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Sample records for radiation mass casualties

  1. 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.

  2. Interlaboratory comparison of the dicentric chromosome assay for radiation biodosimetry in mass casualty events.

    PubMed

    Wilkins, Ruth C; Romm, Horst; Kao, Tzu-Cheg; Awa, Akio A; Yoshida, Mitsuaki A; Livingston, Gordon K; Jenkins, Mark S; Oestreicher, Ursula; Pellmar, Terry C; Prasanna, Pataje G S

    2008-05-01

    This interlaboratory comparison validates the dicentric chromosome assay for assessing radiation dose in mass casualty accidents and identifies the advantages and limitations of an international biodosimetry network. The assay's validity and accuracy were determined among five laboratories following the International Organization for Standardization guidelines. Blood samples irradiated at the Armed Forces Radiobiology Research Institute were shipped to all laboratories, which constructed individual radiation calibration curves and assessed the dose to dose-blinded samples. Each laboratory constructed a dose-effect calibration curve for the yield of dicentrics for (60)Co gamma rays in the 0 to 5-Gy range, using the maximum likelihood linear-quadratic model, Y = c + alphaD + betaD(2). For all laboratories, the estimated coefficients of the fitted curves were within the 99.7% confidence intervals (CIs), but the observed dicentric yields differed. When each laboratory assessed radiation doses to four dose-blinded blood samples by comparing the observed dicentric yield with the laboratory's own calibration curve, the estimates were accurate in all laboratories at all doses. For all laboratories, actual doses were within the 99.75% CI for the assessed dose. Across the dose range, the error in the estimated doses, compared to the physical doses, ranged from 15% underestimation to 15% overestimation.

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

    PubMed

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

    2007-07-01

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

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

    PubMed Central

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

    2007-01-01

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

  5. [Mass casualty events].

    PubMed

    Guła, Przemysław; Hładki, Waldemar; Brongel, Leszek

    2006-01-01

    Authors present problems concerning mass--casualty accidents, specificity of action rescue-system on different levels of co-operation, kind of segregation of victims and efficiency of the medical rescue system in Poland. Attention has been paid to the continuous instructions and education of life-saving services, preferably by simulation of events without earlier information of the interested. It is necessary to establish and abide official dependence by the rules of co-operation of components of life-saving system. A separate problem is the implementation of rescue--activities in special situations: nuclear, biological and chemical contamination, and with very important safety measures for people taking part in rescue action.

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

    PubMed

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

    2014-05-01

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

  7. State-of-the-Art Advances in Radiation Biodosimetry for Mass Casualty Events Involving Radiation Exposure.

    PubMed

    Sproull, Mary; Camphausen, Kevin

    2016-11-01

    With the possibility of large-scale terrorist attacks around the world, the need for modeling and development of new medical countermeasures for potential future chemical, biological, radiological and nuclear (CBRN) has been well established. Project Bioshield, initiated in 2004, provided a framework to develop and expedite research in the field of CBRN exposures. To respond to large-scale population exposures from a nuclear event or radiation dispersal device (RDD), new methods for determining received dose using biological modeling became necessary. The field of biodosimetry has advanced significantly beyond this original initiative, with expansion into the fields of genomics, proteomics, metabolomics and transcriptomics. Studies are ongoing to evaluate the use of lymphocyte kinetics for dose assessment, as well as the development of field-deployable EPR technology. In addition, expansion of traditional cytogenetic assessment methods through the use of automated platforms and the development of laboratory surge capacity networks have helped to advance our biodefense preparedness. In this review of the latest advances in the field of biodosimetry we evaluate our progress and identify areas that still need to be addressed to achieve true field-deployment readiness.

  8. Biological dosimetry by the triage dicentric chromosome assay: potential implications for treatment of acute radiation syndrome in radiological mass casualties.

    PubMed

    Romm, Horst; Wilkins, Ruth C; Coleman, C Norman; Lillis-Hearne, Patricia K; Pellmar, Terry C; Livingston, Gordon K; Awa, Akio A; Jenkins, Mark S; Yoshida, Mitsuaki A; Oestreicher, Ursula; Prasanna, Pataje G S

    2011-03-01

    Biological dosimetry is an essential tool for estimating radiation dose. The dicentric chromosome assay (DCA) is currently the tool of choice. Because the assay is labor-intensive and time-consuming, strategies are needed to increase throughput for use in radiation mass casualty incidents. One such strategy is to truncate metaphase spread analysis for triage dose estimates by scoring 50 or fewer metaphases, compared to a routine analysis of 500 to 1000 metaphases, and to increase throughput using a large group of scorers in a biodosimetry network. Previously, the National Institutes for Allergies and Infectious Diseases (NIAID) and the Armed Forces Radiobiology Research Institute (AFRRI) sponsored a double-blinded interlaboratory comparison among five established international cytogenetic biodosimetry laboratories to determine the variability in calibration curves and in dose measurements in unknown, irradiated samples. In the present study, we further analyzed the published data from this previous study to investigate how the number of metaphase spreads influences dose prediction accuracy and how this information could be of value in the triage and management of people at risk for the acute radiation syndrome (ARS). Although, as expected, accuracy decreased with lower numbers of metaphase spreads analyzed, predicted doses by the laboratories were in good agreement and were judged to be adequate to guide diagnosis and treatment of ARS. These results demonstrate that for rapid triage, a network of cytogenetic biodosimetry laboratories can accurately assess doses even with a lower number of scored metaphases.

  9. 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

  10. 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.

  11. 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.

  12. Airway management during a mass casualty event.

    PubMed

    Talmor, Daniel

    2008-02-01

    Mass casualty respiratory failure will lead to many challenges, not the least of which is safe and secure management of the victims' airways. These patients will be sicker than those typically managed in the operating room and will require more emergency management of their airways. Mass casualty incidents involving biological or chemical agents will pose the additional risk of exposure to pathogen. During the severe acute respiratory syndrome epidemic in Toronto, airway manipulation was clearly identified as the procedure most associated with risk to health care workers. Planning for scenarios such as these will require consideration of personal protection for health care workers to minimize these risks. Understanding the risks involved and the airway techniques required for each possible scenario will be key to planning and preparation.

  13. Mass casualty incidents - time to engage.

    PubMed

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

    2016-01-01

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

  14. Preparing hospitals for toxicological mass casualties events.

    PubMed

    Tur-Kaspa, I; Lev, E I; Hendler, I; Siebner, R; Shapira, Y; Shemer, J

    1999-05-01

    For most hospital staffs, treatment of chemical casualties presents an obscure and even frightening situation. We report our unique experience from hospital drills in order to improve hospital preparedness for patient management under mass casualty conditions involving hazardous chemicals. Twenty-one major hospitals in Israel. A unique hospital deployment plan for the management of chemical casualties was developed, and hospitals were required to have a full chemical practice drill every 3 to 5 yrs. These drills were designed as realistically as possible, and all included the use of personal protective equipment, decontamination, and treatment of simulated patients. Twenty-five percent of these patients, simulating children and adults, required intensive care and ventilation support. Hospitals were inspected and reviewed on the quality of treatment given and the overall continuity of care as well as on their administrative performance. Between 1986 to 1994, 30 full chemical practice drills were conducted in 21 major hospitals. Each drill included treatment of 100 to 400 simulated patients. The lessons from the hospital drills are described and were incorporated in the proposed revised hospital deployment plan. All hospitals significantly improved their ability to respond appropriately to these incidents. The level of preparedness for a chemical mass casualty scenario should be established according to the existing threat and the available resources. The proposed plan can serve as a basis for hospital planning and staff training worldwide, thus facilitating optimal care in the event of an incident involving toxic chemicals. A cost-effective scale for hospital preparation levels according to the existing threat is suggested.

  15. Diagnostic and Treatment Innovations for Mass Casualties

    DTIC Science & Technology

    2016-08-01

    10 –4 coulomb per kilogram ( C kg –1 ) rad [absorbed dose] 1 × 10 –2 joule per kilogram (J kg –1 ) [gray (Gy)] rem [equivalent and effective...6201 Fort Belvoir, VA 22060-6201 T E C H N IC A L R E P O R T DTRA-TR-16-91 Diagnostic and Treatment Innovations for Mass Casualties...3 pascal (Pa) Temperature degree Fahrenheit ( o F) [T( o F) − 32]/1.8 degree Celsius ( o C ) degree Fahrenheit ( o F) [T( o F) + 459.67]/1.8

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

    PubMed

    Wolfson, Nikolaj

    2012-10-01

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

  17. 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.

  18. Prehospital preparedness for pediatric mass-casualty events.

    PubMed

    Shirm, Steve; Liggin, Rebecca; Dick, Rhonda; Graham, James

    2007-10-01

    Recent events have reiterated the need for well-coordinated planning for mass-casualty events, including those that involve children. The objective of this study was to document the preparedness of prehospital emergency medical services agencies in the United States for the care of children who are involved in mass-casualty events. A national list of all licensed prehospital emergency medical services agencies was prepared through contact with each state's emergency medical services office. A survey was mailed to 3748 emergency medical services agencies that were selected randomly from the national list in November 2004; a second survey was mailed to nonresponders in March 2005. Descriptive statistics were used to describe study variables. Most (72.9%) agencies reported having a written plan for response to a mass-casualty event, but only 248 (13.3%) reported having pediatric-specific mass-casualty event plans. Most (69%) services reported that they did not have a specific plan for response to a mass-casualty event at a school. Most (62.1%) agencies reported that their mass-casualty event plan does not include provisions for people with special health care needs. Only 19.2% of the services reported using a pediatric-specific triage protocol for mass-casualty events, and 12.3% reported having a pediatrician involved in their medical control. Although most (69.3%) agencies reported participation in a local or regional disaster drill in the past year, fewer than half of those that participated in drills (49.0%) included pediatric victims. Although children are among the most vulnerable in the event of disaster, there are substantial deficiencies in the preparedness plans of prehospital emergency medical services agencies in the United States for the care of children in a mass-casualty event.

  19. Model uniform core criteria for mass casualty triage.

    PubMed

    2011-06-01

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

  20. 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.

  1. Management of Mass Casualty Burn Disasters

    DTIC Science & Technology

    2005-05-01

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

  2. 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.

  3. 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

  4. Hepatitis B outbreak following a mass-casualty incident, Australia.

    PubMed

    Italiano, Claire M; Speers, David J; Chidlow, Glenys R; Dowse, Gary K; Robertson, Andrew G; Flexman, James P

    2011-08-01

    On 16 April 2009, a boat carrying 47 Afghan asylum seekers and 2 Indonesian crew exploded in Australian waters, resulting in mass casualties. Of these casualties, 23 persons who suffered significant burns were transferred to Royal Perth Hospital, Perth, Western Australia. One patient was subsequently shown to be a hepatitis B virus (HBV) carrier at the time of the explosion. Over the following months, 3 other patients received a diagnosis of acute hepatitis B, and an additional 4 patients showed serological evidence of recent HBV infection, including 1 patient who was transferred to another Australian city. Molecular typing determined that the strains from the HBV carrier and the acute and recent case patients formed a closely related cluster, and the investigation suggested that transmission occurred at or around the time of the boat explosion. This is the first report of confirmed transmission of HBV following a disaster, and it reinforces the importance of postexposure prophylaxis for HBV in mass casualty situations.

  5. Criteria and models for the distribution of casualties in trauma-related mass casualty incidents: a systematic literature review protocol.

    PubMed

    Khajehaminian, Mohammad Reza; Ardalan, Ali; Hosseini Boroujeni, Sayed Mohsen; Nejati, Amir; Keshtkar, Abbasali; Foroushani, Abbas Rahimi; Ebadati E, Omid Mahdi

    2017-07-12

    One of the most critical practices in mass casualty incident management is vacating the victims from scene of the incident and transporting them to proper healthcare facilities. Decision on distribution of casualties needs to be taken on pre-developed policies and structured decision support mechanisms. While many studies tried to present models for the distribution of casualties, no systematic review has yet been conducted to evaluate the existing models on casualty distribution following mass casualty incidents. A systematic review is therefore needed to examine the existing models of patient distribution and to provide a summary of the models. This systematic review protocol is aimed to examine the existing models and extracting rules and principles of mass casualty distribution. This study will comprehensively investigate existing papers with search phrases and terms including "mass casualty incident", distribution, evacuation, and Mesh terms directly corresponding to search phrases. No limitations on the type of studies, date of publication, or language of the relevant documents will be imposed. PubMed, Web of Science, Scopus, and Google Scholar will be searched to access the relevant documents. Included papers will be critically appraised by two independent reviewers. The data including incidents type, scene characteristics, patient features, pre-hospital resources, and hospital resources will be categorized. Subgroup analysis will be conducted when possible. To the best of our knowledge, no study has yet addressed the effects and interaction of contributing factors on the decision-making processes for casualty's distribution. This is the first study that comprehensively assesses and critically appraises the current models of casualty distribution. This study will provide evidences about models and criteria for casualty distribution following mass casualty incidents. PROSPERO Registration Number: CRD42016049115.

  6. Planning for a Mass Casualty Incident in Arkansas Schools

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  7. [Triage--and the management of mass casualty incidents].

    PubMed

    Peters, Sigurd

    2010-01-01

    Triage ("sorting") will only be necessary in the setting of mass casualties and lack of sufficient paramedical and medical specialists as well as equipment. Triage means that the victims will be divided into four categories denoting urgency of treatment and chance of survival. The most experienced medical doctor or officer is responsible for the triage. Copyright (c) 2010. Published by Elsevier GmbH.

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

    SciTech Connect

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

    2016-05-04

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

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

    SciTech Connect

    Greenwalt, R.; Hibbard, W.

    2016-08-09

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

  10. Mass casualty tracking with air traffic control methodologies.

    PubMed

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

    2009-06-01

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

  11. Evacuation Priorities in Mass Casualty Terror-Related Events

    PubMed Central

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

    2004-01-01

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

  12. Mass casualty triage after an airplane crash near Amsterdam.

    PubMed

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

    2013-08-01

    Triage is an important aspect of the management of mass casualty incidents. This study describes the triage after the Turkish Airlines Crash near Amsterdam in 2009. The results of the triage and the injuries of P3 casualties were evaluated. In addition, the role of the trauma mechanism and its effect on spinal immobilisation during transport was analysed. Retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash. Outcomes were triage classification, type of injury, AIS, ISS, emergency interventions and the spinal immobilisation during transport. A minimal documentation of prehospital triage was found, and no exact numbers could be recollected. During inhospital triage 28% was triaged as P1, 10% had an ISS ≥ 16 and 3% met the modified Baxt criteria for emergency intervention. 40% was triaged P3, 72% had an ISS ≤ 8 and 63% was discharged from the Emergency Department after evaluation. In hospital over-triage was up to 89%. Critical mortality rate was 0%. Nine per cent of P3 casualties and 17% of 'walking' casualties had serious injuries. Twenty-two per cent of all casualties was transported with spinal immobilisation. Of the casualties diagnosed with spinal injury 22% was not transported with spinal immobilisation. After the Turkish Airlines Crash documentation of prehospital triage was minimal. According to the Baxt criteria the overtriage was high. Injuries sustained by plane crash survivors that seem minimally harmed must not be underestimated. Considering the high energy trauma mechanism, too little consideration was given to spinal immobilisation during transport. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2017-02-01

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

  14. Are surgical residents prepared for mass casualty incidents?

    PubMed

    Galante, Joseph M; Jacoby, Robert C; Anderson, John T

    2006-05-01

    We hypothesized that resident education is inadequate with respect to management of mass casualty incidents that may involve chemical, biological, and nuclear exposures. Chief level residents in surgery (n = 10), emergency medicine (n = 10), and anesthesia (n = 8) were asked to complete a survey questionnaire. Responses were tabulated and statistically analyzed with Mann-Whitney Rank Sum, Student's t test, and Kruskal-Wallis one-way analysis of variance. All of the residents were similar with respect to age, sex, and intended setting of clinical practice. Only a single resident reported military experience. Two residents (7.1%) had administered medical care while wearing a protective suit. Compared with emergency medicine residents, surgical residents reported significantly less formal teaching in mass casual incidents (P = 0.02), trauma triage (P = 0.01), and nuclear, biological, chemical agents (P = 0.002). When surgical residents were compared with anesthesia residents, there was significantly less training for surgical residents in nuclear, chemical, and biological agents (P = 0.02). Multiple/mass casualty incident experience did not differ between residents. However, the most common incident involved only three to five patients with blunt trauma. Emergency medicine residents were significantly more comfortable in treating patients with exposure to anthrax (P = 0.01), sarin (P = 0.04), and nuclear exposure (P = 0.01). Surgical residents have significantly less formal training in mass casualties, triage, and chemical, biological, and nuclear exposures than residents in other specialties. Therefore, surgical residents are less comfortable treating these types of patients. Because surgeons often are expected to take leadership roles in mass casualty incidents, surgical education should be modified to match or exceed that of other specialties.

  15. Management of blast ear injuries in mass casualty environments.

    PubMed

    Okpala, Nnaemeka

    2011-11-01

    To establish a management pathway for blast ear injuries in mass casualty environments and to review the management of ear injuries caused by blast. Relevant literature search on blast injury was performed through MEDLINE. Comprehensive review of management of blast injuries of the ear was undertaken. There was an overview of the pathophysiology of blast and detailed discussion of management of injuries of the external, middle, and inner ear. With any ear symptoms or injury, the patient should be referred to the otolaryngologist for further management. The management of blast injury should ensure detection at an early stage, potentially life-threatening cases in mass casualty situations and ensuring that subtle injuries affecting the ear are not missed.

  16. 2014 Fort Hood, Texas, mass casualty incident: reviews and perspectives.

    PubMed

    Strommen, Joshua J; Waterman, Scott M; Mitchell, Christopher A; Grogan, Brian F

    2015-09-01

    On April 2, 2014, in Fort Hood, Texas, an active shooter incident occurred where four active duty soldiers were tragically killed. Active shooter incidents are becoming alarmingly more frequent over the last decade in the USA. The authors provide a detailed account of the events that occurred within the hospital and an evaluation of the triage decisions made on that day. A detailed review of mass casualty preparedness and the general approach to triage processes are also described.

  17. Scalable patients tracking framework for mass casualty incidents.

    PubMed

    Yu, Xunyi; Ganz, Aura

    2011-01-01

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

  18. Disaster preparedness: Experience from a smoke inhalation mass casualty incident.

    PubMed

    Goh, Siang-Hiong; Tiah, Ling; Lim, Hoon-Chin; Ng, Elaine Kim-Choon

    2006-12-01

    We describe a modified triage system used in managing a smoke inhalation mass casualty incident that we recently encountered at our community hospital. The patients were triaged as priority 1, 2 or 3 on the basis of their symptoms, signs and circumstances at scene. In addition, the use of fibre-optic examinations of the upper airway, chest radiography and carboxyhaemoglobin levels with arterial blood gas analyses were used to aid in disposal plans. Of the 22 patients evacuated, 15 were triaged as priority 2 and the remaining seven as priority 3. None of the patients was identified as priority 1. All the priority 2 patients underwent further investigations. Those with mild upper airway oedema (four patients) or raised carboxyhaemoglobin levels (two patients) were admitted. Only one patient had both. Another patient who was a known asthmatic developed bronchospasm and was admitted as well. All six were admitted to the general ward with subsequent good recovery and were discharged within 3 days. The remaining nine priority 2 and seven priority 3 patients were discharged from the emergency department. These modified triage criteria, with selective use of fibre-optic examinations, chest radiography and arterial blood gas analyses with carboxyhaemoglobin levels, are useful in smoke inhalation mass casualty incidents without dermal burns. Systemic injury and poisoning by toxic fumes often coexist with airway burns and should not be overlooked. Lastly, disaster planning and frequent drills at both local and national levels will optimize the response to future mass casualty incidents.

  19. Emergency department staff preparedness for mass casualty events involving children.

    PubMed

    Rassin, Michal; Avraham, Miri; Nasi-Bashari, Anat; Idelman, Sigalit; Peretz, Yaniv; Morag, Shani; Silner, Dina; Weiss, Gali

    2007-01-01

    In recent years, the World Health Organization in general, and Israel in particular, have dealt with mass casualty events (MCEs) resulting from terrorism. Children are the casualties in many of these events-a reality that forces hospitals to prepare to deal with such a scenario. A literature review designed to identify unique recommendations regarding pediatric MCEs highlights both a lack of existing training programs and uncertainty on the part of health care staff when dealing with these events. The purpose of the study was to examine the preparedness level of emergency department staff to deal with MCEs involving pediatric casualties. The study included 104 physicians and nurses working in, or responding to, the emergency department at a hospital in Israel. The study included a 41-item questionnaire examining perception, approaches, and staff knowledge regarding dealing with pediatric MCEs versus those involving adults. The reliability of all sections of the questionnaire ranged between Chronbach's alpha coefficient 0.6 alpha-0.94. The preparedness levels for MCEs involving children were found to be low. Study participants ranked the likelihood of a pediatric MCE lower than one involving adults, while ranking significantly higher (P = .000) their ability to cope mentally and the knowledge and skills required when treating adults involved in MCEs. While nurses ranked higher than physicians regarding their knowledge and skills in dealing with pediatric MCE casualties, the level of knowledge for MCEs involving children was low in all subjects. Staff agreement for the parent of an MCE victim to be present during treatment was medium-low. On the basis of these findings, additional research involving a larger number of individuals and hospitals is indicated to determine if these results are consistent throughout the region.

  20. Mass-casualty events at schools: a national preparedness survey.

    PubMed

    Graham, James; Shirm, Steve; Liggin, Rebecca; Aitken, Mary E; Dick, Rhonda

    2006-01-01

    Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.

  1. Assessment of hospital pharmacy preparedness for mass casualty events.

    PubMed

    Awad, Nadia I; Cocchio, Craig

    2015-04-01

    To assess the preparedness of hospital pharmacies in New Jersey to provide pharmaceutical services in mass casualty scenarios. An electronic cross-sectional survey was developed to assess the general knowledge of available resources and attitudes toward the preparedness of the pharmacy department. 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. 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.

  2. 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

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

    PubMed

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

    2008-01-01

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

  4. 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.

  5. Will emergency health care providers respond to mass casualty incidents?

    PubMed

    Syrett, James I; Benitez, John G; Livingston, William H; Davis, Eric A

    2007-01-01

    Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a non-transmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

  6. Will emergency health care providers respond to mass casualty incidents?

    PubMed

    Syrett, James I; Benitez, John G; Livingston, William H; Davis, Eric A

    2007-01-01

    Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

  7. Management of Mass Casualties Using Doctor Helicopters and Doctor Cars.

    PubMed

    Ohsaka, Hiromichi; Ishikawa, Kouhei; Omori, Kazuhiko; Jitsuiki, Kei; Yoshizawa, Toshihiko; Yanagawa, Youichi

    At approximately 10 o'clock in September 2015, a minibus carrying 18 people accidentally slid backwards because of a malfunctioning brake system while climbing a steep incline on Togasayama Mountain, colliding with a van (Toyota HiAce wagon) carrying 11 people that was situated behind the minibus. Togasayama Mountain is located 1 hour by car and 10 minutes by helicopter from our hospital. The minibus slid off a roadside cliff at a height of 0.5 m and rolled over after colliding with the van. There were 7 victims with yellow tags and 22 with green tags. Two Doctor Helicopters and 1 Doctor Car cooperated with the fire departments by providing medical treatments, selection of medical facilities, and dispersion transportation. In this mass casualty event, there were no mortalities, and all of the victims recovered without sequelae. The coordinated and combined use of Doctor Helicopters and Doctor Cars in addition to the activities of the fire department in response to a mass casualty event resulted in appropriate triage, medical treatments, selection of medical facilities, and dispersion transportation. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  8. Education and training of medical students for mass casualties situations.

