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1

A two-hour intervention using START improves prehospital triage of mass casualty incidents  

Microsoft Academic Search

Objective. There are few data concerning the ability of prehospital providers to triage patients in a mass casualty incident (MCI). The authors evaluated the effectiveness of a brief educational intervention on MCI triage with a written scenario and test. The START method (simple triage and rapid treatment) was used. Methods. The authors enrolled and tested 109 prehospital providers consisting of

Brian L. Risavi; Philip N. Salen; Michael B. Heller; Stephen Arcona

2001-01-01

2

ReSTART: A Novel Framework for Resource-Based Triage in Mass-Casualty Events.  

PubMed

Objective: Current guidelines for mass-casualty triage do not explicitly use information about resource availability. Even though this limitation has been widely recognized, how it should be addressed remains largely unexplored. The authors present a novel framework developed using operations research methods to account for resource limitations when determining priorities for transportation of critically injured patients. To illustrate how this framework can be used, they also develop two specific example methods, named ReSTART and Simple-ReSTART, both of which extend the widely adopted triage protocol Simple Triage and Rapid Treatment (START) by using a simple calculation to determine priorities based on the relative scarcity of transportation resources. Methods: The framework is supported by three techniques from operations research: mathematical analysis, optimization, and discrete-event simulation. The authors? algorithms were developed using mathematical analysis and optimization and then extensively tested using 9,000 discrete-event simulations on three distributions of patient severity (representing low, random, and high acuity). For each incident, the expected number of survivors was calculated under START, ReSTART, and Simple-ReSTART. A web-based decision support tool was constructed to help providers make prioritization decisions in the aftermath of mass-casualty incidents based on ReSTART. Results: In simulations, ReSTART resulted in significantly lower mortality than START regardless of which severity distribution was used (paired t test, p < .01). Mean decrease in critical mortality, the percentage of immediate and delayed patients who die, was 8.5% for low-acuity distribution (range ?2.2% to 21.1%), 9.3% for random distribution (range ?0.2% to 21.2%), and 9.1% for high-acuity distribution (range ?0.7% to 21.1%). Although the critical mortality improvement due to ReSTART was different for each of the three severity distributions, the variation was less than 1 percentage point, indicating that the ReSTART policy is relatively robust to different severity distributions. Conclusions: Taking resource limitations into account in mass-casualty situations, triage has the potential to increase the expected number of survivors. Further validation is required before field implementation; however, the framework proposed in here can serve as the foundation for future work in this area. PMID:24604436

Mills, Alex F; Argon, Nilay T; Ziya, Serhan; Hiestand, Brian; Winslow, James

2014-01-01

3

Primary triage of mass burn casualties with associated severe traumatic injuries  

PubMed Central

Summary A key aim in any mass disaster event is to avoid diverting resources by overwhelming specialized tertiary centers with minor casualties. The most crucial aspect of an effective disaster response is pre-hospital triage at the scene. Unfortunately, many triage systems have serious shortcomings in their methodologies and no existing triage system has enough scientific evidence to justify its universal adoption. Moreover, it is observed that the optimal approach to planning is by no means clear-cut and that each new incident involving burns appears to produce its own unique problems not all of which were predictable. In most major burns disasters, victims mostly have combined trauma burn injuries and form a heterogeneous group with a broad range of devastating injuries. Are these victims primarily burn patients or trauma patients? Should they be taken care of in a burn center or in a trauma center or only in a combined burns-trauma center? Who makes the decision? The present review is aimed at answering some of these questions.

Atiyeh, B.; Gunn, S. William A.; Dibo, S.

2013-01-01

4

MiRTE: Mixed Reality Triage and Evacuation game for Mass Casualty information systems design, testing and training  

Microsoft Academic Search

In this paper we introduce a Mixed Reality Triage and Evacuation game, MiRTE, that is used in the development, testing and training of Mass Casualty Incident (MCI) information systems for first responders. Using the Source game engine from Valve software, MiRTE creates immersive virtual environments to simulate various incident scenarios, and enables interactions between multiple players\\/first responders. What distinguishes it

Xunyi Yu; Aura Ganz

2011-01-01

5

Information Sharing for Medical Triage Tasking During Mass Casualty/Humanitarian Operations.  

National Technical Information Service (NTIS)

This thesis will focus on field testing and evaluating the capabilities of a smartphone-based system and associated equipment for 'First Responder Networking.' Further, we will identify information sharing requirements for supporting a medical triage task...

L. A. Abuan

2009-01-01

6

Clinical review: mass casualty triage--pandemic influenza and critical care.  

PubMed

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

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

2007-01-01

7

Integration of information technology, wireless networks, and personal digital assistants for triage and casualty.  

PubMed

The purpose of this study was to evaluate a portable tool for use by first responders in documenting triage of victims in a mass casualty incident (MCI) more effectively. The tool presented in this study allows first responders to gather patients vital signs, injuries, and triage status in a prompt and accurate way, and enables first responders to wirelessly communicate vital health information throughout the entire care continuum. The architecture infrastructure for the portable device is called Triage and Casualty Informatics Technology (TACIT) and can expedite triage, transport and treatment procedures within an MCI. TACIT was developed by integrating handheld devices, wireless networks, global positioning system (GPS), digital cameras, and bar code scanners with customized triage software. Two MCI initial field trials verified that the TACIT software, battery life, data accuracy, and wireless transmission met the emergency response system requirements. Initial field trials also demonstrated robustness of operation, reduced triage collection time and improved collection accuracy. The TACIT system could work as an efficient prehospital response tool and platform. PMID:16942419

Zhao, Xiaoming; Rafiq, Azhar; Hummel, Russel; Fei, Ding-Yu; Merrell, Ronald C

2006-08-01

8

[Mass casualty events].  

PubMed

Authors present problems concerning mass--casualty accidents, specificity of action rescue-system on different levels of co-operation, kind of segregation of victims and efficiency of the medical rescue system in Poland. Attention has been paid to the continuous instructions and education of life-saving services, preferably by simulation of events without earlier information of the interested. It is necessary to establish and abide official dependence by the rules of co-operation of components of life-saving system. A separate problem is the implementation of rescue--activities in special situations: nuclear, biological and chemical contamination, and with very important safety measures for people taking part in rescue action. PMID:17469515

Gu?a, Przemys?aw; H?adki, Waldemar; Brongel, Leszek

2006-01-01

9

[Mass casualties after an explosion].  

PubMed

Because of the intifada, the Israeli-Palestinian conflict has become characterized by violence against civilians on both sides. Since the early 1990s, this conflict has seen directed operations performed by suicide attackers, whose goal is to kill civilians who are not direct participants in the confrontation. For urban and local hospitals this means that they must always be aware of being confronted with limited multiple-casualty incidents. This has required a restructuring of emergency plans at the scene and in the hospital. At the scene the incident is classified according to the number and degree of injury of the victims. The accumulation of such incidents made it necessary in Israel to change views of the system of triage, which has essential differences from the central European system. Apart from changing preclinical and clinical management algorithms, the surgeons specialized in casualties must be prepared for a new quality of injuries. Barotrauma of the lung and multiple, seemingly superficial injuries often only emerge later as life-threatening and lead to the paralysis of intensive care and surgical capacity. PMID:14652722

Stein, M; Hirshberg, A; Gerich, T

2003-10-01

10

Brain Injuries and Mass Casualty Events  

MedlinePLUS

... Injuries Following a Mass Casualty Event Additional Resources Brain Injuries and Mass Casualty Events: Format: Select one ... your health care provider. What is a traumatic Brain Injury? A traumatic brain injury (TBI) is defined ...

11

Medical evacuation and triage of combat casualties in Helmand Province, Afghanistan: October 2010-April 2011.  

PubMed

Medical evacuation of combat casualties in Operation Enduring Freedom-Afghanistan is achieved primarily by helicopter, because of distances involved as well as ground-based threats. In Helmand Province, evacuation from the point of injury may occur on a variety of helicopter evacuation platforms with disparate levels of attendant medical expertise. Furthermore, triage to a medical treatment facility may involve varying echelons of care before definitive management. Consequently, considerable differences in medical care may be encountered between point of injury and definitive treatment. We discuss the role of helicopter-based medical evacuation in Helmand, Afghanistan, as well as triage and timelines to the most appropriate medical facilities. Based on our experience and available evidence, we have made recommendations to regional commanders which favor the utilization of prehospital critical care teams aboard helicopter-based evacuation platforms and direct triage to the highest echelon of care available when feasible. PMID:23198499

Clarke, Jonathan E; Davis, Peter R

2012-11-01

12

Shadowbowl 2003 [simulated mass-casualty exercise  

Microsoft Academic Search

On 25-26 January 2003, a simulated mass-casualty exercise called ShadowBowl was conducted. A mass-casualty incident is an event in which local response capabilities are overwhelmed, and outside resources must be integrated as rapidly as possible to mitigate the situation. This article provides an account of the event, observations, and suggestions for improvements from the CRASAR perspective. ShadowBowl consisted of two

A. Gage; R. R. Murphy; E. Rasmussen; B. Minten

2004-01-01

13

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

PubMed

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

Conlon, Kathe M; Martin, Shawn

2011-06-01

14

Injuries and Mass Casualty Events  

MedlinePLUS

... Event Health Services Study: An Assessment of Victim Transport to Medical Care During and Following a Mass ... paint chips), fumes or smoke present in the air after a disaster event. More serious eye problems ...

15

Oxygen supplies during a mass casualty situation.  

PubMed

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

Ritz, Ray H; Previtera, Joseph E

2008-02-01

16

Immediate mass casualty management in Jos University Teaching Hospital: a successful trial of Jos protocol.  

PubMed

Traumatic, injuries arising from high velocity means of mobility, increased industrialization, frequent ethnic and religious classes and terrorist activities by way of bomb blasts, etc., often result in sudden unexpected mass casualty presenting to a given secondary or tertiary health institution. The successful management of such situation involves multidimensional and multidisciplinary approach anchored on awareness, preplanning and alertness. In response to the challenge, the orthopaedic and trauma unit of Jos University Teaching Hospital worked out the "Jos Protocol" which embodies the principle and strategy for mass casualty management and response to field distress call to the hospital within the practical limitations of our infrastructure. On the sixth of April, 1997 a vehicular collision in a neighbouring village resulted in twenty nine severely injured patients being rushed to the hospital's accident and emergency unit. By activating the protocol and utilizing the cascade call our system, mutual aid, hospital mobilization, reach out system, modified hospital triage, team work, effective manoeuvers and treatment modification, the immediate rescucitation and stabilization of patients was achieved in five hours. The working team comprised fifteen doctors and some hospital workers who could be reached on a weekend. Out of the mortality of 6 patients, 3 died in the triage zone while 3 were brought in dead. The difficulties encountered during the management and recommendation for improved immediate mass casualty management are discussed. Further, we believe that it has become necessary for every secondary and tertiary health institution to work out a mass casualty management protocol adapted to its peculiar working circumstances. A case is made for the establishment of regional disaster committees. PMID:11126091

Nwadiaro, H C; Yiltok, S J; Kidmas, A T

2000-01-01

17

Mass casualties in the Oklahoma City bombing.  

PubMed

The Alfred P. Murrah Federal Building in Oklahoma City was partially destroyed by a terrorist bomb on April 19, 1995. Injuries were sustained by 759 people, 168 of whom died. Fatalities occurred primarily among victims in the collapse zone of the federal building. Only 83 survivors required hospitalization. Twenty-two surviving victims sustained multiple fractures. Most victims arrived at local emergency departments by private vehicle within 2 hours. More severely injured survivors were transported by ambulance. The closer receiving hospitals used emergency department facilities and minor treatment areas. Few survivors were extricated from the bombing site more than 3 hours after the detonation. Mass casualty plans must provide for improved communications, diversion and retriage from facilities nearest the disaster site, and effective coordination of community and hospital resources. PMID:15187837

Teague, David C

2004-05-01

18

UnrealTriage: A Game-Based Simulation for Emergency Response  

Microsoft Academic Search

UnrealTriage * is a simulation of a mass casualty incident built based on a modification of a commercial first person shooter game called Unreal Tournament. The simulation involves multiple emergency response players at the scene of a small airplane crash with 30 casualties. The player objectives developed thus far consist of fire suppression and primary triage. Players must locate and

Dennis McGrath; Doug Hill

2004-01-01

19

Medical management of toxicological mass casualty events.  

PubMed

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

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

2008-11-01

20

Some considerations for mass casualty management in radiation emergencies.  

PubMed

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

Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

2010-06-01

21

An Intelligent 802.11 Triage Tag For Medical Response to Disast ers  

Microsoft Academic Search

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

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

22

Premature chromosome condensation (PCC) assay for dose assessment in mass casualty accidents.  

PubMed

The study was undertaken to establish a dose calibration curve for a practical PCC ring assay and to apply it in a simulated mass casualty accident. The PCC assay was validated against the conventional dicentric assay. A linear relationship was established for PCC rings after (60)Co gamma irradiation with doses up to 20 Gy. In the simulated accident experiment, 62 blood samples were analyzed with both the PCC ring assay and the conventional dicentric assay, applying a triage approach. Samples received various uniform and non-uniform (10-40% partial-body) irradiations up to doses of 13 Gy. The results indicated that both assays yielded good dose estimates for the whole-body exposure scenario, although in the lower-dose range (0-6 Gy) dicentric scoring resulted in more accurate whole-body estimates, whereas PCC rings were better in the high-dose range (>6 Gy). Neither assay was successful in identifying partial-body exposures, most likely due to the low numbers of cells scored in the triage mode. In conclusion, the study confirmed that the PCC ring assay is suitable for use as a biodosimeter after whole-body exposure to high doses of radiation. However, there are limitations for its use in the triage of people exposed to high, partial-body doses. PMID:20041761

Lindholm, Carita; Stricklin, Daniela; Jaworska, Alicja; Koivistoinen, Armi; Paile, Wendla; Arvidsson, Eva; Deperas-Standylo, Joanna; Wojcik, Andrzej

2010-01-01

23

Casualties.  

PubMed

Privation and disease have mainly killed soldiers until very recently. Now that enemy action predominates, faster and better control of bleeding and infection before and during evacuation spares ever more lives today. This essay focuses on psychological war wounds, placing them in the context of military casualties. The surgeon's concepts of 'primary' wounds in war, and of would 'complications' and 'contamination', serve as models for psychological and moral injury in war. 'Psychological injury' is explained and preferred to 'Post-Traumatic Stress Disorder', being less stigmatizing and more faithful to the phenomenon. Primary psychological injury equates to the direct damage done by a bullet; the complications - for example, alcohol abuse - equate to hemorrhage and infection. Two current senses of 'moral injury' equate to wound contamination. As with physical wounds, it is the complications and contamination of mental wounds that most often kill service members or veterans, or blight their lives. PMID:21898967

Shay, Jonathan

2011-01-01

24

Psychosocial Response to Mass Casualty Terrorism: Guidelines for Physicians  

PubMed Central

Background: All physicians would need to address the psychosocial consequences of a mass casualty terrorist attack should it occur. Method: A review of evidence and expert opinion regarding psychosocial response to mass casualty incidents was performed. Data were obtained via the PubMed database in an English-language search using the terms PTSD secondary prevention, psychological first aid, and disaster psychiatry and the dates 1995 through 2004. Results: There is a National Institute of Mental Health consensus statement on the psychiatric response to mass violence, but sparse psychopharmacologic literature. Psychotherapeutic interventions are well studied in posttraumatic settings. Conclusions: The physician's response to mass casualty terrorism must address the high volume of patients with anxiety reactions and somatic symptoms likely to present for care. Supportive interventions include fostering a sense of safety and efficacy, connecting patients with communities and services, and helping parents talk about the trauma with their children. In the future, early pharmacologic interventions may be proven effective.

Fetter, Jeffrey C.

2005-01-01

25

Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data  

PubMed Central

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.

Egan, Joseph R.; Amlot, Richard

2012-01-01

26

Portable ultrasonography in mass casualty incidents: The CAVEAT examination  

PubMed Central

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

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

2010-01-01

27

Counseling support within the Navy Mass Casualty Assistance Team post-September 11.  

PubMed

Prior to the terrorist attacks on the Pentagon and World Trade Center, the Navy Casualty Assistance mass casualty plan was undergoing transformations that were set in place to improve service quality and information flow among all process owners (Navy Leadership, Navy Casualty Assistance Office, Casualty Assistance Calls Officers (CACOs) and next of kin (NOK)). One component of the mass casualty plan was the establishment of a Counseling Support Cell--a group within the Casualty Assistance response team that would provide care and recovery support to team members, CACOs, and NOK. This paper outlines the major objectives of the Counseling Support Cell, phases of implementation, and the impact of our effort. PMID:12363149

Schwerin, Michael J; Kennedy, Kevin; Wardlaw, Michael

2002-09-01

28

The importance of instruction on mass casualty incidents in baccalaureate nursing programs: perceptions of nursing faculty.  

PubMed

This study examined whether a relationship exists between mass casualty incident knowledge and perceived importance of incorporating competencies regarding mass casualty incidents into baccalaureate nursing programs by faculty in Louisiana. A total of 285 educators in baccalaureate nursing programs in Louisiana were asked to complete the survey instrument; usable surveys was collected from 166 participants (58%). Results indicated participants had limited training and life experiences regarding mass casualty incidents, as well as limited knowledge of mass casualty incidents. However, participants perceived mass casualty incident instruction as important for inclusion in nursing curricula. There was a positive relationship between self-perceived knowledge of mass casualty incidents and perceived importance of including these competencies into the nursing curriculum. These findings suggest schools of nursing take steps to identify or train a pool of educators who can teach mass casualty incident preparation. PMID:19476036

Whitty, Kristin K; Burnett, Michael F

2009-05-01

29

[Management of a nuclear, biological and chemical mass casualties event].  

PubMed

The management of a nuclear, biological or chemical mass casualties event (MCE) is a great challenge for emergency medical services and the hospitals of the region. Planing, exactly prepared protocols, adequate resources, instructions and extended training are the most important elements for successfull management of the MCE. This review presents a concept of managing a MCE including recognizing the threat, personal protection, evacuation, lifesaving procedures, decontamination, treatment, transport, hospital management, as well as procedures to avoid further contamination and panic. PMID:17786862

Schmidbauer, Willi; Bubser, Hanspeter; Cwojdzinski, Detlef; Beneker, Jörg; Grüneisen, Ulrich; Kerner, Thoralf

2007-09-01

30

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

PubMed

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

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

31

Comparative analysis of showering protocols for mass-casualty decontamination.  

PubMed

A well-established provision for mass-casualty decontamination that incorporates the use of mobile showering units has been developed in the UK. The effectiveness of such decontamination procedures will be critical in minimizing or preventing the contamination of emergency responders and hospital infrastructure. The purpose of this study was to evaluate three empirical strategies designed to optimize existing decontamination procedures: (1) instructions in the form of a pictorial aid prior to decontamination; (2) provision of a washcloth within the showering facility; and (3) an extended showering period. The study was a three-factor, between-participants (or "independent") design with 90 volunteers. The three factors each had two levels: use of washcloths (washcloth/no washcloth), washing instructions (instructions/no instructions), and shower cycle duration (three minutes/six minutes). The effectiveness of these strategies was quantified by whole-body fluorescence imaging following application of a red fluorophore to multiple, discrete areas of the skin. All five showering procedures were relatively effective in removing the fluorophore "contaminant", but the use of a cloth (in the absence of instructions) led to a significant ( appox. 20%) improvement in the effectiveness of decontamination over the standard protocol (p <0.05). Current mass-casualty decontamination effectiveness, especially in children, can be optimized by the provision of a washcloth. This simple but effective approach indicates the value of performing controlled volunteer trials for optimizing existing decontamination procedures. PMID:21053192

Amlot, Richard; Larner, Joanne; Matar, Hazem; Jones, David R; Carter, Holly; Turner, Elizabeth A; Price, Shirley C; Chilcott, Robert P

2010-01-01

32

Management of the mass casualty from the 2001 Jos crisis.  

PubMed

Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. Materials and Methods: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate. PMID:24909466

Ozoilo, K N; Kidmas, A T; Nwadiaro, H C; Iya, D; Onche, I I; Misauno, M A; Sule, A Z; Yiltok, S J; Uba, A F; Ramyil, V M; Dakum, N K; Ugwu, B T

2014-01-01

33

Development of computer-assisted patient control for use in the hospital setting during mass casualty incidents.  

PubMed

Hospital resolution of mass casualty incidents can have difficulties involving "command and control" and information management, ineffective use of triage classes, and missed diagnostic procedures, leading to lower quality of care. A computer system has been developed to supply continuously updated group and patient data. The system uses barcoded identifiers to represent patients, injuries, facilities, and locations, in order to minimize errors and make exchange of data possible. The system communicates with the permanent hospital information system. This article reports the use of this technology during several experiments and real incidents. Computer registration based on bar codes, despite the greater number of items entered, still showed 25% fewer inaccuracies when compared with handwritten medical charts. Extensive training was shown to be unnecessary. Paramedical personnel judged the automated procedures to be an improvement during the admission of 143 evacuated patients. PMID:8639196

Noordergraaf, G J; Bouman, J H; van den Brink, E J; van de Pompe, C; Savelkoul, T J

1996-05-01

34

Improving hospital mass casualty preparedness through ongoing readiness evaluation.  

PubMed

The objective of this study was to investigate the effect of ongoing use of an evaluation tool on hospitals' emergency preparedness for mass casualty events (MCEs). Two cycles of evaluation of emergency preparedness were conducted based on measurable parameters. A significant increase was found in mean total scores between the 2 cycles (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training, and equipment, but the change was significant only in the training category. Relative increase was highest for hospitals that did not experience real MCEs. This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated, measurable benchmarks. Ongoing assessment of emergency preparedness motivates hospitals to improve capabilities and results in a more effective emergency response mechanism. Use of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the areas evaluated. PMID:22326978

Adini, Bruria; Laor, Daniel; Hornik-Lurie, Tzipora; Schwartz, Dagan; Aharonson-Daniel, Limor

2012-01-01

35

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

PubMed

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

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

2012-07-01

36

Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica  

PubMed Central

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.

Mills, Christopher N.; Mills, Gregory H.

2011-01-01

37

Epidemiology of mass casualty incidents in the United States.  

PubMed

Abstract Objective. We sought to characterize and estimate the frequency of mass casualty incidents (MCIs) occurring in the United States during the year 2010, as reported by emergency medical services (EMS) personnel. Methods. Using the 2010 National EMS Database of the National Emergency Medical Services Information System (NEMSIS), containing data from 32 states and territories, we estimated and weighted the frequency of MCIs documented by EMS personnel based on their perception of the event to produce incidence rates of MCIs per 100,000 population and MCIs per 1,000 9-1-1 calls requesting EMS service. We conducted descriptive analyses to characterize the MCIs by geographic location, incident type, and time of day as well as the MCI patients by demographic and health information. We used chi-squared tests to compare response delays and two-tailed t-tests to compare system response times between EMS responses documented as MCIs and those not. Results. Among the 9,776,094 EMS responses in the 2010 National EMS Database, 14,504 entries were documented as MCI. These entries represented an estimated 9,913 unique MCIs from the National EMS Database: 39.1% occurred in the South Atlantic region of the United States where only 19.1% of the population resides, 60.9% occurred in an urban setting, and 58.4% occurred on a street or highway. There were an estimated 13,677 MCI patients. The prehospital EMS personnel's primary impressions of the patients ranged from electrocution (0.01%) to traumatic injury (40.7%). Of the patients with a primary impression of injury (N = 7,960), motor vehicle traffic crash was the cause of injury for 62.7%. Among the MCI EMS responses, 47.6% documented experiencing a response delay compared to only 12.3% of non-MCI EMS responses. Conclusions. This study demonstrates the range of health conditions and characteristics of EMS responses that EMS personnel perceive as MCIs, suggests that response delays are common during MCIs, and indicates there may be underreporting of all persons involved in an MCI. The National EMS Database is useful for describing MCIs and may help guide national leadership in strengthening EMS system preparedness for MCIs. PMID:24673664

Schenk, Ellen; Wijetunge, Gamunu; Mann, N Clay; Lerner, E Brooke; Longthorne, Anders; Dawson, Drew

2014-01-01

38

Triaging multiple victims in an avalanche setting: the Avalanche Survival Optimizing Rescue Triage algorithmic approach.  

PubMed

As winter backcountry activity increases, so does exposure to avalanche danger. A complicated situation arises when multiple victims are caught in an avalanche and where medical and other rescue demands overwhelm resources in the field. These mass casualty incidents carry a high risk of morbidity and mortality, and there is no recommended approach to patient care specific to this setting other than basic first aid principles. The literature is limited with regard to triaging systems applicable to avalanche incidents. In conjunction with the development of an electronic avalanche rescue training module by the Canadian Avalanche Association, we have designed the Avalanche Survival Optimizing Rescue Triage algorithm to address the triaging of multiple avalanche victims to optimize survival and disposition decisions. PMID:20591351

Bogle, Lee B; Boyd, Jeff J; McLaughlin, Kyle A

2010-03-01

39

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

PubMed

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

Goh, S H

2009-01-01

40

Preparedness of German Paramedics and Emergency Physicians for a Mass Casualty Incident: A National Survey  

Microsoft Academic Search

Objective: Paramedics and physicians are important components of our emergency medical system. To date, no survey has been carried out assessing physicians and paramedics regarding their preparedness for a mass casualty incident (MCI) resulting from a terrorist attack in Germany. The aim of this study was to assess the current state of preparedness of emergency physicians and paramedics for an

Philipp Fischer; Karoush Kabir; Oliver Weber; Dieter C. Wirtz; Hermann Bail; Steffen Ruchholtz; Mickey Stein; Christof Burger

2008-01-01

41

Mass casualty chemical incidents—towards guidance for public health management  

Microsoft Academic Search

The aim of this paper is two-fold. A review of mass casualty chemical incidents occurring naturally or as a result of industrial activities or deliberate release provided an opportunity to consider the problems experienced in medical and public health response. In addition, a literature review of procedures to assist in the management of chemical incidents by medical and public health

V Murray; F Goodfellow

2002-01-01

42

Mass casualty incident surveillance and monitoring using identity aware video analytics  

Microsoft Academic Search

In this paper, we propose an identity aware video analytic system that can assist securing the perimeter of a mass casualty incident scene and generate identity annotated video records for forensics and training purposes. Establishing a secure incident scene perimeter and enforcing access control to different zones is a demanding task for current video surveillance systems which lack the ability

Xunyi Yu; Aura Ganz

2010-01-01

43

Evacuation Priorities in Mass Casualty Terror-Related Events Implications for Contingency Planning  

Microsoft Academic Search

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 evac- uation 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

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

44

Sampling an unknown universe: problems of researching mass casualty incidents (a history of ECRU's field research).  

PubMed

This paper reviews how the Emergency Communications Research Unit (ECRU) at Carleton University in Ottawa, Canada, developed its field research techniques with emphasis on some of its approaches to sampling. Then based on ECRU's experience, it discusses the problems that would arise if an attempt were made to research an incident involving not only mass casualties, but also chemically contaminated mass casualties. While ECRU's findings have been published in scores of book chapters, monographs and academic and other articles, this is only the second time since 1977 that its methods have been described [The Development of a Standby Research Capacity at Carleton University. Emergency Planning: Ottawa, Canada; Int. J. Mass Emergencies and Disasters 1977; 2(1):35-41; Methods of Disaster Research. Xlibris Corporation, 26-302], and the very first time its approaches to sampling have been discussed. PMID:17256806

Scanlon, Joseph

2007-04-15

45

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

PubMed

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

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

2012-09-01

46

Civilian-military health services contingency program for a mass casualty situation and wartime in Israel.  

PubMed

The Israeli civilian-military health services contingency program for mass and wartime casualties has more than four decades of experience. The contingency program includes key civilian and military organizations that are involved in the planning, policy making and delivery of health care and support services to the wounded. During the Persian Gulf war the unified civilian and military command--the supreme hospitalization authority--implemented a national hospital and emergency medical services preparedness system designed to treat the victims of chemical warfare attacks. PMID:1757232

Shemer, J; Heller, O; Danon, Y L

1991-01-01

47

Design and development of a mobile-based system for supporting emergency triage decision making.  

PubMed

Emergency care for mass casualty incidents is a sophisticated multi-participant process. To manage this process effectively, many information systems have been proposed. However, their performance in improving the efficiency and accuracy of patient triage is not satisfactory. This paper is concerned with the development of a mobile-based system for supporting emergency triage in the emergency care process for mass casualty incidents. This system collects the patient's emergency data throughout the whole emergency care process through a mobile application and data transfer mechanism. Using a Cox proportional hazard model, the system has the capacity to present the survival curve to the triage officer, helping him/her to make triage and transportation decisions. This system offers an alternative injury assessment tool based on the vital signs data of the injury patient. With the help of this system, the triage officer can more directly and comprehensively learn about each patient's situation and deterioration without additional operations at the incident site. PMID:24898115

Tian, Yu; Zhou, Tian-Shu; Wang, Yu; Zhang, Mao; Li, Jing-Song

2014-06-01

48

On constant alert: lessons to be learned from Israel's emergency response to mass-casualty terrorism incidents.  

PubMed

In its short modern history, Israel has had to contend with numerous mass-casualty incidents caused by terrorism. As a result, it has developed practical national preparedness policies for responding to such events. Israel's Supreme Health Authority, a committee of the Ministry of Health, coordinates emergency management nationwide. All emergency personnel, health care providers, and medical facilities operate under national policies designed to ensure a swift and coordinated response to any incident, based on an "all hazards" approach that emphasizes core elements commonly encountered in mass-casualty incidents. Israel's emergency management system includes contingency planning, command and control, centrally coordinated response, cooperation, and capacity building. Although every nation is unique, many of the lessons that Israel has learned may be broadly applicable to preparation for mass-casualty incidents in the United States and other countries. PMID:24301403

Adini, Bruria; Peleg, Kobi

2013-12-01

49

Enhancing Public Resilience to Mass-Casualty WMD Terrorism in the United States: Definitions, Challenges, and Recommendations.  

National Technical Information Service (NTIS)

This paper concerns how to enhance public resilience to mass-casualty terrorist attacks with weapons of mass destruction (WMD) in the United States. It aims to develop an actionable definition of public resilience, i.e., one that can be related to specifi...

J. D. Wood J. H. Pollack

2010-01-01

50

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

PubMed

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

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

2013-01-01

51

Radiation injuries, triage, and treatment after a nuclear terrorist attack.  

PubMed

The treatment of injuries from a nuclear weapon or a radioactive dispersal device most likely will be in a mass casualty scenario. Radiation injuries complicate the treatment process, with increased emphasis on early intervention. The care of patients must proceed in an orderly fashion. If radiation injury occurs as part of a mass casualty, some organized method of triage, decontamination, evacuation, and treatment must be implemented. Oral and maxillofacial surgeons should plan to become integral members of the treatment team, especially considering their wide scope of training. It is important for all health care providers to become familiar with the types of injuries that can be expected after a radiologic attack and the treatment modalities that can preserve life should such a catastrophe occur. PMID:18088787

McGhee, Robert K; Praetzel, Daron C; Medley, Christopher C

2005-08-01

52

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

PubMed Central

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

2012-01-01

53

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

PubMed

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

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

2005-01-01

54

Death of an infant after contacting a telephone triage call centre: is telephone triage really safe?  

PubMed

The death of a previously well 13-month-old infant approximately 5 h after his mother contacted the Queensland Nurse led telephone triage call centre '13Health' for advice is the first Australian casualty of telephone triage. Experience from this case and another 'near miss' incident Australia highlight the potential of this model of care to harm patients using the service when it attempts to provide health advice compared with health information. PMID:22802265

Nocera, Antony

2010-01-01

55

[The healthcare chain aiding casualties in Afghanistan].  

PubMed

Rules govern the triage of casualties before evacuation and the organisation of the healthcare chain downstream. The two main links in the chain are combat lifesaving techniques and the role 3 medical treatment facility. An example of the French armed forces health service in Kabul, in Afghanistan. PMID:23316579

Beaume, Sébastien; Andries, Ludovic

2012-12-01

56

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

PubMed

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

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

2008-01-01

57

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

PubMed

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

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

2014-01-01

58

Ethical issues in resource triage.  

PubMed

Mass-care events, such as pandemic influenza, could reach such devastating proportions that there will be the need to make difficult triage decisions that will ultimately result in the deaths or severe disability of patients in large numbers. The method by which we determine how triage of scarce health care resources will be performed must be clearly defined prior to a disaster event. This paper will discuss several of the ethical principles that must be weighed in developing a mass-care triage plan, as well as steps to facilitate its implementation. Development of triage policies in such an event should be developed in an open and transparent manner, be reasonable in design, include the views of the critical stakeholders, and be responsive to and provide a mechanism for accountability, with a clearly defined goal of the just triage of limited health care resources. Planning failure will result in increased deaths from poor triage processes and substantial mistrust of the health care system and its practitioners. PMID:18218150

O'Laughlin, Daniel T; Hick, John L

2008-02-01

59

Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities.  

PubMed

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sudden presentation of large numbers of contaminated individuals. Guidelines for managing contaminated patients have been based on traditional hazardous material response or military experience, neither of which is directly applicable to the civilian HCF. We discuss HCF planning for terrorist events that expose large numbers of people to contamination. Key elements of an effective HCF response plan include prompt recognition of the incident, staff and facility protection, patient decontamination and triage, medical therapy, and coordination with external emergency response and public health agencies. Controversial aspects include the optimal choice of personal protective equipment, establishment of patient decontamination procedures, the role of chemical and biological agent detectors, and potential environmental impacts on water treatment systems. These and other areas require further investigation to improve response strategies. PMID:10634341

Macintyre, A G; Christopher, G W; Eitzen, E; Gum, R; Weir, S; DeAtley, C; Tonat, K; Barbera, J A

2000-01-12

60

Management of casualties from the bombing at the Centennial Olympics  

Microsoft Academic Search

Background: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 am on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and

DavidV Feliciano; GailV Anderson; GraceS Rozycki; WalterL Ingram; JosephP Ansley; Nicholas Namias; JeffreyP Salomone; JohnD Cantwell

1998-01-01

61

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

PubMed Central

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.

2014-01-01

62

TRIAGE DOSE ASSESSMENT FOR PARTIAL-BODY EXPOSURE: DICENTRIC ANALYSIS  

PubMed Central

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

Moroni, Maria; Pellmar, Terry C.

2009-01-01

63

Triage dose assessment for partial-body exposure: dicentric analysis.  

