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Sample records for mass casualty triage

  1. 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.

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

    PubMed

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

    2008-09-01

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

  3. Mass Casualty Incident Primary Triage Methods in China

    PubMed Central

    Chen, Jin-Hong; Yang, Jun; Yang, Yu; Zheng, Jing-Chen

    2015-01-01

    Objective: To evaluate the technical characteristics and application of mass casualty incident (MCI) primary triage (PT) methods applied in China. Data Sources: Chinese literature was searched by Chinese Academic Journal Network Publishing Database (founded in June 2014). The English literature was searched by PubMed (MEDLINE) (1950 to June 2014). We also searched Official Websites of Chinese Central Government's (http://www.gov.cn/), National Health and Family Planning Commission of China (http://www.nhfpc.gov.cn/), and China Earthquake Information (http://www.csi.ac.cn/). Study Selection: We included studies associated with mass casualty events related to China, the PT applied in China, guidelines and standards, and application and development of the carding PT method in China. Results: From 3976 potentially relevant articles, 22 met the inclusion criteria, 20 Chinese, and 2 English. These articles included 13 case reports, 3 retrospective analyses of MCI, two methods introductions, three national or sectoral criteria, and one simulated field testing and validation. There were a total of 19 kinds of MCI PT methods that have been reported in China from 1950 to 2014. In addition, there were 15 kinds of PT methods reported in the literature from the instance of the application. Conclusions: The national and sectoral current triage criteria are developed mainly for earthquake relief. Classification is not clear. Vague criteria (especially between moderate and severe injuries) operability are not practical. There are no triage methods and research for children and special populations. There is no data and evidence supported triage method. We should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real, practical, and efficient PT method. PMID:26415807

  4. 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

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

    PubMed

    Ramesh, Aruna C; Kumar, S

    2010-07-01

    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.

  6. A Consensus-Based Gold Standard for the Evaluation of Mass Casualty Triage Systems

    PubMed Central

    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; Sasser, Scott M.; Schwartz, Richard; Shepherd, Greene; Swienton, Raymond E.

    2016-01-01

    Introduction 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. Objective To develop a consensus-based, functional gold standard definition for each mass casualty triage category. Methods 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. Results 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. Conclusion A consensus-based, functional gold standard definition for each mass casualty triage category was been 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

  7. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    PubMed

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-01-01

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI). PMID:27130042

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

    PubMed

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

    2013-03-31

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

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

    PubMed Central

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

    2013-01-01

    Summary A key aim in any mass disaster event is to avoid diverting resources by overwhelming specialized tertiary centers with minor casualties. The most crucial aspect of an effective disaster response is pre-hospital triage at the scene. Unfortunately, many triage systems have serious shortcomings in their methodologies and no existing triage system has enough scientific evidence to justify its universal adoption. Moreover, it is observed that the optimal approach to planning is by no means clear-cut and that each new incident involving burns appears to produce its own unique problems not all of which were predictable. In most major burns disasters, victims mostly have combined trauma burn injuries and form a heterogeneous group with a broad range of devastating injuries. Are these victims primarily burn patients or trauma patients? Should they be taken care of in a burn center or in a trauma center or only in a combined burns-trauma center? Who makes the decision? The present review is aimed at answering some of these questions. PMID:23966900

  10. A Wireless First Responder Handheld Device for Rapid Triage, Patient Assessment and Documentation during Mass Casualty Incidents

    PubMed Central

    Killeen, James P.; Chan, Theodore C.; Buono, Colleen; Griswold, William G.; Lenert, Leslie A.

    2006-01-01

    Medical care at mass casualty incidents and disasters requires rapid patient triage and assessment, acute care and disposition often in the setting of overwhelming numbers of victims, limited time, and little resources. Current systems rely on a paper triage tag on which rescuers and medical providers mark the patient’s triage status and record limited information on injuries and treatments administered in the field. In this manuscript, we describe the design, development and deployment of a wireless handheld device with an electronic medical record (EMR) for use by rescuers responding to mass casualty incidents (MCIs) and disasters. The components of this device, the WIISARD First Responder (WFR), includes a personal digital assistant (PDA) with 802.11 wireless transmission capabilities, microprocessor and non-volatile memory, and a unique EMR software that replicates the rapidity and ease of use of the standard paper triage tag. WFR also expands its functionality by recording real-time medical data electronically for simultaneous access by rescuers, mid-level providers and incident commanders on and off the disaster site. WFR is a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture. PMID:17238377

  11. Using a joint triage model for multi-hospital response to a mass casualty incident in New York city

    PubMed Central

    Arquilla, Bonnie; Paladino, Lorenzo; Reich, Charlotte; Brandler, Ethan; Lucchesi, Michael; Shetty, Sanjay

    2009-01-01

    This paper defines a specific plan which allows two separate institutions, with different capabilities, to function as a single receiving entity in the event of a mass casualty incident. The street between the two institutions will be closed to traffic and a two-phase process initiated. Arriving ambulances will first be quickly screened to expedite the most critical patients followed by formal triage and directing patients to one of the two facilities. Preparation for this plan requires prior coordination between local authorities and the administrations of both institutions. This plan can serve as a general model for disaster preparedness when two or more institutions with different capabilities are located in close proximity. PMID:19561971

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

    PubMed Central

    2013-01-01

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

  13. Triage of casualties after nuclear attack.

    PubMed

    Pledger, H G

    1986-09-20

    Casualties from a nuclear attack on the United Kingdom would overwhelm the health services, and health workers would be faced with many more people seeking help than could be offered treatment. Discussion is needed to determine which methods of medical and non-medical triage would be acceptable and feasible.

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  16. Qualitative Analysis of Surveyed Emergency Responders and the Identified Factors That Affect First Stage of Primary Triage Decision-Making of Mass Casualty Incidents

    PubMed Central

    Klein, Kelly R.; Burkle Jr., Frederick M.; Swienton, Raymond; King, Richard V.; Lehman, Thomas; North, Carol S.

    2016-01-01

    Introduction: After all large-scale disasters multiple papers are published describing the shortcomings of the triage methods utilized. This paper uses medical provider input to help describe attributes and patient characteristics that impact triage decisions. Methods: A survey distributed electronically to medical providers with and without disaster experience. Questions asked included what disaster experiences they had, and to rank six attributes in order of importance regarding triage. Results: 403 unique completed surveys were analyzed. 92% practiced a structural triage approach with the rest reporting they used “gestalt”.(gut feeling) Twelve per cent were identified as having placed patients in an expectant category during triage. Respiratory status, ability to speak, perfusion/pulse were all ranked in the top three. Gut feeling regardless of statistical analysis was fourth. Supplies were ranked in the top four when analyzed for those who had placed patients in the expectant category. Conclusion: Primary triage decisions in a mass casualty scenario are multifactorial and encompass patient mobility, life saving interventions, situational instincts, and logistics.

  17. Qualitative Analysis of Surveyed Emergency Responders and the Identified Factors That Affect First Stage of Primary Triage Decision-Making of Mass Casualty Incidents

    PubMed Central

    Klein, Kelly R.; Burkle Jr., Frederick M.; Swienton, Raymond; King, Richard V.; Lehman, Thomas; North, Carol S.

    2016-01-01

    Introduction: After all large-scale disasters multiple papers are published describing the shortcomings of the triage methods utilized. This paper uses medical provider input to help describe attributes and patient characteristics that impact triage decisions. Methods: A survey distributed electronically to medical providers with and without disaster experience. Questions asked included what disaster experiences they had, and to rank six attributes in order of importance regarding triage. Results: 403 unique completed surveys were analyzed. 92% practiced a structural triage approach with the rest reporting they used “gestalt”.(gut feeling) Twelve per cent were identified as having placed patients in an expectant category during triage. Respiratory status, ability to speak, perfusion/pulse were all ranked in the top three. Gut feeling regardless of statistical analysis was fourth. Supplies were ranked in the top four when analyzed for those who had placed patients in the expectant category. Conclusion: Primary triage decisions in a mass casualty scenario are multifactorial and encompass patient mobility, life saving interventions, situational instincts, and logistics. PMID:27651979

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

    PubMed

    Burkle, Frederick M

    2002-05-01

    The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent

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

    PubMed

    Burkle, Frederick M

    2002-05-01

    The threat of a BT event has catalyzed serious reflection on the troublesome issues that come with event management and triage. Such reflection has had the effect of multiplying the efforts to find solutions to what could become a catastrophic public health disaster. Management options are becoming more robust, as are reliable detection devices and rapid access to stockpiled antibiotics and vaccines. There is much to be done, however, especially in the organizing, warehousing, and granting/exercising authority for resource allocations. The introduction of these new options should encourage one to believe that, in time, evolving standards of care will make it possible to rethink the currently unthinkable consequences. Unfortunately the cost of such preparedness is high and out of reach of most governments. Most of the developing world has neither the will nor the means to plan for BT events and remains overwhelmed with basic public health concerns (i.e., water, food, sanitation, shelter) that must take priority. Therefore, developed countries will be expected to respond using international exogenous resources to mitigate the effects of such a disaster. As a result, the state capacity of the effected government will be severely compromised. If triage and management of casualties is further compromised, terrorists will have met their goals. One could argue that health sciences will continue for decades to play catch up with the advanced technology driving potential bioagent weaponry. If one lesson was learned from the review of the former Soviet Union's biological weapons program, it is that the unthinkable remains an option to terrorists who have comparable expertise. It is crucial to develop realistic strategies for a BT event. Triage planning (the process of establishing criteria for health care prioritization) permits society to see cases in the context of diverse moral perspectives, limited resources, and compelling health care demands. This includes a competent

  20. A Triage Model for Chemical Warfare Casualties

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Flynn, Daniel F; Goans, Ronald E

    2006-06-01

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

  2. Game-based mass casualty burn training.

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    2009-01-01

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

  5. Development and Validation of a Mass Casualty Conceptual Model

    PubMed Central

    Culley, Joan M.; Effken, Judith A.

    2012-01-01

    Purpose To develop and validate a conceptual model that provides a framework for the development and evaluation of information systems for mass casualty events. Design 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. Methods 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. Findings 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). Conclusions 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. Clinical Relevance 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. PMID:20487188

  6. Managing mass casualties and decontamination.

    PubMed

    Chilcott, Robert P

    2014-11-01

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

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

    SciTech Connect

    Selden, B.S.

    1989-08-01

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

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

    PubMed

    Conlon, Kathe M; Martin, Shawn

    2011-06-01

    Burn experts estimate that 20-30 per cent of injuries from mass casualty events result in serious burns, many requiring specialised care only available at burn centres. Yet, in the USA there are less then 1,850 burn beds available to provide such a level and quality of care. To address this concern, burn centres are beginning to put into practice new mass casualty triage and transport guidelines that must coordinate with local, regional and federal response plans, while still adhering to an accepted standard of care. This presentation describes how one US burn centre developed and implemented a Homeland Security Exercise and Evaluation Program (HSEEP) designed mass casualty incident (MCI) exercise focused on coordinating 'the right patient to the right facility at the right time', based upon acuity and bed availability. Discussion will enable planners to identify methodologies adaptable for incorporation into catastrophic emergency management operations within their regions.

  9. Mass casualty incident after the Taba terrorist attack: an organisational and medical challenge.

    PubMed

    Karp, Erez; Sebbag, Gilbert; Peiser, Jochanan; Dukhno, Oleg; Ovnat, Amnon; Levy, Isaac; Hyam, Eytan; Blumenfeld, Amir; Kluger, Yoram; Simon, Daniel; Shaked, Gad

    2007-03-01

    Two suicide bombings in and around Taba, Egypt, on 7 October 2004 created a complex medical and organisational situation. Since most victims were Israeli tourists, the National Emergency and Disaster Management Division handled their evacuation and treatment. This paper describes the event chronologically, as well as the organisational and management challenges confronted and applied solutions. Forty-nine emergency personnel and physicians were flown early to the disaster area to reinforce scarce local medical resources. Two hundred casualties were recorded: 32 dead and 168 injured. Eilat hospital was transformed into a triage facility. Thirty-two seriously injured patients were flown to two remote trauma centres in central Israel. Management of mass casualty incidents is difficult when local resources are inadequate. An effective response should include: rapid transportation of experienced trauma teams to the disaster zone; conversion of local medical amenities into a triage centre; and rapid evacuation of the seriously injured to higher level medical facilities.

  10. Oxygen supplies during a mass casualty situation.

    PubMed

    Ritz, Ray H; Previtera, Joseph E

    2008-02-01

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

  11. Public experiences of mass casualty decontamination.

    PubMed

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

    2012-09-01

    In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people's experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public's experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties' experiences of the decontamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public's experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public's experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination.

  12. Public experiences of mass casualty decontamination.

    PubMed

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

    2012-09-01

    In this article, we analyze feedback from simulated casualties who took part in field exercises involving mass decontamination, to gain an understanding of how responder communication can affect people's experiences of and compliance with decontamination. We analyzed questionnaire data gathered from 402 volunteers using the framework approach, to provide an insight into the public's experiences of decontamination and how these experiences are shaped by the actions of emergency responders. Factors that affected casualties' experiences of the decontamination process included the need for greater practical information and better communication from responders, and the need for privacy. Results support previous findings from small-scale incidents that involved decontamination in showing that participants wanted better communication from responders during the process of decontamination, including more practical information, and that the failure of responders to communicate effectively with members of the public led to anxiety about the decontamination process. The similarity between the findings from the exercises described in this article and previous research into real incidents involving decontamination suggests that field exercises provide a useful way to examine the effect of responder communication strategies on the public's experiences of decontamination. Future exercises should examine in more detail the effect of various communication strategies on the public's experiences of decontamination. This will facilitate the development of evidence-based communication strategies intended to reduce anxiety about decontamination and increase compliance among members of the public during real-life incidents that involve mass decontamination. PMID:22823588

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

    PubMed

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

    2014-01-01

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

  14. Advanced technology development for remote triage applications in bleeding combat casualties.

    PubMed

    Ryan, Kathy L; Rickards, Caroline A; Hinojosa-Laborde, Carmen; Gerhardt, Robert T; Cain, Jeffrey; Convertino, Victor A

    2011-01-01

    Combat developers within the Army have envisioned development of a "wear-and-forget" physiological status monitor (PSM) that will enhance far forward capabilities for assessment of Warrior readiness for battle, as well as for remote triage, diagnosis and decision-making once Soldiers are injured. This paper will review recent work testing remote triage system prototypes in both the laboratory and during field exercises. Current PSM prototypes measure the electrocardiogram and respiration, but we have shown that information derived from these measurements alone will not be suited for specific, accurate triage of combat injuries. Because of this, we have suggested that development of a capability to provide a metric of circulating blood volume status is required for remote triage. Recently, volume status has been successfully modeled using low-level physiological signals obtained from wearable devices as input to machine-learning algorithms; these algorithms are already able to discriminate between a state of physical activity (common in combat) and that of central hypovolemia, and thus show promise for use in wearable remote triage devices.

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2013-12-01

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

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

    PubMed Central

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

    2013-01-01

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

  18. Medical management of toxicological mass casualty events.

    PubMed

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

    2008-11-01

    The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE.

  19. Development of sulfanegen for mass cyanide casualties.

    PubMed

    Patterson, Steven E; Moeller, Bryant; Nagasawa, Herbert T; Vince, Robert; Crankshaw, Daune L; Briggs, Jacquie; Stutelberg, Michael W; Vinnakota, Chakravarthy V; Logue, Brian A

    2016-06-01

    Cyanide is a metabolic poison that inhibits the utilization of oxygen to form ATP. The consequences of acute cyanide exposure are severe; exposure results in loss of consciousness, cardiac and respiratory failure, hypoxic brain injury, and dose-dependent death within minutes to hours. In a mass-casualty scenario, such as an industrial accident or terrorist attack, currently available cyanide antidotes would leave many victims untreated in the short time available for successful administration of a medical countermeasure. This restricted therapeutic window reflects the rate-limiting step of intravenous administration, which requires both time and trained medical personnel. Therefore, there is a need for rapidly acting antidotes that can be quickly administered to large numbers of people. To meet this need, our laboratory is developing sulfanegen, a potential antidote for cyanide poisoning with a novel mechanism based on 3-mercaptopyruvate sulfurtransferase (3-MST) for the detoxification of cyanide. Additionally, sulfanegen can be rapidly administered by intramuscular injection and has shown efficacy in many species of animal models. This article summarizes the journey from concept to clinical leads for this promising cyanide antidote. PMID:27308865

  20. Medical management of toxicological mass casualty events.

    PubMed

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

    2008-11-01

    The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE. PMID:19070282

  1. Development of sulfanegen for mass cyanide casualties.

    PubMed

    Patterson, Steven E; Moeller, Bryant; Nagasawa, Herbert T; Vince, Robert; Crankshaw, Daune L; Briggs, Jacquie; Stutelberg, Michael W; Vinnakota, Chakravarthy V; Logue, Brian A

    2016-06-01

    Cyanide is a metabolic poison that inhibits the utilization of oxygen to form ATP. The consequences of acute cyanide exposure are severe; exposure results in loss of consciousness, cardiac and respiratory failure, hypoxic brain injury, and dose-dependent death within minutes to hours. In a mass-casualty scenario, such as an industrial accident or terrorist attack, currently available cyanide antidotes would leave many victims untreated in the short time available for successful administration of a medical countermeasure. This restricted therapeutic window reflects the rate-limiting step of intravenous administration, which requires both time and trained medical personnel. Therefore, there is a need for rapidly acting antidotes that can be quickly administered to large numbers of people. To meet this need, our laboratory is developing sulfanegen, a potential antidote for cyanide poisoning with a novel mechanism based on 3-mercaptopyruvate sulfurtransferase (3-MST) for the detoxification of cyanide. Additionally, sulfanegen can be rapidly administered by intramuscular injection and has shown efficacy in many species of animal models. This article summarizes the journey from concept to clinical leads for this promising cyanide antidote.

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

    PubMed

    Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

    2010-06-01

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

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

    PubMed

    Hopmeier, Michael; Abrahams, Jonathan; Carr, Zhanat

    2010-06-01

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

  4. Development of Mass-casualty Life Support-CBRNE (MCLS-CBRNE) in Japan.

    PubMed

    Anan, Hideaki; Otomo, Yasuhiro; Kondo, Hisayoshi; Homma, Masato; Koido, Yuichi; Morino, Kazuma; Oshiro, Kenichi; Harikae, Kiyokazu; Akasaka, Osamu

    2016-10-01

    This report outlines the need for the development of an advanced course in mass-casualty life support (MCLS) and introduces the course content. The current problems with education on disasters involving chemical agents, biological agents, radiation/nuclear attacks, or explosives (CBRNE) in Japan are presented. This newly developed "MCLS-CBRNE" program was created by a Ministry of Health, Labour, and Welfare (Tokyo, Japan) research group based on these circumstances. Modifications were then made after a trial course. Training opportunities for relevant organizations to learn how to act at a CBRNE disaster site currently are lacking. The developed course covers initial responses at a disaster site. This one-day training course comprises lectures, three tabletop simulations, and practical exercises in pre-decontamination triage and post-decontamination triage. With regard to field exercises conducted to date, related organizations have experienced difficulties in understanding each other and adapting their approaches. Tabletop simulations provide an opportunity for participants to learn how organizations working on-site, including fire, police, and medical personnel, act with differing goals and guiding principles. This course appears useful as a means for relevant organizations to understand the importance of developing common guidelines. The MCLS-CBRNE training is proposed to support CBRNE disaster control measures during future events. Anan H , Otomo Y , Kondo H , Homma M , Koido Y , Morino K , Oshiro K , Harikae K , Akasaka O . Development of mass-casualty life support-CBRNE (MCLS-CBRNE) in Japan. Prehosp Disaster Med. 2016;31(5):547-550.

  5. 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.

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

    PubMed

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

    2014-01-01

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

  7. Triage in surgery: from theory to practice, the Medecins Sans Frontières experience.

    PubMed

    Herard, Patrick; Boillot, François

    2013-08-01

    Establishing triage is necessary in mass casualty events. If the concept of triage itself is easy, its application in the field encounters many difficulties at times unforseen. MSF offers a list of the main obstacles encountered when establishing an efficient triage system.

  8. 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.

  9. 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

  10. Modelling mass casualty decontamination systems informed by field exercise data.

    PubMed

    Egan, Joseph R; Amlôt, Richard

    2012-10-16

    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.

  11. Modelling mass casualty decontamination systems informed by field exercise data.

    PubMed

    Egan, Joseph R; Amlôt, Richard

    2012-10-01

    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

  12. Casualties.

    PubMed

    Shay, Jonathan

    2011-01-01

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

  13. Loss of cabin pressure in a military transport: a mass casualty with decompression illnesses.

    PubMed

    Johnston, Mickaila J

    2008-04-01

    Presented here is the sudden cabin depressurization of a military C-130 aircraft carrying 66 personnel. They suffered a depressurization from 2134 to 7317 m, resulting in a potential 66-person mass casualty. The aircrew were able to descend to below 3049 m in less than 5 min. They landed in the Kingdom of Bahrain--the nearest hyperbaric recompression facility. Three cases of peripheral neurologic DCS and one case of spinal DCS were identified. Limited manning, unique host nation concerns, and limited available assets led to difficulties in triage, patient transport, and asset allocation. These led to difficult decisions regarding when and for whom to initiate ground level oxygen or hyperbaric recompression therapy.

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

    PubMed Central

    Fry, Emory A.; Lenert, Leslie A.

