Science.gov

Sample records for mass casualty triage

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

    PubMed Central

    Ramesh, Aruna C.; Kumar, S.

    2010-01-01

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

  2. Implementing RFID technology in a novel triage system during a simulated mass casualty situation.

    PubMed

    Jokela, Jorma; Simons, Tomi; Kuronen, Pentti; Tammela, Juha; Jalasvirta, Pertti; Nurmi, Jouni; Harkke, Ville; Castrén, Maaret

    2008-01-01

    The purpose of this study is to determine the applicability of Radio Frequency Identification (RFID) technology and commercial cellular networks to provide an online triage system for handling mass casualty situations. This was tested by a using a pilot system for a simulated mass casualty situation during a military field exercise. The system proved to be usable. Compared to the currently used system, it also dramatically improves the general view of mass casualty situations and enhances medical emergency readiness in a military medical setting. The system can also be adapted without any difficulties by the civilian sector for the management of mass casualty disasters. PMID:18583298

  3. Primary triage of mass burn casualties with associated severe traumatic injuries

    PubMed Central

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

    2013-01-01

    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

  4. Triage during mass gatherings.

    PubMed

    Turris, Sheila A; Lund, Adam

    2012-12-01

    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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

    Yu, Xunyi; Ganz, Aura

    2011-01-01

    In this paper we introduce a Mixed Reality Triage and Evacuation game, MiRTE, that is used in the development, testing and training of Mass Casualty Incident (MCI) information systems for first responders. Using the Source game engine from Valve software, MiRTE creates immersive virtual environments to simulate various incident scenarios, and enables interactions between multiple players/first responders. What distinguishes it from a pure computer simulation game is that it can interface with external mass casualty incident management systems, such as DIORAMA. The game will enable system developers to specify technical requirements of underlying technology, and test different alternatives of design. After the information system hardware and software are completed, the game can simulate various algorithms such as localization technologies, and interface with an actual user interface on PCs and Smartphones. We implemented and tested the game with the DIORAMA system. PMID:22256245

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

    PubMed

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

    2014-01-01

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

  8. Single-Breath-Count Test: an important adjunct in the triaging of patients in a mass-casualty incident due to botulism.

    PubMed

    Rega, Paul P; Bork, Christopher E; Burkholder-Allen, Kelly; Bisesi, Michael S; Gold, Jeffrey P

    2010-01-01

    Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process. PMID:20586014

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

    PubMed

    Burkle, Frederick M

    2002-05-01

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

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

    PubMed

    Baker, Michael S

    2007-03-01

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

  11. A Triage Model for Chemical Warfare Casualties

    PubMed Central

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

    2015-01-01

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

  12. Game-based mass casualty burn training.

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2009-01-01

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

  14. Preparation for mass casualty incidents.

    PubMed

    VandenBerg, Sheri L; Davidson, Scott B

    2015-06-01

    Mass casualty incidents are events where the number of injured patients exceeds the resources of the health care institution to the degree that care may not be available or may be limited for a portion of the casualties. Mass casualty incidents are increasing in frequency throughout the United States. Managing mass casualty incidents has not traditionally been part of the nursing curriculum; however, our changing world requires us to become educated and prepared to respond to these scenarios. This article focuses on intentional explosive disasters and the nursing and institutional response to these incidents. This information is of value to nursing professionals and other health care providers. PMID:25981720

  15. Scalable patients tracking framework for mass casualty incidents.

    PubMed

    Yu, Xunyi; Ganz, Aura

    2011-01-01

    We introduce a system that tracks patients in a Mass Casualty Incident (MCI) using active RFID triage tags and mobile anchor points (DM-tracks) carried by the paramedics. The system does not involve any fixed deployment of the localization devices while maintaining a low cost triage tag. The localization accuracy is comparable to GPS systems without incurring the cost of providing a GPS based device to every patient in the disaster scene. PMID:22254446

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

    PubMed Central

    2014-01-01

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

  17. Ultrasound applications in mass casualties and extreme environments.

    PubMed

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

    2007-05-01

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

  18. Telemedical support of prehospital emergency care in mass casualty incidents.

    PubMed

    Plischke, M; Wolf, K H; Lison, T; Pretschner, D P

    1999-09-01

    In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation. PMID:10477508

  19. Managing mass casualties and decontamination.

    PubMed

    Chilcott, Robert P

    2014-11-01

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

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

    SciTech Connect

    Selden, B.S.

    1989-08-01

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

  1. Mass casualty incidents - time to engage.

    PubMed

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

    2016-01-01

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

  2. Mass casualties in the Oklahoma City bombing.

    PubMed

    Teague, David C

    2004-05-01

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

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

    PubMed

    Fry, Emory A; Lenert, Leslie A

    2005-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

    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

    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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

    2010-06-01

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

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

    PubMed

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

    2014-01-01

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

  9. Psychosocial Response to Mass Casualty Terrorism: Guidelines for Physicians

    PubMed Central

    Fetter, Jeffrey C.

    2005-01-01

    Background: All physicians would need to address the psychosocial consequences of a mass casualty terrorist attack should it occur. Method: A review of evidence and expert opinion regarding psychosocial response to mass casualty incidents was performed. Data were obtained via the PubMed database in an English-language search using the terms PTSD secondary prevention, psychological first aid, and disaster psychiatry and the dates 1995 through 2004. Results: There is a National Institute of Mental Health consensus statement on the psychiatric response to mass violence, but sparse psychopharmacologic literature. Psychotherapeutic interventions are well studied in posttraumatic settings. Conclusions: The physician's response to mass casualty terrorism must address the high volume of patients with anxiety reactions and somatic symptoms likely to present for care. Supportive interventions include fostering a sense of safety and efficacy, connecting patients with communities and services, and helping parents talk about the trauma with their children. In the future, early pharmacologic interventions may be proven effective. PMID:15841195

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

    PubMed Central

    Egan, Joseph R.; Amlôt, Richard

    2012-01-01

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

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

    PubMed Central

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

    2010-01-01

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

  12. Planning for a Mass Casualty Incident in Arkansas Schools

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    PubMed Central

    Fry, Emory A.; Lenert, Leslie A.

    2005-01-01

    Most medical facilities practice managing the large numbers of seriously injured patients expected during catastrophic events. As the demands on the healthcare team increase, however, the challenges faced by managers escalate, workflow bottlenecks develop and system capacity decreases. This paper describes MASCAL, an integrated softwarehardware 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 Navys 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

  14. Evacuation Priorities in Mass Casualty Terror-Related Events

    PubMed Central

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

    2004-01-01

    Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.200031.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 1520 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

  15. Allocation of scarce resources during mass casualty events.

    PubMed Central

    Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Waxman, Daniel A; Pillemer, Francesca; Carey, Christine; Moore, Melinda; Karir, Veena; Johnson, Tiffani J; Iyer, Neema; Hu, Jianhui; Shanman, Roberta; Larkin, Jody Wozar; Timmer, Martha; Motala, Aneesa; Perry, Tanja R; Newberry, Sydne; Kellermann, Arthur L

    2012-01-01

    OBJECTIVES This systematic review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs). Specifically, the review addresses the following questions: (1) What strategies are available to policymakers to optimize the allocation of scarce resources during MCEs? (2) What strategies are available to providers to optimize the allocation of scarce resources during MCEs? (3) What are the public's key perceptions and concerns regarding the implementation of strategies to allocate scarce resources during MCEs? (4) What methods are available to engage providers in discussions regarding the development and implementation of strategies to allocate scarce resources during MCEs? DATA SOURCES We searched Medline, Scopus, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science®, and the Cochrane Database of Systematic Reviews from 1990 through 2011. To identify relevant non-peer-reviewed reports, we searched the New York Academy of Medicine's Grey Literature Report. We also reviewed relevant State and Federal plans, peer-reviewed reports and papers by nongovernmental organizations, and consensus statements published by professional societies. We included both English- and foreign-language studies. REVIEW METHODS Our review included studies that evaluated tested strategies in real-world MCEs as well as strategies tested in drills, exercises, or computer simulations, all of which included a comparison group. We reviewed separately studies that lacked a comparison group but nonetheless evaluated promising strategies. We also identified consensus recommendations developed by professional societies or government panels. We reviewed existing State plans to examine the current state of planning for scarce resource allocation during MCEs. Two investigators independently reviewed each article, abstracted data, and assessed study quality. RESULTS We considered 5,716 reports for this comparative effectiveness review (CER); we ultimately included 170 in the review. Twenty-seven studies focus on strategies for policymakers. Among this group were studies that examined various ways to distribute biological countermeasures more efficiently during a bioterror attack or influenza pandemic. They provided modest evidence that the way these systems are organized influences the speed of distribution. The review includes 119 studies that address strategies for providers. A number of these studies provided evidence suggesting that commonly used triage systems do not perform consistently in actual MCEs. The number of high-quality studies addressing other specific strategies was insufficient to support firm conclusions about their effectiveness. Only 10 studies included strategies that consider the public's perspective. However, these studies were consistent in their findings. In particular, the public believes that resource allocation guidelines should be simple and consistent across health care facilities but should allow facilities some flexibility to make allocation decisions based on the specific demand and supply situation. The public also believes that a successful allocation system should balance the goals of ensuring the functioning of society, saving the greatest number of people, protecting the most vulnerable people, reducing deaths and hospitalizations, and treating people fairly and equitably. The remaining 14 studies provided strategies for engaging providers in discussions about allocating and managing scarce medical resources. These studies did not identify one engagement approach as clearly superior; however, they consistently noted the importance of a broad, inclusive, and systematic engagement process. CONCLUSIONS Scientific research to identify the most effective adaptive strategies to implement during MCEs is an emerging area. While it remains unclear which of the many options available to policymakers and providers will be most effective, ongoing efforts to develop a focused, well-organized program of applied research should help to identify the optimal methods, techniques, and technologies to strengthen our nation's capacity to respond to MCEs. PMID:24422904

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

    PubMed

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

    2005-03-01

    The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent bums and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event; having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support personnel were instantaneously to hand. Our mass casualty preparation proved useful in managing this event. Most of the patients who survived showed signs of post-traumatic stress syndrome, which was diagnosed and treated by the burn center psychology team. Despite our efforts at treating large burns (>80%) with steam inhalation, mortality was 100 per cent. Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events. PMID:15869134

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

    PubMed

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

    2015-12-01

    In 2014, CDC published updated guidelines for the prevention and treatment of anthrax (Hendricks KA, Wright ME, Shadomy SV, et al. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20[2]. Available at http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm). These guidelines provided recommended best practices for the diagnosis and treatment of persons with naturally occurring or bioterrorism-related anthrax in conventional medical settings. An aerosolized release of Bacillus anthracis spores over densely populated areas could become a mass-casualty incident. To prepare for this possibility, the U.S. government has stockpiled equipment and therapeutics (known as medical countermeasures [MCMs]) for anthrax prevention and treatment. However, previously developed, publicly available clinical recommendations have not addressed the use of MCMs or clinical management during an anthrax mass-casualty incident, when the number of patients is likely to exceed the ability of the health care infrastructure to provide conventional standards of care and supplies of MCMs might be inadequate to meet the demand required. To address this gap, in 2013, CDC conducted a series of systematic reviews of the scientific literature on anthrax to identify evidence that could help clinicians and public health authorities set guidelines for intravenous antimicrobial and antitoxin use, diagnosis of anthrax meningitis, and management of common anthrax-specific complications in the setting of a mass-casualty incident. Evidence from these reviews was presented to professionals with expertise in anthrax, critical care, and disaster medicine during a series of workgroup meetings that were held from August 2013 through March 2014. In March 2014, a meeting was held at which 102 subject matter experts discussed the evidence and adapted the existing best practices guidance to a clinical use framework for the judicious, efficient, and rational use of stockpiled MCMs for the treatment of anthrax during a mass-casualty incident, which is described in this report. This report addresses elements of hospital-based acute care, specifically antitoxins and intravenous antimicrobial use, and the diagnosis and management of common anthrax-specific complications during a mass-casualty incident. The recommendations in this report should be implemented only after predefined triggers have been met for shifting from conventional to contingency or crisis standards of care, such as when the magnitude of cases might lead to impending shortages of intravenous antimicrobials, antitoxins, critical care resources (e.g., chest tubes and chest drainage systems), or diagnostic capability. This guidance does not address primary triage decisions, anthrax postexposure prophylaxis, hospital bed or workforce surge capacity, or the logistics of dispensing MCMs. Clinicians, hospital administrators, state and local health officials, and planners can use these recommendations to assist in the development of crisis protocols that will ensure national preparedness for an anthrax mass-casualty incident. PMID:26632963

  18. Assessment of Hospital Pharmacy Preparedness for Mass Casualty Events

    PubMed Central

    Awad, Nadia I.; Cocchio, Craig

    2015-01-01

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

  19. [Personality identification based on the outcomes of mass casualty events].

    PubMed

    Shcherbakov, V V; Shcherbakova, E V

    2012-01-01

    This study concerns the problem of personality identification based on the outcomes of mass casualty events. New organizational measures are proposed to optimize the work with cadaveric materials. Specifically, they envisage creation of four major working groups and organization of their cooperation along the following lines: collection and delivery of postmortem information, systematization of antemortal information, and functioning of the identification centre. DNA-technologies and computer-assisted data processing are shown to find the increasingly wider application for personality identification. PMID:22567959

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

    PubMed

    Timm, Nathan; Reeves, Scott

    2007-01-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2010-07-01

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

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

    PubMed Central

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

    2007-01-01

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

  4. Physicians, triage, and nuclear war.

    PubMed

    Leaning, J

    1988-07-30

    Difficult ethical choices imposed by triage, the process of sorting casualties according to severity of illness (need) and priority for treatment (allocation), are discussed in the context of recent disasters such as an Amtrak collision and the Mexico city earthquake. The question of medical response to nuclear war raises issues of professional duty to assist in making plans for morally repugnant events such as mass destruction; the feasibility of triage, as a conscious professional act, during a time of extreme stress and carnage; and fundamental differences among physicians in their beliefs about themselves, their roles, and their moral obligation to the world. PMID:2899247

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

    PubMed

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

    2012-07-01

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

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

    PubMed

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

    2012-07-01

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

  7. Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica

    PubMed Central

    Mills, Christopher N.; Mills, Gregory H.

    2011-01-01

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

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

    PubMed

    Hanley, Michael E; Bogdan, Gregory M

    2008-02-01

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

  9. [Simplified schema of action of the ambulance rescue services during mass casualty].

    PubMed

    Guła, Przemysław; Hładki, Waldemar; Górski, Krzysztof; Popławska, Małgorzata

    2008-01-01

    Authors represented problems relating mass - casualty accidents and manner of segregation of victims. Lifesaving activities in mass - casualty usually leads to increased emotional stress. It is the result of event specificity, and also of external threats in the zone of activity. Authors presented schema prepared for needs of Cracow's - Ambulance Rescue Services, being the adaptation of universally accepted in western countries algorithm (SAD CHALETS). PMID:18669100

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

    PubMed

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

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

  11. The design of a decentralized electronic triage system.

    PubMed

    Massey, Tammara; Gao, Tia; Welsh, Matt; Sharp, Jonathan H; Sarrafzadeh, Majid

    2006-01-01

    The Advanced Health and Disaster Aid Network (AID-N) project seeks to identify unmet needs of emergency response teams in the Washington, DC area during mass casualty incidents and conduct feasibility tests of technology-based solutions. The decentralized electronic triage and sensing system uses low power, electronic triage sensors to monitor the vital signs of patients and provide location tracking capabilities. The robust, decentralized location tracking software runs on a small, embedded system with limited memory and computational power that efficiently locates patients. A field study demonstrates the process of current emergency procedures and the design implications of the prototype. This field study, along with the hardware and software architecture of the electronic triage system, lay the foundation for a reliable, decentralized sensor deployment that will continuously extend network coverage during a mass casualty incident. PMID:17238400

  12. [The role of patient flow and surge capacity for in-hospital response in mass casualty events].

    PubMed

    Sefrin, Peter; Kuhnigk, Herbert

    2008-03-01

    Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents. PMID:18350477

  13. Mass casualty chemical exposure and implications for respiratory failure.

    PubMed

    Muskat, Peter C

    2008-01-01

    Exposure to chemical agents, both deliberate and accidental, over the past 100 years has resulted in the deaths of thousands and a significant number of casualties requiring hospitalization. The respiratory system is an important portal of entry into the human body for many of these agents, and pulmonary symptoms are a hallmark of many chemical exposures. The 4 major chemical warfare agents are: lung-damaging, blood, blister, and nerve compounds. The review will cover historical exposures, signs and symptoms, treatment, and long-term consequences. There are numerous examples of deliberate (as well as accidental) exposure to harmful chemicals, and each incident requires the provider to understand the signs and symptoms of the particular chemical so that the correct treatment is provided. The respiratory implications of these agents appear to be dose and timing dependent, with full recovery often seen if supportive measures and appropriate antidotes are administered in a timely fashion. PMID:18173860

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

    PubMed Central

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

    2005-01-01

    When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of anIntelligent 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

  15. Hospital trauma care in multiple-casualty incidents: a critical view.

    PubMed

    Hirshberg, A; Holcomb, J B; Mattox, K L

    2001-06-01

    During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore, the realistic admitting capacity of the hospital is determined primarily by the number of trauma teams that the hospital can recruit. Effective triage of these casualties is often not straightforward, with high overtriage rates. Simplified triage algorithms may be a practical alternative to more elaborate schemes. The concept of minimal acceptable care is the key to a staged management approach during a mass-casualty incident. Discrete-event computer simulation and war game tabletop exercises for key personnel are 2 new modalities that are supplementing the traditional mock disaster drill as effective planning and training tools. PMID:11385336

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2012-09-01

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

  18. [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

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

    2014-01-01

    In 2013 a fire broke out in the Nursing Home (NH) in the Henryszew village 5 km away from the district hospital in Zyrardw. 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

  19. Health care worker protection in mass casualty respiratory failure: infection control, decontamination, and personal protective equipment.