PubMed

Partial-body biodosimetry is likely to be required after a radiological or nuclear exposure. Clinical signs and symptoms, distribution of dicentrics in circulating blood cells, organ-specific biomarkers, and physical signals in teeth and fingernails all can provide indications of non-homogeneous exposures. Organ specific biomarkers may provide early warning regarding physiological systems at risk after radiation injury. Use of a combination of markers and symptoms will be needed for clinical insights for therapeutic approaches. Analysis of dicentrics, a marker specific for radiation injury, is the "gold standard" of biodosimetry and can reveal partial-body exposures. Automation of sample processing for dicentric analysis can increase throughput with customization of off-the-shelf technologies for cytogenetic sample processing and information management. Automated analysis of the metaphase spreads is currently limited, but improvements are in development. The efforts described here bridge the technological gaps to allow the use of dicentric chromosome assay (DCA) for risk-based stratification of mass casualties. This article summarizes current knowledge on partial-body cytogenetic dose assessment, synthesizing information leading to the proposal of an approach to triage dose prediction in radiation mass casualties that is based on equivalent whole-body doses under partial-body exposure conditions and assesses the validity of using this model. An initial screening using only 20 metaphase spreads per subject can confirm irradiation above 2 Gy. A subsequent increase to 50 metaphases improves dose determination to allow risk stratification for clinical triage. Metaphases evaluated for inhomogeneous distribution of dicentrics can reveal partial-body exposures. The authors tested the validity of this approach in an in vitro model that simulates partial-body irradiation by mixing irradiated and un-irradiated lymphocytes in various proportions. Preliminary results support the notion that this approach will be effective under a range of conditions including some partial-body exposures, but may have limitations with low doses or small proportions of irradiated parts of the body. These studies address an important problem in the diagnosis of partial-body irradiation and dose assessment in mass casualties and propose a solution. However, additional work is needed to fully develop and validate the application of DCA to partial-body exposures. PMID:20065689

Prasanna, Pataje G S; Moroni, Maria; Pellmar, Terry C

2010-02-01

64

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

PubMed

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

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

2005-11-01

65

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

PubMed

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

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

2014-06-01

66

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

NASA Astrophysics Data System (ADS)

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

Lizotte, Todd E.

2010-04-01

67

Echelon I interventions and triage are effective and concordant with echelon II care in combat operations.  

PubMed

We describe identified injuries, effectiveness of treatment, and triage categories for combat casualties at echelon 1 from April 1 to June 30, 2005 from western Iraq. A total of 133 casualties were evaluated including 12 who were killed in action and 7 who died of wounds. A medic or corpsman treated 75% of the remaining patients, 9% were treated by bystanders, 2% were seen by a physician or physician assistant, and 15% administered self-aid. Most injuries (84%) were blast related. Commonly wounded regions were the head (47%), lower extremities (40%), upper extremities (22%), and back (11%). Common interventions included dressings (37%), splints (8%), and intramuscular morphine (8%). Field triage categories at echelon I and casualty evacuation categories at echelon II were congruent. No significant injuries were missed and there were no detrimental interventions. In conclusion, combat casualties were assessed, treated, and evacuated appropriately by echelon I providers during this time frame. PMID:19743731

Hurtado, Timothy R; Montoya, Christopher

2009-08-01

68

Assessment of early triage for acute radiation injury in rat model based on urinary amino acid target analysis.  

PubMed

Rapid radiation injury early triage after a radiological or nuclear exposure is vital for treatment of a large number of wounded people. Owing to the high-throughput analysis and minimally invasive nature of sample collection, radiation metabolomics has been recently applied to radiation damage research. In the present study, exploring the feasibility of estimating the acute radiation injury for early triage by means of urinary amino acid target analysis was attempted using a high performance liquid chromatography electrospray tandem mass spectrometry (HPLC-ESI-MS/MS) technique combined with multivariate statistical analysis. The non-linear kernel partial least squares (KPLS) model was used to separate the control and different radiation dose groups. The classification of different groups was performed after feature selection instead of before feature selection, because of its better separation. The classification accuracy at various radiation injury levels at different time points (5, 24, 48 and 72 h) post-irradiation exposure was investigated. For most of the radiation damage levels, the classification accuracy at 72 h after exposure was superior to that at earlier time points. Additionally, the potential radiation injury biomarkers selected suggested that the urea cycle, glycine, serine and threonine metabolism, alanine, aspartate and glutamine metabolism and related metabolic pathways were involved. The findings suggest that non-invasive urinary biomarkers have great potential for serving as an effective tool for rapid triage of mass casualties in nuclear accidents and understanding the pathogenesis of radiation injury. PMID:24647718

Zhang, Yuanyuan; Zhou, Xian; Li, Chao; Wu, Jianfang; Kuo, John E; Wang, Chang

2014-06-01

69

Analysis of responses of radiology personnel to a simulated mass casualty incident after the implementation of an automated alarm system in hospital emergency planning.  

PubMed

The purpose of this study was to evaluate the response to an automated alarm system of a radiology department during a mass casualty incident simulation. An automated alarm system provided by an external telecommunications provider handling up to 480 ISDN lines was used at a level I trauma center. During the exercise, accessibility, availability, and estimated time of arrival (ETA) of the called in staff were recorded. Descriptive methods were used for the statistical analysis. Of the 49 employees, 29 (59%) were accessible, of which 23 (79%) persons declared to be available to come to the department. The ETA was at an average 29 min (SD ±23). Radiologists and residents reported an ETA to their workplace almost two times shorter compared with technicians (19?±?16 and 22?±?16 vs. 40?±?27 min, p?>?0.05). Additional staff reserve is crucial for handling mass casualty incidents. An automated alarm procedure might be helpful. However, the real availability of the employees could not be exactly determined because of unpredictable parameters. But our results allow estimation of the manpower reserve and calculation of maximum radiology service capacities. PMID:21120569

Körner, Markus; Geyer, Lucas L; Wirth, Stefan; Meisel, Claus-Dieter; Reiser, Maximilian F; Linsenmaier, Ulrich

2011-04-01

70

Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS): development and application of computer modeling to selected National Planning Scenarios for high-consequence events.  

PubMed

Few tools exist that are sufficiently robust to allow manipulation of key input variables to produce casualty estimates resulting from high-consequence events reflecting local or specific regions of concern. This article describes the design and utility of a computerized modeling simulation tool, Electronic Mass Casualty Assessment and Planning Scenarios (EMCAPS), developed to have broad application across emergency management and public health fields as part of a catastrophic events preparedness planning process. As a scalable, flexible tool, EMCAPS is intended to support emergency preparedness planning efforts at multiple levels ranging from local health systems to regional and state public health departments to Metropolitan Medical Response System jurisdictions. Designed around the subset of the National Planning Scenarios with health effects, advanced by the US Department of Homeland Security, the tool's platform is supported by the detailed descriptions and readily retrievable evidence-based assumptions of each scenario. The EMCAPS program allows the user to manipulate key scenario-based input variables that would best reflect the region or locale of interest. Inputs include population density, vulnerabilities, event size, and potency, as applicable. Using these inputs, EMCAPS generates the anticipated population-based health surge influence of the hazard scenario. Casualty estimates are stratified by injury severity/types where appropriate. Outputs are graph and table tabulations of surge estimates. The data can then be used to assess and tailor response capabilities for specific jurisdictions, organizations, and health care systems. EMCAPS may be downloaded without cost from http://www.hopkins-cepar.org/EMCAPS/EMCAPS.html as shareware. PMID:18986730

Scheulen, James J; Thanner, Meridith H; Hsu, Edbert B; Latimer, Christian K; Brown, Jeffrey; Kelen, Gabor D

2009-02-01

71

Biological Dosimetry by the Triage Dicentric Chromosome Assay - Further validation of International Networking  

PubMed Central

Biological dosimetry is an essential tool for estimating radiation doses received to personnel when physical dosimetry is not available or inadequate. The current preferred biodosimetry method is based on the measurement of radiation-specific dicentric chromosomes in exposed individuals' peripheral blood lymphocytes. However, this method is labour-, time- and expertise-demanding. Consequently, for mass casualty applications, strategies have been developed to increase its throughput. One such strategy is to develop validated cytogenetic biodosimetry laboratory networks, both national and international. In a previous study, the dicentric chromosome assay (DCA) was validated in our cytogenetic biodosimetry network involving five geographically dispersed laboratories. A complementary strategy to further enhance the throughput of the DCA among inter-laboratory networks is to use a triage DCA where dose assessments are made by truncating the labour-demanding and time-consuming metaphase-spread analysis to 20 to 50 metaphase spreads instead of routine 500 to 1000 metaphase spread analysis. Our laboratory network also validated this triage DCA, however, these dose estimates were made using calibration curves generated in each laboratory from the blood samples irradiated in a single laboratory. In an emergency situation, dose estimates made using pre-existing calibration curves which may vary according to radiation type and dose rate and therefore influence the assessed dose. Here, we analyze the effect of using a pre-existing calibration curve on assessed dose among our network laboratories. The dose estimates were made by analyzing 1000 metaphase spreads as well as triage quality scoring and compared to actual physical doses applied to the samples for validation. The dose estimates in the laboratory partners were in good agreement with the applied physical doses and determined to be adequate for guidance in the treatment of acute radiation syndrome.

Wilkins, Ruth C.; Romm, Horst; Oestreicher, Ursula; Marro, Leonora; Yoshida, Mitsuaki A.; Suto, Y.; Prasanna, Pataje G.S.

2011-01-01

72

Collateral Casualties of Consumerism  

Microsoft Academic Search

Collateral victims of consumerism are the ‘flawed consumers’ - lacking resources that socially approved consumer activity requires. Collateral damages refer to the new frailty of inter-human bonds resulting from the transfer of consumerist patterns upon relations between humans. Collateral casualties of consumerism are all men and women affected by either of these and thereby confronted by a series of unfamiliar

Zygmunt Bauman

2007-01-01

73

Battlefield triage life signs detection techniques  

NASA Astrophysics Data System (ADS)

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.

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

2008-05-01

74

Medical treatment of radiological casualties: current concepts.  

PubMed

The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamination. External contamination from a radioactive cloud is easily evaluated using a simple Geiger-Muller counter and decontamination accomplished by prompt removal of clothing and traditional showering. Management of surgical conditions in the presence of persistent radioactive contamination should be dealt with in a conventional manner with health physics guidance. To be most effective in the medical management of a terrorist event involving high-level radiation, physicians should understand basic manifestations of the acute radiation syndrome, the available medical countermeasures, and the psychosocial implications of radiation incidents. Health policy considerations include stockpiling strategies, effective use of risk communications, and decisionmaking for shelter-in-place versus evacuation after a radiologic incident. PMID:15940101

Koenig, Kristi L; Goans, Ronald E; Hatchett, Richard J; Mettler, Fred A; Schumacher, Thomas A; Noji, Eric K; Jarrett, David G

2005-06-01

75

HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology.  

PubMed

In the experimental arm of a randomised trial, women were tested both for liquid-based cytology and human papillomavirus (HPV) DNA and referred for colposcopy if cytology was ASCUS (atypical cells of undetermined significance) or more severe. We considered those with ASCUS (757) or LSIL (low-grade squamous intraepithelial lesions) (485) and a valid HPV test who received colposcopy. We computed sensitivity, specificity and ROC curves with different values of relative light units (RLU, that are related to viral load) as cut off, using cervical intraepithelial neoplasia grade 2 or more severe (CIN2+) at blind histology review as the endpoint. The area under the receiver operating characteristic (ROC) curve was significantly less among women aged 25-34 years than in those older, both considering ASCUS/AGUS (atypical glandular cells of undetermined significance) (p=0.0355) and LSIL (p=0.0009). At age 35-60 the curves for ASCUS and LSIL were similar, while at age 25-34 the area under the curve for LSIL was significantly less than for ASCUS (p=0.0084). With LSIL cytology, specificity of Hybrid Capture 2 with 2 RLU cut-off was 35.0% (95%CI 28.4-42.1) at age 25-34 and 64.5% (95%CI 58.3-70.3) at age 35-60. In conclusion, triaging by HPV testing performed better in women aged over 35 years than those younger. For older women, HPV triaging should also be considered for managing those with LSIL cytology. PMID:17223540

Ronco, Guglielmo; Cuzick, Jack; Segnan, Nereo; Brezzi, Silvia; Carozzi, Francesca; Folicaldi, Stefania; Dalla Palma, Paolo; Del Mistro, Annarosa; Gillio-Tos, Anna; Giubilato, Pamela; Naldoni, Carlo; Polla, Enzo; Iossa, Anna; Zorzi, Manuel; Confortini, Massimo; Giorgi-Rossi, Paolo

2007-02-01

76

Burns mass disasters: aetiology, predisposing situations and initial management.  

PubMed

Many agents that are encountered daily are liable to cause burns mass disasters. These include flames, hot water and steam, combustible gases and liquids, molten liquids, boiling liquid expanding vapour explosion, chemicals and explosives. They result in disaster when certain lacks in safety occur. The proper management of such burns victims begins with rescue. At the disaster site, triage is important to separate the living from the dead, decide on priorisation for initial treatment and then evacuation to an appropriate facility. Proper management requires team effort and should be continued en-route to hospital. Repeat triage and use of clear guidelines in the Emergency Department ensure optimal and rapid care of the casualties. Finally psychological support for victims, relatives, rescuers and health workers must not be forgotten. PMID:1292392

Anantharaman, V

1992-09-01

77

Serum Enzymes in Combat Casualties.  

National Technical Information Service (NTIS)

Serum levels of lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were determined in combat casualties at the time of admission to the hospital and prior to the administration of any treatment. El...

H. K. Sleeman R. L. Simmons C. A. Heisterkamp

1968-01-01

78

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

PubMed

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

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

2005-09-01

79

Medical Management of Endurance Events: Incidence, Prevention, and Care of Casualties. (Reannouncement with New Availability Information).  

National Technical Information Service (NTIS)

Over the last decade mass-participation endurance events such as marathons, triathlons, cross-country ski races, and bicycle road races have gained tremendous popularity. This chapter discusses the incidence and distribution of casualties at mass-particip...

B. H. Jones W. O. Roberts

1991-01-01

80

User-managed inventory: an approach to forward-deployment of urgently needed medical countermeasures for mass-casualty and terrorism incidents.  

PubMed

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use ("dual utility") and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement. PMID:23241473

Coleman, C Norman; Hrdina, Chad; Casagrande, Rocco; Cliffer, Kenneth D; Mansoura, Monique K; Nystrom, Scott; Hatchett, Richard; Caro, J Jaime; Knebel, Ann R; Wallace, Katherine S; Adams, Steven A

2012-12-01

81

Is conservation triage just smart decision making?  

PubMed

Conservation efforts and emergency medicine face comparable problems: how to use scarce resources wisely to conserve valuable assets. In both fields, the process of prioritising actions is known as triage. Although often used implicitly by conservation managers, scientists and policymakers, triage has been misinterpreted as the process of simply deciding which assets (e.g. species, habitats) will not receive investment. As a consequence, triage is sometimes associated with a defeatist conservation ethic. However, triage is no more than the efficient allocation of conservation resources and we risk wasting scarce resources if we do not follow its basic principles. PMID:18848367

Bottrill, Madeleine C; Joseph, Liana N; Carwardine, Josie; Bode, Michael; Cook, Carly; Game, Edward T; Grantham, Hedley; Kark, Salit; Linke, Simon; McDonald-Madden, Eve; Pressey, Robert L; Walker, Susan; Wilson, Kerrie A; Possingham, Hugh P

2008-12-01

82

Combat Casualty Care research programme.  

PubMed

The Combat Casualty Care research programme is an integrated suite of projects designed to address Defence Medical Services' research needs for casualty care. The programme covers a broad spectrum of topics ranging from the pathophysiological and immunological impact of military relevant injuries to the effects of these disturbances on the response to early treatment. Dstl Porton Down has a long history of studying military injuries and has developed models, both in vivo and physical, to address the research needs. The work is conducted in close collaboration with clinical colleagues at the Royal Centre for Defence Medicine who have direct experience of the clinical issues faced by combat casualties and insights into the potential clinical implications of emerging strategies. This article reviews progress in research areas spanning forward resuscitation, with a particular focus on blast-related injuries, trauma coagulopathy, effects of drugs on the response to haemorrhage and deployed research. A significant 'value added' component has been the underpinning of higher degrees for seconded military clinicians at Dstl Porton Down who have made a valuable contribution to the overall programme. PMID:24574106

Kirkman, Emrys; Watts, S

2014-06-01

83

Emergency department triage: an ethical analysis  

PubMed Central

Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

2011-01-01

84

Accountability Pressure, Academic Standards, and Educational Triage  

ERIC Educational Resources Information Center

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

Lauen, Douglas Lee; Gaddis, S. Michael

2012-01-01

85

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster.  

PubMed

This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment. PMID:21030549

Satterthwaite, Peter S; Atkinson, Carol J

2012-02-01

86

Telephone triage improves demand management effectiveness.  

PubMed

Telephone triage, or telephone advice counseling, is becoming a key managed care point-of-entry tool for patients and health plan members accessing the health system. Telephone triage functions as a logical front-end for health plans, integrated physician groups, or integrated delivery systems that want to shift their managed care efforts toward demand management. Key components of telephone triage include patient education, patient information, and guided access to appropriate care. Telephone triage generally requires 24-hour staffing by registered nurses and a computer software package based on either clinical protocols or clinical algorithms. Organizations can either install an in-house system or purchase this service from a vendor, health plan, or another provider. The decision to develop a telephone triage service in-house or to out-source it is determined largely by volume and the user's strategy for moving to successive levels of risk management. PMID:10182276

Sabin, M

1998-08-01

87

Human casualties in earthquakes: modelling and mitigation  

USGS Publications Warehouse

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

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

2011-01-01

88

Infrared imaging-based combat casualty care system  

NASA Astrophysics Data System (ADS)

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.

Davidson, James E.

1997-08-01

89

Predicting casualties implied by TIPs  

NASA Astrophysics Data System (ADS)

When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral position is uncertain in one direction only: Along the strike of the plate boundary. However, in a case like the Philippines, where several faults capable of very large and great earthquakes exist, we have calculated losses for a number of scenarios that differ strongly. Among those, scenarios with 7.5?M?7.7 along the Marikina Valley Fault system stand out as likely to cause the most significant disasters because they are near the densely populated area around Manila. Our estimates include only casualties due to collapsing buildings. Victims due to tsunamis, landslides, and other auxiliary disasters, such as fires, are not considered.

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

2009-12-01

90

A pivot nurse at triage.  

PubMed

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

Martin, Marie

2012-01-01

91

[Experiences of treatment of mass burn casualties].  

PubMed

A fire in Karamay, Xinjiang on December 8, 1994, took a toll of 323 deaths at the site of the disaster, including 208 children, 75 teenagers and 40 adults. 135 burn patients were admitted to the hospital (including 41 children, 62 teenagers, and 32 adults). They were classified as extremely serious 9, serious 35, moderate 64 and mild 27. Among them 77 patients were complicated by inhalation injury, and tracheostomy was performed for moderate serious cases within 24 hours. Escharectomy and skin-grafting were done for III degree burn wound of hands, and early wound infection was effectively controled. Because of efficient organization, the rescue work and treatment were successful. PMID:10452001

Zhang, S; Jiang, Y; Zhang, J

1997-05-01

92

Mechanics and Biomechanics of Rollover Casualties.  

National Technical Information Service (NTIS)

The purposes of the research were to provide sound a basis for evaluating the benefits of alternative approaches for reducing casualties in rollover crashes. The approach applied national data systems which contain data on rollover crashes and resulting i...

K. H. Digges

1993-01-01

93

Demographics and Casualty Prediction/Analysis.  

National Technical Information Service (NTIS)

This report presents a general method for predicting and bounding casualties from both prompt and delayed effects produced by attacks against population. The method contains analytic sub-models for distributions of population and hardness and for nuclear ...

J. J. Shea

1980-01-01

94

Changes of triage by GPs during the course of prehospital emergency situations in a Norwegian rural community  

PubMed Central

Background Priority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage. Methods In the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (2005–2007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient. Results 236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages. Conclusions In pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases.

2013-01-01

95

Simulated Casualties and Medics for Emergency Training  

Microsoft Academic Search

The MediSim system extends virtual environment technology to allow medical personnelto interact with and train on simulated casualties. The casualty model employsa three-dimensional animated human body that displays appropriate physical and behavioralresponses to injury and#or treatment. Medical corpsmen behaviors were developedto allow the actions of simulated medical personnel to conform to both militarypractice and medical protocols during patient assessment and

Diane M. Chi; Evangelos Kokkevis; Omolola Ogunyemi; Rama Bindiganavale; Michael J. Hollick; John R. Clarke; Bonnie L. Webber

1997-01-01

96

Factors that affect the flow of patients through triage  

PubMed Central

Objective To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. Design A two?phase study comprising observation of 16?h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870?min including 257 patients and for 16 different members of the triage staff. Results No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13?min 34?s; the average length of time to triage for a patient was 4?min 17?s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively “seen and treated” in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. Conclusions The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non?qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients.

Lyons, Melinda; Brown, Ruth; Wears, Robert

2007-01-01

97

Value of the multi-service casualty processing unit in Operation Desert Storm: teamwork and flexibility.  

PubMed

This paper examines the role and implementation of a casualty processing unit (CPU) developed by a multi-service group during Operation Desert Storm in Saudi Arabia. Data were obtained from review of flight manifests, fleet hospital admission records, 24-hour follow-up of patients admitted to Fleet Hospital 15, and patient chart reviews following Desert Storm. The data indicate the CPU proved to be an effective and practical approach to health care in a combat zone, and provided an increased number of returned-to-duty personnel and timely triage of most seriously wounded combatants. In addition, it provided an opportunity for medical personnel of all branches of the armed services to participate as a team. As a result of this study, we propose consideration be given to use of this type of multi-service facility in future combat arenas. PMID:9121660

Crawford, P E; Armstrong, J F; Kerstein, M D; Oxler, S; Draude, T V

1997-03-01

98

Reliability and validity of triage systems in paediatric emergency care  

Microsoft Academic Search

BACKGROUND: Triage in paediatric emergency care is an important tool to prioritize seriously ill children. Triage can also be used to identify patients who do not need urgent care and who can safely wait. The aim of this review was to provide an overview of the literature on reliability and validity of current triage systems in paediatric emergency care METHODS:

Mirjam van Veen; Henriette A Moll

2009-01-01

99

Reliability and validity of emergency department triage systems  

Microsoft Academic Search

Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion validity of the Manchester Triage System (MTS) were studied in chapter 2. The consistency and reproducibility appeared

I. van der Wulp

2010-01-01

100

Gender and age bias in triage decisions  

Microsoft Academic Search

IntroductionRecently it has been recognized that women are less likely than men to be diagnosed with a myocardial infarction (MI) or to receive early or aggressive treatment and are more likely than men to die of an MI. The purpose of this qualitative study was to examine the triage decisions made by ED nurses for persons with symptoms suggestive of

Cynthia Arslanian-Engoren

2000-01-01

101

Midwifery triage of first trimester bleeding  

Microsoft Academic Search

Approximately one of five pregnant women will experience bleeding during the first trimester of pregnancy. Of these women, about half will go on to have a spontaneous abortion. Comfort with triaging this common problem assists the midwife in providing quality, cost-effective care without eliminating continuity. This article reviews the causes of early pregnancy bleeding, offers strategies to differentiate between these

Susan A Krause; Barbara W Graves

1999-01-01

102

Triage Nurse Prediction of Hospital Admission  

Microsoft Academic Search

Introduction: Numerous factors impact patient flow in the emergency department (ED). One important factor that has a negative impact on flow is ED patients waiting for an in-patient bed. It currently takes approximately 5 hours from triage to request for an in-patient bed in our emergency department. Knowledge of patients requiring admission early in their ED evaluation could speed up

Blythe Stover-Baker; Barbara Stahlman; Marc Pollack

103

Job Stress and Coping in Army Casualty Operations Workers.  

National Technical Information Service (NTIS)

Army Casualty Assistance work has no directly comparable civilian occupation. However, like civilian human service occupation, soldiers working in the casualty area are susceptible to job stressor that can lead to low morale, stress, burnout and psychiatr...

M. G. Ender P. T. Bartone

1991-01-01

104

Afghanistan Casualties: Military Forces and Civilians. Updated August 11, 2010.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

105

Afghanistan Casualties: Military Forces and Civilians. Updated June 23, 2010.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

106

Afghanistan Casualties: Military Forces and Civilians. Updated September 14, 2010.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

107

Afghanistan Casualties: Military Forces and Civilians. Updated October 28, 2010.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

108

Afghanistan Casualties: Military Forces and Civilians. Updated July 12, 2010.  

National Technical Information Service (NTIS)

This report collects statistics from a variety of sources on casualties sustained during Operation Enduring Freedom (OEF), which began on October 7, 2001, and is ongoing. OEF actions take place primarily in Afghanistan; however, OEF casualties also includ...

S. G. Chesser

2010-01-01

109

Success Matters: Casualty Sensitivity and the War in Iraq  

Microsoft Academic Search

Since the Vietnam War, U.S. policymakers have worried that the American public will support military operations only if the human costs of the war, as measured in combat casualties, are minimal. Although the public is rightly averse to suffering casualties, the level of popular sensitivity to U.S. military casualties depends critically on the context in which those losses occur. The

Christopher Gelpi; Peter D. Feaver; Jason Reifler

2006-01-01

110

48 CFR 552.270-7 - Fire and Casualty Damage.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Fire and Casualty Damage. 552.270-7 Section 552.270-7...Clauses 552.270-7 Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire...

2013-10-01

111

Road Accident and Casualty Rates in 1968.  

National Technical Information Service (NTIS)

Accident and casualty rates for 1968 were calculated for Great Britain, using traffic data obtained from the traffic census carried out at about 1300 sites in 1966, up-dated by applying trends at a number of permanent census sites. For urban and rural are...

H. D. Johnson

1970-01-01

112

Radiation casualties in a nuclear war  

Microsoft Academic Search

Calculations of the effects of nuclear explosions over London suggest that the proportion and absolute number of radiation fatalities are higher than previously estimated. They are sensitive to the value of LD50 assumed for people, but the number of total casualties, deaths plus injuries, is practically independent of the LD50.

Patricia Lindop; Joseph Rotblat; Philip Webber

1985-01-01

113

Implementing triage in a busy hospice team.  

PubMed

The number of referrals to the Princess Alice Community Team continue to rise and, while it is apparent that the percentage of referrals for patients with non-malignant disease has not increased, the complexity of many referrals and the chronicity of cancer means that patients are referred for longer term care. The Community Team has been responsive but the need to see a patient as urgently as the referrer perceives has placed undue stress on the Clinical Nurse Specialists (CNS). The referral process was uncontrolled. We therefore employed a triage nurse to:? Assess all referrals for appropriateness and urgency ? Gather information about new patients before they are formally assessed ? Respond quickly to urgent referrals ? Speak to patients and carers, introduce the service and gain a sense of their needs ? Assess non-urgent referrals, managing initial new patient needs through liaison with the primary care professionals ? Assign patients to other departments, for example, therapists or day hospice if primary request is for this intervention ? Keep a telephone only contact patient caseload ? Record and audit new referrals and outcome of triage process The post has been a great success. An additional post has been made. ? CNSs have not felt burdened by new referrals arriving with little information. The triage nurse can obtain copies of clinic letters, imaging reports discharge summaries etc. ? Patients have felt welcomed and their cares listened to, an introduction to the service has been undertaken. They have been reassured. ? Some patients have been 'referred back' to the referrer or GP as not appropriate or, more commonly, have been held on the triage caseload until a time that requires a CNS visit. Stats on patterns of referral, outcomes and 'refer backs' will be provided as well as a discussion on future developments. PMID:24653346

Knighy, Andrew

2011-09-01

114

Initial assessment and triage in ER.  

PubMed

Triage refers to quick assessment of a patient in the Emergency Room with a view to define urgency of care and priorities in management. Triage evaluation can be completed in an organized and systematic manner using Pediatric Assessment Triangle (PAT), which refers to immediate visual and auditory assessment of appearance, breathing and circulation. At the end of PAT, patient's illness is categorized as either stable or unstable. Unstable conditions are further classified into life threatening and non life threatening. Patients in the former category include those in need of immediate resuscitation e.g. cardiac arrest, cardio-respiratory failure, decompensated shock, deep coma, severe stridor etc. Once a child is on the way to stabilization, the primary assessment (assessment pentagon),which takes 1-3 min follows. It involves the detailed physical examination/assessment of airway (A), breathing (B), circulation(C), neurologic abnormalities (D) and head to- toe examination (Exposure). After the primary assessment, patient's illness severity is triaged into 5 levels of acuity based on the physiological abnormalities: those in need of Resuscitation, Emergent care, Urgent care, Less urgent and Non-urgent care. PMID:21553208

Jayashree, M; Singhi, Sunit C

2011-09-01

115

Optimizing triage and hospitalization in adult general medical emergency patients: the triage project  

PubMed Central

Background Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site-of-care decisions and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced into clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at the most proximal time point of ED admission. Methods/design Prospective, observational, multicenter, multi-national cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to the medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for discharge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic medical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and functional status, re-hospitalization, satisfaction with care and quality of life measures. We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post acute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, time to social worker involvement, length of hospital stay, reasons for discharge delays, patient’s satisfaction with care, overall hospital costs and patients care needs after returning home. Discussion Using a reliable initial triage system for estimating initial treatment priority, need for in-hospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted and efficient management of medical patients in the ED. The proposed interdisciplinary , multi-national project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient’s outcomes in terms of mortality, re-hospitalization, quality of life and satisfaction with care. Trial registration ClinicalTrials.gov Identifier, NCT01768494

2013-01-01

116

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

PubMed Central

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.

2011-01-01

117

Yale and the Atomic Bomb Casualty Commission.  

PubMed Central

This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation.

Bowers, J. Z.

1983-01-01

118

No Child Overlooked: Mental Health Triage in the Schools  

ERIC Educational Resources Information Center

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…

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

2009-01-01

119

The value of telephone triage for patients with appendicitis.  

PubMed

Although it has been assumed that telephone triage can directly benefit patients by facilitating early diagnosis and treatment, this potential benefit has not been well documented. Using appendicitis cases ascertained from claims data, we compared telephone triage recommendations with what the callers originally intended to do. Over a two-year period, there were 20,230 calls to a telephone triage centre in the US where insurance information was available. Of these, 12,709 calls (63%) had insurance claims made within seven days of the call. Among these calls, 46 had a diagnosis of appendicitis. In 72% of calls concerning appendicitis, the telephone triage recommendation was for a more rapid evaluation than the caller originally intended (P < 0.0001). In 91% of the appendicitis cases, triage nurses directed callers to care within 8 h, but without triage advice, only 39% of callers stated they would have sought care within 8 h (P < 0.0001). Telephone triage significantly reduced the delay in care for appendicitis in comparison with what the caller would have done. This suggests that telephone triage potentially reduces the morbidity associated with appendicitis. PMID:22052965

North, Frederick; Odunukan, Olufunso; Varkey, Prathibha

2011-01-01

120

Web-Based Triage in a College Health Setting  

ERIC Educational Resources Information Center

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

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

2006-01-01

121

Triage during the week of the Sichuan earthquake: A review of utilized patient triage, care, and disposition procedures  

Microsoft Academic Search

ObjectivesThere exists no standard hospital emergency department (ED) triage procedure model for earthquake victims. This study provides an overview of the hospital triage procedure used for patients evaluated and treated at the West China Hospital of Sichuan University, Chengdu in the Sichuan province of China, following the May 12, 2008 Wenchuan earthquake.

Hu Nie; Shi-Yuan Tang; Wayne Bond Lau; Jian-Cheng Zhang; Yao-Wen Jiang; Bernard L. Lopez; Xin L. Ma; Yu Cao; Theodore A. Christopher

2011-01-01

122

An evaluation of police reporting of road casualties  

Microsoft Academic Search

Background:Under-reporting of road traffic casualties in police records has been well documented.Objectives:To investigate the extent and nature of possible under-reporting of road traffic casualties in the West of Scotland.Design:A linked database comprising both police data (STATS19) and hospital in-patient records (SMR01) was created. The study period was 1997–2005 inclusive. Contrasting the number of SMR01-identified road casualties that were also recorded

S Jeffrey; D H Stone; A Blamey; D Clark; C Cooper; K Dickson; M Mackenzie; K Major

2009-01-01

123

Chemically contaminated casualties: different problems and possible solutions.  

PubMed

The initial response to mass casualty incidents is usually informal as uninjured and injured survivors and passersby assist the injured and take them to medical centers. This creates some problems, for example, most victims go to one or two hospitals and the least injured arrive first; but, on the whole, it works. However, the same response does not work when victims are contaminated, and some of the solutions that work when victims are only injured do not work when victims are contaminated. This article suggests an approach that accepts the reality of what happens-the first receiving hospital becomes contaminated--and suggests how planning can begin with that as a starting point. It stressed that current plans are based on false assumptions and that this can lead to inadequate preparation. PMID:20496642

Scanlon, Joseph

2010-01-01

124

Multilocation teleradiology system for emergency triage consultation  

NASA Astrophysics Data System (ADS)

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

Herron, John M.; Yonas, Howard

1996-05-01

125

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

Code of Federal Regulations, 2010 CFR

... false Written report of marine casualty. 4.05-10 Section 4.05-10 Shipping COAST GUARD, DEPARTMENT OF HOMELAND...Notice of Marine Casualty and Voyage Records § 4.05-10 Written report of marine casualty....

2010-10-01

126

Holter triage ambulatory ECG analysis. Accuracy and time efficiency.  

