Science.gov

Sample records for mass casualty triage

  1. 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

  2. SCHEDULING IMPATIENT JOBS IN A CLEARING SYSTEM WITH INSIGHTS ON PATIENT TRIAGE IN MASS CASUALTY

    E-print Network

    Ziya, Serhan

    SCHEDULING IMPATIENT JOBS IN A CLEARING SYSTEM WITH INSIGHTS ON PATIENT TRIAGE IN MASS CASUALTY consider a single-server clearing system in which jobs may abandon the system if they are not taken into service within their "lifetime." In this system, jobs are characterized by their lifetime and service time

  3. Clinical review: Mass casualty triage – pandemic influenza and critical care

    PubMed Central

    Challen, Kirsty; Bentley, Andrew; Bright, John; Walter, Darren

    2007-01-01

    Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process. PMID:17490495

  4. BET 2: Is prehospital focused abdominal ultrasound useful during triage at mass casualty incidents?

    PubMed

    2013-07-01

    A short-cut review was carried out to determined whether the addition of prehospital focused abdominal ultrasound to triage protocols might reduce time to necessary surgery and reduce overall mortality. Thirty-five papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are shown in table 2. It is concluded that although the feasibility of prehospital ultrasound in mass casualty incidents has been demonstrated, there is, as yet, no clear evidence of benefit as part of a triage protocol. PMID:23765767

  5. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises.

    PubMed

    Körner, Markus; Krötz, Michael M; Wirth, Stefan; Huber-Wagner, Stefan; Kanz, Karl-Georg; Boehm, Holger F; Reiser, Maximilian; Linsenmaier, Ulrich

    2009-08-01

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated "critical" by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. PMID:19277671

  6. A Wireless First Responder Handheld Device for Rapid Triage, Patient Assessment and Documentation during Mass Casualty Incidents

    PubMed Central

    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. Development and application of triage and medical evacuation system for casualties at sea.

    PubMed

    Xie, Tai; Liu, Xiao-Rong; Chen, Guo-Liang; Qi, Liang; Xu, Zhi-Yin; Liu, Xu-Dong

    2014-01-01

    Traditional triage could not meet the needs of battlefield casualties' care in modern warfare. This paper designs of triage and medical evacuation system for casualties at sea that can quickly address mass-casualty triage, and store and transmit medical information during battlefield treatment and medical evacuation. This system consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest. PMID:25722870

  8. Triage of casualties after nuclear attack.

    PubMed

    Pledger, H G

    1986-09-20

    Casualties from a nuclear attack on the United Kingdom would overwhelm the health services, and health workers would be faced with many more people seeking help than could be offered treatment. Discussion is needed to determine which methods of medical and non-medical triage would be acceptable and feasible. PMID:2876146

  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. 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

  12. Westgate Shootings: An Emergency Department Approach to a Mass-casualty Incident.

    PubMed

    Wachira, Benjamin W; Abdalla, Ramadhani O; Wallis, Lee A

    2014-10-01

    At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other EDs and hospitals in Kenya, appropriate for the local health care system. Wachira BW , Abdalla RO , Wallis LA . Westgate shootings: an emergency department approach to a mass-casualty incident. Prehosp Disaster Med. 2014;29(5):1-4 . PMID:25204863

  13. Managing mass casualties and decontamination.

    PubMed

    Chilcott, Robert P

    2014-11-01

    Careful planning and regular exercising of capabilities is the key to implementing an effective response following the release of hazardous materials, although ad hoc changes may be inevitable. Critical actions which require immediate implementation at an incident are evacuation, followed by disrobing (removal of clothes) and decontamination. The latter can be achieved through bespoke response facilities or various interim methods which may utilise water or readily available (dry, absorbent) materials. Following transfer to a safe holding area, each casualty's personal details should be recorded to facilitate a health surveillance programme, should it become apparent that the original contaminant has chronic health effects. PMID:24684820

  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. 'Just send them all to a burn centre': managing burn resources in a mass casualty incident.

    PubMed

    Conlon, Kathe M; Martin, Shawn

    2011-06-01

    Burn experts estimate that 20-30 per cent of injuries from mass casualty events result in serious burns, many requiring specialised care only available at burn centres. Yet, in the USA there are less then 1,850 burn beds available to provide such a level and quality of care. To address this concern, burn centres are beginning to put into practice new mass casualty triage and transport guidelines that must coordinate with local, regional and federal response plans, while still adhering to an accepted standard of care. This presentation describes how one US burn centre developed and implemented a Homeland Security Exercise and Evaluation Program (HSEEP) designed mass casualty incident (MCI) exercise focused on coordinating 'the right patient to the right facility at the right time', based upon acuity and bed availability. Discussion will enable planners to identify methodologies adaptable for incorporation into catastrophic emergency management operations within their regions. PMID:21835753

  16. MASCAL: RFID tracking of patients, staff and equipment to enhance hospital response to mass casualty events.

    PubMed

    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. During mass casualty events, as the demands on the healthcare team increase, and the challenges faced by managers escalate, workflow bottlenecks begin to 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

  17. 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

  18. Medical management of toxicological mass casualty events.

    PubMed

    Markel, Gal; Krivoy, Amir; Rotman, Eran; Schein, Ophir; Shrot, Shai; Brosh-Nissimov, Tal; Dushnitsky, Tsvika; Eisenkraft, Arik

    2008-11-01

    The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE. PMID:19070282

  19. Disaster planning: the basics of creating a burn mass casualty disaster plan for a burn center.

    PubMed

    Kearns, Randy D; Conlon, Kathe M; Valenta, Andrea L; Lord, Graydon C; Cairns, Charles B; Holmes, James H; Johnson, Daryhl D; Matherly, Annette F; Sawyer, Dalton; Skarote, Mary Beth; Siler, Sean M; Helminiak, Radm Clare; Cairns, Bruce A

    2014-01-01

    In 2005, the American Burn Association published burn disaster guidelines. This work recognized that local and state assets are the most important resources in the initial 24- to 48-hour management of a burn disaster. Historical experiences suggest there is ample opportunity to improve local and state preparedness for a major burn disaster. This review will focus on the basics of developing a burn surge disaster plan for a mass casualty event. In the event of a disaster, burn centers must recognize their place in the context of local and state disaster plan activation. Planning for a burn center takes on three forms; institutional/intrafacility, interfacility/intrastate, and interstate/regional. Priorities for a burn disaster plan include: coordination, communication, triage, plan activation (trigger point), surge, and regional capacity. Capacity and capability of the plan should be modeled and exercised to determine limitations and identify breaking points. When there is more than one burn center in a given state or jurisdiction, close coordination and communication between the burn centers are essential for a successful response. Burn surge mass casualty planning at the facility and specialty planning levels, including a state burn surge disaster plan, must have interface points with governmental plans. Local, state, and federal governmental agencies have key roles and responsibilities in a burn mass casualty disaster. This work will include a framework and critical concepts any burn disaster planning effort should consider when developing future plans. PMID:23877135

  20. Modelling mass casualty decontamination systems informed by field exercise data.

    PubMed

    Egan, Joseph R; Amlôt, Richard

    2012-10-01

    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

  1. 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

  2. Evacuation Priorities in Mass Casualty Terror-Related Events

    PubMed Central

    Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

    2004-01-01

    Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

  3. A method of transporting critical care mass casualties.

    PubMed

    Hudson, Timothy L; Weichart, Thomas

    2002-09-01

    The use of a self-contained transport platform can aid in the efforts to care for mass casualty victims. The platform is equipped with critical care equipment and has the capabilities of documenting care electronically. It has been used in a number of different settings and has allowed health care personnel to provide more efficient, individualized care to a larger number of victims. PMID:12685464

  4. 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

    2015-01-01

    In 2014, CDC published updated guidelines for the prevention and treatment of anthrax (Hendricks KA, Wright ME, Shadomy SV, et al. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20[2]. Available at http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm). These guidelines provided recommended best practices for the diagnosis and treatment of persons with naturally occurring or bioterrorism-related anthrax in conventional medical settings. An aerosolized release of Bacillus anthracis spores over densely populated areas could become a mass-casualty incident. To prepare for this possibility, the U.S. government has stockpiled equipment and therapeutics (known as medical countermeasures [MCMs]) for anthrax prevention and treatment. However, previously developed, publicly available clinical recommendations have not addressed the use of MCMs or clinical management during an anthrax mass-casualty incident, when the number of patients is likely to exceed the ability of the health care infrastructure to provide conventional standards of care and supplies of MCMs might be inadequate to meet the demand required. To address this gap, in 2013, CDC conducted a series of systematic reviews of the scientific literature on anthrax to identify evidence that could help clinicians and public health authorities set guidelines for intravenous antimicrobial and antitoxin use, diagnosis of anthrax meningitis, and management of common anthrax-specific complications in the setting of a mass-casualty incident. Evidence from these reviews was presented to professionals with expertise in anthrax, critical care, and disaster medicine during a series of workgroup meetings that were held from August 2013 through March 2014. In March 2014, a meeting was held at which 102 subject matter experts discussed the evidence and adapted the existing best practices guidance to a clinical use framework for the 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

  5. 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

  6. 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

  7. High-fidelity human patient simulators compared with human actors in an unannounced mass-casualty exercise.

    PubMed

    Schulz, Christian M; Skrzypczak, Matthias; Raith, Stefan; Hinzmann, Dominik; Krautheim, Veronika; Heuser, Fabian; Mayer, Valentin; Kreuzer, Christoph; Himsl, Meike; Holl, Michael; Lipp, Christina; Kochs, Eberhard F; Wagner, Klaus J

    2014-04-01

    High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA. Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training. PMID:24650543

  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. 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

  10. Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.

    PubMed

    Hanley, Michael E; Bogdan, Gregory M

    2008-02-01

    Disaster preparedness typically includes plans that address the need for surge capacity to manage mass-casualty events. A major concern of disaster preparedness in respiratory therapy focuses on responding to a sudden increase in the volume of patients who require mechanical ventilation. Plans for such disasters must include contingencies to address surge capacity in ventilator inventories and the respiratory therapy staff who will manage the ventilators. Tactics to address these situations include efforts to lower demand by transferring patients to other institutions as well as efforts to augment staffing levels. Staff can be augmented by mobilization of deployable teams of volunteers from outside the region and through exploitation of local resources. The latter includes strategies to recruit local respiratory therapists who are currently in either non-clinical or non-hospital-based positions and policies that optimize existing respiratory therapy resources within an institution by canceling elective surgeries, altering shift structure, and postponing vacations. An alternative approach would employ non-respiratory-therapy staff to assist in the management of patients with respiratory failure. Project XTREME (Cross-Training Respiratory Extenders for Medical Emergencies) is a cross-training program developed to facilitate training of non-respiratory-therapy health professionals to assist in the management of patients who require mechanical ventilation. It includes an interactive digital video disc as well as a competency validation laboratory and is designed to be performed at the time of an emergency. Pilot testing of the program suggests it is effective. PMID:18218149

  11. An Intelligent 802.11 Triage Tag For Medical Response to Disasters

    PubMed Central

    Lenert, Leslie A.; Palmer, Douglas A.; Chan, Theodore C; Rao, Ramesh

    2005-01-01

    When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims’ triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an“Intelligent Triage Tag” (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:16779078

  12. 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

  13. 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

  14. 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

  15. [NATO international advanced course on best way of training for mass casualty situations].

    PubMed

    Klein, L; Michaelson, M

    2010-07-01

    NATO Advanced Training Course on Best Way of Training for Mass Casualty Situations was held in Haifa, Israel in November 16-18, 2009. In total, 22 participants from 8 countries of the Partnership for Peace and Mediterranean Dialogue Programmes attended the course. The participants, divided within three groups, discussed and practised the training methods for the preshospital aspect, the hospital aspect and the non-conventional aspect of the mass casualty management. An international team of experts, among others, used following teaching methods: general lectures, guided discussions, utilization of advanced multimedia tools, tabletop drills, and large scale drill as training tools. The trainees also learned about medical and clinical simulation as a training tool, and subsequently practiced it. A mass casualty drill was held in Rambam Health Care Campus at the end of the Course. The trainees of the course participated as observers and reviewers in the drill, and debriefed it together with Rambam medical staff. Realisation of the successful course was made possible by utilizing a grant of the NATO Science for Peace and Security Programme. PMID:20842911

  16. Triage in the defence medical services.

    PubMed

    Horne, Simon T; Vassallo, J

    2015-06-01

    Triage of patients into categories according to their need for intervention is a core part of military medical practice. This article reviews how triage has evolved in the Defence Medical Services and how it might develop in the context of recent research. In particular, a simple model demonstrates that the ideal sensitivity and specificity of a triage system depends upon the availability of transport and the capacity of the receiving units. As a result, we may need to fundamentally change the way we approach triage in order to optimise outcomes-especially if casualty evacuation timelines become longer and smaller medical units more prevalent on future operations. Some pragmatic options for change are discussed. Finally, other areas of current research around triage are highlighted, perhaps showing where triage may go next. PMID:24951629

  17. 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

  18. 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 revealed by the MASH study into a unified cross-border emergency medical response. PMID:23716370

  19. 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

  20. 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

  1. 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

  2. [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 public in anticipation of such an attack. The more we will encourage patients who suffer flu-like syndromes to consult their family physician, the more instances of early detection of anthrax cases we will discover. However, in so doing, we will increase the level of national stress and flood primary medicine with many thousands of patients without being able to give our general practitioners any simple and effective tool for the diagnosis of anthrax in its early stages. Between the devil of biological warfare and the deep blue sea of public reaction, a small group of decision-makers and their professional advisers is under pressure. Israel is fortunate that this is not a new problem for this group of experts. Large scale drills, thorough preparations and adequate stockpiling of everything required marks the results of this group's activities. The state of Israel is today one of the best-prepared countries for such an event. PMID:12170548

  3. Family support and victim identification in mass casualty terrorist attacks: an integrative approach.

    PubMed

    Gagin, Roni; Cohen, Miri; Peled-Avram, Maya

    2005-01-01

    Terrorist bombing attacks in Israel between 2000 and 2004 caused mass casualties. After each attack in the north of Israel, Rambam Medical Center, the largest hospital in the region, absorbs the majority of injured, especially the more severely injured and unidentified victims. Immediately with the media reports of a terrorist attack, tens of relatives come to the hospital, looking for missing family members. This paper describes an assistance unit for families of unidentified victims. It is staffed by the hospital's social work department, and its tasks are to identify the unidentified victims, help relatives find and be united with them, and assist other relatives in the identification of bodies of deceased family members. The process involves gathering information from relatives and cross-checking it with data and pictures from the hospitals' emergency and operating rooms; and providing crisis intervention and psychological first aid to victims' relatives. The family assistance unit works with several other professional units in the hospital and in the community, and always adjusts its operations to the features of each event. Clearer guidelines for dynamic training of social workers and research-based interventions to prevent compassion fatigue among the workers must be further developed. PMID:16107044

  4. 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 their personal and professional integrity, and abandoning existing patients may do so. For these reasons, responders can permissibly give a degree of priority to existing patients over newcomers in disaster. PMID:23145352

  5. 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.

  6. 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

  7. 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

  8. 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

  9. [Current state of medical care of polytrauma and mass casualty incidents in Germany : Are we well-prepared?].

    PubMed

    Brodauf, L; Heßing, K; Hoffmann, R; Friemert, B

    2015-10-01

    The white paper on the medical care of the severely injured published in 2006 is a collection of proposals and recommendations concerning structure, organization and equipment for the medical care of severely injured patients. Since its publication 50 networks ( http://www.dgu-traumanetzwerk.de/index.php?option=com_content&view=article&id=116&Itemid=54&lang=de ) have been established as part of the trauma network. This and the trauma register have helped to continuously improve the medical care of severely injured patients since 1993 [26]. Numerous studies have documented the progress made in measures required by the trauma network [4, 6]. For example, the mortality rate of severely injured patients has dropped from 25?% to approximately 10?% in the past 15 years. From the register and network data it is difficult to tell how each of these measures is implemented in the participating hospitals, who provides medical treatment to patients when, and how medical care is organized in detail. This is why a survey on medical care for polytrauma and in mass casualty situations was conducted among medical directors in German surgical hospitals who are members of the German Society for Trauma Surgery (DGU). Thanks to the 211 participants (most of whom specialize in orthopedic and trauma surgery) a detailed description of how medical treatment is currently organized and performed could be acquired. The survey showed that care of patients with polytrauma (i.e. medical treatment and management) is important irrespective of the level of training of physicians and of the level of patient treatment in hospitals. The central role of traumatologists was emphasized not only in terms of actual treatment but also as an administrator for organizational and management matters. Almost all hospitals have plans for a mass casualty situation; however, the levels of preparedness show considerable variation. A highly critical view is taken of the new surgical specialists with respect to interdisciplinary and comprehensive emergency medical treatment and casualty care. The survey also revealed the continual conflict between managing costs and maintaining quality and resources. It gives an overview of patient treatment in the transition from preclinical to clinical care and provides insights into the targets achieved, current problems and conflicts. PMID:26324317

  10. Development and organization for casualty management on a 1,000-bed hospital ship in the Persian Gulf.

    PubMed

    Ochsner, M G; Harviel, J D; Stafford, P W; Blankenship, C; Bosse, M J; Timberlake, G A; McSwain, N E

    1992-04-01

    A 1,000-bed hospital ship designed for trauma patients was deployed to the Middle East with the objectives of preparing for large numbers of casualties resulting from Operation Desert Storm from conventional, chemical, and biological weapons. Plans for receipt and decontamination of casualties, triage, and optimal utilization of the 1,000-bed facility were developed. Mass casualty drills were conducted, involving all aspects of patient care from the flight deck to the wards. Trauma and critical care registries were developed to collect casualty data that could then be analyzed for specific military purposes and compared with current civilian registries. Attempts were made to identify the advances in shock resuscitation, systems management, and operative treatment from the civilian community that could be applied to care of combat casualties. Difficulties with accomplishing these objectives included limited trauma experience and supplies and poorly defined medical regulating and evacuation policies. The development of these programs, as well as the unique difficulties encountered, are discussed. PMID:1569624

  11. 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

  12. 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 items and quantities of clinical equipment that are required to treat 100 people at the scene of a big bang mass casualties event. The findings can be used, both in the UK and internationally, to support decision makers in the planning of equipment for such incidents. PMID:24559111

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. [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

  20. 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

  1. 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

  2. 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

  3. 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

  4. Development of a national burn network: providing a co-ordinated response to a burn mass casualty disaster within the Australian health system

    PubMed Central

    Wood, F; Edgar, D; Robertson, AG

    2008-01-01

    With the threat of terrorist activity ever present since the incidents in Bali and Jakarta, the Australian health system must be prepared to manage another mass burn casualty disaster. The Australian and New Zealand Burns Association (ANZBA) highlighted the lack of a national burn disaster response before the 2000 Olympics. With the limited number of burn beds available and the protracted length of stay after such injuries, any state or territory could be overwhelmed with relatively few patient admissions. In 2002, the Australian Health Minister's Conference called for a solution. The objective of this paper is to provide an overview of the process and development of the Australian National Burn Network, which underpins the National Burn Disaster Response (AUSBURNPLAN). PMID:22460213

  5. 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 limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research. PMID:25471837

  6. 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

  7. 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.

  8. Prehospital reflections: diagnosing apnoea at a multiple casualty chemical, biological, radiological and nuclear incident.

    PubMed

    Malpas, Michael

    2011-12-01

    During a multiple casualty chemical, biological, radiological and nuclear incident it is imperative that triage is accurately undertaken to use resources effectively and give the greatest chance of survival to those who need it. This reflection explores an option to assist in this matter by proposing a colorimetric breathing detection system, while remembering that this it is untested, may be a useful aid. PMID:21346259

  9. 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.

  10. Interpersonal Psychotherapy: Evaluation, Support, Triage

    PubMed Central

    Weissman, Myrna; Verdeli, Helen

    2012-01-01

    Depression is highly prevalent and debilitating among medically ill patients. As high as one third of the primary practise patients screen positive for depression symptoms and over half of the patients diagnosed with major depressive disorder are treated in primary care. However, current primary care service arrangements do not efficiently triage patients who screen positive for depression into appropriate treatments that reflect their individual needs and preferences. In this paper, we describe a tool that aims to fill the gap between screening the patients for depression and triaging them to appropriate care. This is a three-session adaptation of interpersonal psychotherapy: ipt; evaluation, support, triage (IPT-EST). We first outline IPT-EST procedures that aim to provide structure and content to primary care practitioners who identify patients with positive depression symptoms, thus assisting the practitioners to explore the patients’ psychosocial triggers of depression, give basic strategies to manage these interpersonal stressors and provide decisions tools about triaging patients with severe/persistent depression into appropriate treatment. PMID:22359316

  11. 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, structure and usefulness of the Handbook before a final version is produced. In order to achieve the project's objectives a consortium has been drawn together including, Belgian Nuclear Research Centre, the Norwegian Radiation Protection Authority, Radiation and Nuclear Safety Authority of Finland, the UK Health Protection Agency, the Central Laboratory for Radiological Protection of Poland and the World Health Organisation. Enviros Consulting is acting as the technical secretariat for the project. The Handbook will aim to harmonise the approaches to handling malevolent acts across Europe. This harmonisation will have an added value on the public confidence in authorities since differing approaches in neighbouring countries could lead to public confusion and mistrust. (authors)

  12. What is orthopaedic triage? A systematic review

    PubMed Central

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-01-01

    Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. PMID:25410703

  13. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (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 or... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Report of casualty or...

  14. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 false Written report of marine casualty. 122.206 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner,...

  15. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 false Written report of marine casualty. 185.206 Section 185...UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine casualty. (a) The owner,...

  16. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 false Written report of marine casualty. 185.206 Section 185...UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine casualty. (a) The owner,...

  17. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 false Written report of marine casualty. 185.206 Section 185...UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine casualty. (a) The owner,...

  18. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Notice of marine casualty. 122.202 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately...

  19. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 false Written report of marine casualty. 122.206 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner,...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 false Written report of marine casualty. 122.206 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner,...

  1. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Notice of marine casualty. 122.202 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 false Written report of marine casualty. 185.206 Section 185...UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine casualty. (a) The owner,...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 false Written report of marine casualty. 122.206 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner,...

  4. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 false Written report of marine casualty. 122.206 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.206 Written report of marine casualty. (a) The owner,...

  5. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Notice of marine casualty. 122.202 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately...

  6. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Notice of marine casualty. 122.202 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately...

  7. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Notice of marine casualty. 122.202 Section 122...MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately...

  8. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

  9. 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.

  10. Evaluating Age in the Field Triage of Injured Persons

    PubMed Central

    Nakamura, Yoko; Daya, Mohamud; Bulger, Eileen M.; Schreiber, Martin; Mackersie, Robert; Hsia, Renee Y.; Mann, N. Clay; Holmes, James F.; Staudenmayer, Kristan; Sturges, Zachary; Liao, Michael; Haukoos, Jason; Kuppermann, Nathan; Barton, Erik D.; Newgard, Craig D.

    2012-01-01

    Study Objective In this study, we evaluated (1) trauma under-triage by age group; (2) the association between age and serious injury after accounting for other field triage criteria and confounders; and (3) the potential impact of a mandatory age triage criterion for field triage. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals in 6 regions of the Western U.S. from 2006 through 2008. We used probabilistic linkage to match EMS records to hospital records, including: trauma registries, state discharge databases and emergency department databases. The primary outcome measure was serious injury, as measured by an Injury Severity Score (ISS) ? 16. We assessed under-triage (ISS ? 16 and triage-negative or transport to a non-trauma center) by age decile and used multivariable logistic regression models to estimate the association (linear and non-linear) between age and ISS ? 16, adjusted for important confounders. We also evaluated the potential impact of age on triage efficiency and trauma center volume. Results 260,027 injured patients were evaluated and transported by EMS over the 3-year study period. Under-triage increased for patients over 60 years of age, reaching approximately 60% for those older than 90 years. There was a strong non-linear association between age and ISS ? 16. For patients not meeting other triage criteria, the probability of serious injury was most notable after 60 years. A mandatory age triage criterion would have decreased under-triage at the expense of over-triage, with one ISS ? 16 patient identified for every 60–65 additional patients transported to major trauma centers. Conclusion Trauma under-triage increases in patients older than 60 years. While the probability of serious injury increases among triage-negative patients with increasing age, the use of a mandatory age triage criterion appears inefficient for improving field triage. PMID:22633339

  11. 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

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. Breast clinic triage tool: telephone assessment of new referrals.

    PubMed

    Cusack, Leila; Brennan, Meagan; Weissenberg, Leisha; Moore, Katrina

    2012-04-01

    Efficient systems to triage increasing numbers of new referrals to breast clinics are needed, to optimise the management of patients with cancer and benign disease. A tool was developed to triage the urgency of referrals and allocate the most appropriate clinician consultation (surgeon or breast physician (BP)). 259 consecutive new referrals were triaged using the tool. 100% new cancers and 256 (98.8%) referrals overall were triaged to both appropriate category of urgency and the appropriate clinician. This triage tool provides a simple method for assessing new referrals to a breast clinic and can be easily delivered by trained administrative staff by telephone. PMID:22113194

  20. 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…

  1. Nurses’ Requirements for Relief and Casualty Support in Disasters: A Qualitative Study

    PubMed Central

    Nekooei Moghaddam, Mahmoud; Saeed, Sara; Khanjani, Narges; Arab, Mansour

    2014-01-01

    Background: Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses. Objectives: In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management. Materials and Methods: This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes. Results: Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants’ comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters. Conclusions: There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives. PMID:25414897

  2. 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; Wi?cek, 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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  4. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  5. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records...or route, including but not limited to fire, flooding, or failure of or damage to fixed fire-extinguishing systems, lifesaving...

  6. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident...Collision; (vi) Allision; (vii) Explosion; (viii) Fire; (ix) Reduction or loss of a vessel's electrical...

  7. 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,...

  8. 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,...

  9. 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...

  10. 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...

  11. 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...

  12. 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,...

  13. 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,...

  14. 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...

  15. 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...

  16. 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,...

  17. 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

  18. 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…

  19. Waiting for Triage: Unmeasured Time in Patient Flow

    PubMed Central

    Houston, Christopher; Sanchez, Leon D.; Fischer, Christopher; Volz, Kathryn; Wolfe, Richard

    2015-01-01

    Introduction The Centers for Medicare and Medicaid Services (CMS) requires reporting of multiple time-sensitive metrics. Most facilities use triage time as the time of arrival. Little is known about how long patients wait prior to triage. As reimbursement to the hospital may be tied to these metrics, it is essential to accurately record the time of arrival. Our objective was to quantify the time spent waiting to be triaged for patients arriving to the emergency department (ED). Methods We conducted this study in an urban, academic, tertiary care center with approximately 54,000 annual ED visits. All patients arriving to the ED from November 1, 2012, to October 1, 2013, were enrolled. If patients didn’t go directly to a bed or triage, an observer greeted patients as they entered the ED and recorded the time of arrival. The triage time was recorded as normal. We calculated the difference between the arrival time and triage time. Results There were 50,576 patient visits during the study period. Of these, 7,795 (15.4%) patients did not go directly to a bed or triage. For patients who waited for triage, median time from arrival to triage was 11 minutes (IQR 5–19, range 1–105). When stratified by the number of new patients who arrived in the ED in the previous hour, the percentage of greeted patients who waited more than 10 minutes for triage was: 0–5 new patients ? 12.4%; 6–10 new patients ? 48.8%; 11–15 new patients ? 64.4%; 16+ new patients ? 68%. Conclusion Patients often waited more than 10 minutes to be triaged. As the number of patients registered in the previous hour increased, the percentage of patients who waited more than 10 minutes for triage increased significantly. During times of peak volume, 8.5% of all patients arriving to the ED waited more than 10 minutes for triage. This wait is not accounted for in the normal reporting of ED throughput times and metrics. PMID:25671006

  20. Westinghouse GOCO conduct of casualty drills

    SciTech Connect

    Ames, C.P.

    1996-02-01

    Purpose of this document is to provide Westinghouse Government Owned Contractor Operated (GOCO) Facilities with information that can be used to implement or improve drill programs. Elements of this guide are highly recommended for use when implementing a new drill program or when assessing an existing program. Casualty drills focus on response to abnormal conditions presenting a hazard to personnel, environment, or equipment; they are distinct from Emergency Response Exercises in which the training emphasis is on site, field office, and emergency management team interaction. The DOE documents which require team training and conducting drills in nuclear facilities and should be used as guidance in non-nuclear facilities are: DOE 5480.19 (Chapter 1 of Attachment I) and DOE 5480.20 (Chapter 1, paragraphs 7 a. and d. of continuing training). Casualty drills should be an integral part of the qualification and training program at every DOE facility.

  1. Balancing human and system visualization during document triage 

    E-print Network

    Bae, Soon Il

    2009-05-15

    People must frequently sort through and identify relevant materials from a large set of documents. Document triage is a specific form of information collecting where people quickly evaluate a large set of documents from ...

  2. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Marine casualty investigation by the Board... PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations §...

  3. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Marine casualty investigation by the Board... PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations §...

  4. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Marine casualty investigation by the Board... PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations §...