    PubMed

    Daugherty, Elizabeth L

    2008-02-01

    Maintenance of a safe and stable health care infrastructure is critical to an effective mass casualty disaster response. Both secondary contamination during chemical disasters and hospital-associated infections during epidemic illness can pose substantial threats to achieving this goal. Understanding basic principles of decontamination and infection control during responses to chemical and biologic disasters can help minimize the risks to patients and health care workers. Effective decontamination following toxic chemical exposure should include both removal of contaminated clothing and decontamination of the victim's skin. Wet decontamination is the most feasible strategy in a mass casualty situation and should be performed promptly by trained personnel. In the event of an epidemic, infection prevention and control measures are based on essential principles of hand hygiene and standard precautions. Expanded precautions should be instituted as needed to target contact, droplet, and airborne routes of infectious disease transmission. Specific equipment and measures for critical care delivery may serve to decrease risk to health care workers in the event of an epidemic. Their use should be considered in developing comprehensive disaster response plans. PMID:18218151

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

    PubMed

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

    2013-01-01

    The European Union (EU) Mass Casualties and Health (MASH) project that ran between 2008 and 2010 was designed to study the management of mass casualties from chemical and radiological releases and associated health implications. One area of study for this project concerned arrangements within EU Member States for the management of mass casualties following a chemical release. This was undertaken via a confidential online questionnaire that was sent to selected points of contact throughout the EU. Responses were obtained from 18 states from respondents holding senior positions in chemical planning and incident response. Information gathered shows a lack of uniformity within the EU about the organization of responses to chemical releases and the provision of medical care. This article presents the overall findings of the study demonstrating differences between countries on planning and organization, decontamination, prehospital emergency medical responses, clinical diagnoses, and therapy and aftercare. Although there may be an understandable reluctance from national respondents to share information on security and other grounds, the findings, nevertheless, revealed substantial differences between current planning and operational responses within the EU states for the management of mass chemical casualties. The existing international networks for response to radiation incidents are not yet matched by equivalent networks for chemical responses yet sufficient information was available from the study to identify potential deficiencies, identify common casualty management pathways, and to make recommendations for future operations within the EU. Improvements in awareness and training and the application of modern information and communications will help to remedy this situation. Specialized advanced life support and other medical care for chemical casualties appear lacking in some countries. A program of specialized training and action are required to apply the findings revealed by the MASH study into a unified cross-border emergency medical response. PMID:23716370

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

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

  3. Mass casualty incident surveillance and monitoring using identity aware video analytics.

    PubMed

    Yu, Xunyi; Ganz, Aura

    2010-01-01

    In this paper, we propose an identity aware video analytic system that can assist securing the perimeter of a mass casualty incident scene and generate identity annotated video records for forensics and training purposes. Establishing a secure incident scene perimeter and enforcing access control to different zones is a demanding task for current video surveillance systems which lack the ability to provide the identity of the target and its security clearance. Our system which combines active RFID sensors with video analytic tools recovers the identity of the target enabling the activation of suitable alert policies. The system also enables annotation of incident scene video with identity metadata, facilitating the incident response process reconstruction for forensics analysis and emergency response training. PMID:21096870

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  6. Truth hurts--hard lessons from Australia's largest mass casualty exercise with contaminated patients.

    PubMed

    Edwards, Nicholas A; Caldicott, David G E; Eliseo, Tony; Pearce, Andrew

    2006-04-01

    In response to the increasing threat of a mass casualty incident involving chemical, biological or radiological agents, and concern over the preparedness of our hospital system to cope with patients from such an incident, we conducted the largest hospital-based field exercise involving contaminated patients that has been held in Australia. In the present paper, we outline the background to, and methodology of, Exercise Supreme Truth, and the efforts made to increase its realism. We focus our discussion on three issues highlighted by the exercise, which we believe have enormous implications for the development of hospital chemical, biological or radiological plans and the likelihood of their success--hospital security, crowd control and decontamination. PMID:16669945

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

    PubMed

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

    2015-02-01

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

  8. Cyanide antidotes for mass casualties: water-soluble salts of the dithiane (sulfanegen) from 3-mercaptopyruvate for intramuscular administration.

    PubMed

    Patterson, Steven E; Monteil, Alexandre R; Cohen, Jonathan F; Crankshaw, Daune L; Vince, Robert; Nagasawa, Herbert T

    2013-02-14

    Current cyanide antidotes are administered by IV infusion, which is suboptimal for mass casualties. Therefore, in a cyanide disaster, intramuscular (IM) injectable antidotes would be more appropriate. We report the discovery of the highly water-soluble sulfanegen triethanolamine as a promising lead for development as an IM injectable cyanide antidote. PMID:23301495

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

    PubMed

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

    2014-06-01

    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

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

    PubMed

    Tia Gao; Massey, T; Selavo, L; Crawford, D; Bor-Rong Chen; Lorincz, K; Shnayder, V; Hauenstein, L; Dabiri, F; Jeng, J; Chanmugam, A; White, D; Sarrafzadeh, M; Welsh, M

    2007-09-01

    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. PMID:23852414

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

    PubMed

    Bookman, Kelly; Zane, Richard

    2013-08-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2005-01-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed Central

    2016-01-01

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

  16. Radiologic diagnosis of explosion casualties.

    PubMed

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

    2008-01-01

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

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

    PubMed Central

    Shirley, Peter J; Mandersloot, Gerlinde

    2008-01-01

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

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

    PubMed

    Eyal, Nir; Firth, Paul

    2012-01-01

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

  19. Scientific Framework for Research on Disaster and Mass Casualty Incident in Korea: Building Consensus Using Delphi Method

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  1. [Surgical activity in a mass casualty situation: humanitarian relief mission in Pakistan].

    PubMed

    Petek, D; Hagon, O; Hoffmeyer, P

    2007-02-28

    On October 8th 2005, a violent earthquake struck the northern region of Pakistan resulting in a large number of injuries and deaths. In response to this catastrophe, the Swiss Agency for Development and Cooperation (SDC) offered logistic support, including material and medical staff. After evaluating the needs, the SDC sent two surgeons to the city of Mansehra for a short term mission. At that site a college had been transformed into a field hospital by a multidisciplinary Pakistani team, already busy at work. Up to 200 casualties per day were brought to that center for a first surgical procedure consisting in debridement, application of traction, or external fixation. In total, more than 2000 people were treated during this two week mission. PMID:17410942

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2016-04-01

    Emerging research indicates the critical role members of the public can play in saving lives and reducing morbidity at the scene in the immediate aftermath of a disaster. It is anticipated that with training, more members of the public will be ready and able to assist should they be present at mass casualty events or other circumstances in which there are serious injuries or potential loss of life. This article describes a training course developed by multiple federal and nonfederal partners aimed at preparing the public to become "active bystanders" followed by a pilot demonstration project conducted by Medical Reserve Corps Units. The outcomes of the project indicated that the training was comprehensive and appropriate for members of the public with little or no first aid knowledge. National availability of the "Becoming an Active Bystander" training course is currently being planned. (Disaster Med Public Health Preparedness. 2016;10:286-292). PMID:26841861

  4. Risk Analysis for Environmental Health Triage

    SciTech Connect

    Bogen, K T

    2005-11-18

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

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

    PubMed

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

    2014-05-01

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

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

    PubMed Central

    2014-01-01

    Background Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. Methods A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each items 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

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

    SciTech Connect

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

    2005-04-01

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

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

    PubMed

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

    2014-06-01

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

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

    PubMed

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

    1992-04-01

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

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

    PubMed Central

    Borgohain, B; Khonglah, T

    2013-01-01

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

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

    PubMed

    Borgohain, B; Khonglah, T

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Lizotte, Todd E.

    2010-04-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed Central

    2009-01-01

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

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

    PubMed Central

    Moroni, Maria; Pellmar, Terry C.

    2009-01-01

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

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

    PubMed

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

    2011-04-01

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

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

    PubMed

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

    2009-02-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2011-01-01

    Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:531:05:32 vs 18:5557:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

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

    PubMed Central

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

    2014-01-01

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

  3. [Emergency Triage. An Overview].

    PubMed

    Christ, Michael; Bingisser, Roland; Nickel, Christian Hans

    2016-03-01

    In emergency departments, patients present with different severities of diseases and traumatic injuries. However, patients with severe and life-threatening conditions compete for the same resources such as personal and structure. As a general rule, each patient should receive immediate diagnostic and treatment, independent of his or her severity of disease or traumatic injury. However, an unexpected number of patients presenting to the emergency department at the same time may exceed available resources. Thus, waiting times will occur and management of patients may be impeded. As a consequence, patients with diseases or traumatic injuries with a need for time-critical management, have to be detected at the time of presentation. After categorization, patients have to be prioritized and guided to the correct place of treatment ("triage"). Starting in Australia and the United States, nurse-driven triage systems have been introduced in the emergency departments. Aim of triage is to correctly identify at increased risk of death and guide them to rapid and correct treatment. In Germany, two five-level triage systems have been introduced: Manchester Triage System (MTS) and Emergency Severity Index (ESI). We give an overview of these risk assessment tools and discuss pros and cons. In addition, new options such as "team triage" and a combination with "Early Warning Scores" are reported. In summary, nurse-driven triage is an instrument to improve patient safety in emergency medicine. A structured and systematic triage of patients using validated triage assessment tools are recommended from national and international societies of emergency medicine. Therefore, nurse-driven triage is also a must in Germany. PMID:26939102

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

    PubMed

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

    2006-01-01

    The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600-700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation ("C") problems, by controlling external hemorrhages. This decision was driven by the lack of equipment and personnel to deal with airway ("A") and breathing ("B") problems. In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communication facilities must be ensured; (2) clear, simple "evacuation plans" should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the disaster and emergency medicine capabilities. This case report is an example for caregivers all over the world, of an amazing lesson of leadership and courage. PMID:16892887

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

    PubMed

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

    2008-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  7. Tsunami Casualty Model

    NASA Astrophysics Data System (ADS)

    Yeh, H.

    2007-12-01

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

  8. Triage as Urban Policy.

    ERIC Educational Resources Information Center

    Marcuse, Peter; And Others

    1982-01-01

    Triage policy is the exclusion of severely declining urban areas from services and programs on the grounds that the intensity of their needs cannot be met and the provision of services is therefore inefficient. Community groups must insist that severity of need, human benefits, and community protection be the priorities for allocation of funds.

  9. Triage as Urban Policy.

    ERIC Educational Resources Information Center

    Marcuse, Peter; And Others

    1982-01-01

    Triage policy is the exclusion of severely declining urban areas from services and programs on the grounds that the intensity of their needs cannot be met and the provision of services is therefore inefficient. Community groups must insist that severity of need, human benefits, and community protection be the priorities for allocation of funds.…

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

    PubMed

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

    2015-06-01

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

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

    PubMed

    Malpas, Michael

    2011-12-01

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

  12. Battlefield triage life signs detection techniques

    NASA Astrophysics Data System (ADS)

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

    2008-04-01

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

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

    SciTech Connect

    Knudson, G.B. )

    1991-06-01

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

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

    PubMed

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

    2012-12-01

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

  15. An Arm Mounted "Scratch and Sniff" Sample Triage Sensor

    NASA Astrophysics Data System (ADS)

    Darrach, M. R.; Kidd, R.; Shiraishi, L.

    2012-06-01

    A sample triage system based on the detection of volatiles released by mechanical abrasion is proposed. The instrument will be capable of detecting trace compounds found in Mars rock and soils. The instrument mass will be approximately 2.8 kg.

  16. Garden Path Repair: Diagnosis and Triage.

    ERIC Educational Resources Information Center

    Fodor, Janet Dean; Inoue, Atsu

    2000-01-01

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

  17. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  18. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  19. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  20. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  1. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

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

    SciTech Connect

    Kruse, P.; Rojas-Palma, C.

    2007-07-01

    European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario, the number of affected people can vary from a few to mass casualties. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. There is a need to develop practicable tools for the adequate response to such acts and more specifically to address European guidelines for triage, monitoring and treatment of exposed people. Although European countries have developed emergency response plans for nuclear accidents they have not all made plans for handling malevolent use of radioactive material. Indeed, there is a need to develop practical guidance on emergency response and medical treatment of the public affected by malevolent acts. Generic guidance on this topic has been published by international organisations. They are, however, not operational documents to be used in emergency situations. The Triage, Monitoring and Treatment (TMT) Handbook aims to strengthen the European ability to efficiently respond to malevolent acts in terms of protecting and treating exposed people. Part of the Handbook is also devoted to public information and communication issues which would contribute to public reassurance in emergency situations. The Handbook will be drafted by European and international experts before it is circulated to all emergency response institutions in Europe that would be a part of the handling of malevolent acts using radioactive material. The institutions would be given a 6 months consultation time with encouragement to test the draft Handbook in national exercises. A workshop will allow feedback from these end users on the content, structure and usefulness of the Handbook before a final version is produced. In order to achieve the project's objectives a consortium has been drawn together including, Belgian Nuclear Research Centre, the Norwegian Radiation Protection Authority, Radiation and Nuclear Safety Authority of Finland, the UK Health Protection Agency, the Central Laboratory for Radiological Protection of Poland and the World Health Organisation. Enviros Consulting is acting as the technical secretariat for the project. The Handbook will aim to harmonise the approaches to handling malevolent acts across Europe. This harmonisation will have an added value on the public confidence in authorities since differing approaches in neighbouring countries could lead to public confusion and mistrust. (authors)

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

    PubMed

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

    2005-01-01

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

  4. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    PubMed

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

    2015-01-01

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

  6. Emergency department triage: an ethical analysis

    PubMed Central

    2011-01-01

    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

  7. Accountability Pressure, Academic Standards, and Educational Triage

    ERIC Educational Resources Information Center

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

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

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

    PubMed

    Satterthwaite, Peter S; Atkinson, Carol J

    2012-02-01

    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

  9. Nursing Software for Emergency Triage (NSET).

    PubMed

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

    2015-01-01

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

  10. Does a physician visual assessment change triage?

    PubMed

    Brillman, J C; Doezema, D; Tandberg, D; Sklar, D P; Skipper, B J

    1997-01-01

    A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. All patients were assigned a triage category by an emergency nurse (RN) who saw the patient and by an emergency physician (EP) who had the option of performing a visual assessment. Triage categorization was compared for interobserver agreement (Kappa [kappa] statistic) and by ability to predict admission (MacNemar's test). A total of 3,949 patients was entered. The patients that physicians visually assessed were triaged by nurses as more ill (P < .001). For triage categories visualized by the EP compared with RN categorization, interobserver agreement was 59.8%, kappa = .21. For triage categories not visualized by EP compared with RN categorization, interobserver agreement was 67.9%, kappa = .45 (P < .001). Sensitivity of EPs to predict admission is as follows: all RN triage, 41.3; not seen by EP, 54.9; seen by EP, 69.3. Specificity is as follows: all RN triage, 93.7; not seen by EP, 88.5, seen by EP, 83.9. When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity. PMID:9002565

  11. Human casualties in earthquakes: modelling and mitigation

    USGS Publications Warehouse

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

    2011-01-01

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

  12. Predicting casualties implied by TIPs

    NASA Astrophysics Data System (ADS)

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

    2009-12-01

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

  13. Infrared imaging-based combat casualty care system

    NASA Astrophysics Data System (ADS)

    Davidson, James E., Sr.

    1997-08-01

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

  14. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  15. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. A pivot nurse at triage.

    PubMed

    Martin, Marie

    2012-01-01

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

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

    PubMed Central

    2013-01-01

    Background Priority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage. Methods In the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (20052007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient. Results 236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages. Conclusions In pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases. PMID:24354953

  18. Factors that affect the flow of patients through triage

    PubMed Central

    Lyons, Melinda; Brown, Ruth; Wears, Robert

    2007-01-01

    Objective To use observational methods to objectively evaluate the organisation of triage and what issues may affect the effectiveness of the process. Design A two?phase study comprising observation of 16?h of triage in a London hospital emergency department and interviews with the triage staff to build a qualitative task analysis and study protocol for phase 2; observation and timing in triage for 1870?min including 257 patients and for 16 different members of the triage staff. Results No significant difference was found between grades of staff for the average triage time or the fraction of time absent from triage. In all, 67% of the time spent absent from triage was due to escorting patients into the department. The average time a patient waited in the reception before triage was 13?min 34?s; the average length of time to triage for a patient was 4?min 17?s. A significant increase in triage time was found when patients were triaged to a specialty, expected by a specialty, or were actively seen and treated in triage. Protocols to prioritise patients with potentially serious conditions to the front of the queue had a significantly positive effect on their waiting time. Supplementary tasks and distractions had varying effects on the timely assessment and triage of patients. Conclusions The human factors method is applicable to the triage process and can identify key factors that affect the throughput at triage. Referring a patient to a specialty at triage affects significantly the triage workload; hence, alternative methods or management should be suggested. The decision to offer active treatment at triage increases the time taken, and should be based on clinical criteria and the workload determined by staffing levels. The proportion of time absent from triage could be markedly improved by support from porters or other non?qualified staff, as well as by proceduralised handovers from triage to the main clinical area. Triage productivity could be improved by all staff by becoming aware of the effect of the number of interruptions on the throughput of patients. PMID:17251608

  19. Evaluating Age in the Field Triage of Injured Persons

    PubMed Central

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

    2012-01-01

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

  20. [Triage quickens the treatment of the most sick patients].

