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1

Model uniform core criteria for mass casualty triage.  

PubMed

There is a need for model uniform core criteria for mass casualty triage because disasters frequently cross jurisdictional lines and involve responders from multiple agencies who may be using different triage tools. These criteria (Tables 1-4) reflect the available science, but it is acknowledged that there are significant research gaps. When no science was available, decisions were formed by expert consensus derived from the available triage systems. The intent is to ensure that providers at a mass-casualty incident use triage methodologies that incorporate these core principles in an effort to promote interoperability and standardization. At a minimum, each triage system must incorporate the criteria that are listed below. Mass casualty triage systems in use can be modified using these criteria to ensure interoperability. The criteria include general considerations, global sorting, lifesaving interventions, and assignment of triage categories. The criteria apply only to providers who are organizing multiple victims in a discrete geographic location or locations, regardless of the size of the incident. They are classified by whether they were derived through available direct scientific evidence, indirect scientific evidence, expert consensus, and/or are used in multiple existing triage systems. These criteria address only primary triage and do not consider secondary triage. For the purposes of this document the term triage refers to mass-casualty triage and provider refers to any person who assigns primary triage categories to victims of a mass-casualty incident. PMID:21685308

2011-06-01

2

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

PubMed Central

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

Ramesh, Aruna C.; Kumar, S.

2010-01-01

3

Mass casualty triage: an evaluation of the science and refinement of a national guideline.  

PubMed

Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed. PMID:21685309

Lerner, E Brooke; Cone, David C; Weinstein, Eric S; Schwartz, Richard B; Coule, Phillip L; Cronin, Michael; Wedmore, Ian S; Bulger, Eileen M; Mulligan, Deborah Ann; Swienton, Raymond E; Sasser, Scott M; Shah, Umair A; Weireter, Leonard J; Sanddal, Teri L; Lairet, Julio; Markenson, David; Romig, Lou; Lord, Gregg; Salomone, Jeffrey; O'Connor, Robert; Hunt, Richard C

2011-06-01

4

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

E-print Network

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

Ziya, Serhan

5

Clinical review: Mass casualty triage - pandemic influenza and critical care  

PubMed Central

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

6

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. PMID:23966900

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

2013-01-01

7

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

PubMed

The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent and compassionate management and triage system and an in-depth and accurate health information system that appropriately addresses every level of threat or consequence. In a PICE stage I to III BT event resources will be compromised. Triage and management will be one process requiring multiple levels of cooperation, coordination, and decision-making. An immediate challenge to existing emergency medical services systems (EMSS) is the recognition that locally there will be a shift of emphasis and decision-making from prehospital first responders to community public health authorities. The author suggests that a working relationship, in most areas, between EMSS and the public health system is lacking. As priorities shift in a BT event to hospitals and public health care systems, they need to: 1. Improve their capabilities and capacities in surveillance, discovery, and in the consequences of different triage and management decisions and interventions in a BT environment, starting at the local level. 2. Develop triage and management systems (with clear lines of authority) based on public health and epidemiologic requirements, capability, and capacity (triage teams, categories, tags, rapid response, established operational priorities, resource-driven responsible management process), and link local level surveillance systems with those at the national or regional level. 3. Use a triage and management system that reflects the population (cohort) at risk, such as the epidemiologic based SEIRV triage framework. 4. Develop an organizational capacity that uses lateral decision-making skills, pre-hospital outpatient centers for triage-specific treatments, health information systems, and resource-driven hospital level pre-designated protocols appropriate for a surge of unprecedented proportions. Such standards of care, it is recommended, should be set at the local to federal levels and spelled out in existing incident-management system protocols. PMID:12132490

Burkle, Frederick M

2002-05-01

8

Creating order from chaos: part I: triage, initial care, and tactical considerations in mass casualty and disaster response.  

PubMed

How do we train for the entire spectrum of potential emergency and crisis scenarios? Will we suddenly face large numbers of combat casualties, an earthquake, a plane crash, an industrial explosion, or a terrorist bombing? The daily routine can suddenly be complicated by large numbers of patients, exceeding the ability to treat in a routine fashion. Disaster events can result in patients with penetrating wounds, burns, blast injuries, chemical contamination, or all of these at once. Some events may disrupt infrastructure or result in loss of essential equipment or key personnel. The chaos of a catastrophic event impedes decision-making and effective treatment of patients. Disasters require a paradigm shift from the application of unlimited resources for the greatest good of each individual patient to the allocation of care, with limited resources, for the greatest good for the greatest number of patients. Training and preparation are essential to remain effective during crises and major catastrophic events. Disaster triage and crisis management represent a tactical art that incorporates clinical skills, didactic information, communication ability, leadership, and decision-making. Planning, rehearsing, and exercising various scenarios encourage the flexibility, adaptability, and innovation required in disaster settings. These skills can bring order to the chaos of overwhelming disaster events. PMID:17436764

Baker, Michael S

2007-03-01

9

Nurse triage, diagnosis and treatment of eye casualty patients: a study of quality and utility  

Microsoft Academic Search

Introduction: Patients presenting to the Accident and Emergency department of a district general hospital with an eye problem are referred directly to a dedicated eye casualty service. They are then triaged by a staff nurse from the eye department. This eye casualty sees around 8000 patients per annum. This study assesses whether the nurse triage of eye casualty patients forms

Anita G Reynolds

2003-01-01

10

Evaluation of a novel algorithm for primary mass casualty triage by paramedics in a physician manned EMS system: a dummy based trial  

PubMed Central

Background The Amberg-Schwandorf Algorithm for Primary Triage (ASAV) is a novel primary triage concept specifically for physician manned emergency medical services (EMS) systems. In this study, we determined the diagnostic reliability and the time requirements of ASAV triage. Methods Seven hundred eighty triage runs performed by 76 trained EMS providers of varying professional qualification were included into the study. Patients were simulated using human dummies with written vital signs sheets. Triage results were compared to a standard solution, which was developed in a modified Delphi procedure. Test performance parameters (e.g. sensitivity, specificity, likelihood ratios (LR), under-triage, and over-triage) were calculated. Time measurements comprised the complete triage and tagging process and included the time span for walking to the subsequent patient. Results were compared to those published for mSTaRT. Additionally, a subgroup analysis was performed for employment status (career/volunteer), team qualification, and previous triage training. Results For red patients, ASAV sensitivity was 87%, specificity 91%, positive LR 9.7, negative LR 0.139, over-triage 6%, and under-triage 10%. There were no significant differences related to mSTaRT. Per patient, ASAV triage required a mean of 35.4 sec (75th percentile 46 sec, 90th percentile 58 sec). Volunteers needed slightly more time to perform triage than EMS professionals. Previous mSTaRT training of the provider reduced under-triage significantly. There were significant differences in time requirements for triage depending on the expected triage category. Conclusions The ASAV is a specific concept for primary triage in physician governed EMS systems. It may detect red patients reliably. The test performance criteria are comparable to that of mSTaRT, whereas ASAV triage might be accomplished slightly faster. From the data, there was no evidence for a clinically significant reliability difference between typical staffing of mobile intensive care units, patient transport ambulances, or disaster response volunteers. Up to now, there is no clinical validation of either triage concept. Therefore, reality based evaluation studies are needed. PMID:25214310

2014-01-01

11

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

PubMed

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

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

2014-10-01

12

Sample tracking in an automated cytogenetic biodosimetry laboratory for radiation mass casualties  

Microsoft Academic Search

Chromosome-aberration-based dicentric assay is expected to be used after mass-casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric

P. R. Martin; R. E. Berdychevski; U. Subramanian; W. F. Blakely; P. G. S. Prasanna

2007-01-01

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

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

15

Assessment of biodosimetry methods for a mass-casualty radiological incident: medical response and management considerations.  

PubMed

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

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

2013-12-01

16

Unstable Ethical Plateaus and Disaster Triage  

Microsoft Academic Search

Disasters are defined medically as mass casualty incidents in which the number of patients presenting during a given time period exceeds the capac- ity of the responders to render effective care in a timely manner. During such circumstances, triage is instituted to allocate scarce medical resources. Current disaster triage attempts to do the most for the most, with the least

Matthew D. Sztajnkrycer; Bo E. Madsen

2006-01-01

17

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

Microsoft Academic Search

Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation.\\u000a UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to\\u000a recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should,\\u000a therefore, be multi-faceted, involving a

Kirsty Challen; Andrew Bentley; John Bright; Darren Walter

2007-01-01

18

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

PubMed

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

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

2014-01-01

19

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. PMID:22474622

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

2010-01-01

20

Planning for a Mass Casualty Incident in Arkansas Schools  

ERIC Educational Resources Information Center

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

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

2005-01-01

21

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

PubMed Central

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

Fry, Emory A.; Lenert, Leslie A.

2005-01-01

22

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

PubMed Central

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

Goransson Nyberg, Ann; Stricklin, Daniela; Sellstrom, Ake

2011-01-01

23

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

PubMed Central

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

2013-01-01

24

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

25

Sample Tracking in an Automated Cytogenetic Biodosimetry Laboratory for Radiation Mass Casualties  

PubMed Central

Chromosome aberration-based dicentric assay is expected to be used after mass casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric assay using peripheral blood from exposed individuals according to internationally accepted laboratory protocols (i.e., within days following radiation exposures). The components of an automated cytogenetic biodosimetry laboratory include blood collection kits for sample shipment, a cell viability analyzer, a robotic liquid handler, an automated metaphase harvester, a metaphase spreader, high-throughput slide stainer and coverslipper, a high-throughput metaphase finder, multiple satellite chromosome-aberration analysis systems, and a computerized sample tracking system. Laboratory automation using commercially available, off-the-shelf technologies, customized technology integration, and implementation of a laboratory information management system (LIMS) for cytogenetic analysis will significantly increase throughput. This paper focuses on our efforts to eliminate data transcription errors, increase efficiency, and maintain samples’ positive chain-of-custody by sample tracking during sample processing and data analysis. This sample tracking system represents a “beta” version, which can be modeled elsewhere in a cytogenetic biodosimetry laboratory, and includes a customized LIMS with a central server, personal computer workstations, barcode printers, fixed station and wireless hand-held devices to scan barcodes at various critical steps, and data transmission over a private intra-laboratory computer network. Our studies will improve diagnostic biodosimetry response, aid confirmation of clinical triage, and medical management of radiation exposed individuals. PMID:18037985

Martin, P.R.; Berdychevski, R.E.; Subramanian, U.; Blakely, W.F.; Prasanna, P.G.S.

2007-01-01

26

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. PMID:21691470

Mills, Christopher N.; Mills, Gregory H.

2011-01-01

27

Review Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica  

E-print Network

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. [West J Emerg Med. 2011;12(1):37-42.] BACKGROUND

Christopher N. Mills; Gregory H. Mills

28

Anthropologist-Directed Triage: Three Distinct Mass Fatality Events Involving Fragmentation of Human Remains  

Microsoft Academic Search

Identifying victims from mass fatality events requires the synchronization of several processes including, but not limited to, recovery, antemortem information collection, mortuary processes, death certification, family assistance, and finally, repatriation. This chapter will discuss one small aspect of the mortuary process, triage, and its interplay with other aspects of the process of identifying highly fragmented remains. Specifically, this paper will

Amy Z. Mundorff

29

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 physi- cians and paramedics regarding their preparedness for a mass casualty incident (MCI) resulting from a ter- rorist attack in Germany. The aim of this study was to assess the current state of preparedness of emergency physicians and paramedics

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

2008-01-01

30

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

31

Decision-support information system to manage mass casualty incidents at a level 1 trauma center.  

PubMed

Mass casualty incidents are probably the greatest challenge to a hospital. When such an event occurs, hospitals are required to instantly switch from their routine activity to conditions of great uncertainty and confront needs that exceed resources. We describe an information system that was uniquely designed for managing mass casualty events. The web-based system is activated when a mass casualty event is declared; it displays relevant operating procedures, checklists, and a log book. The system automatically or semiautomatically initiates phone calls and public address announcements. It collects real-time data from computerized clinical and administrative systems in the hospital, and presents them to the managing team in a clear graphic display. It also generates periodic reports and summaries of available or scarce resources that are sent to predefined recipients. When the system was tested in a nationwide exercise, it proved to be an invaluable tool for informed decision making in demanding and overwhelming situations such as mass casualty events. PMID:24280111

Bar-El, Yaron; Tzafrir, Sara; Tzipori, Idan; Utitz, Liora; Halberthal, Michael; Beyar, Rafael; Reisner, Shimon

2013-12-01

32

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

33

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

PubMed

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

Duchateau, François-Xavier; Verner, Laurent

2012-01-01

34

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

35

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

36

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. PMID:22214518

2012-01-01

37

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

PubMed

Species of plants and animals, as well as nations of human beings were extinguished throughout the prehistory and history of this planet. One of the possible explanations for this phenomenon is a large scale epidemic of viral, bacterial or fungal infections. One well-documented example was the smallpox epidemic among native Indians of South America following the European invasion. Deliberate dissemination of disease was used as a weapon during the Middle Ages when corpses of plague casualties were thrown over the walls and into the besieged towns. The Book of Kings II, of the Bible, in chapter 19 recalls the story of 185,000 soldiers of Sennacherib that died in one night, near the walls of Jerusalem. The possibility of causing mass casualty by dissemination of infectious disease has driven countries and terrorist organizations to produce and store large quantities of bacteria or viruses. The death of thousands in the USA on September 11, 2001, demonstrated that terror has no moral prohibitions, only technical limitations. Terror organizations will not hesitate to use weapons for mass destruction to kill many, and if only few will die, it will still serve the purpose of these evil organizations: to strew panic, to destroy normal life and to increase fear and instability. Any government that faces decisions about how to be better prepared against biological warfare is pushed between the devil and the deep blue sea. On the one hand: the better we will be prepared, equipped with antibiotics and vaccines--the more lives of casualties we will be able to save. Better public education will help to reduce the damage, but, on the other hand--in order to cause more people to make the effort to equip themselves or to refresh their protective kit--we will have to increase their level of concern. In order to improve the medical education of all members of the medical teams we will have to start a broad and intense campaign, thereby taking the risk of increasing stress in the public in anticipation of such an attack. The more we will encourage patients who suffer flu-like syndromes to consult their family physician, the more instances of early detection of anthrax cases we will discover. However, in so doing, we will increase the level of national stress and flood primary medicine with many thousands of patients without being able to give our general practitioners any simple and effective tool for the diagnosis of anthrax in its early stages. Between the devil of biological warfare and the deep blue sea of public reaction, a small group of decision-makers and their professional advisers is under pressure. Israel is fortunate that this is not a new problem for this group of experts. Large scale drills, thorough preparations and adequate stockpiling of everything required marks the results of this group's activities. The state of Israel is today one of the best-prepared countries for such an event. PMID:12170548

Eldad, Arieh

2002-05-01

38

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

39

Reporting for Duty During Mass Casualty Events: A Survey of Factors Influencing Emergency Medicine Physicians  

PubMed Central

Background Academic medical centers play a major role in disaster response, and residents frequently serve as key resources in these situations. Studies examining health care professionals' willingness to report for duty in mass casualty situations have varying response rates, and studies of emergency medicine (EM) residents' willingness to report for duty in disaster events and factors that affect these responses are lacking. Objective We sought to determine EM resident and faculty willingness to report for duty during 4 disaster scenarios (natural, explosive, nuclear, and communicable), to identify factors that affect willingness to work, and to assess opinions regarding disciplinary action for physicians unwilling to work in a disaster situation. Methods We surveyed residents and faculty at 7 US teaching institutions with accredited EM residency programs between April and November 2010. Results A total of 229 faculty and 259 residents responded (overall response rate, 75.4%). Willingness to report for duty ranged from 54.1% for faculty in a natural disaster to 94.2% for residents in a nonnuclear explosive disaster. The 3 most important factors influencing disaster response were concern for the safety of the family, belief in the physician's duty to provide care, and availability of protective equipment. Faculty and residents recommended minimal or no disciplinary action for individuals unwilling to work, except in the infectious disease scenario. Conclusions Most EM residents and faculty indicated they would report for duty. Residents and faculty responses were similar in all but 1 scenario. Disciplinary action for individuals unwilling to work generally was not recommended. PMID:24404305

Snipes, Carly; Miramonti, Charles; Chisholm, Carey; Chisholm, Robin

2013-01-01

40

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

41

An algorithm for the evaluation and management of red, yellow, and green zone patients during a botulism mass casualty incident.  

PubMed

Botulinum toxin is one of the most toxic substances known to humankind. It is one among the six Category A agents in the CDC bioterrorism lexicon. This suggests that, while the possibility of a botulism mass casualty incident (MCI) is remote, its unique acute and long-term ramifications must be addressed and planned for. However, an in-depth knowledge of the disease and its tactical management in the acute MCI phase is inconsistent or superficial among healthcare personnel. Therefore, an algorithm has been developed to assist first receivers with the initial management of multiple probable and potential botulism patients when equipment resources are strained and when expert personnel are not readily available. The algorithm is specifically structured to assist with the identification and management of potential respiratory deterioration of suspected botulism patients. PMID:19860161

Rega, Paul; Burkholder-Allen, Kelly; Bork, Christopher

2009-01-01

42

Risk Analysis for Environmental Health Triage  

SciTech Connect

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

Bogen, K T

2005-11-18

43

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

PubMed

Response to a large-scale radiological incident could require timely medical interventions to minimize radiation casualties. Proper medical care requires knowing the victim's radiation dose. When physical dosimetry is absent, radiation-specific chromosome aberration analysis can serve to estimate the absorbed dose in order to assist physicians in the medical management of radiation injuries. A mock exercise scenario was presented to six participating biodosimetry laboratories as one individual acutely exposed to Co under conditions suggesting whole-body exposure. The individual was not wearing a dosimeter and within 2-3 h of the incident began vomiting. The individual also had other medical symptoms indicating likelihood of a significant dose. Physicians managing the patient requested a dose estimate in order to develop a treatment plan. Participating laboratories in North and South America, Europe, and Asia were asked to evaluate more than 800 electronic images of metaphase cells from the patient to determine the dicentric yield and calculate a dose estimate with 95% confidence limits. All participants were blind to the physical dose until after submitting their estimates based on the dicentric chromosome assay (DCA). The exercise was successful since the mean biological dose estimate was 1.89 Gy whereas the actual physical dose was 2 Gy. This is well within the requirements for guidance of medical management. The exercise demonstrated that the most labor-intensive step in the entire process (visual evaluation of images) can be accelerated by taking advantage of world-wide expertise available on the Internet. PMID:24667387

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

2014-05-01

44

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. PMID:24559111

2014-01-01

45

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

46

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

SciTech Connect

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.

Ansari, Armin (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA); Harper, Frederick Taylor; Smith, James M. (National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA)

2005-04-01

47

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

48

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

Microsoft Academic Search

The purpose of this study was to evaluate the response to an automated alarm system of a radiology department during a mass\\u000a casualty incident simulation. An automated alarm system provided by an external telecommunications provider handling up to\\u000a 480 ISDN lines was used at a level I trauma center. During the exercise, accessibility, availability, and estimated time of\\u000a arrival (ETA)

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

2011-01-01

49

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

50

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

PubMed Central

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

Borgohain, B; Khonglah, T

2013-01-01

51

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

PubMed

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

Borgohain, B; Khonglah, T

2013-01-01

52

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. PMID:20065689

Moroni, Maria; Pellmar, Terry C.

2009-01-01

53

Emergency department triage revisited  

Microsoft Academic Search

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure

Gerard FitzGerald; George A Jelinek; Deborah Scott; Marie Frances Gerdtz

2010-01-01

54

An Advance Triage System  

Microsoft Academic Search

This paper describes the redesign of the triage process in an Emergency Department with the purpose of improving the patient flow and thus increasing patient satisfaction through the reduction of the overall length of stay. The process, Advance Triage, allows the triage nurse to initiate diagnostic protocols for frequently occurring medical problems based on physician-approved algorithms. With staff and physician

W. W. H. Cheung; L. Heeney; J. L. Pound

2002-01-01

55

Creating order from chaos: part II: tactical planning for mass casualty and disaster response at definitive care facilities.  

PubMed

Current events highlight the need for disaster preparedness. We have seen tsunamis, hurricanes, terrorism, and combat in the news every night. There are many variables in a disaster, such as damage to facilities, loss of critical staff members, and overwhelming numbers of casualties. Each medical treatment facility should have a plan for everything from caring for staff members to getting the laundry done and providing enhanced security or mortuary services. Communication and agreements with local, regional, and federal agencies are vital. Then we must train and drill to shape the tools to impose order on chaos and to provide the most care to the greatest number. PMID:17436765

Baker, Michael S

2007-03-01

56

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

PubMed

Well-defined protocols and quality management standards are indispensable for biological dosimetry laboratories. Participation in periodic proficiency testing by interlaboratory comparisons is also required. This harmonization is essential if a cooperative network is used to respond to a mass casualty event. Here we present an international intercomparison based on dicentric chromosome analysis for dose assessment performed in the framework of the IAEA Regional Latin American RLA/9/054 Project. The exercise involved 14 laboratories, 8 from Latin America and 6 from Europe. The performance of each laboratory and the reproducibility of the exercise were evaluated using robust methods described in ISO standards. The study was based on the analysis of slides from samples irradiated with 0.75 (DI) and 2.5 Gy (DII). Laboratories were required to score the frequency of dicentrics and convert them to estimated doses, using their own dose-effect curves, after the analysis of 50 or 100 cells (triage mode) and after conventional scoring of 500 cells or 100 dicentrics. In the conntional scoring, at both doses, all reported frequencies were considered as satisfactory, and two reported doses were considered as questionable. The analysis of the data dispersion among the dicentric frequencies and among doses indicated a better reproducibility for estimated doses (15.6% for DI and 8.8% for DII) than for frequencies (24.4% for DI and 11.4% for DII), expressed by the coefficient of variation. In the two triage modes, although robust analysis classified some reported frequencies or doses as unsatisfactory or questionable, all estimated doses were in agreement with the accepted error of ±0.5 Gy. However, at the DI dose and for 50 scored cells, 5 out of the 14 reported confidence intervals that included zero dose and could be interpreted as false negatives. This improved with 100 cells, where only one confidence interval included zero dose. At the DII dose, all estimations fell within ±0.5 Gy of the reference dose interval. The results obtained in this triage exercise indicated that it is better to report doses than frequencies. Overall, in both triage and conventional scoring modes, the laboratory performances were satisfactory for mutual cooperation purposes. These data reinforce the view that collaborative networking in the case of a mass casualty event can be successful. PMID:21306200

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

2011-05-01

57

Casualty Assistance: An Overview  

MedlinePLUS

... the casualty is governed by seniority (age). Equal relationship situations include divorced parents, children, and siblings with minor children's rights exercised by their parents or legal guardians. The adult NOK is typically the first person highest in ...

58

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. PMID:21949482

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

2011-01-01

59

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

PubMed

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. PMID:21949482

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

2011-09-01

60

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

61

Injuries and Mass Casualty Events  

MedlinePLUS

... and Continuing Education Medical Record Abstraction Form for Domestic Bombing Events Bombings: Injury Patterns and Care Predicting ... Disease Control and Prevention 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO (800-232- ...

62

Making better decisions during triage.  

PubMed

Interactions between nurses and patients during triage are crucial if the urgency of patient need is to be assessed accurately. This article reports on the results of a study of emergency nurses' perspectives and experience of triage in the United States. Findings indicate that triage encounters are multifaceted and that emergency nurses require experience as well as knowledge to make good decisions. Two themes emerged from the study's findings: the need for nurses to connect with patients and the ability of nurses to 'read between the lines'. Nurses who connect with patients can take more detailed histories, while those who can read between the lines can identify the salient points and subtle signs from patients. Nurses with these skills can make better triage decisions. PMID:25270817

Sanders, Susan; Minick, Ptlene

2014-10-01

63

Operation Desert Shield: Medical aspects of weapons of mass destruction  

SciTech Connect

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

Knudson, G.B. (Department of Pathology, Letterman Army Medical Center, Presidio of San Francisco, CA (USA))

1991-06-01

64

Garden Path Repair: Diagnosis and Triage.  

ERIC Educational Resources Information Center

To determine whether triage--which determines the probable revisability of a structure--is a feature of human parsing, its scope must be established. This study compares four hypotheses about how much work triage can do. Identifies empirical predictions that differentiate diagnosis with triage from simple basic diagnosis. What little evidence…

Fodor, Janet Dean; Inoue, Atsu

2000-01-01

65

Republished paper: Emergency department triage revisited  

Microsoft Academic Search

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure

Gerard FitzGerald; George A Jelinek; Deborah Scott; Marie Frances Gerdtz

2010-01-01

66

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

67

First aid, transport, and triage.  

PubMed

A favorable outcome for a patient suffering acute trauma or disease is more likely if prehospital first aid can be administered. Veterinary facilities should teach their clients about first aid and transport and be able to give instructions over the telephone. Once a patient arrives at a veterinary facility, the entire staff should be prepared so that triage, the primary survey, resuscitation and stabilization, and the secondary survey may be performed efficiently and effectively. PMID:7879363

Faggella, A M

1994-11-01

68

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2011-07-01

69

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2012-07-01

70

33 CFR 173.55 - Report of casualty or accident.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation...BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of...

2010-07-01

71

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. PMID:21982119

2011-01-01

72

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

73

Case studies of casualties in assembly occupancies  

Microsoft Academic Search

Based on fire cases of casualties in assembly occupancies from 1979 to 2009, this paper made statistical analysis on the factors of fire cases, such as overall situation, fire occurrence time and regions, the causes, alarm time, firefighters taking part, genders, identities, direct death reasons and specific ages of the casualties. According to the statistical analysis of fire cases, this

Lianrui Jiang; Yingna Fan; Na Xi

2012-01-01

74

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

75

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

76

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., Sr.

1997-08-01

77

Analysis of driver casualty risk for different work zone types  

Microsoft Academic Search

Using driver casualty data from the Fatality Analysis Report System, this study examines driver casualty risk and investigates the risk contributing factors in the construction, maintenance and utility work zones. The multiple t-tests results show that the driver casualty risk is statistically different depending on the work zone type. Moreover, construction work zones have the largest driver casualty risk, followed

Jinxian Weng; Qiang Meng

2011-01-01

78

A+ Auto & Home Insurance is a brand of California Casualty Indemnity Exchange, California Casualty Insurance Company, and California Casualty General Insurance Company of Oregon  

E-print Network

A+ Auto & Home Insurance is a brand of California Casualty Indemnity Exchange, California Casualty Insurance Company, and California Casualty General Insurance Company of Oregon M-523-IDT 3/080041343 Your or flood. You'll also have access to expert help if your identification or financial documents are lost

Gleeson, Joseph G.

