Sample records for casualties

  1. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty or...

  2. American War and Military Operations Casualties: Lists and Statistics

    DTIC Science & Technology

    2015-01-02

    Service 10 Table 7. Vietnam Conflict: Casualty Summary (as of December 22, 2014) Casualty Type Total Army Air Force Marines Navya Killed in Action...December 22, 2014) Casualty Type Total Army Air Force Marines Navya Killed in Action 144 96 20 22 6 Died of Wounds 4 2 0 2 0 Missing in Action—Declared...Service 17 Table 12. Operation Iraqi Freedom (OIF): Casualty Summary by Casualty Category (as of December 22, 2014) Casualty Type Total Army Navya

  3. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Fire and Casualty Damage. As prescribed in 570.603, insert the following clause: Fire and Casualty Damage (SEP 1999) If the entire premises are destroyed by fire or other casualty, this lease will... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Fire and Casualty Damage...

  4. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 will... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Fire and Casualty Damage...

  5. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 will... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Fire and Casualty Damage...

  6. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 will... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Fire and Casualty Damage...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 will... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Fire and Casualty Damage...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  9. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  10. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  11. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  12. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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 Casualty Investigations § 4.40-15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation...

  13. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means...

  14. 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...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  16. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Marine casualty or accident. 4.03-1 Section 4.03-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means...

  17. Casualty Risk From Tornadoes in the United States is Highest in Urbanized Areas Across the Mid South

    NASA Astrophysics Data System (ADS)

    Fricker, T.; Elsner, J.

    2017-12-01

    Risk factors for tornado casualties are well known. Less understood is how and to what degree these determinants, after controlling for strength and urban density, vary spatially and temporally. Here we fit models to casualty counts from all casualty-producing tornadoes since 1995 in order to quantify the interactions between urbanization and energy on casualty rates. Results from the models show that the more urbanized areas of the Mid South are substantively and significantly more vulnerable to casualties from tornadoes than elsewhere in the country. Casualty rates are significantly higher on the weekend for tornadoes in this region. Night and day casualty rates are similar regardless of where they occur. Higher vulnerability to casualties from tornadoes occurring in more urbanized areas correspond significantly with greater percentages of elderly people. Many of the micro cities in the Mid South are threatened by tornadoes annually and this threat might potentially be exacerbated by climate change.

  18. The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China.

    PubMed

    Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi

    2017-02-21

    The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China . 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research.

  19. The Vulnerability of People to Landslides: A Case Study on the Relationship between the Casualties and Volume of Landslides in China

    PubMed Central

    Lin, Qigen; Wang, Ying; Liu, Tianxue; Zhu, Yingqi; Sui, Qi

    2017-01-01

    The lack of a detailed landslide inventory makes research on the vulnerability of people to landslides highly limited. In this paper, the authors collect information on the landslides that have caused casualties in China, and established the Landslides Casualties Inventory of China. 100 landslide cases from 2003 to 2012 were utilized to develop an empirical relationship between the volume of a landslide event and the casualties caused by the occurrence of the event. The error bars were used to describe the uncertainty of casualties resulting from landslides and to establish a threshold curve of casualties caused by landslides in China. The threshold curve was then applied to the landslide cases occurred in 2013 and 2014. The validation results show that the estimated casualties of the threshold curve were in good agreement with the real casualties with a small deviation. Therefore, the threshold curve can be used for estimating potential casualties and landslide vulnerability, which is meaningful for emergency rescue operations after landslides occurred and for risk assessment research. PMID:28230810

  20. Population and energy elasticity of tornado casualties

    NASA Astrophysics Data System (ADS)

    Fricker, Tyler; Elsner, James B.; Jagger, Thomas H.

    2017-04-01

    Tornadoes are capable of catastrophic destruction and mass casualties, but there are yet no estimates of how sensitive the number of casualties are to changes in the number of people in harm's way or to changes in tornado energy. Here the relationship between tornado casualties (deaths and injuries), population, and energy dissipation is quantified using the economic concept of "elasticity." Records of casualties from individual tornadoes over the period 2007-2015 are fit to a regression model. The coefficient on the population term (population elasticity) indicates that a doubling in population increases the casualty rate by 21% [(17, 24)%, 95% credible interval]. The coefficient on the energy term (energy elasticity) indicates that a doubling in energy dissipation leads to a 33% [(30, 35)%, 95% credible interval] increase in the casualty rate. The difference in elasticity values show that on average, changes in energy dissipation have been relatively more important in explaining tornado casualties than changes in population. Assuming no changes in warning effectiveness or mitigation efforts, these elasticity estimates can be used to project changes in casualties given the known population trends and possible trends in tornado activity.

  1. A numerical simulation strategy on occupant evacuation behaviors and casualty prediction in a building during earthquakes

    NASA Astrophysics Data System (ADS)

    Li, Shuang; Yu, Xiaohui; Zhang, Yanjuan; Zhai, Changhai

    2018-01-01

    Casualty prediction in a building during earthquakes benefits to implement the economic loss estimation in the performance-based earthquake engineering methodology. Although after-earthquake observations reveal that the evacuation has effects on the quantity of occupant casualties during earthquakes, few current studies consider occupant movements in the building in casualty prediction procedures. To bridge this knowledge gap, a numerical simulation method using refined cellular automata model is presented, which can describe various occupant dynamic behaviors and building dimensions. The simulation on the occupant evacuation is verified by a recorded evacuation process from a school classroom in real-life 2013 Ya'an earthquake in China. The occupant casualties in the building under earthquakes are evaluated by coupling the building collapse process simulation by finite element method, the occupant evacuation simulation, and the casualty occurrence criteria with time and space synchronization. A case study of casualty prediction in a building during an earthquake is provided to demonstrate the effect of occupant movements on casualty prediction.

  2. Management of mass casualty: a review.

    PubMed

    Adesunkanmi, A R K; Lawal, A O

    2011-09-01

    The aim of this article is to discuss the management of mass casualty and sensitise authorities at various levels and trauma surgeons the need for awareness and training in the management of mass casualty. Thorough Medline and bibliography search and available local literatures relevant to the management of mass casualty was reviewed. The available articles were reviewed in order to decipher the management pattern in various forms and degree of disasters resulting in mass casualty. Little attention was paid to mass casualty management in civilian population until mid nineties, even, in developed countries. Knowledge in this area has expanded in the last 10 years due to terrorist attacks in the United State America. In developing countries, nothing is known to be on the ground in form of planning for appropriate response to mass casualty. Mass casualty usually associated with straining of existing facilities, and with high morbidity and mortality. Pre-incident and adequate training is necessary to reduce morbidity and mortality from major incident which occurrence is often not predictable.

  3. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

  4. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

  5. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

  6. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

  7. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

  8. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

  9. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

  11. 33 CFR 164.61 - Marine casualty reporting and record retention.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

  12. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

  13. 49 CFR 850.15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 850.15... TRANSPORTATION SAFETY BOARD COAST GUARD-NATIONAL TRANSPORTATION SAFETY BOARD MARINE CASUALTY INVESTIGATIONS § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

  14. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Marine casualty reporting and... HOMELAND SECURITY (CONTINUED) PORTS AND WATERWAYS SAFETY NAVIGATION SAFETY REGULATIONS § 164.61 Marine casualty reporting and record retention. When a vessel is involved in a marine casualty as defined in 46...

  16. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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 Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 § 850.15 Marine casualty investigation by the Board. (a) The Board may conduct an investigation under the...

  18. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant...

  19. [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.

  20. Documentation and tagging of casualties in multiple casualty incidents.

    PubMed

    Garner, Alan

    2003-01-01

    The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence-based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad-based educational approach that encourages critical reappraisal of existing procedures is recommended.

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means... efficiency of the vessel. (b) The term “marine casualty or accident” applies to events caused by or involving... of life of any person. (2) Any occurrence involving a vessel that results in— (i) Grounding; (ii...

  2. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... AND INVESTIGATIONS Definitions § 4.03-1 Marine casualty or accident. Marine casualty or accident means... efficiency of the vessel. (b) The term “marine casualty or accident” applies to events caused by or involving... of life of any person. (2) Any occurrence involving a vessel that results in— (i) Grounding; (ii...

  3. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... casualty. (a) The owner, agent, master, or person in charge of a unit for which a report of casualty is... of casualty. (6) Navigation work books. (7) Compass deviation cards. (8) Gyrocompass records. (9...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person in...

  4. 33 CFR 174.107 - Contents of casualty or accident report form.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Contents of casualty or accident... 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. ...

  5. 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. ...

  6. 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 marine...

  7. 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 marine...

  8. 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 marine...

  9. 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, or...

  10. 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 185...

  11. 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 marine...

  12. 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 marine...

  13. 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 185...

  14. 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 marine...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  16. 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 marine...

  17. 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, or...

  18. 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 marine...

  19. 46 CFR 4.05-10 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  20. 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 marine...

  1. 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 185...

  2. 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, or...

  3. 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, or...

  4. 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, or...

  5. 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 185...

  6. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

  7. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

  8. 14 CFR Appendix D to Part 420 - Impact Dispersion Areas and Casualty Expectancy Estimate for an Unguided Suborbital Launch Vehicle

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...”. ER19Oc00.119 where: k { {1, 2, 3, . . . , n} Ac = casualty area (from table D-1) Ak = populated area Nk = population in Ak Table D-1—Effective Casualty Area (Ac) vs. Impact Range Impact range (nm) Effective casualty...

  9. 46 CFR 185.260 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Reports of potential vessel casualty. 185.260 Section 185.260 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.260 Reports of potential vessel casualty. (a) An owner, charterer, managing...

  10. Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

    PubMed

    Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

    2009-07-01

    The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was

  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. Op HERRICK primary care casualties: the forgotten many.

    PubMed

    Nelson, T G; Wall, C; Driver, J; Simpson, R

    2012-09-01

    The number of battle casualties generated during war is far outnumbered by non-battle casualties. Each year the current conflict in Afghanistan sees hundreds of service personnel medically evacuated direct from the front line to the care of their home units' primary care facility. To date these casualties remain undiscovered by medical research. This is the first study to look at the care pathway of primary care casualties from Operation HERRICK using information from the Defence Patient Tracking System (DPTS). Information relating to all casualties from Afghanistan discharged at the airhead between 1 January 2009 and 31 December 2010 was collected from the DPTS. Common conditions were identified and information relating to the follow up care extracted to provide an overview of the care pathway. 387 aeromedical evacuations were identified as primary care casualties. The three commonest conditions were musculoskeletal (183 cases), mental health (29) and noise-induced hearing loss (26). 205 (53%) were not seen outside of primary care for the tracked condition. 166 (81%) of those that remained under primary care had two or less consultations during the time period of the study. The mean time frame between the 1st and 2nd consultation was 5.4 weeks. A significant number of aeromedical evacuations from Afghanistan are for primary care casualties. The DPTS can be used to provide a basic overview of the care pathway of repatriated personnel. Little contact with the medical services would appear to occur for these types of casualties. There is a significant gap in military medical research looking at primary care casualties repatriated from operations.

  13. Penetrating missile injuries during the Iraqi insurgency.

    PubMed

    Ramasamy, A; Harrisson, S E; Stewart, M P M; Midwinter, M

    2009-10-01

    Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. Data were prospectively collected on 100 consecutive patients either injured or killed from hostile action from January 2006 who presented to the sole coalition field hospital in southern Iraq. Eighty-two casualties presented with penetrating missile injuries from hostile action. Three subsequently died of wounds (3.7%). Forty-six (56.1%) casualties had their initial surgery performed by British military surgeons. Twenty casualties (24.4%) sustained gunshot wounds, 62 (75.6%) suffered injuries from fragmentation weapons. These 82 casualties were injured in 55 incidents (mean, 1.49 casualties; range 1-6 casualties) and sustained a total 236 wounds (mean, 2.88 wounds) affecting a mean 2.4 body regions per patient. Improvised explosive devices were responsible for a mean 2.31 casualties (range, 1-4 casualties) per incident. The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons.

  14. 19 CFR 158.21 - Allowance in duties for casualty, loss, or theft while in Customs custody.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Allowance in duties for casualty, loss, or theft... LOST, DAMAGED, ABANDONED, OR EXPORTED Casualty, Loss, or Theft While in Customs Custody § 158.21 Allowance in duties for casualty, loss, or theft while in Customs custody. Section 563(a), Tariff Act of...

  15. American War and Military Operations Casualties: Lists and Statistics

    DTIC Science & Technology

    2008-05-14

    War — Casualty Summary Desert Shield/Desert Storm (as of June 15, 2004) Casualty Type Total Army Air Force Marines Navya ,b Killed in Action 143 96 20...Through April 5, 2008 Casualty Type Totals Army Navya Marines Air Force Hostile 3,158 2,304 60 770 24 Nonhostile 708 521 29 141 17 Total 3,866 2,825 89

  16. Casualty Handling Simulation Using the Scenario-based Engineering Process

    DTIC Science & Technology

    2000-02-28

    HERPES ZOSTER ENCEPHALITIS HEPATITIS INFECTIOUS VIRAL ANIMAL BITES/RABIES EXPOSURE MUMPS INFECTIOUS MONONUCLEOSIS TRACHOMA STD-SYPHILIS STD...casualties as they flow through the system. Identifying the proper mix is complicated by many factors, including the specific casualty stream, the...casualties as they flow through the system. Identifying the proper mix is complicated by its dependence on mission types. For example, the types and

  17. 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

  18. 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.

  19. [The treatment of anxiety and acute stress reaction (ASR) in civilian casualties in community stress centers (CSC) in the 2nd Lebanon War].

    PubMed

    Rubinstein, Zohar; Polakevitz, Yakov; Ben Gershon, Bella; Lubin, Gadi; Bar-Dayan, Yaron

    2010-07-01

    The treatment of anxiety and acute stress reaction (ASR) in civilian casualties exposed to continuous missile attacks during Lebanon War II is described in this study. Casualties were treated in community stress centers (CSC) erected ad-hoc, as a result of cooperation between the Mental Health Section of the Home Front Command of the Israel Defense Forces (IDF), the Mental Health Services of the Ministry of Health (MOH) and the Emergency and Disaster Management Division of the MOH. A total of 536 casualties were admitted to the centers. Eighteen were evacuated to the zone hospitals due to physical problems. The remaining casualties were released within 2-4 hours of intensive intervention according to the protocol. Symptoms of casualties ranged from anxiety (and ASR)--90%; fear (mainly agoraphobia)--7%; adaptation--2%; sleep disturbances--1%. Mental health intervention included counseling talk--80%; ventilation--9%; relaxation--3%; non-verbaL intervention--3%; fulfillment of basic needs--1% and evacuation to hospitals--3%. We discovered that anxiety and ASR were the most prevalent syndromes among those casualties as a result of the missile attacks on the civil population. The CSCs succeeded in providing adequate response and treatment for the majority of the casualties, thus putting off the need to evacuate those casualties to the ERs. Thereby, evacuation resources were saved and the ER load was reduced. The authors recommend that preparedness of the population under missile attacks, as well as other disaster scenarios, which resulted in a high rate of mental casualties, will be focused in the activation of CSCs in the format which has been described in this article.

  20. Patient distribution in a mass casualty event of an airplane crash.

    PubMed

    Postma, Ingri L E; Weel, Hanneke; Heetveld, Martin J; van der Zande, Ineke; Bijlsma, Taco S; Bloemers, Frank W; Goslings, J Carel

    2013-11-01

    Difficulties have been reported in the patient distribution during Mass Casualty Incidents. In this study we analysed the regional patient distribution protocol (PDP) and the actual patient distribution after the 2009 Turkish Airlines crash near Amsterdam. Analysis of the patient distribution of 126 surviving casualties of the crash by collecting data on medical treatment capacity, number of patients received per hospital, triage classification, Injury Severity Score (ISS), secondary transfers, distance from the crash site, and the critical mortality rate. The PDP holds ambiguous definitions of medical treatment capacity and was not followed. There were 14 receiving hospitals (distance from crash: 5.8-53.5 km); four hospitals received 133-213% of their treatment capacity, and 5 hospitals received 1 patient. Three hospitals within 20 km of the crash did not receive any casualties. Level I trauma centres received 89% of the 'critical' casualties and 92% of the casualties with ISS ≥ 16. Only 3 casualties were secondarily transferred, and no casualties died in, or on the way to hospital (critical mortality rate=0%). Patient distribution worked out well after the crash as secondary transfers were low and critical mortality rate was zero. However, the regional PDP was not followed in this MCI and casualties were unevenly distributed among hospitals. The PDP is indistinctive, and should be updated in cooperation between Emergency Services, surrounding hospitals, and Schiphol International Airport as a high risk area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Prehospital burn management in a combat zone.

    PubMed

    Lairet, Kimberly F; Lairet, Julio R; King, Booker T; Renz, Evan M; Blackbourne, Lorne H

    2012-01-01

    The purpose of this article is to provide a descriptive study of the management of burns in the prehospital setting of a combat zone. A retrospective chart review was performed of U.S. casualties with >20% total-body-surface-area thermal burns, transported from the site of injury to Ibn Sina Combat Support Hospital (CSH) between January 1, 2006, and August 30, 2009. Ibn Sina CSH received 225 burn casualties between January 2006 and August 2009. Of these, 48 met the inclusion criteria. The mean Injury Severity Score was 31.7 (range 4 to 75). Prehospital vascular access was obtained in 24 casualties (50%), and 20 of the casualties received fluid resuscitation. Out of the 48 casualties enrolled, 28 (58.3%) did not receive prehospital fluid resuscitation. Of the casualties who received fluid resuscitation, nearly all received volumes in excess of the guidelines established by the American Burn Association and those recommended by the Committee for Tactical Combat Casualty Care. With regard to pain management in the prehospital setting, 13 casualties (27.1%) received pain medication. With regard to the prehospital fluid resuscitation of primary thermal injury in the combat zone, two extremes were noted. The first group did not receive any fluid resuscitation; the second group was resuscitated with fluid volumes higher than those expected if established guidelines were utilized. Pain management was not uniformly provided to major burn casualties, even in several with vascular access. These observations support improved education of prehospital personnel serving in a combat zone.

  2. Penetrating Missile Injuries During the Iraqi Insurgency

    PubMed Central

    Ramasamy, A; Harrisson, SE; Stewart, MPM; Midwinter, M

    2009-01-01

    INTRODUCTION Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. PATIENTS AND METHODS Data were prospectively collected on 100 consecutive patients either injured or killed from hostile action from January 2006 who presented to the sole coalition field hospital in southern Iraq. RESULTS Eighty-two casualties presented with penetrating missile injuries from hostile action. Three subsequently died of wounds (3.7%). Forty-six (56.1%) casualties had their initial surgery performed by British military surgeons. Twenty casualties (24.4%) sustained gunshot wounds, 62 (75.6%) suffered injuries from fragmentation weapons. These 82 casualties were injured in 55 incidents (mean, 1.49 casualties; range 1–6 casualties) and sustained a total 236 wounds (mean, 2.88 wounds) affecting a mean 2.4 body regions per patient. Improvised explosive devices were responsible for a mean 2.31 casualties (range, 1–4 casualties) per incident. CONCLUSIONS The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons. PMID:19833014

  3. American War and Military Operations Casualties: Lists and Statistics

    DTIC Science & Technology

    2010-02-26

    Air Force Marines Navya Killed in Action 144 96 20 22 6 Died of Wounds 4 2 2 Missing in Action—Declared Dead Captured—Declared Dead...Operation Enduring Freedom by Casualty Category Within Service (from October 7, 2001 through February 6, 2010) Casualty Type Total Army Navya Marines...Table 12. Operation Enduring Freedom, Military Wounded in Action (from October 7, 2001, through February 6, 2010) Casualty Type Totals Army Navya

  4. Mass casualty education for undergraduate nursing students in Australia.

    PubMed

    Currie, Jane; Kourouche, Sarah; Gordon, Christopher; Jorm, Christine; West, Sandra

    2018-01-01

    With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. 78 FR 75677 - Proposed Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-12

    ... concerning the Commercial Property and Casualty Insurers Submission for Federal Share Compensation... with ``PRA Comments--Commercial Property and Casualty Insurers Submission for Federal Share...-0200. Title: Terrorism Risk Insurance Program--Commercial Property and Casualty Insurers Submission for...

  6. Maritime Casualty Tabulation (1972)

    DOT National Transportation Integrated Search

    1975-01-01

    The report creates a data base of the maritime casualties during 1972 which would have been candidates for a distress channel in a satellite communications service. There are 1546 casualties recorded in this report for the calendar year 1972; of thes...

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

    PubMed

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

    2011-09-01

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

  8. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... casualty; (5) Gives the name, address, and phone number of persons involved in or witnessing the casualty... number 1625-0001) [CGD 78-160, 47 FR 9383, Mar. 4, 1982, as amended by CGD 82-023a, 47 FR 35741, Aug. 16...

  9. Do lower income areas have more pedestrian casualties?

    PubMed

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

    2013-10-01

    Pedestrian and motor vehicle casualties are analyzed for the State of New Jersey with the objective of determining how the income of an area may be associated with casualties. We develop a maximum-likelihood negative binomial model to examine how various spatially defined variables, including road, income, and vehicle ownership, may be associated with casualties using census block-group level data. Due to suspected spatial correlation in the data we also employ a conditional autoregressive Bayesian model using Markov Chain Monte Carlo simulation, implemented with Crimestat software. Results suggest that spatial correlation is an issue as some variables are not statistically significant in the spatial model. We find that both pedestrian and motor vehicle casualties are greater in lower income block groups. Both are also associated with less household vehicle ownership, which is not surprising for pedestrian casualties, but is a surprising result for motor vehicle casualties. Controls for various road categories provide expected relationships. Individual level data is further examined to determine relationships between the location of a crash victim and their residence zip code, and this largely confirms a residual effect associated with both lower income individuals and lower income areas. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Mass-casualty triage: time for an evidence-based approach.

    PubMed

    Jenkins, Jennifer Lee; McCarthy, Melissa L; Sauer, Lauren M; Green, Gary B; Stuart, Stephanie; Thomas, Tamara L; Hsu, Edbert B

    2008-01-01

    Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.

  11. 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 1989–1996 (pre-graduated driver licensing in Michigan): teens (ages 16–19) and adults (ages 45–65). Rates and rate ratios (RR) based on crash occurrence per 100,000 person miles driven (PMD) compared teens and adults from the two statewide populations. Excess risk was defined as a RR for a specific type of crash that was significantly greater than the RR for all crashes combined. The RRs for all crashes combined for teenage males was 2.41 and 1.75 for teenage females. RRs for teenage males ranged from a low of 2.16 for casualty crashes attributed to alcohol to 8.98 for casualty road departure crashes at night. Among teenage females, RRs ranged from 2.06 for casualty crashes on the weekend to 7.86 for casualty crashes at night with passengers. Casualty crash rates for teenage males ranged from 0.21 per 100,000 PMD for rollover crashes to 1.95 per 100,000 PMD for crashes with passengers. Among teen females, casualty crash rates ranged from 0.21 per 100,000 PMD for drink/driving with passengers to 3.31 per 100,000 PMD for crashes with passengers. Implications for graduated driver licensing, teen driver supervision, and policy are discussed. This study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. PMID:18184510

  12. Mass casualties in Tahrir Square at the climax of the Egyptian uprising: evidence of an emerging pattern of regime's organized escalating violence during 10 hours on the night of January 28, 2011.

    PubMed

    Sarhan, Mohamed D; Dahaba, Ashraf A; Marco, Michael; Salah, Ayman

    2012-12-01

    Documentation of the management of mass casualties in Tahrir Square. We documented the sequences of our medical response to mass casualties in Tahrir Square between January 28, 2011, and February 4, 2011, at "Kasr El-Ainy" Cairo University Hospital, the largest hospital in the Middle East and the tertiary referral center for all hospitals in Egypt that happened to be the closest to Tahrir Square. At the peak of Tahrir Square demonstrations, injured protesters received first aid in a makeshift clinic inside Tahrir Square, manned by volunteer doctors and nurses, before they were evacuated to the Cairo University Hospital Surgical Casualty Department. General surgeons, orthopedic surgeons, anesthesiologists, and critical care nurses from multidisciplinary teams hastily triaged and treated the incoming casualties. Thousands of casualties were seen at the peak of the uprising. This article provides a detailed review of mass casualties seen between January 28, 2011, and February 4, 2011. Of 3012 casualties, 453 were triaged as "immediate care" patients. On arrival, 339 of 453 patients (74.8%) needed surgical intervention within 6 hours of arrival whereas 74 of 453 patients (16.3%) were managed conservatively. Forty of 453 (8.8%) of patients did not survive their injuries. Most of the inpatients (302/453, 66.6%) were admitted within 10 hours on January 28, 2011, during which evidence of a pattern of regime's organized escalating violence emerged. We describe the pattern of injuries and our management of Tahrir Square mass casualties. We believe that forming multidisciplinary teams of surgeons, anesthesiologists, and nurses was the key to our effective management of such a huge event.

  13. [Ethical considerations in mass casualty situation].

    PubMed

    Priel, I E; Dolev, E

    2001-07-01

    Mass casualty is a situation, in which, the physician is compelled to make critical decisions under heavy pressure load, due to severe shortage in time, personnel and information. This task is extremely difficult to fulfill, as the physician has to consider not only professional tools, but needs also to utilize ethical principles, in order to provide the best possible care to most of the casualties who might benefit from it. By definition, in the mass casualty situation the medical facility lacks temporarily the ability to deliver effective therapy to all, as the injured outnumber the medical capacity for a given time. The ethical conflicts and dilemmas that arise during such an event are enormous. Amazingly, only a few articles have addressed the issue of ethical considerations during mass casualty situation. Ethical decision making is based on four principles: beneficence, nonmaleficence, autonomy and justice. Compassion, trustworthiness, discernment and integrity are the four qualities required from those practicing medicine. These virtues should be manifested in mass casualty situations, one of the most demanding situations a physician may face.

  14. Is the Australian hospital system adequately prepared for terrorism?

    PubMed

    Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

    Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

  15. Survey of trauma registry data on tourniquet use in pediatric war casualties.

    PubMed

    Kragh, John F; Cooper, Arthur; Aden, James K; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H

    2012-12-01

    Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009. Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use. The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training. Level 4; case series, therapeutic study.

  16. 46 CFR 308.105 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

  17. 46 CFR 308.105 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

  18. 46 CFR 308.304 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

  19. 46 CFR 308.304 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

  20. 46 CFR 308.304 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

  1. 46 CFR 308.304 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

  2. 46 CFR 308.105 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

  3. 46 CFR 308.105 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

  4. 46 CFR 308.105 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

  5. 46 CFR 308.304 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

  6. Casualty data analysis of the world merchant fleet for reported fire and explosion incidents resulting in marine pollution

    DOT National Transportation Integrated Search

    1995-02-01

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

  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. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Written report of casualty. 146... (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.35 Written report of casualty... written report which: (1) Identifies the facility involved, its owner, operator, and person in charge; (2...

  9. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Written report of casualty. 197.486 Section 197.486... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... report, in narrative form, when the diving installation is on a facility. The written report must contain...

  10. Amputations in natural disasters and mass casualties: staged approach.

    PubMed

    Wolfson, Nikolaj

    2012-10-01

    Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.

  11. 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. What’s more, as the world’s population, housing stock, and living and cultural environments change, methods of loss modeling must accommodate these variables, especially when considering casualties. To truly take advantage of observed earthquake losses, not only do damage surveys need better coordination of international and national reconnaissance teams, but these teams must integrate difference areas of expertise including engineering, public health and medicine. Research is needed to find methods to achieve consistent and practical ways of collecting and modeling casualties in earthquakes. International collaboration will also be necessary to transfer such expertise and resources to the communities in the cities which most need it. Coupling the theories and findings from the field surveys with experiments would also be advantageous as it is not always be possible to validate theories and models with actual earthquake data. In addition, colleagues in other disciplines will benefit from being introduced to the loss algorithms, methodologies and advances familiar to the engineering community, to help dissemination in earthquake mitigation and preparedness programs. It follows that new approaches to loss estimation must include a progressive assessment of what contributes to the final casualty value. In analyzing recent earthquakes, testing common hypotheses, talking to local and international researchers in the field, interviewing search and rescue and medical personnel, and comparing notes with colleagues who have visited other events, the author has developed a list of contributory factors to formulate fatality rates for use in earthquake loss estimation models. In this presentation, we will first look at the current state of data collection and assessment in casualty loss estimation. Then, the analyses of recent earthquake field data, which provide important insights to the contributory factors of fatalities in earthquakes, will be explored. The benefits of a multi-disciplinary approach in deriving fatality rates for masonry buildings will then be examined in detail.

  12. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-27... RAILROADS 1 Operating Expenses-Equipment § 1242.54 Other and casualties and insurance (accounts XX-27-99 and... administration (account XX-27-01). Operating Expenses—Transportation train operations ...

  13. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-26... RAILROADS 1 Operating Expenses-Equipment § 1242.41 Other and casualties and insurance (accounts XX-26-99 and... administration (account XX-26-01). freight cars ...

  14. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-51... RAILROADS 1 Operating Expenses-Transportation § 1242.65 Other and casualties and insurance (accounts XX-51... separation of administration (account XX-51-01). yard operations ...

  15. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-55... RAILROADS 1 Operating Expenses-Transportation § 1242.82 Other and casualties and insurance (accounts XX-55... separation of administration (account XX-55-01). Operating Expenses general and administration ...

  16. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Other and casualties and insurance (accounts XX-52... RAILROADS 1 Operating Expenses-Transportation § 1242.72 Other and casualties and insurance (accounts XX-52... separation of administration (account XX-52-01). train and yard operations common ...

  17. 46 CFR Sec. 4 - Evidence required.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... grounds of stress of weather or other casualty, there must be submitted to the Collector the following: (a) An affidavit of the Master which shall set out fully the nature of the casualty and/or stress of weather encountered; when and where the casualty and/or stress of weather occurred; nature of the damage...

  18. 46 CFR Sec. 4 - Evidence required.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... grounds of stress of weather or other casualty, there must be submitted to the Collector the following: (a) An affidavit of the Master which shall set out fully the nature of the casualty and/or stress of weather encountered; when and where the casualty and/or stress of weather occurred; nature of the damage...

  19. 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 the...

  20. 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 the...

  1. 46 CFR Sec. 4 - Evidence required.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... grounds of stress of weather or other casualty, there must be submitted to the Collector the following: (a) An affidavit of the Master which shall set out fully the nature of the casualty and/or stress of weather encountered; when and where the casualty and/or stress of weather occurred; nature of the damage...

  2. 46 CFR 122.260 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Reports of potential vessel casualty. 122.260 Section 122.260 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS CARRYING MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.260...

  3. Preparedness for treating victims of terrorist attacks in Australia: Learning from recent military experience.

    PubMed

    Rosenfeld, Jeffrey V; Mitra, Biswadev; Smit, De Villiers; Fitzgerald, Mark C; Butson, Benjamin; Stephenson, Michael; Reade, Michael C

    2018-05-09

    The Australian health system is generally well prepared for mass casualty events. Fortunately, there have been very few terrorist attacks and these have involved low numbers of casualties compared with events overseas. Nevertheless, Australian health professionals need to be prepared to treat mass casualties with blast and ballistic trauma. The US military and its allies including Australia have had extensive experience with mass casualty management in the Middle East and Afghanistan wars for more than a decade. To define their experience, they developed the Tactical Combat Casualty Care Guidelines that have saved many lives. It is now prudent to incorporate this knowledge and experience into civilian practice in Australia. © 2018 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Fatal and non-fatal injuries due to intentional explosions in Nepal, 2008-2011: analysis of surveillance data

    PubMed Central

    2013-01-01

    Background Nepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and to describe time trends and epidemiologic patterns for these events. Methods We analyzed surveillance data on fatal and non-fatal injuries due to intentional explosions in Nepal that occurred between 1 January 2008 and 31 December 2011. The case definition included casualties injured or killed by explosive devices knowingly activated by an individual or a group of individuals with the intent to harm, hurt or terrorize. Data were collected through media-based and active community-based surveillance. Results Analysis included 437 casualties injured or killed in 131 intentional explosion incidents. A decrease in the number of incidents and casualties between January 2008 and June 2009 was followed by a pronounced increase between July 2010 and June 2011. Eighty-four (19.2%) casualties were among females and 40 (9.2%) were among children under 18 years of age. Fifty-nine (45.3%) incidents involved one casualty, 47 (35.9%) involved 2 to 4 casualties, and 6 involved more than 10 casualties. The overall case-fatality ratio was 7.8%. The highest numbers of incidents occurred in streets or at crossroads, in victims’ homes, and in shops or markets. Incidents on buses and near stadiums claimed the highest numbers of casualties per incident. Socket, sutali, and pressure cooker bombs caused the highest numbers of incidents. Conclusions Intentional explosion incidents still pose a threat to the civilian population of Nepal. Most incidents are caused by small homemade explosive devices and occur in public places, and males aged 20 to 39 account for a plurality of casualties. Stakeholders addressing the explosive device problem in Nepal should continue to use surveillance data to plan interventions. PMID:23514664

  5. 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. Copyright © 2014 Forensic Science Society. Published by Elsevier Ireland Ltd. All rights reserved.

  6. [Ethical Debates Related to the Allocation of Medical Resources During the Response to the Mass Casualty Incident at Formosa Fun Coast Water Park].

    PubMed

    Tang, Jing-Shia; Chen, Chia-Jung; Huang, Mei-Chih

    2017-02-01

    Disasters are unpredictable and often result in mass casualties. Limited medical resources often affect the response to mass casualty incidents, undermining the ability of responders to adequately protect all of the casualties. Thus, the injuries of casualties are classified in hopes of fully utilizing medical resources efficiently in order to save the maximum possible number of people. However, as opinions on casualty prioritization are subjective, disagreements and disputes often arise regarding allocating medical resources. The present article focused on the 2015 explosion at Formosa Fun Coast, a recreational water park in Bali, New Taipei City, Taiwan as a way to explore the dilemma over the triage and resource allocation for casualties with burns over 90% and 50-60% of their bodies. The principles of utilitarianism and deontology in Western medicine were used to discuss the reasons and rationale behind the allocation of medical resources during this incident. Confucianism, a philosophical mindset that significantly influences Taiwanese society today, was then discussed to describe the "miracles" that happened during the incident, including the acquisition of assistance from the public and medical professionals. External supplies and professional help (social resources) were provided voluntarily after this incident, which had a profound impact on both the immediate response and the longer-term recovery efforts.

  7. The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

    PubMed

    Beck-Razi, Nira; Fischer, Doron; Michaelson, Moshe; Engel, Ahuva; Gaitini, Diana

    2007-09-01

    The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P < .05). In a setting of a war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.

  8. Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned.

    PubMed

    Bilski, Tracy R; Baker, Bruce C; Grove, Jay R; Hinks, Robert P; Harrison, Michael J; Sabra, John P; Temerlin, Steven M; Rhee, Peter

    2003-05-01

    Operation Enduring Freedom is an effort to combat terrorism after an attack on the United States. The first large-scale troop movement (> 1,300) was made by the U.S. Marines into the country of Afghanistan by establishing Camp Rhino. Data were entered into a personal computer at Camp Rhino, using combat casualty collecting software. Surgical support at Camp Rhino consisted of two surgical teams (12 personnel each), who set up two operating tables in one tent. During the 6-week period, a total of 46 casualties were treated, and all were a result of blast or blunt injury. One casualty required immediate surgery, two required thoracostomy tube, and the remainder received fracture stabilization or wound care before being transported out of Afghanistan. The casualties received 6 major surgical procedures and 11 minor procedures, which included fracture fixations. There was one killed in action and one expectant patient. The major problem faced was long delay in access to initial surgical care, which was more than 5 hours and 2 hours for two of the casualties. Smaller, more mobile surgical teams will be needed more frequently in future military operations because of inability to set up current larger surgical facilities, and major problems will include long transport times. Future improvements to the system should emphasize casualty evacuation, en-route care, and joint operations planning between services.

  9. American War and Military Operations Casualties: Lists and Statistics

    DTIC Science & Technology

    2007-06-29

    DesertShield/Desert Storm (as of June 15, 2004) Casualty Type Total Army Air Force Marines Navya ,b Killed in Action 143 96 20 22 5 Died of Wounds 4 2 2...Operation Iraqi Freedom — Military Deaths, May 1, 2003, Through June 2, 2007 (As of June 2, 2007) Casualty Type Totals Army Navya Marines Air Force

  10. Reducing and Mitigating Civilian Casualties: Enduring Lessons

    DTIC Science & Technology

    2013-04-12

    the start of operations, international media began reporting incidents of civilian casualties. Many of these incidents involved villages where...operations. These incidents resulted in a significant outcry from nongovernmental organizations (NGOs) and the media ; the shooting of a vehicle... media ) also suggest that the applicability of lessons regarding ways to minimize civilian casualties and mitigate their impact

  11. 19 CFR 158.27 - Accidental fire or other casualty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Casualty, Loss, or Theft While in Customs Custody § 158.27 Accidental fire or other casualty. In the case... submitted: (a) A declaration of the master of the vessel, the conductor or driver of the vehicle, the... merchandise was on board the vessel or vehicle, in the warehouse, or otherwise in his charge, as the case may...

  12. Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol.

    PubMed

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

    2004-06-01

    Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

  13. [Principles of surgical care organization and structural characteristics of sanitary casualties in counter-terrorist operations in the Northern Caucasus (Report I)].

    PubMed

    Gumanenko, E K; Samokhvalov, I M; Trusov, A A; Severin, V V

    2005-01-01

    Two operational-and-tactical factors had the main influence on organization of the surgical care rendered to the casualties on the Northern Caucasus: the fulminant and maneuverable nature of combat operations at the beginning of both armed conflicts and rather small territory of war theatre. The main special features of organization of surgical care to the casualties were the use of Medical Squads of Special Purpose in the combat conditions and maximal approximation of the specialized surgical care to the wounded by echelonment of medical units and wide use of helicopter evacuation. The structure of sanitary losses was characterized by the increase in the frequency of mechanical traumas, thermal and combined injuries, by the high share of the casualties with head injuries. Besides the number of seriously wounded and critical casualties has increased.

  14. Load index model: An advanced tool to support decision making during mass-casualty incidents.

    PubMed

    Adini, Bruria; Aharonson-Daniel, Limor; Israeli, Avi

    2015-03-01

    In mass-casualty events, accessing information concerning hospital congestion levels is crucial to improving patient distribution and optimizing care. The study aimed to develop a decision support tool for distributing casualties to hospitals in an emergency scenario involving multiple casualties. A comprehensive literature review and structured interviews with 20 content experts produced a shortlist of relevant criteria for inclusion in the model. A "load index model" was prepared, incorporating results of a modified Delphi survey of 100 emergency response experts. The model was tested in three simulation exercises in which an emergency scenario was presented to six groups of senior emergency managers. Information was provided regarding capacities of 11 simulated admitting hospitals in the region, and evacuation destinations were requested for 600 simulated casualties. Of the three simulation rounds, two were performed without the model and one after its presentation. Following simulation experiments and implementation during a real-life security threat, the efficacy of the model was assessed. Variability between experts concerning casualties' evacuation destinations decreased significantly following the model's introduction. Most responders (92%) supported the need for standardized data, and 85% found that the model improved policy setting regarding casualty evacuation in an emergency situation. These findings were reaffirmed in a real-life emergency scenario. The proposed model improved capacity to ensure evacuation of patients to less congested medical facilities in emergency situations, thereby enhancing lifesaving medical services. The model supported decision-making processes in both simulation exercises and an actual emergency situation.

  15. Children and terror casualties receive preference in ICU admissions.

    PubMed

    Peleg, Kobi; Rozenfeld, Michael; Dolev, Eran

    2012-03-01

    Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events. Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry. All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU. Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.

  16. Needle Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations

    DTIC Science & Technology

    2012-07-06

    SUBJECT: Needle Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations 2012-05 2 demonstrating the...Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations 2012-05 3 needle may be too short to reliably reach the...at the AAL as the preferred site for needle decompression of a presumed tension pneumothorax . Further, studies evaluating chest wall thickness are

  17. [Managing an influx of casualties in Afghanistan].

    PubMed

    Planchet, Mathieu; Cazes, Nicolas; Pudupin, Alain; Leyral, Jarome; Lefort, Hugues

    2014-09-01

    Forward medical support is a fundamental principle of French army health service doctrine. During operations, the mission of army doctors and nurses is to treat casualties as high up the rescue chain as possible. This article describes the example of Afghanistan, in 2012, when the French army had to manage in a hostile environment an influx of casualties, sometimes massive and causing resources to become saturated.

  18. 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

    ... casualty be submitted, and what must it contain? 150.820 Section 150.820 Navigation and Navigable Waters... it contain? (a) In addition to the notice of casualty under § 150.815, the owner, operator, or person..., Report of Marine Accident, Injury, or Death, or in narrative form if it contains all of the applicable...