    PubMed

    Skriver, Claus; Lauritzen, Marlene Mauson Pankoke; Forberg, Jakob Lundager; Gaardboe-Poulsen, Ove Bertin; Mogensen, Christian Backer; Hansen, Connie Lrkholm; Berlac, Peter Anthony

    2011-10-01

    Systematic process triage is a relatively unknown concept in Denmark. Currently there are no national recommendations regarding triage models for use in the emergency department (ED). Four medium-sized EDs from different regions across the country cooperated in a joint venture to develop a new triage model, Danish Emergency Process Triage (DEPT). DEPT is inspired by the Swedish ADAPT system, but modified for a Danish context. This paper summarizes the cumulated experience with the new system. PMID:21975184

  1. Machine Learning for Biomedical Literature Triage

    PubMed Central

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

    2014-01-01

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

  2. Simulated casualties and medics for emergency training.

    PubMed

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

    1997-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  4. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  5. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  6. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  7. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  8. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  9. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  10. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  11. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  12. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  13. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  14. Accountability Incentives: Do Schools Practice Educational Triage?

    ERIC Educational Resources Information Center

    Springer, Matthew G.

    2008-01-01

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

  15. Accountability Incentives: Do Schools Practice Educational Triage?

    ERIC Educational Resources Information Center

    Springer, Matthew G.

    2008-01-01

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

  16. Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

    PubMed Central

    Hunskaar, Steinar

    2011-01-01

    Background The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n=18, response rate 90%) as a testretest assessment. Results Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage. PMID:21262792

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

    PubMed

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

    2011-11-01

    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

  18. Yale and the Atomic Bomb Casualty Commission.

    PubMed Central

    Bowers, J. Z.

    1983-01-01

    This is a description, based largely on personal discussions, of the contributions of men from the Yale University School of Medicine to the saga of the immediate and long-term studies on the medical effects of the atomic bombs at Hiroshima and Nagasaki. They played key roles in the immediate studies of bomb effects, in the creation of long-term studies of delayed effects, and in elevating the Atomic Bomb Casualty Commission after 1955 to a position of excellence in its studies and relations with the Japanese. The accumulation of the information presented in this paper derives from research for the preparation of the history of the Atomic Bomb Casualty Commission. In 1975, the commission was passed to Japanese leadership as the Radiation Effects Research Foundation. PMID:6349145

  19. Westinghouse GOCO conduct of casualty drills

    SciTech Connect

    Ames, C.P.

    1996-02-01

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

  20. The fate of triaged and rejected manuscripts.

    PubMed

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

    2015-12-01

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

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

    2013-01-01

    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, patients 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 patients outcomes in terms of mortality, re-hospitalization, quality of life and satisfaction with care. Trial registration ClinicalTrials.gov Identifier, NCT01768494 PMID:23822525

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  5. Social Distribution, Ghettoization, and Educational Triage: A Marxist Analysis.

    ERIC Educational Resources Information Center

    Cameron, Jeanne

    2000-01-01

    Discusses how many urban students are written off as unworthy of scant educational resources, using Weber and Marx to discuss how educational triage is best understood theoretically, exploring how broader processes of social distribution and triage link up with daily practices and policies in urban classrooms, and highlighting the need for a…

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Boa, J. Michael; Gorvett, Rick

    2014-01-01

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

  9. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  10. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  11. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  12. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  13. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  14. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  15. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty losses. (a) In general—(1) Allowance of...

  16. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty losses. (a) In general—(1) Allowance of...

  17. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Itemized Deductions for Individuals and Corporations § 1.165-7 Casualty losses. (a) In general—(1) Allowance of...

  18. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  19. Multilocation teleradiology system for emergency triage consultation

    NASA Astrophysics Data System (ADS)

    Herron, John M.; Yonas, Howard

    1996-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    1999-07-01

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

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

    PubMed

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

    2015-03-01

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

  2. HIPAA privacy and security implications for field triage.

    PubMed

    Schulman, Roslyne

    2006-01-01

    The Health Insurance Portability and Accountability Act (HIPAA) of 1996 addresses insurance reforms, medical savings accounts, fraud and abuse provisions, and health information standards. This report discusses HIPAA issues that could impact field triage and emergency medical services. PMID:16801275

  3. Web-Based Triage in a College Health Setting

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  4. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  9. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  10. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  11. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  12. Casualty Crash Types for which Teens are at Excess Risk

    PubMed Central

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

    2007-01-01

    This study identified casualty crash types for which teen drivers experience excess risk relative to adults. Michigan State Police crash records were used to examine casualty crashes in two statewide populations of drivers who experienced at least one crash from 19891996 (pre-graduated driver licensing in Michigan): teens (ages 1619) and adults (ages 4565). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two statewide populations. Excess risk was defined as a RR for a specific type of crash that was significantly greater than the RR for all crashes combined. The RRs for all crashes combined for teenage males was 2.41 and 1.75 for teenage females. RRs for teenage males ranged from a low of 2.16 for casualty crashes attributed to alcohol to 8.98 for casualty road departure crashes at night. Among teenage females, RRs ranged from 2.06 for casualty crashes on the weekend to 7.86 for casualty crashes at night with passengers. Casualty crash rates for teenage males ranged from 0.21 per 100,000 PMD for rollover crashes to 1.95 per 100,000 PMD for crashes with passengers. Among teen females, casualty crash rates ranged from 0.21 per 100,000 PMD for drink/driving with passengers to 3.31 per 100,000 PMD for crashes with passengers. Implications for graduated driver licensing, teen driver supervision, and policy are discussed. This study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Preventions National Center for Injury Prevention and Control. PMID:18184510

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

    PubMed

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

    2012-08-01

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

  14. Multibiodose radiation emergency triage categorization software.

    PubMed

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

    2014-07-01

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

  15. [The false positive reaction of the Triage panel drug-of-abuse by herbal drugs ma-huang (Ephedra sinica (Ephedraceae))].

    PubMed

    Nishiguchi, M; Kinoshita, H; Higasa, K; Taniguchi, T; Ouchi, H; Minami, T; Marukawa, S; Yoshinaga, K; Yamauchi, J; Aoki, S; Hishida, S

    2001-11-01

    We investigated false-positive reactions obtained from a drug screening test using a Triage panel. We detected 2 cases giving false-positive reaction for AMP (amphetamine, methamphetamine) during the screening of 187 normal subjects. Subsequent follow up testing by high-performance liquid chromatography (HPLC), showed both to be false-positive reactions. As both cases have a history of ingesting the herbal drug, Ma-huang (Ephedra sinica (Ephedraceae)), containing ephedrine, we examined the relationship between false-positive reactions on Triage and Ma-huang. All urine samples collected from 7 healthy volunteers following administration of Ma-huang indicated AMP positive on Triage. Also a high ratio of AMP positives was observed in the patients who were administered Ma-huang-containing drugs at the hospital. However, none of them were identified as true-positives by HPLC or gas chromatography mass spectrometry (GC/MS) analysis. The extract of Ma-huang contained in herbal drugs, which otherwise contain neither amphetamine nor its derivatives, gives (AMP) positive indications on Triage. We speculate that unidentified components of Ma-huang cause the false-positive reactions. We suggest that follow-up tests by GC/MS or HPLC are needed wherever a positive result is obtained from a screening test by Triage. Furthermore, it will be established to continue collecting information on prescribed and non-prescribed drugs. PMID:11905042

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

    PubMed

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

    2016-02-01

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

  17. Higher Education: A Time for Triage?

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature is replete with descriptions of budget cuts and the resultant reallocation of monies. For example, as the budget cuts of the last decade accumulated, maintenance was deferred, and the funds saved were used to shore-up key existing parts of the educational process, such as faculty salaries. State budgets are generally smaller now than they were when the cuts were made, which means that preventive maintenance will continue to be deferred and other resources must be found for capital improvements. Triage often operates in an environment that does not permit promising possibilities to develop. For example, the promise of interactive digital technologies on the learning process may never be fully realized in many institutions if the associated capital and operating costs cannot be accommodated within the cost containment measures being adopted. In an effort to offset part of the lost state support, tuition and fees have been increased at public institutions at a rate that far exceeds growth of the cost of living index. All this is occurring in the face of an increasingly diverse student body and the beginning of "Tidal Wave II," as the surge of new students who are the children of the baby boomers has been called. These demands, along with the expectations for an historically, good American education, will have to be met with fewer dollars. Our ability to fund public higher education by the conventional mechanisms has been affected by a variety of tax reform initiatives. Although the details may vary locally, various kinds of initiatives, propositions, and referenda have severely limited the amount of revenue states can raise. Thus, caps on property taxes have transformed support patterns at the city and county levels. Initiatives, many of which have built-in escalators, that fix the percentages of state spending for various programs have created new kinds of budgetary entitlement groups. These mandates conspire to give government, i.e., governors and legislatures, less discretionary control over a dwindling portion of the state budget. Unfortunately, higher education often finds itself included in that ever-shrinking part of the budget. To keep businesses globally competitive there will be great pressure against raising corporate taxes. These pressures combined with the federal deficit and the growth in entitlements leave little hope for an infusion of the kinds of new public funds that have fueled previous changes in higher education. Some institutions have succeeded in deriving new resources through the establishment of public-private partnerships and vigorous fund raising, activities that have not played a significant role in funding public education in the past. Monies from private sources now account for more than 50% of the budget components in the case of some of the more successful state university initiatives. Successes of this kind raise some interesting questions. For example, how will the evolution of fiscal interactions with the state be affected? How will faculty work loads and compensation patterns be affected? It has become increasingly clear that a number of major issues need attention if we are to engage effectively in triage as a process to maximize what can--and should--be saved in higher education. The following list summarizes discussions that have appeared in a variety of disparate publications. Establish and prioritize the institution's educational goals. Establish value and reward systems for students and faculty that are consistent with the priority goals. Develop leverage and constraint mechanisms to effect change and improve student orientation to the new priorities. Establish a relationship between the price and cost of education and access to it, perhaps incorporating some sort of internal subsidy system. Develop a relationship between the demonstration of public accountability through the reallocation of resources and the measurement of tangible outcomes that justifies enhanced public and private investment. Devise a use of technology that improves productivity, which in turn requires the definition of productivity in an academic setting. Serious discussion of these issues and attempts to address them will undoubtedly prove uncomfortable, perhaps even threatening, to many in academia. Some may question whether the institutions of higher education that we now know as universities will still be "universities." But then, what is a university?

  18. A retrospective quality assessment of the 7119 call triage system in Tokyo - telephone triage for non-ambulance cases.

    PubMed

    Sakurai, Atsushi; Morimura, Naoto; Takeda, Munekazu; Miura, Kunihisa; Kiyotake, Naoshi; Ishihara, Toru; Aruga, Tohru

    2014-05-14

    Summary We assessed the accuracy of telephone triage at the 7119 telephone consultation centre in Tokyo. We evaluated walk-in patients at primary care facilities in a clinic or hospital. Nurses asked all patients calling 7119 to join the study and gave them a specific identification number (ID no) at the end of the telephone consultation. The outcome of the consultation was defined as discharge to home (home), admittance to hospital (hospitalization), referral, or transfer to another hospital. After matching consultation records and patient data by ID no, emergency medical physicians reviewed the protocol for problems. During the study, consultation nurses issued an ID no in 17,141 cases, and hospitals and clinics sent back the data on 1205 patients. Among these patients, 1119 cases (93%) were home, 59 cases (5%) were hospitalization, 18 cases (2%) were referral and 9 cases (1%) were transfer. Of the 86 cases which had an outcome of hospitalization, referral or transfer, there were 56 cases with matched patient data. Among these 56 cases, review showed no significant problems with 37 cases. However, there were 11 cases with patient refusal to comply with the triage recommendation, 4 cases with 7119 staff education problems and 4 cases with problems with the protocol itself. We were able to evaluate the 7119 telephone triage system in Tokyo. The study identified three types of problems with the triage process: refusal of telephone triage recommendations, problems with staff education and problems with the protocol itself. PMID:24829258

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

    PubMed Central

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

    2015-01-01

    Objective To evaluate the ability of out-of-hospital physiologic measures to predict serious injury for field triage purposes among older adults and potentially reduce the under-triage of seriously injured elders to non-trauma hospitals. Methods This was a retrospective cohort study involving injured adults 55 years and older transported by 94 emergency medical services (EMS) agencies to 122 hospitals (trauma and non-trauma) in 7 regions of the western United States from January 1, 2006 to December 31, 2008. We evaluated initial out-of-hospital Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), respiratory rate, heart rate, shock index (SBP heart rate), out-of-hospital procedures, mechanism of injury, and patient demographics. The primary outcome was serious injury, defined as Injury Severity Score (ISS) ? 16, as a measure of trauma center need. We used multivariable regression models, fractional polynomials and binary recursive partitioning to evaluate appropriate physiologic cut-points and the value of different physiologic triage criteria. Results A total of 44,890 injured older adults were evaluated and transported by EMS, of whom 2,328 (5.2%) had ISS ? 16. Nonlinear associations existed between all physiologic measures and ISS ? 16 (unadjusted and adjusted p ? 0.001 for all,), except for heart rate (adjusted p = 0.48). Revised physiologic triage criteria included GCS score ? 14; respiratory rate < 10 or > 24 breaths per minute or assisted ventilation; and SBP < 110 or > 200 mmHg. Compared to current triage practices, the revised criteria would increase triage sensitivity from 78.6 to 86.3% (difference 7.7%, 95% CI 6.19.6%), reduce specificity from 75.5 to 60.7% (difference 14.8%, 95% CI 14.315.3%), 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

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

    PubMed Central

    2010-01-01

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

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

    PubMed

    Qureshi, N A

    2010-06-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  3. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  5. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  6. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  7. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  8. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  9. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  10. 46 CFR 4.05-5 - Substance of marine casualty notice.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  11. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  12. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  13. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Contents of casualty or accident... System Requirements 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in 173.57 of this chapter....

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Contents of casualty or accident... System Requirements 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in 173.57 of this chapter....

  15. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Contents of casualty or accident... System Requirements 174.107 Contents of casualty or accident report form. Each form for reporting a vessel casualty or accident must contain the information required in 173.57 of this chapter....

  16. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  17. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Coast Guard marine casualty investigation for the...) NATIONAL TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.25 Coast Guard marine casualty investigation for the Board. (a) If the Board does...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  20. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  1. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  2. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., casualty, or act of God. 25.282 Section 25.282 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO... From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid by... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer...

  3. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., casualty, or act of God. 25.282 Section 25.282 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO... From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid by... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer...

  4. Children's Cognitive Triage: Optimal Retrieval or Effortful Processing?

    ERIC Educational Resources Information Center

    Brainerd, C. J.; And Others

    1990-01-01

    Cognitive triage is the nonmonotonic relationship between the order in which children read words out of long-term memory and the strength of the memory of the words read. Two experiments with 7 and 12 year olds compared the fuzzy-trace theory with an effortful processing explanation. Findings consistently favored the fuzzy-trace theory's

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

    ERIC Educational Resources Information Center

    Henkel, Steven A.

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Henkel, Steven A.

    2016-01-01

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

  7. Postsecondary Education as Triage: Returns to Academic and Technical Programs.

    ERIC Educational Resources Information Center

    Hollenbeck, Kevin

    1993-01-01

    Examines labor market outcomes of individuals with various types of postsecondary educational experiences, highlighting differences between students who have pursued technical programs, those who have pursued academic programs and those who have not pursued postsecondary education. Employs a triage model suggesting that employer-employee matches…

  8. Children's Cognitive Triage: Optimal Retrieval or Effortful Processing?

    ERIC Educational Resources Information Center

    Brainerd, C. J.; And Others

    1990-01-01

    Cognitive triage is the nonmonotonic relationship between the order in which children read words out of long-term memory and the strength of the memory of the words read. Two experiments with 7 and 12 year olds compared the fuzzy-trace theory with an effortful processing explanation. Findings consistently favored the fuzzy-trace theory's…

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

    ERIC Educational Resources Information Center

    Pomerantz, Jeffrey

    2004-01-01

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

  10. Crisis Assessment: A Three-Dimensional Model for Triage.

    ERIC Educational Resources Information Center

    Myer, Rick A.; And Others

    1992-01-01

    Presents triage assessment model for crisis intervention that enables mental health counselors to initiate appropriate crisis interventions in variety of situations. Model guides assessment of clients in crisis on three domains: affective, cognitive, and behavioral. Describes assessment and rating of severity of impairment for each of the three…

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

    PubMed

    Roberts, J

    1998-04-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

  13. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... routine duties. (3) Loss of a vessel. (4) Damage to or by a vessel, its cargo, apparel or gear, except for... industry vessel must submit a report of each casualty involving that vessel to an organization listed...