  5. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Marine casualty investigation by the Board... PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations §...

  6. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Marine casualty investigation by the Board... PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations §...

  7. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

  8. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

  10. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

  12. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Coast Guard marine casualty investigation for...NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY...CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation...

  14. 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

  15. 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.

  16. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... where damage by casualty has occurred to a building and ornamental or fruit trees used in a trade or business, the decrease in value shall be measured by taking the building and trees into account separately... building and trees. (ii) In determining a casualty loss involving real property and improvements...

  17. 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…

  18. 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 losses. (a) In general—(1) Allowance of...

  19. The metrics of death: emotions and the effects of casualties on public opinion in militarized disputes and terrorism 

    E-print Network

    Mosher, Katrina N.

    2009-05-15

    . The Impact of Casualties and Previous Casualties on Specific Emotions. ........ 134? 21. The Impact of Context and the Identity of the Casualties on the Level of Expressed Sadness.... ............................................................................................. 137? 22. The Impact of Context, Current Number of Casualties, and the Identity of the Casualties on the Level of Expressed Sadness. ............................................ 138? 23. The Current and Previous Number of Casualties, and the Identity...

  20. 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

  1. 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 is replete with descriptions of budget cuts and the resultant reallocation of monies. For example, as the budget cuts of the last decade accumulated, maintenance was deferred, and the funds saved were used to shore-up key existing parts of the educational process, such as faculty salaries. State budgets are generally smaller now than they were when the cuts were made, which means that preventive maintenance will continue to be deferred and other resources must be found for capital improvements. Triage often operates in an environment that does not permit promising possibilities to develop. For example, the promise of interactive digital technologies on the learning process may never be fully realized in many institutions if the associated capital and operating costs cannot be accommodated within the cost containment measures being adopted. In an effort to offset part of the lost state support, tuition and fees have been increased at public institutions at a rate that far exceeds growth of the cost of living index. All this is occurring in the face of an increasingly diverse student body and the beginning of "Tidal Wave II," as the surge of new students who are the children of the baby boomers has been called. These demands, along with the expectations for an historically, good American education, will have to be met with fewer dollars. Our ability to fund public higher education by the conventional mechanisms has been affected by a variety of tax reform initiatives. Although the details may vary locally, various kinds of initiatives, propositions, and referenda have severely limited the amount of revenue states can raise. Thus, caps on property taxes have transformed support patterns at the city and county levels. Initiatives, many of which have built-in escalators, that fix the percentages of state spending for various programs have created new kinds of budgetary entitlement groups. These mandates conspire to give government, i.e., governors and legislatures, less discretionary control over a dwindling portion of the state budget. Unfortunately, hig

  2. Brush-and-Drag: A Multi-touch Interface For Photo Triaging

    E-print Network

    Winkler, Stefan

    photo software provides very limited computational or interface support for photo triaging. For exampleBrush-and-Drag: A Multi-touch Interface For Photo Triaging Seon Joo Kim,1 Hongwei Ng, Stefan of the same scene with only slight variations. To enhance photo triaging, which is a very common photowork

  3. Physiologic Field Triage Criteria for Identifying Seriously Injured Older Adults

    PubMed Central

    Newgard, Craig D.; Richardson, Derek; Holmes, James F.; Rea, Thomas D.; Hsia, Renee Y.; Mann, N. Clay; Staudenmayer, Kristan; Barton, Erik D.; Bulger, Eileen M.; Haukoos, Jason S.

    2015-01-01

    Objective To evaluate the ability of out-of-hospital physiologic measures to predict serious injury for field triage purposes among older adults and potentially reduce the under-triage of seriously injured elders to non-trauma hospitals. Methods This was a retrospective cohort study involving injured adults 55 years and older transported by 94 emergency medical services (EMS) agencies to 122 hospitals (trauma and non-trauma) in 7 regions of the western United States from January 1, 2006 to December 31, 2008. We evaluated initial out-of-hospital Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory rate, heart rate, shock index (SBP ÷ heart rate), out-of-hospital procedures, mechanism of injury, and patient demographics. The primary outcome was “serious injury,” defined as Injury Severity Score (ISS) ? 16, as a measure of trauma center need. We used multivariable regression models, fractional polynomials and binary recursive partitioning to evaluate appropriate physiologic cut-points and the value of different physiologic triage criteria. Results A total of 44,890 injured older adults were evaluated and transported by EMS, of whom 2,328 (5.2%) had ISS ? 16. Nonlinear associations existed between all physiologic measures and ISS ? 16 (unadjusted and adjusted p ? 0.001 for all,), except for heart rate (adjusted p = 0.48). Revised physiologic triage criteria included GCS score ? 14; respiratory rate < 10 or > 24 breaths per minute or assisted ventilation; and SBP < 110 or > 200 mmHg. Compared to current triage practices, the revised criteria would increase triage sensitivity from 78.6 to 86.3% (difference 7.7%, 95% CI 6.1–9.6%), reduce specificity from 75.5 to 60.7% (difference 14.8%, 95% CI 14.3–15.3%), and increase the proportion of patients without serious injuries transported to major trauma centers by 60%. Conclusions Existing out-of-hospital physiologic triage criteria could be revised to better identify seriously injured older adults at the expense of increasing over-triage to major trauma centers. PMID:24933614

  4. 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... SECURITY (CONTINUED) BOATING SAFETY STATE NUMBERING AND CASUALTY REPORTING SYSTEMS Casualty Reporting System Requirements § 174.107 Contents of casualty or accident report form. Each form for reporting...

  5. Triage systems: a review of the literature with reference to Saudi Arabia.

    PubMed

    Qureshi, N A

    2010-06-01

    This review evaluates some of the international literature on triage in order to provide evidence-based data for the medical community in Saudi Arabia specifically and the Eastern Mediterranean Region in general. The aim is to encourage national health planners and decision-makers to apply formal triage systems in the emergency departments of general and specialist hospitals and other relevant health settings, including primary and psychiatric care. Research and training on triage is extremely limited in Saudi Arabia and the Region and this review highlights the need for more research on triage systems and for the inclusion of training on triage in medical education programmes. PMID:20799600

  6. 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... casualty; (5) Gives the name, address, and phone number of persons involved in or witnessing the...

  7. 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...

  8. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty...radiograms sent and received, the radio log, and crew, sailing school student, instructor, and guest lists. The...

  9. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty...radiograms sent and received, the radio log, and crew, sailing school student, instructor, and guest lists. The...

  10. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty...radiograms sent and received, the radio log, and crew, sailing school student, instructor, and guest lists. The...

  11. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty...radiograms sent and received, the radio log, and crew, sailing school student, instructor, and guest lists. The...

  12. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty...radiograms sent and received, the radio log, and crew, sailing school student, instructor, and guest lists. The...

  13. 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....

  14. 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....

  15. 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....

  16. 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....

  17. 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....

  18. "Species Invasions and Climate Change: Triage in Conservation"

    E-print Network

    Anderson, Charles W.

    is recognized as one of the top ten most productive scientists in the world in the field of biological invasions exuberant teaching style and expertise on biological invasions, he is invited around the globe to lecture"Species Invasions and Climate Change: Triage in Conservation" October 17, 2012 3:00-4:00 p

  19. Psychiatric casualties in the Pacific during World War II: servicemen hospitalised in a Brisbane mental hospital.

    PubMed

    Mellsop, G W; Duraiappah, V; Priest, J A

    World War II created many psychiatric casualties but precise incidences were not accurately established. Battle shock was under-reported as some commanding officers were reluctant to admit that their men experienced battle stress. The objective in triage of any casualties was to retain as many patients in the war zone as possible, if further useful service was feasible. This also applied to soldiers with stress-related symptoms, who were treated in base hospitals as near to an operational zone as possible. The main treating maxims were "immediacy, proximity and expectancy", which involved rapid early treatment in the war zone, hoping for an early return to duty (which often meant active duty). Only those with severe psychiatric illness were sent back to their home country. The medical officer had to be sure that the patient had not responded to treatment before sending him home. During the war, the terminology used for psychological responses to the stress of combat was derived from several classifications in textbooks. Psychiatric nomenclature, barely adequate for civilian psychiatry, was totally inadequate for military psychiatry during that period. The aim of classification was to facilitate data collection rather than to provide definitive diagnoses. Psychiatric therapies during World War II were, at least to some degree, diagnostically non-specific. Diagnosis varied according to the soldier's proximity to the war zone (i.e., less severe diagnoses were given to men closer to the frontline, who would be required in battle). In addition, as psychiatrists were rarely available, medical officers without relevant (or having only limited) specialty training usually diagnosed and treated soldiers with psychiatric problems. At the beginning of the war, traumatic psychiatric reactions were classified into psychoneurosis, anxiety state and anxiety reaction, psychoneurosis mixed, and conversion hysteria. By the end of the war, the United States Surgeon General released a revised nomenclature with two new diagnostic categories: transient personality reactions to acute and special stress; and neurotic-type reactions to routine military stress. It was not until the 1950s that formal criteria for the diagnosis of trauma appeared, in the first diagnostic and statistical manual (DSM-I) of the American Psychiatric Association. PMID:8538560

  20. The Atomic Bomb Casualty Commission in retrospect.

    PubMed

    Putnam, F W

    1998-05-12

    For 50 years, the Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation (RERF), have conducted epidemiological and genetic studies of the survivors of the atomic bombs and of their children. This research program has provided the primary basis for radiation health standards. Both ABCC (1947-1975) and RERF (1975 to date) have been a joint enterprise of the United States (through the National Academy of Sciences) and of Japan. ABCC began in devastated, occupied Japan. Its mission had to be defined and refined. Early research revealed the urgent need for long term study. In 1946, a Directive of President Truman enjoined the National Research Council of the National Academy of Sciences to develop the program. By 1950, ABCC staff exceeded 1,000, and clinical and genetic studies were underway. Budgetary difficulties and other problems almost forced closure in 1953. In 1955, the Francis Report led to a unified epidemiological study. Much progress was made in the next decade, but changing times required founding of a binational nonprofit organization (RERF) with equal participation by Japan and the United States. New programs have been developed and existing ones have been extended in what is the longest continuing health survey ever undertaken. PMID:9576898

  1. The Atomic Bomb Casualty Commission in retrospect

    PubMed Central

    Putnam, Frank W.

    1998-01-01

    For 50 years, the Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation (RERF), have conducted epidemiological and genetic studies of the survivors of the atomic bombs and of their children. This research program has provided the primary basis for radiation health standards. Both ABCC (1947–1975) and RERF (1975 to date) have been a joint enterprise of the United States (through the National Academy of Sciences) and of Japan. ABCC began in devastated, occupied Japan. Its mission had to be defined and refined. Early research revealed the urgent need for long term study. In 1946, a Directive of President Truman enjoined the National Research Council of the National Academy of Sciences to develop the program. By 1950, ABCC staff exceeded 1,000, and clinical and genetic studies were underway. Budgetary difficulties and other problems almost forced closure in 1953. In 1955, the Francis Report led to a unified epidemiological study. Much progress was made in the next decade, but changing times required founding of a binational nonprofit organization (RERF) with equal participation by Japan and the United States. New programs have been developed and existing ones have been extended in what is the longest continuing health survey ever undertaken. PMID:9576898

  2. 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.

  3. Improvements in the hemodynamic stability of combat casualties during en route care.

    PubMed

    Apodaca, Amy N; Morrison, Jonathan J; Spott, Mary Ann; Lira, John J; Bailey, Jeffery; Eastridge, Brian J; Mabry, Robert L

    2013-07-01

    Three Forward Aeromedical Evacuation platforms operate in Southern Afghanistan: UK Medical Emergency Response Team (MERT), US Air Force Expeditionary Rescue Squadron (PEDRO), and US Army Medical Evacuation Squadrons (DUSTOFF), each with a different clinical capability. Recent evidence suggests that retrieval by a platform with a greater clinical capability (MERT) is associated with improved mortality in critical patients when compared with platforms with less clinical capability (PEDRO and DUSTOFF). It is unclear whether this is due to en route resuscitation or the dispatch procedure. The aim of this study was to compare prehospital Shock Index (SI = heart rate / systolic blood pressure) with admission values as a measure of resuscitation, across these platforms. Patients were identified from the Department of Defense Trauma Registry, who were evacuated between June 2009 and June 2011 in Southern Afghanistan. Data on platform type, physiology, and injury severity was extracted. Overall, 865 patients were identified: 478 MERT, 291 PEDRO, and 96 DUSTOFF patients and groups were compared across three injury severity scoring (ISS) bins: 1 to 9, 10 to 25, and 26 or greater. An improvement in the admission SI was observed across all platforms in the lowest ISS bin. Within the middle bin, both the MERT and PEDRO groups saw improved SI on admission, but not the DUSTOFF group. This trend was continued only in the MERT group for the highest ISS bin (1.39 ± 0.62 vs. 1.09 ± 0.42; P = 0.001), whereas a deterioration was identified in the PEDRO group (0.88 ± 0.37 vs. 1.02 ± 0.43; P = 0.440). The use of a Forward Aeromedical Evacuation platform with a greater clinical capability is associated with an improved hemodynamic status in critical casualties. The ideal prehospital triage should endeavor to match patient need with clinical capability. PMID:23635851

  4. Triaging self-referred patients attending ophthalmic emergency room

    PubMed Central

    AlSamnan, Mazen S.; Mousa, Ahmed; Al-Kuwaileet, Safa; AlSuhaibani, Adel H.

    2015-01-01

    Objectives: To introduce an effective and safe ophthalmic triaging system to be used by non-ophthalmologists. Methods: A modified scoring triage system with more relevant clinical symptoms and signs from a previously published Rome Eye Scoring System for Urgency and Emergency (RESCUE) was evaluated over a 2-month period. The study was conducted following a prospective cohort design between March and September 2014 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only self-referred patients were included. Its reliability in differentiating urgent and semi-urgent conditions from non-urgent conditions, identifying patients who need immediate intervention, and decreasing the waiting time were tested using Mann Whitney U test. Results: A total of 531 patients were included in the validation phase to evaluate the triaging system reliability, and 824 patients were included in the implementation phase (applying the system in the ophthalmology emergency room). The sensitivity to differentiate urgent and semi-urgent conditions from non-urgent conditions improved from 90.7 to 98.7%, while the specificity decreased from 97.2 to 87% compared with RESCUE. The sensitivity in differentiating urgent conditions from semi-urgent and non-urgent conditions was 99%, and the specificity was 90%. Mean waiting time reduced from 58.23 minutes to 46 minutes (p=0.014), and the median waiting time reduced from 46 minutes to 33 minutes (p=0.009). Conclusion: This triage system appears to be safe and effective in recognizing the urgency of different ophthalmic conditions, reducing unnecessary ophthalmic emergency load and waiting time significantly. PMID:25987109

  5. Examining the influence of civilian casualties on insurgent attacks in Iraq

    E-print Network

    Karnis, Jessica Eve

    2006-01-01

    Although there have been several attempts to tabulate civilian casualties in the Iraq War, the effect of these casualties on the Iraqi population and insurgent organizations has not been thoroughly examined. From the ...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

  7. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

  8. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

  9. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Coast Guard marine casualty investigation for...Section 4.40-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation...

  11. French pre-hospital trauma triage criteria: Does the “pre-hospital resuscitation” criterion provide additional benefit in triage?

    PubMed Central

    Hornez, Emmanuel; Maurin, Olga; Mayet, Aurélie; Monchal, Tristan; Gonzalez, Federico; Kerebel, Delphine

    2014-01-01

    AIM: To evaluate the performance of the specific French Vittel “Pre-Hospital (PH) resuscitation” criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value (PPV) of pre-hospital trauma triage. METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medical service to a trauma center. Patients who met any of the field trauma triage criteria were considered “triage positive”. Hospital data was statistically linked to pre-hospital records. The primary outcome of defining a “major trauma patient” was Injury Severity Score (ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients (ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of “PH resuscitation” was present for 64 patients (32%), but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis (OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However, despite this correlation the overall PPV was not significantly increased by the use of the criterion “PH resuscitation” (68% vs 67.8%). CONCLUSION: The criterion of “pre-hospital resuscitation” was statistically significant with the severity of the trauma, but did not increase the PPV. The use of “pre-hospital resuscitation” criterion could be re-considered if these results are confirmed by larger studies. PMID:25379459

  12. Data Quality for Situational Awareness during Mass-Casualty Events

    PubMed Central

    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 incomplete 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

  13. Selecting samples for Mars sample return: Triage by pyrolysis-FTIR

    NASA Astrophysics Data System (ADS)

    Sephton, Mark A.; Court, Richard W.; Lewis, James M.; Wright, Miriam C.; Gordon, Peter R.

    2013-04-01

    A future Mars Sample Return mission will deliver samples of the red planet to Earth laboratories for detailed analysis. A successful mission will require selection of the best samples that can be used to address the highest priority science objectives including assessment of past habitability and evidence of life. Pyrolysis is a commonly used method for extracting organic information from rocks but is most often coupled with complex analytical steps such as gas chromatography and mass spectrometry. Pyrolysis-Fourier transform infrared spectroscopy is a less resource demanding method that still allows sample characterisation. Here we demonstrate how pyrolysis-Fourier transform infrared spectroscopy could be used to triage samples destined to return to Earth, thereby maximising the scientific return from future sample return missions.

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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 HOMELAND SECURITY (CONTINUED) BOATING SAFETY STATE NUMBERING AND CASUALTY REPORTING SYSTEMS State Reports § 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty...

  3. 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...

  4. 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...

  5. 46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Alcohol or drug use by individuals directly involved in casualties. 4.05-12 Section 4.05-12 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-12 Alcohol or drug use...

  6. 46 CFR 4.05-12 - Alcohol or drug use by individuals directly involved in casualties.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Alcohol or drug use by individuals directly involved in casualties. 4.05-12 Section 4.05-12 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records § 4.05-12 Alcohol or drug use...

  7. 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...

  8. 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...) 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, 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...

  10. 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...

  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. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

    PubMed Central

    2012-01-01

    Background The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second. Methods All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72?hours, and mortality rate within 7 and 30?days. Results Data from 147,579 patients were analysed. The median length of stay was 158?minutes for physician-led team triage, compared with 243 and 197?minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p?triage, 5.3% for nurse/emergency physician, and 9.6% for nurse/junior physician triage (p?triage, 1.0%, compared with 2.1%, and 2.5% for nurse/emergency physician, and nurse/junior physician, respectively (p?triage and 1.0% for the two other triage models (p?triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models. PMID:22905993

  13. 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

  14. 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

  15. 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...

  16. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...) 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...

  17. 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...

  18. 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...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) 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...

  20. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Administration (OSHA) in 29 Code of Federal Regulations (CFR) part 1904. (c) Notice given as required by § 122... 46 Shipping 4 2012-10-01 2012-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS...

  1. 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...

  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, 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...

  4. 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...

  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, 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...

  8. An account of multiple casualties in an austere environment.

    PubMed

    Reynolds, N D; Dalal, S

    2012-09-01

    A satellite compound of an International Security Assistance Force Patrol Base came under assault during OP HERRICK 12 resulting in eight casualties. Multiple fragmentation type injuries were sustained over a short period of time which tested the locations medical capacity. This account describes the events that occurred in extracting and treating those injured. PMID:23472562

  9. 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 facility and those...Officer-in-Charge, Marine Inspection, that records need not be retained onboard. (b) The records required by paragraph (a) of...

  10. Casualties and smoke emissions from regional and global nuclear conflict.

    E-print Network

    Robock, Alan

    Casualties and smoke emissions from regional and global nuclear conflict. #12;About 4000 nuclear warheads in 2012 R.S. Norris, H.M. Kristensen, (2006). #12;Even small nuclear states can have many warheads km from ground zero at Hiroshima High energy radiation emitted - rays,neutrons Thermal radiation

  11. 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...

  12. 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...

  13. Managing critical care casualties on the Navy's hospital ships.

    PubMed

    Boren, Denise; Forbus, Ronald; Bibeau, Patrice; McKenzie, Robin; McKinsey, Karen

    2003-06-01

    In this article, a history of the hospital ships was recounted. Recent missions were described in terms of the ship and crew's capability based on education and mock training exercises. Patient flow was described and a case scenario was presented to illustrate surgically intensive management of critical care casualties. Finally, thoughts on the future of hospital ships were discussed. PMID:12755184

  14. Shouldering the Soldiering: Democracy, Conscription, and Military Casualties

    ERIC Educational Resources Information Center

    Vasquez, Joseph Paul, III

    2005-01-01

    As the American death toll in Iraq surpassed 1,900, some international research scholars may have been perplexed. Only a few years ago, foreign policy makers in Western democracies, including the United States, were described as being extremely sensitive to the risk of military combat casualties. Among the factors that influence the number of…

  15. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... land containing an office building for the lump sum of $90,000. The purchase price is allocated between... as in example (2) except that A purchases land containing a house instead of an office building. The... where damage by casualty has occurred to a building and ornamental or fruit trees used in a trade...

  16. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... land containing an office building for the lump sum of $90,000. The purchase price is allocated between... as in example (2) except that A purchases land containing a house instead of an office building. The... where damage by casualty has occurred to a building and ornamental or fruit trees used in a trade...

  17. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... land containing an office building for the lump sum of $90,000. The purchase price is allocated between... as in example (2) except that A purchases land containing a house instead of an office building. The... where damage by casualty has occurred to a building and ornamental or fruit trees used in a trade...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    (a) The owner, master, agent, or person in charge shall, within five days, file a written report of any marine casualty. This written report is in addition to the immediate notice required by 185.202. This written report must be delivered to a Coast Guard Sector Office, or Marine Inspection...

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    (a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

  20. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    (a) Immediately after the addressing of resultant safety concerns, the owner, agent, master, operator, or person in charge, shall notify the nearest Sector Office, Marine Inspection Office or Coast Guard Group Office whenever a vessel is involved in a marine casualty consisting...

  1. CAREER OUTLOOK FOR ACTUARIES in Property/Casualty

    E-print Network

    Dahl, David B.

    and Risks of Extreme Weather Events." CERES, Sept. 2012. 3. Best's News Service, "University of Illinois Research, NatCatSERVICE. As of January 2013. 6. The Insurance Fact Book 2012. Insurance Information in 20124 25,000 total loss to US property/casualty insurers due to extreme weather in 20112 THE WINDS

  2. Clustering-based Failure Triage for RTL Regression Debugging Zissis Poulos1

    E-print Network

    Veneris, Andreas

    solutions rely on man- ual ad-hoc practices. Typically, engineering teams em- ploy primitive forms of debugClustering-based Failure Triage for RTL Regression Debugging Zissis Poulos1 , Andreas Veneris1 1-suited for detailed debug- ging of each failure. This task is known as failure triage. Despite its resource

  3. Deployment and operation of a transportable burn intensive care unit in response to a burn multiple casualty incident.

    PubMed

    Barillo, David J; Cancio, Leopoldo C; Stack, Richard S; Carr, Shamus R; Broger, Kristine P; Crews, David M; Renz, Evan M; Blackbourne, Lorne H

    2010-01-01

    In many hospitals, intensive care units (ICUs) operate at or above capacity on a daily basis. Multiple casualty incidents will create a sudden need for additional ICU beds and hospital planning for disaster response must anticipate the need for rapid ICU expansion. In this article, the authors describe the management of 6 patients who were burned in Guam and successfully transported a distance of 7,268 miles to San Antonio, TX, for tertiary burn center care. The mission required creation of a temporary burn ICU at Tripler Army Medical Center in Hawaii, approximately midway between the referring hospital and the receiving burn center. A method of creating a temporary burn center is described. Lessons learned, including the need to standardize equipment, and to cross-train and cross-credential medical personnel, are applicable to both military and civilian mass casualty management. PMID:20349698

  4. 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

  5. Applying Lean: Implementation of a Rapid Triage and Treatment System

    PubMed Central

    Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

    2011-01-01

    Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. PMID:21691524

  6. 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. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable. PMID:26157077

  7. Traumatic Spinal Cord Injury Emergency Service Triage Patterns and the Associated Emergency Department Outcomes.

    PubMed

    Selvarajah, Shalini; Haider, Adil H; Schneider, Eric B; Sadowsky, Cristina L; Becker, Daniel; Hammond, Edward R

    2015-12-15

    Paralysis is an indication for trauma patients to be preferentially triaged by emergency services to designated level I or II trauma centers (TC). We sought to describe triage practices for patients with acute traumatic spinal cord injury (TSCI) and its associated emergency department (ED) outcomes. Adults ages ?18 years with a diagnosis of acute TSCI (International Classification of Diseases-9: 806 and 952) in the 2006-2011 United States Nationwide Emergency Department Sample were included in these analyses. Outcomes assessed include triage to non-trauma centers (NTC), which is referred to as "under-triage," and ED mortality. Of 117,444 adults with TSCI, 33.4% were under-triaged to NTC. Under-triage was more prevalent with increasing age. Among patients under-triaged to NTC, 37.4% had new injury severity score (NISS) >15, representing severe injuries or polytrauma. Among patients with NISS >15, the odds of ED mortality in NTC were four-fold greater compared to level I trauma centers (TC-I) (adjusted odds ratio [AOR]?=?4.06; 95% confidence interval?=1.87-8.79; p?triage of adults with acute TSCI occurred in at least one-third of the cases. Patients triaged to NTC rather than TC-I experienced higher likelihood of death in the ED even after controlling for personal and injury characteristics. Further research is necessary to elucidate detailed clinical and logistical factors that may be associated with under-triage of acute TSCI, to facilitate interventions aimed at improving patient experience and outcomes. PMID:26102350

  8. Email triage of new neurological outpatient referrals from general practice

    PubMed Central

    Patterson, V; Humphreys, J; Chua, R

    2004-01-01

    Objectives: To determine whether an email triage system between general practitioners and a neurologist for new outpatient referrals is feasible, acceptable, efficient, safe, and effective. Methods: This was a prospective single cohort study on the interface between primary care practitioners and the neurology clinic of a district general hospital. Seventy six consecutive patients with neurological symptoms from nine GPs, for whom a specialist opinion was deemed necessary, were entered in the study. The number of participants managed without clinic attendance and the reduction in neurologist's time compared with conventional consultation was measured, as was death, other specialist referral, and change in diagnosis in the 6 months after episode completion. The acceptability for GPs was ascertained by questionnaire. Results: Forty three per cent of participants required a clinic appointment, 45% were managed by email advice alone, and 12% by email plus investigations. GP satisfaction was high. Forty four per cent of the neurologist's time was saved compared with conventional consultation. No deaths or significant changes in diagnosis were recorded during the 6 month follow up period. Conclusions: Email triage is feasible, acceptable to GPs, and safe. It has the potential for making the practice of neurologists more efficient, and this needs to be tested in a larger randomised study. PMID:15026509

  9. 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

  10. 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

  11. 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

  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. 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...

  14. 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...

  15. 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 §...

  16. 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 §...

  17. 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...

  18. 46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Alcohol or drug use by individuals directly involved in casualties. 185.210 Section 185.210 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.210 Alcohol or drug use by individuals...

  19. 46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Alcohol or drug use by individuals directly involved in casualties. 185.210 Section 185.210 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.210 Alcohol or drug use by individuals...

  20. Casualties from guided missile impact in warships from another point of view.

    PubMed

    Ebeling, C F

    1991-06-01

    From Kamikaze to Exocet, by learning from history a tool for casualty calculation in modern naval warfare is available, indicating absolute casualty figures per SS guided missile hit. The figures 35 wounded and 30 killed per hit ought to be used. PMID:1852281

  1. 46 CFR 167.65-65 - Notice and reporting of casualty and voyage records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Notice and reporting of casualty and voyage records. 167.65-65 Section 167.65-65 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS PUBLIC NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-65 Notice and reporting of casualty and voyage records. The...

  2. 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...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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

  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

    ...a written report of casualty be submitted, and what must it contain? 150.820 Section 150.820 Navigation and Navigable...a written report of casualty be submitted, and what must it contain? (a) In addition to the notice of casualty...

  14. Nontraumatic splenic emergencies: cross-sectional imaging findings and triage.

    PubMed

    Tonolini, Massimo; Bianco, Roberto

    2013-08-01

    The spleen is commonly involved in a wide spectrum of hematologic, immunologic, neoplastic, infectious, and vascular systemic disorders. Sometimes overlooked on imaging studies outside the trauma setting, the spleen may harbor severe infections, and occasionally undergoes spontaneous bleeding or rupture. This pictorial essay reviews common and unusual causes of nontraumatic acute abnormalities primarily involving the spleen, and their cross-sectional imaging appearances. Emphasis is placed on multidetector computed tomography (MDCT) imaging, which represents the modality of choice to comprehensively assess acute splenic disorders including partial or complete infarctions, vascular diseases such as venous thrombosis, abscess collections, bleeding, and rupture. State-of-the-art magnetic resonance imaging represents a problem-solving technique. Borrowing from experience with grading abdominal trauma according to the traditional American Association for the Surgery of Trauma scale, spontaneous splenic injuries are confidently detected and characterized at MDCT. Furthermore, MDCT allows to identify or exclude coexistent perisplenic and intraperitoneal hemorrhage, presence and source of active bleeding, and contained vascular injury. Occasionally idiopathic, spontaneous splenic injuries should be suspected when acute abdominal manifestations and signs of hemodynamic compromise occur in a background of acute viral infections, endocarditis or sepsis, malaria, immune suppression, hematological disorders, malignancies, coagulopathy, or therapeutic anticoagulation. These uncommon yet life-threatening conditions require prompt diagnostic evaluation that allows correct triage between conservative, medical, interventional, and surgical treatment, and may obviate splenectomy. Finally, MDCT imaging allows differentiation of splenic rupture from other rare causes of spontaneous hemoperitoneum, and reliable follow-up of nonsurgically treated patients. PMID:23318941

  15. 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

  16. 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.