    PubMed

    Adler, J

    1979-06-01

    During the academic years I 9 75 and I 9 76 an interdisciplinary course in mass casualty management was given to sixth year medical students at the Hebrew University-Hadassah Medical School in Jerusalem. The course included introductory lectures in definition of types of disasters, objectives in disaster intervention, description of local and national rescue organizations. Special importance was paid to mage of casualties and to a centralized system of evacuation from the disaster site. Further, hospital planning and deployment, stressing the role of the Emergency Room physician. The specific approach to multiple injuries including neurosurgical, orthopedic, abdominal, chest and soft tissue wounds was discussed in a panel meeting. Stress intervention and a comprehensive lecture on public health problems concluded this part of the course. The last half-day was devoted to a practical exercise, simulating a town severely damaged by an earthquake. Although the course was an elective one, it was extremely well attended by the students, and its implementation was enthusiastically performed by both teachers and students.

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

    PubMed

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

    2008-01-01

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

  10. Improving hospital mass casualty preparedness through ongoing readiness evaluation.

    PubMed

    Adini, Bruria; Laor, Daniel; Hornik-Lurie, Tzipora; Schwartz, Dagan; Aharonson-Daniel, Limor

    2012-01-01

    The objective of this study was to investigate the effect of ongoing use of an evaluation tool on hospitals' emergency preparedness for mass casualty events (MCEs). Two cycles of evaluation of emergency preparedness were conducted based on measurable parameters. A significant increase was found in mean total scores between the 2 cycles (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training, and equipment, but the change was significant only in the training category. Relative increase was highest for hospitals that did not experience real MCEs. This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated, measurable benchmarks. Ongoing assessment of emergency preparedness motivates hospitals to improve capabilities and results in a more effective emergency response mechanism. Use of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the areas evaluated.

  11. 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

  12. Ultrasonographic applications after mass casualty incident caused by Wenchuan earthquake.

    PubMed

    Dan, Deng; Mingsong, Liao; Jie, Tao; Xiaobo, Wu; Zhong, Chen; Yan, Liang; Xiaojin, Lai; Ming, Chang

    2010-06-01

    Ultrasonography has been widely applied in clinical settings, and its role in the assessment of trauma has been approved. However, there are very few reports about its role in the management of mass casualties. In our hospital, we retrospectively analyzed the application, the methods, and the role of ultrasonography in rescuing the Wenchuan earthquake victims. On a total of 3,307 wounded patients, 1,207 were examined by ultrasonography, and on a part of them, a follow-up was also performed. A total number of 1,386 ultrasound examinations were performed. Among them, 115 patients received ultrasound-guided interventional diagnosis and treatments. Ultrasound screening detected 23 cases of hemoperitoneum, 45 cases of pleural effusion (blood), 1 case of traumatic intimal tear of femoral artery, 3 cases of deep veins phlebothrombosis of lower limbs, 12 cases of deep-part hematoma of soft tissues. In five cases of negative results by ultrasonography, visceral injury was confirmed later by surgery or computed tomography or contrast-enhanced ultrasonography. All the ultrasound-guided interventional treatments were performed successfully, without any serious complication. The detection rate of trauma-related diseases was 6.96% (84 of 1,207) without false positive; however, the false negative rate was 5.6% (5 of 89). The bedside ultrasound became the preferred examination for the majority of injuries in middle and later stage after earthquake (72 hours to 6 weeks), accounting for 73.9% (458 of 620) of examinations. Ultrasonography-based FAST method was the primary examination tool of trauma in the early stage after earthquake. In our hospital, ultrasonography was widely used in the triage of earthquake victims, bedside examination of severe cases, and interventional treatments. The advantages of ultrasonography such as convenience, noninvasiveness, high accuracy, and repeatability have been sufficiently demonstrated in this mass casualty, where ultrasonography played a great

  13. 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

  14. 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

  15. [Mass casualty incidents : preparedness of German soccer arenas].

    PubMed

    Luiz, T; Preisegger, T; Madler, C

    2013-04-01

    Each weekend soccer arenas attract hundreds of thousands of spectators with the German Bundesliga being one of the most attractive sport series worldwide. In 2006 when the FIFA soccer World Cup™ took place in Germany, the precautions in the participating arenas against mass casualty incidents (MCI) reached a level formerly unknown in Germany. However, it is unknown how soccer arenas are prepared to deal with such incidents in everyday life. In 2011 all German major soccer league clubs were questioned about medical precautions in case of MCIs occurring in the stadium. The questionnaire included the following items: stadium capacity, the number of paramedic personnel, emergency physicians and ambulance vehicles, the command and communication structures, the availability of MCI plans, recent MCI drills and the frequency of MCI. Out of 39, 15 (38.4 %) participated, 50 % from the first league and 20.8 % from the second league. The mean stadium capacity was 41,800 spectators (minimum 10,600, maximum 80,700). Depending on the number of spectators and the individual risk score of the match the following resources were available within the stadiums (average, minimum, maximum,): emergency medical technicians 61-67 (15, 120), emergency physicians 2.3-2.5 (1, 5) and transport capacity 5.3-5.8 patients (1, 15). In 14 arenas (93.3 %) the medical personnel were trained in mass casualty care and had prepared MCI operation schedules. All stadiums had mission control centers equipped with a variety of wired and wireless communication tools, although only eight (52.3 %) arenas used a joint command structure and five (33.3 %) arenas reported MCIs (defined as a scenario involving more than 10 patients) within the past 10 years. In 40 % of the participants the last MCI-related exercise was conducted more than 36 months ago. Most of the participating arenas were adequately staffed to manage the first phase of MCIs but in contrast command structures and transport capacities often

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

    PubMed

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

    2013-12-01

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

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

    PubMed

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

    1999-09-09

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

  18. Drones at the service for training on mass casualty incident

    PubMed Central

    Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo

    2017-01-01

    Abstract Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants. PMID:28658106

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

    PubMed

    Hanley, Michael E; Bogdan, Gregory M

    2008-02-01

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

  20. 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.

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

    PubMed

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

    2013-11-01

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

  2. Policies for managing emergency medical services in mass casualty incidents.

    PubMed

    Adini, B; Bodas, M; Nilsson, H; Peleg, K

    2017-09-01

    Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of >80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents' origin country. 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Bioterrorism and mass casualty preparedness in hospitals: United States, 2003.

    PubMed

    Niska, Richard W; Burt, Catharine W

    2005-09-27

    This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. The National Hospital Ambulatory Medical Care Survey (NHAMCS) is an annual survey of a probability sample of approximately 500 non-Federal general and short-stay hospitals in the United States. A Bioterrorism and Mass Casualty Supplement was included in the 2003 survey and provided the data for this analysis. Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only

  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. Precision of in-hospital triage in mass-casualty incidents after terror attacks.

    PubMed

    Ashkenazi, Itamar; Kessel, Boris; Khashan, Tawfik; Haspel, Jacob; Oren, Meir; Olsha, Oded; Alfici, Ricardo

    2006-01-01

    Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan. [corrected] The objective of this study was to assess the precision of triage in mass-casualty incidents. The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS). Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 < or = ISS < 16), and 11 severe (ISS <16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%). Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.

  6. 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.

  7. Wireless Vital Sign Sensor Network Simulations for Mass Casualty Response

    DTIC Science & Technology

    2013-11-27

    Casualty, Network Simulation 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT: Unclassified 18. NUMBER OF PAGES 19 19a. NAME OF... security takes priority over medical treatment of the wounded, so it assumed that only two responders are available to provide medical care during...in ZigBee products. Since ZigBee software stacks are widely available and since a standard exists for ZigBee use in healthcare, it is a very

  8. Preparing South Carolina Emergency Departments for Mass Casualties with an Emphasis on the Planning Process

    DTIC Science & Technology

    2013-03-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited PREPARING SOUTH...CAROLINA EMERGENCY DEPARTMENTS FOR MASS CASUALTIES WITH AN EMPHASIS ON THE PLANNING PROCESS by Colleen Mary Donovan March 2013 Thesis ...March 2013 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE PREPARING SOUTH CAROLINA EMERGENCY DEPARTMENTS FOR MASS

  9. 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

  10. 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.

  11. Panel 2.5: mass-casualty management and hospital care.

    PubMed

    Borra, Agostino; Perez, Luis Jorge; Min, Tin; Puavilai, Wilai; Seo, Norimasa; Tipsunthonsak, Nakhon

    2005-01-01

    This is a summary of the presentations and discussion of Panel 2.5, Mass-Casualty Management and Hospital Care of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to mass-casualty management and hospital care as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) recommendations; and (3) conclusions. Subsections of the conclusion section include: (1) lessons learned; (2) what was done well?; and (3) what could have been done better?.

  12. Mass-casualty, terrorist bombings: implications for emergency department and hospital emergency response (Part II).

    PubMed

    Halpern, Pinchas; Tsai, Ming-Che; Arnold, Jeffrey L; Stok, Edita; Ersoy, Gurkan

    2003-01-01

    This article reviews the implications of mass-casualty, terrorist bombings for emergency department (ED) and hospital emergency responses. Several practical issues are considered, including the performance of a preliminary needs assessment, the mobilization of human and material resources, the use of personal protective equipment, the organization and performance of triage, the management of explosion-specific injuries, the organization of patient flow through the ED, and the efficient determination of patient disposition. As long as terrorists use explosions to achieve their goals, mass-casualty, terrorist bombings remain a required focus for hospital emergency planning and preparedness.

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

    PubMed

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

    2014-10-01

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

  14. The Hartford Consensus to improve survivability in mass casualty events: Process to policy.

    PubMed

    Jacobs, Lenworth; Burns, Karyl J

    2014-01-01

    The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events was formed to make recommendations to improve survival from intentional mass casualty incidents. This article describes the development of the Hartford Consensus and the process used to disseminate and implement its findings. Members of the Committee included individuals from select public safety organizations. The first meeting of the Committee was held on April 2, 2013, and a second meeting was held on July 11, 2013. Attendance at the second meeting was enlarged and included representatives from the Federal Emergency Management Agency and the National Security Staff of the Office of the President. The results of these meetings became known as the Hartford Consensus. The ideas generated at the meetings produced two documents, one from each meeting. These are referred to as Hartford Consensus I and II. Hartford Consensus I is a concept document and Hartford Consensus II is a call to action that no one should die from uncontrolled bleeding. The recommendations are being incorporated into training programs and have been endorsed by many organizations whose members are involved in the response to mass casualty incidents. The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events was successful in stimulating policy to bring about change. Training and resources including tourniquets and hemostatic dressing are being directed to help ameliorate the unfortunate reality of intentional mass injury.

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

    PubMed Central

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

    2016-01-01

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

  16. 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.

  17. Information Sharing for Medical Triage Tasking During Mass Casualty/Humanitarian Operations

    DTIC Science & Technology

    2009-12-01

    Mobile file sharing, Humanitarian response, Mass Casualty, WiFi network cloud 16. PRICE CODE 17. SECURITY CLASSIFICATION OF REPORT Unclassified 18... WiFi Cloud ........................60 2. Setup of the Portal ..........................60 3. Command Post Setup ...........................61 4...56 Figure 11. Cisco Aironet Wireless Access Point.............59 Figure 12. Pelican Case w/Customizing Padding..............60 Figure 13. WiFi

  18. Cyanide Antidotes for Mass Casualties: Comparison of Intramuscular Injector by Autoinjector, Intraosseous Injection, and Inhalational Delivery

    DTIC Science & Technology

    2013-10-01

    held high- throughput ultrasonic monodisperse aerosol inhalers for detoxification of massive CN poisoning. IV. CONCLUSIONS Significant effect of...Comparison of Intramuscular Injector by Autoinjector, Intraosseous Injection, and Inhalational Delivery PRINCIPAL INVESTIGATOR: Gerry R...Antidotes for Mass Casualties: Comparison of Intramuscular Injector by Autoinjector, Intraosseous Injection, and Inhalational Delivery 5a. CONTRACT

  19. [Triage protocols for mass casualty incidents : An overview 30 years after START].

    PubMed

    Streckbein, S; Kohlmann, T; Luxen, J; Birkholz, T; Prückner, S

    2016-08-01

    Since the publication of the first mass casualty triage protocol approximately 30 years ago, numerous adaptions and alternatives have been introduced and are currently in use throughout the world. This variety may represent a challenge for the cooperation between emergency medical providers and the interoperability of emergency medical services often required during mass casualty incidents. To enhance cooperation and interoperability a standardization of triage protocols is required. This survey was carried out in order to identify and characterize published triage protocols on national and international levels. Furthermore, evidence for validation of the identified triage algorithms was discussed and recommendations for standardization of triage protocols are given. In a systematic literature search 59 relevant articles were identified and evaluated with respect to the given objectives. A total of 12 triage concepts were identified and characterized which are categorized according to the basic principle. The endpoints of the studies, the chosen observation units and the mode of data collection were discussed with respect to their impact on validation. Furthermore, the impact of the degree and dynamics of system capacity overload, which are pathognomonic for mass casualty incidents, were discussed. There is not sufficient evidence to declare one of the triage protocols superior in all aspects to the others and no triage protocol has been implemented on a comprehensive level in Germany. In order to initialize a national or regional convergence process towards an interoperability of emergency medical services, the model uniform core criteria for mass casualty triage approach has been identified as being appropriate.

  20. 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

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

    PubMed

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

    2007-07-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    DTIC Science & Technology

    2010-11-01

    and only 4.9 percent were very confident that drills had given them the preparation that they needed. Only 45. 7 percent of reporting hospitals had a...board·certified medical toxi- cologist to help in such an emergency. Almost two-thirds (73.6 percent) of those familiar with the online Radiation ...Center attacks of2001, many hospitals recognized the consequences of failing to prepare for mass casualty incidents (MCls) of low probability but

  5. 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.

  6. 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.

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

    PubMed

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

    2017-08-07

    In recent years, mass-casualty incidents (MCIs) have become more frequent and deadly, while emergency department (ED) crowding has grown steadily worse and widespread. The ability of hospitals to implement an effective mass-casualty surge plan, immediately and expertly, has therefore never been more important. Yet, mass-casualty exercises tend to be highly choreographed, pre-scheduled events that provide limited insight into hospitals' true capacity to respond to a no-notice event under real-world conditions. To address this gap, the US Department of Health and Human Services (Washington, DC USA), Office of the Assistant Secretary for Preparedness and Response (ASPR), sponsored development of a set of tools meant to allow any hospital to run a real-time, no-notice exercise, focusing on the first hour and 15 minutes of a hospital's response to a sudden MCI, with the goals of minimizing burden, maximizing realism, and providing meaningful, outcome-oriented metrics to facilitate self-assessment. The resulting exercise, which was iteratively developed, piloted at nine hospitals nationwide, and completed in 2015, is now freely available for anyone to use or adapt. This report demonstrates the feasibility of implementing a no-notice exercise in the hospital setting and describes insights gained during the development process that might be helpful to future exercise developers. It also introduces the use of ED "immediate bed availability (IBA)" as an objective, dynamic measure of an ED's physical capacity for new arrivals. Waxman DA , Chan EW , Pillemer F , Smith TWJ , Abir M , Nelson C . Assessing and improving hospital mass-casualty preparedness: a no-notice exercise. Prehosp Disaster Med. 2017;32(6):1-5.

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

    PubMed

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

    2012-09-01

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

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

    PubMed

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

    2014-01-01

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

  10. 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.

  11. An Analysis of Mass Casualty Incidents in the Setting of Mass Gatherings and Special Events.

    PubMed

    Turris, Sheila A; Lund, Adam; Bowles, Ronald R

    2014-04-16

    Mass gatherings (MGs) and special events typically involve large numbers of people in unfamiliar settings, potentially creating unpredictable situations. To assess the information available to guide emergency services and onsite medical teams in planning and preparing for potential mass casualty incidents (MCIs), we analyzed the literature for the past 30 years. A search of the literature for MCIs at MGs from 1982 to 2012 was conducted and analyzed. Of the 290 MCIs included in this study, the most frequently reported mechanism of injury involved the movement of people under crowded conditions (162; 55.9%), followed by special hazards (eg, airplane crashes, pyrotechnic displays, car crashes, boat collisions: 57; 19.6%), structural failures (eg, building code violations, balcony collapses: 38; 13.1%), deliberate events (26; 9%), and toxic exposures (7; 2.4%). Incidents occurred in Asia (71; 24%), Europe (69; 24%), Africa (48; 17%), North America (48; 27%), South America (27; 9%), the Middle East (25; 9%), and Australasia (2; 1%). A minimum of 12 877 deaths and 27 184 injuries resulted. Based on our findings, we recommend that a centralized database be created. With this database, researchers can further develop evidence to guide prevention efforts and mitigate the effects of MCIs during MGs. (Disaster Med Public Health Preparedness. 2014;0:1-7).

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

    PubMed

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

    2009-01-01

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

  13. Physical medicine and rehabilitation in the military: the Bosnian mass casualty experience.

    PubMed

    Marin, R

    2001-04-01

    On February 5, 1994, a 120-mm mortar shell crashed into the main Market Square of Sarajevo, Bosnia. The explosion killed 66 and injured 206. The United States evacuated 71 of the injured to Landstuhl Regional Medical Center, where the Physical Medicine and Rehabilitation Service evaluated 28 victims. This mass casualty evacuation underscores the role of Army physiatrists in humanitarian assistance and wartime casualty management. The author collected data regarding demographic factors, injury types, complications, and functional limitations. Seventeen of the 28 patients evaluated were injured during the market bombing, with the rest being injured before the bombing. Of 132 diagnoses in these 28 patients, 31 were fractures, 14 were amputations, 8 were peripheral neuropathies, 3 were spinal cord injuries, and 1 was a traumatic brain injury. Contractures and decubitus ulcers, both complications of immobility, accounted for 18 of the diagnoses. Ambulatory impairments were present in all of the patients, and 4 patients had major impairments in activities of daily living.

  14. Critical issues in preparing for a mass casualty event: highlights from a new community planning guide.

    PubMed

    2007-09-01

    To assist community planners in allocating scarce resources in a mass casualty event, the Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) and the Office of the Assistant Secretary for Preparedness and Response collaborated with leading experts on a series of issue papers on preparedness and response. These papers were presented at an expert meeting in Washington, DC, in June 2006. The papers, revised based on meeting discussions, have been published by AHRQ as Mass Medical Care with Scarce Resources: A Community Planning Guide.

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

    PubMed

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

    2015-12-04

    In 2014, CDC published updated guidelines for the prevention and treatment of anthrax (Hendricks KA, Wright ME, Shadomy SV, et al. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20[2]. Available at http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article.htm). These guidelines provided recommended best practices for the diagnosis and treatment of persons with naturally occurring or bioterrorism-related anthrax in conventional medical settings. An aerosolized release of Bacillus anthracis spores over densely populated areas could become a mass-casualty incident. To prepare for this possibility, the U.S. government has stockpiled equipment and therapeutics (known as medical countermeasures [MCMs]) for anthrax prevention and treatment. However, previously developed, publicly available clinical recommendations have not addressed the use of MCMs or clinical management during an anthrax mass-casualty incident, when the number of patients is likely to exceed the ability of the health care infrastructure to provide conventional standards of care and supplies of MCMs might be inadequate to meet the demand required. To address this gap, in 2013, CDC conducted a series of systematic reviews of the scientific literature on anthrax to identify evidence that could help clinicians and public health authorities set guidelines for intravenous antimicrobial and antitoxin use, diagnosis of anthrax meningitis, and management of common anthrax-specific complications in the setting of a mass-casualty incident. Evidence from these reviews was presented to professionals with expertise in anthrax, critical care, and disaster medicine during a series of workgroup meetings that were held from August 2013 through March 2014. In March 2014, a meeting was held at which 102 subject matter experts discussed the evidence and adapted the existing best practices guidance to a clinical use framework for the

  16. Greetings: 50 years of Atomic Bomb Casualty Commission-Radiation Effects Research Foundation studies.

    PubMed

    Shigematsu, I

    1998-05-12

    The Atomic Bomb Casualty Commission was established in Hiroshima in 1947 and in Nagasaki in 1948 under the auspices of the U.S. National Academy of Sciences to initiate a long-term and comprehensive epidemiological and genetic study of the atomic bomb survivors. It was replaced in 1975 by the Radiation Effects Research Foundation which is a nonprofit Japanese foundation binationally managed and supported with equal funding by the governments of Japan and the United States. Thanks to the cooperation of the survivors and the contributions of a multitude of scientists, these studies flourish to this day in what must be the most successful long-term research collaboration between the two countries. Although these studies are necessarily limited to the effects of acute, whole-body, mixed gamma-neutron radiation from the atom bombs, their comprehensiveness and duration make them the most definitive descriptions of the late effects of radiation in humans. For this reason, the entire world relies heavily on these data to set radiation standards. As vital as the study results are, they still represent primarily the effects of radiation on older survivors. Another decade or two should correct this deficiency and allow us to measure definitively the human risk of heritable mutation from radiation. We look to the worldwide radiation and risk community as well as to the survivors who have contributed so much to what has been done already to accomplish this goal.

  17. Greetings: 50 years of Atomic Bomb Casualty Commission–Radiation Effects Research Foundation studies

    PubMed Central

    Shigematsu, Itsuzo

    1998-01-01

    The Atomic Bomb Casualty Commission was established in Hiroshima in 1947 and in Nagasaki in 1948 under the auspices of the U.S. National Academy of Sciences to initiate a long-term and comprehensive epidemiological and genetic study of the atomic bomb survivors. It was replaced in 1975 by the Radiation Effects Research Foundation which is a nonprofit Japanese foundation binationally managed and supported with equal funding by the governments of Japan and the United States. Thanks to the cooperation of the survivors and the contributions of a multitude of scientists, these studies flourish to this day in what must be the most successful long-term research collaboration between the two countries. Although these studies are necessarily limited to the effects of acute, whole-body, mixed gamma-neutron radiation from the atom bombs, their comprehensiveness and duration make them the most definitive descriptions of the late effects of radiation in humans. For this reason, the entire world relies heavily on these data to set radiation standards. As vital as the study results are, they still represent primarily the effects of radiation on older survivors. Another decade or two should correct this deficiency and allow us to measure definitively the human risk of heritable mutation from radiation. We look to the worldwide radiation and risk community as well as to the survivors who have contributed so much to what has been done already to accomplish this goal. PMID:9576897

  18. Identifying Meningitis During an Anthrax Mass Casualty Incident: Systematic Review of Systemic Anthrax Since 1880

    PubMed Central

    Katharios-Lanwermeyer, Stefan; Holty, Jon-Erik; Person, Marissa; Sejvar, James; Haberling, Dana; Tubbs, Heather; Meaney-Delman, Dana; Pillai, Satish K.; Hupert, Nathaniel; Bower, William A.; Hendricks, Katherine

    2016-01-01

    BACKGROUND Bacillus anthracis, the causative agent of anthrax, is a potential bioterrorism agent. Anthrax meningitis may be a manifestation of B. anthracis infection, has high mortality, and requires more aggressive treatment than anthrax without meningitis. Rapid identification and treatment of anthrax meningitis are essential for successful management of an anthrax mass casualty incident. METHODS Three hundred six published reports from 1880 through 2013 met pre-defined inclusion criteria. We calculated descriptive statistics for abstracted cases and conducted multivariable regression on separate derivation and validation cohorts to identify clinical diagnostic and prognostic factors for anthrax meningitis. RESULTS One hundred thirty-two of 363 (36%) cases with systemic anthrax met anthrax meningitis criteria. Severe headache, altered mental status, meningeal signs, and other neurological signs at presentation independently predicted meningitis in the derivation cohort and are proposed as a four-item screening tool for use during mass casualty incidents. Presence of any one factor on admission had a sensitivity for finding anthrax meningitis of 89% (83%) in the adult (pediatric) validation cohorts. Anthrax meningitis was unlikely in the absence of any of these signs or symptoms ([LR−]=0.12 [0.19] for adult [pediatric] cohorts), while presence of two or more factors made meningitis very likely ([LR+]=26.5 [29.2]). Survival of anthrax meningitis was predicted by treatment with a bactericidal agent (P=0.005) and use of multiple antimicrobials (P=0.012). CONCLUSIONS We developed an evidence-based triage tool for screening patients for meningitis during an anthrax mass casualty incident; its use could improve both patient outcomes and resource allocation in such an event. PMID:27025833

  19. A web-based model to support patient-to-hospital allocation in mass casualty incidents.

    PubMed

    Amram, Ofer; Schuurman, Nadine; Hedley, Nick; Hameed, S Morad

    2012-05-01

    In a mass casualty situation, evacuation of severely injured patients to the appropriate health care facility is of critical importance. The prehospital stage of a mass casualty incident (MCI) is typically chaotic, characterized by dynamic changes and severe time constraints. As a result, those involved in the prehospital evacuation process must be able to make crucial decisions in real time. This article presents a model intended to assist in the management of MCIs. The Mass Casualty Patient Allocation Model has been designed to facilitate effective evacuation by providing key information about nearby hospitals, including driving times and real-time bed capacity. These data will enable paramedics to make informed decisions in support of timely and appropriate patient allocation during MCIs. The model also enables simulation exercises for disaster preparedness and first response training. Road network and hospital location data were used to precalculate road travel times from all locations in Metro Vancouver to all Level I to III trauma hospitals. Hospital capacity data were obtained from hospitals and were updated by tracking patient evacuation from the MCI locations. In combination, these data were used to construct a sophisticated web-based simulation model for use by emergency response personnel. The model provides information critical to the decision-making process within a matter of seconds. This includes driving times to the nearest hospitals, the trauma service level of each hospital, the location of hospitals in relation to the incident, and up-to-date hospital capacity. The dynamic and evolving nature of MCIs requires that decisions regarding prehospital management be made under extreme time pressure. This model provides tools for these decisions to be made in an informed fashion with continuously updated hospital capacity information. In addition, it permits complex MCI simulation for response and preparedness training.