  14. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... routine duties. (3) Loss of a vessel. (4) Damage to or by a vessel, its cargo, apparel or gear, except for... industry vessel must submit a report of each casualty involving that vessel to an organization listed...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  17. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  18. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  20. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  1. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  3. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  4. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  5. Impact and Possible Casualty from Videotape Feedback in Marital Therapy

    ERIC Educational Resources Information Center

    Alkire, Armand A.; Brunse, Anthony J.

    1974-01-01

    A controlled study involving group selection of content material to be role-played, videotape feedback of the role-playing situation, and effects on the self-image of disturbed marital couples is presented. A follow-up gives evidence that such a procedure may produce a high "casualty" rate in disturbed married couples.

  6. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  7. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  8. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  9. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  10. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  11. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  12. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  13. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  14. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  15. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  16. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... charge shall, within 10 days of the casualty, submit to the Officer in Charge, Marine Inspection, a written report which: (1) Identifies the facility involved, its owner, operator, and person in charge;...

  17. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... charge shall, within 10 days of the casualty, submit to the Officer in Charge, Marine Inspection, a written report which: (1) Identifies the facility involved, its owner, operator, and person in charge;...

  18. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... industry vessel must submit a report of each casualty involving that vessel to an organization listed in... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  19. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... industry vessel must submit a report of each casualty involving that vessel to an organization listed in... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  20. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... GUARD, DEPARTMENT OF HOMELAND SECURITY UNINSPECTED VESSELS REQUIREMENTS FOR COMMERCIAL FISHING INDUSTRY... industry vessel must submit a report of each casualty involving that vessel to an organization listed in... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  1. The Question of Casualties in Inpatient Small Group Psychotherapy.

    ERIC Educational Resources Information Center

    Erickson, Richard C.

    1987-01-01

    Suggests that the issue of group psychotherapy being harmful to some inpatients, although significant, is meaningless in the absence of further specification of what is being done with whom. Emphasizes the need to address therapeutic "casualties." Questions the clinical folklore regarding patients who must be protected from group psychotherapy,

  2. 76 FR 8788 - Riverside Casualty, Inc.; Notice of Application

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-15

    ... From the Federal Register Online via the Government Publishing Office SECURITIES AND EXCHANGE COMMISSION Riverside Casualty, Inc.; Notice of Application February 8, 2011. AGENCY: Securities and Exchange Commission (``Commission''). ] ACTION: Notice of application for an order under sections 6(b) and 6(e) of the Investment Company Act of 1940...

  3. Triage of HPV positive women in cervical cancer screening.

    PubMed

    Wentzensen, Nicolas; Schiffman, Mark; Palmer, Timothy; Arbyn, Marc

    2016-03-01

    Despite HPV vaccines, screening will remain central for decades to control cervical cancer. Recently, HPV testing alone or with cytology was introduced as an alternative to cytology screening. However, most HPV infections are harmless and additional tests are required to identify women with progressing infections or precancer. With three options for primary screening, and without clear strategies for triage of screen-positive women, there is great confusion about the best approach. Also, increasing HPV vaccination coverage will lead to lower disease prevalence, and force new screening approaches. Currently recommended triage strategies for primary HPV screening include HPV genotyping for HPV16 and HPV18 and cytology. Other alternatives that are currently evaluated include p16/Ki-67 dual stain cytology, host methylation, and viral methylation testing. Clinical management of women with cervical cancer screening results is moving to use risk thresholds rather than individual test results. Specific risk thresholds have been defined for return to primary screening, repeat testing, referral to colposcopy, and immediate treatment. Choice of test algorithms is based on comparison of absolute risk estimates from triage tests with established clinical thresholds. Importantly, triage tests need to be evaluated together with the primary screening test and the downstream clinical management. An optimal integrated screening and triage strategy should reassure the vast majority of women that they are at very low risk of cervical cancer, send the women at highest risk to colposcopy at the right time, when disease can be colposcopically detected, and minimize the intermediate risk group that requires continued surveillance. PMID:26643050

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

    PubMed

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

    2010-01-01

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

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

    PubMed Central

    Sanjay, Jaiswal; Ankur, Verma; Tamorish, Kole

    2015-01-01

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

  6. Demonstration of the Tele-Triage System: A Microcomputer-Based Telephone Triage Program for Use by R.N.'s in Ambulatory Care Settings or Physicians' Offices

    PubMed Central

    Moreland, H.; Johnston, M.; Sharp, D.

    1982-01-01

    The Tele-Triage System (C) is a tool designed to provide standardized telephone triage to people who call a health care facility for assistance or information. Tele-Triage is designed to systematize symptomatologic interviewing, data collection, and patient care management. It is used interactively by a Triage R.N. during telephone interviews to structure and record the interview. A summary of each interview is immediately printed and a record is stored on disk for archival and research purposes. The Tele-Triage System is in its first year of development and currently runs on an Apple II microcomputer. Future plans for the system include research to validate its effectiveness, commercial distribution, and conversion to other computer systems.

  7. Management of Crush Syndrome Casualties after Disasters

    PubMed Central

    Sever, Mehmet Sukru; Vanholder, Raymond

    2011-01-01

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

  8. Meteorite falls in China and some related human casualty events

    NASA Astrophysics Data System (ADS)

    Yau, Kevin; Weissman, Paul; Yeomans, Donald

    1994-11-01

    Statistics of witnessed and recovered meteorite falls found in Chinese historical texts for the period from 700 B.C. to A.D. 1920 are presented. Several notable features can be seen in the binned distribution as a function of time. An apparent decrease in the number of meteorite reports in the 18th century is observed. An excess of observed meteorite falls in the period from 1840 to 1880 seems to correspond to a similar excess in European data. A chi sq probability test suggest that the association between the two data sets are real. Records of human casualities and structural damage resulting from meteorite falls are also given. A calculation based on the number of casualty events in the Chinese meteorite records suggests that the probability of a meteroite striking a human is far greater than previous estimates. However, it is difficult to verify the accuracy of the reported casualty events.

  9. Triaging self-referred patients attending ophthalmic emergency room

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-04-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Strain, John W

    2013-01-01

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

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

    PubMed

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

    2016-01-01

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

  15. [Treatment of injuries in the county of Ringkbing. 2. Function of the closed casualty department].

    PubMed

    Hansen, T B; Kristensen, K A; Poulsen, M B; Gravers, M; Laursen, C N; Hansen, K R

    1992-10-26

    The closed casualty department function in the County of Ringkbing was investigated during a period of four weeks. It was demonstrated that this functioned according to plan as the distribution general practice/casualty department was 3.4:1 and 70% of the patients in the casualty department were referred via general practice. The result of this was that the majority of minor injuries (removal of foreign bodies and treatment of wounds) were treated in general practice. In the casualty departments, there were fewer minor injuries and injuries which did not require specific treatment than are the case in open casualty departments. However, a definite diurnal variation was observed in the function of the closed casualty department as patients showed a greater tendency to seek treatment in the casualty department after working hours than during working hours and the general practitioners referred twice as many patients after working hours for continued treatment in the casualty departments. It is concluded that the closed casualty department system in the County of Ringkbing functions well but that problems may be anticipated with the function if the duty-rosters for the general practitioners are altered so that the distances between general practitioners on duty increase and these have an increased work-load. PMID:1462396

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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.…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

    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.

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

    PubMed Central

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

    2011-01-01

    Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.24.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.63.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.563.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.542.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.15.5) and 1.5% (95% CI = 0.61.8) 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

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

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

    Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage). Design Audit study. Setting Publicly available, free symptom checkers. Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection). Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations). Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations. Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable. PMID:26157077

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

    PubMed

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

    2015-12-15

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

  3. Imaging components for a robotic casualty evaluation system.

    PubMed

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

    2009-01-01

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

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

    PubMed Central

    Patterson, V; Humphreys, J; Chua, R

    2004-01-01

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

  5. CoIN: a network analysis for document triage

    PubMed Central

    Hsu, Yi-Yu; Kao, Hung-Yu

    2013-01-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  7. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  8. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  10. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  11. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  12. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  13. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  14. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, the reporting authority receiving the report must forward a paper or electronic copy...

  15. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, the reporting authority receiving the report must forward a paper or electronic copy...

  16. 33 CFR 174.121 - Forwarding of casualty or accident reports.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... accident reports. 174.121 Section 174.121 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF... 174.121 Forwarding of casualty or accident reports. Within 30 days of the receipt of a casualty or accident report, the reporting authority receiving the report must forward a paper or electronic copy...

  17. 46 CFR 167.65-65 - Notice and reporting of casualty and voyage records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  18. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...'s rules of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The... 46 Shipping 1 2011-10-01 2011-10-01 false Marine casualty investigation by the Board. 4.40-15... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine...

  19. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  20. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... CFR 4.03-1, the master or person in charge of the vessel shall: (a) Ensure compliance with 46 CFR... required by 46 CFR 4.05-15 are retained for: (1) 30 days after the casualty if the vessel remains in the... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Marine casualty reporting...

  1. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  2. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  4. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  5. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  8. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

  9. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

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

  13. Treatment of acute abscesses in the casualty department.

    PubMed Central

    Simms, M H; Curran, F; Johnson, R A; Oates, J; Givel, J C; Chabloz, R; ALexander-Williams, J

    1982-01-01

    In the treatment of acute pyogenic soft-tissue abscess incision, curettage, and primary suture was compared with incision and drainage alone in a randomised prospective trial. Operations were performed under antibiotic cover by casualty officers, and patients were reviewed by an independent observer in a septic dressing clinic. Altogether 114 patients were studied, of whom 54 were treated by curettage and primary suture and 60 by simple drainage. The mean healing time was 8.9 days in those treated by primary suture and 7.8 days in those treated by simple drainage (p less than 0.05). Primary healing failed to occur in 19 (35%) of the sutured wounds, but there were no other complications in either group. It is concluded that incision and drainage alone is adequate treatment for acute soft-tissue abscess. PMID:6805714

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

    PubMed

    Evans, Robert G

    2012-02-01

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

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

    PubMed Central

    Evans, Robert G.

    2012-01-01

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

  16. Trauma-related Infections in Battlefield Casualties From Iraq

    PubMed Central

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

    2007-01-01

    Objective: To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. Background: The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. Methods: Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. Results: Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). Conclusions: Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options. PMID:17457175

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

    USGS Publications Warehouse

    So, Emily; Spence, Robin

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2004-05-01

    Pyroclastic flows clearly present a serious threat to life for the inhabitants of settlements on the slopes of volcanoes with a history of explosive eruptions; but it is increasingly realised that buildings can provide a measure of protection to occupants trapped by such flows. One important example is Vesuvius, whose eruption history includes many events which were lethal for the inhabitants of the neighbouring Vesuvian villages. Recent computational fluid dynamics computer modelling for Vesuvius [Todesco et al., Bull. Volcanol. 64 (2002) 155-177] has enabled a realistic picture of an explosive eruption to be modelled, tracing the time-dependent development of the physical parameters of a simulated flow at a large three-dimensional mesh of points, based on assumed conditions of temperature, mass-flow rate and particle size distribution at the vent. The output includes mapping of temperature, mixture density and mixture velocity over the whole adjacent terrain. But to date this information has not been used to assess the impacts of such flows on buildings and their occupants. In the project reported in this paper, estimates of the near-ground flow parameters were used to assess the impact of a particular simulated pyroclastic flow (modelled roughly on the 1631 eruption) on the buildings and population in four of the Vesuvian villages considered most at risk. The study had five components. First, a survey of buildings and the urban environment was conducted to identify the incidence of characteristics and elements likely to affect human vulnerability, and to classify the building stock. The survey emphasised particularly the number, location and type of openings characteristic of the major classes of the local building stock. In the second part of the study, this survey formed the basis for estimates of the probable impact of the pyroclastic flow on the envelope and internal air conditions of typical buildings. In the third part, a number of distinct ways in which human casualties would occur were identified, and estimates were made of the relationship between casualty rates and environmental conditions for each casualty type. In the fourth part of the study, the assumed casualty rates were used to estimate the proportions of occupants who would be killed or seriously injured for the assumed pyroclastic flow scenario in the Vesuvian villages studied, and their distribution by distance from the vent. It was estimated that in a daytime eruption, 25 min after the start of the eruption, there would be 480 deaths and a further 190 serious injuries, for every 1000 remaining in the area. In a night-time scenario, there would be 360 deaths with a further 230 serious injuries per 1000 after the same time interval. Finally, a set of risk factors for casualties was identified, and factors were discussed and ranked for their mitigation impact in the eruption scenario. The most effective mitigation action would of course be total evacuation before the start of the eruption. But if this were not achieved, barred window openings or sealed openings to slow the ingress of hot gases, together with a reduction of the fire load, could be effective means of reducing casualty levels.

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

    PubMed

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

    2015-01-01

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

  20. Triage and Referrals for Child Sexual Abuse Medical Examinations from the Sociolegal System.

    ERIC Educational Resources Information Center

    Hibbard, Roberta A.

    1998-01-01

    Examines issues concerning triage and referrals for medical child-sexual-abuse examinations from the sociolegal system. Research recommendations are offered in the areas of structure of care, process of care, and outcomes for evaluation. (DB)

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

    PubMed Central

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

    2015-01-01

    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

  2. Health care emergency management: establishing the science of managing mass casualty and mass effect incidents.

    PubMed

    Macintyre, Anthony G; Barbera, Joseph A; Brewster, Peter

    2009-06-01

    Particularly since 2001, the health care industry has witnessed many independent and often competing efforts to address mitigation and preparedness for emergencies. Clinicians, health care administrators, engineers, safety and security personnel, and others have each developed relatively independent efforts to improve emergency response. A broader conceptual approach through the development of a health care emergency management profession should be considered to integrate these various critical initiatives. When based on long-standing emergency management principles and practices, health care emergency management provides standardized, widely accepted management principles, application concepts, and terminology. This approach could also promote health care integration into the larger community emergency response system. The case for a formally defined health care emergency management profession is presented with discussion points outlining the advantages of this approach. PMID:19491589

  3. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    PubMed Central

    Sittichanbuncha, Yuwares; Sanpha-asa, Patchaya; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol

    2015-01-01

    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals. PMID:25922767

  4. 33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 46 CFR subpart 4.07 in conducting the investigation. ... casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Reports and...

  5. 33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 46 CFR subpart 4.07 in conducting the investigation. ... casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Reports and...

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

    SciTech Connect

    1998-06-01

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed

    Bambach, M R; Mitchell, R J

    2015-12-01

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

  9. Alcohol and accidents. A prospective study in a casualty department.

    PubMed

    Antti-Poika, I; Karaharju, E

    1986-01-01

    This study examines the incidence of alcohol-related accidents among trauma patients of working age (15-64 years). The study was made during a one-week period in the Casualty Department of Orthopaedics and Traumatology of Helsinki University Central Hospital in Finland. Patients were divided into two groups according to the time of their admission. The state of alcohol intoxication was determined in Group I using a breath alcohol analyzer (alcometer) and in Group II using both alcometer and blood alcohol concentration (BAC). The frequency of alcohol-related accidents in the whole material was 32.8% (Group I 12.4% and Group II 44.5%). Four-fifths of the patients were man. A high correlation (r = 0.93) was found between alcometer and BAC. In Group II there were intoxication levels of 3% or more (mean 3.6%) in 5.7% of all patients. This is a large number of cases of heavy alcohol intoxication and we propose to take the BAC of all patients having alcometer 3% or more in order to get as accurate a diagnosis of alcohol intoxication as possible. Fights and assaults were most frequently related to the alcohol intoxication cases. PMID:3579190

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

    PubMed

    Mileti?, D; Fuckar, Z; Mraovi?, B; Dimec, D; Mozetic, V

    1999-08-01

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

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

    PubMed Central

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

    1985-01-01

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

  12. Identifying high-risk patients for triage and resource allocation in the ED.

    PubMed

    Ruger, Jennifer Prah; Lewis, Lawrence M; Richter, Christopher J

    2007-09-01

    Five-point triage assessment scales currently used in many emergency departments (EDs) across the country have been shown to be accurate and reliable. We have found the system to be highly predictive of outcome (hospital admission, intensive care unit/operating room admission, or death) at either extreme of the scale but much less predictive in the middle triage group. This is problematic because the middle triage acuity group is the largest, in our experience comprising almost half of all patients. Patients triaged to the 2 highest acuity categories (A and B) have admission/ED death rates of 76% and 43%, respectively. In contrast, the 2 lowest acuity categories (D and E) have admission/ED death rates of 1% or less. The middle category (C), however, has an overall admission/ED death rate of 10%, too high to be comfortable with prolonged delays in the ED evaluation of these patients. We studied this group to determine if easily obtainable clinical factors could identify higher-risk patients in this heterogeneous category. Data were obtained from a retrospective, cross-sectional study of all patients seen in 2001 at an urban academic hospital ED. The main outcome measure for multivariate logistic regression models was hospital admission among patients triaged as acuity C. Acuity C patients who were 65 years or older, presenting with weakness or dizziness, shortness of breath, abdominal pain, or a final diagnosis related group diagnosis of psychosis, were more likely to be admitted than patients originally triaged in category B. These findings suggest that a few easily obtainable clinical factors may significantly improve the accuracy of triage and resource allocation among patients assigned with a middle-acuity score. PMID:17870484

  13. Mass

    SciTech Connect

    Quigg, Chris

    2007-12-05

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

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

    PubMed

    Tonolini, Massimo; Bianco, Roberto

    2013-08-01

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

  15. Redeye: A Digital Library for Forensic Document Triage

    SciTech Connect

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

    2013-01-01

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

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

    PubMed

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

    2015-12-01

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

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

    NASA Astrophysics Data System (ADS)

    Rebbapragada, U.

