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Sample records for mass casualty triage

  1. Mass Casualty Incident Primary Triage Methods in China

    PubMed Central

    Chen, Jin-Hong; Yang, Jun; Yang, Yu; Zheng, Jing-Chen

    2015-01-01

    Objective: To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China. Data Sources: Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014). The English literature was searched by PubMed (MEDLINE) (1950 to June 2014). We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/), National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/), and China Earthquake Information (http://www.csi.ac.cn/). Study Selection: We included studies associated with mass casualty events related to China, the PT applied in China, guidelines and standards, and application and development of the carding PT method in China. Results: From 3976 potentially relevant articles, 22 met the inclusion criteria, 20 Chinese, and 2 English. These articles included 13 case reports, 3 retrospective analyses of MCI, two methods introductions, three national or sectoral criteria, and one simulated field testing and validation. There were a total of 19 kinds of MCI PT methods that have been reported in China from 1950 to 2014. In addition, there were 15 kinds of PT methods reported in the literature from the instance of the application. Conclusions: The national and sectoral current triage criteria are developed mainly for earthquake relief. Classification is not clear. Vague criteria (especially between moderate and severe injuries) operability are not practical. There are no triage methods and research for children and special populations. There is no data and evidence supported triage method. We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real, practical, and efficient PT method. PMID:26415807

  2. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents

    PubMed Central

    Ramesh, Aruna C.; Kumar, S.

    2010-01-01

    In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury. PMID:21829319

  3. Army nurses' knowledge base for determining triage categories in a mass casualty.

    PubMed

    Robison, Jennifer L

    2002-10-01

    The timing, location, and participants in a mass casualty scenario cannot be predicted. Nurses may be involved in performing triage, yet there is no published documentation of military nurses' ability to triage. A prospective design was used to describe 82 Army nurses' knowledge base related to designating triage categories for patients during a mass causality, examining the relationships among their education and experience as evaluated by The Darnall Mass Casualty Triage Test and Demographic Data Form. The most significant areas associated with higher scores on the Triage Test were: completion of Advanced Cardiac Life Support, advanced certification as a Certified Registered Nurse Anesthetists, Certified Emergency Nurse, or Critical Care Registered Nurse, and attendance to the Medical Management of Nuclear Weapons Course. An improved average score for nurses overall was also noted when compared with previous work with the Darnall MASCAL Triage Test. PMID:12392246

  4. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    PubMed

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-01-01

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI). PMID:27130042

  5. Prehospital triage and communication performance in small mass casualty incidents: a gauge for disaster preparedness.

    PubMed

    Johnson, G A; Calkins, A

    1999-03-01

    Because of their infrequency, disasters are difficult to train for. Emergency prehospital personnel frequently participate in small mass casualty incidents (MCIs) (3 to 50 victims). This study sought to examine prehospital performance in small MCIs in areas that are frequently mismanaged in disasters. Prospective data from the resource physician and retrospective data from tape recorded prehospital conversations were collected for a 9-month period. Clinical patient data, patient demographics, emergency medical services squad characteristics, and triage information were recorded. Forty-five consecutive MCIs were studied. Most of these were motor vehicle accidents. Prehospital providers included paid providers, nonpaid providers, and air and ground transport. The mean number of victims first identified (4.6%) was greatly different than the mean number of victims eventually transported from a scene (7.1%). Most patients were treated at a level 1 trauma center. Frequent errors included having multiple communicators on site (38%), misidentifying the number of victims (56%), and having unclear information for the resource physician (43%). Only 38% of events had prehospital triage information that was deemed appropriate in total. These results show that scene and triage errors are frequent in MCIs of small scale. This information can be used to assay a system's readiness for disasters. PMID:10102314

  6. A wireless first responder handheld device for rapid triage, patient assessment and documentation during mass casualty incidents.

    PubMed

    Killeen, James P; Chan, Theodore C; Buono, Colleen; Griswold, William G; Lenert, Leslie A

    2006-01-01

    Medical care at mass casualty incidents and disasters requires rapid patient triage and assessment, acute care and disposition often in the setting of overwhelming numbers of victims, limited time, and little resources. Current systems rely on a paper triage tag on which rescuers and medical providers mark the patient's triage status and record limited information on injuries and treatments administered in the field. In this manuscript, we describe the design, development and deployment of a wireless handheld device with an electronic medical record (EMR) for use by rescuers responding to mass casualty incidents (MCIs) and disasters. The components of this device, the WIISARD First Responder (WFR), includes a personal digital assistant (PDA) with 802.11 wireless transmission capabilities, microprocessor and non-volatile memory, and a unique EMR software that replicates the rapidity and ease of use of the standard paper triage tag. WFR also expands its functionality by recording real-time medical data electronically for simultaneous access by rescuers, mid-level providers and incident commanders on and off the disaster site. WFR is a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:17238377

  7. Redefining the outcomes to resources ratio for burn patient triage in a mass casualty.

    PubMed

    Taylor, Sandra; Jeng, James; Saffle, Jeffrey R; Sen, Soman; Greenhalgh, David G; Palmieri, Tina L

    2014-01-01

    Recent disasters highlight the need for predisaster planning, including the need for accurate triage. Data-driven triage tables, such as that generated from the 2002 National Burn Repository, are vital to optimize resource use during a disaster. The study purpose was to generate a burn resource disaster triage table based on current burn-treatment outcomes. Data from the NBR after the year 2000 were audited. Records that missed age, burn size, or survival status were excluded from analysis. Duplicate records, readmissions, transfers, and nonburn injuries were eliminated. Resource use was divided into expectant (predicted mortality >90%), low (mortality 50-90%), medium (mortality 10-50%), high (mortality <10%, admission 14-21 days), very high (mortality <10%, admission <14 days), and outpatient. Tables were created for all patient admissions and with/without inhalation injury. Of the 286,293 records, 210,683 were from the year 2000 or later. Expectant status for those aged >70 years began at 50% burn; a 20- to 29-year-old never reached expectant status. Inhalation injury lowered the expectant category to a burn size of 40% in >70-year-olds, and at >90% in 20- to 29-year-olds. The 0- to 1.9-year old group without inhalation injury never reached expectant status; with inhalation injury, expectant status was reached at >80% burn. Changes in the triage tables suggest that burn care has changed in the past 10 years. Inhalation injury significantly alters triage in a burn disaster. Use of these updated tables for triage in a disaster may improve our ability to allocate resources. PMID:24270085

  8. Mass casualty management of a large-scale bioterrorist event: an epidemiological approach that shapes triage decisions.

    PubMed

    Burkle, Frederick M

    2002-05-01

    The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent

  9. A Triage Model for Chemical Warfare Casualties

    PubMed Central

    Khoshnevis, Mohammad Ali; Panahi, Yunes; Ghanei, Mostafa; Borna, Hojat; Sahebkar, Amirhossein; Aslani, Jafar

    2015-01-01

    Context: The main objectives of triage are securing patient safety during the process of emergency diagnosis and treatment, and reduction of waiting time for medical services and transport. To date, there is no triage system for nerve agent victims. Evidence Acquisition: This systematic review proposes a new triage system for patients exposed to nerve agents. Information regarding clinical signs and symptoms of intoxication with nerve agents, primary treatments, and classification of patients were extracted from the literature. All related articles were reviewed. Subsequently, specialists from different disciplines were invited to discuss and draft protocols. Results: Finalized triage tables summarizing the classification methods and required protocols in the field were designed after several meetings. Conclusions: The proposed triage protocol encompasses aspects from most of the existing triage systems to create a single overarching guide for unifying the triage process. The proposed protocol can serve as a base for the designing future guidelines. PMID:26543836

  10. Game-based mass casualty burn training.

    PubMed

    Kurenov, Sergei N; Cance, William W; Noel, Ben; Mozingo, David W

    2009-01-01

    An interactive, video game-based training module, Burn Center, was developed to simulate the real-life emergency events of a mass casualty disaster scenario, involving in 40 victims.The game contains two components - triage and resuscitation. The goal of the triage game is to correctly stabilize, sort, tag and transport burn victims during a mass casualty event at a busy theme park. After complete the triage component, the player will then take on the role of a burn care provider, balancing the clinical needs of multiple burn patients through a 36-hour resuscitation period, using familiar computer-simulated hospital devices. Once complete, players of Burn Center will come away with applicable skills and knowledge of burn care, for both field triage and initial resuscitation of the burn patients. PMID:19377134

  11. The "RTR" medical response system for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model.

    PubMed

    Hrdina, Chad M; Coleman, C Norman; Bogucki, Sandy; Bader, Judith L; Hayhurst, Robert E; Forsha, Joseph D; Marcozzi, David; Yeskey, Kevin; Knebel, Ann R

    2009-01-01

    Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The "RTR" system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other

  12. Ultrasound applications in mass casualties and extreme environments.

    PubMed

    Ma, O John; Norvell, Jeffrey G; Subramanian, Srikala

    2007-05-01

    A mass-casualty incident is one in which the number of patients with injuries exceeds the available medical resources to care for them in a timely manner. In such a situation, the numerous advantages of ultrasonography make it an ideal triage tool for helping clinicians rapidly screen patients. Experiences during the 1988 Armenian earthquake and the 1999 Turkish earthquake demonstrated the proficiency of ultrasound in providing rapid clinical data to the physicians caring for the mass-casualty patients. Wireless and satellite transmission of ultrasound images also has been shown to be feasible and may be applied to mass-casualty situations. In addition, ultrasound applications have been demonstrated to aid in the diagnosis of various conditions, including pneumothorax, in the International Space Station. Ultrasound's portability, reproducibility, accuracy, and ease of use will make it an important diagnostic instrument for future space missions. PMID:17446788

  13. Development and Validation of a Mass Casualty Conceptual Model

    PubMed Central

    Culley, Joan M.; Effken, Judith A.

    2012-01-01

    Purpose To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. Design The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Methods Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Findings Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Conclusions Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. Clinical Relevance This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions. PMID:20487188

  14. Adolescent epidemic hysteria presenting as a mass casualty, toxic exposure incident

    SciTech Connect

    Selden, B.S.

    1989-08-01

    Discussed is a case of explosive epidemic hysteria presenting as a mass casualty, toxic inhalation incident. Fifteen adolescent female students were triaged from a school of 700 persons exposed to sewer gas and arrived simultaneously at the emergency department complaining of a variety of nonspecific symptoms without physical findings. These symptoms quickly remitted with reassurance and dispersion of the group. Factors important in the recognition and treatment of epidemic hysteria are presented.

  15. Oxygen supplies during a mass casualty situation.

    PubMed

    Ritz, Ray H; Previtera, Joseph E

    2008-02-01

    Mass casualty and pandemic events pose a substantial challenge to the resources available in our current health care system. The ability to provide adequate oxygen therapy is one of the systems that could be out-stripped in certain conditions. Natural disasters can disrupt manufacturing or delivery, and pandemic events can increase consumption beyond the available supply. Patients may require manual resuscitation, basic oxygen therapy, or positive-pressure ventilation during these scenarios. Available sources of oxygen include bulk liquid oxygen systems, compressed gas cylinders, portable liquid oxygen (LOX) systems, and oxygen concentrators. The last two are available in a variety of configurations, which include personal and home systems that are suitable for individual patients, and larger systems that can provide oxygen to multiple patients or entire institutions. Bulk oxygen systems are robust and are probably sustainable during periods of high consumption, but are at risk if manufacturing or delivery is disrupted. Compressed gas cylinders offer support during temporary periods of need but are not a solution for extended periods of therapy. Personal oxygen concentrators and LOX systems are limited in their application during mass casualty scenarios. Large-capacity oxygen concentrators and LOX systems may effectively provide support to alternative care sites or larger institutions. They may also be appropriate selections for governmental emergency-response scenarios. Careful consideration of the strengths and limitations of each of these options can reduce the impact of a mass casualty event. PMID:18218152

  16. Public experiences of mass casualty decontamination.

    PubMed

    Carter, Holly; Drury, John; Rubin, G James; Williams, Richard; Amlôt, Richard

    2012-09-01

    In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people's experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public's experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties' experiences of the decontamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public's experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public's experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination. PMID:22823588

  17. Mass casualty incidents - time to engage.

    PubMed

    Ben-Ishay, Offir; Mitaritonno, Michele; Catena, Fausto; Sartelli, Massimo; Ansaloni, Luca; Kluger, Yoram

    2016-01-01

    Mass casualty incident continues to overwhelm medical systems worldwide. Preparedness for an MCI is a crucial requisite for the injured better outcome. The World Society of Emergency Surgery initiated a survey in regard to its senior member's personal and institutional preparedness for MCI. The results here in presented indicate that WSES should engage in a formatted and structured preparedness course for medical institutions and individuals."By all appearances it seems to be just another normal Saturday morning in the emergency department (ED). Patients occupy thirty out of the sixty beds; some awaits discharge, some awaits admission to the hospital. All of a sudden the squeaky voice of the red phone is tearing the air, the hard metal voice on the line is reporting of an explosion in the nearby train station, estimated number of casualties is 80. You ask for their estimated time of arrival, when you hear the first sirens of ambulances parking out of the ED; no answer was needed. PMID:26848306

  18. Advanced technology development for remote triage applications in bleeding combat casualties.

    PubMed

    Ryan, Kathy L; Rickards, Caroline A; Hinojosa-Laborde, Carmen; Gerhardt, Robert T; Cain, Jeffrey; Convertino, Victor A

    2011-01-01

    Combat developers within the Army have envisioned development of a "wear-and-forget" physiological status monitor (PSM) that will enhance far forward capabilities for assessment of Warrior readiness for battle, as well as for remote triage, diagnosis and decision-making once Soldiers are injured. This paper will review recent work testing remote triage system prototypes in both the laboratory and during field exercises. Current PSM prototypes measure the electrocardiogram and respiration, but we have shown that information derived from these measurements alone will not be suited for specific, accurate triage of combat injuries. Because of this, we have suggested that development of a capability to provide a metric of circulating blood volume status is required for remote triage. Recently, volume status has been successfully modeled using low-level physiological signals obtained from wearable devices as input to machine-learning algorithms; these algorithms are already able to discriminate between a state of physical activity (common in combat) and that of central hypovolemia, and thus show promise for use in wearable remote triage devices. PMID:21607908

  19. Autonomous mobile platform for enhanced situational awareness in Mass Casualty Incidents.

    PubMed

    Yang, Dongyi; Schafer, James; Wang, Sili; Ganz, Aura

    2014-01-01

    To enhance the efficiency of the search and rescue process of a Mass Casualty Incident, we introduce a low cost autonomous mobile platform. The mobile platform motion is controlled by an Android Smartphone mounted on a robot. The pictures and video captured by the Smartphone camera can significantly enhance the situational awareness of the incident commander leading to a more efficient search and rescue process. Moreover, the active RFID readers mounted on the mobile platform can improve the localization accuracy of victims in the disaster site in areas where the paramedics are not present, reducing the triage and evacuation time. PMID:25570104

  20. Assessment of Biodosimetry Methods for a Mass-Casualty Radiological Incident: Medical Response and Management Considerations

    PubMed Central

    Sullivan, Julie M.; Prasanna, Pataje G. S.; Grace, Marcy B.; Wathen, Lynne; Wallace, Rodney L.; Koerner, John F.; Coleman, C. Norman

    2013-01-01

    Following a mass-casualty nuclear disaster, effective medical triage has the potential to save tens of thousands of lives. In order to best use the available scarce resources, there is an urgent need for biodosimetry tools to determine an individual’s radiation dose. Initial triage for radiation exposure will include location during the incident, symptoms, and physical examination. Stepwise triage will include point of care assessment of less than or greater than 2 Gy, followed by secondary assessment, possibly with high throughput screening, to further define an individual’s dose. Given the multisystem nature of radiation injury, it is unlikely that any single biodosimetry assay can be used as a stand-alone tool to meet the surge in capacity with the timeliness and accuracy needed. As part of the national preparedness and planning for a nuclear or radiological incident, we reviewed the primary literature to determine the capabilities and limitations of a number of biodosimetry assays currently available or under development for use in the initial and secondary triage of patients. Understanding the requirements from a response standpoint and the capability and logistics for the various assays will help inform future biodosimetry technology development and acquisition. Factors considered include: type of sample required, dose detection limit, time interval when the assay is feasible biologically, time for sample preparation and analysis, ease of use, logistical requirements, potential throughput, point-of-care capability, and the ability to support patient diagnosis and treatment within a therapeutically relevant time point. PMID:24162058

  1. Some considerations for mass casualty management in radiation emergencies.

    PubMed

    Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

    2010-06-01

    Radiation emergencies are rather new to humankind, as compared to other types of emergencies such as earthquakes, floods, or hurricanes. Fortunately, they are rare, but because of that, planning for response to large-scale radiation emergencies is least understood. Along with the specific technical aspects of response to radiation emergencies, there are some general guiding principles of responding to mass casualty events of any nature, as identified by the World Health Organization in its 2007 manual for mass casualty management systems. The paper brings forward such general considerations as applicable to radiation mass casualty events, including (1) clear lines of communication; (2) scalability of approach; (3) whole-of-health approach; (4) knowledge based approach; and (5) multisectoral approach. Additionally, some key considerations of planning for mass casualty management systems are discussed, namely, health systems surge capacity and networking, risk and resources mapping, and others. PMID:20445382

  2. Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data

    PubMed Central

    Egan, Joseph R.; Amlôt, Richard

    2012-01-01

    In the event of a large-scale chemical release in the UK decontamination of ambulant casualties would be undertaken by the Fire and Rescue Service (FRS). The aim of this study was to track the movement of volunteer casualties at two mass decontamination field exercises using passive Radio Frequency Identification tags and detection mats that were placed at pre-defined locations. The exercise data were then used to inform a computer model of the FRS component of the mass decontamination process. Having removed all clothing and having showered, the re-dressing (termed re-robing) of casualties was found to be a bottleneck in the mass decontamination process during both exercises. Computer simulations showed that increasing the capacity of each lane of the re-robe section to accommodate 10 rather than five casualties would be optimal in general, but that a capacity of 15 might be required to accommodate vulnerable individuals. If the duration of the shower was decreased from three minutes to one minute then a per lane re-robe capacity of 20 might be necessary to maximise the throughput of casualties. In conclusion, one practical enhancement to the FRS response may be to provide at least one additional re-robe section per mass decontamination unit. PMID:23202768

  3. Portable ultrasonography in mass casualty incidents: The CAVEAT examination

    PubMed Central

    Stawicki, Stanislaw Peter; Howard, James M; Pryor, John P; Bahner, David P; Whitmill, Melissa L; Dean, Anthony J

    2010-01-01

    Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings. PMID:22474622

  4. MASCAL: RFID Tracking of Patients, Staff and Equipment to Enhance Hospital Response to Mass Casualty Events

    PubMed Central

    Fry, Emory A.; Lenert, Leslie A.

    2005-01-01

    Most medical facilities practice managing the large numbers of seriously injured patients expected during catastrophic events. As the demands on the healthcare team increase, however, the challenges faced by managers escalate, workflow bottlenecks develop and system capacity decreases. This paper describes MASCAL, an integrated software–hardware system designed to enhance management of resources at a hospital during a mass casualty situation. MASCAL uses active 802.11b asset tags to track patients, equipment and staff during the response to a disaster. The system integrates tag position information with data from personnel databases, medical information systems, registration applications and the US Navy’s TACMEDCS triage application in a custom visual disaster management environment. MASCAL includes interfaces for a hospital command center, local area managers (emergency room, operating suites, radiology, etc.) and registration personnel. MASCAL is an operational system undergoing functional evaluation at the Naval Medical Center, San Diego, CA. PMID:16779042

  5. Planning for a Mass Casualty Incident in Arkansas Schools

    ERIC Educational Resources Information Center

    Patterson, Harry; Liggin, Rebecca; Shirm, Steve; Nation, Brian; Dick, Rhonda

    2005-01-01

    School preparedness includes the possibility of a natural disaster, but recent events also confirm a need for preparedness and prevention efforts for intentional mass casualty incidents (MCIs). This survey examined the preparedness for the prevention and response for MCIs at public schools in Arkansas. This survey demonstrated that most school…

  6. A burn mass casualty event due to boiler room explosion on a cruise ship: preparedness and outcomes.

    PubMed

    Tekin, Akin; Namias, Nicholas; O'Keeffe, Terence; Pizano, Louis; Lynn, Mauricio; Prater-Varas, Robin; Quintana, Olga Delia; Borges, Leda; Ishii, Mary; Lee, Seong; Lopez, Peter; Lessner-Eisenberg, Sharon; Alvarez, Angel; Ellison, Tom; Sapnas, Katherine; Lefton, Jennifer; Ward, Charles Gillon

    2005-03-01

    The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent bums and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event; having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support

  7. Clinical Framework and Medical Countermeasure Use During an Anthrax Mass-Casualty Incident.

    PubMed

    Bower, William A; Hendricks, Katherine; Pillai, Satish; Guarnizo, Julie; Meaney-Delman, Dana

    2015-12-01

    judicious, efficient, and rational use of stockpiled MCMs for the treatment of anthrax during a mass-casualty incident, which is described in this report. This report addresses elements of hospital-based acute care, specifically antitoxins and intravenous antimicrobial use, and the diagnosis and management of common anthrax-specific complications during a mass-casualty incident. The recommendations in this report should be implemented only after predefined triggers have been met for shifting from conventional to contingency or crisis standards of care, such as when the magnitude of cases might lead to impending shortages of intravenous antimicrobials, antitoxins, critical care resources (e.g., chest tubes and chest drainage systems), or diagnostic capability. This guidance does not address primary triage decisions, anthrax postexposure prophylaxis, hospital bed or workforce surge capacity, or the logistics of dispensing MCMs. Clinicians, hospital administrators, state and local health officials, and planners can use these recommendations to assist in the development of crisis protocols that will ensure national preparedness for an anthrax mass-casualty incident. PMID:26632963

  8. Assessment of Hospital Pharmacy Preparedness for Mass Casualty Events

    PubMed Central

    Awad, Nadia I.; Cocchio, Craig

    2015-01-01

    Objectives: To assess the preparedness of hospital pharmacies in New Jersey to provide pharmaceutical services in mass casualty scenarios. Methods: An electronic cross-sectional survey was developed to assess the general knowledge of available resources and attitudes toward the preparedness of the pharmacy department. Results: Out of 60 invitations to participate, 18 surveys (30%) were completed. Respondents practiced at community hospitals (12, 66.6%) with no trauma center designation (11, 67.4%) that served more than 500 licensed beds (five, 29.4%). Six respondents (35.3%) indicated that 75,000 to 100,000 patients visited their emergency departments annually. Seventeen sites (94.4%) reported the existence of an institutional disaster preparedness protocol; 10 (55.5%) indicated that there is a specific plan for the pharmacy department. Most respondents (10, 55.5%) were unsure whether their hospitals had an adequate supply of analgesics, rapid sequence intubation agents, vasopressors, antiemetics, respiratory medications, ophthalmics, oral antimicrobials, and chemical-weapon-specific antidotes. Five (27.7%) agreed that the pharmacy disaster plan included processes to ensure care for patients already hospitalized, and four (22.2%) agreed that the quantity of medication was adequate to treat patients and hospital employees if necessary. Medication stock and quantities were determined based on national or international guidelines at three (16.6%) institutions surveyed. Conclusion: This survey demonstrates a lack of general consensus regarding hospital pharmacy preparedness for mass casualty scenarios despite individualized institutional protocols for disaster preparedness. Standardized recommendations from government and/or professional pharmacy organizations should be developed to guide the preparation of hospital pharmacy departments for mass casualty scenarios. PMID:25859121

  9. A mass casualty incident involving children and chemical decontamination.

    PubMed

    Timm, Nathan; Reeves, Scott

    2007-01-01

    Mass casualty incidents involving contaminated children are a rare but ever-present possibility. In this article we outline one such event that resulted in 53 pediatric patients and 3 adults presenting to the emergency department of a children's hospital for decontamination and treatment. We pay special attention to the training that allowed this responses to occur. We also outline the institutional response with emphasis on incident command, communication, and resource utilization. Specific lessons learned are explored in detail. Finally, we set forth a series of recommendations to assist other institutions should they be called upon to care for and decontaminate pediatric patients. PMID:17517363

  10. Mass casualties and health care following the release of toxic chemicals or radioactive material--contribution of modern biotechnology.

    PubMed

    Göransson Nyberg, Ann; Stricklin, Daniela; Sellström, Åke

    2011-12-01

    Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons "at risk" of developing health problems, these technologies can aid in securing the unaffected or "worried well". We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking. PMID:22408587

  11. Mass Casualties and Health Care Following the Release of Toxic Chemicals or Radioactive Material—Contribution of Modern Biotechnology

    PubMed Central

    Göransson Nyberg, Ann; Stricklin, Daniela; Sellström, Åke

    2011-01-01

    Catastrophic chemical or radiological events can cause thousands of casualties. Such disasters require triage procedures to identify the development of health consequences requiring medical intervention. Our objective is to analyze recent advancements in biotechnology for triage in mass emergency situations. In addition to identifying persons “at risk” of developing health problems, these technologies can aid in securing the unaffected or “worried well”. We also highlight the need for public/private partnerships to engage in some of the underpinning sciences, such as patho-physiological mechanisms of chemical and radiological hazards, and for the necessary investment in the development of rapid assessment tools through identification of biochemical, molecular, and genetic biomarkers to predict health effects. For chemical agents, biomarkers of neurotoxicity, lung damage, and clinical and epidemiological databases are needed to assess acute and chronic effects of exposures. For radiological exposures, development of rapid, sensitive biomarkers using advanced biotechnologies are needed to sort exposed persons at risk of life-threatening effects from persons with long-term risk or no risk. The final implementation of rapid and portable diagnostics tools suitable for emergency care providers to guide triage and medical countermeasures use will need public support, since commercial incentives are lacking. PMID:22408587

  12. Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001

    PubMed Central

    2013-01-01

    Background Jos has witnessed a series of civil crises which have generated mass casualties that the Jos University Teaching Hospital has had to respond to from time to time. We review the challenges that we encountered in the management of the victims of the 2001 crisis. Methodology We reviewed the findings of our debriefing sessions following the sectarian crisis of September 2001 and identified the challenges and obstacles experienced during these periods. Results Communication was a major challenge, both within and outside the hospital. In the field, there was poor field triage and no prehospital care. Transportation and evacuation was hazardous, for both injured patients and medical personnel. This was worsened by the imposition of a curfew on the city and its environs. In the hospital, supplies such as fluids, emergency drugs, sterile dressings and instruments, splints, and other consumables, blood and food were soon exhausted. Record keeping was erratic. Staff began to show signs of physical and mental exhaustion as well as features of anxiety and stress. Tensions rose between different religious groups in the hospital and an attempt was made by rioters to attack the hospital. Patients suffered poor subsequent care following resuscitation and/or surgery and there was neglect of patients on admission prior to the crisis as well as non trauma medical emergencies. Conclusion Mass casualties from disasters that disrupt organized societal mechanisms for days can pose significant challenges to the best of institutional disaster response plans. In the situation that we experienced, our disaster plan was impractical initially because it failed to factor in such a prolongation of both crisis and response. We recommend that institutional disaster response plans should incorporate provisions for the challenges we have enumerated and factor in peculiarities that would emanate from the need for a prolonged response. PMID:24164778

  13. Predeployment mass casualty and clinical trauma training for US Army forward surgical teams.

    PubMed

    Pereira, Bruno M T; Ryan, Mark L; Ogilvie, Michael P; Gomez-Rodriguez, Juan Carlos; McAndrew, Patrick; Garcia, George D; Proctor, Kenneth G

    2010-07-01

    Since the beginning of the program in 2002, 84 Forward Surgical Teams (FSTs) have rotated through the Army Trauma Training Center (ATTC) at the University of Miami/Ryder Trauma Center including all those deployed to Iraq and Afghanistan. The purpose of this study was to provide the latest updates of our experience with FSTs at the ATTC. Before deployment, each FST participates in a 2-week training rotation at the ATTC. The rotation is divided into 3 phases. Phase 1 is to refresh FST knowledge regarding the initial evaluation and management of the trauma patient. Phase 2 is the clinical phase and is conducted entirely at the Ryder Trauma Center. The training rotation culminates in phase 3, the Capstone exercise. During the Capstone portion of their training, the entire 20-person FST remains at the Ryder Trauma Center and is primarily responsible for the evaluation and resuscitation of all patients arriving over a 24-hour period. Subject awareness concerning their role within the team improved from 71% to 95%, indicating that functioning as a team in the context of the mass casualty training exercise along with clinical codes was beneficial. The clinical component of the rotation was considered by 47% to be the most valuable aspect of the training. Our experience strongly suggests that a multimodality approach is beneficial for preparing a team of individuals with minimal combat (or trauma) experience for the rigors of medical care and triage on the battlefield. The data provided by participants rotating through the ATTC show that through clinical exposure and simulation over a 2-week period, FST performance is optimized by defining provider roles and improving communication. The mass casualty training exercise is a vital component of predeployment training that participants feel is valuable in preparing them for the challenges that lay ahead. PMID:20613574

  14. Mass casualty care in an expeditionary environment: developing local knowledge and expertise in context.

    PubMed

    De Jong, Marla J; Benner, Richard; Benner, Patricia; Richard, Maggie L; Kenny, Deborah J; Kelley, Patricia; Bingham, Mona; Debisette, Annette Tyree

    2010-01-01

    To discover new experience-based clinical and care delivery knowledge learned in the Iraq and Afghanistan combat zones, 107 Air Force, Army, and Navy nurses were interviewed. Eight areas of experiential knowledge were identified in the new care delivery system that featured rapid transport, early trauma and surgical care, and expeditious aeromedical evacuation: (1) organizing for mass casualties, (2) uncertainty about incoming casualties, (3) developing systems to track patients, (4) resource utilization, (5) ripple effects of a mass casualty event, (6) enlarging the scope of nursing practice, (7) operating medical facilities under attack, and (8) nurse emotions related to mass casualties. PMID:20234239

  15. Valley triage: an approach to mass casuality care.

    PubMed

    Gierson, E D; Richman, L S

    1975-03-01

    Organizations prepared to respond to war, fire, flood, earthquake, or attack are essential for effective disaster control. "Valley Triage" the San Fernando Valley Medical Triage Team in Los Angeles, was formed to meet this need. The team is a mobile medical unit staffed by physicians and coordinated with civilian and military emergency services. It incorporates innovative means of communication, transportation, equipment, and training. The primary aim of Valley Triage is to provide on-site medical attention to disaster victims, and to coordinate their transfer to adequately staffed and equipped hospitals. Valley Triage offers a new approach to disaster management and can serve as a model for the development of other teams throughout the nation. PMID:1127742

  16. Roles of a helicopter emergency medical service in mass casualty incidents.

    PubMed

    Stohler, S A; Jacobs, L M; Gabram, S G

    1991-01-01

    The Connecticut helicopter emergency medical service (HEMS) has responded to 12 mass casualty incidents (MCI) in two years. Eight were drills and four were actual events. An MCI response plan was instituted prior to the onset of the HEMS program. All MCIs were reviewed to determine actual victims, knowledge of MCI prior to lift-off, and roles of the HEMS. The actual roles were compared with the pre-established roles. The four actual MCIs (building explosion, hotel fire, bus rollover and plane crash) were reviewed. Sixty-seven victims were involved. Prenotification occurred in one MCI. The roles of the HEMS in each MCI were: triage (n = 4), medical treatment (n = 4), transport (n = 3), augmented response (n = 1), and air surveillance (n = 0). The roles of HEMS response to MCI should be well-defined prior to an event. Air medical benefits include response within a large geographic area, highest level of prehospital medical care, identification of trauma receiving hospitals, and facilitation of transport. PMID:10108935

  17. [Mass maritime casualty incidents in German waters: structures and resources].

    PubMed

    Castan, J; Paschen, H-R; Wirtz, S; Dörges, V; Wenderoth, S; Peters, J; Blunk, Y; Bielstein, A; Kerner, T

    2012-07-01

    The Central Command for Maritime Emergencies was founded in Germany in 2003 triggered by the fire on board of the cargo ship "Pallas" in 1998. Its mission is to coordinate and direct measures at or above state level in maritime emergency situations in the North Sea and the Baltic Sea. A special task in this case is to provide firefighting and medical care. To face these challenges at sea emergency doctors and firemen have been specially trained. This form of organization provides a concept to counter mass casualty incidents and peril situations at sea. Since the foundation of the Central Command for Maritime Emergencies there have been 5 operations for firefighting units and 4 for medical response teams. Assignments and structure of the Central Command for Maritime Emergencies are unique in Europe. PMID:22699223

  18. Mass casualty following unprecedented tornadic events in the Southeast: natural disaster outcomes at a Level I trauma center.

    PubMed

    Hartmann, Elizabeth H; Creel, Nathan; Lepard, Jacob; Maxwell, Robert A

    2012-07-01

    On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries. PMID:22748536

  19. Mass casualty incident response and aeromedical evacuation in antarctica.

    PubMed

    Mills, Christopher N; Mills, Gregory H

    2011-02-01

    Antarctica is one of the most remote regions on Earth. Mass casualty incident (MCI) responses in Antarctica are prone to complications from multiple environmental and operational challenges. This review of the current status of MCI risks and response strategies for Antarctica focuses on aeromedical evacuation, a critical component of many possible MCI scenarios. Extreme cold and weather, a lack of medical resources and a multitude of disparate international bases all exert unique demands on MCI response planning. Increasing cruise ship traffic is also escalating the risk of MCI occurrence. To be successful, MCI response must be well coordinated and undertaken by trained rescuers, especially in the setting of Antarctica. Helicopter rescue or aeromedical evacuation of victims to off-continent facilities may be necessary. Currently, military forces have the greatest capacity for mass air evacuation. Specific risks that are likely to occur include structure collapses, vehicle incapacitations, vehicle crashes and fires. All of these events pose concomitant risks of hypothermia among both victims and rescuers. Antarctica's unique environment requires flexible yet robust MCI response planning among the many entities in operation on the continent. PMID:21691470

  20. Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica

    PubMed Central

    Mills, Christopher N.; Mills, Gregory H.

    2011-01-01

    Antarctica is one of the most remote regions on Earth. Mass casualty incident (MCI) responses in Antarctica are prone to complications from multiple environmental and operational challenges. This review of the current status of MCI risks and response strategies for Antarctica focuses on aeromedical evacuation, a critical component of many possible MCI scenarios. Extreme cold and weather, a lack of medical resources and a multitude of disparate international bases all exert unique demands on MCI response planning. Increasing cruise ship traffic is also escalating the risk of MCI occurrence. To be successful, MCI response must be well coordinated and undertaken by trained rescuers, especially in the setting of Antarctica. Helicopter rescue or aeromedical evacuation of victims to off-continent facilities may be necessary. Currently, military forces have the greatest capacity for mass air evacuation. Specific risks that are likely to occur include structure collapses, vehicle incapacitations, vehicle crashes and fires. All of these events pose concomitant risks of hypothermia among both victims and rescuers. Antarctica’s unique environment requires flexible yet robust MCI response planning among the many entities in operation on the continent. PMID:21691470

  1. Terror and triage: prioritizing access to mass smallpox vaccination.

    PubMed

    Silverman, Ross D; May, Thomas

    2003-04-01

    In response to the threat of a smallpox attack on the United States, the Centers for Disease Control and Prevention ("CDC") recommended the establishment of smallpox clinics designed to distribute a vaccine to the entire U.S. population in a ten day period. However, a number of potential obstacles raise questions about the feasibility of this plan. What is needed is a plan that applies principles of triage to smallpox vaccine distribution following a bioterrorism attack. Only in this way can those most vulnerable--the previously unvaccinated--be protected from a significantly increased risk due to delays that might arise in executing the CDC plan. PMID:15199933

  2. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice.

    PubMed

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; Larner, Joanne; Matar, Hazem; Chilcott, Robert P

    2016-01-01

    Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the "ladder-pipe system" for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

  3. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan.

    PubMed

    Berger, Ferco H; Körner, Markus; Bernstein, Mark P; Sodickson, Aaron D; Beenen, Ludo F; McLaughlin, Patrick D; Kool, Digna R; Bilow, Ronald M

    2016-01-01

    In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients. It can also be used to increase the accuracy of triaging MCI victims, since overtriage (falsely higher triage category) and undertriage (falsely lower triage category) can severely impact resource availability and mortality rates, respectively. This article emphasizes the importance of including the radiology department in hospital preparations for a MCI and highlights factors expected to influence performance during hospital DMP activation including issues pertinent to effective simulation, such as establishing proper learning objectives. After-action reviews including performance evaluation and debriefing on issues are invaluable following simulation drills and DMP activation, in order to improve subsequent preparedness. Historically, most hospital DMPs have not adequately included radiology department operations, and they have not or to a little extent been integrated in the DMP activation simulation. This article aims to increase awareness of the need for radiology department engagement in order to increase radiology department preparedness for DMP activation after a MCI occurs. PMID:26781837

  4. Self-care Decontamination within a Chemical Exposure Mass-casualty Incident.

    PubMed

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

    Growing awareness and concern for the increasing frequency of incidents involving hazardous materials (HazMat) across a broad spectrum of contaminants from chemical, biological, radiological, and nuclear (CBRN) sources indicates a clear need to refine the capability to respond successfully to mass-casualty contamination incidents. Best results for decontamination from a chemical agent will be achieved if done within minutes following exposure, and delays in decontamination will increase the length of time a casualty is in contact with the contaminate. The findings presented in this report indicate that casualties involved in a HazMat/CBRN mass-casualty incident (MCI) in a typical community would not receive sufficient on-scene care because of operational delays that are integral to a standard HazMat/CBRN first response. This delay in response will mean that casualty care will shift away from the incident scene into already over-tasked health care facilities as casualties seek aid on their own. The self-care decontamination protocols recommended here present a viable option to ensure decontamination is completed in the field, at the incident scene, and that casualties are cared for more quickly and less traumatically than they would be otherwise. Introducing self-care decontamination procedures as a standard first response within the response community will improve the level of care significantly and provide essential, self-care decontamination to casualties. The process involves three distinct stages which should not be delayed; these are summarized by the acronym MADE: Move/Assist, Disrobe/Decontaminate, Evaluate/Evacuate. PMID:25915603

  5. Carbamate poisoning: treatment recommendations in the setting of a mass casualties event.

    PubMed

    Rosman, Yossi; Makarovsky, Igor; Bentur, Yedidia; Shrot, Shai; Dushnistky, Tsvika; Krivoy, Amir

    2009-11-01

    The threat of using chemical compounds by terrorists as weapons of mass casualties has been a rising concern in recent years. Carbamates, a group of reversible acetylcholinesterase inhibitors, could be potentially involved in such toxic mass casualty events because they can cause cholinergic crisis that could lead to fatality, similar to that of organophosphate poisoning. The medical management of carbamate poisoning consists of supportive measures and specific antidotal treatment, that is, the anticholinergic compound atropine. The administration of oximes, acetylcholinesterase reactivators, in carbamate poisoning is controversial because of the potential toxicity of oximes in conjunction with carbamate especially in the case of the carbamate--"carbaryl" poisoning. However, recent data suggest that this concern may be unwarranted. In this article, we review the current data regarding the pros and cons of using oximes against carbamates poisoning in a mass casualties event scenario. We also propose a new decision-making algorithm for the medical first responders in a mass casualties event suspected to be caused by a cholinergic substance (organophosphate or carbamate). According to this algorithm, treatment should consist of atropine and oxime regardless of the exact toxic compound involved. We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk. PMID:19931761

  6. The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

    PubMed

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Meei; Sang, Yiing-Yiing; Hou, I-Ching; Kao, Wei-Fong

    2004-09-01

    The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems. PMID:15362014

  7. Panel 2.5: mass-casualty management and hospital care.

    PubMed

    Borra, Agostino; Perez, Luis Jorge; Min, Tin; Puavilai, Wilai; Seo, Norimasa; Tipsunthonsak, Nakhon

    2005-01-01

    This is a summary of the presentations and discussion of Panel 2.5, Mass-Casualty Management and Hospital Care of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to mass-casualty management and hospital care as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) recommendations; and (3) conclusions. Subsections of the conclusion section include: (1) lessons learned; (2) what was done well?; and (3) what could have been done better?. PMID:16496625

  8. Bomb blast mass casualty incidents: initial triage and management of injuries.

    PubMed

    Goh, S H

    2009-01-01

    Bomb blast injuries are no longer confined to battlefields. With the ever present threat of terrorism, we should always be prepared for bomb blasts. Bomb blast injuries tend to affect air-containing organs more, as the blast wave tends to exert a shearing force on air-tissue interfaces. Commonly-injured organs include the tympanic membranes, the sinuses, the lungs and the bowel. Of these, blast lung injury is the most challenging to treat. The clinical picture is a mix of acute respiratory distress syndrome and air embolism, and the institution of positive pressure ventilation in the presence of low venous pressures could cause systemic arterial air embolism. The presence of a tympanic membrane perforation is not a reliable indicator of the presence of a blast injury in the other air-containing organs elsewhere. Radiological imaging of the head, chest and abdomen help with the early identification of blast lung injury, head injury, abdominal injury, eye and sinus injuries, as well as any penetration by foreign bodies. In addition, it must be borne in mind that bomb blasts could also be used to disperse radiological and chemical agents. PMID:19224092

  9. Effect of Hospital Staff Surge Capacity on Preparedness for a Conventional Mass Casualty Event

    PubMed Central

    Welzel, Tyson B.; Koenig, Kristi L.; Bey, Tareg; Visser, Errol

    2010-01-01

    Objectives: To assess current medical staffing levels within the Hospital Referral System in the City of Cape Town Metropolitan Municipality, South Africa, and analyze the surge capacity needs to prepare for the potential of a conventional mass casualty incident during a planned mass gathering. Methods: Query of all available medical databases of both state employees and private medical personnel within the greater Cape Town area to determine current staffing levels and distribution of personnel across public and private domains. Analysis of the adequacy of available staff to manage a mass casualty incident. Results: There are 594 advanced pre-hospital personnel in Cape Town (17/100,000 population) and 142 basic pre-hospital personnel (4.6/100,000). The total number of hospital and clinic-based medical practitioners is 3097 (88.6/100,000), consisting of 1914 general physicians; 54.7/100,000 and 1183 specialist physicians; 33.8/100,000. Vacancy rates for all medical practitioners range from 23.5% to 25.5%. This includes: nursing post vacancies (26%), basic emergency care practitioners (39.3%), advanced emergency care personnel (66.8%), pharmacy assistants (42.6%), and pharmacists (33.1%). Conclusion: There are sufficient numbers and types of personnel to provide the expected ordinary healthcare needs at mass gathering sites in Cape Town; however, qualified staff are likely insufficient to manage a concurrent mass casualty event. Considering that adequate correctly skilled and trained staff form the backbone of disaster surge capacity, it appears that Cape Town is currently under resourced to manage a mass casualty event. With the increasing size and frequency of mass gathering events worldwide, adequate disaster surge capacity is an issue of global relevance. PMID:20823971

  10. Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.