  19. 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

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

    PubMed

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

    2013-12-01

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

  1. Improvements in the Hemodynamic Stability of Combat Casualties During En Route Care

    DTIC Science & Technology

    2013-01-01

    IMPROVEMENTS IN THE HEMODYNAMIC STABILITY OF COMBAT CASUALTIES DURING EN ROUTE CARE Amy N. Apodaca,* Jonathan J. Morrison,†‡ Mary Ann Spott,* John J...greater clinical capability is associated with an improved hemodynamic status in critical casualties. The ideal prehospital triage should endeavor to...before out of theater medical evacuation (MEDEVAC). As SI is measure of hemodynamic stability, patients with isolated severe brain injury or

  2. 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

  3. Mass casualty tracking with air traffic control methodologies.

    PubMed

    Hoskins, Jason D; Graham, Ross F; Robinson, Duane R; Lutz, Clifford C; Folio, Les R

    2009-06-01

    An intrahospital casualty throughput system modeled after air traffic control (ATC) tracking procedures was tested in mass casualty exercises. ATC uses a simple tactile process involving informational progress strips representing each aircraft, which are held in bays representing each stage of flight to prioritize and manage aircraft. These strips can be reordered within the bays to indicate a change in priority of aircraft sequence. In this study, a similar system was designed for patient tracking. We compared the ATC model and traditional casualty tracking methods of paper and clipboard in 18 four-hour casualty scenarios, each with 5 to 30 mock casualties. The experimental and control groups were alternated to maximize exposure and minimize training effects. Results were analyzed with Mann-Whitney statistical analysis with p value < 0.05 (two-sided). The ATC method had significantly (p = 0.017) fewer errors in critical patient data (eg, name, social security number, diagnosis). Specifically, the ATC method better tracked the mechanism of injury, working diagnosis, and disposition of patients. The ATC method also performed considerably better with patient accountability during mass casualty scenarios. Data strips were comparable with the control method in terms of ease of use. In addition, participants preferred the ATC method to the control (p = 0.003) and preferred using the ATC method (p = 0.003) to traditional methods in the future. The ATC model more effectively tracked patient data with fewer errors when compared with the clipboard method. Application of these principles can enhance trauma management and can have application in civilian and military trauma centers and emergency rooms.

  4. Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace.

    PubMed

    Ordoñez, Carlos A; Manzano Nunez, Ramiro; Parra, Michael W; Herrera, Juan Pablo; Naranjo, Maria Paula; Escobar, Sara Sofia; Badiel, Marisol; Morales, Monica; Cevallos, Cecibel; Bayona, Juan G; Sanchez, Alvaro Ignacio; Puyana, Juan Carlos; García, Alberto F

    2017-12-30

    Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods. A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

  5. Combat musculoskeletal wounds in a US Army Brigade Combat Team during operation Iraqi Freedom.

    PubMed

    Belmont, Philip J; Thomas, Dimitri; Goodman, Gens P; Schoenfeld, Andrew J; Zacchilli, Michael; Burks, Rob; Owens, Brett D

    2011-07-01

    A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed. A detailed description of the musculoskeletal combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a US Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Among the 4,122 soldiers deployed, there were 242 musculoskeletal combat wounds in 176 combat casualties. The musculoskeletal combat casualty rate for the Brigade Combat Team was 34.2 per 1,000 soldier combat-years. Spine, pelvis, and long bone fractures comprised 55.9% (33 of 59) of the total fractures sustained in combat. Explosions accounted for 80.7% (142 of 176) of all musculoskeletal combat casualties. Musculoskeletal combat casualty wound incidence rates per 1,000 combat-years were as follows: major amputation, 2.1; minor amputation, 0.6; open fracture, 5.0; closed fracture, 6.4; and soft-tissue/neurovascular injury, 32.8. Among musculoskeletal combat casualties, the likelihood of a gunshot wound causing an open fracture was significantly greater (45.8% [11 of 24]) when compared with explosions (10.6% [15 of 142]) (p = 0.0006). Long bone amputations were more often caused by explosive mechanisms than gunshot wounds. A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.

  6. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012.

    PubMed

    Penn-Barwell, Jowan G; Roberts, Stuart A G; Midwinter, Mark J; Bishop, Jon R B

    2015-05-01

    The United Kingdom was at war in Iraq and Afghanistan for more than a decade. Despite assertions regarding advances in military trauma care during these wars, thus far, no studies have examined survival in UK troops during this sustained period of combat. The aims of this study were to examine temporal changes of injury patterns defined by body region and survival in a population of UK Military casualties between 2003 and 2012 in Iraq and Afghanistan. The UK Military Joint Theatre Trauma Registry was searched for all UK Military casualties (survivors and fatalities) sustained on operations between January 1, 2003, and December 31, 2012. The New Injury Severity Score (NISS) was used to stratify injury severity. There were 2,792 UK Military casualties sustaining 14,252 separate injuries during the study period. There were 608 fatalities (22% of all casualties). Approximately 70% of casualties injured in hostile action resulted from explosive munitions. The extremities were the most commonly injured body region, involved in 43% of all injuries. The NISS associated with a 50% chance of survival rose each year from 32 in 2003 to 60 in 2012. An improvement in survival during the 10-year period is demonstrated. A majority of wounds are a result of explosive munitions, and the extremities are the most commonly affected body region. The authors recommend the development of more sophisticated techniques for the measuring of the performance of combat casualty care systems to include measures of morbidity and functional recovery as well as survival. Epidemiologic study, level III.

  7. Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace

    PubMed Central

    Manzano Nunez, Ramiro; Parra, Michael W; Herrera, Juan Pablo; Naranjo, Maria Paula; Escobar, Sara Sofia; Badiel, Marisol; Morales, Monica; Cevallos, Cecibel; Bayona, Juan G; Sanchez, Alvaro Ignacio; Puyana, Juan Carlos; García, Alberto F

    2017-01-01

    Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation. PMID:29662256

  8. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice

    PubMed Central

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Larner, Joanne; Matar, Hazem; Chilcott, Robert P.

    2016-01-01

    Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the “ladder-pipe system” for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

  9. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.

    PubMed

    Bolster, Ferdia; Linnau, Ken; Mitchell, Steve; Roberge, Eric; Nguyen, Quynh; Robinson, Jeffrey; Lehnert, Bruce; Gross, Joel

    2017-02-01

    The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.

  10. Measures for emergency medical technicians in helping victims at scenes guided by the pattern of injuries and bombing attacks in the three most southern provinces of Thailand.

    PubMed

    Cheeranont, Piyapan

    2009-02-01

    Bombing attacks by terrorists in the three most southern provinces of Thailand increased both in frequency and intensity from the year 2004 until now. Patterns of bombing were not only destroying buildings or killing targets victims by dropping bombs under roads and in public places but also harming scene investigators by dropping second bombs nearby. Emergency medical personnel working there also had some risks from these second bombs while helping victims at the scene. The purposes of the present study aimed to describe patterns and risks of bombing attacks, analyze locations of wounds of bombing casualties and propose a standing operation procedure for emergency medical technicians (EMTs) in helping victims at scenes to reduce harm from second bombs. The authors gathered some information about patterns of bombing from the Forward 4th Army Area Explosive Ordnance Disposal (EOD) team and reviewed insurgency related casualty reports from Yala, Pattani and Narathivasrajanakarin Hospital from January 2004 to December 2006. From these reports, data of deep wounds or wounds that caused serious injuries or deaths of 144 improvised explosive devices (IED) victims was collected and separated into fatal (45 casualties) and nonfatal groups (99 casualties). In each group, casualties' demographic data and number of casualties separated by locations of wounds and occupations are shown and compared by percentage of the total number of each group and was found that most of fatal casualties had wounds on head (42.22%), chest (33.33%) and abdomen (33.33%) that should be protected by wearing helmets and body armors. But there was a higher proportion of extremity injuries in non-fatal casualties (63.64%). Thus, the authors proposed measures for EMTs in helping victims at scenes to reduce their risks by wearing helmets and body armors and quickly removal of the injured with minimal medical intervention.

  11. Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana.

    PubMed

    Damsere-Derry, James; Palk, Gavan; King, Mark

    2018-02-17

    Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

  12. Injuries from roadside improvised explosive devices.

    PubMed

    Ramasamy, Arul; Harrisson, Stuart E; Clasper, Jon C; Stewart, Michael P M

    2008-10-01

    After the invasion of Iraq in April 2003, coalition forces have remained in the country in a bid to maintain stability and support the local security forces. The improvised explosive device (IED) has been widely used by the insurgents and is the leading cause of death and injury among Coalition troops in the region. From January 2006, data were prospectively collected on 100 consecutive casualties who were either injured or killed in hostile action. Mechanism of injury, new Injury Severity Score (NISS), The International Classification of Disease-9th edition diagnosis, anatomic pattern of wounding, and operative management were recorded in a trauma registry. The weapon incident reports were analyzed to ascertain the type of IED employed. Of the 100 casualties injured in hostile action, 53 casualties were injured by IEDs in 23 incidents (mean 2.3 casualties per incident). Twenty-one of 23 (91.3%) of the IEDs employed were explosive formed projectile (EFP) type. Twelve casualties (22.6%) were either killed or died of wounds. Median NISS score of survivors was 3 (range, 1-50). All fatalities sustained unsurvivable injuries with a NISS score of 75. Primary blast injuries were seen in only 2 (3.8%) and thermal injuries in 8 casualties (15.1%). Twenty (48.7%) of survivors underwent surgery by British surgeons in the field hospital. At 18 months follow, all but one of the United Kingdom Service personnel had returned to military employment. The injury profile seen with EFP-IEDs does not follow the traditional pattern of injuries seen with conventional high explosives. Primary blast injuries were uncommon despite all casualties being in close proximity to the explosion. When the EFP-IED is detonated, the EFP produced results in catastrophic injuries to casualties caught in its path, but causes relatively minor injuries to personnel sited adjacent to its trajectory. Improvements in vehicle protection may prevent the EFP from entering the passenger compartments and thereby reduce fatalities.

  13. Job Stress and Coping in Army Casualty Operations Workers

    DTIC Science & Technology

    1991-01-14

    available, stress leading to burnout appears finely balanced , teetering back and forth among particular conditions and situations in casualty work . Many CAO...al., 1986) and brought more in accord with the U.S. Army’s casualty work experience. As with the original, burnout is measured through 22 overall...than 11 miles from work and commute during irregular hours. In respect to general trends among Army NCOs, the characteristics described above appear to

  14. Handbook on Ground Forces Attrition in Modern Warfare

    DTIC Science & Technology

    1986-09-01

    casualty rates since 1600 was re- 0 versed temporarily. The first is a period of about ten years during the Napoleonic Wars ; the second is a period of...are usually 0 higher at the outset of a war than later on when both sides become both exhausted and more careful. Second , the participants in the Middle...Matrix ........... 118 Comparision with World War II Casualty Rates ................. 120 Summary of Casualty Experience for Minor Conflicts

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    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/supmore » 12/ Btu of energy output, and per other appropriate units of output.« less

  16. Acute respiratory distress syndrome in combat casualties: military medicine and advances in mechanical ventilation.

    PubMed

    Morris, Michael James

    2006-11-01

    Military medicine has made numerous enduring contributions to the advancement of pulmonary medicine. Acute respiratory distress syndrome was first recognized as a complication in battlefield casualties in World War I and continued to play a significant role in the treatment of casualties through the Vietnam War. Innovative surgeons during World War II devised methods to assist their patients with positive pressure breathing. This concept was later adopted and applied to the development of mechanical ventilation in the late 1940s and early 1950s. The continued treatment of acute respiratory distress syndrome in combat casualties by military physicians has provided a major impetus for advances in modern mechanical ventilation and intensive care unit medicine.

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

    PubMed

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

    2014-10-01

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

  18. Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution.

    PubMed

    Shartar, Samuel E; Moore, Brooks L; Wood, Lori M

    2017-12-01

    Metropolitan areas must be prepared to manage large numbers of casualties related to a major incident. Most US cities do not have adequate trauma center capacity to manage large-scale mass casualty incidents (MCIs). Creating surge capacity requires the distribution of casualties to hospitals that are not designated as trauma centers. Our objectives were to extrapolate MCI response research into operational objectives for MCI distribution plan development; formulate a patient distribution model based on research, hospital capacities, and resource availability; and design and disseminate a casualty distribution tool for use by emergency medical services (EMS) personnel to distribute patients to the appropriate level of care. Working with hospitals within the region, we refined emergency department surge capacity for MCIs and developed a prepopulated tool for EMS providers to use to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to nontrauma hospitals. A mechanism to remove a hospital from the list of available resources, if it is overwhelmed with patients who self-transport to the location, also was put into place. The number of critically injured survivors from an MCI has proven to be consistent, averaging 7% to 10%. Moving critically injured patients to level 1 trauma centers can result in a 25% reduction in mortality, when compared with care at nontrauma hospitals. US cities face major gaps in the surge capacity needed to manage an MCI. Sixty percent of "walking wounded" casualties self-transport to the closest hospital(s) to the incident. Directing critically ill patients to designated trauma centers has the potential to reduce mortality associated with the event. When applied to MCI responses, damage-control principles reduce resource utilization and optimize surge capacity. A universal system for mass casualty triage was identified and incorporated into the region's EMS. Flagship regional coordinating hospitals were designated to coordinate the logistics of the disaster response of both trauma-designated and undesignated hospitals. Finally, a distribution tool was created to direct the flow of critically injured patients to trauma centers and redirect patients with lesser injuries to centers without trauma designation. The tool was distributed to local EMS personnel and validated in a series of tabletop and functional drills. These efforts demonstrate that a regional response to MCIs can be implemented in metropolitan areas under-resourced for trauma care.

  19. Invasion vs insurgency: US Navy/Marine Corps forward surgical care during Operation Iraqi Freedom.

    PubMed

    Brethauer, Stacy A; Chao, Alex; Chambers, Lowell W; Green, Donald J; Brown, Carlos; Rhee, Peter; Bohman, Harold R

    2008-06-01

    The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by US Marine Corps forward surgical units in Iraq. Case series comparison. Forward Resuscitative Surgical System units in Iraq. Three hundred thirty-eight casualties treated during the invasion of Iraq in 2003 (Operation Iraqi Freedom I [OIF I]) and 895 casualties treated between March 2004 and February 2005 (OIF II). Definitive and damage control procedures for acute combat casualties. Mechanism of injury, procedures performed, time to presentation, and killed in action (KIA) and died of wounds (DOW) rates. More major injuries occurred per patient (2.4 vs 1.6) during OIF II. There were more casualties with fragment wounds (61% vs 48%; P = .03) and a trend toward fewer gunshot wounds (33% vs 43%; P = .15) during OIF II. More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during OIF II. The median time to presentation for critically injured US casualties during OIF I and OIF II were 30 and 59 minutes, respectively. The KIA rate increased from 13.5% to 20.2% and the DOW rate increased from 0.88% to 5.5% for US personnel in the First Marine Expeditionary Force area of responsibility. The transition from maneuver to insurgency warfare has changed the type and severity of casualties treated by US Marine Corps forward surgical units in Iraq. Improvised explosive devices, severity and number of injuries per casualty, longer transport times, and higher KIA and DOW rates represent major differences between periods. Further data collection is necessary to determine the association between transport times and mortality rates.

  20. Prophylaxis for blood-borne diseases during the London 7/7 mass casualty terrorist bombing: a review and the role of bioethics.

    PubMed

    Edwards, Dafydd S; Barnett-Vanes, A; Narayan, N; Patel, H D L

    2016-10-01

    The suicide bombings in London on 7 July 2005 resulted in a mass casualty situation. Over 50% of casualties were treated at the Royal London Hospital where clinicians witnessed large numbers of severely injured patients. In some casualties human biological foreign material was found embedded in the soft tissue originating from the suicide bombers or other casualties. This had the potential of placing individuals at risk of transmission of blood-borne diseases. Advances in the fields of medicine and biology have led to increased survivorship in the context of trauma and mass casualty incidents. This has resulted in the emergence of ethical scenarios surrounding patient management. A systematic review of the literature of the 7/7 bombings, and suicide bombings reported globally, where biological implantation is noted, was performed to examine the medicolegal issues arising during such attack. Twelve casualties with human tissue implanted were recorded in the 7/7 bombings. While all patients at risk were given prophylaxis based on recommendations by the Health Protection Agency, several ethical considerations surfaced as a result. In this paper, we compare the sequence of events and the management process of the victims of the 7/7 bombings and the evidence-based research regarding blood-borne infection transmission. Furthermore, it explores the ethical dilemmas, experienced by the senior author on 7/7, surrounding prophylaxis for blood-borne diseases and protocols to avoid confusion over best practice in future bombing incidents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Burden of injury of serious road injuries in six EU countries.

    PubMed

    Weijermars, Wendy; Bos, Niels; Filtness, Ashleigh; Brown, Laurie; Bauer, Robert; Dupont, Emmanuelle; Martin, Jean Louis; Perez, Katherine; Thomas, Pete

    2018-02-01

    Information about the burden of (non-fatal) road traffic injury is very useful to further improve road safety policy. Previous studies calculated the burden of injury in individual countries. This paper estimates and compares the burden of non-fatal serious road traffic injuries in six EU countries/regions: Austria, Belgium, England, The Netherlands, the Rhône region in France and Spain. It is a cross-sectional study based on hospital discharge databases. of study are patients hospitalized with MAIS3+ due to road traffic injuries. The burden of injury (expressed in years lived with disability (YLD)) is calculated applying a method that is developed within the INTEGRIS study. The method assigns estimated disability information to the casualties using the EUROCOST injury classification. The average burden per MAIS3+ casualty varies between 2.4 YLD and 3.2 YLD per casualty. About 90% of the total burden of injury of MAIS3+ casualties is due to lifelong consequences that are experienced by 19% to 33% of the MAIS3+ casualties. Head injuries, spinal cord injuries and injuries to the lower extremities are responsible for more than 90% of the total burden of MAIS3+ road traffic injuries. Results per transport mode differ between the countries. Differences between countries are mainly due to differences in age distribution and in the distribution over EUROCOST injury groups of the casualties. The analyses presented in this paper can support further improvement of road safety policy. Countermeasures could for example be focused at reducing skull and brain injuries, spinal cord injuries and injuries to the lower extremities, as these injuries are responsible for more than 90% of the total burden of injury of MAIS3+ casualties. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Evacuation Priorities in Mass Casualty Terror-Related Events

    PubMed Central

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

    2004-01-01

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

  3. Died of wounds on the battlefield: causation and implications for improving combat casualty care.

    PubMed

    Eastridge, Brian J; Hardin, Mark; Cantrell, Joyce; Oetjen-Gerdes, Lynne; Zubko, Tamara; Mallak, Craig; Wade, Charles E; Simmons, John; Mace, James; Mabry, Robert; Bolenbaucher, Rose; Blackbourne, Lorne H

    2011-07-01

    Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Battle injury died of wounds (DOW) deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners (OAFME). A panel of military trauma experts classified the injuries as nonsurvivable (NS) or potentially survivable (PS), in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. DOW casualties (n = 558) accounted for 4.56% of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 (48.6%) cases and PS in 287 (51.4%) cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 (83%) NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 (80%) PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso (48%), extremity (31%), and junctional (neck, axilla, and groin) (21%). Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.

  4. Experience with Proctectomy to Manage Combat Casualties Sustaining Catastrophic Perineal Blast Injury Complicated by Invasive Mucor Soft-Tissue Infections

    DTIC Science & Technology

    2014-03-01

    Complicated by Invasive Mucor Soft-Tissue Infections MAJ Jonathan B. Lundy, MC USA; MAJ Ian R. Driscoll, MC USA ABSTRACT Catastrophic pelviperineal injuries...invasive Mucor species infection. The purpose of this report is to describe two catastrophi- cally injured combat casualties with pelviperineal blast...loss of anal sphincter complex, invasive Mucor species pelvic soft- tissue infection, and continued soilage of perineal wounds. Combat Casualty 1 A 25

  5. Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma

    DTIC Science & Technology

    2015-02-01

    of Combat Casualties in a Swine Polytrauma PRINCIPAL INVESTIGATOR: Richard McCarron, PhD CONTRACTING ORGANIZATION: Henry M. Jackson Foundation for the...Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma 5a. CONTRACT NUMBER...of neurotrauma and polytrauma . We plan to investigate the effects of aero-medical evacuation on neurophysiology and lung function in swine models of

  6. The 2004 Fitts Lecture: Current Perspective on Combat Casualty Care

    DTIC Science & Technology

    2005-07-01

    deliver this lecture, I actually wondered whether he had called the wrong number. Dr. Basil Pruitt described Dr. William P. Fitts in his 1992 Fitts Lecture...in our ability to care for injured casualties in a deployed setting. Dr. Basil Pruitt eloquently described the interaction between the AAST and...ation ( ABA ) verified burn centers (Fig. 3) in proximity to the USAF hubs.11 We anticipated between 500 and 2,500 burn casualties and created a

  7. Disasters and mass casualties: I. General principles of response and management.

    PubMed

    Born, Christopher T; Briggs, Susan M; Ciraulo, David L; Frykberg, Eric R; Hammond, Jeffrey S; Hirshberg, Asher; Lhowe, David W; O'Neill, Patricia A

    2007-07-01

    Disaster planning and response to a mass casualty incident pose unique demands on the medical community. Because they would be required to confront many casualties with bodily injury and surgical problems, surgeons in particular must become better educated in disaster management. Compared with routine practice, triage principles in disasters require an entirely different approach to evaluation and care and often run counter to training and ethical values. An effective response to disaster and mass casualty events should focus on an "all hazards" approach, defined as the ability to adapt and apply fundamental disaster management principles universally to any mass casualty incident, whether caused by people or nature. Organizational tools such as the Incident Command System and the Hospital Incident Command System help to effect a rapid and coordinated response to specific situations. The United States federal government, through the National Response Plan, has the responsibility to respond quickly and efficiently to catastrophic incidents and to ensure critical life-saving assistance. International medical surgical response teams are capable of providing medical, surgical, and intensive care services in austere environments anywhere in the world.

  8. Proceedings of the Conference on Fleet Marine Force Combat Casualty Information System Held at San Diego, California on 2-4 April 1984

    DTIC Science & Technology

    1984-10-01

    Ryack Sub~marine Medlical Researchl ILahOratorv tiehlavioral Scxences C De ~partment Naval Submarinte base New London Groton, CT 06349 Dr. William J. Sacco...Computer- Based Patient Management System 1 to Fleet Marine Force Medical Care George Moeller, Ph.D., Naval Submarine Medical Research Laboratory, Groton...combat casualty1 medical record, develop soitware tailor-ed aor cach echelon at casualty care, and ] identity applopridate hardware based on the most

  9. Force Developments. The Measurement of Effectiveness

    DTIC Science & Technology

    1973-01-01

    such as start time and end time. Quotients include propot - tions, ratios, and percentages. In some cases a complex form may result in an index number...count of personnel casualties inflicted. Also called "personnel losses," "’ body count", "red casualties", "blue casualties", or "personnel kill." The...system of mechanics (i.e., the branch of physics that deals with motion and the action of forces on bodies ). It A is reasonable to conclude that the

  10. Infection Casualty Estimation (ICE) Model: Predicting Sepsis in Nuclear Detonation Burn Patient Populations using Procalcitonin as a Biomarker

    DTIC Science & Technology

    2017-06-06

    environments may be injured or killed from the primary blast wave, thermal pulse and ionizing radiation . Burn casualties surviving the initial blast wave are...32]/1.8 degree Celsius (oC) degree Fahrenheit (oF) [T(oF) + 459.67]/1.8 kelvin (K) Radiation activity of radionuclides [curie (Ci)] 3.7 × 1010...develop casualty estimation models for improvised nuclear device (IND) scenarios. The HSRDIPT team has developed health effects models of radiation , burn

  11. Eliminating Preventable Death on the Battlefield

    DTIC Science & Technology

    2011-08-15

    Phases of Tactical Combat Casualty Care Between October 1, 2001, and March 31, 2010 Intervention IVF Dose, mL Casualties, No. Saline lock only NA 35...Saline lock and IVF NA 55 Normal saline 250 1 500 25a 1000 6 1500 1 Hextendb 250 2 500 12a,c 1000 1 Normal salineHextendb 500500 3 1000250 1 500100...1a Lactated ringers 500 2a Abbreviations: IVF , intravenous fluid; NA, not applicable. aFour casualties received 2 saline locks and IVF . bHextend is

  12. Utilizing a Trauma Systems Approach to Benchmark and Improve Combat Casualty Care

    DTIC Science & Technology

    2010-07-01

    modern battlefield utilizing evidence - based medicine . The development of injury care benchmarks enhanced the evolution of the combat casualty care performance improvement process within the trauma system.

  13. 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.

  14. Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Greenwalt, R. J.; Hibbard, W. J.

    2016-05-04

    Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less

  15. Mass Casualty Chemical Incident Operational Framework, Assessment and Best Practices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Greenwalt, R.; Hibbard, W.

    2016-08-09

    Emergency response agencies in most US communities are organized, sized, and equipped to manage those emergencies normally expected. Hospitals in particular do not typically have significant excess capacity to handle massive numbers of casualties, as hospital space is an expensive luxury if not needed. Unfortunately this means that in the event of a mass casualty chemical incident the emergency response system will be overwhelmed. This document provides a self-assessment means for emergency managers to examine their response system and identify shortfalls. It also includes lessons from a detailed analysis of five communities: Baltimore, Boise, Houston, Nassau County, and New Orleans.more » These lessons provide a list of potential critical decisions to allow for pre-planning and a library of best practices that may be helpful in reducing casualties in the event of an incident.« less

  16. Decontamination of mass casualties--re-evaluating existing dogma.

    PubMed

    Levitin, Howard W; Siegelson, Henry J; Dickinson, Stanley; Halpern, Pinchas; Haraguchi, Yoshikura; Nocera, Anthony; Turineck, David

    2003-01-01

    The events of 11 September 2001 became the catalyst for many to shift their disaster preparedness efforts towards mass-casualty incidents. Emergency responders, healthcare workers, emergency managers, and public health officials worldwide are being tasked to improve their readiness by acquiring equipment, providing training and implementing policy, especially in the area of mass-casualty decontamination. Accomplishing each of these tasks requires good information, which is lacking. Management of the incident scene and the approach to victim care varies throughout the world and is based more on dogma than scientific data. In order to plan effectively for and to manage a chemical, mass-casualty event, we must critically assess the criteria upon which we base our response. This paper reviews current standards surrounding the response to a release of hazardous materials that results in massive numbers of exposed human survivors. In addition, a significant effort is made to prepare an international perspective on this response. Preparations for the 24-hour threat of exposure of a community to hazardous material are a community responsibility for first-responders and the hospital. Preparations for a mass-casualty event related to a terrorist attack are a governmental responsibility. Reshaping response protocols and decontamination needs on the differences between vapor and liquid chemical threats can enable local responders to effectively manage a chemical attack resulting in mass casualties. Ensuring that hospitals have adequate resources and training to mount an effective decontamination response in a rapid manner is essential.

  17. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Gender differences in the impact of warfare exposure on self-rated health.

    PubMed

    Wang, Joyce M; Lee, Lewina O; Spiro, Avron

    2015-01-01

    This study examined gender differences in the impact of warfare exposure on self-reported physical health. Data are from the 2010 National Survey of Veterans, a nationally representative survey of veterans from multiple eras of service. Regression analyses assessed gender differences in the association between warfare exposure (deployment to a war zone, exposure to casualties) and health status and functional impairment, adjusting for sociodemographics. Women reported better health status but greater functional impairment than men. Among men, those who experienced casualties only or both casualties and deployment to a war zone had worse health compared with those who experienced neither stressor or deployment to a war zone only. Among women, those who experienced casualties only or both stressors reported worse health than those who experienced war zone only, who did not differ from the unexposed. No association was found between warfare exposure and functional impairment in women; in men, however, those who experienced exposure to casualties or both stressors had greater odds of functional impairment compared with those who experienced war zone only or neither stressor. Exposure to casualties may be more predictive of health than deployment to a war zone, especially for men. We did not find a stronger association between warfare exposure and health for women than men. Given that the expansion of women's military roles has allowed them to serve in direct combat, their degree and scope of warfare exposure is likely to increase in the future. Copyright © 2015 Jacobs Institute of Women's Health. All rights reserved.

  19. Gender Differences in the Impact of Warfare Exposure on Self-Rated Health

    PubMed Central

    Wang, Joyce M.; Lee, Lewina O.; Spiro, Avron

    2014-01-01

    BACKGROUND This study examined gender differences in the impact of warfare exposure on self-reported physical health. METHODS Data are from the 2010 National Survey of Veterans, a nationally representative survey of veterans from multiple eras of service. Regression analyses assessed gender differences in the association between warfare exposure (deployment to a war zone, exposure to casualties) and health status and functional impairment, adjusting for sociodemographics. FINDINGS Women reported better health status but greater functional impairment than men. In men, those who experienced casualties only or both casualties and deployment to a war zone had worse health compared to those who experienced neither stressor or deployment to a war zone only. In women, those who experienced casualties only or both stressors reported worse health than those who experienced war zone only, who did not differ from the unexposed. No association was found between warfare exposure and functional impairment in women, but in men, those who experienced exposure to casualties or both stressors had greater odds of functional impairment compared to those who experienced war zone only or neither stressor. CONCLUSIONS Exposure to casualties may be more predictive of health than deployment to a war zone, especially for men. We did not find a stronger association between warfare exposure and health for women than men. Given that the expansion of women's military roles has allowed them to serve in direct combat, their degree and scope of warfare exposure is likely to increase in the future. PMID:25442366

  20. Strategies for Improved Hospital Response to Mass Casualty Incidents.

    PubMed

    TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas

    2018-03-19

    Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

  1. Immune cytokine response in combat casualties: blast or explosive trauma with or without secondary sepsis.

    PubMed

    Surbatovic, Maja; Filipovic, Nikola; Radakovic, Sonja; Stankovic, Nebojsa; Slavkovic, Zoran

    2007-02-01

    The aim of this study was to assess the prognostic value of tumor necrosis factor (TNF) alpha, interleukin (IL)-8, IL-4, and IL-10 in combat casualties. Fifty-six casualties with severe trauma (blast and explosive) who developed sepsis and 20 casualties with the same severity of trauma without sepsis were enrolled in this study. Fifty-five casualties developed multiple organ dysfunction syndrome; 36 died. Blood was drawn on the first day of trauma. Concentrations of IL-8, TNF-alpha, IL-4, and IL-10 were determined in plasma using enzyme-linked immunosorbent assays. Mean values of IL-8 were 230-fold, IL-10 were 42-fold, and TNF-alpha were 17-fold higher in trauma and sepsis group (p < 0.01). Mean values of IL-8 were 60-fold, TNF-alpha were 43.5-fold, and IL-10 were 70-fold higher in the multiple organ dysfunction syndrome group (p < 0.01). Mean values of IL-8 were 2.3-fold and IL-10 were 1.4-fold higher in nonsurvivors and TNF-alpha were 2.2-fold higher in survivors (p < 0.01). IL-4 had no significance as a predictor of severity and outcome.

  2. Heavy truck casualty collisions, 2001-2005

    DOT National Transportation Integrated Search

    2010-04-01

    This document reviews casualty collisions (fatalities and injuries) involving heavy trucks in Canada : from 2001 to 2005. Collisions involving heavy trucks include all vehicles in these collisions, such as : passenger cars, light trucks and vans, hea...

  3. Heavy truck casualty collisions, 1994-1998

    DOT National Transportation Integrated Search

    2001-12-01

    This document reviews the number of collisions, vehicles involved, and casualties (fatalities and injuries) resulting from heavy truck collisions for each of straight trucks (greater than 4.536 kg) and tractor-trailers. The report also presents table...

  4. Trends in motor vehicle traffic collision statistics, 1988-1997

    DOT National Transportation Integrated Search

    2001-02-01

    This report presents descriptive statistics about Canadian traffic collisions during the ten-year period : from 1988 to 1997, focusing specifically on casualty collisions. Casualty collisions are defined as all : reportable motor vehicle crashes resu...

  5. 33 CFR 150.815 - How must casualties be reported?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... first aid and, if the person is engaged or employed on the deepwater port, that renders the individual... casualties be reported? (a) Immediately after aiding the injured and stabilizing the situation, the owner...

  6. Past and present role of extracorporeal membrane oxygenation in combat casualty care: How far will we go?

    PubMed

    Cannon, Jeremy W; Mason, Phillip E; Batchinsky, Andriy I

    2018-06-01

    Advanced extracorporeal therapies have been successfully applied in the austere environment of combat casualty care over the previous decade. In this review, we describe the historic underpinnings of extracorporeal membrane oxygenation, review the recent experience with both partial and full lung support during combat operations, and critically assess both the current status of the Department of Defense extracorporeal membrane oxygenation program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty care.

  7. Transfusion: -80°C Frozen Blood Products Are Safe and Effective in Military Casualty Care.

    PubMed

    Noorman, Femke; van Dongen, Thijs T C F; Plat, Marie-Christine J; Badloe, John F; Hess, John R; Hoencamp, Rigo

    2016-01-01

    The Netherlands Armed Forces use -80°C frozen red blood cells (RBCs), plasma and platelets combined with regular liquid stored RBCs, for the treatment of (military) casualties in Medical Treatment Facilities abroad. Our objective was to assess and compare the use of -80°C frozen blood products in combination with the different transfusion protocols and their effect on the outcome of trauma casualties. Hemovigilance and combat casualties data from Afghanistan 2006-2010 for 272 (military) trauma casualties with or without massive transfusions (MT: ≥6 RBC/24hr, N = 82 and non-MT: 1-5 RBC/24hr, N = 190) were analyzed retrospectively. In November 2007, a massive transfusion protocol (MTP; 4:3:1 RBC:Plasma:Platelets) for ATLS® class III/IV hemorrhage was introduced in military theatre. Blood product use, injury severity and mortality were assessed pre- and post-introduction of the MTP. Data were compared to civilian and military trauma studies to assess effectiveness of the frozen blood products and MTP. No ABO incompatible blood products were transfused and only 1 mild transfusion reaction was observed with 3,060 transfused products. In hospital mortality decreased post-MTP for MT patients from 44% to 14% (P = 0.005) and for non-MT patients from 12.7% to 5.9% (P = 0.139). Average 24-hour RBC, plasma and platelet ratios were comparable and accompanying 24-hour mortality rates were low compared to studies that used similar numbers of liquid stored (and on site donated) blood products. This report describes for the first time that the combination of -80°C frozen platelets, plasma and red cells is safe and at least as effective as standard blood products in the treatment of (military) trauma casualties. Frozen blood can save the lives of casualties of armed conflict without the need for in-theatre blood collection. These results may also contribute to solutions for logistic problems in civilian blood supply in remote areas.

  8. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable Estate... during the settlement of the estate arising from fires, storms, shipwrecks, or other casualties, or from...

  9. A literature review of dental casualty rates.

    PubMed

    Mahoney, G D; Coombs, M

    2000-10-01

    The ability to determine dental casualty rates for the Australian Defence Force in a given situation is vital for military planners. This article reviews the literature and the available Australian Defence Force data on the subject to give some guide to planners. The review found the studies to be fairly consistent in that a well-prepared dentally fit force can expect 150 to 200 dental casualties per 1,000 soldiers per year. If the force were less prepared, as in the case of a reserve call out, this figure would be likely to increase; in the extreme case of an ill-prepared force or a force assisting in humanitarian aid, the emergency rate could be five times that figure. The literature also indicates a change in the nature of dental casualties. Although maxillofacial cases have remained steady at 25%, dental disease has decreased and endodontic cases have had a corresponding increase.

  10. The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

    PubMed

    Kotwal, Russ S; Howard, Jeffrey T; Orman, Jean A; Tarpey, Bruce W; Bailey, Jeffrey A; Champion, Howard R; Mabry, Robert L; Holcomb, John B; Gross, Kirby R

    2016-01-01

    The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less. To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes. A retrospective descriptive analysis of battlefield data examined 21,089 US military casualties that occurred during the Afghanistan conflict from September 11, 2001, to March 31, 2014. Analysis was conducted from September 1, 2014, to January 21, 2015. Data for all casualties were analyzed according to whether they occurred before or after the mandate. Detailed data for those who underwent prehospital helicopter transport were analyzed according to whether they occurred before or after the mandate and whether they occurred in 60 minutes or less vs more than 60 minutes. Casualties with minor wounds were excluded. Mortality and morbidity outcomes and treatment capability-related variables were compared. For the total casualty population, the percentage killed in action (16.0% [386 of 2411] vs 9.9% [964 of 9755]; P < .001) and the case fatality rate ([CFR] 13.7 [469 of 3429] vs 7.6 [1344 of 17,660]; P < .001) were higher before vs after the mandate, while the percentage died of wounds (4.1% [83 of 2025] vs 4.3% [380 of 8791]; P = .71) remained unchanged. Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved. Among 4542 casualties (mean injury severity score, 17.3; mortality, 10.1% [457 of 4542]) with detailed data, there was a decrease in median transport time after the mandate (90 min vs 43 min; P < .001) and an increase in missions achieving prehospital helicopter transport in 60 minutes or less (24.8% [181 of 731] vs 75.2% [2867 of 3811]; P < .001). When adjusted for injury severity score and time period, the percentage killed in action was lower for those critically injured who received a blood transfusion (6.8% [40 of 589] vs 51.0% [249 of 488]; P < .001) and were transported in 60 minutes or less (25.7% [205 of 799] vs 30.2% [84 of 278]; P < .01), while the percentage died of wounds was lower among those critically injured initially treated by combat support hospitals (9.1% [48 of 530] vs 15.7% [86 of 547]; P < .01). Acute morbidity was higher among those critically injured who were transported in 60 minutes or less (36.9% [295 of 799] vs 27.3% [76 of 278]; P < .01), those severely and critically injured initially treated at combat support hospitals (severely injured, 51.1% [161 of 315] vs 33.1% [104 of 314]; P < .001; and critically injured, 39.8% [211 of 530] vs 29.3% [160 of 547]; P < .001), and casualties who received a blood transfusion (50.2% [618 of 1231] vs 3.7% [121 of 3311]; P < .001), emphasizing the need for timely advanced treatment. A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. Prehospital transport time and treatment capability are important factors for casualty survival on the battlefield.

  11. The use of analgesia in mountain rescue casualties with moderate or severe pain.

    PubMed

    Ellerton, John Alexander; Greene, Mike; Paal, Peter

    2013-06-01

    To assess the effectiveness of analgesia used in mountain rescue (MR) in casualties with moderate or severe pain. To determine if a verbal numeric pain score is practical in this environment. To describe the analgesic strategies used by MR. Prospective, descriptive study. Fifty-one MR teams in England and Wales. The study period was 1 September 2008 to 31 August 2010. 92 MR casualties with a pain scoreof 4/10 or greater. 38% of casualties achieved a pain reduction of 50% or greater in their initial score at 15 min and 60.2% had achieved this at handover. The initial pain score was 8 (median), reducing to 5 at 15 min and 3 at handover. The mean pain reduction was 2.5 ± 2.4 at 15 min and 3.9 ± 2.5 at handover. 80 casualties (87%) were treated with an opioid and seven had two different opioids administered. Seven main strategies were identified in which the principal agent was entonox, intramuscular opioid, oral analgesia, fentanyl lozenge, intranasal or intravenous opioid. The choice of strategy varied with the skills of the casualty carer. Pain should be assessed using a pain score. When possible, intravenous opioid is the gold standard to achieve early and continuing pain control in patients with moderate or severe pain. Entonox and oral analgesics, as sole agents, have limited use in moderate or severe pain. Intranasal opioid and fentanyl lozenge are effective, and appropriate in MR. Research priorities include bioavailability in different environmental conditions and patient's satisfaction with their pain management.

  12. Augmentation of point of injury care: Reducing battlefield mortality-The IDF experience.

    PubMed

    Benov Avi; Elon, Glassberg; Baruch, Erez Nissim; Avi, Shina; Gilad, Twig; Moran, Levi; Itay, Zoarets; Ram, Sagi; Tarif, Bader; David, Dagan; Avraham, Yitzhak; Yitshak, Kreiss

    2016-05-01

    In 2012, the Israel Defense Forces Medical Corps (IDF-MC) set a goal of reducing mortality and eliminating preventable death on the battlefield. A force buildup plan entitled "My Brother's Keeper" was launched addressing: trauma medicine, training, change of Clinical Practice Guidelines (CPGs), injury prevention, data collection, global collaboration and more. The aim of this article is to examine how military medical care has evolved due "My Brother's Keeper" between Second Lebanon War (SLW, 2006) to Operation Protective Edge (OPE, 2014). Records of all casualties during OPE and SLW were extracted and analyzed from the I.D.F Trauma Registry. Noncombat injuries and civilian injuries from missile attacks were excluded from this analysis. The plans main impacts were; incorporation of a physician or paramedic as an integral part of each fighting company, implementation of new CPGs, introduction of new approaches for extremity haemorrhage control and Remote Damage Control Resuscitation at point of injury (POI) using single donor reconstituted freeze dried plasma (25 casualties) and transexamic acid (98 casualties). During OPE, 704 soldiers sustained injuries compared with 833 casualties during SLW. Fatalities were 65 and 119, respectively, cumulating to Case Fatality Rate of 9.2% and 14.3%, respectively. Significant changes in the way the IDF-MC provides combat casualty care have been made in recent years. It is the transformation from concept to doctrine and integration into a structured and Goal-Oriented Casualty Care System, especially POI care that led to the unprecedented survival rates in IDF as shown in this conflict. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties

    PubMed Central

    Al-Damouk, M; Bleetman, A

    2005-01-01

    Background: Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. Objectives: To assess the impact of the DoH initiative on acute hospital and ambulance trusts. To identify deficiencies in the design and operational deployment of the new CPPE, training initiative, and decontamination procedures at hospital level. Method: A survey to assess progress in specific areas of chemical incident preparedness and two simulated incidents with "live" chemically contaminated casualties conducted in two acute trusts. Umpires evaluated the operational performance against DoH SACC standards. Results: There has been marked improvement in many aspects of preparedness for chemical incidents since the original National Focus survey. Some deficiencies remain and this study identified areas for further work. In the live casualty exercises, hospital staff complied well with SACC protocols. Some practical difficulties were encountered with the deployment of the CPPE and in some aspects of the operational response, leading to some delays in the delivery of care to the casualties and to the integrity of the uncontaminated (clean) zones within the hospitals. Conclusion: Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process. PMID:15843703

  14. Planning for burn disasters: lessons learned from one hundred years of history.

    PubMed

    Barillo, David J; Wolf, Steven

    2006-01-01

    The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

  15. Early transfusion on battlefield before admission to role 2: A preliminary observational study during "Barkhane" operation in Sahel.