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

    PubMed

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

    2015-11-01

    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

  18. 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.

  19. 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

  20. Tissue Triage and Freezing for Models of Skeletal Muscle Disease

    PubMed Central

    Meng, Hui; Janssen, Paul M.L.; Grange, Robert W.; Yang, Lin; Beggs, Alan H.; Swanson, Lindsay C.; Cossette, Stacy A.; Frase, Alison; Childers, Martin K.; Granzier, Henk; Gussoni, Emanuela; Lawlor, Michael W.

    2014-01-01

    Skeletal muscle is a unique tissue because of its structure and function, which requires specific protocols for tissue collection to obtain optimal results from functional, cellular, molecular, and pathological evaluations. Due to the subtlety of some pathological abnormalities seen in congenital muscle disorders and the potential for fixation to interfere with the recognition of these features, pathological evaluation of frozen muscle is preferable to fixed muscle when evaluating skeletal muscle for congenital muscle disease. Additionally, the potential to produce severe freezing artifacts in muscle requires specific precautions when freezing skeletal muscle for histological examination that are not commonly used when freezing other tissues. This manuscript describes a protocol for rapid freezing of skeletal muscle using isopentane (2-methylbutane) cooled with liquid nitrogen to preserve optimal skeletal muscle morphology. This procedure is also effective for freezing tissue intended for genetic or protein expression studies. Furthermore, we have integrated our freezing protocol into a broader procedure that also describes preferred methods for the short term triage of tissue for (1) single fiber functional studies and (2) myoblast cell culture, with a focus on the minimum effort necessary to collect tissue and transport it to specialized research or reference labs to complete these studies. Overall, this manuscript provides an outline of how fresh tissue can be effectively distributed for a variety of phenotypic studies and thereby provides standard operating procedures (SOPs) for pathological studies related to congenital muscle disease. PMID:25078247

  1. Management of neck lumps--a triage model.

    PubMed Central

    Smith, O. D.; Ellis, P. D.; Bearcroft, P. W.; Berman, L. H.; Grant, J. W.; Jani, P.

    2000-01-01

    We report our experience in the out-patient triage of 100 patients presenting with a lump in the neck. The out-patient visit consisted of a general history and examination, assessment of the upper air and food passages and, where indicated, ultrasound and core needle biopsy of the lump. Other investigations were performed as appropriate. One hundred neck lump patients were seen in a 9 month period. Ninety-six of these lumps were diagnosed on an out-patient basis, only four requiring admission for formal excision biopsy. Among the diagnoses were eleven lymphomas, nine parotid neoplasms, nine lymph node metastases, five thyroglossal cysts, and four branchial cysts. Almost half the patients seen had either a reactive lymphadenopathy, or no abnormality. The establishment of a tissue diagnosis on an out-patient basis allowed appropriate referrals to be made and management plans to be formulated. The theoretical risk of seeding of malignant cells in the needle tract is acknowledged and discussed. Images Figure 1 PMID:10932654

  2. 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 scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity). PMID:21718476

  3. Emergency department triage scales and their components: a systematic review of the scientific evidence.

    PubMed

    Farrohknia, Nasim; Castrén, Maaret; Ehrenberg, Anna; Lind, Lars; Oredsson, Sven; Jonsson, Håkan; Asplund, Kjell; Göransson, Katarina E

    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 scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity). PMID:21718476

  4. 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

  5. Modelling the effects of land use and temporal factors on child pedestrian casualties.

    PubMed

    Dissanayake, Dilum; Aryaija, James; Wedagama, D M Priyantha

    2009-09-01

    This study investigates the suitability of land use variables in predicting the number of child pedestrian casualties; a subject of concern in Great Britain despite sustained improvements in road safety over the past decade. The relationship between land use and transport is used to establish a link between land use and child pedestrian travel; trip attractors and generators are considered as variables that lead child pedestrians to exposure to high risk environments. Casualty records for Newcastle upon Tyne are analysed to reveal trends of temporal variation of child pedestrian casualty numbers. Land use data is combined with the casualty data using GIS techniques to generate relevant inputs for the analysis. Six Generalized Linear Models (GLMs) are developed to analyse the association of child pedestrian casualty numbers and trip attractor land use types. Two are the main models; the first investigates all types of casualty data including slight, serious and fatal events and the second uses only KSI (Killed or Seriously Injured) data in the analysis. The other four models are developed to investigate the temporal variation of child pedestrian KSI and slight casualties over the day (school time and non-school time) and week (weekday and weekend). The results show that secondary retail and high density residential land use types are associated with all child pedestrian casualties. In addition, educational sites, junction density, primary retail and low density residential land use types are also associated with child casualties at different time periods of the day and week. The study findings are found to concur with the current child road safety policies in Great Britain and will, in fact, provide some guidance for local authorities to deliver successful child road safety audits. PMID:19664440

  6. 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.

  7. Variation in Prehospital Use and Uptake of the National Field Triage Decision Scheme

    PubMed Central

    Barnett, Andy S.; Wang, N. Ewen; Sahni, Ritu; Hsia, Renee Y.; Haukoos, Jason S.; Barton, Erik D.; Holmes, James F.; Newgard, Craig D.

    2013-01-01

    Background The Field Triage Decision Scheme is a national guideline that has been implemented widely for prehospital Emergency Medical Services (EMS) and trauma systems. However, little is known about the uptake, modification or variation in field application of triage criteria between trauma systems. Objective To describe and compare the use of field triage criteria by EMS personnel in 6 regions, including the timing of guideline uptake and use of non-guideline criteria. Methods This was a retrospective cohort study of injured children and adults transported by 48 EMS agencies to 105 hospitals (trauma and non-trauma centers) in 6 Western U.S. regions from 2006 through 2008. We used probabilistic linkage to match patient-level prehospital information from multiple sources, including: EMS records, base-hospital phone communication records and trauma registry data files. Triage criteria were evaluated individually and grouped by “steps” (physiologic, anatomic, mechanism and special considerations). We used descriptive statistics to compare the frequency of triage criteria use (overall and between regions) and to evaluate the timing of guideline uptake across multiple versions of the guidelines. Results A total of 260,027 injured patients were evaluated and transported by EMS over the 3-year study period, of whom 46,414 (18%) met at least one field triage criterion and formed the primary sample for analysis. The 3 most common criteria cited (of 33 in use) were: EMS provider judgment (26%), age < 5 or > 55 years (10%) and GCS score <14 (9%). Of the 33 criteria in use, 5 (15%) were previously retired from the guidelines and 7 (21%) were never included in the guidelines. 11,048 (24%) of patients had more than 1 criteria applied (range 1 – 21). There was large variation in the type and frequency of criteria used between systems, particularly among the non-physiologic triage steps. Only 1 of 6 regions had translated the most recent guidelines into field use within 2 years of release. Conclusion There is large variation between regions in the frequency and type of field triage criteria used. Field uptake of guideline revisions appears slow and variable, suggesting opportunities for improvement in dissemination and implementation of updated guidelines. PMID:23452003

  8. 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 ?s, during which it is first illuminated with laser light tuned to ionize only Sr, and then 1-3 ?s 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 Murchison meteorite using L2MS that closely match previously results (Fig. 1). In conclusion, we ultimately seek to enhance the characterization of landing sites on Mars by providing in-situ triage of potential samples for Earth return, improving the odds of returning relevant samples, and enhancing near-term science return. Figure 1: L2MS spectrum of Murchison organics present at ~10 ppm taken with dating instrument (blue), compared with previous results of Spencer et al, 2008 (red). The red peak at ~100 AMU is a standard, and that blue BPA peaks from 210-230 AMU are from the mounting epoxy. Note that both long period and short period stucture correlate, despite different sample sources, and 5 years between measurements.

  9. 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.

  10. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

  11. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2012-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

  12. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

  13. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

  14. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Coast Guard forms for numbering and casualty...Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY...Certificate of Number § 173.81 Coast Guard forms for numbering and...

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    (2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

  16. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    (2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    (2) The Commandant and the Board agree that the Board shall conduct the investigation, and the casualty involves a public and a nonpublic vessel and at least one fatality or $75,000 in property damage;...

  18. [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

  19. 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

  20. When Do Their Casualties Count? Exploring Wartime Decisions that Pit Security Against Harm 

    E-print Network

    Roblyer, Dwight Andrew

    2011-02-22

    to foreign civilians. It empirically identifies conditions under which leaders in democratic nations are more or less likely to choose to attack a target when confronted with a dilemma between pursuing national security objectives and avoiding civilian... target benefit and lower civilian casualty estimates increased support for the planned attack. Prospect frame influenced decisions in the cases where both target value and the civilian casualty estimates were high and the resulting dilemma was very...

  1. 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.…

  2. Triage in Forensic Accounting using Zipf's Law Adeola Odueke & George R. S. Weir1

    E-print Network

    Strathclyde, University of

    .weir@strath.ac.uk Abstract. In forensic accounting, use of Benford's law has long been acknowledged as a technique the context of fraud detection and then describes an experiment that contrasted Benford's law and Zipf's law accounting. Benford's Law, Zipf's Law, triage. 1 Fraud Categories There are many ways that financial frauds

  3. The RABiT: A Rapid Automated Biodosimetry Tool for radiological triage. II. Technological developments

    E-print Network

    Yao, Y. Lawrence

    . This paper describes recent upgrades and reliability testing of the RABiT. Materials and methods: The RABiThe RABiT: A Rapid Automated Biodosimetry Tool for radiological triage. II. Technological , & DAVID J. BRENNER3 1 Radiological Research Accelerator Facility, 2 Department of Mechanical Engineering

  4. 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

  5. Sport associated eye injury: a casualty department survey.

    PubMed Central

    MacEwen, C. J.

    1987-01-01

    A survey was performed of all patients attending the combined Glasgow Eye Infirmary and Western Infirmary Eye Casualty Department with sports injuries. During an 18-month period a total of 246 patients presented with such injuries. Football was responsible for 110 (44.7%), rugby for 24 (9.8%), squash for 19 (7.7%), badminton for 16 (6.5%), and skiing for 9 (3.7%), and 68 (27.6%) were caused by other sports. One hundred and sixty-two patients (65.8%) had superficial or surrounding soft tissue injuries, 54 (22%) had more severe anterior segment damage in the form of hyphaema or traumatic uveitis, 17 (6.9%) had retinal damage manifest as oedema or retinal tear with or without detachment, and two (0.8%) suffered severe disruption of the globe with subsequent loss of the eye in each case. Forty-six (18.7%) required inpatient care and 200 (81.3%) were treated as outpatients, of whom 104 required at least one follow-up appointment (42.3% of the total). I conclude that with increasing time available for leisure activities there has been a parallel increase in sport associated eye trauma. PMID:3663565

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

    PubMed

    Mileti?, D; Fuckar, Z; Mraovi?, 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

  7. 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

  8. 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.

  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. 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

  11. Smartphone teledermoscopy referrals: a novel process for improved triage of skin cancer patients.

    PubMed

    Börve, Alexander; Dahlén Gyllencreutz, Johan; Terstappen, Karin; Johansson Backman, Eva; Aldenbratt, Anette; Danielsson, Markus; Gillstedt, Martin; Sandberg, Carin; Paoli, John

    2015-02-01

    In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals. PMID:24923283

  12. Manchester Triage System version II and resource utilisation in the emergency department.

    PubMed

    Santos, André Peralta; Freitas, Paulo; Martins, Henrique Manuel Gil

    2014-02-01

    Emergency department (ED) triage systems aim to direct the best clinical assistance to those who are in the greatest urgency and guarantee that resources are efficiently applied. The study's purpose was to determine whether the Manchester Triage System (MTS) second version is a useful instrument for determining the risk of hospital admission, intrahospital death and resource utilisation in ED and to compare it with the MTS first version. This was a prospective study of patients that attended the ED at a large hospital. It comprised a total of 25,218 cases that were triaged between 11 July and 13 October 2011. The MTS codes were grouped into two clusters: red and orange into a 'high acuity/priority' (HP) cluster, and yellow, green and blue into a 'low acuity/priority' cluster. The risk of hospital admission in the HP cluster was 4.86 times that of the LP cluster for both admission route and ages. The percentage of patient hospital admission between medical and surgical specialties, in high and low priority clusters, was similar. We found the risk of death in the HP cluster to be 5.58 times that of the risk of the low acuity/priority cluster. The MTS had an inconsistent association relative to the utilisation of x-ray, while it seemed to portray a consistent association between ECG and laboratory utilisation and MTS cluster. There were no differences between medical and surgical specialities risk of admission. This suggests that improvements were made in the second version of MTS, particularly in the discriminators of patients triaged to surgical specialties, because this was not true for the first version of MTS. PMID:23345313

  13. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Impact Dispersion Areas and Casualty Expectancy...420, App. D Appendix D to Part 420—Impact Dispersion Areas and Casualty Expectancy...define an overflight exclusion zone and impact dispersion areas, and how to...

  14. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Impact Dispersion Areas and Casualty Expectancy...420, App. D Appendix D to Part 420—Impact Dispersion Areas and Casualty Expectancy...define an overflight exclusion zone and impact dispersion areas, and how to...

  15. 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

    ...2014-01-01 2014-01-01 false Impact Dispersion Areas and Casualty Expectancy...420, App. D Appendix D to Part 420—Impact Dispersion Areas and Casualty Expectancy...define an overflight exclusion zone and impact dispersion areas, and how to...

  16. 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

    ...2011-01-01 2011-01-01 false Impact Dispersion Areas and Casualty Expectancy...420, App. D Appendix D to Part 420—Impact Dispersion Areas and Casualty Expectancy...define an overflight exclusion zone and impact dispersion areas, and how to...

  17. Afflux massif de brûlés : la doctrine française de triage en temps de paix

    PubMed Central

    Bargues, L.; Fall, M.M.

    2015-01-01

    Summary Les situations de catastrophe impliquant un grand nombre de brûlés peuvent survenir à tout moment après un incendie, une attaque terroriste, une explosion industrielle ou un accident de transport. Les différentes sociétés internationales de brûlologie ont publié des recommandations sur la préparation à l’afflux massif de brûlés. La Société Française d’Étude et de Traitement des Brûlés (SFETB) propose le triage des victimes selon la Surface Cutanée Brûlée (SCB), l’inhalation de fumées et les lésions traumatiques associées. Ce plan cherche à catégoriser les victimes et à attribuer à chaque patient un lit adapté à ses besoins thérapeutiques (centre des brûlés, réanimation médicale ou chirurgicale, service d’urgences, chirurgie, poste de triage). Les Services d’Aide Médicale Urgente (SAMU) sont au coeur du dispositif : premiers soins, poste Médical Avancé (pMA), régulation, triage et transport, renfort en matériel dans l’hôpital de proximité. Un plan catastrophe pour brûlés doit être adapté aux capacités hospitalières du pays. PMID:26668563

  18. 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 clear that there are no hospital facilities anywhere that could take care of the injured (3/4 of the total casualties) in any of the scenarios, even if we assume that only 1/4 are heavily injured. Given the enormous numbers of casualties that must be expected, even mitigation measure that could only save a fraction of the casualties would help large numbers of people.

  19. Comparison of female and male casualty cohorts from conflicts in Iraq and Afghanistan.

    PubMed

    Hylden, Christina; Johnson, Anthony E; Rivera, Jessica C

    2015-01-01

    Although there has been interest in the literature regarding the casualties within the recent US military conflicts in Iraq and Afghanistan, very little to date has looked specifically at a difference between the sexes. As the role of the female Soldier has changed over the years, so have the risk and the nature of the female casualty. Combat injuries in women are an important medical consideration that has yet to be studied. For the purposes of this study, the following questions pertained: Do female and male casualties from the US military in recent conflicts differ in age, service, rank, military operation, or other demographic characteristics? Do female and male casualties from the US military in recent conflicts differ in their injury characteristics such as Injury Severity Score (ISS), Abbreviated Injury Score (AIS), injury type (blunt versus penetrating), injury cause (mechanism of injury), and injury date? The Department of Defense Trauma Registry (DoDTR) was queried, returning results for 425 female and 14,982 male subjects who sustained musculoskeletal injuries from October 2003 (beginning of hostilities in Iraq) to December 2012. The female and male cohorts were compared and analyzed for significance in demographics (age, service, rank, and military operation) and injury characteristics (ISS, AIS, injury type, injury cause, and injury date). Female casualties differ from their male counterparts in that they are slightly younger (F=26.11, M=27.83 years; P<.001), proportionally more female casualties were in the Army (F=81.5%, M=72.2%; P<.001), and proportionally more women were injured during Operation Iraqi Freedom (F=75.6%, M=63.2%; P<.001). Female casualties showed on average lower ISS (F=7.49; M=9.68; P<.001) and lower AIS specific to the skeletal anatomic region (F=2.06; M=2.36; P<.001); however when broken down into battle versus nonbattle injury, the difference disappeared. Women were less likely to be injured in battle (F=33.1%; M=70.9%; P<.001) and less likely to be injured due to an explosive device (F=27.7%, M=55.2%; P<.001). Women comprised 2.75% of the DoDTR casualties during the studied time frame and were less likely to be involved in explosions or during battle. The ISS were significantly different when comparing battle and nonbattle injuries for both of the sexes. However, since men were more likely to be injured in battle, their total ISS mean was higher. PMID:26101910

  20. Lower cost strategies for triage of human papillomavirus DNA-positive women.

    PubMed

    Qiao, You-Lin; Jeronimo, Jose; Zhao, Fang-Hui; Schweizer, Johannes; Chen, Wen; Valdez, Melissa; Lu, Peter; Zhang, Xun; Kang, Le-Ni; Bansil, Pooja; Paul, Proma; Mahoney, Charles; Berard-Bergery, Marthe; Bai, Ping; Peck, Roger; Li, Jing; Chen, Feng; Stoler, Mark H; Castle, Philip E

    2014-06-15

    Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 25-65 years living in China (n?=?7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA tests-careHPV™ and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPV™-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (?10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8-17.4% for VIA, 17.8-20.9% for an abnormal colposcopic impression; 7.9-10.5% for HPV16/18/45 E6; 23.4-28.4% for HPV16/18/45 DNA; and 48.0-62.6% for higher signal strength (?10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+. PMID:24248915

  1. 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

  2. Lower cost strategies for triage of human papillomavirus DNA-positive women

    PubMed Central

    Qiao, You-Lin; Jeronimo, Jose; Zhao, Fang-Hui; Schweizer, Johannes; Chen, Wen; Valdez, Melissa; Lu, Peter; Zhang, Xun; Kang, Le-Ni; Bansil, Pooja; Paul, Proma; Mahoney, Charles; Berard-Bergery, Marthe; Bai, Ping; Peck, Roger; Li, Jing; Chen, Feng; Stoler, Mark H; Castle, Philip E

    2014-01-01

    Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 25–65 years living in China (n?=?7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA tests—careHPV™ and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPV™-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (?10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.8–17.4% for VIA, 17.8–20.9% for an abnormal colposcopic impression; 7.9–10.5% for HPV16/18/45 E6; 23.4–28.4% for HPV16/18/45 DNA; and 48.0–62.6% for higher signal strength (?10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+. What's new? The careHPV™ test is a novel technology for primary cervical cancer screening of women from lower-resource settings. However, triage strategies are needed to identify which HPV-positive women are at highest risk of cervical precancer and cancer. Here, multiple viable and affordable strategies to manage HPV-positive women depending on local requirements and resources are identified, based on evaluation of the performance of different triage strategies for developing countries. The different strategies for women who test positive for HPV DNA provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). PMID:24248915

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 76 FR 53364 - Recreational Vessel Propeller Strike and Carbon Monoxide Poisoning Casualty Prevention

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ...the Federal Register (73 FR 3316). D. Public Meeting We do not now plan...Cal. Harb. & Nav. Code Sec. 681(d) (West); Wash. Rev. Code Ann...casualties? Dated: August 8, 2011. James A. Watson, Rear Admiral, U.S. Coast...

  9. 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…

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    (a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

  11. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    The notice required in § 4.05-1 must include the name and official number of the vessel involved, the name of the vessel's owner or agent, the nature and circumstances of the casualty, the locality in which it occurred, the nature and extent of injury to persons, and the damage to...

  12. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    (a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

  13. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    (a) The owner, agent, master, operator, or person in charge shall, within five days, file a written report of any marine casualty required to be reported under § 4.05-1. This written report is in addition to the immediate notice required by §...

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

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    (2) 30 days after the return of the vessel to a United States port if the vessel departs the navigable waters of the United States within 30 days after the marine casualty. [CGD 74-77, 42 FR 5956, Jan. 31,...

  15. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    (2) 30 days after the return of the vessel to a United States port if the vessel departs the navigable waters of the United States within 30 days after the marine casualty. [CGD 74-77, 42 FR 5956, Jan. 31,...

  16. Effects of subsidising bus travel on the occurrence of road traffic casualties.

    PubMed

    Nicholl, J P; Freeman, M R; Williams, B T

    1987-03-01

    Between 1975 and 1 April 1986, public transport by bus in the metropolitan county of South Yorkshire, England, was increasingly subsidised. Trends in road traffic accident casualties between 1974 and 1983 in all the six provincial English metropolitan counties have been compared in order to examine the possible effect of this unique subsidy on the incidence of road traffic accident casualties. During that period the total number of casualties in South Yorkshire did not change significantly compared to the other metropolitan counties. However, the proportion of all casualties in South Yorkshire who were bus occupants did increase relative to other metropolitan counties, indicating either an increase in the amount of bus travel or a decrease in travel by other modes. There was a large increase in bus patronage in South Yorkshire relative to the other metropolitan counties, and the conclusion is that it is the transport policy in South Yorkshire which resulted in an actual increase in distances travelled by bus. Since bus is the safest form of road travel, it is concluded that the public transport subsidy in South Yorkshire has benefited the health of the local population by providing the social amenity of additional travel at the least additional health cost. PMID:3668460

  17. 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…

  18. Mass

    SciTech Connect

    Quigg, Chris

    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.

  19. Evaluation of the on-site immunoassay drug-screening device Triage-TOX in routine forensic autopsy.

    PubMed

    Tominaga, Mariko; Michiue, Tomomi; Maeda, Hitoshi

    2015-11-01

    Instrumental identification of drugs with quantification is essential in forensic toxicology, while on-site immunoassay urinalysis drug-screening devices conveniently provide preliminary information when adequately used. However, suitable or sufficient urine specimens are not always available. The present study evaluated the efficacy of a new on-site immunoassay drug-screening device Triage-TOX (Alere Inc., San Diego, CA, USA), which has recently been developed to provide objective data on the one-step automated processor, using 51 urine and 19 pericardial fluid samples from 66 forensic autopsy cases, compared with Triage-Drug of Abuse (DOA) and Monitect-9. For benzodiazepines, the positive predictive value and specificity of Triage-TOX were higher than those of Triage-DOA; however, sensitivity was higher with Monitect-9, despite frequent false-positives. The results for the other drugs with the three devices also included a few false-negatives and false-positives. These observations indicate the applicability of Triage-TOX in preliminary drug screening using urine or alternative materials in routine forensic autopsy, when a possible false-negative is considered, especially for benzodiazepines, providing objective information; however, the combined use of another device such as Monitect-9 can help minimize misinterpretation prior to instrumental analysis. PMID:26593997

  20. The diagnostic accuracy of the HITSNS prehospital triage rule for identifying patients with significant traumatic brain injury: a cohort study.

    PubMed

    Fuller, Gordon; McClelland, Graham; Lawrence, Thomas; Russell, Wanda; Lecky, Fiona

    2016-02-01

    Diversion of suspected traumatic brain injury (TBI) patients to trauma centres may improve outcomes by expediting access to specialist neurosurgical care. This study aimed to determine the accuracy of the Head Injury Straight to Neurosurgery (HITSNS) triage rule for identifying patients with significant TBI. A diagnostic cohort study was performed using data from the HITSNS trial, the Trauma Audit and Research Network registry and the North East Ambulance service database. Sensitivity and specificity of the HITSNS triage rule were calculated against a reference standard of significant TBI, defined by a cranial Abbreviated Injury Scale score of at least 3 or by the performance of a neurosurgical procedure. A total of 3628 patients were included in the complete case analyses. The HITSNS triage tool demonstrated a sensitivity of 28.3% (95% confidence interval 21.8-35.4) and a specificity of 94.4% (95% confidence interval 93.6-95.2). The low sensitivity of the HITSNS triage rule suggests that a considerable proportion of patients with significant TBI may not be triaged directly to trauma centres, and further research is needed to improve the accuracy of bypass protocols. PMID:26375361

  1. 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

  2. Triaging Checklists: a Substitute for a PhD in Static Analysis Khoo Yit Phang Jeffrey S. Foster Michael Hicks Vibha Sazawal

    E-print Network

    Hicks, Michael

    Triaging Checklists: a Substitute for a PhD in Static Analysis Khoo Yit Phang Jeffrey S. Foster propose to use triaging checklists to provide users with systematic guidance to identify false warnings to provide checklist assistants, which is a library of simple analyses designed to aid users in answering

  3. Improving prehospital trauma management for skiers and snowboarders - need for on-slope triage?

    PubMed Central

    2011-01-01

    Background Injuries from skiing and snowboarding became a major challenge for emergency care providers in Switzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of adequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are missing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for future on-slope triage protocols. Methods Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and snowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or abdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age, gender and injury pattern. Results Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and 58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the majority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was more frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury combinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher's exact test demonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and thorax/abdomen (p < 0.001). Conclusion The data presented and the findings from previous investigations indicate the need for development of dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic on-slope tests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed injury surveillance is the future research priority. PMID:21521524

  4. A systematic review of triage-related interventions to improve patient flow in emergency departments

    PubMed Central

    2011-01-01

    Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay. PMID:21771339

  5. Validation of triage criteria for deciding which apparently inebriated persons require emergency department care

    PubMed Central

    Flower, Keith; Post, Anneke; Sussman, Jeremy; Tangherlini, Niels; Mendelson, John; Pletcher, Mark

    2015-01-01

    Some 620,000 emergency department (ED) visits for acute alcohol intoxication occur annually in the U.S. A half to two-thirds of these appear to be uncomplicated, and might safely be triaged to management in non-ED settings. We hypothesized that consensus criteria would afford sensitive and specific triage. Methods: Paramedics collected data on 99 apparently inebriated persons en route to the ED. We retrospectively reviewed these patients’ ED charts to assess who actually required ED care. We then estimated sensitivity and specificity for proposed triage criteria that would have excluded patients from non-ED care: chest or abdominal pain, shortness of breath, suicidal ideation, abnormal vital signs or Glasgow Coma Scale, signs of head trauma, inability to ambulate, seizure, lacerations, fractures, or pregnancy. Results: Subjects were mostly male (89%), homeless (57%), and found on the street (81%); 17 appeared to require ED care, 39 were eligible for non-ED care, but 4 of these would have bounced back to the ED (negative predictive value 90%, sensitivity 76%, 95% CI: 50–93%; specificity 44%, 95% CI: 33–55). Paramedic opinion alone was highly specific (80%) but not very sensitive (41%). Lowering the pulse exclusion threshold from 130 to 83 would increase sensitivity to 100%, but decrease specificity to 22%. A simple post-hoc rule excluding those with age > 55 or pulse > 83 from non-ED care had high sensitivity (94%) and fair specificity (61%). The proposed criteria’s sensitivity and specificity varied (65–83% and 44–49%, respectively) depending on which ED services were considered optional (e.g., psychiatric consultation, EKG, IV fluids, etc). Conclusions: Most apparently inebriated individuals in this study did not require ED care, but prospective identification of these persons is a challenge. A low exclusion cutoff for tachycardia may improve sensitivity. PMID:20616108

  6. 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

  7. Cross-cultural effects of casualties on foreign policy decision making: South Korea and the United States 

    E-print Network

    Park, Nam Tae

    2009-06-02

    It is well accepted that casualties incurred as a result of interstate militarized disputes have a significant influence on domestic public opinion and ultimately on foreign policy decision making (FPDM). Although scholars ...

  8. [Restrictions on use of prolonged and long-term artificial ventilation of the lungs in the wounded and casualties].

    PubMed

    Gavrilin, S V; Belitski?, D V; Boiarintsev, V V; Lopata, V N; Meshakov, D P; Pavlenko, A I; Suvorov, V V

    2004-01-01

    On the basis of an analysis of results of treatment of two groups of the wounded and casualties the authors render concrete indications and contraindications for prolonged and long-lasting artificial ventilation of the lungs. PMID:15199775

  9. 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.

  10. 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

  11. 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

  12. 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

  13. 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 ? = 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.

