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Rauch L, Dotzer M, Händl T. [Management of a mass casualty incident according to the recommendations of the Federal Office of Civil Protection and Disaster Assistance and the principles of the Terror and Disaster Surgical Care Concept in a regional trauma center]. Anaesthesiologie 2024; 73:193-203. [PMID: 38413414 DOI: 10.1007/s00101-024-01384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
Dealing with a mass casualty incident presents many challenges in the clinical and preclinical situation. There are various systems and structures to address this problem. In the present work, the management of the train accident near Garmisch-Partenkirchen on 3 June 2022 is evaluated with the aid of the recommendations of the Federal Office for Civil Protection and Disaster Relief for hospital alarm and deployment planning as well as the recommendations from the terror and disaster surgical care training of the German Academy of Trauma Surgery and the findings are presented from the perspective of a regional trauma center. It also discusses which key factors in the present case have proved to be successful and in which areas there is still a need for improvement.
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Affiliation(s)
- Ludwig Rauch
- Klinikum Garmisch Partenkirchen GmbH, Garmisch-Partenkirchen, Deutschland.
| | - Martin Dotzer
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Thomas Händl
- Klinikum Garmisch Partenkirchen GmbH, Garmisch-Partenkirchen, Deutschland
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2
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Horne S, Hunt P, Hall B, Jefferys S, Vassallo J, Gurney I. A simple research framework will improve mass casualty responses. Lancet 2023; 402:1417. [PMID: 37865462 DOI: 10.1016/s0140-6736(23)01802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Simon Horne
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK.
| | | | - Ben Hall
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
| | | | - James Vassallo
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
| | - Ian Gurney
- Medical Directorate, Royal Centre for Defence Medicine, Birmingham B15 2SG, UK
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3
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Álvarez-García C, Cámara-Anguita S, López-Hens JM, Granero-Moya N, López-Franco MD, María-Comino-Sanz I, Sanz-Martos S, Pancorbo-Hidalgo PL. Development of the Aerial Remote Triage System using drones in mass casualty scenarios: A survey of international experts. PLoS One 2021; 16:e0242947. [PMID: 33974634 PMCID: PMC8112676 DOI: 10.1371/journal.pone.0242947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/25/2021] [Indexed: 11/23/2022] Open
Abstract
The use of drones for triage in mass-casualty incidents has recently emerged as a promising technology. However, there is no triage system specifically adapted to a remote usage. Our study aimed to develop a remote triage procedure using drones. The research was performed in three stages: literature review, the development of a remote triage algorithm using drones and evaluation of the algorithm by experts. Qualitative synthesis and the calculation of content validity ratios were done to achieve the Aerial Remote Triage System. This algorithm assesses (in this order): major bleeding, walking, consciousness and signs of life; and then classify the injured people into several priority categories: priority 1 (red), priority 2 (yellow), priority 3 (green) and priority * (violet). It includes the possibility to indicate save-living interventions to injured people and bystanders, like the compression of bleeding injuries or the adoption of the recovery position. The Aerial Remote Triage System may be a useful way to perform triage by drone in complex emergencies when it is difficult to access to the scene due to physical, chemical or biological risks.
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Affiliation(s)
| | | | | | - Nani Granero-Moya
- Basic Health Area Baeza, District Jaén nordeste, Servicio Andaluz de Salud, Jaén, Spain
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Abstract
ABSTRACT This article outlines a four-part strategy for future research in mental health and complementary disciplines that will broaden understanding of mass shootings and multi-victim gun homicides. First, researchers must abandon the starting assumption that acts of mass violence are driven primarily by diagnosable psychopathology in isolated "lone wolf" individuals. The destructive motivations must be situated, instead, within larger social structures and cultural scripts. Second, mental health professionals and scholars must carefully scrutinize any apparent correlation of violence with mental illness for evidence of racial bias in the official systems that define, measure, and record psychiatric diagnoses, as well as those that enforce laws and impose criminal justice sanctions. Third, to better understand the role of firearm access in the occurrence and lethality of mass shootings, research should be guided by an overarching framework that incorporates social, cultural, legal, and political, but also psychological, aspects of private gun ownership in the United States. Fourth, effective policies and interventions to reduce the incidence of mass shootings over time-and to prevent serious acts of violence more generally-will require an expanded body of well-funded interdisciplinary research that is informed and implemented through the sustained engagement of researchers with affected communities and other stakeholders in gun violence prevention. Emerging evidence that the coronavirus pandemic has produced a sharp increase both in civilian gun sales and in the social and psychological determinants of injurious behavior adds special urgency to this agenda.
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Paganini M, Conti A, Weinstein E, Della Corte F, Ragazzoni L. Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure. Disaster Med Public Health Prep 2020; 14:541-550. [PMID: 32216865 PMCID: PMC7156581 DOI: 10.1017/dmp.2020.57] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 01/15/2023]
Abstract
Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.This study reviewed the available surge science literature specifically to guide an emergency department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team's COVID-19 surge structural response.
