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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

Mass casualty triage: an evaluation of the data and development of a proposed national guideline.  

PubMed

Mass casualty triage is a critical skill. Although many systems exist to guide providers in making triage decisions, there is little scientific evidence available to demonstrate that any of the available systems have been validated. Furthermore, in the United States there is little consistency from one jurisdiction to the next in the application of mass casualty triage methodology. There are no nationally agreed upon categories or color designations. This review reports on a consensus committee process used to evaluate and compare commonly used triage systems, and to develop a proposed national mass casualty triage guideline. The proposed guideline, entitled SALT (sort, assess, life-saving interventions, treatment and/or transport) triage, was developed based on the best available science and consensus opinion. It incorporates aspects from all of the existing triage systems to create a single overarching guide for unifying the mass casualty triage process across the United States. PMID:18769263

Lerner, E Brooke; Schwartz, Richard B; Coule, Phillip L; Weinstein, Eric S; Cone, David C; Hunt, Richard C; Sasser, Scott M; Liu, J Marc; Nudell, Nikiah G; Wedmore, Ian S; Hammond, Jeffrey; Bulger, Eileen M; Salomone, Jeffrey P; Sanddal, Teri L; Markenson, David; O'Connor, Robert E

2008-09-01

3

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

4

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

5

Triage during mass gatherings.  

PubMed

Triage is a complex process and is one means for determining which patients most need access to limited resources. Triage has been studied extensively, particularly in relation to triage in overcrowded emergency departments, where individuals presenting for treatment often are competing for the available stretchers. Research also has been done in relation to the use of prehospital and field triage during mass-casualty incidents and disasters. In contrast, scant research has been done to develop and test an effective triage approach for use in mass-gathering and mass-participation events, although there is a growing body of knowledge regarding the health needs of persons attending large events. Existing triage and acuity scoring systems are suboptimal for this unique population, as these events can involve high patient presentation rates (PPR) and, occasionally, critically ill patients. Mass-gathering events are dangerous; a higher incidence of injury occurs than would be expected from general population statistics. The need for an effective triage and acuity scoring system for use during mass gatherings is clear, as these events not only create multiple patient encounters, but also have the potential to become mass-casualty incidents. Furthermore, triage during a large-scale disaster or mass-casualty incident requires that multiple, local agencies work together, necessitating a common language for triage and acuity scoring. In reviewing existing literature with regard to triage systems that might be employed for this population, it is noted that existing systems are biased toward traumatic injuries, usually ignoring mitigating factors such as alcohol and drug use and environmental exposures. Moreover, there is a substantial amount of over-triage that occurs with existing prehospital triage systems, which may lead to misallocation of limited resources. This manuscript presents a review of the available literature and proposes a triage system for use during mass gatherings that also may be used in the setting of mass-casualty incidents or disaster responses. PMID:23026028

Turris, Sheila A; Lund, Adam

2012-12-01

6

Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey  

PubMed Central

Background In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician’s to correctly triage patients in a simulated mass casualty incident. Methods The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course. Results The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises. Conclusion The mnemonic ABCDE doesn’t significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians’ knowledge of triage, within the ATLS context or separately, are warranted. PMID:24355021

2013-01-01

7

Nuclear terrorism: triage and medical management of radiation and combined-injury casualties.  

PubMed

This article addresses the medical effects of nuclear explosions and other forms of radiation exposure, assessment of radiation dose, triage of victims, definitive treatment of radiation and combined-injury casualties, and planning for emergency services after a terrorist attack involving a nuclear device. It reviews historical events of mass radiation-induced casualties and fatalities at Hiroshima, Chernobyl, and Goiania, and discusses various scenarios for nuclear terrorism. PMID:16781272

Flynn, Daniel F; Goans, Ronald E

2006-06-01

8

Game-based mass casualty burn training.  

PubMed

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

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

2009-01-01

9

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

PubMed

Developing a mass-casualty medical response to the detonation of an improvised nuclear device (IND) or large radiological dispersal device (RDD) requires unique advanced planning due to the potential magnitude of the event, lack of warning, and radiation hazards. In order for medical care and resources to be collocated and matched to the requirements, a [US] Federal interagency medical response-planning group has developed a conceptual approach for responding to such nuclear and radiological incidents. The "RTR" system (comprising Radiation-specific TRiage, TReatment, TRansport sites) is designed to support medical care following a nuclear incident. Its purpose is to characterize, organize, and efficiently deploy appropriate materiel and personnel assets as close as physically possible to various categories of victims while preserving the safety of responders. The RTR system is not a medical triage system for individual patients. After an incident is characterized and safe perimeters are established, RTR sites should be determined in real-time that are based on the extent of destruction, environmental factors, residual radiation, available infrastructure, and transportation routes. Such RTR sites are divided into three types depending on their physical/situational relationship to the incident. The RTR1 sites are near the epicenter with residual radiation and include victims with blast injuries and other major traumatic injuries including radiation exposure; RTR2 sites are situated in relationship to the plume with varying amounts of residual radiation present, with most victims being ambulatory; and RTR3 sites are collection and transport sites with minimal or no radiation present or exposure risk and a victim population with a potential variety of injuries or radiation exposures. Medical Care sites are predetermined sites at which definitive medical care is given to those in immediate need of care. They include local/regional hospitals, medical centers, other sites such as nursing homes and outpatient clinics, nationwide expert medical centers (such as cancer or burn centers), and possible alternate care facilities such as Federal Medical Stations. Assembly Centers for displaced or evacuating persons are predetermined and spontaneous sites safely outside of the perimeter of the incident, for use by those who need no immediate medical attention or only minor assistance. Decontamination requirements are important considerations for all RTR, Medical Care, and Assembly Center sites and transport vehicles. The US Department of Health and Human Services is working on a long-term project to generate a database for potential medical care sites and assembly centers so that information is immediately available should an incident occur. PMID:19618351

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

2009-01-01

10

Shadowbowl 2003 [simulated mass-casualty exercise  

Microsoft Academic Search

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

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

2004-01-01

11

Efficient Resource Estimation During Mass Casualty Emergency Response Based on a Location Aware Disaster Aid Network  

Microsoft Academic Search

The mass casualty emergency response involves logistic impediments like overflowing victims, paper triaging, extended victim\\u000a wait time and transport. We propose a new system based on a location aware wireless sensor network (WSN) to overcome these\\u000a impediments and assists the emergency responders (ER) in providing efficient emergency response. We have developed a ZigBeeready\\u000a acceleration sensor node hardware which is energy

Ashok-kumar Chandra-sekaran; Gerd Flaig; Christophe Kunze; Wilhelm Stork; Klaus D. Mueller-Glaser

2008-01-01

12

Mobile DIORAMA-II: infrastructure less information collection system for mass casualty incidents.  

PubMed

In this paper we introduce DIORAMA-II system that provides real time information collection in mass casualty incidents. Using a mobile platform that includes active RFID tags and readers as well as Smartphones, the system can determine the location of victims and responders. The system provides user friendly multi dimensional user interfaces as well as collaboration tools between the responders and the incident commander. We conducted two simulated mass casualty incidents with 50 victims each and professional responders. DIORAMA-II significantly reduces the evacuation time by up to 43% when compared to paper based triage systems. All responders that participated in all trials were very satisfied. They felt in control of the incident and mentioned that the system significantly reduced their stress level during the incident. They all mentioned that they would use the system in an actual incident. PMID:25570543

Ganz, Aura; Schafer, James M; Yang, Zhuorui; Yi, Jun; Lord, Graydon; Ciottone, Gregory

2014-01-01

13

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

14

Psychosocial Response to Mass Casualty Terrorism: Guidelines for Physicians  

Microsoft Academic Search

Background: All physicians would need to address the psychosocial consequences of a mass casualty terrorist attack should it occur. Method: A review of evidence and expert opinion regarding psychosocial response to mass casualty incidents was performed. Data were obtained via the PubMed database in an English- language search using the terms PTSD secondary prevention, psychological first aid, and disaster psychiatry

Jeffrey C. Fetter

2005-01-01

15

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

PubMed

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

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

2014-08-01

16

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

17

Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data  

PubMed Central

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

Egan, Joseph R.; Amlôt, Richard

2012-01-01

18

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

19

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

20

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

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

2011-01-01

21

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

22

Management of pediatric trauma: Blast victims in a mass casualty incident  

Microsoft Academic Search

Mass casualty events are increasing both worldwide and domestically. The majority of our national experience with mass casualties has come from our military experience and several notable domestic events, including the Oklahoma City bombing and, more recently, the World Trade Center and Pentagon attacks. The objective of this paper is to review the lessons learned from these events and examine

R. Todd Maxson

2002-01-01

23

Planning for mass civilian casualties overseas: IMSuRT-International Medical/Surgical Response Teams.  

PubMed

The increased likelihood of mass casualties involving Americans living abroad has prompted the development of a mobile, civilian medical and surgical unit available for rapid deployment overseas. Using past experience derived from the National Disaster Medical Service, and from recent rescue efforts following the African embassy bombings in 1998, an International Medical-Surgical Response Team was developed. Organized under the Department of Homeland Security, it is staffed by civilian professionals from medical and bioengineering fields. Initial deployments to the World Trade Center (2001) and Guam (2002) have shown the ability to rapidly mobilize appropriate manpower and equipment to a mass casualty site, whether domestic or international. The goals of this organization are to work in cooperation with local authorities at the mass casualty site to provide rapid assessment and medical stabilization of injured persons. When the mass casualty is overseas, rapid evacuation of casualties is accomplished by the responding military air evacuation service. PMID:15187841

Lhowe, David W; Briggs, Susan M

2004-05-01

24

THE ROLE OF FORWARD MEDICAL SUPPORT IN HANDLING MASSES OF CASUALTIES IN ACTIVE NUCLEAR WARFARE  

Microsoft Academic Search

Some facts and opinions are presented relative to the operational ; problem of handling situations wherein masses of casualties occur on the nuclear ; battlefield. To visualize this problem, a situation is assumed in which a battle ; group is inactivated by a nuclear weapon and initially a maximum number of living ; casualties would result. A hypothetical situation is

Sheedy

1962-01-01

25

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

26

Mass casualty incident response and aeromedical evacuation in antarctica.  

PubMed

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

2011-02-01

27

An Intelligent 802.11 Triage Tag for medical response to disasters.  

PubMed

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

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

2005-01-01

28

An Intelligent 802.11 Triage Tag For Medical Response to Disasters  

PubMed Central

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

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

2005-01-01

29

Terror and triage: prioritizing access to mass smallpox vaccination.  

PubMed

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

Silverman, Ross D; May, Thomas

2003-04-01

30

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

PubMed Central

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

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

2010-01-01

31

[The influence of the pre-hospital application of non-invasive measurements of carboxyhemoglobin in the practice of emergency medical services in multiple and mass casualty incidents (MCI)--a case report].  

PubMed

In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardów. At the time of the incident 52 residents and 16 staff members were present in the building. Due to a large number of casualties, the occurrence was classified as a potentially mass casualty incident (MCI). Troops of the State Fire Brigade, Paramedic Rescue Squads, choppers of the Helicopter Emergency Medical Service, the Police, and the NH staff took part in the rescue operation. The priority was given to the evacuation of the NH residents carried out by the NH staff and firefighters, extinguishing the fire, as well as to primary and secondary survey triage. Due to the pre-accident health state of the victims, the latter posed a considerable difficulty. A decisive role was played by the need to conduct non-invasive measurements of carboxyhemoglobin in all the casualties, which then made it possible to adequately diagnose the patients and implement proper procedures. The rescue operation was correctly followed although it proved to be a serious logistical and technical undertaking for the participating emergency services. The residents were not found to be suffering from carbon monoxide poisoning, therefore 46 of the residents safely returned to the building. The fact that all the Paramedic Rescue Squads were equipped with medical triage sets and were able to conduct non-invasive measurements of carboxyhemoglobin made it possible to introduce effective procedures in the cases of suspected carbon monoxide poisoning and abandon costly and complicated organisational procedures when they proved to be unnecessary. PMID:25090858

Ga?azkowski, Robert; Wejnarski, Arkadiusz; Baumberg, Ignacy; ?wie?ewski, Stanis?aw; Timler, Dariusz

2014-01-01

32

The advanced health and disaster aid network: A light-weight wireless medical system for triage  

E-print Network

Abstract—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 allocation, and real-time communication in the Advanced Health and Disaster Aid Network (AID-N). We present the design of electronic triage tags on lightweight, embedded systems with limited memory and computational power. These electronic triage tags use noninvasive, biomedical sensors (pulse oximeter, electrocardiogram, and blood pressure cuff) to continuously monitor the vital signs of a patient and deliver pertinent information to first responders. This electronic triage system facilitates the seamless collection and dissemination of data from the incident site to key members of the distributed emergency response community. The real-time collection of data through a mesh network in a mass casualty drill was shown to approximately triple the number of times patients that were triaged compared with the traditional paper triage system. Index Terms—Biomedical monitoring, emergency services, human factors, multisensor systems. I.

Tia Gao; Tammara Massey; Leo Selavo; David Crawford; Bor-rong Chen; Konrad Lorincz; Victor Shnayder; Matt Welsh

2007-01-01

33

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

PubMed

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

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

2014-06-01

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

Secondary Casualty Information: Casualty Uncertainty, Female Casualties, and Wartime Support  

Microsoft Academic Search

I develop a theory of wartime public opinion that identifies different types of casualty information and the varied roles they play. These roles include Primary Casualty Information (e.g., monthly casualties), which directly influences opinion; Contextual Casualty Information (e.g., enemy casualties), which mitigates the effect of primary casualties; and two new concepts, Casualty Uncertainty, the inability of individuals to infer casualty

Scott Sigmund Gartner

2008-01-01

36

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

PubMed

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

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

2014-01-01

37

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

PubMed

On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses. Dal Ponte ST , Dornelles CFD , Arquilla B , Bloem C , Roblin P . Mass-casualty response to the Kiss Nightclub in Santa Maria, Brazil. Prehosp Disaster Med. 2015;30(1):1-4 . PMID:25544145

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

2015-02-01

38

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

PubMed Central

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

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

2010-01-01

39

Post9\\/11 Responses to Mass Casualty Bombings in Europe: Lessons, Trends and Implications for the United States  

Microsoft Academic Search

This report analyzes the actions taken by emergency responders in three case studies of post-9\\/11 terrorist attacks in Europe (Istanbul [2003], Madrid [2004] and London [2005]). It also assesses the targeting and tactical information gleaned from three European plots that either failed or were foiled by authorities. The focus of this report is on mass casualty, complex attack scenarios involving

Anthony Fratta

2010-01-01

40

An Engineer’s Mathematical Approach to Designing an Emergency Room Decontamination Area for Weapons of Mass Destruction Casualties  

Microsoft Academic Search

This study will focus on the potential requirements for an emergency response facility in case of weapons of mass destruction casualties proposing mathematical models. A complete emergency room layout will be designed taking the following analyses and requirements into consideration: quality function development (QFD) and product layout; average number of patients in the system, average time in the system, average

Eldo E. Frezza; Erica Fletcher; Veronica Flores; Ellen Popolo; Fay Tal Placido

2007-01-01

41

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

Microsoft Academic Search

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

Armin Ansari; Frederick Taylor Harper; James M. Smith

2005-01-01

42

[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

43

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

PubMed

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

Bookman, Kelly; Zane, Richard

2013-08-01

44

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

PubMed

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

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

2014-01-01

45

Repeat triage in disaster relief: questions from haiti.  

PubMed

During a mass casualty disaster, the acute imbalance between need for treatment and capacity to supply care poses difficult rationing problems. It is common to assume that such disasters call for "utilitarian" procedures that deliberately prioritize saving the most lives over other considerations. A group of medical responders to the 2010 Haitian earthquake faced particular challenges in determining how to allocate limited treatment, time and other resources between existing patients and potential patients not yet under care. We identified that rationing dilemmas points occurred at three points: when care had to be limited, when care had to be completed prematurely, and when care had to be withdrawn. "Repeat triage" refers to rationing challenges occurring at all these points, where the allocation of care is between existing and potential patients. By contrast, "initial triage" designates the allocation of access to treatment among new arrivals, all of whom are potential patients. Repeat and initial triage differ significantly. Several considerations make repeat triage special by supporting limited priority to existing patients, in transgression of pure "utilitarian" procedures: (1) Pragmatically, often it is more efficient to complete treatment on existing patients, for whom prognosis can be established with greater certainty and without added time, than to attempt to save new patients; (2) A fiduciary trust relationship has been formed between care-giver and existing patients, which may make the moral obligation towards them somewhat stronger than the one to potential patients; (3) Existing patients will have often arrived earlier, so when needs are equal, the "first come, first served" principle prioritizes them for care; (4) Withdrawal of care during repeat triage may constitute active rather than passive harm, and more often a serious transgression of patient autonomy; (5) Health providers should normally not be asked to behave in ways that profoundly violate their personal and professional integrity, and abandoning existing patients may do so. For these reasons, responders can permissibly give a degree of priority to existing patients over newcomers in disaster. PMID:23145352

Eyal, Nir; Firth, Paul

2012-01-01

46

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

PubMed Central

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

Shirley, Peter J; Mandersloot, Gerlinde

2008-01-01

47

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

48

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

49

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

50

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

51

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

52

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

53

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

54

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

55

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

56

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

PubMed

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

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

2014-07-01

57

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

PubMed

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

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

2008-01-01

58

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

PubMed

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

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

2014-06-01

59

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

PubMed Central

Objective: In this paper, we review the previous classic research paradigms of a mass casualty incident (MCI) systematically and reflect the medical response to the Wenchuan earthquake and Hangzhou bus fire, in order to outline and develop an improved research paradigm for MCI management. Methods: We searched PubMed, EMBASE, China Wanfang, and China Biology Medicine (CBM) databases for relevant studies. The following key words and medical subject headings were used: ‘mass casualty incident’, ‘MCI’, ‘research method’, ‘Wenchuan’, ‘earthquake’, ‘research paradigm’, ‘science of surge’, ‘surge’, ‘surge capacity’, and ‘vulnerability’. Searches were performed without year or language restriction. After searching the four literature databases using the above listed key words and medical subject headings, related articles containing research paradigms of MCI, 2008 Wenchuan earthquake, July 5 bus fire, and science of surge and vulnerability were independently included by two authors. Results: The current progresses on MCI management include new golden hour, damage control philosophy, chain of survival, and three links theory. In addition, there are three evaluation methods (medical severity index (MSI), potential injury creating event (PICE) classification, and disaster severity scale (DSS)), which can dynamically assess the MCI situations and decisions for MCI responses and can be made based on the results of such evaluations. However, the three methods only offer a retrospective evaluation of MCI and thus fail to develop a real-time assessment of MCI responses. Therefore, they cannot be used as practical guidance for decision-making during MCI. Although the theory of surge science has made great improvements, we found that a very important factor has been ignored—vulnerability, based on reflecting on the MCI response to the 2008 Wenchuan earthquake and July 5 bus fire in Hangzhou. Conclusions: This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development of a methodology for disaster research. PMID:25471837

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

2014-01-01

60

War, Casualties, and Public Opinion  

Microsoft Academic Search

The authors begin the construction of a generalizable theory of casualties and opinion, reexamining the logic employed by Mueller and showing that although human costs are an important predictor of wartime opinion, Mueller's operationalization of those costs solely as the log of cumulative national casualties is problematic and incomplete. The authors argue that temporally proximate costs, captured as marginal casualty

Scott Sigmund Gartner; Gary M. Segura

1998-01-01

61

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

PubMed Central

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

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

2013-01-01

62

Family Member Casualty Assistance  

E-print Network

Family Member Casualty Assistance Handbook Taking Care of Our Own #12;2 TABLE OF CONTENTS 1: Important Documents and Information p 22 Appendix 2: Developing Family Plans in Case Your.S. Army Corps of Engineer (USACE*) Family Members whose Soldier or Department of the Army (DA) Civilian

US Army Corps of Engineers

63

Family Member Casualty Assistance  

E-print Network

Family Member Casualty Assistance Handbook Taking Care of Our Own #12;2 TABLE OF CONTENTS 1: Important Documents and Information p 18 Appendix 2: Developing a Family Plan in Case Your.S. Army Corps of Engineer (USACE*) Family Members whose Soldier or Department of the Army (DA) Civilian

US Army Corps of Engineers

64

Tsunami Casualty Model  

NASA Astrophysics Data System (ADS)

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

Yeh, H.

2007-12-01

65

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

PubMed

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

Malpas, Michael

2011-12-01

66

[Use the Netherlands Triage Standard for children].  