    2005-01-01

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

  15. Development of Mass-casualty Life Support-CBRNE (MCLS-CBRNE) in Japan.

    PubMed

    Anan, Hideaki; Otomo, Yasuhiro; Kondo, Hisayoshi; Homma, Masato; Koido, Yuichi; Morino, Kazuma; Oshiro, Kenichi; Harikae, Kiyokazu; Akasaka, Osamu

    2016-10-01

    This report outlines the need for the development of an advanced course in mass-casualty life support (MCLS) and introduces the course content. The current problems with education on disasters involving chemical agents, biological agents, radiation/nuclear attacks, or explosives (CBRNE) in Japan are presented. This newly developed "MCLS-CBRNE" program was created by a Ministry of Health, Labour, and Welfare (Tokyo, Japan) research group based on these circumstances. Modifications were then made after a trial course. Training opportunities for relevant organizations to learn how to act at a CBRNE disaster site currently are lacking. The developed course covers initial responses at a disaster site. This one-day training course comprises lectures, three tabletop simulations, and practical exercises in pre-decontamination triage and post-decontamination triage. With regard to field exercises conducted to date, related organizations have experienced difficulties in understanding each other and adapting their approaches. Tabletop simulations provide an opportunity for participants to learn how organizations working on-site, including fire, police, and medical personnel, act with differing goals and guiding principles. This course appears useful as a means for relevant organizations to understand the importance of developing common guidelines. The MCLS-CBRNE training is proposed to support CBRNE disaster control measures during future events. Anan H , Otomo Y , Kondo H , Homma M , Koido Y , Morino K , Oshiro K , Harikae K , Akasaka O . Development of mass-casualty life support-CBRNE (MCLS-CBRNE) in Japan. Prehosp Disaster Med. 2016;31(5):547-550. PMID:27531062

  16. Mass casualty events: blood transfusion emergency preparedness across the continuum of care.

    PubMed

    Doughty, Heidi; Glasgow, Simon; Kristoffersen, Einar

    2016-04-01

    Transfusion support is a key enabler to the response to mass casualty events (MCEs). Transfusion demand and capability planning should be an integrated part of the medical planning process for emergency system preparedness. Historical reviews have recently supported demand planning for MCEs and mass gatherings; however, computer modeling offers greater insights for resource management. The challenge remains balancing demand and supply especially the demand for universal components such as group O red blood cells. The current prehospital and hospital capability has benefited from investment in the management of massive hemorrhage. The management of massive hemorrhage should address both hemorrhage control and hemostatic support. Labile blood components cannot be stockpiled and a large surge in demand is a challenge for transfusion providers. The use of blood components may need to be triaged and demand managed. Two contrasting models of transfusion planning for MCEs are described. Both illustrate an integrated approach to preparedness where blood transfusion services work closely with health care providers and the donor community. Preparedness includes appropriate stock management and resupply from other centers. However, the introduction of alternative transfusion products, transfusion triage, and the greater use of an emergency donor panel to provide whole blood may permit greater resilience.

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

    PubMed

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

    2005-03-01

    The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. Eleven were triaged to the trauma resuscitation area and four to the surgical emergency room. Seven patients were intubated for respiratory distress or airway protection. Six patients had >80 per cent burns with steam inhalation, and all of these died. One of the 6 patients had 99 per cent burns with steam inhalation and died after withdrawal of support within the first several hours. All patients with major burns required escharotomy on arrival to trauma resuscitation. One patient died in the operating room, despite decompression by laparotomy for abdominal compartment syndrome and pericardiotomy via thoracotomy for cardiac tamponade. Four patients required crystalloid, 20,000 mls/m2-27,000 ml/m2 body surface area (BSA) in the first 48 hours to maintain blood pressure and urine output. Three of these four patients subsequently developed abdominal compartment syndrome and died in the first few days. The fourth patient of this group died after 26 days due to sepsis. Five patients had 13-20 per cent bums and four patients had less than 10 per cent burns. Two of the patients with 20 per cent burns developed edema of the vocal cords with mild hoarseness. They improved and recovered without intubation. The facility was prepared for the mass casualty event; having just completed a mass casualty drill several days earlier. Twenty-six beds were made available in 50 minutes for anticipated casualties. Fifteen physicians reported immediately to the trauma resuscitation area to assist in initial stabilization. The event occurred at shift change; thus, adequate support

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

    PubMed

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

    2015-12-01

    judicious, efficient, and rational use of stockpiled MCMs for the treatment of anthrax during a mass-casualty incident, which is described in this report. This report addresses elements of hospital-based acute care, specifically antitoxins and intravenous antimicrobial use, and the diagnosis and management of common anthrax-specific complications during a mass-casualty incident. The recommendations in this report should be implemented only after predefined triggers have been met for shifting from conventional to contingency or crisis standards of care, such as when the magnitude of cases might lead to impending shortages of intravenous antimicrobials, antitoxins, critical care resources (e.g., chest tubes and chest drainage systems), or diagnostic capability. This guidance does not address primary triage decisions, anthrax postexposure prophylaxis, hospital bed or workforce surge capacity, or the logistics of dispensing MCMs. Clinicians, hospital administrators, state and local health officials, and planners can use these recommendations to assist in the development of crisis protocols that will ensure national preparedness for an anthrax mass-casualty incident. PMID:26632963

  19. 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

    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.

  20. Mass casualties and health care following the release of toxic chemicals or radioactive material--contribution of modern biotechnology.

    PubMed

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

    2011-12-01

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

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

    PubMed Central

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

    2011-01-01

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

  2. Mass casualties and health care following the release of toxic chemicals or radioactive material--contribution of modern biotechnology.

    PubMed

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

    2011-12-01

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

  3. 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

  4. Pediatric and neonatal interfacility transport medicine after mass casualty incidents.

    PubMed

    Lowe, Calvin G

    2009-08-01

    Pediatric and neonatal interfacility transport medicine is a relatively young but a rapidly evolving specialty. Transport teams are essential for the safe interfacility movement of critically ill patients. A mass casualty incident (MCI) can present major challenges for a critical care transport team. This article will examine the capabilities and limitations of pediatric and neonatal critical care transport teams. The predicaments brought about by Hurricane Katrina that hindered the evacuation of pediatric and neonatal patients out of ravaged hospitals are also reviewed. From these experiences, recommendations to improve the efficiency and efficacy of interfacility transport of pediatric patients will be presented.

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

    PubMed

    Timm, Nathan; Reeves, Scott

    2007-01-01

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

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

    PubMed

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

    2010-07-01

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

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

    PubMed

    Schulz, Christian M; Skrzypczak, Matthias; Raith, Stefan; Hinzmann, Dominik; Krautheim, Veronika; Heuser, Fabian; Mayer, Valentin; Kreuzer, Christoph; Himsl, Meike; Holl, Michael; Lipp, Christina; Kochs, Eberhard F; Wagner, Klaus J

    2014-04-01

    High-fidelity simulators (HFSs) have been shown to prompt critical actions at a level equal to that of trained human actors (HAs) and increase perceived realism in intrahospital mass-casualty incident (MCI) exercises. For unannounced prehospital MCI exercises, however, no data are available about the feasibility of incorporating HFSs. This case report describes the integration of HFSs in such an unannounced prehospital MCI drill with HAs and provides data about the differences concerning triage, treatment, and transport of HFSs and HAs with identical injury patterns. For this purpose, 75 actors and four high-fidelity simulators were subdivided into nine groups defined by a specific injury pattern. Four HFSs and six HAs comprised a group suffering from traumatic brain injury and blunt abdominal trauma. Triage results, times for transport, and number of diagnostic and therapeutic tasks were recorded. Means were compared by t test or one-way ANOVA. Triage times and results did not differ between actors and simulators. The number of diagnostic (1.25, SD = 0.5 in simulators vs 3.5, SD = 1.05 in HAs; P = .010) and therapeutic tasks (2.0, SD = 1.6 in simulators vs 4.8, SD = 0.4 in HAs; P = .019) were significantly lower in simulators. Due to difficulties in treating and evacuating the casualties from the site of the accident in a timely manner, all simulators died. Possible causal factors and strategies are discussed, with the aim of increasing the utility of simulators in emergency medicine training. PMID:24650543

  8. Comparative analysis of showering protocols for mass-casualty decontamination.

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2012-07-01

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

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

    PubMed

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

    2012-07-01

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

  11. Mass Casualty Incident Response and Aeromedical Evacuation in Antarctica

    PubMed Central

    Mills, Christopher N.; Mills, Gregory H.

    2011-01-01

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

  12. Managing bioterrorism mass casualties in an emergency department: lessons learned from a rural community hospital disaster drill.

    PubMed

    Vinson, Eric

    2007-01-01

    Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks.

  13. Mass casualty management for radiological and nuclear incidents.

    PubMed

    Bland, S A

    2004-09-01

    The decisions required for the provision of an appropriate medical response to a radiological or nuclear incident range from the traditional major incident response through to a compromised response due to a catastrophic event. A summary of the most likely clinical findings in the first 12-24 hours is given in Table 4. From these findings, appropriate management based upon the needs and available resources can be planned. This includes triage for surgery and the use of the expectant (T4) triage category.

  14. The Design of a Decentralized Electronic Triage System

    PubMed Central

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

    2006-01-01

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

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

    PubMed

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; 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

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

    PubMed

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; 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.

  17. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan.

    PubMed

    Berger, Ferco H; Körner, Markus; Bernstein, Mark P; Sodickson, Aaron D; Beenen, Ludo F; McLaughlin, Patrick D; Kool, Digna R; Bilow, Ronald M

    2016-01-01

    In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients. It can also be used to increase the accuracy of triaging MCI victims, since overtriage (falsely higher triage category) and undertriage (falsely lower triage category) can severely impact resource availability and mortality rates, respectively. This article emphasizes the importance of including the radiology department in hospital preparations for a MCI and highlights factors expected to influence performance during hospital DMP activation including issues pertinent to effective simulation, such as establishing proper learning objectives. After-action reviews including performance evaluation and debriefing on issues are invaluable following simulation drills and DMP activation, in order to improve subsequent preparedness. Historically, most hospital DMPs have not adequately included radiology department operations, and they have not or to a little extent been integrated in the DMP activation simulation. This article aims to increase awareness of the need for radiology department engagement in order to increase radiology department preparedness for DMP activation after a MCI occurs.

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

    PubMed Central

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

    2005-01-01

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

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

    PubMed

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

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

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

    PubMed

    Monteith, Raymond G; Pearce, Laurie D R

    2015-06-01

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

  1. Carbamate poisoning: treatment recommendations in the setting of a mass casualties event.

    PubMed

    Rosman, Yossi; Makarovsky, Igor; Bentur, Yedidia; Shrot, Shai; Dushnistky, Tsvika; Krivoy, Amir

    2009-11-01

    The threat of using chemical compounds by terrorists as weapons of mass casualties has been a rising concern in recent years. Carbamates, a group of reversible acetylcholinesterase inhibitors, could be potentially involved in such toxic mass casualty events because they can cause cholinergic crisis that could lead to fatality, similar to that of organophosphate poisoning. The medical management of carbamate poisoning consists of supportive measures and specific antidotal treatment, that is, the anticholinergic compound atropine. The administration of oximes, acetylcholinesterase reactivators, in carbamate poisoning is controversial because of the potential toxicity of oximes in conjunction with carbamate especially in the case of the carbamate--"carbaryl" poisoning. However, recent data suggest that this concern may be unwarranted. In this article, we review the current data regarding the pros and cons of using oximes against carbamates poisoning in a mass casualties event scenario. We also propose a new decision-making algorithm for the medical first responders in a mass casualties event suspected to be caused by a cholinergic substance (organophosphate or carbamate). According to this algorithm, treatment should consist of atropine and oxime regardless of the exact toxic compound involved. We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk.

  2. The development of intelligent, triage-based, mass-gathering emergency medical service PDA support systems.

    PubMed

    Chang, Polun; Hsu, Yueh-Shuang; Tzeng, Yuann-Meei; Sang, Yiing-Yiing; Hou, I-Ching; Kao, Wei-Fong

    2004-09-01

    The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsite evaluation forms for the mass gatherings, and to evaluate users ' perceived ease of use and usefulness of the systems in terms of Davis ' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. Twenty-three nurses and six physicians in the medical center, who had served at mass gatherings, were invited to examine the new systems and answer the TAM questionnaire. The PDA systems were composed of 450 information items within 42 screens in 6 categories. The results supported the potential for using triage-based PDA systems at mass gatherings. Overall, most of the subjects agreed that the systems were easy to use and useful for mass gatherings, and they were willing to accept the systems.

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

    PubMed

    Goh, S H

    2009-01-01

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

  4. 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.

  5. A national system for disseminating information on victims during mass casualty incidents.

    PubMed

    Adini, Bruria; Peleg, Kobi; Cohen, Robert; Laor, Danny

    2010-04-01

    Immediate provision of information to the public is vital during mass casualty incidents (MCIs). Failure to implement rapidly a communication response system may result in the public overwhelming hospitals. This paper shares Israel's experience in developing and maintaining a national system for supplying information on the location and identification of casualties. ADAM interfaces online with hospitals' patient registration systems, and allows for immediate electronic transfer of designated data. The system permits information centres to access information on which hospital has admitted identified and unidentified casualties. The latter are photographed at the entrance to the hospital and the picture is stored in ADAM. The system enables hospitals and municipalities to ensure immediate availability and accessibility of information and thus (in our belief) mitigate the concerns of family and friends. Use of such an interface system is recommended as an integral element of emergency preparedness. PMID:20002707

  6. Use of Clinical Decision Guidance as a New Public Health Tool for the Medical Management of Internal Contamination in Radiological Mass Casualty Scenarios.

    PubMed

    Wiley, Albert L

    2016-09-01

    This review is a discussion of special issues associated with the medical and public health management of persons at risk of internal contamination from radionuclides, following various radiological mass-casualty scenarios, as well as definition, discussion and use of the Clinical Decision Guidance (CDG) in such scenarios. Specific medical countermeasures are available for reducing the internal radiation dose and the subsequent stochastic and deterministic risks to persons internally contaminated with radionuclides from nuclear power plant, fuel processing and nuclear weapon accidents/incidents. There is a public health need for rapidly identifying and quantifying the 'source term' of such radiation exposures and assessment of the associated committed doses, so that appropriate medical countermeasure(s) can be given as soon as possible. The CDG, which was initially defined in NCRP-161, was specifically developed to be a new public health tool for facilitating the integration of local community healthcare professionals into the general medical, mass casualty, triage and treatment response of internally contaminated populations. PMID:27574325

  7. Evolution of triage systems

    PubMed Central

    Robertson‐Steel, Iain

    2006-01-01

    The French word “trier”, the origin of the word “triage”, was originally applied to a process of sorting, probably around 1792, by Baron Dominique Jean Larrey, Surgeon in Chief to Napoleon's Imperial Guard. Larrey was credited with designing a flying ambulance: the Ambulance Volante. Baron Francois Percy also contributed to the organisation of a care system for the ongoing management of casualties. Out of the French Service de Santé, not only emerged the concept of triage, but the organisational structure necessary to handle the growing number of casualties in modern warfare. PMID:16439754

  8. The role dentists can play in mass casualty and disaster events.

    PubMed

    Guay, Albert H

    2007-10-01

    Dentistry has valuable assets, both in personnel and facilities, to bring to the initial response to a mass casualty event when the local traditional medical system is overwhelmed. This article describes the services dentists can provide to allow physicians to provide the services only they can provide. The education and training of dentists that is required for preparation and the need to develop an integrated emergency response plan are discussed.

  9. 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

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

    PubMed

    Duchateau, François-Xavier; Verner, Laurent

    2012-01-01

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

  11. Explosive outbreak of gastroenteritis on an aircraft carrier: an infectious disease mass casualty situation.

    PubMed

    Bohnker, B; McEwen, G; Feeks, E; Palombaro, J

    1993-07-01

    An aircraft carrier experienced 777 cases of acute gastroenteritis while deployed in the eastern Mediterranean over a 16-d period. These cases were noted in the 5,000-man crew, suggesting a cumulative incidence rate of 15%, though many sailors did not seek medical care for their symptoms. The onboard medical department response included epidemiological investigation with unique shipboard facility considerations, development of a treatment plan, and implementation of preventive/educational programs. Implications for nontrauma related mass casualty situations are discussed. Flight surgeons and operational medicine physicians must have a solid foundation in general preventive medicine to fulfill their responsibilities.

  12. Radiation accident preparedness: a European approach to train physicians to manage mass radiation casualties.

    PubMed

    Hotz, Mark E; Fliedner, Theodor M; Meineke, Viktor

    2010-06-01

    Mass casualties after radiation exposure pose an enormous logistical challenge for national health services worldwide. Successful medical treatment of radiation victims requires that a plan for medical radiation accident management be established, that the plan be tested in regular exercises, and that it be found to be effective in the management of actual victims of a radiological incident. These activities must be provided by a critical mass of clinicians who are knowledgeable in the diagnosis and management of radiation injury. Here, we describe efforts to provide education to physicians engaged in clinical transplantation. Following intensive discussion among European experts at the International Center for Advanced Studies in Health Sciences and Services, University of Ulm, Germany, an advanced training program on "radiation syndromes" was developed for physicians with experience in the management of patients with pancytopenia and multi-organ failure occurring in a transplant setting. The first European advanced training course using this educational tool took place at Oberschleissheim, Germany, on 28-30 November 2007. Small group discussions and practical exercises were employed to teach general principles and unique features of whole body radiation exposure. Topics included the biological effects of contamination, incorporation of radionuclides, clinical consequences of exposure to radiation, and approaches to medical management. Recommendations resulting from this initial educational experience include (1) provision of funding for attending, conducting and updating the curriculum, and (2) development of an educational program that is harmonized among European and non-European experts in medical management of mass casualties from a radionuclear incident. PMID:20445401

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

    PubMed

    Daugherty, Elizabeth L

    2008-02-01

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

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

    PubMed

    Adini, Bruria; Peleg, Kobi

    2013-12-01

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

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

    PubMed

    Adini, Bruria; Peleg, Kobi

    2013-12-01

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

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

    PubMed

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

    2014-06-01

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

  17. Mass Casualty Decontamination Guidance and Psychosocial Aspects of CBRN Incident Management: A Review and Synthesis

    PubMed Central

    Carter, Holly; Amlôt, Richard

    2016-01-01

    Introduction: Mass casualty decontamination is an intervention employed by first responders at the scene of an incident involving noxious contaminants.  Many countries have sought to address the challenge of decontaminating large numbers of affected casualties through the provision of rapidly deployable temporary showering structures, with accompanying decontamination protocols.  In this paper we review decontamination guidance for emergency responders and associated research evidence, in order to establish to what extent psychosocial aspects of casualty management have been considered within these documents. The review focuses on five psychosocial aspects of incident management: likely public behaviour; responder management style; communication strategy; privacy/ modesty concerns; and vulnerable groups. Methods: Two structured literature reviews were carried out; one to identify decontamination guidance documents for first responders, and another to identify evidence which is relevant to the understanding of the psychosocial aspects of mass decontamination.  The guidance documents and relevant research were reviewed to identify whether the guidance documents contain information relating to psychosocial issues and where it exists, that the guidance is consistent with the existing evidence-base. Results: Psychosocial aspects of incident management receive limited attention in current decontamination guidance.  In addition, our review has identified a number of gaps and inconsistencies between guidance and research evidence.  For each of the five areas we identify: what is currently presented in guidance documents, to what extent this is consistent with the existing research evidence and where it diverges.  We present a series of evidence-based recommendations for updating decontamination guidance to address the psychosocial aspects of mass decontamination. Conclusions: Effective communication and respect for casualties’ needs are critical in ensuring

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

    PubMed

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

    1992-04-01

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

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

    PubMed

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

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

    Yu, Xunyi; Ganz, Aura

    2010-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2006-04-01

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

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

    PubMed

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

    2015-01-01

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

  6. Triage in the defence medical services.

    PubMed

    Horne, Simon T; Vassallo, J

    2015-06-01

    Triage of patients into categories according to their need for intervention is a core part of military medical practice. This article reviews how triage has evolved in the Defence Medical Services and how it might develop in the context of recent research. In particular, a simple model demonstrates that the ideal sensitivity and specificity of a triage system depends upon the availability of transport and the capacity of the receiving units. As a result, we may need to fundamentally change the way we approach triage in order to optimise outcomes-especially if casualty evacuation timelines become longer and smaller medical units more prevalent on future operations. Some pragmatic options for change are discussed. Finally, other areas of current research around triage are highlighted, perhaps showing where triage may go next.