79

46 CFR 4.04-1 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Reports of potential vessel casualty. 4.04-1 Section...CASUALTIES AND INVESTIGATIONS Notice of Potential Vessel Casualty § 4.04-1 Reports of potential vessel casualty. A vessel...

2010-10-01

80

46 CFR 4.04-1 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Reports of potential vessel casualty. 4.04-1 Section...CASUALTIES AND INVESTIGATIONS Notice of Potential Vessel Casualty § 4.04-1 Reports of potential vessel casualty. A vessel...

2011-10-01

81

Guidelines for Field Triage of Injured Patients  

PubMed Central

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to the national public health burden associated with trauma and injury. In the United States (U.S.), injury is the leading cause of death for persons aged 1–44 years. In 2008, approximately 30 million injuries resulted in an emergency department (ED) evaluation; 5.4 million (18%) of these patients were transported by Emergency Medical Services (EMS).1 EMS providers determine the severity of injury and begin initial management at the scene. The decisions to transport injured patients to the appropriate hospital are made through a process known as “field triage.” Since 1986, the American College of Surgeons Committee on Trauma (ACS-COT) has provided guidance for the field triage process though its “Field Triage Decision Scheme.” In 2005, the CDC, with financial support from the National Highway Traffic Safety Administration (NHTSA), collaborated with ASC-COT to convene the initial meeting of the National Expert Panel on Field Triage (the Panel) to revise the decision scheme. This revised version was published in 2006 by ASC-COT, and in 2009 the CDC published a detailed description of the scientific rational for revising the field triage criteria entitled, “Guidelines for Field Triage of Injured Patients.”2–3 In 2011, the CDC reconvened the Panel to review the 2006 Guidelines and recommend any needed changes. We present the methodology, findings and updated guidelines from the Morbidity & Mortality Weekly Report (MMWR) from the 2011 Panel along with commentary on the burden of injury in the U.S., and the role emergency physicians have in impacting morbidity and mortality at the population level. PMID:23447758

McCoy, C. Eric; Chakravarthy, Bharath; Lotfipour, Shahram

2013-01-01

82

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

PubMed Central

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

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

2014-01-01

83

46 CFR 185.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

... 7 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping...Marine Casualties and Voyage Records § 185.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2010-10-01

84

46 CFR 185.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2011 CFR

... 7 2011-10-01 2011-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping...Marine Casualties and Voyage Records § 185.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2011-10-01

85

46 CFR 122.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2011 CFR

... 4 2011-10-01 2011-10-01 false Reports of potential vessel casualty. 122.260 Section 122.260 Shipping...Marine Casualties and Voyage Records § 122.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2011-10-01

86

46 CFR 122.260 - Reports of potential vessel casualty.  

Code of Federal Regulations, 2010 CFR

... 4 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 122.260 Section 122.260 Shipping...Marine Casualties and Voyage Records § 122.260 Reports of potential vessel casualty. (a) An owner, charterer,...

2010-10-01

87

Investigation of the MV Kurdistan casualty  

Microsoft Academic Search

The failure of the MV Kurdistan demonstrates the classic combination of high stress, low toughness and defect which are required to cause initiation of a brittle failure. This paper describes the failure investigation. The casualty illustrates the importance that secondary stresses and thermal stresses can have on the conditions which lead to failure. The formal investigation into the Kurdistan involved

S. J. Garwood

1997-01-01

88

Multiple casualty incidents: the prehospital role of the anesthesiologist in Europe.  

PubMed

The recent increase in incidents involving mass casualties has emphasized the need for a planned and coordinated prehospital emergency medical response, with medical teams on-site to provide advanced trauma life support. The special skills of the anesthesiologist make his/her contribution to prehospital emergency care particularly valuable. The United Kingdom's emergency medical services system is operated paramedically like that in the United States, and is based on rapid evacuation of casualties to hospital emergency medical facilities. In contrast, the French approach is based on the use of its emergency care system SAMU, where both structured dispatching and on-site medical care is provided by physicians, including anesthesiologists. In this article, the lessons learned from multiple casualty incidents in Europe during the past 2 decades are considered from the standpoint of the anesthesiologist. PMID:17400164

Baker, David J; Telion, Caroline; Carli, Pierre

2007-03-01

89

The Use of Advanced Simulation in the Training of Anesthesiologists to Treat Chemical Warfare Casualties  

Microsoft Academic Search

Training anesthesiologists to treat nerve gas intoxica- tion in a mass casualty scenario is a complicated task. The scenario is an unfamiliar medical situation involv- ing the need to decontaminate patients before provid- ing definitive medical treatment, and the need for phys- ical protection to the medical team before decontamination. We describe the development of a simulation-based training program. In

RONALD D. MILLER

90

The Advanced Health and Disaster Aid Network: A LightWeight Wireless Medical System for Triage  

Microsoft Academic Search

Advances in semiconductor technology have resulted in the creation of miniature medical embedded systems that can wirelessly monitor the vital signs of patients. These lightweight medical systems can aid providers in large disasters who become overwhelmed with the large number of patients, limited resources, and insufficient information. In a mass casualty incident, small embedded medical systems facilitate patient care, resource

Tia Gao; Tammara Massey; Leo Selavo; David Crawford; Bor-rong Chen; Konrad Lorincz; Victor Shnayder; Logan Hauenstein; Foad Dabiri; James Jeng; Arjun Chanmugam; David White; Majid Sarrafzadeh; Matt Welsh

2007-01-01

91

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. PMID:6349145

Bowers, J. Z.

1983-01-01

92

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

93

Using a theory to understand triage decision making.  

PubMed

The purpose of this discussion is to present triage decision making research within the context of the Revised Cognitive Continuum Theory. Triage is an essential clinical skill in emergency nursing. Understanding the best way to facilitate this skill is vital when educating new nurses or providing continuing education to practicing nurses. Delineating research evidence within a theory allows clinical educators to understand practices that foster successful triage skills and permits the grounding of educational strategies within a theoretical framework. PMID:23615518

Smith, Anita

2013-04-01

94

33 CFR 174.121 - Forwarding of casualty or accident reports.  

Code of Federal Regulations, 2011 CFR

... false Forwarding of casualty or accident reports. 174.121 Section 174...174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has...

2011-07-01

95

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

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Contents of casualty or accident report form. 174.107 Section...174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information...

2010-07-01

96

33 CFR 174.121 - Forwarding of casualty or accident reports.  

Code of Federal Regulations, 2010 CFR

... false Forwarding of casualty or accident reports. 174.121 Section 174...174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, each State that has...

2010-07-01

97

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

98

Triage and case presentations in a chiropractic pediatric clinic  

Microsoft Academic Search

ObjectiveThe use of triage in a chiropractic practice is to determine whether or not a patient who has presented to an office is in need of a referral to another health care provider. The objective of this article is to illustrate the use of triage skills in a primary care, chiropractic pediatric practice. This is examined both in the new

Drew Rubin

2007-01-01

99

Victims of assault attending casualty departments.  

PubMed

Victims of assault make up about 8% of all adult injury cases. The purpose of this study was to analyse the personal characteristics and injuries of 518 victims of assault (=case material) and 496 accidentally injured (=controls), selected at random in a large casualty department. The proportion of males was higher among the assault cases than among controls (76 vs. 61%). Assault victims were more concentrated in the age range 15 to 44 years (81 vs. 64%). Fifty per cent of the cases and 8% of the controls were intoxicated, while the rates of chronic misuse of alcohol were 37 and 18%, respectively. Forty seven per cent of the cases and 18% of the controls arrived at night. Assault cases had sustained mostly minor head injuries. However, injuries needing referral to the ENT department or Dept. of jaw surgery were also common. Casualty departments are well suited to victim studies. Additional information as to social background, criminality and psychiatric morbidity of victims is needed. PMID:7209449

Honkanen, R; Kiviluoto, O; Nordström, R

1980-01-01

100

The Casualty Actuarial Society: Helping Universities Train Future Actuaries  

ERIC Educational Resources Information Center

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

Boa, J. Michael; Gorvett, Rick

2014-01-01

101

Triage and the patient with renal failure.  

PubMed

The call for 'triage' as a specific policy for the selection of patients presenting with chronic renal failure, in the light of increasingly limited resources prompted us to question nephrologist on their bases for selection. We discovered no absolute criteria for rejection, but a consensus of opinion against those with additional and complicating factors to their renal disease such as age, hepatitis carriers and mental illness-a bias seen throughout the National Health Service. In this paper we discuss the validity of such criteria, the implications of the currently pragmatic and often covert practice of selection, and in this potentially finite area of demand we question the rationale for the limitation of resources. PMID:6780691

Parsons, V; Lock, P

1980-12-01

102

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2010 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,...

2010-10-01

103

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. PMID:9576898

Putnam, Frank W.

1998-01-01

104

Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage.  

PubMed

In the United States, injury is the leading cause of death for persons aged 1--44 years, and the approximately 800,000 emergency medical services (EMS) providers have a substantial impact on the care of injured persons and on public health. At an injury scene, EMS providers determine the severity of injury, initiate medical management, and identify the most appropriate facility to which to transport the patient through a process called "field triage." Although basic emergency services generally are consistent across hospital emergency departments (EDs), certain hospitals have additional expertise, resources, and equipment for treating severely injured patients. Such facilities, called "trauma centers," are classified from Level I (centers providing the highest level of trauma care) to Level IV (centers providing initial trauma care and transfer to a higher level of trauma care if necessary) depending on the scope of resources and services available. The risk for death of a severely injured person is 25% lower if the patient receives care at a Level I trauma center. However, not all patients require the services of a Level I trauma center; patients who are injured less severely might be served better by being transported to a closer ED capable of managing milder injuries. Transferring all injured patients to Level I trauma centers might overburden the centers, have a negative impact on patient outcomes, and decrease cost effectiveness. In 1986, the American College of Surgeons developed the Field Triage Decision Scheme (Decision Scheme), which serves as the basis for triage protocols for state and local EMS systems across the United States. The Decision Scheme is an algorithm that guides EMS providers through four decision steps (physiologic, anatomic, mechanism of injury, and special considerations) to determine the most appropriate destination facility within the local trauma care system. Since its initial publication in 1986, the Decision Scheme has been revised four times. In 2005, with support from the National Highway Traffic Safety Administration, CDC began facilitating revision of the Decision Scheme by hosting a series of meetings of the National Expert Panel on Field Triage, which includes injury-care providers, public health professionals, automotive industry representatives, and officials from federal agencies. The Panel reviewed relevant literature, presented its findings, and reached consensus on necessary revisions. The revised Decision Scheme was published in 2006. This report describes the process and rationale used by the Expert Panel to revise the Decision Scheme. PMID:19165138

Sasser, Scott M; Hunt, Richard C; Sullivent, Ernest E; Wald, Marlena M; Mitchko, Jane; Jurkovich, Gregory J; Henry, Mark C; Salomone, Jeffrey P; Wang, Stewart C; Galli, Robert L; Cooper, Arthur; Brown, Lawrence H; Sattin, Richard W

2009-01-23

105

The relationship between transfusion and hypoxemia in combat casualties.  

PubMed Central

The relationship between transfusion and subsequent hypoxemia was examined retrospectively in the records of combat casualties studied by the first three U.S. Army Surgical Research Teams in Vietnam. There was no evident relationship in 425 casualties studied before anesthesia and operation. In 199 casualties studied preoperatively and on at least two of the first three postoperative days, there was no evident relationship in those with injuries not involving the chest or abdomen. Eighteen such casualties received over ten units of blood each (average 24.5) and exhibited subsequent changes in arterial oxygen tension (PaO2) which were indistinguishable from those transfused lesser amounts or not all. Similar observations were made in casualties with injuries to the abdomen, although there was a tendency to lower PaO2 two days after injury in those heavily transfused. In those with thoracic injury, there was statistically significantly lower PaO2 on the first two postoperative days in those heavily transfused. Two possible interpretations are considered, one that blood transfusion contributed to hypoxemia, and alternatively, that a greater magnitude of the injuries accounted for both the worsened hypoxemia and the need for more transfusions. The latter was thought more likely. The differences in PaO2 related to the type of injury exceeded the differences associated with transfusion. PMID:697435

Collins, J A; James, P M; Bredenberg, C E; Anderson, R W; Heisterkamp, C A; Simmons, R L

1978-01-01

106

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

107

Positive-Pressure Ventilation Equipment for Mass Casualty Respiratory Failure  

Microsoft Academic Search

In the event of an influenza pandemic, patients with severe acute respiratory failure (ARF) due to in- fluenza will require positive-pressure ventilation (PPV) in order to survive. In countries with widely available critical care services, PPV is delivered almost exclusively through use of full-feature me- chanical ventilators in intensive care units (ICUs) or specialized hospital wards. But the supply of

Lewis Rubinson; Richard D. Branson; Nicki Pesik; Daniel Talmor

2006-01-01

108

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. PMID:24079719

2013-01-01

109

Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives  

PubMed Central

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

2013-01-01

110

The value of noninvasive measurement of the compensatory reserve index in monitoring and triage of patients experiencing minimal blood loss.  

PubMed

Currently available triage and monitoring tools are often late to detect life-threatening clinically significant physiological aberrations and provide limited data in prioritizing bleeding patients for treatment and evacuation. The Compensatory Reserve Index (CRI) is a novel means of assessing physiologic reserve, shown to correlate with central blood volume loss under laboratory conditions. The purpose of this study was to compare the noninvasive CRI device with currently available vital signs in detecting blood loss. Study subjects were soldiers volunteering for blood donation (n = 230), and the control group was composed of soldiers who did not donate blood (n = 34). Data collected before and after blood donation were compared, receiver operator characteristic curves were generated after either donation or the appropriate time interval, and areas under the curves (AUCs) were compared. Compared with pre-blood loss, blood donation resulted in a mean reduction of systolic blood pressure by 3% (before, 123 mmHg; after, 119 mmHg; P < 0.01). The CRI demonstrated a 16% reduction (before, 0.74; after, 0.62; P < 0.01). Heart rate, diastolic blood pressure, and oxygen saturation remained unchanged. The AUC for change in CRI was 0.81, 0.56 for change in heart rate, 0.53 for change in systolic blood pressure, 0.55 and 0.58 for pulse pressure and shock index, respectively. The AUCs for detecting mild blood loss at a single measurement were 0.73 for heart rate, 0.60 for systolic blood pressure, 0.62 for diastolic blood pressure, 0.45 for pulse oximetry, and 0.84 for CRI. The CRI was better than standard indices in detecting mild blood loss. Single measurement of CRI may enable a more accurate triage, and CRI monitoring may allow for earlier detection of casualty deterioration. PMID:24667628

Nadler, Roy; Convertino, Victor A; Gendler, Sami; Lending, Gadi; Lipsky, Ari M; Cardin, Sylvain; Lowenthal, Alexander; Glassberg, Elon

2014-08-01

111

Examining the influence of civilian casualties on insurgent attacks in Iraq  

E-print Network

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

Karnis, Jessica Eve

2006-01-01

112

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

PubMed Central

Background Efficient management of major incidents involves triage, treatment and transport. In the absence of a standardised interdisciplinary major incident management approach, the Norwegian Air Ambulance Foundation developed Interdisciplinary Emergency Service Cooperation Course (TAS). The TAS-program was established in 1998 and by 2009, approximately 15 500 emergency service professionals have participated in one of more than 500 no-cost courses. The TAS-triage concept is based on the established triage Sieve and Paediatric Triage Tape models but modified with slap-wrap reflective triage tags and paediatric triage stretchers. We evaluated the feasibility and accuracy of the TAS-triage concept in full-scale simulated major incidents. Methods The learners participated in two standardised bus crash simulations: without and with competence of TAS-triage and access to TAS-triage equipment. The instructors calculated triage accuracy and measured time consumption while the learners participated in a self-reported before-after study. Each question was scored on a 7-point Likert scale with points labelled "Did not work" (1) through "Worked excellent" (7). Results Among the 93 (85%) participating emergency service professionals, 48% confirmed the existence of a major incident triage system in their service, whereas 27% had access to triage tags. The simulations without TAS-triage resulted in a mean over- and undertriage of 12%. When TAS-Triage was used, no mistriage was found. The average time from "scene secured to all patients triaged" was 22 minutes (range 15-32) without TAS-triage vs. 10 minutes (range 5-21) with TAS-triage. The participants replied to "How did interdisciplinary cooperation of triage work?" with mean 4,9 (95% CI 4,7-5,2) before the course vs. mean 5,8 (95% CI 5,6-6,0) after the course, p < 0,001. Conclusions Our modified triage Sieve tool is feasible, time-efficient and accurate in allocating priority during simulated bus accidents and may serve as a candidate for a future national standard for major incident triage. PMID:20701802

2010-01-01

113

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

114

26 CFR 1.165-7 - Casualty losses.  

Code of Federal Regulations, 2010 CFR

...occurred to a building and ornamental or fruit trees used in a trade or business, the decrease...be measured by taking the building and trees into account separately, and not together...shall be determined for such building and trees. (ii) In determining a casualty...

2010-04-01

115

26 CFR 1.165-7 - Casualty losses.  

Code of Federal Regulations, 2011 CFR

...occurred to a building and ornamental or fruit trees used in a trade or business, the decrease...be measured by taking the building and trees into account separately, and not together...shall be determined for such building and trees. (ii) In determining a casualty...

2011-04-01

116

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

117

46 CFR 197.488 - Retention of records after casualty.  

Code of Federal Regulations, 2013 CFR

...casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or facility and those...Officer-in-Charge, Marine Inspection, that records need not be retained onboard. (b) The records required by paragraph (a) of...

2013-10-01

118

46 CFR 197.488 - Retention of records after casualty.  

Code of Federal Regulations, 2010 CFR

...casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or facility and those...Officer-in-Charge, Marine Inspection, that records need not be retained onboard. (b) The records required by paragraph (a) of...

2010-10-01

119

46 CFR 197.488 - Retention of records after casualty.  

Code of Federal Regulations, 2012 CFR

...casualty is made under § 197.484 shall retain all records onboard that are maintained on the vessel or facility and those...Officer-in-Charge, Marine Inspection, that records need not be retained onboard. (b) The records required by paragraph (a) of...

2012-10-01

120

Psychiatry and Casualties of War in Germany, 1914–18  

Microsoft Academic Search

This article traces the responses of German psychiatrists to epidemic numbers of shell-shocked men during the first world war, surveying the diagnostic, administrative and therapeutic dimensions of the ‘war neurosis’ problem. First it asks why hysteria, a diagnostic label once reserved for women, was used to diagnose many thousand of psychiatric casualties, and shows how male hysteria diagnosis emerged in

Paul Lerner

2000-01-01

121

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

122

Screening for Cognitive Impairment: A Triage for Outpatient Care  

Microsoft Academic Search

The current increase in aged individuals in number and proportionof the general population warrants dependable strategies to improve early detection of cognitive impairment. It was the goal of the present study to develop a triage for bedside testing and outpatient ser vices. In a prospective clinical cohort study at the outpatient Memory Clinic, University of Ulm, Germany, 232 subjects were

Ulrike Beinhoff; Verena Hilbert; Daniel Bittner; Georg Grön; Matthias W. Riepe

2005-01-01

123

Data triage enables extreme-scale August 1, 2014  

E-print Network

- 1 - Data triage enables extreme-scale computing August 1, 2014 The growing scale, size, and complexity of computing require prioritization to manage the data. However, resources are lacking to process all of the data fully, either by a computer or the end-user. To deal with the lack of resources, more

124

Using Social Metadata in Email Triage: Lessons from the Field  

Microsoft Academic Search

Email archives are full of social information, including how messages are addressed and frequency of contact between senders and receivers. To study the use of this rich metadata for email management, particularly email triage, we deployed SNARF, a prototype tool which uses social metadata to organize received email by correspondent, sort received email by past interactions, and filter email into

Danyel Fisher; A. J. Brush; Bernie Hogan; Marc A. Smith; Andy Jacobs

2007-01-01

125

THE RABIT: A RAPID AUTOMATED BIODOSIMETRY TOOL FOR RADIOLOGICAL TRIAGE  

E-print Network

Paper THE RABIT: A RAPID AUTOMATED BIODOSIMETRY TOOL FOR RADIOLOGICAL TRIAGE Guy Garty,* Youhua. Brenner* Abstract--In response to the recognized need for high through- put biodosimetry methods for use (Rapid Automated BIodosimetry Tool), designed to score micronuclei or -H2AX fluorescence in lymphocytes

126

Balancing human and system visualization during document triage  

E-print Network

of Search Results and Web-based Documents ............................. 12 3.3 Visualization of User Interests in a Document or Document Collection ............ 15 4 USER BEHAVIOR DURING TRIAGE...: ANNOTATION ON WEB-BASED DOCUMENT ................. 56 7.1 Annotation on a Web Page................................................................................ 56 7.2 Visualization of User Interest...

Bae, Soon Il

2009-05-15

127

Adoption of the 2006 Field Triage Decision Scheme for Injured Patients  

PubMed Central

Background: When emergency medical services (EMS) providers respond to the scene of an injury, they must decide where to transport the injured patients for further evaluation and treatment. This is done through a process known as “field triage”, whereby a patient’s injuries are matched to the most appropriate hospital. In 2005–2006 the National Expert Panel on Field Triage, convened by the Centers for Disease Control and Prevention and the National Highway Traffic Safety Administration, revised the 1999 American College of Surgeons Committee on Trauma Field Triage Decision Scheme. This revision, the 2006 Field Triage Decision Scheme, was published in 2006. Methods: State Public Health departments’ and EMS’ external websites were evaluated to ascertain the current status of implementation of the 2006 Field Triage Decision Scheme. Results: Information regarding field triage was located for 41 states. In nine states no information regarding field triage was available on their websites. Of the 41 states where information was located, seven were classified as “full adopters” of the 2006 Field Triage Decision Scheme; nine were considered “partial adopters”; 17 states were found to be using a full version or modification of the 1999 Field Triage Decision Scheme; and eight states were considered to be using a different protocol or scheme for field triage. Conclusion: Many states have adopted the 2006 Decision Scheme (full or partial). Further investigation is needed to determine the reasons why some states do not adopt the guidelines. PMID:21731782

Sasser, Scott M.; Ossmann, Eric; Wald, Marlena M.; Lerner, E. Brooke; Hunt, Richard C.

2011-01-01

128

Physiologic field triage criteria for identifying seriously injured older adults.  

PubMed

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

Newgard, Craig D; Richardson, Derek; Holmes, James F; Rea, Thomas D; Hsia, Renee Y; Mann, N Clay; Staudenmayer, Kristan; Barton, Erik D; Bulger, Eileen M; Haukoos, Jason S; The Western Emergency Services Translational Research Network Westrn Investigators

2014-01-01

129

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. PMID:1260617

Theoret, J.J.

1976-01-01

130

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

131

A Global Earthquake Building Damage and Casualty Database  

Microsoft Academic Search

\\u000a This chapter presents a preliminary overview of the Cambridge University Earthquake Damage Database (CUEDD) now the Cambridge\\u000a Earthquake Impact Database (CEQID) with emphasis on its human casualty component. CUEDD is based on earthquake damage data\\u000a assembled by the Martin Centre at Cambridge University since 1980, complemented by other more-recently published and some\\u000a unpublished data. The database through its organised, expandable

R. Spence; E. So; S. Jenkins; A. Coburn; S. Ruffle

132

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

133

Taxonomic triage and the poverty of phylogeny.  

PubMed

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

Wheeler, Quentin D

2004-04-29

134

Taxonomic triage and the poverty of phylogeny.  

PubMed Central

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

Wheeler, Quentin D

2004-01-01

135

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

136

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. PMID:21691524

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

2011-01-01

137

A Modified Sequential Organ Failure Assessment (MSOFA) Score for Critical Care Triage  

PubMed Central

Objective The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically-ill patients, but requires laboratory measurement of four parameters which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only one laboratory measurement would predict patient outcome as well as the SOFA score. Methods After a retrospective derivation, in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during calendar year 2008 and compared ability to predict mortality and need for mechanical ventilation. Results 1,770 patients (56% male) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% CI: 0.81-0.85) and 0.84 (95% CI 0.82-0.85) respectively (p=0.33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the ICU with an AUC of 0.78 and 0.79 respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted need for mechanical ventilation on Day 3 with an AUC of 0.83 and 0.82 respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58% respectively. Conclusions The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive. PMID:21149228

Grissom, Colin K.; Brown, Samuel M.; Kuttler, Kathryn G.; Boltax, Jonathan P.; Jones, Jason; Jephson, Al R.; Orme, James F.

2013-01-01

138

Tracking Civilian Casualties in Combat Zones using Civilian Battle Damage Assessment Ratios  

Microsoft Academic Search

The Civilian Battle Damage Assessment Ratio (CBDAR) is a method for assessing and tracking proportional patterns of civilian casualties from combat. CBDARs can be applied by both military forces and humanitarian organisations towards the common goal of minimising the civilian impact of conflict. These ratios complement absolute numbers on casualties, are easily integrated into existing assessment systems, and can track

Ewan Cameron; Michael Spagat; Madelyn Hsiao-Rei Hicks

2009-01-01

139

Initial experience with a rapid access blackouts triage clinic.  

PubMed

Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The U.K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate. PMID:21404775

Petkar, S; Bell, W; Rice, N; Iddon, P; Cooper, P; McKee, D; Curtis, N; Hanley, M; Stuart, J; Mackway Jones, K; Fitzpatrick, A P

2011-02-01

140

The effect of epilepsy on road traffic accidents and casualties.  

PubMed

A prospective study was carried out between October 1992 and June 1994 to investigate the effect of epilepsy as a risk factor in road traffic accidents (RTA) and casualties in the United Arab Emirates (UAE). The aim of this paper was to investigate the risk and effect of epilepsy on road traffic accidents and casualties and identify possible risk factors for traffic accidents and casualties and identify possible risk factors for traffic accidents and violations among these drivers. Most (70%) were young drivers and under age 40 years; 43% were UAE nationals; 41% had a primary school education; 48.8% had a full license to drive private or commercial taxis; 41% had less than two years driving experience and 17.1% used seat bolts regularly. Most (65.9%) admitted to crossing red traffic lights; 46.3% to parking in forbidden areas; 66% to speeding; 36% to smoking while driving; 34.1% to using the telephone whilst driving; 43.9% to putting their child in the front seat; 20.8% had been previously involved in an RTA; and 53.7% had sustained serious injury. A figure of 34.1% had at least one seizure per year and 26.8% had at least one seizure per month. The most common violations were careless driving (34.1%) and traffic regulation violations (24.4%). Significantly higher risk was observed for property damage (RR = 1.85; 95% CI = 0.64-5.14) and traffic violations (RR-1.91; 95% CI = 0.54-2.29). In the UAE there are no restrictions on the issue of driving licenses to people prone to epileptic seizures. In conclusion, it is emphasized that patients with conditions such as epilepsy should feel obliged to inform the traffic authorities or the health authorities about their condition. It seems likely that the problem could be greatly reduced if appropriate action was taken concerning epileptic drivers. It is hoped that the results and recommendations of this study will be useful to traffic and health authorities. PMID:8902924

Bener, A; Murdoch, J C; Achan, N V; Karama, A H; Sztriha, L

1996-09-01

141

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

142

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. PMID:19901137

Horwitz, Leora I.; Bradley, Elizabeth H.