PubMed

Studies have shown that the reliability and validity of the Netherlands Triage Standard (NTS) is comparable to the Manchester Triage System. The NTS has good sensitivity and specificity in the emergency room. The Dutch Society of Emergency and Accident Nurses, the Dutch College of General Practitioners and Ambulancezorg Nederland use the NTS as the guideline for both physical and telephone triage in ambulance care, primary care and hospital care with the competence of the triage nurse in a pivotal role. PMID:25563784

Drijver, C R Roeland

2015-01-01

67

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

68

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

PubMed

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

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

2005-01-01

69

Tax aspects of casualty losses  

E-print Network

of the taxpayer. Probably the most controversial phase of the casualty loss deduction is the determination of the year in which the loss is 6 I. R. . -. Circular No. 55-11. Alcoma Associates, Inc. v. United states, 51 A. F. T. R. 1037. 7 I. T. R. , 1. 165-7 (a... underground disturbance resulting in damage to house and lot wss considered a casualty loss in the case of Harvey Johnston Grant v. 16 United States. The taxpayer purchased a parcel of land in; hitefish Bay with a width of 135 feet on Lake Drive, extending...

Lehmann, August Herman

1960-01-01

70

Modeling casualties in nuclear warfare. Final report  

Microsoft Academic Search

In this report, the authors summarize the casualty criteria currently accepted for the estimation of casualties to the various nuclear environments. For the blast and thermal environments, comparisons are made with criteria currently used in the assessment of conventional weapon casualties. In the area of radiation effects, the report also includes a summary of performance degradation methodology developed in the

J. T. Klopcic; D. L. Watson

1989-01-01

71

Human Casualties in Impact Events  

Microsoft Academic Search

It is widespread error to believe that people were never killed by meteorites. It was concluded that there no human casualties due to meteorite falls because there were no reports about such incidents, but there are reports of these rare events. The statement of no one ever being killed by a meteorite may intend that the danger even of asteroid

C. Gritzner

1997-01-01

72

Combat Casualty Care research programme.  

PubMed

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

Kirkman, Emrys; Watts, S

2014-06-01

73

Accountability Pressure, Academic Standards, and Educational Triage  

ERIC Educational Resources Information Center

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

Lauen, Douglas Lee; Gaddis, S. Michael

2012-01-01

74

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

75

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

76

What is orthopaedic triage? A systematic review  

PubMed Central

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

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

2015-01-01

77

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2012-10-01

78

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Written report of marine casualty. 185.206 Section 185...UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.206 Written report of marine casualty. (a) The owner,...

2010-10-01

79

46 CFR 122.206 - Written report of marine casualty.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

80

46 CFR 122.206 - Written report of marine casualty.  

Code of Federal Regulations, 2014 CFR

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

2014-10-01

81

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

82

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2014 CFR

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

2014-10-01

83

46 CFR 122.202 - Notice of marine casualty.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

84

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2013-10-01

85

46 CFR 122.206 - Written report of marine casualty.  

Code of Federal Regulations, 2010 CFR

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

2010-10-01

86

46 CFR 4.03-1 - Marine casualty or accident.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Marine casualty or accident. 4.03-1 ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine...

2011-10-01

87

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2010-10-01

88

46 CFR 122.202 - Notice of marine casualty.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

89

46 CFR 122.202 - Notice of marine casualty.  

Code of Federal Regulations, 2014 CFR

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

2014-10-01

90

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2014 CFR

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

2014-10-01

91

46 CFR 4.05-1 - Notice of marine casualty.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Notice of marine casualty. 4.05-1 Section 4.05-1...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2011-10-01

92

46 CFR 4.03-1 - Marine casualty or accident.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Marine casualty or accident. 4.03-1 ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine...

2010-10-01

93

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

94

46 CFR 122.202 - Notice of marine casualty.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

95

46 CFR 122.206 - Written report of marine casualty.  

Code of Federal Regulations, 2011 CFR

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

2011-10-01

96

46 CFR 4.03-1 - Marine casualty or accident.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Marine casualty or accident. 4.03-1 ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine...

2013-10-01

97

46 CFR 4.03-1 - Marine casualty or accident.  

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Marine casualty or accident. 4.03-1 ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine...

2014-10-01

98

46 CFR 185.206 - Written report of marine casualty.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

99

46 CFR 122.206 - Written report of marine casualty.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

100

46 CFR 4.03-1 - Marine casualty or accident.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Marine casualty or accident. 4.03-1 ...PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine...

2012-10-01

101

46 CFR 122.202 - Notice of marine casualty.  

Code of Federal Regulations, 2012 CFR

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

2012-10-01

102

[Current trends in emergency triage in Taiwan: the five-level triage system].  

PubMed

An ideal triage system should accurately and quickly sort patients according to seriousness of diseases, and ensure that patients in emergency departments (EDs) get adequate management in an appropriate medical environment. Recently, EDs throughout the world have been confronting overcrowding, and are developing a five-level triage system to solve the problems that this presents. Taiwan EDs have used the Taiwan triage system (TTS) since 1999 until recently. In order to follow the trend of the times, EDs in Taiwan adjusted the four-level TTS to a five-level system, and built a computer system which is reliable and effective. This article reviews the literature about emergency triage systems, and describes the differences between the four-level and five-level systems, exploring the reliability, effectiveness, and outcomes of triage systems. Taiwan nurses might treat this article as a basis for reflection on the importance of the five-level triage system. PMID:18543190

Chiu, Hsiou-Yean; Chen, Li-Ching; Lin, Xiu-Zhu; Sang, Ying-Ying; Kang, Qiao-Juan; Chao, Yann-Fen C

2008-06-01

103

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

104

Revising the rural hospital disaster plan: a role for the EMS system in managing the multiple casualty incident.  

PubMed

Much of the effort in disaster planning has been directed toward large-scale, war-related, or major natural disasters. We helped test a rural community's disaster plan in a simulated airport accident, and concluded that this plan was not the most effective for providing the triage and stabilization in the field that are essential to the management of this type of accident. This communication argues for the development of an alternative model of response involving the "escalation" of the everyday emergency medical services system. We believe this will provide more rapid and effective allocation of the rural community's limited medical resources in the management of the multiple casualty incident. PMID:7458031

Melton, R J; Riner, R M

1981-01-01

105

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

PubMed

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

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

2015-01-01

106

A pivot nurse at triage.  

PubMed

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

Martin, Marie

2012-01-01

107

Decision making by emergency nurses in triage assessments  

Microsoft Academic Search

Triage assessment of patients on arrival at emergency departments involves complex decision making, resulting in categories being assigned to prioritize patients' needs for attention. The actual process of triage decision making has received limited attention. The aims of this study were to describe aspects of the triage decision-making process used by both more and less experienced nurses (n = 20)

J. Cioffi

1998-01-01

108

Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.  

PubMed

This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations. PMID:22710003

McGraw, Leigh K; Out, Dorothée; Hammermeister, Jon J; Ohlson, Carl J; Pickering, Michael A; Granger, Douglas A

2013-01-01

109

Machine Learning for Biomedical Literature Triage  

PubMed Central

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

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

2014-01-01

110

Breast clinic triage tool: telephone assessment of new referrals.  

PubMed

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

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

2012-04-01

111

Is conservation triage just smart decision making?  

E-print Network

Is conservation triage just smart decision making? Madeleine C. Bottrill1 , Liana N. Joseph1, Townsville, QLD 4811, Australia 4 Landcare Research, Private Bag 1930, Dunedin 9054, New Zealand Conservation efforts and emergency medicine face com- parable problems: how to use scarce resources wisely to conserve

Kark, Salit

112

Accountability Incentives: Do Schools Practice Educational Triage?  

ERIC Educational Resources Information Center

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

Springer, Matthew G.

2008-01-01

113

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. PMID:25414897

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

2014-01-01

114

Deployed Assessment and Management of mTBI Casualties.  

PubMed

The wars in Afghanistan and Iraq have placed a spotlight on screening, evaluation, and treatment of mild traumatic brain injury, otherwise known as concussion. The author presents a mass casualty case in which a Ranger company medical section assessed and managed 30 Servicemembers (SM) diagnosed with concussion. Through the process of treating these Servicemembers, a consolidated checklist was created based on existing Department of Defense, United States Special Operations Command (USSOCOM), and United States Army Special Operations Command (USASOC) guidelines. During this and subsequent clinical encounters, utilization of this checklist resulted in efficient identification of concussed personnel, appropriate treatment, and documentation. PMID:24048990

Garfin, Benjamin

2013-01-01

115

Implementation of a combat casualty trauma registry.  

PubMed

The Joint Theater Trauma Registry is a standardized, retrospective data collection system for all echelons of combat casualty care. Military-specific data elements include expanded demographic data to include military branch, service, rank, military occupation, and personal protective equipment. Varying data from each echelon are entered into the Joint Theater Trauma Registry, version 3. The Joint Theater Trauma Registry, version 3 at the echelon 4 medical treatment facility requires routine collection of 367 data elements for each casualty, but casualties sustaining burns, deaths, or those with performance improvement issues may have more than 450 data elements recorded. Trauma registries are powerful tools for process improvement. Collaboration between civilian and military trauma programs may foster improvements in registry design and data collection for both groups. PMID:19092507

Glenn, Michael Alan; Martin, Kathleen D; Monzon, Diana; Nettles, William; Rodriquez, Vicky M; Lovasz, Daniel; Defeo, Tracy A; Flaherty, Stephen

2008-01-01

116

Resuscitation in a multiple casualty event.  

PubMed

A major weakness in the emergency medical response to multiple casualty events continues to be the resuscitation component, which should consist of the systematic application of basic, advanced, and prolonged life support and definitive care within 24 hours. There have been major advances in emergency medical care over the last decade, including the feasibility of point-of-care ultrasound to aid in rapid assessment of injuries in the field, damage control resuscitation, and resuscitative surgery protocols, delivered by small trauma/resuscitation teams equipped with regional anesthesia capability for rapid deployment. Widespread adoption of these best practices may improve the delivery of resuscitative care in future multiple casualty events. PMID:23351536

Dudaryk, Roman; Pretto, Ernesto A

2013-03-01

117

Battlefield triage life signs detection techniques  

Microsoft Academic Search

Getting to wounded soldiers on the battlefield is a precarious task, and medics have a very high casualty rate. It is therefore a vital importance to prioritize which soldiers to attend to first. The first step is to detect life signs - if a soldier is dead or alive, and prioritize recovery of live soldiers. The second step is to

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

2008-01-01

118

Success Matters: Casualty Sensitivity and the War in Iraq  

Microsoft Academic Search

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

Christopher Gelpi; Peter D. Feaver; Jason Reifler

2006-01-01

119

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

PubMed Central

Background Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site-of-care decisions and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced into clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at the most proximal time point of ED admission. Methods/design Prospective, observational, multicenter, multi-national cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to the medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for discharge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic medical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and functional status, re-hospitalization, satisfaction with care and quality of life measures. We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post acute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, time to social worker involvement, length of hospital stay, reasons for discharge delays, patient’s satisfaction with care, overall hospital costs and patients care needs after returning home. Discussion Using a reliable initial triage system for estimating initial treatment priority, need for in-hospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted and efficient management of medical patients in the ED. The proposed interdisciplinary , multi-national project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient’s outcomes in terms of mortality, re-hospitalization, quality of life and satisfaction with care. Trial registration ClinicalTrials.gov Identifier, NCT01768494 PMID:23822525

2013-01-01

120

Bushfire disaster burn casualty management: the Australian "Black Saturday" bushfire experience.  

PubMed

Mass burn disasters are among the most difficult disasters to manage, with major burns requiring complex management in a multidisciplinary setting and specialist burns services having limited capacity to deal with large numbers of complex patients. There is a paucity of literature addressing health system responses to mass burn disasters resulting from wildfires, with the events of the "Black Saturday" disaster in the state of Victoria, Australia, able to provide a unique opportunity to draw lessons and increase awareness of key management issues arising in mass burn casualty disasters. The event comprised the worst natural disaster in the state's history and one of the worst wildfire disasters in world history, claiming 173 lives and costing more than AUD 4 billion. This article draws on the national burns disaster plan instituted, Australian Mass Casualty Burn Disaster Plan (AUSBURNPLAN), and details the management of mass burn cases through a systems-based perspective. PMID:22001422

Seifman, Marc; Ek, Edmund W; Menezes, Hana; Rozen, Warren M; Whitaker, Iain S; Cleland, Heather J

2011-11-01

121

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

PubMed Central

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

2011-01-01

122

No Child Overlooked: Mental Health Triage in the Schools  

ERIC Educational Resources Information Center

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

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

2009-01-01

123

'Smart card' speeds triage, boosts safety.  

PubMed

An internally developed 'smart card' and a kiosk equipped with an electronic reader have helped Wellington (FL) Regional Medical Center speed up its triage process considerably. The new technology is extremely popular with the staff, as well as with the patients. Here are some of its benefits: Patients who have the card don't need to provide a detailed history every time they visit the ED. Nurses don't have to type in the patient's medical information. It automatically "populates" their computer screen. Security is maintained, because the information is stored in a database, and not on the card. PMID:18956587

2008-10-01

124

Hospital preparedness for possible nonconventional casualties: an Israeli experience.  

PubMed

Since 9/11, hospitals and health authorities have been preparing medical response in case of various mass terror attacks. The experience of Tel Aviv Sourasky Medical Center in treating suicide-bombing mass casualties served, in the time leading up to the war in Iraq, as a platform for launching a preparedness program for possible attacks with biological and chemical agents of mass destruction. Adapting Quarantelli's criteria on disaster mitigation to the "microinfrastructure" of the hospital, and including human behavior experts, we attempted to foster an interactive emergency management process that would deal with contingencies stemming from the potential hazards of chemical and biological (CB) weapons. The main objective of our work was to encourage an organization-wide communication network that could effectively address the contingent hazards unique to this unprecedented situation. A stratified assessment of needs, identification of unique dangers to first responders, and assignment of team-training sessions paved the way for program development. Empowerment through leadership and resilience training was introduced to emergency team leaders of all disciplines. Focal subject matters included proactive planning, problem-solving, informal horizontal and vertical communication, and coping through stress-management techniques. The outcome of this process was manifested in an "operation and people" orientation supporting a more effective and compatible emergency management. The aim of article is to describe this process and to point toward the need for a broad-spectrum view in such circumstances. Unlike military units, the civilian hospital staff at risk, expected to deal with CB casualties, requires adequate personal consideration to enable effective functioning. Issues remain to be addressed in the future. We believe that collaboration and sharing of knowledge, information, and expertise beyond the medical realm is imperative in assisting hospitals to expedite appropriate preparedness programs. PMID:15474635

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

2004-01-01

125

Review of a rheumatology triage system: simple, accurate, and effective.  

PubMed

Rheumatology triage systems exist to expedite care for those with inflammatory arthritis (IA). This study presents the first 22-month experience of a simple and unique Canadian university-based triage system. Triage accuracy is analyzed as is the effect on access to care for patients with IA. The triage rheumatologist screens all incoming referral letters to attempt to identify possible diagnoses and, consequently, assigns urgency of assessment. The wait time for patients with IA after introduction of the triage system was compared to a random sample of IA patients from the year preceding the triage system. All newly referred IA patients who were incorrectly triaged as a non-inflammatory process were identified, with a subsequent chart review examining for features that may have influenced the triage status. Three thousand four hundred seventy-six new referrals were seen, with 344 patients receiving a final diagnosis of IA. The median wait time for all patients was 57.0 days, 37.5 days for IA patients, and 25.0 days for IA patients assigned a soon urgency status. Compared to the preceding year, this latter group with inflammatory arthritis was seen 25.0 days sooner (p?triage system correctly identifies patients with IA with an accuracy of 91.0 % and effectively reduces their wait time when assigned an appropriate urgency status. Utilization of this triage system may be universally applicable, accurate, and a cost-effective way to optimize rheumatology patients' access to care. PMID:24173719

Carpenter, Thirza; Katz, Steven J

2014-02-01

126

Determining the Amount of Casualty Loss Deductible casualty loss for timber held for business or  

E-print Network

instances. What You Need from Your Forester Treasury regulations requires that casualty loss is deter- mined with respect to the "single identifiable property". In the case of timber, it is normally the entire timber that you own 100 tons of hardwood sawtimber with a total basis of $4,000 kept together in one place

Bolding, M. Chad

127

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

128

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

129

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2011 CFR

... 2011-10-01 2011-10-01 false Marine casualty investigation by the Board. 850...GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board....

2011-10-01

130

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2010 CFR

... 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 850...GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board....

2010-10-01

131

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

Code of Federal Regulations, 2014 CFR

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

2014-10-01

132

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

Code of Federal Regulations, 2013 CFR

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

2013-10-01

133

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

Code of Federal Regulations, 2014 CFR

...2014-10-01 2014-10-01 false Substance of marine casualty notice. 4.05-5 Section 4...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2014-10-01

134

49 CFR 850.15 - Marine casualty investigation by the Board.  

Code of Federal Regulations, 2012 CFR

... 2012-10-01 2012-10-01 false Marine casualty investigation by the Board. 850...GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board....

2012-10-01

135

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

Code of Federal Regulations, 2011 CFR

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

2011-10-01

136

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

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2010-10-01

137

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

Code of Federal Regulations, 2010 CFR

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

2010-10-01

138

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Written report of marine casualty. 4.05-10 Section 4.05-10...SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Notice of Marine Casualty and Voyage Records §...

2011-10-01

139

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

Code of Federal Regulations, 2012 CFR

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

2012-10-01

140

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

Code of Federal Regulations, 2014 CFR

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

2014-10-01

141

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

Federal Register 2010, 2011, 2012, 2013, 2014

...Propeller Strike-Related Casualties B. CO Poisoning-Related Casualties...Poisoning-Related Casualties B. Specific Measures To Address...received during the comment period. B. Viewing Comments and Documents...1\\ H. Ken Cordell et al., Long-Term...

2011-08-26

142

Holter triage ambulatory ECG analysis. Accuracy and time efficiency.  

PubMed

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

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

1996-01-01

143

Roadmap: Insurance Studies Property and Casualty Insurance Bachelor of Science  

E-print Network

Roadmap: Insurance Studies ­ Property and Casualty Insurance ­ Bachelor of Science [RE of Macroeconomics 3 Fulfills Kent Core Additional INS 29000 Introduction to Insurance and Risk 3 Semester Five: [15 Credit Hours] BMRT 21052 Professional Selling Techniques 3 INS 49011 Property and Casualty Insurance Law

Sheridan, Scott

144

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

145

A lightning multiple casualty incident in sequoia and kings canyon national parks.  

PubMed

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

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

2015-03-01

146

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

NASA Astrophysics Data System (ADS)

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

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

1999-07-01

147

Below the Bubble: “Educational Triage” and the Texas Accountability System  

Microsoft Academic Search

This article uses two dominant traditions in the organizational study of schools—the neoinstitutional and faculty workplace approaches—to explain an urban elementary school’s response to the Texas Accountability System. The findings indicate that teachers, guided by an institutional logic, sought to create the appearance of test score improvement by using a constellation of “educational triage” practices. Educational triage was manifest in

Jennifer Booher-Jennings

2005-01-01

148

Manchester triage system in paediatric emergency care: prospective observational study  

PubMed Central

Objective To validate use of the Manchester triage system in paediatric emergency care. Design Prospective observational study. Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants 17?600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital). Intervention Nurses triaged 16?735/17?600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13?554 patients for analysis. Main outcome measures Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. Results The Manchester urgency level agreed with the reference standard in 4582 of 13?554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-3 months v 5.4 (4.5 to 6.5) at 8-16 years). Conclusions The Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult. PMID:18809587

2008-01-01

149

Multibiodose radiation emergency triage categorization software.  

PubMed

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

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

2014-07-01

150

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

PubMed

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

Donohue, Dave

2008-05-01

151

46 CFR 28.80 - Report of casualty.  

Code of Federal Regulations, 2010 CFR

... REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY VESSELS General Provisions...primary insurance for a commercial fishing industry vessel must submit a report...A casualty to a commercial fishing industry vessel must be reported...

2010-10-01

152

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2013 CFR

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

2013-10-01

153

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

154

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2014 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,...

2014-10-01

155

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2012 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,...

2012-10-01

156

46 CFR 109.415 - Retention of records after casualty.  

Code of Federal Regulations, 2011 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,...

2011-10-01

157

Do lower income areas have more pedestrian casualties?  

PubMed

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

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

2013-10-01

158

Higher Education: A Time for Triage?  