PubMed

Triage ambulatory electrocardiographic (ECG) analysis permits relatively unskilled office workers to submit 24-hour ambulatory ECG Holter tapes to an automatic instrument (model 563, Del Mar Avionics, Irvine, CA) for interpretation. The instrument system "triages" what it is capable of automatically interpreting and rejects those tapes (with high ventricular arrhythmia density) requiring thorough analysis. Nevertheless, a trained cardiovascular technician ultimately edits what is accepted for analysis. This study examined the clinical validity of one manufacturer's triage instrumentation with regard to accuracy and time efficiency for interpreting ventricular arrhythmia. A database of 50 Holter tapes stratified for frequency of ventricular ectopic beats (VEBs) was examined by triage, conventional, and full-disclosure hand-count Holter analysis. Half of the tapes were found to be automatically analyzable by the triage method. Comparison of the VEB accuracy of triage versus conventional analysis using the full-disclosure hand count as the standard showed that triage analysis overall appeared as accurate as conventional Holter analysis but had limitations in detecting ventricular tachycardia (VT) runs. Overall sensitivity, positive predictive accuracy, and false positive rate for the triage ambulatory ECG analysis were 96, 99, and 0.9%, respectively, for isolated VEBs, 92, 93, and 7%, respectively, for ventricular couplets, and 48, 93, and 7%, respectively, for VT. Error in VT detection by triage analysis occurred on a single tape. Of the remaining 11 tapes containing VT runs, accuracy was significantly increased, with a sensitivity of 86%, positive predictive accuracy of 90%, and false positive rate of 10%. Stopwatch-recorded time efficiency was carefully logged during both triage and conventional ambulatory ECG analysis and divided into five time phases: secretarial, machine, analysis, editing, and total time. Triage analysis was significantly (P < .05) more time efficient for the machine, analysis, and total time phases and required significantly more time in the editing phases. The triage analysis was limited by the inability of the automatic methodology to detect a specific VT waveform contained on one tape. This result which caused substantial loss of sensitivity for VT, emphasizes the necessity for careful quality control and editing of all automatic Holter analysis methods. PMID:8808523

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

1996-01-01

127

46 CFR 169.807 - Notice of casualty.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Notice of casualty. 169.807 Section 169.807 Shipping COAST GUARD, DEPARTMENT OF HOMELAND...NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.807 Notice of casualty. (a) The...

2013-10-01

128

CRITICAL CARE OF MILITARY BURN CASUALTIES AT ROLE 3 FACILITIES  

Microsoft Academic Search

Burn casualties will inevitably occur in the military environment during both conflict and peacetime. The number and type of casualties will vary on the nature of warfare and the type of troops deployed. New preventative measures have decreased thenumberandseverityofburnsfoundonthebattlefieldhoweverwithnewweaponsystemscasualtiessufferingfromthermal injuries are still to be expected in modern warfare. Over the last 4 decades great advances have been made in the

DAF Parkhouse

129

Trauma triage in the emergency departments of nontrauma centers: An analysis of individual physician caseload on triage patterns  

PubMed Central

Background Treatment at Level I/II trauma centers improves outcomes for patients with severe injuries. Little is known about the role of physicians’ clinical judgment in triage at outlying hospitals. We assessed the association between physician caseload, case mix, and the triage of trauma patients presenting to non-trauma centers. Methods A retrospective cohort analysis of patients evaluated between January 1, 2007 and December 31, 2010 by emergency physicians working in eight community hospitals in western Pennsylvania. We linked billing records to hospital charts, summarized physicians’ caseloads, and calculated rates of under-triage (proportion of patients with moderate to severe injuries not transferred to a trauma center) and over-triage (proportion of patients transferred with a minor injury). We measured the correlation between physician characteristics, caseload and rates of triage. Results 29 (58%) of 50 eligible physicians participated in the study. Physicians had 16.8 (SD=10.1) years of post-residency clinical experience; 21 (72%) were board-certified in Emergency Medicine. They evaluated a median of 2,423 patients/year, of whom 148 (6%) were trauma patients and 3 (0.1%) had moderate to severe injuries. The median under-triage rate was 80%; the median over-triage rate was 91%. Physicians’ caseload of patients with moderate to severe injuries was inversely associated with rates of under-triage (correlation coefficient ?0.42, p=0.03). Compared to physicians in the lowest quartile, those in the highest quartile under-triaged 31% fewer patients. Conclusions Emergency physicians working in non-trauma centers rarely encounter patients with moderate to severe injuries. Caseload was strongly associated with compliance with American College of Surgeons – Committee on Trauma guidelines.

Mohan, Deepika; Barnato, Amber E.; Rosengart, Matthew R.; Farris, Coreen; Yealy, Donald M.; Switzer, Galen E.; Fischhoff, Baruch; Saul, Melissa; Angus, Derek C.

2013-01-01

130

Telephone triage, expert systems and clinical expertise.  

PubMed

This paper reports on a qualitative study of the use of an expert system developed for the British telephone triage service NHS Direct. This system, known as CAS, is designed to standardise and control the interaction between NHS Direct nurses and callers. The paper shows, however, that in practice the nurses use CAS in a range of ways and, in so doing, privilege their own expertise and deliver an individualised service. The paper concludes by arguing that NHS Direct management's policy of using CAS as a means of standardising service delivery will achieve only limited success due not only to the professional ideology of nursing but also to the fact that rule-based expert systems capture only part of what 'experts' do. PMID:16283900

Greatbatch, D; Hanlon, G; Goode, J; O'Cathain, A; Strangleman, T; Luff, D

2005-09-01

131

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

NASA Astrophysics Data System (ADS)

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.

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

1999-07-01

132

Dental triage Hydebank Wood Prison and Young Offenders Centre, Belfast.  

PubMed

Objective The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services.Method The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination.Results Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services.Conclusion This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation. PMID:24809588

Gray, R; Fawcett, T

2014-05-01

133

Intraosseous Vascular Access in the Treatment of Chemical Warfare Casualties Assessed by Advanced Simulation: Proposed Alteration of Treatment Protocol  

Microsoft Academic Search

Current treatment protocols for chemical warfare casu- alties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, im- paired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presenta- tions render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated in- traosseous infusion device may offer an effective solu- tion.

Amir Vardi; Haim Berkenstadt; Inbal Levin; Ariel Bentencur; Amitai Ziv

2004-01-01

134

Redefining Technical Rescue and Casualty Care for SOF: Part 1.  

PubMed

Trauma care in the tactical environment is complex; it requires a unique blend of situational awareness, foresight, medical skill, multitasking, and physical strength. Rescue is a critical, but often over-looked, component of nearly all tactical trauma casualty management. Successful full spectrum casualty management requires proficiency in four areas: casualty access, assessment, stabilization, and extraction. When complex rescue situations arise (casualty removal from roof tops, mountain terrain, collapsed structures, wells, or a karez), casualty care often becomes further complicated. Special Operations units have historically looked to civilian technical rescue techniques and equipment to fill this ?rescue gap.? Similar to the evolution of pre-hospital military medicine from civilian guidelines (e.g. Advanced Trauma Life Support) (ATLS)) to an evidence-based, tactical-specific guideline (Tactical Combat Casualty Care (TCCC)), an evolution is required within the rescue paradigm. This shift from civilian-based technical rescue guidelines towards an Operational Rescue? capability allows tactical variables such as minimal equipment, low light/night vision goggles (NVG) considerations, enemy threats, and variable evacuation times to permeate through the individual rescue skill set. Just as with TCCC, in which the principles of casualty care remain consistent, the practices must be adapted to end-users environment, so it is with rescue. PMID:23536462

McKay, S D; Johnston, J; Callaway, D W

2012-01-01

135

Factors Influencing Triage Decisions in Patients Referred for ICU Admission  

PubMed Central

Background Few data is available on triage of critically ill patients. Because the demand for ICU beds often exceeds their availability, frequently intensivists need to triage these patients in order to equally and efficiently distribute the available resources based on the concept of potential benefit and reasonable chance of recovery. The objective of this study is to evaluate factors influencing triage decisions among patients referred for ICU admission and to assess its impact in outcome. Methods A single-center, prospective, observational study of 165 consecutive triage evaluations was conducted in patients referred for ICU admission that were either accepted, or refused and treated on the medical or surgical wards as well as the step-down and telemetry units. Results Seventy-one patients (43.0%) were accepted for ICU admission. Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 15.3 (0 - 36) and 13.9 (0 - 30) for accepted and refused patients, respectively. Three patients (4.2%) had active advance directives on admission to ICU. Age, gender, and number of ICU beds available at the time of evaluation were not associated with triage decisions. Thirteen patients (18.3%) died in ICU, while the in-hospital mortality for refused patients was 12.8%. Conclusion Refusal of admission to ICU is common, although patients in which ICU admission is granted have higher mortality. Presence of active advance directives seems to play an important role in the triage decision process. Further efforts are needed to define which patients are most likely to benefit from ICU admission. Triage protocols or guidelines to promote efficient critical care beds use are warranted.

Orsini, Jose; Butala, Ashvin; Ahmad, Noeen; Llosa, Alfonso; Prajapati, Ramesh; Fishkin, Edward

2013-01-01

136

Multibiodose radiation emergency triage categorization software.  

PubMed

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

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

137

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

PubMed

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

Donohue, Dave

2008-05-01

138

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2013 CFR

...OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS ...records after casualty. (a) The owner, agent, master, or person in charge of...Crane record book. (c) The owner, agent, master, or person in charge shall,...

2013-10-01

139

Shipboard Casualty Forecasting: Adjustments to Ship Hit Probabilities.  

National Technical Information Service (NTIS)

Adjustment factors needed to contemporize World War Il-based hit probabilities of the SHIPCAS casualty projection model were investigated. Subject Matter Experts provided quantitive responses corresponding to the perceived shifts in hit probability associ...

C. G. Blood J. S. Marks M. S. Odowick

1996-01-01

140

Casualty Crash Types for which Teens are at Excess Risk  

PubMed Central

This study identified casualty crash types for which teen drivers experience excess risk relative to adults. Michigan State Police crash records were used to examine casualty crashes in two statewide populations of drivers who experienced at least one crash from 1989–1996 (pre-graduated driver licensing in Michigan): teens (ages 16–19) and adults (ages 45–65). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two statewide populations. Excess risk was defined as a RR for a specific type of crash that was significantly greater than the RR for all crashes combined. The RRs for all crashes combined for teenage males was 2.41 and 1.75 for teenage females. RRs for teenage males ranged from a low of 2.16 for casualty crashes attributed to alcohol to 8.98 for casualty road departure crashes at night. Among teenage females, RRs ranged from 2.06 for casualty crashes on the weekend to 7.86 for casualty crashes at night with passengers. Casualty crash rates for teenage males ranged from 0.21 per 100,000 PMD for rollover crashes to 1.95 per 100,000 PMD for crashes with passengers. Among teen females, casualty crash rates ranged from 0.21 per 100,000 PMD for drink/driving with passengers to 3.31 per 100,000 PMD for crashes with passengers. Implications for graduated driver licensing, teen driver supervision, and policy are discussed. This study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control.

Bingham, C. R.; Shope, J. T.

2007-01-01

141

Do lower income areas have more pedestrian casualties?  

PubMed

Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas. PMID:23856641

Noland, Robert B; Klein, Nicholas J; Tulach, Nicholas K

2013-10-01

142

Emergency slaughter of casualty cattle increases the prevalence of anthelmintic drug residues in muscle.  

PubMed

The ProSafeBeef project studied the prevalence of residues of anthelmintic drugs used to control parasitic worms and fluke in beef cattle in Ireland. Injured (casualty) cattle may enter the human food chain under certain conditions, verified by an attending veterinarian and the livestock keeper. An analytical survey was conducted to determine if muscle from casualty cattle contained a higher prevalence of anthelmintic drug residues than healthy (full slaughter weight) cattle as a result of possible non-observance of complete drug withdrawal periods. A validated analytical method based on matrix solid-phase dispersive extraction (QuEChERS) and ultra-performance liquid chromatography-tandem mass spectrometry was used to quantify 37 anthelmintic drugs and metabolites in muscle (assay decision limits, CC?, 0.15-10.2?µg?kg?¹). Of 199 control samples of beef purchased in Irish shops, 7% contained detectable anthelmintic drug residues but all were compliant with European Union Maximum Residue Limits (MRL). Of 305 muscle samples from injured cattle submitted to abattoirs in Northern Ireland, 17% contained detectable residues and 2% were non-compliant (containing either residues at concentrations above the MRL or residues of a compound unlicensed for use in cattle). Closantel and ivermectin were the most common residues, but a wider range of drugs was detected in muscle of casualty cattle than in retail beef. These data suggest that specific targeting of casualty cattle for testing for anthelmintic residues may be warranted in a manner similar to the targeted testing for antimicrobial compounds often applied in European National Residues Surveillance Schemes. PMID:22632575

Cooper, K M; Whyte, M; Danaher, M; Kennedy, D G

2012-08-01

143

Higher Education: A Time for Triage?  

NASA Astrophysics Data System (ADS)

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

Lagowski, J. J.

1995-10-01

144

The Atomic Bomb Casualty Commission in retrospect  

PubMed Central

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.

Putnam, Frank W.

1998-01-01

145

Teleconsultation in children with abdominal pain: a comparison of physician triage recommendations and an established paediatric telephone triage protocol  

PubMed Central

Background Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Methods Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. Results In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. Conclusions A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system.

2013-01-01

146

An Integrated Computerized Triage System in the Emergency Department  

PubMed Central

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients.

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

2008-01-01

147

Emergency department triage: A program assessment using the tools of continuous quality improvement  

Microsoft Academic Search

An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff

S. Cook; D. Sinclair

1997-01-01

148

Evaluating the effect of emergency department crowding on triage destination  

PubMed Central

Background Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. Methods This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the ?2 and Fisher exact tests. Results Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P?=?0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P <0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P?=?0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P?=?0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P?=?0.46. Conclusions ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.

2014-01-01

149

The reliability of teledermatology to triage inpatient dermatology consultations.  

PubMed

IMPORTANCE Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients. OBJECTIVE To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations. DESIGN, SETTING, AND PARTICIPANTS Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists. MAIN OUTCOMES AND MEASURES The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations. RESULTS Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The Kendall ? rank correlation coefficients for initial triage concordance between the in-person dermatologist and teledermatologists were 0.41 and 0.48. The Cohen ? coefficients for decision to biopsy concordance were 0.35 and 0.61. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge. CONCLUSIONS AND RELEVANCE Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency. PMID:24522374

Barbieri, John S; Nelson, Caroline A; James, William D; Margolis, David J; Littman-Quinn, Ryan; Kovarik, Carrie L; Rosenbach, Misha

2014-04-01

150

Tactical emergency casualty care?pediatric appendix: novel guidelines for the care of the pediatric casualty in the high-threat, prehospital environment.  

PubMed

Background: Active shooter events and active violent incidents are increasingly targeting civilians, placing children at heightened risk for complex and devastating trauma. The U.S. Department of Homeland Security has identified as a priority preparing domestic first responders to manage complex mass casualty incidents as a primary step in strengthening our medical system. Existing literature suggests that many prehospital providers are uncomfortable treating critically ill or injured pediatric patients and that there is a gap in the consistent provision of high-quality trauma care to these patients. The success of threat-based care developed by the military has led to an exponential rise in the familiarity and utilization of these concepts within certain specialized elements of civilian care. Evolution of these concepts is accelerating to meet the demands of the nonmilitary civilian environment through the formation and subsequent work of the Committee for Tactical Emergency Casualty Care (C-TECC). However, a gap remains in the available literature describing the application of these principles to specialized populations. Methods: In the absence of an evidence-based set of guidelines for prehospital care of the pediatric casualty, the C-TECC sought to establish a set of peer-reviewed guidelines to serve as a foundation describing current best practices. The Pediatric Working Group (PWG) utilized the adult TECC guidelines as a starting point and identified a series of key questions regarding trauma interventions. The PWG conducted a standard PubMed search to identify key relevant or potentially relevant literature. The literature review was presented to the C-TECC Guidelines Committee for review and approval of recommended principles. Recommendations: Given the dearth of supporting literature on the subject, the TECC committee was purposefully conservative in the adaptation of the adult TECC guidelines to a pediatric standard. The guidelines highlight information tailored to the pediatric population and were designed to be a resource for individual agencies seeking guidance for high-threat operations. To our knowledge, the TECC Pediatric Appendix is the first published recommendation for the widespread use of tourniquets in pediatric hemorrhage. In addition, the Guidelines are meant to highlight gaps in trauma literature and stimulate discussion regarding future research in the area of prehospital care of the pediatric casualty. PMID:24227567

Bobko, Joshua; Lai, Tristan T; Smith, E Reed; Shapiro, Geoffrey L; Baldridge, R Todd; Callaway, David W

2013-01-01

151

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

PubMed

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

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

2013-07-01

152

Casualty Data Analysis of the World Merchant Fleet for Reported Fire and Explosion Incidents Resulting in Marine Pollution.  

National Technical Information Service (NTIS)

World wide merchant vessel fire and explosion casualty data were analyzed to determine the contribution of these casualties to the marine pollution problem. The source of information is the Lloyd's Casualty Information System Data Base. The major findings...

M. J. Gentile R. P. Dickenson

1995-01-01

153

Navigating triage to meet targets for waiting times.  

PubMed

An initial assessment process, called navigation, has been introduced at Medway Maritime Hospital emergency department (ED) to address problems with the triage system and to meet the latest ED quality clinical indicators. This article explains the rationale for introducing the new assessment process, describes the system and discusses the change-management process needed to implement it. - PMID:23888562

Diaz Alonso, Inmaculada

2013-06-01

154

Factors Influencing Digital Reference Triage: A Think-Aloud Study  

ERIC Educational Resources Information Center

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

Pomerantz, Jeffrey

2004-01-01

155

High-accuracy Decision of Call-triage by Using Bayesian Network  

NASA Astrophysics Data System (ADS)

A new call-triage system, a key part of emergency support system with stochastic network model is examined. The call-triage is an operation allowing the efficient decision of service grade and dispatching of suitable rescue team service from phone call information. Nowadays, the call-triage is being trialed on a few cities and is achieving an effect. However, there is the issue that if under-triage in which the condition of sick person is estimated more lightly is eliminated, the efficiency is degraded (over-triage). In this report, in order to overcome the issue, the Bayesian network scheme is examined to the call-triage system. The experiments with real call-triage data set results show the Bayesian network achieves precision enhancement.

Yunoki, Shota; Hamagami, Tomoki; Oshige, Kenji; Kawakami, Chihiro; Suzuki, Noriyuki

156

Weapons of Mass Destruction Events With Contaminated Casualties  

Microsoft Academic Search

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essen- tial component of the emergency response system, at present they are poorly prepared for such incidents. The greatest challenge for HCFs may be the sud- den presentation of large numbers of contaminated individuals. Guidelines for managing contaminated patients have

Anthony G. Macintyre; Joseph A. Barbera

2000-01-01

157

27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.  

Code of Federal Regulations, 2010 CFR

...lost by fire, theft, casualty, or act of God. 25.282 Section 25.282 Alcohol...lost by fire, theft, casualty, or act of God. (a) General. The tax paid...unmerchantable by fire, casualty, or act of God. The tax liability on excessive...

2010-04-01

158

27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.  

Code of Federal Regulations, 2010 CFR

...lost by fire, theft, casualty, or act of God. 25.282 Section 25.282 Alcohol...lost by fire, theft, casualty, or act of God. (a) General. The tax paid...unmerchantable by fire, casualty, or act of God. The tax liability on excessive...

2009-04-01

159

Reporting Palestinian casualties in the Israeli press: the case of Haaretz and the Intifada  

Microsoft Academic Search

This article examines how the Israeli quality daily newspaper Haaretz reported Palestinian casualties during the first year of the Palestinian uprising. While Palestinian casualties received few headlines and were reported on the inner pages, Haaretz did not ignore them and, unlike the other major Hebrew newspapers, reported their numbers consistently and reliably. Palestinian casualties, however, were reported as people killed

Alina Korn

2004-01-01

160

Military Casualty with Combat Related Acute Post Traumatic Stress Disorder.  

National Technical Information Service (NTIS)

In the next war in which the U.S. military is involved it is predicted that a large number (25% or greater) of military casualties will have combat related Acute Post Traumatic Stress Disorder (APTSD). The purpose of this study was to describe the level o...

K. L. Johnson

1984-01-01

161

Outcome of sports injuries treated in a casualty department  

Microsoft Academic Search

The present investigation analyses 2493 patients with a sports injury treated in a casualty department during a one-year period. Of the patients 73% were men, the age of the patients averaging 26 years and the mean follow-up time was 24 months. Soccer and indoor ball games caused 24% and 23% of the injuries respectively, these being followed by injuries in

J Sandelin; O Kiviluoto; S Santavirta; R Honkanen

1985-01-01

162

Combat Casualty Hand Burns: Evaluating Impairment and Disability during Recovery  

Microsoft Academic Search

This study evaluated the use of the American Medical Association (AMA) impairment guides and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire in U.S. military casualties recovering from burn injury to the hand. Study sample included patients with burns to at least one hand and complete evaluations of impairment and disability upon discharge from the hospital and at a

Ted T. Chapman; Reg L. Richard; Travis L. Hedman; Evan M. Renz; Steve E. Wolf; John B. Holcomb

2008-01-01

163

Misclassification of injury severity among road casualties in police reports  

Microsoft Academic Search

This study aims to evaluate the discordance between police reports of injury severity among road casualties and the length of hospital stay and the Injury Severity Scale (ISS) by linking information from the crash records of the Hong Kong Police with the trauma records of a regional hospital. Sensitivity and specificity analyses suggest that police injury grading diverges noticeably from

K. L. Tsui; F. L. So; N. N. Sze; S. C. Wong; T. F. Leung

2009-01-01

164

Shouldering the Soldiering: Democracy, Conscription, and Military Casualties  

ERIC Educational Resources Information Center

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…

Vasquez, Joseph Paul, III

2005-01-01

165

Registered nurses integrate traditional Chinese medicine into the triage process.  

PubMed

People in the United States often consult registered nurses (nurses) for advice when they want to explore alternatives to Western medicine, such as traditional Chinese medicine (TCM). Nurses find themselves confronting dilemmas when they are caught between these radically different worlds of medical cultures and thinking. Twenty Minnesota nurses were interviewed to learn how they integrate TCM into their triage process. Symbolic interactionism was the research framework used, and mixed coding methods facilitated data analysis. Several sociological theories explain the findings. The major finding is that nurses use a four-step triage process that begins from the Western medical perspective and includes consideration of TCM use. Nurses' recommendations are influenced by their situational roles and relationships, and by the cues they read from the person who is asking their advice. The results point to nurses being natural disseminators of TCM information and education in their resource role for others making health care decisions. PMID:21890709

Bertrand, Sharon W

2012-02-01

166

Empirical development and evaluation of prehospital trauma triage instruments.  

PubMed

The field identification of the patients who should be taken to trauma centers is a major problem of trauma care. This study appears to be the first to use multivariate analysis to systematically design a field triage instrument and to evaluate its performance in terms of a meaningful and plausible criterion for which patients ought to be treated at trauma centers. Four new triage instruments were created and their performance compared to that of two existing measures, the Trauma Score and the CRAMS scale. The new measures appear to perform better than the best of existing instruments tested, although independent validation is necessary. The one purely physiologic instrument tested appeared to be inferior to instruments that included anatomic and historic as well as physiologic indices. Simple checklists performed approximately as well as weighted scales. No instrument was found to be high in both sensitivity and positive accuracy. PMID:4009748

Kane, G; Engelhardt, R; Celentano, J; Koenig, W; Yamanaka, J; McKinney, P; Brewer, M; Fife, D

1985-06-01

167

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

PubMed

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

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

2009-07-01

168

[Triage in the emergency department. Practical and ethical issues].  

PubMed

Triage is a complex and dynamic decisional process composed of sequential actions and necessary evaluations in order to establish the priority of access to medical attention in emergency care. In the Triage not only medical-biological knowledge is important but also the methods that together are inspired by ethical models. Following the historical considerations and after having brought out the methods and practice used in various countries and also having underlined the personal experience of the Emergency Department of the Emergency Department of the University Policlinic of the "Sapienza" University of Rome (Italy), the biggest hospital in Europe, the authors emphasized the nursing care in the "triage" and support the necessity of an adequate training period not only to acquired the technical knowledge required but also the psychological and social interaction as well as moral and practical competence. By "practical" we intend it to be explicitly a dimension in which moral competence has been acquired in using concrete first person action in a virtuous way towards the betterment of the sick person using the best modes of justice. PMID:19756326

Soldini, M; Anastasi, S

2009-01-01

169

Calibrating urgency: triage decision-making in a pediatric emergency department  

Microsoft Academic Search

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions\\u000a under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients\\u000a are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and\\u000a standardize the triage

Vimla L. Patel; Lily A. Gutnik; Daniel R. Karlin; Martin Pusic

2008-01-01

170

Report of an audit of nurse triage in an accident and emergency department.  

PubMed Central

The nurse triage process in an accident and emergency (A&E) department was audited as part of the nursing quality assurance programme. It was found that in most cases documentation was adequate and guidelines had been adhered to. Triage decisions were accurate in most cases using the discharge diagnosis as a bench-mark. Waiting time improvements were also seen. Triage audit was a useful tool in the continuous quality improvement effort.

Wong, T W; Tseng, G; Lee, L W

1994-01-01

171

Triage System for the Distribution of Outpatient Appointments in a Neurology Department: Systems Description, Validation of Triage System Results and the Report of a Delphi Method Study for Evaluating Criteria Determining Appointment Urgency.  

National Technical Information Service (NTIS)

A triage system is proposed for the distribution of outpatient appointments in a hospital neurology department. The conceptual basis of a triage system is discussed and its adaptation to a department of neurology is detailed. The following elements are vi...

B. Austin D. Chaudhouri J. Conomy

1976-01-01

172

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

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.

2012-01-01

173

Triage and management of cranial injuries.  

PubMed

This article discusses basic head and intracranial CNS anatomy, cerebral physiology, and classifications of head injury. Management principles and the practice of head-injury evaluation are reviewed and supplemented by the presentation of selected head-injury scenarios. The optimal evaluation and treatment of the head-injured patient is predicated on initially following established ATLS principles and preventing secondary injury. Once specific injuries have been identified, maintenance of cerebral perfusion and oxygenation is the key to maximizing patient outcomes, and this often requires measurement and treatment of ICP values. When significant mass lesions are identified or ICP elevations become refractory to medical intervention, surgical intervention is necessary. PMID:23498335

Severson, Meryl A; Bell, Randy S; Armonda, Rocco A

2013-03-01

174

Sport associated eye injury: a casualty department survey  

Microsoft Academic Search

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

C. J. MacEwen

1987-01-01

175

Strategies for casualty mitigation programs by using advanced tsunami computation  

NASA Astrophysics Data System (ADS)

1. Purpose of the study In this study, based on the scenario of great earthquakes along the Nankai trough, we aim on the estimation of the run up and high accuracy inundation process of tsunami in coastal areas including rivers. Here, using a practical method of tsunami analytical model, and taking into account characteristics of detail topography, land use and climate change in a realistic present and expected future environment, we examined the run up and tsunami inundation process. Using these results we estimated the damage due to tsunami and obtained information for the mitigation of human casualties. Considering the time series from the occurrence of the earthquake and the risk of tsunami damage, in order to mitigate casualties we provide contents of disaster risk information displayed in a tsunami hazard and risk map. 2. Creating a tsunami hazard and risk map From the analytical and practical tsunami model (a long wave approximated model) and the high resolution topography (5 m) including detailed data of shoreline, rivers, building and houses, we present a advanced analysis of tsunami inundation considering the land use. Based on the results of tsunami inundation and its analysis; it is possible to draw a tsunami hazard and risk map with information of human casualty, building damage estimation, drift of vehicles, etc. 3. Contents of disaster prevention information To improve the hazard, risk and evacuation information distribution, it is necessary to follow three steps. (1) Provide basic information such as tsunami attack info, areas and routes for evacuation and location of tsunami evacuation facilities. (2) Provide as additional information the time when inundation starts, the actual results of inundation, location of facilities with hazard materials, presence or absence of public facilities and areas underground that required evacuation. (3) Provide information to support disaster response such as infrastructure and traffic network damage prediction. Finally, compiling all this information on a tsunami hazard and risk map with the tsunami inundation animation, it is possible to create and propose strategies for casualty mitigation programs.

IMAI, K.; Imamura, F.

2012-12-01

176

Exercise London: a disaster exercise involving numerous casualties  

PubMed Central

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.

Theoret, J.J.

1976-01-01

177

Calibrating Urgency: Triage Decision-Making in a Pediatric Emergency Department  

ERIC Educational Resources Information Center

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information.…

Patel, Vimla L.; Gutnik, Lily A.; Karlin, Daniel R.; Pusic, Martin

2008-01-01

178

The Social Network and Relationship Finder: Social Sorting for Email Triage  

Microsoft Academic Search

Email triage is the process of going through unhandled email and deciding what to do with it. This process can quickly become a serious problem for users with large volumes of email. Studies have found that people use a variety of approaches to triage their email, many of which have a social component. We believe that email clients can better

Carman Neustaedter; A. J. Bernheim Brush; Marc A. Smith; Danyel Fisher

2005-01-01

179

Health Care Categories have Politics too: Unpacking the Managerial Agendas of Electronic Triage Systems  

Microsoft Academic Search

While investigating the resistance to the electronic triage system, ETRIAGE, at the emergency department of British Columbia Children's Hospital, we revisit the well- known CSCW-debate about THE COORDINATOR concerning the politics of standardized categories. Examining the history as well as the design of ETRIAGE, we reveal four basic assumptions about triage work in emergency departments, which are reflected in the

Pernille Bjørn; Ellen Balka

2007-01-01

180

Improving the Assessment and Triage of Patients with Mental Illness attending the Emergency Department  

Microsoft Academic Search

Since the amalgamation of mental institutions with acute hospitals there has been an increase in presentations of patients with mental illness to the Emergency Department. The first point of contact for the patient attending the Emergency Department is typically triage. It is the point where emergency care begins with the nurse assessing the patient and assigning a triage category that

Jacqueline de Lacy

2011-01-01

181

Applying Lean: Implementation of a Rapid Triage and Treatment System  

PubMed Central

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.

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

2011-01-01

182

018 Cold mountain: do delays to hospital increase the risk of hypothermia in mountain casualties?  

Microsoft Academic Search

IntroductionUK mountain casualties are at risk of hypothermia year-round. Mountain Rescue personnel are often taught that pre-hospital treatment of hypothermia cannot reverse cooling of casualties and so delays in evacuation increase the severity of hypothermia on arrival to hospital. We wondered if this was true—our ED receives many mountain casualties, but very few arrive genuinely hypothermic.AimTo determine the relationship between

Benjamin Jones; Linda Dykes

2011-01-01

183

CoIN: a network analysis for document triage  

PubMed Central

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

Hsu, Yi-Yu; Kao, Hung-Yu

2013-01-01

184

Distributed Medical Intelligence (DMI): Disaster and Preparedness - From Hurricanes to Infectious Disease. Held in New Orleans, Louisiana on 19-21 April 2006 (DVD).  

National Technical Information Service (NTIS)

National catastrophic events have heightened the awareness of the need to be prepared to rapidly respond to mass casualty situations. A critical element of disaster response is surge planning and the provision of medical triage and treatment, public healt...

L. Maiolo

2006-01-01

185

Addenda to Allied Medical Publication 8, NATO Planning Guide for the Estimation of Chemical, Biological, Radiological, and Nuclear (CBRN) Casualties (AMedP-8(C)) to Consider the Impact of Medical Treatment on Casualty Estimation.  

National Technical Information Service (NTIS)

The North Atlantic Treaty Organization (NATO) Allied Medical Publication 8, NATO Planning Guide for the Estimation of CBRN Casualties, referred to as (AMedP-8(C)), describes a methodology for estimating casualties resulting from chemical, biological, radi...

C. A. Curling J. K. Burr K. A. Bishop L. A. LaViolet P. J. Lee

2013-01-01

186

Percentage of US Emergency Department Patients Seen Within the Recommended Triage Time  

PubMed Central

Background The wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds. Methods Using a stratified random sampling of 151 999 visits, representing 539 million ED visits from 1997 to 2006, we examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity. Results The percentage of patients seen within the triage target time declined a mean of 0.8% per year, from 80.0% in 1997 to 75.9% in 2006 (P<.001). The percentage of patients seen within the triage target time declined 2.3% per year for emergent patients (59.2% to 48.0%; P<.001) compared with 0.7% per year for semiurgent patients (90.6% to 84.7%; P<.001). In 2006, the adjusted odds of being seen within the triage target time were 30% lower than in 1997 (odds ratio, 0.70; 95% confidence interval, 0.55-0.89). The adjusted odds of being seen within the triage target time were 87% lower (odds ratio, 0.13; 95% confidence interval, 0.11-0.15) for emergent patients compared with semiurgent patients. Patients of each payment type experienced similar decreases in the percentage seen within the triage target over time (P for interaction=.24), as did patients of each racial/ethnic group (P=.05). Conclusions The percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time. Patients of all racial/ethnic backgrounds and payer types have been similarly affected.

Horwitz, Leora I.; Bradley, Elizabeth H.

2009-01-01

187

Analysis of the Correlation Between Casualties and Human Perception, Cognition & Decision-Making at Sea  

Microsoft Academic Search

Analysis of maritime casualties conducted over the last 30 years showed no improvement in any aspect, and proved that the human factor is still dominant in most casualties. To improve this situation, technology has been introduced to marine navigation an integrated navigation systems, however, this situation remains the same. The collisions and groundings of ocean-going vessels continue to concern those

Ahmed HANAFI

188

The effectiveness of bicyclist helmets: a study of 1710 casualties.  

PubMed

During the 1980s, a sustained campaign increased the rates of helmet use of Victorian bicyclists. The efficacy of helmet use was evaluated by comparison of crashes and injuries (AIS-1985) in 366 helmeted (261 Australian Standard approved and 105 non-approved) and 1344 unhelmeted casualties treated from 1987 through 1989 at Melbourne and Geelong hospitals or dying before hospitalization. Head injury (HI) occurred in 21.1% of wearers of approved helmets and in 34.8% of non-wearers (p < 0.001). The AIS scores were decreased for wearers of approved helmets (p < 0.001), face injuries were reduced (p < 0.01), and extremity/pelvic girdle injuries increased (p < 0.001) and the overall risk of HI was reduced by at least 39% and face injury by 28%. When casualties with dislodged helmets were excluded, HI was reduced 45% by approved helmets. Head injury reduction by helmets, although substantial, was less than that found in a similar study in Seattle, Washington. PMID:8315679

McDermott, F T; Lane, J C; Brazenor, G A; Debney, E A

1993-06-01

189

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

PubMed

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

Arslanian-Engoren, Cynthia; Hagerty, Bonnie M

2013-01-01

190

Simulated evaluation of two triage scales in an emergency department in Israel.  

PubMed

At the time of this study, the Sheba Medical Center Emergency Department (ED) in Israel had no formal triage system in place. To evaluate the interobserver reliability of two triage scales among nurses in our ED, the time-based Australasian Triage Scale (ATS) and the resource-based Emergency Severity Index (ESI), 10 nurses participated in a workshop on ATS and ESI. They then independently assessed 100 simulated triage scenarios taken from actual ED patients, and completed a survey. Intraclass correlation coefficients were calculated. The intraclass correlation coefficient for ATS was 0.64 (95% confidence interval: 0.57, 0.71), whereas for ESI, it was 0.52 (95% confidence interval: 0.45, 0.61). The nurses felt that ESI was slightly easier to use. Using conventional interpretations, the agreement for ATS is considered substantial, whereas that for ESI is considered moderate. Conversely, the nurses found the ESI somewhat easier to use. PMID:24165355

Alpert, Evan A; Lipsky, Ari M; Hertz, Dvora; Rieck, Jonathon; Or, Jacob

2013-12-01

191

Triage systems for pre-hospital emergency medical services - a systematic review.  