2009-01-01

143

Volleyball injuries presenting in casualty: a prospective study.  

PubMed Central

During 1986, all sports injuries (n = 5222) were prospectively recorded at the two casualty departments in Arhus, Denmark. Volleyball injuries (n = 278) accounted for 5.3% of all sports injuries. An evaluation of the rehabilitation period and the consequences of the injuries was undertaken by questionnaire three years after the injury. The injury incidence was 1.9 injuries/1000 inhabitants/year. Hand, finger, and ankle sprains were the most frequent injuries. Female players had significantly more hand/finger injuries than male players, who incurred more ankle/foot injuries. Knee (6%) and ankle injuries (31%) were responsible for the longest duration of absence from sports participation. There were relatively few chronic injuries. The study suggests the need to enhance prophylactic measures with regard to blocking and overhand pass techniques, in order to reduce the number and extent of ankle and hand/finger injuries. PMID:8800857

Solgård, L; Nielsen, A B; Møller-Madsen, B; Jacobsen, B W; Yde, J; Jensen, J

1995-01-01

144

Acute compartment syndrome of the thigh in combat casualties.  

PubMed

Acute compartment syndrome of the thigh is a rare clinical entity often caused by high-energy trauma and presenting with a spectrum of associated injuries. Service members in combat are at risk for these causative mechanisms. This study presents a large cohort of thigh compartment syndrome combat casualties and investigates the injury mechanisms, associated mortality, and complications related to fasciotomies. Blasts were the most frequent injury mechanism, overall mortality was 23%, burns were associated with a higher mortality, and fasciotomy morbidity was reported by all respondents. The mortality was similar to civilian cohorts with thigh compartment syndrome and was isolated to patients with high Injury Severity Scores. While mortality associated with this injury is high, it is likely related to associated injury patterns rather than the compartment syndrome itself. Thigh compartment fasciotomies carried significant morbidity, consistent with civilian trauma publications. PMID:23449054

Masini, Brendan D; Racusin, Adam W; Wenke, Joseph C; Gerlinger, Tad L; Hsu, Joseph R

2013-01-01

145

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

146

State-level Lists of Casualties from the Vietnam Conflict (1957-)  

NSDL National Science Digital Library

The Center for Electronic Records of the US National Archives and Records Administration has recently added this database to its already existing casualty list for the Korean Conflict (discussed in the March 6, 1998 Scout Report). The database, which is only browseable, includes name of casualty, rank, branch of military service, "home of record," date of birth and death, "category of casualty," and an indicator as to whether the remains have been recovered. Records may be sorted alphabetically or by "home of record," within state. The database covers 1957-1995 and contains records for 58,187 individuals.

147

Emergency department triaging of admitted stroke patients--a Bayesian Network analysis.  

PubMed

This study uses hospital administrative data to ascertain the differences in the patient characteristics, process and outcomes of care between the Emergency Department (ED) triage categories of patients admitted from an ED presentation into a large metropolitan teaching hospital with a Stroke Care Unit. Bayesian Networks (BNs) derived from the administrative data were used to provide the descriptive models. Nearly half the patients in each stroke subtype were triaged as 'Urgent' (to be seen within 30 minutes). With a decrease in the urgency of triage categories, the proportion admitted within 8 hours decreased dramatically and the proportion of formal discharge increased. Notably, 45% of transient ischaemic attacks (TIAs) were categorized as 'Semi-urgent' (to be attended within 60 minutes), indicating an opportunity to improve emergency assessment of TIAs. The results illustrate the utility of hospital administrative data and the applicability of BNs for review of the current triage practices and subsequent impact. PMID:22193829

Nadathur, Shyamala G; Warren, James R

2011-12-01

148

Undertriage in the Manchester triage system: an assessment of severity and options for improvement  

Microsoft Academic Search

BackgroundThe Manchester Triage System (MTS) determines an inappropriately low level of urgency (undertriage) to a minority of children. The aim of the study was to assess the clinical severity of undertriaged patients in the MTS and to define the determinants of undertriage.MethodsPatients who had attended the emergency department (ED) were triaged according to the MTS. Undertriage was defined as a

N Seiger; M van Veen; E W Steyerberg; M Ruige; A H J van Meurs; H A Moll

2011-01-01

149

Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel.  

PubMed

In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community. PMID:22773617

Sarmiento, Kelly; Eckstein, Daniel; Zambon, Allison

2013-03-01

150

77 FR 75263 - Surety Companies Acceptable on Federal Bonds: Termination; ULLICO Casualty Company  

Federal Register 2010, 2011, 2012, 2013

...Surety Companies Acceptable on Federal Bonds: Termination; ULLICO Casualty Company...FOR FURTHER INFORMATION CONTACT: Surety Bond Branch at (202) 874-6850. SUPPLEMENTARY...qualify as an acceptable surety on Federal bonds is terminated immediately. Federal...

2012-12-19

151

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

Code of Federal Regulations, 2010 CFR

...Section 196.07-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS OPERATIONS Notice and Reporting of Casualty and Voyage Records § 196.07-1 Notice and reporting of...

2010-10-01

152

Medical Planning Tool for Projecting the Required Casualty Evacuation Assets in a Military Theater of Operations.  

National Technical Information Service (NTIS)

Military medical readiness for ground combat operations requires projections of the evacuation assets needed to transport the casualties incurred through the various echelons of medical care. The OPTEVAC planning tool was designed to minimize the required...

S. A. Matheny, D. C. Keith, S. C. Sundstrom, C. G. Blood

1997-01-01

153

Death and Doctrine: U.S. Army Officers' Perceptions of American Casualty Aversion, 1970-1999  

E-print Network

While academics and commentators have devoted considerable energy to analyzing the relationship between United States military casualties and the reaction of American public opinion, few have taken notice of the opinions and perceptions of military...

Johnson, Daniel I.

2011-08-08

154

Changes in the care of the battle casualty: lessons learned from the Falklands campaign.  

PubMed

In the Falklands War, advanced surgical centers were set up and 241 patients underwent surgery. There were three deaths. The patterns of wounding, method of casualty management, and lessons learned are discussed. PMID:10332172

Batty, C G

1999-05-01

155

Excelsior Surgical Society Edward D Churchill Lecture. Changes in combat casualty care.  

PubMed

There have been many positive changes in combat casualty care since Desert Storm. The Air Force has made a major change and significant improvement in combat casualty care, which is aided by the United States Army and Navy. The current care is second to none, including rehabilitation. This improvement in care and outcomes is due to the dedication of the doctors, nurses, corpsmen, pilots, and the incredible support services that make it happen. PMID:22626545

Trunkey, Donald

2012-06-01

156

The casualty chain inventory: a new scale for measuring peritraumatic responses: a cross-sectional study  

Microsoft Academic Search

Background  Peritraumatic psychological- and sensory impressions in victims of civilian accidents are only partly understood. This study\\u000a scrutinizes the level and duration of perceived psychological threat at scene of injury as well as in hospital (the casualty chain) measured by the Casualty Chain Inventory (CCI). The purpose of the study was to assess and validate\\u000a the CCI, and to examine the

Laila Skogstad; Erlend Hem; Leiv Sandvik; Øivind Ekeberg

2011-01-01

157

Iraq the Vote: Retrospective and Prospective Foreign Policy Judgments on Candidate Choice and Casualty Tolerance  

Microsoft Academic Search

In this article, we model the effect of foreign policy attitudes on both vote choice and casualty tolerance, using survey\\u000a data collected during the 2004 election. We show that prospective judgments of the likelihood of success in Iraq and retrospective\\u000a judgments of whether the war in Iraq was right are significant determinants of both vote choice and casualty tolerance. The

Christopher Gelpi; Jason Reifler; Peter Feaver

2007-01-01

158

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

E-print Network

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

Roblyer, Dwight Andrew

2011-02-22

159

Causes of casualties and the regulation of occupational health and safety in the shipping industry  

Microsoft Academic Search

The aim of this paper is to investigate maritime safety from an occupational hazards perspective as opposed to a maritime\\u000a casualty perspective. It is recognised that safety in shipping should encompass casualties arising from accidents occurring\\u000a in the course of performing normal seafaring duties, not just those arising from technical defects or maritime disasters.\\u000a The paper discusses an investigation involving

Detlef Nielsen; Photis M. Panayides

2005-01-01

160

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

PubMed

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

Farra, Sharon; Nicely, Stephanie; Hodgson, Eric

2014-10-01

161

Evaluation of Contingency Telemedical Support to Improve Casualty Care at a Simulated Military Intermediate Resuscitation Facility: The EM-ANGEL Study.  

PubMed

Objective: We sought to determine whether Contingency Telemedical Support (CTS) improves the success rate and efficiency of primary care providers performing critical actions during simulated combat trauma resuscitation. Critical actions included advanced airway, chest decompression, extremity hemorrhage control, hypothermia prevention, antibiotics and analgesics, and hypotensive resuscitation, among others. Background: Recent studies report improved survival associated with skilled triage and treatment in the out-of-hospital/preoperative phase of combat casualty care. Historically, ground combat units are assigned primary care physicians and physician assistants as medical staff, due to resource limitations. Although they are recognized as optimal resuscitators, demand for military trauma surgeons and emergency physicians exceeds supply and is unlikely to improve in the near term. Methods: A prospective trial of telemedical mentoring during a casualty resuscitation encounter was studied using a high-fidelity patient simulator (HFPS). Subjects were randomized and formed into experimental (CTS) or control teams. CTS team leaders were equipped with a headset/microphone interface and telementored by a combat-experienced emergency physician or trauma surgeon. A standardized, scripted clinical scenario and HFPS were used with 14 critical actions. At completion, subjects were surveyed. Statistical approach included contingency table analysis, two-tailed t-test, and correlation coefficient. This study was reviewed and approved by our institutional review board (IRB). Results: Eighteen CTS teams and 16 control teams were studied. By intention-to-treat ITT analysis, 89% of CTS teams versus 56% of controls completed all life-threatening inventions (LSIs) (p < .01); 78% versus 19% completed all critical actions (p < .01); and 89% versus 56% established advanced airways within 8 minutes (p < .06). Average time to completion in minutes (95% confidence interval [CI] 95) was 12 minutes (10?14) for CTS versus 18 (16?20) for controls, with 75% of control teams not completing all critical actions. Conclusion: In this model, real-time telementoring of simulated trauma resuscitation was feasible and improved accuracy and efficiency of non?emergency-trained resuscitators. Clinical validation and replicated study of these findings for guiding remote damage control resuscitation are warranted. PMID:24604439

Gerhardt, Robert; Berry, Jonathon; Mabry, Robert L; Flournoy, Lawrence; Arnold, Robert G; Hults, Christopher; Robinson, John B; Thaxton, Robert A; Cestero, Ramon; Heiner, Jason D; Koller, Alexandra R; Cox, Kevin M; Patterson, Jay N; Dalton, Warren R; McKeague, Anne L; Gilbert, Gary; Manemeit, Carl; Adams, Bruce D

2014-01-01

162

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. PMID:15693992

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

2005-01-01

163

Triage of Acute Abdominal Pain in Childhood: Clinical Use of a Palm Handheld in a Pediatric Emergency Department  

Microsoft Academic Search

The paper describes design and implementation of a mo- bile clinical triage support system for the evaluation of acute appendicitis in childhood. The MET (Mobile Emergency Triage) system was de- veloped according to the general principles of client- server architecture, with mobile clients running on Palm handhelds. Decision model implemented in MET follows the principles of evidence-based medicine based on

Wojtek Michalowski; Steven Rubin; Roman Slowinski; Szymon Wilk

2004-01-01

164

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

165

Evolution and challenges in the design of computational systems for triage assistance  

PubMed Central

Compared with expert systems for specific disease diagnosis, knowledge-based systems to assist decision making in triage usually try to cover a much wider domain but can use a smaller set of variables due to time restrictions, many of them subjective so that accurate models are difficult to build. In this paper we first study criteria that most affect the performance of systems for triage assistance. Such criteria include whether principled approaches from Machine Learning can be used to increase accuracy and robustness and to represent uncertainty, whether data and model integration can be performed or whether temporal evolution can be modeled to implement retriage or represent medication responses. Following the most important criteria we explore current systems and identify some missing features that, if added, may yield to more accurate triage systems. PMID:18337189

Abad-Grau, María M.; Ierache, Jorge; Cervino, Claudio; Sebastiani, Paola

2008-01-01

166

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

167

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

PubMed

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

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

2013-01-01

168

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

SciTech Connect

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

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

1981-10-01

169

Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.  

PubMed

In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador. PMID:20465071

Kaposy, Chris

2010-01-01

170

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. PMID:22520067

2012-01-01

171

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

172

Missed injuries in casualties from the Iraqi-Iranian war: a study of 35 cases.  

PubMed

Thirty-six injuries were missed in 35 casualties admitted to Basrah University Teaching Hospital from the Iraqi-Iranian war. The errors were made particularly in patients with severe multiple injuries. The incidence of missed injuries and the reasons for the diagnostic failures are discussed. The injuries that were overlooked mostly involved the peripheral nerves, and the factors leading to inadequate initial assessment were poor clinical routine, failure to interpret correctly the physical signs and poor use of X-ray facilities. Casualties with head injury, and those who presented with traumatic amputations, need particular care. Such patients are costly both in staff time and in investigations. PMID:3440608

Hamdan, T A

1987-01-01

173

On-Ground Casualty Risk Reduction by Structural Design for Demise  

NASA Astrophysics Data System (ADS)

In recent years, awareness concerning the risk posed by un-controlled re-entering spacecraft on ground has increased. Some re-entry events such as ESA's GOCE in 2013 and NASA's UARS appeared prominent in international media. Space agencies and nations, in cooperation within the Inter-Agency Space Debris Coordination Committee (IADC), have established a requirements to limited the on-ground risk for future missions. To meet the requirements, the amount of debris falling back on Earth has to be limited in number, mass and size. Design for demise (D4D) refers to all measures taken in the design of a space object to increase the potential for demise of the object and its components during re-entry. SCARAB (Spacecraft Atmospheric Re-entry and Break-Up) is ESA's high-fidelity tool which analyses the thermal and structural effects of atmospheric re-entry on spacecraft in a finite-element approach. For this study, a model of a representative satellite is developed in Scarab to serve as test-bed for D4D analysis on a structural level. The model is used as starting point for different D4D approaches based on increasing the exposure of the satellite components to the aero-thermal environment, as a way to speed up the demise. Statistical bootstrapping is applied to the resulting on-ground fragment lists in order to compare the different re-entry scenarios and to determine the uncertainties of the results. Moreover, the bootstrap results can be used to analyse the casualty risk estimator from a theoretical point of view. The risk reductions for the analysed D4D techniques are presented w.r.t. the reference scenario for the modelled representative satellite.

Lemmens, Stijn; Krag, Holger; Funke, Quirin

174

Mass  

SciTech Connect

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

Quigg, Chris (Fermilab) [Fermilab

2007-12-05

175

Emergency department triaging of admitted stroke patients—A Bayesian Network analysis  

Microsoft Academic Search

This study uses hospital administrative data to ascertain the differences in the patient characteristics, process and outcomes of care between the Emergency Department (ED) triage categories of patients admitted from an ED presentation into a large metropolitan teaching hospital with a Stroke Care Unit. Bayesian Networks (BNs) derived from the administrative data were used to provide the descriptive models. Nearly

Shyamala G Nadathur; James R Warren

2011-01-01

176

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

177

ARTEMIS: A Vision for Remote Triage and Emergency Management Information Integration  

Microsoft Academic Search

This paper describes the design of an automated triage and emergency management information system. The prototype system is capable of monitoring and assessing physiological parameters of individuals, transmitting pertinent medical data to and from multiple echelons of medical service, and providing filtered data for command and control applications. The system employs wireless networking, portable computing devices, and reliable messaging technology

Susan P. McGrath; Eliot Grigg; Suzanne Wendelken; George Blike; Michael De Rosa; Aaron Fiske; Robert Gray

178

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

E-print Network

The RABiT: A Rapid Automated Biodosimetry Tool for radiological triage. II. Technological the Center for Minimally Invasive Radiation Biodosimetry at Columbia University has developed the Rapid Automated Biodosimetry Tool (RABiT), a completely automated, ultra-high throughput biodosimetry workstation

Yao, Y. Lawrence

179

HYPERSPECTRAL AND LUMINESCENCE OBSERVER (HALO) MARS MISSION CONCEPT -INNOVATIVE DATA TRIAGE, COMPRESSION, PROCESSING AND  

E-print Network

conducted from orbit has played a key role in the evolution ofour understanding ofthe surface geology ofMarsHYPERSPECTRAL AND LUMINESCENCE OBSERVER (HALO) MARS MISSION CONCEPT - INNOVATIVE DATA TRIAGE (HALO) instrument concept, designed to conduct surface mapping of Mars as part ofthe Mars Sample Return

Long, Bernard

180

Comprehensive Strategy for the Evaluation and Triage of the Chest Pain Patient  

Microsoft Academic Search

See related editorial, p 168.Study objective: To evaluate the safety and efficacy of a systematic evaluation and triage strategy including immediate resting myocardial perfusion imaging in patients presenting to the emergency department with chest pain of possible ischemic origin. Methods: We conducted an observational study of 1,187 consecutive patients seen in the ED of an urban tertiary care hospital with

James L Tatum; Robert L Jesse; Michael C Kontos; Christopher S Nicholson; Kristin L Schmidt; Charlotte S Roberts; Joseph P Ornato

1997-01-01

181

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

ERIC Educational Resources Information Center

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

Kunisch, Joseph Martin

2012-01-01

182

Battlefield Casualty Extraction Device for Unmanned Ground Vehicles Zachary Sabato Jonathan Sente Sajeel Shiromani David Williams  

E-print Network

· Sajeel Shiromani · David Williams 95th Percentile: 350 lbs Motivation: Robotically extract casualties thus keeping medics out of harm's way Lift Gate Articulated Arm Litter Tray 8 DOF End Physics Based Simulation · Stress Testing (Strain Gage) · ANYSYS and ProMECHANICA · Physics

Oh, Paul

183

Property and Casualty Solvency Funds as a Tax and Social Insurance System  

Microsoft Academic Search

When a Property and Casualty (P&C) insurance company becomes insolvent, solvent insurance companies are forced to pay assessments (a form of taxation) to state guarantee funds ('solvency funds') in order to protect the policyholders of the failed companies. We produce estimates of the costs to the guarantee funds of resolving P&C insurance company insolvencies. We find that the total net

James Bohn; Brian J. Hall

1995-01-01

184

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

185

75 FR 22689 - Surety Companies Acceptable on Federal Bonds: General Casualty Company of Wisconsin  

Federal Register 2010, 2011, 2012, 2013

...Surety Companies Acceptable on Federal Bonds: General Casualty Company of Wisconsin...FOR FURTHER INFORMATION CONTACT: Surety Bond Branch at (202) 874-6850. SUPPLEMENTARY...Authority as an acceptable surety on Federal bonds is hereby issued under 31 U.S.C....

2010-04-29

186

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

Federal Register 2010, 2011, 2012, 2013

...Surety Companies Acceptable on Federal Bonds: Grange Mutual Casualty Company AGENCY...FOR FURTHER INFORMATION CONTACT: Surety Bond Branch at (202) 874-6850. SUPPLEMENTARY...Authority as an acceptable surety on Federal bonds is hereby issued under 31 U.S.C....

2012-02-15

187

26 CFR 20.2054-1 - Deduction for losses from casualties or theft.  

...or theft. A deduction is allowed for losses incurred during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from theft, if the losses are not compensated for by insurance or otherwise. If the loss is...

2014-04-01

188

26 CFR 20.2054-1 - Deduction for losses from casualties or theft.  

Code of Federal Regulations, 2010 CFR

...or theft. A deduction is allowed for losses incurred during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from theft, if the losses are not compensated for by insurance or otherwise. If the loss is...

2010-04-01

189

26 CFR 20.2054-1 - Deduction for losses from casualties or theft.  

Code of Federal Regulations, 2013 CFR

...or theft. A deduction is allowed for losses incurred during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from theft, if the losses are not compensated for by insurance or otherwise. If the loss is...

2013-04-01

190

26 CFR 20.2054-1 - Deduction for losses from casualties or theft.  

Code of Federal Regulations, 2011 CFR

...or theft. A deduction is allowed for losses incurred during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from theft, if the losses are not compensated for by insurance or otherwise. If the loss is...

2011-04-01

191

26 CFR 20.2054-1 - Deduction for losses from casualties or theft.  

Code of Federal Regulations, 2012 CFR

...or theft. A deduction is allowed for losses incurred during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from theft, if the losses are not compensated for by insurance or otherwise. If the loss is...

2012-04-01

192

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

193

The battle for Hue: casualty and disease rates during urban warfare.  

PubMed

Renewed nationalism with the ending of the Cold War has precipitated numerous conflicts between regions or countries that were formerly united. Hostilities between some ethnic and nationalistic factions have reached the point where regional security is threatened and United Nations-sanctioned military operations may be required. Because some U.N. operations could require the forcible removal of an entrenched faction from an urban setting, the present investigation seeks to determine the levels of medical casualties that might be sustained during urban warfare. Casualty rates and illness incidence were examined for U.S. Marine forces participating in the retaking of the city of Hue during the Tet offensive in 1968. The casualty rates were analyzed for different phases of the urban assault and contrasted with a different period of the Vietnam Conflict, and with the high intensity battle for Okinawa during World War II. Rates of casualties during the retaking of Hue were highest during the two phases of the operation that required close-quarter fighting. The house-to-house fighting south of the river yielded a wounded rate of 37.9 per 1,000 strength per day, while the fighting in the inner city yielded a rate of 44.4. Rate of wounded during the "mopping-up" phase was 5.8. The rate of illness incidence was stable over the month-long operation and showed no concomitant increase with battle intensity." PMID:7800172

Blood, C G; Anderson, M E

1994-09-01

194

Potential prevention of medical errors in casualty surgery by using information technology  

Microsoft Academic Search

Recent studies on adverse events in medicine have shown that errors in medicine are not rare and may cause severe harm. Quality problems in discharge letters may be a source of medical error. We have analyzed 150 discharge letters of an outpaitient clinic for casualty surgery in order to identify and to classify typical mistakes. A Failure Mode and Effect

D. Mann; P. Jancke; Klaus Kuhn; Richard Lenz

2004-01-01

195

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

196

Effects of Age and Human Papilloma Viral Load on Colposcopy Triage: Data From the Randomized Atypical Squamous Cells of Undetermined Significance\\/ Low-Grade Squamous Intraepithelial Lesion Triage Study (ALTS)  

Microsoft Academic Search

Background: Testing for oncogenic human papillomavirus (HPV) DNA at a 1.0-pg\\/mL threshold represents a promising approach for colposcopy triage of atypical squamous cells of undetermined significance (ASCUS), but not for low-grade squamous intraepithelial lesions (LSIL). Considering age or viral load could improve colposcopy triage. Methods: We determined the sensitivity for detecting Cervical Intraepithe- lial Neoplasia 3 (CIN3) and cancer and

Mark E. Sherman; Mark Schiffman; J. Thomas Cox

197

A Multi-Site Assessment of the ACSCOT Field Triage Decision Scheme for Identifying Seriously Injured Children and Adults  

PubMed Central

Background ACSCOT has developed and updated field trauma triage protocols for decades, yet the ability to identify major trauma patients remains unclear. We estimate the diagnostic value of the Field Triage Decision Scheme for identifying major trauma patients (Injury Severity Score [ISS] ? 16) in a large and diverse multi-site cohort. Study Design This was a retrospective cohort study of injured children and adults transported by 94 EMS agencies to 122 hospitals in 7 regions of the Western U.S. from 2006 through 2008. Patients who met any of the field trauma triage criteria (per EMS personnel) were considered triage positive. Hospital outcome measures were probabilistically linked to EMS records through trauma registries, state discharge data and emergency department data. The primary outcome defining a “major trauma patient” was ISS ? 16. Results 122,345 injured patients were evaluated and transported by EMS over the 3-year period, of who 34.5% met at least one triage criterion and 5.8% had ISS ? 16. The overall sensitivity and specificity of the criteria for identifying major trauma patients were 85.8% (95% CI 85.0 – 86.6%) and 68.7% (95% CI 68.4 – 68.9%). Triage sensitivity and specificity differed by age: 84.1% and 66.4% (0 – 17 years); 89.5% and 64.3% (18 – 54 years); and 79.9% and 75.4% (? 55 years). Evaluating the diagnostic value of triage by hospital destination (transport to Level I/II trauma centers) did not substantially improve these findings. Conclusions The sensitivity of the Field Triage Decision Scheme for identifying major trauma patients is lower and specificity higher than previously described, particularly among elders. PMID:22107917

Newgard, Craig D; Zive, Dana; Holmes, James F; Bulger, Eileen M; Staudenmayer, Kristan; Liao, Michael; Rea, Thomas; Hsia, Renee Y; Wang, N Ewen; Fleischman, Ross; Jui, Jonathan; Mann, N Clay; Haukoos, Jason S; Sporer, Karl A; Gubler, K Dean; Hedges, Jerris R

2011-01-01

198

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

E-print Network

Recent terrorist events (e.g., London, Madrid, and Bombay train bombings), as well as the attacks on September 11, 2001, have highlighted the impact casualties can have on domestic audiences. These incidents led to major foreign policy shifts...

Mosher, Katrina N.

2009-05-15

199

Using the OntoGene pipeline for the triage task of BioCreative 2012.  

PubMed

In this article, we describe the architecture of the OntoGene Relation mining pipeline and its application in the triage task of BioCreative 2012. The aim of the task is to support the triage of abstracts relevant to the process of curation of the Comparative Toxicogenomics Database. We use a conventional information retrieval system (Lucene) to provide a baseline ranking, which we then combine with information provided by our relation mining system, in order to achieve an optimized ranking. Our approach additionally delivers domain entities mentioned in each input document as well as candidate relationships, both ranked according to a confidence score computed by the system. This information is presented to the user through an advanced interface aimed at supporting the process of interactive curation. Thanks, in particular, to the high-quality entity recognition, the OntoGene system achieved the best overall results in the task. PMID:23396322

Rinaldi, Fabio; Clematide, Simon; Hafner, Simon; Schneider, Gerold; Grigonyte, Gintare; Romacker, Martin; Vachon, Therese

2013-01-01

200

[Lay emphasis on the treatment of massive burn casualties in conflagration].  