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

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

    PubMed Central

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

    2000-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2011-01-01

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

  2. Consistency of retrospective triage decisions as a standardised instrument for audit.

    PubMed Central

    Goodacre, S W; Gillett, M; Harris, R D; Houlihan, K P

    1999-01-01

    OBJECTIVES: To determine the level of agreement between senior medical staff when asked to perform retrospective case note review of nursing triage decisions, both before and after development of a consensus approach. METHODS: Four medical reviewers independently allocated triage categories to 50 emergency department patients after review of their case notes. They were blind to the identity of the triage nurse and their triage categorisation. The process was repeated twice, firstly after agreement on a consensus approach and then using formal guidelines. RESULTS: Agreement between reviewers was initially fair to moderate (kappa = 0.27 to 0.53). This failed to improve after development of a consensus approach (kappa = 0.29 to 0.57). There was a trend towards better agreement when guidelines were used but agreement was still only moderate (kappa = 0.31 to 0.63). CONCLUSIONS: Audit of nurse triage categorisation by senior medical staff performing case note review has only fair to moderate consistency between reviewers. Use of this technique will result in frustration among those whose performance is being audited if they recognise inconsistency in the standard they are compared against. PMID:10505909

  3. Misidentification of English Language Proficiency in Triage: Impact on Satisfaction and Door-to-Room Time.

    PubMed

    Balakrishnan, Vamsi; Roper, Jamie; Cossey, Kori; Roman, Crystal; Jeanmonod, Rebecca

    2016-04-01

    We examined triage nurses' assessment of patients' language proficiency compared to patients' self-reported proficiency and the impact of language discordance on door-to-room time and patient satisfaction. This was a prospective study of emergency department walk-in patients. Patients completed a survey in which they identified their language proficiency. On a Likert scale, patients ranked how well they felt they were understood and how satisfied they were with the triage process. Nurses completed surveys identifying the patient's primary language and how well they felt they understood the patient. Door-to-room times were obtained from medical records. 163 patients were enrolled. 66 % of patients identified themselves as having good English proficiency, while 34 % of patients had limited English proficiency. Nurses misclassified 27 % of self-identified Spanish-speaking patients as being English proficient. Spanish-speakers felt less satisfied with triage than English-speakers (p < 0.01). There were no differences in door-to-room time. Triage nurses overestimate patient language skills. Spanish-speaking patients feel less satisfied with triage than English-speakers. PMID:25750135

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

    PubMed

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

    2013-01-01

    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

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

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Funke, Quirin; Krag, Holger

    2015-06-01

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

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

    SciTech Connect

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

    2014-11-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2008-01-01

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

  9. Requesting wrist radiographs in emergency department triage: developing a training program and diagnostic algorithm.

    PubMed

    Streppa, Joanna; Schneidman, Valerie; Biron, Alain D

    2014-01-01

    Crowding is extremely problematic in Canada, as the emergency department (ED) utilization is considerably higher than in any other country. Consequently, an increase has been noted in waiting times for patients who present with injuries of lesser acuity such as wrist injuries. Wrist fractures are the most common broken bone in patients younger than 65 years. Many nurses employed within EDs are requesting wrist radiographs for patients who present with wrist complaints as a norm within their working practice. Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000) when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris,S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol. As there are no standardized set of rules for assessing patients, presenting with suspected wrist fractures, a training program as well as a diagnostic algorithm was developed to prepare emergency nurses to appropriately request wrist radiographs. The triage nurse-specific training program includes the following topics: wrist anatomy and physiology, commonly occurring wrist injuries, mechanisms of injury, physical assessment techniques, and types of radiographic images required. The triage nurse algorithm includes the clinical decision-making process. Providing triage nurses with up-to-date evidence-based educational material not only allowed triage nurses to independently assess and request wrist radiographs for patients with potential wrist fractures but also strengthening the link between competent nursing care and better patient outcomes. A review of the literature also found that such initiatives increase patient and staff satisfaction as well as promoting efficient use of right staff at the right time. PMID:24487265

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

    PubMed Central

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

    2011-01-01

    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 96.597.4%) of all patients contacting out-of-hours care and in 89% (95% CI 86.790.2%) of patients with high urgency. Ten studies that used high-risk simulated patients showed that on average 46% (95% CI 42.749.8%) 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

  11. Triage Patterns for Medicare Patients Presenting to Nontrauma Hospitals With Moderate or Severe Injuries

    PubMed Central

    Mohan, Deepika; Barnato, Amber E.; Rosengart, Matthew R.; Angus, Derek C.; Wallace, David J.; Kahn, Jeremy M.

    2014-01-01

    Objective To understand hospital-level variation in triage practices for patients with moderate-to-severe injuries presenting initially to nontrauma centers. Background Many patients with moderate-to-severe traumatic injuries receive care at nontrauma hospitals, despite evidence of a survival benefit from treatment at trauma centers. Methods We used claims from the Centers for Medicare and Medicaid Services to identify patients with moderate-to-severe injuries who presented initially to nontrauma centers. We determined whether or not they were transferred to a level I or II trauma center within 24 hours of presentation, and used multivariate regression to assess the influence of hospital-level factors on triage practices, after adjusting for differences in case mix. Results Transfer of patients with moderate-to-severe injuries to trauma centers occurred infrequently, with significant variation among hospitals (median 2%; interquartile range 1%6%). Greater resource availability at nontrauma centers was associated with lower rates of successful triage, including the presence of neurosurgeons (relative reduction in transfer rate: 76%, P < 0.01), more than 20 intensive care unit beds (relative reduction 30%, P < 0.01) and a high resident-to-bed ratio (relative reduction 23%, P < 0.01). However, patients were more likely to survive if they presented to hospitals with higher triage rates (odds of death for patients cared for at hospitals with the highest tercile of triage rates, compared with lowest tercile: 0.92; 95% confidence interval: 0.850.99, P = 0.02). Conclusions Injured Medicare beneficiaries presenting to nontrauma centers experience high rates of undertriage, determined in part by increasing availability of resources. Care at hospitals with low rates of successful triage is associated with worse outcomes. PMID:24670846

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

    PubMed Central

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

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

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

    NASA Astrophysics Data System (ADS)

    So, E.

    2010-12-01

    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. Whats more, as the worlds 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.

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

    SciTech Connect

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

    1981-10-01

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

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

    PubMed Central

    2012-01-01

    Background Low-threshold and out-of-hours services play an important role in the emergency care for people with mental illness. In Norway casualty clinic doctors are responsible for a substantial share of acute referrals to psychiatric wards. This studys aim was to identify patients contacting the casualty clinic for mental illness related problems and study interventions and diagnoses. Methods At four Norwegian casualty clinics information on treatment, diagnoses and referral were retrieved from the medical records of patients judged by doctors to present problems related to mental illness including substance misuse. Also, routine information and relation to mental illness were gathered for all consecutive contacts to the casualty clinics. Results In the initial contacts to the casualty clinics (n?=?28527) a relation to mental illness was reported in 2.5% of contacts, whereas the corresponding proportion in the doctor registered consultations, home-visits and emergency call-outs (n?=?9487) was 9.3%. Compared to other contacts, mental illness contacts were relatively more urgent and more frequent during night time. Common interventions were advice from a nurse, laboratory testing, prescriptions and minor surgical treatment. A third of patients in contact with doctors were referred to in-patient treatment, mostly non-psychiatric wards. Many patients were not given diagnoses signalling mental problems. When police was involved, they often presented the patient for examination. Conclusions Most mental illness related contacts are managed in Norwegian casualty clinics without referral to in-patient care. The patients benefit from a wide range of interventions, of which psychiatric admission is only one. PMID:22520067

  17. On-Ground Casualty Risk Reduction by Structural Design for Demise

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Krag, Holger; Funke, Quirin

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

    Waller, Edward J

    2015-08-01

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

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

    PubMed

    Crossley, Leslie; Mueller, Lori; Horstman, Patricia

    2009-08-01

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

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

    ERIC Educational Resources Information Center

    Kunisch, Joseph Martin

    2012-01-01

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

  2. Optimization versus Effortful Processing in Children's Cognitive Triage: Criticisms, Reanalyses, and New Data.

    ERIC Educational Resources Information Center

    Brainerd, C. J.; And Others

    1993-01-01

    Evaluates two competing explanations for the phenomenon of cognitive triage, or the fact that easy-to-retrieve memories do not come to mind before hard-to-retrieve memories during recall. Reports experimental results that support an optimization model of recall rather than an effortful-processing model. (PAM)

  3. Nonstrategic Facilitation of Children's Recall: Evidence of Triage with Semantically Related Information.

    ERIC Educational Resources Information Center

    Haarnishfeger, Katherine K.; Brainerd, Charles J.

    1994-01-01

    Two studies examined whether triagelike patterns occur when children recall lists of semantically related words that support the use of mnemonic organizational strategies. Results provide evidence of the generality of triage effects in children's recall, finding such effects even in tasks that are highly supportive of mnemonic strategies. (HTH)

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

    ERIC Educational Resources Information Center

    Kunisch, Joseph Martin

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  6. Delivery room triage of large for gestational age infants of diabetic mothers

    PubMed Central

    Rath, Krista; Zheng, Katherine; Landon, Mark B; Nankervis, Craig A

    2014-01-01

    Objective: To review our 4-year experience (20082011) with delivery room triage of large for gestational age infants of diabetic mothers. Design/Methods: Retrospective cohort investigation of 311 large for gestational age infants of diabetic mothers (Whites Class A1 (77), A2 (87), B (77), and C-R (70)). Results: Of 311 women, 31% delivered at 3436 weeks gestational age and 69% at term. While 70% were delivered by cesarean, 30% were vaginal deliveries. A total of 160 asymptomatic infants were triaged from the delivery room to the well baby nursery. Of these, 55 (34%) developed hypoglycemia. In 43 cases, the hypoglycemia was corrected by early feedings; in the remaining 12, intravenous dextrose treatment was required. A total of 151 infants were triaged from the delivery room to the neonatal intensive care unit. Admission diagnoses included respiratory distress (51%), prevention of hypoglycemia (27%), prematurity (21%), and asphyxia (1%). Hypoglycemia affected 66 (44%) of all neonatal intensive care unit infants. Conclusion: Safe triage of asymptomatic large for gestational age infants of diabetic mothers from the delivery room to well baby nursery can be accomplished in the majority of cases. Those infants in need of specialized care can be accurately identified and effectively treated in the neonatal intensive care unit setting. PMID:26770716

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

    PubMed

    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

    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

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

    PubMed Central

    Mahmoodian, Farzad; Eqtesadi, Razie; Ghareghani, Atefe

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2016-06-01

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

  11. 33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and property. The Coast Guard investigator will follow the procedures outlined in 46 CFR subpart 4.07... casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Reports and...

  12. 33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and property. The Coast Guard investigator will follow the procedures outlined in 46 CFR subpart 4.07... casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Reports and...

  13. 33 CFR 150.812 - What is the purpose of reporting casualties on deepwater ports?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and property. The Coast Guard investigator will follow the procedures outlined in 46 CFR subpart 4.07... casualties on deepwater ports? 150.812 Section 150.812 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Reports and...

  14. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Reporting a...

  15. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Reporting a...

  16. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Reporting a...

  17. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Reporting a...

  18. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Reporting a diving-related casualty. Deaths and injuries related to diving within the safety zone of a deepwater port must be reported according to 46 CFR 197.484 and 197.486, rather than to §§ 150.815 and 150... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Reporting a...

  19. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  20. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  2. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  3. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

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

    ERIC Educational Resources Information Center

    Goode, John C.; Beck, Elaine

    At the First Battle of Manassas (Virginia) in 1861 many Union doctors fled the battlefield in fear. Those who remained found themselves without adequate medical supplies or ambulances for their patients. As the U.S. Civil War progressed and casualties mounted, military surgeons became more adept at caring for the wounded. By the Battle of

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

    ERIC Educational Resources Information Center

    Jackson, Elizabeth G.

    2008-01-01

    Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on

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

    ERIC Educational Resources Information Center

    Jackson, Elizabeth G.

    2008-01-01

    Chronic dieting distorts eating behaviors and causes weight escalation. Desperation about losing weight results in pursuit of extreme weight loss measures. Instead of offering yet another diet, nutrition educators can teach chronic dieters (dieting casualties) to develop eating competence. Eating Order, a 13-week class for chronic dieters based on…

  7. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2012-04-01 2012-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  8. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2013-04-01 2013-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  9. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2014-04-01 2014-04-01 false Beer lost by fire, theft... TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY ALCOHOL BEER Refund or Adjustment of Tax or Relief From Liability § 25.282 Beer lost by fire, theft, casualty, or act of God. (a) General. The tax paid...

  10. The Impact of the Triage Health Care Delivery System upon Client Morale, Independent Living and the Cost of Care.

    ERIC Educational Resources Information Center

    Hodgson, Joseph H., Jr.; Quinn, Joan L.

    1980-01-01

    Triage is unique because it includes several functions under a single health care delivery model. Clients' morale improved with their sense of control. Family support systems were enhanced. Costs were reasonable as was the reimbursement system. (JAC)

  11. [The role of the medical service in filling up the ranks of personnel combat casualties during war].

    PubMed

    Krutov, V S; Ziuzgin, S A; Ponomarenko, V N; Tsvetkov, V V

    1995-04-01

    This article is about the contribution of the Red Army Medical Service made in the process of combat casualty recovery of personnel of the active army in the years of the Great Patriotic war by returning wounded and sick to their ranks after their treatment. The authors show the main organizational measures which provided for creation of a casualty recovery system; describe the contents of information procedures for assuring the wounded and sick traffic control; emphasize the necessity to utilize the experience of the Red Army Medical Service for the development of the combat casualty recovery system in the Armed Forces in case of war. PMID:7610607

  12. Comparison of the 1999 and 2006 Trauma Triage Guidelines: Where do Patients Go?

    PubMed Central

    Lerner, E. Brooke; Shah, Manish N.; Swor, Robert; Cushman, Jeremy T.; Guse, Clare E.; Brasel, Karen; Blatt, Alan; Jurkovich, Gregory J.

    2010-01-01

    In 2006, the CDC released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by EMS for transport to a trauma center. Objective To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared to the 1999 scheme, and to determine how the scheme change would affect under- and over-triage rates. Methods EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The number of patients identified by the two schemes was determined. Patients were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics including 95% confidence intervals. Results EMS interviews were conducted for 11,892 patients and outcome data was unavailable for one patient. Average patient age was 48 years; 51% were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. 12% of enrolled patients were identified as needing a trauma center based on medical record review. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% CI:11-13%) being identified as needing a trauma center by EMS providers (40%; 95%CI:39-41% versus 28%; 95%CI:27-29%). 1,344 of those patients did not actually need the resources of a trauma center (94%). 78 (6%) of those patients actually needed the resources of a trauma center and would have been under-triaged. Conclusion Use of the 2006 Field Triage Decision Scheme would have resulted in a significant decrease in the number of patients identified as needing the resources of a trauma center. These changes reduced over-triage while causing a small increase in the number of patients who would have been under-triaged. PMID:21054176

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2011-01-01

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

  15. What do we need for airway management of adult casualties on the Primary Casualty Receiving Facility? A review of airway management on Role 3 Afloat.

    PubMed

    Mercer, S; Read, J; Sudheer, S; Risdall, J E; Connor, D

    2015-01-01

    The Primary Casualty Receiving Facility (PCRF) of the Royal Navy (RN) is currently based on Royal Fleet Auxiliary (RFA) ARGUS and provides a functioning hospital with surgical teams and a CT scanner (Role 3) within the maritime environment. The case mix could include complex trauma, critically ill patients returning to theatre several times, as well as non-battle injury procedures. This paper describes how we have used national guidelines, evidence from recent military experience, and the Clinical Guidelines for Operations (CGOs) to review and rationalise the airway equipment that is available and that would be required for the PCRF in its current configuration, whilst maintaining capability in a deployed setting. PMID:26867417

  16. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-30

    ..., affiliation, address, email, and telephone number. Those without Internet access should contact Suzanne... participants will be sent technical system requirements after registration and will be sent connection access... Internet at http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/default.htm . (Select...