PubMed

The emergency medical services (EMS) cover initiatives and services established to provide essential medical assistance in situations of acute illness. Triage-methods for systematic prioritizing of patients according to how urgent patients need care, including triage of requests of acute medical treatment, are adopted in hospitals as well as in the pre-hospital settings. This systematic review searched to identify available research on the effects of validated triage systems for use in the pre-hospital EMS on health outcomes, patient safety, patient satisfaction, user-friendliness, resource use, goal achievement, and the quality on the information exchange between the different settings of the EMS (for example the quality of documentation). The specific research questions were: 1) are pre-hospital triage systems effective, 2) is one triage system more effective than others, and 3) is it effective to use the same triage system in two or more settings of the EMS-chain? We conducted a systematic literature search in nine databases up to June 2012. We searched for systematic reviews (SRs), randomized controlled trials (RCTs), non-randomized controlled trials (non-RCTs), controlled before and after studies (CBAs) and interrupted time series analyses (ITSs). Two persons independently reviewed titles and abstracts, and the same persons read all possibly relevant full text articles and rated the methodological quality where relevant. The literature search identified 11011 unique references. A total of 120 publications were read in full text. None of the identified articles fulfilled our inclusion criteria, thus our question on the effects of pre-hospital triage systems, if one system is better than other systems, and the question on effects of using the same triage system in two or more settings of the EMS, remain unanswered. We conclude that there is an evidence gap regarding the effects of pre-hospital triage systems and the effects of using the same triage system in two or more settings of the EMS. The finding does not mean that pre-hospital triage systems are ineffective, but that we lack knowledge about potential effects. When introducing a new assessment tool in the EMS, it is timely to conduct well-planned studies aimed to assess the effect. PMID:23587133

Lidal, Ingeborg Beate; Holte, Hilde H; Vist, Gunn Elisabeth

2013-01-01

192

Summary of: Dental triage Hydebank Wood Prison and Young Offenders Centre, Belfast.  

PubMed

Objective The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services.Method The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination.Results Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services.Conclusion This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation. PMID:24809571

Cunningham, Chris

2014-05-01

193

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

PubMed

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

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

2012-10-01

194

A Casualty in the Class War: Canada's Medicare  

PubMed Central

“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.

Evans, Robert G.

2012-01-01

195

Trauma-related Infections in Battlefield Casualties From Iraq  

PubMed Central

Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options.

Petersen, Kyle; Riddle, Mark S.; Danko, Janine R.; Blazes, David L.; Hayden, Richard; Tasker, Sybil A.; Dunne, James R.

2007-01-01

196

Construct an optimal triage prediction model: a case study of the emergency department of a teaching hospital in taiwan.  

PubMed

The purpose of triage is to prevent the delay of treatment for patients in real emergencies due to excessive numbers of patients in the hospital. This study uses the data of patients of consistent triage to develop the triage prediction model. By integrating Principal Component Analysis (PCA) and Support Vector Machine (SVM), the anomaly detection (overestimate and underestimate) prediction accuracy rate can be 100 %, which is better than the accuracy rate of SVM (about 89.2 %) or Back- propagation Neural Networks (BPNN) (96.71 %); afterwards, this study uses Support Vector Regression (SVR) to adopt Genetic Algorithm (GA) to determine three SVR parameters to predict triage. After using the scroll data predictive values, we calculate the Absolute Percentage Error (APE) of each scroll data. The resulting SVR's Mean Absolute Percentage Error (MAPE) is 3.78 %, and BPNN's MAPE is 5.99 %; therefore, the proposed triage prediction model of this study can effectively predict anomaly detection and triage. PMID:23990379

Wang, Shen-Tsu

2013-10-01

197

Developing an operational casualty estimate in a multinational headquarters to inform and drive medical resource allocation.  

PubMed

This article presents a methodology to construct an operational casualty estimate for insurgent clearance operations conducted in 2 districts around Kandahar City appropriate for a multinational operational headquarters. It demonstrates how to identify relevant and recent historical data to establish a casualty rate, apply it against a tactical operational sequence and population at risk to get a daily casualty estimate, and compare that estimate to the capacity of the medical system. This allows medical planners from any contributing nation to express the medical risk and mitigation plan to operational leadership and the commander. PMID:23007938

Davis, Soo Lee; Bricknell, Martin

2012-01-01

198

A triage strategy based on clinical risk factors for selecting elderly women for treatment or bone densitometry: the EPIDOS prospective study.  

PubMed

A triage strategy, based on a clinical hip fracture risk score, may be used to classify elderly women into three groups: one at high risk and requiring treatment, another needing further assessment by bone densitometry, and a third at low risk. We used prospective data from the EPIDOS study (7512 women older than 75 years and followed for an average of 3.9 years) to assess the potential value of such a strategy for identifying elderly women with a hip fracture risk twice the cohort average (i.e. > or =20 per 1000 woman-years). An individual fracture risk score was calculated with the final risk function (Cox model). To compare this strategy with systematic BMD measurement and with current European recommendations, we examined the number of high-risk women identified, their average risk levels, sensitivity for hip fracture, and the number of high-risk women who need to be treated to prevent one hip fracture (hypotheses: all identified women are treated; sensitivity is equal to the point estimate; treatment reduces fracture risk by 35%). A triage strategy based on age, fracture history since the age of 40 years, body mass index, number of instrumental activities of daily living for which assistance is needed, grip strength, and visual acuity can identify 20% of the cohort as at high risk, 75% of them from clinical factors only, and the rest after BMD measurements (threshold: -2.5 T-score). The triage strategy would be significantly more sensitive than systematic BMD screening (51 versus 35%) and would require many fewer BMD examinations (10%). Compared with current recommendations, triage would identify fewer women (20 versus 28%) but at a significantly higher average risk of hip fracture (30 versus 20 per 1000 woman-years). Fewer high-risk women would be treated to prevent one hip fracture (29 versus 41) and fewer bone densitometry tests would be needed (10% versus 54%). The proposed triage strategy may be a useful clinical tool for selecting elderly women for treatment or bone densitometry. PMID:15570415

Dargent-Molina, P; Piault, S; Bréart, G

2005-08-01

199

Effect of Crowd Density on the Expected Number of Casualties in a Suicide Attack.  

National Technical Information Service (NTIS)

Utilizing elementary geometric and probability considerations, the author estimates the effect of crowd blocking in suicide bombing events. It is shown that the effect is quite significant. Beyond a certain threshold, the expected number of casualties dec...

M. Kress

2005-01-01

200

Failed States and Casualty Phobia: Implications for Force Structure and Technology Choices.  

National Technical Information Service (NTIS)

The emergence of failed states as the principal source of international political instability and the appearance of mounting casualty phobia among U.S. political and military elites have significant force structure and technology implications. Overseas, i...

J. Record

2000-01-01

201

Continuous Renal Replacement Therapy Improves Survival in Severely Burned Military Casualties With Acute Kidney Injury.  

National Technical Information Service (NTIS)

Background: Acute kidney injury in severely burned patients is associated with high mortality. We wondered whether early use of continuous renal replacement therapy (CRRT) changes outcomes in severely burned military casualties with predetermined criteria...

E. E. Mann E. M. Renz K. K. Chung L. Juncos S. E. Wolf

2007-01-01

202

Causes and outcomes for patients presenting with diplopia to an eye casualty department  

Microsoft Academic Search

PurposeTo evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department.MethodsPatients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated.ResultsOne hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women

R M Comer; E Dawson; G Plant; J F Acheson; J P Lee

2007-01-01

203

Actual incidences of road casualties, and their injury severity, modelled from police and hospital data, France  

Microsoft Academic Search

Background: Nation-wide road casualty figures usually come from police data. In France, as in many developed countries, the reporting of fatalities is almost complete but the reporting of non-fatal casualties is rather low. It is moreover strongly biased. Valid estimates are needed. Methods: Using the capture-recapture method on police data and on a road trauma registry covering a large county

Emmanuelle Amoros; Jean-Louis Martin; Sylviane Lafont; Bernard Laumon

2008-01-01

204

Evaluation of an emergency department triage screening tool for suspected severe sepsis and septic shock.  

PubMed

Early identification of septic patients is important to prevent delays in appropriate management. To improve detection of septic patients presenting to the emergency department (ED), we implemented a triage screening tool. Our study sought to determine the effect of this tool on time to antibiotics in patients with suspected severe sepsis or septic shock presenting to the ED. This was a retrospective chart review examining the time interval to antibiotics pre- and postimplementation of the triage tool. Multiple linear regression analyses were conducted to evaluate the effect of the triage tool on time to antibiotics while controlling for the effect of level of triage. We identified 185 patients with severe sepsis or septic shock in the pretriage tool group and 170 patients in the posttriage tool group. The mean time (in minutes) to antibiotics (±SD) in the pre- and postcohorts was 283 (±213) and 207 (±150), respectively. The multivariable analysis showed that the mean time to antibiotics decreased by 21% (95% CI 6-36%, p < .0074) comparing pre- versus posttriage tool implementation. The use of a sepsis triage screening tool significantly decreased the time to antibiotics in patients presenting to the ED with suspected severe sepsis or septic shock. PMID:24372995

Patocka, Catherine; Turner, Joel; Xue, Xiaoqing; Segal, Eli

2014-01-01

205

Outcome of sports injuries treated in a casualty department.  

PubMed

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

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

1985-06-01

206

The SceneScore for improved pre-hospital triage of motor-vehicle crash victims.  

PubMed

The SceneScore is a simple mechanism of injury scoring system designed to facilitate the appropriate triage of crash victims. It comprises 7 variables including age, collision type, impact location, airbag deployment, steering wheel deformity, intrusion, and restraint use. A cutoff value of 7 or 8 provides the maximum balance between sensitivity and specificity, with sensitivities of 75% to 83% and specificities of 29% to 46%. For cases triaged to the trauma center based only on high suspicion of injury, the SceneScore reduces the overtriage rate by almost half. Proper application of the SceneScore may lead to improved triage and enhanced communication of mechanism of injury criteria. PMID:18184484

Schulman, C I; Wilbur, V; Leibowitz, B; Labiste, L; Perdeck, E; Bahouth, G; Digges, K; Augenstein, J S

2007-01-01

207

Triaging the right patient to the right place in the shortest time.  

PubMed

Trauma systems have been successful in saving lives and preventing disability. Making sure that the right patient gets the right treatment in the shortest possible time is integral to this success. Most trauma systems have not fully developed trauma triage to optimize outcomes. For trauma triage to be effective, there must be a well-developed pre-hospital system with an efficient dispatch system and adequately resourced ambulance system. Hospitals must have clear designations of the level of service provided and agreed protocols for reception of patients. The response within the hospital must be targeted to ensure the sickest patients get an immediate response. To enable the most appropriate response to trauma patients across the system, a well-developed monitoring programme must be in place to ensure constant refinement of the clinical response. This article gives a brief overview of the current approach to triaging trauma from time of dispatch to definitive treatment. PMID:24961786

Cameron, P A; Gabbe, B J; Smith, K; Mitra, B

2014-08-01

208

Abbott Physicochemical Tiering (APT)--a unified approach to HTS triage.  

PubMed

The selection of the highest quality chemical matter from high throughput screening (HTS) is the ultimate aim of any triage process. Typically there are many hundreds or thousands of hits capable of modulating a given biological target in HTS with a wide range of physicochemical properties that should be taken into consideration during triage. Given the multitude of physicochemical properties that define drug-like space, a system needs to be in place that allows for a rapid selection of chemical matter based on a prioritized range of these properties. With this goal in mind, we have developed a tool, coined Abbott Physicochemical Tiering (APT) that enables hit prioritization based on ranges of these important physicochemical properties. This tool is now used routinely at Abbott to help prioritize hits out of HTS during the triage process. Herein we describe how this tool was developed and validated using Abbott internal high throughput ADME data (HT-ADME). PMID:22727778

Cox, Philip B; Gregg, Robert J; Vasudevan, Anil

2012-07-15

209

Removal of C-spine protection by A&E triage nurses: a prospective trial of a clinical decision making instrument  

Microsoft Academic Search

Objective: To investigate if triage nurses could safely apply a set of clinical criteria, removing hard collars and spinal boards at initial triage assessment.Methods: The Nexus clinical decision rules were applied by trained triage nurses to patients who attended the department with cervical collars and \\/or on spinal boards. Patients were excluded if they were felt to be in need

E Pitt; D K Pedley; A Nelson; M Cumming; M Johnston

2006-01-01

210

Relationships among initial hospital triage, disease progression, and mortality in community-acquired pneumonia  

PubMed Central

Background and objective Appropriate triage of patients with severe community-acquired pneumonia (CAP) may improve morbidity, mortality, and use of hospital resources. Worse outcomes from delayed intensive care unit (ICU) admission have long been suspected but have not been verified. Methods In a retrospective study of consecutive patients with CAP admitted from 1996–2006 to the ICUs of a tertiary care hospital, we measured serial severity scores, intensive therapies received, ICU-free days, and 30-day all-cause mortality. Primary outcome was mortality. We developed a regression model of mortality with ward triage (and subsequent ICU transfer within 72 hours) as the predictor, controlled by propensity for ward triage and radiographic progression. Results Of 1,059 hospital-admitted patients, 269 (25%) were admitted to the ICU during hospitalization. Of those, 167 were directly admitted to the ICU without current requirement for life support, while 61 (23%) were initially admitted to the hospital ward, 50 of those undergoing ICU transfer within 72 hours. Ward triage was associated with increased mortality (OR 2.6, p=0.056) after propensity adjustment. The effect was less (OR 2.2, p=0.12) after controlling for radiographic progression. The effect probably increased (OR 4.0, p=0.08) among patients with ? 3 severity predictors at admission. Conclusions Initial ward triage among patients subsequently transferred to the ICU is associated with twofold higher 30-day mortality. This effect is most apparent among patients with ? 3 severity predictors at admission and is partially attenuated by controlling for radiographic progression. Intensive monitoring of ward-admitted patients with CAP seems warranted. Further research is needed to optimize triage in CAP.

Brown, Samuel M.; Jones, Jason P.; Aronsky, Dominik; Jones, Barbara E.; Lanspa, Michael J.; Dean, Nathan C.

2012-01-01

211

11 March 2004: The terrorist bomb explosions in Madrid, Spain - an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital  

PubMed Central

At 07:39 on 11 March 2004, 10 terrorist bomb explosions occurred almost simultaneously in four commuter trains in Madrid, Spain, killing 177 people instantly and injuring more than 2000. There were 14 subsequent in-hospital deaths, bringing the ultimate death toll to 191. This report describes the organization of clinical management and patterns of injuries in casualties who were taken to the closest hospital, with an emphasis on the critically ill. A total of 312 patients were taken to the hospital and 91 patients were hospitalized, of whom 89 (28.5%) remained in hospital for longer than 24 hours. Sixty-two patients had only superficial bruises or emotional shock, but the remaining 250 patients had more severe injuries. Data on 243 of these 250 patients form the basis of this report. Tympanic perforation occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first-degree or second-degree burns in 18%, eye lesions in 18%, head trauma in 12% and abdominal injuries in 5%. Between 08:00 and 17:00, 34 surgical interventions were performed in 32 patients. Twenty-nine casualties (12% of the total, or 32.5% of those hospitalized) were deemed to be in a critical condition, and two of these died within minutes of arrival. The other 27 survived to admission to intensive care units, and three of them died, bringing the critical mortality rate to 17.2% (5/29). The mean Injury Severity Score and Acute Physiology and Chronic Health Evaluation II scores for critically ill patients were 34 and 23, respectively. Among these critically ill patients, soft tissue and musculoskeletal injuries predominated in 85% of cases, ear blast injury was identified in 67% and blast lung injury was present in 63%. Fifty-two per cent suffered head trauma. Over-triage to the closest hospital probably occurred, and the time of the blasts proved to be crucial to the the adequacy of the medical and surgical response. The number of blast lung injuries seen is probably the largest reported by a single institution, and the critical mortality rate was reasonably low.

de Ceballos, J Peral Gutierrez; Turegano-Fuentes, F; Perez-Diaz, D; Sanz-Sanchez, M; Martin-Llorente, C; Guerrero-Sanz, JE

2005-01-01

212

Evaluation of cytology and visual triage of human papillomavirus-positive women in cervical cancer prevention in India.  

PubMed

Although virtually all cervical cancers and most cervical intraepithelial neoplasia (CIN) are caused by persistent human papillomavirus (HPV) infection, only a small proportion of HPV-positive women have or will develop CIN. Triaging HPV-positive women has been suggested to reduce the false-positive rate and proportion of women referred for CIN confirmation and/or treatment. In two cross-sectional studies and one randomized trial in India, we evaluated the impact of using cytology or visual inspection with acetic acid (VIA) to triage HPV-positive women on the proportion of women who would be referred for CIN confirmation and on the detection rates of high-grade CIN. We present the numbers of HPV test-positive women found and the CIN detected among them. We further assess the proportions that would be referred for CIN confirmation with colposcopy/biopsy and CIN that would be detected if cytology triage or VIA triage were used. Using cytology triage at atypical squamous cells of undetermined significance threshold or VIA triage reduced referrals for colposcopy by about 62% and 59%, respectively (p-value?=?0.012), but missed around 16% and 18%, respectively, of the high-grade CIN (p-value?=?0.539) indicating similar performance of both triaging approaches. The choice of a triage test in different low- and middle-income countries (LMIC) would depend on the availability and affordability in the particular setting. Cytology triage may be considered in settings where adequate infrastructure exists, whereas VIA triage may be suitable in settings with limited or no cytology infrastructure. PMID:24272364

Muwonge, Richard; Wesley, Ramani S; Nene, Bhagwan M; Shastri, Surendra S; Jayant, Kasturi; Malvi, Sylla G; Thara, Somanathan; Sankaranarayanan, Rengaswamy

2014-06-15

213

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

NASA Astrophysics Data System (ADS)

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.

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

2013-12-01

214

Emergency department mental health triage consultancy service: an evaluation of the first year of the service.  

PubMed

This article presents the findings of a review of the first year of a night emergency department (ED) mental health triage and consultancy service. During the first 12 months of operation of the service, data on key performance indicators were entered into an emergency mental health triage and consultancy database. Data were also obtained from pre- and post-satisfaction surveys completed by ED staff and from self-appraisal statements generated by the five mental health nurses who undertook the position during the review period. The findings show the ED mental health triage and consultancy service positively impacted on the functioning of the emergency department. This was evidenced by staff' perceptions regarding the value of the service and through shorter "seen by times", a reduction in the number of patients with psychiatric/psychosocial problems who left the department without being seen, and the effective management of patients presenting with psychiatric/psychosocial problems, particularly those presenting with deliberate self-harm. The review provided evidence regarding the value of the emergency mental health triage and consultancy service and highlighted the advanced practice role undertaken by mental health nurses in this position. PMID:14700570

McDonough, Stuart; Wynaden, Dianne; Finn, Michael; McGowan, Sunita; Chapman, Rose; Hood, Sean

2004-01-01

215

Development of a triage protocol for patients presenting with gastrointestinal hemorrhage: a prospective cohort study  

Microsoft Academic Search

INTRODUCTION: Many patients presenting with acute gastrointestinal hemorrhage (GIH) are admitted to the intensive care unit (ICU) for monitoring. A simple triage protocol based upon validated risk factors could decrease ICU utilization. METHODS: Records of 188 patients admitted with GIH from the emergency department (ED) were reviewed for BLEED criteria (visualized red blood, systolic blood pressure below 100 mm Hg,

Aneesa M Das; Namita Sood; Katherine Hodgin; Lydia Chang; Shannon S Carson

2008-01-01

216

Development of a triage protocol for critical care during an influenza pandemic  

PubMed Central

Background The recent outbreaks of avian influenza (H5N1) have placed a renewed emphasis on preparing for an influenza pandemic in humans. Of particular concern in this planning is the allocation of resources, such as ventilators and antiviral medications, which will likely become scarce during a pandemic. Methods We applied a collaborative process using best evidence, expert panels, stakeholder consultations and ethical principles to develop a triage protocol for prioritizing access to critical care resources, including mechanical ventilation, during a pandemic. Results The triage protocol uses the Sequential Organ Failure Assessment score and has 4 main components: inclusion criteria, exclusion criteria, minimum qualifications for survival and a prioritization tool. Interpretation This protocol is intended to provide guidance for making triage decisions during the initial days to weeks of an influenza pandemic if the critical care system becomes overwhelmed. Although we designed this protocol for use during an influenza pandemic, the triage protocol would apply to patients both with and without influenza, since all patients must share a single pool of critical care resources.

Christian, Michael D.; Hawryluck, Laura; Wax, Randy S.; Cook, Tim; Lazar, Neil M.; Herridge, Margaret S.; Muller, Matthew P.; Gowans, Douglas R.; Fortier, Wendy; Burkle, Frederick M.

2006-01-01

217

The Implementation of Mental Health Clinical Triage Systems in University Health Services  

Microsoft Academic Search

The increase in the level of severity of student psychological difficulties and the growing need for psychological services in higher education settings has placed considerable pressure on college and university mental health services to respond effectively to this demand. One way several of these services have responded has been to implement clinical triage systems. Though these systems have been well

Harry S. Rockland-Miller; Gregory T. Eells

2006-01-01

218

Examination of Selection for Relay Nodes Adapted to Priority of Transportation in Triage Network  

Microsoft Academic Search

Applying sensor network to emergency lifesaving systems called Triage to decide priority of transportation in disasters is an active area of research. It is necessary to keep collecting data by sensors fixed in injured people. Sensors selected as relay nodes consume battery in large quantity and are easy to be out of battery in collecting the data. In addition, sensors

Hiroki Tamura; Hikaru Kobayashi; Hiroshi Shigeno; Ken-ichi Okada

2010-01-01

219

???Disaster management, triage-based wound care, and patient safety: reflections on practice following an earthquake.  

PubMed

??Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes--the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. Situational awareness of system resources is of paramount importance in a disaster. Planning for surge capacity while simultaneously attending to patients who require immediate attention is a must. The recent earthquake in Haiti provided an opportunity to test those skill sets. Scores of clinicians volunteered their time and expertise, elevating wound care to the status of a clinical division. The experience of providing quality wound care despite a myriad of situational limitations suggests that busy wound clinics can learn valuable lessons from the realm of disaster management. The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments. PMID:21131698

Ennis, William J

2010-11-01

220

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

ERIC Educational Resources Information Center

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

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

2011-01-01

221

Level 2 and level 3 patients in emergency severity index triage system: comparison of characteristics and resource utilization.  

PubMed

There is a lack of studies examining distinctions between patients assigned to Level 2 (high risk) and Level 3 (lower risk) in the 5-level ESI triage system. Describing patients assigned to Level 2 and Level 3 may identify unique characteristics related to chief complaint, interventions, and resource needs. A convenience sample of triage nurses was recruited from 2 emergency department (ED) sites. If, at the completion of the patient-nurse triage interaction, the nurse assigned the patient to either Level 2 or Level 3, additional clinical data related to that patient were collected from the ED medical record. Eighteen triage nurses participated in the study with 334 nurse-patient triage interactions collected. Patients presenting with a chief complaint of nausea and vomiting or having a medical history of renal insufficiency/failure were significantly more often assigned to Level 2 than to Level 3 (p = 0.036 and p = 0.013, respectively). Patients assigned to Level 2 were more likely to utilize cardiac monitoring, electrocardiogram, medications, and specialty consultation than patients assigned to Level 3. It is critical that nurses in the triage setting be aware of possible patient factors and resource needs that could influence assignment to specific triage levels. PMID:22075683

Garbez, Roxanne Oertel; Carrieri-Kohlman, Virginia; Stotts, Nancy; Chan, Garrett

2011-01-01

222

Benefits of multidisciplinary collaboration for earthquake casualty estimation models: recent case studies  

NASA Astrophysics Data System (ADS)

Earthquake casualty loss estimation, which depends primarily on building-specific casualty rates, has long suffered from a lack of cross-disciplinary collaboration in post-earthquake data gathering. An increase in our understanding of what contributes to casualties in earthquakes involve coordinated data-gathering efforts amongst disciplines; these are essential for improved global casualty estimation models. It is evident from examining past casualty loss models and reviewing field data collected from recent events, that generalized casualty rates cannot be applied globally for different building types, even within individual countries. For a particular structure type, regional and topographic building design effects, combined with variable material and workmanship quality all contribute to this multi-variant outcome. In addition, social factors affect building-specific casualty rates, including social status and education levels, and human behaviors in general, in that they modify egress and survivability rates. Without considering complex physical pathways, loss models purely based on historic casualty data, or even worse, rates derived from other countries, will be of very limited value. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from the field surveys with experiments would also be advantageous as it is not always be possible to validate theories and models with actual earthquake data. In addition, colleagues in other disciplines will benefit from being introduced to the loss algorithms, methodologies and advances familiar to the engineering community, to help dissemination in earthquake mitigation and preparedness programs. It follows that new approaches to loss estimation must include a progressive assessment of what contributes to the final casualty value. In analyzing recent earthquakes, testing common hypotheses, talking to local and international researchers in the field, interviewing search and rescue and medical personnel, and comparing notes with colleagues who have visited other events, the author has developed a list of contributory factors to formulate fatality rates for use in earthquake loss estimation models. In this presentation, we will first look at the current state of data collection and assessment in casualty loss estimation. Then, the analyses of recent earthquake field data, which provide important insights to the contributory factors of fatalities in earthquakes, will be explored. The benefits of a multi-disciplinary approach in deriving fatality rates for masonry buildings will then be examined in detail.

So, E.

2010-12-01

223

Implementing an obstetric triage acuity scale: interrater reliability and patient flow analysis.  

PubMed

A 5-category Obstetric Triage Acuity Scale (OTAS) was developed with a comprehensive set of obstetrical determinants. The objectives of this study were as follows: (1) to test the interrater reliability of OTAS and (2) to determine the distribution of patient acuity and flow by OTAS level. To test the interrater reliability, 110 triage charts were used to generate vignettes and the consistency of the OTAS level assigned by 8 triage nurses was measured. OTAS performed with substantial (Kappa, 0.61 - 0.77, OTAS 1-4) and near perfect correlation (0.87, OTAS 5). To assess patient flow, the times to primary and secondary health care provider assessments and lengths of stay stratified by acuity were abstracted from the patient management system. Two-thirds of triage visits were low acuity (OTAS 4, 5). There was a decrease in length of stay (median [interquartile range], minutes) as acuity decreased from OTAS 1 (120.0 [156.0] minutes) to OTAS 3 (75.0 [120.8]). The major contributor to length of stay was time to secondary health care provider assessment and this did not change with acuity. The percentage of patients admitted to the antenatal or birthing unit decreased from 80% (OTAS 1) to 12% (OTAS 5). OTAS provides a reliable assessment of acuity and its implementation has allowed for triaging of obstetric patients based on acuity, and a more in-depth assessment of the patient flow. By standardizing assessment, OTAS allows for opportunities to improve performance and make comparisons of patient care and flow across organizations. PMID:23535239

Smithson, David S; Twohey, Rachel; Rice, Tim; Watts, Nancy; Fernandes, Christopher M; Gratton, Robert J

2013-10-01

224

Signify ER Drug Screen Test evaluation: comparison to Triage Drug of Abuse Panel plus tricyclic antidepressants.  

PubMed

Signify ER Drug Screen Test (Signify ER) and Triage Drug of Abuse Panel plus TCA (Triage DOA Panel) rapid drug screening devices were compared at four laboratories. Both assay systems are point of care immunoassays, measuring phencyclidine, barbiturates, amphetamine, cocaine metabolite, methamphetamine, tricyclic antidepressants, opiates, marijuana metabolite, and benzodiazepines in human urine. The performance of these two assay systems, including a cutoff verification and cross-reactivity using spiked urine specimens and accuracy using clinical urine samples, was investigated. The cutoff verification study showed that the Signify ER had 95.4% precision for all drugs tested at concentrations of 50%, 75%, 125%, 150%, and 200% of cutoffs compared to 90% precision obtained with Triage DOA Panel. Accuracy studies testing 53 negative urine samples demonstrated that both Signify ER and Triage DOA Panel have 100% specificity. Testing of 693 positive urine samples demonstrated that Signify ER and Triage DOA Panel have sensitivities of 99.8% and 99.3%, respectively, with an accuracy of 99.9% and 99.6%. A total of 527 compounds were tested for the cross-reactivity study. Eighty-seven structurally related drugs and metabolites were found to cross-react with at least one of the nine tests of the Signify ER. Four hundred forty structurally unrelated compounds that can be found in human urine were shown not to cross-react with the Signify ER. In terms of operating characteristics, the Signify ER device is simpler since only a single pipetting step is required, and reaction completed within 8 min. PMID:12559596

Phillips, Jane Ellen; Bogema, Stuart; Fu, Paul; Furmaga, Wieslaw; Wu, Alan H B; Zic, Vlasta; Hammett-Stabler, Catherine

2003-02-01

225

How Norwegian casualty clinics handle contacts related to mental illness: A prospective observational study  

PubMed Central

Background Low-threshold and out-of-hours services play an important role in the emergency care for people with mental illness. In Norway casualty clinic doctors are responsible for a substantial share of acute referrals to psychiatric wards. This study’s aim was to identify patients contacting the casualty clinic for mental illness related problems and study interventions and diagnoses. Methods At four Norwegian casualty clinics information on treatment, diagnoses and referral were retrieved from the medical records of patients judged by doctors to present problems related to mental illness including substance misuse. Also, routine information and relation to mental illness were gathered for all consecutive contacts to the casualty clinics. Results In the initial contacts to the casualty clinics (n?=?28527) a relation to mental illness was reported in 2.5% of contacts, whereas the corresponding proportion in the doctor registered consultations, home-visits and emergency call-outs (n?=?9487) was 9.3%. Compared to other contacts, mental illness contacts were relatively more urgent and more frequent during night time. Common interventions were advice from a nurse, laboratory testing, prescriptions and minor surgical treatment. A third of patients in contact with doctors were referred to in-patient treatment, mostly non-psychiatric wards. Many patients were not given diagnoses signalling mental problems. When police was involved, they often presented the patient for examination. Conclusions Most mental illness related contacts are managed in Norwegian casualty clinics without referral to in-patient care. The patients benefit from a wide range of interventions, of which psychiatric admission is only one.

2012-01-01

226

Casualty Panic”: Military Recruitment Models, Civil-Military Gap and Their Implications for the Legitimacy of Military Loss  

Microsoft Academic Search

This article addresses the issue of what defines “Casualty Panic,” which in recent years has impacted upon military policy in liberal-democratic states. The author claims that the hesitation to enter into military engagements for fear of incurring casualties is a consequence of “moral panic” among the political and military leadership. This moral panic is engendered by elite groups who have

Udi Lebel

2010-01-01

227

Eating Order: A 13Week Trust Model Class for Dieting Casualties  

Microsoft Academic Search

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 Satter’s How to Eat protocol, within a Health at Every Size

Elizabeth G. Jackson

2008-01-01

228

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

Code of Federal Regulations, 2013 CFR

...of any vessel involved in a marine casualty for...smooth deck and engine room logs, bell books, navigation...sent and received, radio logs, crew and passenger lists...of shipment, official logs, and other material that might be of assistance in investigating and...

2013-10-01

229

46 CFR 122.220 - Records of a voyage resulting in a marine casualty.  

Code of Federal Regulations, 2013 CFR

...of any vessel involved in a marine casualty for...smooth deck and engine room logs, bell books, navigation...sent and received, radio logs, crew and passenger lists...of shipment, official logs, and other material that might be of assistance in investigating and...

2013-10-01

230

The Battle of Bentonville: Caring for Casualties of the Civil War. Teaching with Historic Places.  

ERIC Educational Resources Information Center

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…

Goode, John C.; Beck, Elaine

231

Eating Order: A 13-Week Trust Model Class for Dieting Casualties  

ERIC Educational Resources Information Center

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…

Jackson, Elizabeth G.

2008-01-01

232

Effectiveness and Hazards of Using Dry Ice to Cool a Casualty Bag.  

National Technical Information Service (NTIS)

A small, battery-powered fan heater charged with dry-ice was used in the air space of a casualty bag. The cooling power averaged less than 50 watts. In a hot environment, more than twice this cooling power is needed. When the carbon dioxide was allowed to...

R. J. Osczevski J. F. Tremblay-Lutter

1992-01-01

233

Tax Administration. Information on How the Property/Casualty Insurance Industry Is Taxed.  

National Technical Information Service (NTIS)

Partial Contents: Objectives, scope, and methodology; Financial profile of the property/casualty insurance industry; P/C company advantages; Carryback and carryforward statistics for twenty-nine large P/C company groups as of 12/31/84; Underwriting gains,...

1985-01-01

234

The requirement for the publication of detailed global marine casualties statistics  

Microsoft Academic Search

Today, ships' seaworthiness, naigation and safety and the protection of the marine environment rank very highly among shipping political issues. Yet, the available published statistical data concerning marine casualties relate ony to ‘total losses’. Obviously, total losses are just the tip of a gigantic iceberg of marine incidents and a far more complete analysis of th causes, circumstances and consequences

Jean-Pierre Dobler

1994-01-01

235

Detection of the rescue target in the marine casualty based on visual attention mechanism  

Microsoft Academic Search

The prompt search and rescue of lifesaving target is very important in the case that a marine casualty occurs. To detect the small target in the wide views over the sea, we have proposed a machine vision system to aid search and rescue on the sea, which combines remote sensing, radar, infrared with visual light technology. One of the detection

RAN Xin; SHI Chaojian

236

Development of Image Processing Technique for Detection of the Rescue Target in the Marine Casualty  

Microsoft Academic Search

When a marine casualty occurs, the detection of the rescue target such as life rafts depends on the visual search of human's eye. It is predicted, however, that human eye sometimes loses its sight and ability of detection falls down owing to the long flight and the nasty weather. For a practical purpose of the prompt rescue of human life,

Tetsuhiro Sumimoto; Kazuoki Kuramoto; Saburo Okada; Hidekazu Miyauchi; Masaaki Imade; Hideki Yamamoto; T. Kunishi

1997-01-01

237

Incremental Tree Induction for Detection of the Rescue Target in the Marine Casualty  

Microsoft Academic Search

In the case that a marine casualty occurs, the detection of the rescue target such as life rafts is surely required to carry out the prompt rescue of human life.To detect the small target in the wide views over the sea, we have proposed a new method including the feature extraction techniques based on the color information and the system

Xin Ran; Yongxin Zhang

2009-01-01

238

A CAD system for the capture of combat casualty care information  

Microsoft Academic Search

In this paper we will discuss a system for data capture of combat casualty medical information that is being developed at the Naval Health Research Center for use by the U.S. Marine Corps in forward echelon hospitals. The system captures data through the use of a graphics tablet attach to a “ruggedized” personal computer. Both the system design and a

Thomas J. Sager; William M. Pugh

1988-01-01

239

Development of damage and casualty functions for basement shelters. Final report on phase 2  

SciTech Connect

This report describes progress during the second year's work on a Civil Defense program to provide FEMA with a range of damage functions and casualty functions to determine the survivability fo people in various basement shelters. The characteristics of flat and two-way slab systems and the effects of code specified design procedures, engineering practice, and construction procedures were discussed. Non-upgraded two-way slabs are approximately twice as strong as the flat plate slabs. For upgraded (shored) systems, however, specific building characteristics are not important factors: any shored slab, with standard reinforcing and dimensions, has about the same capacity as any other slab. A mathematical model for the fragility curve of slab systems was developed. Fatality curves have been developed for ceiling collapse and a variety of other casualty mechanism(nuclear weapons effects) with emphasis to date on non-upgraded shelters areas. This review of casualty producing mechanisms is continuing and all casualty curves should be considered as provisional.