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Affiliation(s)
- Matteo Paganini
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Andrea Conti
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Eric Weinstein
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Francesco Della Corte
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM – Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy
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Ahluwalia R, Rocque BG, Shannon CN, Blount JP. The impact of imposed delay in elective pediatric neurosurgery: an informed hierarchy of need in the time of mass casualty crisis. Childs Nerv Syst 2020; 36:1347-1355. [PMID: 32435890 PMCID: PMC7239607 DOI: 10.1007/s00381-020-04671-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.
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Affiliation(s)
- Ranbir Ahluwalia
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
- Florida State University College of Medicine, 1115 W Call St., Tallahassee, FL, 32304, USA.
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey P Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, Birmingham, AL, USA
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9
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Prunet B, Derkenne C, Frattini B, Lesaffre X, Bignand M. The Paris Fire Brigade response to the 2018 Champs-Elysées riots. Lancet 2019; 393:2491-2492. [PMID: 31232368 DOI: 10.1016/s0140-6736(19)30247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Bertrand Prunet
- Department of Emergency Medicine, Paris Fire Brigade, Paris 75017, France.
| | - Clement Derkenne
- Department of Emergency Medicine, Paris Fire Brigade, Paris 75017, France
| | - Benoit Frattini
- Department of Emergency Medicine, Paris Fire Brigade, Paris 75017, France
| | - Xavier Lesaffre
- Department of Emergency Medicine, Paris Fire Brigade, Paris 75017, France
| | - Michel Bignand
- Department of Emergency Medicine, Paris Fire Brigade, Paris 75017, France
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Martín-Ibáñez L, Pérez-Martínez J, Zamora-Mínguez D, Alcón-Rubio F, González-Alonso V, Aroca García-Rubio S, Hernández-Hernández JM, Díaz F, Román-López P. A civilian tactical survival chain for incidents involving multiple intentionalinjury victims: the Victory I Consensus Report. Emergencias 2019; 31:195-201. [PMID: 31210453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.
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Affiliation(s)
- Luis Martín-Ibáñez
- Grupo de Artillería de Campaña, Brigada de Infantería Ligera "Rey Alfonso XIII" II de La Legión, Almería, España
| | | | | | - Francisco Alcón-Rubio
- Batallón de Zapadores, Brigada de Infantería Ligera "Rey Alfonso XIII" II de La Legión, Almería, España
| | | | | | | | - Feliciano Díaz
- Cuerpo Nacional de Policía, Seguridad Ciudadana, Almería, España
| | - Pablo Román-López
- Departamento Enfermería, Universitat Jaume I, Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, España
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Motameni AT, Pike AI, Denzik KR, Arnold LF, Muradov JM, McKinley WI, Benns MV, Harbrecht BG. Stop the Bleed: Is Mass Education the Best Approach? Am Surg 2019; 85:601-605. [PMID: 31267900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Stop the Bleed (STB) course teaches trainees prehospital hemorrhage control with a focus on mass education. Identifying populations most likely to benefit can help save on the significant cost and limited resources. In this study, we attempted to identify those populations and performed a cost analysis. Trainees underwent STB education and completed a survey on completion to assess demographics and prior experiences where STB skills could have been useful. Five hundred seventy-one trainees categorized as first responders (14%), students (56%), and the working public (30%) completed the survey. Most trainees found the lecture and simulation helpful, 96 per cent and 98 per cent, respectively. There were significant differences among groups who had previously been in situations where the STB course would have been helpful (88% first responders versus 40% students versus 43% public workers) (P < 0.001). Teaching a class of 10 students costs approximately $455; the cost can be as high as $1246 for a class of 50 students. Most STB trainees found the course helpful. First responders are most likely to be exposed to situations where course information could be helpful. Focusing on specific high-yield groups rather than mass education might be a more efficient approach to STB education.
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12
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Memish ZA, Steffen R, White P, Dar O, Azhar EI, Sharma A, Zumla A. Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet 2019; 393:2073-2084. [PMID: 31106753 PMCID: PMC7159069 DOI: 10.1016/s0140-6736(19)30501-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreak-prone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed.