NASA Astrophysics Data System (ADS)

Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature is replete with descriptions of budget cuts and the resultant reallocation of monies. For example, as the budget cuts of the last decade accumulated, maintenance was deferred, and the funds saved were used to shore-up key existing parts of the educational process, such as faculty salaries. State budgets are generally smaller now than they were when the cuts were made, which means that preventive maintenance will continue to be deferred and other resources must be found for capital improvements. Triage often operates in an environment that does not permit promising possibilities to develop. For example, the promise of interactive digital technologies on the learning process may never be fully realized in many institutions if the associated capital and operating costs cannot be accommodated within the cost containment measures being adopted. In an effort to offset part of the lost state support, tuition and fees have been increased at public institutions at a rate that far exceeds growth of the cost of living index. All this is occurring in the face of an increasingly diverse student body and the beginning of "Tidal Wave II," as the surge of new students who are the children of the baby boomers has been called. These demands, along with the expectations for an historically, good American education, will have to be met with fewer dollars. Our ability to fund public higher education by the conventional mechanisms has been affected by a variety of tax reform initiatives. Although the details may vary locally, various kinds of initiatives, propositions, and referenda have severely limited the amount of revenue states can raise. Thus, caps on property taxes have transformed support patterns at the city and county levels. Initiatives, many of which have built-in escalators, that fix the percentages of state spending for various programs have created new kinds of budgetary entitlement groups. These mandates conspire to give government, i.e., governors and legislatures, less discretionary control over a dwindling portion of the state budget. Unfortunately, hig

Lagowski, J. J.

1995-10-01

159

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

160

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

161

Physiologic Field Triage Criteria for Identifying Seriously Injured Older Adults  

PubMed Central

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

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

2015-01-01

162

Evaluating the effect of emergency department crowding on triage destination  

PubMed Central

Background Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. Methods This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the ?2 and Fisher exact tests. Results Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P?=?0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P <0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P?=?0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P?=?0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P?=?0.46. Conclusions ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes. PMID:24860626

2014-01-01

163

'Wellbeing': a collateral casualty of modernity?  

PubMed

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

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

2009-11-01

164

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

PubMed

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

Qureshi, N A

2010-06-01

165

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

166

Current status of emergency department triage in mainland China: A narrative review of the literature.  

PubMed

In this review, the current status of emergency department triage in mainland China is explored, with the purpose of generating a deeper understanding of the topic. Literature was identified through electronic databases, and was included for review if published between 2002 and 2012, included significant discussion of daily emergency department triage in mainland China, was peer reviewed, and published in English or Chinese. Thematic analysis was used to identify themes which emerged from the reviewed literature. This resulted in 21 articles included for review. Four themes emerged from the review: triage process, triage training, qualification of triage nurses, and quality of triage. The review demonstrates that there is currently not a unified approach to emergency department triage in mainland China. Additionally, there are limitations in triage training for nurses and confusion around the role of triage nurses. This review highlights that emergency department triage in mainland China is still in its infancy and that more research is needed to further develop the role of triage. PMID:25196171

Peng, Lingli; Hammad, Karen

2014-09-01

167

The effects of technology on triage in A & E.  

PubMed

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

Roberts, J

1998-04-01

168

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

169

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 after large-scale radiological events, a logical approach is complete automation of standard-priority need in an environment of heightened concern over possible radiological or nuclear terrorist attacks

170

33 CFR 150.825 - Reporting a diving-related casualty.  

Code of Federal Regulations, 2010 CFR

... false Reporting a diving-related casualty. 150.825 Section 150.825 Navigation and Navigable Waters COAST GUARD...PORTS: OPERATIONS Reports and Records Reports § 150.825 Reporting a diving-related casualty....

2010-07-01

171

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

172

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

173

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

Code of Federal Regulations, 2010 CFR

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

2010-04-01

174

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

175

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

176

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

177

Casualties and smoke emissions from regional and global nuclear conflict.  

E-print Network

Casualties and smoke emissions from regional and global nuclear conflict. #12;About 4000 nuclear NWS DeFactoIsrael, 116 (102-130) Pakistan, 52 (44-62), 1998 South Africa 7, dismantled 1989, 1979 weapons and the means to deliver them is effectively a superpower. · A regional conflict between India

Robock, Alan

178

Triage: a working solution to overcrowding in the emergency department  

PubMed Central

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

Shah, Chandrakant P.; Carr, Luby M.

1974-01-01

179

Ethics of triage in the event of an influenza pandemic.  

PubMed

The prospect of a severe influenza pandemic poses a daunting public health threat to hospitals and the public they serve. The event of a severe influenza pandemic will put hospitals under extreme stress; only so many beds, ventilators, nurses, and physicians will be available, and it is likely that more patients will require medical attention than can be completely treated. Triage is the process of sorting patients in a time of crisis to determine who receives what level of medical attention. How will hospitals sort patients to determine priority for treatment? What criteria will be used? Who will develop these criteria? This article formulates an answer to these questions by constructing a conceptual framework for anticipating and responding to the ethical issues raised by triage in the event of a severe influenza pandemic. PMID:18525374

Tabery, James; Mackett, Charles W

2008-06-01

180

Small animal behavioral triage: a guide for practitioners.  

PubMed

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

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

2014-05-01

181

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

PubMed Central

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

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

2014-01-01

182

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support  

PubMed Central

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p?triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

2014-01-01

183

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

184

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

Microsoft Academic Search

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 found. Clients also reported significantly less distress after triage implementation. No reduction in

Jennifer A. Hardy; Ryan D. Weatherford; Benjamin D. Locke; Natalie Hernandez DePalma; Nadia T. DIuso

2011-01-01

185

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

Microsoft Academic Search

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

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

2005-01-01

186

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

ERIC Educational Resources Information Center

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

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

2008-01-01

187

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

188

Predicting hospital admission at triage in an emergency department.  

PubMed

Predicting hospital admission for Emergency Department (ED) patients at the time of triage may improve throughput. To predict admission we created and validated a Bayesian Network from 47,993 encounters (training: n=23,996, validation: n=9,599, test: n=14,398). The area under the receiver operator characteristic curve was 0.833 (0.8260.840) for the network and 0.790 (0.7810.799) for the control variable (acuity only). Predicting hospital admission early during an encounter may help anticipate ED workload and potential overcrowding. PMID:18694037

Dexheimer, Judith W; Leegon, Jeffrey; Aronsky, Dominik

2007-01-01

189

Improving Trauma Triage Using Basic Crash Scene Data  

PubMed Central

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

Ryb, Gabriel E.; Dischinger, Patricia C.

2011-01-01

190

A new methodology for estimating nuclear casualties as a function of time.  

PubMed

The Human Response Injury Profile (HRIP) nuclear methodology provides an estimate of casualties occurring as a consequence of nuclear attacks against military targets for planning purposes. The approach develops user-defined, time-based casualty and fatality estimates based on progressions of underlying symptoms and their severity changes over time. This paper provides a description of the HRIP nuclear methodology and its development, including inputs, human response and the casualty estimation process. PMID:21799345

Zirkle, Robert A; Walsh, Terri J; Disraelly, Deena S; Curling, Carl A

2011-09-01

191

CoIN: a network analysis for document triage  

PubMed Central

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

Hsu, Yi-Yu; Kao, Hung-Yu

2013-01-01

192

CoIN: a network analysis for document triage.  

PubMed

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

Hsu, Yi-Yu; Kao, Hung-Yu

2013-01-01

193

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

PubMed

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

Strain, John W

2013-01-01

194

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

NASA Astrophysics Data System (ADS)

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

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

195

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

E-print Network

of casualties on FPDM, the major line of research ignores the possibility that different cultural settings may generate different levels of tolerance for human casualties and thereby differentially mediate public reactions. Therefore, I attempt to clarify...

Park, Nam Tae

2009-06-02

196

An Asset Liability Management Model for Casualty Insurers: Complexity Reduction vs. Parameterized Decision Rules  

Microsoft Academic Search

In this paper we study possibilities for complexity reductions in large scale stochastic programming problems with specific reference to the asset liability management (ALM) problem for casualty insurers. We describe a dynamic, stochastic portfolio selection model, within which the casualty insurer maximizes a concave objective function, indicating that the company perceives itself as risk averse. In this context we examine

Alexei A. Gaivoronski; Petter E. de Lange

2000-01-01

197

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

PubMed

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

Ebeling, C F

1991-06-01

198

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

PubMed Central

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

2013-01-01

199

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

PubMed

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

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

2013-01-01

200

Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients  

PubMed Central

Introduction Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV) tissue plasminogen activator (tPA). Emergency department (ED) triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI) levels and use of ED critical care beds. Methods This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ?18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI) level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001), and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001). Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77); 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53). After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81]) and 3.04 times higher odds of being triaged as ESI 3 vs. ESI 1 or 2 (95% CI [1.36 – 6.82]). Conclusion In a large, urban, academic ED at a primary stroke center, there were no gender differences in triage to critical care beds or ESI levels among acute stroke patients arriving within six hours of symptom onset. These findings suggest that ED triage protocols for stroke patients may be effective in minimizing gender disparities in care. PMID:25671042

Madsen, Tracy E.; Choo, Esther K.; Seigel, Todd A.; Palms, Danielle; Silver, Brian

2015-01-01

201

Pre-Hospital Triage of Trauma Patients Using the Random Forest Computer Algorithm  

PubMed Central

Background Over-triage not only wastes resources but displaces the patient from their community and causes delay of treatment for the more seriously injured. This study aimed to validate the Random Forest computer model (RFM) as means of better triaging trauma patients to Level I trauma centers. Methods Adult trauma patients with “medium activation” presenting via helicopter to a Level I Trauma Center from May 2007 to May 2009 were included. The “medium activation” trauma patient is alert and hemodynamically stable on scene but has either subnormal vital signs or an accumulation of risk factors that may indicate a potentially serious injury. Variables included in the RFM computer analysis including demographics, mechanism of injury, pre-hospital fluid, medications, vitals, and disposition. Statistical analysis was performed via the Random Forest Algorithm to compare our institutional triage rate to rates determined by the RFM. Results A total of 1,653 patients were included in this study of which 496 were used in the testing set of the RFM. In our testing set, 33.8% of patients brought to our Level I trauma center could have been managed at a Level III trauma center and 88% of patients that required a Level I trauma center were identified correctly. In the testing set, there was an over-triage rate of 66% while utilizing the RFM we decreased the over-triage rate to 42% (p<0.001). There was an under-triage rate of 8.3%. The RFM predicted patient disposition with a sensitivity of 89%, specificity of 42%, negative predictive value of 92% and positive predictive value of 34%. Conclusion While prospective validation is required, it appears that computer modeling potentially could be used to guide triage decisions, allowing both more accurate triage and more efficient use of the trauma system. PMID:24484906

Scerbo, Michelle; Radhakrishnan, Hari; Cotton, Bryan; Dua, Anahita; Del Junco, Deborah; Wade, Charles; Holcomb, John B.

2015-01-01

202

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

203

Combat casualty care research: from bench to the battlefield.  

PubMed

Hemorrhagic shock is the leading cause of death in civilian and combat trauma. Effective hemorrhage control and better resuscitation strategies have the potential of saving lives. The Trauma Readiness and Research Institute for Surgery (TRRI-Surg) was established to address the core mission of the Uniformed Services University, "Learning to Care for Those in Harm's Way," by conducting research to improve the outcome of combat casualties. This article highlights the salient achievements of this research effort in the areas of hemorrhage control, resuscitation, design and testing of devices, and some novel concepts such as the use of profound hypothermia. The impact of these basic science research findings on changes in military medical care and outcome of injured soldiers is also described. PMID:15815839

Alam, Hasan B; Koustova, Elena; Rhee, Peter

2005-01-01

204

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

PubMed

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

Wang, Shen-Tsu

2013-10-01

205

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

USGS Publications Warehouse

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

So, Emily; Spence, Robin

2013-01-01

206

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.

207

Validating a vignette-based instrument to study physician decision making in trauma triage  

PubMed Central

Background The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. Methods We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the re-test reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of under-triage (the proportion of severely injured patients not transferred to trauma centers) and over-triage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. Results Physicians made similar transfer decisions for cases (? = 0.42, p<0.01) on two administrations of the instrument. Responses were internally consistent (Kuder-Richardson 0.71–0.91). Surgeons had lower rates of under-triage than emergency physicians (13% v. 70%, p<0.01). No correlation existed between individual rates of under- or over-triage on the vignettes and in practice (r = ?0.17, p = 0.4; r = ?0.03, p = 0.85). Conclusions The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However it did not predict individual physician performance. PMID:24125789

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

2013-01-01

208

Data Triage of Astronomical Transients: A Machine Learning Approach  

NASA Astrophysics Data System (ADS)

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

Rebbapragada, U.

209

Tissue triage and freezing for models of skeletal muscle disease.  

PubMed

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

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

2014-01-01

210

Redeye: A Digital Library for Forensic Document Triage  

SciTech Connect

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

Bogen, Paul Logasa [ORNL] [ORNL; McKenzie, Amber T [ORNL] [ORNL; Gillen, Rob [ORNL] [ORNL

2013-01-01

211

Tissue Triage and Freezing for Models of Skeletal Muscle Disease  

PubMed Central

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

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

2014-01-01

212

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

213

33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?  

Code of Federal Regulations, 2010 CFR

...purpose of reporting casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD...PORTS: OPERATIONS Reports and Records Reports § 150.812 What is the purpose of reporting...

2010-07-01

214

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

PubMed

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

Bridges, Elizabeth; Biever, Kimberlie

2010-01-01

215

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

E-print Network

of force protection as a mission equal to any in a given operation. American officers perceived that their political and military leadership had first grown wary of spending American lives and gradually came to view casualties as synonymous with defeat...

Johnson, Daniel I.

2011-08-08

216

Using multiple datasets to understand trends in serious road traffic casualties.  

PubMed

Accurate information on the incidence of serious road traffic casualties is needed to plan and evaluate prevention strategies. Traditionally police reported collisions are the only data used. This study investigate the extent to which understanding of trends in serious road traffic injuries is aided by the use of multiple datasets. Health and police datasets covering all or part of Great Britain from 1996-2003 were analysed. There was a significantly decreasing trend in police reported serious casualties but not in the other datasets. Multiple data sources provide a more complete picture of road traffic casualty trends than any single dataset. Increasing availability of electronic health data with developments in anonymised data linkage should provide a better platform for monitoring trends in serious road traffic casualties. PMID:18606273

Lyons, Ronan A; Ward, Heather; Brunt, Huw; Macey, Steven; Thoreau, Roselle; Bodger, O G; Woodford, Maralyn

2008-07-01

217

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

PubMed

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (? 15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.We found ED triage scales to be supported, at best, by limited and often insufficient evidence.The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity). PMID:21718476

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

2011-01-01

218

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

219

The Effects of Tax-Law Changes on Property-Casualty Insurance Prices  

Microsoft Academic Search

During the 1980s, the federal income tax treatment of property-casualty insurers and their policyholders underwent several important changes, the most significant of which came in 1986. This paper develops theoretical predictions for how these changes should have affected the equilibrium prices of property-casualty insurance policies, and explores the extent to which the theoretical predictions are reflected in data on industry

David F. Bradford; Kyle Logue

1996-01-01

220

Application of a first impression triage in the Japan railway west disaster.  

PubMed

On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients. PMID:23804140

Hashimoto, Atsunori; Ueda, Takahiro; Kuboyama, Kazutoshi; Yamada, Taihei; Terashima, Mariko; Miyawaki, Atsushi; Nakao, Atsunori; Kotani, Joji

2013-01-01

221

Outcome of sports injuries treated in a casualty department.  

PubMed Central

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

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

1985-01-01

222

Validity of the Manchester Triage System in paediatric emergency care  

PubMed Central

Objective To assess the validity of the Manchester Triage System (MTS) in paediatric emergency care, using information on vital signs, resource utilisation and hospitalisation. Methods Patients were eligible if they had attended the emergency department of a large inner?city hospital in The Netherlands from August 2003 to November 2004 and were <16?years of age. A representative sample of 1065 patients was drawn from 18?469 eligible patients. The originally assigned MTS urgency levels were compared with resource utilisation, hospitalisation and a predefined reference classification for true urgency, based on vital signs, resource utilisation and follow?up. Sensitivity, specificity and percentage of overtriage and undertriage of the MTS were calculated. Results The number of patients who used more than two resources increased with a higher level of MTS urgency. The percentage of hospital admissions increased with the increase in level of urgency, from 1% in the non?urgent patients to 54% in emergent patients. According to the reference classification, the sensitivity of the MTS to detect emergent/very urgent cases was 63%, and the specificity was 78%. Undertriage occurred in 15% of patients, of which 96% were by one urgency category lower than the reference classification. Overtriage occurred in 40%, mostly in lower MTS categories. In 36% of these cases, the MTS classified two or more urgency categories higher than the reference classification. Conclusions The MTS has moderate sensitivity and specificity in paediatric emergency care. Specific modifications of the MTS should be considered in paediatric emergency care to reduce overtriage, while maintaining sensitivity in the highest urgency categories. PMID:17130595

Roukema, J; Steyerberg, E W; van Meurs, A; Ruige, M; van der Lei, J; Moll, H A

2006-01-01

223

Examining triage patterns of inhalation injury and toxic epidermal necrolysis-Stevens Johnson syndrome.  

PubMed

The American Burn Association recommends that patients with toxic epidermal necrolysis-Stevens Johnson syndrome (TEN-SJS) or burn inhalation injuries would benefit from admission or transfer to a burn center (BC). This study examines to what extent those criteria are observed within a regional burn network. Hospital discharge data from 2000 to 2010 was obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Disease-9th revision discharge diagnoses for TEN-SJS or burn inhalation injury and their triage destination were compared using burn triage referral criteria to determine whether the patients were triaged differently from American Burn Association recommendations. Two hundred ninety-nine TEN-SJS and 131 inhalation injuries were admitted to all South Florida hospitals. Only 25 (8.4%) of TEN-SJS and 27 (21%) of inhalation injuries were admitted to the BC. BC patients had greater length of stay (TEN-SJS 22 vs 10 days; inhalation 13 vs 7) and were more likely to be funded by charity or be self-paid (TEN-SJS 24 vs 9.5%, P = .025; inhalation 44 vs 14%, P < .001), but less likely to hold some form of private or government insurance (TEN-SJS 72 vs 88%, P = .02; inhalation 48 vs 81%, P = .006). TEN-SJS BC patients were more frequently discharged home for self-care (76 vs 50%, P = .006). Non-BC patients were more often discharged to other healthcare facilities (28 vs 0% TEN-SJS, 20 vs 7.4% inhalation). Inappropriate triage may occur in more than 3 out of 4 of the TEN-SJS and inhalation injury patients within our burn network. Unfamiliarity with triage criteria, patient insurance status, and overcoding may play a role. Further studies should fully characterize the problem and implement education or incentives to encourage more appropriate triage. PMID:23966120

Davis, James S; Pandya, Reeni K; Pizano, Louis R; Namias, Nicholas; Dearwater, Stephen; Schulman, Carl I

2013-01-01

224

Safety of telephone triage in out-of-hours care: A systematic review  

PubMed Central

Objective Telephone triage in patients requesting help may compromise patient safety, particularly if urgency is underestimated and the patient is not seen by a physician. The aim was to assess the research evidence on safety of telephone triage in out-of-hours primary care. Methods A systematic review was performed of published research on telephone triage in out-of-hours care, searching in PubMed and EMBASE up to March 2010. Studies were included if they concerned out-of-hours medical care and focused on telephone triage in patients with a first request for help. Study inclusion and data extraction were performed by two researchers independently. Post-hoc two types of studies were distinguished: observational studies in contacts with real patients (unselected and highly urgent contacts), and prospective observational studies using high-risk simulated patients (with a highly urgent health problem). Results Thirteen observational studies showed that on average triage was safe in 97% (95% CI 96.5–97.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.7–90.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.7–49.8%) were safe. Adverse events described in the studies included mortality (n = 6 studies), hospitalisations (n = 5), attendance at emergency department (n=1), and medical errors (n = 6). Conclusions There is room for improvement in safety of telephone triage in patients who present symptoms that are high risk. As these have a low incidence, recognition of these calls poses a challenge to health care providers in daily practice. PMID:22126218

Huibers, Linda; Smits, Marleen; Renaud, Vera; Giesen, Paul; Wensing, Michel

2011-01-01

225

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

226

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

Microsoft Academic Search

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

Marius Rehn; Jan E Andersen; Trond Vigerust; Andreas J Krüger; Hans M Lossius

2010-01-01

227

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

PubMed

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

Ennis, William J

2010-11-01

228

Classifying free-text triage chief complaints into syndromic categories with natural language processing  

Microsoft Academic Search

Objective: Develop and evaluate a natural language processing application for classifying chief complaints into syndromic categories for syndromic surveillance. Introduction: Much of the input data for artificial intelligence applications in the medical field are free-text patient medical records, including dictated medical reports and triage chief complaints. To be useful for automated systems, the free-text must be translated into encoded form.