Wilton, C.; Zsutty, T.C.; Willoughby, A.B.

1983-09-01

240

Development of a triage protocol for patients presenting with gastrointestinal hemorrhage: a prospective cohort study  

PubMed Central

Introduction Many patients presenting with acute gastrointestinal hemorrhage (GIH) are admitted to the intensive care unit (ICU) for monitoring. A simple triage protocol based upon validated risk factors could decrease ICU utilization. Methods Records of 188 patients admitted with GIH from the emergency department (ED) were reviewed for BLEED criteria (visualized red blood, systolic blood pressure below 100 mm Hg, elevated prothrombin time [PT], erratic mental status, and unstable comorbid disease) and complication within the first 24 hours of admission. Variables associated with early complication were reassessed in 132 patients prospectively enrolled as a validation cohort. A triage model was developed using significant predictors. Results We studied 188 patients in the development set and 132 in the validation set. Red blood (relative risk [RR] 4.53, 95% confidence interval [CI] 2.04, 10.07) and elevated PT (RR 3.27, 95% CI 1.53, 7.01) were significantly associated with complication in the development set. In the validation cohort, the combination of red blood or unstable comorbidity had a sensitivity of 0.73, a specificity of 0.55, a positive predictive value of 0.24, and a negative predictive value of 0.91 for complication within 24 hours. In simulation studies, a triage model using these variables could reduce ICU admissions without increasing the number of complications. Conclusion Patients presenting to the ED with GIH who have no evidence of ongoing bleeding or unstable comorbidities are at low risk for complication during hospital admission. A triage model based on these variables should be tested prospectively to optimize critical care resource utilization in this common condition.

Das, Aneesa M; Sood, Namita; Hodgin, Katherine; Chang, Lydia; Carson, Shannon S

2008-01-01

241

MET system: a new approach to m-health in emergency triage.  

PubMed

The MET (Mobile Emergency Triage) system is an m-health application that supports emergency triage of various types of acute pain at the point of care. The system is designed for use in the Emergency Department (ED) of a hospital and to aid physicians in disposition decisions. Given patient's condition, MET recommends a triage by consulting decision rules stored in the system's knowledge base. The rules have been created using a data mining method (based on rough set methodology) applied to data collected during a retrospective chart study and verified by the clinicians. MET is designed following the extended client-server architecture, suited for weak-connectivity conditions, where stable connection between clients and a server cannot be provided. The MET server interacts with the hospital's patient information system in order to retrieve information about patients admitted to the ED. It also stores current patients' demographic and clinical data to be exchanged with mobile clients. The MET mobile client, running on a Personal Digital Assistant (PDA), is used for collecting clinical data and supporting triage decisions. The support function runs solely on the client side, thus it can be invoked anytime and anywhere, even if there is no communication link with the server (e.g., there is no wireless network available in the ED). Due to implementation on PDAs and working in weak-connectivity conditions, the MET system is very well suited for use in the ED and fits seamlessly into the regular clinical workflow without introducing any hindrances or disruptions that are often reported when using stationary (i.e., working on desktop computers) clinical systems. The system facilitates patient-centered service and timely, high quality patient management. It provides recommendations using a limited amount of clinical data, normally available at the point of care. Furthermore, it provides a possibility for the structured evaluation of this data by an attending physician. PMID:15747911

Michalowski, Wojtek; Slowinski, Roman; Wilk, Szymon

2004-01-01

242

The value of referral letter information in predicting inflammatory arthritis--factors important for effective triaging.  

PubMed

The aim of this study is to identify factors from referral information predictive of patients with inflammatory arthritis (IA) requiring early review. Four hundred twenty-six consecutive rheumatologist-triaged referrals from February to June 2012 were retrospectively reviewed to identify patients with rheumatologist-diagnosed IA correctly triaged for review within 2 weeks from referral date. Information from referral was analyzed descriptively followed by univariate logistic regression adjusted for age and sex to identify predictors of IA. Of the 108 patients with rheumatologist-confirmed diagnoses seen within 2 weeks, 76 patients (70.4%) were correctly triaged with 44.7% having rheumatoid arthritis (RA); 9.2%, psoriatic arthritis; 9.2%, spondyloarthritis; and 18.4%, undifferentiated inflammatory arthritis. The majority were females (63.2%), with median age of 52.8 years (Q1; Q3 38.4; 61.3) with referrers indicating presence of morning stiffness in 71.4% and symmetrical distribution in 74.6%. Five or more joints were involved in 65.7% with suspected metacarpophalangeal joint (MCPJ) (44.7%) or proximal interphalangeal joint (PIPJ) (59.6%) involvement. Of the referrals with laboratory results, erythrocyte sedimentation rate (ESR) was raised with median 43.5 mm/h (Q1; Q3 24.8; 77.5) and normal median uric acid of 312.5 ?mol/L (Q1; Q3 249.5; 363.5). Univariate analysis revealed that presence of ?5 joints affected (p = 0.001), symmetrical distribution (p = 0.006), MCPJ (p = 0.003), PIPJ (p = 0.003), and elevated ESR (p = 0.001) were predictive of IA after adjustment for age and sex. Specific information including number, pattern, and location of joint involvement with relevant laboratory investigations should be included in referral letters to assist with effective triaging of patients with IA. PMID:24500413

Tay, Sen Hee; Lim, Anita Y N; Lee, Tung Lin; Low, Bernadette P L; Cheung, Peter P

2014-03-01

243

Telephone Triage Service Data for Detection of Influenza-Like Illness  

PubMed Central

Background Surveillance for influenza and influenza-like illness (ILI) is important for guiding public health prevention programs to mitigate the morbidity and mortality caused by influenza, including pandemic influenza. Nontraditional sources of data for influenza and ILI surveillance are of interest to public health authorities if their validity can be established. Methods/Principal Findings National telephone triage call data were collected through automated means for purposes of syndromic surveillance. For the 17 states with at least 500,000 inhabitants eligible to use the telephone triage services, call volume for respiratory syndrome was compared to CDC weekly number of influenza isolates and percentage of visits to sentinel providers for ILI. The degree to which the call data were correlated with either CDC viral isolates or sentinel provider percentage ILI data was highly variable among states. Conclusions Telephone triage data in the U.S. are patchy in coverage and therefore not a reliable source of ILI surveillance data on a national scale. However, in states displaying a higher correlation between the call data and the CDC data, call data may be useful as an adjunct to state-level surveillance data, for example at times when sentinel surveillance is not in operation or in areas where sentinel provider coverage is considered insufficient. Sufficient population coverage, a specific ILI syndrome definition, and the use of a threshold of percentage of calls that are for ILI would likely improve the utility of such data for ILI surveillance purposes.

Yih, W. Katherine; Teates, Kathryn S.; Abrams, Allyson; Kleinman, Ken; Kulldorff, Martin; Pinner, Robert; Harmon, Robert; Wang, Stanley; Platt, Richard

2009-01-01

244

Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage  

PubMed Central

Background: This randomised controlled trial examined the impact of screening for distress followed by two different triage methods on clinically relevant outcomes over a 12-month period. Methods: Newly diagnosed patients attending a large tertiary cancer centre were randomised to one of the two conditions: (1) screening with computerised triage or (2) screening with personalised triage, both following standardised clinical triage algorithms. Patients completed the Distress Thermometer, Pain and Fatigue Thermometers, the Psychological Screen for Cancer (PSSCAN) Part C and questions on resource utilisation at baseline, 3, 6 and 12 months. Results: In all, 3133 patients provided baseline data (67% of new patients); with 1709 (54.5%) retained at 12 months (15.4% deceased). Mixed effects models revealed that both groups experienced significant decreases in distress, anxiety, depression, pain and fatigue over time. People receiving personalised triage and people reporting higher symptom burden were more likely to access services, which was subsequently related to greater decreases in distress, anxiety and depression. Women may benefit more from personalised triage, whereas men may benefit more from a computerised triage model. Conclusion: Screening for distress is a viable intervention that has the potential to decrease symptom burden up to 12?months post diagnosis. The best model of screening may be to incorporate personalised triage for patients indicating high levels of depression and anxiety while providing computerised triage for others.

Carlson, L E; Waller, A; Groff, S L; Zhong, L; Bultz, B D

2012-01-01

245

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

PubMed

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

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

246

A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service  

PubMed Central

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.

de Carvalho, Jose Crespo; Ramos, Madalena; Paixao, Carina

2014-01-01

247

19 CFR 158.21 - Allowance in duties for casualty, loss, or theft while in Customs custody.  

Code of Federal Regulations, 2013 CFR

...Loss, or Theft While in Customs Custody § 158.21...loss, or theft while in Customs custody. Section...other casualty, while in bonded warehouse, or in the public stores...under bond, or while in Customs custody although...

2013-04-01

248

ARDS: Risk Factors, Prognostic Factors, Management and Outcomes. Incidence and Mortality of ARDS in Combat Casualty Care.  

National Technical Information Service (NTIS)

The incidence and mortality of Acute Respiratory Distress Syndrome (ARDS) and utilization of resources for ARDS treatment in current combat casualty care was investigated through a query of the Joint Theater Trauma Registry. Development of ARDS was found ...

J. Cannon L. Napolitano P. Park W. Beninati W. Ye

2009-01-01

249

U.S. Military Casualty Statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Updated September 28, 2010.  

National Technical Information Service (NTIS)

This report presents difficult-to-find statistics regarding U.S. military casualties in Operation New Dawn (OND), Operation Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF, Afghanistan), including those concerning post-traumatic stress disorder (...

H. Fischer

2010-01-01

250

Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties.  

National Technical Information Service (NTIS)

Early detection of hemorrhage is crucial for managing combat casualties. However, mean arterial blood pressure (ABP) and other vital signs are late indicators of a bleed. By contrast, cardiac output (CO), stroke volume (SV), ventricular end-diastolic volu...

R. Mukkamala

2012-01-01

251

Physiologic Waveform Analysis for Early Detection of Hemorrhage during Transport and Higher Echelon Medical Care of Combat Casualties.  

National Technical Information Service (NTIS)

Early detection of hemorrhage is crucial for managing combat casualties. However, mean arterial blood pressure (ABP) and other vital signs are late indicators of a bleed. By contrast, cardiac stroke volume (SV), cardiac end-diastolic volume (EDV), and aut...

R. Mukkamala

2011-01-01

252

Mathematical models for estimating earthquake casualties and damage cost through regression anaylysis using matrices  

NASA Astrophysics Data System (ADS)

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.

Urrutia, J. D.; Bautista, L. A.; Baccay, E. B.

2014-04-01

253

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs  

PubMed Central

Objective To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. Design Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. Setting Three primary care sites in York. Participants 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. Main outcome measures Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. Results The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval –0.19 to 3.15). Conclusions Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments. What is already known on this topicNurse telephone triage is used to manage the increasing demand for same day appointments in general practiceEvidence that nurse telephone triage is effective is limitedWhat this study addsTriage resulted in 29-44% fewer same day appointments with general practitioners than standard managementNursing and overall time increased in the triage group as 40% of patients were managed by nursesTriage was not less costly than standard management because of increased costs for nursing, follow up, out of hours, and accident and emergency care

Richards, David A; Meakins, Joan; Tawfik, Jane; Godfrey, Lesley; Dutton, Evelyn; Richardson, Gerald; Russell, Daphne

2002-01-01

254

“Secret” Casualties: Images of Injury and Death in the Iraq War Across Media Platforms  

Microsoft Academic Search

This study examined more than 2,500 war images from U.S. television news, newspapers, news magazines, and online news sites during the first five weeks of the U.S.-led invasion of Iraq in 2003 and found that only 10% showed injury or death. The paper analyzes which media platforms were most willing to show casualties and offers insights on when journalists should

B. William Silcock; Carol B. Schwalbe; Susan Keith

2008-01-01

255

Casualty Risk Assessment Controlled Re-Entry of EPS - Ariane 5ES - ATV Mission  

NASA Astrophysics Data System (ADS)

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.

Arnal, M.-H.; Laine, N.; Aussilhou, C.

2012-01-01

256

Fluctuations of Lightning Casualties in the United States: 1959-1990.  

NASA Astrophysics Data System (ADS)

Long-term fluctuations in the number of lightning deaths and injuries from 1959 to 1990 have been examined for the contiguous United States. After taking into account the population increase, there was an overall trend amounting to a 30% reduction in casualties during the period. It is possible that this trend resulted from improved forecasts and warnings, increased education efforts of the public, and socioeconomic changes.In addition, there was a 40% reduction in the number of deaths but not of nonfatal injuries. This additional reduction in deaths was probably due to improved medical attention given to lightning victims and a wider knowledge of cardiopulmonary resuscitation techniques among the public. Improved medical care would increase the chances of a person surviving a lightning strike but would not affect the total number of casualties.Superimposed on the overall downward trend there were fluctuations of one or two decades in duration. From 1959 until 1968 there was a sharp reduction in the number of casualties, but starting in 1969 and continuing until the present, there was an overall increase. These oscillations appear to be climatologically related. The patterns of these fluctuations were parallel to nationwide changes in thunder-day frequencies, cyclone frequencies, and surface temperature values, representing thunderstorm, synoptic, and continental scales.

López, Raúl E.; Holle, Ronald L.

1996-03-01

257

Noncontact vital sign monitoring system for isolation unit (casualty care system).  

PubMed

For measuring the vital signs of casualties inside an isolation unit, we developed a noncontact vital sign monitoring system using a microwave radar. The system was tested on eight healthy volunteers ranging in age from 30 to 48 years. The heart and respiratory rates derived by the microwave radar correlated with the heart and respiratory rates determined by electrocardiogram and respiratory sensor (r = 0.98, p < 0.0001 for heart rate; r = 0.84, p < 0.01 for respiratory rate). The exhaled CO and CO2, as a measure of trauma injury, were measured using an exhaled gas analyzer. The CO and CO2 concentrations were found to average 3.8 +/- 4.3 ppm and 2.9 +/- 0.4%, respectively. The expired air temperature and body temperature, as indicators of hemorrhagic hypothermia, averaged 31.8 +/- 1.7 degrees C and 36.2 +/- 0.4 degrees C, respectively. The results show that our system is promising for future prehospital application in determining casualty conditions for fluid infusions by the Casualty Care System intravenous lines. PMID:16895131

Matsui, Takemi; Gotoh, Shinji; Arai, Ikuo; Hattori, Hidemi; Fujita, Makoto; Obara, Kiyohaya; Masuoka, Kazunori; Nakamura, Shingo; Takase, Bonpei; Ishihara, Masayuki; Kikuchi, Makoto

2006-07-01

258

Earthquake casualty models within the USGS Prompt Assessment of Global Earthquakes for Response (PAGER) system  

USGS Publications Warehouse

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.

Jaiswal, K. S.; Wald, D. J.; Earle, P. S.; Porter, K. A.; Hearne, M.

2011-01-01

259

Radiation Injury Treatment Network (RITN): Healthcare professionals preparing for a mass casualty radiological or nuclear incident  

PubMed Central

Purpose To describe the history, composition, and activities of the Radiation Injury Treatment Network (RITN). The Radiation Injury Treatment Network® is a cooperative effort of the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation. The goals of RITN are to educate hematologists, oncologists, and stem cell transplant practitioners about their potential involvement in the response to a radiation incident and provide treatment expertise. Injuries to the marrow system readily occur when a victim is exposed to ionising radiation. This focus therefore leverages the expertise of these specialists who are accustomed to providing the intensive supportive care required by patients with a suppressed marrow function. Following a radiological incident, RITN centres may be asked to: Accept patient transfers to their institutions; provide treatment expertise to practitioners caring for victims at other centres; travel to other centres to provide medical expertise; or provide data on victims treated at their centres. Moving forward, it is crucial that we develop a coordinated interdisciplinary approach in planning for and responding to radiological and nuclear incidents. The ongoing efforts of radiation biologists, radiation oncologists, and health physicists can and should complement the efforts of RITN and government agencies. Conclusion RITN serves as a vital partner in preparedness and response efforts for potential radiological and nuclear incidents.

ROSS, JOEL R.; CASE, CULLEN; CONFER, DENNIS; WEISDORF, DANIEL J.; WEINSTOCK, DAVID; KRAWISZ, ROBERT; CHUTE, JOHN; WILHAUK, JULIE; NAVARRO, WILLIS; HARTZMAN, ROBERT; COLEMAN, C. NORMAN; HATCHETT, RICHARD; CHAO, NELSON

2011-01-01

260

Weapons of Mass Destruction Events With Contaminated Casualties: Effective Planning for Health Care Facilities.  

National Technical Information Service (NTIS)

Biological and chemical terrorism is a growing concern for the emergency preparedness community. While health care facilities (HCFs) are an essential component of the emergency response system, at present they are poorly prepared for such incidents. The g...

A. G. Macintyre G. W. Christopher J. E. Eitzen R. Gum S. Weir

2000-01-01

261

Special report. The Oklahoma City bombing: mass casualties and the local hospital response.  

PubMed

A morning blast at the Alfred P. Murrah Federal Building, Oklahoma City, OK, on April 19, 1995, killed 168 persons and injured more than 500 in the worst terrorist attack in U.S. history. Hospital workers, physicians, and volunteers at nine hospitals there mobilized, put their disaster emergency plans into operation, and treated 466 persons in emergency rooms--many of them later being admitted as patients. To complicate matters, two of the hospitals received bomb threats called in after the disaster. This report will look at the security plans put into force by each of the nine hospitals; the handling of the great influx of persons, including victims, relatives, friends, concerned persons, volunteers, and the news media; and the lessons hospital officials learned from their experiences. PMID:10151262

1995-09-01

262

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

PubMed Central

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.

2011-01-01

263

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

PubMed Central

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.

2011-01-01

264

Major burns in Cape Town: a modified burns score for patient triage.  

PubMed

Major burns equal to, or greater than, 30 per cent total body surface area (TBSA) constitute 23 per cent of the admissions to the adult burns unit in Cape Town. A retrospective review over a 28-month period identified 87 cases of major burns. This paper summarizes the epidemiology and mortality amongst this patient group over this period. Demand for treatment can exceed bed availability in the unit. The difficult issue, this raises, of patient triage in relation to the relatively limited resources is addressed and a simple modified burns score proposed for this unit. The effect this score would have in optimizing the use of our resources is demonstrated. PMID:9601593

Godwin, Y; Wood, S H

1998-02-01

265

Telephone Triage: A Timely Data Source for Surveillance of Influenza-like Diseases  

PubMed Central

We evaluated telephone triage (TT) data for public health early warning systems. TT data is electronically available and contains coded elements that include the demographics and description of a caller’s medical complaints. In the study, we obtained emergency room TT data and after hours TT data from a commercial TT software and service company. We compared the timeliness of the TT data with influenza surveillance data from the Centers for Disease Control using the cross correlation function. Emergency room TT calls are one to five weeks ahead of surveillance data collected by the CDC.

Espino, Jeremy U.; Hogan, William R.; Wagner, Michael M.

2003-01-01

266

Mobile Health Systems that Optimize Resources in Emergency Response Situations  

PubMed Central

During mass casualty incidents, a large number of patients need to be triaged accurately in order to save the maximum number of lives. Recently portable health systems have been developed that can gather patient’s vital signs and wireless transmit this information to a central location for analysis. This research introduces a methodology to improve triage in mass casualty incidents by combining statistical optimization techniques with mobile health systems to manage resources using evidence based data. We combine data collected during a field test with data of patient’s vital signs to simulate how mobile health systems can optimize resources in emergency response situations.

Massey, Tammara; Gao, Tia

2010-01-01

267

Timing of troponin T measurements in triage of pulmonary embolism patients  

PubMed Central

Aim To determine the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of pulmonary embolism (PE) patients. Methods In this single-center prospective study, PE was confirmed in all patients using computed tomography. 104 consecutive patients were divided into three groups (high-risk, intermediate, and low-risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. cTnT levels were measured on admission and then after 6, 24, 48, and 72 hours with threshold values greater than 0.1 ng/mL. Results Intermediate-risk PE patients had higher cTnT levels than low-risk patients already in the first measurement (P?=?0.037). Elevated cTnT levels significantly correlated with disease severity after 6 hours (intermediate vs low risk patients, P?=?0.016, all three groups, P?=?0.009). Conclusion In hemodynamically stable patients, increased cTnT level on admission differentiated intermediate from low-risk patients and could be used as an important element for the appropriate triage of patients.

Bulj, Nikola; Potocnjak, Ines; Sharma, Mirella; Pintaric, Hrvoje; Degoricija, Vesna

2013-01-01

268

Multi-sources data fusion framework for remote triage prioritization in telehealth.  

PubMed

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

Salman, O H; Rasid, M F A; Saripan, M I; Subramaniam, S K

2014-09-01

269

Detector photon response and absorbed dose and their applications to rapid triage techniques  

NASA Astrophysics Data System (ADS)

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.

Voss, Shannon Prentice

270

Urine levels of drugs for which Triage DOA screening was positive.  

PubMed

The purpose of this study was to investigate the relationship between urine levels of target drugs of abuse for which Triage DOA gave positive results, as well as the cut-off levels for these drugs. Thirty-eight forensic urine samples positive for commonly abused drugs were involved. Of these samples, 12 were positive for barbiturates (BAR), 11 for benzodiazepines (BZO), 8 for opiates (OPI), 7 for amphetamines (AMP), and 4 for tricyclic antidepressants (TCA). In the BAR-positive urine samples, phenobarbital, amobarbital or barbital was detected at concentrations higher than cut-off levels. In the BZO-positive samples, diazepam, nordiazepam, triazolam, nitrazepam and/or midazolam was detected at concentrations lower than cut-off levels; in the triazolam-involved urine, alpha-hydroxytriazolam, a metabolite of triazolam, showed concentrations higher than cut-off level. In the AMP-positive samples, methamphetamine was detected at concentrations higher than cut-off level. Urine samples positive for OPI contained total dihydrocodeine, codeine or morphine at concentrations higher than cut-off levels. In TCA-positive samples, amitriptyline was detected at concentrations higher or lower than cut-off level, and clomipramine was detected at a concentration much lower than cut-off level. Metabolites of BZO and TCA, which are not typically analyzed by instrumental procedures, may cross-react to varying degrees with the antibodies used for Triage DOA. PMID:19261513

Moriya, Fumio

2009-04-01

271

Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review  

PubMed Central

Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation.

Allemann Iseli, Martina; Kunz, Regina; Blozik, Eva

2014-01-01

272

Antibiotic prophylaxis at triage for simple traumatic wounds: a pilot study.  

PubMed

Antibiotic administration at the time of wound manipulation has not been shown to decrease infection rates for simple traumatic wounds. Antibiotic administration at the time of initial emergency department (ED) presentation, however, has not been explored. Patients presenting to the ED with simple traumatic wounds received 1 g of oral flucloxacillin, or identical placebo, at triage. Wound closure was completed at the discretion of a physician blinded to study contents. Wound infection rates were determined at 1 month. Time from drug administration to wound manipulation was 64.3 min [95% confidence interval (CI) 36.6-91.9] placebo versus 75.0 min (95% CI: 51.7-98.3) flucloxacillin, P=0.657. Six of 36 patients (17%) reported wound infection in the placebo group, and four of 34 (12%) in the flucloxacillin group, P=0.736. Administration of oral flucloxacillin at triage failed to reduce the rate of wound infection for simple traumatic wounds closed in the ED. PMID:21389858

Cowell, David Lord; Harvey, Martyn; Cave, Grant

2011-10-01

273

Colonization of Libyan civil war casualties with multidrug-resistant bacteria.  

PubMed

In November 2011 51 Libyan war casualties were admitted to the Major Incident Hospital in Utrecht and from there were transferred to 26 other Dutch hospitals. Cultures and clinical data were collected to establish the prevalence of multidrug-resistant (MDR) bacteria in this patient group and to identify the associated risk factors. The prevalence of MDR bacteria was 59% (30/51 patients); extended spectrum ?-lactamase-producing enterobacteriaceae were most common (26/51 patients: 51%). The major risk factor for carriage of MDR bacteria was the presence of open wounds at admission to the Major Incident Hospital. PMID:23413838

Koole, K; Ellerbroek, P M; Lagendijk, R; Leenen, L P H; Ekkelenkamp, M B

2013-07-01

274

Application of a triage approach to peripheral bone densitometry reduces the requirement for central DXA but is not cost effective.  

PubMed

A method proffered for the interpretation of measurements from peripheral dual energy X-ray absorptiometry (pDXA) is a triage approach to stratify patients into one of three risk categories; (i) high-treat, (ii) medium-refer for central DXA and (iii) low-reassure. The aim of this study was to apply the triage approach to measures from peripheral scanners and risk indices and stratify patients into one of three risk categories (i), (ii) or (iii). 207 post-menopausal women had central DXA from which they were categorised as non-osteoporotic or osteoporotic. Additional peripheral scans of the left calcaneus were performed on three scanners (GE Lunar Achilles and PIXI, McCue CubaClinical). From demographic details four risk indices were calculated and algorithms combining measures from peripheral scanners and one risk index were obtained. All peripheral measures, risk indices and combination algorithms were good at identifying women at risk of osteoporosis (ROC areas: 0.67-0.82). Each tool stratified varying numbers of osteoporotic and non-osteoporotic women into each risk category using the triage approach. One combination algorithm (PIXI & osteoporosis indices of risk (OSIRIS)) performed best by minimising misclassification (10% non-osteoporotic, 10% osteoporotic) and reducing requirement for central DXA to 36%. However the cost of implementing the triage approach for PIXI & OSIRIS was greater (263%) than central DXA (100%) scanning all women. Although the triage approach was an effective tool at identifying women at risk of osteoporosis the unnecessary treatment of non-osteoporotic women in the high risk category make it impractical. Therefore an alternative more cost-effective method has been suggested. PMID:16969598

Harrison, Elizabeth J; Adams, Judith E

2006-10-01

275

The association between demographic factors, user reported experiences and user satisfaction: results from three casualty clinics in Norway  

PubMed Central

Background User reported experiences and satisfaction are increasingly used as basis for quality indicators in the health sector. However, there is limited understanding of factors associated with user reported experiences and satisfaction with casualty clinics. Methods A random sample of 542 patients that had contacted any of three casualty clinics from mid April to mid May 2008 was mailed a questionnaire. A reminder was sent to non-respondents after six weeks. Descriptive statistics for four user reported experiences scales and 20 single items are presented. Multivariate regression analysis was used to assess associations between background variables and user reported experiences, and between user reported experiences and user satisfaction. Results 225 (41.5%) patients, carers and guardians returned a completed questionnaire. Users reported most positive experiences with the doctor services and the nursing services at the casualty clinics; on a scale from 0 to 100, where 100 is the best possible experience the doctor scale was 82 and the nursing scale 81. Users reported least positive experiences with the organization of the casualty clinic, with a scale score of 65. Self perceived health was associated with user satisfaction, while self perceived health and age were associated with user reported experiences with organization of the clinics. A range of user reported experience domains were related to user satisfaction, after controlling for socio-demographic variables, including experiences with doctor services at the clinics, organization of the clinics, information and self perceived incorrect treatment. Conclusions Users report positive experiences with the three casualty clinics, with organization as the aspect with largest improvement potential. The importance of age and health status for users' experiences and satisfaction with casualty clinics was shown, but a range of user reported experiences with the clinics were the most important predictors for user satisfaction.

2010-01-01

276

Linking road casualty and clinical data to assess the effectiveness of mobile safety enforcement cameras: a before and after study  

PubMed Central

Objectives To use police STATS19 road casualty data and accident and emergency and in-patient information to estimate the impact of mobile safety cameras on the cost of treating individuals injured in road traffic collisions. Design A data-matching and costing exercise to link casualty and clinical information in a ‘before’ and ‘after’ study of 56 mobile safety cameras. Setting The Northumbria Police Force area of the UK covering six local authority districts. Participants Slight, serious and fatal casualties involved in road traffic collisions at mobile camera sites in the case-study area between April 2001–March 2003 and April 2004–March 2006. Primary and secondary outcome measures Changes in the number and severity of casualties at the mobile camera sites between the ‘before’ and ‘after’ period that can be attributed to mobile safety camera activity, and any impacts these changes had on the ‘cost of treatment saved’ by the secondary healthcare service in the case-study area. Results Using tariff values for accident and emergency and In-patient Health Resource Groups, the impacts of the cameras in terms of the ‘cost of treatment saved’ are in the range £12?500–£15?000 per annum. However, inconsistencies between databases resulted in approximately one-third of the casualties not being matched successfully in the clinical databases. The number of closed fractures requiring investigations, treatment and follow-up care reduced considerably, although this was offset by an increase in head injury contusions and open fractures that require high-cost investigations and extensive in-patient care. Conclusions Road safety cameras could have a significant impact in terms of ‘cost of treatment saved’. However, it is argued that investigating the impacts of road safety measures in the future should be based on Fully Bayesian techniques as they can produce more reliable estimates of the effects of regression to mean and general trends in casualty statistics.

Thorpe, Neil; Fawcett, Lee

2012-01-01

277

When terror is routine: how Israeli nurses cope with multi-casualty terror.  

PubMed

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments. PMID:12410636

Riba, Shoshana; Reches, Hiba

2002-01-01

278

Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.  

PubMed

During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. PMID:24048995

Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

2013-01-01

279

The influence of car registration year on driver casualty rates in Great Britain.  

PubMed

A previous paper analysed data from the British national road accident reporting system to investigate the influence upon car driver casualty rates of the general type of car being driven and its year of first registration. A statistical model was fitted to accident data from 2001 to 2005, and this paper updates the principal results using accident data from 2003 to 2007. Attention focuses upon the role of year of first registration since this allows the influence of developments in car design upon occupant casualty numbers to be evaluated. Three additional topics are also examined with these accident data. Changes over time in frontal and side impacts are compared. Changes in the combined risk for the two drivers involved in a car-car collision are investigated, being the net result of changes in secondary safety and aggressivity. Finally, the results of the new model relating to occupant protection are related to an index that had been developed previously to analyse changes over time in the secondary safety of the car fleet. PMID:22269528

Broughton, Jeremy

2012-03-01

280

Rapid Analytical Methods for On-Site Triage for Traumatic Brain Injury  

NASA Astrophysics Data System (ADS)

Traumatic brain injury (TBI) results from an event that causes rapid acceleration and deceleration of the brain or penetration of the skull with an object. Responses to stimuli and questions, loss of consciousness, and altered behavior are symptoms currently used to justify brain imaging for diagnosis and therapeutic guidance. Tests based on such symptoms are susceptible to false-positive and false-negative results due to stress, fatigue, and medications. Biochemical markers of neuronal damage and the physiological response to that damage are being identified. Biosensors capable of rapid measurement of such markers in the circulation offer a solution for on-site triage, as long as three criteria are met: (a) Recognition reagents can be identified that are sufficiently sensitive and specific, (b) the biosensor can provide quantitative assessment of multiple markers rapidly and simultaneously, and (c) both the sensor and reagents are designed for use outside the laboratory.

North, Stella H.; Shriver-Lake, Lisa C.; Taitt, Chris R.; Ligler, Frances S.

2012-07-01

281

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

NASA Astrophysics Data System (ADS)

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).

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

2012-08-01

282

A far-view intensive care unit monitoring display enables faster triage.  

PubMed

Although nurses perform the majority of the clinical tasks in an intensive care unit, current patient monitors were not designed to support a nurse's workflow. Nurses constantly triage patients, deciding which patient is currently in the most need of care. To make this decision, nurses must observe the patient's vital signs and therapeutic device information from multiple sources. To obtain this information, they often have to enter the patient's room. This study addresses 3 hypotheses. Information provided by far-view monitoring displays (1) reduces the amount of time to determine which patient needs care first, (2) increases the accuracy of assigning priority to the right patient, and (3) reduces nurses mental workload. We developed 2 far-view displays to be read from a distance of 3 to 5 m without entering the patient's room. Both display vital signs, trends, alarms, infusion pump status, and therapy support indicators. To evaluate the displays, nurses were asked to use the displays to decide which of 2 patients required their attention first. They made 60 decisions: 20 with each far-view display and 20 decisions with a standard patient monitor next to an infusion pump. Sixteen nurses (median age of 27.5 years with 2.75 years of experience) participated in the study. Using the 2 far-view displays, nurses more accurately and rapidly identified stable patients and syringe pumps that were nearly empty. Median decision times were 11.3 and 12.4 seconds for the 2 far-view displays and 17.2 seconds for the control display. The 2 far-view displays reduced median decision-making times by 4.8 to 5.9 seconds, increased accuracy in assignment of priority in 2 of 7 patient conditions, and reduced nurses' frustration with the triaging task. In a clinical setting, the proposed far-view display might reduce nurses' mental workload and thereby increase patient safety. PMID:21654229

Görges, Matthias; Kück, Kai; Koch, Sven H; Agutter, Jim; Westenskow, Dwayne R

2011-01-01

283

Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial  

PubMed Central

Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea >7 mmol·L?1, respiratory rate ?30 breaths·min?1, blood pressure <90 mmHg (systolic) or ?60 mmHg (diastolic), age ?65 years (CURB-65) score on triage decisions and length of stay. In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention. On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41–0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40–0.05; p=0.13). There were no differences in adverse outcomes or readmission. Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay.