  14. Cognitive Training Can Reduce Civilian Casualties in a Simulated Shooting Environment.

    PubMed

    Biggs, Adam T; Cain, Matthew S; Mitroff, Stephen R

    2015-08-01

    Shooting a firearm involves a complex series of cognitive abilities. For example, locating an item or a person of interest requires visual search, and firing the weapon (or withholding a trigger squeeze) involves response execution (or inhibition). The present study used a simulated shooting environment to establish a relationship between a particular cognitive ability and a critical shooting error-response inhibition and firing on civilians, respectively. Individual-difference measures demonstrated, perhaps counterintuitively, that simulated civilian casualties were not related to motor impulsivity (i.e., an itchy trigger finger) but rather to an individual's cognitive ability to withhold an already initiated response (i.e., an itchy brain). Furthermore, active-response-inhibition training reduced simulated civilian casualties, which revealed a causal relationship. This study therefore illustrates the potential of using cognitive training to possibly improve shooting performance, which might ultimately provide insight for military and law-enforcement personnel. PMID:26170262

  15. [Errors in performing artificial ventilation of the lungs in the wounded and casualties].

    PubMed

    Gavrilin, S B; Boiarintsev, V V; Belitski?, D V; Meshako v, D P; Pavlenko, A I; Suvorov, V V

    2004-01-01

    Under investigation in the clinics of the Military-Medical Academy there was a group of the wounded and casualties whose lungs were artificially ventilated. The systemic hemodynamics, indices of gas exchange and the acid-base condition were controlled. The invasive and non-invasive methods were used. The most typical errors during performing lung ventilation were revealed and the causes of them were analyzed. PMID:15317160

  16. 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.

  17. 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.

  18. Using community triage centres or non-traditional care facilities during a flu pandemic or other infectious disease outbreak.

    PubMed

    Bone, Eric; Grono, Shawn; Johnson, David H; Johnson, Marcia

    2008-04-01

    One assumption of pandemic planning is that, during an influenza outbreak, acute care facilities may be quickly overrun with patients and as such must prepare in advance. In order to operationalise one component of a pandemic plan, Capital Health in Edmonton, Alberta, piloted a mobile triage centre facility (portable isolation containment systems) and tested pandemic influenza triage and assessment guidelines in the winter of 2006-07. The mobile model provided emergency department surge capacity for communicable disease emergencies with scalable deployment capabilities. The deployable module has several advantages over a fixed structure like a community facility. The triage facility is a location for short-term treatments, such as intravenous therapy, prescriptions, medication distribution, and self-care education, which are needed during a pandemic influenza outbreak. Decanting infectious patients away from the emergency department protects a highly-vulnerable hospitalised group from viral transmission. Based on the pilot, it is found that community triage centres are a viable support option for emergency departments in an urban setting during pandemic influenza. PMID:21339116

  19. 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...

  20. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-30

    ...require the ready availability of large quantities of medical countermeasures for resuscitation, wound management, pain relief, and nutritional- and airway/breathing support in the initial post-injury period. The overall response is...

  1. Bilinear common spatial pattern for single-trial ERP-based rapid serial visual presentation triage

    NASA Astrophysics Data System (ADS)

    Yu, K.; Shen, K.; Shao, S.; Ng, W. C.; Li, X.

    2012-08-01

    Common spatial pattern (CSP) analysis is a useful tool for the feature extraction of event-related potentials (ERP). However, CSP is essentially time invariant, and thus unable to exploit the temporal information of ERP. This paper proposes a variant of CSP, namely bilinear common spatial pattern (BCSP), which is capable of accommodating both spatial and temporal information. BCSP generalizes CSP through iteratively optimizing bilinear filters. These bilinear filters constitute a spatio-temporal subspace in which the separation between two conditions is maximized. The method is unique in the sense that it is mathematically intuitive and simple, as all the bilinear filters are obtained by maximizing the power ratio as CSP does. The proposed method was evaluated on 20 subjects’ ERP data collected in rapid serial visual presentation triage experiments. The results show that BCSP achieved significantly higher average test accuracy (12.3% higher, p < 0.001).

  2. 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

  3. Triage, monitoring and dose assessment for people exposed to ionising radiation following a malevolent act.

    PubMed

    Etherington, G; Rothkamm, K; Shutt, A L; Youngman, M J

    2011-03-01

    The part played by individual monitoring within the context of the overall response to incidents involving the malevolent use of radiation or radioactive material is discussed. The main objectives of an individual monitoring programme are outlined, and types of malevolent use scenario briefly described. Some major challenges facing those with responsibilities for planning the monitoring response to such an incident are identified and discussed. These include the need for rapid selection and prioritisation of people for individual monitoring by means of an effective triage system; the need for rapid initiation of individual monitoring; problems associated with monitoring large numbers of people; the particular difficulties associated with incidents involving pure-beta and alpha-emitting radionuclides; the need for techniques that can provide retrospective estimates of external radiation exposures rapidly and the need for rapid interpretation of contamination monitoring data. The paper concludes with a brief review of assistance networks and relevant international projects planned or currently underway. PMID:21147786

  4. In vivo EPR tooth dosimetry for triage after a radiation event involving large populations.

    PubMed

    Williams, Benjamin B; Flood, Ann Barry; Salikhov, Ildar; Kobayashi, Kyo; Dong, Ruhong; Rychert, Kevin; Du, Gaixin; Schreiber, Wilson; Swartz, Harold M

    2014-05-01

    The management of radiation injuries following a catastrophic event where large numbers of people may have been exposed to life-threatening doses of ionizing radiation will rely critically on the availability and use of suitable biodosimetry methods. In vivo electron paramagnetic resonance (EPR) tooth dosimetry has a number of valuable and unique characteristics and capabilities that may help enable effective triage. We have produced a prototype of a deployable EPR tooth dosimeter and tested it in several in vitro and in vivo studies to characterize the performance and utility at the state of the art. This report focuses on recent advances in the technology, which strengthen the evidence that in vivo EPR tooth dosimetry can provide practical, accurate, and rapid measurements in the context of its intended use to help triage victims in the event of an improvised nuclear device. These advances provide evidence that the signal is stable, accurate to within 0.5 Gy, and can be successfully carried out in vivo. The stability over time of the radiation-induced EPR signal from whole teeth was measured to confirm its long-term stability and better characterize signal behavior in the hours following irradiation. Dosimetry measurements were taken for five pairs of natural human upper central incisors mounted within a simple anatomic mouth model that demonstrates the ability to achieve 0.5 Gy standard error of inverse dose prediction. An assessment of the use of intact upper incisors for dose estimation and screening was performed with volunteer subjects who have not been exposed to significant levels of ionizing radiation and patients who have undergone total body irradiation as part of bone marrow transplant procedures. Based on these and previous evaluations of the performance and use of the in vivo tooth dosimetry system, it is concluded that this system could be a very valuable resource to aid in the management of a massive radiological event. PMID:24711003

  5. Gleaning Data From Disaster: A Hospital-Based Data Mining Method To Studying All-Hazard Triage After A Chemical Disaster

    PubMed Central

    Craig, Jean B.; Culley, Joan M.; Tavakoli, Abbas; Svendsen, Erik R

    2014-01-01

    Objective The objective of this paper is to describe the methods of evaluating currently available triage models for their efficacy in appropriately triaging the surge of patients after an all-hazards disaster. Design We developed a method for evaluating currently available triage models using extracted data from medical records of the victims from the Graniteville chlorine disaster. Setting On January 6, 2005, a freight train carrying three tanker cars of liquid chlorine was inadvertently switched onto an industrial spur in central Graniteville, South Carolina. The train then crashed into a parked locomotive and derailed. This caused one of the chlorine tankers to rupture and immediately release ~60 tons of chlorine. Chlorine gas infiltrated the town with a population of 7,000. Participants This research focuses on the victims who received emergency care in South Carolina. Results With our data mapping and decision tree logic, we were successful in employing the available extracted clinical data to estimate triage categories for use in triage effectiveness research. Conclusions The methodology outlined in this paper can be used to assess the performance of triage models after a disaster. The steps are reliable and repeatable and can easily be extended or applied to other disaster datasets. PMID:24352925

  6. 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.

  7. A physiotherapy triage assessment service for people with low back disorders: evaluation of short-term outcomes

    PubMed Central

    Bath, Brenna; Pahwa, Punam

    2012-01-01

    Purpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders. Methods: Participants with low back–related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists (PTs). Before undergoing the triage assessment, the participants completed a battery of questionnaires covering a range of sociodemographic, clinical, and psychosocial features. The study used the Numeric Pain Rating Scale (NPRS), the Oswestry Disability Index (ODI), and the Medical Outcomes Survey 36-item short-form version 2 (SF-36v2) to assess self-reported pain, function, and quality of life. Baseline measures and variables were analyzed using a descriptive analysis method (ie, proportions, means, medians). Paired samples t-tests or Wilcoxon matched-pair signed-rank tests were used to analyze the overall group differences between the pretest and posttest outcome measures where appropriate. Results: A total of 108 out of 115 (93.9%) participants completed the posttest survey. The Physical Component Summary of the SF36v2 was the only measure that demonstrated significant improvement (P < 0.001). Conclusion: A spinal triage assessment program delivered by PTs can be viewed as a complex intervention that may have the potential to affect a wide range of patient-related outcomes. Further research is needed to examine the long-term outcomes and explore potential mechanisms of improvement using a biopsychosocial framework. PMID:22915980

  8. 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.

  9. Fluid flow evaluation of Fuji Triage and gray and white ProRoot mineral trioxide aggregate intraorifice barriers.

    PubMed

    John, Anthony D; Webb, Terry D; Imamura, Glen; Goodell, Gary G

    2008-07-01

    The purpose of this study was to compare coronal leakage in teeth with 2-mm intraorifice barriers of Fuji Triage glass ionomer, gray mineral trioxide aggregate (MTA), and white MTA using a fluid flow model. Forty anterior teeth were decoronated, instrumented, and obturated. Teeth were divided into positive and negative controls and 3 experimental groups receiving 2-mm barriers of Fuji Triage glass ionomer, gray MTA, or white MTA. Fluid movement was tested 3 times for each tooth, and means were calculated. Data were analyzed with one-way analysis of variance and Student-Newman-Keuls (alpha = .05). Fluid movement means and standard deviations were as follows: Fuji Triage, 0.47 +/- 0.45 mm; gray MTA, 0.49 +/- 0.44 mm; white MTA, 0.52 +/- 0.23 mm; and positive controls, 3.57 +/- 1.13 mm. No significant differences were found among the experimental groups. However, positive controls leaked significantly more than all experimental groups at P <.001. PMID:18570989

  10. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

    PubMed Central

    2011-01-01

    Introduction Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors. Methods This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (< 5%, 5% to 40% and >40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved. Results Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for <5%, 5% to 40% and >40% predicted mortality, respectively. Average cost per life saved for all patients was $103,771 (€82,358) and cost per life-year saved was $7,065 (€5,607). These figures decreased substantially for patients with predicted mortality higher than 40%, $60,046 (€47,656) and $4,088 (€3,244), respectively. Results were very similar when considering three-month mortality. Sensitivity analyses performed to assess the robustness of the results provided findings similar to the main analyses. Conclusions Not only does ICU appear to produce an improvement in survival, but the cost per life saved falls for patients with greater severity of illness. This suggests that intensive care is similarly cost effective to other therapies that are generally regarded as essential. PMID:21306645

  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. 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

  13. 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.

  14. The analytic bilinear discrimination of single-trial EEG signals in rapid image triage.

    PubMed

    Yu, Ke; Ai-Nashash, Hasan; Thakor, Nitish; Li, Xiaoping

    2014-01-01

    The linear discriminant analysis (LDA) method is a classical and commonly utilized technique for dimensionality reduction and classification in brain-computer interface (BCI) systems. Being a first-order discriminator, LDA is usually preceded by the feature extraction of electroencephalogram (EEG) signals, as multi-density EEG data are of second order. In this study, an analytic bilinear classification method which inherits and extends LDA is proposed. This method considers 2-dimentional EEG signals as the feature input and performs classification using the optimized complex-valued bilinear projections. Without being transformed into frequency domain, the complex-valued bilinear projections essentially spatially and temporally modulate the phases and magnitudes of slow event-related potentials (ERPs) elicited by distinct brain states in the sense that they become more separable. The results show that the proposed method has demonstrated its discriminating capability in the development of a rapid image triage (RIT) system, which is a challenging variant of BCIs due to the fast presentation speed and consequently overlapping of ERPs. PMID:24933017

  15. 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

  16. 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

  17. 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 mitigation measures should help to reduce WVC in Portugal. The first involves the improvement of existing crossings with buried and small mesh size fence to guide the individuals towards to the passages, in road segments with high traffic volume (>1200 vehicles/night) and located in preferred carnivore habitats. The second mitigation involves cutting or removal of dense vegetation in verges of road segments with curves to aid motorists in seeing animals about to cross. ?? 2008 Elsevier Ltd.

  18. Homebirth, freebirth and doulas: casualty and consequences of a broken maternity system.

    PubMed

    Dahlen, H G; Jackson, M; Stevens, J

    2011-03-01

    In Australia private homebirth remains unfunded and uninsured and publicly funded homebirth models are not widely available. Doulas are increasingly hired by women for support during childbirth and freebirth (birth intentionally unattended by a health professional) appears to be on the rise. The recently released Improving Maternity Services in Australia--The Report of the Maternity Services Review (MSR) exclude homebirth from the funding and insurance reforms proposed. Drawing on recent research we argue that homebirth has become a casualty of a broken maternity system. The recent rise in the numbers of women employing doulas and choosing to birth at home unattended by any health professional, we argue, is in part a consequence of not adequately meeting the needs of women for continuity of midwifery care and non-medicalised birthing options. PMID:21163719

  19. A Model for the Estimation of Penetrating Wound Lethality Based on Combat Casualty Data

    PubMed Central

    Sacco, William J.; Merkler, Jules; Long, William B.; Dolce, Joseph R.; Champion, Howard R.

    1981-01-01

    The probability that a given combat wound is lethal provides a quantitative basis for the assessment of wounds, comparison of body armors, and estimation of medical workload requirements in various military scenarios. The present paper describes a new lethality model for penetrating injuries. The model employs a new injury classification called PEBL. PEBL codes are constructed by appending additional significant digits to the appropriate codes from the Hospital Adaptation of the International Classification of the World Health Organization (H-ICDA Codes), widely used in both civilian and military hospitals for injury classification. PEBL attains greater specificity by providing for injury size, bone injury characteristics, partial organ damage, and distinguishing peripheral blood vessels and nerves. Probability of lethality estimates were obtained for PEBL codes based on computerized wound data available on 3600 combat casualties.

  20. Damage control surgery and casualty evacuation: techniques for surgeons, lessons for military medical planners.

    PubMed

    Parker, Paul J

    2006-12-01

    Damage Control Surgery (DCS) is a three-phase team-based approach to maximal injury penetrating abdominal trauma. In Phase I, the hypothermic, coagulopathic, acidotic, hypotensive casualty undergoes a proactively planned one-hour time limited laparotomy by an appropriately trained surgical trauma team. In phase II physiological stabilization takes place in the Intensive Care Unit. In phase III--definitive repair occurs. DCS is extremely resource intensive but will save lives on the battlefield. A military DCS patient will perioperatively require fourteen units of blood and seven units of fresh frozen plasma--half the blood stock of a light-scaled FST. Two DCS patients will in one day, exhaust this FSTs oxygen supply. We know that hypothermic patients with an iliac vascular injury (initial core temp < 34 degrees C) suffer four-fold increases in their mortality, yet we cannot heat our tents above 20 degrees C during a mild British winter. Our primary casualty retrieval is excessively slow. A simple casevac request has to go to too much 'middle-management' before a flight decision is made. In Vietnam, wounded soldiers arrived in hospital within twenty-five minutes of injury. In Iraq in 2005, that figure is over one hundred and ten minutes. We use support or anti-tank helicopters that are re-roled on an adhoc basis for the critical care and transport of our sickest patients. We still do not have a dedicated all-weather military helicopter evacuation fleet despite significant evidence that intensive care unit level military evacuation is safe and eminently achievable in both in the primary and secondary care setting. Should we not be asking why? PMID:17508638

  1. Mild head injury: reliability of early computed tomographic findings in triage for admission

    PubMed Central

    af, G; Britton, M

    2005-01-01

    Objective: To search the literature for case reports on adverse outcomes in patients with mild head injury where acute computed tomography (CT) findings had been normal. Methods: Mild head injury was defined as head trauma involving amnesia or loss of consciousness, but where neurological findings are normal on arrival at hospital (GCS 15). The scientific literature was systematically searched for case reports where an early CT was normal and the patient deteriorated within two days. In these cases, early discharge despite a normal CT head scan would have been hazardous. Results: Two prospective studies were found that investigated the safety of early CT in 3300 patients with mild head injury, as were 39 reports on adverse outcomes describing 821 patients. In addition, 52 studies containing over 62 000 patients with mild head injury were reviewed. In total, only three cases were deemed to have experienced an early adverse outcome despite a normal CT and GCS 15 on initial presentation. In another eight cases with incomplete descriptions, the interpretation was doubtful. Many reports of complications were not relevant to our question and excluded. These reports included cases with more severe head injury/not GCS 15 at presentation, complications that occurred after more than two days, or initial CT findings that were not fully normal. Conclusion: Very few cases were found where an early adverse event occurred after normal acute CT in patients with mild head injury. The strongest scientific evidence available at this time shows that a CT strategy is a safe way to triage patients for admission. PMID:15662058

  2. 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

  3. 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

  4. The usefulness of on-site physical therapy-led triage services for professional orchestral musicians – a national cohort study

    PubMed Central

    2013-01-01

    Background Australian professional orchestral musicians reported a lifetime prevalence of musculoskeletal injuries that had interfered with playing at 84%. Physical therapy-led triage clinics may be a practical method to manage the impact of high performance-related musculoskeletal disorders (PRMDs) in professional orchestral musicians. This study aimed to: a) collect information on presenting injuries, b) determine the participant’s provisional diagnosis, c) evaluate uptake of an on-site triage service, d) measure participant satisfaction, and e) identify factors influencing attendance. Methods Eight triage sessions were run on a fortnightly basis during a designated lunch break between rehearsal calls in seven premier symphony orchestras in Australia; a total population of 483 musicians. The participants received one or a combination of: a) education and advice relating to their provisional diagnosis, b) basic acute management and/or c) a referral to a suitable medical practitioner or allied health professional for further consultation or treatment. A three-month follow-up questionnaire was completed and a qualitative narrative themes-based analysis was undertaken to summarise participant and physical therapist feedback. Uptake, participant satisfaction and factors influencing attendance were measured. Results 99 initial consultations (83 individuals) were conducted with more females (61%) utilizing the service than males (49%). The most common injury complaints were in the shoulder (22%), neck (18%), upper back (18%), and hand (8%). 66% of these were diagnosed as PRMDs. Of these injuries, 94% were considered preventable, 93% continued to affect playing, 68% were severe requiring a referral for further management, and 46% were recurrent. The advice at the triage service was rated as helpful or very helpful by 79% of the musicians, whilst 68% responded they were likely or very likely to continue to use the service if it was offered in the future. Of the participants that followed through with the referral advice, 67% reported that the referral advice was helpful or very helpful. Musicians’ and physical therapists’ written feedback indicated their acknowledgement for the need of this service. The main suggestions for improving attendance were increasing the music-specific physical therapy knowledge of therapists and overcoming competing time demands. Conclusion On-site health services for musicians may facilitate better injury management by providing immediate and specific health advice. Trial registration ACTRN12612000220864 PMID:23506482

  5. Predicting Abused Women With Children Who Return to a Shelter: Development and Use of a Rapid Assessment Triage Tool.

    PubMed

    McFarlane, Judith; Pennings, Jacquelyn; Liu, Fuqin; Gilroy, Heidi; Nava, Angeles; Maddoux, John A; Montalvo-Liendo, Nora; Paulson, René

    2016-02-01

    To develop a tool to predict risk for return to a shelter, 150 women with children, exiting a domestic violence shelter, were evaluated every 4 months for 24 months to determine risk factors for returning to a shelter. The study identified four risk factors, including danger for murder, woman's age (i.e., older women), tangible support (i.e., access to money, transportation), and child witness to verbal abuse of the mother. An easy to use, quick triage tool with a weighted score was derived, which can identify with 90% accuracy abused women with children most likely to return to shelters. PMID:26270386

  6. Comment on Alquraini et al.: reliability of Canadian Emergency Department Triage and Acuity Scale (CTAS) in Saudi Arabia.

    PubMed

    Mirhaghi, Amir

    2015-12-01

    It is very common to examine reliability of triage scales using (weighted) kappa statistics. The point is that weighted kappa has grossly underestimated disagreements by one category and put more emphasis on extreme category disagreements; therefore, low prevalence of critically-ill and non-urgent patients has excluded the effect of extreme categories disagreement from calculated kappa coefficient and also contributed to significant overestimation. As a result, weighted kappa coefficient as an estimate of scale reliability is overestimated by the anchoring effect. PMID:26559200

  7. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    PubMed Central

    2012-01-01

    Background Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter. Conclusions The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services. PMID:22217300

  8. Laser pointers revisited: a survey of 14 patients attending casualty at the Bristol Eye Hospital

    PubMed Central

    Sethi, C; Grey, R; Hart, C

    1999-01-01

    AIMS—The largest clinical series of laser pointer exposures to date is described, to document any long term visual sequelae and assess objectively the visual threat from transient ocular exposure.?METHODS—14 cases were collected prospectively and triaged by ophthalmic nurses before referral to an ophthalmologist for a complete ophthalmic examination. Regardless of the need for clinical follow up, all patients were contacted by telephone at a mean interval of 10.5 months following exposure to inquire about new or persisting symptoms.?RESULTS—11/14 cases presented within 24 hours of exposure and 5/14 incidents were reported to the police. Reduced acuity in the affected eye compared with the contralateral were documented in 5/14 cases. The commonest physical sign was a punctate epitheliopathy, seen in 5/14 cases, and the commonest symptom was ocular discomfort, reported by 11/14 patients. There were no consistent retinal findings. Follow up by telephone survey revealed that two patients were wearing new glasses, but had not been refracted before the exposure; one had intermittent ocular discomfort; the remaining 11 were asymptomatic.?CONCLUSIONS—This study is reassuring to the ophthalmology community and the general public in failing to demonstrate consistent, long term damaging effects of transient ocular exposure to laser pointer beams.?? PMID:10502579

  9. Impact of a Physician-in-Triage Process on Resident Education

    PubMed Central

    Nicks, Bret A.; Mahler, Simon; Manthey, David

    2014-01-01

    Introduction Emergency department (ED) crowding negatively impacts patient care quality and efficiency. To reduce crowding many EDs use a physician-in-triage (PIT) process. However, few studies have evaluated the effect of a PIT processes on resident education. Our objective was to determine the impact of a PIT process implementation on resident education within the ED of an academic medical center. Methods We performed a prospective cross-sectional study for a 10-week period from March to June 2011, during operationally historic trended peak patient volume and arrival periods. Emergency medicine residents (three-year program) and faculty, blinded to the research objectives, were asked to evaluate the educational quality of each shift using a 5-point Likert scale. Residents and faculty also completed a questionnaire at the end of the study period assessing the perceived impact of the PIT process on resident education, patient care, satisfaction, and throughput. We compared resident and attending data using Mann-Whitney U tests. Results During the study period, 54 residents and attendings worked clinically during the PIT process with 78% completing questionnaires related to the study. Attendings and residents indicated “no impact” of the PIT process on resident education [median Likert score of 3.0, inter-quartile range (IQR): 2–4]. There was no difference in attending and resident perceptions (p-value =0.18). Both groups perceived patient satisfaction to be “positively impacted” [4.0, IQR:2–4 for attendings vs 4.0, IQR:1–5 for residents, p-value =0.75]. Residents perceived more improvement in patient throughput to than attendings [3.5, IQR:3–4 for attendings vs 4.0, IQR:3–5 for residents, p-value =0.006]. Perceived impact on differential diagnosis generation was negative in both groups [2.0, IQR:1–3 vs 2.5, IQR:1–5, p-value = 0.42]. The impact of PIT on selection of diagnostic studies and medical decision making was negative for attendings and neutral for residents: [(2.0, IQR:1–3 vs 3.0, IQR:1–4, p-value =0.10) and (2.0, IQR:1–4 vs 3.0, IQR:1–5, p-value =0.14 respectively]. Conclusion Implementation of a PIT process at an academic medical center was not associated with a negative (or positive) perceived impact on resident education. However, attendings and residents felt that differential diagnosis development was negatively impacted. Attendings also felt diagnostic test selection and medical decision-making learning were negatively impacted by the PIT process. PMID:25493151

  10. Development of a triage tool for neurodevelopmental risk in children aged 30 months.

    PubMed

    Sim, Fiona; Haig, Caroline; O'Dowd, John; Thompson, Lucy; Law, James; McConnachie, Alex; Gillberg, Christopher; Wilson, Philip

    2015-01-01

    Neurodevelopmental and neuropsychiatric disorders in young children predict educational, health and social problems. Early identification may significantly reduce this burden but relevant tools largely lack validation. We aimed to develop and evaluate the predictive validity of a simple screening tool for neurodevelopmental problems in a community sample of 30 month old children. A sample of children was selected from a community cohort screened at 30 months by health visitors using the Sure Start Language Measure (SSLM) and the Strengths and Difficulties Questionnaire (SDQ) in 2011. Predictive validity was assessed by comparing screening results with detailed psychometric data from the same sample 1-2 years later. Screening performance using different thresholds was explored using Receiver Operating Characteristic (ROC) with ROC area under the curve (AUC) and bootstrapping techniques. The SSLM predicted both language disorder identified by the New Reynell Developmental Language Scales (NRDLS) at follow-up (AUC 0.905) and global developmental delay assessed by the Griffiths Mental Development Scales (AUC 0.983). The SDQ administered at 30 months predicted psychiatric disorders identified by the Development and Wellbeing Assessment (DAWBA) at follow-up (AUC 0.821). Using optimal cut-offs for the SDQ and SSLM at 30 months, both tools together had sensitivity 87%; specificity 64%; positive predictive value 31%; and negative predictive value 97% in the prediction of any kind of neurodevelopmental problem 1-2 years later. The combined measure reported here is not yet sufficient as a stand-alone population screening tool for neurodevelopmental disorders. The SSLM and SDQ did however show promise in identifying preschool children at risk of ongoing language, psychiatric disorders and global developmental delay 1-2 years later but with fairly high false positive rates. Given that current developmental risk prediction in resource-poor settings is little better than random assignment, the SDQ and SSLM may aid clinical judgement when used as interim triage tools for practitioners with no specialist knowledge, in the context of longitudinal follow-up arrangements. PMID:26226112

  11. Global earthquake casualties due to secondary effects: A quantitative analysis for improving rapid loss analyses

    USGS Publications Warehouse

    Marano, K.D.; Wald, D.J.; Allen, T.I.

    2010-01-01

    This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and fire for events during the past 40 years. These processes are of great importance to the US Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/significant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER's overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We find that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra-Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our findings, we have built country-specific disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability. ?? Springer Science+Business Media B.V. 2009.

  12. Improving PAGER's real-time earthquake casualty and loss estimation toolkit: a challenge

    USGS Publications Warehouse

    Jaiswal, K.S.; Wald, D.J.

    2012-01-01

    We describe the on-going developments of PAGER’s loss estimation models, and discuss value-added web content that can be generated related to exposure, damage and loss outputs for a variety of PAGER users. These developments include identifying vulnerable building types in any given area, estimating earthquake-induced damage and loss statistics by building type, and developing visualization aids that help locate areas of concern for improving post-earthquake response efforts. While detailed exposure and damage information is highly useful and desirable, significant improvements are still necessary in order to improve underlying building stock and vulnerability data at a global scale. Existing efforts with the GEM’s GED4GEM and GVC consortia will help achieve some of these objectives. This will benefit PAGER especially in regions where PAGER’s empirical model is less-well constrained; there, the semi-empirical and analytical models will provide robust estimates of damage and losses. Finally, we outline some of the challenges associated with rapid casualty and loss estimation that we experienced while responding to recent large earthquakes worldwide.

  13. [Formation of therapeutic group of casualties in local wars and armed conflicts].