    PubMed

    Benson, M; Koenig, K L; Schultz, C H

    1996-01-01

    Triage of mass casualties in situations in which patients must remain on-scene for prolonged periods of time, such as after a catastrophic earthquake, differs from traditional triage. Often there are multiple scenes (sectors), and the infrastructure is damaged. Available medical resources are limited, and the time to definitive care is uncertain. Early evacuation is not possible, and local initial responders cannot expect significant outside assistance for at least 49-72 hours. Current triage systems are based either on a shorter time to definitive care or on a longer time to initial triage. The Medical Disaster Response (MDR) project deals with the scenario in which specially trained, local health-care providers evaluate patients immediately after the event, but cannot evacuate patients to definitive care. For this type of scenario, a dynamic triage methodology was developed that permits the triage process to evolve over hours or even days, thereby maximizing patient survival and resulting in a more efficient use of resources. This MDR system incorporates a modified version of "Simple Triage and Rapid Treatment" (START) that substitutes radial pulse for capillary refill, coupled with a system of secondary triage termed, "Secondary Assessment of Victim Endpoint" (SAVE). The SAVE triage was developed to direct limited resources to the subgroup of patients expected to benefit most from their use. The SAVE assesses survivability of patients with various injuries and, on the basis of trauma statistics, uses this information to describe the relationship between expected benefits and resources consumed. Because early transport to an intact medical system is unavailable, this information guides treatment priorities in the field to a level beyond the scope of the START methodology. Pre-existing disease and age are factored into the triage decisions. An elderly patient with burns to 70% of body surface area is unsalvageable under austere field conditions and would require

  11. Resource planning for ambulance services in mass casualty incidents: a DES-based policy model.

    PubMed

    Rauner, Marion S; Schaffhauser-Linzatti, Michaela M; Niessner, Helmut

    2012-09-01

    Due to an increasing number of mass casualty incidents, which are generally complex and unique in nature, we suggest that decision makers consider operations research-based policy models to help prepare emergency staff for improved planning and scheduling at the emergency site. We thus develop a discrete-event simulation policy model, which is currently being applied by disaster-responsive ambulance services in Austria. By evaluating realistic scenarios, our policy model is shown to enhance the scheduling and outcomes at operative and online levels. The proposed scenarios range from small, simple, and urban to rather large, complex, remote mass casualty emergencies. Furthermore, the organization of an advanced medical post can be improved on a strategic level to increase rescue quality, including enhanced survival of injured victims. In particular, we consider a realistic mass casualty incident at a brewery relative to other exemplary disasters. Based on a variety of such situations, we derive general policy implications at both the macro (e.g., strategic rescue policy) and micro (e.g., operative and online scheduling strategies at the emergency site) levels. PMID:22653522

  12. K-plan for patient repatriation after mass casualty events abroad.

    PubMed

    Duchateau, François-Xavier; Verner, Laurent

    2012-01-01

    In addition to requests for individual aeromedical evacuation (AE), medical assistance companies also may respond to mass casualty incidents abroad. The purpose of this report was to evaluate the effectiveness of our primary casualty plan, based on experience involving a January 2010 bus crash in southern Egypt. The main evaluative criterion was time elapsed from the initial call until the return of victims to their home country. Three critically injured patients underwent an initial AE to Cairo for advanced trauma care. After stabilization, they arrived back in their home country 42 hours after the initial call. The remaining group of patients arrived 27 hours later, or a total of 69 hours after the first call. These findings suggest that the "K-Plan" standardized operating process may be effective for rapid and appropriate repatriation of numerous victims. Some specific issues, such as efficiently locating a large-capacity charter aircraft, require further improvement. PMID:22386102

  13. A pan-European study of capabilities to manage mass casualties from the release of chemical agents: the MASH project.

    PubMed

    Baker, David J; Murray, Virginia S G; Carli, Pierre A

    2013-01-01

    The European Union (EU) Mass Casualties and Health (MASH) project that ran between 2008 and 2010 was designed to study the management of mass casualties from chemical and radiological releases and associated health implications. One area of study for this project concerned arrangements within EU Member States for the management of mass casualties following a chemical release. This was undertaken via a confidential online questionnaire that was sent to selected points of contact throughout the EU. Responses were obtained from 18 states from respondents holding senior positions in chemical planning and incident response. Information gathered shows a lack of uniformity within the EU about the organization of responses to chemical releases and the provision of medical care. This article presents the overall findings of the study demonstrating differences between countries on planning and organization, decontamination, prehospital emergency medical responses, clinical diagnoses, and therapy and aftercare. Although there may be an understandable reluctance from national respondents to share information on security and other grounds, the findings, nevertheless, revealed substantial differences between current planning and operational responses within the EU states for the management of mass chemical casualties. The existing international networks for response to radiation incidents are not yet matched by equivalent networks for chemical responses yet sufficient information was available from the study to identify potential deficiencies, identify common casualty management pathways, and to make recommendations for future operations within the EU. Improvements in awareness and training and the application of modern information and communications will help to remedy this situation. Specialized advanced life support and other medical care for chemical casualties appear lacking in some countries. A program of specialized training and action are required to apply the findings

  14. Clinical guidelines for responding to chemical, biological, radiological, nuclear and trauma/burn mass casualty incidents: Quick reference guides for emergency department staff.

    PubMed

    Albanese, Joseph; Burich, David; Smith, Deborah; Hayes, Lynn; Paturas, James; Tomassoni, Anthony

    The word 'DISASTER' may be used as a mnemonic for listing the critical elements of emergency response. The National Disaster Life Support Education Foundation's (NDLSEC) DISASTER paradigm emphasises out-of-hospital emergency response and includes the following elements: (1) detect; (2) incident command system; (3) security and safety; (4) assessment; (5) support; (6) triage and treatment; (7) evacuate; and (8) recovery. This paper describes how the DISASTER paradigm was used to create a series of clinical guidelines to assist the preparedness effort of hospitals for mitigating chemical, biological, radiological, nuclear incidents or explosive devices resulting in trauma/burn mass casualty incidents (MCIs) and their initial response to these events. Descriptive information was obtained from observations and records associated with this project. The information contributed by a group of subject matter experts in disaster medicine, at the Yale New Haven Health System Center for Emergency Preparedness and Disaster Response was used to author the clinical guidelines. Akin to the paradigm developed by the NDLSEC for conducting on-scene activities, the clinical guidelines use the letters in the word 'disaster' as a mnemonic for recalling the main elements required for mitigating MCIs in the hospital emergency department. PMID:25416374

  15. Oral and enteral resuscitation of burn shock the historical record and implications for mass casualty care.

    PubMed

    Kramer, George C; Michell, Michael W; Oliveira, Hermes; Brown, Tim La H; Herndon, David; Baker, R David; Muller, Michael

    2010-01-01

    In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10-40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in "peripheral circulatory collapse". The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered. PMID:20827301

  16. Oral and Enteral Resuscitation of Burn Shock The Historical Record and Implications for Mass Casualty Care

    PubMed Central

    Kramer, George C.; Michell, Michael W.; Oliveira, Hermes; Brown, Tim La H.; Herndon, David; Baker, R. David; Muller, Michael

    2010-01-01

    In the aftermath of a mass disaster, standard care methods for treatment of burn injury will often not be available for all victims. A method of fluid resuscitation for burns that has largely been forgotten by contemporary burn experts is enteral resuscitation. We identified 12 studies with over 700 patients treated with enteral resuscitation, defined as drinking or gastric infusion of salt solutions, from the literature. These studies suggest that enteral resuscitation can be an effective treatment for burn shock under conditions in which the standard IV therapy is unavailable or delayed, such as in mass disasters and combat casualties. Enteral resuscitation of burn shock was effective in patients with moderate (10–40% TBSA) and in some patients with more severe injuries. The data suggests that some hypovolemic burn and trauma patients can be treated exclusively with enteral resuscitation, and others might benefit from enteral resuscitation as an initial alternative and a supplement to IV therapy. A complication of enteral resuscitation was vomiting, which occurred less in children and much less when therapy was initiated within the first postburn hour. Enteral resuscitation is contra-indicated when the patient is in “peripheral circulatory collapse”. The optimal enteral solution and regimen has not yet been defined, nor has its efficacy been tested against modern IV resuscitation. The oldest studies used glucose-free solutions of buffered isotonic and hypotonic saline. Studies that are more recent show benefit of adding glucose to electrolyte solutions similar to those used in the treatment of cholera. If IV therapy for mass casualty care is delayed due to logistical constraints, enteral resuscitation should be considered. PMID:20827301

  17. Regional Variation in Causes of Injuries among Terrorism Victims for Mass Casualty Events

    PubMed Central

    Regens, James L.; Schultheiss, Amy; Mould, Nick

    2015-01-01

    The efficient allocation of medical resources to prepare for and respond to mass casualty events (MCEs) attributable to intentional acts of terrorism is a major challenge confronting disaster planners and emergency personnel. This research article examines variation in regional patterns in the causes of injures associated with 77,258 successful terrorist attacks that occurred between 1970 and 2013 involving the use of explosives, firearms, and/or incendiaries. The objective of this research is to estimate regional variation in the use of different conventional weapons in successful terrorist attacks in each world region on variation in injury cause distributions. Indeed, we find that the distributions of the number of injuries attributable to specific weapons types (i.e., by cause) vary greatly among the 13 world regions identified within the Global Terrorism Database. PMID:26347857

  18. Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.

    PubMed

    Dal Ponte, Silvana T; Dornelles, Carlos F D; Arquilla, Bonnie; Bloem, Christina; Roblin, Patricia

    2015-02-01

    On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses. PMID:25544145

  19. Factors influencing injury severity score regarding Thai military personnel injured in mass casualty incident April 10, 2010: lessons learned from armed conflict casualties: a retrospective study

    PubMed Central

    2012-01-01

    Background Political conflicts in Bangkok, Thailand have caused mass casualties, especially the latest event April 10, 2010, in which many military personnel were injured. Most of them were transferred to Phramongkutklao Hospital, the largest military hospital in Thailand. The current study aimed to assess factors influencing Injury Severity Score (ISS) regarding Thai military personnel injured in the mass casualty incident (MCI) April 10, 2010. Methods A total of 728 injured soldiers transferred to Phramongkutklao Hospital were reviewed. Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories. Results In all, 153 subjects defined as major data category were enrolled in this study. Blast injury was the most common mechanism of injury (90.2%). These victims displayed 276 injured body regions. The most common injured body region was the extremities (48.5%). A total of 18 patients (11.7%) had an ISS revealing more than 16 points. Three victims who died were expected to die due to high Trauma and Injury Severity Score (TRISS). However, one with high TRISS survived. Factors influencing ISS were age (p = 0.04), abdomen injury (adjusted OR = 29.9; 95% CI, 5.8-153.5; P < 0.01), head & neck injury (adjusted OR = 13.8; 95% CI, 2.4-80.4; P < 0.01) and chest injury (adjusted OR = 9.9; 95% CI, 2.1-47.3; P < 0.01). Conclusions Blast injury was the most common mechanism of injury among Thai military personnel injured in the MCI April 10, 2010. Age and injured body region such as head & neck, chest and abdomen significantly influenced ISS. These factors should be investigated for effective medical treatment and preparing protective equipment to prevent such injuries in the future. PMID:22214518

  20. Portable ultrasound in disaster triage: a focused review.

    PubMed

    Wydo, S M; Seamon, M J; Melanson, S W; Thomas, P; Bahner, D P; Stawicki, S P

    2016-04-01

    Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings. PMID:26038019

  1. [National preparedness for biological mass casualty event: between the devil and the deep blue sea].

    PubMed

    Eldad, Arieh

    2002-05-01

    Species of plants and animals, as well as nations of human beings were extinguished throughout the prehistory and history of this planet. One of the possible explanations for this phenomenon is a large scale epidemic of viral, bacterial or fungal infections. One well-documented example was the smallpox epidemic among native Indians of South America following the European invasion. Deliberate dissemination of disease was used as a weapon during the Middle Ages when corpses of plague casualties were thrown over the walls and into the besieged towns. The Book of Kings II, of the Bible, in chapter 19 recalls the story of 185,000 soldiers of Sennacherib that died in one night, near the walls of Jerusalem. The possibility of causing mass casualty by dissemination of infectious disease has driven countries and terrorist organizations to produce and store large quantities of bacteria or viruses. The death of thousands in the USA on September 11, 2001, demonstrated that terror has no moral prohibitions, only technical limitations. Terror organizations will not hesitate to use weapons for mass destruction to kill many, and if only few will die, it will still serve the purpose of these evil organizations: to strew panic, to destroy normal life and to increase fear and instability. Any government that faces decisions about how to be better prepared against biological warfare is pushed between the devil and the deep blue sea. On the one hand: the better we will be prepared, equipped with antibiotics and vaccines--the more lives of casualties we will be able to save. Better public education will help to reduce the damage, but, on the other hand--in order to cause more people to make the effort to equip themselves or to refresh their protective kit--we will have to increase their level of concern. In order to improve the medical education of all members of the medical teams we will have to start a broad and intense campaign, thereby taking the risk of increasing stress in the

  2. Improving emergency medical dispatching with emphasis on mass-casualty incidents.

    PubMed

    Kleinoscheg, Gabriel; Burgsteiner, Harald; Bernroider, Martin; Kiechle, Günter; Obermayer, Maria

    2014-01-01

    Dispatching ambulances is a demanding and stressful task for dispatchers. This is especially true in case of mass-casualty incidents. Therefore, the aim of this work was to investigate if and to what extent the dispatch operation of the Red Cross Salzburg can be optimized on such occasions with a computerized system. The basic problem of a dynamic multi-vehicle Dial-a-Ride Problem with time windows was enhanced according to the requirements of the Red Cross Salzburg. The general objective was to minimize the total mileage covered by ambulances and the waiting time of patients. Furthermore, in case of emergencies suitable adaptions to a plan should be carried out automatically. Consequently, the problem is solved by using the Adaptive Large Neighborhood Search. Evaluation results indicate that the system outperforms a human dispatcher by between 2.5% and 36% within 1 minute of runtime concerning total costs. Moreover, the system's response time in case that a plan has to be updated is less than 1 minute on average. PMID:24825692

  3. Expedited electronic entry: a new way to manage mass-casualty radiology order workflow.

    PubMed

    Bookman, Kelly; Zane, Richard

    2013-08-01

    One of the important tenets of emergency preparedness is that planning for disaster response should resemble standard operating procedure whenever possible. Electronic order entry has become part of the standard operating procedures of most institutions but many of these systems are either too cumbersome for use during a surge or can even be rendered non-functional during a sudden patient surge such as a mass-casualty incident (MCI). Presented here is an experience with delayed radiology order entry during a recent MCI and the after action programming of the system based on this real experience. In response to the after action analysis of the MCI, a task force was assigned to solve the MCI radiology order entry problem and a solution to streamline disaster image ordering was devised. A "browse page" was created that lists every x-ray and every CT scan that might be needed in such an event with all required information defaulted to "Disaster." This created a way to order multiple images for any one patient, with 40% time saving over standard electronic order entry. This disaster radiology order entry solution is an example of the surge preparedness needed to promote patient safety and efficient care delivery as the widespread deployment of electronic health records and order entry continues across the United States. PMID:23731567

  4. History of trauma field triage development and the American College of Surgeons criteria.

    PubMed

    Mackersie, Robert C

    2006-01-01

    The use of trauma field triage criteria is designed to match a patient's injury type and severity to prioritized transport and an institution with the resources to provide timely, definitive care. Triage schemes used in austere environments created by war or mass casualty events are less applicable to day-to-day civilian trauma. Civilian triage criteria, developed and refined over the past 25 years, rely on physiologic, anatomic, and mechanistic indicators of severe injury in an attempt to optimize overtriage and undertriage. As organized trauma systems continue to mature, the need for more accurate direction of high- versus low-acuity patients to regional centers, stratified by their capabilities, becomes more apparent and is essential in avoiding a completely 'exclusive' trauma system. New technology utilizing vehicular telemetry and Web-based information systems may simplify the seemingly simple but often formidable task of creating destination decision rules for victims of major injury. PMID:16801263

  5. Using baseline data to address the lack of hospital beds during mass-casualty incidents.

    PubMed

    Hadef, Hysham; Bartier, Jean-Claude; Delplancq, Herve; Dupeyron, Jean-Pierre

    2008-01-01

    The management of victims during mass-casualty incidents (MCIs) is improving. In many countries, physicians and paramedics are well-trained to manage these incidents. A problem that has been encountered during MCIs is the lack of adequate numbers of hospital beds to accommodate the injured. In Europe, hospitals are crowded. One solution for the lack of beds is the creation of baseline data systems that could be consulted by medical personnel in all European countries. A MCI never has occurred in northeastern Europe, but such an event remains a possibility. This paper describes how the use of SAGEC 67, a free-access, information database concerning the availability of beds should help the participating countries, initially France, Germany, and Switzerland, respond to a MCI by dispatching each patient to an appropriate hospital and informing their families and physicians using their own language. Baseline data for more than 20 countries, and for hospitals, especially those in Germany, Switzerland, and France, were collected. Information about the number of beds and their availability hour-by-hour was included. In the case of MCIs, the baseline data program is opened and automatically connects to all of the countries. In case of a necessary hospital evacuation, the required beds immediately are occupied in one of these three countries. Questions and conversations among medical staff or family members can be accomplished between hospitals through computer, secured-line chatting that automatically translates into appropriate language. During the patient evacuation phase of a MCI, respondents acknowledged that a combination of local, state, and private resources and international cooperation eventually would be needed to meet the demand. Patient evacuation is optimized through the use of SAGEC 67, a free baseline database. PMID:18935955

  6. Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes

    PubMed Central

    2016-01-01

    To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs’ epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved ≥ 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6–5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals’ resources. PMID:26955248

  7. Epidemiology of Emergency Medical Services-Assessed Mass Casualty Incidents according to Causes.

    PubMed

    Park, Ju Ok; Shin, Sang Do; Song, Kyoung Jun; Hong, Ki Jeong; Kim, Jungeun

    2016-03-01

    To effectively mitigate and reduce the burden of mass casualty incidents (MCIs), preparedness measures should be based on MCIs' epidemiological characteristics. This study aimed to describe the epidemiological characteristics and outcomes of emergency medical services (EMS)-assessed MCIs from multiple areas according to cause. Therefore, we extracted the records of all MCIs that involved ≥ 6 patients from an EMS database. All patients involved in EMS-assessed MCIs from six areas were eligible for this study, and their prehospital and hospital records were reviewed for a 1-year period. The EMS-assessed MCIs were categorized as being caused by fire accidents (FAs), road traffic accidents (RTAs), chemical and biological agents (CBs), and other mechanical causes (MECHs). A total of 362 EMS-assessed MCIs were identified, with a crude incidence rate of 0.6-5.0/100,000 population. Among these MCIs, 322 were caused by RTAs. The MCIs involved 2,578 patients, and 54.3% of these patients were women. We observed that the most common mechanism of injury varied according to MCI cause, and that a higher number of patients per incident was associated with a longer prehospital time. The highest hospital admission rate was observed for CBs (16 patients, 55.2%), and most patients in RTAs and MECHs experienced non-severe injuries. The total number of deaths was 32 (1.2%). An EMS-assessed MCI database was established using the EMS database and medical records review. Our findings indicate that RTA MCIs create a burden on EMS and emergency department resources, although CB MCIs create a burden on hospitals' resources. PMID:26955248

  8. Telephone triage.

    PubMed

    Preston, F A

    2000-01-01

    Nurses frequently provide advice and education over the phone. Telephone triage is an area of potential litigation for the nurse. Information must be clear, concise, and accurate. The nurse needs to ascertain that the patient understands the instructions provided and feels free to ask questions and receive clarification of any information that is confusing. Documentation needs to describe the nursing process of data collection, planning, intervention, and evaluation. In this way, patients will receive quality information that allows them to manage symptoms at home, understand when medical interventions are necessary, and avoid unnecessary delays in care. Telephone triage is an integral part of oncology care that covers a broad range of activities, including symptom management, medication renewal, coordination of care, education, and psychosocial support. As telephone triage becomes more "high risk, high volume," nurses must review the triage process used in their clinical settings. Areas to discuss and delineate include differentiation between medical, nursing, and secretarial responsibilities; technical support systems and access; documentation guidelines; telephone triage protocols; staff education; and patient satisfaction (Nauright, Moneyham, & Williamson, 1999). PMID:11899331

  9. Radiologic diagnosis of explosion casualties.

    PubMed

    Eastridge, Brian J; Blackbourne, Lorne; Wade, Charles E; Holcomb, John B

    2008-01-01

    The threat of terrorist events on domestic soil remains an ever-present risk. Despite the notoriety of unconventional weapons, the mainstay in the armament of the terrorist organization is the conventional explosive. Conventional explosives are easily weaponized and readily obtainable, and the recipes are widely available over the Internet. According to the US Department of State and the Federal Bureau of Investigation, over one half of the global terrorist events involve explosions, averaging two explosive events per day worldwide in 2005 (Terrorism Research Center. Available at www.terrorism.com. Accessed April 1, 2007). The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads, published by the Institute of Medicine, states that explosions were the most common cause of injuries associated with terrorism (Institute of Medicine Report: The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads. Washington DC: National Academic Press, 2007). Explosive events have the potential to inflict numerous casualties with multiple injuries. The complexity of this scenario is exacerbated by the fact that few providers or medical facilities have experience with mass casualty events in which human and material resources can be rapidly overwhelmed. Care of explosive-related injury is based on same principles as that of standard trauma management paradigms. The basic difference between explosion-related injury and other injury mechanisms are the number of patients and multiplicity of injuries, which require a higher allocation of resources. With this caveat, the appropriate utilization of radiology resources has the potential to impact in-hospital diagnosis and triage and is an essential element in optimizing the management of the explosive-injured patients. PMID:19069034

  10. Repeat triage in disaster relief: questions from haiti.

    PubMed

    Eyal, Nir; Firth, Paul

    2012-01-01

    During a mass casualty disaster, the acute imbalance between need for treatment and capacity to supply care poses difficult rationing problems. It is common to assume that such disasters call for "utilitarian" procedures that deliberately prioritize saving the most lives over other considerations. A group of medical responders to the 2010 Haitian earthquake faced particular challenges in determining how to allocate limited treatment, time and other resources between existing patients and potential patients not yet under care. We identified that rationing dilemmas points occurred at three points: when care had to be limited, when care had to be completed prematurely, and when care had to be withdrawn. "Repeat triage" refers to rationing challenges occurring at all these points, where the allocation of care is between existing and potential patients. By contrast, "initial triage" designates the allocation of access to treatment among new arrivals, all of whom are potential patients. Repeat and initial triage differ significantly. Several considerations make repeat triage special by supporting limited priority to existing patients, in transgression of pure "utilitarian" procedures: (1) Pragmatically, often it is more efficient to complete treatment on existing patients, for whom prognosis can be established with greater certainty and without added time, than to attempt to save new patients; (2) A fiduciary trust relationship has been formed between care-giver and existing patients, which may make the moral obligation towards them somewhat stronger than the one to potential patients; (3) Existing patients will have often arrived earlier, so when needs are equal, the "first come, first served" principle prioritizes them for care; (4) Withdrawal of care during repeat triage may constitute active rather than passive harm, and more often a serious transgression of patient autonomy; (5) Health providers should normally not be asked to behave in ways that profoundly violate

  11. Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events

    PubMed Central

    Yang, Zhuorui; Ciottone, Gregory

    2016-01-01

    We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order. PMID:27433161

  12. Clinical review: The role of the intensive care physician in mass casualty incidents: planning, organisation, and leadership

    PubMed Central

    Shirley, Peter J; Mandersloot, Gerlinde

    2008-01-01

    There is a long-standing, broad assumption that hospitals will ably receive and efficiently provide comprehensive care to victims following a mass casualty event. Unfortunately, the majority of medical major incident plans are insufficiently focused on strategies and procedures that extend beyond the pre-hospital and early-hospital phases of care. Recent events underscore two important lessons: (a) the role of intensive care specialists extends well beyond the intensive care unit during such events, and (b) non-intensive care hospital personnel must have the ability to provide basic critical care. The bombing of the London transport network, while highlighting some good practices in our major incident planning, also exposed weaknesses already described by others. Whilst this paper uses the events of the 7 July 2005 as its point of reference, the lessons learned and the changes incorporated in our planning have generic applications to mass casualty events. In the UK, the Department of Health convened an expert symposium in June 2007 to identify lessons learned from 7 July 2005 and disseminate them for the benefit of the wider medical community. The experiences of clinicians from critical care units in London made a large contribution to this process and are discussed in this paper. PMID:18492221

  13. Risk Analysis for Environmental Health Triage

    SciTech Connect

    Bogen, K T

    2005-11-18

    The Homeland Security Act mandates development of a national, risk-based system to support planning for, response to and recovery from emergency situations involving large-scale toxic exposures. To prepare for and manage consequences effectively, planners and responders need not only to identify zones of potentially elevated individual risk, but also to predict expected casualties. Emergency response support systems now define ''consequences'' by mapping areas in which toxic chemical concentrations do or may exceed Acute Exposure Guideline Levels (AEGLs) or similar guidelines. However, because AEGLs do not estimate expected risks, current unqualified claims that such maps support consequence management are misleading. Intentionally protective, AEGLs incorporate various safety/uncertainty factors depending on scope and quality of chemical-specific toxicity data. Some of these factors are irrelevant, and others need to be modified, whenever resource constraints or exposure-scenario complexities require responders to make critical trade-off (triage) decisions in order to minimize expected casualties. AEGL-exceedance zones cannot consistently be aggregated, compared, or used to calculate expected casualties, and so may seriously misguide emergency response triage decisions. Methods and tools well established and readily available to support environmental health protection are not yet developed for chemically related environmental health triage. Effective triage decisions involving chemical risks require a new assessment approach that focuses on best estimates of likely casualties, rather than on upper plausible bounds of individual risk. If risk-based consequence management is to become a reality, federal agencies tasked with supporting emergency response must actively coordinate to foster new methods that can support effective environmental health triage.

  14. Mass-casualty victim "surge" management. Preparing for bombings and blast-related injuries with possibility of hazardous materials exposure.

    PubMed

    Severance, Harry W

    2002-01-01

    Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination of hospitals systems or whole communities. Federal agencies have been designated and federal mandates have been issued to address mass casualty events, but federal or even regional systems cannot respond in time to address the massive and immediate needs generated by an explosion. Local communities must take the lead in developing incident command systems for initial management of such events. Hospital and pre-hospital providers play a key role in such planning. Ultimate management and disposition of large numbers of casualties, especially if contaminated, cannot follow standard patient management protocols; new protocols are needed. To avoid a total, overwhelming break down of in-hospital resources, hospitals need to assume a lead role in addressing such issues in their local communities. PMID:12970967

  15. Scientific framework for research on disaster and mass casualty incident in Korea: building consensus using Delphi method.

    PubMed

    Kim, Chu Hyun; Park, Ju Ok; Park, Chang Bae; Kim, Seong Chun; Kim, Soo Jin; Hong, Ki Jeong

    2014-01-01

    We aimed to determine the scientific framework for research on disaster and mass casualty incident (MCI) in Korea, especially Korean terminology, feasible definition, and epidemiologic indices. The two staged policy Delphi method was performed by instructors of National Disaster Life Support (NDLS®) with the constructed questionnaire containing items based on the literature review. The first-stage survey was conducted by 11 experts through two rounds of survey for making issue and option. The second-stage survey was conducted by 35 experts for making a generalized group based consensus. Experts were selected among instructors of National Disaster Life Support Course. Through two staged Delphi survey experts made consensus: 1) the Korean terminology "jaenan" with "disaster" and "dajung-sonsang-sago" with "MCI"; 2) the feasible definition of "disaster" as the events that have an effect on one or more municipal local government area (city-county-district) or results in ≥ 10 of death or ≥ 50 injured victims; 3) the feasible definition of MCI as the events that result in ≥ 6 casualties including death; 4) essential 31 epidemiologic indices. Experts could determine the scientific framework in Korea for research on disaster medicine, considering the distinct characteristics of Korea and current research trends. PMID:24431916

  16. Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study.

    PubMed

    Klein, Kelly R; Pepe, Paul E; Burkle, Frederick M; Nagel, Nanci E; Swienton, Raymond E

    2008-09-01

    In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended. PMID:18769266

  17. Engaging Active Bystanders in Mass Casualty Events and Other Life-Threatening Emergencies: A Pilot Training Course Demonstration.

    PubMed

    Smith, Tracey O; Baker, Susan D; Roberts, Kathryn; Payne, Skip A

    2016-04-01

    Emerging research indicates the critical role members of the public can play in saving lives and reducing morbidity at the scene in the immediate aftermath of a disaster. It is anticipated that with training, more members of the public will be ready and able to assist should they be present at mass casualty events or other circumstances in which there are serious injuries or potential loss of life. This article describes a training course developed by multiple federal and nonfederal partners aimed at preparing the public to become "active bystanders" followed by a pilot demonstration project conducted by Medical Reserve Corps Units. The outcomes of the project indicated that the training was comprehensive and appropriate for members of the public with little or no first aid knowledge. National availability of the "Becoming an Active Bystander" training course is currently being planned. PMID:26841861

  18. Book review of "The Ethics of Coercion in Mass Casualty Medicine" by Griffin Trotter MD, PhD

    PubMed Central

    Singh, Sonal

    2007-01-01

    Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters.

  19. The Internet's role in a biodosimetric response to a radiation mass casualty event.

    PubMed

    Sugarman, S L; Livingston, G K; Stricklin, D L; Abbott, M G; Wilkins, R C; Romm, H; Oestreicher, U; Yoshida, M A; Miura, T; Moquet, J E; Di Giorgio, M; Ferrarotto, C; Gross, G A; Christiansen, M E; Hart, C L; Christensen, D M

    2014-05-01

    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. PMID:24667387

  20. Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack.

    PubMed

    Siegel, David; Younggren, Bradley N; Ness, Brian; Kvool, Valerie

    2003-05-01

    In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article. PMID:12775167

  1. Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study

    PubMed Central

    2014-01-01

    Background Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. Methods A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item’s importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. Results Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented. Conclusions This study is the first to produce an expert consensus on the

  2. Hospital management of mass radiological casualties: reassessing exposures from contaminated victims of an exploded radiological dispersal device.

    PubMed

    Smith, James M; Ansari, Armin; Harper, Frederick T

    2005-11-01

    One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event. PMID:16217195

  3. Hospital management of mass radiological casualties : reassessing exposures from contaminated victims of an exploded radiological dispersal device (RDD).

    SciTech Connect

    Ansari, Armin; Harper, Frederick Taylor; Smith, James M.

    2005-04-01

    One of the key issues in the aftermath of an exploded radiological dispersal device from a terrorist event is that of the contaminated victim and the concern among healthcare providers for the harmful exposures they may receive in treating patients, especially if the patient has not been thoroughly decontaminated. This is critically important in the event of mass casualties from a nuclear or radiological incident because of the essential rapidity of acute medical decisions and that those who have life- or limb-threatening injuries may have treatment unduly delayed by a decontamination process that may be unnecessary for protecting the health and safety of the patient or the healthcare provider. To estimate potential contamination of those exposed in a radiological dispersal device event, results were used from explosive aerosolization tests of surrogate radionuclides detonated with high explosives at the Sandia National Laboratories. Computer modeling was also used to assess radiation dose rates to surgical personnel treating patients with blast injuries who are contaminated with any of a variety of common radionuclides. It is demonstrated that exceptional but plausible cases may require special precautions by the healthcare provider, even while managing life-threatening injuries of a contaminated victim from a radiological dispersal device event.

  4. Design and characterisation of a novel in vitro skin diffusion cell system for assessing mass casualty decontamination systems.

    PubMed

    Matar, H; Larner, J; Kansagra, S; Atkinson, K L; Skamarauskas, J T; Amlot, R; Chilcott, R P

    2014-06-01

    The efficient removal of contaminants from the outer surfaces of the body can provide an effective means of reducing adverse health effects associated with incidents involving the accidental or deliberate release of hazardous materials. Showering with water is frequently used by first responders as a rapid method of mass casualty decontamination (MCD). However, there is a paucity of data on the generic effectiveness and safety of aqueous decontamination systems. To address these issues, we have developed a new in vitro skin diffusion cell system to model the conditions of a common MCD procedure ("ladder pipe system"). The new diffusion cell design incorporates a showering nozzle, an air sampling port for measurement of vapour loss and/aerosolisation, adjustable (horizontal to vertical) skin orientation and a circulating manifold system (to maintain a specified flow rate, temperature and pressure of shower water). The dermal absorption characteristics of several simulants (Invisible Red S, curcumin and methyl salicylate) measured with the new in vitro model were in good agreement with previous in vitro and in vivo studies. Moreover, these initial studies have indicated that whilst flow rate and water temperature are important factors for MCD, the presence of clothing during showering may (under certain circumstances) cause transfer and spreading of contaminants to the skin surface. PMID:24412538

  5. TRIAGE DOSE ASSESSMENT FOR PARTIAL-BODY EXPOSURE: DICENTRIC ANALYSIS

    PubMed Central

    Moroni, Maria; Pellmar, Terry C.

    2009-01-01

    Partial-body biodosimetry is likely to be required after a radiological or nuclear exposure. Clinical signs and symptoms, distribution of dicentrics in circulating blood cells, organ-specific biomarkers, physical signals in teeth and nails all can provide indications of non-homogeneous exposures. Organ specific biomarkers may provide early warning regarding physiological systems at risk after radiation injury. Use of a combination of markers and symptoms will be needed for clinical insights for therapeutic approaches. Analysis of dicentrics, a marker specific for radiation injury, is the “Gold standard” of biodosimetry and can reveal partial-body exposures. Automation of sample processing for dicentric analysis can increase throughput with customization of off-the-shelf technologies for cytogenetic sample processing and information management. Automated analysis of the metaphase spreads is currently limited but improvements are in development. Our efforts bridge the technological gaps to allow the use of dicentric chromosome assay (DCA) for risk-based stratification of mass casualties. This article summarizes current knowledge on partial-body cytogenetic dose assessment synthesizing information leading to the proposal of an approach to triage dose prediction in radiation mass casualties, based on equivalent whole-body doses under partial-body exposure conditions and assesses the validity of using this model. An initial screening using only 20 metaphase spreads per subject can confirm irradiation above 2-Gy. A subsequent increase to 50 metaphases improves dose determination to allow risk stratification for clinical triage. Metaphases evaluated for inhomogeneous distribution of dicentrics can reveal partial-body exposures. We tested the validity of this approach in an in vitro model that simulates partial-body irradiation by mixing irradiated and un-irradiated lymphocytes in various proportions. Our preliminary results support the notion that this approach will

  6. Developing and organizing a trauma system and mass casualty management: some useful observations from the israeli trauma model.

    PubMed

    Borgohain, B; Khonglah, T

    2013-01-01

    A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

  7. Dynamic 3D visual analytic tools: a method for maintaining situational awareness during high tempo warfare or mass casualty operations

    NASA Astrophysics Data System (ADS)

    Lizotte, Todd E.

    2010-04-01

    Maintaining Situational Awareness (SA) is crucial to the success of high tempo operations, such as war fighting and mass casualty events (bioterrorism, natural disasters). Modern computer and software applications attempt to provide command and control manager's situational awareness via the collection, integration, interrogation and display of vast amounts of analytic data in real-time from a multitude of data sources and formats [1]. At what point does the data volume and displays begin to erode the hierarchical distributive intelligence, command and control structure of the operation taking place? In many cases, people tasked with making decisions, have insufficient experience in SA of high tempo operations and become overwhelmed easily as vast amounts of data begin to be displayed in real-time as an operation unfolds. In these situations, where data is plentiful and the relevance of the data changes rapidly, there is a chance for individuals to target fixate on those data sources they are most familiar. If these individuals fall into this type of pitfall, they will exclude other data that might be just as important to the success of the operation. To counter these issues, it is important that the computer and software applications provide a means for prompting its users to take notice of adverse conditions or trends that are critical to the operation. This paper will discuss a new method of displaying data called a Crisis ViewTM, that monitors critical variables that are dynamically changing and allows preset thresholds to be created to prompt the user when decisions need to be made and when adverse or positive trends are detected. The new method will be explained in basic terms, with examples of its attributes and how it can be implemented.

  8. Developing and Organizing a Trauma System and Mass Casualty Management: Some Useful Observations from the Israeli Trauma Model

    PubMed Central

    Borgohain, B; Khonglah, T

    2013-01-01

    A trauma system is a chain of arrangements and preparedness to provide quality response to injured from the site of injury to the appropriate hospital for the full range of care. Israel has a unique trauma system developed from the experience gained in peace and in war. The system is designed to fit the state's current health system, which is different from the European and American systems. An effective trauma system may potentially manage mass casualty incidence better. The aim of this paper is to discuss learning points to develop a trauma system based on the Israeli trauma model. After participating in a course on developing a trauma system organized by a top Israeli trauma center, a literature search on the topic on the Internet was done using relevant key words like trauma system and disaster management in Israel using the Google search engine in the pubmed, open access journals and websites of trauma organizations. Israel has a unique trauma system of organizing and managing an emergency event, characterized by a central national organization responsible for management, coordination and ongoing quality control. Because of its unique geopolitical situation, the armed forces has a significant role in the system. Investing adequate resources on continuous education, manpower training, motivation, team-work and creation of public volunteers through advocacy is important for capacity building to develop a trauma system. Wisdom, motivation and pragmatism of the Israeli model may be useful to streamline work in skeletal trauma services of developing countries having fewer resources to bring consistency and acceptable standards in trauma care. PMID:23634336

  9. The Boston Marathon Bombings Mass Casualty Incident: One Emergency Department's Information Systems Challenges and Opportunities.

    PubMed

    Landman, Adam; Teich, Jonathan M; Pruitt, Peter; Moore, Samantha E; Theriault, Jennifer; Dorisca, Elizabeth; Harris, Sheila; Crim, Heidi; Lurie, Nicole; Goralnick, Eric

    2015-07-01

    Emergency department (ED) information systems are designed to support efficient and safe emergency care. These same systems often play a critical role in disasters to facilitate real-time situation awareness, information management, and communication. In this article, we describe one ED's experiences with ED information systems during the April 2013 Boston Marathon bombings. During postevent debriefings, staff shared that our ED information systems and workflow did not optimally support this incident; we found challenges with our unidentified patient naming convention, real-time situational awareness of patient location, and documentation of assessments, orders, and procedures. As a result, before our next mass gathering event, we changed our unidentified patient naming convention to more clearly distinguish multiple, simultaneous, unidentified patients. We also made changes to the disaster registration workflow and enhanced roles and responsibilities for updating electronic systems. Health systems should conduct disaster drills using their ED information systems to identify inefficiencies before an actual incident. ED information systems may require enhancements to better support disasters. Newer technologies, such as radiofrequency identification, could further improve disaster information management and communication but require careful evaluation and implementation into daily ED workflow. PMID:24997562

  10. Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

    PubMed Central

    2009-01-01

    Background Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations. Methods The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission. Results From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene. Conclusions The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI. PMID:20149987

  11. Medical triage in the post-Cold War era.

    PubMed

    Jeffer, E K

    1994-05-01

    Military medicine is caught at the confluence of two major currents of change. The Department of Defense and the American system of health care are both undergoing major revisions. Triage was a key operational concept for patient care during the Cold War era. With the changed world situation, the author suggests new operational concepts including the relegation of triage to a marginal role in wartime care. The author argues that increasing the ratio of medical personnel to combat troops is consistent with a changed national perspective on wartime casualties. PMID:14620409

  12. [Organizational problems of disaster victim identification in mass casualties as exemplified by Tu 154-M and Airbus A310 passenger plane crashes].

    PubMed

    Volkov, A V; Kolkutin, V V; Klevno, V A; Shkol'nikov, B V; Kornienko, I V

    2008-01-01

    Managerial experience is described that was gained during the large-scale work on victim identification following mass casualties in the Tu 154-M and Airbus A310 passenger plane crashes. The authors emphasize the necessity to set up a specialized agency of constant readiness meeting modern requirements for the implementation of a system of measures for personality identification. This agency must incorporate relevant departments of the Ministries of Health, Defense, and Emergency Situations as well as investigative authorities and other organizations. PMID:19048869

  13. Development of a High-Throughput and Miniaturized Cytokinesis-Block Micronucleus Assay for Use as a Biological Dosimetry Population Triage Tool

    PubMed Central

    Lue, Stanley W.; Repin, Mikhail; Mahnke, Ryan; Brenner, David J.