Albrich, Werner C.; Ruegger, Kristina; Dusemund, Frank; Schuetz, Philipp; Arici, Birsen; Litke, Alexander; Blum, Claudine A.; Bossart, Rita; Regez, Katharina; Schild, Ursula; Guglielmetti, Merih; Conca, Antoinette; Schafer, Petra; Schubert, Maria; de Geest, Sabina; Reutlinger, Barbara; Irani, Sarosh; Burgi, Ulrich; Huber, Andreas; Muller, Beat

2013-01-01

284

Spatial-temporal patterns in Mediterranean carnivore road casualties: Consequences for mitigation  

USGS Publications Warehouse

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.

Grilo, C.; Bissonette, J. A.; Santos-Reis, M.

2009-01-01

285

Advanced Product Development for Combat Casualty Care at the U.S. Army Institute of Surgical Research.  

National Technical Information Service (NTIS)

The Institute of Surgical Research (USAISR) is the U.S. Army s lead research laboratory for improving the care of combat casualties. The Institute follows a rigorous process for analyzing patterns of injury and the burden of disease to determine where res...

D. G. Baer J. C. Wenke L. L. McGhee M. A. Dubick V. A. Convertino

2010-01-01

286

Econometric analysis of the changing effects in wind strength and significant wave height on the probability of casualty in shipping  

Microsoft Academic Search

This study uses econometric models to measure the effect of significant wave height and wind strength on the probability of casualty and tests whether these effects changed. While both effects are in particular relevant for stability and strength calculations of vessels, it is also helpful for the development of ship construction standards in general to counteract increased risk resulting from

Sabine Knapp; Shashi Kumar; Yuri Sakurada; Jiajun Shen

2011-01-01

287

Operation GREENHOUSE. Scientific Director's report. Annex 5. 1 - Annex a. Alkali halide and phosphate glass radiological casualty dosimeters  

Microsoft Academic Search

Photochemical reactions induced by ionizing radiations can produce color centers in alkali halide crystals and fluorescent centers in silver-bearing phosphate glasses. These reactions are being investigated as a basis for casualty-badge radiation dosimeters. Potassium bromide and potassium chloride crystals were satisfactorily sensitized by heating in a combined atmosphere of alkali vapor and hydrogen. Doses of 25 r of cobalt 60

R. S. Alger; J. P. Dyson; R. A. Levy; D. W. McQuilling

1951-01-01

288

Visualizing spatio-temporal war casualty data in Google Earth - A case study of Map the Fallen (Invited)  

Microsoft Academic Search

Published on Memorial Day 2009, Map the Fallen is a Google Earth visualization of the 5500+ US and international soldiers that have died in Iraq and Afghanistan since 2001. In addition to providing photos, stories and links for each solider, the time-animated map visually connects hometowns to places of death. This novel way of representing casualty data brings the geographic

S. Askay

2009-01-01

289

Daily variation in natural disaster casualties: information flows, safety, and opportunity costs in tornado versus hurricane strikes.  

PubMed

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

Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

2013-07-01

290

Utilizing the Canadian Emergency Department Triage and Acuity Scale (CTAS) in an oncology urgent care clinic: the university health network experience.  

PubMed

The Canadian Triage Acuity Score (CTAS) is a validated triage method used in Canadian emergency departments (ED) that groups patients according to severity of presenting illness (CIHI, 2005). According to Tanabe, Gimbel, Yarnold and Adams (2004), five-level triage systems can be utilized in order to benchmark with similar programs. CTAS, a five-level triage system, can also be used as an instrument to determine triage quality and to predict admission rates, hospital length of stay and diagnostic utilization (Jiminez et al., 2003). In June 2009, Princess Margaret Hospital launched REACH (Reducing Emergent and Acute Care Hospitalization), an oncology-specific urgent care clinic. In order to appropriately utilize resources, assist patients in a timely manner according to acuity, and compare and contrast data to that which is traditionally reported from our area EDs, we implemented the use of a validated triage methodology, CTAS, in this urgent care clinic. The following paper describes the University Health Network experience with utilizing CTAS in an oncology population. PMID:21462878

Trip, K; Boloorchi, A; Berman, H

2011-01-01

291

Use of surgisis for abdominal wall reconstruction/closure in battlefield casualties during Operation Iraqi Freedom.  

PubMed

A case series and discussion based on experiences gained during Operation Iraqi Freedom are presented. The Army previously published an article on the use of Gore-Tex mesh in the staged closure of open abdominal wounds. We thought that use of a biomaterial could shorten the overall course of abdominal closure and improve outcomes. This is mainly a "proof of concept" type of study. Although class I data are not presented, a useful concept is discussed. To our knowledge, no other report of the use of biomaterials for battle casualties has been published. Several issues that are faced by the military medical system are presented. The use of Surgisis (lyophilized porcine small intestinal submucosa; Cook Biotech, West Lafayette, Indiana) in the described setting is presented as one possible solution. PMID:17985779

Johnson, Eric K; Paquette, Edmond L

2007-10-01

292

An English admiral and an American aviator: advanced trauma life support and two historical military casualties.  

PubMed

This article considers two historical military casualties in the context of present day Advanced Trauma Life Support (ATLS) teaching. The death of Admiral Lord Nelson, Royal Navy, at the Battle of Trafalgar in 1805 has been well documented while that of Lieutenant Luke, an American aviator, U.S. Army Air Service, in France in 1918 has been almost disregarded. Both suffered a gunshot wound to the chest with the responsible weapon similarly sited. Nelson's dying was witnessed and recorded in detail by his surgeon. Luke's death was unwitnessed and has been the subject of considerable speculation. A recent monograph removes much of this speculation but cannot describe his last few minutes of life. This article describes both events and considers the mechanism of injury. It presents speculative radiological reconstructions and an outline of emergency management according to ATLS for both and further clinical speculation on Luke's demise. PMID:21121490

Bridgewater, Franklin H G

2010-11-01

293

Triage and Management of the Injured in World War I: The Diuturnity of Antoine De Page and a Belgian Colleague  

PubMed Central

A system of orderly triage of the injured in World War I and a protocol for early wound management of war injuries were introduced by Antoine De Page in 1914 at the beginning of World War I. The five steps of the De Page protocol (coined by the author as Ordre de Triage) were to be followed in detail by the French and Belgian armies. A younger Belgian colleague, Robert Danis, was recruited to aid in the management of the ambulance corps to transport the injured from dressing (“clearing”) stations to centers of more advanced care, away from the Franco-Belgian front. Danis, also from Brussels, introduced the principles of osteosynthesis of bone a little over a decade later. De Page and Danis, both surgeons, tendered immense carry-forwards for future generations.

Pollock, Richard A.

2008-01-01

294

Full-body x-ray imaging to facilitate triage: a potential aid in high-volume emergency departments.  

PubMed

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol-the Johannesburg trauma protocol-that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily. PMID:24205438

Whiley, S P; Alves, H; Grace, S

2013-01-01

295

A low-bandwidth graphical user interface for high-speed triage of potential items of interest in video imagery  

NASA Astrophysics Data System (ADS)

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.

Huber, David J.; Khosla, Deepak; Martin, Kevin; Chen, Yang

2013-06-01

296

Logistic regression analysis of pedestrian casualty risk in passenger vehicle collisions in China.  

PubMed

A large number of pedestrian fatalities were reported in China since the 1990s, however the exposure of pedestrians in public traffic has never been measured quantitatively using in-depth accident data. This study aimed to investigate the association between the impact speed and risk of pedestrian casualties in passenger vehicle collisions based on real-world accident cases in China. The cases were selected from a database of in-depth investigation of vehicle accidents in Changsha-IVAC. The sampling criteria were defined as (1) the accident was a frontal impact that occurred between 2003 and 2009; (2) the pedestrian age was above 14; (3) the injury according to the Abbreviated Injury Scale (AIS) was 1+; (4) the accident involved passenger cars, SUVs, or MPVs; and (5) the vehicle impact speed can be determined. The selected IVAC data set, which included 104 pedestrian accident cases, was weighted based on the national traffic accident data. The logistical regression models of the risks for pedestrian fatalities and AIS 3+ injuries were developed in terms of vehicle impact speed using the unweighted and weighted data sets. A multiple logistic regression model on the risk of pedestrian AIS 3+ injury was developed considering the age and impact speed as two variables. It was found that the risk of pedestrian fatality is 26% at 50 km/h, 50% at 58 km/h, and 82% at 70 km/h. At an impact speed of 80 km/h, the pedestrian rarely survives. The weighted risk curves indicated that the risks of pedestrian fatality and injury in China were higher than that in other high-income countries, whereas the risks of pedestrian casualty was lower than in these countries 30 years ago. The findings could have a contribution to better understanding of the exposures of pedestrians in urban traffic in China, and provide background knowledge for the development of strategies for pedestrian protection. PMID:20441804

Kong, Chunyu; Yang, Jikuang

2010-07-01

297

Development of a triage engine enabling behavior recognition and lethal arrhythmia detection for remote health care system.  

PubMed

For ubiquitous health care systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote health care system, which is composed of a wireless vital sensor, multiple receivers and a triage engine installed in a desktop personal computer (PC). The middleware installed in the receiver, which was developed in C++, supports reliable data handling of vital data to the ethernet port. On the other hand, the human interface of the triage engine, which was developed in JAVA, shows graphics on his/her ECG data, 3D acceleration data, body surface temperature data and behavior status in the display of the desktop PC and sends an urgent e-mail containing the display data to a pre-registered medical doctor when it detects the occurrence of an abnormal event. In the triage engine, the lethal arrhythmia detection algorithm based on short time Fourier transform (STFT) analysis can achieve 100 % sensitivity and 99.99 % specificity, and the behavior recognition algorithm based on the combination of the nearest neighbor method and the Naive Bayes method can achieve more than 71 % classification accuracy. PMID:22254766

Sugano, Hiroto; Hara, Shinsuke; Tsujioka, Tetsuo; Inoue, Tadayuki; Nakajima, Shigeyoshi; Kozaki, Takaaki; Namkamura, Hajime; Takeuchi, Kazuhide

2011-01-01

298

Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage  

PubMed Central

Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life.

Ames, Bruce N.

2006-01-01

299

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

PubMed Central

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.

2011-01-01

300

An integrative review: triage protocols and the effect on ED length of stay.  

PubMed

The purpose of this integrative review is to identify the effectiveness of using triage protocols to decrease ED length of stay. The review method described by Ganong was used to guide the review process. Data sources included CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline, the Cochrane Library, Mosby's Nursing Consult, and the National Guideline Clearinghouse. In addition, reference lists of all articles were reviewed, 3 authors of previous articles were contacted for more current or updated work, and a hand search of the Journal of Emergency Nursing was conducted. The search generated 56 articles, 8 of which met inclusion criteria. Data were interpreted and evaluated by use of a data summary sheet. Key conclusions drawn from the appraisals included that a decrease in length of stay was related to protocol use and nurses were able to initiate diagnostic testing and treatments appropriately. These conclusions apply to acuity levels 3 and 4, which require either little or no testing or require testing to facilitate a disposition decision. The implications for nursing are that appraisals of evidence lead to better practice decisions, protocols can provide greater nursing autonomy and satisfaction, and protocols are able to increase the facilitation of patient care in the emergency department. PMID:22513188

Robinson, Dana J

2013-07-01

301

The Analytic Bilinear Discrimination of Single-Trial EEG Signals in Rapid Image Triage  

PubMed Central

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.

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

2014-01-01

302

The Challenge of Triaging Chest Pain Patients: The Bernese University Hospital Experience  

PubMed Central

Accurate diagnosis of the causes of chest pain and dyspnea remain challenging. In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED. During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule. Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%). Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5–40% in (71) patients. Coronary catheterization was performed within 24 hours in 91% of the patients with ACS. A culprit lesion was found in 79%. Follow-up (median 4.2 years) information was available for 70% of the patients. Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died. Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms.

Rohacek, Martin; Bertolotti, Amina; Grutzmuller, Nadine; Simmen, Urs; Marty, Hans; Zimmermann, Heinz; Exadaktylos, Aristomenis; Spyridon, Arampatzis

2012-01-01

303

The challenge of triaging chest pain patients: the bernese university hospital experience.  

PubMed

Accurate diagnosis of the causes of chest pain and dyspnea remain challenging. In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED. During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule. Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%). Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5-40% in (71) patients. Coronary catheterization was performed within 24 hours in 91% of the patients with ACS. A culprit lesion was found in 79%. Follow-up (median 4.2 years) information was available for 70% of the patients. Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died. Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms. PMID:22114740

Rohacek, Martin; Bertolotti, Amina; Grützmüller, Nadine; Simmen, Urs; Marty, Hans; Zimmermann, Heinz; Exadaktylos, Aristomenis; Spyridon, Arampatzis

2012-01-01

304

Triage and Management of Accidental Laboratory Exposures to Biosafety Level-3 and -4 Agents  

PubMed Central

The recent expansion of biocontainment laboratory capacity in the United States has drawn attention to the possibility of occupational exposures to BSL-3 and -4 agents and has prompted a reassessment of medical management procedures and facilities to deal with these contingencies. A workshop hosted by the National Interagency Biodefense Campus was held in October 2007 and was attended by representatives of all existing and planned BSL-4 research facilities in the U.S. and Canada. This report summarizes important points of discussion and recommendations for future coordinated action, including guidelines for the engineering and operational controls appropriate for a hospital care and isolation unit. Recommendations pertained to initial management of exposures (ie, immediate treatment of penetrating injuries, reporting of exposures, initial evaluation, and triage). Isolation and medical care in a referral hospital (including minimum standards for isolation units), staff recruitment and training, and community outreach also were addressed. Workshop participants agreed that any unit designated for the isolation and treatment of laboratory employees accidentally infected with a BSL-3 or -4 pathogen should be designed to maximize the efficacy of patient care while minimizing the risk of transmission of infection. Further, participants concurred that there is no medically based rationale for building care and isolation units to standards approximating a BSL-4 laboratory. Instead, laboratory workers accidentally exposed to pathogens should be cared for in hospital isolation suites staffed by highly trained professionals following strict infection control procedures.

Rodak, Colleen; Bray, Mike; Davey, Richard T.

2009-01-01

305

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

PubMed Central

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.??

Sethi, C; Grey, R; Hart, C

1999-01-01

306

EDs credit drills, community engagement with helping them manage casualties from tornado crises.  

PubMed

Emergency department leaders at DCH Regional Medical Center in Tuscaloosa, AL, and Cullman Regional Medical Center in Cullman, AL, credit their regular practice drills with helping them deal with unprecedented demand when deadly tornadoes swept through the South this past April. Both facilities used the hospital instant command structure (HICS) to mobilize the resources needed to care for the surge in patients, and say the approach worked well in helping them meet the needs of their communities. However, the crises also showcased opportunities for improvement. The ED at DCH Regional Medical Center saw more than 600 patients on the day of the storm, a three-fold increase in the hospital's typical volume. CRMC treated 99 patients in the seven hours immediately following the storm when it usually treats 114 patients per day. In addition to a big surge in patients, both hospitals dealt with power outages that limited access to some services such as radiology. Triage proved particularly challenging at DCH Regional Medical Center, as patients flowed into the hospital from numerous access points. The hospital plans to assign coordinators to each area of the hospital to better manage the influx in the future. When reviewing emergency operations plans, Joint Commission reviewers often find deficiencies in hazard vulnerability analyses as well as the processes used to determine the emergency credentials of licensed independent practitioners. PMID:21749003

2011-07-01

307

Syndromic surveillance for local outbreak detection and awareness: evaluating outbreak signals of acute gastroenteritis in telephone triage, web-based queries and over-the-counter pharmacy sales.  

PubMed

For the purpose of developing a national system for outbreak surveillance, local outbreak signals were compared in three sources of syndromic data--telephone triage of acute gastroenteritis, web queries about symptoms of gastrointestinal illness, and over-the-counter (OTC) pharmacy sales of antidiarrhoeal medication. The data sources were compared against nine known waterborne and foodborne outbreaks in Sweden in 2007-2011. Outbreak signals were identified for the four largest outbreaks in the telephone triage data and the two largest outbreaks in the data on OTC sales of antidiarrhoeal medication. No signals could be identified in the data on web queries. The signal magnitude for the fourth largest outbreak indicated a tenfold larger outbreak than officially reported, supporting the use of telephone triage data for situational awareness. For the two largest outbreaks, telephone triage data on adult diarrhoea provided outbreak signals at an early stage, weeks and months in advance, respectively, potentially serving the purpose of early event detection. In conclusion, telephone triage data provided the most promising source for surveillance of point-source outbreaks. PMID:23672877

Andersson, T; Bjelkmar, P; Hulth, A; Lindh, J; Stenmark, S; Widerström, M

2014-02-01

308

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

PubMed Central

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.

Shigematsu, Itsuzo

1998-01-01

309

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

PubMed

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

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

2012-09-01

310

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

USGS Publications Warehouse

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.

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

2012-01-01

311

Brachial plexus injury management in military casualties: who, what, when, why, and how.  

PubMed

The Global War on Terrorism has achieved an unprecedented 90% casualty survival rate because of far forward surgical support, rapid transport, and body armor. Despite the remarkable protection body armor affords, peripheral nerve injuries continue to occur. The brachial plexus in particular is still susceptible to penetrating trauma through the axilla as well as blunt mechanisms. We report 1,818 individuals with reported cases of peripheral nerve injury, 97 of which had brachial plexus injury incident from Operation Iraqi Freedom and Operation Enduring Freedom. We suspect that true prevalence is higher as initial focus on vascular and orthopedic reconstruction in complex shoulder injuries may overlook brachial plexus lesions. Accordingly, emergency physicians, general and orthopedic trauma surgeons, and vascular surgeons should all consider the possibility of brachial plexus and other peripheral nerve injury for early and appropriate referral to surgeons (plastic, orthopedic, or neurosurgical) for further evaluation and reconstruction. The latter group should be familiar with appropriate modern diagnostic and initial as well as salvage therapeutic options. PMID:24902131

Chambers, James A; Hiles, Claire L; Keene, Brian P

2014-06-01

312

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

PubMed

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

Shigematsu, I

1998-05-12

313

Israeli psychological casualties of the Persian Gulf war: characteristics, therapy, and selected issues.  

PubMed

The Persian Gulf war in 1991 presented Israel with its first experience of a threat of chemical attack on the home front. Ground-to-ground missiles were aimed directly at civilian populations, threatening death and destruction over a period of several weeks. Uncertainty as to time, place, and nature of the missile attacks affected the civilian population psychologically. The psychological responses of the population were the result of the continuous nature of the emergency which affected the entire population, and the destruction, injury, and displacement which affected those who were the targets of the attacks. The primary psychological effects of the emergency were investigated in several ways: surveys of samples of civilian and rear-echelon military populations, studies of the military personnel who asked for ambulatory psychological treatment as a result of the war, and studies of the specific populations that bore the brunt of the actual physical attacks were conducted. These studies show a high level of distress in the samples, with considerable differentiation between the populations. Levels of functioning generally remained intact even among the displaced or injured. Interventions were based on experience gained in the treatment of combat stress reaction. The issues of evacuation of psychological casualties to hospitals, psychiatric aspects of chemical attacks, and secondary traumatization of therapeutic and other staff are emphasized. PMID:1757245

Bleich, A; Kron, S; Margalit, C; Inbar, G; Kaplan, Z; Cooper, S; Solomon, Z

1991-01-01

314

Enhanced Influenza Surveillance using Telephone Triage Data in the VA ESSENCE Biosurveillance System  

PubMed Central

Objective To evaluate the utility and timeliness of telephone triage (TT) for influenza surveillance in the Department of Veterans Affairs (VA). Introduction Telephone triage is a relatively new data source available to biosurveillance systems.1–2 Because early detection and warning is a high priority, many biosurveillance systems have begun to collect and analyze data from non-traditional sources [absenteeism records, over-the-counter drug sales, electronic laboratory reporting, internet searches (e.g. Google Flu Trends) and TT]. These sources may provide disease activity alerts earlier than conventional sources. Little is known about whether VA telephone program influenza data correlates with established influenza biosurveillance. Methods Veterans phoning VA’s TT system, and those admitted or seen at a VA facility with influenza or influenza-like-illness (ILI) diagnosis were included in this analysis. Influenza-specific ICD-9-CM coded emergency department (ED) and urgent care (UC) visits, hospitalizations, TT calls, and ILI outpatient visits were analyzed covering 2010–2011 and 2011–2012 influenza seasons (July 11, 2010–April 14, 2012). Data came from 80 VA Medical Centers and over 500 outpatient clinics with complete reporting data for the time period of interest. We calculated Spearman rank-order coefficients, 95% confidence intervals and p-values using Fisher’s z transformation to describe correlation between TT data and other influenza healthcare measures. For comparison of time trends, we plotted data for hospitalizations, ED/UC visits and outpatient ILI syndrome visits against TT encounters. We applied ESSENCE detection algorithms to identify high-level alerts for influenza activity. ESSENCE aberration detection was restricted to the 2011–2012 season because limited historical TT and outpatient data from 2009–2010 was available to accurately predict aberrancy in the 2010–2011 season. We then calculated the peak measure of healthcare utilization during both influenza seasons (2010–2011 and 2011–2012) for each data source and compared timing of peaks and alerts between TT and other healthcare encounters to assess maximum healthcare system usage and timeliness of surveillance. Results There were 7,044 influenza-coded calls, 564 hospitalizations, 1,849 emergency/urgent visits, and 416,613 ILI-coded outpatient visits. Spearman rank correlation coefficients were calculated for influenza-coded calls with hospitalizations (0.77); ED/UC visits (0.85); and ILI-outpatient visits (0.88), respectively (P< 0.0001 for all correlations). Peak influenza activity occurred on the same week or within 1 week across all settings for both seasons. For the 2011–2012 season, TT alerted with increased influenza activity before all other settings. Conclusions Data from VA telephone care correlates well with other VA data sources for influenza activity. TT may serve to augment these existing clinical data sources and provide earlier alerts of influenza activity. As a national health care system with a large patient population, VA could provide a robust early-warning system for influenza if ongoing biosurveillance activities are combined with TT data. Additional analyses are needed to understand and correlate TT with healthcare utilization and severity of illness.

Lucero-Obusan, Cynthia A.; Winston, Carla A.; Schirmer, Patricia L.; Oda, Gina; Mostaghimi, Anoshiravan; Holodniy, Mark

2013-01-01

315

Human papillomavirus testing for triage of women with low-grade squamous intraepithelial lesions.  

PubMed

Low-grade squamous intraepithelial lesion (LSIL) is a common cytologic finding in cervical screening, yet only about 10-20% have significant histologic abnormalities and these are almost always positive for high-risk human papillomavirus (hrHPV). This analysis aims to clarify the role of hrHPV DNA testing in the triage of women with LSIL cytology. In the ATHENA screening trial, we examined 1,084 cases of LSIL, of which 925 had an evaluable biopsy, to determine the extent to which hrHPV testing can identify those patients who have precursor lesions in need of immediate clinical referral and those who have changes more likely to regress spontaneously. Overall, 71.2% of LSIL cases were hrHPV positive, but the prevalence was age dependent, with only 56.1% in women ? 40 years. Among women with LSIL, 11.6% (107/925) had a cervical intraepithelial neoplasia grade 2 or worse (CIN2+) histologic diagnosis and, of these, only nine were hrHPV negative. For CIN3+, 91.7% (44/48) of women with LSIL were hrHPV positive. The negative predictive value of hrHPV testing for CIN3+ in LSIL was 100% for women aged ? 40 years. Women who were HPV16 positive had a higher positive predictive value for CIN2+ (25.4%) than those who were positive for 12 other pooled hrHPV types (11.5%). Testing for hrHPV in women with LSIL is effective in identifying high-grade cervical lesions, thereby avoiding unnecessary referrals to colposcopy and potential over-treatment of non-progressive lesions, especially for women aged ? 40 years. PMID:22806936

Cuzick, Jack; Thomas Cox, J; Zhang, Guili; Einstein, Mark H; Stoler, Mark; Trupin, Suzanne; Behrens, Catherine M

2013-02-15

316

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

PubMed Central

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.

af, G; Britton, M

2005-01-01

317

A Critical Assessment of the Out-of-Hospital Trauma Triage Guidelines for Physiologic Abnormality  

PubMed Central

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.

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

318

Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma  

PubMed Central

Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT). Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts’ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH) and those not requiring immediate surgery (non-LTTH). Statistical Analysis: Parameters were compared using two sample t tests, Mann–Whitney, Fisher's exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD) was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP), pulse pressure, shock index (SI=heart rate/SBP) and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI) is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.

Morrison, Jonathan J; Dickson, Euan J; Jansen, Jan O; Midwinter, Mark J

2012-01-01

319

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

PubMed Central

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

2013-01-01

320

Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events.  

PubMed

Planning and preparation for a large-scale nuclear event would be advanced by assessing the applicability of potentially available bio-dosimetry methods. Using an updated comparative framework the performance of six bio-dosimetry methods was compared for five different population sizes (100-1 000 000) and two rates for initiating processing of the marker (15 or 15 000 people per hour) with four additional time windows. These updated factors are extrinsic to the bio-dosimetry methods themselves but have direct effects on each method's ability to begin processing individuals and the size of the population that can be accommodated. The results indicate that increased population size, along with severely compromised infrastructure, increases the time needed to triage, which decreases the usefulness of many time intensive dosimetry methods. This framework and model for evaluating bio-dosimetry provides important information for policy-makers and response planners to facilitate evaluation of each method and should advance coordination of these methods into effective triage plans. PMID:24729594

Flood, Ann Barry; Boyle, Holly K; Du, Gaixin; Demidenko, Eugene; Nicolalde, Roberto J; Williams, Benjamin B; Swartz, Harold M

2014-06-01

321

Adrenal Incidentaloma Triage With Single-Source (Fast-Kilovoltage Switch) Dual-Energy CT.  

PubMed

OBJECTIVE. The purpose of this article is to evaluate single-source dual-energy CT (DECT) for distinguishing benign and indeterminate adrenal nodules, with attention to the effects of phase of IV contrast enhancement. MATERIALS AND METHODS. A retrospective review revealed 273 contrast-enhanced abdominal DECT examinations from November 2009 through March 2012. Fifty adrenal nodules 0.8 cm or larger were identified in 41 patients (22 women and 19 men; average age, 66 years; age range, 36-88 years). CT postprocessing and measurements were independently performed by two radiologists (readers 1 and 2) for each nodule, as follows: attenuation (in Hounsfield units) on true unenhanced images; contrast-enhanced attenuation (in Hounsfield units) on monochromatic spectral images at 40, 75, and 140 keV; and contrast-enhanced material density (in milligrams per milliliter) on virtual unenhanced images. Nodules were classified as benign (< 10 HU) and indeterminate (? 10 HU) according to true unenhanced images. RESULTS. Interreader agreement regarding benign and indeterminate nodules was high (? = 0.92; 95% CI, 0.8-1.0). At 140 keV, the attenuation of benign nodules was significantly lower (reader 1, 7.0 ± 12.5 HU; reader 2, 7.8 ± 9.2 HU) than that of indeterminate nodules (reader 1, 15.7 ± 20.5 HU [p = 0.004]; reader 2, 17.5 ± 13.4 HU [p < 0.0001]). On virtual unenhanced images, benign nodules had significantly lower material density (reader 1, 992.4 ± 9.9 mg/mL; reader 2, 992.7 ± 9.6 mg/mL) than did indeterminate nodules (reader 1, 1001.1 ± 20.5 mg/mL [p = 0.038]; reader 2, 1007.6 ± 13.4 mg/mL [p < 0.0001]). CONCLUSION. DECT tools can mathematically subtract iodine or minimize its effects in high-energy reconstructions, approximating unenhanced imaging and potentially reducing the need for additional studies to triage adrenal nodules detected on contrast-enhanced DECT examinations. PMID:25055267

Glazer, Daniel I; Maturen, Katherine E; Kaza, Ravi K; Francis, Isaac R; Keshavarzi, Nahid R; Parker, Robert A; Platt, Joel F

2014-08-01

322

Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France  

PubMed Central

Background For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43). The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61), gynaecological (kappa = 0.66) and toxicology complaints (kappa = 1.00). The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09) and hospitalization (kappa = 0.20). When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%). Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs.

2011-01-01

323

Prevalence of acute conjunctivitis caused by chlamydia, adenovirus, and herpes simplex virus in an ophthalmic casualty department.  

PubMed

The causes of acute conjunctivitis in 140 consecutive patients attending an ophthalmic casualty department in London were investigated. Laboratory evidence of infection with Chlamydia trachomatis, adenovirus, or herpes simplex virus was found in 52 (37%) cases. In 70 cases (50%) no evidence of infection with these agents was found. In the remaining 18 cases (13%) laboratory results were inconclusive. The importance of these findings, the role of laboratory investigations in the differential diagnosis of acute conjunctivitis, and their cost-benefit are discussed. PMID:6087876

Wishart, P K; James, C; Wishart, M S; Darougar, S

1984-09-01

324

Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths  

PubMed Central

Background There is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community. Methods We systematically reviewed all published literature to identify studies related to our interventions. We searched PubMed, Cochrane Library, and all World Health Organization Regional Databases and included publications in any language. Quality of available evidence was assessed using GRADE criteria. Recommendations were made for the Lives Saved Tool (LiST) based on rules developed by the Child Health Epidemiology Group. Given the paucity of evidence related to the effect of detection and management of IUGR on stillbirths, we undertook Delphi based evaluation from experts in the field. Results There was insufficient evidence to recommend against or in favor of routine use of fetal movement monitoring for fetal well being. (1) Detection and triage of IUGR with the help of (1a) maternal BMI screening, (1b) symphysial-fundal height measurement and (1c) targeted ultrasound can be an effective method of reducing IUGR related perinatal morbidity and mortality. Pooled results from sixteen studies shows that Doppler velocimetry of umbilical and fetal arteries in ‘high risk’ pregnancies, coupled with the appropriate intervention, can reduce perinatal mortality by 29 % [RR 0.71, 95 % CI 0.52-0.98]. Pooled results for impact on stillbirth showed a reduction of 35 % [RR 0.65, 95 % CI 0.41-1.04]; however, the results did not reach the conventional limits of statistical significance. This intervention could be potentially recommended for high income settings or middle income countries with improving rates and standards of facility based care. Based on the Delphi, a combination of screening with maternal BMI, Symphysis fundal height and targeted ultrasound followed by the appropriate management could potentially reduce antepartum and intrapartum stillbirth by 20% respectively. This estimate is presently being recommended for inclusion in the LiST. Conclusion There is insufficient evidence to recommend in favor or against fetal movement counting for routine use for testing fetal well being. Doppler velocimetry of umbilical and fetal arteries and appropriate intervention is associated with 29 % (95 % CI 2% to 48 %) reduction in perinatal mortality. Expert opinion suggests that detection and management of IUGR with the help of maternal BMI, symphysial-fundal height measurement and targeted ultrasound could be effective in reducing IUGR related stillbirths by 20%.

2011-01-01

325

Using the model of resource and time-based triage (MORTT) to guide scarce resource allocation in the aftermath of a nuclear detonation.  

PubMed

Conventional triage algorithms assume unlimited medical resource availability. After a nuclear detonation, medical resources are likely to be particularly limited, suggesting that conventional triage algorithms need to be rethought. To test various hypotheses related to the prioritization of victims in this setting, we developed the model of resource- and time-based triage (MORTT). This model uses information on time to death, probability of survival if treated and if untreated, and time to treat various types of traumatic injuries in an agent-based model in which the time of medical practitioners or materials can be limited. In this embodiment, MORTT focuses solely on triage for surgical procedures in the first 48 hours after a nuclear detonation. MORTT determines the impact on survival based on user-selected prioritization of victims by severity or type of injury. Using MORTT, we found that in poorly resourced settings, prioritizing victims with moderate life-threatening injuries over victims with severe life-threatening injuries saves more lives and reduces demand for intensive care, which is likely to outstrip local and national capacity. Furthermore, more lives would be saved if victims with combined injury (ie, trauma plus radiation >2 Gy) are prioritized after nonirradiated victims with similar trauma. PMID:21402818

Casagrande, Rocco; Wills, Nick; Kramer, Elizabeth; Sumner, Louise; Mussante, Mark; Kurinsky, Rachel; McGhee, Patrick; Katz, Luba; Weinstock, David M; Coleman, C Norman

2011-03-01

326

Decreased length of stay after addition of healthcare provider in emergency department triage: a comparison between computer-simulated and real-world interventions  

PubMed Central

Objective (1) To determine the effects of adding a provider in triage on average length of stay (LOS) and proportion of patients with >6?h LOS. (2) To assess the accuracy of computer simulation in predicting the magnitude of such effects on these metrics. Methods A group-level quasi-experimental trial comparing the St. Louis Veterans Affairs Medical Center emergency department (1) before intervention, (2) after institution of provider in triage, and discrete event simulation (DES) models of similar (3) ‘before’ and (4) ‘after’ conditions. The outcome measures were daily mean LOS and percentage of patients with LOS >6?h. Results The DES-modelled intervention predicted a decrease in the %6-hour LOS from 19.0% to 13.1%, and a drop in the daily mean LOS from 249 to 200?min (p<0.0001). Following (actual) intervention, the number of patients with LOS >6?h decreased from 19.9% to 14.3% (p<0.0001), with the daily mean LOS decreasing from 247 to 210?min (p<0.0001). Conclusion Physician and mid-level provider coverage at triage significantly reduced emergency department LOS in this setting. DES accurately predicted the magnitude of this effect. These results suggest further work in the generalisability of triage providers and in the utility of DES for predicting quantitative effects of process changes.

Al-Roubaie, Abdul Rahim; Goldlust, Eric Jonathan

2013-01-01

327

Econometric analysis of the changing effects in wind strength and significant wave height on the probability of casualty in shipping.  