    PubMed

    Khalimov, Iu Sh; Tkachuk, N A; Zhekalov, A N

    2012-09-01

    The necessity of improvement of the therapeutic care organization in the RF Armed Forces is dictated by the existing military threats. Conflicts between states or within a single country along with inefficiency of diplomatic, social and political efforts may lead to armed conflicts or local wars. Analysis of medical support results shows the consistent prevalence of therapeutic group of casualties in the overall structure of medical losses. 35-50% of all sanitary losses is accounted for by somatic diseases. Moreover, their structure is similar to the structure of the army's peacetime morbidity rate. Respiratory diseases head the list of somatic diseases in military personnel. Next--diseases of the digestive and circulatory systems. One of the most important tasks for physicians in wartime is early diagnosis and treatment of visceral pathology in the wounded. An additional point is that the use of tactical nuclear weapons during the armed conflict or local war cannot be completely excluded. There is also a real risk of nuclear and chemical facilities damage, with consequences that are comparable to the use of nuclear or chemical weapons. Thus, in the course of armed conflict or local war, military physicians can meet all possible therapeutic spectrum of pathology: from visceral pathology of peace and wartime to combat related therapeutic pathology. PMID:23156105

  14. Greetings: 50 years of Atomic Bomb Casualty Commission-Radiation Effects Research Foundation studies.

    PubMed

    Shigematsu, I

    1998-05-12

    The Atomic Bomb Casualty Commission was established in Hiroshima in 1947 and in Nagasaki in 1948 under the auspices of the U.S. National Academy of Sciences to initiate a long-term and comprehensive epidemiological and genetic study of the atomic bomb survivors. It was replaced in 1975 by the Radiation Effects Research Foundation which is a nonprofit Japanese foundation binationally managed and supported with equal funding by the governments of Japan and the United States. Thanks to the cooperation of the survivors and the contributions of a multitude of scientists, these studies flourish to this day in what must be the most successful long-term research collaboration between the two countries. Although these studies are necessarily limited to the effects of acute, whole-body, mixed gamma-neutron radiation from the atom bombs, their comprehensiveness and duration make them the most definitive descriptions of the late effects of radiation in humans. For this reason, the entire world relies heavily on these data to set radiation standards. As vital as the study results are, they still represent primarily the effects of radiation on older survivors. Another decade or two should correct this deficiency and allow us to measure definitively the human risk of heritable mutation from radiation. We look to the worldwide radiation and risk community as well as to the survivors who have contributed so much to what has been done already to accomplish this goal. PMID:9576897

  15. Global Earthquake Casualties due to Secondary Effects: A Quantitative Analysis for Improving PAGER Losses

    USGS Publications Warehouse

    Wald, David J.

    2010-01-01

    This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and ?re for events during the past 40 years. These processes are of great importance to the US Geological Survey’s (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER) system, which is currently being developed to deliver rapid earthquake impact and loss assessments following large/signi?cant global earthquakes. An important question is how dominant are losses due to secondary effects (and under what conditions, and in which regions)? Thus, which of these effects should receive higher priority research efforts in order to enhance PAGER’s overall assessment of earthquakes losses and alerting for the likelihood of secondary impacts? We ?nd that while 21.5% of fatal earthquakes have deaths due to secondary (non-shaking) causes, only rarely are secondary effects the main cause of fatalities. The recent 2004 Great Sumatra–Andaman Islands earthquake is a notable exception, with extraordinary losses due to tsunami. The potential for secondary hazards varies greatly, and systematically, due to regional geologic and geomorphic conditions. Based on our ?ndings, we have built country-speci?c disclaimers for PAGER that address potential for each hazard (Earle et al., Proceedings of the 14th World Conference of the Earthquake Engineering, Beijing, China, 2008). We will now focus on ways to model casualties from secondary effects based on their relative importance as well as their general predictability.

  16. EMPLOYEE INFLUENZA TRIAGE So what should a manager do if an employee comes to work with a cold (URI) or flu-like

    E-print Network

    Leistikow, Bruce N.

    EMPLOYEE INFLUENZA TRIAGE So what should a manager do if an employee comes to work with a cold (URI close contact to influenza patients, within the past 3 days, can be considered for prophylaxis treatment influenza is very low. Employees should, however, continue to monitor for fevers and flu symptoms for 7 days

  17. Assessment of the MSF triage system, separating patients into different wards pending Ebola virus laboratory confirmation, Kailahun, Sierra Leone, July to September 2014.

    PubMed

    Vogt, Florian; Fitzpatrick, Gabriel; Patten, Gabriela; van den Bergh, Rafael; Stinson, Kathryn; Pandolfi, Luigi; Squire, James; Decroo, Tom; Declerck, Hilde; Van Herp, Michel

    2015-12-17

    Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time. PMID:26727011

  18. High performance of combined HPV testing and genotyping for HPV16/18/52/58 in triaging women with minor cervical cytological abnormalities in northern Thailand.

    PubMed

    Khunamornpong, Surapan; Settakorn, Jongkolnee; Sukpan, Kornkanok; Srisomboon, Jatupol; Intaraphet, Suthida; Siriaunkgul, Sumalee

    2016-01-01

    Human papillomavirus (HPV) infection is an important cause of cervical cancer. Screening with cytology or combined cytology and HPV testing helps to detect early cervical cancers and precancerous lesions (high-grade squamous intraepithelial lesion or worse [HSIL+]). Minor cytological abnormalities (atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion) account for the majority of abnormal cervical cytology results, but only 10-20% of women with minor cytological abnormalities have histologic HSIL+. Triage tests are useful to identify the high-risk patients and reduce the colposcopy burden. This study was aimed to evaluate the triage performance of combined HPV DNA testing and genotyping. Cervical samples from women with minor cytological abnormalities, who underwent colposcopy at Chiang Mai University Hospital in northern Thailand between October 2010 and February 2014, were tested for HPV DNA using Hybrid Capture 2 (HC2). Genotyping was performed using Linear Array assay. Of 223 women with cervical histology confirmation, histologic HSIL+ was detected in 25 women (11.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of 3 triage methods for histologic HSIL+ were; 100%, 47.5%, 19.4%, and 100% by HC2 only; 40.0%, 88.4%, 30.3%, and 92.1% by combined HC2 and genotypes HPV16/18; and 96.0%, 75.8%, 33.3%, and 99.3% by combined HC2 and genotypes HPV16/18/52/58. Triage using combined HC2 and genotypes HPV16/18/52/58 showed significantly greater area under the receiver operating curve than the other 2 methods (P?triaging women with minor cervical cytological abnormalities in northern Thailand. J. Med. Virol. 88:135-143, 2016. © 2015 Wiley Periodicals, Inc. PMID:26129775

  19. Evidence-based improvement of the National Trauma Triage Protocol: The Glasgow Coma Scale versus Glasgow Coma Scale motor subscale

    PubMed Central

    Brown, Joshua B.; Forsythe, Raquel M.; Stassen, Nicole A.; Peitzman, Andrew B.; Billiar, Timothy R.; Sperry, Jason L.; Gestring, Mark L.

    2015-01-01

    BACKGROUND Ideal triage uses simple criteria to identify severely injured patients. Glasgow Coma Scale motor (GCSm) may be easier for field use and was considered for the National Trauma Triage Protocol (NTTP). This study evaluated performance of the NTTP if GCSm is substituted for the current GCS score ? 13 criterion. METHODS Subjects in the National Trauma Data Bank undergoing scene transport were included. Presence of NTTP physiologic (Step 1) and anatomic (Step 2) criteria was determined. GCSm score ? 5 was defined as a positive criterion. Trauma center need (TCN) was defined as Injury Severity Score (ISS) > 15, intensive care unit admission, urgent operation, or emergency department death. Test characteristics were calculated to predict TCN. Area under the curve was compared between GCSm and GCS scores, individually and within the NTTP. Logistic regression was used to determine the association of GCSm score ? 5 and GCS score ? 13 with TCN after adjusting for other triage criteria. Predicted versus actual TCN was compared. RESULTS There were 811,143 subjects. Sensitivity was lower (26.7% vs. 30.3%), specificity was higher (95.1% vs. 93.1%), and accuracy was similar (66.1% vs. 66.3%) for GCSm score ? 5 compared with GCS score ? 13. Incorporated into the NTTP Steps 1 + 2, GCSm score ? 5 traded sensitivity (60.4% vs. 62.1%) for specificity (67.1% vs. 65.7%) with similar accuracy (64.2% vs. 64.2%) to GCS score ? 13. There was no difference in the area under the curve between GCSm score ? 5 and GCS score ? 13 when incorporated into the NTTP Steps 1 + 2 (p = 0.10). GCSm score ? 5 had a stronger association with TCN (odds ratio, 3.37; 95% confidence interval, 3.27–3.48; p < 0.01) than GCS score ? 13 (odds ratio, 3.03; 95% confidence interval, 2.94–3.13; p < 0.01). GCSm had a better fit of predicted versus actual TCN than GCS at the lower end of the scales. CONCLUSION GCSm score ? 5 increases specificity at the expense of sensitivity compared with GCS score ? 13. When applied within the NTTP, there is no difference in discrimination between GCSm and GCS. GCSm score ? 5 is more strongly associated with TCN and better calibrated to predict TCN. Further study is warranted to explore replacing GCS score ? 13 with GCSm score ? 5 in the NTTP. PMID:24977762

  20. Facilitating Real-time Triage of Astronomical Data with Open Source Software

    NASA Astrophysics Data System (ADS)

    Khudikyan, S.; Mattmann, C. A.; Cinquini, L.; Hart, A. F.; Thompson, D. R.; Wagstaff, K.; Burke-Spolaor, S.; Tingay, S.; Wayth, R.; Deller, A.; Majid, W.; Lazio, J.; Jones, D. L.

    2013-12-01

    Relatively bright, millisecond-duration pulses of radio-frequency energy have been discovered recently at the Parkes radio telescope in Australia. These Fast Radio Bursts (FRBs) have properties consistent with extragalactic origin, and they may represent the discovery of a completely new class of astronomical objects. Models for the generation of these events are poorly constrained, in part because the Parkes radio telescope can locate the direction of the pulses to about 15 arcminute (60 arcminutes = 1 degree) precision. The Very Long Baseline Array (VLBA) is a network of 10 telescopes distributed across the United States. If it were to detect such a pulse, it could provide exceptionally precise localization of the pulse's direction (to better than a nanoradian), thus allowing possible identification of the celestial object from which the pulse originated. The challenge is that the data rate from the VLBA antennas can be as large as 20 Gb/s, and the VLBA was not designed to store the data from the individual antennas for any significant length of time. The VLBA Fast Radio Transients (V-FASTR) experiment has developed a real-time, scalable data 'triage' system that makes use of algorithms capable of discovering meaningful signals, and open source code stewarded at the Apache Software Foundation. This system is designed to identify potential FRBs during real-time processing of the VLBA data stream, save only the relevant bits for further (off-line) processing, and curate the data products. As such, the V-FASTR experiment exemplifies the software design for a distributed sensor network that generates data at rates requiring real-time or near-real-time processing. Building flexible portals and applications has become vital with the constantly expanding astronomical data. The V-FASTR collaborative review portal is built using the Apache OODT Balance framework due to the ease at which it integrates with the flexible search capabilities of Apache Solr. We utilize Apache OODT to dump metadata information about each V-FASTR candidate detection from the File Management service into Apache Solr to make data available for inspection through our web portal. Scientists log into the portal daily to either discard spurious detections or preserve interesting ones for follow-up. The Apache OODT Curator provides the service for updating the File Manager catalog (and ultimately Solr on resync) based on the tagging and collaborative review that occurs using the V-FASTR portal. V-FASTR has leveraged open source solutions to effectively and quickly build and deploy an operational software system to handle the large data set produced by VLBA. Our solutions are not specific to the astronomical domain, as shown by the adoption in a number of other science domains including Earth, planetary, and biomedicine that are using similar Open Source software technologies.

  1. Relevance of HPV Screening for Triaging Equivocal Cytology Findings in the Pap II-p, Pap III and Pap IIID Groups – Results of Two Long-Term Studies

    PubMed Central

    Luyten, A.; Petry, K. U.

    2015-01-01

    Introduction: The use of HPV screening for the triage of ASC-US (atypical squamous cells of undetermined significance) cytology results has been established as a sound standard by international trials whereas the data for other cytology findings are in part contradictory. There is a lack of long-term studies on the use of HPV triage in Germany. Materials and Methods: For the present study data from a primary HPV screening project involving women aged over 30 years, ongoing since 2006, and an epidemiological study on women aged between 20 and 27 years, ongoing since 2009, were used. Upon recruitment, all women underwent a smear test for cytology and screening for “high-risk” HPV using Hybrid Capture 2 (HC2). If both tests were positive or if there were persisting remarkable cytology findings or a positive HPV test, then clarification by colposcopy was performed. Results: Altogether, among 282 women with Pap II-p (ASC-US), Pap III (ASC-H) or Pap IIID (LSIL + CIN2) and negative HPV test there was no case of CIN3+. Among the women under 30 years of age, however, 69?% (ASC-US) to 85?% (LSIL + CIN2) of the remarkable findings were HPV positive, also among the older women with Pap IIID, the 71?% prevalence of HPV was too high for a triage and even without triage there was a 23?% risk for CIN3+. On the other hand, of the women over 30 years old with ASC-US (Pap II-p) findings, only 21?% were positive for HPV and the risk for CIN3+ in this group was high at 29?%. Also for ASC-H (Pap III) findings in the age group of over 30 years with an HPV prevalence of 56?% there was an efficient triage for CIN3+. Discussion: In summary, the HPV triage of ASC-US (Pap II-p) findings in women aged over 30 years was found to be efficient; in contrast, LSIL + CIN2 (Pap IIID) findings in this age group justified an immediate referral to colposcopy whereas cytology control appeared to be sufficient for younger women. PMID:26556908

  2. Clinical review: Tokyo – protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance

    PubMed Central

    Okumura, Sumie; Okumura, Tetsu; Ishimatsu, Shinichi; Miura, Kunihisa; Maekawa, Hiroshi; Naito, Toshio

    2005-01-01

    Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the PPE level must be increased and attempts must be made to identify and eliminate the source of the contamination. Finally, if the victims were exposed through ingestion, then consider the possibility that secondary exposure will occur during gastric lavage. PMID:16137390

  3. UNIVERSITY OF TOLEDO HEALTH SCIENCE CAMPUS SUBJECT: CODE YELLOW MASS CASUALTY Procedure No: EP-08-001

    E-print Network

    Azad, Abdul-Majeed

    and Radiation Staff and Hospital Administration will be paged by the Operators to meet in the command center, HICS and the complete Code Yellow Response Annex. Step #3: · Establish the command center in Room 202 Incident Command System (HICS) materials located at the back entrance to the Command Center, in Room 202

  4. Casualties of war: the infection control assessment of civilians transferred from conflict zones to specialist units overseas for treatment.

    PubMed

    Morton, H; Gray, J

    2015-08-01

    The casualties of global conflict attract media attention and sympathy in public, governmental, and non-governmental circles. Hospitals in developed countries offering specialist reconstructive or tertiary services are not infrequently asked to accept civilian patients from overseas conflict for complex surgical procedures or rehabilitation. Concern about the infection prevention and control risks posed by these patients, and the lack of a good evidence base on which to base measured precautions, means that the precautionary principle of accepting zero risk is usually followed. The aim of this article is to highlight infection control considerations that may be required when treating casualties from overseas conflict, based partly on our own experience. Currently there is a lack of published evidence and national consensus on how to manage these patients. The precautionary principle requires that there is an ongoing search for evidence and knowledge that can be used to move towards more traditional risk management. We propose that only by gathering the experiences of the many individual hospitals that have each cared for small numbers of such patients can such evidence and knowledge be assimilated. PMID:26002183

  5. Is a STAS-based tool valid to triage patients at a specialist palliative care inpatient unit?

    PubMed

    Fergus, Cameron J Y; Nicol, Jacqueline S; Russell, Papiya B

    2008-01-01

    Many tools exist to assess the symptoms and needs of palliative care patients, but no tool has been validated to prioritise patients referred for specialist inpatient palliative care. The aim of this study was to produce and validate such a tool. A prospective pilot study produced a Support Team Assessment Schedule- (STAS-) based tool--the Admission Assessment Tool (AAT)--and compared this with the existing system of triage at the Marie Curie Hospice, Edinburgh. Validity of the tool was not confirmed and the tool was modified and re-evaluated. One hundred and twenty-seven consecutive patients referred to the hospice received three AAT scores: from the bed manager; the admitting doctor; and the admitting nurse. The hospice's multidisciplinary team assessed the urgency of each patient's admission. The overall correct classification rate was approximately two thirds, but false positive rates were high and there was poor inter-rate correlation. It is concluded the AAT has not been validated. PMID:18414329

  6. Mortality among workers exposed to coal tar pitch volatiles and welding emissions: an exercise in epidemiologic triage

    SciTech Connect

    Silverstein, M.; Maizlish, N.; Park, R.; Mirer, F.

    1985-11-01

    The United Automobile Workers International Union has established a system of epidemiologic triage to evaluate patterns of mortality among groups of union members. In response to worker concerns, the Union examined mortality at a metal stamping plant, using a method which linked pension records with the State of Michigan computerized death registry. The observed proportion of malignant neoplasms was nearly twice that expected. Two- to five-fold excess proportional mortality from cancer of the digestive organs, lung cancer, and leukemia accounted for most of the overall excess. Strong associations were found between lung and digestive organ cancer and employment as maintenance welders or millwrights in the plant. High levels of six polycyclic aromatic hydrocarbons with mutagenic and carcinogenic properties were found during hot coal tar application to wood block floors, work conducted by the high-risk groups. These levels were substantially reduced following the purchase of new tar pots. The example demonstrates that epidemiologic tools can play a valuable role in occupational health decision making, but care must be taken to avoid mechanical reliance on quantitative testing and to acknowledge the important role of social and political value judgments in the establishment of responsible public policy.

  7. The effect of reduced street lighting on road casualties and crime in England and Wales: controlled interrupted time series analysis

    PubMed Central

    Steinbach, Rebecca; Perkins, Chloe; Tompson, Lisa; Johnson, Shane; Armstrong, Ben; Green, Judith; Grundy, Chris; Wilkinson, Paul

    2015-01-01

    Background Many local authorities in England and Wales have reduced street lighting at night to save money and reduce carbon emissions. There is no evidence to date on whether these reductions impact on public health. We quantified the effect of 4 street lighting adaptation strategies (switch off, part-night lighting, dimming and white light) on casualties and crime in England and Wales. Methods Observational study based on analysis of geographically coded police data on road traffic collisions and crime in 62 local authorities. Conditional Poisson models were used to analyse longitudinal changes in the counts of night-time collisions occurring on affected roads during 2000–2013, and crime within census Middle Super Output Areas during 2010–2013. Effect estimates were adjusted for regional temporal trends in casualties and crime. Results There was no evidence that any street lighting adaptation strategy was associated with a change in collisions at night. There was significant statistical heterogeneity in the effects on crime estimated at police force level. Overall, there was no evidence for an association between the aggregate count of crime and switch off (RR 0.11; 95% CI 0.01 to 2.75) or part-night lighting (RR 0.96; 95% CI 0.86 to 1.06). There was weak evidence for a reduction in the aggregate count of crime and dimming (RR 0.84; 95% CI 0.70 to 1.02) and white light (RR 0.89; 95% CI 0.77 to 1.03). Conclusions This study found little evidence of harmful effects of switch off, part-night lighting, dimming, or changes to white light/LEDs on road collisions or crime in England and Wales. PMID:26219885

  8. Clinical and Serological Features of Patients Referred through a Rheumatology Triage System because of Positive Antinuclear Antibodies

    PubMed Central

    Fitch-Rogalsky, Christie; Steber, Whitney; Mahler, Michael; Lupton, Terri; Martin, Liam; Barr, Susan G.; Mosher, Dianne P.; Wick, James; Fritzler, Marvin J.

    2014-01-01

    Background The referral of patients with positive anti-nuclear antibody (ANA) tests has been criticized as an inappropriate use of medical resources. The utility of a positive ANA test in a central triage (CT) system was studied by determining the autoantibody profiles and clinical diagnoses of patients referred to rheumatologists through a CT system because of a positive ANA test. Methods Patients that met three criteria were included: (1) referred to Rheumatology CT over a three year interval; (2) reason for referral was a “positive ANA”; (3) were evaluated by a certified rheumatologist. The CT clinical database was used to obtain demographic and clinical information and a serological database was used to retrieve specific ANA and/or extractable nuclear antigen (ENA) test results. Clinical information was extracted from the consulting rheumatologist's report. Results 15,357 patients were referred through the CT system; 643 (4.1%) of these because of a positive ANA and of these 263 (40.9%) were evaluated by a certified rheumatologist. In 63/263 (24%) of ANA positive patients, the specialist provided a diagnosis of an ANA associated rheumatic disease (AARD) while 69 (26.2%) had no evidence of any disease; 102 (38.8%) had other rheumatologic diagnoses and 29 (11%) had conditions that did not meet AARD classification criteria. Of ANA positive archived sera, 15.1% were anti-DFS70 positive and 91.2% of these did not have an AARD. Conclusions This is the first study to evaluate the serological and clinical features of patients referred through a CT system because of a positive ANA. The spectrum of autoantibody specificities was wide with anti-Ro52/TRIM21 being the most common autoantibody detected. Approximately 15% of referrals had only antibodies to DFS70, the vast majority of which did not have clinical evidence for an AARD. These findings provide insight into the utility of autoantibody testing in a CT system. PMID:24705829

  9. Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management.

    PubMed

    Cuzick, Jack; Myers, Orrin; Hunt, William C; Saslow, Debbie; Castle, Philip E; Kinney, Walter; Waxman, Alan; Robertson, Michael; Wheeler, Cosette M

    2015-06-15

    In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ? 30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p < 0.001). Overall 82% of women with ASC-US cytology who did not receive co-testing also had an HPV test. HPV positivity was age and cytology result dependent but did not show time trends. For women with negative cytology, 64% received an additional screening test within 3 years if no co-test was done or if it was positive, but this was reduced to 47% with a negative co-test. Reflex HPV testing for ASC-US cytology is well established and occurs in most women. Evidence for reflex testing is also observed following other abnormal cytology outcomes. Co-testing in women aged 30-65 years has more than tripled from 2007 to 2012, but was still only used in 19.1% of women aged 30-65 years attending for screening in 2012. Women receiving co-testing had longer repeat screening intervals, but rescreening within 3 years is still very common even with co-testing. PMID:25447979

  10. Disaster medicine through Google Glass.

    PubMed

    Carenzo, Luca; Barra, Federico Lorenzo; Ingrassia, Pier Luigi; Colombo, Davide; Costa, Alessandro; Della Corte, Francesco

    2015-06-01

    Nontechnical skills can make a difference in the management of disasters and mass casualty incidents and any tool helping providers in action might improve their ability to respond to such events. Google Glass, released by Google as a new personal communication device, could play a role in this field. We recently tested Google Glass during a full-scale exercise to perform visually guided augmented-reality Simple Triage and Rapid Treatment triage using a custom-made application and to identify casualties and collect georeferenced notes, photos, and videos to be incorporated into the debriefing. Despite some limitations (battery life and privacy concerns), Glass is a promising technology both for telemedicine applications and augmented-reality disaster response support to increase operators' performance, helping them to make better choices on the field; to optimize timings; and finally represents an excellent option to take professional education to a higher level. PMID:25460812

  11. Triage of oxidation-prone proteins by Sqstm1/p62 within the mitochondria

    SciTech Connect

    Lee, Minjung; Shin, Jaekyoon

    2011-09-16

    Highlights: {yields} The mitochondrion contains its own protein quality control system. {yields} p62 localizes within the mitochondria and forms mega-dalton sized complexes. {yields} p62 interacts with oxidation-prone proteins and the proteins of quality control. {yields} In vitro delivery of p62 improves mitochondrial functions. {yields} p62 is implicated as a participant in mitochondrial protein quality control. -- Abstract: As the mitochondrion is vulnerable to oxidative stress, cells have evolved several strategies to maintain mitochondrial integrity, including mitochondrial protein quality control mechanisms and autophagic removal of damaged mitochondria. Involvement of an autophagy adaptor, Sqstm1/p62, in the latter process has been recently described. In the present study, we provide evidence that a portion of p62 directly localizes within the mitochondria and supports stable electron transport by forming heterogeneous protein complexes. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) of mitochondrial proteins co-purified with p62 revealed that p62 interacts with several oxidation-prone proteins, including a few components of the electron transport chain complexes, as well as multiple chaperone molecules and redox regulatory enzymes. Accordingly, p62-deficient mitochondria exhibited compromised electron transport, and the compromised function was partially restored by in vitro delivery of p62. These results suggest that p62 plays an additional role in maintaining mitochondrial integrity at the vicinity of target machineries through its function in relation to protein quality control.

  12. The Ranger First Responder Program and Tactical Emergency Casualty Care Implementation: A Whole-Community Approach to Reducing Mortality From Active Violent Incidents.

    PubMed

    Fisher, Andrew D; Callaway, David W; Robertson, Josh N; Hardwick, Shane A; Bobko, Joshua P; Kotwal, Russ S

    2015-01-01

    Active violent incidents are dynamic and challenging situations that can produce a significant amount of preventable deaths. Lessons learned from the military?s experience in Afghanistan and Iraq through the Committee on Tactical Combat Casualty Care and the 75th Ranger Regiment?s Ranger First Responder Program have helped create the Committee for Tactical Emergency Casualty Care (C-TECC) to address the uniqueness of similar wounding patterns and to end preventable deaths. We propose a whole-community approach to active violent incidents, using the C-TECC Trauma Chain of Survival and a tiered approach for training and responsibilities: the first care provider, nonmedical professional first responders, medical first responders, and physicians and trauma surgeons. The different tiers are critical early links in the Chain of Survival and this approach will have a significant impact on active violent incidents. PMID:26360353

  13. Care of World War II convoy casualties in the Kola area of north Russia. Part 2--The Royal Naval Auxiliary Hospital, Vaenga.

    PubMed

    McMillan, G H

    1996-01-01

    The Royal Naval Auxiliary Hospital at Vaenga, North Russia was operational from October 1942 to July 1945. Care and treatment were provided to 752 male and one female in-patients from Arctic convoy merchant ships and their escorts and Allied personnel who became sick or injured while in the Kola area. One hundred and forty nine of the men were casualties of enemy action. An account is given of the hospital's structure, staff, organisation and work. PMID:8776939

  14. Safe management of mass fatalities following chemical, biological, and radiological incidents.

    PubMed

    Baker, David J; Jones, Kelly A; Mobbs, Shelly F; Sepai, Ovnair; Morgan, Dilys; Murray, Virginia S G

    2009-01-01

    Contaminated mass fatalities following the release of chemical, biological, or radiological agents pose a potential major health hazard. A United Kingdom government investigation has identified a number of areas of risk. This paper presents an outline of the findings of the study and describes specific pathways for the management of contaminated and non-contaminated fatalities. Factors determining the choice between cremation and burial are discussed. Effective decontamination remains a neglected area of study for both fatalities and casualties. PMID:19618352

  15. Psychosocial considerations for mass decontamination.

    PubMed

    Lemyre, Louise; Johnson, Colleen; Corneil, Wayne

    2010-11-01

    Mass exposure to explosions, infectious agents, foodborne illnesses, chemicals or radiological materials may require mass decontamination that have critical psychosocial implications for the public and for both traditional and non-traditional responders in terms of impact and of response. Five main issues are common to mass decontamination events: (i) perception, (ii) somatisation, (iii) media role and communication, (iv) information sharing, (v) behavioural guidance and (vi) organisational issues. Empirical evidence is drawn from a number of cases, including Chernobyl; Goiania, Brazil; the sarin gas attack in Tokyo; the anthrax attacks in the USA; Three Mile Island; and by features of the 2003 severe acute respiratory syndrome pandemic. In this paper, a common platform for mass casualty management is explored and suggestions for mass interventions are proposed across the complete event timeline, from pre-event threat and warning stages through to the impact and reconstruction phases. Implication for responders, healthcare and emergency infrastructure, public behaviour, screening processes, risk communication and media management are described. PMID:20924122

  16. Analysis of clothing and urine from Moscow theatre siege casualties reveals carfentanil and remifentanil use.

    PubMed

    Riches, James R; Read, Robert W; Black, Robin M; Cooper, Nicholas J; Timperley, Christopher M

    2012-01-01

    On October 26, 2002, Russian Special Forces deployed a chemical aerosol against Chechen terrorists to rescue hostages in the Dubrovka theatre. Its use confirmed Russian military interest in chemicals with effects on personnel and caused 125 deaths through a combination of the aerosol and inadequate medical care. This study provides evidence from liquid chromatography-tandem mass spectrometry analysis of extracts of clothing from two British survivors, and urine from a third survivor, that the aerosol comprised a mixture of two anaesthetics--carfentanil and remifentanil--whose relative proportions this study was unable to identify. Carfentanil and remifentanil were found on a shirt sample and a metabolite called norcarfentanil was found in a urine sample. This metabolite probably originated from carfentanil. PMID:23002178

  17. Triage biodosimetry using centromeric/telomeric PNA probes and Giemsa staining to score dicentrics or excess fragments in non-stimulated lymphocyte prematurely condensed chromosomes.