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Affiliation(s)
- Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine and Research, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland; Division of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Paul White
- Commonwealth of the Northern Mariana Islands, Epidemiology and Laboratory Capacity Program, Public Health & Hospital Emergency Preparedness Program, Commonwealth Health Care Corporation, Saipan, Northern Mariana Islands, USA
| | - Osman Dar
- Public Health England and Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, Jeddah, Saudi Arabia; Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Avinash Sharma
- National Centre for Microbial Resource, Pune, Maharashtra, India; National Centre for Cell Science, Pune, Maharashtra, India
| | - Alimuddin Zumla
- Division of Infection, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
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Baddock K. This is not us. N Z Med J 2019; 132:6-7. [PMID: 30921305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Kate Baddock
- Chair, New Zealand Medical Association, Wellington
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Tamatea JA, Scott N, Curtis H. Call for action on equity from three angles. N Z Med J 2019; 132:8-10. [PMID: 30921306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jade Au Tamatea
- Senior Lecturer, Te Kupenga Hauora Māori, Waikato Clinical Campus, University of Auckland, Hamilton; Senior Lecturer, Department of Medicine, Waikato Clinical Campus, University of Auckland, Hamilton; Endocrinologist, Endocrinology Department, Waikato District Health Board, Hamilton
| | - Nina Scott
- Clinical Director, Māori Public Health, Waikato District Health Board, Hamilton; Chair, Hei Ahuru Mowai, Māori Cancer Leadership Aotearoa
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Abstract
Little is known regarding the time trend of mass shootings and associated risk factors. In the current study, we intended to explore the time trend and relevant risk factors for mass shootings in the U.S. We attempted to identify factors associated with incidence rates of mass shootings at the population level. We evaluated if state-level gun ownership rate, serious mental illness rate, poverty percentage, and gun law permissiveness could predict the state-level mass shooting rate, using the Bayesian zero-inflated Poisson regression model. We also tested if the nationwide incidence rate of mass shootings increased over the past three decades using the non-homogenous Poisson regression model. We further examined if the frequency of online media coverage and online search interest levels correlated with the interval between two consecutive incidents. The results suggest an increasing trend of mass shooting incidences over time (p < 0.001). However, none of the state-level variables could predict the mass shooting rate. Interestingly, we have found inverse correlations between the interval between consecutive shootings and the frequency of on-line related reports as well as on-line search interests, respectively (p < 0.001). Therefore, our findings suggest that online media might correlate with the increasing incidence rate of mass shootings. Future research is warranted to continue monitoring if the incidence rates of mass shootings change with any population-level factors in order to inform us of possible prevention strategies.
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Affiliation(s)
- Ping-I Lin
- Department of Health Sciences, Karlstad University, Universitetsgatan, Karlstad, Sweden
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - Drew Barzman
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
| | - M. Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States of America
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Affiliation(s)
- Garen J Wintemute
- From the Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis
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17
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Affiliation(s)
- John Maa
- From the Division of General and Acute Care Surgery, Marin General Hospital, Larkspur, CA, and the San Francisco Marin Medical Society, San Francisco (J.M.); and the Department of Surgery, Imperial College London-St. Mary's Hospital, London (A.D.)
| | - Ara Darzi
- From the Division of General and Acute Care Surgery, Marin General Hospital, Larkspur, CA, and the San Francisco Marin Medical Society, San Francisco (J.M.); and the Department of Surgery, Imperial College London-St. Mary's Hospital, London (A.D.)
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Swartz MK. Why is it Different This Time? J Pediatr Health Care 2018; 32:213. [PMID: 29678258 DOI: 10.1016/j.pedhc.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/04/2018] [Indexed: 11/16/2022]
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Rebmann T, McPhee K, Haas GA, Osborne L, McPhillips A, Rose S, Vatwani S. Findings from an Assessment and Inventory of a Regional, Decentralized Stockpile. Health Secur 2018; 16:119-126. [PMID: 29570355 DOI: 10.1089/hs.2017.0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stockpiles can aid with healthcare surge that occurs after a disaster, and experts recommend that these caches be assessed at least annually to ensure supply integrity. The purpose of this study was to assess a regional stockpile to determine its viability and readiness. An assessment was performed in the summer and fall of 2016 on a regionally funded stockpile that was decentralized through a regional network of 15 local hospitals. Each supply was assessed to determine whether the correct amount was present, if it was in a safe and usable condition (ie, deployable), and whether it had expired. Stockpiled materials were categorized by the type of supply or equipment for analysis. The percent of deployable materials was calculated for each item, each category of supplies, and for the entire cache. Almost all sites (93.3%, n = 14) reported that they inventory their cache at least once a year. On average, 60.1% of each site's cache materials were present and deployable (range: 22.1%-87.5%). The best-maintained supplies included personal protective equipment (79.4% deployable) and general medical supplies (73.5% deployable). Decontamination equipment and pediatric supplies had the lowest percentages of deployability (29.0% and 37.7%, respectively). Although almost all sites claimed to assess the stockpile annually, results from this study indicate that almost half of the supplies are either missing or in an unusable condition. This not only represents wasted resources, but it could also hinder disaster response, leading to increased morbidity and mortality. Facilities may need to invest in infrastructure to maintain stockpiled materials after purchase to ensure viability.