  20. Radiological work-up after mass casualty incidents: are ATLS guidelines applicable?

    PubMed

    Postma, Ingri L E; Beenen, L F M; Bijlsma, T S; Berger, F H; Heetveld, M J; Bloemers, F W; Goslings, J C

    2014-03-01

    In mass casualty incidents (MCI) a large number of patients need to be evaluated and treated fast. Well-designed radiological guidelines can save lives. The purpose of this study was to evaluate the Advanced Trauma Life Support (ATLS) radiological guidelines in the MCI of an aeroplane crash. Medical data of all 126 survivors of an aeroplane crash were analysed. Data included type and body region of the radiological studies performed on the survivors, Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) codes and trauma care level of the hospitals. Ninety patients (72 %) underwent one or more imaging studies: in total 297 radiographs, 148 CTs and 18 ultrasounds were performed. Only 18 % received diagnostic imaging of all four body regions as recommended by ATLS. Compliance with ATLS was highest (73.3 %) in severely injured victims (ISS ≥16); this group underwent two thirds of the (near) total body CTs, all performed in level I trauma centres. Overall compliance with ATLS radiological guidelines was low, although high in severely injured patients. Level I trauma centres frequently used (near) total body CT. Deviation from ATLS guidelines in radiological work-up in less severely injured patients can be safe and did not result in delayed diagnosis of serious injury. • Radiological imaging protocols can assist the management of mass casualty incidents needs. • Advanced Trauma Life Support (ATLS) radiological guidelines have been developed. • But radiological guidelines have not frequently been applied in aeroplane crashes. • Aircraft accidents are of high energy so ATLS guidelines should be applied. • Following mass casualty incidents total body CT seems appropriate within ATLS protocols.

  1. Can a pediatric trauma center improve the response to a mass casualty incident?

    PubMed

    Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S

    2012-10-01

    Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. Systematic review, level III.

  2. BET 2: Is prehospital focused abdominal ultrasound useful during triage at mass casualty incidents?

    PubMed

    2013-07-01

    A short-cut review was carried out to determined whether the addition of prehospital focused abdominal ultrasound to triage protocols might reduce time to necessary surgery and reduce overall mortality. Thirty-five papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are shown in table 2. It is concluded that although the feasibility of prehospital ultrasound in mass casualty incidents has been demonstrated, there is, as yet, no clear evidence of benefit as part of a triage protocol.

  3. 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.

  4. Orthopaedic triage during natural disasters and mass casualties: do scoring systems matter?

    PubMed

    Wolfson, Nikolaj

    2013-08-01

    Mass casualty events, either natural disasters or man-made, are associated with extremities injuries. The treating surgeon often faces a challenging decision: can the affected extremity be saved or amputated? The following article will present the author's view on the subject of triage and the use of scoring systems in the decision-making process whether to salvage or amputate an affected extremity. The author will analyse the existing scoring systems and emphasise significance of the regional factors: geographical, cultural and level of health care, as factors playing roles in this process.

  5. Teaching mass casualty triage skills using immersive three-dimensional virtual reality.

    PubMed

    Vincent, Dale S; Sherstyuk, Andrei; Burgess, Lawrence; Connolly, Kathleen K

    2008-11-01

    Virtual reality (VR) environments offer potential advantages over traditional paper methods, manikin simulation, and live drills for mass casualty training and assessment. The authors measured the acquisition of triage skills by novice learners after exposing them to three sequential scenarios (A, B, and C) of five simulated patients each in a fully immersed three-dimensional VR environment. The hypothesis was that learners would improve in speed, accuracy, and self-efficacy. Twenty-four medical students were taught principles of mass casualty triage using three short podcasts, followed by an immersive VR exercise in which learners donned a head-mounted display (HMD) and three motion tracking sensors, one for their head and one for each hand. They used a gesture-based command system to interact with multiple VR casualties. For triage score, one point was awarded for each correctly identified main problem, required intervention, and triage category. For intervention score, one point was awarded for each correct VR intervention. Scores were analyzed using one-way analysis of variance (ANOVA) for each student. Before and after surveys were used to measure self-efficacy and reaction to the training. Four students were excluded from analysis due to participation in a recent triage research program. Results from 20 students were analyzed. Triage scores and intervention scores improved significantly during Scenario B (p < 0.001). Time to complete each scenario decreased significantly from A (8:10 minutes) to B (5:14 minutes; p < 0.001) and from B to C (3:58 minutes; p < 0.001). Self-efficacy improved significantly in the areas of prioritizing treatment, prioritizing resources, identifying high-risk patients, and beliefs about learning to be an effective first responder. Novice learners demonstrated improved triage and intervention scores, speed, and self-efficacy during an iterative, fully immersed VR triage experience.

  6. 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.

  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

    2016-04-29

    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).

  8. Mass Casualty Incident Management Preparedness: A Survey of the American College of Surgeons Committee on Trauma.

    PubMed

    Lewis, Aaron M; Sordo, Salvador; Weireter, Leonard J; Price, Michelle A; Cancio, Leopoldo; Jonas, Rachelle B; Dent, Daniel L; Muir, Mark T; Aydelotte, Jayson D

    2016-12-01

    Mass casualty incidents (MCIs) are events resulting in more injured patients than hospital systems can handle with standard protocols. Several studies have assessed hospital preparedness during MCIs. However, physicians and trauma surgeons need to be familiar with their hospital's MCI Plan. The purpose of this survey was to assess hospitals' and trauma surgeon's preparedness for MCIs. Online surveys were e-mailed to members of the American College of Surgeons committee on Trauma Ad Hoc Committee on Disaster and Mass Casualty Management before the March 2012 meeting. Eighty surveys were analyzed (of 258). About 76 per cent were American College of Surgeons Level I trauma centers, 18 per cent were Level II trauma centers. Fifty-seven per cent of Level I and 21 per cent of Level II trauma centers had experienced an MCI. A total of 98 per cent of respondents thought it was likely their hospital would see a future MCI. Severe weather storm was the most likely event (95%), followed by public transportation incident (86%), then explosion (85%). About 83 per cent of hospitals had mechanisms to request additional physician/surgeons, and 80 per cent reported plans for operative triage. The majority of trauma surgeons felt prepared for an MCI and believed an event was likely to occur in the future. The survey was limited by the highly select group of respondents and future surveys will be necessary.

  9. Surgeon preparedness for mass casualty events: Adapting essential military surgical lessons for the home front.

    PubMed

    Remick, Kyle N; Shackelford, Stacy; Oh, John S; Seery, Jason M; Grabo, Daniel; Chovanes, John; Gross, Kirby R; Nessen, Shawn C; Tai, Nigel Rm; Rickard, Rory F; Elster, Eric; Schwab, C W

    2016-01-01

    Military surgeons have gained familiarity and experience with mass casualty events (MCEs) as a matter of routine over the course of the last two conflicts in Afghanistan and Iraq. Over the same period of time, civilian surgeons have increasingly faced complex MCEs on the home front. Our objective is to summarize and adapt these combat surgery lessons to enhance civilian surgeon preparedness for complex MCEs on the home front. The authors describe the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a MCE on the home front. Military Damage Control Surgery (mDCS) combines the established concept of clinical DCS (cDCS) with key combat situational awareness factors that enable surgeons to optimally care for multiple, complex patients, from multiple simultaneous events, with limited resources. These additional considerations involve the surgeon's role of care within the deployed trauma system and the battlefield effects. The proposed new concept of mass casualty DCS (mcDCS) similarly combines cDCS decisions with key factors of situational awareness for civilian surgeons faced with complex MCEs to optimize outcomes. The additional considerations for a civilian MCE include the surgeon's role of care within the regional trauma system and the incident effects. Adapting institutionalized lessons from combat surgery to civilian surgical colleagues will enhance national preparedness for complex MCEs on the home front.

  10. Pre-hospital management of mass casualty civilian shootings: a systematic literature review.

    PubMed

    Turner, Conor D A; Lockey, David J; Rehn, Marius

    2016-11-08

    Mass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice. Systematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings. From the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally. Key themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

  11. Systematic review of strategies to manage and allocate scarce resources during mass casualty events.

    PubMed

    Timbie, Justin W; Ringel, Jeanne S; Fox, D Steven; Pillemer, Francesca; Waxman, Daniel A; Moore, Melinda; Hansen, Cynthia K; Knebel, Ann R; Ricciardi, Richard; Kellermann, Arthur L

    2013-06-01

    Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of

  12. Principles of Emergency Department facility design for optimal management of mass-casualty incidents.

    PubMed

    Halpern, Pinchas; Goldberg, Scott A; Keng, Jimmy G; Koenig, Kristi L

    2012-04-01

    The Emergency Department (ED) is the triage, stabilization and disposition unit of the hospital during a mass-casualty incident (MCI). With most EDs already functioning at or over capacity, efficient management of an MCI requires optimization of all ED components. While the operational aspects of MCI management have been well described, the architectural/structural principles have not. Further, there are limited reports of the testing of ED design components in actual MCI events. The objective of this study is to outline the important infrastructural design components for optimization of ED response to an MCI, as developed, implemented, and repeatedly tested in one urban medical center. In the authors' experience, the most important aspects of ED design for MCI have included external infrastructure and promoting rapid lockdown of the facility for security purposes; an ambulance bay permitting efficient vehicle flow and casualty discharge; strategic placement of the triage location; patient tracking techniques; planning adequate surge capacity for both patients and staff; sufficient command, control, communications, computers, and information; well-positioned and functional decontamination facilities; adequate, well-located and easily distributed medical supplies; and appropriately built and functioning essential services. Designing the ED to cope well with a large casualty surge during a disaster is not easy, and it may not be feasible for all EDs to implement all the necessary components. However, many of the components of an appropriate infrastructural design add minimal cost to the normal expenditures of building an ED. This study highlights the role of design and infrastructure in MCI preparedness in order to assist planners in improving their ED capabilities. Structural optimization calls for a paradigm shift in the concept of structural and operational ED design, but may be necessary in order to maximize surge capacity, department resilience, and patient and

  13. Continuous arteriovenous hemofiltration with dialysis (CAVH-D): an alternative to hemodialysis in the mass casualty situation.

    PubMed

    Omert, L; Reynolds, H N; Wiles, C E

    1991-01-01

    Renal failure is a common sequela of mass casualty, particularly when crush injury is involved. Traditional management of renal failure with hemodialysis equipment may be difficult or inaccessible due to lack of electricity and water supply or damage to existing equipment. Furthermore, a sudden new population of renal failure patients may overwhelm an existing dialysis program. The rapid mobilization of traditional hemodialysis equipment may be delayed due to limited supply, manufacturing delays, or inventory shortages. For these reasons, we propose the use of continuous arteriovenous hemofiltration with dialysis (CAVH-D) as an alternative renal support modality for the mass casualty situation.

  14. Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events.

    PubMed

    Masterson, Lori; Steffen, Christel; Brin, Michael; Kordick, Mary Frances; Christos, Steve

    2009-01-01

    In May 2003, the TOPOFF 2 national disaster drill demonstrated inadequate preparedness for mass casualty terrorist events and failed to address the willingness of Emergency Department (ED) personnel to assist with these events. The objective of this study was to examine ED personnel willingness to respond to various multiple casualty events. A prospective voluntary survey of ED personnel from multiple hospitals was randomly administered in the form of vignette-based questionnaires. The survey of 204 participants at eight hospitals in the Chicago area revealed that staff members were more willing to work additional hours for victims of an airplane crash (98.0%), than for a radioactive bomb (85.3%), or a biologic agent (54.0%). For the biologic agent only, men were significantly more likely to respond than women. Hospital management should anticipate significant reductions in workforce during biologic and radioactive disaster events. Employees' willingness to respond was not augmented by any incentives offered by hospitals, although enhanced financial remuneration and disability coverage showed the most potential to increase response.

  15. Disasters and mass casualties: II. explosive, biologic, chemical, and nuclear agents.

    PubMed

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

    2007-08-01

    Terrorists' use of explosive, biologic, chemical, and nuclear agents constitutes the potential for catastrophic events. Understanding the unique aspects of these agents can help in preparing for such disasters with the intent of mitigating injury and loss of life. Explosive agents continue to be the most common weapons of terrorists and the most prevalent cause of injuries and fatalities. Knowledge of blast pathomechanics and patterns of injury allows for improved diagnostic and treatment strategies. A practical understanding of potential biologic, chemical, and nuclear agents, their attendant clinical symptoms, and recommended management strategies is an important prerequisite for optimal preparation and response to these less frequently used agents of mass casualty. Orthopaedic surgeons should be aware of the principles of management of catastrophic events. Stress is less an issue when one is adequately prepared. Decontamination is essential both to manage victims and prevent further spread of toxic agents to first responders and medical personnel. It is important to assess the risk of potential threats, thereby allowing disaster planning and preparation to be proportional and aligned with the actual casualty event.

  16. Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

    PubMed

    Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

    2014-10-01

    On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

  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. Perceived preparedness for a mass casualty disaster in the United States: a survey.

    PubMed

    Glick, J; Birnbaum, M L

    1998-01-01

    A mass casualty disaster (MCD) never has occurred in the United States, but such an event remains a fearful possibility. The purpose of this study was to establish baseline information concerning the perceptions relative to the capabilities of the United States to respond to a MCD of persons most likely to involved in the responses to such an event when it does occur. A survey was constructed in 1995 to query the perceptions of persons in authority in federal, state, and local agencies who would participate in the medical responses to a MCD. Participants were asked to select the most likely scenario, a hurricane or earthquake, that could generate 30,000 casualties within their respective region. The survey requested respondent's perceptions as to the timing of the federal responses and the quality and sufficiency of these responses. The survey also sought information about the availability of plans to meet such a catastrophe in the region, and the frequency with which such plans have been exercised. Responses were grouped by phase of the responses and whether the respondents were employed by federal, state, or local agencies. Descriptive statistics were used to summarize the data. When appropriate, a one-tailed t-test was used to compare the responses of the groups. A p-value = 0.05 was considered statistically significant. A total of 104 surveys were distributed of which 88 were completed and returned (85%). Both the federal and state respondents had considerable experienced in this area. Overall, the federal respondents were more optimistic about the availability, utility, and timely arrival of federal resources to assist regions in meeting the medical needs. In each of the three phases of MCD responses evaluated (medical response, patient evacuation, and definitive care), there was concern that there were insufficient resources to meet the requirements. States and local respondents perceived that initially, they will be on their own for field rescue, life

  19. 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

  20. Does self-reporting facilitate history taking in food poisoning mass-casualty incidents?

    PubMed

    Hsu, Ya-I; Huang, Ying C

    2014-08-01

    Medical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response. In some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information. Two resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students' t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics. There were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the

  1. 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.

  2. 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

  3. Management of conventional mass casualty incidents: ten commandments for hospital planning.

    PubMed

    Lynn, Mauricio; Gurr, Daniel; Memon, Abdul; Kaliff, Jennifer

    2006-01-01

    The successful management of mass casualty incidents (MCIs) requires standardization of planning, training, and deployment of response. Recent events in the United States, most importantly the Hurricane season in 2005, demonstrated a lack of a unified response plan at local, regional, state, and federal levels. A standard Israeli protocol for hospital preparedness for conventional MCIs, produced by the Office of Emergency Preparedness of the Israeli Ministry of Health, has been reviewed, modified, adapted, and tested in both drills and actual events at a large university medical center in the United States. Lessons learned from this process are herein presented as the10 most important steps (ie, Commandments) to follow when preparing hospitals to be able to respond to conventional MCIs. The standard Israeli emergency protocols have proved to be universally adaptable, flexible, and designed to be adapted by any healthcare institution, regardless of its size and location.

  4. 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.

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

    PubMed Central

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

    2015-01-01

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

  6. An Interprofessional Approach to Continuing Education With Mass Casualty Simulation: Planning and Execution.

    PubMed

    Saber, Deborah A; Strout, Kelley; Caruso, Lisa Swanson; Ingwell-Spolan, Charlene; Koplovsky, Aiden

    2017-10-01

    Many natural and man-made disasters require the assistance from teams of health care professionals. Knowing that continuing education about disaster simulation training is essential to nursing students, nurses, and emergency first responders (e.g., emergency medical technicians, firefighters, police officers), a university in the northeastern United States planned and implemented an interprofessional mass casualty incident (MCI) disaster simulation using the Project Management Body of Knowledge (PMBOK) management framework. The school of nursing and University Volunteer Ambulance Corps (UVAC) worked together to simulate a bus crash with disaster victim actors to provide continued education for community first responders and train nursing students on the MCI process. This article explains the simulation activity, planning process, and achieved outcomes. J Contin Educ Nurs. 2017;48(10):447-453. Copyright 2017, SLACK Incorporated.

  7. 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

  8. Terrorism, trauma, and mass casualty triage: how might we solve the latest mind-body problem?

    PubMed

    Engel, Charles C; Locke, Steven; Reissman, Dori B; DeMartino, Robert; Kutz, Ilan; McDonald, Michael; Barsky, Arthur J

    2007-06-01

    The global war on terrorism has led to increased concern about the ability of the U.S. healthcare system to respond to casualties from a chemical, biological, or radiological agent attack. Relatively little attention, however, has focused on the potential, in the immediate aftermath of such an attack, for large numbers of casualties presenting to triage points with acute health anxiety and idiopathic physical symptoms. This sort of "mass idiopathic illness" is not a certain outcome of chemical, biological, or radiological attack. However, in the event that this phenomenon occurs, it could result in surges in demand for medical evaluations that may disrupt triage systems and endanger lives. Conversely, if continuous primary care is not available for such patients after initial triage, many may suffer with unrecognized physical and emotional injuries and illness. This report is the result of an expert planning initiative seeking to facilitate triage protocols that will address the possibility of mass idiopathic illness and bolster healthcare system surge capacity. The report reviews key triage assumptions and gaps in knowledge and offers a four-stage triage model for further discussion and research. Optimal triage approaches offer flexibility and should be based on empirical studies, critical incident modeling, lessons from simulation exercises, and case studies. In addition to staging, the proposed triage and longitudinal care model relies on early recognition of symptoms, development of a registry, and use of non-physician care management to facilitate later longitudinal followup and collaboration between primary care and psychiatry for the significant minority of patients who develop persistent idiopathic symptoms associated with reduced functional status.

  9. Mass casualty modelling: a spatial tool to support triage decision making.

    PubMed

    Amram, Ofer; Schuurman, Nadine; Hameed, Syed M

    2011-06-10

    During a mass casualty incident, evacuation of patients to the appropriate health care facility is critical to survival. Despite this, no existing system provides the evidence required to make informed evacuation decisions from the scene of the incident. To mitigate this absence and enable more informed decision making, a web based spatial decision support system (SDSS) was developed. This system supports decision making by providing data regarding hospital proximity, capacity, and treatment specializations to decision makers at the scene of the incident. This web-based SDSS utilizes pre-calculated driving times to estimate the actual driving time to each hospital within the inclusive trauma system of the large metropolitan region within which it is situated. In calculating and displaying its results, the model incorporates both road network and hospital data (e.g. capacity, treatment specialties, etc.), and produces results in a matter of seconds, as is required in a MCI situation. In addition, its application interface allows the user to map the incident location and assists in the execution of triage decisions. Upon running the model, driving time from the MCI location to the surrounding hospitals is quickly displayed alongside information regarding hospital capacity and capability, thereby assisting the user in the decision-making process. The use of SDSS in the prioritization of MCI evacuation decision making is potentially valuable in cases of mass casualty. The key to this model is the utilization of pre-calculated driving times from each hospital in the region to each point on the road network. The incorporation of real-time traffic and hospital capacity data would further improve this model.

  10. 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.

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

    PubMed

    Ozoilo, Kenneth N; Pam, Ishaya C; Yiltok, Simon J; Ramyil, Alice V; Nwadiaro, Hyacinth C

    2013-10-28

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

  12. Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review.