    PubMed

    Karachristou, Ioanna; Karakosta, Maria; Pantelias, Antonio; Hatzi, Vasiliki I; Karaiskos, Pantelis; Dimitriou, Panagiotis; Pantelias, Gabriel; Terzoudi, Georgia I

    2015-11-01

    The frequency of dicentric chromosomes in human peripheral blood lymphocytes at metaphase is considered as the "gold-standard" method for biological dosimetry and, presently, it is the most widely used for dose assessment. Yet, it needs lymphocyte stimulation and a 2-day culture, failing the requirement of rapid dose estimation, which is a high priority in radiation emergency medicine and triage biodosimetry. In the present work, we assess the applicability of cell fusion mediated premature chromosome condensation (PCC) methodology, which enables the analysis of radiation-induced chromosomal aberrations directly in non-stimulated G0-lymphocytes, without the 2-day culture delay. Despite its advantages, quantification of an exposure by means of the PCC-method is not currently widely used, mainly because Giemsa-staining of interphase G0-lymphocyte chromosomes facilitates the analysis of fragments and rings, but not of dicentrics. To overcome this shortcoming, the PCC-method is combined with fluorescence in situ hybridization (FISH), using simultaneously centromeric/telomeric peptide nucleic acid (PNA)-probes. This new approach enables an accurate analysis of dicentric and centric ring chromosomes, which are formed within 8h post irradiation and will, therefore, be present in the blood sample by the time it arrives for dose estimation. For triage biodosimetry, a dose response curve for up to 10Gy was constructed and compared to that obtained using conventional metaphase analysis with Giemsa or centromeric/telomeric PNA-probes in metaphase. Since FISH is labor intensive, a simple PCC-method scoring Giemsa-stained fragments in excess of 46 was also assessed as an even more rapid approach for triage biodosimetry. First, we studied the rejoining kinetics of fragments and constructed a dose-response curve for 24h repair time. Then, its applicability was assessed for four different doses and compared with the PCC-method using centromeric/telomeric PNA-probes, through the evaluation of speed of analysis and minimum number of cells required for dose estimation and categorization of exposed individuals. PMID:26520380

  18. Drowning of the - 150 m reef off Hawaii: A casualty of global meltwater pulse 1A?

    USGS Publications Warehouse

    Webster, J.M.; Clague, D.A.; Riker-Coleman, K.; Gallup, C.; Braga, J.C.; Potts, D.; Moore, J.G.; Winterer, E.L.; Paull, C.K.

    2004-01-01

    We present evidence that the drowning of the - 150 m coral reef around Hawaii was caused by rapid sea-level rise associated with meltwater pulse 1A (MWP-1A) during the last deglaciation. New U/Th and 14C accelerator mass spectrometry dates, combined with reinterpretation of existing radiometric dates, constrain the age of the coral reef to 15.2-14.7 ka (U/Th age), indicating that reef growth persisted for 4.3 k.y. following the end of the Last Glacial Maximum at 19 ka. The drowning age of the reef is roughly synchronous with the onset of MWP-1A between 14.7 and 14.2 ka. Dates from coralline algal material range from 14 to 10 cal ka (calibrated radiocarbon age), 1-4 k.y. younger than the coral ages. A paleoenvironmental reconstruction incorporating all available radiometric dates, high-resolution bathymetry, dive observations, and coralgal paleobathymetry data indicates a dramatic rise in sea level around Hawaii ca. 14.7 ka. Paleowater depths over the reef crest increased rapidly above a critical depth (30-40 m), drowning the shallow reef-building Porites corals and causing a shift to deepwater coralline algal growth, preserved as a crust on the drowned reef crest. ?? 2004 Geological Society of America.

  19. Medical lessons learnt from the US and Canadian experience of treating combat casualties from Afghanistan and Iraq.

    PubMed

    Dharm-Datta, Shreshth; McLenaghan, J

    2013-06-01

    The Winston Churchill Memorial Trust, established in 1965, funds Travelling Fellowships and both authors visited hospitals in Germany, Canada and the USA regarded as centres of excellence with expertise in the early care, reconstruction and rehabilitation of the combat casualties of our NATO Allies, as recipients of these Fellowships. This article presents some of the lessons learnt in the field of musculoskeletal trauma and rehabilitation from the Canadian and US military medical systems. In trauma, there were significant differences in wound debridement policy, use of external fixators for fractures, primary use of circular frames for open tibial fractures and a far more liberal use of bone morphogenetic protein in fracture treatment. Differences in soft tissue reconstruction policy regarding flaps for soft tissue cover over exposed bone, near-universal usage of topical negative pressure dressings and use of Allgöwer-Donati suture pattern to close all wounds were noted. Ertl amputation osteoplasty, a modified form of transtibial amputation, had also been reintroduced. In rehabilitation, the management of heterotopic ossification, in particular with imaging techniques and excision surgery, was identified. For the upper limb, we observed the patient training required to use a myoelectric hand and the future possibility of targeted muscle re-innervation to make controlling these myoelectric prostheses more natural using innate motor patterns. For the lower limb, we found we used identical above knee prostheses. For patients who have had limb reconstruction and have poor function, an energy-storing orthosis was demonstrated to compensate for the loss of range of motion and muscle power. PMID:23720592

  20. Mass illness at an intermediate school: toxic fumes or epidemic hysteria

    SciTech Connect

    Krug, S.E. )

    1992-10-01

    The report of an acute illness involving a large number of clustered children will undoubtedly provoke an urgent emergency care response or, in some instances, a mass casualty or disaster response. While responding to the perceived needs of those involved, the professionals caring for these children must consider epidemic hysteria along with the other causes of mass illness. Since the early recognition of epidemic or mass anxiety hysteria can have tremendous impact on the ease of treating this problem, that awareness is quite important.

  1. Adnexal Masses Suspected to Be Benign Treated with Laparoscopy

    PubMed Central

    Marchand, Greg J.

    2012-01-01

    Objective: Guidelines for referring women with pelvic masses suspicious for ovarian cancer to gynecologic oncologists have been developed by the American College of Obstetrician Gynecologists (ACOG). We set out to evaluate the negative predictive value of these guidelines and to assess a modified algorithm involving minimally invasive surgery in the treatment of women with masses suspected to be benign. Methods: 257 consecutive patients with adnexal masses of 8cm to 13cm on preoperative ultrasound examination meeting Triage Criteria set forth in ACOG Committee Opinion 280. Patients meeting the selection criteria were scheduled for operative laparoscopy, washings, adnexectomy, bagging, and colpotomy. A total of 240 patients successfully completed intended treatment (93.38%), and 234 of these did not require admission (97.5%). There was a low incidence of significant complications: 97.50% of women were successfully treated as outpatients, 97.92% of surgeries lasted <136 minutes, and 97.08% had blood loss <200mL. The negative predictive value of ACOG Committee Opinion 280 Triage Criteria as a deselector for having invasive ovarian malignancy in our population was 95.57% for premenopausal and 90.91% for postmenopausal women. Conclusions: Laparoscopic adnexectomy, bagging, and colpotomy is a desirable goal for patients with ovarian masses in the 8cm to 13cm range meeting selection criteria affording a minimally invasive approach with attendant benefits including outpatient treatment (97.5%), few complications, low likelihood of iatrogenic rupture of the ovarian capsule (1.25%), and low necessity for reoperation after final pathology is evaluated (6.03%). Negative predictive value of ACOG Committee Opinion 280 is confirmed in a community gynecology practice and is recommended to form the basis of a new treatment algorithm for women with adnexal masses. PMID:22906334

  2. Analysis of Casualty Risk per Police-Reported Crash for Model Year 2000 to 2004 Vehicles, using Crash Data from Five States

    SciTech Connect

    Wenzel, Tom

    2011-03-20

    In this report we compare two measures of driver risks: fatality risk per vehicle registration-year, and casualty (fatality plus serious injury) risk per police-reported crash. Our analysis is based on three sets of data from five states (Florida, Illinois, Maryland, Missouri, and Pennsylvania): data on all police-reported crashes involving model year 2000 to 2004 vehicles; 2005 county-level vehicle registration data by vehicle model year and make/model; and odometer readings from vehicle emission inspection and maintenance (I/M) programs conducted in urban areas of four of the five states (Florida does not have an I/M program). The two measures of risk could differ for three reasons: casualty risks are different from fatality risk; risks per vehicle registration-year are different from risks per crash; and risks estimated from national data are different from risks from the five states analyzed here. We also examined the effect of driver behavior, crash location, and general vehicle design on risk, as well as sources of potential bias in using the crash data from five states.

  3. The Maastricht Ultrasound Shoulder pain trial (MUST): Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care

    PubMed Central

    2011-01-01

    Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP) in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US), an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT) will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon) except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed at baseline, 13, 26, 39 and 52 weeks after inclusion. An economic evaluation will be performed from both a health care and societal perspective with a time horizon of 52 weeks. Discussion The results of this trial will give unique evidence regarding the cost-effectiveness of US as a diagnostic triage tool in the management of SP in primary care. PMID:21740540

  4. Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs.

    PubMed

    Philipsen, R H H M; Sánchez, C I; Maduskar, P; Melendez, J; Peters-Bax, L; Peter, J G; Dawson, R; Theron, G; Dheda, K; van Ginneken, B

    2015-01-01

    Molecular tests hold great potential for tuberculosis (TB) diagnosis, but are costly, time consuming, and HIV-infected patients are often sputum scarce. Therefore, alternative approaches are needed. We evaluated automated digital chest radiography (ACR) as a rapid and cheap pre-screen test prior to Xpert MTB/RIF (Xpert). 388 suspected TB subjects underwent chest radiography, Xpert and sputum culture testing. Radiographs were analysed by computer software (CAD4TB) and specialist readers, and abnormality scores were allocated. A triage algorithm was simulated in which subjects with a score above a threshold underwent Xpert. We computed sensitivity, specificity, cost per screened subject (CSS), cost per notified TB case (CNTBC) and throughput for different diagnostic thresholds. 18.3% of subjects had culture positive TB. For Xpert alone, sensitivity was 78.9%, specificity 98.1%, CSS $13.09 and CNTBC $90.70. In a pre-screening setting where 40% of subjects would undergo Xpert, CSS decreased to $6.72 and CNTBC to $54.34, with eight TB cases missed and throughput increased from 45 to 113 patients/day. Specialists, on average, read 57% of radiographs as abnormal, reducing CSS ($8.95) and CNTBC ($64.84). ACR pre-screening could substantially reduce costs, and increase daily throughput with few TB cases missed. These data inform public health policy in resource-constrained settings. PMID:26212560

  5. Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs

    NASA Astrophysics Data System (ADS)

    Philipsen, R. H. H. M.; Sánchez, C. I.; Maduskar, P.; Melendez, J.; Peters-Bax, L.; Peter, J. G.; Dawson, R.; Theron, G.; Dheda, K.; van Ginneken, B.

    2015-07-01

    Molecular tests hold great potential for tuberculosis (TB) diagnosis, but are costly, time consuming, and HIV-infected patients are often sputum scarce. Therefore, alternative approaches are needed. We evaluated automated digital chest radiography (ACR) as a rapid and cheap pre-screen test prior to Xpert MTB/RIF (Xpert). 388 suspected TB subjects underwent chest radiography, Xpert and sputum culture testing. Radiographs were analysed by computer software (CAD4TB) and specialist readers, and abnormality scores were allocated. A triage algorithm was simulated in which subjects with a score above a threshold underwent Xpert. We computed sensitivity, specificity, cost per screened subject (CSS), cost per notified TB case (CNTBC) and throughput for different diagnostic thresholds. 18.3% of subjects had culture positive TB. For Xpert alone, sensitivity was 78.9%, specificity 98.1%, CSS $13.09 and CNTBC $90.70. In a pre-screening setting where 40% of subjects would undergo Xpert, CSS decreased to $6.72 and CNTBC to $54.34, with eight TB cases missed and throughput increased from 45 to 113 patients/day. Specialists, on average, read 57% of radiographs as abnormal, reducing CSS ($8.95) and CNTBC ($64.84). ACR pre-screening could substantially reduce costs, and increase daily throughput with few TB cases missed. These data inform public health policy in resource-constrained settings.

  6. Digital images taken with a mobile phone can assist in the triage of neurosurgical patients to a level 1 trauma centre.

    PubMed

    Bullard, Timothy B; Rosenberg, Marcy S; Ladde, Jay; Razack, Nizam; Villalobos, Hunaldo J; Papa, Linda

    2013-02-01

    We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases. PMID:23528786

  7. Automated chest-radiography as a triage for Xpert testing in resource-constrained settings: a prospective study of diagnostic accuracy and costs

    PubMed Central

    Philipsen, R. H. H. M.; Sánchez, C. I.; Maduskar, P.; Melendez, J.; Peters-Bax, L.; Peter, J. G.; Dawson, R.; Theron, G.; Dheda, K.; van Ginneken, B.

    2015-01-01

    Molecular tests hold great potential for tuberculosis (TB) diagnosis, but are costly, time consuming, and HIV-infected patients are often sputum scarce. Therefore, alternative approaches are needed. We evaluated automated digital chest radiography (ACR) as a rapid and cheap pre-screen test prior to Xpert MTB/RIF (Xpert). 388 suspected TB subjects underwent chest radiography, Xpert and sputum culture testing. Radiographs were analysed by computer software (CAD4TB) and specialist readers, and abnormality scores were allocated. A triage algorithm was simulated in which subjects with a score above a threshold underwent Xpert. We computed sensitivity, specificity, cost per screened subject (CSS), cost per notified TB case (CNTBC) and throughput for different diagnostic thresholds. 18.3% of subjects had culture positive TB. For Xpert alone, sensitivity was 78.9%, specificity 98.1%, CSS $13.09 and CNTBC $90.70. In a pre-screening setting where 40% of subjects would undergo Xpert, CSS decreased to $6.72 and CNTBC to $54.34, with eight TB cases missed and throughput increased from 45 to 113 patients/day. Specialists, on average, read 57% of radiographs as abnormal, reducing CSS ($8.95) and CNTBC ($64.84). ACR pre-screening could substantially reduce costs, and increase daily throughput with few TB cases missed. These data inform public health policy in resource-constrained settings. PMID:26212560

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

    E-print Network

    Wenzel, Tom

    2013-01-01

    Effect of increase weight and or all-wheel size on risk, byweight and footprint (wheelbase times track width), as well as the presence of all- wheelweight, footprint, type, and installed safety features (such as side airbags, ABS, ESC, and all-wheel

  9. Surge Capacity and Capability. A Review of the History and Where the Science is Today Regarding Surge Capacity during a Mass Casualty Disaster

    PubMed Central

    Kearns, Randy D.; Cairns, Bruce A.; Cairns, Charles B.

    2014-01-01

    Disasters which include countless killed and many more injured, have occurred throughout recorded history. Many of the same reports of disaster also include numerous accounts of individuals attempting to rescue those in great peril and render aid to the injured and infirmed. The purpose of this paper is to briefly discuss the transition through several periods of time with managing a surge of many patients. This review will focus on the triggering event, injury and illness, location where the care is provided and specifically discuss where the science is today. PMID:24795873

  10. MEDECOR--a medical decorporation tool to assist first responders, receivers, and medical reach-back personnel in triage, treatment, and risk assessment after internalization of radionuclides.

    PubMed

    Waller, Ed; Wilkinson, Diana

    2010-10-01

    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. 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 aversion (hence risk reduction) 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 optimal 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, it is desirable to have a software tool that compiles existing radionuclide decorporation therapy data and allows a user to perform simple diagnosis leading to optimized decorporation treatment strategies. In its most simple application, the software is a large database of radionuclide decorporation strategies and treatments. The software can also be used in clinical interactive mode, in which the user inputs the radionuclide, estimated activity, route of intake and time since exposure. The software makes suggestions as to the urgency of treatment (i.e., triage) and the suggested therapy. Current developments include risk assessment which impacts the potential risk of delivered therapy and resource allocation of therapeutic agents. The software, developed for the Canadian Department of National Defence (DND), is titled MEDECOR (MEdical DECORporation). The MEDECOR tool was designed for use on both personal digital assistant and laptop computer environments. The tool was designed using HTML/Jscript, to allow for ease of portability amongst different computing platforms. This paper presents the features of MEDECOR, results of testing at a major NATO exercise, and future development of this tool into MEDECOR2. PMID:20838103

  11. Triage of Atypical Glandular Cell by SOX1 and POU4F3 Methylation: A Taiwanese Gynecologic Oncology Group (TGOG) Study

    PubMed Central

    Chang, Cheng-Chang; Ou, Yu-Che; Wang, Kung-Liahng; Chang, Ting-Chang; Cheng, Ya-Min; Chen, Chi-Hau; Chu, Tang-Yuan; Hsu, Shih-Tien; Liou, Wen-Shiung; Chang, Yin-Yi; Wu, Hua-Hsi; Chen, Tze-Ho; Lai, Hung-Cheng

    2015-01-01

    Introduction Invasive procedures including loop electrosurgical excision, cervical conization, and endometrial sampling are often recommended when atypical glandular cells (AGC) are detected on Pap smear with unsatisfactory colposcopy. These invasive procedures may result in patient anxiety, increased medical expense, and increasing the risk of preterm delivery in subsequent pregnancies. This study was performed to assess methylation biomarkers in the triage of AGC on Pap smear for invasive procedures. Methods We conducted a multicenter study in 13 medical centers in Taiwan from May 2012 to May 2014. A total of 55 samples diagnosed “AGC not otherwise specified” (AGC-NOS) were included. All patients with AGC underwent colposcopy, cervical biopsy, endometrial sampling, and conization if indicated. Multiplex quantitative methylation-specific polymerase chain reaction (QMSPCR) was performed. Sensitivity, specificity, and accuracy were calculated for detecting CIN3+ and endometrial complex hyperplasia. Results In 55 patients with AGC, the sensitivity for methylated (m) SOX1m, PAX1 m, ZNF582m,PTPRRm, AJAP1m, HS3ST2m, and POU4F3m for detecting CIN3+ and endometrial complex hyperplasia lesions was 100, 86, 71, 86, 86, 57, and 100%; specificity was 67, 79, 85, 50, 52, 96, and 52%, respectively. Testing for high risk-HPV had a sensitivity of 57% and specificity of 75% for CIN3+ and endometrial complex hyperplasia lesions. Conclusion Methylated (m) SOX1m and POU4F3m could be new methylation biomarkers for detection of CIN3+ and endometrial complex hyperplasia in AGC. Women with AGC and positive SOX1m / POU4F3m, colposcopy, cervical conization or endometrial sampling should be considered. PMID:26057869

  12. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

    PubMed Central

    Cardona-Morrell, Magnolia; Hillman, Ken

    2015-01-01

    Objective To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. Design Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. Main measurements Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. Results Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ?65; meeting ?2 deterioration criteria; an index of frailty with ?2 criteria; early warning score >4; presence of ?1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. Conclusions An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3?months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL. PMID:25613983

  13. Knowledge and skills retention following Emergency Triage, Assessment and Treatment plus Admission course for final year medical students in Rwanda: a longitudinal cohort study

    PubMed Central

    Tuyisenge, Lisine; Kyamanya, Patrick; Van Steirteghem, Samuel; Becker, Martin; English, Mike; Lissauer, Tom

    2014-01-01

    Aim To determine whether, after the Emergency Triage, Assessment and Treatment plus Admission (ETAT+) course, a comprehensive paediatric life support course, final year medical undergraduates in Rwanda would achieve a high level of knowledge and practical skills and if these were retained. To guide further course development, student feedback was obtained. Methods Longitudinal cohort study of knowledge and skills of all final year medical undergraduates at the University of Rwanda in academic year 2011–2012 who attended a 5-day ETAT+ course. Students completed a precourse knowledge test. Knowledge and clinical skills assessments, using standardised marking, were performed immediately postcourse and 3–9?months later. Feedback was obtained using printed questionnaires. Results 84 students attended the course and re-evaluation. Knowledge test showed a significant improvement, from median 47% to 71% correct answers (p<0.001). For two clinical skills scenarios, 98% passed both scenarios, 37% after a retake, 2% failed both scenarios. Three to nine?months later, students were re-evaluated, median score for knowledge test 67%, not significantly different from postcourse (p>0.1). For clinical skills, 74% passed, with 32% requiring a retake, 8% failed after retake, 18% failed both scenarios, a significant deterioration (p<0.0001). Conclusions Students performed well on knowledge and skills immediately after a comprehensive ETAT+ course. Knowledge was maintained 3–9?months later. Clinical skills, which require detailed sequential steps, declined, but most were able to perform them satisfactorily after feedback. The course was highly valued, but several short courses and more practical teaching were advocated. PMID:24925893

  14. Burn care in disaster and other austere settings.

    PubMed

    Jeng, James; Gibran, Nicole; Peck, Michael

    2014-08-01

    In some circumstances, burn care must be delivered in a simple manner without the luxury of modern resources. Such circumstances include care in low- and middle-income countries, war zones, and mass casualty incidents. Triage decisions need to be made carefully, allowing the focus of limited personnel and equipment on those most likely to survive. Simple techniques can be used to help many burn victims, such as utilizing oral resuscitation formulas for burn resuscitation. Although even the best attempts at preparation often fall short, there are many benefits from planning and training. PMID:25085095

  15. [Terrorism--a new dimension in trauma care].

    PubMed

    Schwab, R; Güsgen, C; Hentsch, S; Kollig, E

    2007-10-01

    Bomb attacks on the civilian population are one of the primary instruments of global terrorism. Confronted as we are with the increasingly real threat in Europe too, we now have to be constantly prepared for the mass casualties and new injury patterns in trauma care that are caused by terrorist bombings. This is extraordinarily challenging, on both medical and logistical levels, for the hospitals involved. In this review the basic mechanisms of blast injuries are clarified. In addition, the fundamental principles of triage and the management of multiple trauma are presented; these are oriented on ATLS (advanced trauma life support) and DCS (damage control surgery) guidelines. These treatment concepts, which have proved their worth in both military and civilian environments, involve ongoing triage and constant situational assessment and are the basis of improved treatment results in the care of multiply traumatized victims of terrorist bombings. PMID:17898970

  16. The Application of Classification and Regression Trees for the Triage of Women for Referral to Colposcopy and the Estimation of Risk for Cervical Intraepithelial Neoplasia: A Study Based on 1625 Cases with Incomplete Data from Molecular Tests

    PubMed Central

    Pouliakis, Abraham; Karakitsou, Efrossyni; Chrelias, Charalampos; Pappas, Asimakis; Panayiotides, Ioannis; Valasoulis, George; Kyrgiou, Maria; Paraskevaidis, Evangelos; Karakitsos, Petros

    2015-01-01

    Objective. Nowadays numerous ancillary techniques detecting HPV DNA and mRNA compete with cytology; however no perfect test exists; in this study we evaluated classification and regression trees (CARTs) for the production of triage rules and estimate the risk for cervical intraepithelial neoplasia (CIN) in cases with ASCUS+ in cytology. Study Design. We used 1625 cases. In contrast to other approaches we used missing data to increase the data volume, obtain more accurate results, and simulate real conditions in the everyday practice of gynecologic clinics and laboratories. The proposed CART was based on the cytological result, HPV DNA typing, HPV mRNA detection based on NASBA and flow cytometry, p16 immunocytochemical expression, and finally age and parous status. Results. Algorithms useful for the triage of women were produced; gynecologists could apply these in conjunction with available examination results and conclude to an estimation of the risk for a woman to harbor CIN expressed as a probability. Conclusions. The most important test was the cytological examination; however the CART handled cases with inadequate cytological outcome and increased the diagnostic accuracy by exploiting the results of ancillary techniques even if there were inadequate missing data. The CART performance was better than any other single test involved in this study. PMID:26339651

  17. Study of criteria influencing the success rate of DNA swabs in operational conditions: A contribution to an evidence-based approach to crime scene investigation and triage.

    PubMed

    Baechler, S

    2016-01-01

    DNA is nowadays swabbed routinely to investigate serious and volume crimes, but research remains scarce when it comes to determining the criteria that may impact the success rate of DNA swabs taken on different surfaces and situations. To investigate these criteria in fully operational conditions, DNA analysis results of 4772 swabs taken by the forensic unit of a police department in Western Switzerland over a 2.5-year period (2012-2014) in volume crime cases were considered. A representative and random sample of 1236 swab analyses was extensively examined and codified, describing several criteria such as whether the swabbing was performed at the scene or in the lab, the zone of the scene where it was performed, the kind of object or surface that was swabbed, whether the target specimen was a touch surface or a biological fluid, and whether the swab targeted a single surface or combined different surfaces. The impact of each criterion and of their combination was assessed in regard to the success rate of DNA analysis, measured through the quality of the resulting profile, and whether the profile resulted in a hit in the national database or not. Results show that some situations-such as swabs taken on door and window handles for instance-have a higher success rate than average swabs. Conversely, other situations lead to a marked decrease in the success rate, which should discourage further analyses of such swabs. Results also confirm that targeting a DNA swab on a single surface is preferable to swabbing different surfaces with the intent to aggregate cells deposited by the offender. Such results assist in predicting the chance that the analysis of a swab taken in a given situation will lead to a positive result. The study could therefore inform an evidence-based approach to decision-making at the crime scene (what to swab or not) and at the triage step (what to analyse or not), contributing thus to save resource and increase the efficiency of forensic science efforts. PMID:26590861

  18. Earthquakes and the office-based surgeon.

    PubMed Central

    Conover, W A

    1992-01-01

    A major earthquake may strike while a surgeon is performing an operation in an office surgical facility. A sudden major fault disruption will lead to thousands of casualties and widespread destruction. Surgeons who operate in offices can help lessen havoc by careful preparation. These plans should coordinate with other disaster plans for effective triage, evacuation, and the treatment of casualties. PMID:1413756

  19. Toxicokinetic Triage for Environmental Chemicals

    EPA Science Inventory

    Toxicokinetic (TK) models are essential for linking administered doses to blood and tissue concentrations. In vitro-to-in vivo extrapolation (IVIVE) methods have been developed to determine TK from limited in vitro measurements and chemical structure-based property predictions, p...

  20. Steps required to inclusion in commercial ECG analysis systems--the new ECG indices for quantitating extent, acuteness and severity of acute myocardial ischemia for facilitating emergency triage decisions.

    PubMed

    Hampton, David R

    2014-01-01

    Clinically useful diagnostic methods for chest pain triage often fail to reach everyday practice where they can improve patient outcomes. One means to bridge the gap is through adoption of ECG interpretive algorithms with enhanced accuracy or expanded features into established commercial products. The transition from innovation to industry can be facilitated if researchers consider three factors aiding a successful handoff to companies. First, they should assess their algorithm to assure that it meets a real market need and can be easily assimilated by commercial partners. Second, their design documentation and databases should support the regulated development processes required of manufacturers. Finally, they should hold appropriate expectations for the structure of commercial partnerships that lead to release of a marketed product. PMID:24891263

  1. Negative mass

    NASA Astrophysics Data System (ADS)

    Hammond, Richard T.

    2015-03-01

    Some physical aspects of negative mass are examined. Several unusual properties, such as the ability of negative mass to penetrate any armor, are analysed. Other surprising effects include the bizarre system of negative mass chasing positive mass, naked singularities and the violation of cosmic censorship, wormholes, and quantum mechanical results as well. In addition, a brief look into the implications for strings is given.

  2. Mass loss

    NASA Technical Reports Server (NTRS)

    Goldberg, Leo

    1987-01-01

    Observational evidence for mass loss from cool stars is reviewed. Spectra line profiles are used for the derivation of mass-loss rates with the aid of the equation of continuity. This equation implies steady mass loss with spherical symmetry. Data from binary stars, Mira variables, and red giants in globular clusters are examined. Silicate emission is discussed as a useful indicator of mass loss in the middle infrared spectra. The use of thermal millimeter-wave radiation, Very Large Array (VLA) measurement of radio emission, and OH/IR masers are discussed as a tool for mass loss measurement. Evidence for nonsteady mass loss is also reviewed.

  3. Impact of the AD 79 explosive eruption on Pompeii, II. Causes of death of the inhabitants inferred by stratigraphic analysis and areal distribution of the human casualties

    NASA Astrophysics Data System (ADS)

    Luongo, Giuseppe; Perrotta, Annamaria; Scarpati, Claudio; De Carolis, Ernesto; Patricelli, Giovanni; Ciarallo, Annamaria

    2003-08-01

    Detailed descriptions of the effects of explosive eruptions on urban settlements available to volcanologists are relatively rare. Apart from disease and starvation, the largest number of human deaths caused by explosive eruptions in the twentieth century are due to pyroclastic flows. The relationship between the number of victims related to a specific hazard and the presence of urban settlements in the area covered by the eruption has been shown. However, pyroclastic falls are also extremely dangerous under certain conditions. These conclusions are based on archaeological and volcanological studies carried out on the victims of the well-known AD 79 eruption of Vesuvius that destroyed and buried the Roman city of Pompeii. The stratigraphic level in the pyroclastic deposit and the location of all the casualties found are described and discussed. The total number of victims recovered during the archaeological excavations amounts to 1150. Of these, 1044 well recognisable bodies plus an additional group of 100 individuals were identified based on the analysis of several groups of scattered bones. Of the former, 394 were found in the lower pumice lapilli fall deposit and 650 in the upper stratified ash and pumice lapilli pyroclastic density currents (PDCs) deposits. In addition, a tentative evaluation suggests that 464 corpses may still be buried in the unexcavated part of the city. According to the reconstruction presented in this paper, during the first phase of the eruption (August 24, AD 79) a huge quantity of pumice lapilli fell on Pompeii burying the city under 3 m of pyroclastic material. During this eruptive phase, most of the inhabitants managed to leave the city. However, 38% of the known victims were killed during this phase mainly as a consequence of roofs and walls collapsing under the increasing weight of the pumice lapilli deposit. During the second phase of the eruption (August 25, AD 79) 49% of the total victims were on the roadways and 51% inside buildings. All of these inhabitants, regardless of their location, were killed by the unanticipated PDCs overrunning the city. New data concerning the stratigraphic level of the victims in the pyroclastic succession allow us to discriminate between the sequential events responsible for their deaths. In fact, casts of some recently excavated corpses lay well above the lower PDCs deposit, testifying that some of the inhabitants survived the first pyroclastic current. Finally, during the PDCs phase the victims died quite rapidly by ash asphyxiation. From the attitude of some casts, it seems that some people survived the initial impact of the second pyroclastic current and tried to support head and bust during the progressive aggradation of the deposit at the base of the current.