PubMed

This study uses econometric models to measure the effect of significant wave height and wind strength on the probability of casualty and tests whether these effects changed. While both effects are in particular relevant for stability and strength calculations of vessels, it is also helpful for the development of ship construction standards in general to counteract increased risk resulting from changing oceanographic conditions. The authors analyzed a unique dataset of 3.2 million observations from 20,729 individual vessels in the North Atlantic and Arctic regions gathered during the period 1979-2007. The results show that although there is a seasonal pattern in the probability of casualty especially during the winter months, the effect of wind strength and significant wave height do not follow the same seasonal pattern. Additionally, over time, significant wave height shows an increasing effect in January, March, May and October while wind strength shows a decreasing effect, especially in January, March and May. The models can be used to simulate relationships and help understand the relationships. This is of particular interest to naval architects and ship designers as well as multilateral agencies such as the International Maritime Organization (IMO) that establish global standards in ship design and construction. PMID:21376925

Knapp, Sabine; Kumar, Shashi; Sakurada, Yuri; Shen, Jiajun

2011-05-01

328

Visualizing spatio-temporal war casualty data in Google Earth - A case study of Map the Fallen (Invited)  

NASA Astrophysics Data System (ADS)

Published on Memorial Day 2009, Map the Fallen is a Google Earth visualization of the 5500+ US and international soldiers that have died in Iraq and Afghanistan since 2001. In addition to providing photos, stories and links for each solider, the time-animated map visually connects hometowns to places of death. This novel way of representing casualty data brings the geographic reach and magnitude of the issue into focus together with the very personal nature of individual stories. Innovative visualizations techniques were used that illustrate the spatio-temporal nature of this information and to show the global reach and interconnectivity of this issue. Several of advanced KML techniques employed to create this engaging and performance-conscious map will be discussed during this session. These include: 1) the use of HTML iframes and javascript to minimize the KML size, and extensive cross-linking throughout content; 2) the creation of a time-animated, on-screen casualty counter; 3) the use of parabolic arcs to connect each hometown to place of death; 4) the use of concentric spirals to represent chronological data; and 5) numerous performance optimizations to ensure the 23K placemarks, 2500 screen overlays and nearly 250k line vertices performed well in Google Earth. This session will include a demonstration of the map, conceptual discussions of the techniques used, and some in-depth technical explanation of the KML code.

Askay, S.

2009-12-01

329

Using a forehead reflectance pulse oximeter to detect changes in sympathetic tone  

Microsoft Academic Search

The extreme conditions of combat and multi-casualty rescue often make field triage difficult and put the medic or first responder at risk. In an effort to improve field triage, we have developed an automated remote triage system called ARTEMIS (automated remote triage and emergency management information system) for use in the battlefield or disaster zone. Common to field injuries is

Suzanne M. Wendelken; Susan P McGrath; Metin Akay; George T. Blike

2004-01-01

330

Hospital Triage System for Adult Patients Using an Influenza-Like Illness Scoring System during the 2009 Pandemic--Mexico  

PubMed Central

Background Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico. Methods A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's ?2, Fisher's Exact, and Wilcoxon rank-sum tests. Results Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score?=?15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score?=?11), and 1324 untreated (median ILI-score?=?5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score ?=?19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. Conclusions The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

Rodriguez-Noriega, Eduardo; Gonzalez-Diaz, Esteban; Morfin-Otero, Rayo; Gomez-Abundis, Gerardo F.; Briseno-Ramirez, Jaime; Perez-Gomez, Hector Raul; Lopez-Gatell, Hugo; Alpuche-Aranda, Celia M.; Ramirez, Ernesto; Lopez, Irma; Iguala, Miguel; Chapela, Ietza Bojorquez; Zavala, Ethel Palacios; Hernandez, Mauricio; Stuart, Tammy L.; Villarino, Margarita Elsa; Widdowson, Marc-Alain; Waterman, Steve; Uyeki, Timothy; Azziz-Baumgartner, Eduardo

2010-01-01

331

Dose estimation using dicentric chromosome assay and cytokinesis block micronucleus assay: comparison between manual and automated scoring in triage mode.  

PubMed

In cases of an accidental overexposure to ionizing radiation, it is essential to estimate the individual absorbed dose of a potentially radiation-exposed person. For this purpose, biological dosimetry can be performed to confirm, complement or even replace physical dosimetry when this proves to be unavailable. The most validated biodosimetry techniques for dose estimation are the dicentric chromosome assay, the "gold standard" for individual dose assessment, and cytokinesis-block micronucleus assay. However, both assays are time consuming and require skilled scorers. In case of large-scale accidents, different strategies have been developed to increase the throughput of cytogenetic service laboratories. These are the decrease of cell numbers to be scored for triage dosimetry; the automation of procedures including the scoring of, for example, aberrant chromosomes and micronuclei; and the establishment of laboratory networks in order to enable mutual assistance if necessary. In this study, the authors compared the accuracy of triage mode biodosimetry by dicentric chromosome analysis and the cytokinesis block micronucleus assay performing both the manual and the automated scoring mode. For dose estimation using dicentric chromosome assay of 10 blind samples irradiated up to 6.4 Gy of x-rays, a number of metaphase spreads were analyzed ranging from 20 up to 50 cells for the manual and from 20 up to 500 cells for the automatic scoring mode. For dose estimation based on the cytokinesis block micronucleus assay, the micronucleus frequency in both 100 and 200 binucleated cells was determined by manual and automatic scoring. The results of both assays and scoring modes were compared and analyzed considering the sensitivity, specificity, and accuracy of dose estimation with regard to the discrimination power of clinically relevant binary categories of exposure doses. PMID:24776913

De Amicis, Andrea; De Sanctis, Stefania; Di Cristofaro, Sara; Franchini, Valeria; Regalbuto, Elisa; Mammana, Giacomo; Lista, Florigio

2014-06-01

332

The Real War Will Never Get On Television An Analysis of Casualty Imagery in American Television Coverage of the Iraq War  

Microsoft Academic Search

Abstract ,This paper reports the results of an analysis of battle and casualty imagery in television coverage of the 2003 Iraq War. A team of three graduate coders and two professors analyzed 200 hours of coverage aired from March 20 (the beginning of the war) through April 9 (the day the government,of Saddam Hussein was deposed). Ten hours a day

Sean Aday

2004-01-01

333

Triage of Women with Minor Cervical Lesions: Data Suggesting a ``Test and Treat'' Approach for HPV E6\\/E7 mRNA Testing  

Microsoft Academic Search

BackgroundHuman papillomavirus (HPV) testing is included in the cervical cancer screening program in the triage of women with equivocal (ASC-US) or low-grade (LSIL) cytological lesions. These women have an increased risk for developing high grade dysplasia and cancer (CIN2+) compared to women with normal cytology. However, in order to avoid unnecessary follow-up, as well as overtreatment, a high positive predictive

Sveinung Wergeland Sørbye; Silje Fismen; Tore Gutteberg; Elin Synnøve Mortensen; Maria G. Masucci

2010-01-01

334

10 Evaluating a nurse led triage process in treating patients with left bundle branch block (LBBB) referred for primary percutaneous coronary intervention (pPCI)  

Microsoft Academic Search

BackgroundThe Freeman Hospital (FRH) performs over 900 pPCI a year. Patients with suspected Acute Myocardial Infarction (AMI) are referred either by paramedics or networked hospitals for consideration of pPCI via a Telmed system, which is triaged by experienced CCU nurses. The pPCI Pathway can be activated in patients with LBBB suspected of having an AMI. However, there remains considerable variation

N V Joshi; B R Bawamia; S Jamieson; A Zaman; R Edwards

2011-01-01

335

Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles  

Microsoft Academic Search

In motor vehicle collisions the mechanism of injury is important in determining severity as well as for triage decisions in the pre-hospital phase of patient management. This study correlates deformation of the basic structures of the passenger compartment [windscreen, control panel (dashboard) and steering wheel] with occupants’ injuries in passenger vehicle head-on collisions involving non-airbag-carrying vehicles, with or without compartment

N Stefanopoulos; C Vagianos; M Stavropoulos; E Panagiotopoulos; J Androulakis

2003-01-01

336

Appropriately Prescribing Antibiotics for Patients With Pharyngitis: A Physician-Based Approach vs a Nurse-Only Triage and Treatment Algorithm  

PubMed Central

OBJECTIVE: To assess the safety and appropriateness of antibiotic use in adult patients with pharyngitis who opted for a nurse-only triage and treatment algorithm vs patients who underwent a physician-directed clinical evaluation. PATIENTS AND METHODS: Using International Classification of Diseases, Ninth Revision codes to query the electronic medical record database at our institution, a large multispecialty health care system in LaCrosse, WI, we identified adult patients diagnosed as having pharyngitis from September 1, 2005, through August 31, 2007. Diagnosis, treatment, and outcome data were collected retrospectively. RESULTS: Of 4996 patients who sought treatment for pharyngitis, 3570 (71.5%) saw a physician and 1426 (28.5%) opted for the nurse-only triage and treatment algorithm. Physicians adhered to antibiotic-prescribing guidelines in 3310 (92.7%) of 3570 first visits, whereas nurses using the algorithm adhered to guidelines in 1422 (99.7%) of 1426 first visits (P<.001). Physicians were significantly less likely to follow guidelines at patients' subsequent visits for a single pharyngitis illness than at their initial one (92.7% [3310/3570] vs 83.7% [406/485]; P<.001). CONCLUSION: Instituting a simple nurse-only triage and treatment algorithm for patients presenting with pharyngitis appears to reduce unnecessary antibiotic use.

Undeland, Duane K.; Kowalski, Todd J.; Berth, Wendy L.; Gundrum, Jacob D.

2010-01-01

337

A promising DNA methylation signature for the triage of high-risk human papillomavirus DNA-positive women.  

PubMed

High-risk human papillomavirus (hrHPV)-DNA testing is frequently performed parallel to cytology for the detection of high-grade dysplasia and cervical cancer particularly in women above 30 years of age. Although highly sensitive, hrHPV testing cannot distinguish between HPV-positive women with or without clinically relevant lesions. However, in principle discrimination is possible on the basis of DNA methylation markers. In order to identify novel DNA regions which allow an effective triage of hrHPV-positive cases, hypermethylated DNA enriched from cervical cancers was compared with that from cervical scrapes of HPV16-positive cases with no evidence for disease by CpG island microarray hybridization. The most promising marker regions were validated by quantitative methylation-specific PCR (qMSP) using DNA from archived cervical tissues and cervical scrapes. The performance of these markers was then determined in an independent set of 217 hrHPV-positive cervical scrapes from outpatients with histopathological verification. A methylation signature comprising the 5' regions of the genes DLX1, ITGA4, RXFP3, SOX17 and ZNF671 specific for CIN3 and cervical cancer (termed CIN3+) was identified and validated. A high detection rate of CIN3+ was obtained if at least 2 of the 5 markers were methylated. In the subsequent cross-sectional study all cervical carcinomas (n?=?19) and 56% (13/23) of CIN3 were identified by this algorithm. Only 10% (11/105) of hrHPV-positive women without histological evidence of cervical disease were scored positive by the methylation assay. Of note is that the detection rate of CIN3 differed between age groups. Eight of nine CIN3 were detected among women ?30 years of age but only five of fourteen among <30 year old group (p?=?0.03). The specificity for CIN3+ in the older age group was 76.6% (95% CI 65.6-85.5%). Clinical validation studies are required to determine the usefulness of these novel markers for triage after primary hrHPV testing in a cervical cancer screening setting. PMID:24647315

Hansel, Alfred; Steinbach, Daniel; Greinke, Christiane; Schmitz, Martina; Eiselt, Juliane; Scheungraber, Cornelia; Gajda, Mieczyslaw; Hoyer, Heike; Runnebaum, Ingo B; Dürst, Matthias

2014-01-01

338

A Promising DNA Methylation Signature for the Triage of High-Risk Human Papillomavirus DNA-Positive Women  

PubMed Central

High-risk human papillomavirus (hrHPV)-DNA testing is frequently performed parallel to cytology for the detection of high-grade dysplasia and cervical cancer particularly in women above 30 years of age. Although highly sensitive, hrHPV testing cannot distinguish between HPV-positive women with or without clinically relevant lesions. However, in principle discrimination is possible on the basis of DNA methylation markers. In order to identify novel DNA regions which allow an effective triage of hrHPV-positive cases, hypermethylated DNA enriched from cervical cancers was compared with that from cervical scrapes of HPV16-positive cases with no evidence for disease by CpG island microarray hybridization. The most promising marker regions were validated by quantitative methylation-specific PCR (qMSP) using DNA from archived cervical tissues and cervical scrapes. The performance of these markers was then determined in an independent set of 217 hrHPV-positive cervical scrapes from outpatients with histopathological verification. A methylation signature comprising the 5? regions of the genes DLX1, ITGA4, RXFP3, SOX17 and ZNF671 specific for CIN3 and cervical cancer (termed CIN3+) was identified and validated. A high detection rate of CIN3+ was obtained if at least 2 of the 5 markers were methylated. In the subsequent cross-sectional study all cervical carcinomas (n?=?19) and 56% (13/23) of CIN3 were identified by this algorithm. Only 10% (11/105) of hrHPV-positive women without histological evidence of cervical disease were scored positive by the methylation assay. Of note is that the detection rate of CIN3 differed between age groups. Eight of nine CIN3 were detected among women ?30 years of age but only five of fourteen among <30 year old group (p?=?0.03). The specificity for CIN3+ in the older age group was 76.6% (95% CI 65.6–85.5%). Clinical validation studies are required to determine the usefulness of these novel markers for triage after primary hrHPV testing in a cervical cancer screening setting.

Hansel, Alfred; Steinbach, Daniel; Greinke, Christiane; Schmitz, Martina; Eiselt, Juliane; Scheungraber, Cornelia; Gajda, Mieczyslaw; Hoyer, Heike; Runnebaum, Ingo B.; Durst, Matthias

2014-01-01

339

POLICY IMPLICATIONS OF ADJUSTING RANDOMIZED TRIAL DATA FOR ECONOMIC EVALUATIONS: A DEMONSTRATION FROM THE ASCUS-LSIL TRIAGE STUDY  

PubMed Central

Background Although the randomized controlled trial (RCT) is widely considered the most reliable method for evaluation of health care interventions, challenges to both internal and external validity exist. Thus, the efficacy of an intervention in a trial setting does not necessarily represent the real-world performance that decision makers seek to inform comparative effectiveness studies and economic evaluations. Methods Using data from the ASCUS-LSIL Triage Study (ALTS), we performed a simplified economic evaluation of age-based management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3) among women who were referred to the study with low-grade squamous intraepithelial lesions (LSIL). We used data from the trial itself to adjust for 1) potential lead time bias and random error that led to variation in the observed prevalence of CIN3 by study arm, and 2) potential ascertainment bias among providers in the most aggressive management arm. Results We found that using unadjusted RCT data may result in counterintuitive cost-effectiveness results when random error and/or bias are present. Following adjustment, the rank order of management strategies changed for two of the three age groups we considered. Conclusion Decision analysts need to examine study design, available trial data and cost-effectiveness results closely in order to detect evidence of potential bias. Adjustment for random error and bias in RCTs may yield different policy conclusions relative to unadjusted trial data.

Campos, Nicole G.; Castle, Philip E.; Schiffman, Mark; Kim, Jane J.

2013-01-01

340

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

PubMed Central

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 (95% Confidence Limits 1.36, 2.62). 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 (odds ratios greater than 10). 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.

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

1985-01-01

341

Is a semi-automated approach indicated in the application of the automated micronucleus assay for triage purposes?  

PubMed

Within the EU MULTIBIODOSE project, the automated micronucleus (MN) assay was optimised for population triage in large-scale radiological emergencies. For MN scoring, two approaches were applied using the Metafer4 platform (MetaSystems, Germany): fully automated scoring and semi-automated scoring with visual inspection of the gallery of MN-positive objects. Dose-response curves were established for acute and protracted whole-body and partial-body exposures. A database of background MN yields was set up, allowing determination of the dose detection threshold in both scoring modes. An analysis of the overdispersion of the MN frequency distribution ?(2)/µ obtained by semi-automated scoring showed that the value of this parameter represents a reliability check of the calculated equivalent total body dose in case the accident overexposure is a partial-body exposure. The elaborated methodology was validated in an accident training exercise. Overall, the semi-automated scoring procedure represents important added value to the automated MN assay. PMID:24743767

Thierens, H; Vral, A; Vandevoorde, C; Vandersickel, V; de Gelder, V; Romm, H; Oestreicher, U; Rothkamm, K; Barnard, S; Ainsbury, E; Sommer, S; Beinke, C; Wojcik, A

2014-06-01

342

Optically Stimulated Luminescence (OSL) of Tooth Enamel and its Potential Use in Post-Radiation Exposure Triage  

PubMed Central

Optically stimulated luminescence (OSL) properties of dental enamel are discussed with a view to the development of an in-vivo dose assessment technique for medical triage following a radiological/nuclear accident or terrorist event. In the OSL technique, past radiation exposure is assessed by stimulating the sample with light of one wavelength and monitoring the luminescence at another wavelength under the assumption that the luminescence originates from the recombination of radiation-induced charges trapped at metastable defects in the enamel and that the intensity of the luminescence signal is in proportion to the absorbed radiation dose. Several primary findings emerged from this research: (a) sensitivities varied considerably between different teeth and also between fragments of the same tooth, (b) OSL signals were found to decay rapidly during the first 12 hours after irradiation and slower afterwards, (c) the fading rate of the luminescence signal varied between fragments, (d) blue light stimulation yields greater sensitivity than infra-red stimulation, while the OSL signal obtained with a high-intensity pulsed green-light laser was found to be not correlated with the radiation dose. Significant challenges remain to developing a practical in-vivo technique including the development of calibration procedures and lowering minimum detectable doses.

DeWitt, R.; Klein, D. M.; Yukihara, E. G.; Simon, S. L.; McKeever, S. W. S.

2009-01-01

343

Combat Casualty Care in Ground-Based Tactical Situations: Trauma Technology and Emergency Medical Procedures (Soins aux blesses au combat dans des situations tactiques: technologies des traumas et procedures medicales d'urgence) (CD-ROM).  

National Technical Information Service (NTIS)

Papers presented all had direct short or long-term bearing on combat casualty care and included outstanding science on haemostasis, shock research and resuscitation, as well as technologies and monitoring with rationale solutions for existing problems.

H. Champion R. Van Hoof E. Rodig S. G. Rhind S. B. Rizoli

2004-01-01

344

BiodosEPR-2006 Meeting: Acute dosimetry consensus committee recommendations on biodosimetry applications in events involving uses of radiation by terrorists and radiation accidents  

Microsoft Academic Search

In the aftermath of a radiological terrorism incident or mass-casualty radiation accident, first responders and receivers require prior guidance and pre-positioned resources for assessment, triage and medical management of affected individuals [NCRP, 2005. Key elements of preparing emergency responders for nuclear and radiological terrorism. NCRP Commentary No. 19, Bethesda, Maryland, USA]. Several recent articles [Dainiak, N., Waselenko, J.K., Armitage, J.O.,

George A. Alexander; Harold M. Swartz; Sally A. Amundson; William F. Blakely; Brooke Buddemeier; Bernard Gallez; Nicholas Dainiak; Ronald E. Goans; Robert B. Hayes; Patrick C. Lowry; Michael A. Noska; Paul Okunieff; Andrew L. Salner; David A. Schauer; Francois Trompier; Kenneth W. Turteltaub; Phillipe Voisin; Albert L. Wiley; Ruth Wilkins

2007-01-01

345

Reducing young driver crash casualties in Great Britain - use of routine police crash data to estimate the potential benefits of graduated driver licensing.  

PubMed

Crashes involving young drivers (YD) cause significant morbidity and mortality in Great Britain (GB). Graduated Driver Licensing (GDL) is used in some countries to address this. This study assessed potential casualty and cost savings of possible GDL programmes in GB. Police road crash data were analysed to identify YD crashes at night or while carrying passengers. These data were then used to estimate the potential effects of GDL. 314,561 casualties and 3469 fatalities occurred in YD crashes. 25.1% of YD crashes occurred between 9 pm and 6 am and 24.4% occurred with a 15- to 24-year old passenger in the car. A 'strict' form of GDL in GB (night time restriction 9 pm-6 am, no 15-24 year old passengers) with 50% compliance would prevent 114 deaths and 872 serious casualties each year. The estimated value of prevention is £424M pa. A 'less strict' form of GDL (night time restriction 10 pm-5 am, maximum of one 15-19 year old passenger) with 50% compliance would prevent 81 deaths and 538 serious injuries. The estimated value of prevention is £273M pa. Implementing GDL in GB could save significant numbers of lives. Public health organisations have a duty to advocate for such legislation. PMID:23009650

Jones, Sarah J; Begg, Dorothy J; Palmer, Stephen R

2013-01-01

346

Task-shifting an inpatient triage, assessment, and treatment program improves the quality of care for hospitalized Malawian children  

PubMed Central

Objective We aimed to improve pediatric inpatient surveillance at a busy referral hospital in Malawi with 2 new programs: (1) the provision of vital sign equipment and implementation of an inpatient triage program (ITAT) that includes a simplified pediatric severity-of-illness score; (2) task-shifting ITAT to a new cadre of health care workers called “Vital Sign Assistants” (VSAs). Methods This study, conducted on the pediatric inpatient ward of a large referral hospital in Malawi, was divided into 3 phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided 3 new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores. Results We enrolled 3,994 patients who received 5,155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, p<0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, p=0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%). Conclusions ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task-shifting ITAT to VSAs may improve outcomes in pediatric hospitals in the developing world.

Olson, Dan; Preidis, Geoffrey A.; Milazi, Robert; Spinler, Jennifer K.; Lufesi, Norman; Mwansambo, Charles; Hosseinipour, Mina C.; McCollum, Eric D.

2013-01-01

347

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

PubMed Central

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.

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

348

PAX1 methylation analysis by MS-HRM is useful in triage of high-grade squamous intraepithelial lesions.  

PubMed

This study is aimed to investigate the role of paired boxed gene 1 (PAX1) methylation analysis by methylation- sensitive high-resolution melting (MS-HRM) in the detection of high grade lesions in atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and compared its performance with the Hybrid Capture 2 (HC2) human papillomavirus (HPV) test. In our study, 130 cases with a diagnosis of ASC-H from the cervical cytological screening by Thinprep cytologic test (TCT) technique were selected for triage. Their cervical scrapings were collected and evaluated by using PAX1 methylation analysis (MS-HRM) and high-risk HPV DNA test (HC2), followed by colposcopy and cervical biopsy. Chi-square test were used to test the differences of PAX1 methylation or HPV infection between groups. In the detection of CIN2+, the sensitivity, specificity, the PPV, NPV and the accuracy of PAX1 MS-HRM assay and high-risk HPV (HR-HPV) tests were respectively 80.6% vs 67.7%, 94.9% vs 54.5%, 83.3%, vs 31.8%, 94.0% vs 84.4%, and 91.5% vs 57.7%. The PAX1 MS-HRM assay proved superior to HR-HPV testing in the detection of high grade lesions (CIN2+) in ASC-H. This approach could screen out the majority of high grade lesion cases of ASC-H, and thus could reduce the referral rate to colposcopy. PMID:24568514

Wang, Zhen-Ming

2014-01-01

349

Triage tests for identifying atrial fibrillation in primary care: a diagnostic accuracy study comparing single-lead ECG and modified BP monitors  

PubMed Central

Objective New electronic devices offer an opportunity within routine primary care settings for improving the detection of atrial fibrillation (AF), which is a common cardiac arrhythmia and a modifiable risk factor for stroke. We aimed to assess the performance of a modified blood pressure (BP) monitor and two single-lead ECG devices, as diagnostic triage tests for the detection of AF. Setting 6 General Practices in the UK. Participants 1000 ambulatory patients aged 75?years and over. Primary and secondary outcome measures Comparative diagnostic accuracy of modified BP monitor and single-lead ECG devices, compared to reference standard of 12-lead ECG, independently interpreted by cardiologists. Results A total of 79 participants (7.9%) had AF diagnosed by 12-lead ECG. All three devices had a high sensitivity (93.9–98.7%) and are useful for ruling out AF. WatchBP is a better triage test than Omron autoanalysis because it is more specific—89.7% (95% CI 87.5% to 91.6%) compared to 78.3% (95% CI 73.0% to 82.9%), respectively. This would translate into a lower follow-on ECG rate of 17% to rule in/rule out AF compared to 29.7% with the Omron text message in the study population. The overall specificity of single-lead ECGs analysed by a cardiologist was 94.6% for Omron and 90.1% for Merlin. Conclusions WatchBP performs better as a triage test for identifying AF in primary care than the single-lead ECG monitors as it does not require expertise for interpretation and its diagnostic performance is comparable to single-lead ECG analysis by cardiologists. It could be used opportunistically to screen elderly patients for undiagnosed AF at regular intervals and/or during BP measurement.

Kearley, Karen; Selwood, Mary; Van den Bruel, Ann; Thompson, Matthew; Mant, David; Hobbs, FD Richard; Fitzmaurice, David; Heneghan, Carl

2014-01-01

350

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

SciTech Connect

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.

Lee, Minjung [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)] [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of); Shin, Jaekyoon, E-mail: jkshin@med.skku.ac.kr [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)] [Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine and Samsung Biomedical Research Institute, Suwon-Si, Kyonggi-Do (Korea, Republic of)

2011-09-16

351

Psychosocial considerations for mass decontamination.  

PubMed

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

Lemyre, Louise; Johnson, Colleen; Corneil, Wayne

2010-11-01

352

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

USGS Publications Warehouse

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.

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

353

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

PubMed

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

Dharm-Datta, Shreshth; McLenaghan, J

2013-06-01

354

Cost and logistics of alternative roll-out options for implementing human papillomavirus testing as a triage in cervical screening: results of the sentinel sites study  

PubMed Central

Background: Previous studies have indicated that human papillomavirus (HPV) testing as a triage for managing equivocal cytology is cost-effective. The aim of this study was to assess the costs of alternative roll-out options. Methods: Detailed cost estimates were collected from six laboratories where HPV triage had been implemented. Costs were assessed for the two different service delivery models that were implemented; a ‘hub and spoke model' of central HPV testing in a microbiology laboratory with separate cytology laboratories, and an ‘integrated model' where HPV testing was conducted within the cytology laboratory. Results: Comparison of alternative delivery models indicated that setting up HPV processing within existing cytology laboratory, i.e., an ‘integrated cytology/HPV laboratory' generated savings in staff time amounting to between £2.54 and 4.86 per sample processed. Running full HPV testing batches was also an important consideration. For full batches to be run on a twice weekly basis requires having no more than two laboratories per Strategic Health Authority. Conclusions: To be cost-efficient, and to meet turn-around times, HPV testing needs to be conducted at integrated cytology/HPV testing centres with sufficient throughput to run full batches of HPV tests.

Legood, R; Sadique, Z; Patnick, J; Kitchener, H; Kelly, R; Moss, S

2012-01-01

355

Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol  

PubMed Central

Background Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage. Methods/Design This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ? 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ? 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups with 80% power, we will enroll a total of 370 subjects in this trial. Discussion A three week pilot study was performed which demonstrated the feasibility of implementation of the study protocol.

2011-01-01

356

Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department  

PubMed Central

Objectives The Canadian C-Spine Rule for imaging of the cervical spine was developed for use by physicians. We believe that nurses in the emergency department could use this rule to clinically clear the cervical spine. We prospectively evaluated the accuracy, reliability and acceptability of the Canadian C-Spine Rule when used by nurses. Methods We conducted this three-year prospective cohort study in six Canadian emergency departments. The study involved adult trauma patients who were alert and whose condition was stable. We provided two hours of training to 191 triage nurses. The nurses then assessed patients using the Canadian C-Spine Rule, including determination of neck tenderness and range of motion, reapplied immobilization and completed a data form. Results Of the 3633 study patients, 42 (1.2%) had clinically important injuries of the cervical spine. The kappa value for interobserver assessments of 498 patients with the Canadian C-Spine Rule was 0.78. We calculated sensitivity of 100.0% (95% confidence interval [CI] 91.0%–100.0%) and specificity of 43.4% (95% CI 42.0%–45.0%) for the Canadian C-Spine Rule as interpreted by the investigators. The nurses classified patients with a sensitivity of 90.2% (95% CI 76.0%–95.0%) and a specificity of 43.9% (95% CI 42.0%–46.0%). Early in the study, nurses failed to identify four cases of injury, despite the presence of clear high-risk factors. None of these patients suffered sequelae, and after retraining there were no further missed cases. We estimated that for 40.7% of patients, the cervical spine could be cleared clinically by nurses. Nurses reported discomfort in applying the Canadian C-Spine Rule in only 4.8% of cases. Conclusion Use of the Canadian C-Spine Rule by nurses was accurate, reliable and clinically acceptable. Widespread implementation by nurses throughout Canada and elsewhere would diminish patient discomfort and improve patient flow in overcrowded emergency departments.

Stiell, Ian G.; Clement, Catherine M.; O'Connor, Annette; Davies, Barbara; Leclair, Christine; Sheehan, Pamela; Clavet, Tamara; Beland, Christine; MacKenzie, Taryn; Wells, George A.

2010-01-01

357

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

SciTech Connect

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.

Krug, S.E. (Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Childrens Hospital, Cleveland, OH (United States))

1992-10-01

358

Mass Burns Disaster in Abule-egba, Lagos, Nigeria from a Petroleum Pipeline Explosion Fire  

PubMed Central

Summary The aim of this paper is to review the basic principles of triage in mass burns disasters and discuss the experience of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, in the December 2006 disaster at Abule-Egba, Lagos, Nigeria. It is hoped that the experience gained will help in the planning for and management of similar disasters in the developing countries with limited facilities. Burn injury has been described as the severest form of trauma and its management is very challenging as it is often accompanied by numerous pathophysiological changes. Successful management requires expert management by well-trained personnel in equipped and dedicated centres. In mass disasters the total number of victims may exceed the capability of the facility and its staff and a system for sorting out the patients and caring for those that will benefit from the facilities available needs to be developed. Other patients will either be sent to other medical facilities for further treatment or discharged after initial care for future follow-up. Documented experiences in the management of mass burns disasters from petroleum pipeline explosions from developing countries are rare. However, petroleum pipeline explosions, especially in the Lagos area of Nigeria, are relatively common. These cases have been associated with a variety of factors. The resulting morbidity and mortality have been high. LASUTH has a dedicated burns centre, which has received and managed many burn patients. Triage is the medical process of screening patients according to their need of treatment and the resources available. The aims and objectives of triage are discussed, its various levels described, and the final goals elaborated. All the burn victims involved in the 2006 disaster were studied, together with the triage carried out at different levels and the consequent sorting of the patients. Standard burns management was carried out. A total of 385 patients sustained burns of various degrees from the fire resulting from the explosion. On site, emergency department (ED) and intra-hospital triage were carried out. Ninety patients were brought to the LASUTH ED. Of these, 51 patients (56.67%) received first-aid treatment and were either discharged for out-patient follow-up or referred to secondary health care facilities. Twenty-eight (31.11%) out of the remaining 39 patients with burns in more than 70% total body surface area (TBSA) were categorized as unsalvageable and 11 (12.22%) with less than 70% TBSA as salvageable. All the patients in the unsalvageable group died (i.e. 100% mortality), while one patient died in the salvageable group (mortality rate, 9.09%). The mortality rate for the ruptured petroleum product pipeline incident was 84.16%; the fatality rate for all patients seen at LASUTH was 32.22%. The need for caution in the handling of petroleum products is discussed and the effectiveness of the triage system used is highlighted. In conclusion, burns from flammable petroleum products can be very dangerous and proper triage should therefore be carried out, with salvageable patients being managed by experts in dedicated burns centres.

Fadeyibi, I.O.; Omosebi, D.T.; Jewo, P.I.; Ademiluyi, S.A.

2009-01-01

359

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  

Microsoft Academic Search

In June 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 makeshift

W. E. Bolch; J. L. Hurtado; C. Lee; Ryan P Manger; Nolan Hertel; E. Burgett; W. Dickerson

2012-01-01

360

[Contribution of the Vishnevsky Central Military Clinical Hospital N 3 to the history of combat casualty care and delivery of care to the injured soldiers].  

PubMed

The article is dedicated to the 45-year history of combat casualty care in the Vishnevsky Central Military Clinical Hospital N 3. In the echelon system of medical care the Vishnevsky Central Military Clinical Hospital N 3 ranks the echelon (level) N 3. Specialists of the hospital, along with a medical and preventive activity, practice methodological, educational and innovative activity, participate in different scientific forums. Temporary duty assignment to the combat, human-made disaster and natural disaster areas is a real functional test. 64 physicians have an extreme situation experience. The Vishnevsky Central Military Clinical Hospital N 3 is a clinical base of department of surgery, advanced physician training department, combat casualty care department of the Institute for advanced physician training of Mandryka scientific and educational clinical center. For the purpose of reducing the terms and improving the quality of medical care it was suggested to make the integration connections with leading hospitals of the Ministry of Defense of the Russian Federation. PMID:24000625

Beliakin, S A; Dolgikh, R N; Fokin, Iu N

2013-05-01

361

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

SciTech Connect

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.

Wenzel, Tom

2011-03-20

362

Casualty Assistance: An Overview  

MedlinePLUS

... Counseling Document Translation Financial Counseling Language Interpretation Services SECO Counseling Tax Services Log in for counseling Log ... Policies, procedures, timely articles, cutting-edge social media tools, and support. All in one place, empowering our ...

363

Naval Battle Casualty Study.  

National Technical Information Service (NTIS)

The study was carried out from January to June 1968 at the Naval Support Activity Station Hospital, DaNang, Republic of Vietnam. The purpose of the study was to document the injuries sustained, treatment given, and initial results of treatment occurring t...

J. G. Garrick

1973-01-01

364

Adnexal Masses Suspected to Be Benign Treated with Laparoscopy  

PubMed Central

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.

Marchand, Greg J.

2012-01-01

365

The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: study protocol for a cluster randomised controlled trial comparing nurse-led and GP-led management systems (ESTEEM)  

PubMed Central

Background Recent years have seen an increase in primary care workload, especially following the introduction of a new General Medical Services contract in 2004. Telephone triage and telephone consultation with patients seeking health care represent initiatives aimed at improving access to care. Some evidence suggests that such approaches may be feasible but conclusions regarding GP workload, cost, and patients’ experience of care, safety, and health status are equivocal. The ESTEEM trial aims to assess the clinical- and cost-effectiveness of nurse-led computer-supported telephone triage and GP-led telephone triage, compared to usual care, for patients requesting same-day consultations in general practice. Methods/design ESTEEM is a pragmatic, multi-centre cluster randomised clinical trial with patients randomised at practice level to usual care, computer decision-supported nurse triage, or GP-led triage. Following triage of 350–550 patients per practice we anticipate estimating and comparing total primary care workload (volume and time), the economic cost to the NHS, and patient experience of care, safety, and health status in the 4-week period following the index same-day consultation request across the three trial conditions. We will recruit all patients seeking a non-emergency same-day appointment in primary care. Patients aged 12.0–15.9 years and temporary residents will be excluded from the study. The primary outcome is the number of healthcare contacts taking place in the 4-week period following (and including) the index same-day consultation request. A range of secondary outcomes will be examined including patient flow, primary care NHS resource use, patients’ experience of care, safety, and health status. The estimated sample size required is 3,751 patients (11,253 total) in each of the three trial conditions, to detect a mean difference of 0.36 consultations per patient in the four week follow-up period between either intervention group and usual care 90% power, 5% alpha, and an estimated intracluster correlation coefficient ICC of 0.05. The primary analysis will be based on the intention-to-treat principle and take the form of a random effects regression analysis taking account of the hierarchical nature of the study design. Statistical models will allow for adjustment for practice level minimisation variables and patient-level baseline covariates shown to differ at baseline. Trial registration Current Controlled Trials ISCRTN20687662

2013-01-01

366

Intraosseous Hydroxocobalamin in the Treatment of Acute, Severe Cyanide Induced Cardiotoxicity in a Swine (Sus Scrofa) Model - An Alternate Administration Route for Chemical Mass Casualties.  