Wendy Webber Chapman; Lee M. Christensen; Michael M. Wagner; Peter J. Haug; Oleg Ivanov; John N. Dowling; Robert T. Olszewski

2005-01-01

229

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

230

Recognizing User Interest and Document Value from Reading and Organizing Activities in Document Triage  

E-print Network

to organize relevant documents. They bookmark websites, place papers into piles according to topic, or evenRecognizing User Interest and Document Value from Reading and Organizing Activities in Document of document triage there is reading and organizing activity. Moreover, these tasks can occur in different

Shipman, Frank

231

Triage for conserving populations of threatened species: The case of woodland caribou in Alberta  

Microsoft Academic Search

Prioritization of conservation efforts for threatened and endangered species has tended to focus on factors measuring the risk of extirpation rather than the probability of success and cost. Approaches such as triage are advisable when three main conditions are present: insufficient capacity exists to adequately treat all patients, patients are in a critical state and cannot wait until additional capacity

Richard R. Schneider; Grant Hauer; Stan Boutin

2010-01-01

232

Triage of febrile children at a GP cooperative: determinants of a consultation  

PubMed Central

Background Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. Aim To investigate the determinants related to the outcome of triage in febrile children. Design of study Cross-sectional study. Setting Dutch GP cooperative. Method Receptionists filled out a triage questionnaire when parents called regarding their febrile child (aged between 3 months and 6 years) and estimated the level of concern of the parents. The outcome was either telephone advice, a consultation, or a home visit. Children were divided in subgroups based on age <18 months or ?18 months, and prognostic models for a consultation were constructed. Results Of 422 children, 73% were seen by a GP. Children aged <18 months were more likely to be seen when their parents reported less drinking or shortness of breath. In children aged ?18 months, a duration of fever of ?3 days, drowsiness, or a pale, ashen, or mottled skin were predictors of consultation. Children with alarm symptoms were seen according to the guideline. In both subgroups, children without alarm symptoms were more likely to be seen when their parents were concerned. Conclusion The available guideline was followed to a large extent at a GP cooperative. Because, surprisingly, most children were reported to have alarm symptoms, the validity of the triage questions asking parents about alarm symptoms is questionable. PMID:18494175

Monteny, Miriam; Berger, Marjolein Y; van der Wouden, Johannes C; Broekman, Berth J; Koes, Bart W

2008-01-01

233

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

234

Triage and treatment tools for use in a scarce resources-crisis standards of care setting after a nuclear detonation.  

PubMed

Based on background information in this special issue of the journal, possible triage recommendations for the first 4 days following a nuclear detonation, when response resources will be limited, are provided. The series includes: modeling for physical infrastructure damage; severity and number of injuries; expected outcome of triage to immediate, delayed, or expectant management; resources required for treating injuries of varying severity; and how resource scarcity (particularly medical personnel) worsens outcome. Four key underlying considerations are: 1.) resource adequacy will vary greatly across the response areas by time and location; 2.) to achieve fairness in resource allocation, a common triage approach is important; 3.) at some times and locations, it will be necessary to change from "conventional" to "contingency" or "crisis" standards of medical care (with a resulting change in triage approach from treating the "sickest first" to treating those "most likely to survive" first); and 4.) clinical reassessment and repeat triage are critical, as resource scarcity worsens or improves. Changing triage order and conserving and allocating resources for both lifesaving and palliative care can maintain fairness, support symptomatic care, and save more lives. Included in this article are printable triage cards that reflect our recommendations. These are not formal guidelines. With new research, data, and discussion, these recommendations will undoubtedly evolve. PMID:21402803

Coleman, C Norman; Weinstock, David M; Casagrande, Rocco; Hick, John L; Bader, Judith L; Chang, Florence; Nemhauser, Jeffrey B; Knebel, Ann R

2011-03-01

235

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

NASA Astrophysics Data System (ADS)

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

So, E.

2010-12-01

236

State-level Casualty Lists from the Korean Conflict (1951-57)  

NSDL National Science Digital Library

The Center for Electronic Records of the US National Archives and Records Administration (discussed in the June 10, 1994 Scout Report) provides this set of US casualty lists from the Korean Conflict. The list covers "persons who died as a result of hostilities in Korea, 1950-57, including those who died while missing or captured." CER has created state casualty lists from the larger list. The lists can be browsed by state, and then alphabetically by last name or "'home of record,' as identified by the serviceman upon last entrance into military service." Army casualties list home of record by county within state. The other three branches of the military list by city/town within state. Each record contains the soldier's name, rank, branch of service, home city/town or county, state, date of death, and cause of death. At present the database contains 33,642 names. Unfortunately, the list is not searchable at this time.

1998-01-01

237

A decision analysis of the effectiveness of the pediatric telephone triage program in Japan.  

PubMed

Pediatric telephone triage programs have been initiated to reduce overcrowding of pediatric medical facilities, yet it is unclear what impact these programs have on reducing after hours room visits. This study used a decision analysis model and data from reference literature to investigate the effectiveness of this program and determine the factors that influence the results. The decision analysis model focused on a hypothetical group of children who were not undergoing ongoing treatment but developed symptoms or sustained injuries thought to require a nighttime visit to a medical facility. The model differentiated between urgent, semi-urgent, and non-urgent cases. Model parameters were estimated from the literature whenever possible. We estimated the difference in the number of children who received emergency medical attention, the number of semi-urgent cases in which attention was delayed, and the cases that did not receive medical care, between the telephone triage group and the control group. Telephone triage reduced the number of after hours visits by approximately 4%. There was no change in the number of semi-urgent cases for which medical care was delayed, and the number of semi-urgent cases that did not receive medical attention increased by three. The sensitivity analysis showed that increasing telephone triage use from 10% to 20% would reduce after hours visits by approximately 8%. We conclude that the benefits of this program to the region as a whole would outweigh the harmful effects. However, the effectiveness of telephone triage programs will be limited unless its usage is expanded. PMID:20103845

Maeda, Kenji; Okamoto, Shigeru; Mishina, Hiroki; Nakayama, Takeo

2009-10-01

238

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

PubMed Central

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

Mahmoodian, Farzad; Eqtesadi, Razie; Ghareghani, Atefe

2014-01-01

239

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2013 CFR

...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). Separate...the separation of administration (account XX-51-01). yard...

2013-10-01

240

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2013 CFR

...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). Separate...the separation of administration (account XX-27-01). Operating...

2013-10-01

241

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2010 CFR

...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). Separate...the separation of administration (account XX-55-01). Operating Expenses...

2010-10-01

242

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2010 CFR

...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). Separate...the separation of administration (account XX-51-01). yard...

2010-10-01

243

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2011 CFR

...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). Separate...the separation of administration (account XX-26-01). freight...

2011-10-01

244

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2014 CFR

...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). Separate...the separation of administration (account XX-26-01). freight...

2014-10-01

245

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2010 CFR

...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). Separate...the separation of administration (account XX-27-01). Operating...

2010-10-01

246

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2010 CFR

...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). Separate...the separation of administration (account XX-26-01). freight...

2010-10-01

247

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2013 CFR

...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). Separate...the separation of administration (account XX-52-01). train and yard...

2013-10-01

248

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2012 CFR

...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). Separate...the separation of administration (account XX-27-01). Operating...

2012-10-01

249

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2012 CFR

...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). Separate...the separation of administration (account XX-55-01). Operating Expenses...

2012-10-01

250

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2012 CFR

...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). Separate...the separation of administration (account XX-26-01). freight...

2012-10-01

251

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2014 CFR

...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). Separate...the separation of administration (account XX-51-01). yard...

2014-10-01

252

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2014 CFR

...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). Separate...the separation of administration (account XX-52-01). train and yard...

2014-10-01

253

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2013 CFR

...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). Separate...the separation of administration (account XX-55-01). Operating Expenses...

2013-10-01

254

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2011 CFR

...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). Separate...the separation of administration (account XX-51-01). yard...

2011-10-01

255

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2014 CFR

...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). Separate...the separation of administration (account XX-55-01). Operating Expenses...

2014-10-01

256

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2010 CFR

...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). Separate...the separation of administration (account XX-52-01). train and yard...

2010-10-01

257

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2012 CFR

...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). Separate...the separation of administration (account XX-52-01). train and yard...

2012-10-01

258

49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).  

Code of Federal Regulations, 2011 CFR

...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). 1242...Other and casualties and insurance (accounts XX-52-99 and 50-52-00). Separate...the separation of administration (account XX-52-01). train and yard...

2011-10-01

259

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2011 CFR

...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). Separate...the separation of administration (account XX-27-01). Operating...

2011-10-01

260

49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).  

Code of Federal Regulations, 2013 CFR

...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). 1242...Other and casualties and insurance (accounts XX-26-99 and 50-26-00). Separate...the separation of administration (account XX-26-01). freight...

2013-10-01

261

49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).  

Code of Federal Regulations, 2012 CFR

...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). 1242...Other and casualties and insurance (accounts XX-51-99 and 50-51-00). Separate...the separation of administration (account XX-51-01). yard...

2012-10-01

262

49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).  

Code of Federal Regulations, 2011 CFR

...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). 1242...Other and casualties and insurance (accounts XX-55-99 and 50-55-00). Separate...the separation of administration (account XX-55-01). Operating Expenses...

2011-10-01

263

49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).  

Code of Federal Regulations, 2014 CFR

...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). 1242...Other and casualties and insurance (accounts XX-27-99 and 50-27-00). Separate...the separation of administration (account XX-27-01). Operating...

2014-10-01

264

33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?  

Code of Federal Regulations, 2010 CFR

(a) In addition to the notice of casualty under § 150.815, the owner, operator, or person in charge of a deepwater port must submit a written report of the event to the nearest Officer in Charge of Marine Inspection (OCMI) within 5 days of the casualty...

2010-07-01

265

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

266

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

SciTech Connect

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

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

1983-09-01

267

Science as Sound Bites: The Lancet Iraq Casualty Reports and Prefigured Accommodation  

Microsoft Academic Search

In this article I examine the The Lancet Iraq casualty reports for their demonstration of prefigured accommodation, a rhetorical strategy in which the authors anticipate and attempt to influence their work's wider popularization. My reading of the reports and accompanying commentaries attends to the introduction of journalistic features and calls to political action. As part of my analysis, I interview

Eric Leake

2012-01-01

268

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

269

International comparison of costs of a fatal casualty of road accidents in 1990 and 1999  

Microsoft Academic Search

The purpose of this study is to assemble information of costs per fatal casualty in traffic accidents, adopted by authorities in different countries, analyse and compare these figures as well as the methods used for estimating these values. A questionnaire was sent to 19 countries from which 11 gave information on cost per fatality and methods of valuation. The costs

Anna Trawén; Pia Maraste; Ulf Persson

2002-01-01

270

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

271

46 CFR 97.07-1 - Notice and reporting of casualty and voyage records.  

Code of Federal Regulations, 2010 CFR

...reporting of marine casualties and for retaining voyage records are contained in subpart 4.05 of this chapter. [CGD 84-099, 52 FR 47536, Dec. 14, 1987, as amended by USCG 1998-4442, 63 FR 52191, Sept. 30,...

2010-10-01

272

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

273

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

274

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

275

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

Code of Federal Regulations, 2014 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...

2014-04-01

276

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

277

Ebola triage screening and public health: the new "vital sign zero".  

PubMed

During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new "vital sign zero" should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases. PMID:25351634

Koenig, Kristi L

2015-02-01

278

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

PubMed

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

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

2015-02-01

279

Dicentric assay: Inter-laboratory comparison in Indian laboratories for routine and triage applications.  

PubMed

An Inter-Laboratory Comparison (ILC) study on Dicentric Chromosome Assay (DCA) was carried out between two Indian biodosimetry labs. Human peripheral blood samples exposed to 10 different doses of X-rays up to 5Gy were shared between the labs to generate calibration data. Validation of calibration curves was done by dose estimation of coded samples exposed to X- or gamma radiation. Reliability of the DCA data for triage application was evaluated by scoring 20, 50 and 100 metaphases in the dose range of 0.5-3.0Gy. No significant difference was observed between labs regarding the established calibration data as well as the DCA triage dose assessments. Scoring of 20 metaphases (MP) was adequate to detect radiation exposure of >2Gy whereas 50 MP were sufficient to determine exposures of 0.5Gy. Both labs performed the DCA in a reliable manner and made the first step in setting up a biodosimetry network in India. PMID:25728004

Bakkiam, D; Bhavani, M; Anantha Kumar, A Arul; Sonwani, Swetha; Venkatachalam, P; Sivasubramanian, K; Venkatraman, B

2015-05-01

280

The effect of GP telephone triage on numbers seeking same-day appointments.  

PubMed

Telephone consultations with general practitioners (GPs) have not been shown to be an effective way to reduce the demandfor face-to face appointments during the surgery hours. This study aims to determine if GP telephone triage can effectively reduce the demandforface-to -face consultations for patients seeking same-day appointments in general practice. We report an interrupted time series, twoyears before and one year after introduction of GP-led telephone triage. Demand for face-to face appointments with a GPwas reduced by 39% (95% CI = 29 to 51%, P < 0.001). more than 92% of the telephone calls lasted less thanfive minutes. The telephone bill increased by 26%. For a substantial proportion of patients seeking same-day appointments telephone consultations were an acceptable alternative service. PMID:12014537

Jiwa, Moyez; Mathers, Nigel; Campbell, Mike

2002-05-01

281

A simple tool to predict admission at the time of triage  

PubMed Central

Aim To create and validate a simple clinical score to estimate the probability of admission at the time of triage. Methods This was a multicentre, retrospective, cross-sectional study of triage records for all unscheduled adult attendances in North Glasgow over 2?years. Clinical variables that had significant associations with admission on logistic regression were entered into a mixed-effects multiple logistic model. This provided weightings for the score, which was then simplified and tested on a separate validation group by receiving operator characteristic (ROC) analysis and goodness-of-fit tests. Results 215?231 presentations were used for model derivation and 107?615 for validation. Variables in the final model showing clinically and statistically significant associations with admission were: triage category, age, National Early Warning Score (NEWS), arrival by ambulance, referral source and admission within the last year. The resulting 6-variable score showed excellent admission/discharge discrimination (area under ROC curve 0.8774, 95% CI 0.8752 to 0.8796). Higher scores also predicted early returns for those who were discharged: the odds of subsequent admission within 28?days doubled for every 7-point increase (log odds=+0.0933 per point, p<0.0001). Conclusions This simple, 6-variable score accurately estimates the probability of admission purely from triage information. Most patients could accurately be assigned to ‘admission likely’, ‘admission unlikely’, ‘admission very unlikely’ etc., by setting appropriate cut-offs. This could have uses in patient streaming, bed management and decision support. It also has the potential to control for demographics when comparing performance over time or between departments. PMID:24421344

Cameron, Allan; Rodgers, Kenneth; Ireland, Alastair; Jamdar, Ravi; McKay, Gerard A

2015-01-01

282

Predictive Value of Initial Triage Vital Signs for Critically Ill Older Adults  

PubMed Central

Introduction: Triage of patients is critical to patient safety, yet no clear information exists as to the utility of initial vital signs in identifying critically ill older emergency department (ED) patients. The objective of this study is to evaluate a set of initial vital sign thresholds as predictors of severe illness and injury among older adults presenting to the ED. Methods: We reviewed all visits by patients aged 75 and older seen during 2007 at an academic ED serving a large community of older adults. Patients’ charts were abstracted for demographic and clinical information including vital signs, via automated electronic methods. We used bivariate analysis to investigate the relationship between vital sign abnormalities and severe illness or injury, defined as intensive care unit (ICU) admission or ED death. In addition, we calculated likelihood ratios for normal and abnormal vital signs in predicting severe illness or injury. Results: 4,873 visits by patients aged 75 and above were made to the ED during 2007, and of these 3,848 had a complete set of triage vital signs. For these elderly patients, the sensitivity and specificity of an abnormal vital sign taken at triage for predicting death or admission to an ICU were 73% (66,81) and 50% (48,52) respectively (positive likelihood ratio 1.47 (1.30,1.60); negative likelihood ratio 0.54 (0.30,0.60). Conclusion: Emergency provider assessment and triage scores that rely primarily on initial vital signs are likely to miss a substantial portion of critically ill older adults. PMID:24106542

LaMantia, Michael A.; Stewart, Paul W.; Platts-Mills, Timothy F.; Biese, Kevin J.; Forbach, Cory; Zamora, Ezequiel; McCall, Brenda K.; Shofer, Frances S.; Cairns, Charles B.; Busby-Whitehead, Jan; Kizer, John S.

2013-01-01

283

The Effect of Physician Triage on Emergency Department Length of Stay  

Microsoft Academic Search

Background: Emergency Department (ED) overcrowding is a serious public health issue, but few solutions exist. Objectives: We sought to determine the impact of physician triage on ED length of stay for discharged and admitted patients, left-without-being-seen (LWBS) rates, and ambulance diversion. Methods: This was a pre-post study performed using retrospective data at an urban, academic tertiary care, Level I trauma

Jin H. Han; Daniel J. France; Scott R. Levin; Ian D. Jones; Alan B. Storrow; Dominik Aronsky

2010-01-01

284

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

285

False negative result for amphetamines on the Triage® Drug of Abuse panel?  

Microsoft Academic Search

On-site drug screening devices are widely used today for their simple test procedures and instantaneous results. Among other\\u000a devices, a Triage® Drug of Abuse panel is considered to be highly reliable for its high specificity and sensitivity of abused\\u000a drugs. Although it is known that a false positive amphetamine (AMP) result may be obtained from the urine samples containing\\u000a putrefactive

Wakako Hikiji; Keiko Kudo; Shinji Sato; Yosuke Usumoto; Akiko Tsuji; Noriaki Ikeda

2009-01-01

286

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

PubMed

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

Michalowski, Wojtek; Slowinski, Roman; Wilk, Szymon

2004-01-01

287

Evidence for a higher risk of hypovolemia-induced hemodynamic instability in females: implications for decision support during prehospital triage.  

PubMed

Lower body negative pressure (LBNP) simulates hemorrhage, and tolerance to LBNP (time to presyncope [TTP]) is indicative of tolerance to blood loss. The purpose of this study was to predict TTP based on demographic characteristics (sex, age, height, and body mass index) and physiological variables (heart rate [HR], systolic arterial pressure, diastolic arterial pressure [DAP], pulse pressure, stroke volume, total peripheral resistance [TPR], and baroreflex sensitivity [BRS]) at baseline, and during 2 levels of LBNP (-15, -30 mm Hg). Multiple linear regression analysis was used to create a model to predict TTP (range: 670 to 2516 seconds, n = 187) based on demographic characteristics and physiological variables changes (?) from baseline to -30 mm Hg LBNP. The prediction model revealed that TTP (seconds) = 1667.5 + (5.1 × Age) + (61.1 × Sex) - (21.5 × ?HR) + (55.3 × ?DAP) - (88.2 × ?TPR) - (4.9 × ?BRS). Most significantly, our analysis demonstrated a lesser survival trajectory for females given the same rate and magnitude of hemorrhage compared to males. Young age and female sex are predictors of low tolerance to blood loss, and should be considered for early triage in the prehospital setting. PMID:25747625

Hinojosa-Laborde, Carmen; Aden, James K; Goei, Kathleen A; Convertino, Victor A

2015-03-01

288

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

Code of Federal Regulations, 2012 CFR

...method for performing an impact risk analysis that estimates the expected casualty...dispersion areas, or perform an impact risk analysis in accordance with paragraph (e). (e) Impact Risk Analysis (1) An applicant shall...

2012-01-01

289

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

Code of Federal Regulations, 2010 CFR

...method for performing an impact risk analysis that estimates the expected casualty...dispersion areas, or perform an impact risk analysis in accordance with paragraph (e). (e) Impact Risk Analysis (1) An applicant shall...

2010-01-01

290

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

Code of Federal Regulations, 2013 CFR

...method for performing an impact risk analysis that estimates the expected casualty...dispersion areas, or perform an impact risk analysis in accordance with paragraph (e). (e) Impact Risk Analysis (1) An applicant shall...

2013-01-01

291

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

Code of Federal Regulations, 2011 CFR

...method for performing an impact risk analysis that estimates the expected casualty...dispersion areas, or perform an impact risk analysis in accordance with paragraph (e). (e) Impact Risk Analysis (1) An applicant shall...

2011-01-01

292

Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis  

PubMed Central

Background High costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay. Methods In a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert. Findings A triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort. Conclusions A triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such. PMID:24367555

van’t Hoog, Anna H.; Cobelens, Frank; Vassall, Anna; van Kampen, Sanne; Dorman, Susan E.; Alland, David; Ellner, Jerrold

2013-01-01

293

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

NASA Astrophysics Data System (ADS)

The aim of this study was to develop mathematical models for estimating earthquake casualties such as death, number of injured persons, affected families and total cost of damage. To quantify the direct damages from earthquakes to human beings and properties given the magnitude, intensity, depth of focus, location of epicentre and time duration, the regression models were made. The researchers formulated models through regression analysis using matrices and used ? = 0.01. The study considered thirty destructive earthquakes that hit the Philippines from the inclusive years 1968 to 2012. Relevant data about these said earthquakes were obtained from Philippine Institute of Volcanology and Seismology. Data on damages and casualties were gathered from the records of National Disaster Risk Reduction and Management Council. The mathematical models made are as follows: This study will be of great value in emergency planning, initiating and updating programs for earthquake hazard reductionin the Philippines, which is an earthquake-prone country.