    2015-01-01

    Biodosimetry is an essential tool for providing timely assessments of radiation exposure. For a large mass-casualty event involving exposure to ionizing radiation, it is of utmost importance to rapidly provide dose information for medical treatment. The well-established cytokinesis-block micronucleus (CBMN) assay is a validated method for biodosimetry. However, the need for an accelerated sample processing is required for the CBMN assay to be a suitable population triage tool. We report here on the development of a high-throughput and miniaturized version of the CMBN assay for accelerated sample processing. PMID:26230078

  14. Biological dosimetry intercomparison exercise: an evaluation of triage and routine mode results by robust methods.

    PubMed

    Di Giorgio, M; Barquinero, J F; Vallerga, M B; Radl, A; Taja, M R; Seoane, A; De Luca, J; Oliveira, M Stuck; Valdivia, P; Lima, O García; Lamadrid, A; Mesa, J González; Aguilera, I Romero; Cardoso, T Mandina; Carvajal, Y C Guerrero; Maldonado, C Arceo; Espinoza, M E; Martínez-López, W; Méndez-Acuña, L; Di Tomaso, M V; Roy, L; Lindholm, C; Romm, H; Güçlü, I; Lloyd, D C

    2011-05-01

    Well-defined protocols and quality management standards are indispensable for biological dosimetry laboratories. Participation in periodic proficiency testing by interlaboratory comparisons is also required. This harmonization is essential if a cooperative network is used to respond to a mass casualty event. Here we present an international intercomparison based on dicentric chromosome analysis for dose assessment performed in the framework of the IAEA Regional Latin American RLA/9/054 Project. The exercise involved 14 laboratories, 8 from Latin America and 6 from Europe. The performance of each laboratory and the reproducibility of the exercise were evaluated using robust methods described in ISO standards. The study was based on the analysis of slides from samples irradiated with 0.75 (DI) and 2.5 Gy (DII). Laboratories were required to score the frequency of dicentrics and convert them to estimated doses, using their own dose-effect curves, after the analysis of 50 or 100 cells (triage mode) and after conventional scoring of 500 cells or 100 dicentrics. In the conntional scoring, at both doses, all reported frequencies were considered as satisfactory, and two reported doses were considered as questionable. The analysis of the data dispersion among the dicentric frequencies and among doses indicated a better reproducibility for estimated doses (15.6% for DI and 8.8% for DII) than for frequencies (24.4% for DI and 11.4% for DII), expressed by the coefficient of variation. In the two triage modes, although robust analysis classified some reported frequencies or doses as unsatisfactory or questionable, all estimated doses were in agreement with the accepted error of ±0.5 Gy. However, at the DI dose and for 50 scored cells, 5 out of the 14 reported confidence intervals that included zero dose and could be interpreted as false negatives. This improved with 100 cells, where only one confidence interval included zero dose. At the DII dose, all estimations fell within

  15. Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs

    PubMed Central

    Cibulsky, Susan M; Sokolowski, Danny; Lafontaine, Marc; Gagnon, Christine; Blain, Peter G.; Russell, David; Kreppel, Helmut; Biederbick, Walter; Shimazu, Takeshi; Kondo, Hisayoshi; Saito, Tomoya; Jourdain, Jean- René; Paquet, Francois; Li, Chunsheng; Akashi, Makoto; Tatsuzaki, Hideo; Prosser, Lesley

    2015-01-01

    Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people.  Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities.  Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident.  Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents.  Furthermore, the identity of the hazardous material released may not be known early in an incident.  Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents.  Experts from the Global Health Security Initiative’s Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident. PMID:26635995

  16. Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs.

    PubMed

    Cibulsky, Susan M; Sokolowski, Danny; Lafontaine, Marc; Gagnon, Christine; Blain, Peter G; Russell, David; Kreppel, Helmut; Biederbick, Walter; Shimazu, Takeshi; Kondo, Hisayoshi; Saito, Tomoya; Jourdain, Jean-René; Paquet, Francois; Li, Chunsheng; Akashi, Makoto; Tatsuzaki, Hideo; Prosser, Lesley

    2015-01-01

    Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people.  Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities.  Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident.  Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents.  Furthermore, the identity of the hazardous material released may not be known early in an incident.  Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents.  Experts from the Global Health Security Initiative's Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident. PMID:26635995

  17. Design and evaluation of a wireless electronic health records system for field care in mass casualty settings

    PubMed Central

    Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T C

    2011-01-01

    Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

  18. Development of the science of mass casualty incident management: reflection on the medical response to the Wenchuan earthquake and Hangzhou bus fire*

    PubMed Central

    Shen, Wei-feng; Jiang, Li-bing; Jiang, Guan-yu; Zhang, Mao; Ma, Yue-feng; He, Xiao-jun

    2014-01-01

    Objective: In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management. Methods: We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: ‘mass casualty incident’, ‘MCI’, ‘research method’, ‘Wenchuan’, ‘earthquake’, ‘research paradigm’, ‘science of surge’, ‘surge’, ‘surge capacity’, and ‘vulnerability’. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results: The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored—vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions: This new paradigm breaks through the

  19. Earthquakes and trauma: review of triage and injury-specific, immediate care.

    PubMed

    Gautschi, Oliver P; Cadosch, Dieter; Rajan, Gunesh; Zellweger, René

    2008-01-01

    Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available. PMID:18557301

  20. Effect of Triage Training on Concordance of Triage Level between Triage Nurses and Emergency Medical Technicians

    PubMed Central

    Ghanbarzehi, Nezare; Balouchi, Abbas; Darban, Fatemeh; Khayat, Nastaran Haydari

    2016-01-01

    Introduction The transfer of care occurs frequently between emergency medical technicians and emergency ward nurses during which emergency medical technicians transfer the patients from the society to the hospital. This transfer of care often occurs under crowded conditions and in high acuity which would pave the way for a disruption of communication. Aim This study aimed to investigate the effect of training Emergency Severity Index (ESI) triage on concordance of triage level between emergency medical technicians and triage nurses. Materials and Methods This interventional study was conducted on all triage nurses and emergency medical technicians in Iranshahr City in winter of 2014. Five triage nurses and 30 emergency medical technicians were included into the study using census. To collect data, Personal Information Form (PIF) and ESI Triage Criterion were used. During the project implementation, patients were separately classified before and after triage training by emergency medical technicians and triage nurses. To analyse the data, kappa coefficient under SPSS 16 statistical software was used. Results According to the study results, Cohen’s kappa concordance coefficient showed that triage concordance between emergency medical technicians and triage nurses before training was 0.20 which was at an unfavorable level. After training, Cohen’s kappa concordance coefficient reached 0.62, which showed a desirable level of concordance as well as a significant difference after training. Conclusion It is recommended to train and use common triage system to facilitate transfer or delivery of care between emergency medical technicians and triage nurses.

  1. Challenges of major incident management when excess resources are allocated: experiences from a mass casualty incident after roof collapse of a military command center.

    PubMed

    Romundstad, Luis; Sundnes, Knut Ole; Pillgram-Larsen, Johan; Røste, Geir K; Gilbert, Mads

    2004-01-01

    During a military exercise in northern Norway in March 2000, the snow-laden roof of a command center collapsed with 76 persons inside. Twenty-five persons were entrapped and/or buried under snow masses. There were three deaths. Seven patients had serious injuries, three had moderate injuries, and 16 had minor injuries. A military Convalescence Camp that had been set up in a Sports Hall 125 meters from the scene was reorganized as a causality clearing station. Officers from the Convalescence Camp initially organized search and rescue. In all, 417 persons took part in the rescue work with 36 ambulances, 17 helicopters, three ambulance airplanes and one transport plane available. Two ambulances, five helicopters and one transport aircraft were used. Four patients were evacuated to a civilian hospital and six to a field hospital. The stretcher and treatment teams initially could have been more effectively organized. As resources were ample, this was a mass casualty, not a disaster. Firm incident command prevented the influx of excess resources. PMID:15506256

  2. Medical response of a physician and two nurses to the mass-casualty event resulting in the Phi Phi Islands from the tsunami.

    PubMed

    Ammartyothin, Surasak; Ashkenasi, Issac; Schwartz, Dagan; Leiba, Adi; Nakash, Guy; Pelts, Rami; Goldberg, Avishay; Bar-Dayan, Yaron

    2006-01-01

    The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600-700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation ("C") problems, by controlling external hemorrhages. This decision was driven by the lack of equipment and personnel to deal with airway ("A") and breathing ("B") problems. In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communication facilities must be ensured; (2) clear, simple "evacuation plans" should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the disaster and emergency

  3. Incidence and Mortality Rates of Disasters and Mass Casualty Incidents in Korea: A Population-Based Cross-Sectional Study, 2000-2009

    PubMed Central

    Kim, Soo Jin; Shin, Sang Do; Lee, Seung Chul; Park, Ju Ok; Sung, Joohon

    2013-01-01

    The objective of study was to evaluate the incidence and mortality rates of disasters and mass casualty incidents (MCIs) over the past 10 yr in the administrative system of Korea administrative system and to examine their relationship with population characteristics. This was a population-based cross-sectional study. We calculated the nationwide incidence, as well as the crude mortality and injury incidence rates, of disasters and MCIs. The data were collected from the administrative database of the National Emergency Management Agency (NEMA) and from provincial fire departments from January 2000 to December 2009. A total of 47,169 events were collected from the NEMA administrative database. Of these events, 115 and 3,079 cases were defined as disasters and MCIs that occurred in Korea, respectively. The incidence of technical disasters/MCIs was approximately 12.7 times greater than that of natural disasters/MCIs. Over the past 10 yr, the crude mortality rates for disasters and MCIs were 2.36 deaths per 100,000 persons and 6.78 deaths per 100,000 persons, respectively. The crude injury incidence rates for disasters and MCIs were 25.47 injuries per 100,000 persons and 152 injuries per 100,000 persons, respectively. The incidence and mortality of disasters/MCIs in Korea seem to be low compared to that of trend around the world. PMID:23678255

  4. Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

    PubMed

    Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

    2015-06-01

    In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events. PMID:25868677

  5. Tsunami Casualty Model

    NASA Astrophysics Data System (ADS)

    Yeh, H.

    2007-12-01

    More than 4500 deaths by tsunamis were recorded in the decade of 1990. For example, the 1992 Flores Tsunami in Indonesia took away at least 1712 lives, and more than 2182 people were victimized by the 1998 Papua New Guinea Tsunami. Such staggering death toll has been totally overshadowed by the 2004 Indian Ocean Tsunami that claimed more than 220,000 lives. Unlike hurricanes that are often evaluated by economic losses, death count is the primary measure for tsunami hazard. It is partly because tsunamis kill more people owing to its short lead- time for warning. Although exact death tallies are not available for most of the tsunami events, there exist gender and age discriminations in tsunami casualties. Significant gender difference in the victims of the 2004 Indian Ocean Tsunami was attributed to women's social norms and role behavior, as well as cultural bias toward women's inability to swim. Here we develop a rational casualty model based on humans' limit to withstand the tsunami flows. The application to simple tsunami runup cases demonstrates that biological and physiological disadvantages also make a significant difference in casualty rate. It further demonstrates that the gender and age discriminations in casualties become most pronounced when tsunami is marginally strong and the difference tends to diminish as tsunami strength increases.

  6. Battlefield triage life signs detection techniques

    NASA Astrophysics Data System (ADS)

    Boric-Lubecke, Olga; Lin, Jenshan; Park, Byung-Kwon; Li, Changzhi; Massagram, Wansuree; Lubecke, Victor M.; Host-Madsen, Anders

    2008-04-01

    Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to obtain vital signs from live soldiers, and use this to prioritize which are in most urgent need of attention. Our team at Kai Sensors, University of Hawaii and University of Florida is developing Doppler radar heart sensing technology that provides the means to detect life signs, respiration and/or heart beat, at a distance, even for subjects lying motionless, e.g., unconscious subjects, wearing body armor, and hidden from direct view. Since this technology can deliver heart rate information with high accuracy, it may also enable the assessment of a subject's physiological and psychological state based on heart rate variability (HRV) analysis. Thus, the degree of a subject's injury may also be determined. The software and hardware developments and challenges for life signs detection and monitoring for battlefield triage will be discussed, including heart signal detection from all four sides of the human body, detection in the presence of body armor, and the feasibility of HRV parameter extraction.

  7. Operation Desert Shield: Medical aspects of weapons of mass destruction

    SciTech Connect

    Knudson, G.B. )

    1991-06-01

    The authors concern over possible use of weapons of mass destruction against U.S. forces in the Middle East has increased because Iraq has violated the Geneva Protocol of 1925 and the 1972 Biological Weapons Convention, attempted to acquire nuclear capability and delivery systems, and is reported to be developing biological weapons. The Army Medical Department has had no experience, since World War I, in the management and treatment of mass casualties contaminated by chemical agents, and has never treated casualties resulting from the use of nuclear or biological weapons used against our soldiers. Management and diagnosis of casualties will be complicated by their possible exposure to a mixture of chemical warfare and biological warfare agents. Triage is an essential aspect in the management of mass casualties since the number of injured patients will exceed the maximum medical capability to treat each patient on arrival. All levels of medical support must be prepared to protect themselves, their equipment and supplies, and their patients from contamination. In contaminated operations on the integrated battlefield, it will be of utmost importance to incorporate flexibility and innovation to match the medical and tactical situation.

  8. Diagnostic performance of Triage for benzodiazepines: urine analysis of the dose of therapeutic cases.

    PubMed

    Kurisaki, Emiko; Hayashida, Makiko; Nihira, Makoto; Ohno, Youkichi; Mashiko, Hirobumi; Okano, Takaaki; Niwa, Shin-ichi; Hiraiwa, Kouichi

    2005-09-01

    We evaluated the diagnostic performance of Triage for benzodiazepines in 74 urine specimens from outpatients given therapeutic doses of benzodiazepines and compared the results of EMIT assays. Results obtained in all urine samples were confirmed using liquid chromatography-mass spectrometry (LC-MS). Overall agreement between results of Triage and EMIT assays was 73%. All of the Triage-positive samples were also positive by EMIT assays. Results of Triage and EMIT assays were different for 20 samples obtained from patients given thienodiazepines (etizolam, brotizolam, and clotiazepam) and nitrobenzodiazepines (nitrazepam, flunitrazepam, and clonazepam). LC-MS confirmed parent drugs in urine specimens, consistent with the prescriptions of drugs. The low agreement between Triage and EMIT results in this study might be due to low sensitivity of Triage for thienodiazepines. Thienodiazines are frequently prescribed benzodiazepines, and Triage panel is the most frequently used screening kit in Japan. It should be noted that negative results obtained by a Triage test might not mean the absence of thienodiazepines. PMID:16168176

  9. Development of the triage, monitoring and treatment Handbook for Members of the Public Affected by Radiological Terrorism - A European Response

    SciTech Connect

    Kruse, P.; Rojas-Palma, C.

    2007-07-01

    European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario, the number of affected people can vary from a few to mass casualties. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. There is a need to develop practicable tools for the adequate response to such acts and more specifically to address European guidelines for triage, monitoring and treatment of exposed people. Although European countries have developed emergency response plans for nuclear accidents they have not all made plans for handling malevolent use of radioactive material. Indeed, there is a need to develop practical guidance on emergency response and medical treatment of the public affected by malevolent acts. Generic guidance on this topic has been published by international organisations. They are, however, not operational documents to be used in emergency situations. The Triage, Monitoring and Treatment (TMT) Handbook aims to strengthen the European ability to efficiently respond to malevolent acts in terms of protecting and treating exposed people. Part of the Handbook is also devoted to public information and communication issues which would contribute to public reassurance in emergency situations. The Handbook will be drafted by European and international experts before it is circulated to all emergency response institutions in Europe that would be a part of the handling of malevolent acts using radioactive material. The institutions would be given a 6 months consultation time with encouragement to test the draft Handbook in national exercises. A workshop will allow feedback from these end users on the content

  10. Challenges in presenting high dimensional data to aid in triage in the DARPA virtual soldier project.

    PubMed

    Boyd, A D; Wright, Z C; Ade, A S; Bookstein, F; Ogden, J C; Meixner, W; Athey, B D; Morris, T

    2005-01-01

    One of the goals of the DARPA Virtual Soldier Project is to aid the field medic in the triage of a casualty. In Phase I, we are currently collecting 12 baseline experimental physiological variables and a cardiac gated Computed Tomography (CT) imagery for use in an prototyping a futuristic electronic medical record, the "Holomer". We are using physiological models and Kalman filtering to aid in diagnosis and predict outcomes in relation to cardiac injury. The physiological modeling introduces another few hundred variables. Reducing the complexity of the above into easy-to-read text to aid in the triage by the field medic is the challenge with multiple display solutions. A description of the possible techniques follows. PMID:15718701

  11. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related casualties are reported in accordance with 46 CFR 197.484 and 197.486. ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Diving casualties. 146.40...

  12. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related casualties are reported in accordance with 46 CFR 197.484 and 197.486. ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Diving casualties. 146.40...

  13. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related casualties are reported in accordance with 46 CFR 197.484 and 197.486. ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Diving casualties. 146.40...

  14. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related casualties are reported in accordance with 46 CFR 197.484 and 197.486. ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Diving casualties. 146.40...

  15. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related casualties are reported in accordance with 46 CFR 197.484 and 197.486. ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Diving casualties. 146.40...

  16. The hematologist and radiation casualties.

    PubMed

    Dainiak, Nicholas; Waselenko, Jamie K; Armitage, James O; MacVittie, Thomas J; Farese, Ann M

    2003-01-01

    Since the terrorist attack of September 11, 2001, preparation by the health care system for an act of terrorism has been mandated by leaders of governments. Scenarios for terrorist acts involving radioactive material have been identified, and approaches to management (based on past experience from atomic weapons detonations and radiation accidents) have been developed. Because of their experience in managing patients with profound cytopenia and/or marrow aplasia, hematologists will be asked to play a significant role in evaluating and treating victims of mass accidental or deliberate exposure to radiation. This review provides a framework for understanding how radiation levels are quantified, how radiation alters the function of hematopoietic (and nonhematopoietic) cells and tissues, and how victims receiving a significant radiation dose can be identified and managed. In Section I, Dr. Nicholas Dainiak reviews four components of the Acute Radiation Syndrome: the hematopoietic, neurovascular, gastrointestinal and cutaneous subsyndromes. Clinical signs and symptoms are discussed for exposed individuals at the time of initial presentation (the prodromal phase) and during their course of disease (the manifest illness). In Section II, he presents clinical and laboratory methods to assess radiation doses, including time to onset and severity of vomiting, rate of decline in absolute blood lymphocyte count and the appearance of chromosome aberrations such as dicentrics and ring forms. Potential scenarios of a radiation terrorist event are reviewed, and methods for initial clinical assessment, triage, and early management of the acute radiation syndrome and its component subsyndromes are summarized. In Section III, Dr. Jamie Waselenko reviews the hematopoietic syndrome, and presents guidelines for the use of cytokine therapy, antibiotics, and supportive care that have been developed by the Strategic National Pharmaceutical Stockpile Working Group. Results of preclinical and

  17. Accountability Pressure, Academic Standards, and Educational Triage

    ERIC Educational Resources Information Center

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

    This study aims to determine whether educational accountability promotes educational triage. This study exploits a natural experiment in North Carolina in which standards increased first in math in 2006 and second in reading in 2008 to determine whether an increase in educational standards caused an increase in educational triage at the expense of…

  18. Nursing Software for Emergency Triage (NSET).

    PubMed

    Mandirola Brieux, H F; Guillen, S; La Rosa, F; Moreno, C; Benitez, S

    2015-01-01

    Determining the priority of attention in an Emergency Room (ER) has always been a difficult issue. Priority is determined with a simple triage system as people arrive at the hospital. It is important to establish how long they can wait for treatment. In order to obtain the best assessment of patients' conditions, we built a Nursing Software for Emergency Triage (NSET). The objective of this work was to assess the efficacy of the NSET versus the triage process without any software (TWS). Results showed that the NSET we built was a substantial help. With this software, we decreased significantly:1) the length of the triage system process, 2) the waiting time of patients in the waiting room, 3) the number of complaints and 4) the number of patients who walk away. In conclusion, the NSET improves and helps to define more accurately a patient's risk. NSET helps in the emergency department triage. PMID:26262244

  19. Integration of Affinity Selection-Mass Spectrometry and Functional Cell-Based Assays to Rapidly Triage Druggable Target Space within the NF-κB Pathway.

    PubMed

    Kutilek, Victoria D; Andrews, Christine L; Richards, Matthew P; Xu, Zangwei; Sun, Tianxiao; Chen, Yiping; Hashke, Andrew; Smotrov, Nadya; Fernandez, Rafael; Nickbarg, Elliott B; Chamberlin, Chad; Sauvagnat, Berengere; Curran, Patrick J; Boinay, Ryan; Saradjian, Peter; Allen, Samantha J; Byrne, Noel; Elsen, Nathaniel L; Ford, Rachael E; Hall, Dawn L; Kornienko, Maria; Rickert, Keith W; Sharma, Sujata; Shipman, Jennifer M; Lumb, Kevin J; Coleman, Kevin; Dandliker, Peter J; Kariv, Ilona; Beutel, Bruce

    2016-07-01

    The primary objective of early drug discovery is to associate druggable target space with a desired phenotype. The inability to efficiently associate these often leads to failure early in the drug discovery process. In this proof-of-concept study, the most tractable starting points for drug discovery within the NF-κB pathway model system were identified by integrating affinity selection-mass spectrometry (AS-MS) with functional cellular assays. The AS-MS platform Automated Ligand Identification System (ALIS) was used to rapidly screen 15 NF-κB proteins in parallel against large-compound libraries. ALIS identified 382 target-selective compounds binding to 14 of the 15 proteins. Without any chemical optimization, 22 of the 382 target-selective compounds exhibited a cellular phenotype consistent with the respective target associated in ALIS. Further studies on structurally related compounds distinguished two chemical series that exhibited a preliminary structure-activity relationship and confirmed target-driven cellular activity to NF-κB1/p105 and TRAF5, respectively. These two series represent new drug discovery opportunities for chemical optimization. The results described herein demonstrate the power of combining ALIS with cell functional assays in a high-throughput, target-based approach to determine the most tractable drug discovery opportunities within a pathway. PMID:26969322

  20. Child pedestrian casualties and deprivation.

    PubMed

    Green, James; Muir, Helen; Maher, Mike

    2011-05-01

    The existence of an association between child pedestrian accidents and socio-economic deprivation in Great Britain is well established. The factors driving this association are complex and difficult to isolate. This study uses accident prediction models to investigate the links between child pedestrian casualties and a range of environmental and socio-economic factors commonly linked to deprived areas and people. Separate models are constructed relating to the areas in which the children become casualties, and the areas in which the children reside. Significant socio-economic factors include: single-parenthood, reliance on income support, and crime; and environmental factors include domestic garden area, junction density and pedestrian and vehicular flow density. The study found that factors pertaining to the local environment were more prevalent in the models considering accident locations, whilst socio-economic factors were of greater influence in the residency model. PMID:21376859

  1. Eye casualty services in London

    PubMed Central

    Smith, H B; Daniel, C S; Verma, S

    2013-01-01

    The combined pressures of the European Working Time Directive, 4 h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London's 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London's two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76 034 patients in 2010/11) and 9.6% per year (to 31 128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel ‘referral pathway' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London's eye casualty services in the future. PMID:23370420

  2. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means— (a) Any casualty or accident involving...

  3. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means— (a) Any casualty or accident involving...

  4. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty...

  5. An Analysis of the Relationship between Casualty Risk Per Crash and Vehicle Mass and Footprint for Model Year 2000-2007 Light-Duty Vehicles

    SciTech Connect

    Wenzel, Tom

    2012-08-01

    NHTSA recently completed a logistic regression analysis (Kahane 2012) updating its 2003 and 2010 studies of the relationship between vehicle mass and US fatality risk per vehicle mile traveled (VMT). The new study updates the previous analyses in several ways: updated FARS data for 2002 to 2008 involving MY00 to MY07 vehicles are used; induced exposure data from police reported crashes in several additional states are added; a new vehicle category for car-based crossover utility vehicles (CUVs) and minivans is created; crashes with other light-duty vehicles are divided into two groups based on the crash partner vehicle’s weight, and a category for all other fatal crashes is added; and new control variables for new safety technologies and designs, such as electronic stability controls (ESC), side airbags, and methods to meet voluntary agreement to improve light truck compatibility with cars, are included.

  6. Nurse triage in theory and in practice.

    PubMed Central

    George, S; Read, S; Westlake, L; Williams, B; Pritty, P; Fraser-Moodie, A

    1993-01-01

    'Nurse Triage' refers to the formal process of early assessment of patients attending an accident and emergency (A&E) department by a trained nurse, to ensure that they receive appropriate attention, in a suitable location, with the requisite degree of urgency. The benefits claimed for nurse triage include better patient outcomes, through clinical management reaching those in greatest need of it first. A recent study of nurse triage in a British A&E department failed to demonstrate the benefits claimed: patients undergoing triage were delayed, especially those in the most urgent groups. No differences were noted between the two study groups in levels of satisfaction with the A&E process. The results brought forth criticism from all quarters. In this paper the points made by the critics are considered, and an attempt to answer them is made. PMID:8216599

  7. Contribution of forensic autopsy to scene reconstruction in mass fire casualties: a case of alleged arson on a floor consisting of small compartments in a building.

    PubMed

    Michiue, Tomomi; Ishikawa, Takaki; Oritani, Shigeki; Maeda, Hitoshi

    2015-01-01

    A fire is an important cause of mass disasters, involving various forensic issues. Before dawn on an early morning, 16 male visitors in their twenties to sixties were killed in a possibly incendiary fire at a 'private video parlor' consisting of small compartments in a building. The main causes of death as determined by forensic autopsy were acute carbon monoxide (CO) intoxication for all of the 15 found-dead victims, and hypoxic-ischemic encephalopathy following acute CO intoxication for a victim who died in hospital. Burns were mild (<20% of body surface) in most victims, except for three victims found between the entrance and the estimated fire-outbreak site; thus, identification was completed without difficulty, supported by DNA analysis. Blood carboxyhemoglobin saturation (COHb) was higher for victims found dead in the inner area. Blood cyanide levels were sublethal, moderately correlated to COHb, but were higher in victims found around the estimated fire-outbreak site. There was no evidence of thinner, alcohol or drug abuse, or an attack of disease as a possible cause of an accidental fire outbreak. These observations contribute to evidence-based reconstruction of the fire disaster, and suggest how deaths could have been prevented by appropriate disaster measures. PMID:25311374

  8. Inter-rater Reliability of Triages Performed by the Electronic Triage System

    PubMed Central

    Pourasghar, Faramarz; Daemi, Amin; Tabrizi, Jafar Sadegh; Ala, Alireza

    2015-01-01

    Objective: To examine the inter-rater reliability of triages performed by the Electronic Triage System (ETS) which has recently developed and used in hospital emergency department (ED). Methods: This cross-sectional study was conducted prospectively and studied 408 visitors of Tabriz Imam Reza hospital’s ED. The variables of interest were age, sex, nurse-assigned triage category, physician-assigned triage category, disease type (trauma, non-trauma), and the referred room within the ED. Cohen’s un-weighted kappa, linear weighted kappa, and quadratic weighted kappa were used to describe the reliability. Results: Un-weighted kappa observed to be 0.186 (95% CI: 0.123-0.249). Linear weighted kappa observed as 0.317 (95% CI: 0.251-0.384) and quadratic weighted kappa as 0.462 (95% CI: 0.336-0.589). In general, low agreement was seen between the triage nurses and ED physicians. For trauma patients and for those who were referred to the cardiopulmonary resuscitation room (CPR), all three types of kappa were higher than other visitors of the ED. Conclusion: Inter-rater reliability of the triages performed by the ETS observed as ranging from poor to moderate. Implementing interventions that would create a common language between nurses and physicians about the triage of the ED visitors seems necessary. The more agreement on the triage of trauma and CPR patients might be due to their condition and the more attention to them. PMID:27162918

  9. A pivot nurse at triage.

    PubMed

    Martin, Marie

    2012-01-01

    According to Drs Thom Mayer and Kirk Jensen, widely recognized experts in leadership, management, and customer service, "Improving patient flow essentially means patients spend exactly the right amount of time at every juncture in their journey through an organization, when you improve flow, you can serve more patients, with less effort and you can serve them better." 2 Recognizing that backups in the emergency department are a result of broken processes throughout the hospital is the first step in solving these problems. The most significant challenges are the prevailing attitudes that team triage and immediate bedding could not be done. Another challenge is the broad reaching nature of the issue. ED throughput is truly a system problem. As ED crowding worsens, it is important for departments to improve operations to promote patient throughput. No doubt, operational bottlenecks at the back end of the emergency department will ultimately lead to front-end delays. However, proficient patient processing at the ED front end can minimize the time to physician evaluation, increase patient satisfaction, and decrease totalED length of stay. PMID:22137757

  10. Human casualties in earthquakes: modelling and mitigation

    USGS Publications Warehouse

    Spence, R.J.S.; So, E.K.M.

    2011-01-01

    Earthquake risk modelling is needed for the planning of post-event emergency operations, for the development of insurance schemes, for the planning of mitigation measures in the existing building stock, and for the development of appropriate building regulations; in all of these applications estimates of casualty numbers are essential. But there are many questions about casualty estimation which are still poorly understood. These questions relate to the causes and nature of the injuries and deaths, and the extent to which they can be quantified. This paper looks at the evidence on these questions from recent studies. It then reviews casualty estimation models available, and finally compares the performance of some casualty models in making rapid post-event casualty estimates in recent earthquakes.

  11. Infrared imaging-based combat casualty care system

    NASA Astrophysics Data System (ADS)

    Davidson, James E., Sr.

    1997-08-01

    A Small Business Innovative Research (SBIR) contract was recently awarded to a start up company for the development of an infrared (IR) image based combat casualty care system. The company, Medical Thermal Diagnostics, or MTD, is developing a light weight, hands free, energy efficient uncooled IR imaging system based upon a Texas Instruments design which will allow emergency medical treatment of wounded soldiers in complete darkness without any type of light enhancement equipment. The principal investigator for this effort, Dr. Gene Luther, DVM, Ph.D., Professor Emeritus, LSU School of Veterinary Medicine, will conduct the development and testing of this system with support from Thermalscan, Inc., a nondestructive testing company experienced in IR thermography applications. Initial research has been done with surgery on a cat for feasibility of the concept as well as forensic research on pigs as a close representation of human physiology to determine time of death. Further such studies will be done later as well as trauma studies. IR images of trauma injuries will be acquired by imaging emergency room patients to create an archive of emergency medical situations seen with an infrared imaging camera. This archived data will then be used to develop training material for medical personnel using the system. This system has potential beyond military applications. Firefighters and emergency medical technicians could directly benefit from the capability to triage and administer medical care to trauma victims in low or no light conditions.

  12. Predicting casualties implied by TIPs

    NASA Astrophysics Data System (ADS)

    Trendafiloski, G.; Wyss, M.; Wyss, B. M.

    2009-12-01

    When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral

  13. Toxicokinetic Triage for Environmental Chemicals

    PubMed Central

    Wambaugh, John F.; Wetmore, Barbara A.; Pearce, Robert; Strope, Cory; Goldsmith, Rocky; Sluka, James P.; Sedykh, Alexander; Tropsha, Alex; Bosgra, Sieto; Shah, Imran; Judson, Richard; Thomas, Russell S.; Woodrow Setzer, R.

    2015-01-01

    Toxicokinetic (TK) models link administered doses to plasma, blood, and tissue concentrations. High-throughput TK (HTTK) performs in vitro to in vivo extrapolation to predict TK from rapid in vitro measurements and chemical structure-based properties. A significant toxicological application of HTTK has been “reverse dosimetry,” in which bioactive concentrations from in vitro screening studies are converted into in vivo doses (mg/kg BW/day). These doses are predicted to produce steady-state plasma concentrations that are equivalent to in vitro bioactive concentrations. In this study, we evaluate the impact of the approximations and assumptions necessary for reverse dosimetry and develop methods to determine whether HTTK tools are appropriate or may lead to false conclusions for a particular chemical. Based on literature in vivo data for 87 chemicals, we identified specific properties (eg, in vitro HTTK data, physico-chemical descriptors, and predicted transporter affinities) that correlate with poor HTTK predictive ability. For 271 chemicals we developed a generic HT physiologically based TK (HTPBTK) model that predicts non-steady-state chemical concentration time-courses for a variety of exposure scenarios. We used this HTPBTK model to find that assumptions previously used for reverse dosimetry are usually appropriate, except most notably for highly bioaccumulative compounds. For the thousands of man-made chemicals in the environment that currently have no TK data, we propose a 4-element framework for chemical TK triage that can group chemicals into 7 different categories associated with varying levels of confidence in HTTK predictions. For 349 chemicals with literature HTTK data, we differentiated those chemicals for which HTTK approaches are likely to be sufficient, from those that may require additional data. PMID:26085347

  14. Machine Learning for Biomedical Literature Triage

    PubMed Central

    Almeida, Hayda; Meurs, Marie-Jean; Kosseim, Leila; Butler, Greg; Tsang, Adrian

    2014-01-01

    This paper presents a machine learning system for supporting the first task of the biological literature manual curation process, called triage. We compare the performance of various classification models, by experimenting with dataset sampling factors and a set of features, as well as three different machine learning algorithms (Naive Bayes, Support Vector Machine and Logistic Model Trees). The results show that the most fitting model to handle the imbalanced datasets of the triage classification task is obtained by using domain relevant features, an under-sampling technique, and the Logistic Model Trees algorithm. PMID:25551575

  15. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a) Immediately after the addressing of...

  16. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident...

  17. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident...

  18. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident...

  19. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-1 Notice of marine casualty. (a) Immediately after the addressing of...

  20. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Fire and Casualty Damage... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease...

  1. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Fire and Casualty Damage... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease...

  2. 19 CFR 158.27 - Accidental fire or other casualty.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Accidental fire or other casualty. 158.27 Section... Casualty, Loss, or Theft While in Customs Custody § 158.27 Accidental fire or other casualty. In the case of injury or destruction by accidental fire or other casualty, the following evidence shall...

  3. 19 CFR 158.27 - Accidental fire or other casualty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Accidental fire or other casualty. 158.27 Section... Casualty, Loss, or Theft While in Customs Custody § 158.27 Accidental fire or other casualty. In the case of injury or destruction by accidental fire or other casualty, the following evidence shall...

  4. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or...

  5. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... accordance with paragraph (c) of this section, as soon as possible after the casualty, to the underwriter of... involved in the casualty; and (13) The monetary amount paid for an injury or a death. (d) A casualty to a... the casualty involves any of the following. (1) Loss of life. (2) An injury that requires...

  6. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Fire and Casualty Damage... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease...

  7. Adaption of the Cytokinesis-Block Micronucleus Cytome Assay for Improved Triage Biodosimetry.

    PubMed

    Beinke, C; Port, M; Riecke, A; Ruf, C G; Abend, M

    2016-05-01

    The purpose of this work was to adapt a more advanced form of the cytokinesis-block micronucleus (CBMN) cytome assay for triage biodosimetry in the event of a mass casualty radiation incident. We modified scoring procedures for the CBMN cytome assay to optimize field deployability, dose range, accuracy, speed, economy, simplicity and stability. Peripheral blood of 20 donors was irradiated in vitro (0-6 Gy X ray, maximum photon energy 240 keV) and processed for CBMN. Initially, we assessed two manual scoring strategies for accuracy: 1. Conventional scoring, comprised of micronucleus (MN) frequency per 1,000 binucleated (BN) cells (MN/1,000 BN cells); and 2. Evaluation of 1,000, 2,000 and 3,000 cells in total and different cellular subsets based on MN formation and proliferation (e.g., BN cells with and without MN, mononucleated cells). We used linear and logistic regression models to identify the cellular subsets related closest to dose with the best discrimination ability among different doses/dose categories. We validated the most promising subsets and their combinations with 16 blind samples covering a dose range of 0-8.3 Gy. Linear dose-response relationships comparable to the conventional CBMN assay (r(2) = 0.86) were found for BN cells with MN (r(2) = 0.84) and BN cells without MN (r(2) = 0.84). Models of combined cell counts (CCC) of BN cells with and without MN (BN(+MN) and BN(-MN)) with mononucleated cells (Mono) improved this relationship (r(2) = 0.92). Conventional CBMN discriminated dose categories up to 3 Gy with a concordance between 0.96-1.0 upon scoring 1,000 total cells. In 1,000 BN cells, concordances were observed for conventional CBMN up to 4 Gy as well as BN(+MN) or BN(-MN) (about 0.85). At doses of 4-6 Gy, the concordance of conventional CBMN, BN(+MN) and BN(-MN) declined (about 0.55). We found about 20% higher concordance and more precise dose estimates of irradiated and blinded samples for CCC (Mono + BN(+MN)) after scoring 1,000 total cells

  8. Accountability Incentives: Do Schools Practice Educational Triage?

    ERIC Educational Resources Information Center

    Springer, Matthew G.

    2008-01-01

    Increasingly frequent journalistic accounts report that schools are responding to No Child Left Behind (NCLB) by engaging in what has come to be known as "educational triage." Although these accounts rely almost entirely on anecdotal evidence, the prospect is of real concern. The NCLB accountability system divides schools into those in which a…

  9. Understanding combat casualty care statistics.

    PubMed

    Holcomb, John B; Stansbury, Lynn G; Champion, Howard R; Wade, Charles; Bellamy, Ronald F

    2006-02-01

    Maintaining good hospital records during military conflicts can provide medical personnel and researchers with feedback to rapidly adjust treatment strategies and improve outcomes. But to convert the resulting raw data into meaningful conclusions requires clear terminology and well thought out equations, utilizing consistent numerators and denominators. Our objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care. We first clarified three essential terms: 1) the case fatality rate (CFR) as percentage of fatalities among all wounded; 2) killed in action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty); and 3) died of wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty). These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism. Using this clear set of definitions we used the equations to ask two basic questions: What is the overall lethality of the battlefield? How effective is combat casualty care? To answer these questions with current data, the three services have collaboratively created a joint theater trauma registry (JTTR), cataloging all the serious injuries, procedures, and outcomes for the current war. These definitions and equations, consistently applied to the JTTR, will allow meaningful comparisons and help direct future research and appropriate application of personnel. PMID:16508502

  10. The fate of triaged and rejected manuscripts.

    PubMed

    Zoccali, Carmine; Amodeo, Daniela; Argiles, Angel; Arici, Mustafa; D'arrigo, Graziella; Evenepoel, Pieter; Fliser, Danilo; Fox, Jonathan; Gesualdo, Loreto; Jadoul, Michel; Ketteler, Markus; Malyszko, Jolanta; Massy, Ziad; Mayer, Gert; Ortiz, Alberto; Sever, Mehmet; Vanholder, Raymond; Vinck, Caroline; Wanner, Christopher; Więcek, Andrzej

    2015-12-01

    In 2011, Nephrology Dialysis and Transplantation (NDT) established a more restrictive selection process for manuscripts submitted to the journal, reducing the acceptance rate from 25% (2008-2009) to currently about 12-15%. To achieve this goal, we decided to score the priority of manuscripts submitted to NDT and to reject more papers at triage than in the past. This new scoring system allows a rapid decision for the authors without external review. However, the risk of such a restrictive policy may be that the journal might fail to capture important studies that are eventually published in higher-ranked journals. To look into this problem, we analysed random samples of papers (∼10%) rejected by NDT in 2012. Of the papers rejected at triage and those rejected after regular peer review, 59 and 61%, respectively, were accepted in other journals. A detailed analysis of these papers showed that only 4 out of 104 and 7 out of 93 of the triaged and rejected papers, respectively, were published in journals with an impact factor higher than that of NDT. Furthermore, for all these papers, independent assessors confirmed the evaluation made by the original reviewers. The number of citations of these papers was similar to that typically obtained by publications in the corresponding journals. Even though the analyses seem reassuring, previous observations made by leading journals warn that the risk of 'big misses', resulting from selective editorial policies, remains a real possibility. We will therefore continue to maintain a high degree of alertness and will periodically track the history of manuscripts rejected by NDT, particularly papers that are rejected at triage by our journal. PMID:26597920

  11. Simulated casualties and medics for emergency training.

    PubMed

    Chi, D M; Kokkevis, E; Ogunyemi, O; Bindiganavale, R; Hollick, M J; Clarke, J R; Webber, B L; Badler, N I

    1997-01-01

    The MediSim system extends virtual environment technology to allow medical personnel to interact with and train on simulated casualties. The casualty model employs a three-dimensional animated human body that displays appropriate physical and behavioral responses to injury and/or treatment. Medical corpsmen behaviors were developed to allow the actions of simulated medical personnel to conform to both military practice and medical protocols during patient assessment and stabilization. A trainee may initiate medic actions through a mouse and menu interface; a VR interface has also been created by Stansfield's research group at Sandia National Labs. PMID:10168943

  12. 46 CFR 122.260 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Marine Casualties and Voyage Records § 122.260 Reports of potential vessel casualty. (a) An owner... district rescue coordination center (RCC) cognizant over the area in which the vessel was last...

  13. The Role of Patients' Stories in Emergency Medicine Triage.

    PubMed

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience. PMID:26882466

  14. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by...

  15. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent,...

  16. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent,...

  17. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent,...

  18. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by...

  19. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by...

  20. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent,...

  1. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by...

  2. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Written report of marine casualty. 185.206 Section 185... 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine... of any marine casualty. This written report is in addition to the immediate notice required by...

  3. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Written report of marine casualty. 122.206 Section 122... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner, master, agent,...