National Technical Information Service (NTIS)

To compare the rerum to baseline of mean arterial blood pressure (MAP) between 2 groups of swine in acute cyanide toxicity and treated with IV HOC or 10 HOC. We also compared blood cyanide, lactate, pH, nitrotyrosine levels, cerebral oxygenation, and infl...

J. Lairet R. Pitotti S. Boudreau T. Vargas V. Bebarta

2012-01-01

367

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

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.

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

2014-01-01

368

Methylation marker analysis of self-sampled cervico-vaginal lavage specimens to triage high-risk HPV-positive women for colposcopy.  

PubMed

Methylation markers were studied for their suitability to triage human papillomavirus (HPV)-positive women by testing self-collected cervico-vaginal lavage specimens. For this purpose, we analyzed 355 hrHPV-positive self-collected specimens with three methylation markers, that is, CADM1-m18, MAL-m1 and miR-124-2 by quantitative methylation-specific PCR. The areas under the receiver-operating characteristic (ROC) curve for end-point cervical intraepithelial neoplasia grade 3 or worse (CIN3+) were 0.637 for CADM1-m18, 0.767 for MAL-m1 and 0.762 for miR-124-2. This indicates that CADM1-m18 is not suitable as single marker. By varying the thresholds of both markers in the bi-marker panels CADM1-m18/MAL-m1, CADM1-m18/miR-124-2 and MAL-m1/miR-124-2 upper and lower ROC curves were obtained, depicting the maximum and minimum CIN3+ sensitivity, respectively, at given specificity. For all these bi-marker combinations, the upper curves were similar. However, for the MAL-m1/miR-124-2 panel, the distance between upper and lower ROC curves was closest and this panel displayed the highest assay thresholds, indicating that this combination was most robust. At clinical specificities of 50 and 70%, the MAL-m1/miR-124-2 sensitivity for detection of CIN3+ ranged from 77.0 to 87.8% and from 64.9 to 71.6%, respectively. At 70% specificity thresholds no carcinomas were missed. By comparison, the CIN3+ sensitivity of HPV16/18 genotyping on the self-sampled lavage specimens was 58.1% (95%CI: 46.6-68.8) at a specificity of 87.7% (95%CI: 83.2-91.2). In conclusion, methylation analysis is a promising triage tool that in combination with HPV-DNA testing offers feasible, full molecular screening on self-collected cervico-vaginal lavage specimens. PMID:24474183

Hesselink, A T; Heideman, D A M; Steenbergen, R D M; Gök, M; van Kemenade, F J; Wilting, S M; Berkhof, J; Meijer, C J L M; Snijders, P J F

2014-08-15

369

Methylation of Twelve CpGs in Human Papillomavirus Type 16 (HPV16) as an Informative Biomarker for the Triage of Women Positive for HPV16 Infection.  

PubMed

An accurate biomarker for the follow-up of women positive for human papillomavirus type 16 (HPV16) DNA may improve the efficiency of cervical cancer prevention. Previously, we analyzed all 113 HPV16 CpGs in cervical cytology samples and discovered differential methylation at different stages of premalignancy. In the current study, we identified a methylation biomarker consisting of a panel of 12 HPV16 CpG sites in the E5, L2, and L1 open reading frames, and tested whether it fulfilled three necessary conditions of a prospective biomarker. A total of 33 cytology samples from North American and West African women with all grades of cervical intraepithelial neoplasia (CIN) and invasive cervical cancer (ICC) were analyzed by using DNA bisulfite sequencing. The results showed (i) a highly significant trend for increasing HPV16 biomarker methylation with increasing histologic severity (P < 0.0001), (ii) 100% sensitivity for ICC over a wide range of methylation cutoff scores; 80% detection of CIN3 at cutoff scores up to 39% methylation, and (iii) substantially lower detection of CIN2, from 0% to 71%, depending on the cutoff score. Our results support the prognostic potential of the HPV16 methylation biomarker for the triage to colposcopy of women with HPV16-positive screening tests and, eventually, for the management of women with HPV16-positive CIN2. Cancer Prev Res; 7(5); 526-33. ©2014 AACR. PMID:24556390

Brandsma, Janet L; Harigopal, Malini; Kiviat, Nancy B; Sun, Ying; Deng, Yanhong; Zelterman, Daniel; Lizardi, Paul M; Shabanova, Veronika S; Levi, Angelique; Yaping, Tian; Hu, Xinyuan; Feng, Qinghua

2014-05-01

370

An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast.  

PubMed

Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs). PMID:19215189

Bauman, Richard A; Ling, Geoffrey; Tong, Lawrence; Januszkiewicz, Adolph; Agoston, Dennis; Delanerolle, Nihal; Kim, Young; Ritzel, Dave; Bell, Randy; Ecklund, James; Armonda, Rocco; Bandak, Faris; Parks, Steven

2009-06-01

371

Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial  

PubMed Central

Background: Radial-head subluxation is an easily identified and treated injury. We investigated whether triage nurses in the emergency department can safely reduce radial-head subluxation at rates that are not substantially lower than those of emergency department physicians. Methods: We performed an open, noninferiority, cluster-randomized control trial. Children aged 6 years and younger who presented to the emergency department with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The primary outcome was the proportion of children who had a successful reduction (return to normal arm usage). We used a noninferiority margin of 10%. Results: In total, 268 children were eligible for inclusion and 245 were included in the final analysis. Of the children assigned to receive physician-initiated care, 96.7% (117/121) had a successful reduction performed by a physician. Of the children assigned to receive nurse-treatment care, 84.7% (105/124) had a successful reduction performed by a nurse. The difference in the proportion of successful radial head subluxations between the groups was 12.0% (95% confidence interval [CI] 4.8% to 19.7%). Noninferiority of nurse-initiated radial head subluxation was not shown. Interpretation: In this trial, the rate of successful radial-head subluxation performed by nurses was inferior to the physician success rate. Although the success rate in the nurse-initiated care group did not meet the non-inferiority margin, nurses were able to reduce radial head subluxation for almost 85% of children who presented with probable radial-head subluxation. Trial registration: Clinical Trials.gov, no. NCT00993954.

Dixon, Andrew; Clarkin, Chantalle; Barrowman, Nick; Correll, Rhonda; Osmond, Martin H.; Plint, Amy C.

2014-01-01

372

Impact of the severity of coronary artery calcification on clinical events in patients undergoing coronary artery bypass grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial).  

PubMed

The treatment of calcified coronary lesions by percutaneous coronary intervention has been shown to be associated with poor outcomes and an increased rate of complications. However, the impact of coronary calcification in patients undergoing coronary artery bypass grafting (CABG) is unknown. A total of 755 patients presenting with acute coronary syndrome in the Acute Catheterization and Urgent Intervention Triage Strategy trial underwent CABG. Patients were divided into 3 groups according to the presence and extent of coronary calcifications (lesion level: severe, moderate, none to mild) as assessed by an independent angiographic core laboratory. Major ischemic and bleeding outcomes were assessed at 30 days and 1 year. Severe calcification was found in 103 patients (13.6%), moderate calcification in 249 patients (33.0%), and none-to-mild calcification in 403 patients (53.4%). The presence of severe calcification compared with moderate or none to mild was associated with a significantly higher unadjusted rate of death (11.8% vs 3.7% vs 4.5%, p = 0.006), death or myocardial infarction (MI; 31.1% vs 19.7% vs 16.4%, p = 0.006), and major adverse cardiac event (MACE; 32.0% vs 22.6% vs 20.8%, p = 0.059) at 1 year. By multivariate analysis, severe calcification (vs nonsevere calcification) was identified as an independent predictor of 1-year MACE (hazard ratio 1.49, 95% confidence interval 1.01 to 2.21, p = 0.04) and death or MI (hazard ratio 1.77, 95% confidence interval 1.18 to 2.66, p = 0.006). In conclusion, the presence of severe coronary calcification was associated with worse outcomes after CABG, including an increased risk of death. The presence of severe coronary calcification was identified as an independent predictor of MACE and death or MI 1 year after CABG. PMID:24012035

Ertelt, Konstanze; Généreux, Philippe; Mintz, Gary S; Reiss, George R; Kirtane, Ajay J; Madhavan, Mahesh V; Fahy, Martin; Williams, Mathew R; Brener, Sorin J; Mehran, Roxana; Stone, Gregg W

2013-12-01

373

Expect 2 waves of patients after terrorist attack.  

PubMed

A study examining patient arrival at local EDs after the bombing of the federal building in Oklahoma has shown there are two "waves" of patients after a terrorist attack. Contrary to popular belief, after a mass casualty incident, most patients arrive by means other than ambulance transport. Because the first group of patients arriving at EDs are transporting themselves, they tend to be of less severity than the second wave of patients. While triaging patients from the first wave, you need to prepare for more serious injuries in the second. PMID:11067320

2000-01-01

374

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

PubMed

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

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

2007-10-01

375

Galaxy masses  

NASA Astrophysics Data System (ADS)

Galaxy masses play a fundamental role in our understanding of structure formation models. This review addresses the variety and reliability of mass estimators that pertain to stars, gas, and dark matter. The different sections on masses from stellar populations, dynamical masses of gas-rich and gas-poor galaxies, with some attention paid to our Milky Way, and masses from weak and strong lensing methods all provide review material on galaxy masses in a self-consistent manner.

Courteau, Stéphane; Cappellari, Michele; de Jong, Roelof S.; Dutton, Aaron A.; Emsellem, Eric; Hoekstra, Henk; Koopmans, L. V. E.; Mamon, Gary A.; Maraston, Claudia; Treu, Tommaso; Widrow, Lawrence M.

2014-01-01

376

Screening of amphetamine/methamphetamine and their derivatives in urine using FPIA and Triage 8 and the Scope and limits of a subsequent identification by means of the REMEDi HS system.  

PubMed

This study describes screening and identifying amphetamines, methamphetamines, and their derivatives in urine using immunochemical (Triage, FPIA) and chromatographic techniques (REMEDi HS). Amphetamines, methamphetamines, MDMA (3,4-methylenedioxymethamphetamine), MDA (3,4-methylenedioxyamphetamine), MDE (3,4-methylenedioxyethyl-amphetainine), MBDB (N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine), BDB (3,4-(methylenedioxyphenyl)-2-butanamine), PMA (4-methoxyamphetamine), DOM (2,5-dimethyloxy-4-methylamphetamine), DOB (4-bromo-2,5-dimethyloxyamphetamine), amphetaminil, pholedrine, fenfluramine, and amfepramone were subjected to a comparative study. For this, the substances were analyzed to determine their specific threshold concentration for a positive detection in the Triage test and their limit of detection and positive threshold concentration for the FPIA test and the results compared. Furthermore, the capabilities of a more detailed analysis with the REMEDi system were studied. This HPLC system was able to produce information on the single drugs and main metabolites found in the sample with the danger of false-positive or false-negative screening results greatly minimized. PMID:11110193

Felscher, D; Schulz, K

2000-11-01

377

Subspecialty surgical pathologist's performances as triage pathologists on a telepathology-enabled quality assurance surgical pathology service: A human factors study  

PubMed Central

Background: The case triage practice workflow model was used to manage incoming cases on a telepathology-enabled surgical pathology quality assurance (QA) service. Maximizing efficiency of workflow and the use of pathologist time requires detailed information on factors that influence telepathologists’ decision-making on a surgical pathology QA service, which was gathered and analyzed in this study. Materials and Methods: Surgical pathology report reviews and telepathology service logs were audited, for 1862 consecutive telepathology QA cases accrued from a single Arizona rural hospital over a 51 month period. Ten university faculty telepathologists served as the case readers. Each telepathologist had an area of subspecialty surgical pathology expertise (i.e. gastrointestinal pathology, dermatopathology, etc.) but functioned largely as a general surgical pathologist while on this telepathology-enabled QA service. They handled all incoming cases during their individual 1-h telepathology sessions, regardless of the nature of the organ systems represented in the real-time incoming stream of outside surgical pathology cases. Results: The 10 participating telepathologists’ postAmerican Board of pathology examination experience ranged from 3 to 36 years. This is a surrogate for age. About 91% of incoming cases were immediately signed out regardless of the subspecialty surgical pathologists’ area of surgical pathology expertise. One hundred and seventy cases (9.13%) were deferred. Case concurrence rates with the provisional surgical pathology diagnosis of the referring pathologist, for incoming cases, averaged 94.3%, but ranged from 88.46% to 100% for individual telepathologists. Telepathology case deferral rates, for second opinions or immunohistochemistry, ranged from 4.79% to 21.26%. Differences in concordance rates and deferral rates among telepathologists, for incoming cases, were significant but did not correlate with years of experience as a practicing pathologist. Coincidental overlaps of the area of subspecialty surgical pathology expertise with organ-related incoming cases did not influence decisions by the telepathologists to either defer those cases or to agree or disagree with the referring pathologist's provisional diagnoses. Conclusions: Subspecialty surgical pathologists effectively served as general surgical pathologists on a telepathology-based surgical pathology QA service. Concurrence rates with incoming surgical pathology report diagnoses, and case deferral rates, varied significantly among the 10 on-service telepathologists. We found no evidence that the higher deferral rates correlated with improving the accuracy or quality of the surgical pathology reports.

Braunhut, Beth L.; Graham, Anna R.; Lian, Fangru; Webster, Phyllis D.; Krupinski, Elizabeth A.; Bhattacharyya, Achyut K.; Weinstein, Ronald S.

2014-01-01

378

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)

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.

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

2003-08-01

379

Car size or car mass: which has greater influence on fatality risk?  

PubMed Central

OBJECTIVES. Proposed increases in corporate average fuel economy standards would probably lead to lighter cars. Well-established relationships between occupant risk and car mass predict consequent additional casualties. However, if size, not mass, is the causative factor in these relationships, then decreasing car mass need not increase risk. This study examines whether mass or size is the causative factor. METHODS. Data from the Fatal Accident Reporting System are used to explore relationships between car mass, car size (as represented by wheelbase), and driver fatality risk in two-car crashes. RESULTS. When cars of identical (or similar) wheelbase but different mass crash into each other, driver fatality risk depends strongly on mass; the relationship is quantitatively similar to that found in studies that ignore wheelbase. On the other hand, when cars of similar mass but different wheelbase crash into each other, the data reveal no dependence of driver fatality risk on wheelbase. CONCLUSIONS. Mass is the dominant causative factor in relationships between driver risk and car size in two-car crashes, with size, as such, playing at most a secondary role. Reducing car mass increases occupant risk.

Evans, L; Frick, M C

1992-01-01

380

Abdominal mass  

MedlinePLUS

... as the navel. Cholecystitis can cause a very tender mass that is felt below the liver in ... Crohn's disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen. Diverticulitis ...

381

Mass Sensor  

Microsoft Academic Search

The purpose of this CRADA was to use Honeywell's experience in low temperature cofire ceramics and traditional ceramics to assemble a relatively low-cost, mass-producible miniature mass analyzer. The specific design, given to us by Mass Sensors, LLC, was used to test for helium. The direct benefit for the participant was to have a prototype unit assembled for the purpose of

2001-01-01

382

February 2009 airplane crash at amsterdam schiphol airport: an overview of injuries and patient distribution.  

PubMed

Objective: The objective of this study was to describe the injuries and distribution of casualties resulting from the crash of Turkish Airlines flight TK 1951 near Schiphol Airport in the Netherlands on 25 of February 2009.Methods: This was a retrospective, descriptive study. Based on a review of the hospital records for all casualties of the airplane crash, triage at the scene, time to emergency department, Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), mortality, length of hospital stay and surgical procedures were abstracted.Results: Of the 135 passengers, nine died on-scene. A total of 126 survivors were examined in 15 hospitals; data for all survivors were available for the study. Median time between crash and arrival at an emergency department was 3.5 hours (range 1.25-5.5 hours). Six passengers were uninjured and 66 were admitted to hospital. A total of 305 injuries were recorded. The majority were head and facial injuries (92), spinal injuries (35), and fractures of extremities (38). Eighteen percent of the patients had a spinal injury. The mean ISS was 6.3 (range = 1-57). The ISS score was >15 for 13 patients. Surgical procedures (80) were necessary in 23 patients. There was no in-hospital mortality.Conclusions: Although the accident was in an urban area, there was a significant delay between the time of the accident and the arrival of the casualties at hospital emergency departments. The Turkish Airlines crash provides extensive information for research into mass-casualty or disaster management, triage, plane crash injuries, and survivability. The "Medical Research Turkish Airlines Crash" (MOTAC) study group currently is investigating several of these issues. PMID:22030080

Postma, Ingri L E; Winkelhagen, Jasper; Bloemers, Frank W; Heetveld, Martin J; Bijlsma, Taco S; Goslings, J Carel

2011-01-01

383

Mass spectrometry.  

NASA Technical Reports Server (NTRS)

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.

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

1972-01-01

384

Neutrino mass  

SciTech Connect

The existence of a finite neutrino mass would have important consequences in particle physics, astrophysics, and cosmology. Experimental sensitivities have continued to be pushed down without any confirmed evidence for a finite neutrino mass. Yet there are several observations of discrepancies between theoretical predictions and observations which might be possible indications of a finite neutrino mass. Thus, extensive theoretical and experimental work is underway to resolve these issues.

Bowles, T.J.

1994-04-01

385

Mass Wasting  

NSDL National Science Digital Library

Mass Wasting is a course handout designed to initiate discussion on the factors involved in mass wasting (eg. creep, solifluction, falls, slides, and flows) and the methods used to prevent mass wasting. Definitions are given for key terms such as angle of repose and lahars. Photographs illustrate the effects of rockslides and slumps. Links are provided to the online Physical Geology resources at Georgia Perimeter College.

Gore, Pamela

1998-11-28

386

Inertial Mass  

ERIC Educational Resources Information Center

The inertial balance is one device that can help students to quantify the quality of inertia--a body's resistance to a change in movement--in more generally understood terms of mass. In this hands-on activity, students use the inertial balance to develop a more quantitative idea of what mass means in an inertial sense. The activity also helps…

King, Kenneth P.

2007-01-01

387

Quark masses  

Microsoft Academic Search

We review the current information about the eigenvalues of the quark mass matrix. The theoretical problems involved in a determination of the running masses mu, md, ms, mc and mb from experiment are discussed with the aim of getting reliable numerical values equipped with error bars that represent a conservative estimate of remaining uncertainties.

J. Gasser; H. Leutwyler

1982-01-01

388

Hydrodynamic mass  

SciTech Connect

Many structural components contain, or are submerged in, a fluid. The fluid moving with a vibrating structure has an important effect on the dynamics of the structure, particularly on its natural frequencies. The effect of the fluid on natural frequencies can be accounted for using the hydrodynamic mass associated with the structure. This paper provides formulas, graphs, and computer programs for calculating hydrodynamic mass.

Chung, H.; Chen, S.S.

1984-01-01

389

Atmospheric Mass  

NSDL National Science Digital Library

This is a lesson about the amount of atmosphere a planet is likely to have. Learners will look for the relationship between atmospheric mass and other characteristics of the planet. When the results are not completely conclusive, the students explore possible causes of discrepancies in the data. They conclude that gravity, mass and diameter all have a role in determining atmospheric mass. The lesson models scientific inquiry using the 5E instructional model and includes teacher notes, prerequisite concepts, common misconceptions, student journal and reading. This is lesson 11 in the Astro-Venture Astronomy Unit. The lessons are designed for educators to use in conjunction with the Astro-Venture multimedia modules.

390

Mass Extinction  

NSDL National Science Digital Library

In this video segment adapted from NOVA scienceNOW, learn about a chain of events, including ancient volcanoes, global warming, and deadly gases, which may have caused Earth's greatest mass extinction 250 million years ago.

Foundation, Wgbh E.

2009-11-02

391

Air Masses  

NSDL National Science Digital Library

In this activity, students will examine the physical characteristics of several types of air masses (bodies of air that resemble the characteristics of the land surfaces beneath them). By analyzing maps of air temperature and of dewpoint temperature (prepared by the teacher), they will discover that air masses can be identified and defined by their temperature and moisture content. Student worksheets and links to the necessary maps are provided.

392

Inertial Mass  

NSDL National Science Digital Library

The inertial balance is one device that can help students to quantify the quality of inertia--a body's resistance to a change in movement--in more generally understood terms of mass. In this hands-on activity, students use the inertial balance to develop a more quantitative idea of what mass means in an inertial sense. The activity also helps students refine their ability to use numerical data and line graphs as a tool for making predictions.

King, Kenneth P.

2007-12-01

393

Performance of ProEx C and PreTect HPV-Proofer E6/E7 mRNA tests in comparison with the hybrid capture 2 HPV DNA test for triaging ASCUS and LSIL cytology.  

PubMed

The clinical usefulness of the ProEx C (Becton Dickinson) and PreTect HPV-Proofer E6/E7 mRNA tests (Proofer; Norchip) for the triage of ASCUS and LSIL cytology was determined in comparison with the Hybrid Capture 2 HPV DNA test (HC2; Qiagen). The study population consisted of women with a history of abnormal cytology referred to colposcopy. Histology-confirmed CIN 2+ served as the disease endpoint. The study was based on 1,360 women (mean age 30.7 years), of whom 380 had CIN 2+. Among 315 with ASCUS (CIN 2+, n = 67), the sensitivities of ProEx C, Proofer, and HC2 to detect CIN 2+ were, 71.6, 71.6, and 95.5%, respectively, with a corresponding specificity of 74.6, 74.2, and 35.1%. Among 363 with LSIL (CIN 2+, n = 108), the sensitivities of ProEx C, Proofer, and HC2 were, 67.6, 74.1, and 96.3%, respectively, with a corresponding specificity of 60, 68.2, and 18.4%. Among 225 HC2-positive ASCUS (CIN 2+, n = 64), 105 tested positive by ProEx C, reducing colposcopy referral by 53.3% and detecting 71.9% of CIN 2+; Proofer was positive in 112/225, reducing colposcopy referral by 50.2% and detecting 75.0% of CIN 2+. Among 312 HC2-positive LSIL (CIN 2+, n = 104), 160 tested positive by ProEx C, reducing coloposcopy referral by 48.7% and detecting 66.3% of CIN 2+; Proofer was positive in 159/312, reducing colposcopy referral by 49.0% and detecting 75.0% of CIN 2+. In conclusion, both ProEx C and Proofer have a similar performance profile with a significantly higher specificity but lower sensitivity than HC2 for the detection of CIN 2+. Consequently, although they can reduce colposcopy referral, they will miss a proportion of CIN 2+ cases. This is a major limitation and should be taken into account if these tests are considered for ASCUS or LSIL triage. PMID:23341349

Alaghehbandan, Reza; Fontaine, Daniel; Bentley, James; Escott, Nicholas; Ghatage, Prafull; Lear, Adrian; Coutlee, Francois; Ratnam, Samuel

2013-09-01

394

Mass Extinction  

NSDL National Science Digital Library

This set of multimedia resources, produced for the NOVA television broadcast 'Mass Extinction', explains mass extinctions in general, and in particular the extinction event that occurred at the end of the Permian period, in which more than 90 percent of all marine species died out. An interactive feature presents some of the theories about what caused this event, and lets users vote for the one they consider most likely. There is also a video clip from the broadcast, an audio clip of an interview with a researcher who is using high-precision dating techniques to understand the time scale of the Permian extinction, and an ask-the expert feature in which a scientist from the Smithsonian Institution answers questions about the Permian and other mass extinctions. Other links access a teacher's guide, additional reading materials, and a transcript of the broadcast.

395

Mass customization origins: mass or custom manufacturing?  

Microsoft Academic Search

Mass customization presents a paradox to traditional manufacturing practices. Historically, companies chose to produce either customized, crafted products or mass-produced, standardized products. Thus, mass customization presents a paradox by combining customization and mass production, offering unique products in a mass-produced, low cost, high volume production environment. If mass customization is truly a combination of mass production and craft manufacturer, how

Rebecca Duray

2002-01-01

396

Design of the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study to assess the ability of remote monitoring to treat and triage patients more effectively  

PubMed Central

Background Heart failure patients with implantable defibrillators (ICD) frequently visit the clinic for routine device monitoring. Moreover, in the case of clinical events, such as ICD shocks or alert notifications for changes in cardiac status or safety issues, they often visit the emergency department or the clinic for an unscheduled visit. These planned and unplanned visits place a great burden on healthcare providers. Internet-based remote device interrogation systems, which give physicians remote access to patients' data, are being proposed in order to reduce routine and interim visits and to detect and notify alert conditions earlier. Methods The EVOLVO study is a prospective, randomized, parallel, unblinded, multicenter clinical trial designed to compare remote ICD management with the current standard of care, in order to assess its ability to treat and triage patients more effectively. Two-hundred patients implanted with wireless-transmission-enabled ICD will be enrolled and randomized to receive either the Medtronic CareLink® monitor for remote transmission or the conventional method of in-person evaluations. The purpose of this manuscript is to describe the design of the trial. The results, which are to be presented separately, will characterize healthcare utilizations as a result of ICD follow-up by means of remote monitoring instead of conventional in-person evaluations. Trial registration ClinicalTrials.gov: NCT00873899

Marzegalli, Maurizio; Landolina, Maurizio; Lunati, Maurizio; Perego, Giovanni B; Pappone, Alessia; Guenzati, Giuseppe; Campana, Carlo; Frigerio, Maria; Parati, Gianfranco; Curnis, Antonio; Colangelo, Irene; Valsecchi, Sergio

2009-01-01

397

Mass Extinction  

NSDL National Science Digital Library

This video highlights a team of scientists who work on reconstructing the mass extinction that occurred 250 million years ago, the end of the Permian Period, and wiped out the majority of life on our planet, resetting the evolution of life. Clues suggest that deadly bacteria might have set off a chemical chain reaction that poisoned the Permian seas and atmosphere.

Sciencenow, Nova; Online, Pbs

398

Neutrino mass  

SciTech Connect

Neutrinos play a dominant role in both particle physics, astrophysics, and cosmology. In the our present understanding of the strong, weak, and electromagnetic forces, the group structure of the Standard Model is SU(3){sub C} {circle_times} SU(2){sub L} {circle_times} U(I){sub EM}. In the Weinberg-Salam-Glashow Standard Electroweak Model, left-handed neutrinos sit in a doublet, while right-handed neutrinos are in a singlet, and therefore do not interact with the other known particles. Also in this model, the neutrinos are intrinsically massless. However, while the W-S-G model provides an amazingly accurate picture of our present cold Universe, It has a number of deficits. The Standard Model does not explain the origin of the group structure, It does not reduce the number of coupling constants required, nor does it offer any prediction for the physical masses of the particles. Thus, it is generally assumed that the Standard Model is but a subset of some larger gauge theory. A wide variety of Grand Unified field Theories (GUTs), Super Symmetric Models (SUSY), and Superstring models have been proposed as the model for this larger structure. In general, these models predict nonzero neutrino masses and contain mechanisms that provide for lepton-number violation. Thus, a variety of new phenomena are predicted, including finite neutrino masses and the possibility that neutrinos can oscillate from one type to another. This report looks at the possibility of detecting neutrino vat mass.

Bowles, T.J.

1993-04-01

399

Neutrino mass  

SciTech Connect

Neutrinos play a dominant role in both particle physics, astrophysics, and cosmology. In the our present understanding of the strong, weak, and electromagnetic forces, the group structure of the Standard Model is SU(3)[sub C] [circle times] SU(2)[sub L] [circle times] U(I)[sub EM]. In the Weinberg-Salam-Glashow Standard Electroweak Model, left-handed neutrinos sit in a doublet, while right-handed neutrinos are in a singlet, and therefore do not interact with the other known particles. Also in this model, the neutrinos are intrinsically massless. However, while the W-S-G model provides an amazingly accurate picture of our present cold Universe, It has a number of deficits. The Standard Model does not explain the origin of the group structure, It does not reduce the number of coupling constants required, nor does it offer any prediction for the physical masses of the particles. Thus, it is generally assumed that the Standard Model is but a subset of some larger gauge theory. A wide variety of Grand Unified field Theories (GUTs), Super Symmetric Models (SUSY), and Superstring models have been proposed as the model for this larger structure. In general, these models predict nonzero neutrino masses and contain mechanisms that provide for lepton-number violation. Thus, a variety of new phenomena are predicted, including finite neutrino masses and the possibility that neutrinos can oscillate from one type to another. This report looks at the possibility of detecting neutrino vat mass.

Bowles, T.J.

1993-01-01

400

Mass Spectrometry for the Masses  

ERIC Educational Resources Information Center

A simple, qualitative experiment is developed for implementation, where the gas chromatography-mass spectrometry (GC-MS) plays an important role, into the laboratory curriculum of a chemistry course designed for nonscience majors. This laboratory experiment is well suited for the students as it helps them to determine the validity of their…

Persinger, Jared D.; Hoops, Geoffrey, C.; Samide, Michael J.

2004-01-01

401

Mass customization and mass production  

Microsoft Academic Search

Total quality management resulting from total customer satisfaction today can mean giving every customer a product tailored specifically to his or her needs. In the past, manufacturing was usually characterized by keeping costs down with economies of scale. Mass customization can result in a challenging manufacturing environment typified by both high volume and an excellent product mix, where customers expect

Laetitia Radder; Lynette Louw

1999-01-01

402

Mass Moments  

NSDL National Science Digital Library

Mass Moments is not a website dedicated to celebrating public rebellions, uprisings, or other such activities of the masses, but rather it was created to serve as an electronic almanac of Massachusetts history. Started on January 1, 2005, the site serves as a repository of brief âÂÂmomentsâ in the stateâÂÂs history, such as vignettes that tell the story of WorcesterâÂÂs first airport or Frederick DouglassâÂÂs first appearance before a white audience. Visitors can play each moment, or just read the script. Historic photographs and/or other documents, as well as a nice selection of sources for additional information accompany each script. Visitors can also search all of the previous moments by subject or geographic region, and in keeping with the times, they can also receive each new moment by RSS feed or podcast.

403

Mass burning  

SciTech Connect

With only minimal sorting, garbage can be used to fire a boiler. But the design of a refuse-to-energy plant must account for the corrosive and abrasive nature of the fuel and must include means of scrubbing flue gases and removing ash. This paper describes the working of a typical mass-burning plant. Topics are grouped under the following headings: Firing equipment, Boiler Design, Control and operation, Research and Development, Air Pollution Controls, Ash removal.

Adkin, P.

1988-12-01

404

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

NASA Technical Reports Server (NTRS)

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.

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

2011-01-01

405

The laser ablation ion funnel: Sampling for in situ mass spectrometry on Mars  

NASA Astrophysics Data System (ADS)

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.

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

2011-04-01

406

Mass Sensor  

SciTech Connect

The purpose of this CRADA was to use Honeywell's experience in low temperature cofire ceramics and traditional ceramics to assemble a relatively low-cost, mass-producible miniature mass analyzer. The specific design, given to us by Mass Sensors, LLC, was used to test for helium. The direct benefit for the participant was to have a prototype unit assembled for the purpose of proof of concept and the ability to secure venture capital investors. From that, the company would begin producing their own product for sale. The consumer/taxpayer benefits come from the wide variety of industries that can utilize this technology to improve quality of life. Medical industry can use this technology to improve diagnostic ability; manufacturing industry can use it for improved air, water, and soil monitoring to minimize pollution; and the law enforcement community can use this technology for identification of substances. These are just a few examples of the benefit of this technology. The benefits to DOE were in the area of process improvement for cofire and ceramic materials. From this project we demonstrated nonlinear thickfilm fine lines and spaces that were 5-mil wide with 5-mil spaces; determined height-to diameter-ratios for punched and filled via holes; demonstrated the ability to punch and fill 5-mil microvias; developed and demonstrated the capability to laser cut difficult geometries in 40-mil ceramic; developed and demonstrated coupling LTCC with standard alumina and achieving hermetic seals; developed and demonstrated three-dimensional electronic packaging concepts; and demonstrated printing variable resistors within 1% of the nominal value and within a tightly defined ratio. The capability of this device makes it invaluable for many industries. The device could be used to monitor air samples around manufacturing plants. It also could be used for monitoring automobile exhaust, for doing blood gas analysis, for sampling gases being emitted by volcanoes, for studying activities of insects, and many other things. The ultimate goal was to build two iterations of the mass sensor. However, due to technical difficulties, only one iteration of the device was manufactured. Initial work to optimize the ion source and build a small ion pump was not successful. Consequently, the ion pump was not incorporated into the analyzer design. Mass Sensors, LLC, is still testing the analyzers that were assembled.

Adams, B.E.

2001-01-18

407

Serum biomarker panels for the discrimination of benign from malignant cases in patients with an adnexal mass  

PubMed Central

Objectives The diagnosis of an adnexal mass is a prevalent issue among women in the United States while current methods of identifying those at high risk of malignancy remain insufficient. Ineffective triage of women with malignant masses is associated with delayed or inappropriate treatment and a negative effect on disease outcome. Methods We performed an evaluation of 65 ovarian cancer-related biomarkers in the circulation of women diagnosed with an adnexal mass. Our subject group consisted of women diagnosed with benign masses and early and late stage ovarian cancer. Results Over half of the biomarkers tested were found to differ significantly between benign and malignant cases. As individual markers, HE4 and CA 125 provided the greatest level of discrimination between benign and malignant cases and the combination of these two biomarkers provided a higher level of discriminatory power than either marker considered alone. Multivariate statistical analysis identified several multi-marker panels that could discriminate early stage, late stage, and combined ovarian cancers from benign cases with similar or slightly improved SN/SP levels to the CA 125/HE4 combination, however these larger panels could not outperform the 2-biomarker panel in an independent validation set. We also identified a 3-biomarker panel with particular utility in premenopausal women. Conclusions Our findings serve to advance the development of blood-based screening methods for the discrimination of benign and malignant ovarian masses by confirming and expanding upon the superior utility of the CA 125/HE4 combination.

Nolen, Brian; Velikokhatnaya, Liudmila; Marrangoni, Adele; De Geest, Koen; Lomakin, Aleksey; Bast, Robert C.; Lokshin, Anna

2010-01-01