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

    PubMed

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

    2015-02-01

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

  8. Cyanide Antidotes for Mass Casualties: Water-Soluble Salts of the Dithiane (Sulfanegen) from 3-Mercaptopyruvate for Intramuscular Administration

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-02-14

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

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

    PubMed Central

    2012-01-01

    Background Political conflicts in Bangkok, Thailand have caused mass casualties, especially the latest event April 10, 2010, in which many military personnel were injured. Most of them were transferred to Phramongkutklao Hospital, the largest military hospital in Thailand. The current study aimed to assess factors influencing Injury Severity Score (ISS) regarding Thai military personnel injured in the mass casualty incident (MCI) April 10, 2010. Methods A total of 728 injured soldiers transferred to Phramongkutklao Hospital were reviewed. Descriptive statistics was used to display characteristics of the injuries, relationship between mechanism of injury and injured body regions. Multiple logistic regressions were used to calculate the adjusted odds ratio (adjusted OR) of ISS comparing injured body region categories. Results In all, 153 subjects defined as major data category were enrolled in this study. Blast injury was the most common mechanism of injury (90.2%). These victims displayed 276 injured body regions. The most common injured body region was the extremities (48.5%). A total of 18 patients (11.7%) had an ISS revealing more than 16 points. Three victims who died were expected to die due to high Trauma and Injury Severity Score (TRISS). However, one with high TRISS survived. Factors influencing ISS were age (p = 0.04), abdomen injury (adjusted OR = 29.9; 95% CI, 5.8-153.5; P < 0.01), head & neck injury (adjusted OR = 13.8; 95% CI, 2.4-80.4; P < 0.01) and chest injury (adjusted OR = 9.9; 95% CI, 2.1-47.3; P < 0.01). Conclusions Blast injury was the most common mechanism of injury among Thai military personnel injured in the MCI April 10, 2010. Age and injured body region such as head & neck, chest and abdomen significantly influenced ISS. These factors should be investigated for effective medical treatment and preparing protective equipment to prevent such injuries in the future. PMID:22214518

  11. History of trauma field triage development and the American College of Surgeons criteria.

    PubMed

    Mackersie, Robert C

    2006-01-01

    The use of trauma field triage criteria is designed to match a patient's injury type and severity to prioritized transport and an institution with the resources to provide timely, definitive care. Triage schemes used in austere environments created by war or mass casualty events are less applicable to day-to-day civilian trauma. Civilian triage criteria, developed and refined over the past 25 years, rely on physiologic, anatomic, and mechanistic indicators of severe injury in an attempt to optimize overtriage and undertriage. As organized trauma systems continue to mature, the need for more accurate direction of high- versus low-acuity patients to regional centers, stratified by their capabilities, becomes more apparent and is essential in avoiding a completely 'exclusive' trauma system. New technology utilizing vehicular telemetry and Web-based information systems may simplify the seemingly simple but often formidable task of creating destination decision rules for victims of major injury. PMID:16801263

  12. Use of alternate healthcare facilities as alternate transport destinations during a mass-casualty incident.

    PubMed

    Glassman, Erik S; Parrillo, Steven J

    2010-01-01

    The purpose of this discussion is to review the use of destinations other than the hospital emergency department, to transport patients injured as a result of a mass-casualty incident (MCI). A MCI has the ability to overwhelm traditional hospital resources normally thought of as appropriate destinations for the transport of injured patients. As a result, those with less severe injuries often are required to wait before they can receive definitive treatment. This waiting period, either at the scene of the incident or in the emergency department, can increase morbidity and drain resources that can be better directed toward the transport and care of those more severely injured. Potential alternate transport destinations include physician office buildings, ambulatory care centers, ambulatory surgery centers, and urgent care centers. By allowing for transport to alternate locations, these less severely injured patients can be removed rapidly from the scene, treated, and potentially released. This effort can decrease the strain on traditional resources within the system, better allowing these resources to treat more seriously injured patients.

  13. Gaming to Predict Human Responses to Mass Casualty Events: An Approach for Quick Look Tools for Pandemic Influenza

    SciTech Connect

    Brigantic, Robert T.; Muller, George; Taylor, Aimee E.; Papatyi, Anthony F.

    2009-10-09

    There is a need to better understand and describe social intelligence in the realm of handling mass casualty events such as pandemic influenza, earthquakes, and other natural or manmade disasters. A comprehension of social intelligence is needed in order to accurately feed and drive models and simulations that attempt to describe and quantify human responses to such mass casualty events, which can allow decision makers to identify potential mitigation strategies that might be used to minimize the impacts of these events by reducing numbers of deaths, injuries, and other societal (e.g., economic) consequences. We propose to develop a better understanding of social intelligence and socially driven human responses through the use of games and game-like interfaces with a direct application focused on infectious diseases.

  14. Virtual simulation-enhanced triage training for Iraqi medical personnel.

    PubMed

    Kizakevich, Paul N; Culwell, Andrew; Furberg, Robert; Gemeinhardt, Don; Grantlin, Susan; Hubal, Robert; Stafford, Allison; Dombroski, R Todd

    2007-01-01

    Triage, establishing the priority of care among casualties in disaster management, is generally practiced using constructive tabletop or live exercises. Actual disasters involving multiple casualties occur rarely, offering little opportunity for gaining experience and competency assessment. When they do occur, response needs to be rapid and well-learned. In the Iraqi medical education environment where the need for triage is immediate, but the ability to stage practice is nearly impossible, blending didactic learning with simulation-based triage offers an alternative training methodology. PMID:17377271

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

    PubMed

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

    2016-03-01

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

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

    PubMed Central

    2016-01-01

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

  17. 77 FR 52746 - Medical Countermeasures for a Burn Mass Casualty Incident

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-30

    ... limited and, therefore, FDA may limit the number of participants from each organization. If time and space... serious thermal burns. With respect to a nuclear detonation, these injuries could affect hundreds to... casualty incident such as a nuclear detonation--whereupon an estimated 10,000 or more individuals...

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

    PubMed

    Eyal, Nir; Firth, Paul

    2012-10-22

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

  19. Proposed triage categories for large-scale radiation incidents using high-accuracy biodosimetry methods.

    PubMed

    Rea, Michael E; Gougelet, Robert M; Nicolalde, Roberto J; Geiling, James A; Swartz, Harold M

    2010-02-01

    A catastrophic event such as a nuclear device detonation in a major U.S. city would cause a mass casualty with millions affected. Such a disaster would require screening to accurately and effectively identify patients likely to develop acute radiation syndrome (ARS). A primary function of such screening is to sort the unaffected, or worried-well, from those patients who will truly become symptomatic. This paper reviews the current capability of high-accuracy biodosimetry methods as screening tools for populations and reviews the current triage and medical guidelines for diagnosing and managing ARS. This paper proposes that current triage categories, which broadly categorize patients by likelihood of survival based on current symptoms, be replaced with new triage categories that use high-accuracy biodosimetry methods. Using accurate whole-body exposure dose assessment to predict ARS symptoms and subsyndromes, clinical decision-makers can designate the appropriate care setting, initiate treatment and therapies, and best allocate limited clinical resources, facilitating mass-casualty care following a nuclear disaster. PMID:20065675

  20. Risk Analysis for Environmental Health Triage

    SciTech Connect

    Bogen, K T

    2005-11-18

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

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

    PubMed Central

    Shirley, Peter J; Mandersloot, Gerlinde

    2008-01-01

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

  2. Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events.

    PubMed

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

    2016-01-01

    We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order.

  3. Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events

    PubMed Central

    Yang, Zhuorui; Ciottone, Gregory

    2016-01-01

    We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order. PMID:27433161

  4. Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events.

    PubMed

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

    2016-01-01

    We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order. PMID:27433161

  5. Mass-casualty victim "surge" management. Preparing for bombings and blast-related injuries with possibility of hazardous materials exposure.

    PubMed

    Severance, Harry W

    2002-01-01

    Bombings and other blast-related events place severe demands on pre-hospital and in-hospital systems. The resulting surge of victims can overwhelm the resources of any facility not prepared for such an event. The September 11 terrorist attacks underscore the urgency of our need for preparedness. The challenges become even more daunting when there is possible hazmat exposure as well; this means that adequate and rapid disposition of victims is even more critical in order to avoid contamination of hospitals systems or whole communities. Federal agencies have been designated and federal mandates have been issued to address mass casualty events, but federal or even regional systems cannot respond in time to address the massive and immediate needs generated by an explosion. Local communities must take the lead in developing incident command systems for initial management of such events. Hospital and pre-hospital providers play a key role in such planning. Ultimate management and disposition of large numbers of casualties, especially if contaminated, cannot follow standard patient management protocols; new protocols are needed. To avoid a total, overwhelming break down of in-hospital resources, hospitals need to assume a lead role in addressing such issues in their local communities. PMID:12970967

  6. Book review of "The Ethics of Coercion in Mass Casualty Medicine" by Griffin Trotter MD, PhD

    PubMed Central

    Singh, Sonal

    2007-01-01

    Public health ethics is neither taught widely in medical schools or schools of public health in the US or around the world. It is not surprising that health care professionals are particularly challenged when faced with ethical questions which extend beyond safeguarding the interests of their individual patients to matters that affect overall public good. The perceived threat of terror after September 11 2007, the anthrax attacks and the Katrina debacle are recent circumstances which may result in coercion. These have piqued the interest of medical professionals and the general public on public health ethics. The Ethics of Coercion in Mass Casualty Medicine written by Griffin Trotter MD, PhD attempts to fill a timely void in this area by examining the ethics of coercion in times of public health disasters.

  7. Rural mass casualty preparedness and response: the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events.

    PubMed

    Viswanathan, Kristin P; Bass, Robert; Wijetunge, Gamunu; Altevogt, Bruce M

    2012-10-01

    The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a workshop at the request of the Federal Interagency Committee on Emergency Medical Services (FICEMS) that brought together a range of stakeholders to broadly identify and confront gaps in rural infrastructure that challenge mass casualty incident (MCI) response and potential mechanisms to fill them. This report summarizes the presentations and discussions around 6 major issues specific to rural MCI preparedness and response: (1) improving rural response to MCI through improving daily capacity and capability, (2) leveraging current and emerging technology to overcome infrastructure deficits, (3) sustaining and strengthening relationships, (4) developing and sharing best practices across jurisdictions and sectors, (5) establishing metrics research and development, and (6) fostering the need for federal leadership to expand and integrate EMS into a broader rural response framework. PMID:23077273

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

    PubMed Central

    2014-01-01

    Background Major short-notice or sudden impact incidents, which result in a large number of casualties, are rare events. However health services must be prepared to respond to such events appropriately. In the United Kingdom (UK), a mass casualties incident is when the normal response of several National Health Service organizations to a major incident, has to be supported with extraordinary measures. Having the right type and quantity of clinical equipment is essential, but planning for such emergencies is challenging. To date, the equipment stored for such events has been selected on the basis of local clinical judgment and has evolved without an explicit evidence-base. This has resulted in considerable variations in the types and quantities of clinical equipment being stored in different locations. This study aimed to develop an expert consensus opinion of the essential items and minimum quantities of clinical equipment that is required to treat 100 people at the scene of a big bang mass casualties event. Methods A three round modified Delphi study was conducted with 32 experts using a specifically developed web-based platform. Individuals were invited to participate if they had personal clinical experience of providing a pre-hospital emergency medical response to a mass casualties incident, or had responsibility in health emergency planning for mass casualties incidents and were in a position of authority within the sphere of emergency health planning. Each item’s importance was measured on a 5-point Likert scale. The quantity of items required was measured numerically. Data were analyzed using nonparametric statistics. Results Experts achieved consensus on a total of 134 items (54%) on completion of the study. Experts did not reach consensus on 114 (46%) items. Median quantities and interquartile ranges of the items, and their recommended quantities were identified and are presented. Conclusions This study is the first to produce an expert consensus on the

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

    PubMed Central

    Moroni, Maria; Pellmar, Terry C.

    2009-01-01

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

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

    SciTech Connect

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

    2005-04-01

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

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

    PubMed

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

    2014-06-01

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

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

    PubMed

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

    2014-06-01

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

  13. Modified critical care and treatment space considerations for mass casualty critical illness and injury.

    PubMed

    Hotchkin, David L; Rubinson, Lewis

    2008-01-01

    Mass critical care events are increasingly likely, yet the resource challenges to augment everyday, unrestricted critical care for a surge of disaster victims are insurmountable for nearly all communities. In light of these limitations, an expert panel defined a circumscribed set of key critical care interventions that they believed could be offered to many additional people and yet would also continue to offer substantial life-sustaining benefits for nonmoribund critically ill and injured people. They proposed Emergency Mass Critical Care, which is based on the set of key interventions and includes recommendations for necessary surge medical equipment, treatment space characteristics, and staffing competencies for mass critical care response. To date, Emergency Mass Critical Care is untested, and the real benefits of implementation remain uncertain. Nonetheless, Emergency Mass Critical Care currently remains the only comprehensive construct for mass critical care preparedness and response. This paper reviews current concepts to provide life-sustaining care for hundreds or thousands of people outside of traditional critical care sites. PMID:18173861

  14. Toxicological mass disaster management - a hospital deployment scheme.

    PubMed

    Baniel, J; Ram, Z; Kami, A; Schindel, D

    1986-09-01

    Toxicological mass disasters have occurred frequently in past years and constitute a permanent threat in urban areas. From the standpoint of hospital planning, special consideration is required to treat a large number of poisoned casualties in a relatively short period. Several unique medical aspects characterize toxicological mass disasters: casualties present a single disease entity with many "borderline" cases, most medical personnel are unfamiliar with the problem and casualties present a potential contamination hazard to the hospital. A hospital deployment scheme is presented recommending Decontamination, Triage and simple Treatment Algorithms to meet the medical and organizational challenge of such a mass casualty situation. A further specific deployment scheme for treatment of organophosphorus agents poisoning is described to illustrate the principles presented.

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

    NASA Astrophysics Data System (ADS)

    Lizotte, Todd E.

    2010-04-01

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

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

    PubMed Central

    Borgohain, B; Khonglah, T

    2013-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed Central

    2009-01-01

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

  19. Medical triage in the post-Cold War era.

    PubMed

    Jeffer, E K

    1994-05-01

    Military medicine is caught at the confluence of two major currents of change. The Department of Defense and the American system of health care are both undergoing major revisions. Triage was a key operational concept for patient care during the Cold War era. With the changed world situation, the author suggests new operational concepts including the relegation of triage to a marginal role in wartime care. The author argues that increasing the ratio of medical personnel to combat troops is consistent with a changed national perspective on wartime casualties.

  20. [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. PMID:19048869

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

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

    2015-01-01

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

  3. [Emergency Triage. An Overview].

    PubMed

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

    2016-03-01

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

  4. Management of the irradiated casualty.

    PubMed

    Bland, S A

    2004-09-01

    The initial management of any irradiated casualty is the early identification of the possibility of a significant exposure through dose prediction and recognition of prodromal symptoms. Subsequent management is aimed at supporting the effected systems until there is recovery. Where there is haematological failure, transplantation (bone marrow / stem cell) is possible although limited value in a mass casualty scenario. The provision of gold standard therapy within the field is unlikely to occur and early medical evacuation to an Echelon / Role 4 facility with specialist services will be required. Within the field, early assessment using the above systems of classification could be achieved at Echelon / Role 3 and may be enhanced with the establishment of Radiation Assessment Units. These would select casualties that could benefit from the advanced therapies. A summary of the levels of care is shown in Figure 3.

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

    PubMed

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

    2011-04-01

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

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

    PubMed

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

    2009-02-01

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

  7. 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.

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-11-02

    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.

  10. 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

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

    PubMed Central

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

    2011-01-01

    Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

  12. [War casualty triage during the First World War].

    PubMed

    Ferrandis, Jean-Jacques; Lefort, Hugues; Tabbagh, Xavier; Pons, François

    2014-06-01

    Along with the front hospitals (HOE), the action of sorting out the injured was one of the most important innovations of the Great War. Progressively, it was implemented and codified on each level of the evacuating chain, with variations due to the different phases of the conflict, such as in Verdun or in the Somme. From 1917 onwards, specific sorting centers, managed by experimented soldiers, were set up in the evacuating hospitals.

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2008-01-01

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

  15. Effect of Triage Training on Concordance of Triage Level between Triage Nurses and Emergency Medical Technicians

    PubMed Central

    Ghanbarzehi, Nezare; Balouchi, Abbas; Darban, Fatemeh; Khayat, Nastaran Haydari

    2016-01-01

    Introduction The transfer of care occurs frequently between emergency medical technicians and emergency ward nurses during which emergency medical technicians transfer the patients from the society to the hospital. This transfer of care often occurs under crowded conditions and in high acuity which would pave the way for a disruption of communication. Aim This study aimed to investigate the effect of training Emergency Severity Index (ESI) triage on concordance of triage level between emergency medical technicians and triage nurses. Materials and Methods This interventional study was conducted on all triage nurses and emergency medical technicians in Iranshahr City in winter of 2014. Five triage nurses and 30 emergency medical technicians were included into the study using census. To collect data, Personal Information Form (PIF) and ESI Triage Criterion were used. During the project implementation, patients were separately classified before and after triage training by emergency medical technicians and triage nurses. To analyse the data, kappa coefficient under SPSS 16 statistical software was used. Results According to the study results, Cohen’s kappa concordance coefficient showed that triage concordance between emergency medical technicians and triage nurses before training was 0.20 which was at an unfavorable level. After training, Cohen’s kappa concordance coefficient reached 0.62, which showed a desirable level of concordance as well as a significant difference after training. Conclusion It is recommended to train and use common triage system to facilitate transfer or delivery of care between emergency medical technicians and triage nurses. PMID:27437243

  16. Triage as Urban Policy.

    ERIC Educational Resources Information Center

    Marcuse, Peter; And Others

    1982-01-01

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

  17. Orthopaedic management in a mega mass casualty situation. The Israel Defence Forces Field Hospital in Haiti following the January 2010 earthquake.

    PubMed

    Bar-On, Elhanan; Lebel, Ehud; Kreiss, Yitshak; Merin, Ofer; Benedict, Shaike; Gill, Amit; Lee, Evgeny; Pirotsky, Anatoly; Shirov, Taras; Blumberg, Nehemia

    2011-10-01

    Following the January 2010 earthquake in Haiti, the Israel Defence Forces (IDF) established a field hospital in Port au Prince. The hospital started operating 89 h after the earthquake. We describe the experience of the orthopaedic department in a field hospital operating in an extreme mass casualty situation. The hospital contained 4 operating table and 72 hospitalization beds. The orthopaedic department included 8 orthopaedic surgeons and 3 residents. 1111 patients were treated in the hospital, 1041 of them had adequate records for inclusion. 684 patients were admitted due to trauma with a total of 841 injuries. 320 patients sustained 360 fractures, 18 had joint dislocations and 22 patients were admitted after amputations. 207 patients suffered 315 soft tissue injuries. 221 patients were operated on under general or regional anaesthesia. External fixation was used for stabilization of 48 adult femoral shaft fractures, 24 open tibial fractures and 1 open humeral fracture. All none femoral closed fractures were treated non-operatively. 18 joint reductions and 23 amputations were performed. Appropriate planning, training, operational versatility, and adjustment of therapeutic guidelines according to a constantly changing situation, enabled us to deliver optimal care to the maximal number of patients, in an overwhelming mass trauma situation.

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

    PubMed

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

    2006-01-01

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

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

    PubMed

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

    2006-01-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

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

    2015-06-01

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

  2. The cape triage score: a new triage system South Africa. Proposal from the cape triage group

    PubMed Central

    Gottschalk, S B; Wood, D; DeVries, S; Wallis, L A; Bruijns, S

    2006-01-01

    The Cape Triage Group (CTG) convened with the intention of producing a triage system for the Western Cape, and eventually South Africa. The group includes in-hospital and prehospital staff from varied backgrounds. The CTG triage protocol is termed the Cape Triage Score (CTG), and has been developed by a multi-disciplinary panel, through best available evidence and expert opinion. The CTS has been validated in several studies, and was launched across the Western Cape on 1 January 2006. The CTG would value feedback from readers of this journal, as part of the ongoing monitoring and evaluation process. PMID:16439753

  3. "MedTRIS" (Medical Triage and Registration Informatics System): A Web-based Client Server System for the Registration of Patients Being Treated in First Aid Posts at Public Events and Mass Gatherings.

    PubMed

    Gogaert, Stefan; Vande Veegaete, Axel; Scholliers, Annelies; Vandekerckhove, Philippe

    2016-10-01

    First aid (FA) services are provisioned on-site as a preventive measure at most public events. In Flanders, Belgium, the Belgian Red Cross-Flanders (BRCF) is the major provider of these FA services with volunteers being deployed at approximately 10,000 public events annually. The BRCF has systematically registered information on the patients being treated in FA posts at major events and mass gatherings during the last 10 years. This information has been collected in a web-based client server system called "MedTRIS" (Medical Triage and Registration Informatics System). MedTRIS contains data on more than 200,000 patients at 335 mass events. This report describes the MedTRIS architecture, the data collected, and how the system operates in the field. This database consolidates different types of information with regards to FA interventions in a standardized way for a variety of public events. MedTRIS allows close monitoring in "real time" of the situation at mass gatherings and immediate intervention, when necessary; allows more accurate prediction of resources needed; allows to validate conceptual and predictive models for medical resources at (mass) public events; and can contribute to the definition of a standardized minimum data set (MDS) for mass-gathering health research and evaluation. Gogaert S , Vande veegaete A , Scholliers A , Vandekerckhove P . "MedTRIS" (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562.

  4. "MedTRIS" (Medical Triage and Registration Informatics System): A Web-based Client Server System for the Registration of Patients Being Treated in First Aid Posts at Public Events and Mass Gatherings.