  17. Paramedic operations specification as a launching point for mass casualty incident-targeted engineering design.

    PubMed

    Husain, Azmat; Sharp, Jonathan H; Gao, Tia; White, David

    2006-01-01

    This poster describes research on the workflow of paramedics during disaster response. After thorough solicitation of feedback from the user community, we translated the user workflows into data models that could be encompassed into information technologies for disaster response. Three data models described in this paper are: tasks to be completed by responders, resources used for each task, and communications link between responders. This work has been employed in Advanced Health and Disaster Aid Network (AID-N) architecture. PMID:17238581

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

    PubMed

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

    2015-05-01

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

  19. Evolutionary triage governs fitness in driver and passenger mutations and suggests targeting never mutations.

    PubMed

    Gatenby, R A; Cunningham, J J; Brown, J S

    2014-01-01

    Genetic and epigenetic changes in cancer cells are typically divided into 'drivers' and 'passengers'. Drug development strategies target driver mutations, but inter- and intratumoral heterogeneity usually results in emergence of resistance. Here we model intratumoral evolution in the context of a fecundity/survivorship trade-off. Simulations demonstrate that the fitness value of any genetic change is not fixed but dependent on evolutionary triage governed by initial cell properties, current selection forces and prior genotypic/phenotypic trajectories. We demonstrate that spatial variations in molecular properties of tumour cells are the result of changes in environmental selection forces such as blood flow. Simulated therapies targeting fitness-increasing (driver) mutations usually decrease the tumour burden but almost inevitably fail due to population heterogeneity. An alternative strategy targets gene mutations that are never observed. Because up or downregulation of these genes unconditionally reduces cellular fitness, they are eliminated by evolutionary triage but can be exploited for targeted therapy. PMID:25407411

  20. Evolutionary triage governs fitness in driver and passenger mutations and suggests targeting never mutations

    PubMed Central

    Gatenby, R A.; Cunningham, J. J.; Brown, J. S.

    2014-01-01

    Genetic and epigenetic changes in cancer cells are typically divided into drivers and passengers. Drug development strategies target driver mutations, but inter- and intra-tumoral heterogeneity usually results in emergence of resistance. Here we model intratumoral evolution in the context of a fecundity/survivorship trade-off. Simulations demonstrate the fitness value, of any genetic change is not fixed but dependent on evolutionary triage governed by initial cell properties, current selection forces, and prior genotypic/phenotypic trajectories. We demonstrate spatial variations in molecular properties of tumor cells are the result of changes in environmental selection forces such as blood flow. Simulated therapies targeting fitness-increasing (driver) mutations usually decrease the tumor burden but almost inevitably fail due to population heterogeneity. An alternative strategy targets gene mutations that are never observed. Because up or down regulation of these genes unconditionally reduces cellular fitness, they are eliminated by evolutionary triage but can be exploited for targeted therapy. PMID:25407411

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-02-01

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

  3. Computerized telephone nurse triage. An evaluation of service quality and cost.

    PubMed

    Cariello, Francesca P

    2003-01-01

    The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients. PMID:12698927

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

    PubMed

    Michalowski, Wojtek; Slowinski, Roman; Wilk, Szymon

    2004-01-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

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

  6. Tactical Combat Casualty Care in the Canadian Forces: lessons learned from the Afghan war

    PubMed Central

    Savage, Erin; Forestier, Colleen; Withers, Nicholas; Tien, Homer; Pannell, Dylan

    2011-01-01

    Tactical Combat Casualty Care (TCCC) is intended to treat potentially preventable causes of death on the battlefield, but acknowledges that application of these treatments may place the provider and even the mission in jeopardy if performed at the wrong time. Therefore, TCCC classifies the tactical situation with respect to health care provision into 3 phases (care under fire, tactical field care and tactical evacuation) and only permits certain interventions to be performed in specific phases based on the danger to the provider and casualty. In the 6 years that the Canadian Forces (CF) have been involved in sustained combat operations in Kandahar, Afghanistan, more than 1000 CF members have been injured and more than 150 have been killed. As a result, the CF gained substantial experience delivering TCCC to wounded soldiers on the battlefield. The purpose of this paper is to review the principles of TCCC and some of the lessons learned about battlefield trauma care during this conflict. PMID:22099324

  7. Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties.

    PubMed

    Morrison, Jonathan J; Ross, James D; Rasmussen, Todd E; Midwinter, Mark J; Jansen, Jan O

    2014-05-01

    The control of torso and junctional zone bleeding in combat casualties is particularly challenging because of its noncompressible nature. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has demonstrated promise in translational large animal and early clinical series as an effective resuscitation and hemorrhage control adjunct. However, it is unknown what proportion of combat casualties has an injury pattern and clinical course that is amenable to REBOA deployment. The prospective UK Joint Theatre Trauma Registry was used to retrospectively identify all UK military personnel who has sustained a severe combat injury, defined as an Abbreviated Injury Scale of three or greater, in the course of 10 years. Patients were then divided into three groups based on Abbreviated Injury Scale injury pattern: no indications for REBOA, contraindications (mediastinal, cervical, and axillary hemorrhage), and indications (torso and pelvic hemorrhage). From a total of 1,317 patients, 925 (70.2%) had no indication, 148 (11.2%) had a contraindication, and 244 (18.5%) had an indication for REBOA. Within the group with indications for REBOA, there were 174 deaths: 79 at the point of wounding, 66 en route to hospital, and 29 in-hospital deaths. The median (interquartile range) time to death in patients dying en route was 75 (42-109) min, and the median prehospital time for casualties admitted to hospital was 61 (34-89) min. One-in-five severely injured UK combat casualties have a focus of hemorrhage in the abdomen or pelvic junctional region potentially amenable to REBOA deployment. The UK military should explore REBOA as a potential en route hemorrhage control and resuscitation adjunct. PMID:25133599

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

    PubMed

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-01-01

    To fulfil its mission of compliance check to the French Space Operations Act, CNES has developed ELECTRA tool in order to estimate casualty risk induced by a space activity (like rocket launch, controlled or un-controlled re-entry on Earth of a space object). This article describes the application of such a tool for the EPS controlled re-entry during the second Ariane 5E/S flight (Johannes Kepler mission has been launched in February 2011). EPS is the Ariane 5E/S upper composite which is de-orbited from a 260 km circular orbit after its main mission (release of the Automated Transfer Vehicle - ATV). After a brief description of the launcher, the ATV-mission and a description of all the failure cases taken into account in the mission design (which leads to "back-up scenarios" into the flight software program), the article will describe the steps which lead to the casualty risk assessment (in case of failure) with ELECTRA. In particular, the presence on board of two propulsive means of de-orbiting (main engine of EPS, and 4 ACS longitudinal nozzles in case of main engine failure or exhaustion) leads to a low remaining casualty risk.

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

    USGS Publications Warehouse

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

    2011-01-01

    Since the launch of the USGSs Prompt Assessment of Global Earthquakes for Response (PAGER) system in fall of 2007, the time needed for the U.S. Geological Survey (USGS) to determine and comprehend the scope of any major earthquake disaster anywhere in the world has been dramatically reduced to less than 30 min. PAGER alerts consist of estimated shaking hazard from the ShakeMap system, estimates of population exposure at various shaking intensities, and a list of the most severely shaken cities in the epicentral area. These estimates help government, scientific, and relief agencies to guide their responses in the immediate aftermath of a significant earthquake. To account for wide variability and uncertainty associated with inventory, structural vulnerability and casualty data, PAGER employs three different global earthquake fatality/loss computation models. This article describes the development of the models and demonstrates the loss estimation capability for earthquakes that have occurred since 2007. The empirical model relies on country-specific earthquake loss data from past earthquakes and makes use of calibrated casualty rates for future prediction. The semi-empirical and analytical models are engineering-based and rely on complex datasets including building inventories, time-dependent population distributions within different occupancies, the vulnerability of regional building stocks, and casualty rates given structural collapse.

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

    NASA Astrophysics Data System (ADS)

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

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

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

    PubMed

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

    2008-12-01

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

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

    PubMed

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

    2014-06-15

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

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

    PubMed Central

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

    2014-01-01

    Using human papillomavirus (HPV) testing for cervical cancer screening in lower-resource settings (LRS) will result in a significant number of screen-positive women. This analysis compares different triage strategies for detecting cervical precancer and cancer among HPV-positive women in LRS. This was a population-based study of women aged 2565 years living in China (n?=?7,541). Each woman provided a self-collected and two clinician-collected specimens. The self-collected and one clinician-collected specimen were tested by two HPV DNA testscareHPV and Hybrid Capture 2; the other clinician-collected specimen was tested for HPV16/18/45 E6 protein. CareHPV-positive specimens were tested for HPV16/18/45 DNA. HPV DNA-positive women underwent visual inspection with acetic acid (VIA) and then colposcopic evaluation with biopsies. The performance for detection of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) among HPV DNA-positive women was assessed for different triage strategies: HPV16/18/45 E6 or DNA detection, VIA, colposcopic impression, or higher signal strength (?10 relative light units/positive control [rlu/pc]). The percent triage positive ranges were 14.817.4% for VIA, 17.820.9% for an abnormal colposcopic impression; 7.910.5% for HPV16/18/45 E6; 23.428.4% for HPV16/18/45 DNA; and 48.062.6% for higher signal strength (?10 rlu/pc), depending on the HPV test/specimen combination. The positivity for all triage tests increased with severity of diagnosis. HPV16/18/45 DNA detection was approximately 70% sensitive and had positive predictive values (PPV) of approximately 25% for CIN3+. HPV16/18/45 E6 detection was approximately 50% sensitive with a PPV of nearly 50% for CIN3+. Different triage strategies for HPV DNA-positive women provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for prevalent CIN3+. What's new? The careHPV test is a novel technology for primary cervical cancer screening of women from lower-resource settings. However, triage strategies are needed to identify which HPV-positive women are at highest risk of cervical precancer and cancer. Here, multiple viable and affordable strategies to manage HPV-positive women depending on local requirements and resources are identified, based on evaluation of the performance of different triage strategies for developing countries. The different strategies for women who test positive for HPV DNA provide important tradeoffs in colposcopy or treatment referral percentages and sensitivity for cervical intraepithelial neoplasia grade 3 or cancer (CIN3+). PMID:24248915

  15. [Triage of the injured in military surgery and in exceptional situations].

    PubMed

    Houdelette, P

    1996-01-01

    Sorting casualties is universally accepted as the best means of coordinating a large number of patients with war injuries. Sorting means classifying casualties by characteristic medical and health features according to three types of criteria: diagnosis: gravity of the injury; prognosis: predictable survival; and logistic: evaluation of demand for care and possibilities for evaluation. The sorting process may be systematic or selective. The rules applied in different war situations or in civilian catastrophies vary according to the emergency care system which is called in (French Army, NATO, International Red Cross, GNO). The current role of the intensive care physician as a sorter is underlined. More than a doctrine, surgical sorting is a concept of action to be understood. PMID:9296002

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

    PubMed Central

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

    2002-01-01

    Objective To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. Design Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. Setting Three primary care sites in York. Participants 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. Main outcome measures Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. Results The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference 1.48 more per patient for triage (95% confidence interval 0.19 to 3.15). Conclusions Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments. What is already known on this topicNurse telephone triage is used to manage the increasing demand for same day appointments in general practiceEvidence that nurse telephone triage is effective is limitedWhat this study addsTriage resulted in 29-44% fewer same day appointments with general practitioners than standard managementNursing and overall time increased in the triage group as 40% of patients were managed by nursesTriage was not less costly than standard management because of increased costs for nursing, follow up, out of hours, and accident and emergency care PMID:12446539

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

    PubMed

    Tominaga, Mariko; Michiue, Tomomi; Maeda, Hitoshi

    2015-11-01

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

  18. How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes' Theorem

    PubMed Central

    Thijs, Abel; Bossuyt, Patrick M.; Smulders, Yvo M.

    2016-01-01

    Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes’ theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test. For a maximum proportion of missed PEs of 1% in triage-negative patients, we calculate a 67% 'mandatory minimum' proportion of negative CTA scans. To achieve this, the proportion of patients with PE undergoing triage testing should be appropriately low, in this case no higher than 24%. Pre-test probability, triage test characteristics, the proportion of negative confirmation tests, and the number of missed diagnoses are mathematically entangled. The proportion of negative confirmation tests—not too high, but definitely not too low either—could be a quality benchmark for diagnostic processes. PMID:26939066

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

    PubMed

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

    2016-02-01

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

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

    PubMed Central

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

    2014-01-01

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

  1. Educational Triage and Ability-Grouping in Primary Mathematics: A Case-Study of the Impacts on Low-Attaining Pupils

    ERIC Educational Resources Information Center

    Marks, Rachel

    2014-01-01

    This case-study, drawing on an unanticipated theme arising from a wider study of ability-grouping in primary mathematics, documents some of the consequences of educational triage in the final year of one primary school. The paper discusses how a process of educational triage, as a response to accountability pressures, is justified by teachers on…

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

    PubMed

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

    2000-03-01

    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

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

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

    2015-01-01

    Some 620,000 emergency department (ED) visits for acute alcohol intoxication occur annually in the U.S. A half to two-thirds of these appear to be uncomplicated, and might safely be triaged to management in non-ED settings. We hypothesized that consensus criteria would afford sensitive and specific triage. Methods: Paramedics collected data on 99 apparently inebriated persons en route to the ED. We retrospectively reviewed these patients ED charts to assess who actually required ED care. We then estimated sensitivity and specificity for proposed triage criteria that would have excluded patients from non-ED care: chest or abdominal pain, shortness of breath, suicidal ideation, abnormal vital signs or Glasgow Coma Scale, signs of head trauma, inability to ambulate, seizure, lacerations, fractures, or pregnancy. Results: Subjects were mostly male (89%), homeless (57%), and found on the street (81%); 17 appeared to require ED care, 39 were eligible for non-ED care, but 4 of these would have bounced back to the ED (negative predictive value 90%, sensitivity 76%, 95% CI: 5093%; specificity 44%, 95% CI: 3355). Paramedic opinion alone was highly specific (80%) but not very sensitive (41%). Lowering the pulse exclusion threshold from 130 to 83 would increase sensitivity to 100%, but decrease specificity to 22%. A simple post-hoc rule excluding those with age > 55 or pulse > 83 from non-ED care had high sensitivity (94%) and fair specificity (61%). The proposed criterias sensitivity and specificity varied (6583% and 4449%, respectively) depending on which ED services were considered optional (e.g., psychiatric consultation, EKG, IV fluids, etc). Conclusions: Most apparently inebriated individuals in this study did not require ED care, but prospective identification of these persons is a challenge. A low exclusion cutoff for tachycardia may improve sensitivity. PMID:20616108

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

    PubMed

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

    2014-01-01

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

  6. Cytology Specimen Management, Triage and Standardized Reporting of Fine Needle Aspiration Biopsies of the Pancreas

    PubMed Central

    Yoon, Won Jae; Bishop Pitman, Martha

    2015-01-01

    The recent advances in pancreas cytology specimen sampling methods have enabled a specific cytologic diagnosis in most cases. Proper triage and processing of the cytologic specimen is pivotal in making a diagnosis due to the need for ancillary testing in addition to cytological evaluation, which is especially true in the diagnosis of pancreatic cysts. Newly proposed terminology for pancreaticobiliary cytology offers a standardized language for reporting that aims to improve communication among patient caregivers and provide for increased flexibility in patient management. This review focuses on these updates in pancreas cytology for the optimal evaluation of solid and cystic lesions of the pancreas. PMID:26265683

  7. Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience

    PubMed Central

    Maleki, Mohammadreza; Fallah, Razieh; Riahi, Leila; Delavari, Sajad; Rezaei, Satar

    2015-01-01

    Background: Triage for patients’ prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation. Objectives: The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage. Patients and Methods: Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%). Results: Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant. Conclusions: Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system. PMID:26848473

  8. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    PubMed

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria. PMID:26017368

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

    PubMed Central

    2010-01-01

    Background User reported experiences and satisfaction are increasingly used as basis for quality indicators in the health sector. However, there is limited understanding of factors associated with user reported experiences and satisfaction with casualty clinics. Methods A random sample of 542 patients that had contacted any of three casualty clinics from mid April to mid May 2008 was mailed a questionnaire. A reminder was sent to non-respondents after six weeks. Descriptive statistics for four user reported experiences scales and 20 single items are presented. Multivariate regression analysis was used to assess associations between background variables and user reported experiences, and between user reported experiences and user satisfaction. Results 225 (41.5%) patients, carers and guardians returned a completed questionnaire. Users reported most positive experiences with the doctor services and the nursing services at the casualty clinics; on a scale from 0 to 100, where 100 is the best possible experience the doctor scale was 82 and the nursing scale 81. Users reported least positive experiences with the organization of the casualty clinic, with a scale score of 65. Self perceived health was associated with user satisfaction, while self perceived health and age were associated with user reported experiences with organization of the clinics. A range of user reported experience domains were related to user satisfaction, after controlling for socio-demographic variables, including experiences with doctor services at the clinics, organization of the clinics, information and self perceived incorrect treatment. Conclusions Users report positive experiences with the three casualty clinics, with organization as the aspect with largest improvement potential. The importance of age and health status for users' experiences and satisfaction with casualty clinics was shown, but a range of user reported experiences with the clinics were the most important predictors for user satisfaction. PMID:20925930

