Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents

A Scoping Review of the Essential Components of Emergency Medical Response Systems for Mass Casualty Incidents

OBJECTIVE

Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs.

METHODS

A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems.

RESULTS

Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements.

CONCLUSIONS

Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.

Real-time breath recognition by movies from a small drone landing on victim's bodies

In local and global disaster scenes, rapid recognition of victims' breathing is vital. It is unclear whether the footage transmitted from small drones can enable medical providers to detect breathing. This study investigated the ability of small drones to evaluate breathing correctly after landing on victims' bodies and hovering over them. We enrolled 46 medical workers in this prospective, randomized, crossover study. The participants were provided with envelopes, from which they were asked to pull four notes sequentially and follow the written instructions ("breathing" and "no breathing"). After they lied on the ground in the supine position, a drone was landed on their abdomen, subsequently hovering over them. Two evaluators were asked to determine whether the participant had followed the "breathing" or "no breathing" instruction based on the real-time footage transmitted from the drone camera. The same experiment was performed while the participant was in the prone position. If both evaluators were able to determine the participant's breathing status correctly, the results were tagged as "correct." All experiments were successfully performed. Breathing was correctly determined in all 46 participants (100%) when the drone was landed on the abdomen and in 19 participants when the drone hovered over them while they were in the supine position (p < 0.01). In the prone position, breathing was correctly determined in 44 participants when the drone was landed on the abdomen and in 10 participants when it was kept hovering over them (p < 0.01). Notably, breathing status was misinterpreted as "no breathing" in 8 out of 27 (29.6%) participants lying in the supine position and 13 out of 36 (36.1%) participants lying in the prone position when the drone was kept hovering over them. The landing points seemed wider laterally when the participants were in the supine position than when they were in the prone position. Breathing status was more reliably determined when a small drone was landed on an individual's body than when it hovered over them.

The Role of Hospital Medicine in Emergency Preparedness: A Framework for Hospitalist Leadership in Disaster Preparedness, Response, and Recovery

Recent high-profile mass casualty events illustrate the unique challenges that such occurrences pose to normal hospital operations. These events create patient surges that overwhelm hospital resources, space, and staff. However, in most healthcare systems, hospitalists currently show no integration within emergency planning or incident response. This review aims to provide hospitalists with an overview of disaster management principles so that they can engage their hospitals' disaster management system with a working fluency in emergency management and the incident command system. This review also proposes a framework for hospitalist involvement in preparation, response, and coordination during periods of crisis.

The current state of bioterrorist attack surveillance and preparedness in the US

The use of biological agents as weapons to disrupt established structures, such as governments and especially larger urban populations, has been prevalent throughout history. Following the anthrax letters sent to various government officials in the fall of 2001, the US has been investing in prevention, surveillance, and preparation for a potential bioterrorism attack. Additional funding authorized since 2002 has assisted the Centers for Disease Control and Prevention, the Department of Health and Human Services, and the Environmental Protection Agency to invest in preventative research measures as well as preparedness programs, such as the Laboratory Response Network, Hospital Preparedness Program, and BioWatch. With both sentinel monitoring systems and epidemiological surveillance programs in place for metropolitan areas, the immediate threat of a large-scale bioterrorist attack may be limited. However, early detection is a crucial factor to initiate immediate response measures to prevent further spread following dissemination of a biological agent. Especially in rural areas, an interagency approach to train health care workers and raise awareness for the general public remain primary tasks, which is an ongoing challenge. Risk-management approaches in responding to dissemination of biological agents, as well as appropriate decontamination measures that reduce the probability of further contamination, have been provided, and suggest further investments in preparedness and surveillance. Ongoing efforts to improve preparedness and response to a bioterrorist attack are crucial to further reduce morbidity, mortality, and economic impact on public health.

Pictorial Review of Radiographic Patterns of Injury in Modern Warfare: Imaging the Conflict in Afghanistan

Radiographic assessment of combat injuries has been an important component of casualty care in every major conflict of the 20th and 21st centuries. The advent of multislice computed tomography scanners has provided physicians with the ability to visualize organ injury at submillimetre resolution, changing the way war wounds are treated. Modern wars are, for the most part, asymmetric conflicts where improvised explosive devices have replaced artillery as a major cause of casualties. Both bullets and explosive devices wreak distinctive patterns of injury on the human body. Being able to recognize these patterns and their potential associated morbidities will allow medical personnel to provide expert and timely care to some of the most severely injured patients on earth. This series of pictorial essays will review the radiographic patterns of combat-related injury encountered in southern Afghanistan in 2008–2009.

Civil protection and disaster medicine in Germany today

PURPOSE

This paper seeks to outline the development of disaster medicine services in Germany and the preparedness of the security and rescue forces for mass casualty incidents after an accident, a natural disaster or a terrorist attack.

METHOD

The method used was review of articles and interview with experts.

RESULTS

The plane crash at the 1988 Ramstein air show highlighted problems in the approach to incident management. Following this event, Germany improved the medical management of major incidents. At the railway accident in Eschede in 1998, a "proof of concept" was evident. The newest increases of terrorist threats were also turning points in the further development of disaster medicine in Germany.

CONCLUSIONS

Emergency medical training must be adapted to the increase in disasters, mass casualty incidents, and terrorist threats.

[Hurricane Ike and the University of Texas Medical Branch Hospital's evacuation]

In September 2008 the University of Texas Medical Branch at Galveston was threatened by Hurricane Ike. The incident commander decided to evacuate the hospital. This is a report on how this was accomplished and the lessons learned. An adequate disaster preparedness plan, sufficient logistics, a comprehensive incident command center and the use of complex communication systems were crucial for success. Within 11 h a total of 469 patients had been evacuated using 143 ambulances, 23 helicopters, 2 fixed wing aircraft, buses and numerous passenger vans. The authors encourage physicians, as responsible members of the health care team, to be prepared to respond to disasters.