    PubMed

    Hsu, Edbert B; Jenckes, Mollie W; Catlett, Christina L; Robinson, Karen A; Feuerstein, Carolyn; Cosgrove, Sara E; Green, Gary B; Bass, Eric B

    2004-01-01

    Recently, mass-casualty incident (MCI) preparedness and training has received increasing attention at the hospital level. To review the existing evidence on the effectiveness of disaster drills, technology-based interventions and tabletop exercises in training hospital staff to respond to an MCI. A systematic, evidence-based process was conducted incorporating expert panel input and a literature review with the key terms: "mass casualty", "disaster", "disaster planning", and "drill". Paired investigators reviewed citation abstracts to identify articles that included evaluation of disaster training for hospital staff. Data were abstracted from the studies (e.g., MCI type, training intervention, staff targeted, objectives, evaluation methods, and results). Study quality was reviewed using standardized criteria. Of 243 potentially relevant citations, 21 met the defined criteria. Studies varied in terms of targeted staff, learning objectives, outcomes, and evaluation methods. Most were characterized by significant limitations in design and evaluation methods. Seventeen addressed the effectiveness of disaster drills in training hospital staff in responding to an MCI, four addressed technology-based interventions, and none addressed tabletop exercises. The existing evidence suggests that hospital disaster drills are effective in allowing hospital employees to become familiar with disaster procedures, identify problems in different components of response (e.g., incident command, communications, triage, patient flow, materials and resources, and security) and provide the opportunity to apply lessons learned to disaster response. The strength of evidence on other training methods is insufficient to draw valid recommendations. Current evidence on the effectiveness of MCI training for hospital staff is limited. A number of studies suggest that disaster drills can be effective in training hospital staff. However, more attention should be directed to evaluating the

  13. Mass casualty modelling: a spatial tool to support triage decision making

    PubMed Central

    2011-01-01

    Background During a mass casualty incident, evacuation of patients to the appropriate health care facility is critical to survival. Despite this, no existing system provides the evidence required to make informed evacuation decisions from the scene of the incident. To mitigate this absence and enable more informed decision making, a web based spatial decision support system (SDSS) was developed. This system supports decision making by providing data regarding hospital proximity, capacity, and treatment specializations to decision makers at the scene of the incident. Methods This web-based SDSS utilizes pre-calculated driving times to estimate the actual driving time to each hospital within the inclusive trauma system of the large metropolitan region within which it is situated. In calculating and displaying its results, the model incorporates both road network and hospital data (e.g. capacity, treatment specialties, etc.), and produces results in a matter of seconds, as is required in a MCI situation. In addition, its application interface allows the user to map the incident location and assists in the execution of triage decisions. Results Upon running the model, driving time from the MCI location to the surrounding hospitals is quickly displayed alongside information regarding hospital capacity and capability, thereby assisting the user in the decision-making process. Conclusions The use of SDSS in the prioritization of MCI evacuation decision making is potentially valuable in cases of mass casualty. The key to this model is the utilization of pre-calculated driving times from each hospital in the region to each point on the road network. The incorporation of real-time traffic and hospital capacity data would further improve this model. PMID:21663636

  14. BASIC REVIEW OF ENDOTRACHEAL INTUBATION FOR PROVIDERS AT A MASS CASUALTY.

    PubMed

    Boedeker, Ben; Murray, W Bosseau

    2008-01-01

    During a mass casualty scenario (whether manmade or natural disaster), healthcare providers could likely be overwhelmed by patients, many of whom would need airway support. In such a situation, medical personnel from a wide variety of backgrounds may be called upon to provide airway management. Such personnel could include emergency medical technicians, nurses, physician's assistants and physicians from all specialties. In our current practice, a similar mix of medical providers are being tasked with increased airway management to support conscious sedation delivery. Increasing demand for airway management skills requires more airway training for medical personnel who may be involved in disaster medicine or other 'out of operating room' care. To support the growing airway training needs for medical providers, especially in the advent of a mass casualty situation, a virtual training platform was created in collaboration with the Telemedicine and Advanced Technology Research Center, Medical Material and Research Command, US Army, the United States Army Chemical Care Casualty Division, Aberdeen Proving Grounds, MD and a consortium of universities. This project was funded by an unrestricted educational grant from Karl Storz Endoscopy America, Inc and from a grant from the Telemedicine and Advanced Technology Research Center, Medical Material Research Command, US Army. Its goal is to gradually develop a comprehensive virtual training textbook to support personnel involved in medical disaster management and other out of operating room patient care requiring appropriate airway skills. This web-based manuscript is intended to represent the initial training module in support of the collaborative airway management training project. A mannequin-based intubation training module followed by intubation experience in the operating room are meant to complete the full instructional package. The initial training module was designed with an emphasis on graphics. The web-based format

  15. 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

  16. Mass casualty incidents: are NHS staff prepared? An audit of one NHS foundation trust.

    PubMed

    Milkhu, C S; Howell, D C J; Glynne, P A; Raptis, D; Booth, H L; Langmead, L; Datta, V K

    2008-09-01

    Lack of knowledge of an NHS trust's major incident policies by clinical staff may result in poorly coordinated responses during a mass casualty incident (MCI). To audit knowledge of the major incident policy by clinical staff working in a central London major acute NHS trust designated to receive casualties on a 24-h basis during a MCI. A 12-question proforma was distributed to 307 nursing and medical staff in the hospital, designed to assess their knowledge of the major incident policy. Completed proformas were collected over a 2-month period between December 2006 and February 2007. A reply rate of 34% was obtained, with a reasonable representation from all disciplines ranging from nurses to consultants. Despite only 41% having read the policy in full, 70% knew the correct immediate action to take if informed of major incident activation. 76% knew the correct stand-down procedure. 56% knew the correct reporting point but less than 25% knew that an action card system was utilised. Nurses had significantly (p<0.01) more awareness of the policy than doctors. In view of the heightened terrorist threat in London, knowledge of major incident policy is essential. The high percentage of positive responses relating to immediate and stand-down actions reflects the rolling trust-wide MCI education programme and the organisational memory of the trust following several previous MCI in the capital. There is still scope for an improvement in awareness, however, particularly concerning knowledge of action cards, which are now displayed routinely throughout clinical areas and will be incorporated into induction packs.

  17. 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.

  18. 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

    Boonthep, Nuttapong; Intharachat, Suthee; Iemsomboon, Tassanee

    2012-01-03

    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. 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. 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). 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.

  19. 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

  20. Assessing hospital preparedness using an instrument based on the Mass Casualty Disaster Plan Checklist: results of a statewide survey.

    PubMed

    Higgins, Wayne; Wainright, Charles; Lu, Ning; Carrico, Ruth

    2004-10-01

    Hospitals would play a critical role in a weapon of mass destruction (WMD) event. The purpose of this study is to assess preparedness for mass casualty events in short-term and long-term hospitals in Kentucky. All short-term and long-term hospitals in Kentucky were surveyed using an instrument based on the Mass Casualty Disaster Plan Checklist and a brief supplemental bioterrorism preparedness questionnaire based on a checklist developed for the Agency for Healthcare Research and Quality. Responses were received from 116 of the 118 (98%) hospitals surveyed. Hospitals reported surge capacity equal to 27% of licensed beds, and virtually all respondents were engaged in planning for weapons of mass destruction events. However, advanced planning and preparation were less common. Large regional differences were observed, especially in the area of pharmaceutical planning. Preparedness planning in general and pharmaceutical management planning in particular were more advanced in counties participating in the Metropolitan Medical Response System Program (MMRS). Hospital mass casualty preparedness efforts were in an early stage of development at the time of this survey, and some critical capabilities, such as isolation, decontamination, and syndromic surveillance were clearly underdeveloped. Preparedness planning was more advanced among hospitals located in MMRS counties.

  1. 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. © 2016 AABB.

  2. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises.

    PubMed

    Körner, Markus; Krötz, Michael M; Wirth, Stefan; Huber-Wagner, Stefan; Kanz, Karl-Georg; Boehm, Holger F; Reiser, Maximilian; Linsenmaier, Ulrich

    2009-08-01

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated "critical" by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol.

  3. Diagnostic precision of triage algorithms for mass casualty incidents. English version.

    PubMed

    Heller, A R; Salvador, N; Frank, M; Schiffner, J; Kipke, R; Kleber, C

    2017-08-10

    Regarding survival and quality of life recent mass casualty incidents again emphasize the importance of early identification of the correct degree of injury/illness to enable prioritization of treatment amongst patients and their transportation to an appropriate hospital. The present study investigated existing triage algorithms in terms of sensitivity (SE) and specificity (SP) as well as its process duration in a relevant emergency patient cohort. In this study 500 consecutive air rescue missions were evaluated by means of standardized patient records. Classification of patients was accomplished by 19 emergency physicians. Every case was independently classified by at least 3 physicians without considering any triage algorithm. Existing triage algorithms Primary Ranking for Initial Orientation in Emergency Medical Services (PRIOR), modified Simple Triage and Rapid Treatment (mSTaRT), Field Triage Score (FTS), Amberg-Schwandorf Algorithm for Triage (ASAV), Simple Triage and Rapid Treatment (STaRT), Care Flight, and Triage Sieve were additionally carried out computer based on each case, to enable calculation of quality criteria. The analyzed cohort had an age of (mean ± SD) 59 ± 25 years, a NACA score of 3.5 ± 1.1 and consisted of 57% men. On arrival 8 patients were deceased. Consequently, 492 patients were included in the analysis. The distribution of triage categories T1/T2/T3 were 10%/47%/43%, respectively. The highest diagnostic quality was achieved with START, mSTaRT, and ASAV yielding a SE of 78% and a SP ranging from 80-83%. The subgroup of surgical patients reached a SE of 95% and a SP between 85-91%. The newly established algorithm PRIOR exerted a SE of 90% but merely a SP of 54% in the overall cohort thereby consuming the longest time for overall decision. Triage procedures with acceptable diagnostic quality exist to identify the most severely injured. Due to its high rate of false positive results (over-triage) the recently developed

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

    PubMed

    Eldad, Arieh

    2002-05-01

    Species of plants and animals, as well as nations of human beings were extinguished throughout the prehistory and history of this planet. One of the possible explanations for this phenomenon is a large scale epidemic of viral, bacterial or fungal infections. One well-documented example was the smallpox epidemic among native Indians of South America following the European invasion. Deliberate dissemination of disease was used as a weapon during the Middle Ages when corpses of plague casualties were thrown over the walls and into the besieged towns. The Book of Kings II, of the Bible, in chapter 19 recalls the story of 185,000 soldiers of Sennacherib that died in one night, near the walls of Jerusalem. The possibility of causing mass casualty by dissemination of infectious disease has driven countries and terrorist organizations to produce and store large quantities of bacteria or viruses. The death of thousands in the USA on September 11, 2001, demonstrated that terror has no moral prohibitions, only technical limitations. Terror organizations will not hesitate to use weapons for mass destruction to kill many, and if only few will die, it will still serve the purpose of these evil organizations: to strew panic, to destroy normal life and to increase fear and instability. Any government that faces decisions about how to be better prepared against biological warfare is pushed between the devil and the deep blue sea. On the one hand: the better we will be prepared, equipped with antibiotics and vaccines--the more lives of casualties we will be able to save. Better public education will help to reduce the damage, but, on the other hand--in order to cause more people to make the effort to equip themselves or to refresh their protective kit--we will have to increase their level of concern. In order to improve the medical education of all members of the medical teams we will have to start a broad and intense campaign, thereby taking the risk of increasing stress in the

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

    PubMed

    Yu, Xunyi; Ganz, Aura

    2011-01-01

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

  6. 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.

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

    PubMed

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

    2015-04-01

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

  8. [Emergency preparedness based on coherent integration of crisis response resources: workshop on mass casualty management in Bethlehem in June 1999].

    PubMed

    Amblard, J; Fleury, M; Ruolt, N

    2002-01-01

    In June 1999, the Humanitarian Action Division of the Foreign Affairs Department organized a training course on the mass casualty management within the framework of religious festivities related to the Bethlehem 2000 project. This initiative was undertaken at the request of the Palestinian Authority and the General Consulate of France in Jerusalem. Palestinian and French specialists in the field worked together in three workshops devoted to rescue, search and first aid; medical outposts and triage; and emergency and surgical care in referring hospitals.

  9. Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II.

    PubMed

    Heinrichs, Wm Leroy; Youngblood, Patricia; Harter, Phillip; Kusumoto, Laura; Dev, Parvati

    2010-01-01

    Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures. The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs. Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the "game" interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument. Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either "confident" or "very confident", with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical

  10. 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.

  11. Preparedness of German Paramedics and Emergency Physicians for a Mass Casualty Incident: A National Survey.

    PubMed

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

    2008-10-01

    Paramedics and physicians are important components of our emergency medical system. To date, no survey has been carried out assessing physicians and paramedics regarding their preparedness for a mass casualty incident (MCI) resulting from a terrorist attack in Germany. The aim of this study was to assess the current state of preparedness of emergency physicians and paramedics for an MCI. Using an online questionnaire, we interviewed 1,707 emergency physicians and paramedics in Germany. The replies were analyzed statistically with the one-way analysis of variance (ANOVA) test and the Tukey-Kramer multiple comparisons test. In all, 95% of the emergency physicians and paramedics knew their area of responsibility in the case of an MCI. However, 45% of them were unaware of injury patterns and treatment strategies in patients following nuclear, chemical or biological contamination. Of the interviewed emergency physicians and paramedics, 97% asked for further specific training for MCI/terrorism attacks. Emergency physicians and paramedics are still insufficiently prepared for nuclear, chemical, and biological as well as conventional terrorism attacks. The emergency training of emergency physicians and paramedics must be modified to accommodate the increased risk of catastrophes and terrorist attacks.

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

    PubMed

    Bookman, Kelly; Zane, Richard

    2013-08-01

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

  13. An after-action review tool for EDs: learning from mass casualty incidents.

    PubMed

    Tami, Greenberg; Bruria, Adini; Fabiana, Eden; Tami, Chen; Tali, Ankri; Limor, Aharonson-Daniel

    2013-05-01

    Conducting a thorough after-action review (AAR) process is an important component in improving preparedness for mass casualty incidents (MCIs). The study aimed to develop a structured AAR tool for use by medical teams in emergency departments after an MCI and to identify the best possible procedure for its conduct. On the basis of knowledge acquired from an extensive literature review, a structured tool for conducting an AAR in the emergency department was developed. A modified Delphi process was conducted to achieve content validity of the tool, involving 48 medical professionals from all 6 level I trauma centers in Israel. The AAR tool was tested during a simulated MCI drill. All experts support the conduct of an AAR in the ED after an MCI to build and maintain capacity for an adequate emergency response. More than 80% agreement was achieved regarding 14 components that were implemented in the proposed AAR tool. Ninety-four percent perceived that AARs should be conducted within 24 hours from the event using both written reports and face-to-face discussions. Both physicians and nurses should participate. The incident manager should lead the AAR, limiting the time allocated for each speaker and for the AAR in whole. Conducting a structured AAR in all emergency departments after an MCI facilitates both learning lessons regarding the function of the medical staff and ventilation of feelings, thus mitigating anxieties and expediting a speedy return to normalcy. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Adequacy of US Hospital Security Preparedness for Mass Casualty Incidents: Critical Lessons From the Israeli Experience.

    PubMed

    Golabek-Goldman, Michele

    2016-01-01

    Due to Israel's threat environment, Israeli hospitals have developed effective and innovative security preparations for responding to all-hazards incidents. Although Israeli hospital preparedness has been the subject of international praise and attention, there has been a dearth of research focused specifically on applying Israeli hospital security measures to the US hospital setting to augment emergency planning. This study examined practical and cost-effective lessons from the Israeli experience for improving US hospital security preparedness for a wide range of mass casualty incidents, both natural and man-made. Sixty semi-structured interviews were conducted with officials throughout Israel's and America's health, defense, and emergency response communities. Hospital preparedness was examined and disaster drills were evaluated in both countries, with San Francisco hospitals analyzed as a case study. Qualitative analysis was conducted and recommendations were made on the basis of an all-hazards approach to emergency preparedness. US hospitals examined in this study had not undertaken crucial preparations for managing the security consequences of a large-scale disaster. Recommendations from Israel included installing permanent emergency signage, improving security perimeter protocols and training, increasing defense against primary and secondary attacks, enhancing coordination with law enforcement, the National Guard, and other outside security agencies, and conducting more frequent and realistic lockdown exercises. A number of US hospitals have overlooked the important role of security in emergency preparedness. This study analyzed practical and cost-effective security recommendations from Israel to remedy this dangerous deficiency in some US hospitals' disaster planning.

  15. Drones at the service for training on mass casualty incident: A simulation study.

    PubMed

    Fernandez-Pacheco, Antonio Nieto; Rodriguez, Laura Juguera; Price, Mariana Ferrandini; Perez, Ana Belen Garcia; Alonso, Nuria Perez; Rios, Manuel Pardo

    2017-06-01

    Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants.

  16. 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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2005-01-01

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

  19. Use of a computer-mediated Delphi process to validate a mass casualty conceptual model.

    PubMed

    Culley, Joan M

    2011-05-01

    Since the original work on the Delphi technique, multiple versions have been developed and used in research and industry; however, very little empirical research has been conducted that evaluates the efficacy of using online computer, Internet, and e-mail applications to facilitate a Delphi method that can be used to validate theoretical models. The purpose of this research was to develop computer, Internet, and e-mail applications to facilitate a modified Delphi technique through which experts provide validation for a proposed conceptual model that describes the information needs for a mass-casualty continuum of care. Extant literature and existing theoretical models provided the basis for model development. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships, and indicators in the model. The majority of experts rated the online processes favorably (mean of 6.1 on a seven-point scale). Using online Internet and computer applications to facilitate a modified Delphi process offers much promise for future research involving model building or validation. The online Delphi process provided an effective methodology for identifying and describing the complex series of events and contextual factors that influence the way we respond to disasters.

  20. Identifying Factors That May Influence Decision-Making Related to the Distribution of Patients During a Mass Casualty Incident.

    PubMed

    Hall, Trevor Nt; McDonald, Andrew; Peleg, Kobi

    2017-09-18

    We aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident. A qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile. Fifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement. Agreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2017; page 1 of 8).

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

    PubMed

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

    2016-02-01

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

  2. Multidisciplinary team response to a mass burn casualty event: outcomes and implications.

    PubMed

    Cleland, Heather J; Proud, David; Spinks, Anneliese; Wasiak, Jason

    2011-06-06

    To describe the characteristics of patients with burn injury admitted to a major trauma hospital in Melbourne following the Black Saturday bushfires of 7 February 2009, and to provide a detailed analysis of the hospital's response to the crisis. A retrospective chart review of ambulance and hospital records of patients admitted to the Victorian Adult Burns Service (VABS) at The Alfred Hospital (The Alfred) following the bushfires. Patient characteristics and outcomes: age, sex, total and full thickness body surface area burnt, type and site of burn, hospital and intensive care unit length of stay (LOS) and receipt of standard burn care practices. Estimated glomerular filtration rate, theatre time and LOS data for the bushfire cohort compared with corresponding data for historical cohorts from VABS and from a similar institution in New Zealand. Nineteen patients were admitted to VABS over the first 48 hours after the bushfires. Of these, nine patients were subsequently admitted to The Alfred's intensive care unit. Most patients (74%) were men with a mean age of 52.7 years (SD, 12.4 years). Seventeen patients (89%) underwent at least one surgical procedure, which resulted in 4355 minutes of theatre time for the bushfire cohort in the first week. Hospital LOS was similar for the bushfire and New Zealand cohorts. Compared with the VABS historical cohort, there was a higher incidence of abnormal renal function among the bushfire cohort patients. Although relatively few patients with severe burns were admitted to VABS, significant increases in resource allocation were required to manage them in terms of additional theatre time, consumables and staffing. The experience of VABS may aid planning for future mass burns casualty events.

  3. 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.

  4. 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

  5. Developing a Hospital Disaster Preparedness Plan for Mass Casualty Incidents: Lessons Learned From the Downtown Beirut Bombing.

    PubMed

    El Sayed, Mazen; Chami, Ali F; Hitti, Eveline

    2017-09-20

    Mass casualty incidents (MCIs) are becoming more frequent worldwide, especially in the Middle East where violence in Syria has spilled over to many neighboring countries. Lebanon lacks a coordinated prehospital response system to deal with MCIs; therefore, hospital preparedness plans are essential to deal with the surge of casualties. This report describes our experience in dealing with an MCI involving a car bomb in an urban area of downtown Beirut, Lebanon. It uses general response principles to propose a simplified response model for hospitals to use during MCIs. A summary of the debriefings following the event was developed and an analysis was performed with the aim of modifying our hospital's existing disaster preparedness plan. Casualties' arrival to our emergency department (ED), the performance of our hospital staff during the event, communication, and the coordination of resources, in addition to the response of the different departments, were examined. In dealing with MCIs, hospital plans should focus on triage area, patient registration and tracking, communication, resource coordination, essential staff functions, as well as on security issues and crowd control. Hospitals in other countries that lack a coordinated prehospital disaster response system can use the principles described here to improve their hospital's resilience and response to MCIs. (Disaster Med Public Health Preparedness. 2017; page 1 of 7).

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

    PubMed

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

    2013-02-01

    To design and test a model to predict surge capacity bottlenecks at a large academic medical center in response to a mass-casualty incident (MCI) involving multiple burn victims. Using the simulation software ProModel, a model of patient flow and anticipated resource use, according to principles of disaster management, was developed based upon historical data from the University Hospital of the University of Michigan Health System. Model inputs included: (a) age and weight distribution for casualties, and distribution of size and depth of burns; (b) rate of arrival of casualties to the hospital, and triage to ward or critical care settings; (c) eligibility for early discharge of non-MCI inpatients at time of MCI; (d) baseline occupancy of intensive care unit (ICU), surgical step-down, and ward; (e) staff availability-number of physicians, nurses, and respiratory therapists, and the expected ratio of each group to patients; (f) floor and operating room resources-anticipating the need for mechanical ventilators, burn care and surgical resources, blood products, and intravenous fluids; (g) average hospital length of stay and mortality rate for patients with inhalation injury and different size burns; and (h) average number of times that different size burns undergo surgery. Key model outputs include time to bottleneck for each limiting resource and average waiting time to hospital bed availability. Given base-case model assumptions (including 100 mass casualties with an inter-arrival rate to the hospital of one patient every three minutes), hospital utilization is constrained within the first 120 minutes to 21 casualties, due to the limited number of beds. The first bottleneck is attributable to exhausting critical care beds, followed by floor beds. Given this limitation in number of patients, the temporal order of the ensuing bottlenecks is as follows: Lactated Ringer's solution (4 h), silver sulfadiazine/Silvadene (6 h), albumin (48 h), thrombin topical (72 h), type

  7. Coping with war mass casualties in a hospital under fire: the radiology experience.

    PubMed

    Engel, Ahuva; Soudack, Michalle; Ofer, Amos; Nitecki, Samy S; Ghersin, Eduard; Fischer, Doron; Gaitini, Diana E

    2009-11-01

    We report the role of the imaging department at a level 1 trauma center during the Second Lebanon War (summer 2006). Our institution received 849 military and civilian casualties, an average of 25 war-injured patients per day, 338 with acute traumatic stress disorders and 511 physically injured, coming in waves after a rocket attack or a battle confrontation. About 12 potentially critical physically injured patients per day were referred to the imaging department for sometimes complex imaging procedures. The unpredictable waves of casualties and nature of the injuries forced us to reorganize our routine workflow to provide adequate care to casualties and to nonemergent patients. Our nurses' station was transformed into a small emergency department. The radiology staff was distributed into 12 diagnostic stations, providing 24-hour service. Communication was improved by means of walkie-talkies. Three ultrasound units were placed at the emergency department for immediate focused assessment with sonography for trauma performance enabling initial triage of patients. The site and extent of injuries were accurately diagnosed on CT and CT angiography. Digital angiography allowed definitive vascular diagnosis and interventional procedures. Adequate communication, strict workflow, and correct use of imaging protocols ensured optimal triage, diagnosis, and therapy of casualties while maintaining care for nonwar patients.

  8. Regional health system response to the Virginia Tech mass casualty incident.

    PubMed

    Kaplowitz, Lisa; Reece, Morris; Hershey, Jody Henry; Gilbert, Carol M; Subbarao, Italo

    2007-09-01

    On April 16, 2007 a mass shooting occurred on the campus of Virginia Polytechnic Institute and State University (Virginia Tech). Due to both distance and weather, air transport of the injured directly to a level 1 trauma center was not possible. The injured received all of their care or were initially stabilized at 3 primary hospitals that either had a level 3 trauma center designation or no trauma center designation. This article is a retrospective analysis of the regional health system (prehospital, hospital, regional hospital emergency operations center, and public health local and state) response. Data records from all of the regional responding emergency medical services, hospitals, and coordinating services were reviewed and analyzed. Records for all 26 patients were reviewed and analyzed using triage designations, injury severity scores (ISS), and critical mortality. Twenty-five of the 26 patients were triaged in the field. Excluding 1 patient (asthma), the average ISS for victims presenting was 8.2. Twelve patients had an ISS of > or = 9, and 5 had an ISS score of > or = 15. Ten of the 26 patients (38%) required urgent intervention and surgery in the first 24 hours. The overall regional health system mortality of victims received was 3.8% (1 death [excluding 1 dead on arrival {DOA}]/ 26 victims from scene). The regional health system critical mortality rate (excluding 1 victim who was DOA) was 20% (1/5). The outcomes of the Virginia Tech mass casualty incident, as evidenced by the low overall regional health system mortality of victims received at 3.8% (1/26) and low critical mortality rate (excluding 1 victim who was DOA) of 20%, coupled with a need to treat a significant amount of moderately injured victims 46% (12/26 with ISS > or = 9) gives credence to the successful response. The successful response occurred as a consequence of regional collaborative planning, training, and exercising, which resulted not only in increased expertise and improved

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

    PubMed

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

    2016-10-01

    The suicide bombings in London on 7 July 2005 resulted in a mass casualty situation. Over 50% of casualties were treated at the Royal London Hospital where clinicians witnessed large numbers of severely injured patients. In some casualties human biological foreign material was found embedded in the soft tissue originating from the suicide bombers or other casualties. This had the potential of placing individuals at risk of transmission of blood-borne diseases. Advances in the fields of medicine and biology have led to increased survivorship in the context of trauma and mass casualty incidents. This has resulted in the emergence of ethical scenarios surrounding patient management. A systematic review of the literature of the 7/7 bombings, and suicide bombings reported globally, where biological implantation is noted, was performed to examine the medicolegal issues arising during such attack. Twelve casualties with human tissue implanted were recorded in the 7/7 bombings. While all patients at risk were given prophylaxis based on recommendations by the Health Protection Agency, several ethical considerations surfaced as a result. In this paper, we compare the sequence of events and the management process of the victims of the 7/7 bombings and the evidence-based research regarding blood-borne infection transmission. Furthermore, it explores the ethical dilemmas, experienced by the senior author on 7/7, surrounding prophylaxis for blood-borne diseases and protocols to avoid confusion over best practice in future bombing incidents.