  10. Assessing the applicability of FISH-based prematurely condensed dicentric chromosome assay in triage biodosimetry.

    PubMed

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

    2015-03-01

    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

  11. The essential roles of chemistry in high-throughput screening triage

    PubMed Central

    Dahlin, Jayme L; Walters, Michael A

    2015-01-01

    It is increasingly clear that academic high-throughput screening (HTS) and virtual HTS triage suffers from a lack of scientists trained in the art and science of early drug discovery chemistry. Many recent publications report the discovery of compounds by screening that are most likely artifacts or promiscuous bioactive compounds, and these results are not placed into the context of previous studies. For HTS to be most successful, it is our contention that there must exist an early partnership between biologists and medicinal chemists. Their combined skill sets are necessary to design robust assays and efficient workflows that will weed out assay artifacts, false positives, promiscuous bioactive compounds and intractable screening hits, efforts that ultimately give projects a better chance at identifying truly useful chemical matter. Expertise in medicinal chemistry, cheminformatics and purification sciences (analytical chemistry) can enhance the post-HTS triage process by quickly removing these problematic chemotypes from consideration, while simultaneously prioritizing the more promising chemical matter for follow-up testing. It is only when biologists and chemists collaborate effectively that HTS can manifest its full promise. PMID:25163000

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

    PubMed

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

    2014-09-01

    The healthcare industry is streamlining processes to offer more timely and effective services to all patients. Computerized software algorithm and smart devices can streamline the relation between users and doctors by providing more services inside the healthcare telemonitoring systems. This paper proposes a multi-sources framework to support advanced healthcare applications. The proposed framework named Multi Sources Healthcare Architecture (MSHA) considers multi-sources: sensors (ECG, SpO2 and Blood Pressure) and text-based inputs from wireless and pervasive devices of Wireless Body Area Network. The proposed framework is used to improve the healthcare scalability efficiency by enhancing the remote triaging and remote prioritization processes for the patients. The proposed framework is also used to provide intelligent services over telemonitoring healthcare services systems by using data fusion method and prioritization technique. As telemonitoring system consists of three tiers (Sensors/ sources, Base station and Server), the simulation of the MSHA algorithm in the base station is demonstrated in this paper. The achievement of a high level of accuracy in the prioritization and triaging patients remotely, is set to be our main goal. Meanwhile, the role of multi sources data fusion in the telemonitoring healthcare services systems has been demonstrated. In addition to that, we discuss how the proposed framework can be applied in a healthcare telemonitoring scenario. Simulation results, for different symptoms relate to different emergency levels of heart chronic diseases, demonstrate the superiority of our algorithm compared with conventional algorithms in terms of classify and prioritize the patients remotely. PMID:25047520

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Moriya, Fumio

    2009-04-01

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

  15. A Spinal Triage Programme Delivered by Physiotherapists in Collaboration with Orthopaedic Surgeons

    PubMed Central

    Grona, Stacey Lovo; Janzen, Bonnie

    2012-01-01

    ABSTRACT Purpose: To describe the characteristics of participants in a physiotherapist spinal triage programme, compare the profiles of patients for whom surgery was and was not recommended by a surgeon, and determine the surgical yield among those referred to surgeons. Methods: Data were collected retrospectively by reviewing charts of people who used the service over a 3-year period (20032006). Data from up to1,096 people were used in the analysis; complete data were available for 299 people. Descriptive statistics were used to summarize demographics, clinical features, and management recommendations. Characteristics of those who were and were not recommended for surgery were examined using Pearson's chi-square or Fisher's Exact tests. Results: The majority of 746 participants were classified as mechanical spine (92.5%), 2.9% were other body part, 2.5% were medical/other, and only 2% were classified as surgical spine. Recommendations for surgery (by a surgeon) were independent of patients' age, sex, duration of symptoms, residence (urban/rural), source of health care funding, and diagnosis. The surgical yield was 80%. Conclusions: Most people were not considered candidates for surgery. Triage assessment by physiotherapists can increase the efficiency of an orthopaedic surgeon's caseload by reducing the number of non-surgical referrals and can thus help to ensure more timely access to appropriate health care. PMID:23997390

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

    NASA Astrophysics Data System (ADS)

    Voss, Shannon Prentice

    As radiation specialists, one of our primary objectives in the Navy is protecting people and the environment from the effects of ionizing and non-ionizing radiation. Focusing on radiological dispersal devices (RDD) will provide increased personnel protection as well as optimize emergency response assets for the general public. An attack involving an RDD has been of particular concern because it is intended to spread contamination over a wide area and cause massive panic within the general population. A rapid method of triage will be necessary to segregate the unexposed and slightly exposed from those needing immediate medical treatment. Because of the aerosol dispersal of the radioactive material, inhalation of the radioactive material may be the primary exposure route. The primary radionuclides likely to be used in a RDD attack are Co-60, Cs-137, Ir-192, Sr-90 and Am-241. Through the use of a MAX phantom along with a few Simulink MATLAB programs, a good anthropomorphic phantom was created for use in MCNPX simulations that would provide organ doses from internally deposited radionuclides. Ludlum model 44-9 and 44-2 detectors were used to verify the simulated dose from the MCNPX code. Based on the results, acute dose rate limits were developed for emergency response personnel that would assist in patient triage.

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

    PubMed

    Bruce, Karin; Suserud, Bjrn-Ove

    2005-01-01

    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

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

    PubMed

    Broughton, Jeremy

    2012-03-01

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

  19. Alcohol consumption and casualties: a comparison of emergency room populations in the United States and Mexico.

    PubMed

    Cherpitel, C J; Rosovsky, H

    1990-07-01

    This study compares alcohol consumption and casualties in probability samples of emergency room populations in the U.S. and Mexico: four hospitals representative of a Bay Area California county (N = 3,609) and eight hospitals representative of Mexico City (N = 2,507). Both studies used similar methods and data collection instruments. Patients were breath analyzed and interviewed regarding self-reported alcohol consumption 6 hours prior to the injury or illness event, usual drinking patterns and alcohol-related problems. Similar associations of alcohol consumption and casualties were found between the two populations with positive admission breath-analyzer readings and moderate consumption being positively associated with injuries. Both samples reported higher rates of heavy drinking, drunkenness and alcohol-related problems than that found in general surveys of their respective populations. Differences found between the two samples were largely due to varying drinking patterns in the two cultures and to differing uses of the emergency room for treatment. PMID:2359304

  20. Prediction of alcohol-related casualties in the emergency room: a U.S.-Spain comparison.

    PubMed

    Cherpitel, C J; Pars, A; Rods, J

    1993-05-01

    Alcohol consumption variables predictive of casualties are compared in probability samples of emergency room (ER) patients in two countries with different drinking patterns; (1) Spain, where frequent light drinking is the typical pattern (N = 2,072), and (2) the U.S. (i.e., California), where less frequent heavier drinking is more typical (N = 1,756). Logistic regression was used to evaluate the predictive value of breath-analyzer readings, drinking patterns and problems, time and place of injury, and demographic characteristics on ER admission for injuries vs noninjuries and for alcohol-related injuries vs non-alcohol-related injuries. Quantity and frequency of drinking, time and place of injury, and feeling drunk at the time of the event were predictive of casualties in California. Drinking patterns were less predictive of injury occurrence and of alcohol-related injury in Spain. One possible explanation for this difference may be that drinking is integrated into society as part of the wine drinking culture in Spain, while in the U.S. drinking occasions are more circumscribed by appropriateness of time and place. PMID:8487539

  1. Healthcare-Associated Pneumonia among United States Combat Casualties, 20092010

    PubMed Central

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

    2014-01-01

    Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the 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

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

    NASA Technical Reports Server (NTRS)

    Kelley, R. L.

    2012-01-01

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

  3. An Intervention to Improve the Comfort And Satisfaction of Nurses in the Telephone Triage of Child Maltreatment Calls.

    PubMed

    Hunter, Julie

    2015-01-01

    Nurses are mandated reporters of actual or suspected child maltreatment or the threat thereof. The purpose of this quality improvement project was to determine the knowledge and comfort of nurses in telephone triage in pediatric clinics when dealing with suspected or actual child abuse calls. Nurses (N = 17) from three pediatric primary care clinics and one specialty care orthopedic clinic were surveyed. Based on results of the survey showing a lack of knowledge and adequate referral resources perceived by the nursing staff, resources and staff education were developed, along with a script for guiding maltreatment calls toward standardization of care. Following the intervention, nurses reported an increased comfort level when doing telephone triage for child maltreatment calls, an increase in knowledge of risk factors for county resources. Further, they reported a substantial shift in opinion about the need for a standardized script when responding to child maltreatment telephone calls. Nurses undertaking telephone triage of high-risk child maltreatment calls can improve their comfort and knowledge through a survey of their needs and directed education and resource development for the management of child maltreatment telephone triage. PMID:26837100

  4. After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices.

    ERIC Educational Resources Information Center

    Poole, Steven R.; And Others

    1993-01-01

    Examines data from four years of operation of a program to manage after-hours pediatrics calls using specially trained pediatric nurses with standardized protocols to provide triage and advice. Found that over 100,000 calls had been successfully managed without adverse clinical outcomes. Satisfaction among subscribing pediatricians was 100%, and…

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

    PubMed

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

    2008-04-01

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

  6. Improving Medical Residents' Attitudes toward HIV-Infected Persons through Training in an HIV Staging and Triage Clinic.

    ERIC Educational Resources Information Center

    Orlander, Jay D.; And Others

    1994-01-01

    A study assessed the effectiveness of a weekly outpatient clinic for staging and triage of newly identified human-immunodeficiency-virus (HIV)-infected patients on 21 medical residents' attitudes and knowledge regarding HIV patient care, as compared with 20 control students. Results indicated that the experience positively affected student…

  7. Dentistry and Mass Disaster – A Review

    PubMed Central

    Sakthi, D Sri

    2014-01-01

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

  8. Biopsychosocial predictors of short-term success among people with low back pain referred to a physiotherapy spinal triage service

    PubMed Central

    Bath, Brenna; Lovo Grona, Stacey

    2015-01-01

    Background A spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists. Methods Participants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115). Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of success was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome. Results Despite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores) in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6%) and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%). A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome. Conclusion There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress (measured by the Fear Avoidance Beliefs Questionnaire and the Distress and Risk Assessment Measure) were more likely to improve on certain outcomes. The use of an evaluation framework guided by a biopsychosocial model may help determine potential mechanisms of action for a physiotherapy-delivered triage program. PMID:25960675

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

    USGS Publications Warehouse

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

    2009-01-01

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

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

    PubMed

    Zahran, Sammy; Tavani, Daniele; Weiler, Stephan

    2013-07-01

    Casualties from natural disasters may depend on the day of the week they strike. With data from the Spatial Hazard Events and Losses Database for the United States (SHELDUS), daily variation in hurricane and tornado casualties from 5,043 tornado and 2,455 hurricane time/place events is analyzed. Hurricane forecasts provide at-risk populations with considerable lead time. Such lead time allows strategic behavior in choosing protective measures under hurricane threat; opportunity costs in terms of lost income are higher during weekdays than during weekends. On the other hand, the lead time provided by tornadoes is near zero; hence tornados generate no opportunity costs. Tornado casualties are related to risk information flows, which are higher during workdays than during leisure periods, and are related to sheltering-in-place opportunities, which are better in permanent buildings like businesses and schools. Consistent with theoretical expectations, random effects negative binomial regression results indicate that tornado events occurring on the workdays of Monday through Thursday are significantly less lethal than tornados that occur on weekends. In direct contrast, and also consistent with theory, the expected count of hurricane casualties increases significantly with weekday occurrences. The policy implications of observed daily variation in tornado and hurricane events are considered. PMID:23126406

  11. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... must also include the information relating to alcohol and drug involvement specified by 46 CFR 4.05-12... CFR part 16. (c) If filed immediately after the event, the written report required by paragraph (a) of... casualty be submitted, and what must it contain? 150.820 Section 150.820 Navigation and Navigable...

  12. Examining technologies to control hemorrhage by using modeling and simulation to simulate casualties and treatment.

    PubMed

    von Tersch, Robert; Birch, Harry; Gupta, Raj; Tyner, C F

    2009-02-01

    Military personnel deployed to Iraq and Afghanistan witnessed decreased numbers of soldiers killed in action and increased numbers of soldiers wounded in action. Medical personnel attribute these changes to use of improved body armor, rapid evacuation to medical treatment facilities, and use of medical technology. In recent years, medical technologist performed extensive research to identify and develop better field tourniquets and bandages to support wounded soldiers. Determining the benefit of these technologies to save a wounded soldier's life poses numerous challenges for medical personnel and commanders tasked to determine these benefits and make buy or no-buy decisions. This study uses modeling and simulation (M&S) to produce combat casualties, incorporate the projected benefits of field tourniquets and bandages, and examine their effects on wounded soldiers in a realistic simulated combat setting. The results show the positive benefit of using M&S to support analysis of medical technology and to inform medical research decisions. PMID:19317189

  13. Predictive utility of cardiac ultrasound in traumatic cardiac arrest in a combat casualty.

    PubMed

    Kinnear-Mellor, Rex; Newton, K; Woolley, T; Rickard, R

    2016-02-01

    We report a case of traumatic cardiac arrest in a combat casualty who was resuscitated to return of spontaneous circulation despite asystole and no visible cardiac activity on initial ultrasound examination. This return of spontaneous circulation suggests that survival may be possible in traumatic cardiac arrest due to exsanguination, even when there is no demonstrable cardiac activity on ultrasound. Cardiac ultrasonography was performed for 10?s only. We suggest that cardiac ultrasonography should be performed for a minimum of 1?min during volume resuscitation. If absence of cardiac activity is confirmed once the heart is full, and there are no other signs of life (including pupillary reaction), then termination of resuscitation should be considered. PMID:25736444

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

    PubMed

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

    2011-03-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2009-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-08-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2012-07-01

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

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

    PubMed

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

    2011-03-01

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

  20. The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review

    PubMed Central

    Bunn, Frances; Byrne, Geraldine; Kendall, Sally

    2005-01-01

    Background In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care. Aim To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction. Design of study We looked at randomised controlled trials, controlled studies, controlled before/after studies, and interrupted time series of telephone consultation or triage in a general healthcare setting. Setting All healthcare settings were included but the majority of studies were in primary care. Method We searched the Cochrane Central Register of Controlled Trials, EPOC specialised register, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register and checked reference lists of identified studies and review articles. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. Results Nine studies met our inclusion criteria: five randomised controlled trials; one controlled trial; and three interrupted time series. Six studies compared telephone consultation with normal care; four by a doctor, one by a nurse, and one by a clinic clerk. Three of five studies found a significant decrease in visits to GPs but two found an increase in return consultations. In general at least 50% (range = 25.572.2%) of calls were handled by telephone consultation alone. Of seven studies reporting accident and emergency department visits, six showed no difference between the groups and one of nurse telephone consultation found an increase. Two studies reported deaths and found no difference between nurse telephone consultation and normal care. Conclusions Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction. PMID:16378566

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

    PubMed Central

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

    1994-01-01

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

  2. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

    PubMed Central

    El Hag, Imad A.; Elsiddig, Kamal E.; Elsafi, Mohamed E.M.O; Elfaki, Mona E.E.; Musa, Ahmed M.; Musa, Brima Y.; Elhassan, Ahmed M.

    2013-01-01

    Abstract Background Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective To develop a reliable clinical algorithm for primary care settings to triage cases of non-specific, tuberculous and malignant lymphadenopathies. Methods Calculation of the odd ratios (OR) of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (Receiver Operator Characteristic) curve. Results Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR), nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of 3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area under the ROC curve was 0.964 (95% CI, 0.949 0.980) and -0.856 (95% CI, 0.787 - 0.925) for scores A and B respectively, indicating good performance. Conclusion The developed algorithm can efficiently triage cases with tuberculous and malignant lymphadenopathies for treatment or referral to specialised centres for further work-up.

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

    PubMed

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

    2014-05-01

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

  4. Socio-demographic Characteristics and Leading Causes of Death Among the Casualties of Meteorological Events Compared With All-cause Deaths in Korea, 2000-2011

    PubMed Central

    Lee, Kyung Eun; Myung, Hyung-Nam; Na, Wonwoong

    2013-01-01

    Objectives This study investigated the socio-demographic characteristics and medical causes of death among meteorological disaster casualties and compared them with deaths from all causes. Methods Based on the death data provided by the National Statistical Office from 2000 to 2011, the authors analyzed the gender, age, and region of 709 casualties whose external causes were recorded as natural events (X330-X389). Exact matching was applied to compare between deaths from meteorological disasters and all deaths. Results The total number of deaths for last 12 years was 2 728 505. After exact matching, 642 casualties of meteorological disasters were matched to 6815 all-cause deaths, which were defined as general deaths. The mean age of the meteorological disaster casualties was 51.56, which was lower than that of the general deaths by 17.02 (p<0.001). As for the gender ratio, 62.34% of the meteorological event casualties were male. While 54.09% of the matched all-cause deaths occurred at a medical institution, only 7.6% of casualties from meteorological events did. As for occupation, the rate of those working in agriculture, forestry, and fishery jobs was twice as high in the casualties from meteorological disasters as that in the general deaths (p<0.001). Meteorological disaster-related injuries like drowning were more prevalent in the casualties of meteorological events (57.48%). The rate of amputation and crushing injury in deaths from meteorological disasters was three times as high as in the general deaths. Conclusions The new information gained on the particular characteristics contributing to casualties from meteorological events will be useful for developing prevention policies. PMID:24137528

  5. A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index

    PubMed Central

    Damle, Ash; Casale, Michael; Branson, Kim; Churi, Chaitanya; Komatireddy, Ravi; Feramisco, Jamison

    2015-01-01

    Background We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity. Objective The objective of this study was to compare cGPS results with an established gold standard in emergency triage. Methods We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2). Results Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases). Conclusions These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments. PMID:26063343

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

    PubMed Central

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

    2014-01-01

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

  7. Automatic Pre-Hospital Vital Signs Waveform and Trend Data Capture Fills Quality Management, Triage and Outcome Prediction Gaps

    PubMed Central

    Mackenzie, Colin F; Hu, Peter; Sen, Ayan; Dutton, Rick; Seebode, Steve; Floccare, Doug; Scalea, Tom

    2008-01-01

    Trauma Triage errors are frequent and costly. What happens in pre-hospital care remains anecdotal because of the dual responsibility of treatment (resuscitation and stabilization) and documentation in a time-critical environment. Continuous pre-hospital vital signs waveforms and numerical trends were automatically collected in our study. Abnormalities of pulse oximeter oxygen saturation (< 95%) and validated heart rate (> 100/min) showed better prediction of injury severity, need for immediate blood transfusion, intra-abdominal surgery, tracheal intubation and chest tube insertion than Trauma Registry data or Pre-hospital provider estimations. Automated means of data collection introduced the potential for more accurate and objective reporting of patient vital signs helping in evaluating quality of care and establishing performance indicators and benchmarks. Addition of novel and existing non-invasive monitors and waveform analyses could make the pulse oximeter the decision aid of choice to improve trauma patient triage. PMID:18999022

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

    PubMed Central

    Pollock, Richard A.