    PubMed

    Vitalis, V; Carfantan, C; Montcriol, A; Peyrefitte, S; Luft, A; Pouget, T; Sailliol, A; Ausset, S; Meaudre, E; Bordes, J

    2018-05-01

    Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated. The purpose of this study was to evaluate the transfusion practices on battlefield during the first year following the implementation of this policy. Prospective collection of data about combat related casualties categorized alpha evacuated to a role 2. Battlefield transfusion was defined as any transfusion of blood product (red blood cells, plasma, whole blood) performed by role 1 or Medevac team before admission at a role 2. Patients' characteristics, battlefield transfusions' characteristics and complications were analysed. During the one year study, a total of 29 alpha casualties were included during the period study. Twenty-eight could be analysed, 7/28 (25%) being transfused on battlefield, representing a total of 22 transfusion episodes. The most frequently blood product transfused was French lyophilized plasma (FLYP). Most of transfusion episodes occurred during medevac. Compared to non-battlefield transfused casualties, battlefield transfused casualties suffered more wounded anatomical regions (median number of 3 versus 2, p = 0.04), had a higher injury severity score (median ISS of 45 versus 25, p = 0,01) and were more often transfused at role 2, received more plasma units and whole blood units. There was no difference in evacuation time to role 2 between patients transfused on battlefield and non-transfused patients. There was no complication related to battlefield transfusions. Blood products transfusion onset on battlefield ranged from 75 min to 192 min after injury. Battlefield transfusion for combat-related casualties is a logistical challenge. Our study showed that such a program is feasible even in an extended area as Sahel-Saharan Strip operation theatre and reduces time to first blood product transfusion for alpha casualties. FLYP is the first line blood product on the battlefield. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Optimization of Lyophilized Plasma for Use in Combat Casualties

    DTIC Science & Technology

    2015-01-01

    respiratory distress syndrome and multiple organ failure in combat casualties. This model was developed at Oregon Health & Science University (OHSU) and...during the controlled hemorrhage to induce acidosis and coagulopathy. This reflects current civilian pre-hospital resuscitative practices. Operative

  17. [Rendering surgical care to wounded with neck wounds in an armed conflict].

    PubMed

    Samokhvalov, I M; Zavrazhnov, A A; Fakhrutdinov, A M; Sychev, M I

    2001-10-01

    The results of rendering of the medical care (the first aid, qualified and specialized) obtained in 172 servicemen with neck injuries who stayed in Republic of Chechnya during the period from 09.08.1999 to 28.07.2000 were analyzed. Basing on the results of analysis and experience of casualties' treatment the authors discuss the problems of sequence and volume of surgical care in this group of casualties with reference to available medical evacuation system, surgical tactics at the stage of specialized care. They also consider the peculiarities of operative treatment of the casualties with neck injuries.

  18. The Pros And Cons Of Various Optical Media For The Soldier's Interfacility Radiographic Record (SIRR) In The Combat Casualty Care System

    NASA Astrophysics Data System (ADS)

    Kerlin, Barbara D.; Johnson, William P.

    1989-05-01

    Ongoing research and evaluation projects sponsored by the Army Medical Research and Development Command are leading towards filmless radiography in the combat casualty care system of the 1990s. With the elimination of film, the question arises as to the most appropriate medium for archiving and transporting x-ray images and related patient data with the wounded between facilities. This paper considers the pros and cons of the various candidate media in relation to their specifications, availability, and appropriateness under simulated combat casualty care conditions.

  19. 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. © 2012 Society for Risk Analysis.

  20. 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.

  1. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

  2. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with “Office of Marine Insurance, Maritime Administration, Department of Transportation.” ...

  3. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

  4. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

  5. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

  6. Red Tides: Mass casualty and whole blood at sea Red Tides.

    PubMed

    Miller, Benjamin T; Lin, Andrew H; Clark, Susan C; Cap, Andrew P; Dubose, Joseph J

    2018-02-13

    The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP). The blood supply can be augmented with WFWB collected from a "walking blood bank" (WBB). Following a helicopter crash, six patients were transported by MV-22 Osprey to the USS Bataan. Patient 1 had a pelvic fracture, was managed with a pelvic binder, and received 4 units of pRBC, 2 units of FFP, and 6 units of WFWB. Patient 2, with a comminuted tibia and fibula fracture, underwent lower extremity four-compartment fasciotomy, and received 4 units of WFWB. Patient 3 underwent several procedures, including left anterior thoracotomy, aortic cross-clamping, exploratory laparotomy, small bowel resection, and tracheostomy. He received 8 units of pRBC, 8 units of FFP, and 28 units of WFWB. Patients 4 and 5 had suspected spine injuries and were managed non-operatively. Patient 6, with open tibia and fibula fractures, underwent lower extremity four-compartment fasciotomy with tibia external fixation and received 1 unit of WFWB. All patients survived aeromedical evacuation to a Role 4 medical facility and subsequent transfer to local hospitals. Maritime military mass casualty incidents are challenging, but the U.S. Navy's casualty-receiving ships are ready to perform RDCR at sea. Activation of the ship's WBB to transfuse WFWB is essential for hemostatic resuscitations afloat. V STUDY TYPE: Case series.

  7. Mitigating active shooter impact: Analysis for policy options based on agent/computer-based modeling.

    PubMed

    Anklam, Charles; Kirby, Adam; Sharevski, Filipo; Dietz, J Eric

    2015-01-01

    Active shooting violence at confined settings, such as educational institutions, poses serious security concerns to public safety. In studying the effects of active shooter scenarios, the common denominator associated with all events, regardless of reason/intent for shooter motives, or type of weapons used, was the location chosen and time expended between the beginning of the event and its culmination. This in turn directly correlates to number of casualties incurred in any given event. The longer the event protracts, the more casualties are incurred until law enforcement or another barrier can react and culminate the situation. Using AnyLogic technology, devise modeling scenarios to test multiple hypotheses against free-agent modeling simulation to determine the best method to reduce casualties associated with active shooter scenarios. Test four possible scenarios of responding to active shooter in a public school setting using agent-based computer modeling techniques-scenario 1: basic scenario where no access control or any type of security is used within the school; scenario 2, scenario assumes that concealed carry individual(s) (5-10 percent of the work force) are present in the school; scenario 3, scenario assumes that the school has assigned resource officer; scenario 4, scenario assumes that the school has assigned resource officer and concealed carry individual(s) (5-10 percent) present in the school. Statistical data from modeling scenarios indicating which tested hypothesis resulted in fewer casualties and quicker culmination of event. The use of AnyLogic proved the initial hypothesis that a decrease on response time to an active shooter scenario directly reduced victim casualties. Modeling tests show statistically significant fewer casualties in scenarios where on scene armed responders such as resource officers and concealed carry personnel were present.

  8. Casualties of peace: an analysis of casualties admitted to the intensive care unit during the negotiation of the comprehensive Colombian process of peace.

    PubMed

    Ordoñez, Carlos A; Manzano-Nunez, Ramiro; Naranjo, Maria Paula; Foianini, Esteban; Cevallos, Cecibel; Londoño, Maria Alejandra; Sanchez Ortiz, Alvaro I; García, Alberto F; Moore, Ernest E

    2018-01-01

    After 52 years of war in 2012, the Colombian government began the negotiation of a process of peace, and by November 2012, a truce was agreed. We sought to analyze casualties who were admitted to the intensive care unit (ICU) before and during the period of the negotiation of the comprehensive Colombian process of peace. Retrospective study of hostile casualties admitted to the ICU at a Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (November 2012-December 2016). Patients were compared with respect to time periods. Four hundred forty-eight male patients were admitted to the emergency room. Of these, 94 required ICU care. Sixty-five casualties presented before the truce and 29 during the negotiation period. Median injury severity score was significantly higher before the truce. Furthermore, the odds of presenting with severe trauma (ISS > 15) were significantly higher before the truce (OR, 5.4; (95% CI, 2.0-14.2); p  < 0.01). There was a gradual decrease in the admissions to the ICU, and the performance of medical and operative procedures during the period observed. We describe a series of war casualties that required ICU care in a period of peace negotiation. Despite our limitations, our study presents a decline in the occurrence, severity, and consequences of war injuries probably as a result in part of the negotiation of the process of peace. The hysteresis of these results should only be interpreted for their implications in the understanding of the peace-health relationship and must not be overinterpreted and used for any political end.

  9. Increased situation awareness in major incidents-radio frequency identification (RFID) technique: a promising tool.

    PubMed

    Jokela, Jorma; Rådestad, Monica; Gryth, Dan; Nilsson, Helené; Rüter, Anders; Svensson, Leif; Harkke, Ville; Luoto, Markku; Castrén, Maaret

    2012-02-01

    In mass-casualty situations, communications and information management to improve situational awareness is a major challenge for responders. In this study, the feasibility of a prototype system that utilizes commercially available, low-cost components, including Radio Frequency Identification (RFID) and mobile phone technology, was tested in two simulated mass-casualty incidents. The feasibility and the direct benefits of the system were evaluated in two simulated mass-casualty situations: one in Finland involving a passenger ship accident resulting in multiple drowning/hypothermia patients, and another at a major airport in Sweden using an aircraft crash scenario. Both simulations involved multiple agencies and functioned as test settings for comparing the disaster management's situational awareness with and without using the RFID-based system. Triage documentation was done using both an RFID-based system, which automatically sent the data to the Medical Command, and a traditional method using paper triage tags. The situational awareness was measured by comparing the availability of up-to date information at different points in the care chain using both systems. Information regarding the numbers and status or triage classification of the casualties was available approximately one hour earlier using the RFID system compared to the data obtained using the traditional method. The tested prototype system was quick, stable, and easy to use, and proved to work seamlessly even in harsh field conditions. It surpassed the paper-based system in all respects except simplicity of use. It also improved the general view of the mass-casualty situations, and enhanced medical emergency readiness in a multi-organizational medical setting. The tested technology is feasible in a mass-casualty incident; further development and testing should take place.

  10. A single, improvised "Kassam" rocket explosion can cause a mass casualty incident: a potential threat for future international terrorism?

    PubMed

    Schwartz, D; Ostfeld, I; Bar-Dayan, Y

    2009-04-01

    Over 2000 improvised rockets (called "Kassam" rockets) have been targeted at the south of Israel from the Gaza strip since 2001. Most of them have injured relatively few people. The first known case of a multicasualty incident (MCI) caused by the landing of a single, improvised rocket is described. The event is described according to the disastrous incidents systematic analysis through components, interactions and results methodology (DISAST-CIR). The rocket hit a military training tent camp in the south of Israel at 01:18 hours. At that time, all soldiers were in bed and were not using any protective gear. A total of 76 soldiers was injured (three severe, eight moderate and 65 mild). The most prevalent types of injuries were upper extremity (33%) and lower extremity (30%) trauma, tinnitus (30%) and acute stress reactions (32%). A total of 67 casualties was evacuated to the nearest level two hospital, Barzilai, in a two-phase distribution characterised by different patterns of injury severity and type. All urgent casualties arrived at hospitals within 1 h 24 minutes, whereas most stress casualties arrived in the later phase. Seven casualties were secondarily transported to level one trauma centres. 42 of the casualties were hospitalised and 17 needed urgent surgery. None has died. A single low-tech mortar with poor accuracy and small warhead (estimated weight of 10 kg only) can cause a large-scale MCI. As international terrorist organisations can easily gain access to improvised rockets, the latter may become a threat in many countries. Emergency systems should thus be prepared for that adverse possibility.

  11. 75 FR 36153 - Surety Companies Acceptable On Federal Bonds-Change In Business Address: American Economy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-24

    ... Business Address: American Economy Insurance Company; American Fire and Casualty Company; American States Insurance Company; Employers Insurance Company of Wausau; Liberty Mutual Fire Insurance Company; Ohio Casualty Insurance Company; Peerless Insurance Company; West American Insurance Company AGENCY: Financial...

  12. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... casualty notice. The report may be on Form 2692, Report of Marine Accident, Injury, or Death, or in... operator will ensure that the written report is provided to the nearest Bureau of Ocean Energy Management...

  13. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... casualty notice. The report may be on Form 2692, Report of Marine Accident, Injury, or Death, or in... operator will ensure that the written report is provided to the nearest Bureau of Ocean Energy Management...

  14. 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 student...

  15. 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 student...

  16. Reprioritization of Research for Combat Casualty Care

    DTIC Science & Technology

    2012-01-01

    Today it is not un- common for a war casualty to sur- vive massive head trauma, multiple extremity loss, significant soft-tissue injury, and sensory ...disorder, depres- sion, and/or anxiety and the coexis- tence of debilitating pain syndromes, presents significant challenges to re- habilitation

  17. Plastic Surgery Response in Natural Disasters.

    PubMed

    Chung, Susan; Zimmerman, Amanda; Gaviria, Andres; Dayicioglu, Deniz

    2015-06-01

    Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

  18. SS Sansinena (Liberian); explosion and fire in Los Angeles Harbor, California on 17 December 1976 with loss of life. Marine casualty report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    1977-11-25

    On 17 December 1976 the Liberian tanker SANSINENA, moored at berth 46, Union Oil Terminal, Los Angeles Harbor, California, exploded and burned while taking on ballast and bunkers. The casualty resulted in six members of the SANSINENA's crew known dead, and 22 injured. Two crewmembers and one terminal security guard are missing and presumed dead. Also approximately 36 personal injuries were suffered by the general public. This report contains the U.S. Coast Guard Marine Board of Investigation report and the Action taken by the Commandant to determine the probable cause of the casualty and the recommendations to prevent recurrence. Themore » Commandant concurred with the Marine Board that the probable cause of the casualty was the ignition of a hydrocarbon vapor cloud over the afterdeck of the SANSINENA. The source of ignition cannot be positively identified; however, it was most probably located in the vicinity of the midship deckhouse.« less

  19. From the battlefields to the states: the road to recovery. The role of Landstuhl Regional Medical Center in US military casualty care.

    PubMed

    Tenuta, Joachim J

    2006-01-01

    The transformation of the modern battlefield with respect to weaponry, modes of transportation, enemy capabilities and location, as well as technological advances, has greatly altered the tactical approach to the mission. Combat casualty care must continually evolve in response to the differences in types of injury, the number and triage of casualties, timing of treatment, and location of care. These battlefield changes have been demonstrated on a large scale in the global war on terrorism, which includes the military operations in Afghanistan and Iraq. The medical response has kept pace with this 21st-century conflict. Even in the new environment of armed conflict and with the advent of new technologies, the principles of managing orthopaedic combat casualties remain clear: preservation of life and limb, skeletal stabilization, and aggressive wound débridement. For United States service members wounded in the current conflicts, Landstuhl Regional Medical Center is a crucial stop along the road to recovery.

  20. Provision of nutrition support therapies in the recent Iraq and Afghanistan conflicts.

    PubMed

    Stankorb, Susan M; Ramsey, Casside; Clark, Heidi; Osgood, Tamara

    2014-10-01

    This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

  1. Mass Casualty Decontamination in a Chemical or Radiological/ Nuclear Incident: Further Guiding Principles.

    PubMed

    Carter, Holly; Amlôt, Richard; Williams, Richard; Rubin, G James; Drury, John

    2016-09-15

    This short report presents a response to an article written by Cibulsky et al. (2016). The paper by Cibulsky et al. presents a useful and timely overview of the evidence surrounding the technical and operational aspects of mass casualty decontamination. It identifies three priority targets for future research, the third of which is how casualties' needs can be met in ways that best support compliance with and effectiveness of casualty decontamination. While further investigation into behavioural, communication and privacy issues during mass decontamination is warranted, there is now a substantial body of research in this area which is not considered in detail in the succinct summary provided by Cibulsky et al. (2016). In this short report, we summarise the available evidence around likely public behaviour during mass decontamination, effective communication strategies, and potential issues resulting from a lack of privacy. Our intention is to help further focus the research needs in this area and highlight topics on which more research is needed.

  2. Issue of emergency hormonal contraception through a casualty department in a community hospital.

    PubMed

    Heard-Dimyan, J

    1999-10-01

    The results of this survey show that sexually active women seeking emergency hormonal contraception are finding that a casualty department in a community hospital offers convenience, confidentiality and accessibility above all else. There is a growing tendency for those registered with the local practice to prefer to come to the hospital for post-coital contraception, even though casualty nurses are not family planning qualified. This applies especially to the under twenties. More needs to be done in persuading patients that ongoing contraception should be addressed. To this end, if casualty departments are the preferred outlets in the rural communities, then nurses need further training. All providers of emergency contraception in rural areas need to be aware that offering such a service by well trained RGNs working to a protocol could reduce the incidence of unintended conceptions amongst teenagers. At the same time, every effort has to be made to increase awareness of the availability of emergency hormonal contraception by advertising the sources of contraceptive advice, which could soon include pharmacists.

  3. Mass Casualty Decontamination in a Chemical or Radiological/ Nuclear Incident: Further Guiding Principles

    PubMed Central

    Carter, Holly; Amlôt, Richard; Williams, Richard; Rubin, G. James; Drury, John

    2016-01-01

    This short report presents a response to an article written by Cibulsky et al. (2016). The paper by Cibulsky et al. presents a useful and timely overview of the evidence surrounding the technical and operational aspects of mass casualty decontamination. It identifies three priority targets for future research, the third of which is how casualties' needs can be met in ways that best support compliance with and effectiveness of casualty decontamination. While further investigation into behavioural, communication and privacy issues during mass decontamination is warranted, there is now a substantial body of research in this area which is not considered in detail in the succinct summary provided by Cibulsky et al. (2016). In this short report, we summarise the available evidence around likely public behaviour during mass decontamination, effective communication strategies, and potential issues resulting from a lack of privacy. Our intention is to help further focus the research needs in this area and highlight topics on which more research is needed. PMID:27790381

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

    PubMed

    Duncan, Edward A S; Colver, Keith; Dougall, Nadine; Swingler, Kevin; Stephenson, John; Abhyankar, Purva

    2014-02-22

    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. A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item's importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. 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. 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.

  5. Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

    PubMed

    Buehner, Michelle F; Eastridge, Brian J; Aden, James K; DuBose, Joseph J; Blackbourne, Lorne H; Cestero, Ramon F

    2017-09-01

    Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90. Transfers from role 2 facilities were excluded. Data captured included demographics, admission vital signs, laboratory values, blood products, and mortality. Relationships between admission physiology, blood product utilization, and mortality were developed. Independent associations between variables were determined by logistic regression analysis. 1,703 patients were identified who met our inclusion criteria and composite mortality was 23%. Mortality in those receiving a balanced transfusion ratio was 18% versus 27% (p < 0.0001). Hypotensive casualties who survived were significantly more likely to have a higher presenting Glasgow Coma Score (GCS), temperature, SBP, shock index, and pH. In addition, this group was also more likely to have a lower international normalized ratio, pCO2, and base deficit (p < 0.001). Age, heart rate, and pulse pressure were not significantly different between groups. Independent predictors of mortality included Injury Severity Score, presentation GCS, and initial pH value (p < 0.0001). In contrast, independent predictors of survival included those with above-knee amputation and a balanced transfusion (p < 0.0001). Combat casualties hypotensive on arrival to surgical facilities have a significant expected mortality. Those receiving balanced transfusions demonstrated improved survival. Of the five independent risk factors, pH, GCS, and the presence of above-knee amputation are typically available during initial evaluation. These factors may be helpful in determining resource allocation and mortality risk, especially in triage or mass casualty settings. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  6. Paramedic Application of a Triage Sieve: A Paper-Based Exercise.

    PubMed

    Cuttance, Glen; Dansie, Kathryn; Rayner, Tim

    2017-02-01

    Introduction Triage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area. The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates. Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire. The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups. This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A "just-in-time" educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI. Cuttance G , Dansie K , Rayner T . Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3-13.

  7. 'Mass allergy': acute scombroid poisoning in a deployed Australian Defence Force health facility.

    PubMed

    Ward, David Ian

    2011-02-01

    On the last night of disaster relief operations in Sumatra, Indonesia, a mass casualty event occurred that involved deployed Australian Defence Force personnel. Symptoms of acute urticaria, angioedema, wheeze and gastrointestinal upset were experienced to varying degrees by 16% of the deployed element. The present report describes a presumed scombroid poisoning cluster and demonstrates the difficulties of operating in a deployed environment, the confusion that might be associated with evolving non-kinetic mass casualties, and provides a learning opportunity for an unusual mass casualty incident. © 2011 The Author. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  8. Level I center triage and mass casualties.

    PubMed

    Hoey, Brian A; Schwab, C William

    2004-05-01

    The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.

  9. Lessons learned from modern military surgery.

    PubMed

    Beekley, Alec C; Starnes, Benjamin W; Sebesta, James A

    2007-02-01

    The era of global terrorism and asymmetric warfare heralded by the September 11, 2001 attacks on the United States have blurred the traditional lines between civilian and military trauma. The lessons learned by physicians in the theaters of war, particularly regarding the response to mass casualties, blast and fragmentation injuries, and resuscitation of casualties in austere environments, likely resonate strongly with civilian trauma surgeons in the current era. The evolution of a streamlined trauma system in the theaters of operations, the introduction of an in-theater institution review board process, and dedicated personnel to collect combat casualty data have resulted in improved data capture and realtime, on-the-scene research.

  10. An Alternative Representation of a Simulated Human Body

    DTIC Science & Technology

    2013-11-01

    Casualty Assessment ( ORCA )3 uses this model to determine injury from insults to the body from fragments and bullets. An alternative representation was...Based Casualty Assessment: ORCA Analyst’s Manual; U.S. Army Research Laboratory: Aberdeen Proving Ground, MD, August 2005; draft. 4 U.S. Army Natick

  11. 75 FR 60865 - Surety Companies Acceptable on Federal Bonds: Amendment-Allegheny Casualty Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... 20782. Dated: September 24, 2010. Laura Carrico, Director, Financial Accounting and Services Division...-- Allegheny Casualty Company AGENCY: Financial Management Service, Fiscal Service, Department of the Treasury... notice may be directed to the U.S. Department of the Treasury, Financial Management Service, Financial...

  12. 75 FR 22689 - Surety Companies Acceptable on Federal Bonds: General Casualty Company of Wisconsin

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-29

    ... to the U.S. Department of the Treasury, Financial Management Service, Financial Accounting and...: April 13, 2010. Sandra Paylor-Sanders, Acting Director, Financial Accounting and Services Division. [FR... Casualty Company of Wisconsin AGENCY: Financial Management Service, Fiscal Service, Department of the...

  13. Combat Trauma Lessons Learned from Military Operations of 2001 - 2013

    DTIC Science & Technology

    2015-03-09

    and fentanyl citrate lozenges as described in the TCCC “triple-option analgesia” plan. - Documentation of care by using TCCC Casualty Cards and TCCC...o Meloxicam/acetaminophen o Oral transmucosal fentanyl citrate o Ketamine  Modified tactical combat casualty care (TCCC) measures to optimize

  14. The impact of Ontario’s extended drinking hours on cross-border cities of Windsor and Detroit

    PubMed Central

    Vingilis, E.; McLeod, A.I.; Seeley, J.; Mann, R.; Voas, R.; Compton, C.

    2008-01-01

    Purpose This study evaluated the cross-border safety impact of extended drinking hours from 1:00 to 2:00 a.m., in licensed establishments in Ontario, Canada. Methods This study examined patterns in total and alcohol-related casualties in: (1) Windsor, Ontario, Canada compared to Detroit, Michigan, US with a 2:00 a.m. closing time, and (2) Ontario compared to Michigan for overall trends. The criterion outcome indicators were: (1) monthly motor vehicle casualties (major injuries and fatalities) for the city-regions of Windsor and Detroit and (2) Ontario and Michigan monthly motor vehicle fatalities occurring between 11:00 p.m. and 3:00 a.m. for 4 years pre- and 3 years post-policy change. In order to examine cross-border drinking consequences, data were disaggregated to assess trends of motor vehicle injury collisions involving vehicles with US licence plates and with US drivers aged 16–20 in the Windsor region; similarly trends were assessed for motor vehicle injury collisions involving vehicles with Ontario licence plates in the Detroit region. Results The Windsor region total motor vehicle casualty data showed a non-significant pre–post increase, while the Detroit region showed a statistically significant decrease for total motor vehicle casualties. In the Windsor region, a significant increase was found for alcohol-related motor vehicle casualties after the drinking hours were extended. However, the Detroit region showed a statistically significant decrease in alcohol-related motor vehicle casualties concomitant with Ontario’s drinking hour extension. No similar trends were found for the province of Ontario and the state of Michigan as a whole. Moreover, a significant decrease was found for injury collisions involving vehicles with Ontario licence plates in the Detroit region but no similar pattern was found for injury collisions involving vehicles with US licence plates and with 16–20-year-old US drivers in the Windsor region. Discussion These data seem to support a cross-border impact of the Ontario extended drinking policy. A significant increase in alcohol-related motor vehicle casualties was found in the Windsor region and concomitantly, significant decreases in total and alcohol-related motor vehicle casualties were found in the Detroit region after the extended drinking hours amendment. The Ontario government’s belief that the extended drinking hour policy would “reduce the number of patrons who cross the border when Ontario’s bars and restaurants close” may have been realized. PMID:16169506

  15. Evaluation and management of combat-related spinal injuries: a review based on recent experiences.

    PubMed

    Schoenfeld, Andrew J; Lehman, Ronald A; Hsu, Joseph R

    2012-09-01

    The current approach to the evaluation and treatment of military casualties in the Global War on Terror is informed by medical experience from prior conflicts and combat encounters from the last 10 years. In an effort to standardize the care provided to military casualties in the ongoing conflicts, the Department of Defense (DoD) has published Clinical Practice Guidelines (CPGs) that deal specifically with the combat casualty sustaining a spinal injury. However, the combat experience with spine injuries in the present conflicts remains incompletely described. To describe the CPGs for the care of the combat casualty with suspected spine injuries and discuss them in light of the published military experience with combat-related spinal trauma. Literature review. A literature review was conducted regarding published works that discussed the incidence, epidemiology, and management of combat-related spinal trauma. The CPGs, established by the DoD, are discussed in light of actual military experiences with spine trauma, the present situation in the forward surgical teams and combat support hospitals treating casualties in theater, and recent publications in the field of spine surgery. In the conventional wars fought by the United States between 1950 and 1991 (Korea, Vietnam, Gulf War I), the incidence of spine injuries remained close to 1% of all combat casualties. However, in the Global War on Terror, the enemy has relied on implements of asymmetric warfare, including sniper attacks, ambush, roadside bombs, and improvised explosive devices. The increase in explosive mechanisms of injury has elevated the number of soldiers exposed to blunt force trauma and, consequently, recent publications reported the highest incidence of combat-related spinal injuries in American military history. Wounded soldiers are expeditiously evacuated through the echelons of care but typically do not receive surgical management in theater. The current CPGs for the care of soldiers with combat-related spinal injuries should be re-examined in light of data regarding the increasing number of spine injuries, new injury patterns, such as lumbosacral dissociation and low lumbar burst fractures, and recent reports within the field of spine surgery as a whole. American and coalition forces are sustaining the highest spine combat casualty rates in recorded history and previously unseen injuries are being encountered with increased frequency. While the CPGs provide useful direction in terms of the evaluation and management of combat casualties with spine injuries, such recommendations may warrant periodic re-evaluation in light of recent combat experiences and evolving scientific evidence within the spine literature. Published by Elsevier Inc.

  16. Role 2 military hospitals: results of a new trauma care concept on 170 casualties.

    PubMed

    Ünlü, A; Cetinkaya, R A; Ege, T; Ozmen, P; Hurmeric, V; Ozer, M T; Petrone, P

    2015-04-01

    In recent military conflicts, military surgeons encounter more high-energy injuries associated with explosives. Advances in the field care and shorter evacuation time increased survival. However, casualties still incur severe injuries especially to the extremities. We present wound patterns, anatomical distribution and severity of injuries in a Role 2 hospital. Two years data have been retrospectively reviewed. Only explosives and firearms injuries were included in the study. Patient profile, admission details, mechanism of injury, AIS anatomical locations, ISS, surgical and medical treatments have been analyzed. Data revealed 170 male casualties. IEDs and GSW accounted for 133 (78%) and 37 (22%) casualties, respectively. An average of 1.8 IED and 1.2 GSW anatomical locations were exposed to injuries. Regardless of the mechanism, injuries were most commonly located in the extremities. IEDs caused significantly higher soft tissue injuries. Explosives do not necessarily cause more severe injuries than firearms. However, fragments create multiple, complicated soft tissue injuries which constitute more than half of the injuries. Timely wound debridement and excision of contaminated tissue are crucial to manage extremity soft tissue injuries. Casualty care should be assessed within the context of the capabilities present at a hospital and the cause, type and severity of the wounds. The NATO description of Role 2 care only requires an integrated surgical team for damage control surgery with limited diagnostic and infrastructural capabilities.

  17. Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents.

    PubMed

    Chilcott, Robert P; Mitchell, Hannah; Matar, Hazem

    2018-05-30

    The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as "clinical decontamination") has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography-mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.

  18. 78 FR 8220 - Surety Companies Acceptable on Federal Bonds-Change In Business Address and Redomestication...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    ... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds--Change In Business Address and Redomestication: American Fire and Casualty Company (NAIC 24066) and The Ohio Casualty Insurance Company (NA1C 24074) AGENCY: Financial Management Service, Fiscal Service, Department of the...

  19. 75 FR 38188 - Surety Companies Acceptable on Federal Bonds-Termination: Stonebridge Casualty Insurance Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-01

    ... DEPARTMENT OF THE TREASURY Fiscal Service [NAIC 10952] Surety Companies Acceptable on Federal Bonds--Termination: Stonebridge Casualty Insurance Company AGENCY: Financial Management Service, Fiscal... Certificate of Authority issued by the Treasury to the above-named company under 31 U.S.C. 9305 to qualify as...

  20. 76 FR 39473 - Proposed Collection; Comment Request for Form 1120-PC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-06

    ... 1120-PC AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for comments... comments concerning Form 1120-PC, U.S. Property and Casualty Insurance Company Income Tax Return. DATES... Casualty Insurance Company Income Tax Return. OMB Number: 1545-1027. Form Number: Form 1120-PC. Abstract...

  1. 77 FR 8956 - Surety Companies Acceptable on Federal Bonds: Grange Mutual Casualty Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-15

    ... . Questions concerning this Notice may be directed to the U.S. Department of the Treasury, Financial Management Service, Financial Accounting and Services Division, Surety Bond Branch, 3700 East-West Highway... Mutual Casualty Company AGENCY: Financial Management Service, Fiscal Service, Department of the Treasury...

  2. 77 FR 75263 - Surety Companies Acceptable on Federal Bonds: Termination; ULLICO Casualty Company

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-19

    .... Department of the Treasury, Financial Management Service, Financial Accounting and Services Division, Surety... McIntyre, Acting Director, Financial Accounting and Services Division. [FR Doc. 2012-30422 Filed 12-18-12...: Termination; ULLICO Casualty Company AGENCY: Financial Management Service, Fiscal Service, Department of the...

  3. Response to mass casualty events: from the battlefield to the Stop the Bleed campaign

    PubMed Central

    Knudson, M Margaret; Velmahos, George; Cooper, Zara R

    2016-01-01

    In the aftermath of a number of episodes of mass casualty events, we must be reminded of how important it is to be prepared and to reflect on the knowledge accumulated over the past 15 years of war in Iraq and Afghanistan. PMID:29766063

  4. Joint Threater Trauma System: Saving Lives on the Battlefield

    DTIC Science & Technology

    2008-04-23

    Guerre, Analysis d’observations. Bul.Med Soc.Chir. 44 (1918), 205. 30 SSG Kile , “Operational Medicine Overview,” Combat Care Casualty Course, Powerpoint...U.S. Naval Institute Proceedings 1237, no. 11 (November 2001):68-71 SSG Kile , “Operational Medicine Overview,” Combat Care Casualty Course

  5. 46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

  6. 46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

  7. 46 CFR 122.212 - Mandatory chemical testing following serious marine incidents.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Mandatory chemical testing following serious marine... PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.212 Mandatory chemical testing following serious marine incidents. A marine employer whose vessel is involved in a casualty or incident that is, or...

  8. 76 FR 11502 - Information Collection Request to Office of Management and Budget; OMB Control Number: 1625-0003

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... DEPARTMENT OF HOMELAND SECURITY Coast Guard [USCG-2011-0017] Information Collection Request to... Secretary to collect, analyze and publish reports, information, and statistics on marine casualties. Need... the Secretary (delegated to the Coast Guard) reports, information, and statistics on casualties...

  9. [Quality assurance of emergency medical work].

    PubMed

    Sunde, H G

    1995-03-30

    Patients attending a casualty department often have diseases or injuries needing urgent medical attention. Early and correct diagnosis and treatment may be of major importance for the medical outcome. The continuity of staff is often low, with many doctors and nurses working part time. This may represent a threat to the quality of the medical work. Quality assurance at a casualty department through good training, introduction of written rules, a good flow of information to the staff and local licensing of doctors are factors which can assure that the quality of the medical service remains the best. This paper presents the work done at The Tromsø Municipal Casualty Department to assure the quality of the medical service to the population.

  10. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... planted trees and ornamental shrubs on the grounds surrounding the building. In 1961 the land, building, trees, and shrubs are damaged by hurricane. At the time of the casualty the adjusted basis of the land is $18,000 and the adjusted basis of the building is $66,000. At that time the trees and shrubs have...

  11. Organizational Responses to Death in the Military.

    ERIC Educational Resources Information Center

    Bartone, Paul T.; Ender, Morten G.

    1994-01-01

    Notes that how organizations respond to a death can influence coping in either positive or negative directions for friends and co-workers of the deceased. Reviews how casualty policies have developed in U.S. Army, and draws on Army's casualty experience to suggest ways in which organizational responses to death might facilitate healthy adjustment…

  12. Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries

    DTIC Science & Technology

    2017-11-13

    information and proposes a series of findings and recommendations to improved airway management in the prehospital combat environment. The key...Airway Final Report: Summary of Findings and Recommendations for Suction Devices for Management of Prehospital Combat Casualty Care Injuries...75 General Information and Device Usability

  13. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE.... Reasons for belief that a vessel is in distress include, but are not limited to, lack of communication...

  14. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE.... Reasons for belief that a vessel is in distress include, but are not limited to, lack of communication...

  15. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE.... Reasons for belief that a vessel is in distress include, but are not limited to, lack of communication...

  16. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE.... Reasons for belief that a vessel is in distress include, but are not limited to, lack of communication...

  17. 46 CFR 4.04-1 - Reports of potential vessel casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Reports of potential vessel casualty. 4.04-1 Section 4.04-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE.... Reasons for belief that a vessel is in distress include, but are not limited to, lack of communication...

  18. 33 CFR 173.53 - Immediate notification of death or disappearance.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Immediate notification of death or disappearance. 173.53 Section 173.53 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.53 Immediate...

  19. 76 FR 53364 - Recreational Vessel Propeller Strike and Carbon Monoxide Poisoning Casualty Prevention

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ... in Outdoor Recreation Activity Participation--1980 to Now, May 2009 (A Recreation Research Report in the Internet Research Information Series), available at http://warnell.forestry.uga.edu/nrrt/nsre... casualties caused by propeller strikes and carbon monoxide (CO) poisoning, we will hold a meeting at a time...

  20. Fasciotomy Rates in Operations Enduring Freedom and Iraqi Freedom: Association with Injury Severity and Tourniquet Use

    DTIC Science & Technology

    2011-03-01

    civilian trauma care, more evidence supports their use for hemorrhage control in combat casualties.7–9 With the recent widespread reintroduction of...KK, Juncos LA, Wolf SE, et al. Continuous renal replacement therapy improves survival in severely burned military casualties with acute kidney injury

  1. 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…

  2. 33 CFR 146.303 - Notice and written report of casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Notice and written report of... shall ensure that the notice of casualty requirements of § 146.30 and the written report requirements of... SECURITY (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS Vessels § 146.303 Notice and written...

  3. Investigation of work zone crash casualty patterns using association rules.

    PubMed

    Weng, Jinxian; Zhu, Jia-Zheng; Yan, Xuedong; Liu, Zhiyuan

    2016-07-01

    Investigation of the casualty crash characteristics and contributory factors is one of the high-priority issues in traffic safety analysis. In this paper, we propose a method based on association rules to analyze the characteristics and contributory factors of work zone crash casualties. A case study is conducted using the Michigan M-94/I-94/I-94BL/I-94BR work zone crash data from 2004 to 2008. The obtained association rules are divided into two parts including rules with high-lift, and rules with high-support for the further analysis. The results show that almost all the high-lift rules contain either environmental or occupant characteristics. The majority of association rules are centered on specific characteristics, such as drinking driving, the highway with more than 4 lanes, speed-limit over 40mph and not use of traffic control devices. It should be pointed out that some stronger associated rules were found in the high-support part. With the network visualization, the association rule method can provide more understandable results for investigating the patterns of work zone crash casualties. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Blast injury research models

    PubMed Central

    Kirkman, E.; Watts, S.; Cooper, G.

    2011-01-01

    Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care. PMID:21149352

  5. 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.

  6. Exploring the perception of aid organizations' staff about factors affecting management of mass casualty traffic incidents in Iran: a grounded theory study.

    PubMed

    Bazeli, Javad; Aryankhesal, Aidin; Khorasani-Zavareh, Davoud

    2017-07-01

    Traffic incidents are of main health issues all around the world and cause countless deaths, heavy casualties, and considerable tangible and intangible damage. In this regard, mass casualty traffic incidents are worthy of special attention as, in addition to all losses and damage, they create challenges in the way of providing health services to the victims. The present study is an attempt to explore the challenges and facilitators in management of mass casualty traffic incidents in Iran. This qualitative grounded theory study was carried out with participation of 14 purposively selected experienced managers, paramedics and staff of aid organizations in different provinces of Iran in 2016. Semi-structured interviews were conducted in order to develop the theory. The transcribed interviews were analyzed through open, axial and selective coding. Despite the recent and relatively good improvements in facilities and management procedure of mass casualty traffic incidents in Iran, several problems such as lack of coordination, lack of centralized and integrated command system, large number of organizations participating in operations, duplicate attempts and parallel operations carried out by different organizations, intervention of lay people, and cultural factors halt provision of effective health services to the victims. It is necessary to improve the theoretical and practical knowledge of the relief personnel and paramedics, provide public with education about first aid and improve driving culture, prohibit laypeople from intervening in aid operations, and increase quality and quantity of aid facilities.

  7. An Integrated and Interdisciplinary Model for Predicting the Risk of Injury and Death in Future Earthquakes.

    PubMed

    Shapira, Stav; Novack, Lena; Bar-Dayan, Yaron; Aharonson-Daniel, Limor

    2016-01-01

    A comprehensive technique for earthquake-related casualty estimation remains an unmet challenge. This study aims to integrate risk factors related to characteristics of the exposed population and to the built environment in order to improve communities' preparedness and response capabilities and to mitigate future consequences. An innovative model was formulated based on a widely used loss estimation model (HAZUS) by integrating four human-related risk factors (age, gender, physical disability and socioeconomic status) that were identified through a systematic review and meta-analysis of epidemiological data. The common effect measures of these factors were calculated and entered to the existing model's algorithm using logistic regression equations. Sensitivity analysis was performed by conducting a casualty estimation simulation in a high-vulnerability risk area in Israel. the integrated model outcomes indicated an increase in the total number of casualties compared with the prediction of the traditional model; with regard to specific injury levels an increase was demonstrated in the number of expected fatalities and in the severely and moderately injured, and a decrease was noted in the lightly injured. Urban areas with higher populations at risk rates were found more vulnerable in this regard. The proposed model offers a novel approach that allows quantification of the combined impact of human-related and structural factors on the results of earthquake casualty modelling. Investing efforts in reducing human vulnerability and increasing resilience prior to an occurrence of an earthquake could lead to a possible decrease in the expected number of casualties.

  8. [Analysis of the incidence and causes of mass casualty events in a southern Germany medical rescue area].

    PubMed

    Beck, A; Bayeff-Filloff, M; Bischoff, M; Schneider, B M

    2002-11-01

    The growing number of mass casualty events during the early 1990s led, in January 1996, to the foundation of an honorary group of specially trained emergency physicians for dealing primarily with the management of large-scale emergency events and mass casualties. The incidence and quantity of these casualties was analysed in order to be better prepared for such events in the future. All calls prospectively registered by the Augsburg Rescue Co-ordination Centre (ARCC) in the 5 years from July 1997 to June 2002 were analysed, distinguishing between the different types of damage, number of patients involved, and time of occurrence (time of day/season). The area served by the ARCC includes the city of Augsburg with its surrounding counties. An estimated 850,000 inhabitants live in this area of 4,100 square kilometers (1,600 square miles). Since 1998, more than 145,000 calls a year have been dealt with of which 28,000 were covered by emergency physicians. In the 5 year period discussed here, 75 large-scale-calls were registered, giving an average incidence of 1.25 calls/month. Most of the calls were fire alarms, followed by car accidents. In total, we were able to serve more than 800 patients. The lowest number per event was two people during an emergency landing of a sport aircraft; the largest number was about 150 patients during a large open-air event in the city. While there was no difference in the time of day at which the event happened, most occurred in November and December. Taking these results into account, the authors, supported by the members of the emergency physician team of the German Trauma Society, developed an algorithm describing the optimal procedure for mass casualty events. This is presented here. In mass casualty or large-scale emergency events, an experienced emergency physician is necessary to co-ordinate the rescue brigades on site.