  4. Diagnostic triage for sarcoma: an effective model for reducing referrals to the sarcoma multidisciplinary team

    PubMed Central

    Botchu, R; Ashford, R U; Rennie, W J

    2015-01-01

    Objective: Soft-tissue lesions are common and often benign. Owing to the rarity of soft-tissue sarcomas (STSs), evidence has shown that patients are increasingly referred urgently onto the 2-week wait pathway, which may have a detrimental impact on the management of patients with a proven STS. Imaging plays a vital role in lesion characterization and can be used to triage referrals to reduce the caseload of a sarcoma multidisciplinary team (MDT). In our institution, we established a sarcoma diagnostic triage meeting (SDTM). This study aimed to determine the effectiveness of the SDTM in reducing non-sarcomatous referrals to the main sarcoma MDT. Methods: A retrospective review of the SDTM minutes from July 2011 to June 2012 was performed. Data collected for each case included details of referrer, referral modality and referral outcome. Results: 165 cases were reviewed. 58% of referrals underwent a core biopsy or surgical excision with 85% benign pathology, the commonest being lipoma. 15% of referrals were sarcomatous lesions and were referred onwards to the main MDT. Conclusion: A total of 82% of the patients referred urgently with a suspicious soft-tissue mass was managed by the SDTM and hence not referred onwards to the East Midlands Sarcoma Service MDT. A diagnostic triage is effective in reducing the caseload burden of the main MDT and allowing it to be more effective. Advances in knowledge: Referrals based on imaging can be prioritized by diagnostic triage. Diagnostic triage established in our institution reduced 82% of MDT referrals allowing a more focused MDT discussion on patients with a proven sarcoma. PMID:25697295

  5. No Child Overlooked: Mental Health Triage in the Schools

    ERIC Educational Resources Information Center

    Wilson, F. Robert; Tang, Mei; Schiller, Kelly; Sebera, Kerry

    2009-01-01

    Mental health problems among children in schools are on the increase. To exercise due diligence in their responsibility to monitor and promote mental health among our nation's children, school counselors may learn from triage systems employed in hospitals, clinics, and mental health centers. The School Counselor's Triage Model provides school…

  6. Technology Staff Development: Triage Using Three Mastery Levels.

    ERIC Educational Resources Information Center

    Guffey, J. Stephen; Rampp, Lary C.; Bradley, Mary Jane

    The technology triage is a workable paradigm for straightforward school-site/school-district implementation of technology resources. Development of a triage system of participant involvement and in-service staff development can help address the tendency to ineffectively allocate funds within the total picture of the school commitment to…

  7. Availability of a pediatric trauma center in a disaster surge decreases triage time of the pediatric surge population: a population kinetics model

    PubMed Central

    2011-01-01

    Background The concept of disaster surge has arisen in recent years to describe the phenomenon of severely increased demands on healthcare systems resulting from catastrophic mass casualty events (MCEs) such as natural disasters and terrorist attacks. The major challenge in dealing with a disaster surge is the efficient triage and utilization of the healthcare resources appropriate to the magnitude and character of the affected population in terms of its demographics and the types of injuries that have been sustained. Results In this paper a deterministic population kinetics model is used to predict the effect of the availability of a pediatric trauma center (PTC) upon the response to an arbitrary disaster surge as a function of the rates of pediatric patients' admission to adult and pediatric centers and the corresponding discharge rates of these centers. We find that adding a hypothetical pediatric trauma center to the response documented in an historical example (the Israeli Defense Forces field hospital that responded to the Haiti earthquake of 2010) would have allowed for a significant increase in the overall rate of admission of the pediatric surge cohort. This would have reduced the time to treatment in this example by approximately half. The time needed to completely treat all children affected by the disaster would have decreased by slightly more than a third, with the caveat that the PTC would have to have been approximately as fast as the adult center in discharging its patients. Lastly, if disaster death rates from other events reported in the literature are included in the model, availability of a PTC would result in a relative mortality risk reduction of 37%. Conclusions Our model provides a mathematical justification for aggressive inclusion of PTCs in planning for disasters by public health agencies. PMID:21992575

  8. Multilocation teleradiology system for emergency triage consultation

    NASA Astrophysics Data System (ADS)

    Herron, John M.; Yonas, Howard

    1996-05-01

    A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

  9. Hospital preparedness for possible nonconventional casualties: an Israeli experience.

    PubMed

    Schreiber, Shaul; Yoeli, Naomi; Paz, Gedalia; Barbash, Gabriel I; Varssano, David; Fertel, Nurit; Hassner, Avi; Drory, Margalit; Halpern, Pinchas

    2004-01-01

    Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite

  10. The Tactical Combat Casualty Care Casualty Card TCCC Guidelines ? Proposed Change 1301.

    PubMed

    Kotwal, Russ S; Butler, Frank K; Montgomery, Harold R; Brunstetter, Tyson J; Diaz, George Y; Kirkpatrick, James W; Summers, Nancy L; Shackelford, Stacy A; Holcomb, John B; Bailey, Jeffrey A

    2013-01-01

    Optimizing trauma care delivery is paramount to saving lives on the battlefield. During the past decade of conflict, trauma care performance improvement at combat support hospitals and forward surgical teams in Afghanistan and Iraq has increased through Joint Trauma System and DoD Trauma Registry data collection, analysis, and rapid evidence-based adjustments to clinical practice guidelines. Although casualties have benefitted greatly from a trauma system and registry that improves hospital care, still lacking is a comprehensive and integrated system for data collection and analysis to improve performance at the prehospital level of care. Tactical Combat Casualty Care (TCCC) based casualty cards, TCCC after action reports, and unit-based prehospital trauma registries need to be implemented globally and linked to the DoD Trauma Registry in a seamless manner that will optimize prehospital trauma care delivery. PMID:23877773

  11. The effects of computerized triage on nurse work behavior.

    PubMed

    Levin, Scott; France, Daniel; Mayberry, R Scott; Stonemetz, Shannon; Jones, Ian; Aronsky, Dominik

    2006-01-01

    The complex work processes and communication patterns exhibited in Emergency Medicine may be effectively managed through the use of information technology. These tools must be evaluated within the work environment to understand their effects on work flow, information flow, and patient safety. In this study the efficiency of the Emergency Department triage process was evaluated pre- and post- implementation of a computerized triage system. Time-and-motion analyses revealed no changes in triage documentation time; however, the duration of interruptions and the number of tasks decreased significantly. PMID:17238624

  12. Holter triage ambulatory ECG analysis. Accuracy and time efficiency.

    PubMed

    Cooper, D H; Kennedy, H L; Lyyski, D S; Sprague, M K

    1996-01-01

    Triage ambulatory electrocardiographic (ECG) analysis permits relatively unskilled office workers to submit 24-hour ambulatory ECG Holter tapes to an automatic instrument (model 563, Del Mar Avionics, Irvine, CA) for interpretation. The instrument system "triages" what it is capable of automatically interpreting and rejects those tapes (with high ventricular arrhythmia density) requiring thorough analysis. Nevertheless, a trained cardiovascular technician ultimately edits what is accepted for analysis. This study examined the clinical validity of one manufacturer's triage instrumentation with regard to accuracy and time efficiency for interpreting ventricular arrhythmia. A database of 50 Holter tapes stratified for frequency of ventricular ectopic beats (VEBs) was examined by triage, conventional, and full-disclosure hand-count Holter analysis. Half of the tapes were found to be automatically analyzable by the triage method. Comparison of the VEB accuracy of triage versus conventional analysis using the full-disclosure hand count as the standard showed that triage analysis overall appeared as accurate as conventional Holter analysis but had limitations in detecting ventricular tachycardia (VT) runs. Overall sensitivity, positive predictive accuracy, and false positive rate for the triage ambulatory ECG analysis were 96, 99, and 0.9%, respectively, for isolated VEBs, 92, 93, and 7%, respectively, for ventricular couplets, and 48, 93, and 7%, respectively, for VT. Error in VT detection by triage analysis occurred on a single tape. Of the remaining 11 tapes containing VT runs, accuracy was significantly increased, with a sensitivity of 86%, positive predictive accuracy of 90%, and false positive rate of 10%. Stopwatch-recorded time efficiency was carefully logged during both triage and conventional ambulatory ECG analysis and divided into five time phases: secretarial, machine, analysis, editing, and total time. Triage analysis was significantly (P < .05) more time

  13. [Preclinical and clinical management after mass disaster : Experiences from the train collision in Bad Aibling on 9 February 2016].

    PubMed

    Regel, G; Bracht, M; Huth, M; Maier, K J; Böcker, W

    2016-06-01

    Mass casualty incidents (MCI) in this day and age represent a special challenge, which initially require on-site coordination and logistics and then a professional distribution of victims (triage) to surrounding hospitals. Technical, logistical and even specialist errors can impair this flow of events. It therefore seems advisable to make a detailed analysis of every MCI. In this article the railway incident from 9 February 2016 is analyzed taking the preclinical and clinical cirumstances into consideration and conclusions for future management are drawn. As a special entity it could be determined that fixed table units in passenger trains represent a particularly dangerous hazard and in many instances in this analysis led to characteristic abdominal and thoracic injuries. PMID:27225168

  14. Field deployable EEG monitor for nerve agent casualties.

    PubMed

    McDonnall, Daniel; Hiatt, Scott; Yatsenko, Dimitri; Guillory, K Shane

    2009-01-01

    Early recognition and aggressive management of seizure activity is important in the treatment of patients with nerve agent exposure. However, these patients can experience non-convulsive seizures that are difficult to identify without EEG monitoring. In this paper, we discuss the development and testing of a low-cost, field-deployable device that records and displays patient EEG trends over time. The device is optimized for early levels of care for military and mass casualty patients until they can be relocated to medical facilities with more comprehensive monitoring. The device also records pulse oximetry and acceleration information, and patient data are available for later analysis and improvement of treatment protocols. PMID:19964118

  15. Analysis of driver casualty risk for different work zone types.

    PubMed

    Weng, Jinxian; Meng, Qiang

    2011-09-01

    Using driver casualty data from the Fatality Analysis Report System, this study examines driver casualty risk and investigates the risk contributing factors in the construction, maintenance and utility work zones. The multiple t-tests results show that the driver casualty risk is statistically different depending on the work zone type. Moreover, construction work zones have the largest driver casualty risk, followed by maintenance and utility work zones. Three separate logistic regression models are developed to predict driver casualty risk for the three work zone types because of their unique features. Finally, the effects of risk factors on driver casualty risk for each work zone type are examined and compared. For all three work zone types, five significant risk factors including road alignment, truck involvement, most harmful event, vehicle age and notification time are associated with increased driver casualty risk while traffic control devices and restraint use are associated with reduced driver casualty risk. However, one finding is that three risk factors (light condition, gender and day of week) exhibit opposing effects on the driver casualty risk in different types of work zones. This may largely be due to different work zone features and driver behavior in different types of work zones. PMID:21658509

  16. Web-Based Triage in a College Health Setting

    ERIC Educational Resources Information Center

    Sole, Mary Lou; Stuart, Patricia L.; Deichen, Michael

    2006-01-01

    The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours;…

  17. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... GENERAL PROVISIONS Commercial Diving Operations Records § 197.484 Notice of casualty. (a) In addition to the requirements of subpart 4.05 of this chapter and 33 CFR 146.30, the person-in-charge shall notify the Officer-in-Charge, Marine Inspection, as soon as possible after a diving casualty occurs, if...

  18. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... GENERAL PROVISIONS Commercial Diving Operations Records § 197.484 Notice of casualty. (a) In addition to the requirements of subpart 4.05 of this chapter and 33 CFR 146.30, the person-in-charge shall notify the Officer-in-Charge, Marine Inspection, as soon as possible after a diving casualty occurs, if...

  19. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the requirements of subpart 4.05 of this chapter and 33 CFR 146.30, the person-in-charge shall notify... casualty involves any of the following: (1) Loss of life. (2) Diving-related injury to any person causing... casualty including presumed cause. (6) Nature and extent of the injury to persons. (c) The notice...

  20. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section...) Describes the casualty, including the date and time; (3) Describes the nature and extent of injury to...-2692 for casualties resulting in property damage, personnel injury, or loss of life. (c) If filed...

  1. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the requirements of subpart 4.05 of this chapter and 33 CFR 146.30, the person-in-charge shall notify... casualty involves any of the following: (1) Loss of life. (2) Diving-related injury to any person causing... casualty including presumed cause. (6) Nature and extent of the injury to persons. (c) The notice...

  2. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... GENERAL PROVISIONS Commercial Diving Operations Records § 197.484 Notice of casualty. (a) In addition to the requirements of subpart 4.05 of this chapter and 33 CFR 146.30, the person-in-charge shall notify the Officer-in-Charge, Marine Inspection, as soon as possible after a diving casualty occurs, if...

  3. The Casualty Actuarial Society: Helping Universities Train Future Actuaries

    ERIC Educational Resources Information Center

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

    The Casualty Actuarial Society (CAS) believes that the most effective way to advance the actuarial profession is to work in partnership with universities. The CAS stands ready to assist universities in creating or enhancing courses and curricula associated with property/casualty actuarial science. CAS resources for university actuarial science…

  4. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Retention of records after casualty. 109.415 Section 109.415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Reports, Notifications, and Records Reports and Notifications § 109.415 Retention of records after casualty. (a) The owner,...

  5. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS... casualty. (a) The owner, agent, master, or person in charge of a unit for which a report of casualty is... Charge, Marine Inspection, that records need not be retained on board. (b) The records which must...

  6. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 2 2014-04-01 2014-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty...

  7. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty...

  8. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty...

  9. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty...

  10. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty...

  11. Multibiodose radiation emergency triage categorization software.

    PubMed

    Ainsbury, Elizabeth A; Barnard, Stephen; Barrios, Lleonard; Fattibene, Paola; de Gelder, Virginie; Gregoire, Eric; Lindholm, Carita; Lloyd, David; Nergaard, Inger; Rothkamm, Kai; Romm, Horst; Scherthan, Harry; Thierens, Hubert; Vandevoorde, Charlot; Woda, Clemens; Wojcik, Andrzej

    2014-07-01

    In this note, the authors describe the MULTIBIODOSE software, which has been created as part of the MULTIBIODOSE project. The software enables doses estimated by networks of laboratories, using up to five retrospective (biological and physical) assays, to be combined to give a single estimate of triage category for each individual potentially exposed to ionizing radiation in a large scale radiation accident or incident. The MULTIBIODOSE software has been created in Java. The usage of the software is based on the MULTIBIODOSE Guidance: the program creates a link to a single SQLite database for each incident, and the database is administered by the lead laboratory. The software has been tested with Java runtime environment 6 and 7 on a number of different Windows, Mac, and Linux systems, using data from a recent intercomparison exercise. The Java program MULTIBIODOSE_1.0.jar is freely available to download from http://www.multibiodose.eu/software or by contacting the software administrator: MULTIBIODOSE-software@gmx.com. PMID:24849907

  12. Development of a lightweight portable ventilator for far-forward battlefield combat casualty support

    NASA Astrophysics Data System (ADS)

    Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. Alex

    1999-07-01

    Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

  13. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    PubMed

    Spano, Susanne J; Campagne, Danielle; Stroh, Geoff; Shalit, Marc

    2015-03-01

    Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued. PMID:25281586

  14. Medical triage for WMD incidents incidents: an adaptation of daily triage.

    PubMed

    Donohue, Dave

    2008-05-01

    It's 2000 HRS on a Friday evening. You're assigned to an ALS engine company, and you're just settling down after a busy day when you're dispatched along with a BLS ambulance to a report of a sick person outside a local club where they're holding a concert. During your response, dispatch advises that they're receiving multiple calls on the incident and are dispatching a second BLS ambulance to the call. * As you turn the corner and approach the scene, you notice a haze in the air coming from an industrial site on the same side of the street and see approximately 200 people exiting the club in haste. Several dozen patrons line the street between the club and the subway station. They're coughing and crying, and several are vomiting. * The driver stops the engine in front of the subway entrance, which is located approximately 500 feet from the club and uphill and upwind from the haze. The scene is overwhelming, even to the captain, who turns to you-as the paramedic on the crew-and asks what you want done first. Your first thought is, Triage. But you know that triaging these patients is more complicated than your everyday two-car collision. PMID:18482652

  15. Higher Education: A Time for Triage?

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

  16. Higher Education: A Time for Triage?

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

  17. The development of an obstetric triage acuity tool.

    PubMed

    Paisley, Kathleen S; Wallace, Ruth; DuRant, Patricia G

    2011-01-01

    The purpose of this article is to describe the journey a multicampus hospital system took to improve the obstetric triage process. A review of literature revealed no current comprehensive obstetric acuity tool, and thus our team developed a tool with a patient flow process, revised and updated triage nurse competencies, and then educated the nurses about the new tool and process. Data were collected to assess the functionality of the new process in assigning acuity upon patient arrival, conveying appropriate acuities based on patient complaints, and initiating the medical screening examination, all within prescribed time intervals. Initially data indicated that processes were still not optimal, and re-education was provided for all triage nurses. This improved all data points. The result of this QI project is that our patients are now seen based on their acuity within designated time frames. PMID:21857199

  18. An integrated computerized triage system in the emergency department.

    PubMed

    Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

    2008-01-01

    Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medi-cation reconciliation application. The application includes decision support capabilities such as assessing the patients acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institutions controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >140,000 pediatric and adult patients. PMID:18999190

  19. Competitive concerns bring PAs, NPs into triage area.

    PubMed

    2008-06-01

    The ED at Harborview Medical Center in Seattle has proven new competition doesn't have to mean a loss of business or staff members. They moved physician assistants (PAs) and nurse practitioners (NPs) into triage to compete with urgent care clinics. When you have a hard time attracting midlevel practitioners, examine the local market to see who is recruiting them. Create a small, separate area in triage where midlevel practitioners can treat patients with less serious conditions. Be flexible with the number of hours the PAs and NPs work. Be prepared to expand their hours as demand increases. PMID:18807298

  20. Employees’ views on home-based, after-hours telephone triage by Dutch GP cooperatives

    PubMed Central

    2013-01-01

    Background Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. Methods The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. Results We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Conclusion Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage. PMID:24188407

  1. 46 CFR 185.260 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.260 Reports of potential... imperiled: (1) The Coast Guard district rescue coordination center (RCC) cognizant over the area in...

  2. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or... until advised by the Officer-in-Charge, Marine Inspection, that records need not be retained onboard....

  3. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... casualty; (5) Gives the name, address, and phone number of persons involved in or witnessing the...

  4. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... casualty; (5) Gives the name, address, and phone number of persons involved in or witnessing the...

  5. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or... until advised by the Officer-in-Charge, Marine Inspection, that records need not be retained onboard....

  6. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or... until advised by the Officer-in-Charge, Marine Inspection, that records need not be retained onboard....

  7. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or... until advised by the Officer-in-Charge, Marine Inspection, that records need not be retained onboard....

  8. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or... until advised by the Officer-in-Charge, Marine Inspection, that records need not be retained onboard....

  9. Therapeutic Assessment in Psychological Triage Using the PAI.

    PubMed

    Brown, Joshua D; Morey, Leslie C

    2016-01-01

    This case illustrates the utility of incorporating therapeutic assessment in a triage context that typically involves a focus on gathering information. A man referred to our clinic by a local mental health center was seen by our assessment team for a triage that includes the administration of a single psychological test, the Personality Assessment Inventory (PAI). Although this triage must rapidly gather information to determine client suitability and treatment assignment, we still attempt to work with clients to collaboratively develop goals for this assessment that include addressing questions that are central concerns for the clients. In this case, the test results suggested a severe disorder that accounted for many phenomena that he had been experiencing but had apparently been reluctant to share. The information gathered led to a referral to a different treatment program that could provide pharmacological and more intensive forms of treatment. However, the collaborative bond formed between the assessor and the client during this triage was sufficiently strong that it was our assessor to whom the client turned in a subsequent crisis precipitated by a symptomatic exacerbation. This case illustrates complementary information gathering and therapeutic goals of assessment even in the context of a brief assessment. PMID:26730992

  10. Factors Influencing Digital Reference Triage: A Think-Aloud Study

    ERIC Educational Resources Information Center

    Pomerantz, Jeffrey

    2004-01-01

    This article describes a think-aloud study conducted to identify factors that influence the decisions made by digital reference "triagers" when performing triage on questions received by digital reference services. This study follows and expands on a Delphi study that identified factors that triagers agreed on after the fact of their performance…

  11. The effects of technology on triage in A & E.

    PubMed

    Roberts, J

    1998-04-01

    Within the specialty of Accident and Emergency (A & E) nursing, triage is a term meaning to classify or sort patients according to their need for care (Blythin 1988). Burgess (1992) views this process as a means of prioritizing patients in order, so that the more seriously ill or injured are seen first (Table 1). Triage performance is measured in the author's department by computer. This technological source is used to record the patient's arrival time and the time at which the patient is triaged. Technology is defined by the Oxford Dictionary (1996) as 'the study of mechanical arts and science, their application in industry'. This paper explores the impact of this technology and the related issues on the A & E triage nurse, and will focus on issues related to the Patients' Charter (1991), resource implications, safety and staff training. In conclusion, the quality of a patient's total care, in which the author participated, is discussed with reference to the related issues and implications for future practice. PMID:9677876

  12. Validation of the Hong Kong accident and emergency triage guidelines.

    PubMed

    Fan, Mandy M W; Leung, L P

    2013-06-01

    OBJECTIVE. To validate the Hong Kong Accident and Emergency Triage guidelines. DESIGN. Retrospective chart review. SETTING. The Accident and Emergency Department of a tertiary hospital in Hong Kong. PARTICIPANTS. Patients who attended the Accident and Emergency Department on one day in February 2012. MAIN OUTCOME MEASURES. The inter-rater reliability in two pairs of nurses grouped according to experience and validity as compared with an expert panel. RESULTS. Of the 100 patients recruited and triaged into levels 1 to 5, the weighted kappa coefficient (inter-rater reliability) for the two pairs of nurses was 0.699 and 0.717, respectively. The weighted kappa coefficient for validity was 0.766. When only patients in triage levels 3 and 4 were included, the weighted kappa coefficient for reliability dropped to 0.632 and 0.585, respectively. The weighted kappa coefficient for validity also decreased to 0.558. CONCLUSIONS. The overall inter-rater reliability and validity of the Guidelines appeared acceptable. Further revision of the Guidelines on triaging patients to levels 3 or 4 is probably necessary. PMID:23568939

  13. Using Triage Figuratively to Describe Effective Teaching in Physical Education

    ERIC Educational Resources Information Center

    Henkel, Steven A.

    2016-01-01

    This article presents critical outcomes for physical education in a "triage" framework by comparing the process of determining the severity of injuries at the scene of an accident to the process of prioritizing decisions in the classroom. The intent is to reduce all possible outcomes of effective teaching to six nonnegotiable outcomes…

  14. A concept for major incident triage: full-scaled simulation feasibility study

    PubMed Central

    2010-01-01

    Background Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Results Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Conclusions Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as

  15. eTriage--a novel, web-based triage and booking service: enabling timely access to sexual health clinics.

    PubMed

    Jones, R; Menon-Johansson, A; Waters, A M; Sullivan, A K

    2010-01-01

    In recent years, the sexual health of the nation has risen in profile. We face increasing demands and targets, in particular the 48-hour waiting time directive, and as a result clinic access has become a priority. eTriage is a novel, secure, web-based service designed specifically to increase access to our clinics. It has proved a popular booking method, providing access to 10% of all appointments across the Directorate within six months of introduction. KC60 analyses revealed that the majority of users (58%) underwent asymptomatic screening with the remainder having some degree of pathology. There was a greater percentage prevalence of human papilloma virus, chlamydia, non-specific urethritis, gonorrhoea, herpes and trichomonas in the eTriage population when compared with the general clinic population. A notes review illustrated a high degree of concordance between data entered on eTriage registration and clinical review (97%). A patient survey revealed high levels of patient satisfaction with the service. As an adjunct to our existing booking services, eTriage has served to increase patient choice and has proved itself to be a safe, efficient and effective means of improving patient access. PMID:19884355

  16. 'Wellbeing': a collateral casualty of modernity?

    PubMed

    Carlisle, Sandra; Henderson, Gregor; Hanlon, Phil W

    2009-11-01

    In the now vast empirical and theoretical literature on wellbeing knowledge of the subject is provided mainly by psychology and economics, where understanding of the concept are framed in very different ways. We briefly rehearse these, before turning to some important critical points which can be made about this burgeoning research industry, including the tight connections between the meanings of the concept with the moral value systems of particular 'modern' societies. We then argue that both the 'science' of wellbeing and its critique are, despite their diversity, re-connected by and subsumed within the emerging environmental critique of modern consumer society. This places concerns for individual and social wellbeing within the broader context of global human problems and planetary wellbeing. A growing number of thinkers now suggest that Western society and culture are dominated by materialistic and individualistic values, made manifest at the political and social levels through the unending pursuit of economic growth, and at the individual level by the seemingly endless quest for consumer goods, regardless of global implications such as broader environmental harms. The escalating growth of such values is associated with a growing sense of individual alienation, social fragmentation and civic disengagement and with the decline of more spiritual, moral and ethical aspects of life. Taken together, these multiple discourses suggest that wellbeing can be understood as a collateral casualty of the economic, social and cultural changes associated with late modernity. However, increasing concerns for the environment have the potential to counter some of these trends, and in so doing could also contribute to our wellbeing as individuals and as social beings in a finite world. PMID:19765875

  17. Data quality for situational awareness during mass-casualty events.

    PubMed

    Demchak, Barry; Griswold, William G; Lenert, Leslie A

    2007-01-01

    Incident Command systems often achieve situational awareness through manual paper-tracking systems. Such systems often produce high latencies and in-complete data, resulting in inefficient and ineffective resource deployment. WIISARD (Wireless Internet Information System for Medical Response in Disasters) collects much more data than a paper-based system, dramatically reducing latency while increasing the kinds and quality of information available to incident commanders. Yet, the introduction of IT into a disaster setting is not problem-free. Notably, system component failures can delay the delivery of data. The type and extent of a failure can have varying effects on the usefulness of information displays. We describe a small, coherent set of customizble information overlays to address this problem, and we discuss reactions to these displays by medical commanders. PMID:18693821

  18. Traffic accidents involving fatigue driving and their extent of casualties.

    PubMed

    Zhang, Guangnan; Yau, Kelvin K W; Zhang, Xun; Li, Yanyan

    2016-02-01

    The rapid progress of motorization has increased the number of traffic-related casualties. Although fatigue driving is a major cause of traffic accidents, the public remains not rather aware of its potential harmfulness. Fatigue driving has been termed as a "silent killer." Thus, a thorough study of traffic accidents and the risk factors associated with fatigue-related casualties is of utmost importance. In this study, we analyze traffic accident data for the period 2006-2010 in Guangdong Province, China. The study data were extracted from the traffic accident database of China's Public Security Department. A logistic regression model is used to assess the effect of driver characteristics, type of vehicles, road conditions, and environmental factors on fatigue-related traffic accident occurrence and severity. On the one hand, male drivers, trucks, driving during midnight to dawn, and morning rush hours are identified as risk factors of fatigue-related crashes but do not necessarily result in severe casualties. Driving at night without street-lights contributes to fatigue-related crashes and severe casualties. On the other hand, while factors such as less experienced drivers, unsafe vehicle status, slippery roads, driving at night with street-lights, and weekends do not have significant effect on fatigue-related crashes, yet accidents associated with these factors are likely to have severe casualties. The empirical results of the present study have important policy implications on the reduction of fatigue-related crashes as well as their severity. PMID:26625173

  19. Implications for modeling casualty sustainment during peacekeeping operations.

    PubMed

    Blood, Christopher G; Zhang, Jinjin; Walker, G Jay

    2002-10-01

    Projections of the casualties expected during peacekeeping operations allow medical planners to assess in advance the medical resources needed to support such operations. Data detailing fatalities incurred in previous peacekeeping operations were extracted from several U.N. sources. From these data, rates of killed-in-action were computed for the deployed forces. One hundred eighty-eight peacekeeping incidents in which casualties were sustained were also examined to derive wounded-in-action rates. The estimated mean wounded-in-action rate for these operations was 3.16 per 1,000 strength per year; the estimated wounded-in-action rate for individual operations ranged from 0.49 to 12.50. There were an average of 3.8 wounded and 0.86 killed in the 188 casualty incidents examined. Thirty-eight percent of the wounds were described as serious. The casualty incidence derived in this study can provide a basis for estimating the casualties likely in future peacekeeping operations. PMID:12392258

  20. [Model and enlightenment from rescue of August 2nd Kunshan explosion casualty].

    PubMed

    Tan, Q; Qiu, H B; Sun, B W; Shen, Y M; Nie, L J; Zhang, H W

    2016-01-01

    On August 2nd, 2014, a massive dust explosion occurred in a factory of Kunshan, resulting in a mass casualty involving 185 burn patients. They were transported to 20 medical institutions in Jiangsu province and Shanghai. More than one thousand of medical personnel of our country participated in this emergency rescue, and satisfactory results were achieved. In this paper, the characteristics of this accident were analyzed, the positive effects of interdisciplinary cooperation were affirmed, and the contingency plan, rescue process and pattern, and reserve, organization and management of talents during this rescue process were reviewed retrospectively. PMID:27426066

  1. Triage: a working solution to overcrowding in the emergency department

    PubMed Central

    Shah, Chandrakant P.; Carr, Luby M.

    1974-01-01

    Recently, emergency departments across the continent have become crowded with patients requiring non-urgent care. To alleviate this situation at The Hospital for Sick Children in Toronto, receptionists in the emergency department direct patients requiring urgent care to the emergency room and those requiring non-urgent care to a screening clinic (triage). During a two-month period, 13,551 patients visited the emergency department. The triage receptionist sent 8368 patients to the emergency room and 5183 to the screening clinic. About 45% of patients visiting the emergency room had suffered accidents and injuries, and 19% had respiratory illness; 15% of patient visits resulted in admission to hospital. In contrast to this, 49% of patients sent to the screening clinic had respiratory illness and 18% had infective disease; less than 1% of patients needed hospitalization. PMID:4823110

  2. Small animal behavioral triage: a guide for practitioners.

    PubMed

    Martin, Kenneth M; Martin, Debbie; Shaw, Julie K

    2014-05-01

    Behavioral concerns are the principal cause of a weakened human-animal bond and pet relinquishment. Triaging behavioral concerns and providing early intervention may be the difference between a patient remaining in its current home or relinquishment. Prevention and intervention behavior services using a team approach may also improve pet retention through client education and appropriate assistance. Identifying and integrating qualified animal behavior professionals to assist with the hospital's behavior team ensures appropriate support is provided to the client and patient. PMID:24766692

  3. Invariance of cognitive triage in the development of recall in adulthood.

    PubMed

    Marche, Tammy A; Howe, Mark L; Lane, David G; Owre, Keith P; Briere, Jennifer L

    2009-07-01

    Past research has demonstrated that cognitive triage (weak-strong-weak recall pattern) is a robust effect that optimises children's recall. The aim of the current research was to determine whether adults' free recall also exhibits triage and whether cognitive triage is less marked with older than younger adults' recall. Younger and older adults memorized 16 unrelated words until all items were recalled perfectly. The triage pattern existed for both the younger and older adults' recall and there was evidence for age differences in triage. Our results are consistent with claims of greater verbatim forgetting and increased susceptibility to output interference with age in adulthood. Further research is needed to determine whether fuzzy-trace theory adequately explains the ageing of triage and what factors play a role in the development of this pattern of recall in adulthood. PMID:19468958

  4. Knowledge of triage in the senior medical students in Shiraz University of Medical Sciences

    PubMed Central

    MAHMOODIAN, HOSSEIN; EGHTESADI, RAZIE; GHAREGHANI, ATEFE; NABEIEI, PARISA

    2016-01-01

    Introduction Triage is a response to the problem of overcrowding in Emergency Departments (EDs) and accuracy of decisions made by the triage unit affects the ultimate outcome of EDs. This study was conducted to evaluate the knowledge of triage among last year medical students in Shiraz University of Medical Sciences. Methods This is a cross-sectional analytical study whose subjects were all the senior students of medicine (62) in the last year of medicine from January to June 2013 who attended emergency medicine course in the screen room of 2 University Hospitals. This questionnaire was designed in 3 sections including personal data, 15 questions on knowledge of triage and 10 case scenarios for triage decision making and completed by the students. Statistical analysis was performed in SPSS statistical software (version 14) using independent sample t-test, one way ANOVA, and Pearson correlation coefficient (p≤0.001). Results The total mean score of the participants was 10.6±1.5, ranging from 7 to 13. 58(93.5%) students had poor triage knowledge. In the scenario’s section, the percentage of correct triage by students was 49.2% and those of over and under triage were 28.1% and 22.7%, respectively. There was a significant relationship between the triage accuracy and level of triage (ESI 4) (p≤0.001). Conclusion The level of knowledge of triage in the last year medical students was poor, although most of them had passed a course in the screen room. It is recommended that medical students’ educational courses should include sections on the knowledge of triage in emergency rooms. PMID:27382582

  5. Development and interrater reliability of the UK Mental Health Triage Scale.

    PubMed

    Sands, Natisha; Elsom, Stephen; Colgate, Robert; Haylor, Helen; Prematunga, Roshani

    2016-08-01

    Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendall's coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P < 0.001). The single measure ICC was 0.856 (95% CI: 0.776-0.926 (F (20, 1300) = 394.762, P < 0.001). The overall Kendall's w was 0.88 (P < 0.001). The UK MHTS shows substantial levels of interrater reliability. Reliable mental health triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services. PMID:27027419

  6. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    PubMed Central

    Adeniji, Adeloye Amoo

    2016-01-01

    Background In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting Gugulethu Community Health Centre, Cape Town. Methods A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. PMID:27380788

  7. Bombings specific triage (Bost Tool) tool and its application by healthcare professionals

    PubMed Central

    Sanjay, Jaiswal; Ankur, Verma; Tamorish, Kole

    2015-01-01

    BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to “wrong triage” in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80%) with triage tool performed better in triaging the bomb blast victims than group A (50%) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging. PMID:26693264

  8. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Coast Guard marine casualty investigation for the...) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the Board does...

  9. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Coast Guard marine casualty investigation for the...) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the Board does...

  10. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Coast Guard marine casualty investigation for the Board. 4.40-25 Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations § 4.40-25...

  11. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Coast Guard marine casualty investigation for the...) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the Board does...

  12. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for the Board. 4.40-25 Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations § 4.40-25...

  13. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for the...) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the Board does...

  14. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Contents of casualty or accident... System Requirements § 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in § 173.57 of this chapter....

  15. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of...

  16. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of...

  17. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Contents of casualty or accident... System Requirements § 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in § 173.57 of this chapter....

  18. 46 CFR 196.07-1 - Notice and reporting of casualty and voyage records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... RESEARCH VESSELS OPERATIONS Notice and Reporting of Casualty and Voyage Records § 196.07-1 Notice and reporting of casualty and voyage records. The requirements for providing notice and reporting of marine... 46 Shipping 7 2010-10-01 2010-10-01 false Notice and reporting of casualty and voyage records....

  19. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of...

  20. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of...

  1. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of...

  2. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of...

  3. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of...

  4. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of...

  5. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Substance of marine casualty notice. 4.05-5 Section 4.05-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-5 Substance of...

  6. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of...

  7. 46 CFR 185.220 - Records of a voyage resulting in a marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Records of a voyage resulting in a marine casualty. 185.220 Section 185.220 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.220 Records of a voyage resulting in a marine casualty....

  8. 46 CFR 185.220 - Records of a voyage resulting in a marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Records of a voyage resulting in a marine casualty. 185.220 Section 185.220 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.220 Records of a voyage resulting in a marine casualty....

  9. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a written report, in narrative form, when the diving installation is on a facility. The written report must...

  10. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a written report, in narrative form, when the diving installation is on a facility. The written report must...

  11. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Administration (OSHA) in 29 Code of Federal Regulations (CFR) part 1904. (c) Notice given as required by § 122... 46 Shipping 4 2014-10-01 2014-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS...

  12. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) Notice given as required by 33 CFR 160.215 satisfies the requirement of this section if the marine casualty involves a hazardous condition as defined by 33 CFR 160.204. (c) Except as otherwise required... by paragraph (a)(8) of this section, a report made pursuant to 33 CFR 153.203, 40 CFR 117.21, or...

  13. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Administration (OSHA) in 29 Code of Federal Regulations (CFR) part 1904. (c) Notice given as required by § 122... 46 Shipping 4 2011-10-01 2011-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS...

  14. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Notice given as required by 33 CFR 160.215 satisfies the requirement of this section if the marine casualty involves a hazardous condition as defined by 33 CFR 160.203. (c) Except as otherwise required... by paragraph (a)(8) of this section, a report made pursuant to 33 CFR 153.203, 40 CFR 117.21, or...

  15. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Administration (OSHA) in 29 Code of Federal Regulations (CFR) part 1904. (c) Notice given as required by § 122... 46 Shipping 4 2013-10-01 2013-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS...

  16. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Administration (OSHA) in 29 Code of Federal Regulations (CFR) part 1904. (c) Notice given as required by § 122... 46 Shipping 4 2010-10-01 2010-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS...

  17. Battlefield Documentation of Tactical Combat Casualty Care in Afghanistan.

    PubMed

    Robinson, John B; Smith, Michael P; Gross, Kirby R; Sauer, Samual W; Geracci, James J; Day, Charlie D; Kotwal, Russ S

    2016-01-01

    Performance improvement is reliant on information and data, as you cannot improve what you do not measure. The US military went to war in 2001 without an integrated trauma care system to collect and analyze combat casualty care data. By 2006, the conflict in Afghanistan began appreciating the capture and consolidation of hospital care documentation into the Department of Defense Trauma Registry. In contrast, a paucity of documentation has existed for prehospital or tactical combat casualty care (TCCC). Using the 75th Ranger casualty documentation model established in 2005, the Joint Trauma System developed a casualty data collection system for prehospital care using the TCCC Card, the TCCC After Action Report (AAR), and the Prehospital Trauma Registry. In 2013, this system was mandated for use by US forces in Afghanistan. The Joint Trauma System also created and deployed a prehospital team to be an integral part of the Joint Theater Trauma System in Afghanistan. This prehospital team provided prehospital training and facilitated prehospital data capture. Described and analyzed in this report are prehospital data captured in Afghanistan from 2013 to 2014 using the TCCC Card and the TCCC AAR. PMID:27215873

  18. Primary Casualty Reception Ship: the hospital within--Operation Granby.

    PubMed

    Dewar, E P

    1992-01-01

    As the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RFA Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO). In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed. Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services. The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA. One hundred and five patients were treated of which 78 were returned to duty. Argu as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US. PMID:1460595

  19. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a written report, in narrative form, when the diving installation is on a facility. The written report must...

  20. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a written report, in narrative form, when the diving installation is on a facility. The written report must...

  1. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a written report, in narrative form, when the diving installation is on a facility. The written report must...

  2. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) Notice given as required by 33 CFR 160.215 satisfies the requirement of this section if the marine casualty involves a hazardous condition as defined by 33 CFR 160.204. (c) Except as otherwise required... by paragraph (a)(8) of this section, a report made pursuant to 33 CFR 153.203, 40 CFR 117.21, or...

  3. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school...

  4. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school...

  5. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school...

  6. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school...

  7. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS... to mariners, radiograms sent and received, the radio log, and crew, sailing school...

  8. Taxonomic triage and the poverty of phylogeny.

    PubMed Central

    Wheeler, Quentin D

    2004-01-01

    Revisionary taxonomy is frequently dismissed as merely descriptive, which belies its strong intellectual content and hypothesis-driven nature. Funding for taxonomy is inadequate and largely diverted to studies of phylogeny that neither improve classifications nor nomenclature. Phylogenetic classifications are optimal for storing and predicting information, but phylogeny divorced from taxonomy is ephemeral and erodes the accuracy and information content of the language of biology. Taxonomic revisions and monographs are efficient, high-throughput species hypothesis-testing devices that are ideal for the World Wide Web. Taxonomic knowledge remains essential to credible biological research and is made urgent by the biodiversity crisis. Theoretical and technological advances and threats of mass species extinctions indicate that this is the time for a renaissance in taxonomy. Clarity of vision and courage of purpose are needed from individual taxonomists and natural history museums to bring about this evolution of taxonomy into the information age. PMID:15253345

  9. Design of a Medical Triage Evidence-Based Clinical Management Protocol and Implementation of Medical Triage On-Line Training for Use by Mission of Mercy Volunteers.

    PubMed

    Allen, Kimberly D; DiBartolo, Mary C; Welsh, Debra L; Brown, Voncelia

    2015-01-01

    Evidence-based protocols in safety net settings can help standardize care practices, increase organizational workflow, and enhance quality outcomes for those receiving services. The purpose of this quality improvement project is two-fold: to design an evidence-based medical triage clinical management protocol, and, to influence adherence to that protocol by safety net medical triage volunteers through an on-line volunteer orientation. Leadership skills were required to help translate evidence-based practice recommendations into useful tools to assist in directing practice. Project outcomes included successful multidisciplinary practice change, significantly improved volunteer knowledge surrounding medical triage protocol parameters, increased organizational workflow, and enhanced quality client outcomes. PMID:26529107

  10. Academic-Community Partnership to Develop a Novel Disaster Training Tool for School Nurses: Emergency Triage Drill Kit.

    PubMed

    Burke, Rita V; Goodhue, Catherine J; Berg, Bridget M; Spears, Robert; Barnes, Jill; Upperman, Jeffrey S

    2015-09-01

    As children spend approximately 28% of their day in school and disasters may strike at any time, it is important for school officials to conduct emergency preparedness activities. School nurses, teachers, and staff should be prepared to respond and provide support and first aid treatment. This article describes a collaborative effort within the Los Angeles Unified School District to enhance disaster preparedness. Specifically, the article outlines the program steps and tools developed to prepare staff in mass triage through an earthquake disaster training exercise. PMID:25899521

  11. Improving Trauma Triage Using Basic Crash Scene Data

    PubMed Central

    Ryb, Gabriel E.; Dischinger, Patricia C.

    2011-01-01

    Objective: to analyze the occurrence of severe injuries and deaths among crash victims transported to hospitals in relation to occupant and scene characteristics, including on-scene patient mobility, and their potential use in triaging patients to the appropriate level of care. Methods: the occurrence of death and ISS>15 were studied in relation to occupant, crash and mobility data readily available to EMS at the scene, using weighted NASS-CDS data. Data set was randomly split in two for model development and evaluation. Characteristics were combined to develop new triage schemes. Overtriage and undertriage rates were calculated for the NASS-CDS case trauma center allocation and for the newly developed triage schemes. Results: Compared to the NASS-CDS distribution, a scheme using patient mobility alone showed lower overtriage of those with ISS≤15 (38.8% vs. 55.5%) and lower undertriage of victims who died from their crash-related injuries (2.34% vs. 21.47%). Undertriage of injuries with ISS> 15 was similar (16.0 vs. 16.9). A scheme based on the presence of one of many scene risk factors (age>55, GCS<14, intrusion ≥18”, near lateral impact, far lateral impact with intrusion ≥12”, rollover or lack of restraint use) resulted in an undertriage of 0.86% (death) and 10.5% (ISS>15) and an overtriage of 63.4%. The combination of at least one of the scene risk factors and mobility status greatly decreased overtriage of those with ISS<15 (24.4%) with an increase in death undertriage (3.19%). Further combination of mobility and scene factors allowed for maintenance of a low undertriage (0.86%) as well as an acceptable overtriage (48%). Conclusion: Patient mobility data easily obtained at the scene of a crash allows triaging of injured patients to the appropriate facility with a high sensitivity and specificity. The addition of crash scene data to scene mobility allows further reductions on undertriaging or overtriaging. PMID:22105408

  12. Traditional Nurse Triage vs. Physician Tele-Presence in a Pediatric Emergency Department

    PubMed Central

    Marconi, Greg P.; Chang, Todd; Pham, Phung K.; Grajower, Daniel N.; Nager, Alan L.

    2014-01-01

    Objectives To compare traditional nurse triage (TNT) in a Pediatric Emergency Department (PED) to physician tele-presence (PTP). Methods Prospective, 2×2 crossover study with random assignment using a sample of walk-in patients seeking care in a PED at a large, tertiary care children’s hospital, from May 2012 to January 2013. Outcomes of triage times, documentation errors, triage scores, and survey responses were compared between TNT and PTP. Comparison between PTP to actual treating PED physicians regarding the accuracy of ordering blood and urine tests, throat cultures, and radiologic imaging was also studied. Results Paired samples t-tests showed a statistically significant difference in triage time between TNT and PTP (p=0.03), but no significant difference in documentation errors (p=0.10). Triage scores of TNT were 71% accurate, compared to PTP, which were 95% accurate. Both parents and children had favorable scores regarding PTP and the majority indicated they would prefer PTP again at their next PED visit. PTP diagnostic ordering was comparable to the actual PED physician ordering, showing no statistical differences. Conclusions Utilizing physician tele-presence technology to remotely perform triage is a feasible alternative to traditional nurse triage, with no clinically significant differences in time, triage scores, errors and patient and parent satisfaction. PMID:24445223

  13. Management of Crush Syndrome Casualties after Disasters

    PubMed Central

    Sever, Mehmet Sukru; Vanholder, Raymond

    2011-01-01

    After direct impact of the trauma, crush syndrome is the second most frequent cause of death after mass disasters. However, since crush syndrome is quite rare in daily practice, mistakes are frequent in the treatment of these cases. This paper summarizes the etiopathogenesis of traumatic rhabdomyolysis and of crush syndrome-based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well. The importance of early and energetic fluid resuscitation is underlined for prophylaxis of acute kidney injury. Since there is chaos, and an overwhelming number of victims, logistic drawbacks create a specific problem in the treatment of crush victims after mass disasters. Potential solutions for logistic hurdles and disaster preparedness scenarios have also been provided in this review article. PMID:23908797

  14. Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains.