    2008-01-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

    In this paper, we introduce a user interface called the "Threat Chip Display" (TCD) for rapid human-in-the-loop analysis and detection of "threats" in high-bandwidth imagery and video from a list of "Items of Interest" (IOI), which includes objects, targets and events that the human is interested in detecting and identifying. Typically some front-end algorithm (e.g., computer vision, cognitive algorithm, EEG RSVP based detection, radar detection) has been applied to the video and has pre-processed and identified a potential list of IOI. The goal of the TCD is to facilitate rapid analysis and triaging of this list of IOI to detect and confirm actual threats. The layout of the TCD is designed for ease of use, fast triage of IOI, and a low bandwidth requirement. Additionally, a very low mental demand allows the system to be run for extended periods of time.

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

    PubMed Central

    Bath, Brenna; Pahwa, Punam

    2012-01-01

    Purpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders. Methods: Participants with low backrelated 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

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

    PubMed Central

    Sethi, C; Grey, R; Hart, C

    1999-01-01

    AIMSThe largest clinical series of laser pointer exposures to date is described, to document any long term visual sequelae and assess objectively the visual threat from transient ocular exposure.?METHODS14 cases were collected prospectively and triaged by ophthalmic nurses before referral to an ophthalmologist for a complete ophthalmic examination. Regardless of the need for clinical follow up, all patients were contacted by telephone at a mean interval of 10.5months following exposure to inquire about new or persisting symptoms.?RESULTS11/14 cases presented within 24hours of exposure and 5/14 incidents were reported to the police. Reduced acuity in the affected eye compared with the contralateral were documented in 5/14 cases. The commonest physical sign was a punctate epitheliopathy, seen in 5/14 cases, and the commonest symptom was ocular discomfort, reported by 11/14 patients. There were no consistent retinal findings. Follow up by telephone survey revealed that two patients were wearing new glasses, but had not been refracted before the exposure; one had intermittent ocular discomfort; the remaining 11were asymptomatic.?CONCLUSIONSThis study is reassuring to the ophthalmology community and the general public in failing to demonstrate consistent, long term damaging effects of transient ocular exposure to laser pointer beams.?? PMID:10502579

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

    PubMed

    2011-07-01

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

  13. The PAndemic INfluenza Triage in the Emergency Department (PAINTED) pilot cohort study.

    PubMed Central

    Goodacre, Steve; Irving, Andy; Wilson, Richard; Beever, Daniel; Challen, Kirsty

    2015-01-01

    BACKGROUND Research needs to be undertaken rapidly in the event of an influenza pandemic to develop and evaluate triage methods for people presenting to the emergency department with suspected pandemic influenza. OBJECTIVES We aimed to pilot a research study to be undertaken in a pandemic to identify the most accurate triage method for patients presenting to the emergency department with suspected pandemic influenza. The objectives of the pilot study were to develop a standardised clinical assessment form and secure online database; test both using data from patients with seasonal influenza; seek clinician views on the usability of the form; and obtain all regulatory approvals required for the main study. DESIGN Study methods were piloted using an observational cohort study and clinician views were sought using qualitative, semistructured interviews. SETTING Six acute hospital emergency departments. PARTICIPANTS Patients attending the emergency department with suspected seasonal influenza during winter 2012-13 and clinicians working in the emergency departments. MAIN OUTCOME MEASURES Adverse events up to 30 days were identified, but analysis of the pilot data was limited to descriptive reporting of patient flow, data completeness and patient characteristics. RESULTS Some 165 patients were identified, of whom 10 withdrew their data, leaving 155 (94%) for analysis. Follow-up data were available for 129 of 155 (83%), with 50 of 129 (39%) being admitted to hospital. Three cases (2%) were recorded as having suffered an adverse outcome. There appeared to be variation between the hospitals, allowing for small numbers. Three of the hospitals identified 150 of 165 (91%) of the patients, and all 10 withdrawing patients were at the same hospital. The proportion with missing follow-up data varied from 8% to 31%, and the proportion admitted varied from 4% to 85% across the three hospitals with meaningful numbers of cases. All of the deaths were at one hospital. There was less variation between hospitals in rates of missing data, and for most key variables missing rates were between 5% and 30%. Higher missing rates were recorded for blood pressure (39%), inspired oxygen (43%), capillary refill (36%) and Glasgow Coma Scale score (43%). Chest radiography was performed in 51 of 118 cases, and electrocardiography in 40 of 111 cases with details recorded. Blood test results were available for 32 of 155 cases. The qualitative interviews revealed generally positive views towards the standardised assessment form. Concerns about lack of space for free text were raised but counterbalanced by appreciation that it fitted on to one A4 page. A number of amendments were suggested but only three of these were suggested by more than one participant, and no suggestions were made by more than two participants. CONCLUSIONS A standardised assessment form is acceptable to clinicians and could be used to collect research data in an influenza pandemic, but analysis may be limited by missing data. FUTURE WORK An observational cohort study to identify the most accurate triage method for predicting severe illness in emergency department attendees with suspected pandemic influenza is set up and ready to activate if, or when, a pandemic occurs. TRIAL REGISTRATION Current Controlled Trials ISRCTN56149622. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 3. See the NIHR Journals Library website for further project information. PMID:25587699

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

    PubMed

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

    2011-01-01

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

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

    PubMed

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

    2008-07-01

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

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

    PubMed Central

    Ames, Bruce N.

    2006-01-01

    Inadequate dietary intakes of vitamins and minerals are widespread, most likely due to excessive consumption of energy-rich, micronutrient-poor, refined food. Inadequate intakes may result in chronic metabolic disruption, including mitochondrial decay. Deficiencies in many micronutrients cause DNA damage, such as chromosome breaks, in cultured human cells or in vivo. Some of these deficiencies also cause mitochondrial decay with oxidant leakage and cellular aging and are associated with late onset diseases such as cancer. I propose DNA damage and late onset disease are consequences of a triage allocation response to micronutrient scarcity. Episodic shortages of micronutrients were common during evolution. Natural selection favors short-term survival at the expense of long-term health. I hypothesize that short-term survival was achieved by allocating scarce micronutrients by triage, in part through an adjustment of the binding affinity of proteins for required micronutrients. If this hypothesis is correct, micronutrient deficiencies that trigger the triage response would accelerate cancer, aging, and neural decay but would leave critical metabolic functions, such as ATP production, intact. Evidence that micronutrient malnutrition increases late onset diseases, such as cancer, is discussed. A multivitamin-mineral supplement is one low-cost way to ensure intake of the Recommended Dietary Allowance of micronutrients throughout life. PMID:17101959

  17. Longitudinal characterization of Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonizing and infecting combat casualties.

    PubMed

    Sensenig, Rebekah A; Murray, Clinton K; Mende, Katrin; Wolf, Steven E; Chung, Kevin K; Hospenthal, Duane R; Yun, Heather C

    2012-03-01

    Drug-resistant Acinetobacter baumannii-calcoaceticus complex, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus colonize and infect combat casualties from Iraq and Afghanistan. We retrospectively evaluated relatedness, by pulsed-field gel electrophoresis and antibiotic susceptibility testing, of isolates colonizing and infecting casualties over 2 years. Colonizing organisms were unrelated to isolates producing later infection in up to 27% of cases; most isolates underwent change in antibiotic susceptibilities. The same is true for serial infecting isolates recovered during hospitalization. PMID:21802175

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

    PubMed Central

    2011-01-01

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

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

    PubMed Central

    2014-01-01

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

  20. VEGA 4th Stage Direct Re-Entry Survivability Analysis and Casualty Risk Assessment

    NASA Astrophysics Data System (ADS)

    Battie, F.; Fossati, T.; Gallucci, S.

    2013-08-01

    A key task in launch vehicle (LV) system design process consists in the estimation of upper stage fragmentation during atmospheric re-entry once accomplished the launcher mission, and the related probability of making on-ground casualties. As a European launcher operating from French Guyana, VEGA has to abide by ESA debris mitigation rules, and by the French Law on Space Operations (LOS). The second flight of VEGA aims at demonstrating the versatility of the launcher by performing a multi-payload launch with different target orbits. From a safety point of view, the compliance of VEGA to the LOS will also be extended through the performance of the direct deorbiting of its upper stage, the AVUM, at the end of its mission. Indeed, during the qualification flight, VEGA had submitted to the safety authorities the derogation envisaged by the LOS: under certain conditions, it allows the indirect re-entry of the launcher's upper stage, provided it shall do so in less than 25 years.

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

    PubMed

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

    1991-01-01

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

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

    PubMed

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

    2012-09-01

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

  3. Assessment of the Casualty Risk of Multiple Meteorological Hazards in China

    PubMed Central

    Xu, Wei; Zhuo, Li; Zheng, Jing; Ge, Yi; Gu, Zhihui; Tian, Yugang

    2016-01-01

    A study of the frequency, intensity, and risk of extreme climatic events or natural hazards is important for assessing the impacts of climate change. Many models have been developed to assess the risk of multiple hazards, however, most of the existing approaches can only model the relative levels of risk. This paper reports the development of a method for the quantitative assessment of the risk of multiple hazards based on information diffusion. This method was used to assess the risks of loss of human lives from 11 types of meteorological hazards in China at the prefectural and provincial levels. Risk curves of multiple hazards were obtained for each province and the risks of 10-year, 20-year, 50-year, and 100-year return periods were mapped. The results show that the provinces (municipalities, autonomous regions) in southeastern China are at higher risk of multiple meteorological hazards as a result of their geographical location and topography. The results of this study can be used as references for the management of meteorological disasters in China. The model can be used to quantitatively calculate the risks of casualty, direct economic losses, building collapse, and agricultural losses for any hazards at different spatial scales. PMID:26901210

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

    USGS Publications Warehouse

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

    2010-01-01

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

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

    USGS Publications Warehouse

    Wald, David J.

    2010-01-01

    This study presents a quantitative and geospatial description of global losses due to earthquake-induced secondary effects, including landslide, liquefaction, tsunami, and ?re for events during the past 40 years. These processes are of great importance to the US Geological Surveys (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 PAGERs 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 SumatraAndaman 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.

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

    PubMed

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

    2010-11-01

    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

  7. Assessment of the Casualty Risk of Multiple Meteorological Hazards in China.

    PubMed

    Xu, Wei; Zhuo, Li; Zheng, Jing; Ge, Yi; Gu, Zhihui; Tian, Yugang

    2016-01-01

    A study of the frequency, intensity, and risk of extreme climatic events or natural hazards is important for assessing the impacts of climate change. Many models have been developed to assess the risk of multiple hazards, however, most of the existing approaches can only model the relative levels of risk. This paper reports the development of a method for the quantitative assessment of the risk of multiple hazards based on information diffusion. This method was used to assess the risks of loss of human lives from 11 types of meteorological hazards in China at the prefectural and provincial levels. Risk curves of multiple hazards were obtained for each province and the risks of 10-year, 20-year, 50-year, and 100-year return periods were mapped. The results show that the provinces (municipalities, autonomous regions) in southeastern China are at higher risk of multiple meteorological hazards as a result of their geographical location and topography. The results of this study can be used as references for the management of meteorological disasters in China. The model can be used to quantitatively calculate the risks of casualty, direct economic losses, building collapse, and agricultural losses for any hazards at different spatial scales. PMID:26901210

  8. Tree-based logistic regression approach for work zone casualty risk assessment.

    PubMed

    Weng, Jinxian; Meng, Qiang; Wang, David Z W

    2013-03-01

    This study presents a tree-based logistic regression approach to assessing work zone casualty risk, which is defined as the probability of a vehicle occupant being killed or injured in a work zone crash. First, a decision tree approach is employed to determine the tree structure and interacting factors. Based on the Michigan M-94\\I-94\\I-94BL\\I-94BR highway work zone crash data, an optimal tree comprising four leaf nodes is first determined and the interacting factors are found to be airbag, occupant identity (i.e., driver, passenger), and gender. The data are then split into four groups according to the tree structure. Finally, the logistic regression analysis is separately conducted for each group. The results show that the proposed approach outperforms the pure decision tree model because the former has the capability of examining the marginal effects of risk factors. Compared with the pure logistic regression method, the proposed approach avoids the variable interaction effects so that it significantly improves the prediction accuracy. PMID:22908981

  9. Respiratory protection during high-fidelity simulated resuscitation of casualties contaminated with chemical warfare agents.

    PubMed

    Schumacher, J; Runte, J; Brinker, A; Prior, K; Heringlake, M; Eichler, W

    2008-06-01

    Emergency room personnel are threatened by secondary poisoning when treating victims affected by chemical warfare agents. Therefore, resuscitation skills practised with respiratory protection equipment in place require evaluation. We investigated the influence of wearing air-purifying respirators on the simulated resuscitation of chemical warfare agent casualties. We studied 22 anaesthetic trainees in a simulated resuscitation scenario requiring five set tasks, either unprotected, wearing a binocular visor respirator or a panoramic visor respirator in a randomised, crossover study. Treatment times did not differ between the three groups, with mean (SD) times to complete the tasks being 122 (8) s without a mask, 126 (7) s when wearing the panoramic visor mask and 129 (8) s when wearing the binocular respirator mask. All anaesthetists preferred the panoramic visor in terms of visual orientation but 88% of them rated the binocular mask as being more comfortable. Modern respirators have a negligible effect on simulated resuscitation scenarios for victims affected by chemical warfare agents. Panoramic visor respirators allow better visual orientation for anaesthetists during simulated resuscitation. PMID:18279486

  10. Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties.

    PubMed

    White, Brian K; Mende, Katrin; Weintrob, Amy C; Beckius, Miriam L; Zera, Wendy C; Lu, Dan; Bradley, William; Tribble, David R; Schnaubelt, Elizabeth R; Murray, Clinton K

    2016-02-01

    Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009-12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested. Overall, 59 patients had 119 obligate anaerobes identified (83 were first isolates). Obligate anaerobes were isolated 7-13 days post-injury, primarily from lower extremity wounds (43%), and were largely Bacteroides spp. (42%) and Clostridium spp. (19%). Patients with pelvic wounds were more likely to have Bacteroides spp. and concomitant resistant gram-negative aerobes. Seventy-three percent of isolates were resistant to ?1 antimicrobials. Bacteroides spp. demonstrated the most resistance (16% of first isolates). Patients with resistant isolates had similar outcomes to those with susceptible strains. Serial recovery of isolates occurred in 15% of patients and was significantly associated with isolation of Bacteroides spp., along with resistant gram-negative aerobes. PMID:26607420

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

    PubMed

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

    2014-06-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed Central

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

    2012-01-01

    Background EMS provider judgment was recently added as a field triage criterion to the national guidelines, yet its predictive value and real-world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. Methods We analyzed a population-based retrospective cohort, supplemented by qualitative analysis, of injured children and adults evaluated and transported by 47 EMS agencies to 94 hospitals in 5 regions across the Western U.S. from 20062008. We used logistic regression models to evaluate the independent predictive value of EMS provider judgment for ISS ? 16. EMS narratives were analyzed using qualitative methods to assess and compare common themes for each step in the triage algorithm, plus EMS provider judgment. Results 213,869 injured patients were evaluated and transported by EMS over the 3-year period, of whom 41,191 (19.3%) met at least one of the field triage criteria. EMS provider judgment was the most commonly used triage criterion (40.0% of all triage-positive patients; sole criterion in 21.4%). After accounting for other triage criteria and confounders, the adjusted odds ratio (OR) of ISS ? 16 for EMS provider judgment was 1.23 (95%CI 1.03-1.47), although there was variability in predictive value across sites. Patients meeting EMS provider judgment had concerning clinical presentations qualitatively similar to those meeting mechanistic and other special considerations criteria. Conclusions Among this multi-site cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, was independently associated with serious injury and was useful in identifying high risk patients missed by other criteria. However, there was variability in predictive value between sites. PMID:22673250

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

    PubMed Central

    Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

    2006-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2006-04-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed Central

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

    2005-01-01

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

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

    PubMed

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

    2014-09-01

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

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

    PubMed

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

    2011-09-01

    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

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

    PubMed Central

    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

    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