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

    PubMed

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

    2017-02-01

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

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

    PubMed

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

    2009-05-01

    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.

  12. A state survey of emergency department preparedness for the care of children in a mass casualty event.

    PubMed

    Thompson, Tonya; Lyle, Kristen; Mullins, S Hope; Dick, Rhonda; Graham, James

    2009-01-01

    The Institute of Medicine has issued two reports over the past 10 years raising concerns about the care of children in the emergency medical care system of the United States. Given that children are involved in most mass casualty events and there are deficiencies in the day-to-day emergency care of children, this project was undertaken to document the preparedness of hospitals in AR for the care of children in mass casualty or disaster situations. Mailed survey to all emergency department medical directors in AR. Nonresponders received a second mailed survey and an attempt at survey via phone. Medical directors of the emergency departments of the 80 acute care hospitals in AR. Seventy-two of 80 directors responded (90 percent response rate). Only 13 percent of hospitals reported they have pediatric mass casualty protocols and in only 28 percent of hospitals the disaster plan includes pediatric-specific issues such as parental reunification. Most hospitals hold mass casualty training events (94 percent), at least annually, but only 64 percent report including pediatric patients in their disaster drills. Most hospitals include local fire (90 percent), police (82 percent), and emergency medical services (77 percent) in their drills, but only 23 percent report involving local schools in the disaster planning process. Eighty-three percent of hospitals responding reported their staff is trained in decontamination procedures. Thirty-five percent reported having warm water showers available for infant/children decontamination. Ninety-four percent of hospitals have a plan for calling in extra staff in a disaster situation, which most commonly involves a phone tree (43 percent). Ninety-three percent reported the availability of Ham Radios, walkie-talkie, or Arkansas Wireless Information Network (AWIN) units for communication in case of land line loss, but only 16 percent reported satellite phone or Tandberg units. Twelve percent reported reliance on cell phones in this

  13. An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain).

    PubMed

    Castro Delgado, Rafael; Naves Gómez, Cecilia; Cuartas Álvarez, Tatiana; Arcos González, Pedro

    2016-02-24

    Mass Casualty Incidents (MCI) have been rarely studied from epidemiological approaches. The objective of this study is to establish the epidemiological profile of MCI in the autonomous region of the Principality of Asturias (Spain) and analyse ambulance deployment and severity of patients. This is a population-based prospective study run in 2014. Inclusion criteria for MCI is "every incident with four or more people affected that requires ambulance mobilisation". Thirty-nine MCI have been identified in Asturias in 2014. Thirty-one (79%) were road traffic accidents, three (7.5%) fires and five (12.8%) other types. Twenty-one incidents (56.7%) had four patients, and only three of them (8%) had seven or more patients. An average of 2.41 ambulances per incident were deployed (standard error = 0.18). Most of the patients per incident were minor injured patients (mean = 4; standard error = 0.2), and 0,26 were severe patients (standard error = 0.08). There was a positive significant correlation (p < 0.01) between the total number of patients and the total number of ambulances deployed and between the total number of patients and Advanced Life Support (ALS) ambulances deployed (p < 0.001). The total number of non-ALS ambulances was not related with the total number of patients. Population based research in MCI is essential to define MCI profile. Quantitative definition of MCI, adapted to resources, avoid selection bias and present a more accurate profile of MCI. As espected, road traffic accidents are the most frequent MCI in our region. This aspect is essential to plan training and response to MCI. Analysis of total response to MCI shows that for almost an hour, we should plan extra resources for daily emergencies. This data is an important issue to bear in mind when planning MCI response. The fact that most patients are classified as minor injured and more advanced life support units than needed are deployed shows that analysis of resources

  14. Development of a staff recall system for mass casualty incidents using cell phone text messaging.

    PubMed

    Epstein, Richard H; Ekbatani, Ali; Kaplan, Javier; Shechter, Ronen; Grunwald, Zvi

    2010-03-01

    After a mass casualty incident (MCI), rapid mobilization of hospital personnel is required because of an expected surge of victims. Risk assessment of our department's manual phone tree recall system revealed multiple weaknesses that would limit an effective response. Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging. We sent test text messages to anesthesia staff members' cell phone numbers, determined the distance from their home to the hospital, and stored this information in our AIMS. Latency testing for the time from transmission of SMS test messages from the server to return of an e-mail reply was determined at 2 different times on 2 different dates, 1 of which was a busy holiday weekend, using volunteers within the department. Two unannounced simulated disaster recall drills were conducted, with text messages sent asking for the anticipated time to return to the hospital. A timeline of available staff on site was determined. Reasons for failure to respond to the disaster notification message were tabulated. Latency data were fit by a log-normal distribution with an average of 82 seconds from message transmission to e-mail reply. Replies to the simulated disaster alert were received from approximately 50% of staff, with 16 projecting that they would have been able to be back at the hospital within 30 minutes on both dates. There would have been 21 and 23 staff in-house at 30 minutes, and 32 and 37 staff in-house at 60 minutes on the first and second test date, respectively, including in-house staff. Of the nonresponders to the alert, 48% indicated that their cell phone was not with them or was turned off, whereas 22% missed the message. Our SMS staff recall system is likely to be able to rapidly mobilize sufficient numbers of anesthesia personnel in response to an MCI, but actual performance

  15. Recommendations for action: a community meeting in preparation for a mass-casualty opioid overdose event in Southeastern Ontario.

    PubMed

    Moore, Kieran Michael; Papadomanolakis-Pakis, Nicholas; Hansen-Taugher, Adrienne; Guan, Tianxiu H; Schwartz, Brian; Stewart, Paula; Leece, Pamela; Bochenek, Richard

    2017-01-01

    Given the steady rise of overdose morbidity and mortality in North America, and increasing frequency of sudden clusters of non-fatal and fatal overdoses in other jurisdictions, regional preparedness plans to respond effectively to clusters of overdoses may reduce the impact of such events on the population. On the 27th of February 2017 in Kingston, Ontario, KFL&A Public Health, in collaboration with public health partners, hosted a full-day workshop involving table-top exercises and discussions for service partners on how to prepare for, respond to, and manage a mass-casualty event secondary to opioid overdose in Southeastern Ontario. The workshop assisted in identifying the various challenges faced by service partners, provided an understanding of the roles and responsibilities of partner agencies, and helped to determine next steps in preparation to address a mass opioid overdose situation at the local level. This report suggests key roles and responsibilities of partners involved in responding to a mass-casualty event secondary to opioid overdose, recommendations to address the feedback and challenges raised throughout the workshop, and a protocol to help determine when to activate an Incident Management System (IMS).

  16. Mass-casualty, terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I).

    PubMed

    Arnold, Jeffrey L; Tsai, Ming-Che; Halpern, Pinchas; Smithline, Howard; Stok, Edita; Ersoy, Gurkan

    2003-01-01

    This article characterizes the epidemiological outcomes, resource utilization, and time course of emergency needs in mass-casualty, terrorist bombings producing 30 or more casualties. Eligible bombings were identified using a MEDLINE search of articles published between 1996 and October 2002 and a manual search of published references. Mortality, injury frequency, injury severity, emergency department (ED) utilization, hospital admission, and time interval data were abstracted and relevant rates were determined for each bombing. Median values for the rates and the inter-quartile ranges (IQR) were determined for bombing subgroups associated with: (1) vehicle delivery; (2) terrorist suicide; (3) confined-space setting; (4) open-air setting; (5) structural collapse sequela; and (6) structural fire sequela. Inclusion criteria were met by 44 mass-casualty, terrorist bombings reported in 61 articles. Median values for the immediate mortality rates and IQRs were: vehicle-delivery, 4% (1-25%); terrorist-suicide, 19% (7-44%); confined-space 4% (1-11%); open-air, 1% (0-5%); structural-collapse, 18% (5-26%); structural fire 17% (1-17%); and overall, 3% (1-14%). A biphasic pattern of mortality and unique patterns of injury frequency were noted in all subgroups. Median values for the hospital admission rates and IQRs were: vehicle-delivery, 19% (14-50%); terrorist-suicide, 58% (38-77%); confined-space, 52% (36-71%); open-air, 13% (11-27%); structural-collapse, 41% (23-74%); structural-fire, 34% (25-44%); and overall, 34% (14-53%). The shortest reported time interval from detonation to the arrival of the first patient at an ED was five minutes. The shortest reported time interval from detonation to the arrival of the last patient at an ED was 15 minutes. The longest reported time interval from detonation to extrication of a live victim from a structural collapse was 36 hours. Epidemiological outcomes and resource utilization in mass-casualty, terrorist bombings vary with the

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

    PubMed Central

    Shirley, Peter J; Mandersloot, Gerlinde

    2008-01-01

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

  18. 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

  19. 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.

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

    PubMed

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

    2014-01-01

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

  1. Cost Analysis of 48 Burn Patients in a Mass Casualty Explosion Treated at Chang Gung Memorial Hospital.

    PubMed

    Mathews, Alexandra L; Cheng, Ming-Huei; Muller, John-Michael; Lin, Miffy Chia-Yu; Chang, Kate W C; Chung, Kevin C

    2017-01-01

    Little is known about the costs of treating burn patients after a mass casualty event. A devastating Color Dust explosion that injured 499 patients occurred on June 27, 2015 in Taiwan. This study was performed to investigate the economic effects of treating burn patients at a single medical center after an explosion disaster. A detailed retrospective analysis on 48 patient expense records at Chang Gung Memorial Hospital after the Color Dust explosion was performed. Data were collected during the acute treatment period between June 27, 2015 and September 30, 2015. The distribution of cost drivers for the entire patient cohort (n=48), patients with a percent total body surface area burn (%TBSA)≥50 (n=20), and those with %TBSA <50 (n=28) were analyzed. The total cost of 48 burn patients over the acute 3-month time period was $2,440,688, with a mean cost per patient of $50,848 ±36,438. Inpatient ward fees (30%), therapeutic treatment fees (22%), and medication fees (11%) were found to be the three highest cost drivers. The 20 patients with a %TBSA ≥50 consumed $1,559,300 (63.8%) of the total expenses, at an average cost of $77,965±34,226 per patient. The 28 patients with a %TBSA <50 consumed $881,387 (36.1%) of care expenses, at an average cost of $31,478±23,518 per patient. In response to this mass casualty event, inpatient ward fees represented the largest expense. Hospitals can reduce this fee by ensuring wound dressing and skin substitute materials are regionally stocked and accessible. Medication fees may be higher than expected when treating a mass burn cohort. In preparation for a future event, hospitals should anticipate patients with a %TBSA≥50 will contribute the majority of inpatient expenses. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2016-04-01

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

  4. 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.

  5. Basic Disaster Life Support (BDLS) Training Improves First Responder Confidence to Face Mass-Casualty Incidents in Thailand.

    PubMed

    Kuhls, Deborah A; Chestovich, Paul J; Coule, Phillip; Carrison, Dale M; Chua, Charleston M; Wora-Urai, Nopadol; Kanchanarin, Tavatchai

    2017-06-13

    Medical response to mass-casualty incidents (MCIs) requires specialized training and preparation. Basic Disaster Life Support (BDLS) is a course designed to prepare health care workers for a MCI. The purpose of this study was to evaluate the confidence of health care professionals in Thailand to face a MCI after participating in a BDLS course. Basic Disaster Life Support was taught to health care professionals in Thailand in July 2008. Demographics and medical experience were recorded, and participants rated their confidence before and after the course using a five-point Likert scale in 11 pertinent MCI categories. Survey results were compiled and compared with P<.05 statistically significant. A total of 162 health care professionals completed the BDLS course and surveys, including 78 physicians, 70 nurses, and 14 other health care professionals. Combined confidence increased among all participants (2.1 to 3.8; +1.7; P<.001). Each occupation scored confidence increases in each measured area (P<.001). Nurses had significantly lower pre-course confidence but greater confidence increase, while physicians had higher pre-course confidence but lower confidence increase. Active duty military also had lower pre-course confidence with significantly greater confidence increases, while previous disaster courses or experience increased pre-course confidence but lower increase in confidence. Age and work experience did not influence confidence. Basic Disaster Life Support significantly improves confidence to respond to MCI situations, but nurses and active duty military benefit the most from the course. Future courses should focus on these groups to prepare for MCIs. Kuhls DA , Chestovich PJ , Coule P , Carrison DM , Chua CM , Wora-Urai N , Kanchanarin T . Basic Disaster Life Support (BDLS) training improves first responder confidence to face mass-casualty incidents in Thailand. Prehosp Disaster Med. 2017;32(5):1-9 .

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

    PubMed

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

    2017-07-01

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

  7. 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

  8. Mass casualties on the modern battlefield: a view from the 1st Armored Division (US).

    PubMed

    Nguyen, D

    1994-11-01

    Operations Desert Shield/Desert Storm will go down in history as a resounding success. However, future successes will depend on how much we take away from this experience in the form of lessons learned. This article is a warning message on the need for medical preparedness. The medical personnel shortage remains a problem for both commanders of field units and medical staff. The Professional Filler System, which provides clinicians to deploying combat medical and line units, is not aggressively administered and maintained. Medical Tactical Standard Operating Procedures are not fully integrated, nor are they used in Mission Essential Task List training. LOGOVERWATCH has potential but needs refinement. Finally, important medical and communication equipment needs upgrading to current state-of-the-art standards. On the plus side, the Combat LifeSaver program works well for intensive training on chemical casualties care. Combined with the high state of training and motivation of soldiers and medical professionals, many of the current shortcomings have been masked. This situation cannot go on indefinitely without a degradation of mission capability.

  9. Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia

    PubMed Central

    Shalhoub, Abdullah A. Bin; Khan, Anas A.; Alaska, Yaser A.

    2017-01-01

    Objectives: To identify and describe the hospital disaster preparedness (HDP) in major private hospitals in Riyadh, Saudi Arabia. Methods: This is an observational cross-sectional survey study performed in Riyadh city, Saudi Arabia between December 2015 and April 2016. Thirteen major private hospitals in Riyadh with more than 100 beds capacity were included in this investigation. Results: The 13 hospitals had HDP plan and reported to have an HDP committee. In 12 (92.3%) hospitals, the HDP covered both internal and external disasters and HDP was available in every department of the hospital. There were agreements with other hospitals to accept patients during disasters in 9 facilities (69.2%) while 4 (30.8%) did not have such agreement. None of the hospitals conducted any unannounced exercises in previous year. Conclusion: Most of the weaknesses were apparent particularly in the education, training and monitoring of the hospital staff to the preparedness for disaster emergency occasion. Few hospitals had conducted an exercise with casualties, few had drilled evacuation of staff and patients in the last 12 months, and none had any unannounced exercise in the last year. PMID:28251227

  10. Evaluation of disaster preparedness for mass casualty incidents in private hospitals in Central Saudi Arabia.

    PubMed

    Bin Shalhoub, Abdullah A; Khan, Anas A; Alaska, Yaser A

    2017-03-01

    To identify and describe the hospital disaster preparedness (HDP) in major private hospitals in Riyadh, Saudi Arabia. Methods: This is an observational cross-sectional survey study performed in Riyadh city, Saudi Arabia between December 2015 and April 2016. Thirteen major private hospitals in Riyadh with more than 100 beds capacity were included in this investigation. Results: The 13 hospitals had HDP plan and reported to have an HDP committee. In 12 (92.3%) hospitals, the HDP covered both internal and external disasters and HDP was available in every department of the hospital. There were agreements with other hospitals to accept patients during disasters in 9 facilities (69.2%) while 4 (30.8%) did not have such agreement. None of the hospitals conducted any unannounced exercises in previous year.  Conclusion: Most of the weaknesses were apparent particularly in the education, training and monitoring of the hospital staff to the preparedness for disaster emergency occasion. Few hospitals had conducted an exercise with casualties, few had drilled evacuation of staff and patients in the last 12 months, and none had any unannounced exercise in the last year.

  11. Data collection in a live mass casualty incident simulation: automated RFID technology versus manually recorded system.

    PubMed

    Ingrassia, Pier Luigi; Carenzo, Luca; Barra, Federico Lorenzo; Colombo, Davide; Ragazzoni, Luca; Tengattini, Marco; Prato, Federico; Geddo, Alessandro; Della Corte, Francesco

    2012-02-01

    To demonstrate the applicability and the reliability of a radio frequency identification (RFID) system to collect data during a live exercise. A rooftop collapse of a crowded building was simulated. Fifty-three volunteers were trained to perform as smart victims, simulating clinical conditions, using dynamic data cards, and capturing delay times and triage codes. Every victim was also equipped with a RFID tag. RFID antenna was placed at the entrance of the advanced medical post (AMP) and emergency department (ED) and recorded casualties entering the hospital. A total of 12 victims entered AMP and 31 victims were directly transferred to the ED. 100% (12 of 12 and 31 of 31) of the time cards reported a manually written hospital admission time. No failures occurred in tag reading or data transfers. A correlation analysis was performed between the two methods plotting the paired RFID and manual times and resulted in a r=0.977 for the AMP and r=0.986 for the ED with a P value of less than 0.001. We confirmed the applicability of RFID system to the collection of time delays. Its use should be investigated in every aspect of data collection (triage, treatments) during a disaster exercise.

  12. Mutation, radiation, and species survival: The genetics studies of the Atomic Bomb Casualty Commission in Hiroshima and Nagasaki, Japan

    SciTech Connect

    Lindee, M.S.

    1990-01-01

    This is an analysis of the work of the Atomic Bomb Casualty Commission, an American agency which studied the effects of radiation on survivors of the atomic bombings at Hiroshima and Nagasaki, Japan, 1947-1975. Funded by the U.S. Atomic Energy Commission and directed by the National Academy of Sciences-National Research Council, the ABCC was the largest and longest medical study of the estimated 300,000 survivors. The morphological genetics study dominated the ABCCs first decade. James Neel and his principal collaborator William J. Schull tracked more than 76,000 pregnancies. Their results (1956) suggested the bombs radiation had no detectable impact on the offspring of survivors. Though geneticists knew that radiation caused heritable mutations in experimental organisms such as Drosophila, and believed it caused mutations in humans, the Neel-Schull findings were not a surprise. The practical difficulties of the study, and the relatively small increase in abnormal births to be expected, made a finding of significant effects unlikely. The Neel-Schull approach reflected the scientific debate over genetic load, and the Muller-Dobzhansky classical-balance controversy. Yet the findings also reflected the post-war debate over atomic energy and weapons testing. Many extra-scientific forces militated against a finding of positive effects at Hiroshima and Nagasaki. Negative findings were consistent with the needs of the Atomic Energy Commission, the State Department and the U.S. military. This dissertation explores how both the scientific debate about genetic load, and the political debate about atmospheric weapons testing, shaped this complex epidemiological study.

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

    PubMed

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

    2014-02-22

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

  14. 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

  15. SIMEDIS: a Discrete-Event Simulation Model for Testing Responses to Mass Casualty Incidents.

    PubMed

    Debacker, Michel; Van Utterbeeck, Filip; Ullrich, Christophe; Dhondt, Erwin; Hubloue, Ives

    2016-12-01

    It is recognized that the study of the disaster medical response (DMR) is a relatively new field. To date, there is no evidence-based literature that clearly defines the best medical response principles, concepts, structures and processes in a disaster setting. Much of what is known about the DMR results from descriptive studies and expert opinion. No experimental studies regarding the effects of DMR interventions on the health outcomes of disaster survivors have been carried out. Traditional analytic methods cannot fully capture the flow of disaster victims through a complex disaster medical response system (DMRS). Computer modelling and simulation enable to study and test operational assumptions in a virtual but controlled experimental environment. The SIMEDIS (Simulation for the assessment and optimization of medical disaster management) simulation model consists of 3 interacting components: the victim creation model, the victim monitoring model where the health state of each victim is monitored and adapted to the evolving clinical conditions of the victims, and the medical response model, where the victims interact with the environment and the resources at the disposal of the healthcare responders. Since the main aim of the DMR is to minimize as much as possible the mortality and morbidity of the survivors, we designed a victim-centred model in which the casualties pass through the different components and processes of a DMRS. The specificity of the SIMEDIS simulation model is the fact that the victim entities evolve in parallel through both the victim monitoring model and the medical response model. The interaction between both models is ensured through a time or medical intervention trigger. At each service point, a triage is performed together with a decision on the disposition of the victims regarding treatment and/or evacuation based on a priority code assigned to the victim and on the availability of resources at the service point. The aim of the case

  16. Management of the Formosa Color Dust Explosion: Lessons Learned from the Treatment of 49 Mass Burn Casualty Patients at Chang Gung Memorial Hospital.

    PubMed

    Cheng, Ming-Huei; Mathews, Alexandra L; Chuang, Shiow-Shuh; Lark, Meghan E; Hsiao, Yen-Chang; Ng, Chip-Jin; Chung, Kevin C

    2016-06-01

    This article reports the emergency management of a mass casualty disaster occurring on June 27, 2015, in New Taipei, Taiwan, as a fire erupted over a large crowd, injuring 499 people. Lessons learned in burn care treatment and disaster preparedness are analyzed through following the specific surgical response and patient outcomes of one hospital involved in the disaster response. Information regarding the fire and emergency management was obtained from the Ministry of Health and Welfare of Taiwan. Patient-specific data were obtained from Chang Gung Memorial Hospital's patient records. A mass casualty management system was immediately initiated by the Ministry of Health and Welfare, which contacted local hospitals to prepare for the influx of patients with severe burn injuries. In response, Chang Gung Memorial Hospital called 336 medical personnel to the emergency room for the management of 49 burn patients and divided emergency management roles among chief physicians. The mean burn total body surface area of patients presenting to this hospital was 44.2 percent (range, 10 to 90 percent). No deaths occurred in the first 48 hours after the explosion. As of 3 months after the incident, only 12 deaths had resulted from this accident, all resulting from sepsis and organ failure. Taiwan's effective mass casualty preparation plans, highly trained medical personnel, and large centers capable of treating burn patients allowed 499 injured patients to be successfully transferred and treated in hospitals across Taiwan. Lessons learned from this disaster response can be integrated into existing disaster management plans to aid in the response to mass casualty tragedies. Therapeutic, IV.

  17. [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.

  18. Mass Casualty Incidents in the Underground Mining Industry: Applying the Haddon Matrix on an Integrative Literature Review.

    PubMed

    Engström, Karl Gunnar; Angrén, John; Björnstig, Ulf; Saveman, Britt-Inger

    2017-06-08

    Underground mining is associated with obvious risks that can lead to mass casualty incidents. Information about such incidents was analyzed in an integrated literature review. A literature search (1980-2015) identified 564 modern-era underground mining reports from countries sharing similar occupational health legislation. These reports were condensed to 31 reports after consideration of quality grading and appropriateness to the aim. The Haddon matrix was used for structure, separating human factors from technical and environmental details, and timing. Most of the reports were descriptive regarding injury-creating technical and environmental factors. The influence of rock characteristics was an important pre-event environmental factor. The organic nature of coal adds risks not shared in hard-rock mines. A sequence of mechanisms is commonly described, often initiated by a human factor in interaction with technology and step-wise escalation to involve environmental circumstances. Socioeconomic factors introduce heterogeneity. In the Haddon matrix, emergency medical services are mainly a post-event environmental issue, which were not well described in the available literature. The US Quecreek Coal Mine incident of 2002 stands out as a well-planned rescue mission. Evaluation of the preparedness to handle underground mining incidents deserves further scientific attention. Preparedness must include the medical aspects of rescue operations. (Disaster Med Public Health Preparedness. 2017;page 1 of 9).

  19. [Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery : Presentation of a treatment concept].

    PubMed

    Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M

    2017-08-11

    The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a "normal" MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

  20. An argument for equipping civilian hospitals with a multiple respirator system for a chemical warfare mass casualty situation.