  4. Abdominal mass

    MedlinePLUS

    Several conditions can cause an abdominal mass: Abdominal aortic aneurysm can cause a pulsating mass around the navel. ... This could be a sign of a ruptured aortic aneurysm, which is an emergency condition. Contact your health ...

  5. Truth was an early casualty

    SciTech Connect

    Sich, A.R.

    1996-05-01

    At a May 1986 press conference in Moscow-held just 11 days after the accident at the Chernobyl Nuclear Power Station-the cult of high technology was unabashedly preached to an auditorium full of shocked news correspondents and invited guests. When questioned as to the number of fatalities the accident had caused and the impact of the accident on Soviet society and the Soviet nuclear industry, A.M. Petrosyants (then chairman of the Soviet State Committee on the Utilization of Atomic Energy) responded: {open_quotes}Science requires victims.{close_quotes} The Soviet system numbered its victims in the millions. In a sense, the Chernobyl accident was just one of the many misfortunes misrepresented by the Soviet government over the decades in its continuing effort to shape public perceptions of domestic disasters, natural and manmade. And yet, the international character of the Chernobyl accident, the fact that radioactive fallout knows no national boundaries, made it a watershed event. The accident exposed glaring weaknesses in the Soviet system: its backward technology, its sloppy safety standards, its inability to admit failure. And it brought to the surface many of the injustices, inefficiencies, and secrets that the Soviet government had tried to keep hidden. With the world`s spotlight focused on Chernobyl, General Secretary Mikhail Gorbachev was left with little choice other than to prove to the West his dedication to reform by more fully implementing his recently announced policy of glasnost or `openness.` In turn, glasnost was a major factor that led to the demise of the Soviet Union, which embodied a system that was fundamentally at odds with freedom of expression and accessibile information. Unfortunately, old habits die hard. Ten years after the accident, many nuclear bureaucrats in the former Soviet Union, partiularly in Russia, are still too secretive and too much given to obfuscation.

  6. Grief Casualties on Skid Row.

    ERIC Educational Resources Information Center

    Hughes, Cornelius; Fleming, Dagmar

    1991-01-01

    Case study research in shelter for homeless men revealed small, but notable, minority suffering from unresolved grief resulting from death of spouse, child, parent, or other immediate family member, or to painful divorce. Failure to cope with grief appeared to have robbed them of will to maintain their social standing. (Author/NB)

  7. Mass spectrometry.

    NASA Technical Reports Server (NTRS)

    Burlingame, A. L.; Johanson, G. A.

    1972-01-01

    Review of the current state of mass spectrometry, indicating its unique importance for advanced scientific research. Mass spectrometry applications in computer techniques, gas chromatography, ion cyclotron resonance, molecular fragmentation and ionization, and isotope labeling are covered. Details are given on mass spectrometry applications in bio-organic chemistry and biomedical research. As the subjects of these applications are indicated alkaloids, carbohydrates, lipids, terpenes, quinones, nucleic acid components, peptides, antibiotics, and human and animal metabolisms. Particular attention is given to the mass spectra of organo-inorganic compounds, inorganic mass spectrometry, surface phenomena such as secondary ion and electron emission, and elemental and isotope analysis. Further topics include mass spectrometry in organic geochemistry, applications in geochronology and cosmochemistry, and organic mass spectrometry.

  8. Chemical weapon functional exercise--Cincinnati: observations and lessons learned from a "typical medium-sized" city's response to simulated terrorism utilizing Weapons of Mass Destruction.

    PubMed

    FitzGerald, Denis J; Sztajnkrycer, Matthew D; Crocco, Todd J

    2003-01-01

    In the wake of the September 11, 2001, attacks and the subsequent anthrax scare, there is growing concern about the United States' vulnerability to terrorist use of Weapons of Mass Destruction (WMD). As part of ongoing preparation for this terrible reality, many jurisdictions have been conducting simulated terrorist incidents to provide training for the public safety community, hospitals, and public health departments. As an example of this national effort to improve domestic preparedness for such events, a large scale, multi-jurisdictional chemical weapons drill was conducted in Cincinnati, Ohio, on May 20, 2000. This drill depicted the components of the early warning system for hospitals and public health departments, the prehospital medical response to terrorism. Over the course of the exercise, emergency medical services personnel decontaminated, triaged, treated, and transported eighty-five patients. Several important lessons were learned that day that have widespread applicability to health care delivery systems nationwide, especially in the areas of decontamination, triage, on-scene medical care, and victim transportation. As this training exercise helped Cincinnati to prepare for dealing with future large scale WMD incidents, such drills are invaluable preparation for all communities in a world increasingly at risk from terrorist attacks. PMID:12766215

  9. Guidance on the Use of Hand-Held Survey Meters for Radiological Triage: Time-Dependent Detector Count Rates Corresponding to 50, 250, and 500 mSv Effective Dose for Adult Males and Adult Females

    PubMed Central

    Bolch, Wesley E.; Hurtado, Jorge L.; Lee, Choonsik; Manger, Ryan; Hertel, Nolan; Dickerson, William

    2013-01-01

    In June of 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma-cameras in nuclear medicine departments operated as make-shift whole-body counters. Guidance on this approach is currently available from the CDC. This approach is feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however, substantially large numbers of individuals (100s to 1000s) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated – the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (<50, 50–250, 250–500, and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with either 241Am, 60Cs, 137Cs, 131I, and 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detectors types, positions, and screening distances. Measured count rates can be compared to these values and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening, and that the measurements be conducted in a low-background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website http://emergency.cdc.gov/radiation. PMID:22420020

  10. Mass Deacidification.

    ERIC Educational Resources Information Center

    Harris, Carolyn

    1979-01-01

    Reviews methods being developed for mass deacidification of books to prevent deterioration of paper. The use of diethyl zinc, liquified gas, and morpholine, and the advantages, disadvantages, and cost of each are considered. A 26-item bibliography is included. (JD)

  11. Mass Spectrometer 

    E-print Network

    Unknown

    2011-08-17

    The heat/mass trasfer distribution for turbulent flow in a rotating two-pass square channel having a sharp 180' turn were investigated via the naphthalene sublimation technique. The test section models the internal cooling ...

  12. Neonatal and pediatric regionalized systems in pediatric emergency mass critical care

    PubMed Central

    Barfield, Wanda D.; Krug, Steven E.; Kanter, Robert K.; Gausche-Hill, Marianne; Brantley, Mary D.; Chung, Sarita; Kissoon, Niranjan

    2015-01-01

    Introduction Improved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches. Methods In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations. Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6–7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29–30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. Task Force Recommendations States and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity. PMID:22067921

  13. The Laser Ablation Ion Funnel: Sampling for in situ Mass Spectrometry on Mars

    NASA Technical Reports Server (NTRS)

    Johnson, Paul V.; Hodyss, Robert; Tang, Keqi; Brinckerhoff, William B.; Smith, Richard D.

    2011-01-01

    A considerable investment has been made by NASA and other space agencies to develop instrumentation suitable for in situ analytical investigation of extra terrestrial bodies including various mass spectrometers (time-of-flight, quadrupole ion trap, quadrupole mass filters, etc.). However, the front-end sample handling that is needed to collect and prepare samples for interrogation by such instrumentation remains underdeveloped. Here we describe a novel approach tailored to the exploration of Mars where ions are created in the ambient atmosphere via laser ablation and then efficiently transported into a mass spectrometer for in situ analysis using an electrodynamic ion funnel. This concept would enable elemental and isotopic analysis of geological samples with the analysis of desorbed organic material a possibility as well. Such an instrument would be suitable for inclusion on all potential missions currently being considered such as the Mid-Range Rover, the Astrobiology Field Laboratory, and Mars Sample Return (i.e., as a sample pre-selection triage instrument), among others.

  14. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools.

    PubMed

    Ingrassia, Pier Luigi; Ragazzoni, Luca; Tengattini, Marco; Carenzo, Luca; Della Corte, Francesco

    2014-10-01

    In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of "Disaster Health" according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants' knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools. Table 1 List of Modules and Topics Module Topics 1. Introduction to disaster medicine and public health during emergencies - Modern taxonomy of disaster and common disaster medicine definitions - Differences between disaster and emergency medicine - Principles of public health during disasters - Different phases of disaster management 2. Prehospital disaster management - Mass-casualty disposition, treatment area, and transport issues - Disaster plans and command-and-control chain structure - Functional response roles 3. Specific disaster medicine and triage procedures in the - Mass-casualty triage definitions and principles management of disasters - Different methodologies and protocols - Patient assessment, triage levels and tags 4. Hospital disaster preparedness and response - Hospital disaster laws - Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach - Medical management for a massive influx of casualties 5. Health consequences of different disasters - Characteristics of different types of disasters - Health impact of natural and man-made disasters - Disaster-related injury after exposure to a different disasters with an all-hazard approach 6. Psychosocial care - Techniques to deal with psychic reactions caused by exposure to disaster scenarios - Treatment approaches to acute and delayed critical incident stress reactions 7. Presentation of past disasters and public health emergencies, and Case study: review of assistance experiences - Haiti earthquake - Cholera outbreaks in Haiti - National and international disaster response mechanism Ingrassia PL , Ragazzoni L , Tengattini M , Carenzo L , Della Corte F . Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended lear

  15. Mass spectrometry

    SciTech Connect

    Burlingame, A.L.; Maltby, D.; Russell, D.H.; Holland, P.T.

    1988-06-15

    This review series has served as a timely means to provide critical discussion of the advances and directions, strengths and weaknesses, and the state of maturity and promise of both new and established strategies and methods in a unifying single source. Widely disparate discoveries, inventions, and purposeful developments are required to enable mass spectrometric based strategies to take hold and make inroads into new types of issues at the molecular level of biological, medical, and chemical sciences. These are interdisciplinary endeavors. Of necessity, they have been selective both in the topics covered and in the contributions included but have endeavored to be sufficiently general so that both the new reader and the expert might readily find further literature and necessary detail. They have attempted to provide a thematic context for each topic. They note that this review series has a cumulative continuity about it, and the previous few Overview sections are still timely.

  16. Characterization of environmental samples using ion trap-secondary ion mass spectrometry

    SciTech Connect

    Groenewold, G.S.; Appelhans, A.D.; Ingram, J.C.

    1998-02-01

    The detection of chemical warfare agent residues on environmental surfaces is an important analytical activity because of the potential for proliferation of these weapons, and for environmental monitoring in areas where they are stored. Historically, one of the most widely used agents has been bis(2-chloroethyl) sulfide, also known as mustard gas and HD. It was initially used in combat in 1917; by the end of the First World War, more than 16% of all casualties were due to chemicals, in most cases mustard. Manufacture of mustard is continuing to this day; consequently, there are ongoing opportunities for exposure. 2-Chloroethyl ethyl sulfide (CEES) is used as a simulant for mustard (HD) in a study to develop secondary ion mass spectrometry (SIMS) for rapid, semi-quantitative detection of mustard on soil. Using SIMS with single stage mass spectrometry, a signature for CEES can be unequivocally observed only at the highest concentrations (0.1 monolayer and above). Selectivity and sensitivity are markedly improved employing multiple-stage mass spectrometry using an ion trap. C{sub 2}H{sub 5}SC{sub 2}H{sub 4}{sup +} from CEES eliminates C{sub 2}H{sub 4} and H{sub 2}S, which are highly diagnostic. CEES was detected at 0.0012 monolayer on soil. A single analysis could be conducted in under 5 minutes.

  17. Preventing post-traumatic stress disorder after mass exposure to violence.

    PubMed

    Boris, Neil W; Ou, Alan C; Singh, Rohini

    2005-01-01

    Bioterrorism preparedness plans must take into account the psychosocial consequences of exposure to mass violence. If possible, post-traumatic stress disorder (PTSD), which is associated with significant morbidity and cost, should be prevented. There are, however, no effective interventions that have been scaled up to prevent PTSD following mass exposure to violence. In fact, randomized controlled trials of the most commonly used preventive intervention, psychological debriefing, suggest no efficacy, or even potential harm. Fortunately, randomized controlled trials of cognitive behavioral therapy--that is, targeting individuals who are symptomatic in the weeks after trauma--reveal significant efficacy. Given the potential for repeated mass violence exposure, public health professionals need to refine methods for screening and tracking large numbers of casualties. At the same time, the use of telephone and internet-based cognitive behavioral therapy protocols should be further tested as strategies for bringing the only effective early intervention for PTSD to scale. Research on preventive pharmacotherapy for PTSD and on the effects of media exposure on PTSD severity is also a priority. PMID:16000047

  18. Pattern of patients and diseases during mass transit: The day of Arafat experience

    PubMed Central

    Sindy, Abdulfattah I.; Baljoon, Mostafa Jamil; Zubairi, Nadeem Alam; Dhafar, Khalid Obaid; Gazzaz, Zohair Jamil; Deiab, Basma Abdulhameed; Hothali, FauzeaTalea Al

    2015-01-01

    Background and Objective: Every year 2-3 million Muslims gather for a few days around the Holy city of Makkah in Saudi Arabia to perform Hajj. Managing enormous health issues associated with such a mass gathering requires a very vibrant health delivery plan. Related research is part of the strategy. This study was done to assess the pattern of patients and illnesses encountered at one health facility at Arafat on the 2nd day of Hajj, when all the pilgrims move from Mina and stay in Arafat for a few hours. The objective of the study was to provide input so that recommendations can be given for future improvement of health care during this mass transit. Methods: All patients reporting sick to the Nimra Hospital on the Day of Arafat were included and documented on a detailed Performa and analyzed. Results: We received 211 patients, essentially all of those were in need of acute medical intervention. Acute severe asthma and injuries were the major problems encountered. There were two deaths both related to heat stroke. Patients received were predominantly Arabic speaking. Conclusions: Only those needing acute intervention seek medical advice during transit. Well equipped and staffed health facilities are, however, needed to cater these and for any mass casualties. Pre Hajj training and mandatory Flu vaccination can help. PMID:26648994

  19. Plastic surgeons and the management of trauma: from the JFK assassination to the Boston Marathon bombing.

    PubMed

    Luce, Edward A; Hollier, Larry H; Lin, Samuel J

    2013-11-01

    The fiftieth anniversary of the death by assassination of President John Kennedy is an opportunity to pay homage to his memory and also reflect on the important role plastic surgeons have played in the management of trauma. That reflection included a hypothetical scenario, a discussion of the surgical treatment of Kennedy (if he survived) and Governor Connally. The scenario describes the management of cranioplasty in the presence of scalp soft-tissue contracture, reconstruction of the proximal trachea, reconstitution of the abdominal wall, and restoration of a combined radius and soft-tissue defect. The development of diagnostic and therapeutic advances over the past 50 years in the care of maxillofacial trauma is described, including the evolution of imaging, timing of surgery, and operative techniques. Finally, contemporary measures of triage in situations involving mass casualties, as in the Boston Marathon bombings, complete the dedication to President Kennedy. PMID:24165614

  20. An Automated Method to Quantify Radiation Damage in Human Blood Cells

    SciTech Connect

    Gordon K. Livingston, Mark S. Jenkins and Akio A. Awa

    2006-07-10

    Cytogenetic analysis of blood lymphocytes is a well established method to assess the absorbed dose in persons exposed to ionizing radiation. Because mature lymphocytes circulate throughout the body, the dose to these cells is believed to represent the average whole body exposure. Cytogenetic methods measure the incidence of structural aberrations in chromosomes as a means to quantify DNA damage which occurs when ionizing radiation interacts with human tissue. Methods to quantify DNA damage at the chromosomal level vary in complexity and tend to be laborious and time consuming. In a mass casualty scenario involving radiological/nuclear materials, the ability to rapidly triage individuals according to radiation dose is critically important. For high-throughput screening for dicentric chromosomes, many of the data collection steps can be optimized with motorized microscopes coupled to automated slide scanning platforms.

  1. [Current organization of disaster medicine].

    PubMed

    Julien, Henri

    2013-12-01

    The concept of disaster medicine, derivedfrom medical management of casualties caused by terrorist attacks or earthquakes, began to be taught in medical school in 1982. It adapts military intervention tactics to civilian practices, and differentiates major disasters (in which preformed teams are sent to the scene) from disasters with limited effects (predefined plans form the backbone of the rescue organization). Management of blast and crush syndromes, triage, care of numerous burn victims, on-site amputation, necrotomy, medicopsychological support, mass decontamination, and rescue management are some of the aspects with which physicians should be familiar. Predefined intervention teams and ad hoc materials have been created to provide autonomous logistic support. Regulations, ethical aspects and managerial methods still need to be refined, and research and teaching must be given a new impetus. PMID:26137817

  2. Mass definition, mass measurement and recommendations

    SciTech Connect

    Braudaway, D.W.

    1990-09-01

    Mass measurements may be greatly enhanced by an understanding of the operation of balances, the effects of buoyancy, practices encountered in weighing and the impacts and meanings of revelant mass standards. Beginning with the basic forces acting on weights, the equations brought to equality in balances are developed. These give explanation of the weighing process and an appreciation for some balance characteristics. The requirements of relevant mass standards are also reviewed. Recommendations are made for operation of practical mass calibration. An appendix is attached which gives computation examples using apparent mass'' and also gives a method for determining the density of mass artifacts or unknown materials. 2 tabs.

  3. Accurate Gene Expression-Based Biodosimetry Using a Minimal Set of Human Gene Transcripts

    SciTech Connect

    Tucker, James D.; Joiner, Michael C.; Thomas, Robert A.; Grever, William E.; Bakhmutsky, Marina V.; Chinkhota, Chantelle N.; Smolinski, Joseph M.; Divine, George W.; Auner, Gregory W.

    2014-03-15

    Purpose: Rapid and reliable methods for conducting biological dosimetry are a necessity in the event of a large-scale nuclear event. Conventional biodosimetry methods lack the speed, portability, ease of use, and low cost required for triaging numerous victims. Here we address this need by showing that polymerase chain reaction (PCR) on a small number of gene transcripts can provide accurate and rapid dosimetry. The low cost and relative ease of PCR compared with existing dosimetry methods suggest that this approach may be useful in mass-casualty triage situations. Methods and Materials: Human peripheral blood from 60 adult donors was acutely exposed to cobalt-60 gamma rays at doses of 0 (control) to 10 Gy. mRNA expression levels of 121 selected genes were obtained 0.5, 1, and 2 days after exposure by reverse-transcriptase real-time PCR. Optimal dosimetry at each time point was obtained by stepwise regression of dose received against individual gene transcript expression levels. Results: Only 3 to 4 different gene transcripts, ASTN2, CDKN1A, GDF15, and ATM, are needed to explain ?0.87 of the variance (R{sup 2}). Receiver-operator characteristics, a measure of sensitivity and specificity, of 0.98 for these statistical models were achieved at each time point. Conclusions: The actual and predicted radiation doses agree very closely up to 6 Gy. Dosimetry at 8 and 10 Gy shows some effect of saturation, thereby slightly diminishing the ability to quantify higher exposures. Analyses of these gene transcripts may be advantageous for use in a field-portable device designed to assess exposures in mass casualty situations or in clinical radiation emergencies.

  4. Primary mass standard based on atomic masses

    NASA Astrophysics Data System (ADS)

    Becker, Peter; Gläser, Michael

    2006-04-01

    The paper summarises the activities of several national and international Metrology Institutes in replacing the kilogram artefact, the unit of mass, by the mass of a certain number of atoms, in particular the atomic masses of silicon or bismuth. This task is based on two different experiments: a very accurate determination of the Avogadro constant, NA, measuring the density and lattice parameter of an enriched silicon-28 crystal, and the accumulation of decelerated bismuth-209 ions by using a mass separator. The relative measurement uncertainties reached so far are in the first case 2 parts in 107, and in the latter several part in 104. The bismuth experiment is still in an early state of the work. The ratios between the masses of 28Si or 209Bi, respectively, and the present atomic mass standard, the mass of 12C, can be determined with an accuracy now approaching 10-10 using high precision Penning traps mass spectrometers.

  5. Mass eigenstates and mass eigenvalues of seesaw

    E-print Network

    Takuya Morozumi

    2005-12-30

    The light neutrino mass spectrum and mixing matrix of seesaw model including three right-handed neutrinos are studied for the most general case. An approximate formulae for mass eigenvalues, mixing matrix, and CP violation of neutrino oscillations are given.

  6. Alienation, Mass Society and Mass Culture.

    ERIC Educational Resources Information Center

    Dam, Hari N.

    This monograph examines the nature of alienation in mass society and mass culture. Conceptually based on the "Gemeinschaft-Gesellschaft" paradigm of sociologist Ferdinand Tonnies, discussion traces the concept of alienation as it appears in the philosophies of Hegel, Marx, Kierkegaard, Sartre, and others. Dwight Macdonald's "A Theory of Mass

  7. New information technology tools for a medical command system for mass decontamination.

    PubMed

    Fuse, Akira; Okumura, Tetsu; Hagiwara, Jun; Tanabe, Tomohide; Fukuda, Reo; Masuno, Tomohiko; Mimura, Seiji; Yamamoto, Kaname; Yokota, Hiroyuki

    2013-06-01

    In a mass decontamination during a nuclear, biological, or chemical (NBC) response, the capability to command, control, and communicate is crucial for the proper flow of casualties at the scene and their subsequent evacuation to definitive medical facilities. Information Technology (IT) tools can be used to strengthen medical control, command, and communication during such a response. Novel IT tools comprise a vehicle-based, remote video camera and communication network systems. During an on-site verification event, an image from a remote video camera system attached to the personal protective garment of a medical responder working in the warm zone was transmitted to the on-site Medical Commander for aid in decision making. Similarly, a communication network system was used for personnel at the following points: (1) the on-site Medical Headquarters; (2) the decontamination hot zone; (3) an on-site coordination office; and (4) a remote medical headquarters of a local government office. A specially equipped, dedicated vehicle was used for the on-site medical headquarters, and facilitated the coordination with other agencies. The use of these IT tools proved effective in assisting with the medical command and control of medical resources and patient transport decisions during a mass-decontamination exercise, but improvements are required to overcome transmission delays and camera direction settings, as well as network limitations in certain areas. PMID:23388578

  8. Mass shooting in Colorado: practice drills, disaster preparations key to successful emergency response.

    PubMed

    2012-10-01

    While EDs are accustomed to preparing for mass-casualty events, the EDs responsible for caring for the victims of the mass shooting at an Aurora, CO, movie theater on July 20, 2012, say the emotional impact of dealing with such a senseless, horrific event remains challenging. Still, the ED directors from the two hospitals who cared for the most patients that night credit established disaster-response procedures and regular practice drills with helping them to successfully manage the crisis. Within a 30-minute time period, the University of Colorado's Anschutz Medical Campus in Aurora, CO, received 23 critically ill or injured patients, one of which was deceased upon arrival.There were no additional fatalities among the remaining 22 patients. The Medical Center of Aurora received 18 patients, 13 of which where suffering from gun shot wounds; all survived. Hospital administrators say ED providers and staff have responded in different ways to the tragedy, but the emotional impact has been difficult for some. Resources, ranging from spiritual support and grief counselors to psychiatric help, have been made available to help ED personnel access the kind of help they need. PMID:23045762

  9. Advanced Trauma Life Support aboard RFA Argus.

    PubMed

    Greenslade, G L; Taylor, R H

    1992-01-01

    The Advanced Trauma Life Support (ATLS) system was adopted for casualty reception and resuscitation. ATLS permitted well-informed triage decisions to be made, coupled with appropriate initial, possibly life-saving, treatment. The training given on board has continued to benefit patients treated by ex-Argus staff in their peacetime roles. PMID:1453364

  10. Ultra High Mass Range Mass Spectrometer System

    DOEpatents

    Reilly, Peter T. A. [Knoxville, TN

    2005-12-06

    Applicant's present invention comprises mass spectrometer systems that operate in a mass range from 1 to 10.sup.16 DA. The mass spectrometer system comprising an inlet system comprising an aerodynamic lens system, a reverse jet being a gas flux generated in an annulus moving in a reverse direction and a multipole ion guide; a digital ion trap; and a thermal vaporization/ionization detector system. Applicant's present invention further comprises a quadrupole mass spectrometer system comprising an inlet system having a quadrupole mass filter and a thermal vaporization/ionization detector system. Applicant's present invention further comprises an inlet system for use with a mass spectrometer system, a method for slowing energetic particles using an inlet system. Applicant's present invention also comprises a detector device and a method for detecting high mass charged particles.

  11. The view from the trenches: part 2-technical considerations for EPR screening.

    PubMed

    Nicolalde, Roberto J; Gougelet, Robert M; Rea, Michael; Williams, Benjamin B; Dong, Ruhong; Kmiec, Maciej M; Lesniewski, Piotr N; Swartz, Harold M

    2010-02-01

    There is growing awareness of the need for methodologies that can be used retrospectively to provide the biodosimetry needed to carry out screening and triage immediately after an event in which large numbers of people have potentially received clinically significant doses of ionizing radiation. The general approach to developing such methodologies has been a technology centric one, often ignoring the system integrations considerations that are key to their effective use. In this study an integrative approach for the evaluation and development of a physical biodosimetry technology was applied based on in vivo electron paramagnetic resonance (EPR) dosimetry. The EPR measurements are based on physical changes in tissues whose magnitudes are not affected by the factors that can confound biologically-based assessments. In this study the use of a pilot simulation exercise to evaluate an experimental EPR system and gather stakeholders' feedback early on in the development process is described. The exercise involved: ten non-irradiated participants, representatives from a local fire department; Department of Homeland Security certified exercise evaluators, EPR experts, physicians; and a human factors engineer. Stakeholders were in agreement that the EPR technology in its current state of development could be deployed for the screening of mass casualties. Furthermore, stakeholders' recommendations will be prioritized and incorporated in future developments of the EPR technique. While the results of this exercise were aimed specifically at providing feedback for the development of EPR dosimetry for screening mass casualties, the methods and lessons learned are likely to be applicable to other biodosimetric methods. PMID:20065674

  12. Civilian exposure to toxic agents: emergency medical response.

    PubMed

    Baker, David

    2004-01-01

    Civilian populations are at risk from exposure to toxic materials as a result of accidental or deliberate exposure. In addition to industrial hazards, toxic agents designed for use in warfare now are a potential hazard in everyday life through terrorist action. Civil emergency medical responders should be able to adapt their plans for dealing with casualties from hazardous materials (HazMat) to deal with the new threat. Chemical and biological warfare (CBW) and HazMat agents can be viewed as a continuous spectrum. Each of these hazards is characterized by qualities of toxicity, latency of action, persistency, and transmissibility. The incident and medical responses to release of any agent is determined by these characteristics. Chemical and biological wardare agents usually are classified as weapons of mass destruction, but strictly, they are agents of mass injury. The relationship between mass injury and major loss of life depends very much on the protection, organization, and emergency care provided. Detection of a civil toxic agent release where signs and symptoms in casualties may be the first indicator of exposure is different from the military situation where intelligence information and tuned detection systems generally will be available. It is important that emergency medical care should be given in the context of a specific action plan. Within an organized and protected perimeter, triage and decontamination (if the agent is persistent) can proceed while emergency medical care is provided at the same time. The provision of advanced life support (TOXALS) in this zone by protected and trained medical responders now is technically feasible using specially designed ventilation equipment. Leaving life support until after decontamination may have fatal consequences. Casualties from terrorist attacks also may suffer physical as well as toxic trauma and the medical response also should be capable of dealing with mixed injuries. PMID:15506255

  13. Advanced Technology Applications for Combat Casualty Care

    NASA Technical Reports Server (NTRS)

    Watkins, Sharmila; Baumann, David; Wu, Jimmy

    2010-01-01

    Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC s goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions.

  14. The Common Core's First Casualty: Playful Learning

    ERIC Educational Resources Information Center

    Bowdon, Jill

    2015-01-01

    Although the Common Core standards do not prescribe pedagogy or forbid playful learning, kindergarten teachers will find it challenging to maintain a playful classroom under this reform. Kindergarten teachers have to cover a more rigorous and accelerated curriculum now, and they are doing so in a context that rewards procedural teaching.

  15. War casualties on the home front

    SciTech Connect

    Brenda J. Flinn

    2005-11-01

    On May 12, 1942, at Christopher coal mine No. 3 in Osage, West Virginia, a continent away from the frontlines of World War II, Superintendent Ed O'Neil saw the mine ventilation fan suddenly run backwards, propelled by a strong gust of air that tore the belt off the huge blower. The second shift mantrip of 115 coal miners, traversing the drift mouth for the 3:00 p.m. shift, ground to an uneasy halt. The article recounts the tragic consequences of this incident. It also tells of other events affecting coal miners during World War I and World War II.