PubMed

Burn surgery belongs to disaster medicine. Burn is a common trauma that occurs in social activities of human beings in all ages, either in the time of peace or war. During the development of human medicine in modern times, the summary of experience in treating massive burn casualties due to severe fire accidents has effectively promoted the renovation of treating technology and theory of burns and the development of burn surgery. The results of treatment of burn injury in casualties occurred in the fire of Cocoanut Grove night club in Boston in 1942, and the high-rise apartment house fire in Shanghai in 2010 were summarized and analyzed in this article, emphasizing the correlating issues of inhalation injury. PMID:22967968

Tang, Hong-tai; Ma, Bing; Xia, Zhao-fan

2012-06-01

201

Clinical management of casualties exposed to lung damaging agents: a critical review  

PubMed Central

There is no specific antidote for the treatment of casualties exposed to chlorine, phosgene, or mustards; therefore, management is largely supportive. Corticosteroid treatment has been given to casualties accidentally exposed to chlorine. Clinical data on efficacy are inconclusive as the numbers given steroids have been small and the indications for administration unclear. There have been no clinical controlled studies. There is a stronger evidence base from animal studies, particularly from porcine and rodent models. Lung injury induced by phosgene and mustard appears to be mediated by glutathione depletion, lipid peroxidation, free radical generation, and subsequent cellular toxicity. There is limited evidence to suggest that repletion of glutathione reduces and/or prevents lung damage by these agents. This may provide an opportunity for therapeutic intervention. PMID:16714497

Russell, D; Blaine, P G; Rice, P

2006-01-01

202

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. PMID:21801106

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

203

On the origin of mass casualty incidents in Kosovo, Yugoslavia, in 1990  

Microsoft Academic Search

In March 1990, a mysterious outbreak of illness spread suddenly among thousands of ethnic Albanian high school students in Kosovo (Yugoslavia). It was an unprecedented event on the worldwide scale both in terms of the number of cases and in terms of controversies concerning the aetiology. A retrospective analysis indicated that the epidemic consisted mainly of cases who felt ill

Z. Radovanovic

1996-01-01

204

Micronucleus test for radiation biodosimetry in mass casualty events: Evaluation of visual and automated scoring  

Microsoft Academic Search

In the case of a large-scale nuclear or radiological incidents a reliable estimate of dose is an essential tool for providing timely assessment of radiation exposure and for making life-saving medical decisions. Cytogenetics is considered as the “gold standard” for biodosimetry. The dicentric analysis (DA) represents the most specific cytogenetic bioassay. The micronucleus test (MN) applied in interphase in peripheral

Claudia Bolognesi; Cristina Balia; Paola Roggieri; Francesco Cardinale; Paolo Bruzzi; Francesca Sorcinelli; Florigio Lista; Raffaele D’Amelio; Enzo Righi

2011-01-01

205

Are we preparing health services administration students to respond to bioterrorism and mass casualty management?  

PubMed

Bioterrorism/natural disaster events add significant specialized demands and disrupt normal operation of the health system, often for an indefinite period of time. Health administration leaders should be educationally prepared for and informed about these potential events, but few receive this knowledge via their academic preparation in health administration. This study examined the existence of coverage of bioterrorism topics in health administration curricula and characteristics of bioterrorism coverage in current health administration programs through a self-completed survey among AUPHA graduate and undergraduate program members. Of the total survey respondents, only 32% of programs have current coverage of bioterrorism. The main reasons for nothavingbioterrorism coverage were not having enough resources; not having enough time to develop course/materials; and not thinking it is necessary to add these courses/materials. To prepare better and to inform future health administrators regarding major disruptive circumstances, advocacy and documentation are important to develop and implement bioterrorism awareness. Possibly, suggested minimum curricular requirements, content, and mechanisms for inclusion can be developed in the near future. Health administration educators should address the new reality and demonstrate that their graduates can function and lead in crises and situations disruptive to normal commerce. PMID:16700442

Houser, Shannon H; Houser, Howard W

2006-01-01

206

After-hours paediatric telephone triage and advice: the Neuchâtel experience  

Microsoft Academic Search

Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice

Sybil Bolli; Guy Van Melle; Bernard Laubscher

2005-01-01

207

DRAFT: RABIT - RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGHPUT RADIOLOGICAL TRIAGE  

Microsoft Academic Search

This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control V.S. soft time control cycles. The design and

Youhua Chen; Jian Zhang; Hongliang Wang; Guy Garty; Yanping Xu; Oleksandra V. Lyulko; Helen Turner; Gerhard Randers-Pehrson; Nabil Simaan; Y. Lawrence Yao; D. J. Brenner

2009-01-01

208

3q26 Amplification Is an Effective Negative Triage Test for LSIL: A Historical Prospective Study  

PubMed Central

Background Women with low grade squamous intraepithelial lesions (LSIL) at cervical cancer screening are currently referred for further diagnostic work up despite 80% having no precancerous lesion. The primary purpose of this study is to measure the test characteristics of 3q26 chromosome gain (3q26 gain) as a host marker of carcinogenesis in women with LSIL. A negative triage test may allow these women to be followed by cytology alone without immediate referral to colposcopy. Methods and Findings A historical prospective study was designed to measure 3q26 gain from the archived liquid cytology specimens diagnosed as LSIL among women attending colposcopy between 2007 and 2009. 3q26 gain was assessed on the index liquid sample; and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were measured at immediate triage and at 6–16 months after colposcopic biopsy. The sensitivity of 3q26 gain measured at immediate triage from automated and manually reviewed tests in 65 non-pregnant unique women was 70% (95% CI: 35, 93) with a NPV of 89% (95% CI: 78, 96). The sensitivity and NPV increased to 80% (95% CI: 28, 99) and 98% (95% CI: 87, 100), respectively, when only the automated method of detecting 3q26 gain was used. Conclusions 3q26 gain demonstrates high sensitivity and NPV as a negative triage test for women with LSIL, allowing possible guideline changes to routine surveillance instead of immediate colposcopy. Prospective studies are ongoing to establish the sensitivity, specificity, PPV and NPV of 3q26 gain for LSIL over time. PMID:22792164

Heitmann, Erica R.; Lankachandra, Kamani M.; Wall, Jeff; Harris, George D.; McKinney, Hollie J.; Jalali, G. Reza; Verma, Yogita; Kershnar, Eric; Kilpatrick, Michael W.; Tsipouras, Petros; Harper, Diane M.

2012-01-01

209

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

PubMed

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

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

2014-02-01

210

Should physicians prepare for war? 1. The obligation to care for the casualties.  

PubMed

This is an introduction to a set of four commentaries on the controversy that has arisen over whether physicians should cooperate in Defense Department planning for the care of military casualties, airlifted to U.S. civilian hospitals, in the event of a large-scale war. The commentaries are by Jay C. Bisgard, H. Jack Geiger, James T. Johnson, and Thomas H. Murray. PMID:7096057

Bisgard, J C

1982-04-01

211

“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

212

Coastal flood risks and seasonal tourism: analysing the effects of tourism dynamics on casualty calculations  

Microsoft Academic Search

Since coastal tourism is one of the fastest growing sectors of tourism industry, coastal areas have become increasingly vulnerable\\u000a in the case of flooding. While in recent years a number of different methods have been put forward to map coastal flood risks,\\u000a the implications of tourism dynamics for the assessment of human casualties has remained largely overlooked in these models.

Wim Kellens; Tijs Neutens; Pieter Deckers; Johan Reyns; Philippe De Maeyer

213

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

214

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

215

Cause of casualty and drinking patterns: an emergency room study of unintentional injuries.  

PubMed

A probability sample of 1494 adult casualty patients sampled in four hospitals in a single Californian county were breathalyzed and interviewed regarding the cause of injury, drinking prior to the injury, quantity and frequency of usual drinking, frequency of drunkenness and prior alcohol-related accidents. In the total sample, 9% were positive on the breathalyzer (4% were at or above 0.10), 17% reported drinking within 6 h prior to the injury, and 29% reported heavy drinking during the last year. Overall, 15% reported a prior alcohol-related accident and this was significantly greater among heavy drinkers than other drinkers. Cause of casualty (fall, cutting/piercing, motor vehicle accident, other collision, fire, other cause) in relation to alcohol consumption variables was analyzed separately in gender- and age-specific categories. Few significant associations were found between drinking variables and individual causes of injury. While these findings may be due to the relatively small number of cases for some causes, as well as to other variables not examined here including severity and type of injury, such baseline exploratory data are important in furthering our understanding of alcohol's involvement in casualty occurrence and point to the need for additional research on alcohol and causes of injury. PMID:8082557

Cherpitel, C J

1994-03-01

216

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. PMID:22828610

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

2012-01-01

217

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. PMID:24376365

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

2014-01-01

218

Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza.  

PubMed

The purpose of this study was to identify supplementary criteria to provide direction when the Ontario Health Plan for an Influenza Pandemic (OHPIP) critical care triage protocol is rendered insufficient by its inability to discriminate among patients assessed as urgent, and there are insufficient critical care resources available to treat those in that category. To accomplish this task, a Supplementary Criteria Task Force for Critical Care Triage was struck at the University of Toronto Joint Centre for Bioethics. The task force reviewed publically available protocols and policies on pandemic flu planning, identified 13 potential triage criteria and determined a set of eight key ethical, legal and practical considerations against which it assessed each criterion. An online questionnaire was distributed to clinical, policy and community stakeholders across Canada to obtain feedback on the 13 potential triage criteria toward selecting those that best met the eight considerations. The task force concluded that the balance of arguments favoured only two of the 13 criteria it had identified for consideration: first come, first served and random selection. The two criteria were chosen in part based on a need to balance the clearly utilitarian approach employed in the OHPIP with equity considerations. These criteria serve as a defensible "fail safe" mechanism for any triage protocol. PMID:25191808

Winsor, Shawn; Bensimon, Cécile M; Sibbald, Robert; Anstey, Kyle; Chidwick, Paula; Coughlin, Kevin; Cox, Peter; Fowler, Robert; Godkin, Dianne; Greenberg, Rebecca A; Shaul, Randi Zlotnik

2014-01-01

219

A Triple-Option Analgesia Plan for Tactical Combat Casualty Care: TCCC Guidelines Change 13-04.  

PubMed

Although the majority of potentially preventable fatalities among U.S. combat forces serving in Afghanistan and Iraq have died from hemorrhagic shock, the majority of U.S. medics carry morphine autoinjectors for prehospital battlefield analgesia. Morphine given intramuscularly has a delayed onset of action and, like all opioids, may worsen hemorrhagic shock. Additionally, on a recent assessment of prehospital care in Afghanistan, combat medical personnel noted that Tactical Combat Casualty Care (TCCC) battlefield analgesia recommendations need to be simplified?there are too many options and not enough clear guidance on which medication to use in specific situations. They also reported that ketamine is presently being used as a battlefield analgesic by some medics in theater with good results. This report proposes that battlefield analgesia be achieved using one or more of three options: (1) the meloxicam and Tylenol in the TCCC Combat Pill Pack for casualties with relatively minor pain who are still able to function as effective combatants; (2) oral transmucosal fentanyl citrate (OTFC) for casualties who have moderate to severe pain, but who are not in hemorrhagic shock or respiratory distress and are not at significant risk for developing either condition; or (3) ketamine for casualties who have moderate to severe pain but who are in hemorrhagic shock or respiratory distress or are at significant risk for developing either condition. Ketamine may also be used to increase analgesic effect for casualties who have previously been given opioids (morphine or fentanyl.). PMID:24604434

Butler, Frank K; Kotwal, Russ S; Buckenmaier, Chester C; Edgar, Erin P; O'Connor, Kevin C; Montgomery, Harold R; Shackelford, Stacy A; Gandy, John V; Wedmore, Ian S; Timby, Jeffrey W; Gross, Kirby R; Bailey, Jeffrey A

2014-01-01

220

Application and prospect of a high-resolution remote sensing and geo-information system in estimating earthquake casualties  

NASA Astrophysics Data System (ADS)

An accurate estimation of a casualty rate is critical in response to earthquake disasters, and could allow an increase in the survival rate. Building damage is considered to be a major cause of earthquake casualties in developing countries. High-resolution satellite imagery (HRSI) can be used to detect the building damage in a period of a short time. This makes it possible to use a model to estimate earthquake casualties immediately after the occurrence of an earthquake. With respect to the capability of HRSI, this study built a new model for estimating the casualty rate in an earthquake disaster based on remote sensing and a geographical information system. Three groups of earthquake data, the 2003 Bam earthquake, the 2008 Wenchuan earthquake, and the 2010 Yushu earthquake, were used to evaluate this model. The results indicated that our new model significantly improved the accuracy in predicting the casualty rate. The parameters used in the model vary between developed and developing countries. This study could provide valuable information for a more efficient rescue operation in response to earthquakes.

Feng, T.; Hong, Z.; Fu, Q.; Ma, S.; Jie, X.; Wu, H.; Jiang, C.; Tong, X.

2014-08-01

221

The importance of operational definitions in design of a combat casualty information system.  

PubMed

Attention to the quality of information in design of a medical information system is fundamental to the success of that system. This point is made using WWI and WWII combat casualty statistics. While the analyses presented are legitimate, serious problems of interpretation arise from the operational definitions used in gathering and analyzing these data. The impact of this is illustrated in a hypothetical battle, a model emphasizing the introduction of biases resulting from an apparent inattention to operational definitions on the part of combat care managers in WWII. The paper concludes with some broad recommendations. PMID:6358400

Henderson, J V

1983-10-01

222

Emergency Medical Text Classifier: New system improves processing and classification of triage notes  

PubMed Central

Objective Automated syndrome classification aims to aid near real-time syndromic surveillance to serve as an early warning system for disease outbreaks, using Emergency Department (ED) data. We present a system that improves the automatic classification of an ED record with triage note into one or more syndrome categories using the vector space model coupled with a ‘learning’ module that employs a pseudo-relevance feedback mechanism. Materials and Methods: Terms from standard syndrome definitions are used to construct an initial reference dictionary for generating the syndrome and triage note vectors. Based on cosine similarity between the vectors, each record is classified into a syndrome category. We then take terms from the top-ranked records that belong to the syndrome of interest as feedback. These terms are added to the reference dictionary and the process is repeated to determine the final classification. The system was tested on two different datasets for each of three syndromes: Gastro-Intestinal (GI), Respiratory (Resp) and Fever-Rash (FR). Performance was measured in terms of sensitivity (Se) and specificity (Sp). Results: The use of relevance feedback produced high values of sensitivity and specificity for all three syndromes in both test sets: GI: 90% and 71%, Resp: 97% and 73%, FR: 100% and 87%, respectively, in test set 1, and GI: 88% and 69%, Resp: 87% and 61%, FR: 97% and 71%, respectively, in test set 2. Conclusions: The new system for pre-processing and syndromic classification of ED records with triage notes achieved improvements in Se and Sp. Our results also demonstrate that the system can be tuned to achieve different levels of performance based on user requirements. PMID:25379126

Haas, Stephanie W.; Travers, Debbie; Waller, Anna; Mahalingam, Deepika; Crouch, John; Schwartz, Todd A.; Mostafa, Javed

2014-01-01

223

Using the Design for Demise Philosophy to Reduce Casualty Risk Due to Reentering Spacecraft  

NASA Technical Reports Server (NTRS)

Recently the reentry of a number of vehicles has garnered public attention due to their risk of human casualty due to fragments surviving reentry. In order to minimize this risk for their vehicles, a number of NASA programs have actively sought to minimize the number of components likely to survive reentry at the end of their spacecraft's life in order to meet and/or exceed NASA safety standards for controlled and uncontrolled reentering vehicles. This philosophy, referred to as "Design for Demise" or D4D, has steadily been adopted, to at least some degree, by numerous programs. The result is that many programs are requesting evaluations of components at the early stages of vehicle design, as they strive to find ways to reduce the number surviving components while ensuring that the components meet the performance requirements of their mission. This paper will discuss some of the methods that have been employed to ensure that the consequences of the vehicle s end-of-life are considered at the beginning of the design process. In addition this paper will discuss the technical challenges overcome, as well as some of the more creative solutions which have been utilized to reduce casualty risk.

Kelley, R. L.

2012-01-01

224

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

225

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

226

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

227

A Physiotherapy Triage Service for Orthopaedic Surgery: An Effective Strategy for Reducing Wait Times  

PubMed Central

ABSTRACT Purpose: To investigate the effectiveness of a physiotherapy triage service for orthopaedic surgery referrals from primary-care physicians. Methods: A prospective, observational design was used with patients referred to an orthopaedic surgeon based out of two small urban centres in British Columbia. The level of agreement between the physiotherapist and surgeon was determined using a weighted kappa statistic (?w) with 95% CI. A patient satisfaction questionnaire was administered, and the surgical conversion rate (SCR) was calculated to assess the level of appropriate referrals. Results: The analysis found substantial agreement (?w=0.77; 95% CI, 0.60–0.94) between surgeon and physiotherapist for surgical management decisions. All patients reported being “satisfied” or “very satisfied” with the overall care they received from the physiotherapist. The SCR of patients referred by the physiotherapist to the surgeon was 91%, versus 22% among patients referred by a general practitioner or emergency physician. Conclusion: More than three-fourths of patients referred by primary-care physicians did not need to see a surgeon and were able to be managed by an experienced orthopaedic physiotherapist. This triage model could have considerable impact on orthopaedic wait times in Canada by minimizing unnecessary referrals; the model could also promote timely and conservative management of non-surgical conditions by physiotherapists. PMID:24396164

McCormack, Robert G.; Hunt, Michael A.; Brooks-Hill, Alexandra

2013-01-01

228

Application of topical local anesthetic at triage reduces treatment time for children with lacerations: a randomized controlled trial  

Microsoft Academic Search

Study objective: We determine whether application of topical local anesthetic at triage reduces total treatment time for children with simple lacerations. Methods: This prospective, randomized, double-blind, controlled trial was conducted in an urban pediatric emergency department (ED). Participants were children who were aged 1 to 10 years and had simple lacerations. Exclusions were wounds to digits, ears, penis, nose, or

Stephen Priestley; Anne-Maree Kelly; Linda Chow; Colin Powell; Anne Williams

2003-01-01

229

A Comparison of Wait Times and Patients Leaving Without Being Seen When Licensed Nurses Versus Unlicensed Assistive Personnel Perform Triage  

Microsoft Academic Search

IntroductionIn today's health care environment, nurses are sometimes substituted with unlicensed assistive personnel (UAP), despite the lack of research into the possible negative effects. This study compared the wait time and the number of patients who left without being seen (LWBS) between triage systems that use nurses (including licensed practical nurses, nurses with an associate's degree, and nurses with a

Diane Louise Paulson

2004-01-01

230

Clay Templeton, Travis Brown, Sayan Battacharyya, and Jordan Boyd-Graber. Mining the Dispatch under Super-vision: Using Casualty Counts to Guide Topics from the Richmond Daily Dispatch Corpus. Chicago Colloquium  

E-print Network

Super- vision: Using Casualty Counts to Guide Topics from the Richmond Daily Dispatch Corpus. Chicago = {Chicago, IL}, Title = {Mining the Dispatch under Supervision: Using Casualty Counts to Guide Topics from the Richmond Daily D } 1 #12;Mining the Dispatch under Supervision: Using Casualty Counts to Guide Topics from

Boyd-Graber, Jordan

231

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

232

A Framework for Comparative Evaluation of Dosimetric Methods to Triage a Large Population Following a Radiological Event.  

PubMed

BACKGROUND: To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. OBJECTIVE: To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. METHODS: We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. CONCLUSIONS: This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods' strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation. PMID:21949481

Flood, Ann Barry; Nicolalde, Roberto J; Demidenko, Eugene; Williams, Benjamin B; Shapiro, Alla; Wiley, Albert L; Swartz, Harold M

2011-09-01

233

A Framework for Comparative Evaluation of Dosimetric Methods to Triage a Large Population Following a Radiological Event  

PubMed Central

Background To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. Objective To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. Methods We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. Conclusions This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods’ strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation. PMID:21949481

Flood, Ann Barry; Nicolalde, Roberto J.; Demidenko, Eugene; Williams, Benjamin B.; Shapiro, Alla; Wiley, Albert L.; Swartz, Harold M.

2011-01-01

234

Long-term disabilities associated with combat casualties: measuring disability and reintegration in combat veterans.  

PubMed

Many physical and mental health problems associated with combat casualties affect the reintegration of service members into home and community life. Quantifying and measuring reintegration is important to answer questions about clinical, research, economic, and policy issues that directly affect combat veterans. Although the construct of participation presented in the International Statistical Classification of Diseases and Related Health Problems and in the International Classification of Functioning, Disability and Health provides a theoretical framework with which to understand and measure community reintegration in general, a measure was needed that specifically addressed the reintegration of combat veterans. To address this need, the Community Reintegration for Service Members global outcomes measure was developed. It consists of three scales, which measure extent of participation, perceived limitations, and satisfaction. The measure was validated in a general sample of veterans and in a sample of severely wounded service members. The computer-adapted test version shows good precision, reliability, construct validity, and predictive validity. PMID:22865133

Resnik, Linda; Reiber, Gayle

2012-01-01

235

Pedestrian Injury Patterns According to Car and Casualty Characteristics in France  

PubMed Central

This paper describes the injury patterns of pedestrians involved in collisions with cars, compares them with other road casualties and estimates the possible effect of car front profile on injury location. Injury patterns were identified using the Rhône Road Trauma Registry which covers all the casualties resulting from crashes in the Rhône Département (1.6 million inhabitants) who seek medical care in health facilities. Fatality rates were estimated from national police reports for the same years (1996–2007), and the two data sources were linked to obtain information on the front profile of the striking car. As with all groups of road users, most of the pedestrians involved in car crashes were young. However elderly people were overrepresented when the size of the exposed population was taken into account. The most frequently injured body regions were the lower extremities (50% of victims), the head/face/neck (38%) and the upper extremities (27%). Pelvic injuries were much more common for women. The most severe injuries (AIS4+) were mostly to the head and thorax, for all groups of road users. However, pedestrians sustained twice as many head injuries as thoracic injuries. When the front profiles were grouped together according to the most common car types in Europe, the risk of being killed was higher for MPVs. More specifically, the risk of sustaining an AIS2+ thoracic injury was higher in a collision with an MPV. Our study confirms that it is quite justified for the tests based on European Enhanced Vehicle-Safety Committee guidelines to be focused on the head and the lower extremities. However, no test procedure exists for thoracic injuries, which is the body region with the second highest number of severe or fatal injuries. PMID:22105391

Martin, Jean-Louis; Lardy, Audrey; Laumon, Bernard

2011-01-01

236

Alcohol and casualties: a comparison of emergency room and coroner data.  

PubMed

Data from a probability sample of casualty patients treated at a county hospital emergency room (ER) during a 1 year period (N = 1124) are compared to data from coroner reports of all fatalities arising from unnatural causes during the same time period in the same county (N = 304). The two samples are compared on: demographic characteristics, causes of casualty (fall, laceration/puncture wound, motor vehicle, fire, ingestion, other cause), place of injury, and alcohol and drug use prior to the event. Alcohol and drug use data were obtained by breathalyzer and self-reports in the ER sample and by toxicology screening of blood upon autopsy in the coroner sample. The coroner sample was significantly more likely to be male, younger and white compared to the ER sample. A significantly larger proportion of the coroner sample was positive for alcohol (43%) compared to those breathalyzed within 6 hr of injury who reported no drinking after the event (11%) and to those who reported drinking within the 6 hr prior to the event (28%) in the ER sample. Among those who were alcohol positive no difference was found between the coroner sample and the ER sample for the proportion of those who were also drug positive (24% in each). Cases in the coroner sample were no more likely to involve violence (17%) than those in the ER sample (20%). Violence-related fatalities were more likely to involve alcohol (47%) than non-fatal injuries (19%), but were no more likely to involve drug use in combination with alcohol (39% vs. 31%, respectively). PMID:8080603

Cherpitel, C J

1994-03-01

237

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

238

DESIGN AND PRELIMINARY VALIDATION OF A RAPID AUTOMATED BIODOSIMETRY TOOL FOR HIGH THROUGPUT RADIOLOGICAL TRIAGE  

PubMed Central

This paper presents design, hardware, software, and parameter optimization for a novel robotic automation system. RABiT is a Rapid Automated Biodosimetry Tool for high throughput radiological triage. The design considerations guiding the hardware and software architecture are presented with focus on methods of communication, ease of implementation, and need for real-time control versus soft time control cycles. The design and parameter determination for a non-contact PVC capillary laser cutting system is presented. A novel approach for lymphocyte concentration estimation based on computer vision is reported. Experimental evaluations of the system components validate the success of our prototype system in achieving a throughput of 6,000 samples in a period of 18 hours. PMID:21258614

Chen, Youhua; Zhang, Jian; Wang, Hongliang; Garty, Guy; Xu, Yanping; Lyulko, Oleksandra V.; Turner, Helen C.; Randers-Pehrson, Gerhard; Simaan, Nabil; Yao, Y. Lawrence; Brenner, D. J.

2010-01-01

239

Rapid Clinical Assessment to Facilitate the Triage of Adults with Falciparum Malaria, a Retrospective Analysis  

PubMed Central

Background Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone. Methods We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage. Results If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm’s positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI) 97.8–99.9) and for survival to discharge 96.9% (95% CI 94.3–98.5). In the 712 patients receiving artesunate, the algorithm’s positive predictive value for survival to 48 hours was 100% (95% CI 97.3–100) and to discharge was 98.5% (95% CI 94.8–99.8). Conclusions Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data. PMID:24489828

Hanson, Josh; Lee, Sue J.; Mohanty, Sanjib; Faiz, M. Abul; Anstey, Nicholas M.; Price, Ric N.; Charunwatthana, Prakaykaew; Yunus, Emran Bin; Mishra, Saroj K.; Tjitra, Emiliana; Rahman, Ridwanur; Nosten, Francois; Htut, Ye; Maude, Richard J.; Thi Hong Chau, Tran; Phu, Nguyen Hoan; Hien, Tran Tinh; White, Nicholas J.; Day, Nicholas P. J.; Dondorp, Arjen M.