    PubMed

    Gogaert, Stefan; Vande Veegaete, Axel; Scholliers, Annelies; Vandekerckhove, Philippe

    2016-10-01

    First aid (FA) services are provisioned on-site as a preventive measure at most public events. In Flanders, Belgium, the Belgian Red Cross-Flanders (BRCF) is the major provider of these FA services with volunteers being deployed at approximately 10,000 public events annually. The BRCF has systematically registered information on the patients being treated in FA posts at major events and mass gatherings during the last 10 years. This information has been collected in a web-based client server system called "MedTRIS" (Medical Triage and Registration Informatics System). MedTRIS contains data on more than 200,000 patients at 335 mass events. This report describes the MedTRIS architecture, the data collected, and how the system operates in the field. This database consolidates different types of information with regards to FA interventions in a standardized way for a variety of public events. MedTRIS allows close monitoring in "real time" of the situation at mass gatherings and immediate intervention, when necessary; allows more accurate prediction of resources needed; allows to validate conceptual and predictive models for medical resources at (mass) public events; and can contribute to the definition of a standardized minimum data set (MDS) for mass-gathering health research and evaluation. Gogaert S , Vande veegaete A , Scholliers A , Vandekerckhove P . "MedTRIS" (Medical Triage and Registration Informatics System): a web-based client server system for the registration of patients being treated in first aid posts at public events and mass gatherings. Prehosp Disaster Med. 2016;31(5):557-562. PMID:27499102

  5. The Haiti earthquake: the provision of wound care for mass casualties utilizing negative-pressure wound therapy.

    PubMed

    Gabriel, Allen; Gialich, Shelby; Kirk, Julie; Edwards, Sheriden; Beck, Brooke; Sorocéanu, Alexandra; Nelson, Scott; Gabriel, Cassie; Gupta, Subhas

    2011-10-01

    Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed. PMID:21926673

  6. The Haiti earthquake: the provision of wound care for mass casualties utilizing negative-pressure wound therapy.

    PubMed

    Gabriel, Allen; Gialich, Shelby; Kirk, Julie; Edwards, Sheriden; Beck, Brooke; Sorocéanu, Alexandra; Nelson, Scott; Gabriel, Cassie; Gupta, Subhas

    2011-10-01

    Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed.

  7. Tsunami Casualty Model

    NASA Astrophysics Data System (ADS)

    Yeh, H.

    2007-12-01

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

  8. Operation Desert Shield: medical aspects of weapons of mass destruction.

    PubMed

    Knudson, G B

    1991-06-01

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

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

    SciTech Connect

    Knudson, G.B. )

    1991-06-01

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

  10. Prairie North: a joint civilian/military mass casualty exercise highlights the role of the National Guard in community disaster response.

    PubMed

    Vukotich, George; Bayram, Jamil D; Miller, Miriam I

    2012-01-01

    In a joint military/civilian exercise conducted in June 2010, military National Guard medical and decontamination response efforts proved to be paramount in supporting hospital resources to sustain an adequate response during a simulated terrorist event. Traditionally, hospitals include local responders in their disaster preparedness but overlook other available state and federal resources such as the National Guard. Lessons learned from the exercise included the value of regular joint disaster planning and training between the military and civilian medical sectors. Additionally, military communication and medical equipment compatibility with the civilian infrastructure was identified as one of the top areas for the improvement of this joint exercise. Involving the National Guard in community disaster planning provides a valuable medical support asset that can be critical in responding to multiple casualty events. National Guard response is inherently faster than its federal counterpart. Based on the findings from our joint exercise, states are encouraged to incorporate their corresponding National Guard in civilian critical medical infrastructure disaster preparedness activities, as the National Guard can be an integral part of the disaster response efforts in real multiple casualty events.

  11. Prairie North: a joint civilian/military mass casualty exercise highlights the role of the National Guard in community disaster response.

    PubMed

    Vukotich, George; Bayram, Jamil D; Miller, Miriam I

    2012-01-01

    In a joint military/civilian exercise conducted in June 2010, military National Guard medical and decontamination response efforts proved to be paramount in supporting hospital resources to sustain an adequate response during a simulated terrorist event. Traditionally, hospitals include local responders in their disaster preparedness but overlook other available state and federal resources such as the National Guard. Lessons learned from the exercise included the value of regular joint disaster planning and training between the military and civilian medical sectors. Additionally, military communication and medical equipment compatibility with the civilian infrastructure was identified as one of the top areas for the improvement of this joint exercise. Involving the National Guard in community disaster planning provides a valuable medical support asset that can be critical in responding to multiple casualty events. National Guard response is inherently faster than its federal counterpart. Based on the findings from our joint exercise, states are encouraged to incorporate their corresponding National Guard in civilian critical medical infrastructure disaster preparedness activities, as the National Guard can be an integral part of the disaster response efforts in real multiple casualty events. PMID:22649870

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

    SciTech Connect

    Kruse, P.; Rojas-Palma, C.

    2007-07-01

    European national emergency response plans have long been focused on accidents at nuclear power plants. Recently, the possible threats by disaffected groups have shifted the focus to being prepared also for malevolent use of radiation that are aimed at creating disruption and panic in the society. The casualties will most likely be members of the public. According to the scenario, the number of affected people can vary from a few to mass casualties. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. There is a need to develop practicable tools for the adequate response to such acts and more specifically to address European guidelines for triage, monitoring and treatment of exposed people. Although European countries have developed emergency response plans for nuclear accidents they have not all made plans for handling malevolent use of radioactive material. Indeed, there is a need to develop practical guidance on emergency response and medical treatment of the public affected by malevolent acts. Generic guidance on this topic has been published by international organisations. They are, however, not operational documents to be used in emergency situations. The Triage, Monitoring and Treatment (TMT) Handbook aims to strengthen the European ability to efficiently respond to malevolent acts in terms of protecting and treating exposed people. Part of the Handbook is also devoted to public information and communication issues which would contribute to public reassurance in emergency situations. The Handbook will be drafted by European and international experts before it is circulated to all emergency response institutions in Europe that would be a part of the handling of malevolent acts using radioactive material. The institutions would be given a 6 months consultation time with encouragement to test the draft Handbook in national exercises. A workshop will allow feedback from these end users on the content

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

    PubMed

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

    2012-12-01

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

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

    PubMed

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

    2012-12-01

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

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

    PubMed

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

    2005-01-01

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

  16. Accountability Pressure, Academic Standards, and Educational Triage

    ERIC Educational Resources Information Center

    Lauen, Douglas Lee; Gaddis, S. Michael

    2012-01-01

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

  17. Emergency department triage: an ethical analysis

    PubMed Central

    2011-01-01

    Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach. PMID:21982119

  18. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  19. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  20. Improving competence in emergency mental health triage.

    PubMed

    Broadbent, M; Jarman, H; Berk, M

    2002-07-01

    The Emergency Department is an important contact point for people with mental health problems (Tobin et al. 1999, p. 2). The Barwon Health Emergency Department is no exception. Approximately 1000 clients per year, or 2.6% of the 38,000 people seen annually in the Barwon Health, Geelong Hospital Emergency Department present with a primary mental health complaint or associated issue. The triage scale used in the Emergency Department contained little guidance for the triage of clients with mental health problems. A triage scale specifically designed to highlight mental health emergencies was implemented and its impact on practice was assessed. Improvements in communication, nurses' confidence in triaging clients with mental health problems and time to intervention by mental health staff were made. This article describes the implementation and evaluation of a mental health triage scale and changes to practice that resulted.

  1. Nursing Software for Emergency Triage (NSET).

    PubMed

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

    2015-01-01

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

  2. Integration of Affinity Selection-Mass Spectrometry and Functional Cell-Based Assays to Rapidly Triage Druggable Target Space within the NF-κB Pathway.

    PubMed

    Kutilek, Victoria D; Andrews, Christine L; Richards, Matthew P; Xu, Zangwei; Sun, Tianxiao; Chen, Yiping; Hashke, Andrew; Smotrov, Nadya; Fernandez, Rafael; Nickbarg, Elliott B; Chamberlin, Chad; Sauvagnat, Berengere; Curran, Patrick J; Boinay, Ryan; Saradjian, Peter; Allen, Samantha J; Byrne, Noel; Elsen, Nathaniel L; Ford, Rachael E; Hall, Dawn L; Kornienko, Maria; Rickert, Keith W; Sharma, Sujata; Shipman, Jennifer M; Lumb, Kevin J; Coleman, Kevin; Dandliker, Peter J; Kariv, Ilona; Beutel, Bruce

    2016-07-01

    The primary objective of early drug discovery is to associate druggable target space with a desired phenotype. The inability to efficiently associate these often leads to failure early in the drug discovery process. In this proof-of-concept study, the most tractable starting points for drug discovery within the NF-κB pathway model system were identified by integrating affinity selection-mass spectrometry (AS-MS) with functional cellular assays. The AS-MS platform Automated Ligand Identification System (ALIS) was used to rapidly screen 15 NF-κB proteins in parallel against large-compound libraries. ALIS identified 382 target-selective compounds binding to 14 of the 15 proteins. Without any chemical optimization, 22 of the 382 target-selective compounds exhibited a cellular phenotype consistent with the respective target associated in ALIS. Further studies on structurally related compounds distinguished two chemical series that exhibited a preliminary structure-activity relationship and confirmed target-driven cellular activity to NF-κB1/p105 and TRAF5, respectively. These two series represent new drug discovery opportunities for chemical optimization. The results described herein demonstrate the power of combining ALIS with cell functional assays in a high-throughput, target-based approach to determine the most tractable drug discovery opportunities within a pathway. PMID:26969322

  3. The hematologist and radiation casualties.

    PubMed

    Dainiak, Nicholas; Waselenko, Jamie K; Armitage, James O; MacVittie, Thomas J; Farese, Ann M

    2003-01-01

    Since the terrorist attack of September 11, 2001, preparation by the health care system for an act of terrorism has been mandated by leaders of governments. Scenarios for terrorist acts involving radioactive material have been identified, and approaches to management (based on past experience from atomic weapons detonations and radiation accidents) have been developed. Because of their experience in managing patients with profound cytopenia and/or marrow aplasia, hematologists will be asked to play a significant role in evaluating and treating victims of mass accidental or deliberate exposure to radiation. This review provides a framework for understanding how radiation levels are quantified, how radiation alters the function of hematopoietic (and nonhematopoietic) cells and tissues, and how victims receiving a significant radiation dose can be identified and managed. In Section I, Dr. Nicholas Dainiak reviews four components of the Acute Radiation Syndrome: the hematopoietic, neurovascular, gastrointestinal and cutaneous subsyndromes. Clinical signs and symptoms are discussed for exposed individuals at the time of initial presentation (the prodromal phase) and during their course of disease (the manifest illness). In Section II, he presents clinical and laboratory methods to assess radiation doses, including time to onset and severity of vomiting, rate of decline in absolute blood lymphocyte count and the appearance of chromosome aberrations such as dicentrics and ring forms. Potential scenarios of a radiation terrorist event are reviewed, and methods for initial clinical assessment, triage, and early management of the acute radiation syndrome and its component subsyndromes are summarized. In Section III, Dr. Jamie Waselenko reviews the hematopoietic syndrome, and presents guidelines for the use of cytokine therapy, antibiotics, and supportive care that have been developed by the Strategic National Pharmaceutical Stockpile Working Group. Results of preclinical and

  4. What is orthopaedic triage? A systematic review

    PubMed Central

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

    2015-01-01

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

  5. Triage in medical practices: an unacceptable model?

    PubMed

    Bell, Nora K

    1981-12-01

    Two basic presuppositions of triage are challenged: the utilitarian notion that it is morally preferable to save the greater number, and the extension of the salvageability concept as a model for macroallocation of scarce medical resources. The 'more is better' principle lacks the status of a universal moral obligation and leads to an impersonal view of the valuing of life. In the allocation of scarce resources, triage is suspect since life-saving decisions involve medical, social, economic, and political criteria. Triage thus perpetuates existing injustices.

  6. Reducing uncertainty in triaging mental health presentations: examining triage decision-making.

    PubMed

    Brown, Anne-Marie; Clarke, Diana E

    2014-01-01

    Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses' decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage. In this paper, we review the current research regarding the effectiveness of triage tools particularly with mental health presentations, present a theoretical framework that may guide research in understanding how triage nurses approach decision-making, and apply that framework to thinking about research in mental health-related triage. Developing a better understanding of how triage nurses make decisions, particularly in situations where issues related to mental health and illness may raise the levels of uncertainty, is crucial to ensure that they have the skills and tools they need to provide the most effective, sensitive, and compassionate care possible.

  7. Eye casualty services in London

    PubMed Central

    Smith, H B; Daniel, C S; Verma, S

    2013-01-01

    The combined pressures of the European Working Time Directive, 4 h waiting time target, and growing rates of unplanned hospital attendances have forced a major consolidation of eye casualty departments across the country, with the remaining units seeing a rapid increase in demand. We examine the effect of these changes on the provision of emergency eye care in Central London, and see what wider lessons can be learned. We surveyed the managers responsible for each of London's 8 out-of-hours eye casualty services, analysed data on attendance numbers, and conducted detailed interviews with lead clinicians. At London's two largest units, Moorfields Eye Hospital and the Western Eye Hospital, annual attendance numbers have been rising at 7.9% per year (to 76 034 patients in 2010/11) and 9.6% per year (to 31 128 patients in 2010/11), respectively. Using Moorfields as a case study, we discuss methods to increase capacity and efficiency in response to this demand, and also examine some of the unintended consequences of service consolidation including patients travelling long distances to geographically inappropriate units, and confusion over responsibility for out-of-hours inpatient cover. We describe a novel ‘referral pathway' developed to minimise unnecessary travelling and delay for patients, and propose a forum for the strategic planning of London's eye casualty services in the future. PMID:23370420

  8. An Analysis of the Relationship between Casualty Risk Per Crash and Vehicle Mass and Footprint for Model Year 2000-2007 Light-Duty Vehicles

    SciTech Connect

    Wenzel, Tom

    2012-08-01

    NHTSA recently completed a logistic regression analysis (Kahane 2012) updating its 2003 and 2010 studies of the relationship between vehicle mass and US fatality risk per vehicle mile traveled (VMT). The new study updates the previous analyses in several ways: updated FARS data for 2002 to 2008 involving MY00 to MY07 vehicles are used; induced exposure data from police reported crashes in several additional states are added; a new vehicle category for car-based crossover utility vehicles (CUVs) and minivans is created; crashes with other light-duty vehicles are divided into two groups based on the crash partner vehicle’s weight, and a category for all other fatal crashes is added; and new control variables for new safety technologies and designs, such as electronic stability controls (ESC), side airbags, and methods to meet voluntary agreement to improve light truck compatibility with cars, are included.

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

    PubMed

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

    2015-01-01

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

  10. A pivot nurse at triage.

    PubMed

    Martin, Marie

    2012-01-01

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

  11. Mental health triage nursing: an Australian perspective.

    PubMed

    Sands, N

    2004-04-01

    This paper presents the findings of a doctoral research project that involved a state-wide investigation into mental health triage nursing in Victoria, Australia. Mental health triage is a specialized domain of nursing practice that has emerged within the context of wider mental health reform in the State. The overall aim of the study was to produce a comprehensive definition and description of psychiatric triage nursing in Victoria. Methodological triangulation was used in the design of the study to enable the use of both survey (n = 139) and semi-structured interview (n = 21) data collection methods. Mental health triage nursing was found to be a complex, stressful role that involves high levels of responsibility, clinical decision making, and multiple role functions, many of which overlap into areas of practice previously the exclusive domain of medicine, such as assessment, diagnosis, and referral. The paper raises discussion on contemporary professional issues of concern to mental health triage nursing, and concludes with recommendations for the future development of the discipline.

  12. 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. PMID:17003206

  13. Toxicokinetic Triage for Environmental Chemicals.

    PubMed

    Wambaugh, John F; Wetmore, Barbara A; Pearce, Robert; Strope, Cory; Goldsmith, Rocky; Sluka, James P; Sedykh, Alexander; Tropsha, Alex; Bosgra, Sieto; Shah, Imran; Judson, Richard; Thomas, Russell S; Setzer, R Woodrow

    2015-09-01

    Toxicokinetic (TK) models link administered doses to plasma, blood, and tissue concentrations. High-throughput TK (HTTK) performs in vitro to in vivo extrapolation to predict TK from rapid in vitro measurements and chemical structure-based properties. A significant toxicological application of HTTK has been "reverse dosimetry," in which bioactive concentrations from in vitro screening studies are converted into in vivo doses (mg/kg BW/day). These doses are predicted to produce steady-state plasma concentrations that are equivalent to in vitro bioactive concentrations. In this study, we evaluate the impact of the approximations and assumptions necessary for reverse dosimetry and develop methods to determine whether HTTK tools are appropriate or may lead to false conclusions for a particular chemical. Based on literature in vivo data for 87 chemicals, we identified specific properties (eg, in vitro HTTK data, physico-chemical descriptors, and predicted transporter affinities) that correlate with poor HTTK predictive ability. For 271 chemicals we developed a generic HT physiologically based TK (HTPBTK) model that predicts non-steady-state chemical concentration time-courses for a variety of exposure scenarios. We used this HTPBTK model to find that assumptions previously used for reverse dosimetry are usually appropriate, except most notably for highly bioaccumulative compounds. For the thousands of man-made chemicals in the environment that currently have no TK data, we propose a 4-element framework for chemical TK triage that can group chemicals into 7 different categories associated with varying levels of confidence in HTTK predictions. For 349 chemicals with literature HTTK data, we differentiated those chemicals for which HTTK approaches are likely to be sufficient, from those that may require additional data.

  14. 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.

  15. Infrared imaging-based combat casualty care system

    NASA Astrophysics Data System (ADS)

    Davidson, James E., Sr.

    1997-08-01

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

  16. Adaption of the Cytokinesis-Block Micronucleus Cytome Assay for Improved Triage Biodosimetry.

    PubMed

    Beinke, C; Port, M; Riecke, A; Ruf, C G; Abend, M

    2016-05-01

    The purpose of this work was to adapt a more advanced form of the cytokinesis-block micronucleus (CBMN) cytome assay for triage biodosimetry in the event of a mass casualty radiation incident. We modified scoring procedures for the CBMN cytome assay to optimize field deployability, dose range, accuracy, speed, economy, simplicity and stability. Peripheral blood of 20 donors was irradiated in vitro (0-6 Gy X ray, maximum photon energy 240 keV) and processed for CBMN. Initially, we assessed two manual scoring strategies for accuracy: 1. Conventional scoring, comprised of micronucleus (MN) frequency per 1,000 binucleated (BN) cells (MN/1,000 BN cells); and 2. Evaluation of 1,000, 2,000 and 3,000 cells in total and different cellular subsets based on MN formation and proliferation (e.g., BN cells with and without MN, mononucleated cells). We used linear and logistic regression models to identify the cellular subsets related closest to dose with the best discrimination ability among different doses/dose categories. We validated the most promising subsets and their combinations with 16 blind samples covering a dose range of 0-8.3 Gy. Linear dose-response relationships comparable to the conventional CBMN assay (r(2) = 0.86) were found for BN cells with MN (r(2) = 0.84) and BN cells without MN (r(2) = 0.84). Models of combined cell counts (CCC) of BN cells with and without MN (BN(+MN) and BN(-MN)) with mononucleated cells (Mono) improved this relationship (r(2) = 0.92). Conventional CBMN discriminated dose categories up to 3 Gy with a concordance between 0.96-1.0 upon scoring 1,000 total cells. In 1,000 BN cells, concordances were observed for conventional CBMN up to 4 Gy as well as BN(+MN) or BN(-MN) (about 0.85). At doses of 4-6 Gy, the concordance of conventional CBMN, BN(+MN) and BN(-MN) declined (about 0.55). We found about 20% higher concordance and more precise dose estimates of irradiated and blinded samples for CCC (Mono + BN(+MN)) after scoring 1,000 total cells

  17. Factors influencing triage decisions in mental health services.

    PubMed

    Grigg, Margaret; Herrman, Helen; Harvey, Carol; Endacott, Ruth

    2007-05-01

    The aim of the study was to identify the factors influencing the timing of an assessment after contact with a triage program in a community-based area mental health service in Australia. Triage decisions apparently were influenced by several groups of factors: patient characteristics; the source and mode of the contact with triage; and to a large extent by mental health service factors including the training, supervision and support of triage workers and the perceived availability of an assessment. While demand factors such as patient characteristics influenced the triage decision, supply factors also played an important role.

  18. Breast clinic triage tool: telephone assessment of new referrals.

    PubMed

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

    2012-04-01

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

  19. Triage teams are a streetwise success story.

    PubMed

    Cole, Elaine

    2014-11-01

    There is concern that large numbers of people with mental health problems are detained in police cells after showing signs of crisis in public. In some parts of England, street triage teams of mental health nurses and police officers working in partnership appear to have had great success in reducing detentions and ensuring appropriate care.

  20. Accountability Incentives: Do Schools Practice Educational Triage?

    ERIC Educational Resources Information Center

    Springer, Matthew G.

    2008-01-01

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

  1. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  2. 48 CFR 552.270-7 - Fire and Casualty Damage.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Fire and Casualty Damage... Fire and Casualty Damage. As prescribed in 570.703, insert the following clause: Fire and Casualty Damage (JUN 2011) If the entire premises are destroyed by fire or other casualty, this lease...

  4. 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...

  5. 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...

  6. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 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...

  7. 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...

  8. 46 CFR 4.03-1 - Marine casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 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...

  9. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Report of casualty or accident. 173.55 Section 173.55 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or...

  10. [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. PMID:25464629

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

    PubMed

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

    2013-01-01

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

  12. Deployed Assessment and Management of mTBI Casualties.

    PubMed

    Garfin, Benjamin

    2013-01-01

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

  13. An examination of telephone triage in a mental health context.

    PubMed

    Kevin, Jim

    2002-12-01

    Mental health triage is performed via the telephone in some institutions. The process by which an accurate mental health assessment can be made over the phone has not been documented in the literature. Telephone triage has only been comprehensively investigated within the context of Accident and Emergency departments. This paper provides a summary of the main issues that arise from this literature and then provides a number of research questions that can be directed toward telephone triage in a mental health context.

  14. An ethnographic study of three mental health triage programs.

    PubMed

    Grigg, Margaret; Endacott, Ruth; Herrman, Helen; Harvey, Carol

    2004-09-01

    Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services.

  15. The Role of Patients' Stories in Emergency Medicine Triage.

    PubMed

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience. PMID:26882466

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

    PubMed Central

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

    2014-01-01

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

  17. 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.