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Abstract
The goals herein are to describe and discuss existing plans for the medical preparedness and response to a radiological incident/nuclear detonation, present the systems approach to nuclear response, introduce methods to assess operational capabilities, and posit suggestions for the way forward to implementation. This discussion seeks to review where these U.S. government efforts began 10 y ago, then moves through the collective National progress in preparedness planning for an improvised nuclear device detonation and differentiates between important preparedness planning efforts and the challenges of understanding national implementation. Finally, a way forward for the immediate future is suggested.
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Klinger JG. Radiological Preparedness in the Land of Lincoln. Health Phys 2018; 114:136-140. [PMID: 30086002 DOI: 10.1097/hp.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The paper will provide a brief overview of past preparedness efforts in Illinois with special emphasis on the Chicago urban area for an improvised nuclear device (IND) event, current status, and near- and long-term plans to address this daunting challenge. The planning assumption involved the detonation of a 10 kT IND in downtown Chicago at noon on a workday. Major efforts began in 2010 involving over 300 federal, state, and local public and private entities. The planning efforts included three summits and 16 workshops that produced essential response planning documents. Many capability gaps were identified during the planning process, and all essential major tasks were identified. Task sequencing, interdependencies of the task sequencing, time-phased task sequencing, and resource constrained time-phased task sequencing were reviewed in detail by the various working groups, and a draft integrated response plan and associated appendices were prepared. A Federal Emergency Management Agency (FEMA) Region V integrated IND Senior Leaders Tabletop Exercise involving six major tasks of the draft plan was conducted on 5 December 2013. Although all six tasks were performed "with some challenges," much more preparedness work is still needed. Future preparedness efforts regarding INDs and radiological dispersal devices (RDDs) will be described. One of the major capability deficiencies noted during the planning process is the lack of adequate technical resources necessary to provide assistance and support for response, recovery, and population monitoring. This paper will highlight two of the ongoing national efforts to address this deficiency. Specifically, these programs are: (1) Radiological Operations Support Specialist (ROSS) initiative, which is a collaboration of the U.S. Department of Homeland Security's FEMA, U.S. Department of Energy's National Nuclear Security Administration (NNSA) and the Conference of Radiation Control Program Directors, Inc. (CRCPD); and (2) the Radiation Response Volunteer Corps Program of the CRCPD and the Centers for Disease Control and Prevention. Ultimately, these efforts will aid in providing the requisite resources in a manner consistent with the existing Emergency Management Assistance Compact currently in place for all hazards.
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NCRP 53rd Annual Meeting, Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Bringing it all Together-Conclusions and Path Forward Panel Discussion & Q&A. Health Phys 2018; 114:225-31. [PMID: 30086020 DOI: 10.1097/HP.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Irwin W. The ROSS: A Radiological/Nuclear Subject Matter Expert Filling a Critical National Need. Health Phys 2018; 114:141-147. [PMID: 30086003 DOI: 10.1097/hp.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper was created from a presentation the author made at the 2017 National Council on Radiation Protection and Measurements (NCRP) Annual Meeting on 6 March 2017. The Fifty-Third Annual Meeting of the NCRP was titled Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps? Like the presentation, this paper describes one effort to fill what has been identified as one of the more critical gaps in our U.S. nuclear and radiological emergency preparedness. The Radiological Operations Support Specialist (ROSS) may help address the national need for subject matter experts that can help the nation, states, and municipalities respond to and recover from radiological and nuclear emergencies. The author is one of the four members of the ROSS Steering Committee and was the first state health physicist to serve as a ROSS at a national-level improvised nuclear device exercise. From his experiences, the ROSS is described from its genesis 3 y ago to its status today, along with some thoughts about where the ROSS will be in the future.
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Regehr C, Glancy GD, Carter A, Ramshaw L. A comprehensive approach to managing threats of violence on a university or college campus. Int J Law Psychiatry 2017; 54:140-147. [PMID: 28687175 DOI: 10.1016/j.ijlp.2017.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 04/01/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
Horrifying, high profile acts of violence on campuses remain relatively rare, nevertheless, academic administrators are required to manage threats of violence on campus on an increasingly regular basis. These threats take two primary forms, those in which the perpetrator and the intended victim(s) are clearly identified, often involving repeated threats and threatening behaviour towards an individual; and those involving anonymous threats to commit acts of larger scale violence. Complicating factors in managing these threats include: fear contagion; mass media and social media attention; responsibilities to all members of the university community sometimes including individuals issuing the threat and the intended victims; demands for safety and security measures that are often at odds with professional advice; and permeable campus boundaries that cause security challenges. This paper considers the changing landscape of threat assessment and risk assessment on university and college campuses and suggests opportunities for partnerships between forensic mental health professionals and academic administrators.