  9. Deprived children or deprived neighbourhoods? A public health approach to the investigation of links between deprivation and injury risk with specific reference to child road safety in Devon County, UK.

    PubMed

    Hewson, Paul

    2004-05-10

    Worldwide, injuries from road traffic collisions are a rapidly growing problem in terms of morbidity and mortality. The UK has amongst the worst records in Europe with regard to child pedestrian safety. A traditional view holds that resources should be directed towards training child pedestrians. In order to reduce socio-economic differentials in child pedestrian casualty rates it is suggested that these should be directed at deprived children. This paper seeks to question whether analysis of extant routinely collected data supports this view. Routine administrative data on road collisions has been used. A deprivation measure has been assigned to the location where a collision was reported, and the home postcode of the casualty. Aggregate data was analysed using a number of epidemiological models, concentrating on the Generalised Linear Mixed Model. This study confirms evidence suggesting a link between increasing deprivation and increasing casualty involvement of child pedestrians. However, suggestions are made that it may be necessary to control for the urban nature of an area where collisions occur. More importantly, the question is raised as to whether the casualty rate is more closely associated with deprivation measures of the ward in which the collision occurred than with the deprivation measures of the home address of the child. Conclusions have to be drawn with great caution. Limitations in the utility of the officially collected data are apparent, but the implication is that the deprivation measures of the area around the collision is a more important determinant of socio-economic differentials in casualty rates than the deprivation measures of the casualties' home location. Whilst this result must be treated with caution, if confirmed by individual level case-controlled studies this would have a strong implication for the most appropriate interventions.

  10. [Chemical and biological terrorism: psychological aspects, and guidelines for psychiatric preparedness].

    PubMed

    Bleich, Avi; Kutz, Ilan

    2002-05-01

    Chemical or biological terror may cause mass casualties, but the major damage of such a threat is related mainly to psychological terror. Anxiety and panic that accompany chemical or biological threat, may affect mass populations, disrupt their lives, and enormously increase the demands from the medical systems. In the case of real attack, such an increased demands may be critical, especially to the functional ability of hospitals. The Israeli experience, during the Persian Gulf war, concerning preparations to chemical attacks at the national level, was unique in its nature. In addition, the Scud missiles attacks, accompanied with non-conventional threat, supplied valuable information on the populations behavior, and on the needed preparations for similar threats. In the case of chemical or biological threat or attack, the main task of the psychiatrist is to treat stress and anxiety casualties. At the same time, he should be aware of the possibility that the psychological & behavioral symptoms may reflect organic brain damage due to the pathogenic agent, and that such a differential diagnosis may be life saving for the patient. Stress casualties will be referred from the ER, and treated by the mental health team, at a specifically designed "center for stress casualties". In addition, the psychiatrist will consult the medical teams, or sometimes directly intervene, with combined casualties, at other locations of the hospital. At the regional or community level, one should plane and exercise deployment and activation of multi-professional teams, including mental health, in existing installations designed for screening, treatment, and temporary containment of casualties. It is recommended that the head of the local authority, will be responsible for the preparations and activation of this formation. A planned and rational usage of the media may have a critical influence on the ability of the authorities to manage the crisis situation and on shaping the behavior of the population. In certain scenarios, the media may even serve as the main tool for calming and instructing the people being isolated at their homes.

  11. Evaluating cold, wind, and moisture protection of different coverings for prehospital maritime transportation-a thermal manikin and human study.

    PubMed

    Jussila, Kirsi; Rissanen, Sirkka; Parkkola, Kai; Anttonen Hannu

    2014-12-01

    Prehospital maritime transportation in northern areas sets high demands on hypothermia prevention. To prevent body cooling and hypothermia of seriously-ill or injured casualties during transportation, casualty coverings must provide adequate thermal insulation and protection against cold, wind, moisture, and water splashes. The aim of this study was to determine the thermal protective properties of different types of casualty coverings and to evaluate which would be adequate for use under difficult maritime conditions (cold, high wind speed, and water splashes). In addition, the study evaluated the need for thermal protection of a casualty and verified the optimum system for maritime casualty transportation. The study consisted of two parts: (1) the definition and comparison of the thermal protective properties of different casualty coverings in a laboratory; and (2) the evaluation of the chosen optimum protective covering for maritime prehospital transportation. The thermal insulations of ten different casualty coverings were measured according to the European standard for sleeping bags (EN 13537) using a thermal manikin in a climate chamber (-5°C) with wind speeds of 0.3 m/s and 4.0 m/s, and during moisture simulations. The second phase consisted of measurements of skin and core temperatures, air temperature, and relative humidity inside the clothing of four male test subjects during authentic maritime prehospital transportation in a partially-covered motor boat. Wind (4 m/s) decreased the total thermal insulation of coverings by 11%-45%. The decrement of thermal insulation due to the added moisture inside the coverings was the lowest (approximately 22%-29%) when a waterproof reflective sheet inside blankets or bubble wrap was used, whereas vapor-tight rescue bags and bubble wrap provide the most protection against external water splashes. During authentic maritime transportation lasting 30 minutes, mean skin temperature decreased on average by 0.5°C when a windproof and water-resistant rescue bag was used over layered winter clothing. The selected optimum rescue bag consisted of insulating and water-resistant layers providing sufficient protection against cold, wind, and water splashes during prehospital transportation lasting 30 minutes in the uncovered portion of a motor boat. The minimum thermal insulation for safe maritime transportation (30 minutes) is 0.46 m²K/W at a temperature of -5°C and a wind speed of 10 m/s.

  12. Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience

    DTIC Science & Technology

    2007-11-01

    airway obstruction: chin lift or jaw thrust, nasopharyngeal airway, place casualty in recovery position Surgical cricothyroidotomy (with lidocaine ...laryngeal mask airway /ILMA or Combitube or endotracheal intubation or surgical cricothyroidotomy (with lidocaine if conscious) Spinal immobilization is...surgical cricothyroidotomy (with lidocaine If conscious) 3. Breathing Consider tension pneumothorax and decompress with needle thoracostomy if

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....29(a) must be made on Form CG- 3920, Change of Address Notice. (4) Each notification required by... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Coast Guard forms for numbering... Issue of Certificate of Number § 173.81 Coast Guard forms for numbering and casualty reporting. (a) In a...

  14. Battle Casualty Survival with Emergency Tourniquet Use to Stop Limb Bleeding

    DTIC Science & Technology

    2009-01-01

    WITH EMERGENCY TOURNIQUET USE TO STOP LIMB BLEEDING John F. Kragh, Jr, COL, MC, USA,* Michelle L. Littrel, CPT, AN, USA,† John A. Jones ,* Thomas J...battlefield: a 4-year accumulated expe- rience. J Trauma 2003;54(Suppl 5):S221–5. 0. Mucciarone JJ, Llewellyn CH, Wightman JM. Tactical combat casualty care

  15. Popliteal Artery Repair in Massively Transfused Military Trauma Casualties: A Pursuit to Save Life and Limb

    DTIC Science & Technology

    2010-07-01

    were centrally scored and calculated by trained re- search nurses and staff using ISS-98 after patient discharge. A Level I facility was defined as a...casualties, once evacuated to the United States, had limited remaining autogenous vein and required prosthetic grafts in the secondary management of failed

  16. [Care concepts in mass casualty incidents and disasters. Concept for primary care clinic].

    PubMed

    Adams, H A; Flemming, A; Lange, C; Koppert, W; Krettek, C

    2015-02-01

    Patient care in mass casualty incidents and disaster strongly demand a joint approach of all preclinical and clinical forces. Special emphasis must be placed on immediate triage, establishment and preservation of transportability of high-risk patients and their clinical treatment as soon as possible. During limited mass casualties, the preclinical rescue station additionally serves as a buffer for patients, whereby in case of disaster, the focus on transportation of high-risk patients is imperative. Primary care hospitals are a decisive part in the chain of medical supply and are confronted with great challenges, which demand detailed emergency plans and also repeated exercises. In planning and exercises, special attention should be given to the cooperation with the fire department and other medical services.

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

    PubMed

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

    2012-06-01

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

  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. Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013).

    PubMed

    de Lesquen, Henri; Beranger, Fabien; Berbis, Julie; Boddaert, Guillaume; Poichotte, Antoine; Pons, Francois; Avaro, Jean-Philippe

    2016-09-01

    This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war. From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included. Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%. The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. An Integrated and Interdisciplinary Model for Predicting the Risk of Injury and Death in Future Earthquakes

    PubMed Central

    Shapira, Stav; Novack, Lena; Bar-Dayan, Yaron; Aharonson-Daniel, Limor

    2016-01-01

    Background A comprehensive technique for earthquake-related casualty estimation remains an unmet challenge. This study aims to integrate risk factors related to characteristics of the exposed population and to the built environment in order to improve communities’ preparedness and response capabilities and to mitigate future consequences. Methods An innovative model was formulated based on a widely used loss estimation model (HAZUS) by integrating four human-related risk factors (age, gender, physical disability and socioeconomic status) that were identified through a systematic review and meta-analysis of epidemiological data. The common effect measures of these factors were calculated and entered to the existing model’s algorithm using logistic regression equations. Sensitivity analysis was performed by conducting a casualty estimation simulation in a high-vulnerability risk area in Israel. Results the integrated model outcomes indicated an increase in the total number of casualties compared with the prediction of the traditional model; with regard to specific injury levels an increase was demonstrated in the number of expected fatalities and in the severely and moderately injured, and a decrease was noted in the lightly injured. Urban areas with higher populations at risk rates were found more vulnerable in this regard. Conclusion The proposed model offers a novel approach that allows quantification of the combined impact of human-related and structural factors on the results of earthquake casualty modelling. Investing efforts in reducing human vulnerability and increasing resilience prior to an occurrence of an earthquake could lead to a possible decrease in the expected number of casualties. PMID:26959647

  1. A survey of the practice of nurses' skills in Wenchuan earthquake disaster sites: implications for disaster training.

    PubMed

    Yin, Huahua; He, Haiyan; Arbon, Paul; Zhu, Jingci

    2011-10-01

    To determine nursing skills most relevant for nurses participating in disaster response medical teams; make recommendations to enhance training of nurses who will be first responders to a disaster site; to improve the capacity of nurses to prepare and respond to severe natural disasters. Worldwide, nurses play a key role in disaster response teams at disaster sites. They are often not prepared for the challenges of dealing with mass casualties; little research exists into what basic nursing skills are required by nurses who are first responders to a disaster situation. This study assessed the most relevant disaster nursing skills of first responder nurses at the 2008 Wenchuan earthquake disaster site. Data were collected in China in 2008 using a self-designed questionnaire, with 24 participants who had been part of the medical teams that were dispatched to the disaster sites. The top three skills essential for nurses were: intravenous insertion; observation and monitoring; mass casualty triage. The three most frequently used skills were: debridement and dressing; observation and monitoring; intravenous insertion. The three skills performed most proficiently were: intravenous insertion; observation and monitoring; urethral catheterization. The top three ranking skills most important for training were: mass casualty transportation; emergency management; haemostasis, bandaging, fixation, manual handling. The core nursing skills for disaster response training are: mass casualty transportation; emergency management; haemostasis, bandaging, fixation, manual handling; observation and monitoring; mass casualty triage; controlling specific infection; psychological crisis intervention; cardiopulmonary resuscitation; debridement and dressing; central venous catheter insertion; patient care recording. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  2. Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

    PubMed

    Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

    2015-04-01

    This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (P<0.001). The time to complete each scenario and its decrease from day 1 to day 3 were detected equally in the two groups (P<0.05). Virtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

  3. Assessing and Improving Hospital Mass-Casualty Preparedness: A No-Notice Exercise.

    PubMed

    Waxman, Daniel A; Chan, Edward W; Pillemer, Francesca; Smith, Timothy Wj; Abir, Mahshid; Nelson, Christopher

    2017-12-01

    In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals' true capacity to respond to a no-notice event under real-world conditions. To address this gap, the US Department of Health and Human Services (Washington, DC USA), Office of the Assistant Secretary for Preparedness and Response (ASPR), sponsored development of a set of tools meant to allow any hospital to run a real-time, no-notice exercise, focusing on the first hour and 15 minutes of a hospital's response to a sudden MCI, with the goals of minimizing burden, maximizing realism, and providing meaningful, outcome-oriented metrics to facilitate self-assessment. The resulting exercise, which was iteratively developed, piloted at nine hospitals nationwide, and completed in 2015, is now freely available for anyone to use or adapt. This report demonstrates the feasibility of implementing a no-notice exercise in the hospital setting and describes insights gained during the development process that might be helpful to future exercise developers. It also introduces the use of ED "immediate bed availability (IBA)" as an objective, dynamic measure of an ED's physical capacity for new arrivals. Waxman DA , Chan EW , Pillemer F , Smith TWJ , Abir M , Nelson C . Assessing and improving hospital mass-casualty preparedness: a no-notice exercise. Prehosp Disaster Med. 2017;32(6):662-666.

  4. [HIGH VELOCITY PENETRATING HEAD AND NECK INJURIES OF SYRIAN CIVIL WAR CASUALTIES TREATED IN THE GALILEE MEDICAL CENTER].

    PubMed

    Ronen, Ohad; Assadi, Nidal; Sela, Eyal

    2017-05-01

    For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department. Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated. Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p <0.0001). The majority of cases (42.1%) were aged 21-27 years. The most common cause of injury was a gunshot wound. Thirty five patients (77.7%) suffered from multiple trauma, and complex injuries of the maxillofacial bones and upper respiratory tract. Eight (18%) of the cases arrived at the medical center with a tracheotomy. The average length of hospital stay was 15 days (range: 1-141). Of the 450 cases, 97.3% were discharged back to Syria, and 12 died. Of all Syrian injured treated in the ENT department, the vast majority were young men. The main cause of injury was gunshot wounds. It is likely that the lack of protective gear that exist in western armies is a factor in the complex injuries treated at the Galilee Medical Center.

  5. A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center.

    PubMed

    Gaylord, Kathryn M; Holcomb, John B; Zolezzi, Maria E

    2009-04-01

    Posttraumatic stress disorder (PTSD) has been identified in 12% to 20% of noninjured veterans and in 32% of combat casualties. Eight percent of the US general population experience PTSD symptoms, whereas 25.5% of civilians with major burns have PTSD. Known predictors of physical outcomes of patients with burn are age, total body surface area (TBSA) burned, and Injury Severity Score (ISS). The United States Army Institute of Surgical Research Burn Center provides burn care for combat casualties and civilians. We hypothesized that we would find no difference in PTSD incidence between these two populations and that age, TBSA, and ISS are associated with PTSD. We retrospectively examined the clinical records of 1,792 patients admitted between October 2003 and May 2008. Records were stratified by PTSD, age, TBSA, and ISS. PTSD scores were compared. Descriptive analyses were used. Four hundred ninety-nine patients (372 military [74.5%]; 127 civilians [25.5%]) were assessed for PTSD using PTSD checklist military and civilian versions. PTSD was defined as >or=44 on the PTSD checklist instruments. We found no significant difference in PTSD between combat casualties and civilians (25% vs. 17.32%, p = 0.761). TBSA and ISS were significantly associated with PTSD; however, no association between age and PTSD was found. The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury.

  6. A Descriptive Analysis of Tactical Casualty Care Interventions Performed by Law Enforcement Personnel in the State of Wisconsin, 2010-2015.

    PubMed

    Stiles, Chad M; Cook, Christopher; Sztajnkrycer, Matthew D

    2017-06-01

    Introduction Based upon military experience, law enforcement has developed guidelines for medical care during high-threat conditions. The purpose of the current study was to provide a descriptive analysis of reported outcomes of law enforcement medical interventions. This was a descriptive analysis of a convenience sample of cases submitted to the Wisconsin Tactical Medicine Initiative (Wisconsin USA), after the provision of successful patient care, between January 2010 and December 2015. The study was reviewed by the Mayo Foundation Institutional Review Board (Rochester, Minnesota USA) and deemed exempt. Nineteen agencies submitted information during the study period. Of the 56 episodes of care reported, four (7.1%) cases involved care provided to injured officers while 52 (92.9%) involved care to injured civilians, including suspects. In at least two cases, on-going threats existed during the provision of medical care to an injured civilian. Law enforcement rendered care prior to Emergency Medical Services (EMS) arrival in all but two cases. The current case series demonstrates the life-saving potential for law enforcement personnel trained and equipped under current Tactical Combat Casualty Care (TCCC)/ Committee on Tactical Emergency Casualty Care (C-TECC) tactical casualty care guidelines. Although originally developed to save the lives of wounded combat personnel, in the civilian sector, the training appears more likely to save victims rather than law enforcement personnel. Stiles CM , Cook C , Sztajnkrycer MD . A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the State of Wisconsin, 2010-2015. Prehosp Disaster Med. 2017;32(3):284-288.

  7. Analysis of the Relationship Between Vehicle Weight/Size and Safety, and Implications for Federal Fuel Economy Regulation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wenzel, Thomas P.

    This report analyzes the relationship between vehicle weight, size (wheelbase, track width, and their product, footprint), and safety, for individual vehicle makes and models. Vehicle weight and footprint are correlated with a correlation coefficient (R{sup 2}) of about 0.62. The relationship is stronger for cars (0.69) than for light trucks (0.42); light trucks include minivans, fullsize vans, truck-based SUVs, crossover SUVs, and pickup trucks. The correlation between wheelbase and track width, the components of footprint, is about 0.61 for all light vehicles, 0.62 for cars and 0.48 for light trucks. However, the footprint data used in this analysis does notmore » vary for different versions of the same vehicle model, as curb weight does; the analysis could be improved with more precise data on footprint for different versions of the same vehicle model. Although US fatality risk to drivers (driver fatalities per million registered vehicles) decreases as vehicle footprint increases, there is very little correlation either for all light vehicles (0.01), or cars (0.07) or trucks (0.11). The correlation between footprint and fatality risks cars impose on drivers of other vehicles is also very low (0.01); for trucks the correlation is higher (0.30), with risk to others increasing as truck footprint increases. Fatality risks reported here do not account for differences in annual miles driven, driver age or gender, or crash location by vehicle type or model. It is difficult to account for these factors using data on national fatal crashes because the number of vehicles registered to, for instance, young males in urban areas is not readily available by vehicle type or model. State data on all police-reported crashes can be used to estimate casualty risks that account for miles driven, driver age and gender, and crash location. The number of vehicles involved in a crash can act as a proxy of the number of miles a given vehicle type, or model, is driven per year, and is a preferable unit of exposure to a serious crash than the number of registered vehicles. However, because there are relatively few fatalities in the states providing crash data, we calculate casualty risks, which are the sum of fatalities and serious or incapacitating injuries, per vehicle involved in a crash reported to the police. We can account for driver age/gender and driving location effects by excluding from analysis crashes (and casualties) involving young males and the elderly, and occurring in very rural or very urban counties. Using state data on all police-reported crashes in five states, we find that excluding crashes involving young male and elderly drivers has little effect on casualty risk; however, excluding crashes that occurred in the most rural and most urban counties (based on population density) increases casualty risk for all vehicle types except pickups. This suggests that risks for pickups are overstated unless they account for the population density of the county in which the crashes occur. After removing crashes involving young males and elderly drivers, and those occurring in the most rural and most urban counties, we find that casualty risk in all light-duty vehicles tends to increase with increasing weight or footprint; however, the correlation (R{sup 2}) between casualty risk and vehicle weight is 0.31, while the correlation with footprint is 0.23. These relationships are stronger for cars than for light trucks. The correlation between casualty risk in frontal crashes and light-duty vehicle wheelbase is 0.12, while the correlation between casualty risk in left side crashes and track width is 0.36. We calculated separately the casualty risks vehicles impose on drivers of the other vehicles with which they crash. The correlation between casualty risk imposed by light trucks on drivers of other vehicles and light truck footprint is 0.15, while the correlation with light truck footprint is 0.33; risk imposed on others increases as light truck weight or footprint increases. Our analysis indicates that, after excluding crashes involving young male and elderly drivers, and crashes in very rural and very urban counties, and accounting for vehicle weight and footprint, sports cars, pickup trucks and truck-based SUVs have higher risk to their drivers than cars, while import luxury cars and crossover SUVs have lower risk to their drivers than cars. Similarly, pickups and sports cars impose a large casualty risk on drivers of other vehicles, after accounting for vehicle weight and footprint. Our analysis suggests that excluding young male and elderly drivers, and crashes in very rural and urban counties, accounting for vehicle weight, footprint, and type explains only about half of the variability in casualty risk to drivers, and to drivers of other vehicles, by vehicle model.« less

  8. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... be relieved of liability for the tax if, before transfer of title to the beer to any other person... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer between... loss of beer before transfer of title of the beer to another person and who desires to adjust the tax...

  9. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... be relieved of liability for the tax if, before transfer of title to the beer to any other person... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer between... loss of beer before transfer of title of the beer to another person and who desires to adjust the tax...

  10. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... be relieved of liability for the tax if, before transfer of title to the beer to any other person... by fire, casualty, or act of God. The tax liability on excessive losses of beer from transfer between... loss of beer before transfer of title of the beer to another person and who desires to adjust the tax...

  11. Understanding Loss Deductions For Yard Trees

    Treesearch

    John Greene

    1998-01-01

    The sudden destruction of trees or other yard plants due to a fire, storm, or massive insect attack qualifies for a casualty loss deduction. Unfortnately, the casualty loss rules for personal use property allow deductions only for large losses. To calculate your deduction, start with the lesser of the decrease in fair market value of your property caused by the loss of...

  12. Investigations & Casualty Analysis « Coast Guard Maritime Commons

    Science.gov Websites

    marine casualty reporting property damage thresholds now in effect This post provides links to updated : This post was updated April 10, 2018 to reflect that Inmarsat will begin the migration 1400 UTC May 9 website provided in our blog post. Inmarsat announced that it will migrate Inmarsat-C, Mini C, and Fleet77

  13. Prescribing of benzodiazepines by casualty officers.

    PubMed Central

    Nazareth, I D; King, M B

    1989-01-01

    The prescribing of benzodiazepines by casualty officers in a busy district hospital over a three month period was examined by a retrospective review of case notes. Benzodiazepines, mainly diazepam, were given to 1.1% of attenders, the majority of whom had disorders involving minor muscle spasm. The efficacy of diazepam in these conditions, as well as its potential for dependence, is discussed. PMID:2569040

  14. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 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 by...

  15. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Charge of Marine Inspection (OCMI) within 5 days of the casualty notice. The report may be on Form 2692, Report of Marine Accident, Injury, or Death, or in narrative form if it contains all of the applicable... written report is provided to the nearest regional Bureau of Ocean Energy Management, Regulation and...

  16. 33 CFR 150.820 - When must a written report of casualty be submitted, and what must it contain?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Charge of Marine Inspection (OCMI) within 5 days of the casualty notice. The report may be on Form 2692, Report of Marine Accident, Injury, or Death, or in narrative form if it contains all of the applicable... written report is provided to the nearest regional Bureau of Ocean Energy Management, Regulation and...

  17. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2011-04-01 2011-04-01 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 by...

  18. 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…

  19. Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident.

    PubMed

    Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz

    2016-02-01

    The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.

  20. The 1983 Beirut Airport terrorist bombing. Injury patterns and implications for disaster management.

    PubMed

    Frykberg, E R; Tepas, J J; Alexander, R H

    1989-03-01

    The casualty profile and results of the medical care provided for the survivors of the terrorist truck bombing of the U.S. Marine Corps facility in Beirut, Lebanon, in 1983 were reviewed to determine the factors that influenced casualty survival. This explosion resulted in 346 casualties, of whom 234 (68%) were immediately killed. The spectrum of injury was determined in 85 survivors using the Injury Severity Score (ISS). There were seven (6.3%) deaths among the 112 immediate survivors. All deaths occurred among the 19 (17%) victims who were critically injured (ISS greater than 15), giving a mortality in this population of 37 per cent. Six (86%) of the seven deaths were associated with an initial delay in treatment. Head injury was the most common fatal injury among both immediate fatalities (71.4%) and immediate survivors (57%). Thoracic injury and burns each accounted for 29 per cent of survivor deaths. Triage efficiency, as determined by the rates of overtriage (80%) and undertriage (0), did not appear adversely to affect mortality. Critical analysis of disasters such as this can contribute to improvements in preparation and casualty care in the event of future disasters.

  1. 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.

  2. [Mass casualty incidents - current concepts and developments].

    PubMed

    Savinsky, Godo; Stuhr, Markus; Kappus, Stefan; Trümpler, Stefan; Wenderoth, Stephan; Wohlers, Jan-Hauke; Paschen, Hans-Richard; Kerner, Thoralf

    2014-12-01

    Medical concepts and strategies are permanently changing. Due to the emergency response in a mass casualty incident everyone who is involved has to work together with different organisations and public authorities, which are not part of the regular emergency medical service. Within the last 25 years throughout the whole country of Germany the role of a "chief emergency physician" has been implemented and in preparation for the FIFA World Cup 2006 mobile treatment units were set up. In 2007, special units of the "Medical Task Force" - funded by the german state - were introduced and have been established by now. They will be a permanent part of regional plannings for mass casualty incidents. This article highlights current concepts and developments in different parts of Germany. © Georg Thieme Verlag Stuttgart · New York.

  3. The contribution of the Israeli trauma system to the survival of road traffic casualties.

    PubMed

    Goldman, Sharon; Siman-Tov, Maya; Bahouth, H; Kessel, B; Klein, Y; Michaelson, M; Miklosh, B; Rivkind, A; Shaked, G; Simon, D; Soffer, D; Stein, M; Peleg, Kobi

    2015-01-01

    According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties. 1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user. A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals. During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths compared to the actual 108 traffic related deaths. A 41% difference was noted between the actual number of deaths and the expected number. This study clearly shows that without any improvement in the health system, specifically the trauma system, the number of traffic deaths would be considerably greater. Although the health system has a significant contribution on reducing mortality, it does not receive the appropriate acknowledgment or resources for its proportion in the fight against traffic accidents.

  4. Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic Shock

    DTIC Science & Technology

    2012-11-01

    Award Number: W81XWH-11-2-0019 TITLE: Intraosseous Erythropoietin for Acute Tissue Protection in Battlefield Casualties Suffering Hypovolemic...REPORT TYPE Final 3. DATES COVERED 4 October 2010- 3 October 2012 4. TITLE AND SUBTITLE Intraosseous Erythropoietin for Acute Tissue Protection in...Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT- The project investigated whether intraosseous administration of erythropoietin (EPO) during

  5. Seven Firefights in Vietnam

    DTIC Science & Technology

    1970-03-25

    Casualty 40 Armored Cavalry Assault Vehicle 42 Hoisting CONEX Container for Convoy Loading 46 Burning Truck With Trailer, Opposite Banana Grove...sisting on bananas for five days. He declared that three North Viet- namese battalions were on Chu Pong mountain, anxious to kill Americans but as...attempting, it seemed, to surround all of Company B. A fierce firefight ensued, both sides taking casualties. The enemy soldiers then peeled off to

  6. Development of a Mass Casualty Triage Performance Assessment Tool

    DTIC Science & Technology

    2015-02-01

    mass casualty triage and interviews with members of the unit, the triage assessment development involved three steps: (1) identification of key...Unlimited c. THIS PAGE Unlimited Unlimited Unclassified 35 19b. TELEPHONE NUMBER (include area code ) i Technical...in this report was initiated by ARI-FHRU to develop a prototype measure of performance for one of the three collective tasks identified in the

  7. Research issues in preparedness for mass casualty events, disaster, war, and terrorism.

    PubMed

    Hinton Walker, Patricia; Garmon Bibb, Sandra C; Elberson, Karen L

    2005-09-01

    This article provides a perspective on the types of research questions that might be explored and strategies used in relation to disaster,terrorism, and mass casualty events. Research is addressed in the context of three areas of focus: issues related to the health care provider; issues affecting the patient, individual, family, and community; and issues related to the health care system.

  8. Multistage Deployment of the Army Theater Hospital

    DTIC Science & Technology

    2013-12-01

    analysis on the effects warfare tactics, casualty timing, and casualty types had on the medical treatment facility (Cecchine et al., 2001). This proved...the 44-bed mobile portion of the current CSH was potentially inadequate to support approximately four brigades in an asymmetrical warfare scenario...systems and its increased force effectiveness on the fleet. He utilized quantitative analysis with Lanchester and Hughes-Salvo models to show that

  9. Challenges to Improving Combat Casualty Survivability on the Battlefield

    DTIC Science & Technology

    2015-01-01

    Rescue Medic in Mogadishu , Somalia, and Special Forces battalion surgeon during Operation Enduring Freedom. He is currently the Director of the Military...the CoTCCC, an organization born outside the traditional military medical establishment, exposes a void in ownership and expertise in battle - field...serve as bat- talion surgeons responsible for the resuscitation of battle casualties in the battalion aid station. This is reminiscent of how

  10. The Application of Contagious Disease Epidemiological Models to Known Population Structure and Movement

    DTIC Science & Technology

    2016-03-01

    subpopulation in which they were located, as shown in the following table. 3 While similar in many...estimates in terms of the following three metrics: 1. total numbers of expected casualties, 2. the overall duration of the modeled outbreak, and 3 . the...11  3 . The Effect of Population Structure and Movement on Casualty Estimates ..............15 A.  Plague Results

  11. Assessment of Casualty Transport Equipment and Procedures Aboard U.S. Navy Submarines to Accommodate Anti-Shock Trousers

    DTIC Science & Technology

    2012-10-24

    Figure 6. Haul-Safe Winch System (Spec Rescue International). .................................................. 9 Figure 7. Submarine bridge...illustrating limited deck space for winch system . ............................. 9 vi [THIS PAGE INTENTIONALLY LEFT BLANK] INTRODUCTION U.S...and out the submarine sail for helicopter transport. In addition, a winch system used to lift casualties up and out the sail was also evaluated. 4

  12. Addition of Tranexamic Acid to the Tactical Combat Casualty Care Guidelines

    DTIC Science & Technology

    2011-09-23

    ASSISTANT SECRETARY OF DEFENSE (HEAL TH AFFAIRS) SUBJECT: Recommendations Regarding the Addition of Tranexamic Acid to the Tactical Combat Casualty...of the literature (as provided in this report) found that the antifibrinolytic tranexamic acid (TXA) has proven to decrease all cause mortality...following major trauma. In trauma patients experiencing severe hemorrhage on the battlefield, tranexamic acid has the potential to reduce both· mortality

  13. Civilian casualties of terror-related explosions: The impact of vascular trauma on treatment and prognosis.

    PubMed

    Heldenberg, Eitan; Givon, Adi; Simon, Daniel; Bass, Arie; Almogy, Gidon; Peleg, Kobi

    2016-09-01

    A high prevalence (10%) of vascular trauma (VT) was previously described in terror-related trauma as compared with non-terror-related trauma (1%), in a civilian setting. No data regarding outcome of VT casualties of improvised explosive device (IED) explosions, in civilian settings, are available. The aim of the current study is to present the prognosis of civilian casualties of IED explosions with and without VT. A retrospective analysis of the Israeli National Trauma Registry was performed. All patients in the registry from September 2000 to December 2005 who were victims of explosions were included. These patients were subdivided into patients with VT (n = 109) and non-VT (NVT) (n = 1,152). Both groups were analyzed according to mechanism of trauma, type and severity of injury, and treatment. Of 1,261 explosion casualties, there were 109 VT victims (8.6%). Patients with VT tended to be more complex, with a higher injury severity score (ISS): 17.4% with ISS 16 to 24 as compared with only 10.5%. In the group of critically injured patients (ISS, 25-75), 51.4% had VT compared with only 15.5% of the NVT patients. As such, a heavy share of hospitals' resources were used-trauma bay admission (62.4%), operating rooms (91.7%), and intensive care unit beds (55.1%). The percentage of VT patients who were admitted for more than 15 days was 2.3 times higher than that observed among the NVT patients. Lower-extremity VT injuries were the most prevalent. Although many resources are being invested in treating this group of patients, their mortality rate is approximately five times more than NVT (22.9% vs. 4.9%). Vascular trauma casualties of IED explosions are more complex and have poorer prognosis. Their higher ISS markedly increases the hospital's resource utilization, and as such, it should be taken into consideration either upon the primary evacuation from the scene or when secondary modulation is needed in order to reduce the burden of the hospitals receiving the casualties. Prognostic/epidemiologic study, level V.

  14. Development of a novel information and communication technology system to compensate for a sudden shortage of emergency department physicians.

    PubMed

    Tanaka, Kumiko; Nakada, Taka-Aki; Fukuma, Hiroshi; Nakao, Shota; Masunaga, Naohisa; Tomita, Keisuke; Matsumura, Yosuke; Mizushima, Yasuaki; Matsuoka, Tetsuya

    2017-01-23

    A sudden shortage of physician resources due to overwhelming patient needs can affect the quality of care in the emergency department (ED). Developing effective response strategies remains a challenging research area. We created a novel system using information and communication technology (ICT) to respond to a sudden shortage, and tested the system to determine whether it would compensate for a shortage. Patients (n = 4890) transferred to a level I trauma center in Japan during 2012-2015 were studied. We assessed whether the system secured the necessary physicians without using other means such as phone or pager, and calculated fulfillment rate by the system as a primary outcome variable. We tested for the difference in probability of multiple casualties among total casualties transferred to the ED as an indicator of ability to respond to excessive patient needs, in a secondary analysis before and after system introduction. The system was activated 24 times (stand-by request [n = 12], attendance request [n = 12]) in 24 months, and secured the necessary physicians without using other means; fulfillment rate was 100%. There was no significant difference in the probability of multiple casualties during daytime weekdays hours before and after system introduction, while the probability of multiple casualties during night or weekend hours after system introduction significantly increased compared to before system introduction (4.8% vs. 12.9%, P < 0.0001). On the whole, the probability of multiple casualties increased more than 2 times after system introduction 6.2% vs. 13.6%, P < 0.0001). After introducing the system, probability of multiple casualties increased. Thus the system may contribute to improvement in the ability to respond to sudden excessive patient needs in multiple causalities. A novel system using ICT successfully secured immediate responses from needed physicians outside the hospital without increasing user workload, and increased the ability to respond to excessive patient needs. The system appears to be able to compensate for a shortage of physician in the ED due to excessive patient transfers, particularly during off-hours.

  15. Terrorist bombings. Lessons learned from Belfast to Beirut.

    PubMed Central

    Frykberg, E R; Tepas, J J

    1988-01-01

    Experience in the management of mass casualties following a disaster is relatively sparse. The terrorist bombing serves as a timely and effective model for the analysis of patterns of injury and mortality and the determination of the factors influencing casualty survival in the wake of certain forms of disaster. For this purpose, a review of the published experience with terrorist bombings was carried out, providing a study population of 3357 casualties from 220 incidents worldwide. There were 2934 immediate survivors of these incidents (87%), of whom 881 (30%) were hospitalized. Forty deaths ultimately occurred among these survivors (1.4%), 39 of whom were among those hospitalized (4.4%). Injury severity was determined from available data for 1339 surviving casualties, 251 of whom were critically injured (18.7%). Of this population evaluable for injury severity, there were 31 late deaths, all of which occurred among those critically injured, accounting for an overall "critical mortality" rate of 12.4%. Overall triage efficiency was characterized by a mean overtriage rate (noncritically injured among those hospitalized or evacuated) of 59%, and a mean undertriage rate (critically injured among those not hospitalized or evacuated) of .05%. Multiple linear regression analysis of all major bombing incidents demonstrated a direct linear relationship between overtriage and critical mortality (r2 = .845), and an inversely proportional relationship between triage discrimination and critical mortality (r2 = 0.855). Although head injuries predominated in both immediate (71%) and late (52%) fatalities, injury to the abdomen carried the highest specific mortality rate (19%) of any single body system injury among immediate survivors. These data clearly document the importance of accurate triage as a survival determinant for critically injured casualties of these disasters. Furthermore, the data suggest that explosive force, time interval from injury to treatment, and anatomic site of injury are all factors that correlated with the ultimate outcome of terrorist bombing victims. Critical analysis of past disasters should allow for sufficient preparation so as to minimize casualty mortality in the future. Images Fig. 1. Fig. 2. PMID:3056287

  16. How will military/civilian coordination work for reception of mass casualties from overseas?

    PubMed

    Mackenzie, Colin; Donohue, John; Wasylina, Philip; Cullum, Woodrow; Hu, Peter; Lam, David M

    2009-01-01

    In Maryland, there have been no military/civilian training exercises of the Medical Mutual Aid Agreement for >20 years. The aims of this paper are to describe the National Disaster Medical System (NDMS), to coordinate military and civilian medical mutual aid in response to arrival of overseas mass casualties, and to evaluate the mass-casualty reception and bed "surge" capacity of Maryland NDMS Hospitals. Three tabletop exercises and a functional exercise were performed using a simulated, overseas, military mass-casualty event. The first tabletop exercise was with military and civilian NMDS partners. The second tested the revised NDMS activation plan. The third exercised the Authorities of State Emergency Medical System and Walter Reed Army Medical Center Directors of Emergency Medicine over Maryland NDMS hospitals, and their Medical Mutual Aid Agreement. The functional exercise used Homeland Security Exercise Evaluation Program tools to evaluate reception, triage, staging, and transportation of 160 notional patients (including 20 live, moulaged "patients") and one canine. The first tabletop exercise identified deficiencies in operational protocols for military/civilian mass-casualty reception, triage, treatment, and problems with sharing a Unified Command. The second found improvements in the revised NDMS activation plan. The third informed expectations for NDMS hospitals. In the functional exercise, all notional patients were received, triaged, dispatched, and accounted in military and five civilian hospitals within two hours. The canine revealed deficiencies in companion/military animal reception, holding, treatment, and evacuation. Three working groups were suggested: (1) to ensure 100% compliance with triage tags, patient accountability, and return of equipment used in mass casualty events and exercises; (2) to investigate making information technology and imaging networks available for Emergency Operation Centers and Incident Command; and (3) to establish NDMS training, education, and evaluation to further integrate and support civil-military operations. The exercises facilitated military/state inter-agency cooperation, resulting in revisions to the Maryland Emergency Operations Plan across all key state emergency response agencies. The recommendations from these exercises likely apply to the vast majority of NDMS activities in the US.

  17. Serious gaming technology in major incident triage training: a pragmatic controlled trial.

    PubMed

    Knight, James F; Carley, Simon; Tregunna, Bryan; Jarvis, Steve; Smithies, Richard; de Freitas, Sara; Dunwell, Ian; Mackway-Jones, Kevin

    2010-09-01

    By exploiting video games technology, serious games strive to deliver affordable, accessible and usable interactive virtual worlds, supporting applications in training, education, marketing and design. The aim of the present study was to evaluate the effectiveness of such a serious game in the teaching of major incident triage by comparing it with traditional training methods. Pragmatic controlled trial. During Major Incident Medical Management and Support Courses, 91 learners were randomly distributed into one of two training groups: 44 participants practiced triage sieve protocol using a card-sort exercise, whilst the remaining 47 participants used a serious game. Following the training sessions, each participant undertook an evaluation exercise, whereby they were required to triage eight casualties in a simulated live exercise. Performance was assessed in terms of tagging accuracy (assigning the correct triage tag to the casualty), step accuracy (following correct procedure) and time taken to triage all casualties. Additionally, the usability of both the card-sort exercise and video game were measured using a questionnaire. Tagging accuracy by participants who underwent the serious game training was significantly higher than those who undertook the card-sort exercise [Chi2=13.126, p=0.02]. Step accuracy was also higher in the serious game group but only for the numbers of participants that followed correct procedure when triaging all eight casualties [Chi2=5.45, p=0.0196]. There was no significant difference in time to triage all casualties (card-sort=435+/-74 s vs video game=456+/-62 s, p=0.155). Serious game technologies offer the potential to enhance learning and improve subsequent performance when compared to traditional educational methods. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Decompressive craniectomy and cranioplasty: experience and outcomes in deployed UK military personnel.

    PubMed

    Roberts, S A G; Toman, E; Belli, A; Midwinter, M J

    2016-10-01

    In recent conflicts, many UK personnel sustained head injuries requiring damage-control surgery and aeromedical transfer to the UK. This study aims to examine indications, complications and outcomes of UK military casualties undergoing craniectomy and cranioplasty from conflicts in Afghanistan and Iraq. The UK military Joint Theatre Trauma Registry (JTTR) was searched for all UK survivors in Afghanistan and Iraq between 2004 and 2014 requiring craniectomy and cranioplasty resulting from trauma. Fourteen decompressive craniectomies and cranioplasties were performed with blast and gunshot wounds equally responsible for head injury. Ten survivors (71%) had an Injury Severity Score (ISS) of 75, normally designated as 'unsurvivable'. Most were operated on the day of injury. Seventy-one percent received a reverse question mark incision and 7% received a bicoronal incision. Seventy-nine percent had bone flaps discarded. Overall infection rate was 43%. Acinetobacter spp was the causative organism in 50% of cases. Median Glasgow Outcome Scale (GOS) at final follow-up was 4. All casualties had a GOS score greater than 3. Timely neurosurgical intervention is imperative for military personnel given high survival rates in those sustaining what are designated 'un-survivable' injuries. Early decompression facilitates safe aeromedical evacuation of casualties. Excellent outcomes validate the UK military trauma system and the stepwise performance gains throughout recent conflicts however trauma registers most evolving to have specific relevance to military casualties. In high-energy trauma with contamination and soft-tissue destruction, surgery should be conducted with regard for future soft tissue reconstruction. Bone flaps should be discarded and cranioplasty performed according to local preference. Facilities receiving military casualties should have specialist microbiological input mindful of the difficulties treating unusual microbes.