  16. Childhood casualties during civil war: Syrian experience.

    PubMed

    Çelikel, Adnan; Karbeyaz, Kenan; Kararslan, Bekir; Arslan, M Mustafa; Zeren, Cem

    2015-08-01

    In war areas a lot of children die as well as adults. According to UNICEF, almost 2 million children have died in the wars took place in the last 10 years. In this study, we aimed to evaluate demographical data and injury characteristics of Syrian children who were wounded in Syria Civil War and died while being treated in Turkey. Postmortem examination and autopsy reports of 985 forensic deaths from Hatay -a Syrian neighborhood city of Turkey-between January 2012 and August 2014 were analyzed retrospectively. Among 763 Syrian people who were wounded in the war and died while being treated in Turkey, 140 cases (18.3%) who were younger than 18 years of age were taken into the scope of this study. Among those cases 77.9% (n = 109) were male and 22.1% were female. Median ages of female cases are 14 (min-max: 2-18) and median age of female cases are 9 (min-max: 1-18). Frequency distribution is highest between 13 and 18 years of age (n: 71, 50.7%). In 70% (n: 98) of cases, cause of death is bombing and shrapnel injuries, 13.6% (19) of them were killed by gunshot wounds. According to injury sites most of the injuries were reported to be on multiple body parts (54.3%, n: 76) and only head and neck injuries (%30). Cause of death was intracranial bleeding and cerebral parenchymal injury in most of the cases (n: 66, %47.1) followed by vascular damage with external bleeding (n: 15, %10.7) and internal organ damage with internal bleeding (n: 15, %10.7). The cases had very high level Abbreviated Injury Scales and Injury Severity Sores. In conclusion, a lot of children have died in the Civil War of Syria. Their average abbreviated injury scale and injury severity score values reported very high. Children that we evaluated were mostly died of head and neck injuries predominantly caused by bombing attacks and Autopsies of them revealed fatal intracranial hemorrhages and parenchymal injuries. PMID:26165650

  17. Bio-Terrorism Threat and Casualty Prevention

    SciTech Connect

    NOEL,WILLIAM P.

    2000-01-01

    The bio-terrorism threat has become the ''poor man's'' nuclear weapon. The ease of manufacture and dissemination has allowed an organization with only rudimentary skills and equipment to pose a significant threat with high consequences. This report will analyze some of the most likely agents that would be used, the ease of manufacture, the ease of dissemination and what characteristics of the public health response that are particularly important to the successful characterization of a high consequence event to prevent excessive causalities.

  18. Case study documenting the diagnosis of idiopathic CD4+ Lymphocytopenia in a patient with atypical fungal infection (disseminated blastomycosis) by FNA of adrenal mass

    PubMed Central

    Siderits, Richard H; Ouattara, Osman; Marcus, Alan; Gao, Hong Guang; Deng, Hong Bing; Godyn, Janusz

    2010-01-01

    Idiopathic CD4+ lymphocytopenia, described in 1992 by the Centers for Disease Control, is characterized by persistent CD4+ lymphocytopenia (less than 300 cells per micro-liter) in nonimmunosuppressed, HIV negative individuals, who present with atypical infections. This rare though likely undiagnosed entity is associated with chronic disseminated forms of either fungal or bacterial infections in otherwise healthy adults. We report a case of a 59-year-old male with ring-enhancing brain lesions, bilateral adrenal masses, lung and vocal cord nodules, where the diagnosis of exclusion was metastatic malignancy. Fine needle aspiration (FNA) of the adrenal mass and a subsequent vocal cord biopsy confirmed chronic widely disseminated blastomycosis. Flow cytometric evaluation of peripheral blood documented persistent selective CD4+ lymphocytopenia with T8 (suppressor) T-Lymphocyte count within normal range. We believe that idiopathic CD4+ lymphocytopenia is an important etiologic factor to be considered for patients who present with mass lesions and are diagnosed by FNA with atypical fungal infections. We relate the diagnostic criteria for idiopathic CD4+ lymphocytopenia and the importance of providing on-site triage for FNA samples for fungal studies and correlation for flow cytometry. PMID:20806085

  19. Mass spectrometric immunoassay

    DOEpatents

    Nelson, Randall W (Phoenix, AZ); Williams, Peter (Phoenix, AZ); Krone, Jennifer Reeve (Granbury, TX)

    2007-12-04

    Rapid mass spectrometric immunoassay methods for detecting and/or quantifying antibody and antigen analytes utilizing affinity capture to isolate the analytes and internal reference species (for quantification) followed by mass spectrometric analysis of the isolated analyte/internal reference species. Quantification is obtained by normalizing and calibrating obtained mass spectrum against the mass spectrum obtained for an antibody/antigen of known concentration.

  20. Mass spectrometric immunoassay

    DOEpatents

    Nelson, Randall W.; Williams, Peter; Krone, Jennifer Reeve

    2005-12-13

    Rapid mass spectrometric immunoassay methods for detecting and/or quantifying antibody and antigen analytes utilizing affinity capture to isolate the analytes and internal reference species (for quantification) followed by mass spectrometric analysis of the isolated analyte/internal reference species. Quantification is obtained by normalizing and calibrating obtained mass spectrum against the mass spectrum obtained for an antibody/antigen of known concentration.

  1. Mass spectrometric immunoassay

    DOEpatents

    Nelson, Randall W; Williams, Peter; Krone, Jennifer Reeve

    2013-07-16

    Rapid mass spectrometric immunoassay methods for detecting and/or quantifying antibody and antigen analytes utilizing affinity capture to isolate the analytes and internal reference species (for quantification) followed by mass spectrometric analysis of the isolated analyte/internal reference species. Quantification is obtained by normalizing and calibrating obtained mass spectrum against the mass spectrum obtained for an antibody/antigen of known concentration.

  2. Heavy quark masses

    NASA Technical Reports Server (NTRS)

    Testa, Massimo

    1990-01-01

    In the large quark mass limit, an argument which identifies the mass of the heavy-light pseudoscalar or scalar bound state with the renormalized mass of the heavy quark is given. The following equation is discussed: m(sub Q) = m(sub B), where m(sub Q) and m(sub B) are respectively the mass of the heavy quark and the mass of the pseudoscalar bound state.

  3. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies

    PubMed Central

    Kaijser, J.

    2015-01-01

    Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more “evidence-based”. These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal “evidence-based” approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care). These important themes will likely control the future agenda of the IOTA project. PMID:25897371

  4. Imaging mass spectrometer with mass tags

    DOEpatents

    Felton, James S.; Wu, Kuang Jen J.; Knize, Mark G.; Kulp, Kristen S.; Gray, Joe W.

    2013-01-29

    A method of analyzing biological material by exposing the biological material to a recognition element, that is coupled to a mass tag element, directing an ion beam of a mass spectrometer to the biological material, interrogating at least one region of interest area from the biological material and producing data, and distributing the data in plots.

  5. Imaging mass spectrometer with mass tags

    DOEpatents

    Felton, James S.; Wu, Kuang Jen; Knize, Mark G.; Kulp, Kristen S.; Gray, Joe W.

    2010-06-01

    A method of analyzing biological material by exposing the biological material to a recognition element, that is coupled to a mass tag element, directing an ion beam of a mass spectrometer to the biological material, interrogating at least one region of interest area from the biological material and producing data, and distributing the data in plots.

  6. The interaction between speed camera enforcement and speed-related mass media publicity in Victoria, Australia.

    PubMed

    Cameron, M H; Newstead, S V; Diamantopoulou, K; Oxley, P

    2003-01-01

    The objective was to measure the presence of any interaction between the effect of mobile covert speed camera enforcement and the effect of intensive mass media road safety publicity with speed-related themes. During 1999, the Victoria Police varied the levels of speed camera activity substantially in four Melbourne police districts according to a systematic plan. Camera hours were increased or reduced by 50% or 100% in respective districts for a month at a time, during months when speed-related publicity was present and during months when it was absent. Monthly frequencies of casualty crashes, and their severe injury outcome, in each district during 1996-2000 were analysed to test the effects of the enforcement, publicity and their interaction. Reductions in crash frequency were associated monotonically with increasing levels of speed camera ticketing, and there was a statistically significant 41% reduction in fatal crash outcome associated with very high camera activity. High publicity awareness was associated with 12% reduction in crash frequency. The interaction between the enforcement and publicity was not statistically significant. PMID:12941230

  7. Mass and Elite Views on Nuclear Security: US National Security Surveys 1993-1999

    SciTech Connect

    HERRON,KERRY G.; JENKINS-SMITH,HANK C.; HUGHES,SCOTT D.

    2000-06-01

    This is the fourth report in an ongoing series of studies examining how US perspectives about nuclear security are evolving in the post-Cold War era. In Volume 1 the authors present findings from a nationwide telephone survey of randomly selected members of the US general public conducted from 13 September to 14 October 1999. Results are compared to findings from previous surveys in this series conducted in 1993, 1995, and 1997, and trends are analyzed. Key areas of investigation reported in Volume 1 include evolving perceptions of nuclear weapons risks and benefits, preferences for related policy and spending issues, and views about three emerging issue areas: deterrent utility of precision guided munitions; response options to attacks in which mass casualty weapons are used; and expectations about national missile defenses. In this volume they relate respondent beliefs about nuclear security to perceptions of nuclear risks and benefits and to policy preferences. They develop causal models to partially explain key preferences, and they employ cluster analysis to group respondents into four policy relevant clusters characterized by similar views and preferences about nuclear security within each cluster. Systematic links are found among respondent demographic characteristics, perceptions of nuclear risks and benefits, policy beliefs, and security policy and spending preferences. In Volume 2 they provide analysis of in-depth interviews with fifty members of the US security policy community.

  8. Mass Psychogenic Illness

    MedlinePLUS

    ... time even though there is no physical or environmental reason for them to be sick. Is mass ... outbreaks of mass psychogenic illness start with an environmental "trigger." The environmental trigger can be a bad ...

  9. Improved Jänecke mass formula

    NASA Astrophysics Data System (ADS)

    He, Z.; Bao, M.; Zhao, Y. M.; Arima, A.

    2014-11-01

    In this paper we improve an empirical mass formula constructed by Jänecke and collaborators. This formula is enlightened by the Garvey-Kelson mass relations. The new version of the Jänecke formula reproduces 2275 atomic masses with neutron number N ?10 and proton number Z ?6 , at an average accuracy of 128 keV, by employing 576 parameters. The predictive power of our formula is exemplified by comparison with predicted results of other mass models.

  10. Evanescent gravitational mass

    E-print Network

    Lluis Bel

    2009-05-17

    A simple and {\\it innocent} modification of Poisson's equation leads to a modified Newtonnian theory of gravitation where a localized and {\\it positive} energy density of the gravitational field contributes to its own source. The result is that the total {\\it active gravitational mass} of a compact object is the sum of its {\\it proper mass} and an {\\it evanescent gravitational mass} which is a mass equivalent to the gravitational energy.

  11. On Defining Mass

    ERIC Educational Resources Information Center

    Hecht, Eugene

    2011-01-01

    Though central to any pedagogical development of physics, the concept of mass is still not well understood. Properly defining mass has proven to be far more daunting than contemporary textbooks would have us believe. And yet today the origin of mass is one of the most aggressively pursued areas of research in all of physics. Much of the excitement…

  12. Elbow mass flow meter

    DOEpatents

    McFarland, Andrew R. (College Station, TX); Rodgers, John C. (Santa Fe, NM); Ortiz, Carlos A. (Bryan, TX); Nelson, David C. (Santa Fe, NM)

    1994-01-01

    Elbow mass flow meter. The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity.

  13. Seismic mass Top electrode

    E-print Network

    Kraft, Michael

    by the suspension system of the seismic mass, which is either a "swastika"or an "articulated" design. Another difference in the design is that the seismic mass may be solid or hollow. Fig. 4.1 shows an exploded view of a sensing element with a "swastika"seismic mass; fig. 4.2 the centre electrode of the "articulated"design

  14. Top quark mass measurements

    SciTech Connect

    Hill, Christopher S.; /UC, Santa Barbara

    2004-12-01

    The top quark, with its extraordinarily large mass (nearly that of a gold atom), plays a significant role in the phenomenology of EWSB in the Standard Model. In particular, the top quark mass when combined with the W mass constrains the mass of the as yet unobserved Higgs boson. Thus, a precise determination of the mass of the top quark is a principal goal of the CDF and D0 experiments. With the data collected thus far in Runs 1 and 2 of the Tevatron, CDF and D0 have measured the top quark mass in both the lepton+jets and dilepton decay channels using a variety of complementary experimental techniques. The author presents an overview of the most recent of the measurements.

  15. Neutrino mass anarchy

    PubMed

    Hall; Murayama; Weiner

    2000-03-20

    What is the form of the neutrino mass matrix which governs the oscillations of the atmospheric and solar neutrinos? Features of the data have led to a dominant viewpoint where the mass matrix has an ordered, regulated pattern, perhaps dictated by a flavor symmetry. We challenge this viewpoint and demonstrate that the data are well accounted for by a neutrino mass matrix which appears to have random entries. PMID:11017272

  16. Bounding gauged Skyrmion masses

    SciTech Connect

    Brihaye, Yves; Hill, Christopher T.; Zachos, Cosmas K.

    2004-12-01

    Normally, standard (ungauged) skyrmion masses are proportional to the coupling of the Skyrme term needed for stability, and so can grow to infinite magnitude with increasing coupling. In striking contrast, when skyrmions are gauged, their masses are bounded above for any Skyrme coupling, and, instead, are of the order of monopole masses, O(v/g), so that the coupling of the Skyrme term is not very important. This boundedness phenomenon and its implications are investigated.

  17. Residential Thermal Mass Construction 

    E-print Network

    Thieken, J. S.

    1988-01-01

    -hour period. The interior of a building with mass, on the other hand, would not rise as high or fall as low. Also, the high and low peak temperatures would be greatly delayed. The reason for this moderating effect is that the mass absorbs... the heat and delays its transfer. In more technical terms, the thermal mass effect (TME) is the reduction in a building's heating and cooling energy caused by absolute reductions and shifting of dynamic heat fluxes through a massive envelope...

  18. Neutrino Mass Anarchy

    NASA Astrophysics Data System (ADS)

    Hall, Lawrence; Murayama, Hitoshi; Weiner, Neal

    2000-03-01

    What is the form of the neutrino mass matrix which governs the oscillations of the atmospheric and solar neutrinos? Features of the data have led to a dominant viewpoint where the mass matrix has an ordered, regulated pattern, perhaps dictated by a flavor symmetry. We challenge this viewpoint and demonstrate that the data are well accounted for by a neutrino mass matrix which appears to have random entries.

  19. BIOLOGICAL ANALYSIS Mass Spectrometry

    E-print Network

    Painter, Kevin

    Single Crystal X-ray Diffractometry Mass Spectrometry Elemental Analysis (CHN) Other Analytical Methods chamber with Near field scanner Superconductor Chamber Microwave Network Analysers OPTICAL DIAGNOSTICS

  20. Light Quark Mass Reweighting

    E-print Network

    Qi Liu; Norman H. Christ; Chulwoo Jung

    2012-06-01

    We present a systematic study of the effectiveness of light quark mass reweighting. This method allows a single lattice QCD ensemble, generated with a specific value of the dynamical light quark mass, to be used to determine results for other, nearby light dynamical quark masses. We study two gauge field ensembles generated with 2+1 flavors of dynamical domain wall fermions with light quark masses m_l=0.02 (m_\\pi=620 MeV) and m_l=0.01 (m_\\pi=420 MeV). We reweight each ensemble to determine results which could be computed directly from the other and check the consistency of the reweighted results with the direct results. The large difference between the 0.02 and 0.01 light quark masses suggests that this is an aggressive application of reweighting as can be seen from fluctuations in the magnitude of the reweighting factor by four orders of magnitude. Never-the-less, a comparison of the reweighed topological charge, average plaquette, residual mass, pion mass, pion decay constant, and scalar correlator between these two ensembles shows agreement well described by the statistical errors. The issues of the effective number of configurations and finite sample size bias are discussed. An examination of the topological charge distribution implies that it is more favorable to reweight from heavier mass to lighter quark mass.

  1. Nuclear Masses in Astrophysics

    E-print Network

    Christine Weber; Klaus Blaum; Hendrik Schatz

    2008-12-09

    Among all nuclear ground-state properties, atomic masses are highly specific for each particular combination of N and Z and the data obtained apply to a variety of physics topics. One of the most crucial questions to be addressed in mass spectrometry of unstable radionuclides is the one of understanding the processes of element formation in the Universe. To this end, accurate atomic mass values of a large number of exotic nuclei participating in nucleosynthesis are among the key input data in large-scale reaction network calculations. In this paper, a review on the latest achievements in mass spectrometry for nuclear astrophysics is given.

  2. Mass of Ne-16 

    E-print Network

    Woodward, C. J.; Tribble, Robert E.; Tanner, D. M.

    1983-01-01

    , 'He)' Ne reaction. The Q value of the reaction was determined to be ?60. 197+0.023 MeV, which corresponds to a mass excess of 23.984+0.024 MeV. The weighted average of this result with two previous mea- surements yields a mass excess of 23....994+0.020 MeV. This value is in reasonable agree- ment with the quadratic isobaric multiplet mass equation. The four parameter isobaric mul- tiplet mass equation suggests a cubic or quartic coefficient of 4+3 keV for the A =16 multi- plet. NUCLEAR REACTIONS...

  3. Mass of Si-24 

    E-print Network

    Tribble, Robert E.; Tanner, D. M.; Zeller, A. F.

    1980-01-01

    used to determine the mass of '"Si. The reaction Q value and mass excess were found to be ?61.433 +0.021 and 10.782+0.022 MeV, respectively. The "Si mass completes the fifth member of the A = 24 isobaric quintet. The quintet members are in good... for a, nu- clear cdi in the d, &, shell. ' EXPERIMENTAL PROCEDURE The mass of '4Si was determined by measuring the Q value of the "Si('He, 'He)"Si reaction. An incident o. beam of 128.8 MeV was supplied by the Texas AIM University 224 cm cyclotron...

  4. Gas Chromatography -Mass Spectrometry

    E-print Network

    Nizkorodov, Sergey

    GCMS - 1 Gas Chromatography - Mass Spectrometry GC-MS ANALYSIS OF ETHANOL AND BENZENE IN GASOLINE Last updated: June 17, 2014 #12;GCMS - 2 Gas Chromatography - Mass Spectrometry GC-MS ANALYSIS). The goal of this experiment is to separate the components in a sample of gasoline using Gas Chromatography

  5. The Origins of Mass

    SciTech Connect

    Lincoln, Don

    2014-07-30

    The Higgs boson was discovered in July of 2012 and is generally understood to be the origin of mass. While those statements are true, they are incomplete. It turns out that the Higgs boson is responsible for only about 2% of the mass of ordinary matter. In this dramatic new video, Dr. Don Lincoln of Fermilab tells us the rest of the story.

  6. Thermal masses in leptogenesis

    E-print Network

    Clemens P. Kiessig; Michael Plumacher

    2009-10-26

    We investigate the validity of using thermal masses in the kinematics of final states in the decay rate of heavy neutrinos in leptogenesis calculations. We find that using thermal masses this way is a reasonable approximation, but corrections arise through quantum statistical distribution functions and leptonic quasiparticles.

  7. Neutrino Mass Phenomenology

    SciTech Connect

    Marrone, A.

    2005-10-12

    The present knowledge about neutrino mass and mixing, in the framework of three active neutrino mixing, is reviewed. All available data on solar, atmospheric, reactor, and accelerator oscillation neutrino experiments are analysed and combined with data on absolute neutrino masses, coming from beta decay and neutrinoless double beta decay experiments and astrophysical and cosmological researches.

  8. Mass Storage Systems.

    ERIC Educational Resources Information Center

    Ranade, Sanjay; Schraeder, Jeff

    1991-01-01

    Presents an overview of the mass storage market and discusses mass storage systems as part of computer networks. Systems for personal computers, workstations, minicomputers, and mainframe computers are described; file servers are explained; system integration issues are raised; and future possibilities are suggested. (LRW)

  9. Nanopore Mass Spectrometry

    NASA Astrophysics Data System (ADS)

    Stein, Derek; Bush, Joseph; Mihovilovic, Mirna; Maulbetsch, William; Moon, Wooyoung; Bazemore-Walker, Carthene; Weber, Peter

    2012-02-01

    We describe a concept for single-DNA analysis called nanopore mass spectrometry, which seeks to combine the benefits of nanopores with the speed, sensitivity, and robustness of single base detection by mass spectrometry. The basic idea is to cleave the individual nucleotides from a DNA polymer as they transit a nanopore in sequence, and to identify each one by determining its charge-to-mass ratio in a mass spectrometer. We describe how nanopore mass spectrometry can addresse the challenges faced by other nanopore-based DNA analysis approaches. We also describe the design, construction, and testing of a prototype instrument that interfaces a nanopore ion source with a quadrupole mass filter and a single ion detector. We are using this new instrument to test the key scientific questions bearing on our analysis strategy: 1) Can DNA nucleotides be reliably transferred from their native liquid phase into the vacuum environment of a mass spectrometer? 2) Can nucleotides be detected with near 100% efficiency? 3) Can DNA polymers be controllably cleaved to isolate ionized bases or nucleotides in the mass spectrometer?

  10. The Origins of Mass

    ScienceCinema

    Lincoln, Don

    2014-08-07

    The Higgs boson was discovered in July of 2012 and is generally understood to be the origin of mass. While those statements are true, they are incomplete. It turns out that the Higgs boson is responsible for only about 2% of the mass of ordinary matter. In this dramatic new video, Dr. Don Lincoln of Fermilab tells us the rest of the story.

  11. Masses of Heavy Hadrons

    E-print Network

    Harpreet Kaur; M. P. Khanna

    2000-05-09

    An estimate has been made of the masses of heavy hadrons in nonrelativistic quark model, which includes spin and flavor-dependent hyperfine splitting for two quarks. The effect of variation of the wavefunction value at origin and the strong coupling constant, with flavor, has also been included in calculating the mass values.

  12. Geometry of mass.

    PubMed

    Dietrich, D D

    2015-08-01

    We study the effect of mass on geometric descriptions of gauge field theories. In an approach in which the massless theory resembles general relativity, the introduction of the mass entails non-zero torsion and the generalization to Einstein-Cartan-Sciama-Kibble theories. The relationships to pure torsion formulations (teleparallel gravity) and to higher gauge theories are also discussed. PMID:26124248

  13. Elbow mass flow meter

    DOEpatents

    McFarland, A.R.; Rodgers, J.C.; Ortiz, C.A.; Nelson, D.C.

    1994-08-16

    The present invention includes a combination of an elbow pressure drop generator and a shunt-type mass flow sensor for providing an output which gives the mass flow rate of a gas that is nearly independent of the density of the gas. For air, the output is also approximately independent of humidity. 3 figs.

  14. Earthquake triggering of landslides in highly jointed rock masses: Reconstruction of the 1783 Scilla rock avalanche (Italy)

    NASA Astrophysics Data System (ADS)

    Bozzano, Francesca; Lenti, Luca; Martino, Salvatore; Montagna, Alfredo; Paciello, Antonella

    2011-06-01

    The Scilla rock avalanche occurred on 6 February 1783 along the coast of the Calabria region (southern Italy), close to the Messina Strait. It was triggered by a mainshock of the “Terremoto delle Calabrie” seismic sequence, and it induced a tsunami wave responsible for more than 1500 casualties along the neighbouring Marina Grande beach. Based on subaerial and submarine surveys, a 5 × 106 m3 subaerial landslide was identified together with a 3 × 106 m3 submarine scar area, whereas block deposits are present in both the subaerial and submerged regions. A detailed geological reconstruction of the slope was obtained and a geomechanical characterisation of the metamorphic rocks involved in the landslide was performed. Based on this reconstruction, intense jointing conditions of the rock mass can be related to main fault zones parallel and normally oriented to the actual coastline. An engineering geology model of the landslide was devised according to an equivalent continuum approach to evaluate both stiffness and strength of the rock mass within the slope. A finite difference stress-strain numerical modelling of the Scilla landslide was performed under dynamic conditions to back-analyse the landslide trigger as well as local seismic amplifications. This modelling gave new insights into the physical interactions between seismic inputs and slopes, as it demonstrated the fundamental role played by i) the interaction between the seismic input and geological setting of unsheared rock slopes (i.e., without preexisting landslide masses), ii) cumulated strain effects due to seismic sequences, and iii) jointing conditions of the involved rock masses responsible for the seismic amplification of the landslide-prone volume, driving it toward failure conditions.

  15. Neutrino mass measurements.

    PubMed

    Wark, D L

    2003-11-15

    Before we can be sure we have a dark-matter problem we have to first be certain that no known particle can account for the missing matter. The last possibility has long been the neutrino, which, while massless in the Standard Model of particle physics, is the second most numerous particle in the Universe (after the photon) and thus (if massive) a potential source of substantial unaccounted for mass. Recent neutrino oscillation measurements have, in fact, confirmed that the Standard Model is incomplete and that neutrinos have mass. However, recent measurements have confirmed that the resulting mass is insufficient for neutrinos to make up the bulk of the dark matter. In fact, observations of the matter distribution in the Universe are now competing with laboratory measurements in their sensitivity to the absolute masses of neutrinos. The article discusses all these measurements and gives some guesses about where we may get in our measurements of neutrino masses in the future. PMID:14667316

  16. Mass of He-8 

    E-print Network

    Tribble, Robert E.; Cossairt, J. D.; May, D. P.; Kenefick, R. A.

    1977-01-01

    measurement of the mass of 'He has been performed by observing 'He events from the reaction Ni(He, He} Ni at an incident beam energy of 80 MeV. The Q values and mass excess are determined to be Q = ?31.796 & 0,008 MeV and mass excess = 31.S93 & 0.008 MeV... excess. Deduced coefficients of IMME for the A=8 isobaric quintet. INTRODUCTION TABLE I. Summary of previous 8He mass measure- ments. Reaction Mass excess {MeV) Reference 26Mg {4He,SHe)22Mg "Mg{4He sHe)"Mg "O{4He SHe)"O "Ni{4He, 'He)~Ni 31.65 +0...

  17. Probabilistic Mass Growth Uncertainties

    NASA Technical Reports Server (NTRS)

    Plumer, Eric; Elliott, Darren

    2013-01-01

    Mass has been widely used as a variable input parameter for Cost Estimating Relationships (CER) for space systems. As these space systems progress from early concept studies and drawing boards to the launch pad, their masses tend to grow substantially, hence adversely affecting a primary input to most modeling CERs. Modeling and predicting mass uncertainty, based on historical and analogous data, is therefore critical and is an integral part of modeling cost risk. This paper presents the results of a NASA on-going effort to publish mass growth datasheet for adjusting single-point Technical Baseline Estimates (TBE) of masses of space instruments as well as spacecraft, for both earth orbiting and deep space missions at various stages of a project's lifecycle. This paper will also discusses the long term strategy of NASA Headquarters in publishing similar results, using a variety of cost driving metrics, on an annual basis. This paper provides quantitative results that show decreasing mass growth uncertainties as mass estimate maturity increases. This paper's analysis is based on historical data obtained from the NASA Cost Analysis Data Requirements (CADRe) database.

  18. Dynamical Mass Generation

    SciTech Connect

    Bashir, A.; Raya, A.

    2006-09-25

    Understanding the origin of mass, in particular that of the fermions, is one of the most uncanny problems which lie at the very frontiers of particle physics. Although the celebrated Standard Model accommodates these masses in a gauge invariant fashion, it fails to predict their values. Moreover, the mass thus generated accounts for only a very small percentage of the mass which permeates the visible universe. Most of the observed mass is accounted for by the strong interactions which bind quarks into protons and neutrons. How does that exactly happen in its quantitative details is still an unsolved mystery. Lattice formulation of quantum chromodynamics (QCD) or continuum studies of its Schwinger-Dyson equations (SDEs) are two of the non-perturbative means to try to unravel how quarks, starting from negligible current masses can acquire enormously large constituent masses to account for the observed proton and neutron masses. Analytical studies of SDEs in this context are extremely hard as one has to resort to truncation schemes whose quantitative reliability can be established only after a very careful analysis. Let alone the far more complicated realm of QCD, arriving at reliable truncation schemes in simpler scenarios such as quantum electrodynamics (QED) has also proved to be a hard nut to crack. In the last years, there has been an increasing group of physicists in Mexico which is taking up the challenge of understanding how the dynamical generation of mass can be understood in a reliable way through SDEs of gauge theories in various contexts such as (i) in arbitrary space-time dimensions d as well as d {<=} 4 (ii) finite temperatures and (ii) in the presence of magnetic fields. In this article, we summarise some of this work.

  19. THE MASS DISTRIBUTION OF STELLAR-MASS BLACK HOLES

    E-print Network

    Farr, Will M.

    We perform a Bayesian analysis of the mass distribution of stellar-mass black holes using the observed masses of 15 low-mass X-ray binary systems undergoing Roche lobe overflow and 5 high-mass, wind-fed X-ray binary systems. ...

  20. The distribution of mass.

    NASA Astrophysics Data System (ADS)

    King, I. R.

    Contents: 1. The formulas of Galactic rotation. 2. The rotation curve. 3. The rotation constants. 4. The dark halo. 5. Mass models of the Milky Way. 6. The potential fields of galaxy-like configurations.