2014-01-01

240

Improving the Manchester Triage System for Pediatric Emergency Care: An International Multicenter Study  

PubMed Central

Objectives This multicenter study examines the performance of the Manchester Triage System (MTS) after changing discriminators, and with the addition use of abnormal vital sign in patients presenting to pediatric emergency departments (EDs). Design International multicenter study Settings EDs of two hospitals in The Netherlands (2006–2009), one in Portugal (November–December 2010), and one in UK (June–November 2010). Patients Children (<16years) triaged with the MTS who presented at the ED. Methods Changes to discriminators (MTS 1) and the value of including abnormal vital signs (MTS 2) were studied to test if this would decrease the number of incorrect assignment. Admission to hospital using the new MTS was compared with those in the original MTS. Likelihood ratios, diagnostic odds ratios (DORs), and c-statistics were calculated as measures for performance and compared with the original MTS. To calculate likelihood ratios and DORs, the MTS had to be dichotomized in low urgent and high urgent. Results 60,375 patients were included, of whom 13% were admitted. When MTS 1 was used, admission to hospital increased from 25% to 29% for MTS ‘very urgent’ patients and remained similar in lower MTS urgency levels. The diagnostic odds ratio improved from 4.8 (95%CI 4.5–5.1) to 6.2 (95%CI 5.9–6.6) and the c-statistic remained 0.74. MTS 2 did not improve the performance of the MTS. Conclusions MTS 1 performed slightly better than the original MTS. The use of vital signs (MTS 2) did not improve the MTS performance. PMID:24454699

Seiger, Nienke; van Veen, Mirjam; Almeida, Helena; Steyerberg, Ewout W.; van Meurs, Alfred H. J.; Carneiro, Rita; Alves, Claudio F.; Maconochie, Ian; van der Lei, Johan; Moll, Henriëtte A.

2014-01-01

241

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

PubMed

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

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

2014-05-01

242

Telephone triage of cardiac emergency calls by dispatchers: a prospective study of 1386 emergency calls.  

PubMed Central

OBJECTIVES--To evaluate the handling of potential cardiac emergency calls by dispatchers, to determine their final diagnosis and urgency, and to determine the value of the main complaint in predicting urgency and the ability of the dispatchers to recognise non-urgent conditions. DESIGN--Prospective data collection and recording of main complaint of emergency calls placed via the 06-11 alarm telephone number with follow up to hospital when the patients were transported and the general practitioner when they were not. SETTING--Dispatch centres of the emergency medical services in Amsterdam (urban area) and Enschede (rural area). PATIENTS--1386 consecutive adult subjects of emergency calls placed by citizens about chest problems or unconsciousness not caused by injury. MAIN OUTCOME MEASURES--Frequency of characteristics of the calls, outcome in diagnosis, and assessment of urgency. RESULTS--69 (5%) patients were dead when the ambulance arrived. Diagnosis was established in 1071 patients (77%). The disorders most often reported were cardiac, with acute ischaemia in 15% of all subjects. In 28% of cases and for each presenting complaint no organic explanation was found. Overall 39% of all emergency calls were urgent; the urgency rate was lowest for calls for people with abdominal discomfort. Dispatchers correctly identified 90% of the non-urgent calls, but 55% of the calls that they identified as urgent proved to be non-urgent. CONCLUSION--Currently, direct dialling for an ambulance without the intervention of a general practitioner imposes a high work load on emergency systems and hospitals because triage by dispatchers is not sufficiently accurate. It may be possible to increase the accuracy of triage by developing and testing decision algorithms. PMID:8011407

Sramek, M.; Post, W.; Koster, R. W.

1994-01-01

243

Dentistry and mass disaster - a review.  

PubMed

Mass disaster situations may arise from natural or manmade circumstances like bioterrorism and dentists or dental responders have significant roles in human identification, following such occurrences. The various roles of dentists in mass disaster management, that include bio surveillance and notification, diagnosis and monitoring, triage, referrals of patients, immunizations, decontamination and infection control would be considered. The varying extents of use of forensic dental techniques and the resulting positive impacts made on human identification will also be included. The importance of preparation by way of special training for the dental personnel, mass disaster rehearsal, and use of modern day technology will be stressed on. PMID:25177658

Nathan, Mark David Edward; Sakthi, D Sri

2014-07-01

244

HPV mRNA Is More Specific than HPV DNA in Triage of Women with Minor Cervical Lesions  

PubMed Central

Background In Norway, repeat cytology and HPV testing comprise delayed triage of women with minor cytological lesions. The objective of this study was to evaluate HPV DNA and HPV mRNA testing in triage of women with an ASC-US/LSIL diagnosis. Materials and Methods We used repeat cytology, HPV DNA testing (Cobas 4800) and HPV mRNA testing (PreTect HPV-Proofer) to follow up 311 women aged 25–69 years with ASC-US/LSIL index cytology. Results Of 311 women scheduled for secondary screening, 30 women (9.6%) had ASC-H/HSIL cytology at triage and 281 women (90.4%) had ASC-US/LSIL or normal cytology. The HPV DNA test was positive in 92 (32.7%) of 281 instances, and 37 (13.2%) were mRNA positive. Of the 132 women with repeated ASC-US/LSIL, we received biopsies from 97.0% (65/67) of the DNA-positive and 92.9% (26/28) of the mRNA-positive cases. The positive predictive values for CIN2+ were 21.5% (14/65) for DNA positive and 34.6% (9/26) for mRNA positive (ns). The odds ratio for being referred to colposcopy in DNA-positive cases were 2.8 times (95% CI: 1.8–4.6) higher that of mRNA-positive cases. Compared to the mRNA test, the DNA test detected four more cases of CIN2 and one case of CIN3. Conclusions The higher positivity rate of the DNA test in triage leads to higher referral rate for colposcopy and biopsy, and subsequent additional follow-up of negative biopsies. By following mRNA-negative women who had ASC-US/LSIL at triage with cytology, the additional cases of CIN2+ gained in DNA screening can be discovered. Our study indicates that in triage of repeated ASC-US/LSIL, HPV mRNA testing is more specific and is more relevant in clinical use than an HPV DNA test. PMID:25405981

Sørbye, Sveinung Wergeland; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve; Skjeldestad, Finn Egil

2014-01-01

245

Prioritizing Burn-Injured Patients During a Disaster Carri W. Chan, Linda V. Green, Yina Lu  

E-print Network

other triage methods. Based on data from previous burn catastrophes, we study the feasibility of being in a bioterrorism or other mass casualty event (AHRQ Brief 2006). There are many important operational issues to provide care for all the patients. To prepare for the possibility of a burn disaster occurring in American

Chan, Carri W.

246

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

247

Abstract--Unattended hemorrhage is a major source of mortality in trauma casualties. In this study, we explore a set of  

E-print Network

CFR Part 46. L. Chen is with the Bioinformatics Cell, Telemedicine and Advanced Technology Research collected from 898 trauma casualties during and after transport by helicopter service from the scene

248

Should transient loss of consciousness in blunt head trauma be a pre-hospital trauma triage criterion?  

Microsoft Academic Search

The objective of this study was to evaluate pre-hospital triage of patients with an isolated brief loss of consciousness (LOC) to a regional trauma center (RTC). Data from a 6-month period were retrospectively reviewed from an existing pre-hospital data collection set. Patients were included if either they or a witness claimed a LOC, but they had regained consciousness to at

B. Zane Horowitz; Onna J Earle

2001-01-01

249

The pattern of contact with general practice and casualty departments of immigrants and non-immigrants in Copenhagen, Denmark  

Microsoft Academic Search

In the past 30 years Denmark has experienced immigration from non-West- ern countries, but little is known about immigrants' use of health care. The purpose of this study was to compare and quantify the contact patterns with general practice and casualty departments of immigrants of non-Western origin and non-immigrants in Copenhagen City, Denmark. Descriptive register-based study including 2,041,454 daytime contacts

Lise Dyhr; John Sahl Andersen; Gerda Engholm

250

Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology  

PubMed Central

Objective Acute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain. Methods In this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P?triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain. PMID:25180047

2014-01-01

251

Deciphering the Use and Predictive Value of "EMS Provider Judgment" in Out-of-Hospital Trauma Triage: A Multi-site, Mixed Methods Assessment  

PubMed Central

Background “EMS provider judgment” was recently added as a field triage criterion to the national guidelines, yet its predictive value and real-world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. Methods We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in 5 regions across the Western U.S. from 2006–2008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for ISS ? 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. Results 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio (OR) of ISS ? 16 for EMS provider judgment was 1.23 (95%CI 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Conclusions Among this multi-site cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, was independently associated with serious injury and was useful in identifying high risk patients missed by other criteria. However, there was variability in predictive value between sites. PMID:22673250

Newgard, Craig D.; Kampp, Michael; Nelson, Maria; Holmes, James F.; Zive, Dana; Rea, Thomas; Bulger, Eileen M.; Liao, Michael; Sherck, John; Hsia, Renee Y.; Wang, N. Ewen; Fleischman, Ross J.; Barton, Erik D.; Daya, Mohamud; Heineman, John; Kuppermann, Nathan

2012-01-01

252

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. PMID:19634998

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

2009-01-01

253

Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.  

PubMed Central

PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after. PMID:16628305

Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

2006-01-01

254

Question design in nurse-led and GP-led telephone triage for same-day appointment requests: a comparative investigation  

PubMed Central

Objective To compare doctors’ and nurses’ communication with patients in primary care telephone triage consultations. Design Qualitative comparative study of content and form of questions in 51 telephone triage encounters between practitioners (general practitioners (GPs)=29; nurses=22) and patients requesting a same-day appointment in primary care. Audio-recordings of nurse-led calls were synchronised with video recordings of nurse's use of computer decision support software (CDSS) during triage. Setting 2 GP practices in Devon and Warwickshire, UK. Participants 4 GPs and 29 patients; and 4 nurses and 22 patients requesting a same-day face-to-face appointment with a GP. Main outcome measure Form and content of practitioner-initiated questions and patient responses during clinical assessment. Results A total of 484 question–response sequences were coded (160 GP; 324 N). Despite average call lengths being similar (GP=4?min, 37?s, (SD=1?min, 26?s); N=4?min, 39?s, (SD=2?min, 22?s)), GPs and nurses differed in the average number (GP=5.51, (SD=4.66); N=14.72, (SD=6.42)), content and form of questions asked. A higher frequency of questioning in nurse-led triage was found to be due to nurses’ use of CDSS to guide telephone triage. 89% of nurse questions were oriented to asking patients about their reported symptoms or to wider-information gathering, compared to 54% of GP questions. 43% of GP questions involved eliciting patient concerns or expectations, and obtaining details of medical history, compared to 11% of nurse questions. Nurses using CDSS frequently delivered questions designed as declarative statements requesting confirmation and which typically preferred a ‘no problem’ response. In contrast, GPs asked a higher proportion of interrogative questions designed to request information. Conclusions Nurses and GPs emphasise different aspects of the clinical assessment process during telephone triage. These different styles of triage have implications for the type of information available following nurse-led or doctor-led triage, and for how patients experience triage. PMID:24598305

Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Val; Fletcher, Emily; Campbell, John L

2014-01-01

255

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

PubMed Central

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

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

2005-01-01

256

Intelligent mobile voice information centre system: Taking the emergency triage support system as an example.  

PubMed

According to research by the International Telecommunications Union (ITU), Taiwan has the highest percentage of people holding mobile (cell) phones, and every one has one or two cell phones. We usually use mobile phones to make contact with hospitals or dial 119 in an emergency. We have developed a new call flow style and combine traditional passive call flow. The system is designed with a voice menu and users can command services actively. The telephone connects to a computer server to enter the call flow module with ASR and TTS. The recognition term comes from a voice term database. The voice management center is an ER triage decision system. We have tested three scenarios which are DOA, a large number of patients and critical trauma. We measured the completion time and recognition rate for all the scenarios. The recognition rate in all three cases was above 90%. The average completion time for DOA is 38.6 seconds, for the large number of patients is 20 seconds and for the critical trauma case, the average is 252.7 seconds. It is too slow to input one patient's data but the communication transfer of the message is fast and convenient; the DOA notice only takes 38 seconds to inform medical staff, which is very efficient and medical staff believe that this can help their communication. We will continue to extend our system and further apply it to other domains. Future studies may combine the Internet platform with the WiFi phone and soft phone (Skype) and broaden the scope of the application in Taiwan. PMID:17102346

Hsiao, Fang-Ying; Chang, Polun

2006-01-01

257

Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding  

PubMed Central

Introduction Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added value of prediction scores to gastroenterologists’ Gut Feeling in patients with a suspected upper GI bleeding. Methods We prospectively evaluated Gut Feeling of senior gastroenterologists and asked them to estimate: (1) the risk that a clinical intervention is needed; (2) the risk of rebleeding; and (3) the risk of mortality in patients presenting with suspected upper GI bleeding, subdivided into low, medium, or high risk. The predictive value of the gastroenterologists’ Gut Feeling was compared to the Blatchford and Rockall scores for various outcomes. Results We included 974 patients, of which 667 patients (68.8%) underwent a clinical intervention. During the 30-day follow up, 140 patients (14.4%) developed recurrent bleeding and 44 patients (4.5%) died. Gut Feeling was independently associated with all studied outcomes, except for the predicted mortality after endoscopy. Predictive power, based on the AUC of the Blatchford and Rockall prediction scores, was higher than the Gut Feeling of the gastroenterologists. However, combining both the Blatchford and Rockall scores and the Gut Feeling yielded the highest predictive power for the need of an intervention (AUC 0.88), rebleeding (AUC 0.73), and mortality (AUC 0.71 predicted before and 0.77 predicted after endoscopy, respectively). Conclusions Gut Feeling is an independent predictor for the need of a clinical intervention, rebleeding, and mortality in patients presenting with upper GI bleeding; however, the Blatchford and Rockall scores are stronger predictors for these outcomes. Combining Gut Feeling with the Blatchford and Rockall scores resulted in the most optimal prediction.

van Oijen, MGH; Kessels, K; Hemmink, M; Weusten, BLAM; Timmer, R; Hazen, WL; van Lelyveld, N; Vermeijden, JR; Curvers, WL; Baak, LC; Verburg, R; Bosman, JH; de Wijkerslooth, LRH; de Rooij, J; Venneman, NG; Pennings, M; van Hee, K; Scheffer, RCH; van Eijk, RL; Meiland, R; Siersema, PD; Bredenoord, AJ

2014-01-01

258

A Deployable In Vivo EPR Tooth Dosimeter for Triage After a Radiation Event Involving Large Populations.  

PubMed

In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators.Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately five minutes, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care. PMID:21966241

Williams, Benjamin B; Dong, Ruhong; Flood, Ann Barry; Grinberg, Oleg; Kmiec, Maciej; Lesniewski, Piotr N; Matthews, Thomas P; Nicolalde, Roberto J; Raynolds, Tim; Salikhov, Ildar K; Swartz, Harold M

2011-09-01

259

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. PMID:22988401

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

2012-01-01

260

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. PMID:20154558

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

261

Natural immune responses against eight oncogenic human papillomaviruses in the ASCUS-LSIL Triage Study.  

PubMed

Only a subset of women with human papillomavirus (HPV) infections will become seropositive, and the factors influencing seroconversion are not well understood. We used a multiplex serology assay in women with mildly abnormal cytology results to examine seroreactivity to oncogenic HPV genotypes. An unbiased subset of women in the atypical squamous cell of undetermined significance /low-grade squamous intraepithelial lesion Triage Study provided blood samples at trial enrollment for serological testing. A Luminex assay based on glutathione s-transferase-L1 fusion proteins as antigens was used to test seroreactivity against eight carcinogenic HPV genotypes (16, 18, 31, 33, 35, 45, 52 and 58). We analyzed the relationship between seroprevalence in women free of precancer (N = 2,464) and HPV DNA status, age, sexual behavior and other HPV-related risk factors. The overall seroprevalence was 24.5% for HPV16 L1 and ?20% for 18L1 and 31L1. Among women free of precancer, seroprevalence peaked in women less than 29 years and decreased with age. Type-specific seroprevalence was associated with baseline DNA detection for HPV16 (OR = 1.36, 95%CI: 1.04-1.79) and HPV18 (OR = 2.31, 95%CI: 1.61-3.32), as well as for HPV52 and HPV58. Correlates of sexual exposure were associated with increased seroprevalence across most genotypes. Women who were current or former smokers were less likely to be seropositive for all eight of the tested oncogenic genotypes. The multiplex assay showed associations between seroprevalence and known risk factors for HPV infection across nearly all tested HPV genotypes but associations between DNA- and serostatus were weak, suggesting possible misclassification of the participants' HPV serostatus. PMID:23588935

Wilson, Lauren E; Pawlita, Michael; Castle, Phillip E; Waterboer, Tim; Sahasrabuddhe, Vikrant; Gravitt, Patti E; Schiffman, Mark; Wentzensen, Nicolas

2013-11-01

262

An economic analysis of a nurse-led telephone triage service.  

PubMed

Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers' intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings. PMID:25059246

Navratil-Strawn, Jessica L; Ozminkowski, Ronald J; Hartley, Stephen K

2014-09-01

263

Using CT colonography as a triage technique after a positive faecal occult blood test in colorectal cancer screening  

PubMed Central

Objective: The purpose of this study was to evaluate the effectiveness of CT colonography (CTC) as a triage technique in faecal occult blood test (FOBT)-positive screening participants. Methods: Consecutive guaiac (G-FOBT) and immunochemical (I-FOBT) FOBT-positive patients scheduled for colonoscopy underwent CTC with iodine tagging bowel preparation. Each CTC was read independently by two experienced observers. Per patient sensitivity, specificity and positive and negative predictive values (PPV and NPV) were calculated based on double reading with different CTC cut-off lesion sizes using segmental unblinded colonoscopy as the reference standard. The acceptability of the technique to patients was evaluated with questionnaires. Results: 302 FOBT-positive patients were included (54 G-FOBT and 248 I-FOBT). 22 FOBT-positive patients (7%) had a colorectal carcinoma and 211 (70%) had a lesion ?6 mm. Participants considered colonoscopy more burdensome than CTC (p<0.05). Using a 6 mm CTC size cut-off, per patient sensitivity for CTC was 91% (95% CI 85% to 91%) and specificity was 69% (95% CI 60% to 89%) for the detection of colonoscopy lesions ?6 mm. The PPV of CTC was 87% (95% CI 80% to 93%) and NPV 77% (95% CI 69% to 85%). Using CTC as a triage technique in 100 FOBT-positive patients would mean that colonoscopy could be prevented in 28 patients while missing ?10 mm lesions in 2 patients. Conclusion: CTC with limited bowel preparation has reasonable predictive values in an FOBT-positive population and a higher acceptability to patients than colonoscopy. However, due to the high prevalence of clinically relevant lesions in FOBT-positive patients, CTC is unlikely to be an efficient triage technique in a first round FOBT population screening programme. PMID:19625276

Liedenbaum, M H; van Rijn, A F; de Vries, A H; Dekker, H M; Thomeer, M; van Marrewijk, C J; Hol, L; Dijkgraaf, M G W; Fockens, P; Bossuyt, P M M; Dekker, E; Stoker, J

2009-01-01

264

An evaluation of compliance and performance following the introduction of the Inter-Facility Transport Triage Guideline  

PubMed Central

BACKGROUND: In Hong Kong, the reorganization of healthcare frame work for better utilization of resources has led to an increase in the frequency of inter-facility transport in recent years. An Inter-Facility Transport Triage Guideline (IFTTG) was introduced and evaluated on its compliance and performance. This study aimed to evaluate the compliance to the IFTTG and performance of inter-facility transport after the IFTTG was implemented. METHODS: The patients who required emergency IFT with accompanying personnel in two consecutive periods (pre-implementation period: January 1, 2006 to April 30, 2006; post-implementation period: May 1, 2006 to August 31, 2006) were included. The compliance to pre-transport triage and transport team configuration was evaluated by a review panel with eight performance indicators identified. The performance indicators were compared individually and as an overall score. RESULTS: Sixty-eight (26 in the pre-implementation period and 42 in the post-implementation period) IFTs were reviewed. There was demonstrable improvement on compliance to the IFTTG. The appropriateness of pre-transport triage increased from 34.6% to 54.8% whereas appropriateness of transport team configuration rose significantly from 73.1% to 92.9% (P<0.05). Staff performance on individual IFT performance indicator was satisfactory in both periods and the means of overall score on performance indicators were 7.12 and 7.29 respectively. The most improved performance indicator was the appropriateness of transport team configuration. CONCLUSIONS: The compliance and performance with the newly implemented IFTTG were satisfactory. However, staff comment and satisfaction with the use of the new guideline should be collected so as to achieve continuous quality improvement.

Siu, Venus WS; Pau, Y; Lok, PY; Lee, Larry LY; Tang, Simon YH; Chan, Jimmy TS

2011-01-01

265

[The delivery of medical care to light casualties, those with mild illness and minor injuries among the missile forces].  

PubMed

It is supposed that medical care to minimally injured and wounded will be rendered immediately at the zone of launching positions or command posts. Their evacuation to the medical establishments can be performed after combat launch of missiles or after adequate personnel replacement. Multipurpose hospitals of rocket troops will be able to render secondary medical care with the elements of tertiary medical care. Casualty staging must be performed by helicopters or ambulances to the military hospitals or to the rear hospitals of the Ministry of Health of Russia. The multipurpose hospital must have a gynaecological unit for minimally wounded women. PMID:8236889

Ramodin, G I

1993-08-01

266

Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging  

Microsoft Academic Search

Introduction  Axillary node fine needle aspiration cytology (FNAC) has the potential to triage women with operable breast cancer to initial\\u000a nodal surgical procedure. Because of variability in the reported accuracy of this test its role and clinical utility in pre-operative\\u000a staging remains controversial.\\u000a \\u000a \\u000a \\u000a Methods  We retrospectively evaluated the accuracy of ultrasound-guided axillary FNAC in all consecutive clinically T1–2 N0–1 breast\\u000a cancers that

Stefano Ciatto; Beniamino Brancato; Gabriella Risso; Daniela Ambrogetti; Paolo Bulgaresi; Cristina Maddau; Patricia Turco; Nehmat Houssami

2007-01-01

267

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 PMID:23506482

2013-01-01

268

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

269

Driver inattention and driver distraction in serious casualty crashes: data from the Australian National Crash In-depth Study.  

PubMed

Driver inattention and driver distraction represent a major problem in road safety. Although both are believed to contribute to increased crash risk, there is currently limited reliable information on their role in crashes. The current study used in-depth data from the Australian National Crash In-depth Study to investigate the role of driver distraction and inattention in serious casualty crashes. The sample included 856 crashes from 2000 to 2011, in which at least one party was admitted to hospital due to crash-related injuries. Crashes were coded using a taxonomy of driver inattention that delineates five inattention subtypes: restricted attention, misprioritised attention, neglected attention, cursory attention, and diverted attention (distraction). Approximately 45% of crashes could not be coded due to insufficient information while in an additional 15% the participant indicated the "other driver was at fault" without specifying whether inattention was involved. Of the 340 remaining cases, most showed evidence of driver inattention (57.6%) or possible inattention (5.9%). The most common subtypes of inattention were restricted attention, primarily due to intoxication and/or fatigue, and diverted attention or distraction. The most common types of distraction involved voluntary, non-driving related distractions originating within the vehicle, such as passenger interactions. The current study indicates that a majority of serious injury crashes involve driver inattention. Most forms of inattention and distraction observed are preventable. This study demonstrates the feasibility of using in-depth crash data to investigate driver inattention in casualty crashes. PMID:23499981

Beanland, Vanessa; Fitzharris, Michael; Young, Kristie L; Lenné, Michael G

2013-05-01

270

Orthopaedic triaging by podiatrists: a prospective study of patient satisfaction and service efficiency.  

PubMed

Background The Southern Adelaide Local Health Network is serviced by one orthopaedic surgeon specialising in foot and ankle surgery. In 2011, the waiting list to see the surgeon was expanding and the need for assistance was growing. The Department of Podiatry agreed to provide a podiatrist to assist in the management of the outpatient waiting list. Although patient outcome is an important outcome measure, we were interested in evaluating the service with respect to how satisfied patients were with seeing a podiatrist. Therefore, the primary aim of the study was to evaluate patient satisfaction with podiatry-led clinics for the orthopaedic outpatient waiting list. Secondary outcomes included discharge rate and efficiency of care. Methods We prospectively recruited a consecutive sample discharged from the Department of Podiatry between 1 May and 1 November 2013 to complete the Client Satisfaction Survey (CSQ-8). This survey was used to evaluate the satisfaction of patients following discharge from the Department of Podiatry. Results There were 49 patients (16 men, 33 women) enrolled in the survey during the 6-month period. Of the 49 patients discharged, 21 (43%) were discharged from the outpatient waiting list. Twenty-eight patients (57%) were referred on to the Department of Orthopaedic Surgery for opinion and management. The mean (± s.d.) number of appointments for each patient was 1.3±0.6. Overall, patients were very satisfied with the assessment and/or treatment they received. Conclusion A podiatrist, working at an extended scope of practice and in collaboration with an orthopaedic surgeon, can successfully and efficiently assess and treat patients on an orthopaedic outpatient waiting list. Patients generally reported a high level of satisfaction with the process and would return to the clinic again if necessary. Hospital networks wanting to efficiently reduce waiting lists may endorse task substitution for appropriately skilled podiatrists. What is known about the topic? Allied health professionals have acted in extended scope of practice roles across several professions. These roles are often implemented in response to long waiting lists to see medical specialists. The acceptance of these practitioners by patients and the efficiency of these clinics are yet to be formally evaluated. What does the paper add? This paper should provide confidence in implementing orthopaedic triaging roles for podiatrists. High satisfaction rates were noted, along with an efficient service, both of which may be attractive for hospital networks. What are the implications for practitioners? Extended scope of practice podiatry roles may be implemented to assist in managing orthopaedic outpatient waiting lists. PMID:24871204

Walsh, Tom P; Pilkington, Dolores C; Wong, Esther J; Brown, Christopher H; Mercer, Graham E

2014-09-01

271

[It is not always necessary to establish a "first aid station" at mass gatherings. Cutty Sark Tallships Race 1993].  