  19. Spinal cord injuries sustained in road crashes are not on the decrease in france: a study based on epidemiological trends.

    PubMed

    Lieutaud, Thomas; Ndiaye, Amina; Laumon, Bernard; Chiron, Mireille

    2012-02-10

    Traumatic spinal cord injuries (SCI) are rare but extremely costly. In order to improve the modelling of inclusion criteria for studies of SCI it is necessary to determine what epidemiological trends affect SCI. Using the Rhone Registry, which contains all the casualties resulting from road crashes in the Rhône département of France and codes their injuries using the Abbreviated Injury Scale (AIS), we describe the epidemiological trends that affect spinal cord injury (SCI), major spinal trauma (MST) and severe injuries (AIS4+) to other body regions between two periods 1996-2001 and 2003-2008. Although there has been a marked decrease (35%) in the incidence of casualties after a road traffic crash, and reductions of 22% in the incidence of MST and 33% in that of severe injuries (AIS4+) (p<0.001), for SCI the incidence rate and number of casualties have remained surprisingly stable. In the second period, there was no change in the incidence of SCI resulting from road traffic crashes, nor in the associated fatality, mortality and survival rates. The incidence for car users was significantly lower in the second period. This contrasts with the incidences for motorcyclists and for the group including pedestrians and cyclists which were respectively 47% and 77% higher in the second period. The median age of the casualties, the age-adjusted incidence of SCI and the number of associated injuries were also higher in the second period. We have observed a marked reduction in the incidence of road trauma including the most severe injuries, but not SCI. The higher proportion of motorcyclists, the increase in the age of casualties and the greater presence of multiple injuries are new factors in the epidemiology of SCI after a road crash.

  20. A consensus-based gold standard for the evaluation of mass casualty triage systems.

    PubMed

    Lerner, E Brooke; McKee, Courtney H; Cady, Charles E; Cone, David C; Colella, M Riccardo; Cooper, Arthur; Coule, Phillip L; Lairet, Julio R; Liu, J Marc; Pirrallo, Ronald G; Sasser, Scott M; Schwartz, Richard; Shepherd, Greene; Swienton, Raymond E

    2015-01-01

    Accuracy and effectiveness analyses of mass casualty triage systems are limited because there are no gold standard definitions for each of the triage categories. Until there is agreement on which patients should be identified by each triage category, it will be impossible to calculate sensitivity and specificity or to compare accuracy between triage systems. To develop a consensus-based, functional gold standard definition for each mass casualty triage category. National experts were recruited through the lead investigators' contacts and their suggested contacts. Key informant interviews were conducted to develop a list of potential criteria for defining each triage category. Panelists were interviewed in order of their availability until redundancy of themes was achieved. Panelists were blinded to each other's responses during the interviews. A modified Delphi survey was developed with the potential criteria identified during the interview and delivered to all recruited experts. In the early rounds, panelists could add, remove, or modify criteria. In the final rounds edits were made to the criteria until at least 80% agreement was achieved. Thirteen national and local experts were recruited to participate in the project. Six interviews were conducted. Three rounds of voting were performed, with 12 panelists participating in the first round, 12 in the second round, and 13 in the third round. After the first two rounds, the criteria were modified according to respondent suggestions. In the final round, over 90% agreement was achieved for all but one criterion. A single e-mail vote was conducted on edits to the final criterion and consensus was achieved. A consensus-based, functional gold standard definition for each mass casualty triage category was developed. These gold standard definitions can be used to evaluate the accuracy of mass casualty triage systems after an actual incident, during training, or for research.

  1. A review of casualties during the Iraqi insurgency 2006--a British field hospital experience.

    PubMed

    Ramasamy, Arul; Harrisson, Stuart; Lasrado, Irwin; Stewart, Michael P M

    2009-05-01

    Following the invasion of Iraq in April 2003, British and coalition forces have been conducting counter-insurgency operations in the country. As this conflict has evolved from asymmetric warfare, the mechanism and spectrum of injury sustained through hostile action (HA) was investigated. Data was collected on all casualties of HA who presented to the British Military Field Hospital Shaibah (BMFHS) between January and October 2006. The mechanism of injury, anatomical distribution, ICD-9 diagnosis and initial discharge information was recorded for each patient in a trauma database. There were 104 HA casualties during the study period. 18 were killed in action (KIA, 21%). Of the remaining 86 surviving casualties, a further three died of their wounds (DOW, 3.5%). The mean number of diagnoses per survivor was 2.70, and the mean number of anatomical regions injured was 2.38. Wounds to the extremities accounted for 67.8% of all injuries, a percentage consistent with battlefield injuries sustained since World War II. Open wounds and fractures were the most common diagnosis (73.8%) amongst survivors of HA. Improvised explosive devices (IEDs) accounted for the most common cause of injury amongst casualties (54%). Injuries in conflict produce a pattern of injury that is not seen in routine UK surgical practice. In an era of increasing surgical sub-specialisation, the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. IEDs have become the modus operandi for terrorists. In the current global security situation, these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries is relevant to both military and civilian surgeons.

  2. The Impacts of Air Temperature on Accidental Casualties in Beijing, China.

    PubMed

    Ma, Pan; Wang, Shigong; Fan, Xingang; Li, Tanshi

    2016-11-02

    Emergency room (ER) visits for accidental casualties, according to the International Classification of Deceases 10th Revision Chapters 19 and 20, include injury, poisoning, and external causes (IPEC). Annual distribution of 187,008 ER visits that took place between 2009 and 2011 in Beijing, China displayed regularity rather than random characteristics. The annual cycle from the Fourier series fitting of the number of ER visits was found to explain 63.2% of its total variance. In this study, the possible effect and regulation of meteorological conditions on these ER visits are investigated through the use of correlation analysis, as well as statistical modeling by using the Distributed Lag Non-linear Model and Generalized Additive Model. Correlation analysis indicated that meteorological variables that positively correlated with temperature have a positive relationship with the number of ER visits, and vice versa. The temperature metrics of maximum, minimum, and mean temperatures were found to have similar overall impacts, including both the direct impact on human mental/physical conditions and indirect impact on human behavior. The lag analysis indicated that the overall impacts of temperatures higher than the 50th percentile on ER visits occur immediately, whereas low temperatures show protective effects in the first few days. Accidental casualties happen more frequently on warm days when the mean temperature is higher than 14 °C than on cold days. Mean temperatures of around 26 °C result in the greatest possibility of ER visits for accidental casualties. In addition, males were found to face a higher risk of accidental casualties than females at high temperatures. Therefore, the IPEC-classified ER visits are not pure accidents; instead, they are associated closely with meteorological conditions, especially temperature.

  3. Development and validation of a mass casualty conceptual model.

    PubMed

    Culley, Joan M; Effken, Judith A

    2010-03-01

    To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. The model was designed based on extant literature and existing theoretical models. A purposeful sample of 18 experts validated the model. Open-ended questions, as well as a 7-point Likert scale, were used to measure expert consensus on the importance of each construct and its relationship in the model and the usefulness of the model to future research. Computer-mediated applications were used to facilitate a modified Delphi technique through which a panel of experts provided validation for the conceptual model. Rounds of questions continued until consensus was reached, as measured by an interquartile range (no more than 1 scale point for each item); stability (change in the distribution of responses less than 15% between rounds); and percent agreement (70% or greater) for indicator questions. Two rounds of the Delphi process were needed to satisfy the criteria for consensus or stability related to the constructs, relationships, and indicators in the model. The panel reached consensus or sufficient stability to retain all 10 constructs, 9 relationships, and 39 of 44 indicators. Experts viewed the model as useful (mean of 5.3 on a 7-point scale). Validation of the model provides the first step in understanding the context in which mass casualty events take place and identifying variables that impact outcomes of care. This study provides a foundation for understanding the complexity of mass casualty care, the roles that nurses play in mass casualty events, and factors that must be considered in designing and evaluating information-communication systems to support effective triage under these conditions.

  4. Quantifying the causal effects of 20mph zones on road casualties in London via doubly robust estimation.

    PubMed

    Li, Haojie; Graham, Daniel J

    2016-08-01

    This paper estimates the causal effect of 20mph zones on road casualties in London. Potential confounders in the key relationship of interest are included within outcome regression and propensity score models, and the models are then combined to form a doubly robust estimator. A total of 234 treated zones and 2844 potential control zones are included in the data sample. The propensity score model is used to select a viable control group which has common support in the covariate distributions. We compare the doubly robust estimates with those obtained using three other methods: inverse probability weighting, regression adjustment, and propensity score matching. The results indicate that 20mph zones have had a significant causal impact on road casualty reduction in both absolute and proportional terms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Did the defeat of Saddam Hussein reduce suicide bombing casualties and attacks in Israel? A statistical analysis.

    PubMed

    Schumm, Walter R

    2004-12-01

    It was hypothesized that one of the reasons for the U.S. invasion of Iraq was to stop the payments being made by Saddam Hussein to the families of suicide (homicide) bombers in Israel. The consequences of suicide (homicide) bombing attacks against Israel between March 2001 and August 2004 were evaluated as related to the time of the U.S. invasion of Iraq. On average per month during this period, there were fewer overall casualties after the invasion than before it. As many as nearly 1,100 casualties may have been prevented in Israel as a consequence of the U.S. invasion of Iraq, suggesting that at least one possible goal of the U.S. invasion may have been achieved, at least as averaged over the first 17 months after the invasion.

  6. Manipulating the Geometric Computer-aided Design of the Operational Requirements-based Casualty Assessment Model within BRL-CAD

    DTIC Science & Technology

    2018-03-30

    ARL-TR-8336 ● MAR 2018 US Army Research Laboratory Manipulating the Geometric Computer-aided Design of the Operational...so designated by other authorized documents. Citation of manufacturer’s or trade names does not constitute an official endorsement or approval of...Army Research Laboratory Manipulating the Geometric Computer-aided Design of the Operational Requirements-based Casualty Assessment Model within

  7. SimCenter Hawaii Technology Enabled Learning and Intervention Systems

    DTIC Science & Technology

    2008-01-01

    manikin training in acquiring triage skills and self -efficacy. Phase II includes the development of the VR training scenarios, which includes iterative...Task A5. Skills acquisition relative to self -efficacy study See Appendix F, Mass Casualty Triage Training using Human Patient Simulators Improves...relative to self -efficacy study • See Appendix F, Mass Casualty Triage Training using Human Patient Simulators Improves Speed and Accuracy of First

  8. Combat and Operational Stress: Minimizing Its Adverse Effects on Service Members

    DTIC Science & Technology

    2008-04-18

    munitions. Combat stress has received many labels since the First World War. These labels include “shell shock, war neurosis , psychoneurosis, combat...war neurosis and psychoneurosis carried an inherently negative connotation because they implied by their name that a mental illness or disorder...who became combat stress casualties. In 1916, the term war neurosis replaced shell shocked as the number of combat stress casualties continued due

  9. Biological Effects of Short, High-Level Exposure to Gases: Carbon Monoxide.

    DTIC Science & Technology

    1980-06-01

    Selection of maximum allowable concentrations for use in the military should be based more appropriately on considerations of casualty prevention (i.e...base selection of maximum allow- able concentrations for use in the military upon considerations of casualty prevention (i.e., immediate incapacitation...which is reversible, and that no injury will result from the exposure. Persons with myocardial disease are expected to be the most susceptible. These

  10. Exploratory Analysis of Factors Surrounding Aeromedical Evacuation (Patient Movement) from Operation Iraqi Freedom (OEF) Focusing on Placement of Wounded Warriors in US/CONUS-based Military Treatment Facilities (MTFs)

    DTIC Science & Technology

    2007-05-01

    below), there were 281,881 casualties listed Table 1. Ametican War and Military Operations Casualties: Usts and Statistcs . Number Wounds not Battle...but the need for Solace was greater than ever. With the outbreak of yellow fever and malaria among the troops in Cuba, the situation was quite grave

  11. Command and Control of the U.S. Tenth Army During the Battle of Okinawa

    DTIC Science & Technology

    2009-06-12

    existing data sources , gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments...the supporting Allied naval force with massed kamikaze attacks, resulting in heavy casualties. Ultimately, Lt. Gen. Buckner committed both corps to a...force with massed kamikaze attacks, resulting in heavy casualties. Ultimately, Lt. Gen. Buckner committed both corps to a frontal attack on the

  12. Biological Warfare and American Strategic Risk

    DTIC Science & Technology

    2000-06-01

    pandemics. 43 Col Ronald F. Bellamy and Col Craig H. Llewellyn, “Preventable Casualties: Rommel’s Flaw...of Air Power. New York: Free Press, 1989. Cook- Deegan , Robert. The Gene Wars: Science, Politics, and the Human Genome. New York: W.W. Norton and Co...and Col Craig H. Llewellyn. “Preventable Casualties: Rommel’s Flaw, Slim’s Edge.” Army (May 1990): 52-56. Burrows, W. Dickinson and Sara E. Renner

  13. Predicting Resource Needs for Multiple and Mass Casualty Events in Combat: Lessons Learned From Combat Support Hospital Experience in Operation Iraqi Freedom

    DTIC Science & Technology

    2009-04-01

    from rocket attack near a forward operating base (Photo courtesy of Tommy A. Brown). Predicting Resource Needs for Mass Casualty in Combat Volume 66...combat support hospital. J Trauma 2008; 64(2 suppl):S79–S85. 19. Wedmore I, McManus JG, Pusateri AE, et al. A special report on the chitosan -based

  14. Beyond Precision: Issues of Morality and Decision Making in Minimizing Collateral Casualties

    DTIC Science & Technology

    2003-04-28

    possible contributions from moral judgment and decision making . As Fuller himself said, laws “can create the conditions essential for a rational ...BEYOND PRECISION: Issues of Morality and Decision Making in Minimizing Collateral Casualties Program in Arms Control, Disarmament, and...28 APR 2003 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Beyond Precision: Issues of Morality and Decision Making in

  15. Management of Mass Casualty Burn Disasters

    DTIC Science & Technology

    2005-05-01

    jet fuel, to complex and hard-to-deploy weapons such as biologic and chemical agents’ (3). The purpose of this article is to review recent experience ...1994 Pope Air Force Base (AFB) aircraft crash from an anaesthesiology perspective (14). Those authors noted critical shortages of laryngoscopes...responses of nearby hospitals have been described (18–20). In addition, Yurt and colleagues reviewed their experi - ence with casualties from that disaster who

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

    NASA Astrophysics Data System (ADS)

    López, Raúl E.; Holle, Ronald L.

    1996-03-01

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

  17. Penetrating missile injuries during asymmetric warfare in the 2003 Gulf conflict.

    PubMed

    Hinsley, D E; Rosell, P A E; Rowlands, T K; Clasper, J C

    2005-05-01

    War wounds produce a significant burden on medical facilities in wartime. Workload from the recent conflict was documented in order to guide future medical needs. All data on war injuries were collected prospectively. This information was supplemented with a review of all patients admitted during the study period. During the first 2 weeks of the conflict, the sole British field hospital in the region received 482 casualties. One hundred and four were battle injuries of which nine were burns. Seventy-nine casualties had their initial surgery performed by British military surgeons and form the study group. Twenty-nine casualties (37 per cent) sustained gunshot wounds, 49 (62 per cent) suffered wounds from fragmentation weapons and one casualty detonated an antipersonnel mine. These 79 patients had a total of 123 wounds that were scored prospectively using the Red Cross Wound Classification. Twenty-seven (34 per cent) of the wounded were non-combatants; eight of these were children. Four patients (5 per cent) died. War is changing; modern conflicts appear likely to be fought in urban or remote environments, producing different wounding patterns and placing non-combatants in the line of fire. Military medical skills training and available resources must reflect these fundamental changes in preparation for future conflicts.

  18. 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 S.; Porter, Keith A.; Hearne, Mike

    2011-01-01

    Since the launch of the USGS’s Prompt Assessment of Global Earthquakes for Response (PAGER) system in fall of 2007, the time needed for the U.S. Geological Survey (USGS) to determine and comprehend the scope of any major earthquake disaster anywhere in the world has been dramatically reduced to less than 30 min. PAGER alerts consist of estimated shaking hazard from the ShakeMap system, estimates of population exposure at various shaking intensities, and a list of the most severely shaken cities in the epicentral area. These estimates help government, scientific, and relief agencies to guide their responses in the immediate aftermath of a significant earthquake. To account for wide variability and uncertainty associated with inventory, structural vulnerability and casualty data, PAGER employs three different global earthquake fatality/loss computation models. This article describes the development of the models and demonstrates the loss estimation capability for earthquakes that have occurred since 2007. The empirical model relies on country-specific earthquake loss data from past earthquakes and makes use of calibrated casualty rates for future prediction. The semi-empirical and analytical models are engineering-based and rely on complex datasets including building inventories, time-dependent population distributions within different occupancies, the vulnerability of regional building stocks, and casualty rates given structural collapse.

  19. Analysis of México’s Narco-War Network (2007–2011)

    PubMed Central

    Espinal-Enríquez, Jesús; Larralde, Hernán

    2015-01-01

    Since December 2006, more than a thousand cities in México have suffered the effects of the war between several drug cartels, amongst themselves, as well as with Mexican armed forces. Sources are not in agreement about the number of casualties of this war, with reports varying from 30 to 100 thousand dead; the economic and social ravages are impossible to quantify. In this work we analyze the official report of casualties in terms of the location and the date of occurrence of the homicides. We show how the violence, as reflected by the number of casualties, has increased over time and spread across the country. Next, based on the correlations between cities in the changes of the monthly number of casualties attributed to organized crime, we construct a narco-war network where nodes are the affected cities and links represent correlations between them. We find that close geographical distance between violent cities does not imply a strong correlation amongst them. We observe that the dynamics of the conflict has evolved in short-term periods where a small core of violent cities determines the main theatre of the war at each stage. This kind of analysis may also help to describe the emergence and propagation of gang-related violence waves. PMID:25993657

  20. Chinese traffic fatalities and injuries in police reports, hospital records, and in-depth records from one city.

    PubMed

    Qiu, Jun; Zhou, Jihong; Zhang, Liang; Yao, Yuan; Yuan, Danfeng; Shi, Jianguo; Gao, Zhiming; Zhou, Lin; Wang, Zhengguo; Evans, Leonard

    2015-01-01

    Claims of sharp reductions in Chinese traffic casualties after 2002 based on police-reported data have been questioned in the literature. The objective of this study is to determine whether a decline in casualties occurred and to better understand the police data. The first of 2 unrelated studies analyzed data from 210 military hospitals throughout China providing records for inpatients injured in traffic accidents (2001-2007). The second compared in-depth crash records (2000-2006) from one city to officially released data. Hospital data showed that casualties increased from 2002 to 2007. The city investigation showed consistently far more fatalities and injuries in the in-depth data than officially released. For example, in-depth data showed 1,720 fatalities. Only 557 of these were reported officially (data loss = 68%). Disaggregating into 3 regions showed a data loss of 41% in urban areas, 63% in rural areas, and 90% in rural-urban fringe zones. For injuries, data losses were even greater. Traffic fatalities and injuries did not decrease from 2002 to 2006. The in-depth city data contained 3 times as many fatalities and 5 times as many injuries as reported by police. Reasons why this occurred and suggestions to improve data collection and reduce casualties are given.

  1. The 274th Forward Surgical Team experience during Operation Enduring Freedom.

    PubMed

    Peoples, George E; Gerlinger, Tad; Craig, Robert; Burlingame, Brian

    2005-06-01

    The 274th Forward Surgical Team (FST) was deployed in support of Operation Enduring Freedom from October 14, 2001 to May 8, 2002. During this period, the FST was asked to perform many nondoctrinal missions. The FST was tasked with functioning as a mini-combat support hospital during the earlier phases of Operation Enduring Freedom, performing in-flight surgical procedures and resuscitation of combat wounded, conducting split operations with surgical coverage of both Karshi and Khanabad, Uzbekistan, and Bagram, Afghanistan, and leading the multinational medical coalition assembled for Operation Anaconda and other combat operations staged from Bagram. Overall, the 274th FST took care of approximately 90% of U.S. combat casualties during this period and treated a total of 221 combat casualties. The FST treated 103 total surgical cases, including 73 with combat wounds. At the time, this experience with combat casualties and the surgical care of combat wounds was the largest since the Persian Gulf War. More importantly, this account describes the flow, frequency, and type of combat casualties seen in a low-intensity conflict like that being waged currently in Afghanistan. It is hoped that this depiction will aid in the preparation, equipping, and overall utilization of surgical assets in similar future conflicts.

  2. First responder and physician liability during an emergency.

    PubMed

    Eddy, Amanda

    2013-01-01

    First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency. The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.

  3. Evaluation of Neurophysiologic and Systematic Changes during Aeromedical Evacuation and en Route Care of Combat Casualties in a Swine Polytrauma Model

    DTIC Science & Technology

    2014-02-01

    Chamber construction has been completed and swine experiments have been initiated. The NMRC Center for Hypobaric Experimentation, Simulation and...Aeromedical evacuation, en-route care, hypobaric conditions, hypobaric chamber, swine model 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...diminished morbidity and mortality among combat casualties. However, not much is known about the effects of long range aero-medical evacuation in hypobaric

  4. 49 CFR 1242.33 - Other expenses and casualties and insurance (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50-18-00, and 50-19-00). 1242.33 Section 1242.33....33 Other expenses and casualties and insurance (accounts XX-17-99, XX-18-99, XX-19-99, 50-17-00, 50... separation of administrative—other (account XX-19-06). Operating Expenses—Equipment locomotives ...

  5. Army Sustainability Modelling Analysis and Reporting Tool (A-SMART) Prototype: Model Description and Algorithms

    DTIC Science & Technology

    2012-12-01

    states.2 The research activities in this area are focused on the mathematical description of the dynamic behaviour within the hierarchy of organisations...Aviation, Infantry, Medical, Catering, Armoured , Artillery, Transport, Signals, and Ordnance). The corps structure essentially maps to that of the training...calculation of the casualty levels for personnel from a hypothetical force composed of infantry and armour . Table 2: Calculated Monthly Casualty Rates for

  6. Conflict Without Casualties: Non-Lethal Weapons in Irregular Warfare

    DTIC Science & Technology

    2007-09-01

    the body,” and the Geneva Protocol of 1925, bans the use of chemical and biological weapons .11 On 8 April 1975, President Ford issued Executive...E Funding – PE 63851M) (accessed 15 December 2006). The American Journal of Bioethics . “Medical Ethics and Non-Lethal Weapons .” Bioethics.net...CASUALTIES: NON-LETHAL WEAPONS IN IRREGULAR WARFARE by Richard L. Scott September 2007 Thesis Advisor: Robert McNab Second Reader

  7. 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.

  8. Earthquakes; January-February, 1979

    USGS Publications Warehouse

    Person, W.J.

    1979-01-01

    The first major earthquake (magnitude 7.0 to 7.9) of the year struck in southeastern Alaska in a sparsely populated area on February 28. On January 16, Iran experienced the first destructive earthquake of the year causing a number of casualties and considerable damage. Peru was hit by a destructive earthquake on February 16 that left casualties and damage. A number of earthquakes were experienced in parts of the Untied States, but only minor damage was reported. 

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Selden, B.S.

    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.

  10. No Failure of Imagination: Examining Foundational Flaws in America’s Homeland Security Enterprise

    DTIC Science & Technology

    2011-09-01

    Casualty Actuarial Society Enterprise Risk Management Committee (2003) has adopted the following definition of ERM in May 2003: ERM is the...refused to go to an air- raid shelter due to the mathematical improbability of a bomb killing him out of all the people in Moscow. He changed his mind... Actuarial Society. Casualty Actuarial Society Enterprise Risk Management Committee. (2003). Technical Report. Overview of enterprise risk management

  11. Long Range Transport of War-Related Burn Casualties

    DTIC Science & Technology

    2008-02-01

    Long Range Transport of War-Related Burn Casualties Evan M. Renz, MD, FACS, Leopoldo C . Cancio, MD, FACS, David J. Barillo, MD, FACS, Christopher E...White, MD, FACS, Michael C . Albrecht, MD, Charles K. Thompson, PA- C , Jody L. Ennis, RN, BSN, Sandra M. Wanek, MD, James A. King, MD, FACEP, Kevin K...sched- Submitted for publication October 29, 2007. Accepted for publication October 30, 2007. Copyright © 2008 by Lippincott Williams & Wilkins From the

  12. Risk analysis of chemical, biological, or radionuclear threats: implications for food security.

    PubMed

    Mohtadi, Hamid; Murshid, Antu Panini

    2009-09-01

    If the food sector is attacked, the likely agents will be chemical, biological, or radionuclear (CBRN). We compiled a database of international terrorist/criminal activity involving such agents. Based on these data, we calculate the likelihood of a catastrophic event using extreme value methods. At the present, the probability of an event leading to 5,000 casualties (fatalities and injuries) is between 0.1 and 0.3. However, pronounced, nonstationary patterns within our data suggest that the "reoccurrence period" for such attacks is decreasing every year. Similarly, disturbing trends are evident in a broader data set, which is nonspecific as to the methods or means of attack. While at the present the likelihood of CBRN events is quite low, given an attack, the probability that it involves CBRN agents increases with the number of casualties. This is consistent with evidence of "heavy tails" in the distribution of casualties arising from CBRN events.

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

    NASA Technical Reports Server (NTRS)

    Yau, Kevin; Weissman, Paul; Yeomans, Donald

    1994-01-01

    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.

  14. Surgical resource utilization in urban terrorist bombing: a computer simulation.

    PubMed

    Hirshberg, A; Stein, M; Walden, R

    1999-09-01

    The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

  15. 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.

  16. Vulnerability of populations and the urban health care systems to nuclear weapon attack – examples from four American cities

    PubMed Central

    Bell, William C; Dallas, Cham E

    2007-01-01

    Background The threat posed by the use of weapons of mass destruction (WMD) within the United States has grown significantly in recent years, focusing attention on the medical and public health disaster capabilities of the nation in a large scale crisis. While the hundreds of thousands or millions of casualties resulting from a nuclear weapon would, in and of itself, overwhelm our current medical response capabilities, the response dilemma is further exacerbated in that these resources themselves would be significantly at risk. There are many limitations on the resources needed for mass casualty management, such as access to sufficient hospital beds including specialized beds for burn victims, respiration and supportive therapy, pharmaceutical intervention, and mass decontamination. Results The effects of 20 kiloton and 550 kiloton nuclear detonations on high priority target cities are presented for New York City, Chicago, Washington D.C. and Atlanta. Thermal, blast and radiation effects are described, and affected populations are calculated using 2000 block level census data. Weapons of 100 Kts and up are primarily incendiary or radiation weapons, able to cause burns and start fires at distances greater than they can significantly damage buildings, and to poison populations through radiation injuries well downwind in the case of surface detonations. With weapons below 100 Kts, blast effects tend to be stronger than primary thermal effects from surface bursts. From the point of view of medical casualty treatment and administrative response, there is an ominous pattern where these fatalities and casualties geographically fall in relation to the location of hospital and administrative facilities. It is demonstrated that a staggering number of the main hospitals, trauma centers, and other medical assets are likely to be in the fatality plume, rendering them essentially inoperable in a crisis. Conclusion Among the consequences of this outcome would be the probable loss of command-and-control, mass casualties that will have to be treated in an unorganized response by hospitals on the periphery, as well as other expected chaotic outcomes from inadequate administration in a crisis. Vigorous, creative, and accelerated training and coordination among the federal agencies tasked for WMD response, military resources, academic institutions, and local responders will be critical for large-scale WMD events involving mass casualties. PMID:17328796

  17. Vulnerability of populations and the urban health care systems to nuclear weapon attack--examples from four American cities.

    PubMed

    Bell, William C; Dallas, Cham E

    2007-02-28

    The threat posed by the use of weapons of mass destruction (WMD) within the United States has grown significantly in recent years, focusing attention on the medical and public health disaster capabilities of the nation in a large scale crisis. While the hundreds of thousands or millions of casualties resulting from a nuclear weapon would, in and of itself, overwhelm our current medical response capabilities, the response dilemma is further exacerbated in that these resources themselves would be significantly at risk. There are many limitations on the resources needed for mass casualty management, such as access to sufficient hospital beds including specialized beds for burn victims, respiration and supportive therapy, pharmaceutical intervention, and mass decontamination. The effects of 20 kiloton and 550 kiloton nuclear detonations on high priority target cities are presented for New York City, Chicago, Washington D.C. and Atlanta. Thermal, blast and radiation effects are described, and affected populations are calculated using 2000 block level census data. Weapons of 100 Kts and up are primarily incendiary or radiation weapons, able to cause burns and start fires at distances greater than they can significantly damage buildings, and to poison populations through radiation injuries well downwind in the case of surface detonations. With weapons below 100 Kts, blast effects tend to be stronger than primary thermal effects from surface bursts. From the point of view of medical casualty treatment and administrative response, there is an ominous pattern where these fatalities and casualties geographically fall in relation to the location of hospital and administrative facilities. It is demonstrated that a staggering number of the main hospitals, trauma centers, and other medical assets are likely to be in the fatality plume, rendering them essentially inoperable in a crisis. Among the consequences of this outcome would be the probable loss of command-and-control, mass casualties that will have to be treated in an unorganized response by hospitals on the periphery, as well as other expected chaotic outcomes from inadequate administration in a crisis. Vigorous, creative, and accelerated training and coordination among the federal agencies tasked for WMD response, military resources, academic institutions, and local responders will be critical for large-scale WMD events involving mass casualties.

  18. Challenges facing the veterinary profession in Ireland: 3. emergency and casualty slaughter certification.

    PubMed

    Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J

    2017-01-01

    Veterinarians are faced with significant conflicts of interest when issuing certificates for the transport and slaughter of acutely injured and casualty livestock. In a recent Policy Delphi study, emergency and casualty slaughter certification was a key concern identified by veterinary professionals in Ireland. In this case study (the third in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and the on-farm use of veterinary antimicrobials), we aim to provide a value-based reflection on the constraints and opportunities for best practice in emergency and casualty slaughter certification in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely a representative from the regulatory body, local authority veterinarians with research experience in emergency slaughter, an animal welfare research scientist, official veterinarians from the competent authority, a private veterinary practitioner, and a member of a farming organisation. Results revealed a conflict between the responsibility of private veterinary practitioners (PVPs) to safeguard the welfare of acutely injured bovines on-farm and the client's commercial concerns. As a consequence, some PVPs may feel under pressure to certify, for example, an acutely injured animal for casualty slaughter instead of recommending either on-farm emergency slaughter or disposal by the knackery service. Among Official Veterinarians, there are concerns about the pressure within processing plants to accept acutely injured livestock as casualty animals. Confusion pertaining to legislation and definition of fitness to travel also contribute to these dilemmas. Conflicts of interest arise due to the gap between governance and provision to facilitate on-farm emergency slaughter of livestock. Increased availability and acceptance of on-farm emergency slaughter by Food Business Operators (FBOs) would mitigate the need to certify acutely injured animals fit for transport and slaughter and thereby safeguard animal welfare. In the absence of nationwide availability and acceptance of on-farm emergency slaughter by FBOs, consideration should be given to methods to encourage all those involved in the food chain to prioritise animal welfare when in conflict with the commercial value of the animal. Training and guidelines for PVPs on the regulatory landscape and ethical decision-making should become available. The reintroduction of the fallen animal scheme should be considered to support farm animal welfare.

  19. Creating a Global Building Inventory for Earthquake Loss Assessment and Risk Management

    USGS Publications Warehouse

    Jaiswal, Kishor; Wald, David J.

    2008-01-01

    Earthquakes have claimed approximately 8 million lives over the last 2,000 years (Dunbar, Lockridge and others, 1992) and fatality rates are likely to continue to rise with increased population and urbanizations of global settlements especially in developing countries. More than 75% of earthquake-related human casualties are caused by the collapse of buildings or structures (Coburn and Spence, 2002). It is disheartening to note that large fractions of the world's population still reside in informal, poorly-constructed & non-engineered dwellings which have high susceptibility to collapse during earthquakes. Moreover, with increasing urbanization half of world's population now lives in urban areas (United Nations, 2001), and half of these urban centers are located in earthquake-prone regions (Bilham, 2004). The poor performance of most building stocks during earthquakes remains a primary societal concern. However, despite this dark history and bleaker future trends, there are no comprehensive global building inventories of sufficient quality and coverage to adequately address and characterize future earthquake losses. Such an inventory is vital both for earthquake loss mitigation and for earthquake disaster response purposes. While the latter purpose is the motivation of this work, we hope that the global building inventory database described herein will find widespread use for other mitigation efforts as well. For a real-time earthquake impact alert system, such as U.S. Geological Survey's (USGS) Prompt Assessment of Global Earthquakes for Response (PAGER), (Wald, Earle and others, 2006), we seek to rapidly evaluate potential casualties associated with earthquake ground shaking for any region of the world. The casualty estimation is based primarily on (1) rapid estimation of the ground shaking hazard, (2) aggregating the population exposure within different building types, and (3) estimating the casualties from the collapse of vulnerable buildings. Thus, the contribution of building stock, its relative vulnerability, and distribution are vital components for determining the extent of casualties during an earthquake. It is evident from large deadly historical earthquakes that the distribution of vulnerable structures and their occupancy level during an earthquake control the severity of human losses. For example, though the number of strong earthquakes in California is comparable to that of Iran, the total earthquake-related casualties in California during the last 100 years are dramatically lower than the casualties from several individual Iranian earthquakes. The relatively low casualties count in California is attributed mainly to the fact that more than 90 percent of the building stock in California is made of wood and is designed to withstand moderate to large earthquakes (Kircher, Seligson and others, 2006). In contrast, the 80 percent adobe and or non-engineered masonry building stock with poor lateral load resisting systems in Iran succumbs even for moderate levels of ground shaking. Consequently, the heavy death toll for the 2003 Bam, Iran earthquake, which claimed 31,828 lives (Ghafory-Ashtiany and Mousavi, 2005), is directly attributable to such poorly resistant construction, and future events will produce comparable losses unless practices change. Similarly, multistory, precast-concrete framed buildings caused heavy casualties in the 1988 Spitak, Armenia earthquake (Bertero, 1989); weaker masonry and reinforced-concrete framed construction designed for gravity loads with soft first stories dominated losses in the Bhuj, India earthquake of 2001 (Madabhushi and Haigh, 2005); and adobe and weak masonry dwellings in Peru controlled the death toll in the Peru earthquake of 2007 (Taucer, J. and others, 2007). Spence (2007) after conducting a brief survey of most lethal earthquakes since 1960 found that building collapses remains a major cause of earthquake mortality and unreinforced masonry buildings are one of the mos

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

    DTIC Science & Technology

    2013-09-09

    81 Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02 Frank K. Butler, MD; Joseph J. Dubose, MD; Edward...open pneumothorax ) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax ). New research from the...U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which incre- ments of

  1. An Update on the Surgeons Scope and Depth of Practice to All Hazards Emergency Response

    DTIC Science & Technology

    2006-06-01

    initiatives that are designed to react to and deal effectively with acts of terrorism. All aspects of the surgeon’s role in response to mass casualty...endpoint in terrorism’s designs. Increasingly frequent and effective terrorist acts have forced public health systems worldwide to examine and im...prove their abilities to care for mass casualties. Frykberg and Tepas noted that the most efficient and effective medical response systems have been

  2. The Military Casualty with Combat Related Acute Post Traumatic Stress Disorder

    DTIC Science & Technology

    1984-05-01

    explored. A researcher designed "Combat Fatigue Questionnaire" was mailed to 600 USAF nurses selected randomly. Three hundred sixty one USAF nurses...psychiatry noted: "Exhaustion was selected because it best described the appearance of most psychia- tric casualties" (p. xvii). Ernie Pyle, a World War II...Haber & Runyon, PL 1977), 600 (13.3% of the total USAF nurse population) names were selected . The "Combat Fatigue Questionnaire" was mailed between

  3. Preparedness for the Evaluation and Management of Mass Casualty Incidents Involving Anticholinesterase Compounds: A Survey of Emergency Department Directors in the 12 Largest Cities in the United States

    DTIC Science & Technology

    2010-11-01

    ORIGINAL ARTICLE Preparedness for the evaluation and management of mass casualty incidents involving anticholinesterase compounds: A survey of...Greenberg, MD, MPH Abstract Objectives: Anticholinesterases include carba- mate and organophosphorus (OP) insecticides and nerve agents. Release of...counterpart to REMM would be either moderately or very helpful for MCIs involving anticholinesterases . DOI:IO.5055/ajdm.2010.0035

  4. Multi Service Tactics, Techniques, and Procedures for Treatment of Chemical Warfare Agent Casualties and Conventional Military Chemical Injuries

    DTIC Science & Technology

    2016-08-02

    at mechanical ventilation of a severely exposed casualty until atropine takes effect . Administering supplemental oxygen as available. Chapter 3 3-10...Scavengers; hydroxocobalamin, and dicobalt edetate (2) Provision of S-Groups, thiosulfate (3) Assisted ventilation (4) Oxygen cyanogen... temperature index for light work. Refer to table 1-3 on page 1-12 for work and rest cycles and also water consumption chart. Chapter 1 1-12 ATP 4

  5. Emergency response to mass casualty incidents in Lebanon.

    PubMed

    El Sayed, Mazen J

    2013-08-01

    The emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure.

  6. Drone Strikes in Pakistan: Reasons to Assess Civilian Casualties

    DTIC Science & Technology

    2014-04-01

    Investigative Journalism (B~J), a media or- ganization headquartered in the United Kingdom, and the New America Foundation (NAF), a U.S. think tank. In...alongside the cniginal re- ports. Both organizations reference a broad set of media dispatches, an approach that generates estimated ranges of...casualties can tend Lo he Loo low while media reporL<> can sometimes he too high; Larry Lewis and Sarah Holewinski, "Changing of the Guard: Ci\\ilian

  7. Flood risk assessment of potential casualties in a global scale

    NASA Astrophysics Data System (ADS)

    Diaz Loaiza, Andres; Englhardt, Johanna; Boekhorst, Ellen; Ward, Philip; Aerts, Jeroen

    2017-04-01

    Flood risk assessment of potential casualties in a global scale. M. Andres Diaz-Loaiza (1), Johanna Englhardt (1), Ellen de Boekhorst (1), Philip J. Ward (1) and Jeroen Aerts (1) (1) Institute for Environmental Studies, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands. andres.diazloaiza@vu.nl Floods are one of the most dangerous natural disasters for humanity, affecting many people every year. Quantitative risk models on a global scale are nowadays available tools for institutions and actors in charge of risk management in order to plan possible mitigation measures in case of flood risk events. Many of these models have been focus on potential economic damage, population and GDP exposure, but the potential casualties assessment has been left aside. This is partially due to the complexity of the problem itself, in which several variables like the age of a pedestrian (drag/exposed to a flood event), or his weight and swimming experience can be decisive for the complete understanding of the problem. In the present work is presented the advances for the development of a methodology in order to include in the GLOFRIS model a new indicator in case of flood risk events. Preliminary analysis relating the GDP with the potential casualties shows that undeveloped countries have more susceptibility to loss of life in case of flood events. This because the GDP indicator evidences as well the protection measures available in a country.

  8. The art and science of surge: experience from Israel and the U.S. military.

    PubMed

    Tadmor, Boaz; McManus, John; Koenig, Kristi L

    2006-11-01

    In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what is often referred to as "surge." Surge capacity in emergency care can be described in technical, scientific terms that are measured by numbers and benchmarks (e.g., beds, patients, and medications) or can take on a more conceptual and abstract form (e.g., decisions, authority, and responsibility). The former may be referred to as the "science" of surge, whereas the latter, an equal if not more important component of surge systems that is more conceptual and abstract, can be considered the "art" of surge. The experiences from Israel and the U.S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U.S. military and provides solutions that may be applied to other health care systems when faced with similar situations.

  9. Research approaches to mass casualty incidents response: development from routine perspectives to complexity science.

    PubMed

    Shen, Weifeng; Jiang, Libing; Zhang, Mao; Ma, Yuefeng; Jiang, Guanyu; He, Xiaojun

    2014-01-01

    To review the research methods of mass casualty incident (MCI) systematically and introduce the concept and characteristics of complexity science and artificial system, computational experiments and parallel execution (ACP) method. We searched PubMed, Web of Knowledge, China Wanfang and China Biology Medicine (CBM) databases for relevant studies. Searches were performed without year or language restrictions and used the combinations of the following key words: "mass casualty incident", "MCI", "research method", "complexity science", "ACP", "approach", "science", "model", "system" and "response". Articles were searched using the above keywords and only those involving the research methods of mass casualty incident (MCI) were enrolled. Research methods of MCI have increased markedly over the past few decades. For now, dominating research methods of MCI are theory-based approach, empirical approach, evidence-based science, mathematical modeling and computer simulation, simulation experiment, experimental methods, scenario approach and complexity science. This article provides an overview of the development of research methodology for MCI. The progresses of routine research approaches and complexity science are briefly presented in this paper. Furthermore, the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems. And the only feasible alternative is complexity science. Finally, this summary is followed by a review that ACP method combining artificial systems, computational experiments and parallel execution provides a new idea to address researches for complex MCI.