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Affiliation(s)
- Cheryl Regehr
- Factor-Inwentash Faculty of Social Work and Faculty of Law, University of Toronto, Canada.
| | - Graham D Glancy
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Canada.
| | - Andrea Carter
- Student Wellness Support and Success, University of Toronto Mississauga, Canada; Interdisciplinary Studies, University of Western Ontario, Canada.
| | - Lisa Ramshaw
- Department of Psychiatry, University of Toronto, Center for Addiction and Mental Health, Canada.
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Rebmann T, McPhee K, Osborne L, Gillen DP, Haas GA. Best Practices for Healthcare Facility and Regional Stockpile Maintenance and Sustainment: A Literature Review. Health Secur 2017; 15:409-417. [PMID: 28767309 DOI: 10.1089/hs.2016.0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Preparing for mass casualty incidents is essential to maximizing community resilience. Many US-based organizations and regions have developed stockpiles of medications, supplies, and equipment for mass casualty incident preparedness. The Centers for Disease Control and Prevention (CDC) assess and manage federally stockpiled materials, but hospitals, healthcare systems, and regional organizations are responsible for maintaining locally owned caches. The CDC has protocols for assessing and managing the Strategic National Stockpile, but no such guidance exists for local or geographical/regional stockpiles. This article outlines best practices and recommendations identified in the literature related to maintaining and sustaining a local or regional stockpile. Recommendations are provided on the timing and procedures for assessing, inventorying, storing, managing, tracking, and deploying materials stockpiled on site, in a trailer, or in a warehouse. In addition, alternative approaches for maintaining a local or regional cache, such as vendor- or user-managed inventory methods, are addressed. Management of local or regional caches requires an investment in infrastructure and training but is necessary to ensure the integrity of stockpiled medication and supplies and to enable rapid and appropriate activation during a mass casualty incident. Hospitals, healthcare systems, businesses, academic institutions, public health agencies, organizations, and regions can use the recommendations here to develop protocols or policies to properly manage their existing stockpiles, which should minimize costs related to damaged supplies.
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Abstract
Rampage shootings is a relatively new term to describe a phenomenon that has a long history. Rampage shootings are mass shootings (generally defined as involving four or more victims), taking place in a public location, with victims chosen randomly or for symbolic purposes. These shootings are isolated events, meaning they are not connected to another criminal act (such as robbery or terrorism). Research suggests that rampage shootings are not a new phenomenon, but have occurred throughout the US since the early 1900s. There is some evidence of an increase in recent years, but definitional differences across studies and data sources make interpreting trends somewhat tenuous. Theories regarding the perpetration of rampage shootings center on masculinity, mental illness, and contagion effects. Policies aimed at preventing rampage shootings remain somewhat controversial and not well-tested in the literature.
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Affiliation(s)
- Michael Rocque
- Bates College, Department of Sociology, Lewiston, ME, USA.
| | - Grant Duwe
- Minnesota Department of Corrections, 1450 Energy Park Drive, Suite 200, St. Paul, MN 55108, USA
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Hart A, Chai PR, Griswold MK, Lai JT, Boyer EW, Broach J. Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management. Am J Disaster Med 2017; 12:261-265. [PMID: 29468628 DOI: 10.5055/ajdm.2017.0279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. DESIGN Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). SETTING A Single Urban New England Academic Tertiary Care Medical Center. PARTICIPANTS Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. CONCLUSIONS Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.
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Affiliation(s)
- Alexander Hart
- Fellow in Disaster Medicine, Clinical Instructor, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Westborough, Massachusetts
| | - Peter R Chai
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew K Griswold
- Department of Emergency Medicine, Hartford Hospital, Hartford, Connecticut
| | - Jeffrey T Lai
- Fellow in Medical Toxicology, Clinical Instructor, Department of Emergency Medicine, University of Massachusetts Medical Center, North Worcester, Massachusetts
| | - Edward W Boyer
- Director of Academic Development, Associate Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - John Broach
- Assistant Professor, Department of Emergency Medicine, University of Massachusetts Medical Center, North Worcester, Massachusetts
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Abstract
The subject of terrorism risk can be confusing for both the general public and for those responsible for protecting us from attack. Relatively minor terrorist threats are often conflated with much more serious ones, in part because it is hard to quantify either intent or technical ability to carry out an attack. Plotting threats on a "potential mass casualties" versus "ease of obtainment or production" matrix creates some order out of a seemingly endless array of worldwide threats, and it highlights those threats that are in need of more urgent attention. The specific threats on this 2x2 matrix can fall into one or multiple quadrants, which can be qualitatively described as "most dangerous," "dangerous but difficult," "worrisome," and "persistent terror." By placing threats into these quadrants and illustrating movement within and between them, the matrix can help (1) visualize and parse a diverse set of threats, (2) view how threats have changed over time and judge the efficacy of current countermeasures, and (3) evaluate the merit of future actions and investments. Having a dynamic matrix that can visually map the comparative risk of terrorist threat events in toto and that can help us monitor the effectiveness of present and future resource investments can add intellectual rigor to some of the most difficult and daunting decisions pertaining to our nation's safety and security.
