. Responses followed the management plan formulated over many years and experiences. The rotating command procedures used worked well. Multiple communications systems were used, including landline telephones, mobile telephones, and radios. Plans should include caring for both adults and children. Well-planned psychosocial services and functional compute services are essential components.
KAMEDO Report No. 83 European Union Summit in Göteborg, 2001
Authors: Fellenius Eva , Lindberg Håkan , Hedelin Annika , Örtenwall Per , Riddez Louis 
Published: August 2016

AbstractA European Union (EU) Summit in Göteborg, Sweden, was held 15–16 June 2001. This meeting presented various security and medical concerns to city officials. In preparation for a large meeting such as the EU Summit, a plan should be established that includes basic facts, management organization, and guidelines. Clear communication beteween city agencies also must be established. Hospital inventories should be recorded daily and reported to medical staff. A command center must be in place for police and medical command. An emergency medical provider should ride in each police vehicle, so in case of a riot situation, victims can be treated quickly. An information officer should be assigned with the task of providing information regarding the injured to the media.
Prevalence of Radioactive Signals from Surveillance of an Emergency Department
Authors: Guyette Frank , Suyama Joe , Rosen Jerry , Allswede Michael 
Published: August 2016

AbstractIntroduction:Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.Objective:The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).Methods:A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).Results:A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.Conclusion:The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.
Disaster Healthcare System Management and Crisis Intervention Leadership in Thailand–Lessons Learned from the 2004 Tsunami Disaster
Authors: Peltz Rami , Ashkenazi Issac , Schwartz Dagan , Shushan Ofer , Nakash Guy , Leiba Adi , Levi Yeheskel , Goldberg Avishay , Bar-Dayan Yaron 
Published: August 2016

AbstractIntroduction:Quarantelli established criteria for evaluating the effectiveness of disaster management.Objectives:The objectives of this study were to analyze the response of the healthcare system to the Tsunami disaster according to the Quarantelli principles, and to validate these principles in a scenario of a disaster due to natural hazards.Methods:The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research team to study the response of the Thai medical system to the disaster. The analysis of the disaster management was based on Quarantelli's 10 criteria for evaluating the management of community disasters. Data were collected through personal and group interviews.Results:The three most important elements for effective disaster management were: (1) the flow of information; (2) overall coordination; and (3) leadership. Although pre-event preparedness was for different and smaller scenarios, medical teams repeatedly reported a better performance in hospitals that recently conducted drills.Conclusions:In order to increase effectiveness, disaster management response should focus on: (1) the flow of information; (2) overall coordination; and (3) leadership.
The Volendam Fire: Lessons Learned from Disaster Research
Authors: Harten Sabine M.van , Bierens Joost J.L.M. , Welling Lieke , Patka Peter , Kreis Robert W. , Boers Maarten 
Published: August 2016

AbstractIntroduction:After the Volendam fire, a multidisciplinary, integral evaluation, called the Medical Evaluation of the Disaster in Volendam (MERV), was established. This article is a discussion of disaster research methodology. It describes the organizational framework of this project and the methodological problems.Methods:A scientific steering group consisting of members from three hospitals prepared and guided the project. A research team wrote the final study protocol and performed the study. The project was funded by the Ministry of Health. The study protocol had a modular design in which each of the modules focused on one specific area or location. The main questions for each location were: (1) which treatment protocols were used; (2)what was the condition of the patient; and (3) was medical care provided according to existing protocols. After the fire, 241 victims were treated in hospitals; they all were included in the study. Most of the victims had burn injuries, and approximately one-third suffered from inhalation injury. All hospitals and ambulance services involved were visited in order to collect data, and interviewers obtained additional information. The government helped obtain permission for data-collection in three of the hospitals. Over 1,200 items of information about each patient and >200,000 total items were collected. During data processing, the data were re-organized, categorized, and presented in a uniform and consistent style. A cross-sectional site analysis and a longitudinal patient analysis were conducted. This was facilitated by the use of several sub-data-bases. The modular approach made it possible to obtain a complete overview of the medical care provided. The project team was guided by a multidisciplinary steering group and the research was performed by a research team. This enabled the research team to focus on the scientific aspects.Conclusion:The evaluation of the Volendam fire indicates that a project approach with a modular design is effective for the analysis of complex incidents. The use of several sub-databases makes it easy to combine findings and conduct cross-sectional and longitudinal analyses. The government played an important role in the funding and support of the project. To limit and structure data collection and analysis, a pilot study based on several predefined main questions should be conducted. The questions then can be specified further based on the availability of data.