    PubMed

    Pennardt, Andre; Kamin, Rich; Llewellyn, Craig; Shapiro, Geoff; Carmona, Philip A; Schwartz, Richard B

    2016-01-01

    Tactical emergency medical support (TEMS) is a critical component of the out-of-hospital response to domestic high-threat incidents such as hostage scenarios, warrant service, active shooter or violent incidents, terrorist attacks, and other intentional mass casualty-producing acts. From its grass-roots inception in the form of medical support of select law enforcement special weapons and tactics (SWAT) units in the 1980s, the TEMS subspecialty of prehospital care has rapidly grown and evolved over the past 40 years. The National TEMS Initiative and Council (NTIC) competencies and training objectives are the only published recommendations of their kind and offer the opportunity for national standardization of TEMS training programs and a future accreditation process. Building on the previous work of the NTIC and the creation of acknowledged competency domains for TEMS and the acknowledged civilian translation of TCCC by the Committee for Tactical Emergency Casualty Care (C-TECC), the Joint Review Committee (JRC) has created an opportunity to bring forward the work in a form that could be operationally useful in an all-hazards and whole of community format. PMID:27450605

  15. Telephone triage in general practices: A written case scenario study in the Netherlands

    PubMed Central

    Smits, Marleen; Hanssen, Suzan; Huibers, Linda; Giesen, Paul

    2016-01-01

    Objective General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. Design Cross-sectional observational study using a web-based survey among practice assistants including questions on background characteristics and triage organization. Furthermore, practice assistants were asked to assess the required type of care of written case scenarios with varying health problems and levels of urgency. To determine the adequacy of the assessments, a comparison with a reference standard was made. In addition, the association between background characteristics and triage organization and the adequacy of triage was examined. Setting Daytime general practices. Subjects Practice assistants. Main outcome measures Over- and under-estimation, sensitivity, specificity. Results The response rate was 41.1% (n = 973). The required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1%. The sensitivity of identifying patients with a highly urgent problem was 76.7% and the specificity was 94.0%. The adequacy of the assessments of the required care was higher for more experienced assistants and assistants with fixed daily work meetings with the GP. Triage training, use of a triage tool, and authorization of advice were not associated with adequacy of triage. Conclusion Triage by practice assistants in general practices is efficient (high specificity), but potentially unsafe in highly urgent cases (suboptimal sensitivity). It is important to train practice assistants in identifying highly urgent cases. Key pointsGeneral practices increasingly use telephone triage to manage patient flows, but little is known about the organization and adequacy of triage in daytime practices.Telephone triage by general practice assistants is

  16. Emergency department triage: a program assessment using the tools of continuous quality improvement.

    PubMed

    Cook, S; Sinclair, D

    1997-01-01

    An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff job descriptions, organization charts, orientation manual, and physical facilities was conducted. A chart audit was completed on 100 triage notes. Direct observation was undertaken on nine occasions. An evaluation of the data gathered was performed using the tools of continuous quality improvement, and resulted in specific recommendations being made to improve the process of care. It was concluded that emergency medical attendants function very well in an emergency medicine triage system and the tools of continuous quality improvement can be applied to a clinical service to improve the quality of care. PMID:9404811

  17. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE.

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

    The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians. PMID:26721057

  18. The use of multiple intraosseous catheters in combat casualty resuscitation.

    PubMed

    Sarkar, Debjeet; Philbeck, Thomas

    2009-02-01

    During the current military engagements in Iraq and Afghanistan, establishing intravenous (IV) access for resuscitation of critically injured casualties remains a persistent challenge. Intraosseous (IO) access has emerged as a viable alternative in resuscitation. In this case report, a 19 year-old male soldier was severely wounded by a roadside bomb in Iraq. Given the heavy initial blood loss, anatomic location of the injuries and gross wound contamination, peripheral IV access could not be established. Instead, multiple IO catheters were used to initiate fluid resuscitation prior to transfer to a combat support hospital. To our knowledge, this is the first report of such extensive usage of IO catheters. Multiple IO catheters can be placed rapidly and safely and may help solve the challenge of establishing vascular access for resuscitation of critically injured casualties. PMID:19317188

  19. CoIN: a network analysis for document triage.

    PubMed

    Hsu, Yi-Yu; Kao, Hung-Yu

    2013-01-01

    In recent years, there was a rapid increase in the number of medical articles. The number of articles in PubMed has increased exponentially. Thus, the workload for biocurators has also increased exponentially. Under these circumstances, a system that can automatically determine in advance which article has a higher priority for curation can effectively reduce the workload of biocurators. Determining how to effectively find the articles required by biocurators has become an important task. In the triage task of BioCreative 2012, we proposed the Co-occurrence Interaction Nexus (CoIN) for learning and exploring relations in articles. We constructed a co-occurrence analysis system, which is applicable to PubMed articles and suitable for gene, chemical and disease queries. CoIN uses co-occurrence features and their network centralities to assess the influence of curatable articles from the Comparative Toxicogenomics Database. The experimental results show that our network-based approach combined with co-occurrence features can effectively classify curatable and non-curatable articles. CoIN also allows biocurators to survey the ranking lists for specific queries without reviewing meaningless information. At BioCreative 2012, CoIN achieved a 0.778 mean average precision in the triage task, thus finishing in second place out of all participants. Database URL: http://ikmbio.csie.ncku.edu.tw/coin/home.php. PMID:24218542

  20. Evaluation of symptom checkers for self diagnosis and triage: audit study

    PubMed Central

    Semigran, Hannah L; Linder, Jeffrey A; Gidengil, Courtney

    2015-01-01

    Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage). Design Audit study. Setting Publicly available, free symptom checkers. Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection). Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations). Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations. Conclusions Symptom checkers had deficits in both triage and diagnosis

  1. Exercise London: a disaster exercise involving numerous casualties

    PubMed Central

    Theoret, J.J.

    1976-01-01

    A large-scale disaster exercise was conducted to assess how one large community would handle such a situation — particularly, how it would deal with 150 casualties. The planning, undertaken by a subcommittee composed of representatives of all resource groups in the city, took more than a year. The deficiencies of the disaster plan detected during the exercise, which included a lack of trained personnel and various problems of communication, are now being corrected. PMID:1260617

  2. Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US Military.

    PubMed

    Butler, Frank K; Smith, David J; Carmona, Richard H

    2015-08-01

    Thirteen years of continuous combat operations have enabled the US Military and its coalition partners to make a number of major advances in casualty care. The coalition nations have developed a superb combat trauma system and achieved unprecedented casualty survival rates. There remains, however, a need to accelerate the translation of new battlefield trauma care information, training, and equipment to units and individuals deploying in support of combat operations. In addition, the US Military needs to ensure that these advances are sustained during peace intervals and that we continue to build upon our successes as we prepare for future conflicts. This article contains recommendations designed to accomplish those goals. For the proposed actions to benefit all branches of our armed services, the direction will need to come from the Office of the Secretary of Defense in partnership with the Joint Staff. Effective translation of military advances in prehospital trauma care may also increase survival for law enforcement officers wounded in the line of duty and for civilian victims of Active Shooter or terrorist-related mass-casualty incidents. PMID:26218704

  3. Investigation of work zone crash casualty patterns using association rules.

    PubMed

    Weng, Jinxian; Zhu, Jia-Zheng; Yan, Xuedong; Liu, Zhiyuan

    2016-07-01

    Investigation of the casualty crash characteristics and contributory factors is one of the high-priority issues in traffic safety analysis. In this paper, we propose a method based on association rules to analyze the characteristics and contributory factors of work zone crash casualties. A case study is conducted using the Michigan M-94/I-94/I-94BL/I-94BR work zone crash data from 2004 to 2008. The obtained association rules are divided into two parts including rules with high-lift, and rules with high-support for the further analysis. The results show that almost all the high-lift rules contain either environmental or occupant characteristics. The majority of association rules are centered on specific characteristics, such as drinking driving, the highway with more than 4 lanes, speed-limit over 40mph and not use of traffic control devices. It should be pointed out that some stronger associated rules were found in the high-support part. With the network visualization, the association rule method can provide more understandable results for investigating the patterns of work zone crash casualties. PMID:27038500

  4. The Influential Factor Analysis of Classification Partition Management Mode on the Emergency Triage

    PubMed Central

    NA, Zhang; HUAIXIN, Cui

    2016-01-01

    Background: The aim of the study was to discuss on the influential factors of the mode of classification of partition management in the emergency triage. Method: Retrospectively analyzing the effects of emergency triage of 156 cases who adopted the classification partition management mode during Oct 2014 to Oct 2015 in Xuzhou Central Hospital (Xuzhou, Jiangsu Province, China). They were divided into triage success group of 108 cases and triage failure group of 48 cases. Comparing the single factor analysis and multi-factor analysis, and selecting possible influential factors. Result: According to the single factor analysis, for the patients who came to the doctor in the daytime and working days, the higher education degree and compliance they had, the faster the back-show time of emergency inspect and check came back, the more comprehensive the body examination and disease history taking were done, the simpler the disease condition was, the higher triage success rate they received. Compared to the emergency observation time between two groups, the difference was not statistically significant. According to the multi-factor analysis, the emergency check and examination back-show time, the comprehensive degree of body examination and disease history taking and the complexity degree of disease could be the independent risk factors for triage success. Conclusion: Simplify the examination procedure, improve the efficiency of back-show and acquire detail disease information are important methods for the improvement of triage success. PMID:27516994

  5. Decision analytic model exploring the cost and cost-offset implications of street triage

    PubMed Central

    Heslin, Margaret; Callaghan, Lynne; Packwood, Martin; Badu, Vincent; Byford, Sarah

    2016-01-01

    Objectives To determine if street triage is effective at reducing the total number of people with mental health needs detained under section 136, and is associated with cost savings compared to usual police response. Design Routine data from a 6-month period in the year before and after the implementation of a street triage scheme were used to explore detentions under section 136, and to populate a decision analytic model to explore the impact of street triage on the cost to the NHS and the criminal justice sector of supporting people with a mental health need. Setting A predefined area of Sussex, South East England, UK. Participants All people who were detained under section 136 within the predefined area or had contact with the street triage team. Interventions The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. Primary and secondary outcome measures The primary outcome was change in the total number of detentions under section 136 between the before and after periods assessed. Secondary analysis focused on whether the additional costs of street triage were offset by cost savings as a result of changes in detentions under section 136. Results Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ2 (1df) 18.542, p<0.001). Total NHS and criminal justice costs were estimated to be £1043 in the street triage period compared to £1077 in the usual response period. Conclusions Investment in street triage was offset by savings as a result of reduced detentions under section 136, particularly detentions in custody. Data available did not include assessment of patient outcomes, so a full economic evaluation was not possible. PMID:26868943

  6. CBRNE TC3: A Hybrid Approach to Casualty Care in the CBRNE Environment.

    PubMed

    Strain, John W

    2013-01-01

    The implementation of Tactical Combat Casualty Care (TCCC) guidelines for the Operation Enduring Freedom and Operation Iraqi Freedom contingency operations has dramatically reduced preventable combat deaths. A study of these principles and their application to medical treatment in the chemical, biological, radiological, nuclear, and high-yield explosives (CBRNE), weapons of mass destruction (WMD) environment is presented as a potential readiness and force multiplier for units engaged in this area of operations. Preparing medical operators for support of WMD sampling and mitigation missions requires extensive preventive medicine and post-exposure and downrange trauma threat preparedness. Training and equipping CBRN operators with treatment skills and appropriate interventional material requires pre-implementation planning specific to WMD threats (e.g., anthrax, radiation, organophosphates, and contaminated trauma). A scenario-based study reveals the tactics, techniques, and procedures for training, resourcing, and fielding the CBRN operator of the future. PMID:23817878

  7. Ubiquilins Chaperone and Triage Mitochondrial Membrane Proteins for Degradation.

    PubMed

    Itakura, Eisuke; Zavodszky, Eszter; Shao, Sichen; Wohlever, Matthew L; Keenan, Robert J; Hegde, Ramanujan S

    2016-07-01

    We investigated how mitochondrial membrane proteins remain soluble in the cytosol until their delivery to mitochondria or degradation at the proteasome. We show that Ubiquilin family proteins bind transmembrane domains in the cytosol to prevent aggregation and temporarily allow opportunities for membrane targeting. Over time, Ubiquilins recruit an E3 ligase to ubiquitinate bound clients. The attached ubiquitin engages Ubiquilin's UBA domain, normally bound to an intramolecular UBL domain, and stabilizes the Ubiquilin-client complex. This conformational change precludes additional chances at membrane targeting for the client, while simultaneously freeing Ubiquilin's UBL domain for targeting to the proteasome. Loss of Ubiquilins by genetic ablation or sequestration in polyglutamine aggregates leads to accumulation of non-inserted mitochondrial membrane protein precursors. These findings define Ubiquilins as a family of chaperones for cytosolically exposed transmembrane domains and explain how they use ubiquitin to triage clients for degradation via coordinated intra- and intermolecular interactions. PMID:27345149

  8. The development and testing of the nurses' cardiac triage instrument.

    PubMed

    Arslanian-Engoren, Cynthia; Hagerty, Bonnie M

    2013-01-01

    Rapid recognition and treatment of myocardial infarction (MI) reduces morbidity and mortality. Although emergency department (ED) nurses are often the first provider to evaluate individuals and are in a prime position to initiate MI guideline recommendations, no valid and reliable instrument was found to quantify their decision-making processes. The purpose of this study was to develop and test the psychometric properties of a new theoretically driven, empirically based instrument for measuring nurses' cardiac triage decisions. Using a descriptive research design, data were collected using a mailed survey. There were 158 ED nurses who completed a mailed questionnaire. Factor analysis revealed three factors (patient presentation, unbiased nurse reasoning process, and nurse action) with good internal consistency (Cronbach's alpha = .903, .809, .718) and sample adequacy (KMO = .758) of the 30-item instrument. The newly developed instrument has the potential to improve patient outcomes surrounding early MI identification and treatment. PMID:23923344

  9. DEVELOPMENT OF IT TRIAGE SYSTEM (TRACY) TO SHARE REGIONAL DISASTER MEDICAL INFORMATION

    NASA Astrophysics Data System (ADS)

    Numada, Muneyoshi; Hada, Yasunori; Ohara, Miho; Meguro, Kimiro

    We developed an IT triage system for collecting disaster medical information in real time. FeliCa cards and card readers are used to obtain the number and cond ition of patients. The system is composed of two elements. First, the number of patie nts for each triage level and the accepted number of patients in each diagnosis and treatment department are obtained in real time, including response for changing triage level. Second, this information can be shared among hospitals, the administration, and residents in real time who are searching for their family. A disaster drill utiliz ing this system was held at the University of Yamanashi Hospital with 450 participants.

  10. Tactical combat casualty care in the assault on Punta Paitilla Airfield.

    PubMed

    Mucciarone, James J; Llewellyn, Craig H; Wightman, John M

    2006-08-01

    Casualties incurred during the assault on Punta Paitilla Airfield during Operation Just Cause were evaluated through reviews of records and interviews with the participants. There were eight initial casualties. One-half of all subsequent casualties were wounded trying to move to these men while still under effective hostile fire. Consistent with other studies, the most common cause of death was internal hemorrhage; the second most common was catastrophic brain injury. Rapid control of external exsanguination was the technique most likely to prevent death. Tourniquets were applied to three lower extremities for two casualties, without sequelae. PMID:16933806

  11. Multi-Injury Casualty Stream Simulation in a Shipboard Combat Environment.

    PubMed

    D'Souza, Edwin; Wing, Vern; Zouris, James; Vickers, Ross; Lawnick, Mary; Galarneau, Michael

    2016-01-01

    Accurate forecasts of casualty streams are essential for estimating personnel and materiel requirements for future naval combat engagements. The scarcity of recent naval combat data makes accurate forecasting difficult. Furthermore, current forecasts are based on single injuries only, even though empirical evidence indicates most battle casualties suffer multiple injuries. These anticipated single-injury casualty streams underestimate the needed medical resources. This article describes a method of simulating realistic multi-injury casualty streams in a maritime environment by combining available shipboard data with ground combat blast data. The simulations, based on the Military Combat Injury Scale, are expected to provide a better tool for medical logistics planning. PMID:26741479

  12. Paper and people: the work of the casualty reception clerk.

    PubMed

    Hughes, D

    1989-12-01

    This paper examines the exercise of discretion by casualty reception staff, focussing on the problems of accountability that arise when their judgements help shape the process of patient categorization that culminates in clinical diagnosis. Rules and guidelines which ostensibly relate to bureaucratic objectives, are applied in ways which reflect situational exigencies of reception work, and values embedded in organisational culture. But reception staff are reluctant to acknowledge the importance of their decisions, and, particularly where judgements relate to patient condition, present rule-use as a straightforward and certain activity in which interpretation plays little part. PMID:10304220

  13. Application of novel hyperspectral imaging technologies in combat casualty care

    NASA Astrophysics Data System (ADS)

    Cancio, Leopoldo C.

    2010-02-01

    Novel hyperspectral imaging (HSI) methods may play several important roles in Combat Casualty Care: (1) HSI of the skin may provide spatial data on hemoglobin saturation of oxygen, as a "window" into perfusion during shock. (2) HSI or similar technology could be incorporated into closed-loop, feedback-controlled resuscitation systems. (3) HSI may provide information about tissue viability and/or wound infection. (4) HSI in the near-infrared range may provide information on the tissue water content--greatly affected, e.g., by fluid resuscitation. Thus, further refinements in the speed and size of HSI systems are sought to make these capabilities available on the battlefield.

  14. A needs analysis for computer-based telephone triage in a community AIDS clinic.

    PubMed Central

    Henry, S. B.; Schreiner, J. G.; Borchelt, D.; Musen, M. A.

    1992-01-01

    This study describes the complexity of the telephone-triage task in a community-based AIDS clinic. We identify deficiencies related to the data management for and documentation of the telephone-triage encounter, including inaccessibility of the medical record and failure to document required data elements. Our needs analysis suggests five design criteria for a computer-based system that assists nurses with the telephone-triage task: (1) online accessibility of the medical record, (2) ability to move among modules of the medical record and the triage-encounter module, (3) ease of data entry, (4) compliance with standards for documentation, and (5) notification of the primary-care physician in an appropriate and timely manner. PMID:1482941

  15. Evaluation of the ACT intervention to improve nurses' cardiac triage decisions.

    PubMed

    Arslanian-Engoren, Cynthia; Hagerty, Bonnie; Eagle, Kim A

    2010-10-01

    Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest-posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage (ACT) intervention to improve ED nurses' cardiac triage decisions. Charts of all women who received an ED ECG 3 months before ( n = 171) and after (n = 184) the intervention and who were at least 18 years of age were reviewed. A 1-hr educational session was conducted to improve nurses' (n = 23) cardiac triage decisions. Postintervention, the proportion of women receiving an ECG within 10 min of ED arrival improved, as did the odds of women receiving a timely ECG. Preliminary evaluation of the ACT intervention indicates its effectiveness at improving ED nurses' cardiac triage decisions and obtaining a 10-min physician-read ECG. PMID:20634399

  16. The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

    PubMed Central

    Ebrahimi, Mohsen; Mazlom, Reza; Heydari, Abbas; Nassehi, Asra; Jafari, Mojtaba

    2016-01-01

    Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse's role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42 ± 5.94) years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses. PMID:27382500

  17. Imaging components for a robotic casualty evaluation system.

    PubMed

    Wong, Kenneth H; Lob, Shih-Chung; Lin, Ching-Fang; Lasser, Bob; Mun, Seong K

    2009-01-01

    Combat medics have a vital role in the protection of wounded soldiers in the battlespace. However, their duties expose them to great risks. Furthermore, these medics are a limited resource and must be carefully tasked in order to provide maximum benefit to their units. For these reasons, we are applying the American GNC Corporation's (AGNC) Coremicro(R) Robotic System for autonomous evaluation of battlefield casualties. These robots are intended to navigate to a casualty, determine his/her overall health status, and perform limited diagnostic imaging in order to assess the presence of injuries that would prevent or complicate extraction. In this paper, we describe development work on some of the key components of the proposed robotic system, namely the overall concept of operations (ConOps) and initial testing of infrared and ultrasound imaging cameras. When fully deployed, this system will act as a medical force multiplier, enabling improved care of wounded soldiers and protecting the health and safety of military medical personnel. PMID:19964740

  18. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Coast Guard forms for numbering and casualty reporting. 173.81 Section 173.81 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In...

  19. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Coast Guard marine casualty investigation for the Board. 850.25 Section 850.25 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard...

  20. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Coast Guard forms for numbering and casualty reporting. 173.81 Section 173.81 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In...

  1. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Coast Guard marine casualty investigation for the Board. 4.40-25 Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety...

  2. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Coast Guard forms for numbering and casualty reporting. 173.81 Section 173.81 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In...

  3. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Coast Guard forms for numbering and casualty reporting. 173.81 Section 173.81 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In...

  4. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Coast Guard marine casualty investigation for the Board. 4.40-25 Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety...

  5. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Coast Guard forms for numbering and casualty reporting. 173.81 Section 173.81 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In...

  6. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Coast Guard marine casualty investigation for the Board. 4.40-25 Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety...

  7. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... § 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has an approved numbering system must forward a copy of that report to...

  8. 77 FR 8956 - Surety Companies Acceptable on Federal Bonds: Grange Mutual Casualty Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-15

    ... Supplement No. 7 to the Treasury Department Circular 570, 2011 Revision, published July 1, 2011, at 76 FR... Fiscal Service Surety Companies Acceptable on Federal Bonds: Grange Mutual Casualty Company AGENCY.... 9305 to the following company: Grange Mutual Casualty Company (NAIC 14060). Business Address: 671...

  9. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The Board shall... 49 Transportation 7 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS §...

  10. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...'s rules of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The... 46 Shipping 1 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 4.40-15... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine...

  11. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... § 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has an approved numbering system must forward a copy of that report to...

  12. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... CFR 4.03-1, the master or person in charge of the vessel shall: (a) Ensure compliance with 46 CFR... required by 46 CFR 4.05-15 are retained for: (1) 30 days after the casualty if the vessel remains in the... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Marine casualty reporting...

  13. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...'s rules of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The... 46 Shipping 1 2012-10-01 2012-10-01 false Marine casualty investigation by the Board. 4.40-15... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine...

  14. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... CFR 4.03-1, the master or person in charge of the vessel shall: (a) Ensure compliance with 46 CFR... required by 46 CFR 4.05-15 are retained for: (1) 30 days after the casualty if the vessel remains in the... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Marine casualty reporting...

  15. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The Board shall... 49 Transportation 7 2014-10-01 2014-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS §...

  16. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... CFR 4.03-1, the master or person in charge of the vessel shall: (a) Ensure compliance with 46 CFR... required by 46 CFR 4.05-15 are retained for: (1) 30 days after the casualty if the vessel remains in the... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Marine casualty reporting...

  17. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The Board shall... 49 Transportation 7 2012-10-01 2012-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS §...

  18. Bilateral Image Subtraction and Multivariate Models for the Automated Triaging of Screening Mammograms

    PubMed Central

    Celaya-Padilla, José; Martinez-Torteya, Antonio; Rodriguez-Rojas, Juan; Galvan-Tejada, Jorge; Treviño, Victor; Tamez-Peña, José

    2015-01-01

    Mammography is the most common and effective breast cancer screening test. However, the rate of positive findings is very low, making the radiologic interpretation monotonous and biased toward errors. This work presents a computer-aided diagnosis (CADx) method aimed to automatically triage mammogram sets. The method coregisters the left and right mammograms, extracts image features, and classifies the subjects into risk of having malignant calcifications (CS), malignant masses (MS), and healthy subject (HS). In this study, 449 subjects (197 CS, 207 MS, and 45 HS) from a public database were used to train and evaluate the CADx. Percentile-rank (p-rank) and z-normalizations were used. For the p-rank, the CS versus HS model achieved a cross-validation accuracy of 0.797 with an area under the receiver operating characteristic curve (AUC) of 0.882; the MS versus HS model obtained an accuracy of 0.772 and an AUC of 0.842. For the z-normalization, the CS versus HS model achieved an accuracy of 0.825 with an AUC of 0.882 and the MS versus HS model obtained an accuracy of 0.698 and an AUC of 0.807. The proposed method has the potential to rank cases with high probability of malignant findings aiding in the prioritization of radiologists work list. PMID:26240818

  19. Investigating the validity and usability of an interactive computer programme for assessing competence in telephone-based mental health triage.

    PubMed

    Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; King, Peter; Bourke-Finn, Karen; Brunning, Debra

    2016-02-01

    Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage. PMID:26365233

  20. Fine-grained dengue forecasting using telephone triage services

    PubMed Central

    Abdur Rehman, Nabeel; Kalyanaraman, Shankar; Ahmad, Talal; Pervaiz, Fahad; Saif, Umar; Subramanian, Lakshminarayanan

    2016-01-01

    Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline. PMID:27419226

  1. Data Triage of Astronomical Transients: A Machine Learning Approach

    NASA Astrophysics Data System (ADS)

    Rebbapragada, U.

    This talk presents real-time machine learning systems for triage of big data streams generated by photometric and image-differencing pipelines. Our first system is a transient event detection system in development for the Palomar Transient Factory (PTF), a fully-automated synoptic sky survey that has demonstrated real-time discovery of optical transient events. The system is tasked with discriminating between real astronomical objects and bogus objects, which are usually artifacts of the image differencing pipeline. We performed a machine learning forensics investigation on PTF’s initial system that led to training data improvements that decreased both false positive and negative rates. The second machine learning system is a real-time classification engine of transients and variables in development for the Australian Square Kilometre Array Pathfinder (ASKAP), an upcoming wide-field radio survey with unprecedented ability to investigate the radio transient sky. The goal of our system is to classify light curves into known classes with as few observations as possible in order to trigger follow-up on costlier assets. We discuss the violation of standard machine learning assumptions incurred by this task, and propose the use of ensemble and hierarchical machine learning classifiers that make predictions most robustly.

  2. Tau triage decisions mediated by the chaperone network.

    PubMed

    Cook, Casey; Petrucelli, Leonard

    2013-01-01

    The pathological accumulation of the microtubule-binding protein tau is linked to an increasing number of neurodegenerative conditions associated with aging, though the mechanisms by which tau accumulates in disease are unclear. In this review, we will summarize our previous research assessing the mechanism of action, as well as the therapeutic potential of Hsp90 inhibition for the treatment of tauopathies. Specifically, we describe the development of a high-throughput screening approach to identify and rank compounds, and demonstrate the selective elimination of aberrant p-tau species in the brain following treatment with an Hsp90 inhibitor. Additionally, we identify CHIP as an essential component of the Hsp90 chaperone complex that mediates tau degradation, and present evidence to suggest that CHIP functions to identify and sequester neurotoxic tau species. Finally, we discuss recent data identifying an additional mechanism by which CHIP modulates protein triage decisions involving Hsp90. Specifically, CHIP indirectly regulates Hsp90 chaperone activity by modulating steady-state levels of the Hsp90 deacetylase, HDAC6, thus influencing both the acetylation state and function of Hsp90. Thus future research directions will focus on the manipulation of this network to promote degradation of pathogenic tau species in disease. PMID:22596270

  3. Respiratory rate estimation during triage of children in hospitals.

    PubMed

    Shah, Syed Ahmar; Fleming, Susannah; Thompson, Matthew; Tarassenko, Lionel

    2015-01-01

    Accurate assessment of a child's health is critical for appropriate allocation of medical resources and timely delivery of healthcare in Emergency Departments. The accurate measurement of vital signs is a key step in the determination of the severity of illness and respiratory rate is currently the most difficult vital sign to measure accurately. Several previous studies have attempted to extract respiratory rate from photoplethysmogram (PPG) recordings. However, the majority have been conducted in controlled settings using PPG recordings from healthy subjects. In many studies, manual selection of clean sections of PPG recordings was undertaken before assessing the accuracy of the signal processing algorithms developed. Such selection procedures are not appropriate in clinical settings. A major limitation of AR modelling, previously applied to respiratory rate estimation, is an appropriate selection of model order. This study developed a novel algorithm that automatically estimates respiratory rate from a median spectrum constructed applying multiple AR models to processed PPG segments acquired with pulse oximetry using a finger probe. Good-quality sections were identified using a dynamic template-matching technique to assess PPG signal quality. The algorithm was validated on 205 children presenting to the Emergency Department at the John Radcliffe Hospital, Oxford, UK, with reference respiratory rates up to 50 breaths per minute estimated by paediatric nurses. At the time of writing, the authors are not aware of any other study that has validated respiratory rate estimation using data collected from over 200 children in hospitals during routine triage. PMID:26548638

  4. Creation of a virtual triage exercise: an interprofessional communication strategy.

    PubMed

    Farra, Sharon; Nicely, Stephanie; Hodgson, Eric

    2014-10-01

    Virtual reality simulation as a teaching method is gaining increased acceptance and presence in institutions of higher learning. This study presents an innovative strategy using the interdisciplinary development of a nonimmersive virtual reality simulation to facilitate interprofessional communication. The purpose of this pilot project was to describe nursing students' attitudes related to interprofessional communication following the collaborative development of a disaster triage virtual reality simulation. Collaboration between and among professionals is integral in enhancing patient outcomes. In addition, ineffective communication is linked to detrimental patient outcomes, especially during times of high stress. Poor communication has been identified as the root cause of the majority of negative sentinel events occurring in hospitals. The simulation-development teaching model proved useful in fostering interprofessional communication and mastering course content. Mean scores on the KidSIM Attitudes Towards Teamwork in Training Undergoing Designed Educational Simulation survey demonstrated that nursing students, after simulation experience,had agreement to strong agreement inall areas surveyed including interprofessional education, communication, roles and responsibilities of team members, and situational awareness. The findings indicate that students value interprofessional teamwork and the opportunity to work with other disciplines. PMID:25140445

  5. Redeye: A Digital Library for Forensic Document Triage

    SciTech Connect

    Bogen, Paul Logasa; McKenzie, Amber T; Gillen, Rob

    2013-01-01

    Forensic document analysis has become an important aspect of investigation of many different kinds of crimes from money laundering to fraud and from cybercrime to smuggling. The current workflow for analysts includes powerful tools, such as Palantir and Analyst s Notebook, for moving from evidence to actionable intelligence and tools for finding documents among the millions of files on a hard disk, such as FTK. However, the analysts often leave the process of sorting through collections of seized documents to filter out the noise from the actual evidence to a highly labor-intensive manual effort. This paper presents the Redeye Analysis Workbench, a tool to help analysts move from manual sorting of a collection of documents to performing intelligent document triage over a digital library. We will discuss the tools and techniques we build upon in addition to an in-depth discussion of our tool and how it addresses two major use cases we observed analysts performing. Finally, we also include a new layout algorithm for radial graphs that is used to visualize clusters of documents in our system.

  6. Fine-grained dengue forecasting using telephone triage services.

    PubMed

    Abdur Rehman, Nabeel; Kalyanaraman, Shankar; Ahmad, Talal; Pervaiz, Fahad; Saif, Umar; Subramanian, Lakshminarayanan

    2016-07-01

    Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline. PMID:27419226

  7. Swallowable fluorometric capsule for wireless triage of gastrointestinal bleeding.

    PubMed

    Nemiroski, A; Ryou, M; Thompson, C C; Westervelt, R M

    2015-12-01

    Real-time detection of gastrointestinal bleeding remains a major challenge because there does not yet exist a minimally invasive technology that can both i) monitor for blood from an active hemorrhage and ii) uniquely distinguish it from blood left over from an inactive hemorrhage. Such a device would be an important tool for clinical triage. One promising solution, which we have proposed previously, is to inject a fluorescent dye into the blood stream and to use it as a distinctive marker of active bleeding by monitoring leakage into the gastrointestinal tract with a wireless fluorometer. This paper reports, for the first time to our knowledge, the development of a swallowable, wireless capsule with a built-in fluorometer capable of detecting fluorescein in blood, and intended for monitoring gastrointestinal bleeding in the stomach. The embedded, compact fluorometer uses pinholes to define a microliter sensing volume and to eliminate bulky optical components. The proof-of-concept capsule integrates optics, low-noise analog sensing electronics, a microcontroller, battery, and low power Zigbee radio, all into a cylindrical package measuring 11 mm × 27 mm and weighing 10 g. Bench-top experiments demonstrate wireless fluorometry with a limit-of-detection of 20 nM aqueous fluorescein. This device represents a major step towards a technology that would enable simple, rapid detection of active gastrointestinal bleeding, a capability that would save precious time and resources and, ultimately, reduce complications in patients. PMID:26490455

  8. A redundant resource: a pre-planned casualty clearing station for a FIFA 2010 Stadium in Durban.

    PubMed

    Hardcastle, Timothy C; Samlal, Sanjay; Naidoo, Rajen; Hendrikse, Steven; Gloster, Alex; Ramlal, Melvin; Ngema, Sibongiseni; Rowe, Michael

    2012-10-01

    This report details the background, planning, and establishment of a mass-casualty management area for the Durban Moses Mabhida Stadium at the Natal Mounted Rifles base, by the Department of Health and the eThekwini Fire and Rescue Service, for the Fédération Internationale de Football Association (FIFA) 2010 Soccer World Cup. The report discusses the use of the site during the seven matches played at that stadium, and details the aspects of mass-gathering major incident site planning for football (soccer). The area also was used as a treatment area for other single patient incidents outside of the stadium, but within the exclusion perimeter, and the 22 patients treated by the Casualty Clearing Station (CCS) team are described and briefly discussed. A site-specific patient presentation rate of 0.48 per 10,000 and transport-to-hospital rate (TTHR) of 0.09/10,000 are reported. Lessons learned and implications for future event planning are discussed in the light of the existing literature. PMID:22591650

  9. A Casualty in the Class War: Canada's Medicare

    PubMed Central

    Evans, Robert G.

    2012-01-01

    “There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning.” (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare. PMID:23372577

  10. A Casualty in the Class War: Canada's Medicare.

    PubMed

    Evans, Robert G

    2012-02-01

    "There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning." (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare. PMID:23372577

  11. Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence

    PubMed Central

    2011-01-01

    Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other

  12. Estimating shaking-induced casualties and building damage for global earthquake events: a proposed modelling approach

    USGS Publications Warehouse

    So, Emily; Spence, Robin

    2013-01-01

    Recent earthquakes such as the Haiti earthquake of 12 January 2010 and the Qinghai earthquake on 14 April 2010 have highlighted the importance of rapid estimation of casualties after the event for humanitarian response. Both of these events resulted in surprisingly high death tolls, casualties and survivors made homeless. In the Mw = 7.0 Haiti earthquake, over 200,000 people perished with more than 300,000 reported injuries and 2 million made homeless. The Mw = 6.9 earthquake in Qinghai resulted in over 2,000 deaths with a further 11,000 people with serious or moderate injuries and 100,000 people have been left homeless in this mountainous region of China. In such events relief efforts can be significantly benefitted by the availability of rapid estimation and mapping of expected casualties. This paper contributes to ongoing global efforts to estimate probable earthquake casualties very rapidly after an earthquake has taken place. The analysis uses the assembled empirical damage and casualty data in the Cambridge Earthquake Impacts Database (CEQID) and explores data by event and across events to test the relationships of building and fatality distributions to the main explanatory variables of building type, building damage level and earthquake intensity. The prototype global casualty estimation model described here uses a semi-empirical approach that estimates damage rates for different classes of buildings present in the local building stock, and then relates fatality rates to the damage rates of each class of buildings. This approach accounts for the effect of the very different types of buildings (by climatic zone, urban or rural location, culture, income level etc), on casualties. The resulting casualty parameters were tested against the overall casualty data from several historical earthquakes in CEQID; a reasonable fit was found.

  13. Conservation triage or injurious neglect in endangered species recovery

    PubMed Central

    Gerber, Leah R.

    2016-01-01

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for “costly yet futile” recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species. PMID:26976572

  14. Conservation triage or injurious neglect in endangered species recovery.

    PubMed

    Gerber, Leah R

    2016-03-29

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for "costly yet futile" recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species. PMID:26976572

  15. Novel Human Radiation Exposure Biomarker Panel Applicable for Population Triage

    SciTech Connect

    Bazan, Jose G.; Chang, Polly; Balog, Robert; D'Andrea, Annalisa; Shaler, Thomas; Lin, Hua; Lee, Shirley; Harrison, Travis; Shura, Lei; Schoen, Lucy; Knox, Susan J.; Cooper, David E.

    2014-11-01

    Purpose: To identify a panel of radiation-responsive plasma proteins that could be used in a point-of-care biologic dosimeter to detect clinically significant levels of ionizing radiation exposure. Methods and Materials: Patients undergoing preparation for hematopoietic cell transplantation using radiation therapy (RT) with either total lymphoid irradiation or fractionated total body irradiation were eligible. Plasma was examined from patients with potentially confounding conditions and from normal individuals. Each plasma sample was analyzed for a panel of 17 proteins before RT was begun and at several time points after RT exposure. Paired and unpaired t tests between the dose and control groups were performed. Conditional inference trees were constructed based on panels of proteins to compare the non-RT group with the RT group. Results: A total of 151 patients (62 RT, 41 infection, 48 trauma) were enrolled on the study, and the plasma from an additional 24 healthy control individuals was analyzed. In comparison with to control individuals, tenascin-C was upregulated and clusterin was downregulated in patients receiving RT. Salivary amylase was strongly radiation responsive, with upregulation in total body irradiation patients and slight downregulation in total lymphoid irradiation patients compared with control individuals. A panel consisting of these 3 proteins accurately distinguished between irradiated patients and healthy control individuals within 3 days after exposure: 97% accuracy, 0.5% false negative rate, 2% false positive rate. The accuracy was diminished when patients with trauma, infection, or both were included (accuracy, 74%-84%; false positive rate, 14%-33%, false negative rate: 8%-40%). Conclusions: A panel of 3 proteins accurately distinguishes unirradiated healthy donors from those exposed to RT (0.8-9.6 Gy) within 3 days of exposure. These findings have significant implications in terms of triaging individuals in the case of nuclear or other

  16. Building vulnerability and human casualty estimation for a pyroclastic flow: a model and its application to Vesuvius

    NASA Astrophysics Data System (ADS)

    Spence, Robin J. S.; Baxter, Peter J.; Zuccaro, Giulio

    2004-05-01

    Pyroclastic flows clearly present a serious threat to life for the inhabitants of settlements on the slopes of volcanoes with a history of explosive eruptions; but it is increasingly realised that buildings can provide a measure of protection to occupants trapped by such flows. One important example is Vesuvius, whose eruption history includes many events which were lethal for the inhabitants of the neighbouring Vesuvian villages. Recent computational fluid dynamics computer modelling for Vesuvius [Todesco et al., Bull. Volcanol. 64 (2002) 155-177] has enabled a realistic picture of an explosive eruption to be modelled, tracing the time-dependent development of the physical parameters of a simulated flow at a large three-dimensional mesh of points, based on assumed conditions of temperature, mass-flow rate and particle size distribution at the vent. The output includes mapping of temperature, mixture density and mixture velocity over the whole adjacent terrain. But to date this information has not been used to assess the impacts of such flows on buildings and their occupants. In the project reported in this paper, estimates of the near-ground flow parameters were used to assess the impact of a particular simulated pyroclastic flow (modelled roughly on the 1631 eruption) on the buildings and population in four of the Vesuvian villages considered most at risk. The study had five components. First, a survey of buildings and the urban environment was conducted to identify the incidence of characteristics and elements likely to affect human vulnerability, and to classify the building stock. The survey emphasised particularly the number, location and type of openings characteristic of the major classes of the local building stock. In the second part of the study, this survey formed the basis for estimates of the probable impact of the pyroclastic flow on the envelope and internal air conditions of typical buildings. In the third part, a number of distinct ways in which

  17. Care of the Burn Casualty in the Prolonged Field Care Environment.

    PubMed

    Studer, Nicholas M; Driscoll, Ian R; Daly, Ivonne M; Graybill, John C

    2015-01-01

    Burns are frequently encountered on the modern battlefield, with 5% - 20% of combat casualties expected to sustain some burn injury. Addressing immediate life-threatening conditions in accordance with the MARCH protocol (massive hemorrhage, airway, respirations, circulation, hypothermia/head injury) remains the top priority for burn casualties. Stopping the burning process, total burn surface area (TBSA) calculation, fluid resuscitation, covering the wounds, and hypothermia management are the next steps. If transport to definitive care is delayed and the prolonged field care stage is entered, the provider must be prepared to provide for the complex resuscitation and wound care needs of a critically ill burn casualty. PMID:26360361

  18. Marine casualty and pollution database (raw data only) (on CD-ROM). Data file

    SciTech Connect

    1998-06-01

    The Marine Casualty and Pollution Database provides details about marine casualty and pollution incidents investigated by the US Coast Guard Marine Safety Officer. The database is an invaluable source of information to understand particulars and circumstances of marine accidents and pollution incidents. The CD-ROM contains forty data tables derived from marine casualty and pollution investigations conducted by investigators at US Coast Guard Marine Safety Offices throughout the United States. The data collection period began in 1973 and is ongoing. Also included on the CD-ROM are vessel and facility tables with specific information on vessel and facility constitution and operating details. The Coast Guard maintains a comprehensive database on approximately 460,000 US and foreign vessels and 32,000 facilities. Entity and attribute descriptions and suggested solutions to general marine pollution, vessel casualty, and personnel injury and death questions are outlined in the documentation.