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

2014-04-01

294

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

295

Development and implementation of a custom integrated database with dashboards to assist with hematopathology specimen triage and traffic  

PubMed Central

Background: At some institutions, including ours, bone marrow aspirate specimen triage is complex, with hematopathology triage decisions that need to be communicated to downstream ancillary testing laboratories and many specimen aliquot transfers that are handled outside of the laboratory information system (LIS). We developed a custom integrated database with dashboards to facilitate and streamline this workflow. Methods: We developed user-specific dashboards that allow entry of specimen information by technologists in the hematology laboratory, have custom scripting to present relevant information for the hematopathology service and ancillary laboratories and allow communication of triage decisions from the hematopathology service to other laboratories. These dashboards are web-accessible on the local intranet and accessible from behind the hospital firewall on a computer or tablet. Secure user access and group rights ensure that relevant users can edit or access appropriate records. Results: After database and dashboard design, two-stage beta-testing and user education was performed, with the first focusing on technologist specimen entry and the second on downstream users. Commonly encountered issues and user functionality requests were resolved with database and dashboard redesign. Final implementation occurred within 6 months of initial design; users report improved triage efficiency and reduced need for interlaboratory communications. Conclusions: We successfully developed and implemented a custom database with dashboards that facilitates and streamlines our hematopathology bone marrow aspirate triage. This provides an example of a possible solution to specimen communications and traffic that are outside the purview of a standard LIS. PMID:25250187

Azzato, Elizabeth M.; Morrissette, Jennifer J. D.; Halbiger, Regina D.; Bagg, Adam; Daber, Robert D.

2014-01-01

296

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

297

Provenancing of unidentified World War II casualties: Application of strontium and oxygen isotope analysis in tooth enamel.  

PubMed

In 2010 and 2012 two sets of unidentified human remains of two World War II soldiers were recovered in the area where the 1944-1945 Kapelsche Veer bridgehead battle took place in The Netherlands. Soldiers of four Allied nations: British Royal Marine Commandos, Free Norwegian Commandos, Free Poles and Canadians, fought against the German Army in this battle. The identification of these two casualties could not be achieved using dental record information of DNA analysis. The dental records of Missing in Action soldiers of the Allied nations did not match with the dental records of the two casualties. A DNA profile was determined for the casualty found in 2010, but no match was found. Due to the lack of information on the identification of the casualties provided by routine methods, an isotope study was conducted in teeth from the soldiers to constrain their provenance. The isotope study concluded that the tooth enamel isotope composition for both casualties matched with an origin from the United Kingdom. For one of the casualties a probable origin from the United Kingdom was confirmed, after the isotope study was conducted, by the recognition of a characteristic belt buckle derived from a Royal Marine money belt, only issued to British Royal Marines, found with the remains of the soldier. PMID:25577002

Font, Laura; Jonker, Geert; van Aalderen, Patric A; Schiltmans, Els F; Davies, Gareth R

2015-01-01

298

The Casualty Assistance Readiness Enhancement System: A Case Study in Rapid Prototyping and Design for Flexibility  

NASA Astrophysics Data System (ADS)

Numerous government benefits are available to the surviving family of fallen U.S. military service members. Unfortunately, most of these entitlements require a considerable amount of paperwork to process correctly, necessitating a great deal of patience, attention to detail, and composure from families at a time when their grief is raw. Even though the U.S. Army appoints a Casualty Assistance Officer (CAO) to help surviving family members through this process, the soldiers serving as CAOs tend to be inexperienced and oftentimes find themselves challenged to provide accurate and thorough assistance. Consequently, some families do not receive all benefits in a timely manner, and some entitlements may be overlooked entirely. To help with the military's Casualty Program, we have developed the Casualty Assistance Readiness Enhancement System (CARES), an information system that improves how the Department of the Army cares for military families in arguably their greatest time of need. The tool and associated process reduced the time required to complete forms, reduced the potential for errors on repetitive information, assisted CAOs through the process, and provided electronic copies of completed forms.

Goerger, Simon R.; Wong, Ernest Y.; Henderson, Dale L.; Sperling, Brian K.; Bland, William

299

Social vulnerability and the natural and built environment: a model of flood casualties in Texas.  

PubMed

Studies on the impacts of hurricanes, tropical storms, and tornados indicate that poor communities of colour suffer disproportionately in human death and injury.(2) Few quantitative studies have been conducted on the degree to which flood events affect socially vulnerable populations. We address this research void by analysing 832 countywide flood events in Texas from 1997-2001. Specifically, we examine whether geographic localities characterised by high percentages of socially vulnerable populations experience significantly more casualties due to flood events, adjusting for characteristics of the natural and built environment. Zero-inflated negative binomial regression models indicate that the odds of a flood casualty increase with the level of precipitation on the day of a flood event, flood duration, property damage caused by the flood, population density, and the presence of socially vulnerable populations. Odds decrease with the number of dams, the level of precipitation on the day before a recorded flood event, and the extent to which localities have enacted flood mitigation strategies. The study concludes with comments on hazard-resilient communities and protection of casualty-prone populations. PMID:18435768

Zahran, Sammy; Brody, Samuel D; Peacock, Walter Gillis; Vedlitz, Arnold; Grover, Himanshu

2008-12-01

300

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, Kishor; Wald, David J.; Earle, Paul S.; Porter, Keith A.; Hearne, Mike

2011-01-01

301

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

302

The Simple Triage Scoring System (STSS) successfully predicts mortality and critical care resource utilization in H1N1 pandemic flu: a retrospective analysis  

Microsoft Academic Search

INTRODUCTION: Triage protocols are only initiated when it is apparent that resource deficits will occur across a broad geographical area despite efforts to expand or acquire additional capacity. Prior to the pandemic the UK Department of Health (DOH) recommended the use of a staged triage plan incorporating Sepsis-related Organ Failure Assessment (SOFA) developed by the Ontario Ministry of Health to

Kayode A Adeniji; Rebecca Cusack

2011-01-01

303

Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service  

PubMed Central

Purpose To evaluate participant and referring care provider satisfaction associated with a spinal triage assessment service delivered by physiotherapists in collaboration with orthopedic surgeons. Methods People with low back-related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists. Measures of patient and provider satisfaction were completed at approximately 4 weeks after the assessment. The satisfaction surveys were analyzed quantitatively with descriptive statistics and qualitatively with an inductive thematic approach of open and axial coding. Results A total of 108/115 participants completed the posttest satisfaction survey. Sixty-six percent of participants were “very satisfied” with the service and 55% were “very satisfied” with the recommendations that were made. Only 18% of referring care providers completed the satisfaction survey and 90.5% of those were “very satisfied” with the recommendations. Sixty-one participants and 14 care providers provided comments which revealed a diverse range of themes which were coded into positive (ie, understanding the problem, communication, customer service, efficiency, and management direction), negative (ie, lack of detail, time to follow-up, cost) and neutral related to the triage service, and an “other” category unrelated to the service (ie, chronic symptoms, comorbidities, and limited access to health care.) Conclusion The quantitative results of the participant survey demonstrated very high levels of satisfaction with the service and slightly less satisfaction with the recommendations that were made. Satisfaction of referring care providers with the recommendations and report was also high, but given the low response rate, these results should be interpreted with caution. Qualitative analysis of participant and provider comments revealed a diverse range of themes. These other issues may be important contextual factors that have the potential to impact patient relevant outcomes. PMID:22328826

Bath, Brenna; Janzen, Bonnie

2012-01-01

304

Tornado disaster in rural Georgia: triage response, injury patterns, lessons learned.  

PubMed

Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military helicopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris. PMID:10759190

Millie, M; Senkowski, C; Stuart, L; Davis, F; Ochsner, G; Boyd, C

2000-03-01

305

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

306

Triage, not just for the emergency department: a discussion of the appropriate level of care for the transitioning infant.  

PubMed

Determining the appropriate placement for infants experiencing a delay in transition or who require more intensive assessment, monitoring, and nursing care can be a challenge. Not all of these infants need to be admitted to the NICU. Since 1994, we have had a triage program to care for these infants. We define triage as a temporary (12 hours or fewer) level of care for monitoring, assessment, and intervention. This level of care is more intensive than in the newborn nursery, but the infant does not require an immediate NICU admission. Caring for these infants presents challenges in staffing, family-centered care, and reimbursement. This article shares information on the evolution of our triage program, its benefits to infants and their families, and how it is integrated into our NICU practices. PMID:21520683

Allison, Beth Ann; Burcin, Elizabeth

2011-01-01

307

Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage  

PubMed Central

Background The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the likelihood of being admitted to ICU. Alternative locations outside the ICU in which care for critically ill patients could be delivered should be considered during times of extreme ICU-bed shortage. PMID:25247021

Orsini, Jose; Blaak, Christa; Yeh, Angela; Fonseca, Xavier; Helm, Tanya; Butala, Ashvin; Morante, Joaquin

2014-01-01

308

Triage of patients for short term observation after elective coronary angioplasty  

PubMed Central

OBJECTIVE—To evaluate triage of patients for short term observation after elective percutaneous transluminal coronary angioplasty (PTCA), as appropriate selection of patients for short term observation after angioplasty may facilitate early discharge.?METHODS—1015 consecutive patients scheduled for elective PTCA were prospectively included for short term observation. Patients with unstable angina Braunwald class III were excluded. There were no angiographic exclusion criteria. Patients were discharged from the interventional centre when considered stable during 4 hours of observation after PTCA. It was left to the operator's discretion whether to prolong the observation period. Procedural complications were defined as death, coronary bypass surgery, early repeat PTCA, and myocardial infarction.?OUTCOME MEASURES—The need for prolonged observation (> 4 hours) and the occurrence of complications. Predictors for prolonged observation and the occurrence of complications after the 4 hours observation were assessed by univariate and multivariate analysis.?RESULTS—Two patients died, including one of six patients who underwent emergency bypass surgery. In all, 922 patients (90.8%) were triaged to short term observation and had an uncomplicated three day follow up. Observation was prolonged in 87 patients (8.6%), and 40 patients had a complicated course. Independent predictors of procedural complications were acute closure (odds ratio (OR) 9.7; 95% confidence interval 4.4 to 21.4), side branch occlusion (OR 8.9; 3.4 to 23.7), no angiographic success (OR 5.1; 2.4 to 11.0), female sex (OR 3.1, 1.7 to 5.7), any unplanned stent (OR 2.8, 1.4 to 5.9), and ostial lesion (OR 2.2, 1.0 to 4.7).?CONCLUSIONS—A 4 hour observation period is safe after elective coronary angioplasty. As procedural variables are the strongest predictors of postprocedural complications, the immediate procedural results allow effective triage of patients for short term or prolonged observation in order to anticipate complications.???Keywords: angioplasty; triage; interventional cardiology PMID:10768908

Koch, K; Piek, J; Prins, M; de Winter, R J; Mulder, K; Lie, K; Tijssen, J

2000-01-01

309

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

310

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

Federal Register 2010, 2011, 2012, 2013, 2014

...of public workshop; request for abstracts for poster presentation...MD 20993. Entrance for the public meeting participants (non-FDA-employees...indicate if you wish to present an abstract during the poster session. FDA...

2012-08-30

311

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

E-print Network

current medical staffing levels within the Hospital Referralcurrent medical staffing levels within the Hospital ReferralHospital Staff Surge Capacity and private medical personnel within the greater Cape Town area to determine current staffing

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

2010-01-01

312

The handover process and triage of ambulance-borne patients: the experiences of emergency nurses.  

PubMed

One of the most important tasks that a nurse faces in the emergency room, when receiving a patient, is handover and the triage function. The aim of the study was to explore the experiences of nurses receiving patients who were brought into hospital as emergencies by ambulance crews through an analysis of the handover and triage process. A qualitative descriptive interview study inspired by the phenomenological method was used with six emergency nurses. There are three elements to a handover: a verbal report, handing over documented accounts and the final symbolic handover when a patient is transferred from the ambulance stretcher onto the hospital stretcher. The study identified that the verbal communication between ambulance and emergency nurses was often very structured. The ideal handovers often involved patients with very distinct medical problems. The difficult handover or the 'non-ideal' one was characterized by a significantly more complicated care situation. The handover function was pivotal in ensuring that the patient received the correct care and that care was provided at the appropriate level. The most seriously afflicted patients arrived by ambulance; therefore, the interplay between pre-hospital and hospital personnel was vital in conveying this important information. To some extent, this functioned well, but this research has identified areas where this care can be improved. PMID:15997974

Bruce, Karin; Suserud, Björn-Ove

2005-01-01

313

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

314

Triage management, survival, and the law in the age of ebola.  

PubMed

Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. (Disaster Med Public Health Preparedness. 2014;0:1-6). PMID:25343493

Burkle, Frederick M; Burkle, Christopher M

2015-02-01

315

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

PubMed Central

Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation. PMID:25028538

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

2014-01-01

316

Assessing the Applicability of FISH-based Prematurely Condensed Dicentric Chromosome Assay in Triage Biodosimetry.  

PubMed

The dicentric chromosome assay (DCA) has been regarded as the gold standard of radiation biodosimetry. The assay, however, requires a 2-d peripheral blood lymphocyte culture before starting metaphase chromosome analyses to estimate biological doses. Other biological assays also have drawbacks with respect to the time needed to obtain dose estimates for rapid decision on the correct line of medical treatment. Therefore, alternative technologies that suit requirements for triage biodosimetry are needed. Radiation-induced DNA double strand breaks in G0 lymphocytes can be detected as interphase chromosome aberrations by the cell fusion-mediated premature chromosome condensation (PCC) method. The method, in combination with fluorescence in situ hybridization (FISH) techniques, has been proposed in early studies as a powerful tool for obtaining biological dose estimates without 2-d lymphocyte culture procedures. The present work assesses the applicability of FISH-based PCC techniques using pan-centromeric and telomeric peptide nucleic acid (PNA) probes in triage mode biodosimetry and demonstrates that an improved rapid procedure of the prematurely condensed dicentric chromosome (PCDC) assay has the potential for evaluating exposed radiation doses in as short as 6 h after the collection of peripheral blood specimens. PMID:25627950

Suto, Yumiko; Gotoh, Takaya; Noda, Takashi; Akiyama, Miho; Owaki, Makiko; Darroudi, Firouz; Hirai, Momoki

2015-03-01

317

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

318

The efficacy of telemedicine for ophthalmology triage by a general practitioner.  

PubMed

Although there are enough ophthalmologists for the Brazilian population, they are not evenly distributed throughout the country. Tele-ophthalmology may therefore be a useful tool. We have examined the feasibility of ophthalmology triage, performed by a general practitioner (GP) with remote support from an ophthalmologist. Forty patients with a variety of external and internal eye disorders were examined by the GP and also reassessed by an ophthalmologist, face to face, and then remotely by another ophthalmologist. There was agreement in 95% of the diagnoses between face-to-face and distant evaluation. The use of a digital camera and slit-lamp allowed greater accuracy of telediagnosis than the use of a digital camera alone. The GP would have referred 36 patients to an ophthalmologist, while both the local and the remote ophthalmologist saw the need for referral in 31 cases, i.e. assessment by tele-ophthalmology resulted in a 14% decrease in referrals. GP triage therefore appears to be feasible after appropriate training. PMID:16036006

Taleb, Alexandre Chater; Böhm, György M; Avila, Marcos; Wen, Chao Lung

2005-01-01

319

Timing of troponin T measurements in triage of pulmonary embolism patients  

PubMed Central

Aim To determine the appropriate timing of cardiac troponin T (cTnT) measurement for the early triage of pulmonary embolism (PE) patients. Methods In this single-center prospective study, PE was confirmed in all patients using computed tomography. 104 consecutive patients were divided into three groups (high-risk, intermediate, and low-risk) based on their hemodynamic status and echocardiographic signs of right ventricular dysfunction. cTnT levels were measured on admission and then after 6, 24, 48, and 72 hours with threshold values greater than 0.1 ng/mL. Results Intermediate-risk PE patients had higher cTnT levels than low-risk patients already in the first measurement (P?=?0.037). Elevated cTnT levels significantly correlated with disease severity after 6 hours (intermediate vs low risk patients, P?=?0.016, all three groups, P?=?0.009). Conclusion In hemodynamically stable patients, increased cTnT level on admission differentiated intermediate from low-risk patients and could be used as an important element for the appropriate triage of patients. PMID:24382851

Bulj, Nikola; Poto?njak, Ines; Sharma, Mirella; Pintari?, Hrvoje; Degoricija, Vesna

2013-01-01

320

From bandit colonialism to the modern triage society: Towards a moral and cognitive reconstruction of knowledge and citizenship  

Microsoft Academic Search

This article argues that the transition from bandit colonialism through the intricate systems of the modern triage society that is wired for Western cultural compliance requires more than just critique, or a prayer for the meek to inherit the earth. It requires a decisive consensus that the meek do not inherit the earth by their meekness alone – they need

Catherine A. Odora Hoppers

2009-01-01

321

Analyses of battle casualties by weapon type aboard U.S. Navy warships.  

PubMed

The number of casualties was determined for 513 incidents involving U.S. Navy warships sunk or damaged during World War II. Ship type and weapon were significant factors in determining the numbers of wounded and killed. Multiple weapon attacks and kamikazes yielded more wounded in action than other weapon types. Multiple weapons and torpedos resulted in a higher incidence of killed in action than other weapons. Penetrating wounds and burns were the most prominent injury types. Kamikaze attacks yielded significantly more burns than incidents involving bombs, gunfire, torpedos, mines, and multiple weapons. Mine explosions were responsible for more strains, sprains, and dislocations than the other weapon types. PMID:1603403

Blood, C G

1992-03-01

322

The Emergency Severity Index, version 4, for pediatric triage: a reliability study in Tabriz Children’s Hospital, Tabriz, Iran  

PubMed Central

Background The Emergency Severity Index (ESI) has earned reliability and validity in adult populations but has not been adequately evaluated in pediatric patients. The aim of this study was to assess the reliability of the ESI version 4 and inter-rater reliability measures to evaluate the performance of nurses in the emergency ward. Methods Raters were part of the same team of pediatric emergency medicine team, including pediatric emergency medicine (PEM) physicians and pediatric triage (PT) nurses. Reliability and agreement rates were measured using kappa statistics. The measurements were compared with the admission rates, readmissions to the PEM division, location of admission and death as outcomes. Results Initially, PT nurses rated 20 case scenarios. Further in a prospective cohort study, 1104 children were assigned ESI scores by both nurses and physicians. The ratings of case scenarios showed a kappa value of 0.84. In actual patients, ratings showed high concordance with the physicians’ ratings with the kappa value of 0.82 being in a good agreement with the nurses’ ratings. The main area of discordance was detected in level 4 where 48 cases were triaged in higher levels and 25 were triaged in lower levels. The analysis showed the likelihood of admission clearly increased as the ESI score decreased (p<0.0001). There was a significant correlation between the admission status and triage level in both PT nurses’ and PEM physicians’ ratings (Spearman coefficient=0.374, 0.407; p<0.0001). Conclusion ESI scores assigned to the pediatric patients are reliable in the hands of experienced PT nurses and PEM physicians. The very good agreement between PT nurses and PEM physicians, demonstrated in this study, is essential in cooperative work in crowded referral emergency departments and helpful in challenging triage cases. PMID:24088367

2013-01-01

323

Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010.  

PubMed

Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the United States, 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0 vs. 6.0; p < 0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care. PMID:25562865

Yun, Heather C; Weintrob, Amy C; Conger, Nicholas G; Li, Ping; Lu, Dan; Tribble, David R; Murray, Clinton K

2015-01-01

324

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

325

Healthcare-Associated Pneumonia among United States Combat Casualties, 2009–2010  

PubMed Central

Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the U.S., 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0, versus 6.0; p<0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care. PMID:25562865

Yun, Heather C.; Weintrob, Amy C.; Conger, Nicholas G.; Li, Ping; Lu, Dan; Tribble, David R.; Murray, Clinton K.

2014-01-01

326

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

327

Decision aids for triage of patients with chest pain: a systematic review of field evaluation studies.  

PubMed Central

We performed an overview of published controlled trials to assess the overall effectiveness of decision aids directed at improving triage of patients with acute chest pain. Searches of the Medline database identified 11 randomized or quasi-randomized controlled trials testing various decision aids: risk stratification system (n = 6), practice guidelines (n = 3), and formalized protocols of care (n = 2). Sensitivity, specificity of the decision aid and length of stay (LOS) in the intensive care unit (ICU) were the main outcomes. Decision aids slightly modified sensitivity and specificity (available in 5 studies), but sensitivity was already high in reference groups. Among the 9 studies providing information on LOS, 7 showed a statistically significant difference favoring the decision aid. The level of evidence concerning the efficacy of decision aids in this domain is relatively low. Larger and appropriately designed clinical trials are required to show an impact on acute cardiac ischaemia complications and mortality. PMID:10566454

Colombet, I.; Chatellier, G.; Jaulent, M. C.; Degoulet, P.