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Alqahtani AS, Yamazaki K, Alqahtani WH, Tashani M, Heywood AE, Booy R, Wiley KE, Rashid H. Australian Hajj pilgrims' perception about mass casualty incidents versus emerging infections at Hajj. Travel Med Infect Dis 2016; 15:81-83. [PMID: 27856351 PMCID: PMC7128702 DOI: 10.1016/j.tmaid.2016.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Kaoruko Yamazaki
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wejdan H Alqahtani
- King Khalid University, School of Applied Medical Science, Abha, Saudi Arabia
| | - Mohamed Tashani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Anita E Heywood
- School of Public Health and Community Medicine, The University of New South Wales, Australia, Sydney, New South Wales, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide, Australia
| | - Kerrie E Wiley
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, New South Wales, Australia; The Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, New South Wales, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, Australia
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Underwood E. PUBLIC HEALTH. California approves publicly funded gun research center. Science 2016; 352:1505. [PMID: 27339962 DOI: 10.1126/science.352.6293.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Johnson SR. Could funding gun violence research help prevent another Orlando? Mod Healthc 2016; 46:10-11. [PMID: 27526481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Goozner M. Reinstate the assault weapons ban. Mod Healthc 2016; 46:24. [PMID: 27526486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Affiliation(s)
- Lawrence O Gostin
- University Professor and Faculty Director, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights. His most recent bo
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Van Trimpont F, Ebogo TE, Waroquier F, Verwilghen D, Schmidt R, Mols P. [Not Available]. Rev Med Brux 2016; 37:35-39. [PMID: 27120934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The implementation of preventive devices is always a difficult task to anticipate. It is also difficult to verify the adequacy of resources used to the needs. For this purpose, the Belgian Red Cross created the computer tool collecting administrative information, diagnostic codes, destination of the patient, triage, level of emergency as well as kinetics of admission to the preventive care station. Data analysis in the various types of events confirms the usefulness of prevention devices. Although it can be improved, the tool is reliable and permits a great extent the adaptative means to the needs.
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Fredricks T. Hemorrhage Control Beyond the Traditional Audiences: Instructions for Authors. J Spec Oper Med 2016; 16:74-75. [PMID: 27263132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Newcomb TL, Bruhn AM, Ulmer LH, Diawara N. Performance of Dental Hygiene Students in Mass Fatality Training and Radiographic Imaging of Dental Remains. J Dent Hyg 2015; 89:313-320. [PMID: 26519495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Mass fatality incidents can overwhelm local, state and national resources quickly. Dental hygienists are widely distributed and have the potential to increase response teams' capacity. However, appropriate training is required. The literature is void of addressing this type of training for dental hygienists and scant in dentistry. Hence, the purpose of this study was to assess one facet of such training: Whether the use of multimedia is likely to enhance educational outcomes related to mass fatality training. METHODS A randomized, double-blind, pre- and post-test design was used to evaluate the effectiveness of comparable educational modules for 2 groups: a control group (n=19) that received low media training and a treatment group (n=20) that received multimedia training. Participants were second-year, baccalaureate dental hygiene students. Study instruments included a multiple-choice examination, a clinical competency-based radiology lab scored via a standardized rubric, and an assessment of interest in mass fatality education as a specialty. ANOVA was used to analyze results. RESULTS Participants' pre- and post-test scores and clinical competency-based radiology lab scores increased following both educational approaches. Interest in mass fatality training also increased significantly for all participants (p=0.45). There was no significant difference in pre- and post-test multiple choice scores (p=0.6455), interest (p=0.9133) or overall competency-based radiology lab scores (p=0.997) between groups. CONCLUSION Various educational technique may be effective for mass fatality training. However, mass fatality training that incorporates multimedia is an appropriate avenue for training instruction. Continued research about multimedia's role in this specialty area is encouraged.