  19. Advancing critical care: joint combat casualty research team and joint theater trauma system.

    PubMed

    Bridges, Elizabeth; Biever, Kimberlie

    2010-01-01

    Despite the severity and complexity of injuries, survival rates among combat casualties are equal to or better than those from civilian trauma. This article summarizes the evidence regarding innovations from the battlefield that contribute to these extraordinary survival rates, including preventing hemorrhage with the use of tourniquets and hemostatic dressings, damage control resuscitation, and the rapid evacuation of casualties via MEDEVAC and the US Air Force Critical Care Air Transport Teams. Care in the air for critically injured casualties with pulmonary injuries and traumatic brain injury is discussed to demonstrate the unique considerations required to ensure safe en route care. Innovations being studied to decrease sequelae associated with complex orthopedic and extremity trauma are also presented. The role and contributions of the Joint Combat Casualty Research Team and the Joint Theater Trauma System are also discussed. PMID:20683227

  20. An Instrument for In-situ Triage of Mars 2020 Rover Samples for Organics and Chronology

    NASA Astrophysics Data System (ADS)

    Anderson, F.; Whitaker, T.; Andrews, J.

    2013-12-01

    We have developed a prototype instrument for triaging samples for elemental chemistry, organics, and Rb-Sr dates on the Mars 2020 Rover. Determining organic content and rock age are key drivers for Mars Sample Return (MSR). By identifying samples with organics, and potentially a range of dates, we increase near-term science return, while maximizing scientific and political will to compel the ultimate return of samples. Though organics have proven difficult to identify in-situ, understanding their distribution and variety could provide key constraints on the possibility of life; on the other hand, datable outcrops are clearly present at a range of potential landing sites, and could provide insight into the evolution of both local and global geology, and the history of solar system bombardment. Our instrument uses laser desorption resonance ionization mass spectrometry (LDRIMS) for Rb-Sr dates, and a subset of the LDRIMS lasers for L2MS measurements of organics. With LDRIMS, a sample is placed in a time-of-flight (TOF) mass spectrometer and surface atoms, molecules, and ions are desorbed with a 213 nm laser. The plume of expanding atoms is present for many μs, during which it is first illuminated with laser light tuned to ionize only Sr, and then 1-3 μs later, Rb . This eliminates isobars for Rb and Sr, and insures that the measured atoms come from the same ablation event, and hence target materials. L2MS uses high-power IR laser ablation to desorb neutral organic molecules, followed by a second, UV laser beam for ionization. Advantages of L2MS include the measurement of a wide array of elements, and it is one of the most sensitive available organic detection methods, with demonstrated detection to 10-18. We have previously demonstrated dates on granites with an average of 1.727×0.087 Ga (MSWD=1; ×0.062 for MSWD=2); both values have a precision and accuracy exceeding that called for by NASA. Finally, we have demonstrated ppm-level detections of organics in the

  1. Estimating the human recovery costs of seriously injured road crash casualties.

    PubMed

    Bambach, M R; Mitchell, R J

    2015-12-01

    Road crashes result in substantial trauma and costs to societies around the world. Robust costing methods are an important tool to estimate costs associated with road trauma, and are key inputs into policy development and cost-benefit analysis for road safety programmes and infrastructure projects. With an expanding focus on seriously injured road crash casualties, in addition to the long standing focus on fatalities, methods for costing seriously injured casualties are becoming increasingly important. Some road safety agencies are defining a seriously injured casualty as an individual that was admitted to hospital following a road crash, and as a result, hospital separation data provide substantial potential for estimating the costs associated with seriously injured road crash casualties. The aim of this study is to establish techniques for estimating the human recovery costs of (non-fatal) seriously injured road crash casualties directly from hospital separation data. An individuals' road crash-related hospitalisation record and their personal injury insurance claim were linked for road crashes that occurred in New South Wales, Australia. These records provided the means for estimating all of the costs to the casualty directly related to their recovery from their injuries. A total of 10,897 seriously injured road crash casualties were identified and four methods for estimating their recovery costs were examined, using either unit record or aggregated hospital separation data. The methods are shown to provide robust techniques for estimating the human recovery costs of seriously injured road crash casualties, that may prove useful for identifying, implementing and evaluating safety programmes intended to reduce the incidence of road crash-related serious injuries. PMID:26436488

  2. [Emergency and disaster response in critical care unit in the Mexican Social Security Institute: triage and evacuation].

    PubMed

    Echevarría-Zuno, Santiago; Cruz-Vega, Felipe; Elizondo-Argueta, Sandra; Martínez Valdés, Everardo; Franco-Bey, Rubén; Méndez-Sánchez, Luis Miguel

    2013-01-01

    Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care. PMID:23769257

  3. Mass

    SciTech Connect

    Chris Quigg

    2007-12-05

    In the classical physics we inherited from Isaac Newton, mass does not arise, it simply is. The mass of a classical object is the sum of the masses of its parts. Albert Einstein showed that the mass of a body is a measure of its energy content, inviting us to consider the origins of mass. The protons we accelerate at Fermilab are prime examples of Einsteinian matter: nearly all of their mass arises from stored energy. Missing mass led to the discovery of the noble gases, and a new form of missing mass leads us to the notion of dark matter. Starting with a brief guided tour of the meanings of mass, the colloquium will explore the multiple origins of mass. We will see how far we have come toward understanding mass, and survey the issues that guide our research today.

  4. Outcome of sports injuries treated in a casualty department.

    PubMed Central

    Sandelin, J; Kiviluoto, O; Santavirta, S; Honkanen, R

    1985-01-01

    The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23% of the injuries respectively, these being followed by injuries in ice hockey in 14%. Track and field injuries scored low with 2% out of all injuries. Injuries to the lower extremity predominated. At follow-up, ligamentous injuries of the lower extremity were the major cause of discomfort. Further, in the group of patients with persistent discomfort 36% had suffered a fracture or a dislocation, 13% a contusion and 10% a wound. The mean period of sports incapacity after a sustained injury was 3 weeks. In track and field events the injury seldom disturbed training for more than one week, but in soccer, indoor ball games, skiing and skating the mean sports incapacity period varied between 6 and 3 weeks. Out of the total injured, 2% had to give up their sports activity completely. An injury of the lower extremity demanded on average 4 weeks' rest, an injury of the upper extremity and the trunk 2 weeks and injuries of the head and neck one week's rest. According to the present investigation sports injuries were in the majority of cases of a relatively benign nature and sick leave from work seldom exceeded 2 weeks. Images p103-a PMID:4027492

  5. Ultrasonography in the evaluation of hemoperitoneum in war casualties.

    PubMed

    Miletić, D; Fuckar, Z; Mraović, B; Dimec, D; Mozetic, V

    1999-08-01

    The aim of this study was to evaluate the sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the detection of hemoperitoneum among war casualties, and to compare the results of this method in a specific war situation and civil conditions. Ninety-four wounded individuals with suspected blunt or penetrating abdominal trauma were treated at a level I war hospital (group W), and 242 civilians with multiple injuries with suspected blunt abdominal trauma were evaluated at the emergency center of a university hospital (group C). All examinations were performed in less than 5 minutes with a portable ultrasonographic scanner, and typical points were scanned (Morison's pouch, Douglas and perisplenic spaces, paracolic gutter). In group W, hemoperitoneum was identified correctly in 19 patients, with three false-negative and no false-positive findings, whereas group C presented 98 true-positive results, 13 false-negative results, and again no false-positive results. We observed that ultrasonography in specific war conditions showed sensitivity of 86%, specificity of 100%, accuracy as high as 97%, positive predictive value of 100%, and negative predictive value of 96%, whereas in civil conditions the corresponding values were 88%, 100%, 95%, 100%, and 91%, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values of emergent ultrasound examination in the diagnosis of hemoperitoneum are approximately equal in war and civil conditions. PMID:10459274

  6. Scope of practice review: providers for triage and assessment of spine-related disorders

    PubMed Central

    Boakye, Omenaa; Birney, Arden; Suter, Esther; Phillips, Leah Adeline; Suen, Victoria YM

    2016-01-01

    Purpose This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers’ legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals’ scope of practice. Results Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. PMID:27274267

  7. Operational Testing of a Combined Hardware-Software Strategy for Triage of Radiologically-Contaminated Persons.

    PubMed

    Waller, Edward J

    2015-08-01

    After a radiological dispersal device (RDD) event, it is possible for radionuclides to enter the human body through inhalation, ingestion, and skin and wound absorption. The dominant pathway will be through inhalation. From a health physics perspective, it is important to know the magnitude of the intake to perform dosimetric assessments. From a medical perspective, removal of radionuclides leading to dose (hence risk) aversion is of high importance. The efficacy of medical decorporation strategies is extremely dependent upon the time of treatment delivery after intake. The "golden hour," or more realistically 3-4 h, is imperative when attempting to increase removal of radionuclides from extracellular fluids prior to cellular incorporation. To assist medical first response personnel in making timely decisions regarding appropriate treatment delivery modes, a software tool has been developed which compiles existing radionuclide decorporation therapy data and allows a user to perform simple triage leading to potential appropriate decorporation treatment strategies. Three triage algorithms were included: (1) multi-parameter model (MPM), (2) clinical decision guidance (CDG) model, and (3) annual limit on intake (ALI) model. A radiation triage mask (RTM) has simultaneously been developed to provide a simple and rapid hardware solution for first responders to triage internally exposed personnel in the field. The hardware/software strategy was field tested with a military medical unit and was found by end-users to be relatively simple to learn and use. PMID:26102327

  8. Using electronic wristbands and a triage protocol to protect mental health patients in the emergency department.

    PubMed

    Macy, Deborah; Johnston, Michelle

    2007-01-01

    In the emergency department of Mercy Hospital, concerns about possible elopement of mental health patients led to the use of the services of security officers, who were called for an average of 40 patient watches per week. Modified electronic wristbands, paired with a triage protocol, have significantly decreased the need for patient watches and decreased security costs. PMID:17353756

  9. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    ERIC Educational Resources Information Center

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  10. Software-assisted spine registered nurse care coordination and patient triage--one organization's approach.

    PubMed

    Crossley, Leslie; Mueller, Lori; Horstman, Patricia

    2009-08-01

    Back disorders encompass a spectrum of conditions, from those of acute onset and short duration to lifelong disorders. The use of a traditional spine center model of patient flow, in which the patient is scheduled the first available appointment without an initial assessment of spine-related symptoms at West Virginia University Spine Center, Morgantown, West Virginia, resulted in frustration and delays for the spine patient and referring physician dissatisfaction. Today, the use of a software-assisted spine patient triage and registered nurse care coordinator patient navigation system in this multidiscipline, multimodality comprehensive spine program provides quick and efficient patient triage to the appropriate level of spine care (surgeon vs. nonsurgeon). The model consists of five major steps, which are explored in this article: medical history intake; films or studies retrieval; rapid review of the patient's medical condition and diagnostics by a spine specialist preappointment and subsequent triage to the appropriate level of spine care; registered nurse care coordinator patient education and guided navigation through the patient's preferred treatment plan; and last, diagnostic study, pain injection, and provider scheduling. Patient satisfaction scores, referring physician satisfaction scores, and resultant impact on referral volumes, ancillary utilization, workload productivity, and surgical yield demonstrate that this new approach to patient triage has made significant improvements in efficiency, productivity, and service. PMID:19678508

  11. Meeting the Demand for College Student Concerns in College Counseling Centers: Evaluating a Clinical Triage System

    ERIC Educational Resources Information Center

    Hardy, Jennifer A.; Weatherford, Ryan D.; Locke, Benjamin D.; DePalma, Natalie Hernandez; D'Iuso, Nadia T.

    2011-01-01

    University counseling centers, experiencing an imbalance between student demand and available resources, respond in various ways. The current mixed-method study evaluated one university counseling center transitioning from a wait-list system to a triage method of managing demand. Significant reductions in wait time and increase in attendance were…

  12. Assessment of Emergency Preparedness Modules in Introductory Pharmacy Practice Experiences

    PubMed Central

    von Waldner, Trina; McEwen, Deanna W.; White, Catherine A.

    2016-01-01

    Objective. To determine the impact of emergency preparedness simulations in mass triage and mass dispensing on student pharmacist performance and perceived competency when assuming pharmacist roles in disaster situations. Design. Second-year student pharmacists (144) completed two 3-hour simulations focusing on mass triage and mass dispensing. The mass triage simulation consisted of virtual and live victims to be triaged and assigned a transport order. In the mass dispensing simulation, students assumed patient and pharmacist roles in a point-of-dispensing exercise for influenza. Assessment. For the mass triage simulation, students were challenged most by determining which patients could wait for emergency care but did well assessing those who required immediate or minimal care (83% and 64% correct, respectively). During the mass dispensing simulation, students performed screening and dispensing functions with accuracy rates of 88% and 90%, respectively. Conclusion. Student pharmacists performed well in screening and dispensing functions, but struggled with mass casualty triage during emergency preparedness simulations. PMID:27073276

  13. Assessment of Emergency Preparedness Modules in Introductory Pharmacy Practice Experiences.

    PubMed

    Hannings, Ashley N; von Waldner, Trina; McEwen, Deanna W; White, Catherine A

    2016-03-25

    Objective. To determine the impact of emergency preparedness simulations in mass triage and mass dispensing on student pharmacist performance and perceived competency when assuming pharmacist roles in disaster situations. Design. Second-year student pharmacists (144) completed two 3-hour simulations focusing on mass triage and mass dispensing. The mass triage simulation consisted of virtual and live victims to be triaged and assigned a transport order. In the mass dispensing simulation, students assumed patient and pharmacist roles in a point-of-dispensing exercise for influenza. Assessment. For the mass triage simulation, students were challenged most by determining which patients could wait for emergency care but did well assessing those who required immediate or minimal care (83% and 64% correct, respectively). During the mass dispensing simulation, students performed screening and dispensing functions with accuracy rates of 88% and 90%, respectively. Conclusion. Student pharmacists performed well in screening and dispensing functions, but struggled with mass casualty triage during emergency preparedness simulations. PMID:27073276

  14. Waiting Times in Emergency Department After Using the Emergency Severity Index Triage Tool

    PubMed Central

    Mahmoodian, Farzad; Eqtesadi, Razie; Ghareghani, Atefe

    2014-01-01

    Background: Hospital emergency departments (EDs) are as barometers of the health care system. Crowded EDs threaten delivery of timely care. Prolonged ED wait times reduce the quality of care and increase adverse and sometimes irreversible events. Objectives: The purpose of this study was to determine the patients' waiting time at Namazi and Shahid Faghihi hospitals in Shiraz, Iran. Patients and Methods: This analytical cross-sectional study was conducted in two phases from December 2012 to May 2013. First, the researcher attended the EDs of the two hospitals and recorded the information of 900 patients who entered the ED, including arrival time, level of triage, and time of first visit by physician. Then, among patients admitted to the ED units, 273 were followed and waiting times for the first physician order in the referral unit and the commencement of clinical interventions (defined as check time by the nurse) were recorded. Results: The median waiting time from arrival to first visit by physician for the 900 patients included in the study was 8 (5-14) minutes [median (interquartile range)]. For the patients admitted to referral units, waiting time was 84 (43-145) minutes for the physician order and 85 (45-147) minutes for the commencement of first clinical intervention; 75% of the patients in triage level I, 84.6% in triage level II, and 95.6% in triage level III were visited within the target time limit. Conclusions: Waiting time for commencement of clinical action in patients admitted to the EDs was considerably high for patients with higher priorities; so, rapid care of critically ill patients, identified during the triage process, should be emphasized. PMID:25738132

  15. COST-EFFECTIVENESS OF USING HUMAN PAPILLOMAVIRUS 16/18 GENOTYPE TRIAGE IN CERVICAL CANCER SCREENING

    PubMed Central

    Vijayaraghavan, Arthi; Efrusy, Molly; Mazonson, Peter; Goodman, Karyn; Santas, Christopher; Huh, Warner

    2015-01-01

    Objective Testing for human papillomavirus (HPV) 16 and 18 genotypes, which are known to cause more than 65-70% of invasive cervical cancer cases, may allow clinicians to identify women at highest risk for underlying high-grade dysplasia missed by Pap cytology. Our objective was to determine the cost-effectiveness of adding HPV-16 and 18 genotype triage to current cervical cancer screening strategies in the United States. Methods We developed a lifetime Markov model to assess the cost-effectiveness of adding HPV genotyping to current cervical cancer screening algorithms. All costs were estimated from a payer perspective in 2007 U.S. dollars. Outcome measures included lifetime risk of cervical cancer, quality-adjusted life-years saved (QALYs), and incremental cost-effectiveness ratios (ICERs). Results In our model, the use of HPV genotype triage prevented 51-73 deaths per 100,000 women screened compared to screening using liquid-based cytology (LBC) followed by HPV triage and 4-26 deaths compared to co-screening with LBC and HPV. Use of HPV genotyping to triage all high-risk HPV-positive women every three years had an ICER of $34,074 per QALY compared to HPV and LBC co-screening. HPV genotyping with co-screening was the most effective strategy and had an ICER of $33,807 per QALY compared to HPV genotyping for all high-risk HPV-positive women. Conclusion The addition of HPV-16 and -18 genotype triage to current adjunctive HPV screening with LBC is a cost-effective screening strategy in the United States. PMID:20713299

  16. Determining the optimal approach to improving trauma triage decisions: a cost-effectiveness analysis

    PubMed Central

    Mohan, Deepika; Barnato, Amber E; Rosengart, Matthew R; Angus, Derek C; Smith, Kenneth J

    2013-01-01

    Objective To identify the optimal target of a future intervention to improve physician decision making in trauma triage. Study Design A comparison of the incremental cost-effectiveness ratios (ICERs) of current practice versus hypothetical interventions targeting either physicians’ decisional thresholds (attitudes towards transferring patients to trauma centers) or perceptual sensitivity (ability to identify patients who meet guidelines for transfer). Methods Taking the societal perspective, we constructed a Markov decision model. We drew estimates of triage patterns, mortality, utilities, and costs from the literature. We assumed that an intervention to change decisional threshold would reduce under-triage but also increase over-triage more than an intervention to change perceptual sensitivity. We performed a series of one-way sensitivity analyses, and studied the most influential variables in a Monte Carlo simulation. Results The ICER of an intervention to change perceptual sensitivity was $62,799/ quality-adjusted life years (QALY)-gained compared with current practice. The ICER of an intervention to change decisional threshold was $104,975/QALY-gained compared with an intervention to change perceptual sensitivity. These findings were most sensitive to the relative cost of hospitalizing patients with moderate-severe injuries and their relative risk of dying at non-trauma centers. In probabilistic sensitivity analyses, at a willingness-to-pay threshold of $100,000/QALY-gained, there was a 62% likelihood that an intervention to change perceptual sensitivity was the most cost-effective alternative. Conclusions Even a minor investment in changing decision making in trauma triage could greatly improve the quality of care provided. The optimal intervention depends on the characteristics of the individual trauma systems. PMID:22435966

  17. Validation of a DNA methylation HPV triage classifier in a screening sample.

    PubMed

    Lorincz, Attila T; Brentnall, Adam R; Scibior-Bentkowska, Dorota; Reuter, Caroline; Banwait, Rawinder; Cadman, Louise; Austin, Janet; Cuzick, Jack; Vasiljević, Natasa

    2016-06-01

    High-risk human papillomavirus (hrHPV) DNA tests have excellent sensitivity for detection of cervical intraepithelial neoplasia 2 or higher (CIN2+). A drawback of hrHPV screening, however, is modest specificity. Therefore, hrHPV-positive women might need triage to reduce adverse events and costs associated with unnecessary colposcopy. We compared the performance of HPV16/18 genotyping with a predefined DNA methylation triage test (S5) based on target regions of the human gene EPB41L3, and viral late gene regions of HPV16, HPV18, HPV31 and HPV33. Assays were run using exfoliated cervical specimens from 710 women attending routine screening, of whom 38 were diagnosed with CIN2+ within a year after triage to colposcopy based on cytology and 341 were hrHPV positive. Sensitivity and specificity of the investigated triage methods were compared by McNemar's test. At the predefined cutoff, S5 showed better sensitivity than HPV16/18 genotyping (74% vs 54%, P = 0.04) in identifying CIN2+ in hrHPV-positive women, and similar specificity (65% vs 71%, P = 0.07). When the S5 cutoff was altered to allow equal sensitivity to that of genotyping, a significantly higher specificity of 91% was reached (P < 0.0001). Thus, a DNA methylation test for the triage of hrHPV-positive women on original screening specimens might be a valid approach with better performance than genotyping. PMID:26790008

  18. Validation of a DNA methylation HPV triage classifier in a screening sample

    PubMed Central

    Brentnall, Adam R.; Scibior‐Bentkowska, Dorota; Reuter, Caroline; Banwait, Rawinder; Cadman, Louise; Austin, Janet; Cuzick, Jack; Vasiljević, Natasa

    2016-01-01

    High‐risk human papillomavirus (hrHPV) DNA tests have excellent sensitivity for detection of cervical intraepithelial neoplasia 2 or higher (CIN2+). A drawback of hrHPV screening, however, is modest specificity. Therefore, hrHPV‐positive women might need triage to reduce adverse events and costs associated with unnecessary colposcopy. We compared the performance of HPV16/18 genotyping with a predefined DNA methylation triage test (S5) based on target regions of the human gene EPB41L3, and viral late gene regions of HPV16, HPV18, HPV31 and HPV33. Assays were run using exfoliated cervical specimens from 710 women attending routine screening, of whom 38 were diagnosed with CIN2+ within a year after triage to colposcopy based on cytology and 341 were hrHPV positive. Sensitivity and specificity of the investigated triage methods were compared by McNemar's test. At the predefined cutoff, S5 showed better sensitivity than HPV16/18 genotyping (74% vs 54%, P = 0.04) in identifying CIN2+ in hrHPV‐positive women, and similar specificity (65% vs 71%, P = 0.07). When the S5 cutoff was altered to allow equal sensitivity to that of genotyping, a significantly higher specificity of 91% was reached (P < 0.0001). Thus, a DNA methylation test for the triage of hrHPV‐positive women on original screening specimens might be a valid approach with better performance than genotyping. PMID:26790008

  19. Improved quality and efficiency after the introduction of physician-led team triage in an emergency department

    PubMed Central

    Burström, Lena; Engström, Marie-Louise; Castrén, Maaret; Wiklund, Tony; Enlund, Mats

    2016-01-01

    Background Overcrowding in the emergency department (ED) may negatively affect patient outcomes, so different triage models have been introduced to improve performance. Physician-led team triage obtains better results than other triage models. We compared efficiency and quality measures before and after reorganization of the triage model in the ED at our county hospital. Materials and methods We retrospectively compared two study periods with different triage models: nurse triage in 2008 (baseline) and physician-led team triage in 2012 (follow-up). Physician-led team triage was in use during day-time and early evenings on weekdays. Data were collected from electronic medical charts and the National Mortality Register. Results We included 20,073 attendances in 2008 and 23,765 in 2012. The time from registration to physician presentation decreased from 80 to 33 min (P < 0.001), and the length of stay decreased from 219 to 185 min (P < 0.001) from 2008 to 2012, respectively. All of the quality variables differed significantly between the two periods, with better results in 2012. The odds ratio for patients who left before being seen or before treatment was completed was 0.62 (95% confidence interval 0.54–0.72). The corresponding result for unscheduled returns was 0.36 (0.32–0.40), and for the mortality rates within 7 and 30 days 0.72 (0.59–0.88) and 0.84 (0.73–0.97), respectively. The admission rate was 37% at baseline and 32% at follow-up (P < 0.001). Conclusion Physician-led team triage improved the efficiency and quality in EDs. PMID:26553523

  20. Can Team Triage Improve Patient Flow in the Emergency Department? A Systematic Review and Meta-Analysis.

    PubMed

    Ming, Thomas; Lai, Aaron; Lau, Pui-Man

    2016-01-01

    This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice. PMID:27482995

  1. On-ground casualty risk reduction by structural design for demise

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Funke, Quirin; Krag, Holger

    2015-06-01

    In recent years, awareness concerning the on-ground risk posed by un-controlled re-entering space systems has increased. On average over the past decade, an object with mass above 800 kg re-enters every week from which only a few, e.g. ESA's GOCE in 2013 and NASA's UARS in 2011, appeared prominent in international media. Space agencies and nations have discussed requirements to limit the on-ground risk for future missions. To meet the requirements, the amount of debris falling back on Earth has to be limited in number, mass and size. Design for demise (D4D) refers to all measures taken in the design of a space object to increase the potential for demise of the object and its components during re-entry. SCARAB (Spacecraft Atmospheric Re-entry and Break-Up) is ESA's high-fidelity tool which analyses the thermal and structural effects of atmospheric re-entry on spacecraft with a finite-element approach. For this study, a model of a representative satellite is developed in SCARAB to serve as test-bed for D4D analyses on a structural level. The model is used as starting point for different D4D approaches based on increasing the exposure of the satellite components to the aero-thermal environment, as a way to speed up the demise. Statistical bootstrapping is applied to the resulting on-ground fragment lists in order to compare the different re-entry scenarios and to determine the uncertainties of the results. Moreover, the bootstrap results can be used to analyse the casualty risk estimator from a theoretical point of view. The risk reductions for the analysed D4D techniques are presented with respect to the reference scenario for the modelled representative satellite.

  2. Using Propensity to Succeed Modeling to Increase Utilization and Adherence in a Nurse HealthLine Telephone Triage Program.

    PubMed

    Navratil-Strawn, Jessica L; Hawkins, Kevin; Hartley, Stephen K; Wells, Timothy S; Ozminkowski, Ronald J; Migliori, Richard J; Yeh, Charlotte S

    2016-01-01

    Propensity to succeed modeling was used to identify characteristics associated with higher utilization of a telephone triage program and adherence to nurse recommendations among callers. Characteristics significantly associated with calling the telephone triage service and engaging in triage services were being female and having an elevated health risk score. Callers most likely to adhere to nurse recommendations were younger than 85 years of age, had called on a weekday, and had received a recommendation to seek care at an emergency department or a doctor's office visit. Additional analyses suggest the propensity to succeed modeling is stable and valid. PMID:27232680

  3. Epidemiology of child pedestrian casualty rates: can we assume spatial independence?

    PubMed

    Hewson, Paul J

    2005-07-01

    Child pedestrian injuries are often investigated by means of ecological studies, yet are clearly part of a complex spatial phenomena. Spatial dependence within such ecological analyses have rarely been assessed, yet the validity of basic statistical techniques rely on a number of independence assumptions. Recent work from Canada has highlighted the potential for modelling spatial dependence within data that was aggregated in terms of the number of road casualties who were resident in a given geographical area. Other jurisdictions aggregate data in terms of the number of casualties in the geographical area in which the collision took place. This paper contrasts child pedestrian casualty data from Devon County UK, which has been aggregated by both methods. A simple ecological model, with minimally useful covaraties relating to measures of child deprivation, provides evidence that data aggregated in terms of the casualty's home location cannot be assumed to be spatially independent and that for analysis of these data to be valid there must be some accounting for spatial auto-correlation within the model structure. Conversely, data aggregated in terms of the collision location (as is usual in the UK) was found to be spatially independent. Whilst the spatial model is clearly more complex it provided a superior fit to that seen with either collision aggregated or non-spatial models. Of more importance, the ecological level association between deprivation and casualty rate is much lower once the spatial structure is accounted for, highlighting the importance using appropriately structured models. PMID:15949456

  4. Occupational safety data and casualty rates for the uranium fuel cycle. [Glossaries

    SciTech Connect

    O'Donnell, F.R.; Hoy, H.C.

    1981-10-01

    Occupational casualty (injuries, illnesses, fatalities, and lost workdays) and production data are presented and used to calculate occupational casualty incidence rates for technologies that make up the uranium fuel cycle, including: mining, milling, conversion, and enrichment of uranium; fabrication of reactor fuel; transportation of uranium and fuel elements; generation of electric power; and transmission of electric power. Each technology is treated in a separate chapter. All data sources are referenced. All steps used to calculate normalized occupational casualty incidence rates from the data are presented. Rates given include fatalities, serious cases, and lost workdays per 100 man-years worked, per 10/sup 12/ Btu of energy output, and per other appropriate units of output.

  5. Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale

    PubMed Central

    Dhiliwal, Sunil; Salins, Naveen; Deodhar, Jayitha; Rao, Raghavendra; Muckaden, Mary Ann

    2016-01-01

    Introduction: Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale. Methods: Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care. Results: “High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ2 = 27.3, P < 0.001) compared to Group 2 (28.6%) and Group 3 (15.4%). Group 2 had more hospital deaths. Interval duration from triaging to first intervention was a significant predictor of survival with odds

  6. Mobilized progenitor cells as a bridging therapy for radiation casualties: a brief review of tocopherol succinate-based approaches.

    PubMed

    Singh, Vijay K; Singh, Pankaj K; Wise, Stephen Y; Seed, Thomas M

    2011-07-01

    Nuclear detonation through either military or terrorist action would most likely lead to a mass-casualty scenario involving victims with varying degrees of exposure to ionizing radiation. As a result of radiation injury to the hematopoietic system, victims would suffer from a lack of red blood cells that deliver oxygen, immune cells that detect and eliminate infectious agents, and blood platelets that promote blood clot formation. In part, these symptoms are generally referred to as acute radiation syndrome (ARS). While some victims of moderate to high levels of radiation will be beyond saving, most will have received enough radiation to injure but not kill their bone marrow cells completely. Such people will recover from their injuries but face a 30-60day period during which they cannot fully fight infections and are prone to uncontrolled bleeding and anemia. To keep them alive until their hematopoietic system recovers, they must receive supportive care. Recently, using experimental animal models of ARS, transfusion of myeloid progenitor cells have been tried as a bridging therapy for radiation-exposed animals. Such cells have been shown to be effective in protecting animals exposed to lethal doses of radiation. These myeloid progenitors (along with of other hematopoietic progenitor cell types) can be mobilized out of the bone marrow into the blood for the reconstitution of hematopoiesis. This review discusses various approaches to the mobilization of progenitors using different mobilizing agents, and their utility as a bridging therapy for radiation casualties. We suggest that α-tocopherol succinate (TS) is an optimal mobilizing agent for progenitors. The extent of progenitor mobilization TS elicits in experimental mice is comparable to clinically used drugs such as recombinant granulocyte-colony stimulating factor rhG-CSF/Neupogen® and the bicyclam AMD3100 (plerixafor/Mozobil); therefore, we propose that TS be considered for further translational development

  7. On-Ground Casualty Risk Reduction by Structural Design for Demise

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Krag, Holger; Funke, Quirin

    In recent years, awareness concerning the risk posed by un-controlled re-entering spacecraft on ground has increased. Some re-entry events such as ESA's GOCE in 2013 and NASA's UARS appeared prominent in international media. Space agencies and nations, in cooperation within the Inter-Agency Space Debris Coordination Committee (IADC), have established a requirements to limited the on-ground risk for future missions. To meet the requirements, the amount of debris falling back on Earth has to be limited in number, mass and size. Design for demise (D4D) refers to all measures taken in the design of a space object to increase the potential for demise of the object and its components during re-entry. SCARAB (Spacecraft Atmospheric Re-entry and Break-Up) is ESA's high-fidelity tool which analyses the thermal and structural effects of atmospheric re-entry on spacecraft in a finite-element approach. For this study, a model of a representative satellite is developed in Scarab to serve as test-bed for D4D analysis on a structural level. The model is used as starting point for different D4D approaches based on increasing the exposure of the satellite components to the aero-thermal environment, as a way to speed up the demise. Statistical bootstrapping is applied to the resulting on-ground fragment lists in order to compare the different re-entry scenarios and to determine the uncertainties of the results. Moreover, the bootstrap results can be used to analyse the casualty risk estimator from a theoretical point of view. The risk reductions for the analysed D4D techniques are presented w.r.t. the reference scenario for the modelled representative satellite.

  8. Quantitative Estimates of the Numbers of Casualties to be Expected due to Major Earthquakes Near Megacities

    NASA Astrophysics Data System (ADS)

    Wyss, M.; Wenzel, F.

    2004-12-01

    Defining casualties as the sum of the fatalities plus injured, we use their mean number, as calculated by QUAKELOSS (developed by Extreme Situations Research Center, Moscow) as a measure of the extent of possible disasters due to earthquakes. Examples of cities we examined include Algiers, Cairo, Istanbul, Mumbai and Teheran, with populations ranging from about 3 to 20 million. With the assumption that the properties of the building stock has not changed with time since 1950, we find that the number of expected casualties will have increased about 5 to 10 fold by the year 2015. This increase is directly proportional to the increase of the population. For the assumed magnitude, we used M7 and M6.5 because shallow earthquakes in this range can occur in the seismogenic layer, without rupturing the surface. This means, they could occur anywhere in a seismically active area, not only along known faults. As a function of epicentral distance the fraction of casualties of the population decrease from about 6% at 20 km, to 3% at 30 km and 0.5% at 50 km, for an earthquake of M7. At 30 km distance, the assumed variation of the properties of the building stock from country to country give rise to variations of 1% to 5% for the estimate of the percent of the population that become casualties. As a function of earthquake size, the expected number of casualties drop by approximately an order of magnitude for an M6.5, compared to an M7, at 30 km distance. Because the computer code and database in QUAKELOSS are calibrated based on about 1000 earthquakes with fatalities, and verified by real-time loss estimates for about 60 cases, these results are probably of the correct order of magnitude. However, the results should not be taken as overly reliable, because (1) the probability calculations of the losses result in uncertainties of about a factor of two, (2) the method has been tested for medium size cities, not for megacities, and (3) many assumptions were made. Nevertheless, it is

  9. Dicentric assay: inter-laboratory comparison in Indian laboratories for routine and triage applications.

    PubMed

    Bakkiam, D; Bhavani, M; Anantha Kumar, A Arul; Sonwani, Swetha; Venkatachalam, P; Sivasubramanian, K; Venkatraman, B

    2015-05-01

    An Inter-Laboratory Comparison (ILC) study on Dicentric Chromosome Assay (DCA) was carried out between two Indian biodosimetry labs. Human peripheral blood samples exposed to 10 different doses of X-rays up to 5Gy were shared between the labs to generate calibration data. Validation of calibration curves was done by dose estimation of coded samples exposed to X- or gamma radiation. Reliability of the DCA data for triage application was evaluated by scoring 20, 50 and 100 metaphases in the dose range of 0.5-3.0Gy. No significant difference was observed between labs regarding the established calibration data as well as the DCA triage dose assessments. Scoring of 20 metaphases (MP) was adequate to detect radiation exposure of >2Gy whereas 50 MP were sufficient to determine exposures of 0.5Gy. Both labs performed the DCA in a reliable manner and made the first step in setting up a biodosimetry network in India. PMID:25728004

  10. Using the OntoGene pipeline for the triage task of BioCreative 2012

    PubMed Central

    Rinaldi, Fabio; Clematide, Simon; Hafner, Simon; Schneider, Gerold; Grigonytė, Gintarė; Romacker, Martin; Vachon, Therese

    2013-01-01

    In this article, we describe the architecture of the OntoGene Relation mining pipeline and its application in the triage task of BioCreative 2012. The aim of the task is to support the triage of abstracts relevant to the process of curation of the Comparative Toxicogenomics Database. We use a conventional information retrieval system (Lucene) to provide a baseline ranking, which we then combine with information provided by our relation mining system, in order to achieve an optimized ranking. Our approach additionally delivers domain entities mentioned in each input document as well as candidate relationships, both ranked according to a confidence score computed by the system. This information is presented to the user through an advanced interface aimed at supporting the process of interactive curation. Thanks, in particular, to the high-quality entity recognition, the OntoGene system achieved the best overall results in the task. PMID:23396322

  11. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... appendix also provides a method for performing an impact risk analysis that estimates the expected casualty... risk analysis in accordance with paragraph (e). (e) Impact Risk Analysis (1) An applicant shall... following summation of risk: ER19OC00.120 (viii) Alternative casualty expectancy (Ec) analysis. An...

  12. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-26... RAILROADS 1 Operating Expenses-Equipment § 1242.41 Other and casualties and insurance (accounts XX-26-99 and... administration (account XX-26-01). freight cars...

  13. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-51... RAILROADS 1 Operating Expenses-Transportation § 1242.65 Other and casualties and insurance (accounts XX-51... separation of administration (account XX-51-01). yard operations...

  14. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-27... RAILROADS 1 Operating Expenses-Equipment § 1242.54 Other and casualties and insurance (accounts XX-27-99 and... administration (account XX-27-01). Operating Expenses—Transportation train operations...

  15. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-55... RAILROADS 1 Operating Expenses-Transportation § 1242.82 Other and casualties and insurance (accounts XX-55... separation of administration (account XX-55-01). Operating Expenses general and administration...

  16. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-52... RAILROADS 1 Operating Expenses-Transportation § 1242.72 Other and casualties and insurance (accounts XX-52... separation of administration (account XX-52-01). train and yard operations common...

  17. Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study

    PubMed Central

    2012-01-01

    Background United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. Methods We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). Results We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant between-physician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds. Conclusions On a case vignette-based questionnaire, both sensory and

  18. A simple tool to predict admission at the time of triage

    PubMed Central

    Cameron, Allan; Rodgers, Kenneth; Ireland, Alastair; Jamdar, Ravi; McKay, Gerard A

    2015-01-01

    Aim To create and validate a simple clinical score to estimate the probability of admission at the time of triage. Methods This was a multicentre, retrospective, cross-sectional study of triage records for all unscheduled adult attendances in North Glasgow over 2 years. Clinical variables that had significant associations with admission on logistic regression were entered into a mixed-effects multiple logistic model. This provided weightings for the score, which was then simplified and tested on a separate validation group by receiving operator characteristic (ROC) analysis and goodness-of-fit tests. Results 215 231 presentations were used for model derivation and 107 615 for validation. Variables in the final model showing clinically and statistically significant associations with admission were: triage category, age, National Early Warning Score (NEWS), arrival by ambulance, referral source and admission within the last year. The resulting 6-variable score showed excellent admission/discharge discrimination (area under ROC curve 0.8774, 95% CI 0.8752 to 0.8796). Higher scores also predicted early returns for those who were discharged: the odds of subsequent admission within 28 days doubled for every 7-point increase (log odds=+0.0933 per point, p<0.0001). Conclusions This simple, 6-variable score accurately estimates the probability of admission purely from triage information. Most patients could accurately be assigned to ‘admission likely’, ‘admission unlikely’, ‘admission very unlikely’ etc., by setting appropriate cut-offs. This could have uses in patient streaming, bed management and decision support. It also has the potential to control for demographics when comparing performance over time or between departments. PMID:24421344

  19. Evaluation of the Triage PPY on-site testing device for the detection of dextropropoxyphene in urine.

    PubMed

    Poklis, Alphonse; Poklis, Justin L; Tarnai, Lisa D; Backer, Ronald C

    2004-09-01

    A new point-of-care colloidal metal immunoassay urine drugs-of-abuse testing device, the BIOSITE TRIAGE Plus Propoxyphene (TPP), was evaluated for the rapid detection of dextropropoxyphene (PPY) and/or its primary metabolite, norpropoxyphene (NP), in urine at a total PPY/NP concentration of 300 ng/mL or greater. This assay has been added to the Triage device that tests for commonly abused drugs. Adding to drug-free urine PPY and NP established the linearity of the TPP assay at concentrations of 40%, 80%, 120%, and 160% of the cut-off concentration. No significant cross-reactivity was found at 1.0 g/L for 32 drugs commonly encountered in emergency department admissions. Significant cross-reactivity was observed only with diphenhydramine and tricyclic antidepressants. TPP results from 160 urine specimens screened for PPY and/or NP were compared to those obtained by testing with DRI enzyme immunoassay, Emit II plus immunoassay, Abuscreen Online immunoassay and gas chromatography-mass spectrometry (GC-MS). There was a 98.8% agreement of positive or negative results between TPP and both the DRI and OnLine assays. The two discordant TPP results were due to concentrations of NP below the TPP minimum cross-reactivity value of 400 ng/mL. These two specimens yielded GC-MS NP concentrations of 262 and 359 ng/mL. These NP concentrations were within +/- 20% of the cross-reactivity cut-off value for NP for TPP, DRI, and Online. There was only an 88% agreement of positive or negative results between TPP and the Emit assay. Twenty urine specimens yielding PPY positive results when tested by TPP were negative by Emit testing. The discordant TPP results were due to poor cross-reactivity of Emit to NP. A 98.8% agreement of positive PPY results was observed between TPP and GC-MS. Discordant urines were found to contain PPY concentrations below the cut-off value of the assay. TPP was found to be an accurate device for the detection of PPY and NP in urine. PMID:15516300

  20. The Triage of Injured Patients: Mechanism of Injury, Regardless of Injury Severity, Determines Hospital Destination.

    PubMed

    Staudenmayer, Kristan; Wang, N Ewen; Weiser, Thomas G; Maggio, Paul; Mackersie, Robert C; Spain, David; Hsia, Renee Y

    2016-04-01

    The target rate for trauma undertriage is <5 per cent, but rates are as high as 30 to 40 per cent in many trauma systems. We hypothesized that high undertriage rates were due to the tendency to undertriage injured elderly patients and a growing elderly population. We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database over a 5-year period. All hospital admissions and emergency department visits associated with injury were longitudinally linked. The primary outcome was triage pattern. Triage patterns were stratified across three dimensions: age, mechanism of injury, and access to care. A total of 60,182 severely injured patients were included in the analysis. Fall-related injuries were frequently undertriaged compared with injuries from motor vehicle collisions (MVCs) and penetrating trauma (52% vs 12% and 10%, respectively). This pattern was true for all age groups. Conversely, MVCs and penetrating traumas were associated with high rates of overtriage (>70% for both). In conclusion, in contrast to our hypothesis, we found that triage is largely determined by mechanism of injury regardless of injury severity. High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance. PMID:27097630

  1. Door to disposition times for obstetric triage visits: Is there a July phenomenon?

    PubMed

    Mehra, S; Gavard, J A; Gross, G; Myles, T; Nguyen, T; Amon, E

    2016-01-01

    The July phenomenon refers to a change in patient outcomes within teaching hospitals with the arrival of new and inexperienced house staff at the start of the academic year (July to June). In our obstetric triage unit we retrospectively evaluated the door to disposition time (DTDT) for 1817 patients who presented across July, December and May of academic years 2009-2010 and 2010-2011. DTDT was examined for three visit levels: non-urgent, urgent and emergent. No significant differences in disposition time were found for emergent visits. For urgent visits the median DTDT significantly decreased from 171 min in July to 155 min in December and 135 min in May (p < 0.001). Similarly for non-urgent visits, the median DTDT was greater during July than May (179 min vs. 133 min; p < 0.05). Electronic medical records (EMRs) were implemented in November 2010. Following the introduction of EMR shorter DTDT was seen in December 2010 versus December 2009 (median, 171 min vs. 150 min; p < 0.05), respectively. Our findings suggest a 'July Phenomenon' of greater disposition intervals for urgent and non-urgent obstetric triage visits across the academic year. Additionally the use of EMRs may facilitate patient flow through the OB triage unit. PMID:26368274

  2. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Reporting a...