    PubMed

    Heller, O; Aldar, Y; Vosk, M; Shemer, J

    1991-01-01

    During the Persian Gulf war, the entire Israeli population was under the threat of chemical missiles. One of the main effects of chemical agents (e.g., organophosphorus) is respiratory distress, which requires treatment with mechanical ventilation and oxygen enrichment. In the event of a chemical missile attack, the civilian hospitals may enter a state of insufficiency for treating such victims due to the limited amount of equipment, staff and oxygen/air sources. A possible technological solution is a multiple respirator system (MRS) with a multiple oxygen enrichment system designed for use in the battlefield. The advantages of these technologies in the civilian hospital setting during a chemical mass casualty situation are: (a) rapid deployment, (b) high transportability, (c) capability of operation in any location, (d) modularity, and (e) less medical staff for operation. Two types of MRS are described and issues concerning their selection are discussed. The authorities responsible for national health policy may wish to adopt and incorporate these technologies into their hospital and emergency services preparedness system.

  1. Medical support in the Tangshan earthquake: a review of the management of mass casualties and certain major injuries.

    PubMed

    Sheng, Z Y

    1987-10-01

    The Tangshan earthquake was probably the worst catastrophe in this century. It took a death toll of 242,769, with 164,851 injured in addition. This presentation describes the organization of disaster relief work after the earthquake, the rescue of buried victims, the organization of medical resources, and the sanitation work to forestall epidemics. It also presents the author's reflections on the management of three major injuries, namely, crush syndrome, fracture of pelvis, and traumatic paraplegia, by reviewing the available data pertaining to these injuries. The author concurs with the prevailing opinion that fasciotomy plays an important role in the successful management of crush injury. It not only prevented acute renal failure subsequent to intracompartmental increase of pressure, but also the occurrence of Volkmann's ischemic contracture as a late sequela. Herbs to induce catharsis and diuresis were used to alleviate intracompartmental pressure. For the management of pelvic fractures, two newly developed treatment techniques are described. On analysis of clinical data, it is the author's opinion that traumatic paraplegia should not be given the priority of early surgery in the circumstances of mass casualties. The primary concern should be the stability and restoration of normal curvature of the spine, especially in cases of complete paraplegia. Decompression of the spinal cord through an anterolateral approach gave promising results in hyperflexion type of spinal fracture.

  2. 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.

  3. 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

  4. Using Clinical Signs and Symptoms for Medical Management of Radiation Casualties - 2015 NATO Exercise.

    PubMed

    Dörr, H; Abend, M; Blakely, W F; Bolduc, D L; Boozer, D; Costeira, T; Dant, T; De Amicis, A; De Sanctis, S; Dondey, M; Drouet, M; Entine, F; Francois, S; Gagna, G; Guitard, N; Hérodin, F; Hoefer, M; Lamkowski, A; La Sala, G; Lista, F; Loiacono, P; Majewski, M; Martigne, P; Métivier, D; Michel, X; Pateux, J; Pejchal, J; Reeves, G; Riccobono, D; Sinkorova, Z; Soyez, L; Stricklin, D; Tichy, A; Valente, M; Woodruff, C R; Zarybnicka, L; Port, M

    2017-03-01

    The utility of early-phase (≤5 days) radiation-induced clinical signs and symptoms (e.g., vomiting, diarrhea, erythema and changes in blood cell counts) was examined for the prediction of later occurring acute radiation syndrome (ARS) severity and the development of medical management strategies. Medical treatment protocols for radiation accident victims (METREPOL) was used to grade ARS severities, which were assigned response categories (RCs). Data on individuals (n = 191) with mild (RC1, n = 45), moderate (RC2, n = 19), severe (RC3, n = 20) and fatal (RC4, n = 18) ARS, as well as nonexposed individuals (RC0, n = 89) were generated using either METREPOL (n = 167) or the system for evaluation and archiving of radiation accidents based on case histories (SEARCH) database (n = 24), the latter comprised of real-case descriptions. These data were converted into tables reflecting clinical signs and symptoms, and submitted to eight teams representing five participating countries. The teams were comprised of medical doctors, biologists and pharmacists with subject matter expertise. The tables comprised cumulated clinical data from day 1-3 and day 1-5 postirradiation. While it would have reflected a more realistic scenario to provide the data to the teams over the course of a 3- or 5-day period, the logistics of doing so proved too challenging. In addition, the team members participating in this exercise chose to receive the cumulated reports of day 1-3 and 1-5. The teams were tasked with predicting ARS incidence, ARS severity and the requirement for hospitalization for multiple cases, as well as providing the certainty of their diagnosis. Five of the teams also performed dose estimates. The teams did not employ harmonized methodologies, and the expertise among the members varied, as did the tools used and the means of analyzing the clinical data. The earliest report time was 3 h after the tables were sent to the team members. The majority of cases developing ARS (89

  5. Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system.

    PubMed

    Shah, Adil Aijaz; Rehman, Abdul; Sayyed, Raza Hasnain; Haider, Adil Hussain; Bawa, Amber; Zafar, Syed Nabeel; Zia-Ur-Rehman; Ali, Kamran; Zafar, Hasnain

    2015-01-01

    Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia. We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries. A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived. This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties. Copyright © 2014 Elsevier Ltd

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

    PubMed

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

    2012-07-01

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

  7. Preparedness for the evaluation and management of mass casualty incidents involving anticholinesterase compounds: a survey of emergency department directors in the 12 largest cities in the United States.

    PubMed

    Madsen, James M; Greenberg, Michael I

    2010-01-01

    Anticholinesterases include carbamate and organophosphorus (OP) insecticides and nerve agents. Release of these compounds can flood emergency departments (EDs) with large numbers of poisoned victims and worried individuals. It was hypothesized that despite the focus of disaster preparedness on large metropolitan areas, EDs in these cities would still report self-perceptions of deficiencies in preparedness for mass casualty incidents (MCIs) involving these chemicals. A secure and anonymous online survey was prepared and piloted, and E-mail invitations were sent to the physician directors of the 220 continuously staffed EDs in the 12 most populous incorporated cities in the United States. Forty-six ED directors could not be contacted despite repeated attempts. Of the remaining 174 directors, eight declined and 89 took the survey, for a response rate of 51.1 percent. Fewer than 20 percent were very confident in the effectiveness of their training, and only 4.9 percent were very confident that drills had given them the preparation that they needed. Only 45. 7 percent of reporting hospitals had a board-certified medical toxicologist to help in such an emergency. Almost two-thirds (73.6 percent) of those familiar with the online Radiation Event Medical Management (REMM) module from the National Library of Medicine and the National Institutes of Health thought that a chemical counterpart to REMM would be either moderately or very helpful for MCIs involving anticholinesterases. This study demonstrates that physician ED directors perceived marked deficiencies in their abilities to respond to this kind of toxicological emergency and suggests critical directions for remediation of these deficiencies.

  8. The grave is wide: the Hibakusha of Hiroshima and Nagasaki and the legacy of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation.

    PubMed

    O'Malley, Gerald F

    2016-07-01

    Following the atomic bomb attacks on Japan in 1945, scientists from the United States and Japan joined together to study the Hibakusha - the bomb affected people in what was advertised as a bipartisan and cooperative effort. In reality, despite the best efforts of some very dedicated and earnest scientists, the early years of the collaboration were characterized by political friction, censorship, controversy, tension, hostility, and racism. The 70-year history, scientific output and cultural impact of the Atomic Bomb Casualty Commission and the Radiation Effects Research Foundation are described in the context of the development of Occupied Japan.

  9. 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.

  10. Description of procedures performed on patients by emergency medical services during mass casualty incidents in the United States.

    PubMed

    El Sayed, Mazen; Tamim, Hani; Mann, N Clay

    2015-08-01

    Emergency medical services (EMS) preparedness is essential to reduce morbidity and mortality from mass casualty incidents (MCIs). We sought to describe types and frequencies of common procedures performed during MCIs by EMS providers at different service levels. This study was carried out using the 2012 US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System. Emergency medical services activations coded as MCI at dispatch or by EMS personnel were included. The Center for Medicare and Medicaid Services service level was used for the level of service provided. A descriptive analysis characterizing the most common procedure types and frequencies by service level was carried out. Among the 19831189 EMS activations in the 2012 national data set, 53334 activations had an MCI code, of which 26110 activations were included. There were 8179 advanced life support (31.3%), 5811 basic life support (22.3%), 399 air medical transport (air transport fixed or rotary) (1.5%), and 38 specialty care transport (0.2%) activations. A total of 107 different procedure types were reported. The most common procedures by procedure count were "spine immobilization" (21.8%) followed by "venous access extremity" (14.1%) and "assessment adult" (13.4%). A similar order was found for procedure frequencies by included EMS activations (24.1%, 19.3%, and 18.3%, respectively). Top 20 procedures had different frequencies by levels of care except for "medical director control" (P = .19). Advanced EMS interventions are not frequent during MCIs in the United States. Emergency medical services systems with other types of providers or MCI response patterns might report different findings. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed

    Borgohain, B; Khonglah, T

    2013-01-01

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

  12. 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

  13. Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States.

    PubMed

    El Sayed, Mazen; Tamim, Hani; Mann, N Clay

    2016-04-01

    Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs). This study describes prehospital medication administration during MCIs by different EMS service levels. The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study. Emergency Medical Services activations coded as MCI at dispatch, or by EMS personnel, were included. The Center for Medicare and Medicaid Services (CMS) service level was used for the level of service provided. A descriptive analysis of medication administration by EMS service level was carried out. Among the 19,831,189 EMS activations, 53,334 activations had an MCI code, of which 26,110 activations were included. There were 8,179 (31.3%) Advanced Life Support (ALS), 5,811 (22.3%) Basic Life Support (BLS), 399 (1.5%) Air Medical Transport (AMT; fixed or rotary), and 38 (0.2%) Specialty Care Transport (SCT) activations. More than 80 different medications from 18 groups were reported. Seven thousand twenty-one activations (26.9%) had at least one medication administered. Oxygen was most common (16.3%), followed by crystalloids (6.9%), unknown (5.2%), analgesics (3.2%) mainly narcotics, antiemetics (1.5%), cardiac/vasopressors/inotropes (0.9%), bronchodilators (0.9%), sedatives (0.8%), and vasodilators/antihypertensives (0.7%). Overall, medication administration rates and frequencies of medications groups significantly varied between EMS service levels (P<.01) except for "Analgesia (other)" (P=.40) and "Pain medications (nonsteroidal anti-inflammatory drug; NSAID)" (P=.07). Medications are administered frequently in MCIs, mainly Oxygen, crystalloids, and narcotic pain medications. Emergency Medical Services systems can use the findings of this study to better prepare their stockpiles for MCIs.

  14. Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event.

    PubMed

    Toltzis, Philip; Soto-Campos, Gerardo; Shelton, Christian R; Kuhn, Evelyn M; Hahn, Ryan; Kanter, Robert K; Wetzel, Randall C

    2015-09-01

    ICU resources may be overwhelmed by a mass casualty event, triggering a conversion to Crisis Standards of Care in which critical care support is diverted away from patients least likely to benefit, with the goal of improving population survival. We aimed to devise a Crisis Standards of Care triage allocation scheme specifically for children. A triage scheme is proposed in which patients would be divided into those requiring mechanical ventilation at PICU presentation and those not, and then each group would be evaluated for probability of death and for predicted duration of resource consumption, specifically, duration of PICU length of stay and mechanical ventilation. Children will be excluded from PICU admission if their mortality or resource utilization is predicted to exceed predetermined levels ("high risk"), or if they have a low likelihood of requiring ICU support ("low risk"). Children entered into the Virtual PICU Performance Systems database were employed to develop prediction equations to assign children to the exclusion categories using logistic and linear regression. Machine Learning provided an alternative strategy to develop a triage scheme independent from this process. One hundred ten American PICUs : One hundred fifty thousand records from the Virtual PICU database. None. The prediction equations for probability of death had an area under the receiver operating characteristic curve more than 0.87. The prediction equation for belonging to the low-risk category had lower discrimination. R for the prediction equations for PICU length of stay and days of mechanical ventilation ranged from 0.10 to 0.18. Machine learning recommended initially dividing children into those mechanically ventilated versus those not and had strong predictive power for mortality, thus independently verifying the triage sequence and broadly verifying the algorithm. An evidence-based predictive tool for children is presented to guide resource allocation during Crisis Standards

  15. PATTERN OF INJURIES SEEN IN MASS CASUALTIES IN TERRORIST ATTACKS IN BALUCHISTAN, PAKISTAN--A THREE YEARS EXPERIENCE.

    PubMed

    Maqsood, Rasikh; Rasikh, Alia; Abbasi, Tariq; Shukr, Irfan

    2015-01-01

    As a front line state in war against terror, Pakistan has been a victim of terrorism, for the last many years & Baluchistan has been the hub of all such terror activities. The objective of this study was to determine the incidence and type of injuries in mass casualties in terrorist activities in Baluchistan. The study was done by the review of the record of all patients of terrorist attacks who were admitted in Combined Military Hospital (CMH) Quetta from 27th Aug 2012 to 31st Jul 2015. The final injuries sustained by the victims were documented in the patient charts after repeated examination. The data was collected from these patient charts. Data was analysed using SPSS-21. Frequency & percentages of different injuries was calculated to determine the injury pattern. A total of 3034 patients reported to the hospital (n-3034), 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. Sex ratio was M/F=5.7: 1 Mean hospital stay was 6.31 days. Majority of the injured had multisystem injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the subspecialties' should include orthopaedics, vascular, thoracic and neurosurgery.

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

    PubMed

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

    2012-12-01

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

  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. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  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. Personal Protective Equipment Guide for Military Medical Treatment Facility Personnel Handling Casualties From Weapons of Mass Destruction and Terrorism Events

    DTIC Science & Technology

    2003-08-01

    Press, Washington, 1999. 134. Tactics, Techniques , and Procedures for Biological Defense, Army Field Manual 3-11.86. Note: currently being...appropriate Army Field Manuals and other references for these situations, such as Medical Management of Chemical Casualties Handbook (USAMRICD...August 2003 indicates that most cases occurred after direct contact with blood, secretions , or tissues of infected patients or nonhuman

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

    PubMed

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

    2009-04-01

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

  1. MACRAD: A mass analysis code for radiators

    SciTech Connect

    Gallup, D.R.

    1988-01-01

    A computer code to estimate and optimize the mass of heat pipe radiators (MACRAD) is currently under development. A parametric approach is used in MACRAD, which allows the user to optimize radiator mass based on heat pipe length, length to diameter ratio, vapor to wick radius, radiator redundancy, etc. Full consideration of the heat pipe operating parameters, material properties, and shielding requirements is included in the code. Preliminary results obtained with MACRAD are discussed.

  2. 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

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

    PubMed

    Lampi, Maria; Vikström, Tore; Jonson, Carl-Oscar

    2013-12-20

    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. 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. The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises

  4. Guidelines for Mass Casualty Decontamination During a HAZMAT/Weapon of Mass Destruction Incident. Volumes 1 and 2 (Update)

    DTIC Science & Technology

    2013-08-01

    be applied to Toxic In- dustrial Chemicals (TICs), Toxic Industrial Materials (TIMs), and toxins (collectively re- ferred to in this document as...for First Responders when arriving at an incident scene. A risk -based response strategy is recommended before and upon arrival at the incident scene...A risk -based re- sponse process is defined as a systematic process by which responders analyze a problem involving HAZMAT/weapons of mass

  5. Virtual-world hospital simulation for real-world disaster response: Design and validation of a virtual reality simulator for mass casualty incident management.

    PubMed

    Pucher, Philip H; Batrick, Nicola; Taylor, Dave; Chaudery, Muzzafer; Cohen, Daniel; Darzi, Ara

    2014-08-01

    Mass casualty incidents are unfortunately becoming more common. The coordination of mass casualty incident response is highly complex. Currently available options for training, however, are limited by either lack of realism or prohibitive expense and by a lack of assessment tools. Virtual worlds represent a potentially cost-effective, immersive, and easily accessible platform for training and assessment. The aim of this study was to assess feasibility of a novel virtual-worlds-based system for assessment and training in major incident response. Clinical areas were modeled within a virtual, online hospital. A major incident, incorporating virtual casualties, allowed multiple clinicians to simultaneously respond with appropriate in-world management and transfer plans within limits of the hospital's available resources. Errors, delays, and completed actions were recorded, as well as Trauma-NOnTECHnical Skills (T-NOTECHS) score. Performance was compared between novice and expert clinician groups. Twenty-one subjects participated in three simulations: pilot (n = 7), novice (n = 8), and expert groups (n = 6). The novices committed more critical events than the experts, 11 versus 3, p = 0.006; took longer to treat patients, 560 (299) seconds versus 339 (321) seconds, p = 0.026; and achieved poorer T-NOTECHS scores, 14 (2) versus 21.5 (3.7), p = 0.003, and technical skill, 2.29 (0.34) versus 3.96 (0.69), p = 0.001. One hundred percent of the subjects thought that the simulation was realistic and superior to existing training options. A virtual-worlds-based model for the training and assessment of major incident response has been designed and validated. The advantages of customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods and may be applicable to further areas of surgery as well.

  6. Shifting the Paradigm of Trauma Medicine to Positively Influence Critical Mortality Rates Following a Mass Casualty Event

    DTIC Science & Technology

    2009-06-01

    ground zero, while another 300 sought care at the next hospital which was within one mile ( Pesola , Dujar, & Wilson, 2002, pp. 220-2). On March 11, 2004...another 300 sought care at the next hospital over which was within one mile ( Pesola , 2002, p. 220). It is prudent that the lessons of military...logistics, injuries, sustained and clinical management of casualties treated at the closets hospitals. Critical Care, 9, 104-111. Pesola , G.R

  7. 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.

  8. Radiation Monitoring for the Masses.

    PubMed

    Wagner, Eric; Sorom, Rich; Wiles, Linda

    2016-01-01

    In response to the Fukushima-Daiichi incident, many commercial vendors have produced applications and equipment targeted at the average member of the public in order to enable them to make radiation measurements themselves at little to no cost. The authors have evaluated a small selection of these items in order to validate their performance when exposed to a calibrated 137Cs dose rate irradiator. The products fall into two primary categories: the first using the CMOS from the camera on ubiquitous smartphones and the second using an accessory that performs the radiation measurement. Presented here are the performance data of a selection and recommendations on how to interpret the produced values.

  9. Leadership as a component of crowd control in a hospital dealing with a mass-casualty incident: lessons learned from the October 2000 riots in Nazareth.

    PubMed

    Pinkert, Moshe; Bloch, Yuval; Schwartz, Dagan; Ashkenazi, Isaac; Nakhleh, Bishara; Massad, Barhoum; Peres, Michal; Bar-Dayan, Yaron

    2007-01-01

    Crowd control is essential to the handling of mass-casualty incidents (MCIs). This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals. Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered. The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed. During 10 days of riots (01-10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the "immediate care"location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control. During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management

  10. 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.

  11. Evaluation of absorbent materials for use as ad hoc dry decontaminants during mass casualty incidents as part of the UK’s Initial Operational Response (IOR)

    PubMed Central

    Kassouf, Nick; Syed, Sara; Larner, Joanne; Amlôt, Richard

    2017-01-01

    The UK’s Initial Operational Response (IOR) is a revised process for the medical management of mass casualties potentially contaminated with hazardous materials. A critical element of the IOR is the introduction of immediate, on-scene disrobing and decontamination of casualties to limit the adverse health effects of exposure. Ad hoc cleansing of the skin with dry absorbent materials has previously been identified as a potential means of facilitating emergency decontamination. The purpose of this study was to evaluate the in vitro oil and water absorbency of a range of materials commonly found in the domestic and clinical environments and to determine the effectiveness of a small, but representative selection of such materials in skin decontamination, using an established ex vivo model. Five contaminants were used in the study: methyl salicylate, parathion, diethyl malonate, phorate and potassium cyanide. In vitro measurements of water and oil absorbency did not correlate with ex vivo measurements of skin decontamination. When measured ex vivo, dry decontamination was consistently more effective than a standard wet decontamination method (“rinse-wipe-rinse”) for removing liquid contaminants. However, dry decontamination was ineffective against particulate contamination. Collectively, these data confirm that absorbent materials such as wound dressings and tissue paper provide an effective, generic capability for emergency removal of liquid contaminants from the skin surface, but that wet decontamination should be used for non-liquid contaminants. PMID:28152053

  12. Evaluation of absorbent materials for use as ad hoc dry decontaminants during mass casualty incidents as part of the UK's Initial Operational Response (IOR).

    PubMed

    Kassouf, Nick; Syed, Sara; Larner, Joanne; Amlôt, Richard; Chilcott, Robert P

    2017-01-01

    The UK's Initial Operational Response (IOR) is a revised process for the medical management of mass casualties potentially contaminated with hazardous materials. A critical element of the IOR is the introduction of immediate, on-scene disrobing and decontamination of casualties to limit the adverse health effects of exposure. Ad hoc cleansing of the skin with dry absorbent materials has previously been identified as a potential means of facilitating emergency decontamination. The purpose of this study was to evaluate the in vitro oil and water absorbency of a range of materials commonly found in the domestic and clinical environments and to determine the effectiveness of a small, but representative selection of such materials in skin decontamination, using an established ex vivo model. Five contaminants were used in the study: methyl salicylate, parathion, diethyl malonate, phorate and potassium cyanide. In vitro measurements of water and oil absorbency did not correlate with ex vivo measurements of skin decontamination. When measured ex vivo, dry decontamination was consistently more effective than a standard wet decontamination method ("rinse-wipe-rinse") for removing liquid contaminants. However, dry decontamination was ineffective against particulate contamination. Collectively, these data confirm that absorbent materials such as wound dressings and tissue paper provide an effective, generic capability for emergency removal of liquid contaminants from the skin surface, but that wet decontamination should be used for non-liquid contaminants.

  13. Predictive models of radiative neutrino masses

    NASA Astrophysics Data System (ADS)

    Julio, J.

    2016-06-01

    We discuss two models of radiative neutrino mass generation. The first model features one-loop Zee model with Z4 symmetry. The second model is the two-loop neutrino mass model with singly- and doubly-charged scalars. These two models fit neutrino oscillation data well and predict some interesting rates for lepton flavor violation processes.

  14. Predictive models of radiative neutrino masses

    SciTech Connect

    Julio, J.

    2016-06-21

    We discuss two models of radiative neutrino mass generation. The first model features one–loop Zee model with Z{sub 4} symmetry. The second model is the two–loop neutrino mass model with singly- and doubly-charged scalars. These two models fit neutrino oscillation data well and predict some interesting rates for lepton flavor violation processes.

  15. Radiative neutrino mass, dark matter, and leptogenesis

    SciTech Connect

    Gu Peihong; Sarkar, Utpal

    2008-05-15

    We propose an extension of the standard model, in which neutrinos are Dirac particles and their tiny masses originate from a one-loop radiative diagram. The new fields required by the neutrino mass generation also accommodate the explanation for the matter-antimatter asymmetry and dark matter in the Universe.

  16. 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.

  17. 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

  18. Population and energy elasticity of tornado casualties

    NASA Astrophysics Data System (ADS)

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

    2017-04-01

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

  19. Development of a national burn network: providing a co-ordinated response to a burn mass casualty disaster within the Australian health system

    PubMed Central

    Wood, F; Edgar, D; Robertson, AG

    2008-01-01

    With the threat of terrorist activity ever present since the incidents in Bali and Jakarta, the Australian health system must be prepared to manage another mass burn casualty disaster. The Australian and New Zealand Burns Association (ANZBA) highlighted the lack of a national burn disaster response before the 2000 Olympics. With the limited number of burn beds available and the protracted length of stay after such injuries, any state or territory could be overwhelmed with relatively few patient admissions. In 2002, the Australian Health Minister's Conference called for a solution. The objective of this paper is to provide an overview of the process and development of the Australian National Burn Network, which underpins the National Burn Disaster Response (AUSBURNPLAN). PMID:22460213

  20. 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

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

    PubMed

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

    2014-12-01

    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. 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. 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. This new paradigm breaks through the limitation of traditional research paradigms and will contribute to the development

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

    DTIC Science & Technology

    2009-04-01

    explosions and gunshot wound ) firefights. The primary mechanism of injury for the majority of casualties (73%) was explosion, with the remaining 27% of...casualties injured by gunshot wound . The mean ISS for casualties who were in- jured in explosive incidents (improvised explosives, rocket, or mortar...slightly lower base deficit (5 vs. 3.5, p 0.05), and lower ISS (8.1 vs. 9.8, p 0.05) in patients who suffered gunshot wound mechanism compared

  3. Solids mass flow indication with radiation

    DOEpatents

    Macko, Joseph E.; Estriplet, Isnard

    1985-06-04

    Method and apparatus for indicating mass flow of a solid particulate material through a rotary feeder. A radiation source and detector are positioned in a manner whereby radiation flux is directed through, and attenuated by, particulate material contained in rotating pockets. A Cesium-137 gamma source can be mounted within the shaft of the feeder, and one or more detectors can be mounted outside of the feeder housing. The detected signal is indicative of the mass of particulate material contained within a given pocket rotating within the feeder.