  18. Diagnostic triage for sarcoma: an effective model for reducing referrals to the sarcoma multidisciplinary team

    PubMed Central

    Botchu, R; Ashford, R U; Rennie, W J

    2015-01-01

    Objective: Soft-tissue lesions are common and often benign. Owing to the rarity of soft-tissue sarcomas (STSs), evidence has shown that patients are increasingly referred urgently onto the 2-week wait pathway, which may have a detrimental impact on the management of patients with a proven STS. Imaging plays a vital role in lesion characterization and can be used to triage referrals to reduce the caseload of a sarcoma multidisciplinary team (MDT). In our institution, we established a sarcoma diagnostic triage meeting (SDTM). This study aimed to determine the effectiveness of the SDTM in reducing non-sarcomatous referrals to the main sarcoma MDT. Methods: A retrospective review of the SDTM minutes from July 2011 to June 2012 was performed. Data collected for each case included details of referrer, referral modality and referral outcome. Results: 165 cases were reviewed. 58% of referrals underwent a core biopsy or surgical excision with 85% benign pathology, the commonest being lipoma. 15% of referrals were sarcomatous lesions and were referred onwards to the main MDT. Conclusion: A total of 82% of the patients referred urgently with a suspicious soft-tissue mass was managed by the SDTM and hence not referred onwards to the East Midlands Sarcoma Service MDT. A diagnostic triage is effective in reducing the caseload burden of the main MDT and allowing it to be more effective. Advances in knowledge: Referrals based on imaging can be prioritized by diagnostic triage. Diagnostic triage established in our institution reduced 82% of MDT referrals allowing a more focused MDT discussion on patients with a proven sarcoma. PMID:25697295

  19. Simulated casualties and medics for emergency training.

    PubMed

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

    1997-01-01

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

  20. 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...

  1. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the vessel at the time of the casualty; (8) The weather conditions at the time of the casualty, if the weather caused or contributed to the cause of the casualty; (9) The damages to or by the vessel, its... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  2. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the vessel at the time of the casualty; (8) The weather conditions at the time of the casualty, if the weather caused or contributed to the cause of the casualty; (9) The damages to or by the vessel, its... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  3. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the vessel at the time of the casualty; (8) The weather conditions at the time of the casualty, if the weather caused or contributed to the cause of the casualty; (9) The damages to or by the vessel, its... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  4. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the vessel at the time of the casualty; (8) The weather conditions at the time of the casualty, if the weather caused or contributed to the cause of the casualty; (9) The damages to or by the vessel, its... commercial fishing industry vessel must be reported to an organization that has knowledge and experience...

  5. 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,...

  6. 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...

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

    PubMed Central

    2011-01-01

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

  8. Disaster triage after the Haitian earthquake.

    PubMed

    Smith, R M; Dyer, G S M; Antonangeli, K; Arredondo, N; Bedlion, H; Dalal, A; Deveny, G M; Joseph, G; Lauria, D; Lockhart, S H; Lucien, S; Marsh, S; Rogers, S O; Salzarulo, H; Shah, S; Toussaint, R J; Wagoner, J

    2012-11-01

    In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future.

  9. 'Smart card' speeds triage, boosts safety.

    PubMed

    2008-10-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  11. Mental health triage: towards a model for nursing practice.

    PubMed

    Sands, N

    2007-05-01

    Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.

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

    ERIC Educational Resources Information Center

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

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

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

    PubMed

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

    2011-11-01

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

  14. [Preclinical and clinical management after mass disaster : Experiences from the train collision in Bad Aibling on 9 February 2016].

    PubMed

    Regel, G; Bracht, M; Huth, M; Maier, K J; Böcker, W

    2016-06-01

    Mass casualty incidents (MCI) in this day and age represent a special challenge, which initially require on-site coordination and logistics and then a professional distribution of victims (triage) to surrounding hospitals. Technical, logistical and even specialist errors can impair this flow of events. It therefore seems advisable to make a detailed analysis of every MCI. In this article the railway incident from 9 February 2016 is analyzed taking the preclinical and clinical cirumstances into consideration and conclusions for future management are drawn. As a special entity it could be determined that fixed table units in passenger trains represent a particularly dangerous hazard and in many instances in this analysis led to characteristic abdominal and thoracic injuries. PMID:27225168

  15. [Preclinical and clinical management after mass disaster : Experiences from the train collision in Bad Aibling on 9 February 2016].

    PubMed

    Regel, G; Bracht, M; Huth, M; Maier, K J; Böcker, W

    2016-06-01

    Mass casualty incidents (MCI) in this day and age represent a special challenge, which initially require on-site coordination and logistics and then a professional distribution of victims (triage) to surrounding hospitals. Technical, logistical and even specialist errors can impair this flow of events. It therefore seems advisable to make a detailed analysis of every MCI. In this article the railway incident from 9 February 2016 is analyzed taking the preclinical and clinical cirumstances into consideration and conclusions for future management are drawn. As a special entity it could be determined that fixed table units in passenger trains represent a particularly dangerous hazard and in many instances in this analysis led to characteristic abdominal and thoracic injuries.

  16. An exploration of clinical decision making in mental health triage.

    PubMed

    Sands, Natisha

    2009-08-01

    Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

  17. Application of topical analgesia in triage: a potential for harm.

    PubMed

    Shachor-Meyouhas, Yael; Galbraith, Roger; Shavit, Itai

    2008-07-01

    To reduce the overall time spent in the ED, triage nurses are encouraged to treat patients with a topical anesthetic cream, eutectic mixture of local anesthetics (EMLA). We present a case in which a 28-day-old neonate who was treated with EMLA cream in triage developed severe methemoglobinemia 18 hours post admission to the pediatric ward. This case demonstrates that there may be some risks associated with this approach, and that protocols for the use of EMLA at triage should include not only the indications for its use, but also need to ensure that there is a process to have the EMLA removed before patient discharge or transfer. PMID:18281179

  18. The effects of computerized triage on nurse work behavior.

    PubMed

    Levin, Scott; France, Daniel; Mayberry, R Scott; Stonemetz, Shannon; Jones, Ian; Aronsky, Dominik

    2006-01-01

    The complex work processes and communication patterns exhibited in Emergency Medicine may be effectively managed through the use of information technology. These tools must be evaluated within the work environment to understand their effects on work flow, information flow, and patient safety. In this study the efficiency of the Emergency Department triage process was evaluated pre- and post- implementation of a computerized triage system. Time-and-motion analyses revealed no changes in triage documentation time; however, the duration of interruptions and the number of tasks decreased significantly. PMID:17238624

  19. Triage nurse's assessment of a child with a fever.

    PubMed

    Knight, Angela

    2015-05-01

    Fever in children is a common presentation to the emergency department and in most instances has no adverse consequences. The role of the triage nurse is to have thorough knowledge of up to date practices in caring for the child with fever, and to accurately assess and manage the child. Using evidence based practice to apply appropriate triage categories, effective care including accurate and informed education of parents. Every nurse working on triage should maintain current knowledge and have continuous education concerning the child with fever and the unwell child to promote best patient outcomes and maintain best practice standards.

  20. Triage and initial treatment of burns in the Gothenburg fire disaster 1998. On-call plastic surgeons' experiences and lessons learned.

    PubMed

    Gewalli, Fredrik; Fogdestam, Ingemar

    2003-01-01

    Just before midnight on the 29 October 1998 the on-call plastic surgeons were alarmed because of a fire accident thought to involve a few burned patients. Quite soon the information suggested an in-door fire disaster in which many of the 400 young people visiting a disco were caught by a rapidly spreading fire. A cross-sectional survey of the resulting overload, triage and initial treatment of burns was analysed. Two-hundred and thirteen patients were transported to the four hospitals in Gothenburg area and a total of 150 were admitted as inpatients, 73 to Sahlgrenska University Hospital. The initial organisation at the scene of the fire was seriously inadequate because of incorrect information about the number of casualties. As there was no triage officer the principle of "scoop and run" was practised, placing the major burden on the receiving hospitals. The emergency disaster plan in our hospital was not launched, because of misinformation and lack of communication. Early documentation in emergency case books was incomplete as the whole organisation was overloaded. Intubation or tracheostomy and escharotomy at the intensive care unit were not delayed. Triage for transportation to burns units was adequate.

  1. Hospital preparedness for possible nonconventional casualties: an Israeli experience.

    PubMed

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

    2004-01-01

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

  2. Responding to and managing casualties: detection, personal protection, and decontamination.

    PubMed

    Lepler, Lawrence; Lucci, Edward

    2004-03-01

    Unfortunately, a mass casualty caused by chemical or biologic terrorism has become a real threat to the United States. A well-considered preparedness plan is needed to minimize tOe impact of a chemical or biologic attack on civilians and responders. This article describes some of the key elements in a preparedness plan, specifically issues regarding early detection, decontamination. and personal protection. Although chemical and biologic terrorism is often considered as a single entity, there are important distinctions in detection, decontamination, and personal protection procedures that effect preparedness planning. Therefore, any preparedness plan needs to be flexible enough to deal with both biologic and chemical terrorism. Preparedness plans also need to be thorough enough to deal with the differences in response to a variety of specific chemical or biologic agents. PMID:15062224

  3. Chemically contaminated casualties: different problems and possible solutions.

    PubMed

    Scanlon, Joseph

    2010-01-01

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

  4. Web-Based Triage in a College Health Setting

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  5. Analysis of driver casualty risk for different work zone types.

    PubMed

    Weng, Jinxian; Meng, Qiang

    2011-09-01

    Using driver casualty data from the Fatality Analysis Report System, this study examines driver casualty risk and investigates the risk contributing factors in the construction, maintenance and utility work zones. The multiple t-tests results show that the driver casualty risk is statistically different depending on the work zone type. Moreover, construction work zones have the largest driver casualty risk, followed by maintenance and utility work zones. Three separate logistic regression models are developed to predict driver casualty risk for the three work zone types because of their unique features. Finally, the effects of risk factors on driver casualty risk for each work zone type are examined and compared. For all three work zone types, five significant risk factors including road alignment, truck involvement, most harmful event, vehicle age and notification time are associated with increased driver casualty risk while traffic control devices and restraint use are associated with reduced driver casualty risk. However, one finding is that three risk factors (light condition, gender and day of week) exhibit opposing effects on the driver casualty risk in different types of work zones. This may largely be due to different work zone features and driver behavior in different types of work zones.

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

    PubMed

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

    2009-01-23

    In the United States, injury is the leading cause of death for persons aged 1--44 years, and the approximately 800,000 emergency medical services (EMS) providers have a substantial impact on the care of injured persons and on public health. At an injury scene, EMS providers determine the severity of injury, initiate medical management, and identify the most appropriate facility to which to transport the patient through a process called "field triage." Although basic emergency services generally are consistent across hospital emergency departments (EDs), certain hospitals have additional expertise, resources, and equipment for treating severely injured patients. Such facilities, called "trauma centers," are classified from Level I (centers providing the highest level of trauma care) to Level IV (centers providing initial trauma care and transfer to a higher level of trauma care if necessary) depending on the scope of resources and services available. The risk for death of a severely injured person is 25% lower if the patient receives care at a Level I trauma center. However, not all patients require the services of a Level I trauma center; patients who are injured less severely might be served better by being transported to a closer ED capable of managing milder injuries. Transferring all injured patients to Level I trauma centers might overburden the centers, have a negative impact on patient outcomes, and decrease cost effectiveness. In 1986, the American College of Surgeons developed the Field Triage Decision Scheme (Decision Scheme), which serves as the basis for triage protocols for state and local EMS systems across the United States. The Decision Scheme is an algorithm that guides EMS providers through four decision steps (physiologic, anatomic, mechanism of injury, and special considerations) to determine the most appropriate destination facility within the local trauma care system. Since its initial publication in 1986, the Decision Scheme has been revised

  7. Multibiodose radiation emergency triage categorization software.

    PubMed

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

    2014-07-01

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

  8. Validation of the Alder Hey Triage Pain Score

    PubMed Central

    Stewart, B; Lancaster, G; Lawson, J; Williams, K; Daly, J

    2004-01-01

    Aims: To describe the validation and reliability of a new pain tool (the Alder Hey Triage Pain Score, AHTPS) for children at triage in the accident and emergency (A&E) setting. Methods: A new behavioural observational pain tool was developed because of dissatisfaction with available tools and a lack of confidence in self-assessment scores at triage. The study was conducted in a large paediatric A&E department; 575 children (aged 0–16 years) were included. Inter-rater reliability and various aspects of validity were assessed. In addition this tool was compared to the Wong-Baker self-assessment tool.1 The children were concurrently scored by a research nurse and triage nurses to assess inter-rater reliability. Construct validity was assessed by comparing the research nurse's triage score with the research nurse reassessment score after intervention and/or analgesia. Known group construct validity was assessed by comparing the research nurse's score at triage with the level of pain of the condition as judged by the discharge diagnosis. Predictive validity was assessed by comparing the research nurse's AHTPS with the level of analgesia needed by each patient. The AHTPS was also compared to a self-assessment score. Results: A high level of inter-rater reliability, kappa statistic 0.84 (95% CI 0.80 to 0.88), was shown. Construct validity was well demonstrated; known group construct validity and predictive validity were also demonstrated to a varying degree. Conclusions: Results support the use of this observational pain scoring tool in the triage of children in A&E. PMID:15210492

  9. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Operations § 169.807 Notice of casualty. (a) The owner, agent, master, or person in charge of a vessel..., agent, master, or other person in charge of any vessel involved in a marine casualty shall retain for..., navigation charts, navigation work books, compass deviation cards, gyrocompass records, record of draft,...

  10. 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....

  11. 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....

  12. 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....

  13. 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....

  14. 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....

  15. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 7 2012-10-01 2012-10-01 false Written report of casualty. 197.486 Section 197.486... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a...

  16. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Written report of casualty. 197.486 Section 197.486... STANDARDS GENERAL PROVISIONS Commercial Diving Operations Records § 197.486 Written report of casualty. The... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a...

  17. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  18. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  19. 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…

  20. 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... occurs, as follows: (a) On Form CG-2692, when the diving installation is on a vessel. (b) Using a...

  1. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED... loss sustained results from a single casualty. Similarly, if a hurricane causes high waves, all...

  2. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED... loss sustained results from a single casualty. Similarly, if a hurricane causes high waves, all...

  3. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED... loss sustained results from a single casualty. Similarly, if a hurricane causes high waves, all...

  4. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 2 2014-04-01 2014-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED... loss sustained results from a single casualty. Similarly, if a hurricane causes high waves, all...

  5. 26 CFR 1.165-7 - Casualty losses.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Casualty losses. 1.165-7 Section 1.165-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED... loss sustained results from a single casualty. Similarly, if a hurricane causes high waves, all...

  6. The development and use of mental health triage scales in Australia.

    PubMed

    Broadbent, Marc; Moxham, Lorna; Dwyer, Trudy

    2007-12-01

    In Australian emergency departments, the triage of people with physical illness and injury is well developed and supported by the Australasian Triage Scale. The Australasian Triage Scale contains brief descriptors of mental illness and it is unknown if these provide the same reliability in triage decision-making for emergency triage nurses assessing people with a mental illness. Specialist mental health triage scales have been developed to cater for this deficit and to aid emergency staff who have lacked training in the assessment and management of people with a mental illness. A review of the development of mental health triage scales and their use in Australia identifies that using a mental health triage scale improves the competence and confidence of emergency department staff in triaging people with mental illness. Despite this, there is no consistent national approach to the emergency triage of people with a mental illness. There is ad hoc use of mental health triage scales and there are few reports of improvements in service provision to this client group as a result of the use of a mental health triage scale. These findings suggest that despite the intentions of the National Mental Health Strategy, a lack of equity remains in emergency departments in the provision of care to people with a mental illness who make up one in five of adult Australians. Consideration should be given to the introduction of a national approach to the use of a mental health triage scale in Australian emergency departments.

  7. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    PubMed

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

    2015-03-01

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

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

    NASA Astrophysics Data System (ADS)

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

    1999-07-01

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

  9. A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

    PubMed

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

    2015-03-01

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

  10. Higher Education: A Time for Triage?

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

  11. Effective Spine Triage: Patterns of Pain

    PubMed Central

    Hall, Hamilton

    2014-01-01

    Background The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. Methods Identifying a patient's pain pattern is achieved primarily through an assessment of the patient's history. The patient interview begins with a series of questions to determine the specific syndrome. A subsequent physical examination supports or refutes the findings in history. Combining information from the history with the findings of the physical examination, the clinician has the ability to rule out a number of potentially grim diagnoses. Results More than 90% of back pain patients have benign mechanical problems and their pain can be classified into 4 distinct patterns: 2 back-dominant patterns and 2 leg-dominant patterns. Conclusion A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care. PMID:24688339

  12. Higher Education: A Time for Triage?

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

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

    PubMed Central

    2013-01-01

    Background Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Methods Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. Results In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. Conclusions A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system. PMID:24079719

  14. Emergency department mental health triage consultancy service: a qualitative evaluation.

    PubMed

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

    2003-07-01

    This study evaluated staff perception of a three-month clinical trial of an emergency mental health triage and consultancy service. Eleven night duty emergency department (ED) staff were interviewed on the last night of the trial. Data was analysed according to the standards of qualitative research and through content analysis major themes were identified. Staff-perceived value of the emergency mental health triage and consultancy service to the emergency department was identified under three major themes: "enhancing the quality of service for people requiring psychiatric/psychosocial intervention", "the impact on the ED environment" and "providing education and support". The findings of this study show that ED staff perceived that the emergency mental health triage and consultancy service made a valuable contribution to the overall functioning of the ED. The findings also highlight the advanced practice role undertaken by mental health nurses in the ED.

  15. Disaster triage systems for large-scale catastrophic events.

    PubMed

    Bostick, Nathan A; Subbarao, Italo; Burkle, Frederick M; Hsu, Edbert B; Armstrong, John H; James, James J

    2008-09-01

    Large-scale catastrophic events typically result in a scarcity of essential medical resources and accordingly necessitate the implementation of triage management policies to minimize preventable morbidity and mortality. Accomplishing this goal requires a reconceptualization of triage as a population-based systemic process that integrates care at all points of interaction between patients and the health care system. This system identifies at minimum 4 orders of contact: first order, the community; second order, prehospital; third order, facility; and fourth order, regional level. Adopting this approach will ensure that disaster response activities will occur in a comprehensive fashion that minimizes the patient care burden at each subsequent order of intervention and reduces the overall need to ration care. The seamless integration of all orders of intervention within this systems-based model of disaster-specific triage, coordinated through health emergency operations centers, can ensure that disaster response measures are undertaken in a manner that is effective, just, and equitable. PMID:18769264

  16. Decontamination of multiple casualties who are chemically contaminated: a challenge for acute hospitals.

    PubMed

    Clarke, Simon F J; Chilcott, Rob P; Wilson, James C; Kamanyire, Robie; Baker, David J; Hallett, Anthony

    2008-01-01

    Patients who have been contaminated by chemical compounds present a number of difficulties to emergency departments, in particular, the risk of secondary contamination of healthcare staff and facilities. The Department of Health in the United Kingdom has provided equipment to decontaminate chemically contaminated casualties who present at emergency departments. The capacity of this equipment is limited, and although both the ambulance and fire services have equipment to cope with mass casualties at the scene of a chemical incident, there is still the possibility that acute hospitals will be overwhelmed by large numbers of self-presenting patients. The risks and potential consequences of this gap in resilience are discussed and a number of possible practical solutions are proposed.

  17. Competitive concerns bring PAs, NPs into triage area.

    PubMed

    2008-06-01

    The ED at Harborview Medical Center in Seattle has proven new competition doesn't have to mean a loss of business or staff members. They moved physician assistants (PAs) and nurse practitioners (NPs) into triage to compete with urgent care clinics. When you have a hard time attracting midlevel practitioners, examine the local market to see who is recruiting them. Create a small, separate area in triage where midlevel practitioners can treat patients with less serious conditions. Be flexible with the number of hours the PAs and NPs work. Be prepared to expand their hours as demand increases. PMID:18807298

  18. EKG at triage slashes door-to-aspirin time.

    PubMed

    2006-09-01

    Giving all chest pain patients an electrocardiogram (EKG) in triage can significantly improve treatment times and quality of care and it eliminates the need to prioritize patients and takes undue pressure off the nurses, ED managers say. Triage delays in chest pain evaluation are eliminated by giving all patients the same treatment. Time to first aspirin at one hospital was slashed from 67 minutes to eight minutes. Asking nurses to differentiate patients on the basis of an interview and a set of vitals is unrealistic, managers say.

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

    PubMed

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

    2012-01-01

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

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

    PubMed

    Qureshi, N A

    2010-06-01

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

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

    PubMed Central

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Myer, Rick A.; And Others

    1992-01-01

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

  3. Emergency department mental health triage scales improve outcomes.

    PubMed

    Broadbent, Marc; Jarman, Heather; Berk, Michael

    2004-02-01

    The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients' reactions to the impact of this change to service delivery in future evaluations.