1999-01-01

328

Decision aids for triage of patients with chest pain: a systematic review of field evaluation studies.  

PubMed Central

We performed an overview of published controlled trials to assess the overall effectiveness of decision aids directed at improving triage of patients with acute chest pain. Searches of the Medline database identified 11 randomized or quasi-randomized controlled trials testing various decision aids: risk stratification system (n = 6), practice guidelines (n = 3), and formalized protocols of care (n = 2). Sensitivity, specificity of the decision aid and length of stay (LOS) in the intensive care unit (ICU) were the main outcomes. Decision aids slightly modified sensitivity and specificity (available in 5 studies), but sensitivity was already high in reference groups. Among the 9 studies providing information on LOS, 7 showed a statistically significant difference favoring the decision aid. The level of evidence concerning the efficacy of decision aids in this domain is relatively low. Larger and appropriately designed clinical trials are required to show an impact on acute cardiac ischaemia complications and mortality. PMID:10566355

Colombet, I.; Chatellier, G.; Jaulent, M. C.; Degoulet, P.

1999-01-01

329

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

330

Informed Cytology for Triaging HPV-Positive Women: Substudy Nested in the NTCC Randomized Controlled Trial  

PubMed Central

Background: Human papillomavirus (HPV)–based screening needs triage. In most randomized controlled trials (RCTs) on HPV testing with cytological triage, cytology interpretation has been blind to HPV status. Methods: Women age 25 to 60 years enrolled in the New Technology in Cervical Cancer (NTCC) RCT comparing HPV testing with cytology were referred to colposcopy if HPV positive and, if no cervical intraepithelial neoplasia (CIN) was detected, followed up until HPV negativity. Cytological slides taken at the first colposcopy were retrieved and independently interpreted by an external laboratory, which was only aware of patients’ HPV positivity. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were computed for histologically proven CIN2+ with HPV status–informed cytology for women with a determination of atypical squamous cells of undetermined significance (ASCUS) or more severe. All statistical tests were two-sided. Results: Among HPV-positive women, informed cytology had cross-sectional sensitivity, specificity, PPV and 1-NPV for CIN2+ of 85.6% (95% confidence interval [CI] = 76.6 to 92.1), 65.9% (95% CI = 63.1 to 68.6), 16.2% (95% CI = 13.0 to 19.8), and 1.7 (95% CI = 0.9 to 2.8), respectively. Cytology was also associated with subsequent risk of newly diagnosed CIN2+ and CIN3+. The cross-sectional relative sensitivity for CIN2+ vs blind cytology obtained by referring to colposcopy and following up only HPV positive women who had HPV status–informed cytology greater than or equal to ASCUS was 1.58 (95% CI = 1.22 to 2.01), while the corresponding relative referral to colposcopy was 0.95 (95% CI = 0.86 to 1.04). Conclusions: Cytology informed of HPV positivity is more sensitive than blind cytology and could allow longer intervals before retesting HPV-positive, cytology-negative women. PMID:25568167

Bergeron, Christine; Giorgi-Rossi, Paolo; Cas, Frederic; Schiboni, Maria Luisa; Ghiringhello, Bruno; Dalla Palma, Paolo; Minucci, Daria; Rosso, Stefano; Zorzi, Manuel; Naldoni, Carlo; Segnan, Nereo; Confortini, Massimo

2015-01-01

331

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

332

Utility of Conization with Frozen Section for Intraoperative Triage Prior to Definitive Hysterectomy  

PubMed Central

Objective To review our experience with conization with intraoperative frozen section analysis and to compare results from our tertiary cancer center with those from 2 community hospitals. Methods The records of all women who underwent conization with intraoperative frozen section analysis from January 1, 1997, through April 30, 2011, at The University of Texas MD Anderson Cancer Center and 2 community hospitals—The Woman’s Hospital of Texas and St. Luke’s Episcopal Hospital—were reviewed. Findings on pathologic analysis of frozen sections, permanent loop electrosurgical excisional procedure/conization specimens, and hysterectomy specimens were compared for each patient, and results from the cancer center were compared to those from the community hospitals. Results One hundred fifty-three patients met the inclusion criteria. Rates of accuracy of conization with frozen section analysis in predicting definitive pathologic findings were as follows: cervix with no residual disease after prior extirpative procedure 96.5% (95% CI 86.9–100%); cervical squamous carcinoma in situ, 95.4% (95% CI 84.5–100%); cervical adenocarcinoma in situ, 98.7% (95% CI 92.7–100%); microinvasive carcinoma, 97.4% (95% CI 90.1–100%); and invasive carcinoma ? 3 mm, 100%. Most importantly, conization with frozen section analysis was 100% accurate for triaging patients to simple or radical hysterectomy. Finally, this approach performed equally well in the cancer center with subspecialized pathologists and the 2 community hospitals with general pathologists. Conclusion Conization with frozen section analysis is an effective technique for intraoperative triage of patients to immediate simple or radical hysterectomy and can be accurately performed in both academic and community hospitals. PMID:22842126

Martinelli, Fabio; Schmeler, Kathleen M.; Johnson, Chelsea; Brown, Jubilee; Euscher, Elizabeth D.; Ramirez, Pedro T.; Frumovitz, Michael

2014-01-01

333

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

334

Toward An Ontology of Geo-Reasoning to Aid Response to Weapons of Mass Destruction  

E-print Network

Toward An Ontology of Geo-Reasoning to Aid Response to Weapons of Mass Destruction David Kirsh1 Response System units in mitigating the impact of attacks with weapons of mass destruction (WMD responders. INTRODUCTION AND BACKGROUND Mass casualty events are chaotic and dynamic. Personnel, victims

Kirsh, David

335

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

Microsoft Academic Search

European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario,

P. Kruse; C. Rojas-Palma

2007-01-01

336

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

337

Helicopter Emergency Medical Services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia  

PubMed Central

Background In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. Methods The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS?12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. Results A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. Conclusions HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of transport performed. Although severely injured HEMS patients are more costly to treat, HEMS patients with minor injuries make up the majority of HEMS transports and have larger relative potential funding discrepancies. Future episode funding models need to account for the variability of trauma patients and the proportion of patients transported via HEMS. PMID:23815080

2013-01-01

338

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

USGS Publications Warehouse

Many carnivores have been seriously impacted by the expansion of transportation systems and networks; however we know little about carnivore response to the extent and magnitude of road mortality, or which age classes may be disproportionately impacted. Recent research has demonstrated that wildlife-vehicle-collisions (WVC) involving carnivores are modulated by temporal and spatial factors. Thus, we investigated road mortality on a guild of small and medium-sized carnivores in southern Portugal using road-kill data obtained from a systematic 36 months monitoring period along highways (260 km) and national roads (314 km) by addressing the following questions: (a) which species and age class are most vulnerable to WVC? (b) are there temporal and/or spatial patterns in road-kill? and (c) which life-history and/or spatial factors influence the likelihood of collisions? We recorded a total of 806 carnivore casualties, which represented an average of 47 ind./100 km/year. Red fox and stone marten had the highest mortality rates. Our findings highlight three key messages: (1) the majority of road-killed individuals were adults of common species; (2) all carnivores, except genets, were more vulnerable during specific life-history phenological periods: higher casualties were observed when red fox and stone marten were provisioning young, Eurasian badger casualties occurred more frequently during dispersal, and higher Egyptian mongoose mortality occurred during the breeding period; and (3) modeling demonstrated that favorable habitat, curves in the road, and low human disturbance were major contributors to the deadliest road segments. Red fox carcasses were more likely to be found on road sections with passages distant from urban areas. Conversely, stone marten mortalities were found more often on national roads with high of cork oak woodland cover; Egyptian mongoose and genet road-kills were found more often on road segments close to curves. Based on our results, two key mitigation measures should help to reduce WVC in Portugal. The first involves the improvement of existing crossings with buried and small mesh size fence to guide the individuals towards to the passages, in road segments with high traffic volume (>1200 vehicles/night) and located in preferred carnivore habitats. The second mitigation involves cutting or removal of dense vegetation in verges of road segments with curves to aid motorists in seeing animals about to cross. ?? 2008 Elsevier Ltd.

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

2009-01-01

339

Helicopter Brown-Out costs the US approximately $100 M per year in casualties/fatalities and signifi-  

E-print Network

Helicopter Brown-Out costs the US approximately $100 M per year in casualties be used not only for mitigation but also to predict and avoid brown-out conditions. Helicopter Brown) data from RADARSAT-2 is analyzed for detection of soils susceptible to helicopter brown-out. He

340

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

PubMed Central

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

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

2014-01-01

341

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

PubMed Central

A system of orderly triage of the injured in World War I and a protocol for early wound management of war injuries were introduced by Antoine De Page in 1914 at the beginning of World War I. The five steps of the De Page protocol (coined by the author as Ordre de Triage) were to be followed in detail by the French and Belgian armies. A younger Belgian colleague, Robert Danis, was recruited to aid in the management of the ambulance corps to transport the injured from dressing (“clearing”) stations to centers of more advanced care, away from the Franco-Belgian front. Danis, also from Brussels, introduced the principles of osteosynthesis of bone a little over a decade later. De Page and Danis, both surgeons, tendered immense carry-forwards for future generations. PMID:22110790

Pollock, Richard A.

2008-01-01

342

Combat casualties undergoing lifesaving interventions have decreased heart-rate complexity at multiple time scales  

PubMed Central

Purpose We found that heart-rate (HR) complexity metrics, such as sample entropy (SampEn), identified trauma patients receiving lifesaving interventions (LSIs). We now aimed: 1) to test a new multiscale entropy (MSE) index; 2) to compare it to single-scale measures including SampEn; and 3) to assess different parameter values for calculation of SampEn and MSE. Methods This was a study of combat casualties in an Emergency Department (ED) in Iraq. ECGs of 70 acutely injured adults were recorded. Twelve underwent LSIs and 58 did not. LSIs included endotracheal intubation (9); tube thoracostomy (9); and emergency transfusion (4). From each ECG, a segment of 800 consecutive beats was selected. Off-line, R waves were detected and R-to-R (RR) interval time series were generated. SampEn, MSE, and time-domain measures of HR variability (mean HR, standard deviation, pNN20, pNN50, rMSSD) were computed. Results Differences in mean HR (LSI=111±33, NonLSI=90±17) were not significant. Systolic arterial pressure was statistically but not clinically different (LSI=123±19, NonLSI=135±19). SampEn (LSI=0.90±0.42, NonLSI=1.19±0.35, p<0.05) and MSE index (LSI = 2.58±2.55, NonLSI=5.67±2.48, p<0.001) differed significantly. Conclusions Complexity of HR dynamics over a range of time scales was lower in high-risk than in low-risk combat casualties and outperformed traditional vital signs. PMID:24140167

Cancio, Leopoldo C.; Batchinsky, Andriy I.; Baker, William L.; Necsoiu, Corina; Salinas, José; Goldberger, Ary L.; Costa, Madalena D.

2013-01-01

343

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

PubMed Central

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

Bath, Brenna; Pahwa, Punam

2012-01-01

344

An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels  

PubMed Central

IMPORTANCE Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. OBJECTIVE To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. DESIGN, SETTING, AND PARTICIPANTS Adolescent patients (age range, 12–17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview–Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. MAIN OUTCOMES AND MEASURES For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview–Substance Abuse Module as the criterion standard. RESULTS Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84%(95%CI, 76%–89%) for identifying nontobacco substance use, 90% (95%CI, 77%–96%) and 94%(95%CI, 89%–96%) for substance use disorders, 100% and 94%(95%CI, 90%–96%) for severe substance use disorders, and 75% (95%CI, 52%–89%) and 98%(95%CI, 95%–100%) for nicotine dependence. No significant differences were found in sensitivity or specificity between the full tool and the Screening to Brief Intervention. CONCLUSIONS AND RELEVANCE A single screening question assessing past-year frequency use for 8 commonly misused categories of substances appears to be a valid method for discriminating among clinically relevant risk categories of adolescent substance use. PMID:25070067

Levy, Sharon; Weiss, Roger; Sherritt, Lon; Ziemnik, Rosemary; Spalding, Allegra; Van Hook, Shari; Shrier, Lydia A.

2014-01-01

345

Triage of Women with Low-Grade Cervical Lesions - HPV mRNA Testing versus Repeat Cytology  

PubMed Central

Background In Norway, women with low-grade squamous intraepithelial lesions (LSIL) are followed up after six months in order to decide whether they should undergo further follow-up or be referred back to the screening interval of three years. A high specificity and positive predictive value (PPV) of the triage test is important to avoid unnecessary diagnostic and therapeutic procedures. Materials and Methods At the University Hospital of North Norway, repeat cytology and the HPV mRNA test PreTect HPV-Proofer, detecting E6/E7 mRNA from HPV types 16, 18, 31, 33 and 45, are used in triage of women with ASC-US and LSIL. In this study, women with LSIL cytology in the period 2005–2008 were included (n?=?522). Two triage methods were evaluated in two separate groups: repeat cytology only (n?=?225) and HPV mRNA testing in addition to repeat cytology (n?=?297). Histologically confirmed cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) was used as the study endpoint. Results Of 522 women with LSIL, 207 had biopsies and 125 of them had CIN2+. The sensitivity and specificity of repeat cytology (ASC-US or worse) were 85.7% (95% confidence interval (CI): 72.1, 92.2) and 54.4 % (95% CI: 46.9, 61.9), respectively. The sensitivity and specificity of the HPV mRNA test were 94.2% (95% CI: 88.7, 99.7) and 86.0% (95% CI: 81.5, 90.5), respectively. The PPV of repeat cytology was 38.4% (95% CI: 29.9, 46.9) compared to 67.0% (95% CI: 57.7, 76.4) of the HPV mRNA test. Conclusion HPV mRNA testing was more sensitive and specific than repeat cytology in triage of women with LSIL cytology. In addition, the HPV mRNA test showed higher PPV. These data indicate that the HPV mRNA test is a better triage test for women with LSIL than repeat cytology. PMID:21918682

Sørbye, Sveinung Wergeland; Arbyn, Marc; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve

2011-01-01

346

The impact of using computer decision-support software in primary care nurse-led telephone triage: interactional dilemmas and conversational consequences.  

PubMed

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. PMID:25514212

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

2015-02-01

347

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

348

Attitude changes among emergency department triage staff after conducting routine alcohol screening.  

PubMed

Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine. PMID:15922512

Nordqvist, C; Johansson, K; Lindqvist, K; Bendtsen, P

2006-02-01

349

Prediction of adverse outcomes of acute coronary syndrome using intelligent fusion of triage information with HUMINT  

NASA Astrophysics Data System (ADS)

Faculty from the University of Tennessee at Chattanooga and the University of Tennessee College of Medicine, Chattanooga Unit, have used data mining techniques and neural networks to examine a set of fourteen features, data items, and HUMINT assessments for 2,148 emergency room patients with symptoms possibly indicative of Acute Coronary Syndrome. Specifically, the authors have generated Bayesian networks describing linkages and causality in the data, and have compared them with neural networks. The data includes objective information routinely collected during triage and the physician's initial case assessment, a HUMINT appraisal. Both the neural network and the Bayesian network were used to fuse the disparate types of information with the goal of forecasting thirty-day adverse patient outcome. This paper presents details of the methods of data fusion including both the data mining techniques and the neural network. Results are compared using Receiver Operating Characteristic curves describing the outcomes of both methods, both using only objective features and including the subjective physician's assessment. While preliminary, the results of this continuing study are significant both from the perspective of potential use of the intelligent fusion of biomedical informatics to aid the physician in prescribing treatment necessary to prevent serious adverse outcome from ACS and as a model of fusion of objective data with subjective HUMINT assessment. Possible future work includes extension of successfully demonstrated intelligent fusion methods to other medical applications, and use of decision level fusion to combine results from data mining and neural net approaches for even more accurate outcome prediction.

McCullough, Claire L.; Novobilski, Andrew J.; Fesmire, Francis M.

2006-04-01

350

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

PubMed Central

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.

2011-01-01

351

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

PubMed Central

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

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

2014-01-01

352

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

353

Dentistry and Mass Disaster – A Review  

PubMed Central

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

Sakthi, D Sri

2014-01-01

354

Applying simulation optimization to dynamic financial analysis for the asset–liability management of a property–casualty insurer  

Microsoft Academic Search

The Dynamic Financial Analysis (DFA) system is a useful decision-support system for the insurer, but it lacks optimization capability. This article applies a simulation optimization technique to a DFA system and use the enhanced system to search an Asset–Liability Management (ALM) solution for a Property–Casualty (P&C) insurance company. The simulation optimization technique used herein is a Genetic Algorithm (GA), and

Tzu-Yi Yu; Chenghsien Tsai; Hsiao-Tzu Huang; Chuen-Lung Chen

2011-01-01

355

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

E-print Network

THE METRICS OF DEATH: EMOTIONS AND THE EFFECTS OF CASUALTIES ON PUBLIC OPINION IN MILITARIZED DISPUTES AND TERRORISM A Dissertation by KATRINA N. MOSHER Submitted to the Office of Graduate Studies of Texas A&M University... AND TERRORISM A Dissertation by KATRINA N. MOSHER Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Approved by: Chair of Committee, Nehemia...

Mosher, Katrina N.

2009-05-15

356

The evolution of casualty evacuation in the British Army in the 20th century (Part 3)--1945 to present.  

PubMed

This is the third in a series of papers describing the evolution of the British casualty evacuation chain during the 20th century. This period was dominated by the threat of war between NATO and the Warsaw Pact in Central Europe. The Suez Crisis in 1956, the Falklands War in 1982, the GulfWar in 1991 and events in the Balkans during the 1990s demonstrated the requirement for a flexible system for medical support to the UK Armed Forces. PMID:12743936

Bricknell, M C M

2003-03-01

357

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

USGS Publications Warehouse

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

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

2010-01-01

358

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

USGS Publications Warehouse

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

Wald, David J.

2010-01-01

359

Multi-slice computed tomography (MSCT) of mountaineering casualties in the Swiss Alps - Advantages and limitations.  

PubMed

As an Alpine country, Switzerland has not only a thriving mountaineering tourist industry, but also many mountaineering casualties. At the request of the state attorney, most of the victims undergo only an external inspection without autopsy. One of the main tasks of the forensic pathologist under these circumstances is the correct identification of the deceased for a fast release to their kin. Nevertheless, detailed knowledge of the injuries sustained may lead to improved safety measures, such as better protective equipment. In this study, we examined the feasibility of using cross-sectional imaging with postmortem multi-slice computed tomography (MSCT) to detect lesions of the skeletal structures and internal organs. For this purpose, we used whole-body MSCT to examine 10 corpses that suffered fatal falls from great height while climbing in the Swiss part of the European Alps from the years 2007 to 2009. We conclude that postmortem CT imaging is a valuable tool for dental identification and is superior to plain X-rays as a viable compromise between a solely external legal inspection and an autopsy because it delivers otherwise irretrievable additional internal findings non-invasively. This fact is of great importance in cases where an autopsy is refused. PMID:20728397

Steffen, Ross; Suter, Cosima; Patricia, Flach; Lars, Oesterhelweg; Michael, Thali; Stephan, Bolliger

2010-11-01

360

International comparison of costs of a fatal casualty of road accidents in 1990 and 1999.  

PubMed

The purpose of this study is to assemble information of costs per fatal casualty in traffic accidents, adopted by authorities in different countries. analyse and compare these figures as well as the methods used for estimating these values. A questionnaire was sent to 19 countries from which 11 gave information on cost per fatality and methods of valuation. The costs per fatality, usually defined as direct and indirect costs plus a value of safety per se, are compared both between countries and over time, 1990 and 1999, for each country. The average cost per fatality has increased between 1990 and 1999 (fixed prices) due to both changes in the methodology and changes of valuations. Great Britain, New Zealand, Sweden and the US conduct own willingness-to-pay (WTP) surveys, while the Netherlands and Norway make reviews of these studies. In Finland, the cost per fatality is a combination of the value of lost productivity and the cost of care for an institutionalised disabled person. In Australia, Austria, Germany and Switzerland, the cost per fatality is estimated as a value of lost productivity and an addition of a human cost based on compensation payments or insurance payments. Estimates from recently conducted WTP surveys or meta-analyses are considered in Austria, Finland and Sweden, however, not yet adopted as official values for use in road traffic planning. PMID:11939361

Trawén, Anna; Maraste, Pia; Persson, Ulf

2002-05-01

361

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

PubMed

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

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

2012-09-01

362

Emergency department triage of low acuity patients to a Federally Qualified Health Center.  