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

    PubMed

    Baker, Michael S

    2007-03-01

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

  5. 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.

  6. Resonant-mass detectors of gravitational radiation

    NASA Astrophysics Data System (ADS)

    Michelson, Peter F.; Price, John C.; Taber, Robert C.

    1987-07-01

    A network of second-generation low-temperature gravitational radiation detectors is nearing completion. These detectors, sensitive to mechanical strains of order 10 to the -18th, are possible because of a variety of technical innovations that have been made in cryogenics, low-noise superconducting instrumentation, and vibration isolation techniques. Another five orders of magnitude improvement in energy sensitivity of resonant-mass detectors is possible before the linear amplifier quantum limit is encountered.

  7. 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

  8. 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

  9. 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

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

    PubMed Central

    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. PMID:26781837

  11. Assessment of hospital disaster plans for conventional mass casualty incidents following terrorist explosions using a live exercise based upon the real data of actual patients.

    PubMed

    Ashkenazi, I; Ohana, A; Azaria, B; Gelfer, A; Nave, C; Deutch, Z; Gens, I; Fadlon, M; Dahan, Y; Rapaport, L; Kishkinov, D; Bar, A; Tal-Or, E; Vaknin, N; Blumenfeld, A; Kessel, B; Alfici, R; Olsha, O; Michaelson, M

    2012-04-01

    The National Committee for Hospital Preparedness for Conventional Mass Casualty Incidents and the Hospital Preparedness Division of the Home Front Command are in charge of preparing live exercises held yearly in public hospitals in Israel. Our experience is that live exercises are limited in their ability to test clinical decision making and its influence upon incident management. A live exercise was designed upon real patient data and tested in several public hospitals. The aim of the manuscript is to describe the impact of this new format on clinical decision making in large-scale live exercises. A database of histories, physical examination findings, laboratory results and imaging results for 420 patients treated following terrorist explosions was created using information derived from actual patient encounters. Similar information for 100 patients treated following motor vehicle accidents was also collected. Information from the database was used to create victim profiles used during the course of exercises held in eight public hospitals with 60-800-bed capacities. Before implementing the new injury tags, no conclusions could be made concerning the quality of clinical decision making. Conducting the exercise using the new format helped identify deficiencies in the hospital disaster plan in triage, emergency department management and in the proper utilisation of resources such as radiology, operating rooms and the secondary transfer of patients. Previous knowledge of patient diagnoses and resource needs allow the identification and quantification of deficiencies and problems identified in clinical decision making, resource utilisation and incident management.

  12. 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.

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

    PubMed Central

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

    2013-01-01

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

  14. Incidence and mortality rates of disasters and mass casualty incidents in Korea: a population-based cross-sectional study, 2000-2009.

    PubMed

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

    2013-05-01

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

  15. 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.

  16. New development in radiative neutrino mass generation

    NASA Astrophysics Data System (ADS)

    Julio

    2014-10-01

    We present a simple and predictive model of radiative neutrino masses. It is a special case of the Zee model with a family-dependent Z4 symmetry acting on the leptons. A variety of predictions follow: The hierarchy of neutrino masses must be inverted; the lightest neutrino mass is extremely small and calculable; one of the neutrino mixing angles is determined in terms of the other two; the phase parameters take CP-conserving values with δCP = π and the effective mass in neutrinoless double beta decay lies in a narrow range, mββ =(17.6-18.5) meV. The ratio of vacuum expectation values of the two Higgs doublets, tan β, is determined to be either 1.9 or 0.19 from neutrino oscillation data. Flavor-conserving and flavor-changing couplings of the Higgs doublets are also determined from neutrino data. The non-standard neutral Higgs bosons, if they are moderately heavy, decay significantly into μ and τ with prescribed branching ratios. Observable rates for the decays μ → eγ and τ → 3μ are predicted if these scalars have masses in the range of 150-500 GeV.

  17. Research and Development of a Convertible Use Rapidly Expandable Model for Response to Disasters and Mass Casualties

    DTIC Science & Technology

    2009-10-01

    hours in the wake of a terrorist incident or other public health emergency: • 500 cases per million population for patients with symptoms of acute...infections disease, especially smallpox, anthrax, plague, tularemia, and influenza, • 50 cases per million population for patients with symptoms of...for patients suffering burn or trauma, • 50 cases per million for patients manifesting the symptoms of radiation-induced injury, especially bone

  18. Radiation Design of Ion Mass Spectrometers

    NASA Technical Reports Server (NTRS)

    Sittler, Ed; Cooper, John; Christian, Eric; Moore, Tom; Sturner, Steve; Paschalidis, Nick

    2011-01-01

    In the harsh radiation environment of Jupiter and with the JUpiter ICy moon Explorer (JUICE) mission including two Europa flybys where local intensities are approx. 150 krad/month behind 100 mils of Al shielding, so background from penetrating radiation can be a serious issue for detectors inside an Ion Mass Spectrometer (IMS). This can especially be important for minor ion detection designs. Detectors of choice for time-of-flight (TOF) designs are microchannel plates (MCP) and some designs may include solid state detectors (SSD). The standard approach is to use shielding designs so background event rates are low enough that the detector max rates and lifetimes are first not exceeded and then the more stringent requirement that the desired measurement can successfully be made (i.e., desired signal is sufficiently greater than background noise after background subtraction is made). GEANT codes are typically used along with various electronic techniques, but such designs need to know how the detectors will respond to the simulated primary and secondary radiations produced within the instrument. We will be presenting some preliminary measurements made on the response of MCPs to energetic electrons (20 ke V to 1400 ke V) using a Miniature TOF (MTOF) device and the High Energy Facility at Goddard Space Flight Center which has a Van de Graaff accelerator.

  19. Primary Triage in a Mass-casualty Event Possesses a Risk of Increasing Informational Confusion: A Simulation Study Using Shannon's Entropy.

    PubMed

    Ajimi, Yasuhiko; Sasaki, Masaru; Uchida, Yasuyuki; Kaneko, Ichiro; Nakahara, Shinya; Sakamoto, Tetsuya

    2016-10-01

    Introduction Primary triage in a mass-casualty event setting using low-visibility tags may lead to informational confusion and difficulty in judging triage attribution of patients. In this simulation study, informational confusion during primary triage was investigated using a method described in a prior study that applied Shannon's Information Theory to triage. Hypothesis Primary triage using a low-visibility tag leads to a risk of informational confusion in prioritizing care, owing to the intermingling of pre- and post-triage patients. It is possible that Shannon's entropy evaluates the degree of informational confusion quantitatively and improves primary triage. The Simple Triage and Rapid Treatment (START) triage method was employed. In Setting 1, entropy of a triage area with 32 patients was calculated for the following situations: Case 1 - all 32 patients in the triage area at commencement of triage; Case 2 - 16 randomly imported patients to join 16 post-triage patients; Case 3 - eight patients imported randomly and another eight grouped separately; Case 4 - 16 patients grouped separately; Case 5 - random placement of all 32 post-triage patients; Case 6 - isolation of eight patients of minor priority level; Case 7 - division of all patients into two groups of 16; and Case 8 - separation of all patients into four categories of eight each. In Setting 2, entropies in the triage area with 32 patients were calculated continuously with each increase of four post-triage patients in Systems A and B (System A - triage conducted in random manner; and System B - triage arranged into four categories). In Setting 1, entropies in Cases 1-8 were 2.00, 3.00, 2.69, 2.00, 2.00, 1.19, 1.00, and 0.00 bits/symbol, respectively. Entropy increased with random triage. In Setting 2, entropies of System A maintained values the same as, or higher than, those before initiation of triage: 2.00 bits/symbol throughout the triage. The graphic waveform showed a concave shape and took 3

  20. Three years experience with forward-site mass casualty triage-, evacuation-, operating room-, ICU-, and radiography-enabled disaster vehicles: development of usage strategies from drills and deployments.

    PubMed

    Griffiths, Jane L; Kirby, Neil R; Waterson, James A

    2014-01-01

    Delineation of the advantages and problems related to the use of forward-site operating room-, Intensive Care Unit (ICU)-, radiography-, and mass casualty-enabled disaster vehicles for site evacuation, patient stabilization, and triage. The vehicles discussed have six ventilated ICU spaces, two ORs, on-site radiography, 21 intermediate acuity spaces with stretchers, and 54 seated minor acuity spaces. Each space has piped oxygen with an independent vehicle-loaded supply. The vehicles are operated by the Dubai Corporate Ambulance Services. Their support hospital is the main trauma center for the Emirate of Dubai and provides the vehicles' surgical, intensivist, anesthesia, and nursing staff. The disaster vehicles have been deployed 264 times in the last 5 years (these figures do not include deployments for drills). Introducing this new service required extensive initial planning and ongoing analysis of the performance of the disaster vehicles that offer ambulance services and receiving hospitals a large array of possibilities in terms of triage, stabilization of priority I and II patients, and management of priority III patients. In both drills and in disasters, the vehicles were valuable in forward triage and stabilization and in the transport of large numbers of priority III patients. This has avoided the depletion of emergency transport available for priority I and II patients. The successful utilization of disaster vehicles requires seamless cooperation between the hospital staffing the vehicles and the ambulance service deploying them. They are particularly effective during preplanned deployments to high-risk situations. These vehicles also potentially provide self-sufficient refuges for forward teams in hostile environments.

  1. Indoor fire in a nursing home: evaluation of the medical response to a mass casualty incident based on a standardized protocol.

    PubMed

    Koning, S W; Ellerbroek, P M; Leenen, L P H

    2015-04-01

    This retrospective study reports the outcome of a mass casualty incident (MCI) caused by a fire in a nursing home. Data from the medical charts and registration system of the Major Incident Hospital (MIH) and ambulance service were analyzed. The evaluation reports from the MIH and an independent research institute were used. The protocol for reports from major accidents and disaster was used to standardize the reporting [Lennquist, in Int J Disaster Med 1(1):79-86, 2003]. The emergency services were quickly at the scene. The different levels of pre-hospital management performed a tight coordination. However, miscommunication led to confusion in the registration and tracking of patients. In total, 49 persons needed medical treatment, 46 were treated in the MIH. Because of (possible) inhalation injury nine patients needed mechanical ventilation and nine patients were hospitalized to exclude delayed onset of pulmonary symptoms. No incident related deaths occurred. The intensive care unit of the MIH was initially understaffed despite the efforts of the automated calling system and switchboard operators. The handwritten registration of incoming staff was incomplete and should be performed digitally. Some staff members were unfamiliar with the MIH procedures. The medical chart appeared too extensive. Miscommunication between chain partners resulted in the delayed sharing of (semi) medical information. The different levels of incident managers performed a tight coordination. The MIH demonstrated its potency to provide emergency care for 46 patients and 9 intubated patients. No deaths or persistent disabilities occurred. Areas of improvement were recognized both in the pre-hospital as the hospital phase.

  2. Enteral resuscitation of burn shock using World Health Organization oral rehydration solution: a potential solution for mass casualty care.

    PubMed

    Michell, Michael W; Oliveira, Hermes M; Kinsky, Michael P; Vaid, Sumreen U; Herndon, David N; Kramer, George C

    2006-01-01

    Enteral resuscitation could provide a means to resuscitate burn shock when intravenous (IV) therapy is unavailable, such as in mass disasters. We evaluated the extent of intestinal absorption and resuscitative effects of World Health Organization Oral Rehydration Solution after a 40% TBSA burn in anesthetized swine compared with the IV infusion of lactated Ringer's infused by Parkland formula. Plasma volume (PV) was measured using indocyanine green dye dilution. Intestinal absorption was assessed using phenol red as a nonabsorbable marker. Changes in hematocrit, hemodynamics, and measured PV showed equivalent resuscitative effects of enteral and IV resuscitation. The duodenal fluid absorption rate started at 77 +/- 32 ml/hr per meter of intestine during the first hour and increased to 296 +/- 40 ml/hr during the fourth hour of resuscitation, with a total of 93 +/- 2% of World Health Organization Oral Rehydration Solution infused into the intestine being absorbed. Intestinal absorption rates after burn injury are sufficient to resuscitate a 40% TBSA burn.

  3. 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.

  4. A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members.

    PubMed

    Ciraulo, David L; Frykberg, Eric R; Feliciano, David V; Knuth, Thomas E; Richart, Charles M; Westmoreland, Christy D; Williams, Kathryn A

    2004-05-01

    The goal of this survey was to establish a benchmark for trauma surgeons' level of operational understanding of the command structure for a pre-hospital incident, a mass casualty incident (MCI), and weapons of mass destruction (WMD). The survey was distributed before the World Trade Center destruction on September 11, 2001. The survey was developed by the authors and reviewed by a statistician for clarity and performance. The survey was sent to the membership of the 2000 Eastern Association for the Surgery of Trauma spring mailing, with two subsequent mailings and a final sampling at the Eastern Association for the Surgery of Trauma 2001 meeting. Of 723 surveys mailed, 243 were returned and statistically analyzed (significance indicated by p < 0.05). No statistical difference existed between level of designation of a trauma center (state or American College of Surgeons) and a facility's level of pre-paredness for MCIs or WMD. Physicians in communities with chemical plants, railways, and waterway traffic were statistically more likely to work at facilities with internal disaster plans addressing chemical and biological threats. Across all variables, physicians with military training were significantly better prepared for response to catastrophic events. With the exception of cyanide (50%), less than 30% of the membership was prepared to manage exposure to a nerve agent, less than 50% was prepared to manage illness from intentional biological exposure, and only 73% understood and were prepared to manage blast injury. Mobile medical response teams were present in 46% of the respondents' facilities, but only 30% of those teams deployed a trauma surgeon. Approximately 70% of the membership had been involved in an MCI, although only 60% understood the command structure for a prehospital incident. Only 33% of the membership had training regarding hazardous materials. Of interest, 76% and 65%, respectively, felt that education about MCIs and WMD should be included in

  5. The state of US trauma systems: public perceptions versus reality--implications for US response to terrorism and mass casualty events.

    PubMed

    Champion, Howard R; Mabee, Marcia S; Meredith, J Wayne

    2006-12-01

    not been made a national priority. Trauma systems must be adequately developed and supported to fulfill the public's expectation to receive the best possible care if seriously injured, and to ensure readiness for mass casualty and terrorist incidents.

  6. 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.

  7. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S Initial Operational Response (IOR)

    PubMed Central

    Riddle, Lorna; Larner, Joanne

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions

  8. Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR).

    PubMed

    Amlôt, Richard; Carter, Holly; Riddle, Lorna; Larner, Joanne; Chilcott, Robert P

    2017-01-01

    Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an "Initial Operational Response" by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer's forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised

  9. 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.

  10. Yale and the Atomic Bomb Casualty Commission.

    PubMed Central

    Bowers, J. Z.

    1983-01-01

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

  11. Yale and the Atomic Bomb Casualty Commission.

    PubMed

    Bowers, J Z

    1983-01-01

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

  12. Radiologic diagnosis of explosion casualties.

    PubMed

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

    2008-01-01

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

  13. Masses of radiation pressure supported stars in extreme relativistic realm

    NASA Astrophysics Data System (ADS)

    Mitra, Abhas

    2007-04-01

    It is known that there could be stars supported by radiation pressure alone. In Newtonian gravity, it turns out that such stars must be excessively massive and are called ``Supermassive Stars''. We show that this requirement for excessive mass arises because of weak gravity associated with Newtonian stars . The weakness of gravity here is expressed by the fact that for Newtonian stars, z << 1, where z is the surface gravitational redshift of the star. However, it is also known that sufficiently massive stars undergo continued gravitational collapse to become Black Holes (BH) marked by z=Infinity. Hence as the massive stars would tend to form BHs, they would pass through stages z>> 1. Recently, it has been shown that, such z>>1 stages would be be completely dominated by radiation energy rather than rest mass energy (Mitra, MNRAS Lett., 367, L66, 2006, gr-qc/0601025). By using this result, we show here that, in the realm of extremely strong gravity, there could be radiation pressure supported stars at arbitrary mass scale. Therefore, as we break free from the Newtonian restriction of z <<1, (1) Radiation Pressure Supported Stars need not be supermassive , (2) Radiation Pressure supported stars may have arbitrary low mass (say a few solar mass) or (3) They could be as massive as billion solar masses. The latter would be examples of Relativistic Supermassive Stars. All radiation pressure supported stars are shining at their respective maximal Eddington values and they are never in strict hydrodynamical equilibrium. On the other hand, they are in dynamical quasistatic state and their luminosity could be simply due to secular gravitational contraction known as Helmholtz -Kelvin process. The observed BH candidates could be in this intermediate state of radiation pressure supported relativistic stars (z >>1) rather than in the limiting BH stage (z = Infinity). Ref: A. Mitra, ``Radiation Pressure Supported Stars in Einstein Gravity: Eternally Collapsing Objects'', MNRAS (in

  14. Rapid Analysis of Mass Distribution of Radiation Shielding

    NASA Technical Reports Server (NTRS)

    Zapp, Edward

    2007-01-01

    Radiation Shielding Evaluation Toolset (RADSET) is a computer program that rapidly calculates the spatial distribution of mass of an arbitrary structure for use in ray-tracing analysis of the radiation-shielding properties of the structure. RADSET was written to be used in conjunction with unmodified commercial computer-aided design (CAD) software that provides access to data on the structure and generates selected three-dimensional-appearing views of the structure. RADSET obtains raw geometric, material, and mass data on the structure from the CAD software. From these data, RADSET calculates the distribution(s) of the masses of specific materials about any user-specified point(s). The results of these mass-distribution calculations are imported back into the CAD computing environment, wherein the radiation-shielding calculations are performed.

  15. Radiation Biomarker Research Using Mass Spectrometry

    DTIC Science & Technology

    2007-07-01

    The data was of insufficient quality to obtain definitive biomarkers. Trips were also made to AFRL/HEDR at Brooks City Base to assist with their...sample analysis using the Finnigan LTQ located there. Mr. Mullens and Ms. Nagore assisted with training personnel at AFRL/HEDR and when necessary...techniques with saliva samples and matrix- assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), we have been able to

  16. Radiatively generated hierarchy of lepton and quark masses

    NASA Astrophysics Data System (ADS)

    Hernández, A. E. Cárcamo; Kovalenko, Sergey; Schmidt, Ivan

    2017-02-01

    We propose a model for radiatively generating the hierarchy of the Standard Model (SM) fermion masses: tree-level top quark mass; 1-loop bottom, charm, tau and muon masses; 2-loop masses for the light up, down and strange quarks as well as for the electron; and 4-loop masses for the light active neutrinos. Our model is based on a softlybroken S 3 × Z 2 discrete symmetry. Its scalar sector consists only of one SM Higgs doublet and three electrically neutral SM-singlet scalars. We do not need to invoke either electrically charged scalar fields, or an extra SU2 L scalar doublet, or the spontaneous breaking of the discrete group, which are typical for other radiative models in the literature. The model features a viable scalar dark matter candidate.

  17. A model of radiatively induced quark and lepton mass model

    NASA Astrophysics Data System (ADS)

    Nomura, Takaaki

    2017-07-01

    We discuss a radiatively induced quark and lepton mass model in the rst and second generation introducing extra U(1) gauge symmetry, discrete Z 2 symmetry, vector-like fermions and exotic scalar elds. Then we analyze the allowed parameter regions which simultaneously satisfy the constraints of FCNCs for the quark sector and of LFVs including μ - e conversion, observed quark mass and mixing, and the lepton mass and mixing. In addition, the typical value for the (g - 2) μ in our model is presented. We also show extension of the model in which Majorana type neutrino masses are generated at the two loop level.

  18. [Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty].

    PubMed

    Yang, W X; Guo, G H; Shen, G L; Lin, W; Zhao, X Y; Qi, Q; Qian, H G; Xie, W Z; Wang, Z X

    2016-03-01

    To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty. The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University, the 100th Hospital of the People's Liberation Army, and Suzhou Municipal Hospital were retrospectively analyzed. The patients were divided into traditional monitoring group (T, n=22) and PiCCO monitoring group (P, n=19) according to the monitoring technic during delayed resuscitation. The input volumes of electrolyte, colloids, and water of patients in the two groups within 2 hours after admission, the first, second, and third 8 hours post injury (HPI), and the first 24 HPI were recorded. The fluid infusion coefficients of patients in the two groups within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were calculated. The urine volume, mean arterial pressure (MAP), and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8, 16, 24, 48, 72, and 96 were recorded. The blood lactate, base excess, hematocrit (HCT), and platelet count of patients in the two groups at PIH 24, 48, 72, and 96 were recorded. Complications and death of patients in the two groups were recorded. Data were processed with analysis of variance for repeated measurement, Chi-square test, t test, and Wilcoxon test. The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI, and the deviations between figure 1 and the fluid infusion coefficients of the second, third or fourth 24 HPI were calculated, and the three groups deviations were analyzed by Pearson correlation analysis. (1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (with Z values respectively -3.506 and -2

  19. Casualties from terrorist bombings.

    PubMed

    Cooper, G J; Maynard, R L; Cross, N L; Hill, J F

    1983-11-01

    The physical factors responsible for injury following an explosion in a room or building are: direct exposure to overpressure; blast-induced whole body displacement; impact of blast-energized debris; burns from flash and hot gases. The patterns of injury seen in the casualties from four terrorist bombings are described to illustrate the types and severity of particular wounds. The most common fatal injury is brain damage; 'blast lung' is uncommon in civilian terrorist bombings; flash burns, fractures, serious soft-tissue damage, and eardrum injuries are seen in people close to the bomb, who usually require hospital admission; many others taken to hospital can be treated for injury by debris and released. The environment and its internal structure and the position of the occupants of the space can influence the type and severity of injuries.

  20. Radiative neutrino mass model with degenerate right-handed neutrinos

    NASA Astrophysics Data System (ADS)

    Kashiwase, Shoichi; Suematsu, Daijiro

    2016-03-01

    The radiative neutrino mass model can relate neutrino masses and dark matter at a TeV scale. If we apply this model to thermal leptogenesis, we need to consider resonant leptogenesis at that scale. It requires both finely degenerate masses for the right-handed neutrinos and a tiny neutrino Yukawa coupling. We propose an extension of the model with a U(1) gauge symmetry, in which these conditions are shown to be simultaneously realized through a TeV scale symmetry breaking. Moreover, this extension can bring about a small quartic scalar coupling between the Higgs doublet scalar and an inert doublet scalar which characterizes the radiative neutrino mass generation. It also is the origin of the Z_2 symmetry which guarantees the stability of dark matter. Several assumptions which are independently supposed in the original model are closely connected through this extension.

  1. 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.

  2. Optimal shield mass distribution for space radiation protection

    NASA Technical Reports Server (NTRS)

    Billings, M. P.

    1972-01-01

    Computational methods have been developed and successfully used for determining the optimum distribution of space radiation shielding on geometrically complex space vehicles. These methods have been incorporated in computer program SWORD for dose evaluation in complex geometry, and iteratively calculating the optimum distribution for (minimum) shield mass satisfying multiple acute and protected dose constraints associated with each of several body organs.

  3. Searching for radiative neutrino mass generation at the LHC

    NASA Astrophysics Data System (ADS)

    Volkas, Raymond R.

    2015-04-01

    In this talk (talk given at the International Conference on Massive Neutrinos, Singapore, 9-13 February 2015), I describe the general characteristics of radiative neutrino mass models that can be probed at the LHC. I then cover the specific constraints on a new, explicit model of this type.