  10. Fatal head and neck injuries in military underbody blast casualties.

    PubMed

    Stewart, Sarah K; Pearce, A P; Clasper, Jon C

    2018-04-21

    Death as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is at a higher rate and somewhat more predictable than injury caused by more classical forms of tertiary injury. Recent studies have focused on the transmission of axial load through the cervical spine with clinically relevant injury caused by resultant compression and flexion. This paper seeks to clarify the pattern of head and neck injuries in fatal UBB incidents using a pragmatic anatomical classification. This retrospective study investigated fatal UBB incidents in UK triservice members during recent operations in Afghanistan and Iraq. Head and neck injuries were classified by anatomical site into: skull vault fractures, parenchymal brain injuries, base of skull fractures, brain stem injuries and cervical spine fractures. Incidence of all injuries and of each injury type in isolation was compared. 129 fatalities as a consequence of UBB were identified of whom 94 sustained head or neck injuries. 87 casualties had injuries amenable to analysis. Parenchymal brain injuries (75%) occurred most commonly followed by skull vault (55%) and base of skull fractures (32%). Cervical spine fractures occurred in only 18% of casualties. 62% of casualties had multiple sites of injury with only one casualty sustaining an isolated cervical spine fracture. Improvement of UBB survivability requires the understanding of fatal injury mechanisms. Although previous biomechanical studies have concentrated on the effect of axial load transmission and resultant injury to the cervical spine, our work demonstrates that cervical spine injuries are of limited clinical relevance for UBB survivability and that research should focus on severe brain injury secondary to direct head impact. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Changes in blood transfusion practices in the UK role 3 medical treatment facility in Afghanistan, 2008-2011.

    PubMed

    Jansen, J O; Morrison, J J; Midwinter, M J; Doughty, H

    2014-06-01

    To document blood component usage in the UK medical treatment facility, Afghanistan, over a period of 4 years; and to examine the relationship with transfusion capability, injury pattern and survival. Haemostatic resuscitation is now firmly established in military medical practice, despite the challenges of providing such therapy in austere settings. Retrospective study of blood component use in service personnel admitted for trauma. Data were extracted from the UK Joint Theatre Trauma Registry. A total of 2618 patients were identified. Survival increased from 76 to 84% despite no change in injury severity. The proportion of patients receiving blood components increased from 13 to 32% per annum; 417 casualties received massive transfusion (≥10 units of RCC), the proportion increasing from 40 to 62%. Use of all blood components increased significantly in severely injured casualties, to a median (IQR) of 16 (9-25) units of red cell concentrate (P = 0·006), 15 (8-24) of plasma (P = 0·002), 2 (0-5) of platelets (P < 0·001) and 1 (0-3) of cryoprecipitate (P < 0·001). Cryoprecipitate (P = 0·009) and platelet use (P = 0·005) also increased in moderately injured casualties. The number of blood components transfused to individual combat casualties increased during the 4-year period, despite no change in injury severity or injury pattern. Survival also increased. Combat casualties requiring massive transfusion have a significantly higher chance of survival than civilian patients. Survival is the product of the entire system of care. However, we propose that the changes in military transfusion practice and capability have contributed to increased combat trauma survival. © 2013 Crown copyright. Transfusion Medicine © 2013 British Blood Transfusion Society. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

  12. Experience in the management of the mass casualty from the January 2010 Jos Crisis.

    PubMed

    Ozoilo, K N; Amupitan, I; Peter, S D; Ojo, E O; Ismaila, B O; Ode, M; Adoga, A A; Adoga, A S

    2016-01-01

    On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

  13. Noninvasive Continuous Hemoglobin Monitoring in Combat Casualties: A Pilot Study.

    PubMed

    Bridges, Elizabeth; Hatzfeld, Jennifer J

    2016-09-01

    To describe the accuracy and precision of noninvasive hemoglobin measurement (SpHb) compared with laboratory or point-of-care Hb, and SpHb ability to trend in seriously injured casualties. Observational study in a convenience sample of combat casualties undergoing resuscitation at two US military trauma hospitals in Afghanistan. SpHb was obtained using the Masimo Rainbow SET (Probe Rev E/Radical-7 Pulse CO-Oximeter v 7.6.2.1). Clinically indicated Hb was analyzed with a Coulter or iStat and compared with simultaneous SpHb values. Twenty-three patients were studied (ISS 20 ± 9.8; age 29 ± 9 years; male 97%; 100% intubated). Primary injury cause: improvised explosive device (67%) or gunshot (17%). There were 49 SpHb-Hb pairs (median 2 per subject). Bias: 0.3 ± 1.6 g/dL (95% LOA -2.4, 3.4 g/dL). The SpHb-Hb difference < ± 1 g/dL in 37% of pairs. Eighty-six percent of pairs changed in a similar direction. Using an absolute change in Hb of >1 g/dL, a concurrent absolute change in SpHb of >1 g/dL had a sensitivity: 61%, specificity 85%, positive predictive value: 80%, and a negative predictive value: 69%. The SpHb signal was present in 4643 of 6137 min monitored (76%). This was the first study to describe continuous SpHb in seriously injured combat casualties. Using a threshold of 1 g/dL previously specified in the literature, continuous SpHb is not precise enough to serve as sole transfusion trigger in trauma patients. Further research is needed to determine if it is useful for trending Hb changes or as an early indicator of deterioration in combat casualties.

  14. Minimizing casualties in biological and chemical threats (war and terrorism): the importance of information to the public in a prevention program.

    PubMed

    Noy, Shabtai

    2004-01-01

    The most effective means of defending against biological or chemical warfare, whether in war or as a result of terror, is the use of primary prevention. The main goal of such a prevention program is to minimize the human loss by reducing the number of casualties (fatalities, physical wounds, and psychological injury). A secondary objective is to prevent the widespread sense of helplessness in the general population. These two aims complement each other. The more the public is active in defending itself, rather than viewing itself as helpless, the lesser the expected number of casualties of any kind. In order to achieve these two goals, educating the civilian population about risk factors and pointing out appropriate defensive strategies is critical. In the absence of an effective prevention program and active participation by the public, there is a high risk for massive numbers of physical and psychological casualties. An essential ingredient of any preventive program, which ultimately may determine the success or failure of all other protective actions, is early, gradual dissemination of information and guidance to the public, so that citizens can become active participants in the program. The public needs to be given information concerning the nature of the threat and effective methods of coping with it, should an unconventional attack occur. Lack of such adaptive behavior (such as wearing protective gear) is likely to bring about vast numbers of physical and psychological casualties. These large numbers may burden the medical, political, and public safety systems beyond their ability to manage. Failure to provide reasonable prevention and effective interventions can lead to a destruction of the social and emotional fabric of individuals and the society. Furthermore, inadequate preparation, education, and communication can result in the development of damaging mistrust of the political and military leadership, disintegration of social and political structures, and perhaps, even risk the collapse of the democracy.

  15. Providing for the Casualties of War: The American Experience Through World War II

    DTIC Science & Technology

    2013-01-01

    Freud sug- gested that this may be an inherent trait, that “conflicts of interest between man and man are resolved, in principle, by the recourse to...violence” (Einstein and Freud , 1931– 1932). Although people have not been able to overcome their essential proclivity to make war on one another over...and methods of treatment of combat casualties. (Bliss, 1949) Army Psychiatry on the Eve of World War II After World War I, the writings of Sigmund

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

    DTIC Science & Technology

    2013-05-01

    122 I. Q Fever Model Parameters (Section C131) ....................................................128 1...needed to incorporate human response models for five biological agents not originally considered in AMedP-8(C): brucellosis, glanders, Q fever ...0103.1b should be modified to read: b. Biological agents include the causative agents of anthrax, brucellosis, glanders, Q fever , tularemia

  17. The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion

    DTIC Science & Technology

    2008-02-01

    The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion Philip C...REPORT TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE The Effect of Recombinant Activated Factor VII on Mortality in Combat...Boffard study,17 the effect of rFVIIa on 24-hour blood product ad- ministration was only determined for patients who lived for at least 24 hours

  18. Triage Decision Trees and Triage Protocols: Changing Strategies for Medical Rescue in Civilian Mass Casualty Situations.

    DTIC Science & Technology

    1984-02-06

    MASS CASUALTY SITUATIONS FINAL REPORT for 0O FEDERAL EMERGENCY MANAGEMENT AGENCY WASHINGTON, D.C. 20472 FEMA CONTRACT NUMBER EMW-C-1202 e FEMA WORK UNIT...20006 FINAL REPORT for FEDERAL EMERGENCY MANAGEMENT AGENCY WASHINGTON, D.C. 20472 FEMA CONTRACT NUMBER EMW-C-1202 FEMA WORK UNIT NUMBER 2412G...February 1984 This repnrt has been reviewed in the Federal Emergency Management Agency and approved for publication. Approval does not signify that the

  19. Historical Simulation and the American Civil War.

    DTIC Science & Technology

    1991-06-07

    book, Little Wars. Wells’ game used a toy gun firing wooden bullets to inflict casualties. His tactics involved positioning of guns , proper use of cover...Confederates initiated the game -turn by concen- trating the fire of 14 guns against Kleiser’s 6 gun battery causing one casting casualty. At the...brought in flanking fire on Wynkoop’s and Tibbit’s cavalry brigades. Imboden claimed, "The effect was magical . The first discharge of the gun threw his

  20. Bouncing Back From War Trauma: Resiliency in Global War on Terror’s Wounded Warriors

    DTIC Science & Technology

    2015-02-11

    Casualties of the Global War on Terror and Their Future Impact on Health Care and Society: A Looming Public Health Crisis .” Military Medicine 179 (April...Casualties of the Global War on Terror and Their Future Impact on Health Care and Society: A Looming Public Health Crisis .” Military Medicine 179...AIR WAR COLLEGE AIR UNIVERSITY BOUNCING BACK FROM WAR TRAUMA: RESILIENCY IN GLOBAL WAR ON TERROR’S WOUNDED WARRIORS by Katherine H

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

    DTIC Science & Technology

    2008-02-01

    of burn casualties with greater than 40% to- tal body surface area (TBSA) burns, acute kidney injury, or nephrology consultation in the 2 years before...TBSA burns with kidney injury with or without nephrology consultation (control group); 18 were treated with CRRT since (CRRT group). Groups were...with nephrology con- sultation in eight patients. Both 28-day mor- tality (22% vs. 75%, p 0.002) and in-hospital mortality (56% vs. 88%, p 0.04

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

    DTIC Science & Technology

    2007-10-01

    of burn casualties with greater than 40% to- tal body surface area (TBSA) burns, acute kidney injury, or nephrology consultation in the 2 years before...TBSA burns with kidney injury with or without nephrology consultation (control group); 18 were treated with CRRT since (CRRT group). Groups were...with nephrology con- sultation in eight patients. Both 28-day mor- tality (22% vs. 75%, p 0.002) and in-hospital mortality (56% vs. 88%, p 0.04

  3. The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

    DTIC Science & Technology

    2016-01-01

    psychological and physical aggression than they reported prior to the deployment. 1 H. Fischer, A Guide to U.S. Military Casualty Statistics ...analyses include a large number of statistical tests and thus the results pre- sented in this report should be viewed in terms of patterns, rather...Military Children and Families,” The Future of Children, Vol. 23, No. 2, 2013, pp. 13–39. Fischer, H., A Guide to U.S. Military Casualty Statistics

  4. Safety and Efficacy of Oral Transmucosal Fentanyl Citrate for Prehospital Pain Control on the Battlefield

    DTIC Science & Technology

    2012-01-01

    Butler FK, Blackbourne LH. We don’t know what we don’t know: combat casualty care pre-hospital data. US Army Med Dep J. 2011;11 14. 50. Kotwal RS... used for prehospital analgesia on the battlefield during the past century has been morphine. Intramuscular morphine has a delayed onset of pain relief...to March 31, 2010, were analyzed. Patients were US Army Special Operations Command casualties. Patients receiving OTFC for acute pain were evaluated

  5. Development and Field Test of Task-Based MOS-Specific Criterion Measures. Volume 1. Appendixes A-E

    DTIC Science & Technology

    1988-04-01

    WOUND 081-831-1033 APPLY A DRESSING TO AN OPEN HEAD WOUND 081-831-1005 PREVENT SHOCK 081-831-1034 SPLINT A SUSPECTED FRACTURE 081-831-1007 GTVE FIRST...Check seat belts and shoulder harnesses Check unit vehicle/trailer blackout system Service refrigeration unit Check and clean cab interior/exterior...DRESSING TO AN OPEN HEAD WOUND 081-831-1040 TRANSPORT A CASUALTY USING A ONE MAN CARRY 081-831-1041 TRANSPORT A CASUALTY USING A TWO MAN CARRY OR

  6. The birth of nerve agent warfare: lessons from Syed Abbas Foroutan.

    PubMed

    Newmark, Jonathan

    2004-05-11

    The author reviewed Farsi-language articles published recently by Dr. Syed Abbas Foroutan, which constitute the only firsthand clinical descriptions of battlefield nerve agent casualties in the world literature, and the author compares his comments with US and North Atlantic Treaty Organization (NATO) chemical casualty care doctrine. Foroutan's lessons learned reassure us that a robust medical evacuation system, coupled with timely and appropriate medical care of nerve agent poisoning, will save many more lives on future battlefields.

  7. Management of In-Field Patient Tracking and Triage by Using Near-Field Communication in Mass Casualty Incidents.

    PubMed

    Cheng, Po-Liang; Su, Yung-Cheng; Hou, Chung-Hung; Chang, Po-Lun

    2017-01-01

    Near field communications (NFC) is an emerging technology that may potentialy assist with disaster management. A smartphone-based app was designed to help track patient flow in real time. A table-drill was held as a brief evaluation and it showed significant imporvement in both efficacy and accuracy of patient management. It is feasible to use NFC-embedded smartphones to clarify the ambiguous and chaotic patient flow in a mass casualty incident.

  8. 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

    2015-12-04

    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.

  9. Casualty and surgical services in Perthshire general practitioner hospitals 1954-84

    PubMed Central

    Blair, J.S.G.; Grant, J.; McBride, H.; Martin, A.; Ross, R.T.A.

    1986-01-01

    The results are reported of a study of casualty and surgical services in five general practitioner hospitals in Perthshire — Aberfeldy, Auchterarder, Blairgowrie, Crieff and Pitlochry. Details of the total workload, the nature of the conditions treated and the referral rate to major hospitals are given. Figures for the Royal Infirmary, Perth, the main referral hospital for the county, are also given for comparison. The surgical service at one of the rural hospitals is described. Experience has demonstrated the usefulness of these hospitals in providing casualty and surgical services to both the local population and to visitors, and their superiority in providing these services over health centres because staff and beds are available 24 hours a day. Rural general practitioner hospitals merit a continuing share of resources and bed allocation as they spare major hospitals surgical and medical work. The general practitioners serving the hospitals studied here undertook almost 40% of the total accident and emergency workload in the Perth and Kinross area of Scotland. PMID:3735224

  10. Medical implications of enhanced radiation weapons.

    PubMed

    Reeves, Glen I

    2010-12-01

    During the 1960s through 1980s the United States and several other nations developed, and even considered deploying, enhanced-radiation warheads (ERWs). The main effect of ERWs (sometimes called "neutron bombs"), as compared to other types of nuclear weapons, is to enhance radiation casualties while reducing blast and thermal damage to the infrastructure. Five nations were reported to have developed and tested ERWs during this period, but since the termination of the "Cold War" there have been no threats of development, deployment, or use of such weapons. However, if the technology of a quarter of a century ago has been developed, maintained, or even advanced since then, it is conceivable that the grim possibility of future ERW use exists. The type of destruction, initial triage of casualties, distribution of patterns of injury, and medical management of ERWs will be shown to significantly differ from that of fission weapons. Emergency response planners and medical personnel, civilian or military, must be aware of these differences to reduce the horrible consequences of ERW usage and appropriately treat casualties.

  11. 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

  12. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Stansfield, S.; Shawver, D.; Sobel, A.

    This paper presents a prototype virtual reality (VR) system for training medical first responders. The initial application is to battlefield medicine and focuses on the training of medical corpsmen and other front-line personnel who might be called upon to provide emergency triage on the battlefield. The system is built upon Sandia`s multi-user, distributed VR platform and provides an interactive, immersive simulation capability. The user is represented by an Avatar and is able to manipulate his virtual instruments and carry out medical procedures. A dynamic casualty simulation provides realistic cues to the patient`s condition (e.g. changing blood pressure and pulse) andmore » responds to the actions of the trainee (e.g. a change in the color of a patient`s skin may result from a check of the capillary refill rate). The current casualty simulation is of an injury resulting in a tension pneumothorax. This casualty model was developed by the University of Pennsylvania and integrated into the Sandia MediSim system.« less

  13. The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015.

    PubMed

    Butler, Frank K; Blackbourne, Lorne H; Gross, Kirby

    2015-01-01

    While the list presented here is by no means a comprehensive list of all of the research areas of interest in battlefield trauma care, much less a list of research needs across the entire continuum of combat casualty care, it does provide the collective judgment of the CoTCCC about the highest priorities for RDT&E that relate to battlefield trauma care. Two additional observations should be made regarding that point: (1) As the landmark Eastridge et al. 2012 study convincingly documented, most combat fatalities occur in the prehospital phase of care, so research efforts that enable Combat medics, corpsmen, and PJs to care for their casualties more effectively will convey the highest probability of further reducing the case fatality rate and preventable deaths among US Combat casualties; and (2) inasmuch as the mission of the CoTCCC is to update the TCCC Guidelines as needed, this group has excellent visibility of the most important current research questions in battlefield trauma care.

  14. Drowning in the bible and contemporary society: responsibilities of religious caregivers.

    PubMed

    Avramidis, Stathis

    2010-06-01

    The aim of this study was to research drowning incidents and rescues that are included in the Bible and provide recommendations for how religious caregivers can support psychologically affected victims. Results confirm that the Bible contains six aquatic emergencies. Persons threatened with drowning were saved by an act of God, a human act and acts of human/divine interaction, when, for example, a person was ordered by God to perform an action which resulted in saving people on the threshold of drowning. The drowning casualties were largely individual males and some cases with multiple victims (male and female) as well. The outcomes of the drowning incidents were the survival of most of the casualties whose stories are told in the Bible. One person is reported to have drowned. Drowning incidents occurred at sea and on earth. The types of rescues used were reach-rescue and rescue and survival. The drowning casualties were rescued from land and from ships and boats by human rescuers. Some rescues were achieved by divine miracles.

  15. Information technologies for Marine Corps combat medicine.

    PubMed

    Carey, N B; Rattelman, C R; Nguyen, H Q

    1998-09-01

    Future Marine Corps warfighting concepts will make it more difficult to locate casualties, which will complicate casualty evacuation, lengthen casualty wait times, and require infantrymen or corpsmen to provide more extensive treatment. In these future scenarios, information flow and communications will be critical to medical functions. We asked, for Navy medical support to the Marines, what information will future combat medicine require and what technologies should supply those information needs? Based on analyses of patient data streams, focus groups of Navy medical personnel, and our estimates of the cost and feasibility of communications systems, we recommend the following: (1) increase medical training for some fraction of Marines, especially in hemorrhage control; (2) augment corpsmen's training; (3) furnish data systems for evacuation and supply that would provide in-transit visibility and simplify requests; (4) provide all ground medical personnel with access to treatment information systems and limited voice communications; and (5) exploit e-mail systems to reduce reliance on voice communications. Implementation time frames are discussed.

  16. A Sex Disparity Among Earthquake Victims.

    PubMed

    Ardagh, Michael; Standring, Sarah; Deely, Joanne M; Johnston, David; Robinson, Viki; Gulliver, Pauline; Richardson, Sandra; Dierckx, Alieke; Than, Martin

    2016-02-01

    Understanding who is most vulnerable during an earthquake will help health care responders prepare for future disasters. We analyzed the demography of casualties from the Christchurch earthquake in New Zealand. The demography of the total deceased, injured, and hospitalized casualties of the Christchurch earthquake was compared with that of the greater Christchurch population, the Christchurch central business district working population, and patients who presented to the single acute emergency department on the same month and day over the prior 10 years. Sex data were compared to scene of injury, context of injury, clinical characteristics of injury, and injury severity scores. Significantly more females than males were injured or killed in the entire population of casualties (P20% were injured at commercial or service localities (444/2032 males [22%]; 1105/4627 females [24%]). Adults aged between 20 and 69 years (1639/2032 males [81%]; 3717/4627 females [80%]) were most frequently injured. Where people were and what they were doing at the time of the earthquake influenced their risk of injury.

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

    PubMed

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

    2012-10-01

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

  18. MARC ES: a computer program for estimating medical information storage requirements.

    PubMed

    Konoske, P J; Dobbins, R W; Gauker, E D

    1998-01-01

    During combat, documentation of medical treatment information is critical for maintaining continuity of patient care. However, knowledge of prior status and treatment of patients is limited to the information noted on a paper field medical card. The Multi-technology Automated Reader Card (MARC), a smart card, has been identified as a potential storage mechanism for casualty medical information. Focusing on data capture and storage technology, this effort developed a Windows program, MARC ES, to estimate storage requirements for the MARC. The program calculates storage requirements for a variety of scenarios using medical documentation requirements, casualty rates, and casualty flows and provides the user with a tool to estimate the space required to store medical data at each echelon of care for selected operational theaters. The program can also be used to identify the point at which data must be uploaded from the MARC if size constraints are imposed. Furthermore, this model can be readily extended to other systems that store or transmit medical information.

  19. Scanning and War: Utility of FAST and CT in the Assessment of Battlefield Abdominal Trauma.

    PubMed

    Smith, Iain M; Naumann, David N; Marsden, Max E R; Ballard, Mark; Bowley, Douglas M

    2015-08-01

    To determine utilization and accuracy of focused assessment with sonography for trauma (FAST) and computed tomography (CT) in a mature military trauma system to inform service provision for future conflicts. FAST and CT scans undertaken by attending radiologists contribute to surgical decision making for battlefield casualties at the Joint Force, Role 3 Medical Treatment Facility at Camp Bastion (R3), Afghanistan. Registry data for abdominally injured casualties treated at R3 from July to November 2012 were matched to radiological and surgical records to determine diagnostic accuracy for FAST and CT and their influence on casualty management. A total of 468 casualties met inclusion criteria, of whom 85.0% underwent FAST and 86.1% abdominal CT; 159 (34.0%) had abdominal injuries. For detection of intra-abdominal injury, FAST sensitivity (Sn) was 0.56, specificity (Sp) 0.98, positive predictive value (PPV) 0.87, negative predictive value (NPV) 0.90, and accuracy (Acc) 0.89. For CT, Sn was 0.99, Sp 0.99, PPV 0.96, NPV 1.00, and Acc 0.99. Forty-six solid organ injuries were identified in 38 patients by CT; 17 were managed nonoperatively. A further 61 patients avoided laparotomy after CT confirmed extra-abdominal wounds only. The negative laparotomy rate was 3.9%. FAST and CT contribute to triage, guide surgical management, and reduce nontherapeutic laparotomy. When imaging is available, these data challenge current doctrine about inadvisability of nonoperative management of abdominal injury after combat trauma.

  20. Terrorism in Turkey.

    PubMed

    Rodoplu, Ulkumen; Arnold, Jeffrey; Ersoy, Gurkan

    2003-01-01

    Over the past two decades, terrorism has exacted an enormous toll on the Republic of Turkey, a secular democracy with a 99.8% Muslim population. From 1984 to 2000, an estimated 30,000 to 35,000 Turkish citizens were killed by a nearly continuous stream of terrorism-related events. During this period, the Partiya Karekerren Kurdistan (PKK), a Kurdish separatist group (re-named KADEK in 2002), was responsible for the vast majority of terrorism-related events (and casualties), which disproportionately affected the eastern and southeastern regions of Turkey, in which the PKK has focused its activities. Most terrorist attacks over the past two decades have been bombings or shootings that produced < 10 casualties per event. From 1984 to 2003, 15 terrorist attacks produced > or = 30 casualties (eight shootings, five bombings, and two arsons). The maximum number of casualties produced by any of these events was 93 in the Hotel Madimak arson attack by the Turkish Islamic Movement in 1993. This pattern suggests that terrorist attacks in Turkey rarely required more than local systems of emergency medical response, except in rural areas where Emergency Medical Services (EMS) are routinely provided by regional military resources. The last decade has seen the development of several key systems of local emergency response in Turkey, including the establishment of the medical specialty of Emergency Medicine, the establishment of training programs for EMS providers, the spread of a generic, Turkish hospital emergency plan based on the Hospital Emergency Incident Command System, and the spread of advanced training in trauma care modeled after Advanced Trauma Life Support.

  1. Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis.

    PubMed

    Schauer, Steven G; April, Michael D; Simon, Erica; Maddry, Joseph K; Carter, Robert; Delorenzo, Robert A

    2017-08-01

    Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included. Data Fifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as "routine." Follow-up data were available for 36 of the subjects and 97% were discharged alive. The most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines. Schauer SG , April MD , Simon E , Maddry JK , Carter R III , Delorenzo RA . Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465-468.

  2. 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.

  3. Point of injury tourniquet application during Operation Protective Edge-What do we learn?

    PubMed

    Shlaifer, Amir; Yitzhak, Avraham; Baruch, Erez N; Shina, Avi; Satanovsky, Alexandra; Shovali, Amiram; Almog, Ofer; Glassberg, Elon

    2017-08-01

    Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate- and short-term outcomes of point of injury (POI) tourniquet applications during "Operation Protective Edge" (OPE). A case series study regarding tourniquet application at the POI during OPE was collected. The data gathered included reports by medical providers at the POI, aerial and land evacuation vehicles, and receiving hospitals. Variables collected included, the number of tourniquet applications, caregiver level, tourniquet type, limb characters, tourniquet effectiveness, in-hospital procedures, complications, and short-term limb outcome. During OPE, the Israeli Defense Forces Medical Corps treated 704 casualties. Of these, 90 casualties were treated with 119 tourniquets of which 79 survived. Penetrating trauma was the mechanism of injury in 97.8% (88 of 90) of the casualties. Injuries sustained from improvised explosive devices and shrapnel were related to the use of more than one tourniquet per casualty and per limb (p = 0.034). The success rate of the first tourniquet was reported to be 70% (84 of 119), regardless of caregiver level (p = 0.56), tourniquet type (p = 0.16), or limb characters (p = 0.48). Twenty-seven (25.7%) of 105 of the tourniquets were converted to direct pressure dressings enroute to receiving hospitals two of the conversions failed and thus a new tourniquet was applied. Fasciotomy was performed on eight casualties (a single limb in each). Vascular injury was presumed to be the indication for fasciotomy in three of these cases, in the other five limbs (6%, 5 of 85), no vascular involvement was discovered during surgery, and the fasciotomy is suspected as tourniquet related. 7%) 6 of 85) suffered from neurological sequela that could not be explained by their primary injury. Total complication rate was 11.7% (10 of 85) (one patient had both fasciotomy and neural complication without vascular injury). Tourniquet use on the battlefield is a simple method of eliminating preventable death, we believe that clinical practice guidelines should promote liberal use of tourniquets by trained combatants and medical personnel with abilities to convert to direct pressure hemorrhage control when possible since an unjustified tourniquet application risks low rates minor morbidity, whereas a justifiable tourniquet not applied may be lethal. Epidemiologic study, level III; Therapeutic study, level IV.

  4. The effect on road safety of a modal shift from car to bicycle.

    PubMed

    Stipdonk, Henk; Reurings, Martine

    2012-01-01

    To describe and apply a method to assess the effect on road safety of a modal shift from cars to bicycles. Ten percent of all car trips shorter than 7.5 km were assumed to be replaced by bicycle trips. Single-vehicle and multivehicle crashes involving cars and/or bicycles were considered. The safety of car occupants and cyclists was taken into account as well as the safety of other road users involved in such crashes. The computations were carried out by age and gender. Assuming constant risk (casualties per distance traveled), the expected number of accidents is proportional to the mobility shift. Several types of risk were considered: the risk of being injured as a car driver or cyclist and the risk of being involved as a car driver or cyclist in a crash in which another road user is injured. The results indicated that the total gain of the modal shift was negative for fatalities, which means that there was a net increase in the number of fatalities. The modal shift was advantageous for young drivers and disadvantageous for elderly drivers. In addition, it was more positive for males than for females. The turning point was around the age of 35. For hospitalized casualties, due to the strong influence of the many hospitalized cyclists in nonmotorized vehicle crashes, there was a strong negative overall effect, and the modal shift resulted in a positive effect for 18- and 19-year-old males only. Overall, a small increase (up to 1%) in the number of cyclist fatalities and a greater increase of 3.5 percent in the number of inpatients was expected. The increase in casualties was mainly due to the proportion of single-vehicle bicycle crashes with serious injuries in relation to the total number of injured cyclists. The effect of the modal shift was shown to depend on age and gender, resulting in fewer casualties for younger drivers and for women. It is possible to provide a first approximation of the effect on road safety of a mobility shift from cars to bicycles. This approximation indicates that, in general, road safety does not benefit from this modal shift. The effect differs for gender and age groups. Elderly drivers are safer inside a car than on a bicycle. For the number of hospitalized casualties, the modal shift increases the number of casualties for practically all ages and both genders.

  5. Design of a model to predict surge capacity bottlenecks for burn mass casualties at a large academic medical center.

    PubMed

    Abir, Mahshid; Davis, Matthew M; Sankar, Pratap; Wong, Andrew C; Wang, Stewart C

    2013-02-01

    To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims. Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability-number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources-anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability. Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type AB packed red blood cells (76 h), silver dressing/Acticoat (100 h), bismuth tribromophenate/Xeroform (102 h), and gauze bandage rolls/Kerlix (168 h). The following items do not precipitate a bottleneck: ventilators, topical epinephrine, staplers, foams, antimicrobial non-adherent dressing/Telfa types A, B, or O blood. Nurse, respiratory therapist, and physician staffing does not induce bottlenecks. This model, and similar models for non-burn-related MCIs, can serve as a real-time estimation and management tool for hospital capacity in the setting of MCIs, and can inform supply decision support for disaster management.

  6. Audit of the effectiveness of command and control arrangements for medical evacuation of seriously ill or injured casualties in southern Afghanistan 2007.

    PubMed

    Cordell, R F; Cooney, M S; Beijer, D

    2008-12-01

    The effectiveness of the command and control of medical evacuation by helicopter (MEDEVAC) of casualties sustained in southern Afghanistan each month from 1 May to 31 July 2007 was audited. In this period 762 casualties of all categories were evacuated to International Security Assistance Force (ISAF) field hospital facilities under the direction of Operations and medical staff of NATO Regional Command (South) (RC-S). The criterion for the audit was the time taken from notification in the RC-S Combined Joint Operations Centre (CJOC) until the helicopter landed ("Wheels Down") at the destination field hospital's helicopter landing site. The standard to be met was 90 minutes for all "9-liner" Category A (URGENT) and Category B (URGENT - surgical) cases (in hospital within 2 hours of wounding) allowing for time from injury to first notification in the CJOC, and time from landing to transfer to the Emergency Department (30 minutes together) at the designated destination hospital. Those that did not meet this target were assessed in order to review their outcome and to identify means for improving performance. Analysis of evacuation times for all missions each month from May to July revealed that three quarters of A and B category missions met the 90 minute target. No adverse outcome resulted from those which did not meet this target, reasons for which included distance (more than 30 minutes flying time each way), delay in securing a hostile landing site, delay in obtaining sufficient information, incorrect categorization of the casualty's priority, and on one occasion, an overmatch of assets available at that time. No casualties died who were recoverable. Comparison with data from the two previous RC-S rotations (prior to 1 May 07) showed an improvement in mean response time, but little change in median response on the rotation of RC-S staff on 1 May 07. The major change that had occurred on this rotation was to move the medical operations staff into the CJOC. The convergence of median and mean at this time indicates a reduction in "outliers", providing evidence that collocation of medical and operations staff improves incident response and should be the "default setting" in deployed tactical formation headquarters. Regular audit of MEDEVAC response should be routine for Medical Operations staff, in order to ensure the optimal casualty care pathway from point of wounding to field hospital.

  7. Death on the battlefield (2001-2011): implications for the future of combat casualty care.

    PubMed

    Eastridge, Brian J; Mabry, Robert L; Seguin, Peter; Cantrell, Joyce; Tops, Terrill; Uribe, Paul; Mallett, Olga; Zubko, Tamara; Oetjen-Gerdes, Lynne; Rasmussen, Todd E; Butler, Frank K; Kotwal, Russ S; Kotwal, Russell S; Holcomb, John B; Wade, Charles; Champion, Howard; Lawnick, Mimi; Moores, Leon; Blackbourne, Lorne H

    2012-12-01

    Critical evaluation of all aspects of combat casualty care, including mortality, with a special focus on the incidence and causes of potentially preventable deaths among US combat fatalities, is central to identifying gaps in knowledge, training, equipment, and execution of battlefield trauma care. The impetus to produce this analysis was to develop a comprehensive perspective of battlefield death, concentrating on deaths that occurred in the pre-medical treatment facility (pre-MTF) environment. The Armed Forces Medical Examiner Service Mortality Surveillance Division was used to identify Operation Iraqi Freedom and Operation Enduring Freedom combat casualties from October 2001 to June 2011 who died from injury in the deployed environment. The autopsy records, perimortem records, photographs on file, and Mortality Trauma Registry of the Armed Forces Medical Examiner Service were used to compile mechanism of injury, cause of injury, medical intervention performed, Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS) on all lethal injuries. All data were used by the expert panel for the conduct of the potential for injury survivability assessment of this study. For the study interval between October 2001 and June 2011, 4,596 battlefield fatalities were reviewed and analyzed. The stratification of mortality demonstrated that 87.3% of all injury mortality occurred in the pre-MTF environment. Of the pre-MTF deaths, 75.7% (n = 3,040) were classified as nonsurvivable, and 24.3% (n = 976) were deemed potentially survivable (PS). The injury/physiologic focus of PS acute mortality was largely associated with hemorrhage (90.9%). The site of lethal hemorrhage was truncal (67.3%), followed by junctional (19.2%) and peripheral-extremity (13.5%) hemorrhage. Most battlefield casualties died of their injuries before ever reaching a surgeon. As most pre-MTF deaths are nonsurvivable, mitigation strategies to impact outcomes in this population need to be directed toward injury prevention. To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention.Understanding battlefield mortality is a vital component of the military trauma system. Emphasis on this analysis should be placed on trauma system optimization, evidence-based improvements in Tactical Combat Casualty Care guidelines, data-driven research, and development to remediate gaps in care and relevant training and equipment enhancements that will increase the survivability of the fighting force.

  8. Evaluation of Role 2 (R2) Medical Resources in the Afghanistan Combat Theater: Past, Present and Future

    DTIC Science & Technology

    2017-10-01

    casualty care using descriptive statistical analysis and modeling techniques. Aim 2: Identify the ideal provider training and competency assessment... Methodologies , Course  Type,  Course  Availability,  Assessment  Criteria,  Requirements,  Funding,  Alignment  with Clinical  Practice  Guidelines  (CPGs...Aim 1:  Descriptive study of all available information for combat casualties in Afghanistan.  Specific Tasks:  1) who – patients treated; clinician mix

  9. Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

    PubMed

    Remick, Kyle N

    2016-01-01

    The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

  10. A Comparison of the Incidence of Cricothyrotomy in the Deployed Setting to the Emergency Department at a Level 1 Military Trauma Center: A Descriptive Analysis

    DTIC Science & Technology

    2015-03-01

    the providers in the deployed setting and include the Tactical Combat Casualty Care casualty card. Data are then coded for query and analysis. All...intubate, can’t ventilate” and disruption of head/neck anatomy. Of the four procedures performed in the ED setting, three patients survived to hospital...data from SAMMC are limited by the search methods and data extraction. We searched by Current Procedural Ter- minology code , which requires that the

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

    PubMed

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

    2008-01-01

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

  12. Use of simulation technology in Australian Defence Force resuscitation training.

    PubMed

    Hendrickse, A D; Ellis, A M; Morris, R W

    2001-06-01

    Realistic training of health personnel for the resuscitation of military casualties is problematic. There are few opportunities for personnel to obtain the necessary experience unless working in a busy emergency or trauma environment. Even so, the specific nature of military trauma means that many aspects of casualty management may not be adequately covered in the civilian domain. This paper discusses the use of advanced simulation technology in the training of military resuscitation teams. Such training has been available to members of the Australian Defence Force (ADF) for two years.

  13. German General Officer Casualties in World War II -- Harbinger for U.S. Army General Officer Casualties in Airland Battle

    DTIC Science & Technology

    1988-12-07

    grenades, air attacks, tank fire, snipers, and partisans. Many of these causes, such as air attacks and tank fire, were relatively infrequent occurrences...Tank Fire 5 9 Small Arms Fire 7 13 Grenade 3 5 Air Attack 18 32 Tank Fire 2 4 Partisans 5 9 Sniper 3 5 In World War I personal danger for officers had...accounts of individual demises reflect this increased lethality, and better describe the significant dangers to these senior commanders. 18 AIR ATTACK

  14. NATO Planning Guide for the Estimation of Chemical, Biological, Radiological, and Nuclear (CBRN) Casualties (AMedP-8(C)) - Parameters for Estimation of Casualties from Exposure to Specified Biological Agents. Addenda to Allied Medical Publication 8

    DTIC Science & Technology

    2011-01-01

    glanders, Q fever, and tularemia , as well as the biotoxin staphylococcal enterotoxin B. Incorporating these five agents into the published NATO guide will...Specified Biological Agents: Brucellosis, Glanders, Q Fever, SEB, and Tularemia . This document describes the research methods used by the study authors...enterotoxin B (SEB), and tularemia . Several editorial changes, such as renumbering figures and tables, updating the corresponding references in the text, and

  15. End-to-end military pain management

    PubMed Central

    Aldington, D. J.; McQuay, H. J.; Moore, R. A.

    2011-01-01

    The last three years have seen significant changes in the Defence Medical Services approach to trauma pain management. This article seeks to outline these changes that have occurred at every level of the casualty's journey along the chain of evacuation, from the point of injury to rehabilitation and either continued employment in the Services or to medical discharge. Particular attention is paid to the evidence for the interventions used for both acute pain and chronic pain management. Also highlighted are possible differences in pain management techniques between civilian and military casualties. PMID:21149362

  16. 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.

  17. Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb.

    PubMed

    Fox, Charles J; Perkins, Jeremy G; Kragh, John F; Singh, Niten N; Patel, Bhavin; Ficke, James R

    2010-07-01

    Popliteal artery war wounds can bleed severely and historically have high rates of amputation associated with ligation (72%) and repair (32%). More than before, casualties are now surviving the initial medical evacuation and presenting with severely injured limbs that prompt immediate limb salvage decisions in the midst of life-saving maneuvers. A modern analysis of current results may show important changes because previous limb salvage strategies were limited by the resuscitation and surgical techniques of their eras. Because exact comparisons between wars are difficult, the objective of this study was to calculate a worst-case (a pulseless, fractured limb with massive hemorrhage from popliteal artery injury) amputation-free survival rate for the most severely wounded soldiers undergoing immediate reconstruction to save both life and limb. We performed a retrospective study of trauma casualties admitted to the combat support hospital at Ibn Sina Hospital in Baghdad, Iraq, between 2003 and 2007. US military casualties requiring a massive transfusion (> or = 10 blood units transfused within 24 hours of injury) were identified. We extracted data on the subset of casualties with a penetrating supra or infrageniculate popliteal arterial vascular injury. Demographics, injury mechanism, Injury Severity Score, tourniquet use, physiologic parameters, damage control adjuncts, surgical repair techniques, operative time, and outcomes (all-cause 30-day mortality, amputation rates, limb salvage failure, and graft patency) were investigated. Forty-six massively transfused male casualties, median age 24 years (range, 19-54 years; mean Injury Severity Score, 19 +/- 8.0), underwent immediate orthopedic stabilization and vascular reconstruction. There was one early death. The median operative time for the vascular repairs was 217 minutes (range, 94-630 minutes) and included all damage control procedures. Combined arterial and venous injuries occurred in 17 (37%). Ligation was performed for no arterial and 9 venous injuries. Amputations (transtibial or transfemoral) were considered limb salvage failures (14 of 48, 29.2%) and were grouped as immediate (< or = 48 hours, 5), early (>48 hours and < or = 30 days, 6), or late (>30 days, 3). Limb losses were from graft thrombosis, infection, or chronic pain. Combined arterial and venous injuries occurred in 17 (37%). Ligation was performed for no arterial and nine venous injuries. For a median follow-up (excluding death) of 48 months (range, 23-75 months), the amputation-free survival rate was 67%. This study, a worst-case study, showed comparable results to historical controls regarding limb salvage rates (71% for Iraq vs. 56-69% for the Vietnam War). Thirty-day survival (98%), 4-year amputation-free survival (67%), and complication-free rates (35%) fill knowledge gaps. Guidelines for managing popliteal artery injuries show promising results because current resuscitation practices and surgical care yielded similar amputation rates to prior conflicts despite more severe injuries. Significant transfusion requirements and injury severity may not indicate a life-over-limb strategy for popliteal arterial repairs. Future studies of limb salvage failures may help improve casualty care by reducing the complications that directly impact amputation-free survival.