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Schwartz B, Nafziger S, Milsten A, Luk J, Yancey A. Mass Gathering Medical Care: Resource Document for the National Association of EMS Physicians Position Statement. PREHOSP EMERG CARE 2015; 19:559-568. [PMID: 26270473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mass gatherings are heterogeneous in terms of size, duration, type of event, crowd behavior, demographics of the participants and spectators, use of recreational substances, weather, and environment. The goals of health and medical services should be the provision of care for participants and spectators consistent with local standards of care, protection of continuing medical service to the populations surrounding the event venue, and preparation for surge to respond to extraordinary events. Pre-event planning among jurisdictional public health and EMS, acute care hospitals, and event EMS is essential, but should also include, at a minimum, event security services, public relations, facility maintenance, communications technicians, and the event planners and organizers. Previous documented experience with similar events has been shown to most accurately predict future needs. Future work in and guidance for mass gathering medical care should include the consistent use and further development of universally accepted consistent metrics, such as Patient Presentation Rate and Transfer to Hospital Rate. Only by standardizing data collection can evaluations be performed that link interventions with outcomes to enhance evidence-based EMS services at mass gatherings. Research is needed to evaluate the skills and interventions required by EMS providers to achieve desired outcomes. The event-dedicated EMS Medical Director is integral to acceptable quality medical care provided at mass gatherings; hence, he/she must be included in all aspects of mass gathering medical care planning, preparations, response, and recovery. Incorporation of jurisdictional EMS and community hospital medical leadership, and emergency practitioners into these processes will ensure that on-site care, transport, and transition to acute care at appropriate receiving facilities is consistent with, and fully integrated into the community's medical care system, while fulfilling the needs of event participants.
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Jacobs LM. The Hartford Consensus III: Implementation of Bleeding Control. Conn Med 2015; 79:431-435. [PMID: 26411183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Onischenko GG, Popova AY, Smolensky VY, Maletskaya OV, Taran TV, Dubyansky VM, Semenko OV, Agapitov DS, Grizhebovsky GM, Manin EA, Klindukhov VP, Oroby VG, Antonenko AD. [Analysis of foreign experience of maintenance of biological safety of the Olympic Games]. Zh Mikrobiol Epidemiol Immunobiol 2015:105-109. [PMID: 26016352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The analysis of the international experience in providing measures of health and disease safety at the Olympic Games was done. The stages of the formation of bio-security system at public events were considered, including measures to prevent infection outbreaks, the use of computer and information technologies.
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Abstract
Four assumptions frequently arise in the aftermath of mass shootings in the United States: (1) that mental illness causes gun violence, (2) that psychiatric diagnosis can predict gun crime, (3) that shootings represent the deranged acts of mentally ill loners, and (4) that gun control "won't prevent" another Newtown (Connecticut school mass shooting). Each of these statements is certainly true in particular instances. Yet, as we show, notions of mental illness that emerge in relation to mass shootings frequently reflect larger cultural stereotypes and anxieties about matters such as race/ethnicity, social class, and politics. These issues become obscured when mass shootings come to stand in for all gun crime, and when "mentally ill" ceases to be a medical designation and becomes a sign of violent threat.
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Affiliation(s)
- Jonathan M Metzl
- Jonathan M. Metzl is with the Center for Medicine, Health, and Society and the Departments of Sociology and Psychiatry, Vanderbilt University, Nashville, TN. Kenneth T. MacLeish is with the Center for Medicine, Health, and Society and the Department of Anthropology, Vanderbilt University
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Eastman AL. The continuing threat of active shooter and intentional mass casualty events. Local and law enforcement and hemorrhage control. J Spec Oper Med 2015; 15:146-148. [PMID: 27280223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Fabbri WP. The Continuing Threat of Intentional Mass Casualty Events in the U.S. Observations of federal law enforcement. J Spec Oper Med 2015; 15:142-145. [PMID: 26630108 DOI: 10.55460/awcr-b62l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 06/05/2023]
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Jiang L, Li J, Shen C, Yang S, Han Z. Obstacle optimization for panic flow--reducing the tangential momentum increases the escape speed. PLoS One 2014; 9:e115463. [PMID: 25531676 PMCID: PMC4274084 DOI: 10.1371/journal.pone.0115463] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/23/2014] [Indexed: 11/20/2022] Open
Abstract
A disastrous form of pedestrian behavior is a stampede occurring in an event involving a large crowd in a panic situation. To deal with such stampedes, the possibility to increase the outflow by suitably placing a pillar or some other shaped obstacles in front of the exit has been demonstrated. We present a social force based genetic algorithm to optimize the best design of architectural entities to deal with large crowds. Unlike existing literature, our simulation results indicate that appropriately placing two pillars on both sides but not in front of the door can maximize the escape efficiency. Human experiments using 80 participants correspond well with the simulations. We observed a peculiar property named tangential momentum, the escape speed and the tangential momentum are found to be negatively correlated. The idea to reduce the tangential momentum has practical implications in crowd architectural design.