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

    PubMed

    Roberts, J

    1998-04-01

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

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

    PubMed

    Roberts, J

    1998-04-01

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

  6. Therapeutic Assessment in Psychological Triage Using the PAI.

    PubMed

    Brown, Joshua D; Morey, Leslie C

    2016-01-01

    This case illustrates the utility of incorporating therapeutic assessment in a triage context that typically involves a focus on gathering information. A man referred to our clinic by a local mental health center was seen by our assessment team for a triage that includes the administration of a single psychological test, the Personality Assessment Inventory (PAI). Although this triage must rapidly gather information to determine client suitability and treatment assignment, we still attempt to work with clients to collaboratively develop goals for this assessment that include addressing questions that are central concerns for the clients. In this case, the test results suggested a severe disorder that accounted for many phenomena that he had been experiencing but had apparently been reluctant to share. The information gathered led to a referral to a different treatment program that could provide pharmacological and more intensive forms of treatment. However, the collaborative bond formed between the assessor and the client during this triage was sufficiently strong that it was our assessor to whom the client turned in a subsequent crisis precipitated by a symptomatic exacerbation. This case illustrates complementary information gathering and therapeutic goals of assessment even in the context of a brief assessment. PMID:26730992

  7. Validation of the Hong Kong accident and emergency triage guidelines.

    PubMed

    Fan, Mandy M W; Leung, L P

    2013-06-01

    OBJECTIVE. To validate the Hong Kong Accident and Emergency Triage guidelines. DESIGN. Retrospective chart review. SETTING. The Accident and Emergency Department of a tertiary hospital in Hong Kong. PARTICIPANTS. Patients who attended the Accident and Emergency Department on one day in February 2012. MAIN OUTCOME MEASURES. The inter-rater reliability in two pairs of nurses grouped according to experience and validity as compared with an expert panel. RESULTS. Of the 100 patients recruited and triaged into levels 1 to 5, the weighted kappa coefficient (inter-rater reliability) for the two pairs of nurses was 0.699 and 0.717, respectively. The weighted kappa coefficient for validity was 0.766. When only patients in triage levels 3 and 4 were included, the weighted kappa coefficient for reliability dropped to 0.632 and 0.585, respectively. The weighted kappa coefficient for validity also decreased to 0.558. CONCLUSIONS. The overall inter-rater reliability and validity of the Guidelines appeared acceptable. Further revision of the Guidelines on triaging patients to levels 3 or 4 is probably necessary. PMID:23568939

  8. Implementation of a Pediatric Emergency Triage System in Xiamen, China

    PubMed Central

    Lin, Gang-Xi; Yang, Yin-Ling; Kudirka, Denise; Church, Colleen; Yong, Collin K K; Reilly, Fiona; Zeng, Qi-Yi

    2016-01-01

    Background: Pediatric emergency rooms (PERs) in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians. The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system (CPETS), modeled after the Canadian Triage System and Acuity Scale. Methods: In this study, we compared CPETS outcomes in our PER relative to those of the prior two-level system. Patients who visited our PER before (January 2013–June 2013) and after (January 2014–June 2014) the CPETS was implemented served as the control and experimental group, respectively. Patient flow, triage rates, triage accuracy, wait times (overall and for severe patients), and patient/family satisfaction were compared between the two groups. Results: Relative to the performance of the former system experienced by the control group, the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER (Cox-Stuart test, t = 0, P < 0.05), a higher triage rate (93.40% vs. 90.75%; χ2 = 801.546, P < 0.001), better triage accuracy (96.32% vs. 85.09%; χ2 = 710.904, P < 0.001), shorter overall wait times (37.30 ± 13.80 min vs. 41.60 ± 15.40 min; t = 11.27, P < 0.001), markedly shorter wait times for severe patients (2.07 [0.65, 4.11] min vs. 3.23 [1.90,4.36] min; z = –2.057, P = 0.040), and higher family satisfaction rates (94.23% vs. 92.21%; χ2 = 321.528, P < 0.001). Conclusions: Implementing the CPETS improved nurses’ abilities to triage severe patients and, thus, to deliver the urgent treatments more quickly. The system shunted nonurgent patients to outpatient care effectively, resulting in improved efficiency of PER health-care delivery. PMID:27748332

  9. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  10. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  11. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  12. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  13. 46 CFR 197.488 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  14. Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

    PubMed Central

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

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

    PubMed

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

    2012-08-01

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

  16. The Atomic Bomb Casualty Commission in retrospect.

    PubMed

    Putnam, F W

    1998-05-12

    For 50 years, the Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation (RERF), have conducted epidemiological and genetic studies of the survivors of the atomic bombs and of their children. This research program has provided the primary basis for radiation health standards. Both ABCC (1947-1975) and RERF (1975 to date) have been a joint enterprise of the United States (through the National Academy of Sciences) and of Japan. ABCC began in devastated, occupied Japan. Its mission had to be defined and refined. Early research revealed the urgent need for long term study. In 1946, a Directive of President Truman enjoined the National Research Council of the National Academy of Sciences to develop the program. By 1950, ABCC staff exceeded 1,000, and clinical and genetic studies were underway. Budgetary difficulties and other problems almost forced closure in 1953. In 1955, the Francis Report led to a unified epidemiological study. Much progress was made in the next decade, but changing times required founding of a binational nonprofit organization (RERF) with equal participation by Japan and the United States. New programs have been developed and existing ones have been extended in what is the longest continuing health survey ever undertaken.

  17. Data quality for situational awareness during mass-casualty events.

    PubMed

    Demchak, Barry; Griswold, William G; Lenert, Leslie A

    2007-01-01

    Incident Command systems often achieve situational awareness through manual paper-tracking systems. Such systems often produce high latencies and in-complete data, resulting in inefficient and ineffective resource deployment. WIISARD (Wireless Internet Information System for Medical Response in Disasters) collects much more data than a paper-based system, dramatically reducing latency while increasing the kinds and quality of information available to incident commanders. Yet, the introduction of IT into a disaster setting is not problem-free. Notably, system component failures can delay the delivery of data. The type and extent of a failure can have varying effects on the usefulness of information displays. We describe a small, coherent set of customizble information overlays to address this problem, and we discuss reactions to these displays by medical commanders. PMID:18693821

  18. Data Quality for Situational Awareness during Mass-Casualty Events

    PubMed Central

    Demchak, Barry; Griswold, William G.; Lenert, Leslie A.

    2007-01-01

    Incident Command systems often achieve situational awareness through manual paper-tracking systems. Such systems often produce high latencies and incomplete data, resulting in inefficient and ineffective resource deployment. WIISARD (Wireless Internet Information System for Medical Response in Disasters) collects much more data than a paper-based system, dramatically reducing latency while increasing the kinds and quality of information available to incident commanders. Yet, the introduction of IT into a disaster setting is not problem-free. Notably, system component failures can delay the delivery of data. The type and extent of a failure can have varying effects on the usefulness of information displays. We describe a small, coherent set of customizble information overlays to address this problem, and we discuss reactions to these displays by medical commanders. PMID:18693821

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

    PubMed

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

    2008-11-01

    Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed. PMID:17364221

  20. 'Wellbeing': a collateral casualty of modernity?

    PubMed

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

    2009-11-01

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

  1. Comparison of emergency nurses association Emergency Severity Triage and Australian emergency mental health triage systems for the evaluation of psychiatric patients.

    PubMed

    Downey, La Vonne A; Zun, Leslie S; Burke, Trena

    2014-01-01

    The use of a triage system in the emergency department allows for the ability to reliably assign patients for treatment within a short amount of time in order to prioritize and treat on the basis of patients injury and illness. A 5 point triage system has been shown to have the highest correlation with effective resource utilizations, lower time to be seen and treatment times, and admission or release outcomes for patients. The problem is, however, that these triage scales were developed on the basis of physical illness and not on the ever-increasing number of patients who present with mental illness. This article compares one physical and one specific mental illness-based triage system to measure the differences in times to be seen by a physician. It found that the specialized psychiatric triage system decreased wait times and allowed symptoms to be addressed sooner for patients presenting with psychiatric complaints.

  2. One-two-triage: validation and reliability of a novel triage system for low-resource settings

    PubMed Central

    Khan, Ayesha; Mahadevan, S V; Dreyfuss, Andrea; Quinn, James; Woods, Joan; Somontha, Koy; Strehlow, Matthew

    2016-01-01

    Objectives To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings. Methods This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital. Results Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308). Conclusions OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience. PMID:27466347

  3. Triage: a working solution to overcrowding in the emergency department

    PubMed Central

    Shah, Chandrakant P.; Carr, Luby M.

    1974-01-01

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

  4. [Model and enlightenment from rescue of August 2nd Kunshan explosion casualty].

    PubMed

    Tan, Q; Qiu, H B; Sun, B W; Shen, Y M; Nie, L J; Zhang, H W

    2016-01-01

    On August 2nd, 2014, a massive dust explosion occurred in a factory of Kunshan, resulting in a mass casualty involving 185 burn patients. They were transported to 20 medical institutions in Jiangsu province and Shanghai. More than one thousand of medical personnel of our country participated in this emergency rescue, and satisfactory results were achieved. In this paper, the characteristics of this accident were analyzed, the positive effects of interdisciplinary cooperation were affirmed, and the contingency plan, rescue process and pattern, and reserve, organization and management of talents during this rescue process were reviewed retrospectively.

  5. [Model and enlightenment from rescue of August 2nd Kunshan explosion casualty].

    PubMed

    Tan, Q; Qiu, H B; Sun, B W; Shen, Y M; Nie, L J; Zhang, H W

    2016-01-01

    On August 2nd, 2014, a massive dust explosion occurred in a factory of Kunshan, resulting in a mass casualty involving 185 burn patients. They were transported to 20 medical institutions in Jiangsu province and Shanghai. More than one thousand of medical personnel of our country participated in this emergency rescue, and satisfactory results were achieved. In this paper, the characteristics of this accident were analyzed, the positive effects of interdisciplinary cooperation were affirmed, and the contingency plan, rescue process and pattern, and reserve, organization and management of talents during this rescue process were reviewed retrospectively. PMID:27426066

  6. Implications for modeling casualty sustainment during peacekeeping operations.

    PubMed

    Blood, Christopher G; Zhang, Jinjin; Walker, G Jay

    2002-10-01

    Projections of the casualties expected during peacekeeping operations allow medical planners to assess in advance the medical resources needed to support such operations. Data detailing fatalities incurred in previous peacekeeping operations were extracted from several U.N. sources. From these data, rates of killed-in-action were computed for the deployed forces. One hundred eighty-eight peacekeeping incidents in which casualties were sustained were also examined to derive wounded-in-action rates. The estimated mean wounded-in-action rate for these operations was 3.16 per 1,000 strength per year; the estimated wounded-in-action rate for individual operations ranged from 0.49 to 12.50. There were an average of 3.8 wounded and 0.86 killed in the 188 casualty incidents examined. Thirty-eight percent of the wounds were described as serious. The casualty incidence derived in this study can provide a basis for estimating the casualties likely in future peacekeeping operations. PMID:12392258

  7. Liability in triage: management of EMTALA regulations and common obstetric risks.

    PubMed

    Angelini, Diane J; Mahlmeister, Laura R

    2005-01-01

    The Emergency Medical Treatment and Active Labor Act (EMTALA) affects all clinicians who provide triage care for pregnant women. EMTALA has specific regulations for hospitals relative to women in active labor. Violations can carry stiff penalties. It is critical for clinicians performing obstetric triage to understand the duties and obligations of this law. This article discusses EMTALA and reviews common liability risks in obstetric triage as well as strategies to modify those risks.

  8. Knowledge of triage in the senior medical students in Shiraz University of Medical Sciences

    PubMed Central

    MAHMOODIAN, HOSSEIN; EGHTESADI, RAZIE; GHAREGHANI, ATEFE; NABEIEI, PARISA

    2016-01-01

    Introduction Triage is a response to the problem of overcrowding in Emergency Departments (EDs) and accuracy of decisions made by the triage unit affects the ultimate outcome of EDs. This study was conducted to evaluate the knowledge of triage among last year medical students in Shiraz University of Medical Sciences. Methods This is a cross-sectional analytical study whose subjects were all the senior students of medicine (62) in the last year of medicine from January to June 2013 who attended emergency medicine course in the screen room of 2 University Hospitals. This questionnaire was designed in 3 sections including personal data, 15 questions on knowledge of triage and 10 case scenarios for triage decision making and completed by the students. Statistical analysis was performed in SPSS statistical software (version 14) using independent sample t-test, one way ANOVA, and Pearson correlation coefficient (p≤0.001). Results The total mean score of the participants was 10.6±1.5, ranging from 7 to 13. 58(93.5%) students had poor triage knowledge. In the scenario’s section, the percentage of correct triage by students was 49.2% and those of over and under triage were 28.1% and 22.7%, respectively. There was a significant relationship between the triage accuracy and level of triage (ESI 4) (p≤0.001). Conclusion The level of knowledge of triage in the last year medical students was poor, although most of them had passed a course in the screen room. It is recommended that medical students’ educational courses should include sections on the knowledge of triage in emergency rooms. PMID:27382582

  9. Development and interrater reliability of the UK Mental Health Triage Scale.

    PubMed

    Sands, Natisha; Elsom, Stephen; Colgate, Robert; Haylor, Helen; Prematunga, Roshani

    2016-08-01

    Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendall's coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P < 0.001). The single measure ICC was 0.856 (95% CI: 0.776-0.926 (F (20, 1300) = 394.762, P < 0.001). The overall Kendall's w was 0.88 (P < 0.001). The UK MHTS shows substantial levels of interrater reliability. Reliable mental health triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services.

  10. Development and interrater reliability of the UK Mental Health Triage Scale.

    PubMed

    Sands, Natisha; Elsom, Stephen; Colgate, Robert; Haylor, Helen; Prematunga, Roshani

    2016-08-01

    Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendall's coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P < 0.001). The single measure ICC was 0.856 (95% CI: 0.776-0.926 (F (20, 1300) = 394.762, P < 0.001). The overall Kendall's w was 0.88 (P < 0.001). The UK MHTS shows substantial levels of interrater reliability. Reliable mental health triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services. PMID:27027419

  11. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    PubMed Central

    Adeniji, Adeloye Amoo

    2016-01-01

    Background In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting Gugulethu Community Health Centre, Cape Town. Methods A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. PMID:27380788

  12. Taxonomic triage and the poverty of phylogeny.

    PubMed Central

    Wheeler, Quentin D

    2004-01-01

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

  13. Taxonomic triage and the poverty of phylogeny.

    PubMed

    Wheeler, Quentin D

    2004-04-29

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

  14. Academic-Community Partnership to Develop a Novel Disaster Training Tool for School Nurses: Emergency Triage Drill Kit.

    PubMed

    Burke, Rita V; Goodhue, Catherine J; Berg, Bridget M; Spears, Robert; Barnes, Jill; Upperman, Jeffrey S

    2015-09-01

    As children spend approximately 28% of their day in school and disasters may strike at any time, it is important for school officials to conduct emergency preparedness activities. School nurses, teachers, and staff should be prepared to respond and provide support and first aid treatment. This article describes a collaborative effort within the Los Angeles Unified School District to enhance disaster preparedness. Specifically, the article outlines the program steps and tools developed to prepare staff in mass triage through an earthquake disaster training exercise. PMID:25899521

  15. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  16. 49 CFR 850.25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  20. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  1. 27 CFR 25.282 - Beer lost by fire, theft, casualty, or act of God.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  4. 46 CFR 167.65-65 - Notice and reporting of casualty and voyage records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Notice and reporting of casualty and voyage records. 167... SCHOOLS PUBLIC NAUTICAL SCHOOL SHIPS Special Operating Requirements § 167.65-65 Notice and reporting of casualty and voyage records. The requirements for providing notice and reporting of marine casualties...

  5. 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...

  6. 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...

  7. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Written report of casualty. 146... (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.35 Written report of...

  8. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Written report of casualty. 146... (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.35 Written report of...

  9. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Written report of casualty. 146... (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.35 Written report of...

  10. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  11. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Written report of casualty. 197.486 Section 197.486 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE OCCUPATIONAL SAFETY AND HEALTH... under control number 1625-0001)...

  12. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reporting requirements of 46 CFR 4.05-12. (b) The written report required by paragraph (a) of this section... 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...

  13. Battlefield Documentation of Tactical Combat Casualty Care in Afghanistan.

    PubMed

    Robinson, John B; Smith, Michael P; Gross, Kirby R; Sauer, Samual W; Geracci, James J; Day, Charlie D; Kotwal, Russ S

    2016-01-01

    Performance improvement is reliant on information and data, as you cannot improve what you do not measure. The US military went to war in 2001 without an integrated trauma care system to collect and analyze combat casualty care data. By 2006, the conflict in Afghanistan began appreciating the capture and consolidation of hospital care documentation into the Department of Defense Trauma Registry. In contrast, a paucity of documentation has existed for prehospital or tactical combat casualty care (TCCC). Using the 75th Ranger casualty documentation model established in 2005, the Joint Trauma System developed a casualty data collection system for prehospital care using the TCCC Card, the TCCC After Action Report (AAR), and the Prehospital Trauma Registry. In 2013, this system was mandated for use by US forces in Afghanistan. The Joint Trauma System also created and deployed a prehospital team to be an integral part of the Joint Theater Trauma System in Afghanistan. This prehospital team provided prehospital training and facilitated prehospital data capture. Described and analyzed in this report are prehospital data captured in Afghanistan from 2013 to 2014 using the TCCC Card and the TCCC AAR. PMID:27215873

  14. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  15. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  16. 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...

  17. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  18. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  20. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  1. 46 CFR 185.202 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... in a marine casualty shall notify the nearest Sector Office, Marine Inspection Office, or Coast Guard... fire extinguishing systems, lifesaving equipment, auxiliary power generating equipment, or bilge... Regulations (CFR) part 1904. (c) Notice given as required by § 185.203 satisfies the requirement of...

  2. 46 CFR 185.202 - Notice of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... in a marine casualty shall notify the nearest Sector Office, Marine Inspection Office, or Coast Guard... fire extinguishing systems, lifesaving equipment, auxiliary power generating equipment, or bilge... Regulations (CFR) part 1904. (c) Notice given as required by § 185.203 satisfies the requirement of...

  3. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... casualty involves a hazardous condition as defined by 33 CFR 160.204. (c) Except as otherwise required... meets any criterion of paragraphs (a) (3) through (8); (3) A loss of main propulsion, primary steering..., lifesaving equipment, auxiliary power-generating equipment, or bilge-pumping systems; (5) A loss of life;...

  4. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... casualty involves a hazardous condition as defined by 33 CFR 160.203. (c) Except as otherwise required... meets any criterion of paragraphs (a) (3) through (8); (3) A loss of main propulsion, primary steering..., lifesaving equipment, auxiliary power-generating equipment, or bilge-pumping systems; (5) A loss of life;...

  5. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Retention of records after casualty. 109.415 Section 109.415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person...

  6. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Retention of records after casualty. 109.415 Section 109.415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person...

  7. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Retention of records after casualty. 109.415 Section 109.415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person...

  8. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Retention of records after casualty. 109.415 Section 109.415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS...) The radio log. (14) Personnel list. (15) Crane record book. (c) The owner, agent, master, or person...

  9. Triage in opioid replacement therapy: what's the wait?

    PubMed

    Harlow, Warren; Happell, Brenda Mary; Browne, Graeme; Choudhury, Jahar; Pinchin, David

    2013-01-01

    In Australia, a wait for Opioid Replacement Therapy (ORT) has been reported although the magnitude is unknown. This study examined data recorded by one urban publicly funded ORT clinic (from 2009 to 2011) to identify if people (n = 803) were waiting for ORT assessment appointments and to explore how triage influences access to ORT. Data analysis incorporated descriptive methods and the use of Kaplan-Meier estimator of the cumulative incidence function. The implications and limitations of this study are included with further research suggestions.

  10. [How to implement a unique triage system in the emergency departments of Latium, Italy].

    PubMed

    De Luca, A; Francia, C; Gabriele, S; Guasticchi, G

    2008-01-01

    Triage is an efficient system that emergency departments (EDs) use to sort out presenting patients on the basis of the speed with which they need treatment. Because triage is not used consistently in the EDs of Latium, a region in central Italy, the regional Public Health Agency (PHA) planned and implemented a regional model of triage in all EDs. This manuscript describe the regional implementation strategy. The PHA activated the "Regional Triage Program--RTP" including: development and testing of a "triage section" in the computerized EDs clinical chart; production of an operational handbook for the RTP for triage health professionals (HPs); implementation of an continuum educational program on the "RTP" in all EDs of Latium. The computerized triage section was tested and implemented in all EDs in the region. The handbook for triage HPs was produced. The educational program, has been ongoing since 2008 in all regional EDs. Selected HPs, identified as "facilitators", were trained on how to implement the RTP. They will organize, in their own EDs, small groups of nurses to conduct on-site training of the RTP. The RTP was received with enthusiasm by most HPs, however its introduction into current practice could be hampered by organizational/structural problems and conflicts between nurses and doctors. Next actions of the regional program will be to overcome the possible above mentioned troubles.