PubMed

Many emergency departments (ED) are experiencing ever increasing volumes as they serve as a safety net for patients without established access to primary care. Impending physician shortages, our aging population, and recent changes in national healthcare policy are expected to further exacerbate this situation and worsen ED overcrowding. These conditions could result in a dilution of ED resources and significantly impact the ability of emergency personnel to provide quality care for patients with serious illnesses. Previous studies have demonstrated that low acuity patients without emergencies can be safely and legally identified in triage and can be sent away from the ED for further outpatient treatment and evaluation. However, without a specific designated clinic follow up, these patients often fail to get the appropriate care required. In this study, we couple the ED medical screening exam process with a timely medical referral system to a local Federally Qualified Healthcare Clinic (FQHC). These referred patients were monitored for subsequent success in satisfaction with their primary care needs and their rate of recidivism to the ED. Most of the non-emergent patients who were judged to be appropriate to refer to the FQHC were satisfied with their medical screening process (89%) and most elected to attend the same day clinic appointment at the FQHC (85%). Only 17% of these patients who were referred out of our ED returned to be seen in our ED within the three-month interval. We concluded that referring low acuity patients out of the emergency department to a primary care clinic setting provided an opportunity for these patients to establish a medical home for future access to non-emergent health care. PMID:24498708

Nguyen, Nghia D; Moore, Justin B; McIntosh, Nathan P; Jones, Michael L; Zimmerman, Jason; Summers, Richard L

2013-10-01

363

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

364

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. PMID:25360303

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

365

The German Version of the Manchester Triage System and Its Quality Criteria – First Assessment of Validity and Reliability  

PubMed Central

Background The German Version of the Manchester Triage System (MTS) has found widespread use in EDs across German-speaking Europe. Studies about the quality criteria validity and reliability of the MTS currently only exist for the English-language version. Most importantly, the content of the German version differs from the English version with respect to presentation diagrams and change indicators, which have a significant impact on the category assigned. This investigation offers a preliminary assessment in terms of validity and inter-rater reliability of the German MTS. Methods Construct validity of assigned MTS level was assessed based on comparisons to hospitalization (general / intensive care), mortality, ED and hospital length of stay, level of prehospital care and number of invasive diagnostics. A sample of 45,469 patients was used. Inter-rater agreement between an expert and triage nurses (reliability) was calculated separately for a subset group of 167 emergency patients. Results For general hospital admission the area under the curve (AUC) of the receiver operating characteristic was 0.749; for admission to ICU it was 0.871. An examination of MTS-level and number of deceased patients showed that the higher the priority derived from MTS, the higher the number of deaths (p<0.0001 / ?2 Test). There was a substantial difference in the 30-day survival among the 5 MTS categories (p<0.0001 / log-rank test).The AUC for the predict 30-day mortality was 0.613. Categories orange and red had the highest numbers of heart catheter and endoscopy. Category red and orange were mostly accompanied by an emergency physician, whereas categories blue and green were walk-in patients. Inter-rater agreement between expert triage nurses was almost perfect (??=?0.954). Conclusion The German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department. PMID:24586477

Gräff, Ingo; Goldschmidt, Bernd; Glien, Procula; Bogdanow, Manuela; Fimmers, Rolf; Hoeft, Andreas; Kim, Se-Chan; Grigutsch, Daniel

2014-01-01

366

Risky business: using necessarily imprecise casualty counts to estimate occupational risks for HIV-1 infection.  

PubMed

Although the genesis of healthcare worker anxiety regarding occupational risks of HIV-1 infection is clear, the reasons for continued insistence on a meticulous "casualty count" become less clear with time. One could, in fact, argue that the precise number of such infections has become virtually meaningless, because the routes of occupational/nosocomial transmission of HIV-1 and the magnitude of risk for infection following an adverse exposure in the healthcare setting have been well-characterized. Nevertheless, with the substantial limitations of these data clearly in mind, we have summarized the numbers of healthcare workers reported to have HIV-1 infection in each of the above categories in Table 2. The likelihood that an individual case represents true occupational infection decreases as one moves down the table. Having waded through the depths of this literature, we have reached the conclusion that, of the available data, the magnitude of risk for occupational HIV-1 infection remains the single most useful and instructive statistic available. Longitudinal cohort studies of HCWs involved in the day-to-day care of HIV-1-infected patients and in the handling and processing of specimens from such patients provide the best available evidence regarding the magnitude of risk for transmission of this virus in the healthcare setting. Fourteen prospective studies are currently in progress, with approximately 2,000 HCWs enrolled (Table 4). Six HCWs enrolled in these studies have developed serologic evidence of HIV-1 infection following percutaneous exposures, yielding an infection rate per participant of 0.32% and an infection rate per exposure of 0.31%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2165506

Beekmann, S E; Fahey, B J; Gerberding, J L; Henderson, D K

1990-07-01

367

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

PubMed

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

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

2014-06-01

368

Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke.  

PubMed

Purpose To describe the use of an imaging selection tool, multiphase computed tomographic (CT) angiography, in patients with acute ischemic stroke (AIS) and to demonstrate its interrater reliability and ability to help determine clinical outcome. Materials and Methods The local ethics board approved this study. Data are from the pilot phase of PRoveIT, a prospective observational study analyzing utility of multimodal imaging in the triage of patients with AIS. Patients underwent baseline unenhanced CT, single-phase CT angiography of the head and neck, multiphase CT angiography, and perfusion CT. Multiphase CT angiography generates time-resolved images of pial arteries. Pial arterial filling was scored on a six-point ordinal scale, and interrater reliability was tested. Clinical outcomes included a 50% or greater decrease in National Institutes of Health Stroke Scale (NIHSS) over 24 hours and 90-day modified Rankin Scale (mRS) score of 0-2. The ability to predict clinical outcomes was compared between single-phase CT angiography, multiphase CT angiography, and perfusion CT by using receiver operating curve analysis, Akaike information criterion (AIC), and Bayesian information criterion (BIC). Results A total of 147 patients were included. Interrater reliability for multiphase CT angiography is excellent (n = 30, ? = 0.81, P < .001). At receiver operating characteristic curve analysis, the ability to predict clinical outcome is modest (C statistic = 0.56, 95% confidence interval [CI]: 0.52, 0.63 for ?50% decrease in NIHSS over 24 hours; C statistic = 0.6, 95% CI: 0.53, 0.68 for 90-day mRS score of 0-2) but better than that of models using single-phase CT angiography and perfusion CT (P < .05 overall). With AIC and BIC, models that use multiphase CT angiography are better than models that use single-phase CT angiography and perfusion CT for a decrease of 50% or more in NIHSS over 24 hours (AIC = 166, BIC = 171.7; values were lowest for multiphase CT angiography) and a 90-day mRS score of 0-2 (AIC = 132.1, BIC = 137.4; values were lowest for multiphase CT angiography). Conclusion Multiphase CT angiography is a reliable tool for imaging selection in patients with AIS. (©) RSNA, 2015 Online supplemental material is available for this article. PMID:25633505

Menon, Bijoy K; d'Esterre, Christopher D; Qazi, Emmad M; Almekhlafi, Mohammed; Hahn, Leszek; Demchuk, Andrew M; Goyal, Mayank

2015-05-01

369

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

PubMed Central

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

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

2014-01-01

370

Overcrowding in medium-volume emergency departments: effects of aged patients in emergency departments on wait times for non-emergent triage-level patients.  

PubMed

This study aims to examine patient wait times from triaging to physician assessment in the emergency department (ED) for non-emergent patients, and to see whether patient flow and process (triage) are impacted by aged patients. A retrospective study method was used to analyse 185 patients in three age groups. Key data recorded were triage level, wait time to physician assessment and ED census. Multiple linear regression analysis was used to determine the strength of association with increased wait time. A longer average wait time for all patients occurred when there was an increase in the number of patients aged > or = 65 years in the ED. Further analysis showed 12.1% of the variation extending ED wait time associated with the triage process was explained by the number of patients aged > or = 65 years. In addition, extended wait time, overcrowding and numbers of those who left without being seen were strongly associated (P < 0.05) with the number of aged patients in the ED. The effects of aged patients on ED structure and process have significant implications for nursing. Nursing process and practice sets clear responsibilities for nursing to ensure patient safety. However, the impact of factors associated with aged patients in ED, nursing's role and ED process can negatively impact performance expectations and requires further investigation. PMID:20618543

Knapman, Mary; Bonner, Ann

2010-06-01

371

A Randomized Controlled Trial Comparing Health and Quality of Life of Lung Transplant Recipients Following Nurse and Computer-Based Triage Utilizing Home Spirometry Monitoring  

PubMed Central

Abstract Background: Lung transplantation is now a standard intervention for patients with advanced lung disease. Home monitoring of pulmonary function and symptoms has been used to follow the progress of lung transplant recipients in an effort to improve care and clinical status. The study objective was to determine the relative performance of a computer-based Bayesian algorithm compared with a manual nurse decision process for triaging clinical intervention in lung transplant recipients participating in a home monitoring program. Materials and Methods: This randomized controlled trial had 65 lung transplant recipients assigned to either the Bayesian or nurse triage study arm. Subjects monitored and transmitted spirometry and respiratory symptoms daily to the data center using an electronic spirometer/diary device. Subjects completed the Short Form-36 (SF-36) survey at baseline and after 1 year. End points were change from baseline after 1 year in forced expiratory volume at 1?s (FEV1) and quality of life (SF-36 scales) within and between each study arm. Results: There were no statistically significant differences between groups in FEV1 or SF-36 scales at baseline or after 1 year.: Results were comparable between nurse and Bayesian system for detecting changes in spirometry and symptoms, providing support for using computer-based triage support systems as remote monitoring triage programs become more widely available. Conclusions: The feasibility of monitoring critical patient data with a computer-based decision system is especially important given the likely economic constraints on the growth in the nurse workforce capable of providing these early detection triage services. PMID:24083367

Lindgren, Bruce R.; Robiner, William; Lindquist, Ruth; Hertz, Marshall; Carlin, Bradley P.; VanWormer, Arin

2013-01-01

372

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

373

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

374

MP&C GLS 02 Cert. C 1 MetLife Auto and Home is a brand of Metropolitan Property and Casualty Insurance Company and its Affiliates, Warwick, RI  

E-print Network

Insurance Company and its Affiliates, Warwick, RI MetLife Auto & Home Metropolitan Property and CasualtyMP&C GLS 02 Cert. C 1 MetLife ® Auto and Home is a brand of Metropolitan Property and Casualty Insurance Company 700 Quaker Lane, Warwick, RI 02887 Legal Services Plan Certificate of Coverage We're Glad

Provancher, William

375

Triage of cervical cytological diagnoses of atypical squamous cells by DNA methylation of paired boxed gene 1 (PAX1).  

PubMed

Detection of cervical high-grade squamous intraepithelial lesions (HSIL) in patients with equivocal cytological abnormalities, such as atypical squamous cells (ASC) of undetermined significance (ASCUS) or inability to exclude high-grade squamous intraepithelial lesions (ASC-H) is still a challenge. This study tested the efficacy of PAX1 methylation analysis in the triage of cervical ASCUS and ASC-H and compared its performance with Hybrid Capture 2 (HC2) HPV test. A hospital-based case-control study was conducted. Cervical scrapings from patients with ASCUS or ASC-H were used for the quantitative methylation analysis of PAX1 methylation by MethyLight and HPV testing by HC2. Patients with ASC-H or ASCUS with repeated abnormal smears underwent colposcopic biopsy and subsequent therapies. Diagnoses were made by histopathology at a follow-up of 2 years. The efficacies of detecting high-grade lesions were compared. Fifty-eight cervical scrapings with cytological diagnosis of ASCUS (n = 41) and ASC-H (n = 17) were analyzed. One of the 41 (2.4%) ASCUS patients and seven of 17 (41.2%) ASC-H patients were confirmed to have HSIL. After dichotomy of the PMR, PAX1 methylation rates were significantly higher in ASC developing HSIL compared with those developing reactive atypia (87.5% vs. 12.5%, P < 0.001). Testing PAX1 methylation in cervical swabs of patients with ASC confers better sensitivity (87.5% vs. 62.5%) and specificity (98.0% vs. 86.0%) than HC2 HPV testing. We show for the first time that PAX1 hypermethylation analysis may be a better choice than HC2 in the triage of ASCUS and ASC-H. PMID:21710649

Chao, Tai-Kuang; Ke, Feng-Yi; Liao, Yu-Ping; Wang, Hui-Chen; Yu, Cheng-Ping; Lai, Hung-Cheng

2013-01-01

376

Methylphenidate intoxications in children and adults: exposure circumstances and evidence-based dose threshold for pre-hospital triage.  

PubMed

Abstract Context. Methylphenidate intoxications mostly have a relatively mild course, although serious complications can occur. Objective. We aimed to characterize methylphenidate exposures and reassess our current dose threshold for hospital referral (2 mg/kg). Methods. In a prospective follow-up study, we analysed 364 consecutive methylphenidate exposures that were reported to the Dutch Poisons Information Center. Patients and/or physicians were surveyed by telephone using standardized questionnaires. Three physicians independently scored the observed severity of the intoxication of each patient as 'no/mild' (observation at home) or 'moderate/severe' (hospital referral necessary). Results. Unintentional exposures (40%) mostly occurred at home involving the patients' own medication or those from a family member. Compared to unintentionally exposed patients, intentionally exposed patients were exposed to relatively high methylphenidate doses (3.1 vs 1.6 mg/kg), more often used immediate release methylphenidate formulations (62 vs 34%) and more frequently had concomitant exposures (71 vs 17%). Severe symptoms like convulsions or coma were reported only in patients with concomitant exposures. Following exposure to methylphenidate only (i.e. no concomitant exposures), the most commonly reported symptoms were dry mucosa, headache, agitation, sleepiness and tachycardia. Our results show that the reported methylphenidate dose is predictive of the observed severity of the intoxication and can therefore aid in pre-hospital triage. Conclusion. We increased our current dose threshold for hospital referral from 2 to 3 mg/kg. In addition, we will refer patients at lower doses when clinical symptoms indicate the need for hospital referral. Application of this new dose threshold optimizes triage, thereby reducing unnecessary hospital referral and thus costs, without jeopardising patient safety. PMID:25650984

Hondebrink, Laura; Rietjens, Saskia J; Hunault, Claudine C; Pereira, Rob R; Kelleci, Nuriye; Yasar, Gulhan; Ghebreslasie, Ariam; Lo-A-Foe, Cindy; De Vries, Irma; Meulenbelt, Jan

2015-03-01

377

A multidisciplinary approach to teach responses to weapons of mass destruction and terrorism using combined simulation modalities  

Microsoft Academic Search

Study objectiveTo reinforce concepts presented in the lectures; understand the complexity and speed of casualty and information generation during a Weapons of Mass Destruction and Terrorism (WMD\\/T) event; experience the novelty of combined weapons' effects; recognize the time course of the various chemical, biological, and radiation agents; and make challenging decisions with incomplete and conflicting information.

Richard R Kyle; Darin K Via; R. Joel Lowy; James M Madsen; Aileen M Marty; Paul D Mongan

2004-01-01

378

State propaganda and mental disorders: the issue of psychiatric casualties among Japanese soldiers during the Asia-Pacific War.  

PubMed

This article explores the politics of Japanese wartime medical policy, demonstrating how state propaganda about the people and their armed forces influenced authoritative views on health and what might endanger it. By focusing on the obstacles faced by psychiatrists trying to promote more official concern for mental health issues, it challenges the validity of figures indicating a low incidence of psychological trauma among the country's soldiers. Civilian psychiatrists had to contend with the threat of censorship and arrest for even discussing war-induced mental disorders; at the same time, army psychiatrists as military insiders were pressured to convince their patients that their conditions were not serious and did not merit compensation. While discussing the neglected topic of Japanese psychiatric casualties, an attempt is made to provide a comparative approach by referring to the state of military psychiatry in other national settings. PMID:15591696

Matsumura, Janice

2004-01-01

379

The evolution of casualty evacuation in the British Army in the 20th century (Part 2)--1918 to 1945.  

PubMed

This is the second in a series of papers that examine the evolution of the military casualty evacuation chain during the 20th century. The Spanish Civil War demonstrated to the world the revolutionary tactic of 'Blitzkrieg' developed by the Germans. This and the experience of the British Expeditionary Force in 1940 emphasised the need for mobility in forward medical units. The campaign in the Western Desert led to the creation of a number of new units such as the Field Surgical Unit and the Field Transfusion Unit which were introduced across the British Army as a result of the findings of the Hartgill Committee. The aeroplane transformed the evacuation chain from CCSs to base hospitals and beyond. PMID:12469437

Bricknell, M C M

2002-09-01

380

Cervical cancer screening in sub-Saharan Africa: A randomized trial of VIA versus cytology for triage of HPV-positive women.  

PubMed

Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV-positive women. The aim of the study is to compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV-positive women to detect cervical intraepithelial neoplasia or Grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self-HPV testing. HPV-positive women (n = 259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV-positive women had both cervical biopsy and endocervical curettage to detect biopsy-confirmed CIN2+. All statistical tests were two-sided. The prevalence of HPV was 38.5%, and the mean age of HPV-positive women was 41.5 ± 10.1 years. One hundred ninety-eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1-59.1%), and the sensitivity of cytology was 90.0% (59.6-98.2%). The specificity was 74.2% (95% CI, 64.2-82.1%) for VIA and 85.2% (76.3-91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV-positive women. Further investigations are needed to determine the optimal triage method for HPV-positive women. PMID:25420434

Bigoni, Jérôme; Gundar, Mélissa; Tebeu, Pierre-Marie; Bongoe, Adamo; Schäfer, Sonja; Fokom-Domgue, Joël; Catarino, Rosa; Tincho, Evelyne Foguem; Bougel, Stéphanie; Vassilakos, Pierre; Petignat, Patrick

2015-07-01

381

Sensitivity, Specificity, and Clinical Value of Human Papillomavirus (HPV) E6/E7 mRNA Assay as a Triage Test for Cervical Cytology and HPV DNA Test ?  

PubMed Central

There is evidence that testing for human papillomavirus (HPV) E6/E7 mRNA is more specific than testing for HPV DNA. A retrospective study was carried out to evaluate the performance of the PreTect HPV-Proofer E6/E7 mRNA assay (Norchip) as a triage test for cytology and HPV DNA testing. This study analyzed 1,201 women, 688 of whom had a colposcopy follow-up and 195 of whom had histology-confirmed high-grade intraepithelial neoplasia or worse (CIN2+). The proportion of positive results and the sensitivity and specificity for CIN2+ were determined for HPV mRNA in comparison to HPV DNA and cytology. All data were adjusted for follow-up completeness. Stratified by cytological grades, the HPV mRNA sensitivity was 83% (95% confidence interval [CI] = 63 to 94%) in ASC-US (atypical squamous cells of undetermined significance), 62% (95% CI = 47 to 75%) in L-SIL (low-grade squamous intraepithelial lesion), and 67% (95% CI = 57 to 76%) in H-SIL (high-grade squamous intraepithelial lesion). The corresponding figures were 99, 91, and 96%, respectively, for HPV DNA. The specificities were 82, 76, and 45%, respectively, for HPV mRNA and 29, 13, and 4%, respectively, for HPV DNA. Used as a triage test for ASC-US and L-SIL, mRNA reduced colposcopies by 79% (95% CI = 74 to 83%) and 69% (95% CI = 65 to 74%), respectively, while HPV DNA reduced colposcopies by 38% (95% CI = 32 to 44%) and by 15% (95% CI = 12 to 19%), respectively. As a HPV DNA positivity triage test, mRNA reduced colposcopies by 63% (95% CI = 60 to 66%), having 68% sensitivity (95% CI = 61 to 75%), whereas cytology at the ASC-US+ threshold reduced colposcopies by 23% (95% CI = 20 to 26%), showing 92% sensitivity (95% CI = 87 to 95%). In conclusion, PreTect HPV-Proofer mRNA can serve as a better triage test than HPV DNA to reduce colposcopy referral in both ASC-US and L-SIL. It is also more efficient than cytology for the triage of HPV DNA-positive women. Nevertheless, its low sensitivity demands a strict follow-up of HPV DNA positive-mRNA negative cases. PMID:21525231

Benevolo, Maria; Vocaturo, Amina; Caraceni, Donatella; French, Deborah; Rosini, Sandra; Zappacosta, Roberta; Terrenato, Irene; Ciccocioppo, Lucia; Frega, Antonio; Rossi, Paolo Giorgi

2011-01-01

382

Evaluation and optimization of compound solubilization and delivery methods in a two-tiered ion channel lead optimization triage.  