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Affiliation(s)
- Li Jiang
- School of Systems Science, Beijing Normal University, Beijing, 100875, P. R. China
| | - Jingyu Li
- School of Systems Science, Beijing Normal University, Beijing, 100875, P. R. China
- Institute of Policy and Management, Chinese Academy of Sciences, Beijing, 100190, P. R. China
| | - Chao Shen
- School of Systems Science, Beijing Normal University, Beijing, 100875, P. R. China
- College of Information System and Management, National University of Denfense Technology, Hunan, 410073, P. R. China
| | - Sicong Yang
- School of Systems Science, Beijing Normal University, Beijing, 100875, P. R. China
| | - Zhangang Han
- School of Systems Science, Beijing Normal University, Beijing, 100875, P. R. China
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Abstract
Careful planning and regular exercising of capabilities is the key to implementing an effective response following the release of hazardous materials, although ad hoc changes may be inevitable. Critical actions which require immediate implementation at an incident are evacuation, followed by disrobing (removal of clothes) and decontamination. The latter can be achieved through bespoke response facilities or various interim methods which may utilise water or readily available (dry, absorbent) materials. Following transfer to a safe holding area, each casualty's personal details should be recorded to facilitate a health surveillance programme, should it become apparent that the original contaminant has chronic health effects.
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Sugarman SL, Livingston GK, Stricklin DL, Abbott MG, Wilkins RC, Romm H, Oestreicher U, Yoshida MA, Miura T, Moquet JE, Di Giorgio M, Ferrarotto C, Gross GA, Christiansen ME, Hart CL, Christensen DM. The Internet's role in a biodosimetric response to a radiation mass casualty event. Health Phys 2014; 106:S65-S70. [PMID: 24667387 DOI: 10.1097/hp.0000000000000080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Response to a large-scale radiological incident could require timely medical interventions to minimize radiation casualties. Proper medical care requires knowing the victim's radiation dose. When physical dosimetry is absent, radiation-specific chromosome aberration analysis can serve to estimate the absorbed dose in order to assist physicians in the medical management of radiation injuries. A mock exercise scenario was presented to six participating biodosimetry laboratories as one individual acutely exposed to Co under conditions suggesting whole-body exposure. The individual was not wearing a dosimeter and within 2-3 h of the incident began vomiting. The individual also had other medical symptoms indicating likelihood of a significant dose. Physicians managing the patient requested a dose estimate in order to develop a treatment plan. Participating laboratories in North and South America, Europe, and Asia were asked to evaluate more than 800 electronic images of metaphase cells from the patient to determine the dicentric yield and calculate a dose estimate with 95% confidence limits. All participants were blind to the physical dose until after submitting their estimates based on the dicentric chromosome assay (DCA). The exercise was successful since the mean biological dose estimate was 1.89 Gy whereas the actual physical dose was 2 Gy. This is well within the requirements for guidance of medical management. The exercise demonstrated that the most labor-intensive step in the entire process (visual evaluation of images) can be accelerated by taking advantage of world-wide expertise available on the Internet.
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Affiliation(s)
- S L Sugarman
- *Oak Ridge Associated Universities, REAC/TS, P.O. Box 117, Oak Ridge, TN, 37831; †Applied Research Associates, Arlington, VA, 22203; ‡Health Canada, Consumer and Clinical Radiation Protection Bureau, Ottawa, ON K1A 1C1, Canada; §Bundesamt fuer Strahlenschutz, 85764 Neuherberg, Germany; **Institute of Radiation Emergency Medicine, Hirosaki University, 036-8564, Hirosaki, Japan; ††Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxfordshire OX11 0RQ, UK; ‡‡Autoridad Regulatoria Nuclear (ARN), Av. Del Libertador 8250, C1429BNP, Buenos Aires, Argentina
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Knopf A. Untreated mental disorders, unchecked guns. Behav Healthc 2014; 34:32-35. [PMID: 24864548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Dell'Olio L, Ibeas A, Barreda R, Sañudo R. Passenger behavior in trains during emergency situations. J Safety Res 2013; 46:157-166. [PMID: 23932697 DOI: 10.1016/j.jsr.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 04/22/2013] [Accepted: 05/06/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION This research presents a methodology for analyzing the behavior of people (passengers and crew) involved in emergency situations on passenger trains. METHODS This methodological tool centers around a qualitative character study coming from Focus Groups (FG) and in-depth interviews to extract the determinant variables on passenger and crew behavior when faced with certain emergency situations on trains. RESULTS This research has led to the creation of a classification of possible behaviors associated to each type of incident and dependent on certain variables. The qualitative study was used as the basis for modeling stated preference data using logit type discrete choice models to characterize and quantify the behavior. The most important results show that the determinant variables on passenger behavior correspond to the type of emergency suffered (its degree of seriousness), the type of passenger, the reasons for the journey (demands of time), the information received during the incident, the relationship between crew and passengers, the duration of the incident and the conditions (temperature control, availability of water, occupancy of the train), the distance to the destination station, and finally, the outside weather conditions. This research was carried out using the Spanish railway network as its reference, although it is applicable to any geographical area. IMPACT ON INDUSTRY The results show that the information variable should be considered in the development of future research and that the evidences of this research can be used to develop behavioral models for modeling railway passenger evacuations.
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Affiliation(s)
- Luigi Dell'Olio
- University of Cantabria, Av. De los Castros s-n, 39005, Santander, Cantabria, Spain.
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