  18. Overview of entry risk predictions

    NASA Astrophysics Data System (ADS)

    Mrozinski, R.; Mendeck, G.; Cutri-Kohart, R.

    Risk to people on the ground from uncontrolled entries of spacecraft is a primary concern when analyzing end-of-life disposal options for satellites. Countries must balance this risk with the need to mitigate an exponentially growing space debris population. Currently the United States does this via guidelines that call for a satellite to be disposed of in a controlled manner if an uncontrolled entry would be too risky to people on the ground. This risk is measured by a quantity called "casualty expectation", or E , where casualty expectation is defined as the expectedc number of people suffering death or injury due to a spacecraft entry event. If Ec exceeds 1 in 10,000, U. S. guidelines state that the entry should be controlled rather than uncontrolled. Since this guideline can have serious impacts on the cost, lifetime, and even the mission and functionality of a satellite, it is critical that this quantity be estimated well, and decision makers understand all assumptions and limitations inherent in the resulting value. This paper discusses several issues regarding estimates of casualty expectation, beginning with an overview of relevant United States policies and guidelines. The equation the space industry typically uses to estimate casualty expectation is presented, along with a look at the sensitivity of the results to the typical assumptions, models, and initial condition uncertainties. Differences in these modeling issues with respect to launch failure Ec estimates are included in the discussion. An alternate quantity to assess risks due to spacecraft entries is introduced. "Probability of casualty", or Pc , is defined as the probability of one or more instances of people suffering death or injury due to a spacecraft entry event. The equation to estimate Pc is derived, where the same assumptions, modeling, and initial condition issues for Ec apply. Several examples are then given of both Ec and Pc estimate calculations. Due to the difficult issues in estimating both Ec and Pc, it is argued that "true" absolute quantities can never be computed. However, E and Pc are ideal for relativec analyses against a standard tool that eliminates these issues. Such a tool is recommended for assessing compliance with requirements of regulating institutions.

  19. Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma.

    PubMed

    Ramasamy, Arul; Midwinter, Mark; Mahoney, Peter; Clasper, Jon

    2009-12-01

    Current ATLS protocols dictate that spinal precautions should be in place when a casualty has sustained trauma from a significant mechanism of injury likely to damage the cervical spine. In hostile environments, the application of these precautions can place pre-hospital medical teams at considerable personal risk. It may also prevent or delay the identification of airway problems. In today's global threat from terrorism, this hostile environment is no longer restricted to conflict zones. The aim of this study was to ascertain the incidence of cervical spine injury following penetrating ballistic neck trauma in order to evaluate the need for pre-hospital cervical immobilisation in these casualties. We retrospectively reviewed the medical records of British military casualties of combat, from Iraq and Afghanistan presenting with a penetrating neck injury during the last 5.5 years. For each patient, the mechanism of injury, neurological state on admission, medical and surgical intervention was recorded. During the study period, 90 casualties sustained a penetrating neck injury. The mechanism of injury was by explosion in 66 (73%) and from gunshot wounds in 24 (27%). Cervical spine injuries (either cervical spine fracture or cervical spinal cord injury) were present in 20 of the 90 (22%) casualties, but only 6 of these (7%) actually survived to reach hospital. Four of this six subsequently died from injuries within 72 h. Only 1 (1.8%) of the 56 survivors to reach a surgical facility sustained an unstable cervical spine injury that required surgical stabilisation. This patient later died as result of a co-existing head injury. Penetrating ballistic trauma to the neck is associated with a high mortality rate. Our data suggests that it is very unlikely that penetrating ballistic trauma to the neck will result in an unstable cervical spine in survivors. In a hazardous environment (e.g. shooting incidents or terrorist bombings), the risk/benefit ratio of mandatory spinal immobilisation is unfavourable and may place medical teams at prolonged risk. In addition cervical collars may hide potential life-threatening conditions.

  20. Managing mild casualties in mass-casualty incidents: lessons learned from an aborted terrorist attack.

    PubMed

    Bloch, Yuval H; Leiba, Adi; Veaacnin, Nurit; Paizer, Yohanan; Schwartz, Dagan; Kraskas, Ahuva; Weiss, Gali; Goldberg, Avishay; Bar-Dayan, Yaron

    2007-01-01

    Mildly injured and "worried well" patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties. Data were collected during and after the event, using patient records and formal debriefings. They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission. A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint. During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently. Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%). Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine. Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.

  1. Nuclear war between Israel and Iran: lethality beyond the pale

    PubMed Central

    2013-01-01

    Background The proliferation of nuclear technology in the politically volatile Middle East greatly increases the likelihood of a catastrophic nuclear war. It is widely accepted, while not openly declared, that Israel has nuclear weapons, and that Iran has enriched enough nuclear material to build them. The medical consequences of a nuclear exchange between Iran and Israel in the near future are envisioned, with a focus on the distribution of casualties in urban environments. Methods Model estimates of nuclear war casualties employed ESRI's ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency's WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency's (DTRA's) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. Further development for thermal burn casualties was based on Brode, as modified by Binninger, to calculate thermal fluence. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory's LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data. Results Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for three Israeli and eighteen Iranian cities. Nuclear weapon detonations in the densely populated cities of Iran and Israel will result in an unprecedented millions of numbers of dead, with millions of injured suffering without adequate medical care, a broad base of lingering mental health issues, a devastating loss of municipal infrastructure, long-term disruption of economic, educational, and other essential social activity, and a breakdown in law and order. Conclusions This will cause a very limited medical response initially for survivors in Iran and Israel. Strategic use of surviving medical response and collaboration with international relief could be expedited by the predicted casualty distributions and locations. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Any rational analysis of a nuclear war between Iran and Israel reveals the utterly unacceptable outcomes for either nation. PMID:23663406

  2. Blood transfusion is associated with infection and increased resource utilization in combat casualties.

    PubMed

    Dunne, James R; Riddle, Mark S; Danko, Janine; Hayden, Rich; Petersen, Kyle

    2006-07-01

    Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P < 0.01), a higher pulse rate (105 +/- 4 vs. 93 +/- 3, P < 0.0001), and a lower admission HCT (27 +/- 1 vs. 33 +/- 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 +/- 2.1 days vs. 1.4 +/- 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

  3. Ratio-driven resuscitation predicts early fascial closure in the combat wounded.

    PubMed

    Glaser, Jacob; Vasquez, Matthew; Cardarelli, Cassandra; Dunne, James; Elster, Eric; Hathaway, Emily; Bograd, Benjamin; Safford, Shawn; Rodriguez, Carlos

    2015-10-01

    Operation Iraqi Freedom and Operation Enduring Freedom have seen the highest rates of combat casualties since Vietnam. These casualties often require massive transfusion (MT) and immediate surgical attention to control hemorrhage. Clinical practice guidelines dictate ratio-driven resuscitation (RDR) for patients requiring MT. With the transition from crystalloid to blood product resuscitation, we have seen fewer open abdomens in combat casualties. We sought to determine the effect RDR has on achieving early definitive abdominal fascial closure in combat casualties undergoing exploratory laparotomy. Records of 1,977 combat casualties admitted to a single US military hospital from April 2003 to December 2011 were reviewed. Patients receiving an MT and laparotomy in theater constituted the study cohort. The cohort was divided into RDR, defined as a ratio of 0.8-U to 1.2-U packed red blood cells to 1-U fresh frozen plasma, and No-RDR groups. Age, injury patterns, mechanism of injury, injury severity, blood products, number of laparotomies, and days to fascial closure were collected. Assessed outcomes were number of days (early ≤ 2 days) and number of laparotomies to achieve fascial closure. The mean age of the study cohort (n = 172) was 24.0 years, and mean Injury Severity Score (ISS) was 24.8. Improvised explosive device blast was the most common mechanism of injury (74.4%). The cohort was divided into RDR patients (n = 73) and no RDR (n = 99). There was no difference in mean age, mean ISS, or rate of nontherapeutic exploratory laparotomies between the groups. RDR patients had a significantly lower abdominal injury rate (34.2% vs. 72.7%, p < 0.01), had fewer laparotomies (2.7 vs. 4.3, p = 0.003), and achieved primary fascial closure faster (2.4 days vs. 7.2 days, p = 0.004). On multivariate analysis, RDR (2.74; 95% confidence interval, 1.44-5.2) was an independent predictor for early fascial closure. Adherence to RDR guidelines resulted in significantly decreased number of abdominal operations and was identified as an independent predictor for early fascial closure. Further investigation is warranted to validate these findings. Therapeutic study, level III.

  4. Rural hospital mass casualty response to a terrorist shooting spree.

    PubMed

    Waage, S; Poole, J C; Thorgersen, E B

    2013-08-01

    Civilian mass casualty incidents may occur infrequently and suddenly, and are caused by accidents, natural disasters or human terrorist incidents. Most reports deal with trauma centre management in large cities, and data from small local hospitals are scarce. A rural hospital response to a mass casualty incident caused by a terrorist shooting spree was evaluated. An observational study was undertaken to evaluate the triage, diagnosis and management of all casualties received from the Utøya youth camp in Norway on 22 July 2011 by a local hospital, using data from the hospital's electronic records. Descriptive data are presented for patient demographics, injuries and patient flow. The shooting on Utøya youth camp left 69 people dead and 60 wounded. A rural hospital (Ringerike Hospital) triaged 35 patients, of whom 18 were admitted. During the main surge, the hospital triaged and treated 22 patients within 1 h, of whom 13 fulfilled the criteria for activating the hospital trauma team, including five with critical injuries (defined as an Injury Severity Score above 15). Ten computed tomography scans, two focused assessment with sonography for trauma (FAST) scans and 25 conventional X-rays were performed. During the first 24 h, ten surgical procedures were performed and four chest drains inserted. No patient died. Critical deviation from the major incident plan was needed, and future need for revision is deemed necessary based on the experience. Communication systems and the organization of radiological services proved to be most vulnerable. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  5. 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

  6. Risks of Mortality and Morbidity from Worldwide Terrorism: 1968-2004

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bogen, K T; Jones, E D

    Worldwide data on terrorist incidents between 1968 and 2004 gathered by the RAND corporation and the Oklahoma City National Memorial Institute for the Prevention of Terrorism (MIPT) were assessed for patterns and trends in morbidity/mortality. Adjusted data analyzed involve a total of 19,828 events, 7,401 ''adverse'' events (each causing {ge}1 victim), and 86,568 ''casualties'' (injuries) of which 25,408 were fatal. Most terror-related adverse events, casualties and deaths involved bombs and guns. Weapon-specific patterns and terror-related risk levels in Israel (IS) have differed markedly from those of all other regions combined (OR). IS had a fatal fraction of casualties about halfmore » that of OR, but has experienced relatively constant lifetime terror-related casualty risks on the order of 0.5%--a level 2 to 3 orders of magnitude more than those experienced in OR that increased {approx}100-fold over the same period. Individual event fatality has increased steadily, the median increasing from 14 to 50%. Lorenz curves obtained indicate substantial dispersion among victim/event rates: about half of all victims were caused by the top 2.5% (or 10%) of harm-ranked events in OR (or IS). Extreme values of victim/event rates were approximated fairly well by generalized Pareto models (typically used to fit to data on forest fires, sea levels, earthquakes, etc.). These results were in turn used to forecast maximum OR- and IS-specific victims/event rates through 2080, illustrating empirically based methods that could be applied to improve strategies to assess, prevent and manage terror-related risks and consequences.« less

  7. Risks of mortality and morbidity from worldwide terrorism: 1968-2004.

    PubMed

    Bogen, Kenneth T; Jones, Edwin D

    2006-02-01

    Worldwide data on terrorist incidents between 1968 and 2004 gathered by the RAND Corporation and the Oklahoma City National Memorial Institute for the Prevention of Terrorism (MIPT) were assessed for patterns and trends in morbidity/mortality. Adjusted data analyzed involve a total of 19,828 events, 7,401 "adverse" events (each causing >or= 1 victim), and 86,568 "casualties" (injuries), of which 25,408 were fatal. Most terror-related adverse events, casualties, and deaths involved bombs and guns. Weapon-specific patterns and terror-related risk levels in Israel (IS) have differed markedly from those of all other regions combined (OR). IS had a fatal fraction of casualties about half that of OR, but has experienced relatively constant lifetime terror-related casualty risks on the order of 0.5%--a level 2 to 3 orders of magnitude more than those experienced in OR that increased approximately 100-fold over the same period. Individual event fatality has increased steadily, the median increasing from 14% to 50%. Lorenz curves obtained indicate substantial dispersion among victim/event rates: about half of all victims were caused by the top 2.5% (or 10%) of harm-ranked events in OR (or IS). Extreme values of victim/event rates were approximated fairly well by generalized Pareto models (typically used to fit to data on forest fires, sea levels, earthquakes, etc.). These results were in turn used to forecast maximum OR- and IS-specific victims/event rates through 2080, illustrating empirically-based methods that could be applied to improve strategies to assess, prevent, and manage terror-related risks and consequences.

  8. Mass-casualty events at schools: a national preparedness survey.

    PubMed

    Graham, James; Shirm, Steve; Liggin, Rebecca; Aitken, Mary E; Dick, Rhonda

    2006-01-01

    Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

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

    PubMed

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

    2013-05-01

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

  10. The 'ABC' of examining foot radiographs.

    PubMed

    Pearse, Eyiyemi O; Klass, Benjamin; Bendall, Stephen P

    2005-11-01

    We report a simple systematic method of assessing foot radiographs that improves diagnostic accuracy and can reduce the incidence of inappropriate management of serious forefoot and midfoot injuries, particularly the Lisfranc-type injury. Five recently appointed senior house officers (SHOs), with no casualty or Orthopaedic experience prior to their appointment, were shown a set of 10 foot radiographs and told the history and examination findings recorded in the casualty notes of each patient within 6 weeks of taking up their posts. They were informed that the radiographs might or might not demonstrate an abnormality. They were asked to make a diagnosis and decide on a management plan. The test was repeated after they were taught the 'ABC' method of evaluating foot radiographs. Diagnostic accuracy improved after SHOs were taught a systematic method of assessing foot radiographs. The proportion of correct diagnoses increased from 0.64 to 0.78 and the probability of recognising Lisfranc injuries increased from 0 to 0.6. The use of this simple method of assessing foot radiographs can reduce the incidence of inappropriate management of serious foot injuries by casualty SHOs, in particular the Lisfranc type injury.

  11. The casualty profile from the Reading train crash, November 2004: proposals for improved major incident reporting and the application of trauma scoring systems.

    PubMed

    Howells, N R; Dunne, N; Reddy, S

    2006-07-01

    To report the casualty profile of the major incident at the Royal Berkshire Hospital, Reading, following the Ufton Nervet Train crash, November 2004. To make further proposals regarding major incident reporting and implementation of trauma-scoring systems. Retrospective analysis of emergency department and hospital notes. Calculation of index Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS) in all patients. Of 61 casualties, the majority (74%) were seen in the minors area of our emergency department with a mixture of blunt impact and penetrating glass injuries. One died and 16 were admitted. 10% had an ISS >16. All surviving patients had a TRISS predicted probability of survival >90%. We propose mandatory major incident reporting within 6 months of a major incident to aid development of a national database. As previously proposed, this will aid education and facilitate future major incident planning. We further propose the widespread use of trauma scoring systems to facilitate comparative analysis between major incidents, perhaps extrapolating this to develop a major incident score.

  12. 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. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Impact of the effect of economic crisis and the targeted motorcycle safety programme on motorcycle-related accidents, injuries and fatalities in Malaysia.

    PubMed

    Law, T H; Umar, R S Radin; Zulkaurnain, S; Kulanthayan, S

    2005-03-01

    In 1997, a Motorcycle Safety Programme (MSP) was introduced to address the motorcycle-related accident problem. The MSP was specifically targeted at motorcyclists. In addition to the MSP, the recent economic recession has significantly contributed to a reduction of traffic-related incidents. This paper examines the effects of the recent economic crisis and the MSP on motorcycle-related accidents, casualties and fatalities in Malaysia. The autocorrelation integrated moving average model with transfer function was used to evaluate the overall effects of the interventions. The variables used in developing the model were gross domestic product and MSPs. The analysis found a 25% reduction in the number of motorcycle-related accidents, a 27% reduction in motorcycle casualties and a 38% reduction in motorcycle fatalities after the implementation of MSP. Findings indicate that the MSP has been one of the effective measures in reducing motorcycle safety problems in Malaysia. Apart from that, the performance of the country's economy was also found to be significant in explaining the number of motorcycle-related accidents, casualties and fatalities in Malaysia.

  14. Improvised explosive devices: pathophysiology, injury profiles and current medical management.

    PubMed

    Ramasamy, A; Hill, A M; Clasper, J C

    2009-12-01

    The improvised explosive device (IED), in all its forms, has become the most significant threat to troops operating in Afghanistan and Iraq. These devices range from rudimentary home made explosives to sophisticated weapon systems containing high-grade explosives. Within this broad definition they may be classified as roadside explosives and blast mines, explosive formed pojectile (EFP) devices and suicide bombings. Each of these groups causeinjury through a number of different mechanisms and can result in vastly different injury profiles. The "Global War on Terror" has meant that incidents which were previously exclusively seen in conflict areas, can occur anywhere, and clinicians who are involved in emergency trauma care may be required to manage casualties from similar terrorist attacks. An understanding of the types of devices and their pathophysiological effects is necessary to allow proper planning of mass casualty events and to allow appropriate management of the complex poly-trauma casualties they invariably cause. The aim of this review article is to firstly describe the physics and injury profile from these different devices and secondly to present the current clinical evidence that underpins their medical management.

  15. An empirical test of Lanchester's square law: mortality during battles of the fire ant Solenopsis invicta

    PubMed Central

    Plowes, Nicola J.R; Adams, Eldridge S

    2005-01-01

    Lanchester's models of attrition describe casualty rates during battles between groups as functions of the numbers of individuals and their fighting abilities. Originally developed to describe human warfare, Lanchester's square law has been hypothesized to apply broadly to social animals as well, with important consequences for their aggressive behaviour and social structure. According to the square law, the fighting ability of a group is proportional to the square of the number of individuals, but rises only linearly with fighting ability of individuals within the group. By analyzing mortality rates of fire ants (Solenopsis invicta) fighting in different numerical ratios, we provide the first quantitative test of Lanchester's model for a non-human animal. Casualty rates of fire ants were not consistent with the square law; instead, group fighting ability was an approximately linear function of group size. This implies that the relative numbers of casualties incurred by two fighting groups are not strongly affected by relative group sizes and that battles do not disproportionately favour group size over individual prowess. PMID:16096093

  16. An analysis of consultations with the crowd doctors at Glasgow Celtic football club, season 1999–2000

    PubMed Central

    Crawford, M; Donnelly, J; Gordon, J; MacCallum, R; MacDonald, I; McNeill, M; Mulhearn, N; Tilston, S; West, G

    2001-01-01

    Objective—To analyse all clinical presentations to the crowd doctors at Scotland's largest football stadium over the course of one complete season. Methods—A standard clinical record form was used to document all consultations with the crowd doctors including treatment and subsequent referrals. The relevance of alcohol consumption was assessed. Results—A total of 127 casualties were seen at 26 matches, a mean of 4.88 per match. Twenty casualties were transferred to hospital, including one successfully defibrillated after a cardiac arrest. Alcohol excess was a major contributing factor in 26 cases. Conclusions—The workload of the crowd doctors was very variable and diverse. The social problem of excessive alcohol consumption contributed considerably to the workload. The provision of medical facilities at football grounds means that attendance there is now one of the least adverse circumstances in which to have a cardiac arrest. The study confirmed previous impressions that more casualties are seen at high profile matches. Key Words: crowd doctor; major sporting event; football grounds; Gibson report PMID:11477019

  17. FALLOUT DOSAGE AND MONITORING

    PubMed Central

    Kinsman, Simon

    1960-01-01

    At present there are a large number of people capable of conducting the task of surface and area radiation monitoring including external monitoring of personnel. Once the extent and the intensity of radioactivity in an area is determined, good use of personnel can be made without too much risk. This is fortunate for the medical profession whose personnel can devote their talents to casualty care during or following nuclear warfare. Most individuals who know how to detect and measure the extent of radioactive contamination are also capable of conducting personnel decontamination operations and would do so if necessary. Consequently the spread of contamination can be minimized by adequate decontamination and the medical personnel can treat casualties who are relatively free of external radioactive contamination. The appropriate use of trained manpower and radiation detection equipment which are available in California combined with sufficient rehearsals prior to a nuclear war will greatly reduce any casualty damage due to radioactive fallout. The chances of survival of individuals can be greatly improved with a little knowledge of protection from radioactive contamination and of salvage of food and water. PMID:14409247

  18. Chapter 3 innovations in the en route care of combat casualties.

    PubMed

    Hatzfeld, Jennifer J; Dukes, Susan; Bridges, Elizabeth

    2014-01-01

    The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status. In addition to institutionalizing these innovations, future efforts are needed to eliminate secondary insults to patients with traumatic brain injuries and technologies to provide closed-loop sedation and ventilation.

  19. 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.

  20. Overconfidence, preview, and probability in strategic planning

    NASA Technical Reports Server (NTRS)

    Wickens, Christopher D.; Pizarro, David; Bell, Brian

    1991-01-01

    The performance of eight subjects in a 'rescue' video game requiring choices as to which node they should fly to in order to rescue the simulated casualties is presently studied with a view to biases and display support criteria in strategic planning. After each choice, the subjects needed to fly a challenging tracking dynamic along a path to reach the next node. The results obtained indicate that the choices of the subjects were less optimal when full preview was offered, perhaps due to subjects' reliance on the simple strategy of choosing routes with the greatest number of casualties.

  1. Patient safety culture in Norwegian primary care: a study in out-of-hours casualty clinics and GP practices.

    PubMed

    Bondevik, Gunnar Tschudi; Hofoss, Dag; Hansen, Elisabeth Holm; Deilkås, Ellen Catharina Tveter

    2014-09-01

    This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Seven OOH casualty clinics and 17 GP practices in Norway. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics - on several patient safety factors.

  2. [Even more critical medicine: a retrospective analysis of casualties admitted to the intensive care unit in the Spanish Military Hospital in Herat (Afghanistan)].

    PubMed

    Navarro Suay, R; Bartolomé Cela, E; Jara Zozaya, I; Hernández Abadía de Barbará, A; Gutiérrez Ortega, C; García Labajo, J D; Planas Roca, A; Gilsanz Rodríguez, F

    2011-04-01

    To analyze casualties from firearm and explosives injuries who were admitted to the Intensive Care Unit in the Spanish ROLE-2E from December 2005 to December 2008 and to evaluate which damaging agent had produced the highest morbidity-mortality in our series using score indices with anatomical base (ISS and NISS). Observational and retrospective study performed between 2005 and 2008. Polyvalent Intensive Care Unit in the Spanish Military Hospital of those deployed in Afghanistan. The inclusion criteria were all patients who had been wounded by firearm or by explosive devices and who had been admitted in ICU in Spanish Military Hospital in Herat (Afghanistan). The anatomic scores Injury Severity Score and the New Injury Severity Score (NISS) were applied to all the selected patients to estimate the grade of severity of their injuries. Independent: damaging agent, injured anatomical area, protection measures and dependent: mortality, surgical procedure applied, score severity and socio-demographics and control variables. Eighty-six casualties, 30 by firearm and 56 by explosive devices. Applying the NISS, 38% of the casualties had suffered severe injuries. Mean stay in the ICU was 2.8 days and mortality was 10%. Significant differences in admission to the ICU for the damaging agent were not observed (P=.142). No significant differences were observed in the need for admission and stay in the ICU according to the damaging agent. The importance of the strategy, care and logistics of the intensive care military physician in Intensive Medicine in the Operating Room in Afghanistan is stressed. © 2010 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  3. Intraosseous vascular access in disasters and mass casualty events: A review of the literature.

    PubMed

    Burgert, James M

    2016-01-01

    The intraosseous (IO) route of vascular access has been increasingly used to administer resuscitative fluids and drugs to patients in whom reliable intravenous (IV) access could not be rapidly or easily obtained. It is unknown that to what extent the IO route has been used to gain vascular access during disasters and mass casualty events. The purpose of this review was to examine the existing literature to answer the research question, "What is the utility of the IO route compared to other routes for establishing vascular access in patients resulting from disasters and mass casualty events?" Keyword-based online database search of PubMed, CINAHL, and the Cochrane Database of Systematic Reviews. University-based academic research cell. Included evidence were randomized and nonrandomized trials, systematic reviews with and without meta-analysis, case series, and case reports. Excluded evidence included narrative reviews and expert opinion. Not applicable. Of 297 evidence sources located, 22 met inclusion criteria. Located evidence was organized into four categories including chemical agent poisoning, IO placement, while wearing chemical protective clothing (PPE), military trauma, and infectious disease outbreak. Evidence indicates that the IO route of infusion is pharmacokinetically equal to the IV route and superior to the intramuscular (IM) and endotracheal routes for the administration of antidotal drugs in animal models of chemical agent poisoning while wearing full chemical PPE. The IO route is superior to the IM route for antidote administration during hypovolemic shock. Civilian casualties of explosive attacks and mass shootings would likely benefit from expanded use of the IO route and military resuscitation strategies. The IO route is useful for fluid resuscitation in the management of diarrheal and hemorrhagic infectious disease outbreaks.

  4. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR).

    PubMed

    Amlôt, Richard; Carter, Holly; Riddle, Lorna; Larner, Joanne; Chilcott, Robert P

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an "Initial Operational Response" by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer's forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.

  5. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S Initial Operational Response (IOR)

    PubMed Central

    Riddle, Lorna; Larner, Joanne

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely. PMID:28622352

  6. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    PubMed

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and staff safety.

  7. Risks from Worldwide Terrorism: Mortality and Morbidity Patterns and Trends

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bogen, K T; Jones, E D

    Worldwide data on terrorist incidents between 1968 and 2004 gathered by the RAND corporation and the Oklahoma City National Memorial Institute for the Prevention of Terrorism (MIPT) were assessed for patterns and trends in morbidity/mortality. The data involve a total of 19,828 events, 7,401 ''adverse'' events (each causing {ge}1 victim), 91,346 cases of casualty (either injury or death) and 25,408 deaths. Analyses revealed a number of interesting patterns and apparently significant trends. Most terror-related adverse events, casualties and deaths involved bombs and guns. Weapon-specific patterns and terror-related risk levels in Israel (ISR) have differed markedly from those of all othermore » regions combined (AOR). ISR had a fatal fraction of casualties about half that of AOR, but has experienced relatively constant lifetime terror-related casualty risks on the order of 0.5%--a level 2 to 3 orders of magnitude more than those experienced in AOR, which have increased {approx}100-fold over the same period. Individual event fatality has increased steadily, the median increasing from 14 to 50%. Lorenz curves obtained indicate substantial dispersion among victim/event rates: about half of all victims were caused by the top 2% (10%) of harm-ranked events in OAR (ISR). Extreme values of victim/event rates were found to be well modeled by classic or generalized Pareto distributions, indicating that these rates have been as predictable as similarly extreme phenomena such as rainfall, sea levels, earthquakes, etc. This observation suggests that these extreme-value patterns may be used to improve strategies to prevent and manage risks associated with terror-related consequences.« less

  8. Mass chemical casualties: treatment of 41 patients with burns by anhydrous ammonia.

    PubMed

    Zhang, Fang; Zheng, Xing-Feng; Ma, Bing; Fan, Xiao-Ming; Wang, Guang-Yi; Xia, Zhao-Fan

    2015-09-01

    This article reports a chemical burn incident that occurred on 31 August 2013 in Shanghai. We describe situations at the scene, emergency management, triage, evacuation, and follow-up of the victims. The scene of the incident and information on the 41 victims of this industrial chemical incident were investigated. The emergency management, triage, evacuation, and hospitalization data of the patients were summarized. At the time of the incident, 58 employees were working in a closed refrigerator workshop, 41 of whom sustained burns following the leakage of anhydrous ammonia. Ten victims died of severe inhalation injury at the scene, and another five victims died during the process of evacuation to the nearest hospital. After receiving information on the incident, a contingency plan for the burn disaster was launched immediately, and a first-aid group and an emergency and triage group were dispatched by the Changhai Hospital to the scene to aid the medical organization, emergency management, triage, and evacuation. All casualties were first rushed to the nearest hospital by ambulance. The six most serious patients with inhalation injuries were evacuated to the Changhai Hospital and admitted to the burn intensive care unit (BICU) for further treatment, one of whom died of respiratory failure and pulmonary infection. This mass casualty incident of anhydrous ammonia leakage caused potential devastating effects to the society, especially to the victims and their families. Early first-aid organization, emergency management, triage, and evacuation were of paramount importance, especially rapid evaluation of the severity of inhalation injury, and subsequent corresponding medical treatment. The prognosis of ammonia burns was poor and the sequelae were severe. Management and treatment lessons were drawn from this mass casualty chemical burn incident. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  9. Predeployment training for forward medicalisation in a combat zone: the specific policy of the French Military Health Service.

    PubMed

    Pasquier, Pierre; Dubost, Clément; Boutonnet, Mathieu; Chrisment, Anne; Villevieille, Thierry; Batjom, Emmanuel; Bordier, Emmanuel; Ausset, Sylvain; Puidupin, Marc; Martinez, Jean-Yves; Bay, Christian; Escarment, Jacques; Pons, François; Lenoir, Bernard; Mérat, Stéphane

    2014-09-01

    To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury. The aim of our article is to describe the process and the result of the SC training. Records from the French Military Health Service Academy - École du Val-de-Grâce administration, head of the SC teaching programme, defining its guidelines, and supporting its structure and its execution, were examined and analyzed, since the standardisation of the SC training programme in 2008. The total number of trainees was listed following the different courses (SC1, SC2, SC3). At the end of 2013, every deployed combatant underwent SC1 courses (confidential data), 785 health-qualified combatants were graduated for SC2 courses and 672 Role 1 physician-nurse pairs for SC3 courses. The SC concept and programmes were defined in France in 2007 and are now completely integrated into the predeployment training of all combatants but also of French Military Health Service providers. Finally, SC teaching programmes enhance the importance of teamwork in forward combat medicalisation settings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

    PubMed

    Stewart, Ian J; Faulk, Tarra I; Sosnov, Jonathan A; Clemens, Michael S; Elterman, Joel; Ross, James D; Howard, Jeffrey T; Fang, Raymond; Zonies, David H; Chung, Kevin K

    2016-03-01

    Rhabdomyolysis has been associated with poor outcomes in patients with traumatic injury, especially in the setting of acute kidney injury (AKI). However, rhabdomyolysis has not been systematically examined in a large cohort of combat casualties injured in the wars in Iraq and Afghanistan. We conducted a retrospective study of casualties injured during combat operations in Iraq and Afghanistan who were initially admitted to the intensive care unit from February 1, 2002, to February 1, 2011. Information on age, sex, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), mechanism of injury, shock index, creatine kinase, and serum creatinine were collected. These variables were examined via multivariate logistic and Cox regression analyses to determine factors independently associated with rhabdomyolysis, AKI, and death. Of 6,011 admissions identified, a total of 2,109 patients met inclusion criteria and were included for analysis. Rhabdomyolysis, defined as creatine kinase greater than 5,000 U/L, was present in 656 subjects (31.1%). Risk factors for rhabdomyolysis identified on multivariable analysis included injuries to the abdomen and extremities, increased ISS, male sex, explosive mechanism of injury, and shock index greater than 0.9. After adjustment, patients with rhabdomyolysis had a greater than twofold increase in the odds of AKI. In the analysis for mortality, rhabdomyolysis was significantly associated with death until AKI was added, at which point it lost statistical significance. We found that rhabdomyolysis is associated with the development of AKI in combat casualties. While rhabdomyolysis was strongly associated with mortality on the univariate model and in conjunction with both ISS and age, it was not associated with mortality after the inclusion of AKI. This suggests that the effect of rhabdomyolysis on mortality may be mediated by AKI. Prognostic and epidemiologic study, level III.

  11. [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

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

  12. Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880

    PubMed Central

    Katharios-Lanwermeyer, Stefan; Holty, Jon-Erik; Person, Marissa; Sejvar, James; Haberling, Dana; Tubbs, Heather; Meaney-Delman, Dana; Pillai, Satish K.; Hupert, Nathaniel; Bower, William A.; Hendricks, Katherine

    2016-01-01

    BACKGROUND Bacillus anthracis, the causative agent of anthrax, is a potential bioterrorism agent. Anthrax meningitis may be a manifestation of B. anthracis infection, has high mortality, and requires more aggressive treatment than anthrax without meningitis. Rapid identification and treatment of anthrax meningitis are essential for successful management of an anthrax mass casualty incident. METHODS Three hundred six published reports from 1880 through 2013 met pre-defined inclusion criteria. We calculated descriptive statistics for abstracted cases and conducted multivariable regression on separate derivation and validation cohorts to identify clinical diagnostic and prognostic factors for anthrax meningitis. RESULTS One hundred thirty-two of 363 (36%) cases with systemic anthrax met anthrax meningitis criteria. Severe headache, altered mental status, meningeal signs, and other neurological signs at presentation independently predicted meningitis in the derivation cohort and are proposed as a four-item screening tool for use during mass casualty incidents. Presence of any one factor on admission had a sensitivity for finding anthrax meningitis of 89% (83%) in the adult (pediatric) validation cohorts. Anthrax meningitis was unlikely in the absence of any of these signs or symptoms ([LR−]=0.12 [0.19] for adult [pediatric] cohorts), while presence of two or more factors made meningitis very likely ([LR+]=26.5 [29.2]). Survival of anthrax meningitis was predicted by treatment with a bactericidal agent (P=0.005) and use of multiple antimicrobials (P=0.012). CONCLUSIONS We developed an evidence-based triage tool for screening patients for meningitis during an anthrax mass casualty incident; its use could improve both patient outcomes and resource allocation in such an event. PMID:27025833

  13. Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880.

    PubMed

    Katharios-Lanwermeyer, Stefan; Holty, Jon-Erik; Person, Marissa; Sejvar, James; Haberling, Dana; Tubbs, Heather; Meaney-Delman, Dana; Pillai, Satish K; Hupert, Nathaniel; Bower, William A; Hendricks, Katherine

    2016-06-15

    Bacillus anthracis, the causative agent of anthrax, is a potential bioterrorism agent. Anthrax meningitis is a common manifestation of B. anthracis infection, has high mortality, and requires more aggressive treatment than anthrax without meningitis. Its rapid identification and treatment are essential for successful management of an anthrax mass casualty incident. Three hundred six published reports from 1880 through 2013 met predefined inclusion criteria. We calculated descriptive statistics for abstracted cases and conducted multivariable regression on separate derivation and validation cohorts to identify clinical diagnostic and prognostic factors for anthrax meningitis. One hundred thirty-two of 363 (36%) cases with systemic anthrax met anthrax meningitis criteria. Severe headache, altered mental status, meningeal signs, and other neurological signs at presentation independently predicted meningitis in the derivation cohort and were tested as a 4-item assessment tool for use during anthrax mass casualty incidents. Presence of any 1 factor on admission had a sensitivity for finding anthrax meningitis of 89% (83%) in the adult (pediatric) validation cohorts. Anthrax meningitis was unlikely in the absence of any of these signs or symptoms (likelihood ratio [LR]- = 0.12 [0.19] for adult [pediatric] cohorts), while presence of 2 or more made meningitis very likely (LR+ = 26.5 [30.0]). Survival of anthrax meningitis was predicted by treatment with a bactericidal agent (P = .005) and use of multiple antimicrobials (P = .01). We developed an evidence-based assessment tool for screening patients for meningitis during an anthrax mass casualty incident. Its use could improve both patient outcomes and resource allocation in such an event. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  14. Can we improve the clinical utility of respiratory rate as a monitored vital sign?

    PubMed

    Chen, Liangyou; Reisner, Andrew T; Gribok, Andrei; McKenna, Thomas M; Reifman, Jaques

    2009-06-01

    Respiratory rate (RR) is a basic vital sign, measured and monitored throughout a wide spectrum of health care settings, although RR is historically difficult to measure in a reliable fashion. We explore an automated method that computes RR only during intervals of clean, regular, and consistent respiration and investigate its diagnostic use in a retrospective analysis of prehospital trauma casualties. At least 5 s of basic vital signs, including heart rate, RR, and systolic, diastolic, and mean arterial blood pressures, were continuously collected from 326 spontaneously breathing trauma casualties during helicopter transport to a level I trauma center. "Reliable" RR data were identified retrospectively using automated algorithms. The diagnostic performances of reliable versus standard RR were evaluated by calculation of the receiver operating characteristic curves using the maximum-likelihood method and comparison of the summary areas under the receiver operating characteristic curves (AUCs). Respiratory rate shows significant data-reliability differences. For identifying prehospital casualties who subsequently receive a respiratory intervention (hospital intubation or tube thoracotomy), standard RR yields an AUC of 0.59 (95% confidence interval, 0.48-0.69), whereas reliable RR yields an AUC of 0.67 (0.57-0.77), P < 0.05. For identifying casualties subsequently diagnosed with a major hemorrhagic injury and requiring blood transfusion, standard RR yields an AUC of 0.60 (0.49-0.70), whereas reliable RR yields 0.77 (0.67-0.85), P < 0.001. Reliable RR, as determined by an automated algorithm, is a useful parameter for the diagnosis of respiratory pathology and major hemorrhage in a trauma population. It may be a useful input to a wide variety of clinical scores and automated decision-support algorithms.

  15. Summaries of Research 1984.

    DTIC Science & Technology

    1984-01-01

    JOURNAL OF BUNE AND JOINT SURGERY (AMJ 19d4 JAN;o(1):107-12 CASUALTY CARE M0095.PN.0Ol.,)dJ REPORT N0.18 ANTIBODIES BCNE AND BONES HLA ANTIGENS AD A145...7;304(LllB):177-d4 HYPERBARIC MEuICINE M0099.01C.OuO l kPURT NO.21 CENTRAL NERVOUS SYSTEM DISEASES DECOMPRESSION SICKNESS DOGS A AD A145 175 N14RI 84-0012...JOURNAL OF SUkGiLAL RESEARCH 1S84 MAY;36(51:.516-2i CASUALTY CARE M0U95.0O1.hU2 KLPUKT NJ.7 DOGS ESCHEkdCHIA CJLi i;AFECTIONS 16UPRUFEN INDOMETHACIN 1

  16. Long-Term Follow-Up and Amputation-Free Survival in 497 Casualties with Combat-Related Vascular Injuries and Damage-Control Resuscitation

    DTIC Science & Technology

    2012-01-01

    minutes). US casualties (n 111) had limb salvage attempted for 113 extremity vascular injuries (3 [2%] iliac , 33 [30%] femoral, 23 [20%] popliteal...Patients Amputation Survival Follow-Up, Mean (Range), d Iliac 1 1 1 3 3 (100%) 3 (100%) 347 (29 1,079) Femoral 10 20 3 33 29 (87.9%) 4 (12.1%) 33 (100...3 4 3 (75%) 1 (25%) 4 (100%) Radial 2 2 4 4 (100%) 4 (100%) Total 28 80 5 113 96 (84.9%) 16 (14.2%) 110 (99.1%) *One bilateral repair. J Trauma Acute

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

    PubMed

    Blood, C G

    1992-03-01

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

  18. Improving Estimation of Ground Casualty Risk From Reentering Space Objects

    NASA Technical Reports Server (NTRS)

    Ostrom, Chris L.

    2017-01-01

    A recent improvement to the long-term estimation of ground casualties from reentering space debris is the further refinement and update to the human population distribution. Previous human population distributions were based on global totals with simple scaling factors for future years, or a coarse grid of population counts in a subset of the world's countries, each cell having its own projected growth rate. The newest population model includes a 5-fold refinement in both latitude and longitude resolution. All areas along a single latitude are combined to form a global population distribution as a function of latitude, creating a more accurate population estimation based on non-uniform growth at the country and area levels. Previous risk probability calculations used simplifying assumptions that did not account for the ellipsoidal nature of the Earth. The new method uses first, a simple analytical method to estimate the amount of time spent above each latitude band for a debris object with a given orbit inclination and second, a more complex numerical method that incorporates the effects of a non-spherical Earth. These new results are compared with the prior models to assess the magnitude of the effects on reentry casualty risk.

  19. Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

    PubMed

    Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

    2014-10-01

    On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

  20. The analysis of a World War I U.S. service member's dental remains recovered in France.

    PubMed

    Shiroma, Calvin Y

    2014-11-01

    In October 2009, the grave of an unknown World War I (WWI) U.S. service member was exhumed in Rembercourt-Sur-Mad Village, in the Lorraine Region of France. The skeletal remains and material evidence were accessioned into the Joint POW/MIA Accounting Command's (JPAC) Central Identification Laboratory (CIL). The personnel records for the associated casualty were requested, received, and reviewed. A dental profile was present among the service member's personal information. There were multiple points of concordance between the dental records of the associated casualty, and the recovered dental remains to include eight restored teeth, 15 unrestored teeth, and three antemortem missing teeth. Distinctive restorations which compared favorably included a porcelain crown and multiple gold foil fillings. All lines of evidence (historical, material evidence/personal effects, anthropological, and dental) and the circumstances of loss compared positively with the associated casualty. On April 1, 2010, the previously unaccounted-for U.S. service member was positively identified and on June 23, 2010, was buried with full military honors at Arlington National Cemetery. Published 2014. This article is a U.S. Government work and is in the public domain in the U.S.A.