PubMed

Low-volume dispensing of neat dimethyl sulfoxide (DMSO) into plate-based assays conserves compound, assay reagents, and intermediate dilution plate cost and, as we demonstrate here, significantly improves structure-activity relationship resolution. Acoustic dispensing of DMSO solutions into standard volume 384W plates yielded inconsistent results in studies with 2 cell lines because of apparent effects on the integrity of the cell monolayer (increased intracellular Ca?? levels as indicated by elevated basal dye fluorescence after acoustic transfer). PocketTip-mediated transfer was successful at increasing apparent potency on a more consistent basis. Notably, the correlation coefficient among fluorescence imaging plate reader (FLIPR):electrophysiology (EP) across a representative ~125 compound collection was increased ~5× via conversion to a PocketTip direct dispensation, indicating a triage assay more predictive of activity in the decisional patch-clamp assay. Very importantly, the EP-benchmarked false-negative rate as measured by compounds with FLIPR EC?? more than the highest concentration tested fell from >11% to 5% assay-wide, and the relative FLIPR:EP rank-order fidelity increased from 55% to 78%. Elimination of the aqueous intermediate step provided additional benefits, including reduced assay cost, decreased cycle time, and reduced wet compound consumption rate. Direct DMSO dispensing has broad applicability to cell-based functional assays of multiple varieties, especially in cases where limit solubility in assay buffer is a recognized impediment to maximizing interassay connectivity. PMID:22085018

Hendricson, Adam W; Gallagher, Liz; Matchett, Michele; Ferrante, Meredith; Spence, Steve; Paiva, Tony; Shou, Wilson; Tertyshnikova, Svetlana; Krambis, Mike; Post-Munson, Deborah; Zhang, Litao; Knox, Ron

2012-04-01

383

High-content phenotypic screening and triaging strategy to identify small molecules driving oligodendrocyte progenitor cell differentiation.  

PubMed

Multiple Sclerosis is a demyelinating disease of the CNS and the primary cause of neurological disability in young adults. Loss of myelinating oligodendrocytes leads to neuronal dysfunction and death and is an important contributing factor to this disease. Endogenous oligodendrocyte precursor cells (OPCs), which on differentiation are responsible for replacing myelin, are present in the adult CNS. As such, therapeutic agents that can stimulate OPCs to differentiate and remyelinate demyelinated axons under pathologic conditions may improve neuronal function and clinical outcome. We describe the details of an automated, cell-based, morphometric-based, high-content screen that is used to identify small molecules eliciting the differentiation of OPCs after 3 days. Primary screening was performed using rat CG-4 cells maintained in culture conditions that normally support a progenitor cell-like state. From a library of 73,000 diverse small molecules within the Sanofi collection, 342 compounds were identified that increased OPC morphological complexity as an indicator of oligodendrocyte maturation. Subsequent to the primary high-content screen, a suite of cellular assays was established that identified 22 nontoxic compounds that selectively stimulated primary rat OPCs but not C2C12 muscle cell differentiation. This rigorous triaging yielded several chemical series for further expansion and bio- or cheminformatics studies, and their compelling biological activity merits further investigation. PMID:25394729

Peppard, Jane V; Rugg, Catherine A; Smicker, Matthew A; Powers, Elaine; Harnish, Erica; Prisco, Joy; Cirovic, Dragan; Wright, Paul S; August, Paul R; Chandross, Karen J

2015-03-01

384

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

385

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

386

C-reactive protein and serum amyloid A as early-phase and prognostic indicators of acute radiation exposure in nonhuman primate total-body irradiation model  

Microsoft Academic Search

Terrorist radiological attacks or nuclear accidents could expose large numbers of people to ionizing radiation. In mass-casualty radiological incidents early medical-management requires triage tools for first-responders to quantitatively identify individuals exposed to life-threatening radiation doses and for early initiation (i.e., within one day after radiation exposure) of cytokine therapy for treatment of bone marrow acute radiation syndrome.Herein, we present results

N. I. Ossetrova; D. J. Sandgren; W. F. Blakely

2011-01-01

387

Verification of exposure to sulfur mustard in two casualties of the Iran-Iraq conflict.  

PubMed

The exposure of two Iranian victims of the Iran-Iraq conflict (1980-1988) to sulfur mustard was established by immunochemical and mass spectrometric analysis of blood samples taken 22 and 26 days after alleged exposure. One victim suffered from skin injuries compatible with sulfur mustard intoxication but did not have lung injuries; the symptoms of the other victim were only vaguely compatible with sulfur mustard intoxication. Both patients recovered. Immunochemical analysis was based on detection of the N7-guanine adduct of the agent in DNA from lymphocytes and granulocytes, whereas the N-terminal valine adduct in globin was determined by gas chromatography-mass spectrometry after a modified Edman degradation. The valine adduct levels correspond with those found in human blood after in vitro treatment with 0.9 microM sulfur mustard. PMID:9248939

Benschop, H P; van der Schans, G P; Noort, D; Fidder, A; Mars-Groenendijk, R H; de Jong, L P

1997-01-01

388

Road Casualties and Changes in Risky Driving Behavior in France Between 2001 and 2004 Among Participants in the GAZEL Cohort  

PubMed Central

Objectives. We investigated behavioral changes in a large cohort of drivers to identify underlying causes of the decline in road casualties in France. Methods. In 2001 and 2004, 11 240 participants used self-administered questionnaires to report attitudes toward road safety and driving behaviors. Injury road traffic collisions were recorded from 2001 to 2005 through the cohort's annual questionnaire. Results. Between 2001 and 2004, speeding and cell phone use decreased concomitantly with a decrease in injury road traffic collision rates among participants. Reported driving while sleepy remained unchanged and driving while alcohol intoxicated was reported by a higher proportion in 2004 than in 2001. Decreases in speeding between 2001 and 2004 were strongly linked with positive attitudes toward road safety in 2001. Conclusions. In this cohort, speeding and using a cell phone while driving decreased over the 2001 to 2004 period concomitantly with increases in traffic law enforcement and a dramatic decline in road mortality in France. However, the deterrent effect of traffic enforcement policies may have been reduced by negative attitudes toward traffic safety and having had a history of traffic penalty cancellations. PMID:18923124

Salmi, Louis Rachid; Lafont, Sylviane; Chiron, Mireille; Lagarde, Emmanuel

2009-01-01

389

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

PubMed

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

Wang, Zhen-Ming

2014-01-01

390

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

PubMed

In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ?30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p?

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

2015-06-15

391

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

392

Disaster medicine through Google Glass.  

PubMed

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

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

2014-11-27

393

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

SciTech Connect

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

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

2011-09-16

394

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

USGS Publications Warehouse

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

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

2004-01-01

395

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

NASA Astrophysics Data System (ADS)

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

Webster, Jody M.; Clague, David A.; Riker-Coleman, Kristin; Gallup, Christina; Braga, Juan C.; Potts, Donald; Moore, James G.; Winterer, Edward L.; Paull, Charles K.

2004-03-01

396

Increasing volume of patients at level I trauma centres: Is there a need for triage modification in elderly patients with injuries of low severity?  

PubMed Central

Introduction Since the introduction of a regionalized trauma system in Quebec in 1993, patient loads at level I trauma centres have been increasing gradually. We aimed to investigate the type of patient presenting to 4 tertiary trauma centres in Quebec, the nature of their injuries and whether there was a need to modify triage protocols. Methods The study consisted of a review of major trauma patients entered into a regional trauma registry between Apr. 7, 1993, and Mar. 31, 2000. A total of 29 669 patients fulfilled the eligibility criteria. We compared patient demographics, injury type and severity and mechanism of injury. Results During the 7 years of the study, there was an increase in the volume and presentation of patients injured in falls (p < 0.01), patients with extremity injuries (p < 0.01), single injuries (p < 0.01) and injuries to single body regions (p < 0.01). Young patients were mostly injured in motor vehicle collisions and had multiple injuries of high severity whereas elderly patients were mostly injured in falls and experienced isolated extremity injuries of low severity. Conclusions The proportion of elderly patients injured in falls, experiencing isolated extremity injuries of low severity and being treated at tertiary trauma centres in Quebec is overwhelmingly high. Revision of pre-hospital triage protocols should be considered and studied in order to transport trauma patients to appropriate facilities. PMID:14680352

Liberman, Moishe; Mulder, David S.; Sampalis, John S.

2003-01-01

397

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

398

Casualty Assistance: An Overview  

MedlinePLUS

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399

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

400

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

401

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan.  

PubMed

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation. PMID:25764152

Tilkeridis, Konstantinos; Chari, Basavraj; Cheema, Nusrat; Tryfonidis, Marios; Khaleel, Arshad

2015-04-01

402

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

PubMed Central

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

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

2014-01-01

403

Triaging HPV-positive women with normal cytology by p16/Ki-67 dual-stained cytology testing: Baseline and longitudinal data.  

PubMed

Primary human papillomavirus (HPV)-based screening results in a 2-5% lower specificity for cervical intraepithelial neoplasia Grade 2 or worse (CIN2+) compared to Pap cytology. To identify HPV-positive women with CIN2+, we retrospectively evaluated the cross-sectional and longitudinal performance of p16/Ki-67 dual-stained cytology in HPV-positive women with normal cytology participating in population-based cervical screening. Conventional Pap cytology specimens of 847 of these women derived from the VUSA-Screen study were dual-stained for p16/Ki-67. Cross-sectional clinical performance in detecting CIN3 or worse (CIN3+), and CIN2+ was compared to that of baseline HPV genotyping. Moreover, 5-year cumulative incidence risks (CIR) for CIN3+ (CIN2+) were determined. The sensitivity of p16/Ki-67 dual-stained cytology for CIN3+ (CIN2+) was 73.3% (68.8%) with a specificity of 70.0% (72.8%). HPV16/18 genotyping showed a sensitivity for CIN3+ (CIN2+) of 46.7% (43.8%), with a specificity of 78.3% (79.4%). The 5-year CIR for CIN3+ in HPV-positive women with normal cytology was 6.9%. Testing these women with p16/Ki-67 dual-stained cytology resulted in a significantly lower CIN3+ 5-year CIR of 3.3% (p?=?0.017) in case of a negative test result. A negative HPV16/18 genotyping test result also led to a lower 5-year CIN3+ CIR of 3.6%. p16/Ki-67 dual-stained cytology detects more than 70% of underlying CIN3+ lesions in HPV-positive women with normal cytology at baseline and is therefore suitable for triaging these women to colposcopy. Furthermore, the CIN3+ 5-year CIR of 3.3% after a negative dual-stain result is significantly lower compared to the 5-year CIR of 6.9% in women without p16/Ki-67 dual-stained cytology triage. PMID:25345358

Uijterwaal, Margot H; Polman, Nicole J; Witte, Birgit I; van Kemenade, Folkert J; Rijkaart, Dorien; Berkhof, Johannes; Balfoort-van der Meij, G A M A; Ridder, Ruediger; Snijders, Peter J F; Meijer, Chris J L M

2015-05-15

404

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

405

[In-hospital management of victims of chemical weapons of mass destruction].  

PubMed

Emergency situations caused by chemical weapons of mass destruction add a new dimension of risk to those handling and treating casualties. The fundamental difference between a hazardous materials incident and conventional emergencies is the potential for risk from contamination to health care professionals, patients, equipment and facilities of the Emergency Department. Accurate and specific guidance is needed to describe the procedures to be followed by emergency medical personnel to safely care for a patient, as well as to protect equipment and people. This review is designed to familiarize readers with the concepts, terminology and key operational considerations that affect the in-hospital management of incidents by chemical weapons. PMID:16037657

Barelli, Alessandro; Gargano, Flavio; Proietti, Rodolfo

2005-01-01

406

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

407

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

PubMed Central

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

Cardona-Morrell, Magnolia; Hillman, Ken

2015-01-01

408

C-reactive protein and white blood cell count as triage test between urgent and nonurgent conditions in 2961 patients with acute abdominal pain.  

PubMed

The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging.Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. Parameters of diagnostic accuracy were calculated for clinically applicable cutoff values of CRP levels and WBC count, and for combinations.A total of 2961 patients were included of which 1352 patients (45.6%) had an urgent final diagnosis. The median WBC count and CRP levels were significantly higher in the urgent group than in the nonurgent group (12.8?×10/L; interquartile range [IQR] 9.9-16) versus (9.3?×10/L; IQR 7.2-12.1) and (46?mg/L; IQR 12-100 versus 10?mg/L; IQR 7-26) (P?50?mg/L and WBC count >15?×10/L were combined; however, 85.3% of urgent cases was missed.A high CRP level (>50?mg/L) combined with a high WBC count (>15?×10/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48?hours). PMID:25738473

Gans, Sarah L; Atema, Jasper J; Stoker, Jaap; Toorenvliet, Boudewijn R; Laurell, Helena; Boermeester, Marja A

2015-03-01

409

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

410

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

411

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

412

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

413

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

414

Evaluations over the medical emergency responding to chemical terrorist attack.  

PubMed

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond to it in terms of medical management. It is very important to provide the best lifesaving medical care and triage in a chemical-contaminated area. Mass casualties exposed to chemical agents require immediate medical intervention to save their lives and should be classified in accordance to medical care priorities and available medical sources, including antidotes and sophisticated health facilities. Establishing the decontamination area for chemical casualties where it is located at the suitable place with respect to the wind direction is necessary. To overcome the mass destruction effects of chemical warfare agents following the terrorist attack, we must have the emergency medical response plan involving experienced triage officers and medical care providers to be able to perform medical management in the chemical-contaminated area and health facilities. PMID:12943031

Karayilano?lu, Turan; Kenar, Levent; Gulec, Mahir

2003-08-01

415

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

416

Grief Casualties on Skid Row.  

ERIC Educational Resources Information Center

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

Hughes, Cornelius; Fleming, Dagmar

1991-01-01

417

California Casualty First Aid America  

E-print Network

To You Kettle Masters KeVita Probiotic Drinks Mix1 All Natural Protein Shakes Panera Bread, Newport Beach Specialty's Café & Bakery UCI Hospitality and Dining & UCI Subway UCI Weight Management Program Whole Foods for Integrative Medicine UCIMC Admissions Department UCIMC Cardiovascular Center UCIMC Chao Family Comprehensive

Rose, Michael R.

418

Triage of HR-HPV Positive Women with Minor Cytological Abnormalities: A Comparison of mRNA Testing, HPV DNA Testing, and Repeat Cytology Using a 4-Year Follow-Up of a Population-Based Study  

PubMed Central

Objective Expression of the viral E6/E7 oncogenes of high-risk human papillomaviruses (HR-HPV) is necessary for malignant conversion and maintenance in cervical tissue. In order to determine whether HR-HPV E6/E7 mRNA testing more effectively predicts precancerous lesions and invasive cervical cancer than HR-HPV DNA testing, we aimed to compare triage using HR-HPV E6/E7 mRNA testing by APTIMA HPV Assay (APTIMA) to HPV16 DNA testing, HPV16/18 DNA testing, and repeat cytology. Methods Liquid-based (PreservCyt) cell samples were obtained from HR-HPV-positive women diagnosed with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) within the framework of the population-based cervical cancer screening program in Stockholm, Sweden. Samples were tested for HR-HPV E6/E7 mRNA by APTIMA (Gene-Probe Inc., San Diego, CA, USA). Women were followed up for 4 years after the index cytology via medical and laboratory records, and the Stockholm Oncology Center. Results Nine of 25 (36%) women in the ASCUS group, and 64 of 180 (36%) women in the LSIL group developed cervical intraepithelial neoplasia (CIN) grade 2 or worse during 4 years of follow-up. 162 (74%) women were APTIMA-positive, and APTIMA had the highest sensitivity to predict CIN2 or worse and CIN3 or worse in the ASCUS (77.8% and 100%) and LSIL (78.1 and 75.8%) groups, although specificity was insufficient (<50%). HPV16 DNA testing and repeat cytology were more specific than APTIMA. Conclusion The results of this population-based study with comprehensive follow-up support the use of APTIMA as a triage test for women with ASCUS. More focused investigation is required for women with LSIL. PMID:24587193

Persson, Maria; Elfström, K. Miriam; Brismar Wendel, Sophia; Weiderpass, Elisabete; Andersson, Sonia

2014-01-01

419

Negative mass  

NASA Astrophysics Data System (ADS)

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

Hammond, Richard T.

2015-03-01

420

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

421

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

422

Abdominal mass  

MedlinePLUS

Mass in the abdomen ... the doctor make a diagnosis. For example, the abdomen is usually divided into four areas: Right-upper ... pain or masses include: Epigastric -- center of the abdomen just below the rib cage Periumbilical -- area around ...

423

Mass Sensor  

Microsoft Academic Search

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

2001-01-01

424

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

425

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

426

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

PubMed

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

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

2013-09-01

427

Mass spectrometry  

Microsoft Academic Search

A review of mass spectrometry in organic chemistry is given, dealing with advances in instrumentation and computer techniques, selected topics in gas-phase ion chemistry, and applications in such fields as biomedicine, natural-product studies, and environmental pollution analysis. Innovative techniques and instrumentation are discussed, along with chromatographic-mass spectrometric on-line computer techniques, mass spectral interpretation and management techniques, and such topics in

A. L. Burlingame; Cedric H. L. Shackleton; Ian. Howe; O. S. Chizhov

1978-01-01

428

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.

Pamela Gore

1998-11-28

429

Mass extinctions  

Microsoft Academic Search

This paper discusses methane driven oceanic eruptions and other possible causes for mass extinction during the end-Permian era and the Triassic-Jurassic boundary. During the earth's vast history, devastating events have caused colossal destruction to terrestrial and oceanic life. There are numerous scientific explanations for mass extinctions including volcanic eruption, methane eruption, and asteroid impact. Greenhouse models and volcanic eruption cycles,

Simon Conway Morris; Janice Ma; John O'Donohue

2005-01-01

430

Response of Thai hospitals to the tsunami disaster.  

PubMed

The disaster caused by the tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters. The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients. Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims. Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed. Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system. PMID:16602271

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

2006-01-01

431

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.

WGBH Educational Foundation

2009-11-02

432

Scrotal masses  

MedlinePLUS

... the scrotum Hydrocele -- fluid collection in the scrotum Spermatocele -- a cyst-like growth in the scrotum that ... from the scrotal mass. A hematocele, hydrocele, or spermatocele may sometimes need surgery to remove the collection ...

433

Mass action  

NSDL National Science Digital Library

In the first part of this video, we derive the law of mass action from one example of a picture of molecular collisions. For this course, we use the "law of mass action" to refer to an idea that chemical reaction kinetic rates can be expressed using products of the abundances of reactants raised to exponents. Studying cooperativity and Hill functions in the second part of the video allows us to investigate a simple example of bistability in the third video segment.

2013-06-21

434

Masses & Springs  

NSDL National Science Digital Library

In this online activity, learners use a realistic mass and spring laboratory. They hang masses from springs and adjust the spring stiffness and damping. Learners can even slow time and transport the lab to different planets! A chart shows the kinetic, potential, and thermal energy for each spring. Use this activity for a lesson on Hooke's Law and Conservation of Energy. This activity includes an online simulation, sample learning goals, a teacher's guide, and translations in over 30 languages.

Michael Dubson

2011-01-01

435

Mass Wasting  

NSDL National Science Digital Library

First, Professor Stephen Nelson at Tulane University provides a straightforward description of mass wasting and recent disasters around the world (1). Visitors can find helpful illustrations of slumps and rock slides as well as a chart depicting the different processes that occur with varying velocities and water content. The second website, provided by Pamela Gore at Georgia Perimeter College, presents the factors involved with mass wasting and mass wasting processes (2). Visitors can find excellent real-life images of creep, rock slides, and talus slopes. Next, North Dakota State University illustrates creep, earthflow, slope failure, and slumps (3). The website furnishes images of mass wasting processes and explains the physical characteristics of the landscape. Fourth, the California State University at Long Beach discusses the causes, prevention, and types of mass wasting (4). Visitors can learn about the mass wasting disasters that occurred at La Conchita, Portuguese Bend, Mount Huascaran, Cable Canyon, and Vaiont Dam. Next, Professor Pidwirny at Okanagan University College offers an online text describing hillslope stability and mass movement (5). Students can learn about soil creep through a simple animation. The sixth website, developed by Natural Resources Canada, furnishes an interactive map of landslides in Canada (6). Users can select to view historic landslides, bedrock geology, surficial geology, and more. Next, the USGS offers information on the National Landslides Hazards Program, the National Landslide Information Center, and recent landslide events (7). Users can find a tutorial on landslides, real-time monitoring active of landslides, and related research projects. Lastly, at the Oswego State University of New York visitors can test their knowledge of mass wasting processes through a short quiz (8).

436

Suitability of emergency department attenders to be assessed in primary care: survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project  

PubMed Central

Objectives To assess the proportion of emergency department (ED) attendances that would be suitable for primary care and the inter-rater reliability of general practitioner (GP) assessment of primary care suitability. Design of study Survey of GPs’ agreement of suitability for primary care on a random anonymised sample of all ED patients attending over a 1-month period. Setting ED of a UK Hospital serving a population of 600?000. Method Four GPs independently used data extracted from clinical notes to rate the appropriateness for management in primary care as well as need for investigations, specialist review or admission. Agreement was assessed using Cohen's ?. Results The mean percentage of patients that GPs considered suitable for primary care management was 43% (range 38–47%).