  3. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Reporting a...

  4. Eating Order: A 13-Week Trust Model Class for Dieting Casualties

    ERIC Educational Resources Information Center

    Jackson, Elizabeth G.

    2008-01-01

    Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on…

  5. Rate of British psychiatric combat casualties compared to recent American wars.

    PubMed

    Price, H H

    2007-01-01

    This paper examines factors leading to the low rate of combat psychiatric casualties in the British recapture of the Falklands compared to the American experience in North Africa, Italy, Europe and South Pacific theatres during World War II, the Korean Conflict and Vietnam. The factors compared are those thought to affect rates seen in these past wars. The factors highlighted are psychiatric screening of evacuees, presence of psychiatric personnel in line units, intensity of combat and use of elite units. Factors also mentioned are presence of possible occult psychiatric casualties such as frostbite and malaria, amount of indirect fire and the offensive or defensive nature of the combat. A unique aspect of the Falklands War examined is the exclusive use of hospital ships to treat psychiatric casualties and the impact of the Geneva Convention rules regarding hospital ships on the classic treatment principles of proximity and expectancy. The types and numbers of various diagnoses are also presented. The British Campaign in the Falklands produced a remarkably low rate of psychiatric casualties. When viewed in light of American experience in recent wars, this low rate represents a concentration of optimal factors leading to healthy function in combat. The results of this war should not be used to predict a similar outcome in future combat as this particular constellation of factors may not recur. PMID:18214088

  6. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE... Guard district rescue coordination center (RCC) cognizant over the area the vessel was last operating...

  7. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  8. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  9. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  10. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  11. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  12. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Reporting a...

  13. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Reporting a...

  14. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Reporting a...

  15. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  16. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  17. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  18. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  19. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  20. 76 FR 53364 - Recreational Vessel Propeller Strike and Carbon Monoxide Poisoning Casualty Prevention

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ... regarding our public dockets in the January 17, 2008, issue of the Federal Register (73 FR 3316). D. Public... Department of Homeland Security ECOS Engine cut-off switches EPA Environmental Protection Agency FR Federal... recreational vessel and propeller strike-related casualties. See 60 FR 25191 (May 11, 1995) (Request...

  1. 46 CFR 122.220 - Records of a voyage resulting in a marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Records of a voyage resulting in a marine casualty. 122.220 Section 122.220 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER... order books, radiograms sent and received, radio logs, crew and passenger lists and counts, articles...

  2. The Battle of Bentonville: Caring for Casualties of the Civil War. Teaching with Historic Places.

    ERIC Educational Resources Information Center

    Goode, John C.; Beck, Elaine

    At the First Battle of Manassas (Virginia) in 1861 many Union doctors fled the battlefield in fear. Those who remained found themselves without adequate medical supplies or ambulances for their patients. As the U.S. Civil War progressed and casualties mounted, military surgeons became more adept at caring for the wounded. By the Battle of…

  3. A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service

    PubMed Central

    de Carvalho, José Crespo; Ramos, Madalena; Paixão, Carina

    2014-01-01

    Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients. PMID:24376365

  4. [Triage of the injured in military surgery and in exceptional situations].

    PubMed

    Houdelette, P

    1996-01-01

    Sorting casualties is universally accepted as the best means of coordinating a large number of patients with war injuries. Sorting means classifying casualties by characteristic medical and health features according to three types of criteria: diagnosis: gravity of the injury; prognosis: predictable survival; and logistic: evaluation of demand for care and possibilities for evaluation. The sorting process may be systematic or selective. The rules applied in different war situations or in civilian catastrophies vary according to the emergency care system which is called in (French Army, NATO, International Red Cross, GNO). The current role of the intensive care physician as a sorter is underlined. More than a doctrine, surgical sorting is a concept of action to be understood. PMID:9296002

  5. Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza.

    PubMed

    Winsor, Shawn; Bensimon, Cécile M; Sibbald, Robert; Anstey, Kyle; Chidwick, Paula; Coughlin, Kevin; Cox, Peter; Fowler, Robert; Godkin, Dianne; Greenberg, Rebecca A; Shaul, Randi Zlotnik

    2014-01-01

    The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol. PMID:25191808

  6. Development and implementation of a custom integrated database with dashboards to assist with hematopathology specimen triage and traffic

    PubMed Central

    Azzato, Elizabeth M.; Morrissette, Jennifer J. D.; Halbiger, Regina D.; Bagg, Adam; Daber, Robert D.

    2014-01-01

    Background: At some institutions, including ours, bone marrow aspirate specimen triage is complex, with hematopathology triage decisions that need to be communicated to downstream ancillary testing laboratories and many specimen aliquot transfers that are handled outside of the laboratory information system (LIS). We developed a custom integrated database with dashboards to facilitate and streamline this workflow. Methods: We developed user-specific dashboards that allow entry of specimen information by technologists in the hematology laboratory, have custom scripting to present relevant information for the hematopathology service and ancillary laboratories and allow communication of triage decisions from the hematopathology service to other laboratories. These dashboards are web-accessible on the local intranet and accessible from behind the hospital firewall on a computer or tablet. Secure user access and group rights ensure that relevant users can edit or access appropriate records. Results: After database and dashboard design, two-stage beta-testing and user education was performed, with the first focusing on technologist specimen entry and the second on downstream users. Commonly encountered issues and user functionality requests were resolved with database and dashboard redesign. Final implementation occurred within 6 months of initial design; users report improved triage efficiency and reduced need for interlaboratory communications. Conclusions: We successfully developed and implemented a custom database with dashboards that facilitates and streamlines our hematopathology bone marrow aspirate triage. This provides an example of a possible solution to specimen communications and traffic that are outside the purview of a standard LIS. PMID:25250187

  7. How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes' Theorem

    PubMed Central

    Thijs, Abel; Bossuyt, Patrick M.; Smulders, Yvo M.

    2016-01-01

    Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes’ theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test. For a maximum proportion of missed PEs of 1% in triage-negative patients, we calculate a 67% 'mandatory minimum' proportion of negative CTA scans. To achieve this, the proportion of patients with PE undergoing triage testing should be appropriately low, in this case no higher than 24%. Pre-test probability, triage test characteristics, the proportion of negative confirmation tests, and the number of missed diagnoses are mathematically entangled. The proportion of negative confirmation tests—not too high, but definitely not too low either—could be a quality benchmark for diagnostic processes. PMID:26939066

  8. How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes' Theorem.

    PubMed

    Sikkens, Jonne J; Beekman, Djoeke G; Thijs, Abel; Bossuyt, Patrick M; Smulders, Yvo M

    2016-01-01

    Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes' theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test. For a maximum proportion of missed PEs of 1% in triage-negative patients, we calculate a 67% 'mandatory minimum' proportion of negative CTA scans. To achieve this, the proportion of patients with PE undergoing triage testing should be appropriately low, in this case no higher than 24%. Pre-test probability, triage test characteristics, the proportion of negative confirmation tests, and the number of missed diagnoses are mathematically entangled. The proportion of negative confirmation tests-not too high, but definitely not too low either-could be a quality benchmark for diagnostic processes. PMID:26939066

  9. What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat.

    PubMed

    Mercer, S; Read, J; Sudheer, S; Risdall, J E; Connor, D

    2015-01-01

    The Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting. PMID:26867417

  10. The psychological impact of mass casualty incidents on first responders: A systematic review.

    PubMed

    Morgan, Paula M

    2016-01-01

    First responders are exposed to various types of disasters throughout their career. Because of their roles, they are often regarded as stronger people than individuals from other occupations. A systematic review of literature was conducted to determine if distinct characteristics exist that make first responders more susceptible to psychological trauma. Five categories of traits were found to put first responders at risk for psychological problems: personal, predisposing, peridisposing, postdisposing, and protective. To counteract the impact of psychological trauma, first responders need additional preincident psychological and resiliency training. Preparedness and awareness will help combat psychological impact from disasters and compassion fatigue. PMID:27438963

  11. Radiation Injury Treatment Network (RITN): Healthcare professionals preparing for a mass casualty radiological or nuclear incident

    PubMed Central

    ROSS, JOEL R.; CASE, CULLEN; CONFER, DENNIS; WEISDORF, DANIEL J.; WEINSTOCK, DAVID; KRAWISZ, ROBERT; CHUTE, JOHN; WILHAUK, JULIE; NAVARRO, WILLIS; HARTZMAN, ROBERT; COLEMAN, C. NORMAN; HATCHETT, RICHARD; CHAO, NELSON

    2011-01-01

    Purpose To describe the history, composition, and activities of the Radiation Injury Treatment Network (RITN). The Radiation Injury Treatment Network® is a cooperative effort of the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation. The goals of RITN are to educate hematologists, oncologists, and stem cell transplant practitioners about their potential involvement in the response to a radiation incident and provide treatment expertise. Injuries to the marrow system readily occur when a victim is exposed to ionising radiation. This focus therefore leverages the expertise of these specialists who are accustomed to providing the intensive supportive care required by patients with a suppressed marrow function. Following a radiological incident, RITN centres may be asked to: Accept patient transfers to their institutions; provide treatment expertise to practitioners caring for victims at other centres; travel to other centres to provide medical expertise; or provide data on victims treated at their centres. Moving forward, it is crucial that we develop a coordinated interdisciplinary approach in planning for and responding to radiological and nuclear incidents. The ongoing efforts of radiation biologists, radiation oncologists, and health physicists can and should complement the efforts of RITN and government agencies. Conclusion RITN serves as a vital partner in preparedness and response efforts for potential radiological and nuclear incidents. PMID:21801106

  12. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-30

    ..., affiliation, address, email, and telephone number. Those without Internet access should contact Suzanne... participants will be sent technical system requirements after registration and will be sent connection access... Internet at http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/default.htm . (Select...

  13. China eastern MD-11 mass casualty--expect the unexpected: a case report.

    PubMed

    Towne, L E

    1995-10-01

    On April 5, 1993, a China Eastern MD-11 underwent three violent pitch-up maneuvers, injuring over 100 passengers. The pilot made an emergency landing at 3:20 a.m. at Shemya, a tiny Aleutian Island with minimal medical facilities and personnel. The author describes their medical response, problems encountered and lessons learned. PMID:8526838

  14. Emergency Medical Text Classifier: New system improves processing and classification of triage notes

    PubMed Central

    Haas, Stephanie W.; Travers, Debbie; Waller, Anna; Mahalingam, Deepika; Crouch, John; Schwartz, Todd A.; Mostafa, Javed

    2014-01-01

    Objective Automated syndrome classification aims to aid near real-time syndromic surveillance to serve as an early warning system for disease outbreaks, using Emergency Department (ED) data. We present a system that improves the automatic classification of an ED record with triage note into one or more syndrome categories using the vector space model coupled with a ‘learning’ module that employs a pseudo-relevance feedback mechanism. Materials and Methods: Terms from standard syndrome definitions are used to construct an initial reference dictionary for generating the syndrome and triage note vectors. Based on cosine similarity between the vectors, each record is classified into a syndrome category. We then take terms from the top-ranked records that belong to the syndrome of interest as feedback. These terms are added to the reference dictionary and the process is repeated to determine the final classification. The system was tested on two different datasets for each of three syndromes: Gastro-Intestinal (GI), Respiratory (Resp) and Fever-Rash (FR). Performance was measured in terms of sensitivity (Se) and specificity (Sp). Results: The use of relevance feedback produced high values of sensitivity and specificity for all three syndromes in both test sets: GI: 90% and 71%, Resp: 97% and 73%, FR: 100% and 87%, respectively, in test set 1, and GI: 88% and 69%, Resp: 87% and 61%, FR: 97% and 71%, respectively, in test set 2. Conclusions: The new system for pre-processing and syndromic classification of ED records with triage notes achieved improvements in Se and Sp. Our results also demonstrate that the system can be tuned to achieve different levels of performance based on user requirements. PMID:25379126

  15. A prediction model for prehospital triage of patients with suspected cardiac ischemia.

    PubMed

    Grzybowski, M; Zalenski, R J; Ross, M A; Bock, B

    2000-01-01

    The American College of Cardiology recommends that patients with high risk acute myocardial infarction (AMI) be triaged to hospitals with percutaneous transluminal coronary angioplasty capability. However, there are no prehospital triage criteria to select candidates for bypassing community hospitals and being taken directly to "cardiac centers." This article assesses which independent variables predict death within 7 days in patients with suspected AMI transported by EMS. This is a retrospective study of 291 AMI patients transported by ambulance to 3 hospitals during 1996-1997. Included were patients who were (n = 244) > or =18 years of age, had a ED chief complaint of chest pain or dyspnea for whom we had mortality data. Mortality at 7 days, our primary outcome measure, was obtained by using a metropolitan Detroit tricounty death index records. Differences between the survivors and nonsurvivors were assessed using the Student's t-test and chi-square tests. Multiple triage criteria were assessed for optimal identification of high risk patients by constructing a logistic multivariate model. Among the study population, 15% died within 7 days (95% confidence interval (CI) 10.3-19.2), and this group represented 63.2% of all deaths over a 2 year surveillance period. Survivors, compared to nonsurvivors, were 14.1 years younger (P < or = .001) and more often men (P < or = 0.001). The dispatch time to ED arrival was less among survivors than nonsurvivors (42.8 vs. 50.6 min, P < or = .01). EMS vital signs differed by survivor status. Among survivors, HR was lower (-11.9 bpm; P < or = 0.01), RR was lower (-6.7 rpm; P < or = .001), SBP was higher (+14.5 mmHg; P < or = 0.05) and DBP was higher (+13.2 mm Hg; P < or = .01). A multivariate model identified the following as independent predictors of early mortality: female gender (OR = 2.3; P < or = .05), age > or =65 (OR = 5.9; P < or = .01), RR > or = 20 (OR = 4.6; P < or = .001), SBP < 120 (OR = 2.4; P < or = .05). The overall

  16. Cytology Specimen Management, Triage and Standardized Reporting of Fine Needle Aspiration Biopsies of the Pancreas

    PubMed Central

    Yoon, Won Jae; Bishop Pitman, Martha

    2015-01-01

    The recent advances in pancreas cytology specimen sampling methods have enabled a specific cytologic diagnosis in most cases. Proper triage and processing of the cytologic specimen is pivotal in making a diagnosis due to the need for ancillary testing in addition to cytological evaluation, which is especially true in the diagnosis of pancreatic cysts. Newly proposed terminology for pancreaticobiliary cytology offers a standardized language for reporting that aims to improve communication among patient caregivers and provide for increased flexibility in patient management. This review focuses on these updates in pancreas cytology for the optimal evaluation of solid and cystic lesions of the pancreas. PMID:26265683

  17. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage

    PubMed Central

    Orsini, Jose; Blaak, Christa; Yeh, Angela; Fonseca, Xavier; Helm, Tanya; Butala, Ashvin; Morante, Joaquin

    2014-01-01

    Background The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the

  18. Cost-effectiveness evaluation of a home visiting triage program for family planning in Turkey.

    PubMed

    Bertera, R L; Green, L W

    1979-09-01

    Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk and $526 for low-risk couples. PMID:112875

  19. The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

    PubMed Central

    Ogunbanjo, Gboyega A.; Mbuka, Deogratias O.

    2016-01-01

    Background The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS) tool at the Mahalapye District Hospital - Emergency Department (MDH-ED), a setting where the majority of the nurses were not formally trained on the use of the SATS. Methods This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage. Results From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green), 146 (46%) and 125 (40%), respectively, or in the urgent category (yellow), they assigned 140 (44%) and 111 (35%) cases, respectively. Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5), although the level of agreement was satisfactory. Conclusion Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6). PMID:27543284

  20. Perceptions of doctors and nurses at a Ugandan hospital regarding the introduction and use of the South African Triage Scale

    PubMed Central

    Blitz, Julia

    2016-01-01

    Background International Hospital Kampala (IHK) experienced a challenge with how to standardise the triaging and sorting of patients. There was no triage tool to help to prioritise which patients to attend to first, with very sick patient often being missed. Aim and setting To explore whether the introduction of the South African Triage Scale (SATS) was seen as valuable and sustainable by the IHK’s outpatient department and emergency unit (OPD and EU) staff. Methods The study used qualitative methods to introduce SATS in the OPD and EU at IHK and to obtain the perceptions of doctors and nurses who had used it for 3–6 months on its applicability and sustainability. Specific questions about challenges faced prior to its introduction, strengths and weaknesses of the triage tool, the impact it had on staff practices, and their recommendations on the continued use of the tool were asked. In-depth interviews were conducted with 4 doctors and 12 nurses. Results SATS was found to be necessary, applicable and recommended for use in the IHK setting. It improved the sorting of patients, as well as nurse-patient and nurse-doctor communication. The IHK OPD & EU staff attained new skills, with nurses becoming more involved in-patient care. It is possibly also useful in telephone triaging and planning of hospital staffing. Conclusion Adequate nurse staffing, a computer application for automated coding of patients, and regular training would encourage consistent use and sustainability of SATS. Setting up a hospital committee to review signs and symptoms would increase acceptability and sustainability. SATS is valuable in the IHK setting because it improved overall efficiency of triaging and care, with significantly more strengths than weaknesses. PMID:27247152

  1. Tactical combat casualty care in the Canadian Forces: lessons learned from the Afghan war.

    PubMed

    Savage, Erin; Forestier, Colleen; Withers, Nicholas; Tien, Homer; Pannell, Dylan

    2011-12-01

    Tactical Combat Casualty Care (TCCC) is intended to treat potentially preventable causes of death on the battlefield, but acknowledges that application of these treatments may place the provider and even the mission in jeopardy if performed at the wrong time. Therefore, TCCC classifies the tactical situation with respect to health care provision into 3 phases (care under fire, tactical field care and tactical evacuation) and only permits certain interventions to be performed in specific phases based on the danger to the provider and casualty. In the 6 years that the Canadian Forces (CF) have been involved in sustained combat operations in Kandahar, Afghanistan, more than 1000 CF members have been injured and more than 150 have been killed. As a result, the CF gained substantial experience delivering TCCC to wounded soldiers on the battlefield. The purpose of this paper is to review the principles of TCCC and some of the lessons learned about battlefield trauma care during this conflict. PMID:22099324

  2. Tactical Combat Casualty Care in the Canadian Forces: lessons learned from the Afghan war

    PubMed Central

    Savage, Erin; Forestier, Colleen; Withers, Nicholas; Tien, Homer; Pannell, Dylan

    2011-01-01

    Tactical Combat Casualty Care (TCCC) is intended to treat potentially preventable causes of death on the battlefield, but acknowledges that application of these treatments may place the provider and even the mission in jeopardy if performed at the wrong time. Therefore, TCCC classifies the tactical situation with respect to health care provision into 3 phases (care under fire, tactical field care and tactical evacuation) and only permits certain interventions to be performed in specific phases based on the danger to the provider and casualty. In the 6 years that the Canadian Forces (CF) have been involved in sustained combat operations in Kandahar, Afghanistan, more than 1000 CF members have been injured and more than 150 have been killed. As a result, the CF gained substantial experience delivering TCCC to wounded soldiers on the battlefield. The purpose of this paper is to review the principles of TCCC and some of the lessons learned about battlefield trauma care during this conflict. PMID:22099324

  3. Mathematical models for estimating earthquake casualties and damage cost through regression analysis using matrices

    NASA Astrophysics Data System (ADS)

    Urrutia, J. D.; Bautista, L. A.; Baccay, E. B.

    2014-04-01

    The aim of this study was to develop mathematical models for estimating earthquake casualties such as death, number of injured persons, affected families and total cost of damage. To quantify the direct damages from earthquakes to human beings and properties given the magnitude, intensity, depth of focus, location of epicentre and time duration, the regression models were made. The researchers formulated models through regression analysis using matrices and used α = 0.01. The study considered thirty destructive earthquakes that hit the Philippines from the inclusive years 1968 to 2012. Relevant data about these said earthquakes were obtained from Philippine Institute of Volcanology and Seismology. Data on damages and casualties were gathered from the records of National Disaster Risk Reduction and Management Council. The mathematical models made are as follows: This study will be of great value in emergency planning, initiating and updating programs for earthquake hazard reductionin the Philippines, which is an earthquake-prone country.

  4. Patient Throughput Benefits of Triage Liaison Providers are Lost in a Resource Neutral Model: A Prospective Trial

    PubMed Central

    Nestler, David M.; Halasy, Michael P.; Fratzke, Alesia R.; Church, Christopher J.; Scanlan-Hanson, Lori N.; Lohse, Christine M.; Campbell, Ronna L.; Sadosty, Annie T.; Hess, Erik P.

    2014-01-01

    Objectives Patient throughput is an increasingly important cause of emergency department (ED) crowding. The authors previously reported shorter patient length-of-stay (LOS) when adding a triage liaison provider, which required additional personnel. Here, the objective was to evaluate the effect of moving a fast track provider to the triage liaison role. Methods This was a prospective observational before-and-after study design with predefined outcomes measures. A ‘standard staffing’ situation (where an advanced practice provider [APP] staffed treatment rooms in the fast track) was compared with an APP performing the triage liaison staffing role, with no additional staff. Eleven intervention (‘triage liaison staffing’) days were compared with 11 matched control (‘standard staffing’) days immediately preceding the intervention. Total LOS was measured for all adult Emergency Severity Index (ESI) 3, 4, and 5 patients (excluding behavioral health patients), and results were compared using Wilcoxon rank sum and chi-square tests. Results A total of 681 patients registered on control days, and 599 on intervention days. There was no significant difference in total patient LOS: median 273 minutes, IQR 176 to 384 minutes on intervention days vs. median 253 minutes, IQR 175 to 365 minutes on control days (p = 0.20). There was no difference in LWBS rates (n = 48, 7% on control days vs. n = 35, 6% on intervention days; p=0.38). Secondary analysis of only ESI 3 patients showed no difference in total LOS between periods (median 284 minutes, IQR 194 to 396 minutes on intervention days vs. median 290 minutes, IQR 217 to 397 minutes on control days; p = 0.22). There was, however, significantly greater total LOS for ESI 4 and 5 patients during the intervention period (median 238 minutes, IQR 124 to 350 minutes on intervention days vs median 192 minutes, IQR 124 to 256 minutes on control days; p = 0.011). Conclusions The previously reported benefits on patient LOS and LWBS

  5. The clinical value of HPV genotyping in triage of women with high-risk-HPV-positive self-samples.

    PubMed

    Ebisch, Renée M F; de Kuyper-de Ridder, Gabriëlle M; Bosgraaf, Remko P; Massuger, Leon F A G; IntHout, Joanna; Verhoef, Viola M J; Heideman, Daniëlle A M; Snijders, Peter J F; Meijer, Chris J L M; van Kemenade, Folkert J; Bulten, Johan; Siebers, Albert G; Bekkers, Ruud L M; Melchers, Willem J G

    2016-08-01

    Cytology alone, or combined with HPV16/18 genotyping, might be an acceptable method for triage in hrHPV-cervical cancer screening. Previously studied HPV-genotype based triage algorithms are based on cytology performed without knowledge of hrHPV status. The aim of this study was to explore the value of hrHPV genotyping combined with cytology as triage tool for hrHPV-positive women. 520 hrHPV-positive women were included from a randomised controlled self-sampling trial on screening non-attendees (PROHTECT-3B). Eighteen baseline triage strategies were evaluated for cytology and hrHPV genotyping (Roche Cobas 4800) on physician-sampled triage material. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), referral rate, and number of referrals needed to diagnose (NRND) were calculated for CIN2+ and CIN3+. A triage strategy was considered acceptable if the NPV for CIN3+ was ≥98%, combined with maintenance or improvement of sensitivity and an increase in specificity in reference to the comparator, being cytology with a threshold of atypical cells of undetermined significance (ASC-US). Three triage strategies met the criteria: HPV16+ and/or ≥LSIL; HPV16+ and/or ≥HSIL; (HPV16+ and/or HPV18+) and/or ≥HSIL. Combining HPV16+ and/or ≥HSIL yielded the highest specificity (74.9%, 95% CI 70.5-78.9), with a sensitivity (94.4%, 95% CI 89.0-97.7) similar to the comparator (93.5%, 95% CI 87.7-97.1), and a decrease in referral rate from 52.2% to 39.5%. In case of prior knowledge of hrHPV presence, triage by cytology testing can be improved by adjusting its threshold, and combining it with HPV16/18 genotyping. These strategies improve the referral rate and specificity for detecting CIN3+ lesions, while maintaining adequate sensitivity. PMID:26991464

  6. A comparison of adherence to correctly documented triage level of critically ill patients between emergency department and the ambulance service nurses.

    PubMed

    Jönsson, Kenneth; Fridlund, Bengt

    2013-07-01

    Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (p<0.001), but individual percentages ranged from 27% to 88%. Patient safety is jeopardised when nurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken. PMID:23830372

  7. Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties.

    PubMed

    Morrison, Jonathan J; Ross, James D; Rasmussen, Todd E; Midwinter, Mark J; Jansen, Jan O

    2014-05-01

    The control of torso and junctional zone bleeding in combat casualties is particularly challenging because of its noncompressible nature. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has demonstrated promise in translational large animal and early clinical series as an effective resuscitation and hemorrhage control adjunct. However, it is unknown what proportion of combat casualties has an injury pattern and clinical course that is amenable to REBOA deployment. The prospective UK Joint Theatre Trauma Registry was used to retrospectively identify all UK military personnel who has sustained a severe combat injury, defined as an Abbreviated Injury Scale of three or greater, in the course of 10 years. Patients were then divided into three groups based on Abbreviated Injury Scale injury pattern: no indications for REBOA, contraindications (mediastinal, cervical, and axillary hemorrhage), and indications (torso and pelvic hemorrhage). From a total of 1,317 patients, 925 (70.2%) had no indication, 148 (11.2%) had a contraindication, and 244 (18.5%) had an indication for REBOA. Within the group with indications for REBOA, there were 174 deaths: 79 at the point of wounding, 66 en route to hospital, and 29 in-hospital deaths. The median (interquartile range) time to death in patients dying en route was 75 (42-109) min, and the median prehospital time for casualties admitted to hospital was 61 (34-89) min. One-in-five severely injured UK combat casualties have a focus of hemorrhage in the abdomen or pelvic junctional region potentially amenable to REBOA deployment. The UK military should explore REBOA as a potential en route hemorrhage control and resuscitation adjunct. PMID:25133599

  8. Car driver casualty rates in Great Britain by type of car.

    PubMed

    Broughton, Jeremy

    2008-07-01

    Since 1989, the British STATS19 national road accident reporting system has included the Vehicle Registration Mark (VRM). This allows the basic vehicle record to be augmented with details such as the date of first registration and codes that specify the vehicle's make and model. In order to examine the influence of car type upon the driver casualty rate, this paper groups car models into six types, ranging from 'Minis and Superminis' to '4x4s and people carriers (pc)'. Exploratory analyses of data from accidents that occurred between 2001 and 2005 show that the driver casualty rate falls markedly with size of car. In car-car collisions, the rate also rises markedly with the size of the other car. The car's year of first registration also influences the casualty rate, and represents the influence of changes in the characteristics of new cars. Statistical models are fitted to identify the separate influences on a driver's risk of injury in a car-car collision of the type and registration year of the driver's car and the type and registration year of the other car in the collision. The analysis is extended to include collisions with other vehicles such as lorries and buses. PMID:18606288

  9. The Casualty Assistance Readiness Enhancement System: A Case Study in Rapid Prototyping and Design for Flexibility

    NASA Astrophysics Data System (ADS)

    Goerger, Simon R.; Wong, Ernest Y.; Henderson, Dale L.; Sperling, Brian K.; Bland, William

    Numerous government benefits are available to the surviving family of fallen U.S. military service members. Unfortunately, most of these entitlements require a considerable amount of paperwork to process correctly, necessitating a great deal of patience, attention to detail, and composure from families at a time when their grief is raw. Even though the U.S. Army appoints a Casualty Assistance Officer (CAO) to help surviving family members through this process, the soldiers serving as CAOs tend to be inexperienced and oftentimes find themselves challenged to provide accurate and thorough assistance. Consequently, some families do not receive all benefits in a timely manner, and some entitlements may be overlooked entirely. To help with the military's Casualty Program, we have developed the Casualty Assistance Readiness Enhancement System (CARES), an information system that improves how the Department of the Army cares for military families in arguably their greatest time of need. The tool and associated process reduced the time required to complete forms, reduced the potential for errors on repetitive information, assisted CAOs through the process, and provided electronic copies of completed forms.

  10. Earthquake casualty models within the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David J.; Earle, Paul; Porter, Keith A.; Hearne, Mike

    2011-01-01

    Since the launch of the USGS’s Prompt Assessment of Global Earthquakes for Response (PAGER) system in fall of 2007, the time needed for the U.S. Geological Survey (USGS) to determine and comprehend the scope of any major earthquake disaster anywhere in the world has been dramatically reduced to less than 30 min. PAGER alerts consist of estimated shaking hazard from the ShakeMap system, estimates of population exposure at various shaking intensities, and a list of the most severely shaken cities in the epicentral area. These estimates help government, scientific, and relief agencies to guide their responses in the immediate aftermath of a significant earthquake. To account for wide variability and uncertainty associated with inventory, structural vulnerability and casualty data, PAGER employs three different global earthquake fatality/loss computation models. This article describes the development of the models and demonstrates the loss estimation capability for earthquakes that have occurred since 2007. The empirical model relies on country-specific earthquake loss data from past earthquakes and makes use of calibrated casualty rates for future prediction. The semi-empirical and analytical models are engineering-based and rely on complex datasets including building inventories, time-dependent population distributions within different occupancies, the vulnerability of regional building stocks, and casualty rates given structural collapse.

  11. Casualty Risk Assessment Controlled Re-Entry of EPS - Ariane 5ES - ATV Mission

    NASA Astrophysics Data System (ADS)

    Arnal, M.-H.; Laine, N.; Aussilhou, C.

    2012-01-01

    To fulfil its mission of compliance check to the French Space Operations Act, CNES has developed ELECTRA© tool in order to estimate casualty risk induced by a space activity (like rocket launch, controlled or un-controlled re-entry on Earth of a space object). This article describes the application of such a tool for the EPS controlled re-entry during the second Ariane 5E/S flight (Johannes Kepler mission has been launched in February 2011). EPS is the Ariane 5E/S upper composite which is de-orbited from a 260 km circular orbit after its main mission (release of the Automated Transfer Vehicle - ATV). After a brief description of the launcher, the ATV-mission and a description of all the failure cases taken into account in the mission design (which leads to "back-up scenarios" into the flight software program), the article will describe the steps which lead to the casualty risk assessment (in case of failure) with ELECTRA©. In particular, the presence on board of two propulsive means of de-orbiting (main engine of EPS, and 4 ACS longitudinal nozzles in case of main engine failure or exhaustion) leads to a low remaining casualty risk.

  12. Social vulnerability and the natural and built environment: a model of flood casualties in Texas.

    PubMed

    Zahran, Sammy; Brody, Samuel D; Peacock, Walter Gillis; Vedlitz, Arnold; Grover, Himanshu

    2008-12-01

    Studies on the impacts of hurricanes, tropical storms, and tornados indicate that poor communities of colour suffer disproportionately in human death and injury.(2) Few quantitative studies have been conducted on the degree to which flood events affect socially vulnerable populations. We address this research void by analysing 832 countywide flood events in Texas from 1997-2001. Specifically, we examine whether geographic localities characterised by high percentages of socially vulnerable populations experience significantly more casualties due to flood events, adjusting for characteristics of the natural and built environment. Zero-inflated negative binomial regression models indicate that the odds of a flood casualty increase with the level of precipitation on the day of a flood event, flood duration, property damage caused by the flood, population density, and the presence of socially vulnerable populations. Odds decrease with the number of dams, the level of precipitation on the day before a recorded flood event, and the extent to which localities have enacted flood mitigation strategies. The study concludes with comments on hazard-resilient communities and protection of casualty-prone populations. PMID:18435768

  13. Provenancing of unidentified World War II casualties: Application of strontium and oxygen isotope analysis in tooth enamel.

    PubMed

    Font, Laura; Jonker, Geert; van Aalderen, Patric A; Schiltmans, Els F; Davies, Gareth R

    2015-01-01

    In 2010 and 2012 two sets of unidentified human remains of two World War II soldiers were recovered in the area where the 1944-1945 Kapelsche Veer bridgehead battle took place in The Netherlands. Soldiers of four Allied nations: British Royal Marine Commandos, Free Norwegian Commandos, Free Poles and Canadians, fought against the German Army in this battle. The identification of these two casualties could not be achieved using dental record information of DNA analysis. The dental records of Missing in Action soldiers of the Allied nations did not match with the dental records of the two casualties. A DNA profile was determined for the casualty found in 2010, but no match was found. Due to the lack of information on the identification of the casualties provided by routine methods, an isotope study was conducted in teeth from the soldiers to constrain their provenance. The isotope study concluded that the tooth enamel isotope composition for both casualties matched with an origin from the United Kingdom. For one of the casualties a probable origin from the United Kingdom was confirmed, after the isotope study was conducted, by the recognition of a characteristic belt buckle derived from a Royal Marine money belt, only issued to British Royal Marines, found with the remains of the soldier. PMID:25577002

  14. Detector photon response and absorbed dose and their applications to rapid triage techniques

    NASA Astrophysics Data System (ADS)

    Voss, Shannon Prentice

    As radiation specialists, one of our primary objectives in the Navy is protecting people and the environment from the effects of ionizing and non-ionizing radiation. Focusing on radiological dispersal devices (RDD) will provide increased personnel protection as well as optimize emergency response assets for the general public. An attack involving an RDD has been of particular concern because it is intended to spread contamination over a wide area and cause massive panic within the general population. A rapid method of triage will be necessary to segregate the unexposed and slightly exposed from those needing immediate medical treatment. Because of the aerosol dispersal of the radioactive material, inhalation of the radioactive material may be the primary exposure route. The primary radionuclides likely to be used in a RDD attack are Co-60, Cs-137, Ir-192, Sr-90 and Am-241. Through the use of a MAX phantom along with a few Simulink MATLAB programs, a good anthropomorphic phantom was created for use in MCNPX simulations that would provide organ doses from internally deposited radionuclides. Ludlum model 44-9 and 44-2 detectors were used to verify the simulated dose from the MCNPX code. Based on the results, acute dose rate limits were developed for emergency response personnel that would assist in patient triage.

  15. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review

    PubMed Central

    Allemann Iseli, Martina; Kunz, Regina; Blozik, Eva

    2014-01-01

    Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation. PMID:25028538

  16. Triage management, survival, and the law in the age of Ebola.

    PubMed

    Burkle, Frederick M; Burkle, Christopher M

    2015-02-01

    Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. PMID:25343493

  17. Multi-sources data fusion framework for remote triage prioritization in telehealth.

    PubMed

    Salman, O H; Rasid, M F A; Saripan, M I; Subramaniam, S K

    2014-09-01

    The healthcare industry is streamlining processes to offer more timely and effective services to all patients. Computerized software algorithm and smart devices can streamline the relation between users and doctors by providing more services inside the healthcare telemonitoring systems. This paper proposes a multi-sources framework to support advanced healthcare applications. The proposed framework named Multi Sources Healthcare Architecture (MSHA) considers multi-sources: sensors (ECG, SpO2 and Blood Pressure) and text-based inputs from wireless and pervasive devices of Wireless Body Area Network. The proposed framework is used to improve the healthcare scalability efficiency by enhancing the remote triaging and remote prioritization processes for the patients. The proposed framework is also used to provide intelligent services over telemonitoring healthcare services systems by using data fusion method and prioritization technique. As telemonitoring system consists of three tiers (Sensors/ sources, Base station and Server), the simulation of the MSHA algorithm in the base station is demonstrated in this paper. The achievement of a high level of accuracy in the prioritization and triaging patients remotely, is set to be our main goal. Meanwhile, the role of multi sources data fusion in the telemonitoring healthcare services systems has been demonstrated. In addition to that, we discuss how the proposed framework can be applied in a healthcare telemonitoring scenario. Simulation results, for different symptoms relate to different emergency levels of heart chronic diseases, demonstrate the superiority of our algorithm compared with conventional algorithms in terms of classify and prioritize the patients remotely. PMID:25047520

  18. The essential roles of chemistry in high-throughput screening triage

    PubMed Central

    Dahlin, Jayme L; Walters, Michael A

    2015-01-01

    It is increasingly clear that academic high-throughput screening (HTS) and virtual HTS triage suffers from a lack of scientists trained in the art and science of early drug discovery chemistry. Many recent publications report the discovery of compounds by screening that are most likely artifacts or promiscuous bioactive compounds, and these results are not placed into the context of previous studies. For HTS to be most successful, it is our contention that there must exist an early partnership between biologists and medicinal chemists. Their combined skill sets are necessary to design robust assays and efficient workflows that will weed out assay artifacts, false positives, promiscuous bioactive compounds and intractable screening hits, efforts that ultimately give projects a better chance at identifying truly useful chemical matter. Expertise in medicinal chemistry, cheminformatics and purification sciences (analytical chemistry) can enhance the post-HTS triage process by quickly removing these problematic chemotypes from consideration, while simultaneously prioritizing the more promising chemical matter for follow-up testing. It is only when biologists and chemists collaborate effectively that HTS can manifest its full promise. PMID:25163000

  19. Timing of troponin T measurements in triage of pulmonary embolism patients

    PubMed Central

    Bulj, Nikola; Potočnjak, Ines; Sharma, Mirella; Pintarić, Hrvoje; Degoricija, Vesna

    2013-01-01

    Aim To determine the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of pulmonary embolism (PE) patients. Methods In this single-center prospective study, PE was confirmed in all patients using computed tomography. 104 consecutive patients were divided into three groups (high-risk, intermediate, and low-risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. cTnT levels were measured on admission and then after 6, 24, 48, and 72 hours with threshold values greater than 0.1 ng/mL. Results Intermediate-risk PE patients had higher cTnT levels than low-risk patients already in the first measurement (P = 0.037). Elevated cTnT levels significantly correlated with disease severity after 6 hours (intermediate vs low risk patients, P = 0.016, all three groups, P = 0.009). Conclusion In hemodynamically stable patients, increased cTnT level on admission differentiated intermediate from low-risk patients and could be used as an important element for the appropriate triage of patients. PMID:24382851

  20. Evolutionary triage governs fitness in driver and passenger mutations and suggests targeting never mutations

    PubMed Central

    Gatenby, R A.; Cunningham, J. J.; Brown, J. S.

    2014-01-01

    Genetic and epigenetic changes in cancer cells are typically divided into “drivers” and “passengers”. Drug development strategies target driver mutations, but inter- and intra-tumoral heterogeneity usually results in emergence of resistance. Here we model intratumoral evolution in the context of a fecundity/survivorship trade-off. Simulations demonstrate the fitness value, of any genetic change is not fixed but dependent on evolutionary triage governed by initial cell properties, current selection forces, and prior genotypic/phenotypic trajectories. We demonstrate spatial variations in molecular properties of tumor cells are the result of changes in environmental selection forces such as blood flow. Simulated therapies targeting fitness-increasing (driver) mutations usually decrease the tumor burden but almost inevitably fail due to population heterogeneity. An alternative strategy targets gene mutations that are never observed. Because up or down regulation of these genes unconditionally reduces cellular fitness, they are eliminated by evolutionary triage but can be exploited for targeted therapy. PMID:25407411

  1. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    PubMed

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria. PMID:26017368

  2. Patient use and compliance with medical advice delivered by a web-based triage system in primary care.

    PubMed

    Nijland, Nicol; Cranen, Karlijn; Boer, Henk; van Gemert-Pijnen, Julia E W C; Seydel, Erwin R

    2010-01-01

    We studied a web-based triage system which was accessible to the general public in the Netherlands. In a retrospective analysis we investigated the type of complaints that were submitted and the kind of advice provided. Over a period of 15 months, 13,133 different people began using the web-based triage system and 3812 patients went right through the triage process to the end. The most frequent complaints were common cold symptoms, such as cough and a sore throat (22%), itch problems (13%), urinary complaints (12%), diarrhoea (10%), headache (8%) and lower back pain (8%). Most commonly, the system generated the advice to contact a doctor (85%) and in 15% of the cases the system provided fully automated, problem-tailored, self-care advice. A total of 192 patients participated in a prospective study and completed an online survey immediately after the delivery of advice. A follow-up questionnaire on actual compliance was completed by 35 patients. Among these, 20 (57%) had actually complied with the advice provided by the system. A regression analysis revealed that intention to comply was strongly related to actual compliance. In turn, intention to comply was strongly related to attitude towards the advice (P < 0.001). Web-based triage can contribute to a more efficient primary care system, because it facilitates the gatekeeper function. PMID:20086260

  3. An Intervention to Improve the Comfort And Satisfaction of Nurses in the Telephone Triage of Child Maltreatment Calls.

    PubMed

    Hunter, Julie

    2015-01-01

    Nurses are mandated reporters of actual or suspected child maltreatment or the threat thereof. The purpose of this quality improvement project was to determine the knowledge and comfort of nurses in telephone triage in pediatric clinics when dealing with suspected or actual child abuse calls. Nurses (N = 17) from three pediatric primary care clinics and one specialty care orthopedic clinic were surveyed. Based on results of the survey showing a lack of knowledge and adequate referral resources perceived by the nursing staff, resources and staff education were developed, along with a script for guiding maltreatment calls toward standardization of care. Following the intervention, nurses reported an increased comfort level when doing telephone triage for child maltreatment calls, an increase in knowledge of risk factors for county resources. Further, they reported a substantial shift in opinion about the need for a standardized script when responding to child maltreatment telephone calls. Nurses undertaking telephone triage of high-risk child maltreatment calls can improve their comfort and knowledge through a survey of their needs and directed education and resource development for the management of child maltreatment telephone triage. PMID:26837100

  4. Evaluation of the Triage Micro Parasite Panel for Detection of Giardia lamblia, Entamoeba histolytica/Entamoeba dispar, and Cryptosporidium parvum in Patient Stool Specimens

    PubMed Central

    Sharp, Susan E.; Suarez, Clarisa A.; Duran, Yolanda; Poppiti, Robert J.