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  13. Telephone triage in general practices: A written case scenario study in the Netherlands

    PubMed Central

    Smits, Marleen; Hanssen, Suzan; Huibers, Linda; Giesen, Paul

    2016-01-01

    Objective General practices increasingly use telephone triage to manage patient flows. During triage, the urgency of the call and required type of care are determined. This study examined the organization and adequacy of telephone triage in general practices in the Netherlands. Design Cross-sectional observational study using a web-based survey among practice assistants including questions on background characteristics and triage organization. Furthermore, practice assistants were asked to assess the required type of care of written case scenarios with varying health problems and levels of urgency. To determine the adequacy of the assessments, a comparison with a reference standard was made. In addition, the association between background characteristics and triage organization and the adequacy of triage was examined. Setting Daytime general practices. Subjects Practice assistants. Main outcome measures Over- and under-estimation, sensitivity, specificity. Results The response rate was 41.1% (n = 973). The required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1%. The sensitivity of identifying patients with a highly urgent problem was 76.7% and the specificity was 94.0%. The adequacy of the assessments of the required care was higher for more experienced assistants and assistants with fixed daily work meetings with the GP. Triage training, use of a triage tool, and authorization of advice were not associated with adequacy of triage. Conclusion Triage by practice assistants in general practices is efficient (high specificity), but potentially unsafe in highly urgent cases (suboptimal sensitivity). It is important to train practice assistants in identifying highly urgent cases. Key pointsGeneral practices increasingly use telephone triage to manage patient flows, but little is known about the organization and adequacy of triage in daytime practices.Telephone triage by general practice assistants is

  14. Measuring the effectiveness of the national Mental Health Triage Scale in an emergency department.

    PubMed

    Happell, Brenda; Summers, Monica; Pinikahana, Jaya

    2003-12-01

    The mainstreaming process has significantly altered the means of access to mental health services in Australia. Increasingly people seeking mental health care present at general hospital emergency departments. The triage system, which has proven effective for prioritizing physical illness and injury, has proven problematic when applied to mental health-related problems. This paper presents the results of a study undertaken in the emergency department of a Victorian public hospital. The Mental Health Triage Scale was introduced and used independently by triage nurses and the psychiatric nurse consultants employed in the department. Following a 3-month period, the two sets of triage scores for psychiatric presentations (n = 137) were compared. The findings suggest that triage nurses are rating clients experiencing mental health problems as in more urgent need of care than their psychiatric nursing counterparts. This suggests that the introduction of the guidelines alone is insufficient, and that education is required for more effective use of the tool.

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

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

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

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

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Triage in the developing world—can it be done?

    PubMed Central

    Robertson, M; Molyneux, E

    2001-01-01

    AIM—To assess guidelines for the emergency triage, assessment, and treatment (ETAT) of sick children presenting to hospitals in the developing world. This study pretested the guidelines in Malawi, assessing their performance when used by nurses compared to doctors trained in advanced paediatric life support (APLS).
METHODS—Triage was performed simultaneously by a nurse and assessing doctor on 2281 children presenting to the under 5s clinic. Each patient was allocated one of three priorities, according to the ETAT guidelines. Any variation between nurse and assessor was recorded on the assessment forms.
RESULTS—Nurses identified 92 children requiring emergency treatment and 661 with signs indicating a need for urgent medical assessment. One hundred and forty two (6.2%) had different priorities allocated by the APLS trained doctor, but these children did not tend to need subsequent admission. Eighty five per cent of admissions were prioritised to an emergency or urgent category.
CONCLUSION—Although there are no gold standards for comparison the ETAT guidelines appear to reliably select out the majority of patients requiring admission.

 PMID:11517102

  19. CoIN: a network analysis for document triage.

    PubMed

    Hsu, Yi-Yu; Kao, Hung-Yu

    2013-01-01

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

  20. Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains.

    PubMed

    Pennardt, Andre; Kamin, Rich; Llewellyn, Craig; Shapiro, Geoff; Carmona, Philip A; Schwartz, Richard B

    2016-01-01

    Tactical emergency medical support (TEMS) is a critical component of the out-of-hospital response to domestic high-threat incidents such as hostage scenarios, warrant service, active shooter or violent incidents, terrorist attacks, and other intentional mass casualty-producing acts. From its grass-roots inception in the form of medical support of select law enforcement special weapons and tactics (SWAT) units in the 1980s, the TEMS subspecialty of prehospital care has rapidly grown and evolved over the past 40 years. The National TEMS Initiative and Council (NTIC) competencies and training objectives are the only published recommendations of their kind and offer the opportunity for national standardization of TEMS training programs and a future accreditation process. Building on the previous work of the NTIC and the creation of acknowledged competency domains for TEMS and the acknowledged civilian translation of TCCC by the Committee for Tactical Emergency Casualty Care (C-TECC), the Joint Review Committee (JRC) has created an opportunity to bring forward the work in a form that could be operationally useful in an all-hazards and whole of community format. PMID:27450605

  1. Management of Crush Syndrome Casualties after Disasters

    PubMed Central

    Sever, Mehmet Sukru; Vanholder, Raymond

    2011-01-01

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

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

    PubMed

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

    2015-08-01

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

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

    PubMed

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

    2015-08-01

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

  4. The use of multiple intraosseous catheters in combat casualty resuscitation.

    PubMed

    Sarkar, Debjeet; Philbeck, Thomas

    2009-02-01

    During the current military engagements in Iraq and Afghanistan, establishing intravenous (IV) access for resuscitation of critically injured casualties remains a persistent challenge. Intraosseous (IO) access has emerged as a viable alternative in resuscitation. In this case report, a 19 year-old male soldier was severely wounded by a roadside bomb in Iraq. Given the heavy initial blood loss, anatomic location of the injuries and gross wound contamination, peripheral IV access could not be established. Instead, multiple IO catheters were used to initiate fluid resuscitation prior to transfer to a combat support hospital. To our knowledge, this is the first report of such extensive usage of IO catheters. Multiple IO catheters can be placed rapidly and safely and may help solve the challenge of establishing vascular access for resuscitation of critically injured casualties. PMID:19317188

  5. The Influential Factor Analysis of Classification Partition Management Mode on the Emergency Triage

    PubMed Central

    NA, Zhang; HUAIXIN, Cui

    2016-01-01

    Background: The aim of the study was to discuss on the influential factors of the mode of classification of partition management in the emergency triage. Method: Retrospectively analyzing the effects of emergency triage of 156 cases who adopted the classification partition management mode during Oct 2014 to Oct 2015 in Xuzhou Central Hospital (Xuzhou, Jiangsu Province, China). They were divided into triage success group of 108 cases and triage failure group of 48 cases. Comparing the single factor analysis and multi-factor analysis, and selecting possible influential factors. Result: According to the single factor analysis, for the patients who came to the doctor in the daytime and working days, the higher education degree and compliance they had, the faster the back-show time of emergency inspect and check came back, the more comprehensive the body examination and disease history taking were done, the simpler the disease condition was, the higher triage success rate they received. Compared to the emergency observation time between two groups, the difference was not statistically significant. According to the multi-factor analysis, the emergency check and examination back-show time, the comprehensive degree of body examination and disease history taking and the complexity degree of disease could be the independent risk factors for triage success. Conclusion: Simplify the examination procedure, improve the efficiency of back-show and acquire detail disease information are important methods for the improvement of triage success. PMID:27516994

  6. Exercise London: a disaster exercise involving numerous casualties

    PubMed Central

    Theoret, J.J.

    1976-01-01

    A large-scale disaster exercise was conducted to assess how one large community would handle such a situation — particularly, how it would deal with 150 casualties. The planning, undertaken by a subcommittee composed of representatives of all resource groups in the city, took more than a year. The deficiencies of the disaster plan detected during the exercise, which included a lack of trained personnel and various problems of communication, are now being corrected. PMID:1260617

  7. Strategies for casualty mitigation programs by using advanced tsunami computation

    NASA Astrophysics Data System (ADS)

    IMAI, K.; Imamura, F.

    2012-12-01

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

  8. 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. PMID:27038500

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

    PubMed Central

    Horwitz, Leora I.; Bradley, Elizabeth H.

    2009-01-01

    Background The wait time to see a physician in US emergency departments (EDs) is increasing and may differentially affect patients with varied insurance status and racial/ethnic backgrounds. Methods Using a stratified random sampling of 151 999 visits, representing 539 million ED visits from 1997 to 2006, we examined trends in the percentage of patients seen within the triage target time by triage category (emergent, urgent, semiurgent, and nonurgent), payer type, and race/ethnicity. Results The percentage of patients seen within the triage target time declined a mean of 0.8% per year, from 80.0% in 1997 to 75.9% in 2006 (P<.001). The percentage of patients seen within the triage target time declined 2.3% per year for emergent patients (59.2% to 48.0%; P<.001) compared with 0.7% per year for semiurgent patients (90.6% to 84.7%; P<.001). In 2006, the adjusted odds of being seen within the triage target time were 30% lower than in 1997 (odds ratio, 0.70; 95% confidence interval, 0.55-0.89). The adjusted odds of being seen within the triage target time were 87% lower (odds ratio, 0.13; 95% confidence interval, 0.11-0.15) for emergent patients compared with semiurgent patients. Patients of each payment type experienced similar decreases in the percentage seen within the triage target over time (P for interaction=.24), as did patients of each racial/ethnic group (P=.05). Conclusions The percentage of patients in the ED who are seen by a physician within the time recommended at triage has been steadily declining and is at its lowest point in at least 10 years. Of all patients in the ED, the most emergent are the least likely to be seen within the triage target time. Patients of all racial/ethnic backgrounds and payer types have been similarly affected. PMID:19901137

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

    NASA Astrophysics Data System (ADS)

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

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

  11. Children's cognitive triage: optimal retrieval or effortful processing?

    PubMed

    Brainerd, C J; Reyna, V F; Howe, M L

    1990-06-01

    Cognitive triage is a surprising nonmonotonic relationship that exists between the order in which children read words out of long-term memory and the memory strengths of those same words. Two forgetting experiments with 7- and 12-year-old children are reported in which fuzzy-trace theory's explanation of this effect was pitted against an effortful processing explanation. The two explanations make different predictions about the relative rates of forgetting for words that are recalled at the primacy and recency positions of output queues. The data consistently favored fuzzy-trace theory's predictions. We discuss the implications of our results for two assumptions that are commonly made in theories of memory development--namely, that recall accuracy is a monotonic-increasing function of memory strength and that recall order is a monotonic-decreasing function of memory strength.

  12. Earthquakes and crush syndrome casualties: lessons learned from the Kashmir disaster.

    PubMed

    Vanholder, R; van der Tol, A; De Smet, M; Hoste, E; Koç, M; Hussain, A; Khan, S; Sever, M S

    2007-01-01

    Major earthquakes may provoke a substantial number of crush casualties complicated by acute kidney injury (AKI). After the 1988 Armenian earthquake, the International Society of Nephrology (ISN) established the Renal Disaster Relief Task Force (RDRTF) to organize renal care in large disasters; this approach proved to be useful in several recent disasters. This paper depicts the organizational aspects of the rescue intervention during the Kashmir earthquake, in 2005. Specific problems were fierce geographic circumstances, lack of pre-registered local keymen, transportation problems, and inexperience of local teams to cope with problems related to mass disasters. Once treatment was installed, global outcomes were favorable. It is concluded that well-organized international help in renal disasters can be effective in saving many lives, but still necessitates conceptual adaptations owing to specific local circumstances.

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

    PubMed

    Strain, John W

    2013-01-01

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

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

    PubMed

    Strain, John W

    2013-01-01

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

  15. 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. PMID:21799345

  16. A needs analysis for computer-based telephone triage in a community AIDS clinic.

    PubMed Central

    Henry, S. B.; Schreiner, J. G.; Borchelt, D.; Musen, M. A.

    1992-01-01

    This study describes the complexity of the telephone-triage task in a community-based AIDS clinic. We identify deficiencies related to the data management for and documentation of the telephone-triage encounter, including inaccessibility of the medical record and failure to document required data elements. Our needs analysis suggests five design criteria for a computer-based system that assists nurses with the telephone-triage task: (1) online accessibility of the medical record, (2) ability to move among modules of the medical record and the triage-encounter module, (3) ease of data entry, (4) compliance with standards for documentation, and (5) notification of the primary-care physician in an appropriate and timely manner. PMID:1482941

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

    PubMed

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

    2016-01-01

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

  18. Developing an Intelligent Phone-based Emergency Triage Communication and Support System

    PubMed Central

    Hsiao, Fang-Ying; Kuo, Yu-Yin; Chang, Polun

    2006-01-01

    In this study, the emergency triage support system was taken as an example. We develop new call flow style and combine traditional passive call flow. The system is designed by voice menu and users can command services actively. The telephone connect computer server to enter call flow module with ASR and TTS. Then the recognition term come from voice term database. Voice management center is an ER triage decision system. PMID:17238573

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

    PubMed Central

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

    2015-01-01

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

  20. Education to improve the triage of mental health patients in general hospital emergency departments.

    PubMed

    Clarke, Diana E; Brown, Anne-Marie; Hughes, Linda; Motluk, Lori

    2006-10-01

    General hospital emergency departments (EDs) are obvious places for individuals in distress or in a mental health crisis to seek assistance. However, triage nurses admit to a lack of expertise and confidence in psychiatric assessment which can result in less accurate assessments than for medical or trauma presentations. The objectives of a collaborative project between an Adult Mental Health Program and an Adult Emergency Program in a Canadian regional health authority were to: provide education and training to triage nurses regarding mental health and illness; monitor the transit of mental health patients through the ED; monitor wait times; and determine the adequacy of the Canadian Triage Acuity and Assessment Scale in the triage of psychiatric presentations. Although the percentages of patients triaged as "emergent" did not change as a result of the education, the percentage of patients who were triaged as "not urgent" but required hospitalization was significantly reduced. Although average lengths of stay in the ED were also reduced after the education, this may or may not have been related to the educational sessions. The project was successful in increasing collaboration between the two departments and has resulted in enhanced, on-going mental health education for ED nurses.

  1. The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

    PubMed Central

    Ebrahimi, Mohsen; Mazlom, Reza; Heydari, Abbas; Nassehi, Asra; Jafari, Mojtaba

    2016-01-01

    Background. Triage nurses play a pivotal role in the emergency department. However some researchers have attempted to expand triage nurse's role; remarkable discrepancies exist among scholarly communities. The aim was to develop a role description of triage nurse relying on the experts. Methods. A modified Delphi study consisting of 3 rounds was performed from March to October 2014. In the first round, an extensive review of the literature was conducted. Expert selection was conducted through a purposeful sample of 38 emergency medicine experts. Results. Response rates for the second and third rounds were 37% and 58%. Average age of panelists was (38.42 ± 5.94) years. Thirty-nine out of 54 items reached to the final round. Prioritizing had the higher agreement rate and least agreement on triage related interventions. Conclusion. Triage nursing as a relatively new role for nurses needs significant development to be practiced. Comprehensive educational programs and developmental research are required to support diagnostic and therapeutic interventions in triage practice by nurses. PMID:27382500

  2. Paper and people: the work of the casualty reception clerk.

    PubMed

    Hughes, D

    1989-12-01

    This paper examines the exercise of discretion by casualty reception staff, focussing on the problems of accountability that arise when their judgements help shape the process of patient categorization that culminates in clinical diagnosis. Rules and guidelines which ostensibly relate to bureaucratic objectives, are applied in ways which reflect situational exigencies of reception work, and values embedded in organisational culture. But reception staff are reluctant to acknowledge the importance of their decisions, and, particularly where judgements relate to patient condition, present rule-use as a straightforward and certain activity in which interpretation plays little part. PMID:10304220

  3. Kidney function and risk triage in adults: threshold values and hierarchical importance

    PubMed Central

    Foley, Robert N.; Wang, Changchun; Snyder, Jon J.; Rule, Andrew D.; Collins, Allan J.

    2012-01-01

    In this study, we attempted to identify threshold values for kidney function measures that maximally discriminate short-term mortality, to identify major population segments in which these thresholds apply, and to classify the hierarchical rank of the thresholds when other classic risk factors are also considered. To do this we retrospectively identified estimated glomerular filtration rate (eGFR) and urinary albumin–creatinine ratio (ACR) thresholds to maximize sensitivity and specificity predictions for death in non-institutionalized NHANES III participants, representative of the United States population from 1988 to 1994 and followed through 2000. In a classification tree excluding dichotomizing variables, age 57 years was initially selected; ACR appeared in the second round and eGFR in the third. The prognostic discrimination of optimum eGFR and ACR thresholds exceeded those of commonly advocated public health screening measures, such as LDL cholesterol and fasting blood glucose, with body mass index appearing in the third round, and smoking and LDL cholesterol in the fourth. In a tree permitting dichotomizing variables, the ACR, systolic blood pressure, and glucose first appeared in the third round, with eGFR, smoking, and LDL in the fourth. Thus, the albumin–creatinine ratio and eGFR may be at least as efficient for survival-based clinical triage as most other classic risk factors. PMID:20720528

  4. Bilateral Image Subtraction and Multivariate Models for the Automated Triaging of Screening Mammograms

    PubMed Central

    Celaya-Padilla, José; Martinez-Torteya, Antonio; Rodriguez-Rojas, Juan; Galvan-Tejada, Jorge; Treviño, Victor; Tamez-Peña, José

    2015-01-01

    Mammography is the most common and effective breast cancer screening test. However, the rate of positive findings is very low, making the radiologic interpretation monotonous and biased toward errors. This work presents a computer-aided diagnosis (CADx) method aimed to automatically triage mammogram sets. The method coregisters the left and right mammograms, extracts image features, and classifies the subjects into risk of having malignant calcifications (CS), malignant masses (MS), and healthy subject (HS). In this study, 449 subjects (197 CS, 207 MS, and 45 HS) from a public database were used to train and evaluate the CADx. Percentile-rank (p-rank) and z-normalizations were used. For the p-rank, the CS versus HS model achieved a cross-validation accuracy of 0.797 with an area under the receiver operating characteristic curve (AUC) of 0.882; the MS versus HS model obtained an accuracy of 0.772 and an AUC of 0.842. For the z-normalization, the CS versus HS model achieved an accuracy of 0.825 with an AUC of 0.882 and the MS versus HS model obtained an accuracy of 0.698 and an AUC of 0.807. The proposed method has the potential to rank cases with high probability of malignant findings aiding in the prioritization of radiologists work list. PMID:26240818

  5. Bilateral Image Subtraction and Multivariate Models for the Automated Triaging of Screening Mammograms.

    PubMed

    Celaya-Padilla, José; Martinez-Torteya, Antonio; Rodriguez-Rojas, Juan; Galvan-Tejada, Jorge; Treviño, Victor; Tamez-Peña, José

    2015-01-01

    Mammography is the most common and effective breast cancer screening test. However, the rate of positive findings is very low, making the radiologic interpretation monotonous and biased toward errors. This work presents a computer-aided diagnosis (CADx) method aimed to automatically triage mammogram sets. The method coregisters the left and right mammograms, extracts image features, and classifies the subjects into risk of having malignant calcifications (CS), malignant masses (MS), and healthy subject (HS). In this study, 449 subjects (197 CS, 207 MS, and 45 HS) from a public database were used to train and evaluate the CADx. Percentile-rank (p-rank) and z-normalizations were used. For the p-rank, the CS versus HS model achieved a cross-validation accuracy of 0.797 with an area under the receiver operating characteristic curve (AUC) of 0.882; the MS versus HS model obtained an accuracy of 0.772 and an AUC of 0.842. For the z-normalization, the CS versus HS model achieved an accuracy of 0.825 with an AUC of 0.882 and the MS versus HS model obtained an accuracy of 0.698 and an AUC of 0.807. The proposed method has the potential to rank cases with high probability of malignant findings aiding in the prioritization of radiologists work list.

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

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Rebbapragada, U.

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

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

    PubMed

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

    2015-12-01

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

  12. Fine-grained dengue forecasting using telephone triage services.

    PubMed

    Abdur Rehman, Nabeel; Kalyanaraman, Shankar; Ahmad, Talal; Pervaiz, Fahad; Saif, Umar; Subramanian, Lakshminarayanan

    2016-07-01

    Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline. PMID:27419226

  13. Redeye: A Digital Library for Forensic Document Triage

    SciTech Connect

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

    2013-01-01

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

  14. Fine-grained dengue forecasting using telephone triage services

    PubMed Central

    Abdur Rehman, Nabeel; Kalyanaraman, Shankar; Ahmad, Talal; Pervaiz, Fahad; Saif, Umar; Subramanian, Lakshminarayanan

    2016-01-01

    Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline. PMID:27419226

  15. 46 CFR 122.220 - Records of a voyage resulting in a marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... The owner, agent, master, or person in charge of any vessel involved in a marine casualty for which a..., compass deviation cards, gyrocompass records, stowage plans, records of draft, aids to mariners, night... the cause of the casualty. The owner, agent, master, other officer, or person responsible for...

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

    PubMed

    Ebeling, C F

    1991-06-01

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

  17. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

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

  18. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  19. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  20. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

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

  1. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  2. 33 CFR 173.81 - Coast Guard forms for numbering and casualty reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  4. 46 CFR 4.40-25 - Coast Guard marine casualty investigation for the Board.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  7. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of practice for transportation accident hearings in 49 CFR part 845 shall apply. (b) The Board shall... 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 §...

  9. Drink-driver casualties in Victoria. Peak periods on Thursday, Friday and Saturday nights.

    PubMed

    McDermott, F T; Hughes, E S

    1983-06-25

    Blood alcohol estimations are compulsory for all road accident casualties aged 15 years or older who present at public hospitals in Victoria. This article examines the results of blood alcohol estimations performed between 1978 and 1980 in casualties known to have been motor vehicle drivers (excluding motorcyclists). There were three times more male than female driver casualties. Blood alcohol levels in excess of the legal limit of 11 mmol/L (0.05 g/100 mL) were found in 36% of male and 12% of female driver casualties; in approximately half of these, blood alcohol levels exceeded 33 mmol/L (0.15 g/100 mL). Between Monday and Wednesday inclusive, the legal limit was exceeded in 19% of driver casualties. On Friday, Saturday and Sunday, the percentage of driver casualties with blood alcohol levels above the legal limit was 30%, 40%, and 32%, respectively. The percentage of male driver casualties with illegal blood alcohol levels was highest on Thursday, Friday, and Saturday nights (6 p.m. to 6 a.m.), and attained 56%, 62%, and 65% respectively. Of all drink-driver casualties, 56% sustained their injuries on these three nights. These results direct attention to the need for improved driver education and behaviour, and for intensified law enforcement by traffic police during Thursday, Friday, and Saturday nights. PMID:6855680

  10. 46 CFR 185.210 - Alcohol or drug use by individuals directly involved in casualties.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Alcohol or drug use by individuals directly involved in casualties. 185.210 Section 185.210 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SMALL PASSENGER VESSELS (UNDER 100 GROSS TONS) OPERATIONS Marine Casualties and Voyage Records § 185.210 Alcohol or drug use by individuals...