PubMed

Previous studies from outdoor music festivals have recommended medical service facilities at first-aid stations. The Cutty Sark Tallships Race was a large outdoor event that took place over four days in Esbjerg harbour with about 500,000 participants and spectators. A total of 68 patients were treated, 28 in the first-aid station at the harbour and 40 at the nearby located hospital. The disease and injuries presented were not severe. The orthopaedic casualties dominated (82%), wounds, contusions and fractures being the most common ones. Only seven casualties were related to alcohol abuse. No casualties were related to drug abuse. The economic expense was estimated to DKK 14,676. Thus, at outdoor mass gatherings of a nature like the Cutty Sark Tallships Race, located near a hospital, first-aid stations are not necessary. PMID:8545931

Larsen, S E; Sørensen, L; Røck, N D

1995-12-18

272

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. PMID:22398851

Al-Roubaie, Abdul Rahim; Goldlust, Eric Jonathan

2013-01-01

273

Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the Myocardial Infarction Triage and Intervention Registry)  

Microsoft Academic Search

This study compared the presentation (symptoms and signs), treatment, and outcome of 1,097 consecutive patients (851 men and 246 women) from the Myocardial Infarction Triage and Intervention (MITI) Project Registry with confirmed acute myocardial infarction (AMI), all of whom were initially evaluated in the prehospital setting, met clinical criteria for possible thrombolysis, and were followed throughout their hospital course. Women

Peter J. Kudenchuk; Charles Maynard; Jenny S. Martin; Mark Wirkus; W. Douglas Weaver

1996-01-01

274

Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-Event Disasters  

Microsoft Academic Search

Threats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fear- based signs and symptoms, may be extremely debilitating and lead to chron- ic problems with risk of permanent damage to the brain's locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be

John A. Burns; H. Stefan Bracha; Frederick M. Burkle

275

p16INK4a immunocytochemistry versus HPV testing for triage of women with minor cytological abnormalities: A systematic review and meta-analysis  

PubMed Central

Background The best method to identify women with minor cervical lesions that require diagnostic work-up remains unclear. We performed a meta-analysis to assess the accuracy of p16INK4a immunocytochemistry compared to hrHPV DNA testing with hybrid capture II (HC2) to detect cervical intraepithelial neoplasia (CIN2+ and CIN3+) in women with a cervical cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade cervical lesions (LSIL). Methods A literature search was performed in three electronic databases to identify studies eligible for this meta-analysis. Results Seventeen studies were included in the meta-analysis. The pooled sensitivity of p16INK4a to detect CIN2+ was 83.2% (95%CI: 76.8–88.2%) and 83.8% (95%CI: 73.5–90.6%) in ASC-US and LSIL cervical cytology respectively; pooled specificities were 71.0% (95%CI: 65.0–76.4%) and 65.7% (95%CI: 54.2–75.6%). Eight studies provided both HC2 and p16INK4a triage data. p16INK4a and HC2 have a similar sensitivity and p16INK4a has significantly higher specificity in the triage of women with ASC-US (relative sensitivity: 0.95 (95%CI: 0.89–1.01); relative specificity: 1.82 (95%CI: 1.57–2.12)). In the triage of LSIL, p16INK4a has a significantly lower sensitivity but higher specificity compared to HC2 (relative sensitivity: 0.87 (95%CI: 0.81–0.94); relative specificity: 2.74 (1.99–3.76)). Conclusion The published literature indicates an improved accuracy of p16INK4a compared to HC2 testing in the triage of ASC-US. In LSIL triage p16INK4a is more specific but less sensitive. PMID:22700382

Roelens, Jolien; Reuschenbach, Miriam; von Knebel-Doeberitz, Magnus; Wentzensen, Nicolas; Bergeron, Christine; Arbyn, Marc

2014-01-01

276

MicroRNA Detection in Cervical Exfoliated Cells as a Triage for Human Papillomavirus–Positive Women  

PubMed Central

Background Papanicolaou (Pap) triage, with high specificity, has been recommended for primary Human papillomavirus (HPV) testing but is flawed by poor sensitivity and cytologist dependence. We evaluated the potential role of microRNA (miRNA) detection in cervical exfoliated cells in HPV-positive women from a clinic-based population. Methods Primary HPV testing as well as Pap test were performed on all eligible women. Six miRNAs (miR-424/miR-375/miR-34a/miR-218/miR-92a/miR-93) were detected by RT-qPCR in cervical exfoliated cells. All HPV-positive women underwent colposcopy and further biopsy if indicated. Mann–Whitney U test, the receiver operating characteristic curve, logistic regression, and Pearson’s Chi-square were used to assess data. All tests of statistical significance were two-sided. Results A total of 1021 eligible HPV-positive women were enrolled. The expression of miR-424/miR-375/miR-34a/miR-218 in high-grade cervical intraepithelial neoplasia (CIN) and abnormal cytology was statistically significantly lower than that in low-grade CIN and normal cytology, respectively (all P < .05). Compared with the Pap test, both miR-424 and miR-375 detection achieved higher sensitivity (76.0% and 74.9% vs 63.8%, P < .05), higher negative predictive value (NPV) (85.7% and 85.4% vs 79.3%, P < .05), and comparable specificity while identifying CIN2 or worse (CIN2+). Similar results were achieved while identifying CIN3+. Multi-marker panels based on miR-424, miR-375, and miR-218 further improved the performance over any single miRNA test or Pap test. Conclusion Single miR-424 or miR-375 detection and miR-424/miR-375/miR-218–based multimarker panels in cervical exfoliated cells show superior performance over Pap triage for high-grade CIN identification in a clinic-based population. Detection of miRNA may provide a new triage option for HPV-positive women. PMID:25190727

Tian, Qifang; Li, Yang; Wang, Fenfen; Li, Ying; Xu, Junfen; Shen, Yuanming; Ye, Feng; Wang, Xinyu; Cheng, Xiaodong; Chen, Yaxia; Wan, Xiaoyun; Lu, Weiguo

2014-01-01

277

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

278

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

NASA Astrophysics Data System (ADS)

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

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

2013-12-01

279

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

280

The clinical performance of APTIMA human papillomavirus and Hybrid Capture 2 assays in the triage of lesser abnormal cervical cytologies  

PubMed Central

Objective This study was performed to evaluate the clinical performance of APTIMA human papillomavirus (AHPV) assay and Hybrid Capture 2 (HC2) assay in screening for cervical disease, especially in women with atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Methods A total of 411 women diagnosed with ASC-US or LSIL were referred and further triaged by HC2 test. Prior to colposcopy, liquid-based cytology specimens were collected for the AHPV assay. Sensitivity and specificity were established based on the histological findings of cervical intraepithelial neoplasia (CIN). Results In all 411 subjects, the positive detection rate of AHPV assay was 70.8% (95% confidence interval [CI], 66.4 to 75.2), which was significantly lower than the positive detection rate of 94.9% obtained using HC2 test (95% CI, 92.3 to 96.8). Only one CIN 3-positive case was detected among the 120 AHPV-negative women, which was then confirmed by Pap smear test to be LSIL. The sensitivities of AHPV and HC2 for CIN 3 were similar (94.1% and 100%, respectively). However, AHPV showed a significantly higher specificity than HC2 test (30.2% and 5.3%, respectively; p<0.001). Conclusion AHPV assay is effective in identifying CIN 3-positive cases because of its high specificity and lower false-negative rate. The use of AHPV for the triage of ASC-US and LSIL might help to reduce the referral rate of colposcopy during cervical cancer screening. PMID:25142625

Guo, Yanli; You, Ke; Qiao, Jie

2014-01-01

281

An economic analysis of human papillomavirus triage for the management of women with atypical and abnormal Pap smear results in Germany  

Microsoft Academic Search

We developed decision-analytic models to determine the cost effectiveness of incorporating human papillomavirus (HPV) testing\\u000a into the management of atypical and abnormal Pap smear results in Germany. The models compare three management strategies:\\u000a (1) repeat Pap smear, (2) triage with HPV DNA testing, or (3) immediate treatment. The primary outcome measure is incremental\\u000a cost per case of cervical intraepithelial neoplasia

Sara K. Sheriff; K. Ulrich Petry; Hans Ikenberg; Geoffrey Crouse; Peter D. Mazonson; Christopher C. Santas

2007-01-01

282

Transport and use of point-of-care ultrasound by a disaster medical assistance team.  

PubMed

The role of ultrasound in disaster medicine has not been not well established. This report describes the transport and use of point-of-care ultrasound by a Disaster Medical Assistance Team (DMAT) responding to a mass-casualty incident due to a cyclone. Ultrasound-competent physicians on the team were able to use portable ultrasound on cyclone casualties to exclude intra-abdominal hemorrhage, pericardial fluid, pneumothoraces, and hemothoraces. Information obtained using ultrasound made initial patient management, and subsequent decisions regarding triage for transport safer and based on more detailed clinical information. PMID:19591309

Mazur, Stefan M; Rippey, James

2009-01-01

283

Mortality, survival and residual injury burden of Royal Navy and Royal Marine combat casualties sustained in 11-years of operations in Iraq and Afghanistan.  

PubMed

We present eleven years of prospectively-gathered data defining the full spectrum of the United Kingdom's (UK) Naval Service (Royal Navy and Royal Marines) casualties, and characterise the injury patterns, recovery and residual functional burden from the conflicts of the last decade. The UK Military Trauma Registry was searched for all Naval Service personnel injured between March 2003 and April 2013. These records were then cross-referenced with the records of the Naval Service Medical Board of Survey (NSMBOS), which evaluates injured Naval Service personnel for medical discharge, continued service in a reduced capacity or Return to Full Duty (RTD). Population at risk data was calculated from service records. There were 277 casualties in the study period: 63 (23%) of these were fatalities. Of the 214 survivors, 63 or 29% (23% of total) were medically discharged; 24 or 11% (9% of total) were placed in a reduced fitness category with medical restrictions placed on their continued military service. A total of 127 individuals (46% of the total and 59% of survivors) RTD without any restriction. The greatest number of casualties was sustained in 2007. There was a 3% casualty risk per year of operational service for Naval Service personnel. The most common reason cited by Naval Service Medical Board of Survey (NSMBOS) for medical downgrading or discharge was injury to the lower limb, with upper limb trauma the next most frequent. This study characterises the spectrum of injuries sustained by the Naval Service during recent conflicts with a very high rate of follow-up. Extremity injuries pose the biggest challenge to reconstructive and rehabilitative services striving to maximise the functional outcomes of injured service personnel. PMID:25335311

Penn-Barwell, J; Fries, C A; Bennett, P M; Midwinter, M J; Baker, A

2014-01-01

284

A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology  

PubMed Central

Background Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively). Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity. The 2007 ACC/AHA guidelines for UA/NSTEMI do not identify patients at low risk for adverse cardiac events who can be safely discharged without provocative testing. As a result large numbers of low risk patients are triaged to chest pain observation units and undergo provocative testing, at significant cost to the healthcare system. Clinical decision rules use clinical findings (history, physical exam, test results) to suggest a diagnostic or therapeutic course of action. Currently no methodologically robust clinical decision rule identifies patients safe for early discharge. Methods/design The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i) apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii) determine the inter-observer reliability of the clinical information; iii) determine the statistical association between the clinical findings and the composite outcome; and iv) use multivariable analysis to derive a highly sensitive clinical decision rule to guide triage decisions. Discussion The study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments. PMID:18254973

Hess, Erik P; Wells, George A; Jaffe, Allan; Stiell, Ian G

2008-01-01

285

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

PubMed

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. PMID:4051064

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

1985-11-01

286

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. PMID:4051064

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

1985-01-01

287

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

288

Are you ready for anthrax, or worse? You must revamp your bioterrorism plan.  

PubMed

A study has shown that EDs are unprepared to handle mass casualties of bioterrorism, and plans must be revamped. Alternate care and triage areas must be selected in advance and may include parking lots and hallways between buildings. Care for contaminated patients in areas that can be abandoned, so regular patient care areas are not disrupted. Have a system in place to decontaminate patients before they enter the ED. PMID:11769134

2001-12-01

289

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. PMID:23600592

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

2013-01-01

290

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. PMID:24793250

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

2014-01-01

291

Efficacy of multi-detector coronary computed tomography angiography in comparison with exercise electrocardiogram in the triage of patients of low risk acute chest pain  

PubMed Central

Objectives To compare the safety and diagnostic efficacy of coronary computed tomography angiography (CTA) with exercise electrocardiography (XECG) in triaging patients of low risk acute chest pain. Background Noninvasive assessment of coronary stenosis by CTA may improve early and accurate triage of patients presenting with acute chest pain to the emergency department (ED). Methods Low risk patients of possible acute coronary syndrome (ACS) were included in the study. The patients in CTA arm with significant stenosis (?50%) underwent catheterization, while those with no or intermediate stenosis (<50%) were discharged from ED and followed up periodically for six months for major adverse cardiovascular events (MACE). The same protocol was applied for XECG arm. Outcomes included: safety and diagnostic efficacy. Results A total of 81 (41 CTA and 40 XECG) patients were enrolled. In this study CTA was observed to be 100% sensitive and 95.7% specific in diagnosing MACE in low risk patients of chest pain presenting to the ED, with a PPV of 94.7% and an NPV of 100%.The overall diagnostic efficacy was 97.6%. XECG was observed to be 72.7% sensitive and 96.6% specific in diagnosing MACE with a PPV of 88.9% and NPV of 90.3% in low risk chest pain patients presenting to the ED. The overall diagnostic accuracy was 90%. Conclusion CTA is an excellent diagnostic tool in ED patients with low risk of ACS, with minimum time delay as compared to XECG, and also is safe for triaging such patients. PMID:25173203

Nagori, M.; Narain, V.S.; Saran, R.K.; Dwivedi, S.K.; Sethi, R.

2014-01-01

292

[Conditions for the survival of combat casualties in overseas operations: procedure and experience from the Afghan out-of-hospital theater].  

PubMed

Recent conflicts have led the French Army Health Service to specify the setting condition for the survival of combat casualties in overseas operations. The majority of them are victims of explosion injuries, and an early and effective control of bleeding is the primary means of improving survival. A procedure called "Combat Rescue" is taught. This chronological procedure favours external haemostasis and led to specific equipment, in particular a tourniquet and a haemostatic bandage of high efficiency. It is applied in recent years on the Afghan out-of-hospital theatre. A very front medical presence, which is systematic during evacuations, is a feature of the French Army Health Service operations support. PMID:23550451

Palmier, Bruno

2012-01-01

293

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

PubMed

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 intrusion. The study took place in the broad urban area of Patras, over an 18-month period (January 2000-June 2001) and evaluated 48 vehicle crashes. Car and compartment deformation are significant factors affecting occupants' injuries and consequently the appropriate type of further treatment, either in the hospital setting or primary health-care centres. It would be particularly useful to transmit the post-crash condition of a vehicle to the trauma dispatch centre, utilising satellite technology, thus allowing the centre to organise the rescue teams, plan triage in advance and provide the emergency medical personnel with all necessary information before their arrival at the scene of the accident. PMID:12832173

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

2003-07-01

294

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. PMID:23037717

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

2012-01-01

295

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

296

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. PMID:21272365

2011-01-01

297

Effects on a Poison Center's (PC) triage and follow-up after implementing the no Ipecac use policy.  

PubMed

For years, The American Academy of Pediatrics (AAP) had supported home use of syrup of Ipecac. However, due to mounting evidence that Ipecac use did not improve outcome nor reduce Emergency Department (ED) referrals, the AAP in November of 2003 issued a statement that Ipecac not be used for the home management of poison ingestion. To determine if the cessation of the use of Ipecac for home ingestions is associated with an increased number of follow-up calls, an increased time of observation at home and an increase in the number of ED referrals for care by poison center staff were administered. Fifty randomly selected pediatric (<6 years) cases that received Ipecac ("Ipecac" group) from January 1, 2003 to October 31, 2003 were selected for study. Up to two controls ("no Ipecac" group) were matched by age, amount ingested, and by toxin. Controls were selected from the 2004-2006 time period (Ipecac no longer in use). Fifty "Ipecac" cases and 84 "no Ipecac" controls were analyzed. The groups had no significant differences with respect to percent symptomatic, median time post-ingestion, mean age, and distribution of toxin categories (e.g., antidepressants, beta blockers, etc.). The "no Ipecac" group had nearly ten times the odds of ED referral compared to the "Ipecac" group, (OR = 9.9, 95%CI 3.3-32.2). The mean total hours of follow-up was not significantly different between the groups (diff = -1.1, t = -1.8, p = 0.07). The mean number of follow-up calls was significantly less in the "no Ipecac" group (diff = -1.4 calls, t = -6.8, p < 0.001). Toxicology consults were greater in the "no Ipecac" group (chi (2 )= 4.05, p = 0.04); however, consults were not associated with ED referral. For the time period from 2004 to 2006, the "no Ipecac" policy resulted in an increase in ED referrals at our center. While prior studies have shown that not using Ipecac did not affect clinical outcome, our research suggested that it may have initially influenced triaging outcome. Since the use of Ipecac by centers was once a commonly used home remedy for some ingestions (albeit without rigorously established efficacy), poison center personnel had to transition to the "no Ipecac" policy. Although our referrals increased during a transitional period of time, referral rates have since stabilized and returned to baseline. PMID:20623216

Lapus, Robert M; Slattery, Ann P; King, William D

2010-06-01

298

Injury pattern, hospital triage, and mortality of 1250 patients with severe traumatic brain injury caused by road traffic accidents.  

PubMed

This epidemiological study analyzed the incidence, risk factors, hospital triage, and outcome of patients with severe traumatic brain injuries (sTBIs) caused by road traffic accidents (RTAs) admitted to hospitals in the Trauma Center West-Netherlands (TCWN) region. Trauma registry data were used to identify TBI in all RTA victims admitted to hospitals in the mid-West region of the Netherlands from 2003 to 2011. Type of head injury and severity were classified using the Abbreviated Injury Scale (AIS). Head injuries with AIS severity scores ? 3 were considered sTBI. Ten percent of all 12,503 hospital-admitted RTA victims sustained sTBI, ranging from 5.4% in motorcyclists, 7.4% in motorists, 9.6% in cyclists, and 12.7% in moped riders to 15.1% in pedestrians (p<0.0001). Among RTA victims admitted to hospital, sTBI was most prevalent in pedestrians (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.78-2.86) and moped riders (OR, 1.86; 95% CI, 1.51-2.30). Injury patterns differed between road user groups. Incidence of contusion ranged from 46.6% in cyclists to 74.2% in motorcyclists, whereas basilar and open-skull fractures were least common in motorcyclists (22.6%) and most common in moped riders (51.5%). Hemorrhage incidence ranged from 44.9% (motorists) to 63.6% (pedestrians). Subdural and -arachnoid bleedings were most frequent. Age, Glasgow Coma Scale, and type of hemorrhage were independent prognostic factors for in-hospital mortality after sTBI. In-hospital mortality ranged from 4.2% in moped riders to 14.1% in motorists. Pedestrians have the highest risk to sustain sTBI and, more specifically, intracranial hemorrhage. Hemorrhage and contusion both occur in over 50% of patients with sTBI. Specific brain injury patterns can be distinguished for specific road user groups, and independent prognostic risk factors for sTBI were identified. This knowledge may be used to improve vigilance for particular injuries in specific patient groups and stimulate development of focused diagnostic strategies. PMID:24093437

Leijdesdorff, Henry A; van Dijck, Jeroen T J M; Krijnen, Pieta; Vleggeert-Lankamp, Carmen L A M; Schipper, Inger B

2014-03-01

299

Cost-effectiveness of fibronectin testing in a triage in women with threatened preterm labor: alleviation of pregnancy outcome by suspending tocolysis in early labor (APOSTEL-I trial)  

Microsoft Academic Search

BACKGROUND: At present, women with threatened preterm labor before 32 weeks of gestation are, after transfer to a perinatal center, treated with tocolytics and corticosteroids. Many of these women are treated unnecessarily. Fibronectin is an accurate predictor for the occurrence of preterm birth among women with threatened preterm labor. We will assess whether triage of these women with fibronectin testing,

Jolande Y Vis; Femke F Wilms; Martijn A Oudijk; Martina M Porath; Hubertina CJ Scheepers; Kitty WM Bloemenkamp; Annemiek C Bolte; Jérôme Cornette; Jan B Derks; Johannes J Duvekot; Jim van Eyck; Anneke Kwee; Brent C Opmeer; Maria G van Pampus; Fred K Lotgering; Sicco A Scherjon; Krystyna M Sollie; Marc EA Spaanderman; Christine Willekes; Joris AM van der Post; Ben Willem J Mol

2009-01-01

300

Nursing Triage and the Use of Standing Orders in Student Health Care Settings As nurses working in student health, we are often (if not always) the "front line" of assessment  

E-print Network

1 Nursing Triage and the Use of Standing Orders in Student Health Care Settings As nurses working in student health, we are often (if not always) the "front line" of assessment of patient needs for immediate us to bear in mind: 1) Be confident of what you know. You are an experienced professional; dont

Watson, Craig A.

301

HPV DNA testing improves CIN2+ risk stratification and detection of CIN2+ in delayed triage of ASCUS and LSIL. A population-based follow-up study from Western Norway  

PubMed Central

In Norway, Pap smears with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) are triaged after 6?months. The aim of the study was to evaluate effects of implementing human papillomavirus (HPV) test (2005) in delayed triage of ASCUS and LSIL in a cohort of women from Western Norway. After a survey of 119,469 cervical Pap smears during 2005–2007, a total of 1055 women with an index ASCUS or LSIL were included in the study and followed up for 3–6?years with respect to progression into cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Overall sensitivity for detection of CIN2+ with HPV testing and cytology was 96% and 72%, respectively. The sensitivity for detection of CIN2+ was not affected by age, but the specificity of the HPV test increased with age. Thus, for the age groups <34?years, 34–50?years, and >50?years, the specificity of a positive HPV test to detect CIN2+ was 47%, 71%, and 82%, respectively. Positive predictive values for CIN2+ in women with positive cytology, positive HPV test, negative cytology, negative HPV test, or negative HPV and cytology tests were 52%, 41%, 8%, 1.5%, and 0.4%, respectively. HPV testing resulted in a net 22% increased detection of CIN2+. Fifty-six percent of CIN2+ was detected at an earlier time point with HPV testing in triage. Implementation of HPV testing in delayed triage of ASCUS and LSIL improved the stratification of CIN2+ risk and increased CIN2+ detection and at an earlier time point than with triage by cytology alone. PMID:24403090

Budal, Elisabeth B; Haugland, Hans K; Skar, Robert; Maehle, Bj?rn O; Bj?rge, Tone; Vintermyr, Olav K

2014-01-01

302

Method Paper - Distance and Travel Time to Casualty Clinics in Norway Based on Crowdsourced Postcode Coordinates: A Comparison with Other Methods  

PubMed Central

We describe a method that uses crowdsourced postcode coordinates and Google maps to estimate average distance and travel time for inhabitants of a municipality to a casualty clinic in Norway. The new method was compared with methods based on population centroids, median distance and town hall location, and we used it to examine how distance affects the utilisation of out-of-hours primary care services. At short distances our method showed good correlation with mean travel time and distance. The utilisation of out-of-hours services correlated with postcode based distances similar to previous research. The results show that our method is a reliable and useful tool for estimating average travel distances and travel times. PMID:24551243

Raknes, Guttorm; Hunskaar, Steinar

2014-01-01

303

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 PMID:23286331

2013-01-01

304

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

PubMed Central

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

2011-01-01

305

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

306

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. 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

307

Management of External Hemorrhage in Tactical Combat Casualty Care: Chitosan-Based Hemostatic Gauze Dressings - TCCC Guidelines-Change 13-05.  

PubMed

Hemorrhage remains the leading cause of combat death and a major cause of death from potentially survivable injuries. Great strides have been made in controlling extremity hemorrhage with tourniquets, but not all injuries are amenable to tourniquet application. Topical hemostatic agents and dressings have also contributed to success in controlling extremity and compressible junctional hemorrhage, and their efficacy continues to increase as enhanced products are developed. Since the addition of Combat Gauze™ (Z-Medica Corporation, Wallingford, CT, USA; http://www.z-medica.com/) in April 2008 to the Tactical Combat Casualty Care (TCCC) Guidelines, there are consistent data from animal studies of severe hemorrhage that chitosan-based hemostatic gauze dressings developed for battlefield application are, at least, equally efficacious as Combat Gauze. Successful outcomes are also reported using newer chitosan-based dressings in civilian hospital-based surgical case reports and prehospital (battlefield) case reports and series. Additionally, there have been no noted complications or safety concerns in these cases or across many years of chitosan-based hemostatic dressing use in both the military and civilian prehospital sectors. Consequently, after a decade of clinical use, there is added benefit and a good safety record for using chitosan-based gauze dressings. For these reasons, many specific US military Special Operations Forces, NATO militaries, and emergency medical services (EMS) and law enforcement agencies have already implemented the widespread use of these new recommended chitosan-based hemostatic dressings. Based on the past battlefield success, this report proposes to keep Combat Gauze as the hemostatic dressing of choice along with the new addition of Celox™ Gauze (Medtrade Products Ltd., Crewe, UK; http://www.celoxmedical.com/usa/products /celox-gauze/) and ChitoGauze® (HemCon Medical Technologies, Portland, OR, USA; http://www.hemcon.com/) to the TCCC Guidelines. PMID:25344707

Bennett, Brad L; Littlejohn, Lanny F; Kheirabadi, Bijan S; Butler, Frank K; Kotwal, Russ S; Dubick, Michael A; Bailey, Jeffrey A

2014-01-01

308

Management of crush victims in mass disasters: highlights from recently published recommendations.  

PubMed

Crush syndrome is the second most common cause of death after earthquakes (the first most common is direct trauma). Many logistic problems with the treatment of patients with crush syndrome are due to chaotic disaster circumstances; consequently, medical and logistic recommendations on the treatment of crush victims are needed. In a joint initiative of the Renal Disaster Relief Task Force of the International Society of Nephrology and European Renal Best Practice, a work group of nephrologists, intensivists, surgeons, and logisticians with disaster experience or experts in guideline preparation collaborated to provide comprehensive information and recommendations on the management of crush casualties considering their occurrence with "epidemic" dimensions after mass disasters. The result is the monograph "Recommendations for the Management of Crush Victims in Mass Disasters", which may help provide effective health care to disaster victims with renal problems. This article discusses medical and logistic principles of the treatment of crush victims, both at the disaster field and on admission to hospitals, and guidance is described. The importance of early fluid administration even before extrication of the victims and avoidance of potassium-containing solutions during the treatment of crush victims is underlined. Also, the logistic problems in treating crush casualties are emphasized. The most important aspects of the recently published recommendations are highlighted. PMID:23024157

Sever, Mehmet Sukru; Vanholder, Raymond

2013-02-01

309

Radiation-induced Changes in Levels of Selected Proteins in Peripheral Blood Serum of Breast Cancer Patients as a Potential Triage Biodosimeter for Large-scale Radiological Emergencies.  

PubMed

The threat of a large scale radiological emergency, where thousands of people may require fast biological dosimetry for the purpose of triage, makes it necessary to search for new, high throughput biological dosimeters. The authors tested an assay based on the quantitative analysis of selected proteins in peripheral blood serum. They were particularly interested in testing proteins that are specific to irradiation of skin, as these can be used in cases of partial body exposure. Candidate proteins were identified in an earlier study with mice, where skin of the animals was exposed to different doses of radiation and global expression of serum proteins was analyzed. Eight proteins were found, the expression of which showed a consistent dose-response relationship. Human analogues of these proteins were identified, and their expression was measured in peripheral blood serum of 16 breast cancer patients undergoing external beam radiotherapy. The proteins were Apolipoprotein E; Apolipoprotein H; Complement protein 7; Prothrombinase; Pantothenate Kinase 4; Alpha-2-macroglobulin; Fetuin B and Alpha-1-Anti-Chymotrypsin. Measurements were carried out in blood samples collected prior to exposure (control), on the day after one fraction (2 Gy), on the day after five fractions (10 Gy), on the day after 10 fractions (20 Gy), and 1 mo after 23-25 fractions (total dose of 46-50 Gy). Multivariate analysis was carried out, and a multinomial logistic regression model was built. The results indicate that the combined analysis of Apolipoprotein E, Factor X, and Pantothenate Kinase 4 allows discriminating between exposure to 2 Gy and lower and between 10 Gy and higher. The discrimination is possible up to 1 mo after exposure. PMID:25353241

Deperas-Kaminska, Marta; Bajinskis, Ainars; Marczyk, Michal; Polanska, Joanna; Wersäll, Peter; Lidbrink, Elisabet; Ainsbury, Elizabeth A; Guipaud, Oliver; Benderitter, Marc; Haghdoost, Siamak; Wojcik, Andrzej

2014-12-01

310

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

PubMed Central

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

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

2014-01-01

311

The Pope Air Force Base aircraft crash and burn disaster.  