    2001-01-01

    A study comparing the Triage Micro Parasite Panel (Biosite Diagnostics, Inc., San Diego, Calif.) to conventional O&P examination (O&P) was performed using patient fecal specimens. Five hundred twenty-three stool samples were compared. Nineteen specimens were found to be positive by Triage, and 29 were found to be positive by O&P. Seven specimens were positive for Giardia lamblia, four were positive for Entamoeba histolytica/E. dispar, and three were positive for Cryptosporidium parvum as determined by both methods. There was one false positive by Triage (C. parvum) and four false negatives by O&P (two G. lamblia, one E. histolytica/E. dispar, and one C. parvum). The Triage test accurately detected all 18 specimens that contained one of the three organisms that it was designed to detect. The Triage test is a rapid, easy-to-use enzyme immunoassay for the detection of G. lamblia, E. histolytica/E. dispar, and C. parvum in fresh or fresh-frozen fecal specimens. These data suggest that the Triage test can be used as a screen for the immediate testing of stool specimens for these three pathogenic parasites. If Triage test results are negative, O&P can be performed if parasitic infections other than G. lamblia, E. histolytica/E. dispar, or C. parvum are suspected. PMID:11136793

  5. Biopsychosocial predictors of short-term success among people with low back pain referred to a physiotherapy spinal triage service

    PubMed Central

    Bath, Brenna; Lovo Grona, Stacey

    2015-01-01

    Background A spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists. Methods Participants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115). Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of “success” was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome. Results Despite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores) in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6%) and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%). A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome. Conclusion There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress (measured by the Fear Avoidance Beliefs Questionnaire and the Distress and Risk Assessment

  6. DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE.

    PubMed

    Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V; Turner, Helen C; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y Lawrence; Brenner, D J

    2009-01-01

    This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

  7. Rapid Analytical Methods for On-Site Triage for Traumatic Brain Injury

    NASA Astrophysics Data System (ADS)

    North, Stella H.; Shriver-Lake, Lisa C.; Taitt, Chris R.; Ligler, Frances S.

    2012-07-01

    Traumatic brain injury (TBI) results from an event that causes rapid acceleration and deceleration of the brain or penetration of the skull with an object. Responses to stimuli and questions, loss of consciousness, and altered behavior are symptoms currently used to justify brain imaging for diagnosis and therapeutic guidance. Tests based on such symptoms are susceptible to false-positive and false-negative results due to stress, fatigue, and medications. Biochemical markers of neuronal damage and the physiological response to that damage are being identified. Biosensors capable of rapid measurement of such markers in the circulation offer a solution for on-site triage, as long as three criteria are met: (a) Recognition reagents can be identified that are sufficiently sensitive and specific, (b) the biosensor can provide quantitative assessment of multiple markers rapidly and simultaneously, and (c) both the sensor and reagents are designed for use outside the laboratory.

  8. DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE

    PubMed Central

    Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V.; Turner, Helen C.; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y. Lawrence; Brenner, D. J.

    2010-01-01

    This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

  9. Developing a wireless speech- and touch-based intelligent comprehensive triage support system.

    PubMed

    Chang, Polun; Sheng, Yu-Hsiang; Sang, Yiing-Yiing; Wang, Da-Wei

    2008-01-01

    The implementation of voice recognition technology has been expected to occur in mobile healthcare settings, but it is the least studied solution in nursing. The objective of this study is to examine its value to mobile nursing. The study was done at a triage station in an emergency department. The system was developed using VB6.0, Microsoft Speech SDK 5.1 and the Simplified Chinese Language pack, and was installed on touchscreen PCs with wireless headsets. Thirty nurses were enrolled. Accuracy rate and operation time were used to measure the subjects' performance. A "willingness to use" score on a scale of 1 to 10 was used to measure subjects' preference for the system. The results showed that the average accuracy rate was 99%, the average operation time was 108 seconds, and the mean "willingness to use" rating was 8.2. This study demonstrates the value of multimodal voice recognition techniques to mobile nursing. PMID:18091619

  10. Ultrasound: the triage tool in the emergency department: using ultrasound first.

    PubMed

    Nicola, Refky; Dogra, Vikram

    2016-05-01

    Ultrasound in the emergency department has long been recognized as a powerful screening and diagnostic tool for both physicians and radiologists. In the emergency department, since time is of the essence, it becomes a critical tool in triaging patients. Over the years, ultrasound has gained several advantages over other modalities because of its non-ionizing radiation, portability, accessibility, non-invasive method and simpler learning curve. As a result, ultrasound has become one of the most frequently used diagnostic tools in the emergency department by non-radiologists. The value of ultrasound is implemented in every acute ailment in the emergency department such as trauma, acute abdomen, acute pelvic pain, acute scrotal pain, appendicitis in children and acute deep venous thrombosis. Our objective is to discuss the benefit of using ultrasound as the primary modality for each of these diseases. PMID:26568440

  11. Sufficiency of care in disasters: ventilation, ventilator triage, and the misconception of guideline-driven treatment.

    PubMed

    Trotter, Griffin

    2010-01-01

    This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a "sufficiency of care" perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for "ventilator triage" or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers' clumsily interpreting events through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas. PMID:21313863

  12. The pre-hospital management of injury following mass toxic release; a comparison of military and civil approaches.

    PubMed

    Baker, D J

    1999-10-01

    Mass release of toxic substances may occur either accidentally or deliberately in both peace and war. Different approaches to the management of casualties from such an event have been developed by civil and military emergency medical teams, and reflect the different circumstances in which they operate. The nature and classification of toxic hazards is considered and the civil and military operational and medical responses compared. Both systems have different aspects that can contribute to early casualty management in a contaminated environment. PMID:10617335

  13. The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

    PubMed Central

    Varley, Anna; Warren, Fiona C.; Richards, Suzanne H.; Calitri, Raff; Chaplin, Katherine; Fletcher, Emily; Holt, Tim A.; Lattimer, Valerie; Murdoch, Jamie; Richards, David A.; Campbell, John

    2016-01-01

    Background Nurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. Objective To investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. Design Questionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage. Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings 15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants 45 nurse practitioners and practice nurse trained in the use of clinical decision support software. Methods We investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. Results Valid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more

  14. Triage of patients with AUS/FLUS on thyroid cytopathology: effectiveness of the multimodal diagnostic techniques.

    PubMed

    Kim, Tae Hyuk; Jeong, Dae Joon; Hahn, Soo Yeon; Shin, Jung Hee; Oh, Young Lyun; Ki, Chang-Seok; Kim, Jong-Won; Jang, Ju Young; Cho, Yoon Young; Chung, Jae Hoon; Kim, Sun Wook

    2016-05-01

    The management of patients with thyroid cytopathologic diagnosis of atypia (or follicular lesion) of undetermined significance (AUS/FLUS) is a complex clinical problem. The purpose of this study was to develop a practical triage scheme based on multiple diagnostic tests in general use. We performed a retrospective cohort study involving 15,335 consecutive patients with a referral diagnosis of thyroid nodule between April 2011 and March 2015 using an institutional database. We obtained 904 patients with an initial cytopathologic diagnosis of AUS/FLUS who underwent repeat fine-needle aspiration or core needle biopsy, 388 of whom had a corresponding histopathological diagnosis for excised index lesions. The diagnostic performance of ultrasound (US) findings, repeat biopsy, and BRAF(V) (600E) mutation in cytopathologic specimens were evaluated individually or as a set. Of the 388 resected AUS/FLUS cases, 338 (87.1%) were thyroid cancer. The positive likelihood ratios (LRs) for BRAF(V) (600E) mutation and repeat biopsy result of suspicious for malignant cell (SMC) or worse were 11.6 (95% CI = 1.7-77.8) and 13.7 (95% CI = 4.6-41.0), respectively. The absence of suspicious findings on US combined with cytologic result of less than SMC or negative BRAF(V) (600E) mutation produced negative LRs ranging from 0.06 to 0.15, corresponding to negative predictive values of over 90% in both primary and referral settings. For patients with AUS/FLUS cytopathology, clinical decision making can be guided by a simple triage scheme based on US findings, repeat biopsy, or BRAF(V) (600E) mutation. PMID:26775803

  15. Telomerase Activity as a Potential Diagnostic Marker for Triage of Abnormal Pap Smears

    PubMed Central

    Ault, Kevin A.; Allen, Heather K.; Phillips, Stacia L.; Bridget Zimmerman, M.; Klingelhutz, Aloysius J.

    2008-01-01

    Objectives To determine whether there is an association between high levels of telomerase and premalignant cervical disease and to provide a preliminary analysis of telomerase activity as a potential triage strategy. Materials and Methods Premenopausal women were invited to participate in the study during routine gynecologic visits as well as visits where colposcopy was performed. Samples were taken from the cervix using a broom device and placed in cold phosphate-buffered saline. A total of 92 samples were evaluated. Cells were counted and lysed, and a semi-quantitative measure of telomerase activity was determined using a commercially available telomerase enzyme-linked immunosorbent assay kit. The presence of human papillomavirus (HPV) types 16 and 18 was assessed by polymerase chain reaction analysis. One-way analysis of variance was used to test for the association of telomerase activity with cytology, HPV type 16 or 18 status, and colposcopy and/or biopsy findings. Results When telomerase levels were analyzed according to Pap smear results, there were no differences among four groups of cytology findings (normal, atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion). When colposcopy and/or biopsy results were considered, significantly higher levels of telomerase were detected in cervical intraepithelial neoplasia (CIN) 2,3 samples than in normal Pap smear samples and CIN 1 samples (p = .035). There was no significant difference in telomerase levels between samples that tested positive for HPV type 16 or 18 and those that did not (p = .111). Conclusions Telomerase levels were significantly higher in cytologic samples from women with biopsy-proven CIN 2,3 than in samples from women with normal cytology results or CIN 1. These results warrant larger studies to determine whether telomerase activity may be a useful triage tool for abnormal cytologic findings. PMID:15870530

  16. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

    PubMed Central

    El Hag, Imad A.; Elsiddig, Kamal E.; Elsafi, Mohamed E.M.O; Elfaki, Mona E.E.; Musa, Ahmed M.; Musa, Brima Y.; Elhassan, Ahmed M.

    2013-01-01

    Abstract Background Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective To develop a reliable clinical algorithm for primary care settings to triage cases of non-specific, tuberculous and malignant lymphadenopathies. Methods Calculation of the odd ratios (OR) of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (Receiver Operator Characteristic) curve. Results Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR), nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of 3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area under the ROC curve was 0.964 (95% CI, 0.949 – 0.980) and -0.856 (95% CI, 0.787 - 0.925) for scores A and B respectively, indicating good performance. Conclusion The developed algorithm can efficiently triage cases with tuberculous and malignant lymphadenopathies for treatment or referral to specialised centres for further work-up.

  17. Family characteristics and posttraumatic stress disorder: a follow-up of Israeli combat stress reaction casualties.

    PubMed

    Solomon, Z; Mikulincer, M; Freid, B; Wosner, Y

    1987-09-01

    This study assessed the role of family status and family relationships in the course of combat-related posttraumatic stress disorder (PTSD). The sample consisted of 382 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War. Results showed that one year after the war married soldiers had higher rates of PTSD than did unmarried soldiers. Furthermore, higher rates of PTSD were associated with low expressiveness, low cohesiveness, and high conflict in the casualties' families. Theoretical, methodological, and clinical implications are discussed. PMID:3622749

  18. Military casualties in Baranja and east Slavonia during the first 9 months of the war in Croatia.

    PubMed

    Ropac, D; Milas, J

    1999-09-01

    The total number of Croatian Army soldiers killed in the period from the beginning of July 1991 until the end of March 1992 was 487. The number of severely wounded was 1,160, and 1,141 soldiers were slightly wounded. The ratio of the killed to wounded was 1:5, except in the municipality of Osijek, where it was 1:2.5. The number of casualties increased continually and culminated during November 1991, the period of fiercest fighting in this territory, followed by a gradual decrease. The most common mechanism of injury was explosives, which were responsible for almost half of all casualties (47.9%). An equal number of soldiers were killed by explosives and infantry weapons (46.4% and 44.9%, respectively). Casualties caused by motor vehicle crashes are not to be ignored, especially after the cease-fire agreement. Car crashes frequently resulted in death (from 4.5%-12.4%). PMID:10495635

  19. Using the Design for Demise Philosophy to Reduce Casualty Risk Due to Reentering Spacecraft

    NASA Technical Reports Server (NTRS)

    Kelley, R. L.

    2012-01-01

    Recently the reentry of a number of vehicles has garnered public attention due to their risk of human casualty due to fragments surviving reentry. In order to minimize this risk for their vehicles, a number of NASA programs have actively sought to minimize the number of components likely to survive reentry at the end of their spacecraft's life in order to meet and/or exceed NASA safety standards for controlled and uncontrolled reentering vehicles. This philosophy, referred to as "Design for Demise" or D4D, has steadily been adopted, to at least some degree, by numerous programs. The result is that many programs are requesting evaluations of components at the early stages of vehicle design, as they strive to find ways to reduce the number surviving components while ensuring that the components meet the performance requirements of their mission. This paper will discuss some of the methods that have been employed to ensure that the consequences of the vehicle s end-of-life are considered at the beginning of the design process. In addition this paper will discuss the technical challenges overcome, as well as some of the more creative solutions which have been utilized to reduce casualty risk.

  20. When terror is routine: how Israeli nurses cope with multi-casualty terror.

    PubMed

    Riba, Shoshana; Reches, Hiba

    2002-01-01

    The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments. PMID:12410636

  1. Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010.

    PubMed

    Yun, Heather C; Weintrob, Amy C; Conger, Nicholas G; Li, Ping; Lu, Dan; Tribble, David R; Murray, Clinton K

    2015-01-01

    Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the United States, 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0 vs. 6.0; p < 0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care. PMID:25562865

  2. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

    PubMed

    Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

    2013-01-01

    During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. PMID:24048995

  3. The influence of car registration year on driver casualty rates in Great Britain.

    PubMed

    Broughton, Jeremy

    2012-03-01

    A previous paper analysed data from the British national road accident reporting system to investigate the influence upon car driver casualty rates of the general type of car being driven and its year of first registration. A statistical model was fitted to accident data from 2001 to 2005, and this paper updates the principal results using accident data from 2003 to 2007. Attention focuses upon the role of year of first registration since this allows the influence of developments in car design upon occupant casualty numbers to be evaluated. Three additional topics are also examined with these accident data. Changes over time in frontal and side impacts are compared. Changes in the combined risk for the two drivers involved in a car-car collision are investigated, being the net result of changes in secondary safety and aggressivity. Finally, the results of the new model relating to occupant protection are related to an index that had been developed previously to analyse changes over time in the secondary safety of the car fleet. PMID:22269528

  4. Dentistry and Mass Disaster – A Review

    PubMed Central

    Sakthi, D Sri

    2014-01-01

    Mass disaster situations may arise from natural or manmade circumstances like bioterrorism and dentists or dental responders have significant roles in human identification, following such occurrences. The various roles of dentists in mass disaster management, that include bio surveillance and notification, diagnosis and monitoring, triage, referrals of patients, immunizations, decontamination and infection control would be considered. The varying extents of use of forensic dental techniques and the resulting positive impacts made on human identification will also be included. The importance of preparation by way of special training for the dental personnel, mass disaster rehearsal, and use of modern day technology will be stressed on. PMID:25177658

  5. A low-bandwidth graphical user interface for high-speed triage of potential items of interest in video imagery

    NASA Astrophysics Data System (ADS)

    Huber, David J.; Khosla, Deepak; Martin, Kevin; Chen, Yang

    2013-06-01

    In this paper, we introduce a user interface called the "Threat Chip Display" (TCD) for rapid human-in-the-loop analysis and detection of "threats" in high-bandwidth imagery and video from a list of "Items of Interest" (IOI), which includes objects, targets and events that the human is interested in detecting and identifying. Typically some front-end algorithm (e.g., computer vision, cognitive algorithm, EEG RSVP based detection, radar detection) has been applied to the video and has pre-processed and identified a potential list of IOI. The goal of the TCD is to facilitate rapid analysis and triaging of this list of IOI to detect and confirm actual threats. The layout of the TCD is designed for ease of use, fast triage of IOI, and a low bandwidth requirement. Additionally, a very low mental demand allows the system to be run for extended periods of time.

  6. Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department

    PubMed Central

    Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Menezes, Ricardo

    2015-01-01

    Objective. To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the “right” use of emergency services, on the division of work between ED nurses and general practitioners (GPs). Design. An observational and quasi-experimental study based on before–after comparisons. Setting. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. Subjects. GPs and nurses from two different primary care EDs. Main outcome measures. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. Results. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. Conclusion. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing. PMID:25968180

  7. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage.

    PubMed

    Ames, Bruce N

    2006-11-21

    Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life. PMID:17101959

  8. [A Triage Scale for Mental Health, an Emerging Practice, a Value-Add for Measuring Demand for Mental Health Services].

    PubMed

    Boucher, Lucie

    2016-01-01

    Objectives The article aims to present two studies supporting the development of l'Échelle brève de triage RIFCAS en santé mentale 0-99 ans, a measuring instrument used to determine - based on the level of customer demand, seriousness, and urgent need for intervention - the priority of a mental health service across all age groups.Methods Both versions have been subject to a measurement interjudge agreement that is compared against the judgment of professionals and other comparison tools.Results The results produced by the interjudge agreement reflect significant correlations with the priorities established by l'Échelle brève de triage RIFCAS en santé mentale 0-99 ans, the judgment of professional experts and the usual instruments used.Conclusion The final version of the triage scale provides an objective measure for the priority that should be given to all mental health service requests - these encompass all recognized and essential clinical information. Clinicians can rely on a reliable and proven instrument to prioritize service requests before placing them on the waiting list. The use of this instrument facilitates the development of a common procedure between professionals and ensures a fair and safe treatment of users. PMID:27570963

  9. Spatial-temporal patterns in Mediterranean carnivore road casualties: Consequences for mitigation

    USGS Publications Warehouse

    Grilo, C.; Bissonette, J.A.; Santos-Reis, M.

    2009-01-01

    Many carnivores have been seriously impacted by the expansion of transportation systems and networks; however we know little about carnivore response to the extent and magnitude of road mortality, or which age classes may be disproportionately impacted. Recent research has demonstrated that wildlife-vehicle-collisions (WVC) involving carnivores are modulated by temporal and spatial factors. Thus, we investigated road mortality on a guild of small and medium-sized carnivores in southern Portugal using road-kill data obtained from a systematic 36 months monitoring period along highways (260 km) and national roads (314 km) by addressing the following questions: (a) which species and age class are most vulnerable to WVC? (b) are there temporal and/or spatial patterns in road-kill? and (c) which life-history and/or spatial factors influence the likelihood of collisions? We recorded a total of 806 carnivore casualties, which represented an average of 47 ind./100 km/year. Red fox and stone marten had the highest mortality rates. Our findings highlight three key messages: (1) the majority of road-killed individuals were adults of common species; (2) all carnivores, except genets, were more vulnerable during specific life-history phenological periods: higher casualties were observed when red fox and stone marten were provisioning young, Eurasian badger casualties occurred more frequently during dispersal, and higher Egyptian mongoose mortality occurred during the breeding period; and (3) modeling demonstrated that favorable habitat, curves in the road, and low human disturbance were major contributors to the deadliest road segments. Red fox carcasses were more likely to be found on road sections with passages distant from urban areas. Conversely, stone marten mortalities were found more often on national roads with high of cork oak woodland cover; Egyptian mongoose and genet road-kills were found more often on road segments close to curves. Based on our results, two key

  10. Slope Failure Prediction and Early Warning Awareness Education for Reducing Landslides Casualty in Malaysia

    NASA Astrophysics Data System (ADS)

    Koay, S. P.; Tay, L. T.; Fukuoka, H.; Koyama, T.; Sakai, N.; Jamaludin, S. B.; Lateh, H.

    2015-12-01

    Northeast monsoon causes heavy rain in east coast of Peninsular Malaysia from November to March, every year. During this monsoon period, besides the happening of flood along east coast, landslides also causes millions of Malaysian Ringgit economical losses. Hence, it is essential to study the prediction of slope failure to prevent the casualty of landslides happening. In our study, we introduce prediction method of the accumulated rainfall affecting the stability of the slope. If the curve, in the graph, which is presented by rainfall intensity versus accumulated rainfall, crosses over the critical line, the condition of the slope is considered in high risk where the data are calculated and sent from rain gauge in the site via internet. If the possibility of slope failure is going high, the alert message will be sent out to the authorities for decision making on road block or setting the warning light at the road side. Besides road block and warning light, we propose to disseminate short message, to pre-registered mobile phone user, to notify the public for easing the traffic jam and avoiding unnecessary public panic. Prediction is not enough to prevent the casualty. Early warning awareness of the public is very important to reduce the casualty of landslides happening. IT technology does not only play a main role in disseminating information, early warning awareness education, by using IT technology, should be conducted, in schools, to give early warning awareness on natural hazard since childhood. Knowing the pass history on landslides occurrence will gain experience on the landslides happening. Landslides historical events with coordinate information are stored in database. The public can browse these historical events via internet. By referring to such historical landslides events, the public may know where did landslides happen before and the possibility of slope failure occurrence again is considered high. Simulation of rainfall induced slope failure mechanism

  11. Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.

    PubMed

    Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

    2013-07-01

    Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. PMID:23126406

  12. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Expectancy Estimate for an Unguided Suborbital Launch Vehicle D Appendix D to Part 420 Aeronautics and Space... Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle (a) Introduction (1) This appendix... unguided suborbital launch vehicle would be launched. The appendix describes how to define an...

  13. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... must also include the information relating to alcohol and drug involvement specified by 46 CFR 4.05-12... CFR part 16. (c) If filed immediately after the event, the written report required by paragraph (a) of... casualty be submitted, and what must it contain? 150.820 Section 150.820 Navigation and Navigable...

  14. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... must also include the information relating to alcohol and drug involvement specified by 46 CFR 4.05-12... CFR part 16. (c) If filed immediately after the event, the written report required by paragraph (a) of... casualty be submitted, and what must it contain? 150.820 Section 150.820 Navigation and Navigable...

  15. [The modern approaches to the principles of medical and surgical casualty estimation. The US and British experience].

    PubMed

    Zhuravlev, V K; Golota, A S; Krassiĭ, A B; Mironov, V G; Parfenov, V D

    2014-01-01

    The current article is dedicated to the principles of medical and surgical casualty estimation elaborated by the medical services of the US and Great Britain Armed Forces on the basis of their experience obtained during Afghanistan and Iraq operations. PMID:24734435

  16. Designing for Risk Assessment Systems for Patient Triage in Primary Health Care: A Literature Review

    PubMed Central

    Carvalho, Paulo Victor Rodrigues

    2016-01-01

    Background This literature review covers original journal papers published between 2011 and 2015. These papers review the current status of research on the application of human factors and ergonomics in risk assessment systems’ design to cope with the complexity, singularity, and danger in patient triage in primary health care. Objective This paper presents a systematic literature review that aims to identify, analyze, and interpret the application of available evidence from human factors and ergonomics to the design of tools, devices, and work processes to support risk assessment in the context of health care. Methods Electronic search was performed on 7 bibliographic databases of health sciences, engineering, and computer sciences disciplines. The quality and suitability of primary studies were evaluated, and selected papers were classified according to 4 classes of outcomes. Results A total of 1845 papers were retrieved by the initial search, culminating in 16 selected for data extraction after the application of inclusion and exclusion criteria and quality and suitability evaluation. Conclusions Results point out that the study of the implications of the lack of understanding about real work performance in designing for risk assessment in health care is very specific, little explored, and mostly focused on the development of tools. PMID:27528543

  17. HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia

    PubMed Central

    Peralta-Zaragoza, Oscar; Deas, Jessica; Gómez-Cerón, Claudia; García-Suastegui, Wendy Argelia; Fierros-Zárate, Geny del Socorro; Jacobo-Herrera, Nadia Judith

    2013-01-01

    Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer. PMID:23690785

  18. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a Measure of Injury Severity.

    PubMed

    Yates, Morgan Thorn; Ishikawa, Takuro; Schneeberg, Amy; Brussoni, Mariana

    2016-01-01

    This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally. Of these children, 32.4% (n = 83) were hospitalized and 67.6% (n = 173) were treated in the emergency department and released. They completed the PedsQL(TM), a validated measure of health related quality of life, at baseline (pre-injury status), one-month, four- to six-months, and 12-months post-injury. In this secondary data analysis, PaedsCTAS was found to be significantly associated with hospitalization and length of stay, sensitive to the differences between PaedsCTAS II and III, and related to physical but not psychosocial HRQoL. The findings suggest that PaedsCTAS may be a useful proxy measure of injury severity to supplement or replace hospitalization status and/or length of stay, currently proxy measures. PMID:27399743

  19. Clinical review: Considerations for the triage of maternity care during an influenza pandemic - one institution's approach

    PubMed Central

    2010-01-01

    The ongoing pandemic of 2009 H1N1 swine-origin influenza A has heightened the world's attention to the reality of influenza pandemics and their unpredictable nature. Currently, the 2009 H1N1 influenza strain appears to cause mild clinical disease for the majority of those infected. However, the risk of severe disease from this strain or other future strains remains an ongoing concern and is noted in specific patient populations. Pregnant women represent a unique patient population that historically has been disproportionately affected by both seasonal and pandemic influenza outbreaks. Data thus far suggest that the current 2009 H1N1 outbreak is following this same epidemiologic tendency among pregnant women. The increased predilection to worse clinical outcomes among pregnant women has potential to produce an acute demand for critical care resources that may overwhelm supply in facilities providing maternity care. The ability of healthcare systems to optimize maternal-child health outcomes during an influenza pandemic or other biologic disaster may therefore depend on the equitable allocation of these limited resources. Triage algorithms for resource allocation have been delineated in the general medical population. However, no current guidance considers the unique aspects of pregnant women and their unborn fetuses. An approach is suggested that may help guide facilities faced with these challenges. PMID:20587086

  20. HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia.

    PubMed

    Peralta-Zaragoza, Oscar; Deas, Jessica; Gómez-Cerón, Claudia; García-Suastegui, Wendy Argelia; Fierros-Zárate, Geny Del Socorro; Jacobo-Herrera, Nadia Judith

    2013-01-01

    Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer. PMID:23690785

  1. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.

    PubMed Central

    Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

    2006-01-01

    PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after. PMID:16628305

  2. Prediction of adverse outcomes of acute coronary syndrome using intelligent fusion of triage information with HUMINT

    NASA Astrophysics Data System (ADS)

    McCullough, Claire L.; Novobilski, Andrew J.; Fesmire, Francis M.

    2006-04-01

    Faculty from the University of Tennessee at Chattanooga and the University of Tennessee College of Medicine, Chattanooga Unit, have used data mining techniques and neural networks to examine a set of fourteen features, data items, and HUMINT assessments for 2,148 emergency room patients with symptoms possibly indicative of Acute Coronary Syndrome. Specifically, the authors have generated Bayesian networks describing linkages and causality in the data, and have compared them with neural networks. The data includes objective information routinely collected during triage and the physician's initial case assessment, a HUMINT appraisal. Both the neural network and the Bayesian network were used to fuse the disparate types of information with the goal of forecasting thirty-day adverse patient outcome. This paper presents details of the methods of data fusion including both the data mining techniques and the neural network. Results are compared using Receiver Operating Characteristic curves describing the outcomes of both methods, both using only objective features and including the subjective physician's assessment. While preliminary, the results of this continuing study are significant both from the perspective of potential use of the intelligent fusion of biomedical informatics to aid the physician in prescribing treatment necessary to prevent serious adverse outcome from ACS and as a model of fusion of objective data with subjective HUMINT assessment. Possible future work includes extension of successfully demonstrated intelligent fusion methods to other medical applications, and use of decision level fusion to combine results from data mining and neural net approaches for even more accurate outcome prediction.

  3. Triage for suspected acute Pulmonary Embolism: Think before opening Pandora's Box.

    PubMed

    Levin, David; Seo, Joon Beom; Kiely, David G; Hatabu, Hiroto; Gefter, Warren; van Beek, Edwin J R; Schiebler, Mark L

    2015-06-01

    This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation-perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources. PMID:25864020

  4. A Deployable In Vivo EPR Tooth Dosimeter for Triage After a Radiation Event Involving Large Populations

    PubMed Central

    Williams, Benjamin B.; Dong, Ruhong; Flood, Ann Barry; Grinberg, Oleg; Kmiec, Maciej; Lesniewski, Piotr N.; Matthews, Thomas P.; Nicolalde, Roberto J.; Raynolds, Tim; Salikhov, Ildar K.; Swartz, Harold M.

    2011-01-01

    In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators. Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately five minutes, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care. PMID:21966241

  5. The use of the MCMI-III in the screening and triage of offenders.

    PubMed

    Retzlaff, Paul; Stoner, John; Kleinsasser, Dennis

    2002-06-01

    The Millon Clinical Multiaxial Inventory-III (MCMI-III) is well suited for use in corrections settings. The MCMI-III's scales correlate with the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) personality disorders (frequently found in correctional settings), and the publisher offers a corrections-specific interpretive package. To further elucidate the usefulness of the MCMI-III with offenders and assess its efficacy, the authors administered the test to more than 10,000 inmates of the Colorado Department of Corrections. Scale scores were compared to intake judgment and outcome variables across mental health, substance abuse, and violence variables. A number of scales were found to predict several mental health variables such as subsequent diagnosis, medication prescription, and therapy time. Substance abuse scale elevations corresponded to subsequent intake recommendations. Although more modest, the aggressive personality disorder scales and several of the neurotic scales correlated with future institutional violence. The authors discuss the relevance of these findings to screening, triage, and correctional assessment. PMID:12113210

  6. Pediatric Canadian Triage and Acuity Scale (PaedsCTAS) as a Measure of Injury Severity

    PubMed Central

    Yates, Morgan Thorn; Ishikawa, Takuro; Schneeberg, Amy; Brussoni, Mariana

    2016-01-01

    This research explored whether the pediatric version of the Canadian Triage Acuity Scale (PaedsCTAS) represented a valid alternative indicator for surveillance of injury severity. Every patient presenting in a Canadian emergency department is assigned a CTAS or PaedsCTAS score in order to prioritize access to care and to predict the nature and scope of care that is likely to be required. The five-level PaedsCTAS score ranges from I (resuscitation) to V (non-urgent). A total of 256 children, 0 to 17-years-old, who attended a pediatric hospital for an injury were followed longitudinally. Of these children, 32.4% (n = 83) were hospitalized and 67.6% (n = 173) were treated in the emergency department and released. They completed the PedsQLTM, a validated measure of health related quality of life, at baseline (pre-injury status), one-month, four- to six-months, and 12-months post-injury. In this secondary data analysis, PaedsCTAS was found to be significantly associated with hospitalization and length of stay, sensitive to the differences between PaedsCTAS II and III, and related to physical but not psychosocial HRQoL. The findings suggest that PaedsCTAS may be a useful proxy measure of injury severity to supplement or replace hospitalization status and/or length of stay, currently proxy measures. PMID:27399743

  7. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments

    PubMed Central

    Vigil, Jacob M.; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S.; Strenth, Chance; Parshall, Mark; Cichowski, Sara B.

    2016-01-01

    Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups

  8. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments.

    PubMed

    Vigil, Jacob M; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S; Strenth, Chance; Parshall, Mark; Cichowski, Sara B

    2016-04-01

    Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment.The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses.A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, <1% American Indian/Alaska Native, and 1% mixed ethnicity. After controlling for demographic characteristics of nurses and patients, African-American, Hispanic, and mixed-ethnicity patients reported higher average PI scores but lower HRs and RRs than NHW patients. NHW patients received higher priority ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans).This study provides evidence for systemic differences in how patients' vital signs are applied for determining ESI scores for different ethnic groups. Additional

  9. Combat casualty care in an air force theater hospital: perspectives of recently deployed cardiothoracic surgeons.

    PubMed

    McNeil, Jeffrey D; Pratt, Jerry W

    2008-01-01

    Current military operations have generated a large number of casualties and have led to the establishment of the first Air Force Theater Hospital since Vietnam. Located at Balad Airbase, Iraq, this hospital is a busy trauma center. Thoracic injuries are relatively infrequent but highly lethal. The cardiothoracic surgeon is uniquely trained to provide sophisticated surgical management to some of the most severely injured patients. The operative experiences of four recently deployed cardiothoracic surgeons are described. Mortality from combat injury in this conflict is lower than in prior wars. Body armor may prevent some fatal injuries. Several features of military medical care process are helping to improve our outcomes-specifically, the development of a trauma care system modeled on successful civilian centers, the expanded use of damage control concepts, and utilization of early transportation out of the theater of operations using Critical Care Air Transport Teams (CCATT). PMID:18420132

  10. Rehabilitation of the Combat Casualty: Lessons Learned from Past and Current Conflicts.

    PubMed

    Pasquina, Paul F; Shero, John C

    2016-01-01

    The field of rehabilitation is deeply rooted in military medicine, especially in promoting the restoration of function and community reintegration of injured service members returning from war. Since military operations began in Iraq and Afghanistan over a decade ago, rehabilitative care programs have been integral in supporting the Military Healthcare System in providing high quality comprehensive care for combat casualties and their families, particularly those with complex blast injuries resulting in conditions such as amputation and other limb dysfunction, traumatic brain injury, and spinal cord injury. Fundamental to a successful rehabilitation program is the coordination of interdisciplinary care that not only crosses multiple medical specialties and disciplines, but also promotes ongoing education, research, quality improvement and readiness. This brief article is intended to highlight some of the most important lessons learned from current and past conflicts in delivering the highest quality rehabilitative care to our nation's heroes. PMID:27215872

  11. Deciphering the Use and Predictive Value of “EMS Provider Judgment” in Out-of-Hospital Trauma Triage: A Multi-site, Mixed Methods Assessment

    PubMed Central

    Newgard, Craig D.; Kampp, Michael; Nelson, Maria; Holmes, James F.; Zive, Dana; Rea, Thomas; Bulger, Eileen M.; Liao, Michael; Sherck, John; Hsia, Renee Y.; Wang, N. Ewen; Fleischman, Ross J.; Barton, Erik D.; Daya, Mohamud; Heineman, John; Kuppermann, Nathan

    2012-01-01

    Background “EMS provider judgment” was recently added as a field triage criterion to the national guidelines, yet its predictive value and real-world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. Methods We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in 5 regions across the Western U.S. from 2006–2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for ISS ≥ 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. Results 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio (OR) of ISS ≥ 16 for EMS provider judgment was 1.23 (95%CI 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Conclusions Among this multi-site cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, was independently associated with serious injury and was useful in identifying high risk patients missed by other criteria. However, there was variability in predictive value between sites. PMID:22673250

  12. The impact of using computer decision-support software in primary care nurse-led telephone triage: interactional dilemmas and conversational consequences.

    PubMed

    Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Valerie; Fletcher, Emily; Campbell, John L

    2015-02-01

    Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. PMID:25514212

  13. Cholinergic symptoms due to nerve agent attack: a strategy for management.

    PubMed

    Schecter, William P

    2004-09-01

    This article provides a brief history of nerve agent development and use and discusses the pharmacology, symptoms, signs, and treatment of nerve agent exposure. In addition, this article discusses the challenges of mass-casualty triage, decontamination, resuscitation, and intensive care. PMID:15325720

  14. Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation

    PubMed Central

    Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Val; Fletcher, Emily; Campbell, John L

    2014-01-01

    Objective To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting 2 GP practices in Devon and Warwickshire, UK. Participants 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4 min, 37 s, (SD=1 min, 26 s); N=4 min, 39 s, (SD=2 min, 22 s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have

  15. A Critical Assessment of the Out-of-Hospital Trauma Triage Guidelines for Physiologic Abnormality

    PubMed Central

    Newgard, Craig D.; Rudser, Kyle; Hedges, Jerris R.; Kerby, Jeffrey D.; Stiell, Ian G.; Davis, Daniel P.; Morrison, Laurie J.; Bulger, Eileen; Terndrup, Tom; Minei, Joseph P.; Bardarson, Berit; Emerson, Scott

    2013-01-01

    Background It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) “step 1” field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. Methods We analyzed an out-of-hospital, consecutive patient, prospective cohort of injured adults ≥15 years collected from December 1, 2005, to February 28, 2007, by 237 emergency medical service agencies transporting to 207 acute care hospitals in 11 sites across the United States and Canada. Patients were included based on ACSCOT field decision scheme physiologic criteria systolic blood pressure ≤90, respiratory rate <10 or >29 breaths/min, Glasgow Coma Scale score ≤12, or field intubation. Seven field physiologic variables and four additional demographic and mechanism variables were included in the analysis. The composite outcome was mortality (field or in-hospital) or hospital length of stay >2 days. Results Of 7,127 injured persons, 6,259 had complete outcome information and were included in the analysis. There were 3,631 (58.0%) persons with death or LOS >2 days. Using only physiologic measures, the derived rule included advanced airway intervention, shock index >1.4, Glasgow Coma Scale <11, and pulse oximetry <93%. Rule validation demonstrated sensitivity 72% (95% confidence interval: 70%–74%) and specificity 69% (95% confidence interval: 67%–72%). Inclusion of demographic and mechanism variables did not significantly improve performance measures. Conclusions We were unable to omit or further restrict any ACSCOT step 1 physiologic measures in a decision rule practical for field use without missing high-risk trauma patients. PMID:20154558

  16. Intelligent mobile voice information centre system: Taking the emergency triage support system as an example.

    PubMed

    Hsiao, Fang-Ying; Chang, Polun

    2006-01-01

    According to research by the International Telecommunications Union (ITU), Taiwan has the highest percentage of people holding mobile (cell) phones, and every one has one or two cell phones. We usually use mobile phones to make contact with hospitals or dial 119 in an emergency. We have developed a new call flow style and combine traditional passive call flow. The system is designed with a voice menu and users can command services actively. The telephone connects to a computer server to enter the call flow module with ASR and TTS. The recognition term comes from a voice term database. The voice management center is an ER triage decision system. We have tested three scenarios which are DOA, a large number of patients and critical trauma. We measured the completion time and recognition rate for all the scenarios. The recognition rate in all three cases was above 90%. The average completion time for DOA is 38.6 seconds, for the large number of patients is 20 seconds and for the critical trauma case, the average is 252.7 seconds. It is too slow to input one patient's data but the communication transfer of the message is fast and convenient; the DOA notice only takes 38 seconds to inform medical staff, which is very efficient and medical staff believe that this can help their communication. We will continue to extend our system and further apply it to other domains. Future studies may combine the Internet platform with the WiFi phone and soft phone (Skype) and broaden the scope of the application in Taiwan. PMID:17102346

  17. An economic analysis of a nurse-led telephone triage service.

    PubMed

    Navratil-Strawn, Jessica L; Ozminkowski, Ronald J; Hartley, Stephen K

    2014-09-01

    Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers' intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings. PMID:25059246

  18. Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90

    PubMed Central

    Brown, Joshua B.; Gestring, Mark L.; Forsythe, Raquel M.; Stassen, Nicole A.; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.

    2015-01-01

    BACKGROUND Undertriage is a concern in geriatric patients. The National Trauma Triage Protocol (NTTP) recognized that systolic blood pressure (SBP) less than 110 mm Hg may represent shock in those older than 65 years. The objective was to evaluate the impact of substituting an SBP of less than 110 mm Hg for the current SBP of less than 90 mm Hg criterion within the NTTP on triage performance and mortality. METHODS Subjects undergoing scene transport in the National Trauma Data Bank (2010–2012) were included. The outcome of trauma center need was defined as Injury Severity Score (ISS) greater than 15, intensive care unit admission, urgent operation, or emergency department death. Geriatric (age > 65 years) and adult (age, 16–65 years) cohorts were compared. Triage characteristics and area under the curve (AUC) were compared between SBP of less than 110 mm Hg and SBP of less than 90 mm Hg. Hierarchical logistic regression was used to determine whether geriatric patients newly triaged positive under this change (SBP, 90–109 mm Hg) have a risk of mortality similar to those triaged positive with SBP of less than 90 mm Hg. RESULTS There were 1,555,944 subjects included. SBP of less than 110mm Hg had higher sensitivity but lower specificity in geriatric (13% vs. 5%, 93% vs. 99%) and adult (23% vs. 10%, 90% vs. 98%) cohorts. AUC was higher for SBP of less than 110 mm Hg individually in both geriatric and adult (p < 0.01) cohorts. Within the NTTP, the AUC was similar for SBP of less than 110 mm Hg and SBP of less than 90 mm Hg in geriatric subjects but was higher for SBP of less than 90 mm Hg in adult subjects (p < 0.01). Substituting SBP of less than 110 mm Hg resulted in an undertriage reduction of 4.4% with overtriage increase of 4.3% in the geriatric cohort. Geriatric subjects with SBP of 90 mm Hg to 109 mm Hg had an odds of mortality similar to those of geriatric patients with SBP of less than 90 mm Hg (adjusted odds ratio, 1.03; 95% confidence interval, 0.88–1

  19. [The organizational aspects of treating light casualties in modern warfare (2)].

    PubMed

    Nechaev, E A; Maksimov, G K; Agapov, V K; Golov, Iu S

    1993-07-01

    The experience gathered by Medical Service during the war in Afghanistan and during liquidation of the consequences of various disasters and accidents has shown that the most rational method of treatment of minor wounded near the combat area or zone of disaster was a two-staged (and sometimes a three-staged) management system. At the combat tactical zone it is expedient to render the secondary surgical care and reanimation procedures of vital cases, and also provide treatment of minor wounded who could be returned to their ranks in 10 days. For this purpose it is necessary to integrate the sections of medical triage and minor wounded treatment into organic structure of the Brigade medical company and Divisional hospital. As for Army Medical Brigade it must have in its structure a hospital for minor wounded who could be returned to their ranks in 20 days. All the wounded who have to be treated more than 20 days must be evacuated to the Front hospital for minor wounded. PMID:8249347

  20. EDs credit drills, community engagement with helping them manage casualties from tornado crises.

    PubMed

    2011-07-01

    Emergency department leaders at DCH Regional Medical Center in Tuscaloosa, AL, and Cullman Regional Medical Center in Cullman, AL, credit their regular practice drills with helping them deal with unprecedented demand when deadly tornadoes swept through the South this past April. Both facilities used the hospital instant command structure (HICS) to mobilize the resources needed to care for the surge in patients, and say the approach worked well in helping them meet the needs of their communities. However, the crises also showcased opportunities for improvement. The ED at DCH Regional Medical Center saw more than 600 patients on the day of the storm, a three-fold increase in the hospital's typical volume. CRMC treated 99 patients in the seven hours immediately following the storm when it usually treats 114 patients per day. In addition to a big surge in patients, both hospitals dealt with power outages that limited access to some services such as radiology. Triage proved particularly challenging at DCH Regional Medical Center, as patients flowed into the hospital from numerous access points. The hospital plans to assign coordinators to each area of the hospital to better manage the influx in the future. When reviewing emergency operations plans, Joint Commission reviewers often find deficiencies in hazard vulnerability analyses as well as the processes used to determine the emergency credentials of licensed independent practitioners. PMID:21749003