  11. Mass

    SciTech Connect

    Quigg, Chris

    2007-12-05

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

  12. 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. PMID:22591650

  13. 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.

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

    PubMed

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

    2011-01-01

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

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

    PubMed Central

    2011-01-01

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

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

    PubMed

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

    2016-04-01

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

  17. Telephone survey of service-user experiences of a telephone-based mental health triage service.

    PubMed

    Elsom, Stephen; Sands, Natisha; Roper, Cath; Hoppner, Cayte; Gerdtz, Marie

    2013-10-01

    The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service-user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service-users' (consumers and informal carers) experiences of a telephone-based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone-based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision-making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self-referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer-focused care.

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

    SciTech Connect

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

    2014-11-01

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

  19. Conservation triage or injurious neglect in endangered species recovery.

    PubMed

    Gerber, Leah R

    2016-03-29

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for "costly yet futile" recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species.

  20. Conservation triage or injurious neglect in endangered species recovery.

    PubMed

    Gerber, Leah R

    2016-03-29

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for "costly yet futile" recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species. PMID:26976572

  1. Conservation triage or injurious neglect in endangered species recovery

    PubMed Central

    Gerber, Leah R.

    2016-01-01

    Listing endangered and threatened species under the US Endangered Species Act is presumed to offer a defense against extinction and a solution to achieve recovery of imperiled populations, but only if effective conservation action ensues after listing occurs. The amount of government funding available for species protection and recovery is one of the best predictors of successful recovery; however, government spending is both insufficient and highly disproportionate among groups of species, and there is significant discrepancy between proposed and actualized budgets across species. In light of an increasing list of imperiled species requiring evaluation and protection, an explicit approach to allocating recovery funds is urgently needed. Here I provide a formal decision-theoretic approach focusing on return on investment as an objective and a transparent mechanism to achieve the desired recovery goals. I found that less than 25% of the $1.21 billion/year needed for implementing recovery plans for 1,125 species is actually allocated to recovery. Spending in excess of the recommended recovery budget does not necessarily translate into better conservation outcomes. Rather, elimination of only the budget surplus for “costly yet futile” recovery plans can provide sufficient funding to erase funding deficits for more than 180 species. Triage by budget compression provides better funding for a larger sample of species, and a larger sample of adequately funded recovery plans should produce better outcomes even if by chance. Sharpening our focus on deliberate decision making offers the potential to achieve desired outcomes in avoiding extinction for Endangered Species Act-listed species. PMID:26976572

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

    PubMed Central

    Evans, Robert G.

    2012-01-01

    “There's class warfare, all right, but it's my class, the rich class, that's making war, and we're winning.” (Warren Buffett, five years ago.) Last year's Occupy Wall Street movement suggested that people are finally catching on. Note, making war: Buffett meant that there was deliberate intent and agency behind the huge transfer of wealth, since 1980, from the 99% to the 1%. Nor is the war metaphorical. There are real casualties, even if no body bags. Sadly, much Canadian commentary on inequality is pitiably 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. PMID:23372577

  3. 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. PMID:23372577

  4. Definitive treatment of combat casualties at military medical centers.

    PubMed

    Andersen, Romney C; Frisch, H Michael; Farber, Gerald L; Hayda, Roman A

    2006-01-01

    More than 9,000 casualties have been evacuated during the current conflict, and more than 40,000 orthopaedic surgical procedures have been performed. The most severely injured patients are treated in the United States at military medical centers. Individualized reconstructive plans are developed, and patients are treated with state-of-the-art techniques. Rehabilitation includes the assistance of the physical medicine and rehabilitation, physical therapy, and occupational therapy services, as well as, when necessary, psychiatric or other services. The extreme challenges of treating war-related soft-tissue defects include neurovascular injuries, burns, heterotopic ossification, infection, prolonged recovery, and persistent pain. Such injuries do not allow full restoration of function. Because of such devastating injuries, and despite use of up-to-date methods, outcomes can be less than optimal.

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

    PubMed

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

    2009-06-01

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

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

    PubMed Central

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

    2008-01-01

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

  7. 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.

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

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

    PubMed

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

    2013-01-01

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

  12. Assessment of Emergency Preparedness Modules in Introductory Pharmacy Practice Experiences

    PubMed Central

    von Waldner, Trina; McEwen, Deanna W.; White, Catherine A.

    2016-01-01

    Objective. To determine the impact of emergency preparedness simulations in mass triage and mass dispensing on student pharmacist performance and perceived competency when assuming pharmacist roles in disaster situations. Design. Second-year student pharmacists (144) completed two 3-hour simulations focusing on mass triage and mass dispensing. The mass triage simulation consisted of virtual and live victims to be triaged and assigned a transport order. In the mass dispensing simulation, students assumed patient and pharmacist roles in a point-of-dispensing exercise for influenza. Assessment. For the mass triage simulation, students were challenged most by determining which patients could wait for emergency care but did well assessing those who required immediate or minimal care (83% and 64% correct, respectively). During the mass dispensing simulation, students performed screening and dispensing functions with accuracy rates of 88% and 90%, respectively. Conclusion. Student pharmacists performed well in screening and dispensing functions, but struggled with mass casualty triage during emergency preparedness simulations. PMID:27073276

  13. Assessment of Emergency Preparedness Modules in Introductory Pharmacy Practice Experiences.

    PubMed

    Hannings, Ashley N; von Waldner, Trina; McEwen, Deanna W; White, Catherine A

    2016-03-25

    Objective. To determine the impact of emergency preparedness simulations in mass triage and mass dispensing on student pharmacist performance and perceived competency when assuming pharmacist roles in disaster situations. Design. Second-year student pharmacists (144) completed two 3-hour simulations focusing on mass triage and mass dispensing. The mass triage simulation consisted of virtual and live victims to be triaged and assigned a transport order. In the mass dispensing simulation, students assumed patient and pharmacist roles in a point-of-dispensing exercise for influenza. Assessment. For the mass triage simulation, students were challenged most by determining which patients could wait for emergency care but did well assessing those who required immediate or minimal care (83% and 64% correct, respectively). During the mass dispensing simulation, students performed screening and dispensing functions with accuracy rates of 88% and 90%, respectively. Conclusion. Student pharmacists performed well in screening and dispensing functions, but struggled with mass casualty triage during emergency preparedness simulations. PMID:27073276

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

    SciTech Connect

    1998-06-01

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

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

    PubMed

    Bambach, M R; Mitchell, R J

    2015-12-01

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

  16. Scope of practice review: providers for triage and assessment of spine-related disorders

    PubMed Central

    Boakye, Omenaa; Birney, Arden; Suter, Esther; Phillips, Leah Adeline; Suen, Victoria YM

    2016-01-01

    Purpose This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers’ legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals’ scope of practice. Results Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. PMID:27274267

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

    PubMed

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

    2004-01-01

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

  18. Using electronic wristbands and a triage protocol to protect mental health patients in the emergency department.

    PubMed

    Macy, Deborah; Johnston, Michelle

    2007-01-01

    In the emergency department of Mercy Hospital, concerns about possible elopement of mental health patients led to the use of the services of security officers, who were called for an average of 40 patient watches per week. Modified electronic wristbands, paired with a triage protocol, have significantly decreased the need for patient watches and decreased security costs.

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

    ERIC Educational Resources Information Center

    Kunisch, Joseph Martin

    2012-01-01

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

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

    PubMed

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

    2011-03-01

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

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

    PubMed

    Miletić, D; Fuckar, Z; Mraović, B; Dimec, D; Mozetic, V

    1999-08-01

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

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

    PubMed Central

    Mahmoodian, Farzad; Eqtesadi, Razie; Ghareghani, Atefe

    2014-01-01

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

  3. Can Team Triage Improve Patient Flow in the Emergency Department? A Systematic Review and Meta-Analysis.

    PubMed

    Ming, Thomas; Lai, Aaron; Lau, Pui-Man

    2016-01-01

    This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice. PMID:27482995

  4. Can Team Triage Improve Patient Flow in the Emergency Department? A Systematic Review and Meta-Analysis.

    PubMed

    Ming, Thomas; Lai, Aaron; Lau, Pui-Man

    2016-01-01

    This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice.

  5. 11 March 2004: The terrorist bomb explosions in Madrid, Spain--an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital.

    PubMed

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

    2005-02-01

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

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

    NASA Astrophysics Data System (ADS)

    Lemmens, Stijn; Funke, Quirin; Krag, Holger

    2015-06-01

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

  7. Epidemiology of child pedestrian casualty rates: can we assume spatial independence?

    PubMed

    Hewson, Paul J

    2005-07-01

    Child pedestrian injuries are often investigated by means of ecological studies, yet are clearly part of a complex spatial phenomena. Spatial dependence within such ecological analyses have rarely been assessed, yet the validity of basic statistical techniques rely on a number of independence assumptions. Recent work from Canada has highlighted the potential for modelling spatial dependence within data that was aggregated in terms of the number of road casualties who were resident in a given geographical area. Other jurisdictions aggregate data in terms of the number of casualties in the geographical area in which the collision took place. This paper contrasts child pedestrian casualty data from Devon County UK, which has been aggregated by both methods. A simple ecological model, with minimally useful covaraties relating to measures of child deprivation, provides evidence that data aggregated in terms of the casualty's home location cannot be assumed to be spatially independent and that for analysis of these data to be valid there must be some accounting for spatial auto-correlation within the model structure. Conversely, data aggregated in terms of the collision location (as is usual in the UK) was found to be spatially independent. Whilst the spatial model is clearly more complex it provided a superior fit to that seen with either collision aggregated or non-spatial models. Of more importance, the ecological level association between deprivation and casualty rate is much lower once the spatial structure is accounted for, highlighting the importance using appropriately structured models.

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

    PubMed

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

    2015-02-01

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

  9. 3q26 Amplification Is an Effective Negative Triage Test for LSIL: A Historical Prospective Study

    PubMed Central

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

    2012-01-01

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

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

    SciTech Connect

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

    1981-10-01

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

  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

  12. The Triage of Injured Patients: Mechanism of Injury, Regardless of Injury Severity, Determines Hospital Destination.

    PubMed

    Staudenmayer, Kristan; Wang, N Ewen; Weiser, Thomas G; Maggio, Paul; Mackersie, Robert C; Spain, David; Hsia, Renee Y

    2016-04-01

    The target rate for trauma undertriage is <5 per cent, but rates are as high as 30 to 40 per cent in many trauma systems. We hypothesized that high undertriage rates were due to the tendency to undertriage injured elderly patients and a growing elderly population. We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database over a 5-year period. All hospital admissions and emergency department visits associated with injury were longitudinally linked. The primary outcome was triage pattern. Triage patterns were stratified across three dimensions: age, mechanism of injury, and access to care. A total of 60,182 severely injured patients were included in the analysis. Fall-related injuries were frequently undertriaged compared with injuries from motor vehicle collisions (MVCs) and penetrating trauma (52% vs 12% and 10%, respectively). This pattern was true for all age groups. Conversely, MVCs and penetrating traumas were associated with high rates of overtriage (>70% for both). In conclusion, in contrast to our hypothesis, we found that triage is largely determined by mechanism of injury regardless of injury severity. High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance. PMID:27097630

  13. Telephone Triage Service Data for Detection of Influenza-Like Illness

    PubMed Central

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

    2009-01-01

    Background Surveillance for influenza and influenza-like illness (ILI) is important for guiding public health prevention programs to mitigate the morbidity and mortality caused by influenza, including pandemic influenza. Nontraditional sources of data for influenza and ILI surveillance are of interest to public health authorities if their validity can be established. Methods/Principal Findings National telephone triage call data were collected through automated means for purposes of syndromic surveillance. For the 17 states with at least 500,000 inhabitants eligible to use the telephone triage services, call volume for respiratory syndrome was compared to CDC weekly number of influenza isolates and percentage of visits to sentinel providers for ILI. The degree to which the call data were correlated with either CDC viral isolates or sentinel provider percentage ILI data was highly variable among states. Conclusions Telephone triage data in the U.S. are patchy in coverage and therefore not a reliable source of ILI surveillance data on a national scale. However, in states displaying a higher correlation between the call data and the CDC data, call data may be useful as an adjunct to state-level surveillance data, for example at times when sentinel surveillance is not in operation or in areas where sentinel provider coverage is considered insufficient. Sufficient population coverage, a specific ILI syndrome definition, and the use of a threshold of percentage of calls that are for ILI would likely improve the utility of such data for ILI surveillance purposes. PMID:19381342

  14. Door to disposition times for obstetric triage visits: Is there a July phenomenon?

    PubMed

    Mehra, S; Gavard, J A; Gross, G; Myles, T; Nguyen, T; Amon, E

    2016-01-01

    The July phenomenon refers to a change in patient outcomes within teaching hospitals with the arrival of new and inexperienced house staff at the start of the academic year (July to June). In our obstetric triage unit we retrospectively evaluated the door to disposition time (DTDT) for 1817 patients who presented across July, December and May of academic years 2009-2010 and 2010-2011. DTDT was examined for three visit levels: non-urgent, urgent and emergent. No significant differences in disposition time were found for emergent visits. For urgent visits the median DTDT significantly decreased from 171 min in July to 155 min in December and 135 min in May (p < 0.001). Similarly for non-urgent visits, the median DTDT was greater during July than May (179 min vs. 133 min; p < 0.05). Electronic medical records (EMRs) were implemented in November 2010. Following the introduction of EMR shorter DTDT was seen in December 2010 versus December 2009 (median, 171 min vs. 150 min; p < 0.05), respectively. Our findings suggest a 'July Phenomenon' of greater disposition intervals for urgent and non-urgent obstetric triage visits across the academic year. Additionally the use of EMRs may facilitate patient flow through the OB triage unit. PMID:26368274

  15. Mobilized progenitor cells as a bridging therapy for radiation casualties: a brief review of tocopherol succinate-based approaches.

    PubMed

    Singh, Vijay K; Singh, Pankaj K; Wise, Stephen Y; Seed, Thomas M

    2011-07-01

    Nuclear detonation through either military or terrorist action would most likely lead to a mass-casualty scenario involving victims with varying degrees of exposure to ionizing radiation. As a result of radiation injury to the hematopoietic system, victims would suffer from a lack of red blood cells that deliver oxygen, immune cells that detect and eliminate infectious agents, and blood platelets that promote blood clot formation. In part, these symptoms are generally referred to as acute radiation syndrome (ARS). While some victims of moderate to high levels of radiation will be beyond saving, most will have received enough radiation to injure but not kill their bone marrow cells completely. Such people will recover from their injuries but face a 30-60day period during which they cannot fully fight infections and are prone to uncontrolled bleeding and anemia. To keep them alive until their hematopoietic system recovers, they must receive supportive care. Recently, using experimental animal models of ARS, transfusion of myeloid progenitor cells have been tried as a bridging therapy for radiation-exposed animals. Such cells have been shown to be effective in protecting animals exposed to lethal doses of radiation. These myeloid progenitors (along with of other hematopoietic progenitor cell types) can be mobilized out of the bone marrow into the blood for the reconstitution of hematopoiesis. This review discusses various approaches to the mobilization of progenitors using different mobilizing agents, and their utility as a bridging therapy for radiation casualties. We suggest that α-tocopherol succinate (TS) is an optimal mobilizing agent for progenitors. The extent of progenitor mobilization TS elicits in experimental mice is comparable to clinically used drugs such as recombinant granulocyte-colony stimulating factor rhG-CSF/Neupogen® and the bicyclam AMD3100 (plerixafor/Mozobil); therefore, we propose that TS be considered for further translational development

  16. Quantitative Estimates of the Numbers of Casualties to be Expected due to Major Earthquakes Near Megacities

    NASA Astrophysics Data System (ADS)

    Wyss, M.; Wenzel, F.

    2004-12-01

    Defining casualties as the sum of the fatalities plus injured, we use their mean number, as calculated by QUAKELOSS (developed by Extreme Situations Research Center, Moscow) as a measure of the extent of possible disasters due to earthquakes. Examples of cities we examined include Algiers, Cairo, Istanbul, Mumbai and Teheran, with populations ranging from about 3 to 20 million. With the assumption that the properties of the building stock has not changed with time since 1950, we find that the number of expected casualties will have increased about 5 to 10 fold by the year 2015. This increase is directly proportional to the increase of the population. For the assumed magnitude, we used M7 and M6.5 because shallow earthquakes in this range can occur in the seismogenic layer, without rupturing the surface. This means, they could occur anywhere in a seismically active area, not only along known faults. As a function of epicentral distance the fraction of casualties of the population decrease from about 6% at 20 km, to 3% at 30 km and 0.5% at 50 km, for an earthquake of M7. At 30 km distance, the assumed variation of the properties of the building stock from country to country give rise to variations of 1% to 5% for the estimate of the percent of the population that become casualties. As a function of earthquake size, the expected number of casualties drop by approximately an order of magnitude for an M6.5, compared to an M7, at 30 km distance. Because the computer code and database in QUAKELOSS are calibrated based on about 1000 earthquakes with fatalities, and verified by real-time loss estimates for about 60 cases, these results are probably of the correct order of magnitude. However, the results should not be taken as overly reliable, because (1) the probability calculations of the losses result in uncertainties of about a factor of two, (2) the method has been tested for medium size cities, not for megacities, and (3) many assumptions were made. Nevertheless, it is

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

    PubMed

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

    2015-01-01

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

  18. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 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...

  19. 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...

  20. 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...

  1. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 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...

  2. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 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...

  3. 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...

  4. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 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...

  5. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 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...

  6. 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...

  7. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 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...

  8. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 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...

  9. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 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...

  10. 49 CFR 1242.41 - Other and casualties and insurance (accounts XX-26-99 and 50-26-00).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 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...

  11. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 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...

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

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 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 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 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...

  14. 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...

  15. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 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...

  16. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 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...

  17. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 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...

  18. 49 CFR 1242.54 - Other and casualties and insurance (accounts XX-27-99 and 50-27-00).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 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...

  19. 49 CFR 1242.72 - Other and casualties and insurance (accounts XX-52-99 and 50-52-00).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 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...

  20. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 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...

  1. 49 CFR 1242.82 - Other and casualties and insurance (accounts XX-55-99 and 50-55-00).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 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...

  2. 49 CFR 1242.65 - Other and casualties and insurance (accounts XX-51-99 and 50-51-00).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 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...

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

    PubMed

    de Carvalho, José Crespo; Ramos, Madalena; Paixão, Carina

    2013-01-01

    Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed 'remote' triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients.

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

    PubMed

    Bisgard, J C

    1982-04-01

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

  5. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  6. 33 CFR 150.825 - Reporting a diving-related casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

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

    SciTech Connect

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

    1983-09-01

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

  8. 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...

  9. 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…

  10. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  11. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  12. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  13. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Deduction for losses from casualties or theft. 20.2054-1 Section 20.2054-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) ESTATE AND GIFT TAXES ESTATE TAX; ESTATES OF DECEDENTS DYING AFTER AUGUST 16, 1954 Taxable...

  14. 26 CFR 20.2054-1 - Deduction for losses from casualties or theft.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  15. 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…

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

    PubMed

    Blood, C G; Anderson, M E

    1994-09-01

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

  17. 17 CFR 210.12-18 - Supplemental information (for property-casualty insurance underwriters).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... claim adjustment expenses Discount, if any, deducted in column C 4 Unearned premiums Earned premiums Net investment income Claims and claim adjustment expenses incurred related to (1) Current year (2) Prior years...) Proportionate share of registrant and its subsidiaries' 50%-or-less-owned property-casualty equity investees...

  18. 76 FR 53364 - Recreational Vessel Propeller Strike and Carbon Monoxide Poisoning Casualty Prevention

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ... recreational vessel and propeller strike-related casualties. See 60 FR 25191 (May 11, 1995) (Request for... propeller guards. See 72 FR 59064 (Oct. 18, 2007) (Notice of Withdrawal). In the Notice of Withdrawal, the... regarding our public dockets in the January 17, 2008, issue of the Federal Register (73 FR 3316). D....

  19. How Much Overtesting Is Needed to Safely Exclude a Diagnosis? A Different Perspective on Triage Testing Using Bayes' Theorem.

    PubMed

    Sikkens, Jonne J; Beekman, Djoeke G; Thijs, Abel; Bossuyt, Patrick M; Smulders, Yvo M

    2016-01-01

    Ruling out disease often requires expensive or potentially harmful confirmation testing. For such testing, a less invasive triage test is often used. Intuitively, few negative confirmatory tests suggest success of this approach. However, if negative confirmation tests become too rare, too many disease cases could have been missed. It is therefore important to know how many negative tests are needed to safely exclude a diagnosis. We quantified this relationship using Bayes' theorem, and applied this to the example of pulmonary embolism (PE), for which triage is done with a Clinical Decision Rule (CDR) and D-dimer testing, and CT-angiography (CTA) is the confirmation test. For a maximum proportion of missed PEs of 1% in triage-negative patients, we calculate a 67% 'mandatory minimum' proportion of negative CTA scans. To achieve this, the proportion of patients with PE undergoing triage testing should be appropriately low, in this case no higher than 24%. Pre-test probability, triage test characteristics, the proportion of negative confirmation tests, and the number of missed diagnoses are mathematically entangled. The proportion of negative confirmation tests--not too high, but definitely not too low either--could be a quality benchmark for diagnostic processes.

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

    PubMed

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

    2014-01-01

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