PubMed

This report describes the initial hospital and burn center management of a mass casualty incident resulting from an aircraft crash and fire. One hundred thirty soldiers were injured, including 10 immediate fatalities. Womack Army Medical Center at Fort Bragg, North Carolina, managed the casualties and began receiving patients 15 minutes after the crash. As a result of repetitive training that included at least two mass casualty drills each year, the triage area and emergency department were cleared of all patients within 2 hours. Fifty patients were transferred to burn centers, including 43 patients to the US Army Institute of Surgical Research. This constitutes the largest single mass casualty incident experienced in the 57-year history of the Institute. All patients of the US Army Institute of Surgical Research survived to hospital discharge, and 34 returned to duty 3 months after the crash. The scenario of an on-ground aircraft explosion and fire approximates what might be seen as a result of an aircraft hijacking, bombing, or intentional crash. Lessons learned from this incident have utility in the planning of future response to such disasters. PMID:15756114

Mozingo, David W; Barillo, David J; Holcomb, John B

2005-01-01

312

Burn care in disaster and other austere settings.  

PubMed

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

Jeng, James; Gibran, Nicole; Peck, Michael

2014-08-01

313

Spatial Mass  

E-print Network

In analogy to the transverse mass constructed from two objects, we define the spatial mass constructed from the input objects 3-vector momenta. This observable is insensitive to jet mass scale and resolution uncertainties when constructed from small-radius hadronic jets. Thus it improves the effective resolution on multijet masses for searches and measurements in hadronic final states. To illustrate the efficacy of the spatial mass, we consider a top quark mass measurement at the Large Hadron Collider (LHC) in the 3-jet final state. The reduction in uncertainty comes with a negligible cost in sensitivity.

Nachman, Benjamin

2014-01-01

314

Spatial Mass  

E-print Network

In analogy to the transverse mass constructed from two objects, we define the spatial mass constructed from the input objects 3-vector momenta. This observable is insensitive to jet mass scale and resolution uncertainties when constructed from small-radius hadronic jets. Thus it improves the effective resolution on multijet masses for searches and measurements in hadronic final states. To illustrate the efficacy of the spatial mass, we consider a top quark mass measurement at the Large Hadron Collider (LHC) in the 3-jet final state. The reduction in uncertainty comes with a negligible cost in sensitivity.

Benjamin Nachman; Ariel Schwartzman

2014-07-08

315

Mass loss  

NASA Technical Reports Server (NTRS)

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

Goldberg, Leo

1987-01-01

316

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

317

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

318

CONTINENTAL CASUALTY COMPANY Chicago, Illinois  

E-print Network

. 5. Personalized data such as contact lists, photos, video, and music downloads. Customized software, such as personal information managers(PIM's)ring tones,games,or screensavers. 6. Covered Accessories willonly: All eligibleequipmenttypes: $6.99 permonth F. WHEN COVERAGE IS EFFECTIVE. All co

Fisher, Kathleen

319

California Casualty First Aid America  

E-print Network

To You Kettle Masters KeVita Probiotic Drinks Mix1 All Natural Protein Shakes Panera Bread, Newport Beach. Road Runner Sports StayWell Health Management UCI Campus Recreation UCI Health Education Center

Rose, Michael R.

320

Truth was an early casualty  

SciTech Connect

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

Sich, A.R.

1996-05-01

321

Tax aspects of casualty losses  

E-print Network

dry up in the 13 summer months unless there was an unusually heavy rainfall. How- ever, if this occurrence had not been normal, but an unexpected, 11 Rev. Rul. S5-367, C . B. 19 55-1, p. 25. 12 Charles E. 'pringer and K'arion E . . ?pringer v... dry up in the 13 summer months unless there was an unusually heavy rainfall. How- ever, if this occurrence had not been normal, but an unexpected, 11 Rev. Rul. S5-367, C . B. 19 55-1, p. 25. 12 Charles E. 'pringer and K'arion E . . ?pringer v...

Lehmann, August Herman

2012-06-07

322

Flora North America: Austerity Casualty?  

ERIC Educational Resources Information Center

The greatest cooperative effort of taxonomists in the United States of America and Canada to study flora of this continent has come to an abrupt end after seven years of preparatory work. Financial support from government agency has been withdrawn and all significant projects have no alternative but to be closed down. (PS)

Irwin, Howard S.

1973-01-01

323

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

324

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. PMID:25057432

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

2014-01-01

325

Web-based scoring of the dicentric assay, a collaborative biodosimetric scoring strategy for population triage in large scale radiation accidents.  

PubMed

In the case of a large scale radiation accident high throughput methods of biological dosimetry for population triage are needed to identify individuals requiring clinical treatment. The dicentric assay performed in web-based scoring mode may be a very suitable technique. Within the MULTIBIODOSE EU FP7 project a network is being established of 8 laboratories with expertise in dose estimations based on the dicentric assay. Here, the manual dicentric assay was tested in a web-based scoring mode. More than 23,000 high resolution images of metaphase spreads (only first mitosis) were captured by four laboratories and established as image galleries on the internet (cloud). The galleries included images of a complete dose effect curve (0-5.0 Gy) and three types of irradiation scenarios simulating acute whole body, partial body and protracted exposure. The blood samples had been irradiated in vitro with gamma rays at the University of Ghent, Belgium. Two laboratories provided image galleries from Fluorescence plus Giemsa stained slides (3 h colcemid) and the image galleries from the other two laboratories contained images from Giemsa stained preparations (24 h colcemid). Each of the 8 participating laboratories analysed 3 dose points of the dose effect curve (scoring 100 cells for each point) and 3 unknown dose points (50 cells) for each of the 3 simulated irradiation scenarios. At first all analyses were performed in a QuickScan Mode without scoring individual chromosomes, followed by conventional scoring (only complete cells, 46 centromeres). The calibration curves obtained using these two scoring methods were very similar, with no significant difference in the linear-quadratic curve coefficients. Analysis of variance showed a significant effect of dose on the yield of dicentrics, but no significant effect of the laboratories, different methods of slide preparation or different incubation times used for colcemid. The results obtained to date within the MULTIBIODOSE project by a network of 8 collaborating laboratories throughout Europe are very promising. The dicentric assay in the web based scoring mode as a high throughput scoring strategy is a useful application for biodosimetry in the case of a large scale radiation accident. PMID:24557539

Romm, H; Ainsbury, E; Bajinskis, A; Barnard, S; Barquinero, J F; Barrios, L; Beinke, C; Puig-Casanovas, R; Deperas-Kaminska, M; Gregoire, E; Oestreicher, U; Lindholm, C; Moquet, J; Rothkamm, K; Sommer, S; Thierens, H; Vral, A; Vandersickel, V; Wojcik, A

2014-05-01

326

Review of gunshot injuries in cats and dogs and utility of a triage scoring system to predict short-term outcome: 37 cases (2003-2008).  

PubMed

Objective-To describe the signalment, wound characteristics, and treatment of gunshot injuries in cats and dogs in urban and rural environments, and to evaluate the utility of the animal trauma triage (ATT) score as an early predictor of survival to discharge from the hospital. Design-Retrospective case series. Animals-29 dogs and 8 cats. Procedures-Medical records of cats and dogs evaluated for gunshot wounds from 2003 and 2008 at a private urban referral practice in Cedar Rapids, Iowa, and an urban veterinary teaching hospital in Ames, Iowa, were reviewed. Information collected included signalment, chief reason for evaluation, circumstance of the injury, general physical examination findings, wound characteristics, treatments provided, cost of care, survival to discharge from the hospital (yes vs no), and duration of hospital stay. For each animal, ATT scores were calculated and evaluated as a prognostic tool. Results-37 animals met study inclusion criteria. Animals with higher ATT scores had a greater likelihood of poor outcome following gunshot injury. Animals with higher ATT scores, classified as low (< 4.5) or high (> 4.5), were found to have a longer duration of stay, classified as zero (0 days), short (1 to 3 days), or long (> 3 days). Young male dogs generally considered working breeds were overrepresented (29/37 [78.4%]). A preference for low-velocity, low-kinetic-energy firearms was identified (19/37 [52%]). The most numerous wounds were those inflicted to the limbs (12/37 [32.4%]), during low-visibility hours or hunting excursions. Calculated ATT scores on admission were higher in animals requiring blood products or surgical procedures and in nonsurvivors. Conclusions and Clinical Relevance-Results of the present study suggested that regional preferences in breed ownership and firearm choice are responsible for variation in gunshot injury characteristics and management in animals sustaining injuries in rural and urban settings in Iowa. In cats and dogs, calculation of an ATT score may provide a useful predictor of the need for surgery or blood products, duration of stay, and likelihood of survival to discharge from the hospital. PMID:25285934

Olsen, Lisa E; Streeter, Elizabeth M; DeCook, Rhonda R

2014-10-15

327

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

328

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

329

3 Echo: concept of operations for early care and evacuation of victims of mass violence.  

PubMed

This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event. PMID:24909363

Autrey, Allen W; Hick, John L; Bramer, Kurtis; Berndt, Jeremy; Bundt, Jonathan

2014-08-01

330

Earthquakes and the office-based surgeon.  

PubMed Central

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

Conover, W A

1992-01-01

331

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

332

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

333

Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times  

PubMed Central

Background Internationally, emergency departments are struggling with crowding and its associated morbidity, mortality, and decreased patient and health-care worker satisfaction. The objective was to evaluate the addition of a MDRNSTAT (Physician (MD)-Nurse (RN) Supplementary Team At Triage) on emergency department patient flow and quality of care. Methods Pragmatic cluster randomized trial. From 131 weekday shifts (8:00–14:30) during a 26-week period, we randomized 65 days (3173 visits) to the intervention cluster with a MDRNSTAT presence, and 66 days (3163 visits) to the nurse-only triage control cluster. The primary outcome was emergency department length-of-stay (EDLOS) for patients managed and discharged only by the emergency department. Secondary outcomes included EDLOS for patients initially seen by the emergency department, and subsequently consulted and admitted, patients reaching government-mandated thresholds, time to initial physician assessment, left-without being seen rate, time to investigation, and measurement of harm. Results The intervention’s median EDLOS for discharged, non-consulted, high acuity patients was 4:05 [95th% CI: 3:58 to 4:15] versus 4:29 [95th% CI: 4:19–4:38] during comparator shifts. The intervention’s median EDLOS for discharged, non-consulted, low acuity patients was 1:55 [95th% CI: 1:48 to 2:05] versus 2:08 [95th% CI: 2:02–2:14]. The intervention’s median physician initial assessment time was 0:55 [95th% CI: 0:53 to 0:58] versus 1:21 [95th% CI: 1:18 to 1:25]. The intervention’s left-without-being-seen rate was 1.5% versus 2.2% for the control (p = 0.06). The MDRNSTAT subgroup analysis resulted in significant decreases in median EDLOS for discharged, non-consulted high (4:01 [95th% CI: 3:43–4:16]) and low acuity patients (1:10 95th% CI: 0:58–1:19]), as well as physician initial assessment time (0:25 [95th% CI: 0:23–0:26]). No patients returned to the emergency department after being discharged by the MDRNSTAT at triage. Conclusions The intervention reduced delays and left-without-being-seen rate without increased return visits or jeopardizing urgent care of severely ill patients. Trial registration number NCT00991471 ClinicalTrials.gov PMID:24207160

2013-01-01

334

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

335

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

336

Mass Deacidification.  

ERIC Educational Resources Information Center

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

Harris, Carolyn

1979-01-01

337

Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method  

PubMed Central

Background Delirium is a common form of acute brain dysfunction with prognostic significance. Health care professionals caring for older emergency department (ED) patients miss delirium approximately 75% of cases. This error results from a lack of available measures that can be performed rapidly enough to be incorporated into clinical practice. Therefore, we developed and evaluated a novel two-step approach to delirium surveillance for the ED. Methods This prospective observational study was conducted at an academic ED in patients ? 65 years old. A research assistant (RA) and physician performed the Delirium Triage Screen (DTS), designed to be a highly sensitive rule-out test, and the Brief Confusion Assessment Method (bCAM), designed to be a highly specific rule-in test for delirium. The reference standard for delirium was a comprehensive psychiatrist assessment using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. All assessments were independently conducted within 3 hours of each other. Sensitivities, specificities, and likelihood ratios with their 95% confidence intervals (95%CI) were calculated. Results Of 406 enrolled patients, 50 (12.3%) had delirium diagnosed by the psychiatrist reference standard. The DTS was 98.0% (95%CI: 89.5% – 99.5%) sensitive with an expected specificity of approximately 55% for both raters. The DTS’ negative likelihood ratio was 0.04 (95%CI: 0.01 – 0.25) in both raters. As the complement, the bCAM had a specificity of 95.8% (95%CI: 93.2% – 97.4%) and 96.9% (95%CI: 94.6% – 98.3%) and a sensitivity of 84.0% (95%CI: 71.5% – 91.7%) and 78.0% (95%CI: 64.8% – 87.2%) when performed by the physician and RA, respectively. The positive likelihood ratios for the bCAM were 19.9 (95%CI: 12.0 – 33.2) and 25.2 (95%CI: 13.9 – 46.0), respectively. If the RA DTS was followed by the physician bCAM, the sensitivity of this combination was 84.0% (95%CI: 71.5% – 91.7%) and the specificity was 95.8% (95%CI: 93.2% – 97.4%). If the RA performed both the DTS and bCAM, this combination was 78.0% (95%CI: 64.8% – 87.2%) sensitive and 97.2% (95%CI: 94.9% – 98.5%) specific. If the physician performed both the DTS and bCAM, this combination was 82.0% (95%CI: 69.2% – 90.2%) sensitive and 95.8% (95CI: 93.2% – 97.4%) specific. Conclusions In older ED patients, this two-step approach (highly sensitive DTS followed by highly specific bCAM) may enable healthcare professionals, regardless of clinical background, to efficiently screen for delirium. Larger, multi-centered trials are needed to confirm these findings and to determine the impact of these assessments on delirium recognition in the ED. PMID:23916018

Han, Jin H.; Wilson, Amanda; Vasilevskis, Eduard E.; Shintani, Ayumi; Schnelle, John F.; Dittus, Robert S.; Graves, Amy J.; Storrow, Alan B.; Shuster, John; Ely, E. Wesley

2013-01-01

338

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

PubMed

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

Hampton, David R

2014-01-01

339

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.

340

Mass transfer andMass transfer and Mass transfer andMass transfer and  

E-print Network

eknik Mass transfer andMass transfer and arationste Mass transfer andMass transfer and separation / mass transfer analogy7. Heat / mass transfer analogy Massöve Ron Zevenhoven �bo Akademi Universityy.1 Heat / mass transfer analogy7.1 Heat / mass transfer analogy 4 erföringo gygy Massöve RoNzfebruari 2012

Zevenhoven, Ron

341

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

342

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

343

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

344

Mass Audubon  

NSDL National Science Digital Library

Founded in 1896 by two women with a passion for the protection of birds, Mass Audubon works to protect the nature of Massachusetts for people and wildlife. Its 100,000 members help care for 35,000 acres of conservation land. On its site, visitors can learn about its advocacy work through reports, policy papers, and educational outreach efforts. In the Our Conservation Network area, visitors can learn about Mass audubon's work in land conservation, ecological management, community reach, and climate change. Moving on, the Learn area features information about the Museum of American Bird Art, resources for young conservationists ("EcoKids"), and resources for school groups hoping to pay a visit to some of their land holdings. It's worth nothing that the News & Events area contains blogs, videos, press releases, and details on fun photo contests.

345

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

346

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

PubMed Central

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

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

2013-01-01

347

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  

SciTech Connect

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 wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however, substantially larger numbers of individuals (100 s to 1,000 s) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated by the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (G50, 50Y250, 250Y500, and 9500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances. Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

Bolch, W.E. [University of Florida; Hurtado, J.L. [University of Florida; Lee, C. [University of Florida; Manger, Ryan P [ORNL; Hertel, Nolan [Georgia Institute of Technology; Burgett, E. [Georgia Institute of Technology; Dickerson, W. [Armed Force Radiobiological Research Institute

2012-01-01

348

Guidance on the use of handheld survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSV effective dose for adult males and adult females.  

PubMed

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 wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however,substantially larger numbers of individuals (100’s to 1,000’s) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated--the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (< 50, 50-250, 250-500,and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances.Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation). PMID:22420020

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

2012-03-01

349

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

350

Mass transfer andMass transfer and Mass transfer andMass transfer and  

E-print Network

eknik Mass transfer andMass transfer and arationste Mass transfer andMass transfer and separationSepa Massöverföring och separationsteknikMassöverföring och separationsteknik ("M�F("M�F--ST")ST") 4 erföringo 6. Mass transfer and convection6. Mass transfer and convection Massöve Ron Zevenhoven �bo Akademi Universityy

Zevenhoven, Ron

351

Mass definition, mass measurement and recommendations  

SciTech Connect

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

Braudaway, D.W.

1990-09-01

352

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

PubMed

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

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

2014-10-01

353

Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trials).  

PubMed

Percutaneous coronary intervention (PCI) of calcified coronary lesions has been associated with increased rates of adverse ischemic events. However, the potential association between the presence and severity of calcific deposits and bleeding complications has yet to be investigated. Data from 6,855 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) or ST-segment elevation myocardial infarction (STEMI) treated with PCI were pooled from 2 large-scale randomized controlled trials-Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction. Patients were stratified into 3 groups according the grade of target PCI lesion calcium (none to mild, moderate, and severe) as assessed by an independent angiographic core laboratory. Thirty-day bleeding event rates were assessed and compared among groups. In the total cohort undergoing PCI, none-to-mild target lesion calcium was found in 4,665 patients (68.1%), moderate target lesion calcium in 1,788 patients (26.1%), and severe target lesion calcium in 402 patients (5.9%). The 30-day rates of non-coronary artery bypass graft surgery major bleeding increased significantly with each degree of coronary calcium (none to mild = 5.9%, moderate = 7.2%, and severe = 11.2%, p = 0.0003). By multivariable analysis, presence of severe calcium was an independent predictor of non-coronary artery bypass graft major bleeding after PCI (hazard ratio 1.54, 95% confidence interval 1.09 to 2.17, p = 0.01). In conclusion, in patients undergoing PCI for non-ST-segment elevation acute coronary syndrome and ST-segment elevation myocardial infarction, target lesion coronary calcium was an independent predictor of major bleeding events. Further studies are needed to elucidate mechanisms underlying this finding and to optimize treatment of this high-risk population. PMID:24440325

Généreux, Philippe; Madhavan, Mahesh V; Mintz, Gary S; Maehara, Akiko; Kirtane, Ajay J; Palmerini, Tullio; Tarigopula, Madhusudhan; McAndrew, Tom; Lansky, Alexandra J; Mehran, Roxana; Brener, Sorin J; Stone, Gregg W

2014-03-15

354

Residential Thermal Mass Construction  

E-print Network

completely shied away from high mass construction practices. In an attempt to revitalize the use of high mass in residential construction, we have designed a special "Thermal Mass Block." This new block incorporates the use of modern construction techniques...

Thieken, J. S.

1988-01-01

355

Origins of mass  

E-print Network

Newtonian mechanics posited mass as a primary quality of matter, incapable of further elucidation. We now see Newtonian mass as an emergent property. That mass-concept is tremendously useful in the approximate description ...

Wilczek, Frank

356

Effective Mass and Energy-Mass Relationship  

E-print Network

The particle effective mass is often a challenging concept in solid state physics due to the many different definitions of the effective mass that are routinely used. Also, the most commonly used theoretical definition of the effective mass was derived from the assumption of a parabolic energy-momentum relationship, E(p), and therefore should not be applied to non-parabolic materials. In this paper, we use wave-particle duality to derive a definition of the effective mass and the energy-mass approximation suitable for non-parabolic materials. The new energy-mass relationship can be considered a generalization of Einstein's E=mc^2 suitable for arbitrary E(p) and therefore applicable to solid state materials and devices. We show that the resulting definition of the effective mass seems suitable for non-paraboic solid state materials such as HgCdTe, GaAs, and graphene.

Viktor Ariel

2012-05-14

357

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

PubMed

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

2012-10-01

358

Thermal desorption mass spectrometer for mass metrology  

NASA Astrophysics Data System (ADS)

This article presents a device for the study of physisorbed elements on polished surfaces (diameter ?56 mm) of the kind used in mass metrology. The technique is based on mass spectrometry of molecules desorbed after heating under vacuum of the analyzed surface. We describe a first application of the device to study current and future mass standards in order to understand how their surface reactivity depends on storage conditions, cleaning processes, and polishing methods. Surface contamination analysis by thermal desorption mass spectrometry to examine the effect of cleaning on pure iridium is given as an example.

Silvestri, Z.; Azouigui, S.; Bouhtiyya, S.; Macé, S.; Plimmer, M. D.; Pinot, P.; Tayeb-Chandoul, F.; Hannachi, R.

2014-04-01

359

California Casualty (26) First Aid America (69)  

E-print Network

Fresh To You (60) Kettle Masters (OUT) KeVita Probiotic Drinks(76) Mix1 All Natural Protein Shakes (86 (65) Paws for Healing, Inc. (36) Road Runner Sports (OUT) StayWell Health Management (21) UCI Campus

Rose, Michael R.

360

Simulated Casualties and Medics for Emergency Training  

E-print Network

-1976 215573-7453 fax Abstract The MediSim system extends virtual environment technology to allow medical per;1 Introduction The MediSim system allows medical personnel to interact with and train on simulated casu- alties as a set of networked application modules to enable its integration into Distributed Interactive Systems

Badler, Norman I.

361

Bio-Terrorism Threat and Casualty Prevention  

SciTech Connect

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

NOEL,WILLIAM P.

2000-01-01

362

Truth in Education: A Chronic Casualty.  

ERIC Educational Resources Information Center

Examples from a variety of sources (history texts, newspaper reporting, courts) are used to show that truth telling is commonly subordinated to other goals, especially the self-justification or the profits, power, and prestige of those promoting the lies. (24 references) (Author/LB)

Robinson, W. P.

1992-01-01

363

Linear mass actuator  

NASA Technical Reports Server (NTRS)

A linear mass actuator includes an upper housing and a lower housing connectable to each other and having a central passageway passing axially through a mass that is linearly movable in the central passageway. Rollers mounted in the upper and lower housings in frictional engagement with the mass translate the mass linearly in the central passageway and drive motors operatively coupled to the roller means, for rotating the rollers and driving the mass axially in the central passageway.

Holloway, Sidney E., III (inventor); Crossley, Edward A., Jr. (inventor); Jones, Irby W. (inventor); Miller, James B. (inventor); Davis, C. Calvin (inventor); Behun, Vaughn D. (inventor); Goodrich, Lewis R., Sr. (inventor)

1992-01-01

364

Heavy quark masses  

NASA Technical Reports Server (NTRS)

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

Testa, Massimo

1990-01-01

365

Mass definition, mass measurement and recommendations  

Microsoft Academic Search

Mass measurements may be greatly enhanced by an understanding of the operation of balances, the effects of buoyancy, practices encountered in weighing and the impacts and meanings of revelant mass standards. Beginning with the basic forces acting on weights, the equations brought to equality in balances are developed. These give explanation of the weighing process and an appreciation for some

Braudaway

1990-01-01

366

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

PubMed

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

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

2013-11-01

367

An Automated Method to Quantify Radiation Damage in Human Blood Cells  

SciTech Connect

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

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

2006-07-10

368

The incidental renal mass.  

PubMed

Incidental renal masses are extremely common. Although most represent benign renal cysts, not all incidental renal masses are benign. Most renal cell carcinomas are discovered incidentally when an imaging examination is performed to evaluate a nonrenal complaint. Therefore, differentiating incidental benign renal masses from those that are potentially malignant is important. There are well-established, time-tested, image-based criteria that can be used to diagnose most renal masses definitively. However, some renal masses remain indeterminate even after a thorough evaluation with imaging. This article discusses the evaluation, diagnosis, and treatment options of the incidental renal mass. PMID:21333783

Israel, Gary M; Silverman, Stuart G

2011-03-01

369

Validation of QuickScan dicentric chromosome analysis for high throughput radiation biological dosimetry.  

PubMed

Currently, the dicentric chromosome assay (DCA) is used to estimate radiation doses to individuals following accidental radiological and nuclear overexposures when traditional dosimetry methods are not available. While being an exceptionally sensitive method for estimating doses by radiation, conventional DCA is time-intensive and requires highly trained expertise for analysis. For this reason, in a mass casualty situation, triage-quality conventional DCA struggles to provide dose estimations in a timely manner for triage purposes. In Canada, a new scoring technique, termed DCA QuickScan, has been devised to increase the throughput of this assay. DCA QuickScan uses traditional DCA sample preparation methods while adapting a rapid scoring approach. In this study, both conventional and QuickScan methods of scoring the DCA assay were compared for accuracy and sensitivity. Dose response curves were completed on four different donors based on the analysis of 1,000 metaphases or 200 events at eight to nine dose points by eight different scorers across two laboratories. Statistical analysis was performed on the data to compare the two methods within and across the laboratories and to test their respective sensitivities for dose estimation. This study demonstrated that QuickScan is statistically similar to conventional DCA analysis and is capable of producing dose estimates as low as 0.1 Gy but up to six times faster. Therefore, DCA QuickScan analysis can be used as a sensitive and accurate method for scoring samples for radiological biodosimetry in mass casualty situations or where faster dose assessment is required. PMID:22217587

Flegal, F N; Devantier, Y; Marro, L; Wilkins, R C

2012-02-01

370

On Gravity and Mass  

E-print Network

Motivated mainly by the fact that no charged elementary particles having zero mass have been observed up to now, we investigate the question whether the mass of the elementary particles is connected with their electric charge and whether gravity can be derived from QED. The graviton is considered as a two-photon bound state. A relation between mass and charge of elementary particles is derived. Masses of the light quarks $d$ and $u$ are calculated from the electron mass, assuming that $d$, $u$ and $e$ are all fundamental and not composite. In this picture, the heavier quarks and leptons are considered as not fundamental, the massive neutral gauge bosons (and then their charged partners) are composite. The here calculated $u$ and $d$ quark masses, result in quark-mass ratios which display interesting regularities. The lightest quark mass turns out to be quite small. This may be interesting in connection to the strong CP problem.