  1. Management of Mass Casualties Using Doctor Helicopters and Doctor Cars.

    PubMed

    Ohsaka, Hiromichi; Ishikawa, Kouhei; Omori, Kazuhiko; Jitsuiki, Kei; Yoshizawa, Toshihiko; Yanagawa, Youichi

    At approximately 10 o'clock in September 2015, a minibus carrying 18 people accidentally slid backwards because of a malfunctioning brake system while climbing a steep incline on Togasayama Mountain, colliding with a van (Toyota HiAce wagon) carrying 11 people that was situated behind the minibus. Togasayama Mountain is located 1 hour by car and 10 minutes by helicopter from our hospital. The minibus slid off a roadside cliff at a height of 0.5 m and rolled over after colliding with the van. There were 7 victims with yellow tags and 22 with green tags. Two Doctor Helicopters and 1 Doctor Car cooperated with the fire departments by providing medical treatments, selection of medical facilities, and dispersion transportation. In this mass casualty event, there were no mortalities, and all of the victims recovered without sequelae. The coordinated and combined use of Doctor Helicopters and Doctor Cars in addition to the activities of the fire department in response to a mass casualty event resulted in appropriate triage, medical treatments, selection of medical facilities, and dispersion transportation. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  2. Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran.

    PubMed

    Khaji, Ali; Fallahdoost, Shoaodin; Soroush, Mohammad-Reza; Rahimi-Movaghar, Vafa

    2012-01-01

    To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years+/-19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.

  3. [The Main Gate Syndrome: a new format in mass-casualty victim "surge" management?].

    PubMed

    Sockeel, P; De Saint Roman, C; Massoure, M-P; Nadaud, J; Cinquetti, G; Chatelain, E

    2008-01-01

    Recent suicide bombings pose the novel problem for Trauma Centers of the massive simultaneous arrival of many gravely wounded patients. We report the experience of the French-German Military Trauma Group, a Level 2 Trauma Center, in Afghanistan during the wave of suicide bombings in February 2007. Fourteen casualties were received. A first triage was carried out by the U S Army Level I group prior to evacuation. A second surgical triage was carried out with systematic ultrasound exam. Four cases (ISS>25) were re-categorized and underwent emergency surgical procedures. Suicide bombing in crowded locations near an evacuation hospital may overwhelm the medical resources of the receiving center. It has been referred to as "The Main Gate Syndrome." We introduced the novel concept of a semi-evacuation hospital or receiving center where a second surgical triage was carried out. These exceptional circumstances require open-minded flexibility, a tailored approach, and close cooperation between surgeons and anesthetists to share experience, opinions, and ideas. In the setting of mass casualties, emergency ultrasound exam was shown to be a valuable and effective tool by virtue of its mobility, reproducibility, and immediate results.

  4. 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.

  5. Triage of mass casualties in war conditions: realities and lessons learned.

    PubMed

    Rigal, Sylvain; Pons, François

    2013-08-01

    The authors made a retrospective analysis of three triage situations of war wounded in Chad and Rwanda in which mass casualties overwhelmed available medical facilities. The triage classification is based on the waiting period for surgery. The categories are: extreme, first, second and third emergencies, expectant, walking wounded. In Chad, 23 wounded adults were received in 24 hours, and 19 were operated up on within 48 hours. In Rwanda 1, 94 wounded were received in two hours, of whom 68 were operated upon, 23 on the first day. In Rwanda 2, 59 wounded were received in 12 hours, treatment of extreme and first emergencies required 48 hours, while second and third emergencies were treated during the three following days. These episodes were very different when considering the setting, the number of casualties, the type of wounds, the logistical and medical difficulties. The authors report the difficulties faced and the lessons learned. "Il faut toujours commencer par le plus douloureusement blessé sans avoir égard aux rangs et aux distinctions." You must always begin with those who are most seriously wounded without regard to rank or other distinction. Baron Larrey (1766-1842), surgeon to Napoléon's Imperial Guard.

  6. Extending injury prevention methodology to chemical terrorism preparedness: the Haddon Matrix and sarin.

    PubMed

    Varney, Shawn; Hirshon, Jon Mark; Dischinger, Patricia; Mackenzie, Colin

    2006-01-01

    The Haddon Matrix offers a classic epidemiological model for studying injury prevention. This methodology places the public health concepts of agent, host, and environment within the three sequential phases of an injury-producing incident-pre-event, event, and postevent. This study uses this methodology to illustrate how it could be applied in systematically preparing for a mass casualty disaster such as an unconventional sarin attack in a major urban setting. Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feedback in the data review session. Four injury prevention strategies (education, engineering, enforcement, and economics) were applied to the individual factors and event phases of the Haddon Matrix. The majority of factors identified in all phases were modifiable, primarily through educational interventions focused on individual healthcare providers and first responders. The Haddon Matrix provides a viable means of studying an unconventional problem, allowing for the identification of modifiable factors to decrease the type and severity of injuries following a mass casualty disaster such as a sarin release. This strategy could be successfully incorporated into disaster planning for other weapons attacks that could potentially cause mass casualties.

  7. Analysis of evacuations from areas of operation to the Spanish Role 4 medical treatment facility (2008-2013).

    PubMed

    Navarro Suay, Ricardo; Tamburri Bariain, Rafael; Gutiérrez Ortega, Carlos; Hernández Abadía de Barbará, Alberto; López Soberón, Edurne; Rodríguez Moro, Carlos

    2014-01-01

    Since 1987, the Spanish Armed Forces have deployed their troops in a multitude of conflicts and natural disasters worldwide. The Spanish Military Medical Corps has the ability to deploy Role 1, Role 2, and one Role 3 medical treatment facilities. It also has a Role 4 in operation, the "Gómez Ulla" Central Hospital of Defense, in Madrid. The aim of this study is to describe the type of Spanish casualties evacuated from different areas of operation to the Role 4 from 2008 to 2013. A retrospective, cross-sectional study was performed on a sample of 232 patients. Among these, 211 (91%) were noncombat casualties: 126 because of illness, 53 because of an accident, and 32 because of sports injuries. The remaining 21 (9%) were combat casualties: 11 from improvised explosive devices and 10 from gunfire. Afghanistan, followed by Lebanon, is the operational area where most evacuees originate. The authors consider it essential that the Spanish Armed Forces rely on a Role 4 medical treatment facility as part of their medical support to international operations. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  8. Triage in military settings.

    PubMed

    Falzone, E; Pasquier, P; Hoffmann, C; Barbier, O; Boutonnet, M; Salvadori, A; Jarrassier, A; Renner, J; Malgras, B; Mérat, S

    2017-02-01

    Triage, a medical term derived from the French word "trier", is the practical process of sorting casualties to rationally allocate limited resources. In combat settings with limited medical resources and long transportation times, triage is challenging since the objectives are to avoid overcrowding medical treatment facilities while saving a maximum of soldiers and to get as many of them back into action as possible. The new face of modern warfare, asymmetric and non-conventional, has led to the integrative evolution of triage into the theatre of operations. This article defines different triage scores and algorithms currently implemented in military settings. The discrepancies associated with these military triage systems are highlighted. The assessment of combat casualty severity requires several scores and each nation adopts different systems for triage on the battlefield with the same aim of quickly identifying those combat casualties requiring lifesaving and damage control resuscitation procedures. Other areas of interest for triage in military settings are discussed, including predicting the need for massive transfusion, haemodynamic parameters and ultrasound exploration. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  9. Improving Estimation of Ground Casualty Risk from Reentering Space Objects

    NASA Technical Reports Server (NTRS)

    Ostrom, C.

    2017-01-01

    A recent improvement to the long-term estimation of ground casualties from reentering space debris is the further refinement and update to the human population distribution. Previous human population distributions were based on global totals with simple scaling factors for future years, or a coarse grid of population counts in a subset of the world's countries, each cell having its own projected growth rate. The newest population model includes a 5-fold refinement in both latitude and longitude resolution. All areas along a single latitude are combined to form a global population distribution as a function of latitude, creating a more accurate population estimation based on non-uniform growth at the country and area levels. Previous risk probability calculations used simplifying assumptions that did not account for the ellipsoidal nature of the earth. The new method uses first, a simple analytical method to estimate the amount of time spent above each latitude band for a debris object with a given orbit inclination, and second, a more complex numerical method that incorporates the effects of a non-spherical Earth. These new results are compared with the prior models to assess the magnitude of the effects on reentry casualty risk.

  10. Hazards of deep-sea fishing1

    PubMed Central

    Schilling, R. S. F.

    1971-01-01

    Schilling, R. S. F. (1971). Brit. J. industr. Med., 28, 27-35. Hazards of deep-sea fishing. During the nineteenth century sailing smacks suffered heavy losses at sea. Their replacement by steam trawlers and motor vessels reduced casualties to both ships and men. The accident mortality of fishermen in England and Wales has been grossly underestimated by the Registrar General of Births and Deaths because all but a few deaths at sea are reported separately to the Registrar General of Shipping and Seamen and are not taken into account in calculating mortality rates. By including deaths at sea in the period 1959-63, fishermen's standardized mortality ratio for accidents is increased from 466 to 1 726. Between 1958 and 1967, 92 fishermen on British trawlers lost their lives as a result of casualties to vessels; and 116 from individual accidents, mostly by drowning. The importance of individual accidents is emphasized by the fact that in years when ther was no heavy loss of life from vessel casualties, fishermen's fatal accident rates were at least twice those of coal miners and more than 20 times the rate of men in manufacturing industries. Crews of distant-water vessels have higher fatal accident rates than crews of near- and middle-water vessels (2·3 against 1·8 per 1 000 man-years); for skippers and mates on distant-water vessels the rate is 3·2 per 1 000 man-years which is higher than the corresponding rate of 2·6 for deck-hands and almost double that for other crew members. In 47 out of 90 trawlers lost or serioulsy damaged, the cause of the casualty was attributable to negligent navigation. Fatigue due to excessively long hours of work may contribute to casualties to both vessels and individuals. The Committee of Inquiry into Trawler Safety set up by the British Government after the loss of three trawlers in 1968 made many recommendations for higher standards of design, construction, and stability of vessels for the deep-sea fleet and for a reduction in the hours of work for deck-hands. The Committee also recommended the supply of a support ship at sea offering special services such as weather forecasting, medical and technical aid, and the provision of occupational health services for fishermen in port. PMID:5101166

  11. Is vertebrate mortality correlated to potential permeability by underpasses along low-traffic roads?

    PubMed

    Delgado, Juan D; Morelli, Federico; Arroyo, Natalia L; Durán, Jorge; Rodríguez, Alexandra; Rosal, Antonio; Palenzuela, María Del Valle; Rodríguez, Jesús D G P

    2018-09-01

    Road permeability to animal movements depends among several factors on structures which, integrated in the road design, operate as safe conducts to mitigate vehicle collision and barrier effects. There is abundant evidence that wildlife makes use of such structures as safe passages to cross roads. We analyzed the spatial relationship between road drainage elements (N = 253; mostly culverts) as potential faunal underpasses, and mortality due to vehicle collisions in two seasons and on four relatively low-traffic roads (<5000 cars/day) traversing oak rangelands of western Andalusia (S Spain). Focusing on amphibians, reptiles and mammals, we recorded and located casualties (N = 238 individuals, 35 species) along these roads, identifying and characterizing all potential underpasses. Overall frequencies of casualties and spatial distribution were highly variable both within and among these roads. We obtained an estimation of potential permeability for the different roads. We detected, located and described a wide supply and a very variable pattern of drainage culverts and other underpasses, with differences among roads in passage attributes potentially affecting permeability for wildlife, such as spatial arrangement, number, density (frequency or concentration of passages) and dimensions. We used Mantel tests to assess spatial congruence of passages and road-killed animals. We applied generalized linear mixed models fitted by maximum likelihood through Akaike Information Criterion to explain the variation in the distance of the 238 casualties to the nearest underpasses, with road transect and season as random factors, and traffic intensity, speed and vertebrate class as fixed effects. Both road-killed animals and underpass distribution followed aggregated patterns, and casualties were not significantly related to underpasses along any of the 4 roads. There were no differences in distance of casualties to the nearest underpass for the three vertebrate classes. Although existing underpasses were abundant, we could not correlate potential permeability with reduced mortality along these roads, and other factors potentially affecting roadkill aggregations should be evaluated along with permeability assessment. Mitigation of road-caused mortality can still be greatly improved for these roads, through measures of reconditioning and proper management of existing underpasses, aiming to maximize road permeability and reducing major impacts upon animal populations of Andalusian rangelands. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Managing multiple-casualty incidents: a rural medical preparedness training assessment.

    PubMed

    Glow, Steven D; Colucci, Vincent J; Allington, Douglas R; Noonan, Curtis W; Hall, Earl C

    2013-08-01

    The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants' knowledge in the areas of communications, incident command systems (ICS), and triage. Participants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities. A total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage. Mass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals' roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system and triage. The practice scenarios should be matched to the specific resources of the community. The authors also believe that these trainings should be provided with all disciplines represented to eliminate training "silos," to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.

  13. Epidemiological Study of Child Casualties of Landmines and Unexploded Ordnances: A National Study from Iran.

    PubMed

    Mousavi, Batool; Soroush, Mohammad Reza; Masoumi, Mehdi; Khateri, Shahriar; Modirian, Ehsan; Shokoohi, Hamid; Fatemi, Mohammad Javad; Ali Hematti, Mohammad; Soroush, Mansour; Ghassemi-Broumand, Mohammad; Rassafiani, Mehdi; Allami, Mostafa; Nouri, Farshad; Yavari, Amir; Ganjparvar, Zohreh; Kamyab, Mojtaba; Mirsadeghi, Seyed Abbas

    2015-10-01

    Despite landmine-risk education programs and extensive demining activities on the Western border of Iran, landmines and unexploded ordnance (UXOs) still cause civilian and child casualties three decades after the Iraq-Iran war (1980-1988). The objective of this study was to understand the epidemiological patterns and risk factors of injury in child casualties of landmines and UXOs in Western and Southwestern Iran. Children who were 18 years old or younger at the time of study and who sustained injuries from landmines and UXOs were identified through a search at the Iranian National Veterans Registry. These children participated in a 5-day gathering. The information on socioeconomic status, health-related issues, quality of life, health care utilization, and clinical profiles concerning the landmine and UXO injuries were collected. The method of data collection consisted of three component surveys: health interview, social survey, and medical examinations. Social surveys and health interviews were conducted in a face-to-face method by utilizing a questionnaire consisting of 39 questions addressing household and individual components, including information on time and type of injuries, physical activity, mental health, and quality of life. A comprehensive team of physicians in different subspecialties evaluated and examined children to assess the current medical and psychiatric conditions and physical activity, and recommended and arranged further medical, rehabilitation, or surgical planning. Seventy-eight child casualties were identified and participated in the study. The mean age of the participants at the time of study was 16.11 years old (SD=2 years). The mean age of victims at the time of injury was 8.2 years (SD=3.12 years; ranged from 2 to 15 years old). Sixty-seven (85.9%) of the children were male. Provinces of Kurdistan and Kermanshah had the highest number of casualties, with a total number of 54 children (68.3%). Eighty percent of the injuries were caused by landmines, and UXO explosions were reported in 20% of the cases. Overall, 24 children (30%) had received some landmine-risk education before or after the events. Sixty percent of the explosions had happened in the morning between 9:00 am and 12:00 pm. Playing and grazing livestock were the most prevalent activities/reasons at the time of injury, which were reported in 77% of the subjects. Sixty-three percent of incidents had multiple casualties and in only 13 explosions were the children the only victims of the explosion. The most prevalent injuries were amputations in 41 subjects (52.56%), followed by hearing loss in 23 subjects (29.5%). Amputations were more common in upper extremities (62%) than in lower extremities (38%). Landmines and UXOs comprise a significant safety hazard to the children living in the Western border of Iran decades after the Iraq-Iran War. The large number of injuries and lack of risk training among victims suggest that landmine cleanings and landmine-risk education should be age-specifically targeted and expanded substantially.

  14. Systematic review of strategies to manage and allocate scarce resources during mass casualty events.

    PubMed

    Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Pillemer, Francesca; Waxman, Daniel A; Moore, Melinda; Hansen, Cynthia K; Knebel, Ann R; Ricciardi, Richard; Kellermann, Arthur L

    2013-06-01

    Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of distribution. Second, as a strategy to optimize use of existing resources, commonly used field triage systems do not perform consistently during actual mass casualty events. The number of high-quality studies addressing other strategies was insufficient to support conclusions about their effectiveness because of differences in study context, comparison groups, and outcome measures. Our literature search may have missed key resource management and allocation strategies because of their extreme heterogeneity. Interrater reliability was not assessed for quality assessments or strength of evidence ratings. Publication bias is likely, given the large number of studies reporting positive findings. The current evidence base is inadequate to inform providers and policymakers about the most effective strategies for managing or allocating scarce resources during mass casualty events. Consensus on methodological standards that encompass a range of study designs is needed to guide future research and strengthen the evidence base. Evidentiary standards should be developed to promote consensus interpretations of the evidence supporting individual strategies. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  15. Statistics of Casualties, 1979.

    DTIC Science & Technology

    1980-12-01

    Pilots-Ftea.........----............. ..... ...... ...--- Pilots- Sae ............. ....... ..... . . . . . . . . . . . . . ... . Lienused...1871 Crwmember ........... 72 17222214 22 17ŕ 4140 67 0 7 20126 8 2 N 100.44 8 Otber

  16. The grave is wide: the Hibakusha of Hiroshima and Nagasaki and the legacy of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation.

    PubMed

    O'Malley, Gerald F

    2016-07-01

    Following the atomic bomb attacks on Japan in 1945, scientists from the United States and Japan joined together to study the Hibakusha - the bomb affected people in what was advertised as a bipartisan and cooperative effort. In reality, despite the best efforts of some very dedicated and earnest scientists, the early years of the collaboration were characterized by political friction, censorship, controversy, tension, hostility, and racism. The 70-year history, scientific output and cultural impact of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation are described in the context of the development of Occupied Japan.

  17. Defining the problem, main objective, and strategies of medical management in mass-casualty incidents caused by terrorist events.

    PubMed

    Ashkenazi, Itamar; Kessel, Boris; Olsha, Oded; Khashan, Tawfik; Oren, Meir; Haspel, Jacob; Alfici, Ricardo

    2008-01-01

    Based on the experience of managing > 20 such events during the last decade, the authors' understanding of a mass-casualty incident is that it is an event in which there may be many victims, but only a few that actually suffer from life-threatening injuries. To make an impact on survival, one must identify those who are severely wounded as quickly as possible and offer those patients optimal care. Experienced trauma physicians are the most important resource available to achieve this objective, and they should be allocated to the treatment of seriously injured victims instead of more traditional management roles such as triage and incident manager.

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

    PubMed

    Baker, Michael S

    2007-03-01

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

  19. Educating medical staff about responding to a radiological or nuclear emergency.

    PubMed

    McCurley, M Carol; Miller, Charles W; Tucker, Florie E; Guinn, Amy; Donnelly, Elizabeth; Ansari, Armin; Holcombe, Maire; Nemhauser, Jeffrey B; Whitcomb, Robert C

    2009-05-01

    A growing body of audience research reveals medical personnel in hospitals are unprepared for a large-scale radiological emergency such as a terrorist event involving radioactive or nuclear materials. Also, medical personnel in hospitals lack a basic understanding of radiation principles, as well as diagnostic and treatment guidelines for radiation exposure. Clinicians have indicated that they lack sufficient training on radiological emergency preparedness; they are potentially unwilling to treat patients if those patients are perceived to be radiologically contaminated; and they have major concerns about public panic and overloading of clinical systems. In response to these findings, the Centers for Disease Control and Prevention (CDC) has developed a tool kit for use by hospital medical personnel who may be called on to respond to unintentional or intentional mass-casualty radiological and nuclear events. This tool kit includes clinician fact sheets, a clinician pocket guide, a digital video disc (DVD) of just-in-time basic skills training, a CD-ROM training on mass-casualty management, and a satellite broadcast dealing with medical management of radiological events. CDC training information emphasizes the key role that medical health physicists can play in the education and support of emergency department activities following a radiological or nuclear mass-casualty event.

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

    PubMed

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

    2011-05-01

    This study uses econometric models to measure the effect of significant wave height and wind strength on the probability of casualty and tests whether these effects changed. While both effects are in particular relevant for stability and strength calculations of vessels, it is also helpful for the development of ship construction standards in general to counteract increased risk resulting from changing oceanographic conditions. The authors analyzed a unique dataset of 3.2 million observations from 20,729 individual vessels in the North Atlantic and Arctic regions gathered during the period 1979-2007. The results show that although there is a seasonal pattern in the probability of casualty especially during the winter months, the effect of wind strength and significant wave height do not follow the same seasonal pattern. Additionally, over time, significant wave height shows an increasing effect in January, March, May and October while wind strength shows a decreasing effect, especially in January, March and May. The models can be used to simulate relationships and help understand the relationships. This is of particular interest to naval architects and ship designers as well as multilateral agencies such as the International Maritime Organization (IMO) that establish global standards in ship design and construction. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2015-01-01

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

  2. Uncovering the 2010 Haiti earthquake death toll

    NASA Astrophysics Data System (ADS)

    Daniell, J. E.; Khazai, B.; Wenzel, F.

    2013-05-01

    Casualties are estimated for the 12 January 2010 earthquake in Haiti using various reports calibrated by observed building damage states from satellite imagery and reconnaissance reports on the ground. By investigating various damage reports, casualty estimates and burial figures, for a one year period from 12 January 2010 until 12 January 2011, there is also strong evidence that the official government figures of 316 000 total dead and missing, reported to have been caused by the earthquake, are significantly overestimated. The authors have examined damage and casualties report to arrive at their estimation that the median death toll is less than half of this value (±137 000). The authors show through a study of historical earthquake death tolls, that overestimates of earthquake death tolls occur in many cases, and is not unique to Haiti. As death toll is one of the key elements for determining the amount of aid and reconstruction funds that will be mobilized, scientific means to estimate death tolls should be applied. Studies of international aid in recent natural disasters reveal that large distributions of aid which do not match the respective needs may cause oversupply of help, aggravate corruption and social disruption rather than reduce them, and lead to distrust within the donor community.

  3. The cost-effectiveness of mandatory 20 mph zones for the prevention of injuries.

    PubMed

    Peters, Jaime L; Anderson, Rob

    2013-03-01

    Traffic calming and speed limits are major public health strategies for further reducing road injuries, especially for vulnerable pedestrians such as children and the elderly. We conducted a cost-benefit analysis (CBA-favoured by transport economists) alongside a cost-utility analysis (CUA-favoured by health economists) of mandatory 20 mph zones, providing a unique opportunity to compare assumptions and results. A CUA from the public sector perspective and a CBA from a broader societal perspective. One-way, threshold and probabilistic sensitivity analyses were undertaken. In low casualty areas the intervention was not cost-effective regardless of approach (CUA: cost per QALY = £429 800; CBA: net present value = -£25 500). In high casualty areas, the intervention was cost-effective from the CBA (a saving of £90 600), but not from the CUA [cost per quality-adjusted life year (QALY) = £86 500; assuming National Institute for Health and Clinical Excellence's benchmark for approving health technologies]. Mandatory 20 mph zones may be cost-effective in high casualty areas when a CBA from a societal perspective is considered. Although CBA may appear, in principle, more appropriate, the quality, age or absence of reliable data for many parameters means that there is a great deal of uncertainty and the results should be interpreted with caution.

  4. An experimental predeployment training program improves self-reported patient treatment confidence and preparedness of Army combat medics.

    PubMed

    Gerhardt, Robert T; Hermstad, Erik L; Oakes, Michael; Wiegert, Richard S; Oliver, Jeffrey

    2008-01-01

    To develop and assess impact of a focused review of International Trauma Life Support (ITLS) and combat casualty care with hands-on procedure training for U.S. Army medics deploying to Iraq. The setting was a U.S. Army Medical Department Center and School and Camp Eagle, Iraq. Investigators developed and implemented a command-approved prospective educational intervention with a post hoc survey. Subjects completed a three-day course with simulator and live-tissue procedure laboratories. At deployment's end, medics were surveyed for experience, confidence, and preparedness in treating various casualty severity levels. Investigators used two-tailed t-test with unequal variance for continuous data and chi-square for categorical data. Twenty-nine medics deployed. Eight completed the experimental program. Twenty-one of 25 (84%) available medics completed the survey including six of the eight (75%) experimental medics. The experimental group reported significantly greater levels of preparedness and confidence treating "minimal," "delayed," and "immediate" casualties at arrival in Iraq. These differences dissipated progressively over the time course of the deployment. This experimental program increased combat medic confidence and perceived level of preparedness in treating several patient severity levels. Further research is warranted to determine if the experimental intervention objectively improves patient care quality and translates into lives saved early in deployment.

  5. 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.

  6. The 1945 Balochistan earthquake and probabilistic tsunami hazard assessment for the Makran subduction zone

    NASA Astrophysics Data System (ADS)

    Höchner, Andreas; Babeyko, Andrey; Zamora, Natalia

    2014-05-01

    Iran and Pakistan are countries quite frequently affected by destructive earthquakes. For instance, the magnitude 6.6 Bam earthquake in 2003 in Iran with about 30'000 casualties, or the magnitude 7.6 Kashmir earthquake 2005 in Pakistan with about 80'000 casualties. Both events took place inland, but in terms of magnitude, even significantly larger events can be expected to happen offshore, at the Makran subduction zone. This small subduction zone is seismically rather quiescent, but a tsunami caused by a thrust event in 1945 (Balochistan earthquake) led to about 4000 casualties. Nowadays, the coastal regions are more densely populated and vulnerable to similar events. Additionally, some recent publications raise the question of the possiblity of rare but huge magnitude 9 events at the Makran subduction zone. We first model the historic Balochistan event and its effect in terms of coastal wave heights, and then generate various synthetic earthquake and tsunami catalogs including the possibility of large events in order to asses the tsunami hazard at the affected coastal regions. Finally, we show how an effective tsunami early warning could be achieved by the use of an array of high-precision real-time GNSS (Global Navigation Satellite System) receivers along the coast.

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

    PubMed

    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.

  8. [Patterns of injury in a combat environment. 2007 update].

    PubMed

    Willy, C; Voelker, H-U; Steinmann, R; Engelhardt, M

    2008-01-01

    Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas. MEDLINE (1949-2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed. The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8-15% of the deaths appeared to be preventable. Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.

  9. Terrorism-related injuries versus road traffic accident-related trauma: 5 years of experience in Israel.

    PubMed

    Peleg, Kobi; Savitsky, Bella

    2009-12-01

    Terrorism victims comprise the minority among trauma injured people, but this small population imposes a burden on the health care system. Thirty percent of the population injured in terrorist activities experienced severe trauma (injury severity score > or =16), more than half of them need a surgical procedure, and 25% of the population affected by terrorism had been admitted to intensive care. Furthermore, compared with patients with non-terrorism-related trauma, victims of terrorism often arrive in bulk, as part of a mass casualty event. This poses a sudden load on hospital resources and requires special organization and preparedness. The present study compared terrorism-related and road accident-related injuries and examined clinical characteristics of both groups of patients. This study is a retrospective study of all patients injured through terrorist acts and road traffic accidents from September 29, 2000 to December 31, 2005, and recorded in the Israel Trauma Registry. Data on the nature of injuries, treatment, and outcome were obtained from the registry. Medical diagnoses were extracted from the registry and classified based on International Classification of Diseases coding. Diagnoses were grouped to body regions, based on the Barell Injury Diagnosis Matrix. The study includes 2197 patients with terrorism-related injuries and 30,176 patients injured in road traffic accidents. All in all, 27% of terrorism-related casualties suffered severe to critical injuries, comparing to 17% among road traffic accident-related victims. Glasgow Coma Scale scores

  10. Analysis of injury patterns and roles of care in US and Israel militaries during recent conflicts: Two are better than one.

    PubMed

    Antebi, Ben; Benov, Avi; Mann-Salinas, Elizabeth A; Le, Tuan D; Cancio, Leopoldo C; Wenke, Joseph C; Paran, Haim; Yitzhak, Avraham; Tarif, Bader; Gross, Kirby R; Dagan, David; Glassberg, Elon

    2016-11-01

    As new conflicts emerge and enemies evolve, military medical organizations worldwide must adopt the "lessons learned." In this study, we describe roles of care (ROCs) deployed and injuries sustained by both US and Israeli militaries during recent conflicts. The purpose of this collaborative work is facilitate exchange of medical data among allied forces in order to advance military medicine and facilitate strategic readiness for future military engagements that may involve less predictable situations of evacuation and care, such as prolonged field care. This retrospective study was conducted for the periods of 2003 to 2014 from data retrieved from the Department of Defense Trauma Registry and the Israel Defense Force (IDF) Trauma Registry. Comparative analyses included ROC capabilities, casualties who died of wounds, as well as mechanism of injury, anatomical wound distribution, and Injury Severity Score of US and IDF casualties during recent conflicts. Although concept of ROCs was similar among militaries, the IDF supports increased capabilities at point of injury and Role 1 including the presence of physicians, but with limited deployment of other ROCs; conversely, the US maintains fewer capabilities at Role 1 but utilized the entire spectrum of care, including extensive deployment of Roles 2/2+, during recent conflicts. Casualties from US forces (n = 19,005) and IDF (n = 2,637) exhibited significant differences in patterns of injury with higher proportions of casualties who died of wounds in the US forces (4%) compared with the IDF (0.6%). As these data suggest deployed ROCs and injury patterns of US and Israeli militaries were both conflict and system specific. We envision that identification of discordant factors and common medical strategies of the two militaries will enable strategic readiness for future conflicts as well as foster further collaboration among allied forces with the overarching universal goal of eliminating preventable death on the battlefield.

  11. Radioprotective agents in medicine.

    PubMed

    Duraković, A

    1993-12-01

    The diminished probability of strategic nuclear confrontation alleviates some of the global concerns about large numbers of radiation casualties in the event of a nuclear war. As a result of the protection of the environment, the management of smaller numbers of radiation casualties assumes a more predictable and more specific role confined to accidents in nuclear energy projects, industry, technology and science. Recent experience of the consequences of accidents in nuclear power plants, in the field of radiotherapy and in the disposal of radioactive waste and spent fuel, present the medical and scientific communities with formidable problems if such events are to lead to minimal adverse effects on the biosphere. Whereas it is not possible to predict a nuclear or radiation accident, radioprotection is hardly an issue of health science alone, but rather an issue of the strictest quality assurance in all aspects of the utilization of nuclear energy and ionizing radiation. Thus, the medical community concerned with radioprotection will have to confine its emphasis on the management of radiation-induced alterations of the human organism from acute radiation syndromes to the stochastic concepts of chronic alterations of radiosensitive organic systems. Current multidisciplinary research in the field of radioprotection involves all aspects of basic and clinical research ranging from the subatomic mechanisms of free radical formation, macromolecular and intracellular radiation-induced alterations, biochemical and physiological homeostatic mechanisms and organ level manifestations to the clinical management of radiation casualties in a controlled hospital environment. Radioprotective agents, although widely studied in the past four decades and including several thousand agents, have not reached the level of providing the field of medicine with an agent that conforms to all criteria of an optimal radioprotectant, including effectiveness, toxicity, availability, specificity and tolerance. This article discusses the current state of radioprotection in medical therapy, and emphasizes a need for continued research in the area of medical management of radiation casualties from the viewpoint of a realistic probability of nuclear incidents or accidents in the nuclear energy-dependent world at the end of the millennium.

  12. The capability of accident and emergency departments to safely decontaminate victims of chemical incidents

    PubMed Central

    Horby, P.; Murray, V.; Cummins, A.; Mackway-Jones, K.; Euripidou, R.

    2000-01-01

    Objectives—To evaluate the capability of accident and emergency (A&E) departments in six health regions of England to safely decontaminate casualties exposed to hazardous chemicals. Methods—In January 1999 a postal questionnaire was sent to the clinical director of all A&E departments in Trent, North and South Thames, South and West, North West and, Anglia and Oxford Health Regions. The questionnaire inquired about characteristics of the department, decontamination facilities and equipment, and staff training. Non-responders were sent a second questionnaire and contacted by telephone if they failed to respond to the second mailing. Results—308 of 326 departments identified (94%) returned a questionnaire. There was no significant difference in response rate by region (p = 0.99). Analysis was restricted to 154 major departments seeing more than 20 000 new attendances per year. Of these 154 departments, 109 (71%) had a written chemical incident plan but only 55 (36%) maintained a list of nearby industrial chemical sites. Fifty nine departments (38%) stated that members of staff had received training in the management of chemically contaminated casualties in the preceding year. Eighteen departments (12%) possessed the level of personal protective equipment (PPE) recommended for decontamination by the Ambulance Services Association. Ninety six departments (62%) had a designated decontamination room but only seven (7%) of them incorporated all the features generally considered necessary for safe decontamination. Forty one units (27%) had the capability to decontaminate casualties outside of the department either with warm water from a shower attachment or with a mobile decontamination unit. Thirty six departments (23%) had neither a decontamination room nor the ability to decontaminate casualties outside the department. Only 16 units (10%) had both adequate PPE and either a decontamination room or the capability to decontaminate outside the department. Conclusions—This study has identified deficiencies in the current NHS capability to respond to chemical incidents. To resolve this, nationally recognised standards for decontamination facilities, equipment and training should be formulated, agreed and implemented. PMID:11005405

  13. Finding the signal in the noise: Could social media be utilized for early hospital notification of multiple casualty events?

    PubMed Central

    Moore, Sara; Wakam, Glenn; Hubbard, Alan E.; Cohen, Mitchell J.

    2017-01-01

    Introduction Delayed notification and lack of early information hinder timely hospital based activations in large scale multiple casualty events. We hypothesized that Twitter real-time data would produce a unique and reproducible signal within minutes of multiple casualty events and we investigated the timing of the signal compared with other hospital disaster notification mechanisms. Methods Using disaster specific search terms, all relevant tweets from the event to 7 days post-event were analyzed for 5 recent US based multiple casualty events (Boston Bombing [BB], SF Plane Crash [SF], Napa Earthquake [NE], Sandy Hook [SH], and Marysville Shooting [MV]). Quantitative and qualitative analysis of tweet utilization were compared across events. Results Over 3.8 million tweets were analyzed (SH 1.8 m, BB 1.1m, SF 430k, MV 250k, NE 205k). Peak tweets per min ranged from 209–3326. The mean followers per tweeter ranged from 3382–9992 across events. Retweets were tweeted a mean of 82–564 times per event. Tweets occurred very rapidly for all events (<2 mins) and represented 1% of the total event specific tweets in a median of 13 minutes of the first 911 calls. A 200 tweets/min threshold was reached fastest with NE (2 min), BB (7 min), and SF (18 mins). If this threshold was utilized as a signaling mechanism to place local hospitals on standby for possible large scale events, in all case studies, this signal would have preceded patient arrival. Importantly, this threshold for signaling would also have preceded traditional disaster notification mechanisms in SF, NE, and simultaneous with BB and MV. Conclusions Social media data has demonstrated that this mechanism is a powerful, predictable, and potentially important resource for optimizing disaster response. Further investigated is warranted to assess the utility of prospective signally thresholds for hospital based activation. PMID:28982201

  14. Incidence and epidemiology of combat injuries sustained during "the surge" portion of operation Iraqi Freedom by a U.S. Army brigade combat team.

    PubMed

    Belmont, Philip J; Goodman, Gens P; Zacchilli, Michael; Posner, Matthew; Evans, Clifford; Owens, Brett D

    2010-01-01

    A prospective, longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed. A detailed description of the combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a U.S. Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Among the 4,122 soldiers deployed, there were 500 combat wounds in 390 combat casualties. The combat casualty rate for the Brigade Combat Team was 75.7 per 1,000 soldier combat-years. The % killed in action (KIA) was 22.1%, and the %died of wounds was 3.2%. The distribution of these wounds was as follows: head/neck 36.2%, thorax 7.5%, abdomen 6.9%, and extremities 49.4%. The percentage of combat wounds showed a significant increase in the head/neck region (p < 0.0001) and a decrease in the extremities (p < 0.03) compared with data from World War II, Korea, and Vietnam. The percentage of thoracic wounds (p < 0.03) was significantly less than historical data from World War II and Vietnam. The %KIA was significantly greater in those soldiers injured by an explosion (26.3%) compared with those soldiers injured by a gunshot wound (4.6%; p = 0.003). Improvised explosive devices accounted for 77.7% of all combat wounds. There was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts. The 22.1% KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices. The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6% with the use of individual body armor.

  15. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield.

    PubMed

    Mabry, R L; Holcomb, J B; Baker, A M; Cloonan, C C; Uhorchak, J M; Perkins, D E; Canfield, A J; Hagmann, J H

    2000-09-01

    This study was undertaken to determined the differences in injury patterns between soldiers equipped with modern body armor in an urban environment compared with the soldiers of the Vietnam War. From July 1998 to March 1999, data were collected for a retrospective analysis on all combat casualties sustained by United States military forces in Mogadishu, Somalia, on October 3 and 4, 1993. This was the largest and most recent urban battle involving United States ground forces since the Vietnam War. There were 125 combat casualties. Casualty distribution was similar to that of Vietnam; 11% died on the battlefield, 3% died after reaching a medical facility, 47% were evacuated, and 39% returned to duty. The incidence of bullet wounds in Somalia was higher than in Vietnam (55% vs. 30%), whereas there were fewer fragment injuries (31% vs. 48%). Blunt injury (12%) and burns (2%) caused the remaining injuries in Somalia. Fatal penetrating injuries in Somalia compared with Vietnam included wounds to the head and face (36% vs. 35%), neck (7% vs. 8%), thorax (14% vs. 39%), abdomen (14% vs. 7%), thoracoabdominal (7% vs. 2%), pelvis (14% vs. 2%), and extremities (7% vs. 7%). No missiles penetrated the solid armor plate protecting the combatants' anterior chests and upper abdomens. Most fatal penetrating injuries were caused by missiles entering through areas not protected by body armor, such as the face, neck, pelvis, and groin. Three patients with penetrating abdominal wounds died from exsanguination, and two of these three died after damage-control procedures. The incidence of fatal head wounds was similar to that in Vietnam in spite of modern Kevlar helmets. Body armor reduced the number of fatal penetrating chest injuries. Penetrating wounds to the unprotected face, groin, and pelvis caused significant mortality. These data may be used to design improved body armor.

  16. Plastic Surgery Challenges in War Wounded II: Regenerative Medicine

    PubMed Central

    Valerio, Ian L.; Sabino, Jennifer M.; Dearth, Christopher L.

    2016-01-01

    Background: A large volume of service members have sustained complex injuries during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). These injuries are complicated by contamination with particulate and foreign materials, have high rates of bacterial and/or fungal infections, are often composite-type defects with massive soft tissue wounds, and usually have multisystem involvement. While traditional treatment modalities remain a mainstay for optimal wound care, traditional reconstruction approaches alone may be inadequate to fully address the scope and magnitude of such massive complex wounds. As a result of these difficult clinical problems, the use of regenerative medicine therapies, such as autologous adipose tissue grafting, stem cell therapies, nerve allografts, and dermal regenerate templates/extracellular matrix scaffolds, is increased as adjuncts to traditional reconstructive measures. Basic and Clinical Science Advances: The beneficial applications of regenerative medicine therapies have been well characterized in both in vitro studies and in vivo animal studies. The use of these regenerative medicine techniques in the treatment of combat casualty injuries has been increasing throughout the recent war conflicts. Clinical Care Relevance: Military medicine has shown positive results when utilizing certain regenerative medicine modalities in treating complex war wounds. As a result, multi-institution clinical trials are underway to further evaluate these observations and reconstruction measures. Conclusion: Successful combat casualty wound care often requires a combination of traditional aspects of the reconstructive ladder/elevator with adoption of various regenerative medicine therapies. Due to the recent OIF/OEF conflicts, a high volume of combat casualties have benefited from adoption of regenerative medicine therapies and increased access to innovative clinical trials. Furthermore, many of these patients have had long-term follow-up to report on clinical outcomes that substantiate current treatment paradigms and concepts within regenerative medicine, reconstructive, and rehabilitation care. These results are applicable to not only combat casualty care but also to nonmilitary patients. PMID:27679752

  17. [Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts].

    PubMed

    Gaĭdar, B V; Ivantsov, V A; Sidel'nikov, V O; Rusev, I T; Madaĭ, D Iu; Kokoev, V G; Zinov'ev, E V; Mutalibov, M M

    2004-06-01

    The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

  18. 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.

  19. Psychiatry in the Korean War: perils, PIES, and prisoners of war.

    PubMed

    Ritchie, Elspeth Cameron

    2002-11-01

    In the initial months of the Korean War, very high numbers of psychological casualties occurred among American troops, 250 per 1,000 per annum. Initially, these men were evacuated to Japan or the United States, and very few of them were returned to duty. Then the principles of early and far-forward treatment, learned in the previous world wars, were reinstituted. Up to 80% of neuropsychiatric casualties were returned to duty. During and after the war, the prisoners of war were believed to have been "brainwashed," have "give-it-upitis," and exhibit apathy and depression. Mistakenly believed to be signs of moral decay, the psychiatric symptoms during and after release were probably a result of extended inhumane treatment and vitamin deficiencies.

  20. 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 naïve or deliberately obfuscatory. The 1% have captured national governments. The astronomical cost of American elections excludes the 99%. In Canada, parliamentary government permits one man to rule as a de facto dictator. The 1% don't like medicare.

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