Athanasios Markou

2009-03-03

371

Mass modeling for bars  

NASA Technical Reports Server (NTRS)

Methods of modeling mass for bars are surveyed. A method for extending John Archer's concept of consistent mass beyond just translational inertia effects is included. Recommendations are given for various types of modeling situations.

Butler, Thomas G.

1987-01-01

372

Computer Forensics Field Triage Process Model  

Microsoft Academic Search

With the proliferation of digital based evidence, the need for the timely identification, analysis and interpretation of digital evidence is becoming more crucial. In many investigations critical information is required while at the scene or within a short period of time - measured in hours as opposed to days. The traditional cyber forensics approach of seizing a system(s)\\/media, transporting it

Marcus K. Rogers; James Goldman; Rick Mislan; Timothy Wedge; Steve Debrota

2006-01-01

373

Triage and the Art of Institutional Research.  

ERIC Educational Resources Information Center

Principles that institutional researchers should follow are discussed. The most important dictate is to present decision-makers the bare minimum of information necessary for the task; the material should be simple, short, and succinct. A report to assist decision-makers should not include extensive supporting documentation. The first step is to…

Norris, Donald M.

1983-01-01

374

Heterogeneous artificial agents for triage nurse assistance  

Microsoft Academic Search

A dream of humanoid robot researchers is to develop a complete “human-like” (whatever that means) artificial agent both in terms of body and brain. We now have seen an increasing number of humanoid robots (such as Honda's ASIMO, Aldebaran's Nao and many others). These, however, display only a limited number of cognitive skills in terms of perception, learning and decision-making.

D. M. Wilkes; Stan Franklin; Erdem Erdemir; Stephen Gordon; Steve Strain; Karen Miller; Kazuhiko Kawamura

2010-01-01

375

Mass spectrometer mixture calibrations  

Microsoft Academic Search

Mass spectrometric analyses of hydrogen isotope mixtures can be difficult to make for a number of reasons. The most difficult problem is the possibility of confronting extremely great and extremely small relative mass differences in the same analysis. Commercial mass spectrometers are now available that can overcome these problems. The analytical capabilities and limitations of these instruments will be discussed.

Hicks

1986-01-01

376

Erosion of mass culture  

Microsoft Academic Search

In the last few decades, advertisers, academics, political operatives, and the producers of mass entertainment have had increasing difficulty conveying media messages to broad audiences. While the purveyors of mass culture were never able to reach everyone, fewer of them are even trying, and they often content themselves with communicating their message to only one part of the mass audience.

Paul Jerome Croce

1993-01-01

377

On the graviton mass  

Microsoft Academic Search

It was suggested that observations of the solar system exclude massive gravity, in the sense that the graviton mass must be rigorously zero. This is because there is a discontinuity in the linearized gravity theory at graviton mass equal to zero. The linearized Schwarzschild metric is not recovered for infinitesimal graviton mass, contradicting observations on light deviation by the Sun

Andrei Gruzinov

2005-01-01

378

Center of Mass 3  

NSDL National Science Digital Library

This lab is an inquiry activity if it is done before the discussion of how center of mass and balance are related. However, students should have an idea of what center of mass is before they start the lab. Students should see that when the center of mass

Horton, Michael

2009-05-30

379

Meson Mass Decomposition  

E-print Network

Hadron masses can be decomposed as a sum of components which are defined through hadronic matrix elements of QCD operators. The components consist of the quark mass term, the quark energy term, the glue energy term and the trace anomaly term. We calculate these components of mesons with lattice QCD for the first time. The calculation is carried out with overlap fermion on $2+1$ flavor domain-wall fermion gauge configurations. We confirm that $\\sim 50\\%$ of the light pion mass comes from the quark mass and $\\sim 10\\%$ comes from the quark energy, whereas, the contributions are found to be the other way around for the $\\rho$ mass. The combined glue components contribute $\\sim 40 - 50\\%$ for both mesons. It is interesting to observe that the quark mass contribution to the mass of the vector meson is almost linear in quark mass over a large quark mass region below the charm quark mass. For heavy mesons, the quark mass term dominates the masses, while the contribution from the glue components is about $400\\sim500$...

Yang, Yi-Bo; Draper, Terrence; Gong, Ming; Liu, Keh-Fei; Liu, Zhaofeng; Ma, Jian-Ping

2014-01-01

380

Calculating centres of mass  

E-print Network

Calculating centres of mass 15.2 Introduction In this section we show how the idea of integration as the limit of a sum can be used to find the centre of mass of an object such as a thin plate completing this Section you should be able to . . . calculate the position of the centre of mass

Vickers, James

381

Fourier Transform Mass Spectrometry.  

ERIC Educational Resources Information Center

Discusses the nature of Fourier transform mass spectrometry and its unique combination of high mass resolution, high upper mass limit, and multichannel advantage. Examines its operation, capabilities and limitations, applications (ion storage, ion manipulation, ion chemistry), and future applications and developments. (JN)

Gross, Michael L.; Rempel, Don L.

1984-01-01

382

Fractional Conservation of Mass  

Microsoft Academic Search

The traditional conservation of mass equation is derived using a first-order Taylor Series to represent flux change in a control volume, which is valid strictly for cases of linear changes in flux through the control volume. We show that using higher-order Taylor Series approximations for the mass flux results in mass conservation equations that are intractable. We then show that

S. W. Wheatcraft; M. M. Meerachaert

2008-01-01

383

Fractional conservation of mass  

Microsoft Academic Search

The traditional conservation of mass equation is derived using a first-order Taylor series to represent flux change in a control volume, which is valid strictly for cases of linear changes in flux through the control volume. We show that using higher-order Taylor series approximations for the mass flux results in mass conservation equations that are intractable. We then show that

Stephen W. Wheatcraft; Mark M. Meerschaert

2008-01-01

384

On the Graviton Mass  

E-print Network

It was suggested that observations of the solar system exclude massive gravity, in the sense that the graviton mass must be rigorously zero. This is because there is a discontinuity in the linearized gravity theory at graviton mass equal to zero. The linearized Schwarzschild metric is not recovered for infinitesimal graviton mass, contradicting observations on light deviation by the Sun and Mercury perihelion advance. It was then argued that non-perturbative effects make the massive gravity theory continuous in the graviton mass. Both the original suggestion and its refutation were based on a non-covariant and linearized action, and the physical interpretation of these results remained questionable. Here we use a covariant quasi-massive gravity theory that is known to be discontinuous in the graviton mass in the linear approximation. We show that non-perturbative effects do restore the continuity; the weak-field Schwarzschild solution is recovered in the limit of small graviton mass. We also show that weak-field Schwarzschild with matter is recovered for infinitesimal graviton mass. Thus: Observations of the solar system only put an upper limit on the graviton mass (in the context of the gravity theory that we use, inverse graviton mass, as measured at distances of order inverse graviton mass, is $\\gtrsim 100$ Mpc). But graviton can be massive, with a cosmologically interesting mass.

Andrei Gruzinov

2001-12-11

385

Fourier Transform Mass Spectrometry  

PubMed Central

This article provides an introduction to Fourier transform-based mass spectrometry. The key performance characteristics of Fourier transform-based mass spectrometry, mass accuracy and resolution, are presented in the view of how they impact the interpretation of measurements in proteomic applications. The theory and principles of operation of two types of mass analyzer, Fourier transform ion cyclotron resonance and Orbitrap, are described. Major benefits as well as limitations of Fourier transform-based mass spectrometry technology are discussed in the context of practical sample analysis, and illustrated with examples included as figures in this text and in the accompanying slide set. Comparisons highlighting the performance differences between the two mass analyzers are made where deemed useful in assisting the user with choosing the most appropriate technology for an application. Recent developments of these high-performing mass spectrometers are mentioned to provide a future outlook. PMID:21742802

Scigelova, Michaela; Hornshaw, Martin; Giannakopulos, Anastassios; Makarov, Alexander

2011-01-01

386

On Negative Mass  

NASA Astrophysics Data System (ADS)

The Schwarzschild solution to the matter free, spherically symmetric Einstein equations has one free parameter, the mass. But the mass can be of any sign. What is the meaning of the negative mass solutions? The answer to this question for the case of a pure Schwarzschild negative mass black solution is still elusive, however, in this essay, we will consider negative mass solutions within a Schwarzschild-de Sitter geometry. We show that there exist reasonable configurations of matter, bubbles of distributions of matter, that satisfy the dominant energy condition everywhere, that are nonsingular and well behaved everywhere, but correspond to the negative mass Schwarzschild-de Sitter geometry outside the matter distribution. These negative mass bubbles could occur as the end state of a quantum tunneling transition.

Belletête, Jonathan; Paranjape, M. B.

2013-06-01

387

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

SciTech Connect

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

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

2000-06-01

388

Civilian exposure to toxic agents: emergency medical response.  

PubMed

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

Baker, David

2004-01-01

389

Spore biomarker detection using a MEMS differential mobility spectrometer  

Microsoft Academic Search

Early detection technologies permit quick characterization of a bioweapons threat and identification of a hoax that will minimize human casualties and reduce the time and financial burdens associated with containment, triage and clean up. In this paper, we demonstrate that distinctive biological markers are present in pyrolyzed Bacillus endospore samples and these volatile chemical signatures can be detected by differential

C. E. Davis; J. M. Kang; C. E. Dube; J. T. Borenstein; E. G. Nazarov; R. A. Miller; ZapataAM

2003-01-01

390

Top quark mass measurements  

SciTech Connect

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

Hill, Christopher S.; /UC, Santa Barbara

2004-12-01

391

Energy-mass conversion  

NSDL National Science Digital Library

How do physicists make new particles? In this page of a particle physics tutorial, students are introduced to the concept of converting kinetic energy to mass. Students read that low-mass particles placed into an accelerator can be smashed together to produce more massive particles through the conversion of energy to mass. They see an example in which two pieces of fruit are accelerated and smashed, and additional types of fruit are produced. Copyright 2005 Eisenhower National Clearinghouse

Group, Lawrence B.

2002-01-01

392

The Mass Extinctions  

NSDL National Science Digital Library

This brief overview of the six generally agreed-upon mass extinction events in geologic history examines the gaps in the fossil record and the possibility of a cyclic nature to mass extinctions. Links are provided to information on each of the six known mass extinction events, including their approximate ages, types and numbers or percentages of species that disappeared, and some postulated reasons for the die-offs.

393

Phantom mass gravitational effects  

E-print Network

I derive the basic relativistic corrections to the equations of motion of test particles and light rays in the field of a source with active mass $m$, including the phantom mass density that any such source generates when a modification of Newton's action at a distance includes a long range term. The technical framework of this paper is that of Einstein's theory of gravitation at the linear approximation with respect to the mass parameter $m$.

Ll. Bel

2013-11-27

394

Mass vs. Weight  

NSDL National Science Digital Library

This laboratory activity worksheet engages students in an exploration of mass and weight. Students use a balance to measure the mass and a spring scale to measure the weight of a series of objects. They then analyze the data to determine the relationship between these two quantities and conceptualize the distinction between the mass and weight through questions regarding measurements on the moon and other planets.

Nelson, Jane; Nelson, Jim

2011-06-14

395

Ion Trap Mass Spectrometry  

SciTech Connect

This chapter describes research conducted in a few research groups in the 1990s in which RF quadrupole ion trap mass spectrometers were coupled to a powerful atomic ion source, the inductively coupled plasma used in conventional ICP-MS instruments. Major section titles for this chapter are: RF Quadrupole Ion Traps Features of RF Quadrupole Ion Trap Mass Spectrometers Selective Ion Trapping methods Inductively Coupled Plasma Source Ion Trap Mass Spectrometers

Eiden, Greg C.

2005-09-01

396

The neck mass.  

PubMed

Many head and neck disease processes are manifest as neck masses. These conditions are treated by surgical excision except for some inflammatory masses, and often those too must be excised before a diagnosis can be made. The real question is when to excise the lesion to expedite treatment in the most cost-effective manner. In general, when signs of inflammation are associated with the mass, antibiotic treatment with short-term observation is acceptable. Persistence of the mass or an increase in mass size during observation mandates for their evaluation. Biopsy of a mass is considered for progressive growth, isolated nature or asymmetry of the mass, location (supraclavicular), development of symptoms associated with lymphoma (fever and hypertrophy of the spleen, liver, or Waldeyer's ring), or static size (if > 3 cm). In the adult patient, a complete head and neck physical examination is mandatory before biopsy. Needle biopsy of the neck mass is the current standard of care if no cause of the mass is found on examination. Identified benign cystic lesions or lymphomas indicate a need for excision, either as definitive treatment or for diagnostic reasons. If results of the needle biopsy are positive, equivocal, or even negative in the presence of a high index of suspicion for metastatic squamous cell carcinoma, an endoscopic examination is mandatory before open excision. If no discrete lesion is seen, guided biopsy of the upper aerodigestive tract is performed. Open biopsy of the mass should be accompanied by a frozen-section examination of the mass. A concomitant definitive neck dissection should be performed if the mass proves to be metastatic carcinoma. PMID:9927971

McGuirt, W F

1999-01-01

397

Dynamical Young Star Masses  

NASA Astrophysics Data System (ADS)

Mass is a star's most important property, once composition has been established, and determines the entire life trajectory of an object. Only a couple dozen young stars have absolute dynamical mass measurements, and many of those are imprecise. We propose to observe ~17 young close visual binaries in the Taurus star forming region to advance our knowledge of young star masses. We will use NIRSPEC in high-resolution mode behind the adaptive optics system on the Keck II telescope.

Prato, Lisa; Schaefer, Gail; Simon, Michal

2013-08-01

398

MASS CALC: Z CALCULATE THE Z MASS  

E-print Network

for Grades 9-12: · Content Standard A o Abilities necessary to do scientific inquiry · Content Standard B o that they can use this real data to calculate the Z mass. The students are teams doing a "double- blind

Quigg, Chris

399

Nuclear Masses in Astrophysics  

E-print Network

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

Christine Weber; Klaus Blaum; Hendrik Schatz

2008-12-09

400

Mass-Loaded Flows  

E-print Network

A key process within astronomy is the exchange of mass, momentum, and energy between diffuse plasmas in many types of astronomical sources (including planetary nebulae, wind-blown bubbles, supernova remnants, starburst superwinds, and the intracluster medium) and dense, embedded clouds or clumps. This transfer affects the large scale flows of the diffuse plasmas as well as the evolution of the clumps. I review our current understanding of mass-injection processes, and examine intermediate-scale structure and the global effect of mass-loading on a flow. I then discuss mass-loading in a variety of diffuse sources.

J. M. Pittard

2006-07-13

401

EMS response to an airliner crash.  

PubMed

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol. While multiple errors can occur during a mass-casualty event, these can be reduced by frequent simulation exercises during which various personnel practice and learn designated roles. Efficient triage, proper communication, and knowledge of the roles are important in ensuring the best possible outcome. While the triage system and response of the EMS personnel were effective for this magnitude of catastrophe, more work is needed in order to meet predetermined standards. Ways in which this can be overcome include: (1) hosting more disaster simulation exercises; (2) encouraging more involvement with first responders; and (3) strengthening the links in the local EMS system. Vigorous public education must be instituted and maintained. PMID:22853919

Dasgupta, Shuvra; French, Simone; Williams-Johnson, Jean; Hutson, Rhonda; Hart, Nicole; Wong, Mark; Williams, Eric; Espinosa, Kurdell; Maycock, Celeste; Edwards, Romayne; McCartney, Trevor; Cawich, Shamir; Crandon, Ivor

2012-06-01

402

Acceleration and Mass  

NSDL National Science Digital Library

Although this lab is not an inquiry activity, it is very important in learning about acceleration and mass. It is a deeply held misconception among students that objects of different masses fall at different rates. Simply explaining that this is not true

Horton, Michael

2009-05-30

403

Microscopic mass estimations  

E-print Network

The quest to build a mass formula which have in it the most relevant microscopic contributions is analyzed. Inspired in the successful Duflo-Zuker mass description, the challenges to describe the shell closures in a more transparent but equally powerful formalism are discussed.

Jorge G. Hirsch; Joel Mendoza-Temis

2010-03-09

404

On the Photon Mass  

E-print Network

We review the case for the photon having a tiny mass compatible with the experimental limits. We go over some possible experimental tests for such a photon mass including the violation of Lorentz symmetry. We point out that such violations may already have been witnessed in tests involving high energy gamma rays from outer space as also ultra high energy cosmic rays.

Burra G. Sidharth

2007-06-22

405

Mass Spectrometry Primer  

NSDL National Science Digital Library

This website developed by Waters Corporation provides a brief primer on mass spectrometry which includes information on instrumentation, a discussion of mass accuracy, resolution, and LC-MS. As such the site should be a valuable resource for both students and faculty.

2011-06-13

406

Masses and Structure  

SciTech Connect

The use of nuclear masses to elucidate structure and its evolution with Z and N is discussed, with emphasis on two-neutron separation energies and the proton-neutron interaction as extracted from double differences of binding energies. The enhanced sensitivity of masses to structure in deformed nuclei is also discussed.

Cakirli, R. B. [Max-Planck-Institut fuer Kernphysik, Saupfercheckweg 1, D-69117 Heidelberg (Germany); Department of Physics, University of Istanbul, Istanbul (Turkey); Casten, R. F. [Wright Nuclear Structure Laboratory, Yale University, New Haven, Connecticut 06520 (United States)

2010-08-04

407

Cyclotrons as mass spectrometers  

SciTech Connect

The principles and design choices for cyclotrons as mass spectrometers are described. They are illustrated by examples of cyclotrons developed by various groups for this purpose. The use of present high energy cyclotrons for mass spectrometry is also described. 28 references, 12 figures.

Clark, D.J.

1984-04-01

408

Gas Chromatography -Mass Spectrometry  

E-print Network

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

Nizkorodov, Sergey

409

Elbow mass flow meter  

DOEpatents

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

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

1994-08-16

410

Mass/Weight Connection  

NSDL National Science Digital Library

Students will recognize that the mass of an object is a measure that is independent of gravity. If they can effectively complete the guided inquiry activity as well as the short writing summary to reinforce what they learned, they will gain a foundation for understanding the difference between mass and weight.

King, Lance

2011-07-26

411

Deconstructed Transverse Mass Variables  

E-print Network

Traditional searches for R-parity conserving natural supersymmetry (SUSY) require large transverse mass and missing energy cuts to separate the signal from large backgrounds. SUSY models with compressed spectra inherently produce signal events with small amounts of missing energy that are hard to explore. We use this difficulty to motivate the construction of "deconstructed" transverse mass variables which are designed preserve information on both the norm and direction of the missing momentum. We demonstrate the effectiveness of these variables in searches for the pair production of supersymmetric top-quark partners which subsequently decay into a final state with an isolated lepton, jets and missing energy. We show that the use of deconstructed transverse mass variables extends the accessible compressed spectra parameter space beyond the region probed by traditional methods. The parameter space can further be expanded to neutralino masses that are larger than the difference between the stop and top masses. ...

Ismail, Ahmed; Virzi, Joseph S; Walker, Devin G E

2014-01-01

412

Negative Mass Propulsion  

NASA Astrophysics Data System (ADS)

Schrödinger's analysis of the Dirac equation gives a hint for the existence of negative masses hidden behind positive masses. But their use for propulsion by reducing the inertia of matter for example, in the limit of macroscopic bodied with zero rest mass, depends on a technical solution to free them from their imprisonment by positive masses. It appears that there are basically two ways this might be achieved: 1. By the application of strong electromagnetic or gravitational fields or by high particle energies. 2. By searching for places in the universe where nature has already done this separation, and from where the negative masses can be mined. The first of these two possibilities is for all practical means excluded, because if possible at all, it would depend on electromagnetic or gravitational fields with strength beyond what is technically attainable, or on extremely large likewise not attainable particle energies. With regard to the 2nd possibility, it has been observed that non-baryonic cold dark matter tends to accumulate near the center of galaxies, or places in the universe which have a large gravitational potential well. Because of the equivalence principle of general relativity, the attraction towards the center of a gravitational potential well, produced by a positive mass, is for negative masses the same as for positive masses, and large amounts of negative masses might have over billions of years been trapped in these gravitational potential wells. Now it just happens that the center of the moon is a potential well, not too deep that it cannot be reached by making a tunnel through the moon, not possible for the deeper potential well of the earth, where the temperature and pressure are too high. Making a tunnel through the moon, provided there is a good supply of negative mass, could revolutionize interstellar space flight. A sequence of thermonuclear shape charges would make such tunnel technically feasible.

Winterberg, F.

413

Screening and characterization of reactive compounds with in vitro peptide-trapping and liquid chromatography/high-resolution accurate mass spectrometry.  

PubMed

The present study describes a novel methodology for the detection of reactive compounds using in vitro peptide-trapping and liquid chromatography-high-resolution accurate mass spectrometry (LC-HRMS). Compounds that contain electrophilic groups can covalently bind to nucleophilic moieties in proteins and form adducts. Such adducts are thought to be associated with drug-mediated toxicity and therefore represent potential liabilities in drug discovery programs. In addition, reactive compounds identified in biological screening can be associated with data that can be misinterpreted if the reactive nature of the compound is not appreciated. In this work, to facilitate the triage of hits from high-throughput screening (HTS), a novel assay was developed to monitor the formation of covalent peptide adducts by compounds suspected to be chemically reactive. The assay consists of in vitro incubations of test compounds (under conditions of physiological pH) with synthetically prepared peptides presenting a variety of nucleophilic moieties such as cysteine, lysine, histidine, arginine, serine, and tyrosine. Reaction mixtures were analyzed using full-scan LC-HRMS, the data were interrogated using postacquisition data mining, and modified amino acids were identified by subsequent LC-HRMS/mass spectrometry. The study demonstrated that in vitro nucleophilic peptide trapping followed by LC-HRMS analysis is a useful approach for screening of intrinsically reactive compounds identified from HTS exercises, which are then removed from follow-up processes, thus obviating the generation of data from biochemical activity assays. PMID:23796688

Wei, Cong; Chupak, Louis S; Philip, Thomas; Johnson, Benjamin M; Gentles, Robert; Drexler, Dieter M

2014-02-01

414

Probabilistic Mass Growth Uncertainties  

NASA Technical Reports Server (NTRS)

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

Plumer, Eric; Elliott, Darren

2013-01-01

415

Absolute neutrino mass measurements  

SciTech Connect

The neutrino mass plays an important role in particle physics, astrophysics and cosmology. In recent years the detection of neutrino flavour oscillations proved that neutrinos carry mass. However, oscillation experiments are only sensitive to the mass-squared difference of the mass eigenvalues. In contrast to cosmological observations and neutrino-less double beta decay (0v2{beta}) searches, single {beta}-decay experiments provide a direct, model-independent way to determine the absolute neutrino mass by measuring the energy spectrum of decay electrons at the endpoint region with high accuracy.Currently the best kinematic upper limits on the neutrino mass of 2.2eV have been set by two experiments in Mainz and Troitsk, using tritium as beta emitter. The next generation tritium {beta}-experiment KATRIN is currently under construction in Karlsruhe/Germany by an international collaboration. KATRIN intends to improve the sensitivity by one order of magnitude to 0.2eV. The investigation of a second isotope ({sup 137}Rh) is being pursued by the international MARE collaboration using micro-calorimeters to measure the beta spectrum. The technology needed to reach 0.2eV sensitivity is still in the R and D phase. This paper reviews the present status of neutrino-mass measurements with cosmological data, 0v2{beta} decay and single {beta}-decay.

Wolf, Joachim [Karlsruhe Institute of Technology (KIT), IEKP, Postfach 3640, 76021 Karlsruhe (Germany)

2011-10-06

416

Disaster management following explosion.  

PubMed

Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making. PMID:18522253

Sharma, B R

2008-01-01

417

Multi-parameter dose estimations in radiation biodosimetry using the automated cytokinesis-block micronucleus assay with imaging flow cytometry.  

PubMed

The cytokinesis-block micronucleus (CBMN) assay is an established technique in radiation biological dosimetry for estimating the dose to an individual by measuring the frequency of micronuclei (MN) in binucleated lymphocyte cells (BNCs). The assay has been partially automated using slide-scoring algorithms, but an automated multiparameter method without the need of the slide-making procedure would be advantageous to further increase throughput for application in mass casualty events. The development of the ImageStreamX (ISX) imaging flow cytometer has made it possible to adapt the CBMN assay to an automated imaging flow cytometry (FCM) method. The protocol and analysis presented in this work tailor and expand the assay to a multiparameter biodosimetry tool. Ex vivo irradiated whole blood samples were cultured, processed, and analyzed on the ISX and BNCs, MN, and mononuclear cells were imaged, identified, and enumerated automatically and simultaneously. Details on development of the method, gating strategy, and dose response curves generated for the rate of MN per BNC, percentage of mononuclear cells as well as the replication index are presented. Results indicate that adapting the CBMN assay for use in imaging FCM has produced a rapid, robust, multiparameter analysis method with higher throughput than is currently available with standard microscopy. We conclude that the ISX-CBMN method may be an advantageous tool following a radiological event where triage biodosimetry must be performed on a large number of casualties. PMID:25154929

Rodrigues, M A; Beaton-Green, L A; Kutzner, B C; Wilkins, R C

2014-10-01

418

Dynamical Mass Generation  

NASA Astrophysics Data System (ADS)

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

Bashir, A.; Raya, A.

2006-09-01

419

MassMass transfer andtransfer and MassMass transfer andtransfer and  

E-print Network

coefficientcoefficient /1/1 Mass flow species A:interface a p A = A mol/s M f1 (L) 2 (G) Mass transfer rate per area: A = A/a = "A mol/(m2·s) 1 (L) 2 (G) xi C1.i M t f ffi i t k x C y 1.i AA !!! Mass transfer coefficients, k, (unit: m/s) for both sides of C1 y C2 the interface: = k ·(c -c ) = k ·(c2-c2 ) yi C2.i L G

Zevenhoven, Ron

420

Micromechanical Oscillating Mass Balance  

NASA Technical Reports Server (NTRS)

A micromechanical oscillating mass balance and method adapted for measuring minute quantities of material deposited at a selected location, such as during a vapor deposition process. The invention comprises a vibratory composite beam which includes a dielectric layer sandwiched between two conductive layers. The beam is positioned in a magnetic field. An alternating current passes through one conductive layers, the beam oscillates, inducing an output current in the second conductive layer, which is analyzed to determine the resonant frequency of the beam. As material is deposited on the beam, the mass of the beam increases and the resonant frequency of the beam shifts, and the mass added is determined.

Altemir, David A. (Inventor)

1997-01-01