  4. Casualty management: scud missile attack, Dhahran, Saudi Arabia.

    PubMed

    Humphrey, J C

    1999-05-01

    On the evening of February 25, 1991, an Iraqi scud missile plunged into a "barracks/warehouse" used to house U.S. Army soldiers assigned to the 475th Quartermaster Group in Dhahran, Saudi Arabia. As a consequence of this scud attack, 28 soldiers died, 110 were hospitalized, and 150 experienced minor physical injuries and/or subsequent mental health problems. This one scud's impact accounted for more than one-third of all U.S. soldiers killed during the war. Fortunately, there were very few "models" of mass casualty experiences during the Persian Gulf War to evaluate the critical clinical outcomes to the soldiers. An analysis of this event has important implications for future military operations that feature a multinational medical force structure. This article summarizes the medical preparations before the war, the key, chronological events, and the medical outcomes of the mass casualty event. Lessons learned in casualty management for future Army contingency medical planners are identified.

  5. A radiative neutrino mass model with SIMP dark matter

    NASA Astrophysics Data System (ADS)

    Ho, Shu-Yu; Toma, Takashi; Tsumura, Koji

    2017-07-01

    We propose the first viable radiative seesaw model, in which the neutrino masses are induced radiatively via the two-loop Feynman diagram involving Strongly Interacting Massive Particles (SIMP). The stability of SIMP dark matter (DM) is ensured by a ℤ 5 discrete symmetry, through which the DM annihilation rate is dominated by the 3 → 2 self-annihilating processes. The right amount of thermal relic abundance can be obtained with perturbative couplings in the resonant SIMP scenario, while the astrophysical bounds inferred from the Bullet cluster and spherical halo shapes can be satisfied. We show that SIMP DM is able to maintain kinetic equilibrium with thermal plasma until the freeze-out temperature via the Yukawa interactions associated with neutrino mass generation.

  6. Unification of gauge couplings in radiative neutrino mass models

    NASA Astrophysics Data System (ADS)

    Hagedorn, Claudia; Ohlsson, Tommy; Riad, Stella; Schmidt, Michael A.

    2016-09-01

    We investigate the possibility of gauge coupling unification in various radiative neutrino mass models, which generate neutrino masses at one- and/or two-loop level. Renormalization group running of gauge couplings is performed analytically and numerically at one- and two-loop order, respectively. We study three representative classes of radiative neutrino mass models: (I) minimal ultraviolet completions of the dimension-7 Δ L = 2 operators which generate neutrino masses at one- and/or two-loop level without and with dark matter candidates, (II) models with dark matter which lead to neutrino masses at one-loop level and (III) models with particles in the adjoint representation of SU(3). In class (I), gauge couplings unify in a few models and adding dark matter amplifies the chances for unification. In class (II), about a quarter of the models admits gauge coupling unification. In class (III), none of the models leads to gauge coupling unification. Regarding the scale of unification, we find values between 1014 GeV and 1016 GeV for models belonging to class (I) without dark matter, whereas models in class (I) with dark matter as well as models of class (II) prefer values in the range 5·1010 - 5·1014 GeV.

  7. Radiation therapy of lymphoblastic renal masses - benefit or hazard

    SciTech Connect

    Saarinen, U.M.

    1985-05-01

    A child with non-Hodgkin lymphoma and massively enlarged kidneys received a single dose of 300 rad (3 Gy) to the right kidney before initiation of chemotherapy. Measurement of the split renal function with 99m-Tc-DTPA four days postirradiation revealed that the function of the right kidney had substantially deteriorated, suggesting that hazards may be involved with the use of radiation therapy for lymphoblastic renal masses.

  8. Is rapid hepatitis C virus testing from corpses a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field?

    PubMed

    Hagen, Ralf M; Wulff, B; Loderstaedt, U; Fengler, I; Frickmann, H; Schwarz, N G; Polywka, S

    2014-09-01

    We tested a commercially available rapid hepatitis C virus (HCV) test assay for its potential use for analyses of corpses as a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field. 50 blood samples were drawn from 16 recently deceased confirmed HCV-positive patients whose corpses were stored at 4°C in the mortuary and were analysed at admission and up to 48 h post mortem by rapid serological testing using the ImmunoFlow HCV test (Core Diagnostics, Birmingham, UK) in comparison with automated serological assays and PCR. Samples from 50 HCV-negative corpses were also analysed. The blood of only four of the 16 HCV-positive corpses reacted clearly with the ImmunoFlow HCV test, while in five cases the result was only weakly reactive and three cases showed very weak reactivity. Four of the infected corpses showed initially negative results, three of which became very weakly reactive 48 h post mortem. 49 out of 50 samples (98%) from HCV-negative corpses tested negative. The rapid test system we investigated showed insufficient sensitivity regarding the identification of HCV positivity. Automated serological testing or PCR should be preferred if it is realistically available in the deployed military setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Reducing and Mitigating Civilian Casualties: Enduring Lessons

    DTIC Science & Technology

    2013-04-12

    was not completely resolved: later in the conflict, Multinational Forces – Iraq ( MNF -I) 2 Off...Target: The Conduct of the War and Civilian Casualties in Iraq, report, Human Rights Watch, December 2003. 3 Though Multinational Forces-Iraq ( MNF ...I) did not establish a dedicated tracking cell for civilian casualties (CIVCAS) as did ISAF, the MNF -I Headquarters (HQ) tracked these casualties

  10. A radiative model of quark masses with binary tetrahedral symmetry

    NASA Astrophysics Data System (ADS)

    Natale, Alexander

    2017-01-01

    A radiative model of quark and lepton masses utilizing the binary tetrahedral (T‧) flavor symmetry, or horizontal symmetry, is proposed which produces the first two generation of quark masses through their interactions with vector-like quarks that carry charges under an additional U (1). By softly-breaking the T‧ to a residual Z4 through the vector-like quark masses, a CKM mixing angle close to the Cabibbo angle is produced. In order to generate the cobimaximal neutrino oscillation pattern (θ13 ≠ 0 ,θ23 = π / 4 ,δCP = ± π / 2) and protect the horizontal symmetry from arbitrary corrections in the lepton sector, there are automatically two stabilizing symmetries in the dark sector. Several benchmark cases where the correct relic density is achieved in a multi-component DM scenario, as well as the potential collider signatures of the vector-like quarks are discussed.

  11. Medical treatment of radiological casualties: current concepts.

    PubMed

    Koenig, Kristi L; Goans, Ronald E; Hatchett, Richard J; Mettler, Fred A; Schumacher, Thomas A; Noji, Eric K; Jarrett, David G

    2005-06-01

    The threat of radiologic or nuclear terrorism is increasing, yet many physicians are unfamiliar with basic treatment principles for radiologic casualties. Patients may present for care after a covert radiation exposure, requiring an elevated level of suspicion by the physician. Traditional medical and surgical triage criteria should always take precedence over radiation exposure management or decontamination. External contamination from a radioactive cloud is easily evaluated using a simple Geiger-Muller counter and decontamination accomplished by prompt removal of clothing and traditional showering. Management of surgical conditions in the presence of persistent radioactive contamination should be dealt with in a conventional manner with health physics guidance. To be most effective in the medical management of a terrorist event involving high-level radiation, physicians should understand basic manifestations of the acute radiation syndrome, the available medical countermeasures, and the psychosocial implications of radiation incidents. Health policy considerations include stockpiling strategies, effective use of risk communications, and decisionmaking for shelter-in-place versus evacuation after a radiologic incident.

  12. Optimization of NTP System Truss to Reduce Radiation Shield Mass

    NASA Technical Reports Server (NTRS)

    Scharber, Luke L.; Kharofa, Adam; Caffrey, Jarvis A.

    2016-01-01

    The benefits of nuclear thermal propulsion are numerous and relevant to the current NASA mission goals involving but not limited to the crewed missions to mars and the moon. They do however also present new and unique challenges to the design and logistics of launching/operating spacecraft. One of these challenges, relevant to this discussion, is the significant mass of the shielding which is required to ensure an acceptable radiation environment for the spacecraft and crew. Efforts to reduce shielding mass are difficult to accomplish from material and geometric design points of the shield itself, however by increasing the distance between the nuclear engines and the main body of the spacecraft the required mass of the shielding is lessened considerably. The mass can be reduced significantly per unit length, though any additional mass added by the structure to create this distance serves to offset those savings, thus the design of a lightweight structure is ideal. The challenges of designing the truss are bounded by several limiting factors including; the loading conditions, the capabilities of the launch vehicle, and achieving the ideal truss length when factoring for the overall mass reduced. Determining the overall set of mass values for a truss of varying length is difficult since to maintain an optimally designed truss the geometry of the truss or its members must change. Thus the relation between truss mass and length for these loading scenarios is not linear, and instead has relation determined by the truss design. In order to establish a mass versus length trend for various truss designs to compare with the mass saved from the shield versus length, optimization software was used to find optimal geometric properties that still met the design requirements at established lengths. By solving for optimal designs at various lengths, mass trends could be determined. The initial design findings show a clear benefit to extending the engines as far from the main

  13. Radiation pressure calibration and test mass reflectivities for LISA Pathfinder

    NASA Astrophysics Data System (ADS)

    Korsakova, Natalia; Kaune, Brigitte; LPF Collaboration

    2017-05-01

    This paper describes a series of experiments which were carried out during the main operations of LISA Pathfinder. These experiments were performed by modulating the power of the measurement and reference beams. In one series of experiments the beams were sequentially switched on and off. In the other series of experiments the powers of the beams were modulated within 0.1% and 1% of the constant power. These experiments use recordings of the total power measured on the photodiodes to infer the properties of the Optical Metrology System (OMS), such as reflectivities of the test masses and change of the photodiode efficiencies with time. In the first case the powers are back propagated from the different photodiodes to the same place on the optical bench to express the unknown quantities in the measurement with the complimentary photodiode measurements. They are combined in the way that the only unknown left is the test mass reflectivities. The second experiment compared two estimates of the force applied to the test masses due to the radiation pressure that appears because of the beam modulations. One estimate of the force is inferred from the measurements of the powers on the photodiodes and propagation of this measurement to the test masses. The other estimation of the force is done by calculating it from the change in the main scientific output of the instrument - differential displacement of the two test masses.

  14. An assessment of telemedicine possibilities in massive casualties situations.

    PubMed

    Paunksnis, A; Barzdziukas, V; Kurapkiene, S; Vaicaitiene, R; Sereika, V

    2005-01-01

    The use of existing possibilities of Telemedicine Center of Kaunas University of Medicine allows the live distant consultations from high-level medical specialised centers to rural areas. On July 2004 the Telemedicine Center took part in the RESCUER/MEDCEUR project exercise. A special objective was the use of telemedicine facilities for distant consultations and sorting of victims directly at the event place. Telemedicine Center used appropriate telecommunication devices for joint activities of civil and multinational military services in critical situations such as mass casualty events. There were used ISDN lines and IP radio-connection. On the final and most intensive day of the anti-terrorism drills, the multinational force of medics at the Kairiu Training Range in Lithuania reacted to a large mass casualty event--treating hundreds of victims from a simulated train crash. Using on-line telemedicine facilities from Kaunas Medical University Hospital there were corrected the tactics of giving the first help and sorting of casualties. The most complicated initiated cases of eye trauma, neurosurgical trauma, maxilloface trauma and traumatic amputation of limbs evaluated and selected for emergent evacuation to the third level hospitals. All those cases transported to Kaunas and Vilnius Universities Hospitals by helicopters (200 and 300 km from the event place). The common use of existing military and civil telemedicine infrastructure showed the possibilities of interaction in management, giving the first help and sorting of casualties between military and civil medical services during the rescue operations.

  15. Noninvasive detection of weapons of mass destruction using terahertz radiation

    NASA Astrophysics Data System (ADS)

    Campbell, Matthew B.; Heilweil, Edwin J.

    2003-08-01

    The growing and immediate threat of biological and chemical weapons has placed urgency on the development of chemical and biological warfare agent (CWA/BWA) screening devices. Specifically, the ability to detect CWA/BWA prior to deployment is paramount to mitigating the threat without exposing individuals to its effects. SPARTA, Inc. and NIST are currently investigating the feasibility of using far-infrared radiation, or terahertz (THz, 1 THz = 1012 Hz) radiation, to non-invasively detect biological and chemical agents, explosives and drugs/narcotics inside sealed containers. Small-to-medium sized molecules (3-100 atoms) in gas, liquid and solid phases consistently exhibit identifiable spectral features in the far-IR portion of the spectrum. Many compounds associated with weapons of mass destruction are made up of molecules of this size. The THz portion of the spectrum lies between visible light and radio waves, allowing for partial transmission of 0.3-10.0 THz (30-1000 μm, 10-330 cm-1) light through most common materials. Therefore, transmission measurements of THz light can potentially be used to non-invasively detect the presence of CWA/BWA, explosives and drugs in the pathway of a THz radiation beam.

  16. How to Explain the Non-Zero Mass of Electromagnetic Radiation Consisting of Zero-Mass Photons

    ERIC Educational Resources Information Center

    Gabovich, Alexander M.; Gabovich, Nadezhda A.

    2007-01-01

    The mass of electromagnetic radiation in a cavity is considered using the correct relativistic approach based on the concept of a scalar mass not dependent on the particle (system) velocity. It is shown that due to the non-additivity of mass in the special theory of relativity the ensemble of chaotically propagating mass-less photons in the cavity…

  17. How to Explain the Non-Zero Mass of Electromagnetic Radiation Consisting of Zero-Mass Photons

    ERIC Educational Resources Information Center

    Gabovich, Alexander M.; Gabovich, Nadezhda A.

    2007-01-01

    The mass of electromagnetic radiation in a cavity is considered using the correct relativistic approach based on the concept of a scalar mass not dependent on the particle (system) velocity. It is shown that due to the non-additivity of mass in the special theory of relativity the ensemble of chaotically propagating mass-less photons in the cavity…

  18. 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.

  19. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Human Casualties in Impact Events

    NASA Astrophysics Data System (ADS)

    Gritzner, C.

    1997-10-01

    It is widespread error to believe that people were never killed by meteorites. It was concluded that there no human casualties due to meteorite falls because there were no reports about such incidents, but there are reports of these rare events. The statement of no one ever being killed by a meteorite may intend that the danger even of asteroid and comet impacts onto the Earth is only fiction, but the danger is real. It is a low-probability-high-consequence event for large impactors (more than 1 km). Even from meteorites, however, people were reported struck to death. This article gives a survey over reports of human casualties from 616 A.D. well to our century.

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty...

  2. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

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

  3. 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... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty...

  4. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty...

  5. 33 CFR 173.55 - Report of casualty or accident.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Report of casualty or accident... (CONTINUED) BOATING SAFETY VESSEL NUMBERING AND CASUALTY AND ACCIDENT REPORTING Casualty and Accident Reporting § 173.55 Report of casualty or accident. (a) The operator of a vessel shall submit the casualty...

  6. Iraq: U.S. Casualties

    DTIC Science & Technology

    2009-05-14

    compiled by the Department of Defense (DOD), as tallied from the agency’s press releases. Table 1 provides statistics on fatalities during Operation...Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on those wounded...http://siadapp.dmdc.osd.mil/ personnel/CASUALTY/castop.htm. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded as of May 14, 2009, 10

  7. Iraq: U.S. Casualties

    DTIC Science & Technology

    2009-01-29

    was compiled by the Department of Defense (DOD), as tallied from the agency’s press releases. Table 1 provides statistics on fatalities during...Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on...website at http://siadapp.dmdc.osd.mil/ personnel/CASUALTY/castop.htm. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded as of January

  8. Iraq: U.S. Casualties

    DTIC Science & Technology

    2009-06-26

    were compiled by the Department of Defense (DOD), as tallied from the agency’s press releases. Table 1 provides statistics on fatalities during...Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on those...website at http://siadapp.dmdc.osd.mil/ personnel/CASUALTY/castop.htm. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded as of June 25, 2009

  9. Iraq: U.S. Casualties

    DTIC Science & Technology

    2008-08-28

    was compiled by the Department of Defense (DOD), as tallied from the agency’s press releases. Table 1 provides statistics on fatalities during...Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on those...following DOD website: [http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm]. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded as of

  10. 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

  11. An Alternative Health Care Facility: Concept of Operations for the Off-site Triage, Treatment, and Transportation Center (OST3C). Mass Casualty Care Strategy for a Chemical Terrorism Incident

    DTIC Science & Technology

    2001-03-01

    develop non- cardiogenic pulmonary edema within 6 hours after exposure to a “choking” agent such as phosgene. These patients should be transported to a...admitted for observation, as they may develop pulmonary edema . E. Psychological Casualties Disasters have a tremendous emotional and psychological

  12. Rotating, radiating mass imbedded in a de Sitter universe

    SciTech Connect

    Hadley, R.H.

    1991-01-01

    This study presents a new solution to the Einstein field equations for a rotating, radiating mass imbedded in a de Sitter universe, the Kerr de Sitter-Vaidya or KDV line element. Solutions presented were precursers to the new solution. One of these, the Vaidya-Mallett or VM metric is used as a starting point to derive the KDV metric by a method called complexification. The mathematical framework for the KDV metric is the Newman-Penrose formalism, a powerful tool that provides insight into the various properties of the space-time geometry and optical properties of the radiation field. Using this formalism, the metric can be expressed in tetrad form and the Newman-Penrose spin coefficient equations solved for tetrad components of the trace-free Ricci tensor, Ricci scalar, Maxwell tensor, and Weyl tensor. Using the tetrad components of the Weyl tensor, the Petrov type for the gravitational and electromagnetic fields are found. The new solution is shown to be a solution to the Einstein-Maxwell equations for a particular choice of energy-momentum tensor which is studied in detail.

  13. 19 CFR 158.27 - Accidental fire or other casualty.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... be, at the time of the casualty; and (3) That it was totally destroyed and there is no probability of... the time of casualty, stating: (1) The time, place, and nature of such casualty; (2) That...

  14. ON THE MASS RADIATED BY COALESCING BLACK HOLE BINARIES

    SciTech Connect

    Barausse, E.; Morozova, V.; Rezzolla, L.

    2012-10-10

    We derive an analytic phenomenological expression that predicts the final mass of the black hole (BH) remnant resulting from the merger of a generic binary system of BHs on quasi-circular orbits. Besides recovering the correct test-particle limit for extreme mass-ratio binaries, our formula reproduces well the results of all the numerical-relativity simulations published so far, both when applied at separations of a few gravitational radii and when applied at separations of tens of thousands of gravitational radii. These validations make our formula a useful tool in a variety of contexts ranging from gravitational-wave (GW) physics to cosmology. As representative examples, we first illustrate how it can be used to decrease the phase error of the effective-one-body waveforms during the ringdown phase. Second, we show that, when combined with the recently computed self-force correction to the binding energy of nonspinning BH binaries, it provides an estimate of the energy emitted during the merger and ringdown. Finally, we use it to calculate the energy radiated in GWs by massive BH binaries as a function of redshift, using different models for the seeds of the BH population.

  15. Radiation Metabolomics. 5. Identification of Urinary Biomarkers of Ionizing Radiation Exposure in Nonhuman Primates by Mass Spectrometry-Based Metabolomics

    PubMed Central

    Johnson, Caroline H.; Patterson, Andrew D.; Krausz, Kristopher W.; Kalinich, John F.; Tyburski, John B.; Kang, Dong Wook; Luecke, Hans; Gonzalez, Frank J.; Blakely, William F.; Idle, Jeffrey R.

    2012-01-01

    Mass spectrometry-based metabolomics has previously demonstrated utility for identifying biomarkers of ionizing radiation exposure in cellular, mouse and rat in vivo radiation models. To provide a valuable link from small laboratory rodents to humans, γ-radiation-induced urinary biomarkers were investigated using a nonhuman primate total-body-irradiation model. Mass spectrometry-based metabolomics approaches were applied to determine whether biomarkers could be identified, as well as the previously discovered rodent biomarkers of γ radiation. Ultra-performance liquid chromatography-electrospray ionization quadrupole time-of-flight mass spectrometry analysis was carried out on a time course of clean-catch urine samples collected from nonhuman primates (n = 6 per cohort) exposed to sham, 1.0, 3.5, 6.5 or 8.5 Gy doses of 60Co γ ray (~0.55 Gy/min) ionizing radiation. By multivariate data analysis, 13 biomarkers of radiation were discovered: N-acetyltaurine, isethionic acid, taurine, xanthine, hypoxanthine, uric acid, creatine, creatinine, tyrosol sulfate, 3-hydroxytyrosol sulfate, tyramine sulfate, N-acetylserotonin sulfate, and adipic acid. N-Acetyltaurine, isethionic acid, and taurine had previously been identified in rats, and taurine and xanthine in mice after ionizing radiation exposure. Mass spectrometry-based metabolomics has thus successfully revealed and verified urinary biomarkers of ionizing radiation exposure in the nonhuman primate for the first time, which indicates possible mechanisms for ionizing radiation injury. PMID:22954391

  16. Fast migration of low-mass planets in radiative discs

    NASA Astrophysics Data System (ADS)

    Pierens, A.

    2015-12-01

    Low-mass planets are known to undergo Type I migration and this process must have played a key role during the evolution of planetary systems. Analytical formulae for the disc torque have been derived assuming that the planet evolves on a fixed circular orbit. However, recent work has shown that in isothermal discs, a migrating protoplanet may also experience dynamical corotation torques that scale with the planet drift rate. The aim of this study is to examine whether dynamical corotation torques can also affect the migration of low-mass planets in non-isothermal discs. We performed 2D radiative hydrodynamical simulations to examine the orbital evolution outcome of migrating protoplanets as a function of disc mass. We find that a protoplanet can enter a fast migration regime when it migrates in the direction set by the entropy-related horseshoe drag and when the Toomre stability parameter is less than a threshold value below which the horseshoe region contracts into a tadpole-like region. In that case, an underdense trapped region appears near the planet, with an entropy excess compared to the ambient disc. If the viscosity and thermal diffusivity are small enough so that the entropy excess is conserved during migration, the planet then experiences strong corotation torques arising from the material flowing across the planet orbit. During fast migration, we observe that a protoplanet can pass through the zero-torque line predicted by static torques. We also find that fast migration may help in disrupting the mean-motion resonances that are formed by convergent migration of embryos.

  17. Mass Casualty Triage Performance Assessment Tool

    DTIC Science & Technology

    2015-02-01

    Jonathan J. Bryson Heidi Keller-Glaze ICF International Christopher L. Vowels U.S. Army Research Institute February 2015 United...Christopher L. Vowels 5c. PROJECT NUMBER A790 5d. TASK NUMBER 5e. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES...Contracting Officer’s Representative and Subject Matter POC: Dr. Christopher L. Vowels 14. ABSTRACT (Maximum 200 words): This report

  18. The Atomic Bomb Casualty Commission in retrospect

    PubMed Central

    Putnam, Frank W.

    1998-01-01

    For 50 years, the Atomic Bomb Casualty Commission (ABCC) and its successor, the Radiation Effects Research Foundation (RERF), have conducted epidemiological and genetic studies of the survivors of the atomic bombs and of their children. This research program has provided the primary basis for radiation health standards. Both ABCC (1947–1975) and RERF (1975 to date) have been a joint enterprise of the United States (through the National Academy of Sciences) and of Japan. ABCC began in devastated, occupied Japan. Its mission had to be defined and refined. Early research revealed the urgent need for long term study. In 1946, a Directive of President Truman enjoined the National Research Council of the National Academy of Sciences to develop the program. By 1950, ABCC staff exceeded 1,000, and clinical and genetic studies were underway. Budgetary difficulties and other problems almost forced closure in 1953. In 1955, the Francis Report led to a unified epidemiological study. Much progress was made in the next decade, but changing times required founding of a binational nonprofit organization (RERF) with equal participation by Japan and the United States. New programs have been developed and existing ones have been extended in what is the longest continuing health survey ever undertaken. PMID:9576898

  19. 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.

  20. 33 CFR 146.40 - Diving casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Diving casualties. 146.40 Section 146.40 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OUTER CONTINENTAL SHELF ACTIVITIES OPERATIONS OCS Facilities § 146.40 Diving casualties. Diving related...

  1. 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.

  2. Predicting casualties implied by TIPs

    NASA Astrophysics Data System (ADS)

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

    2009-12-01

    When an earthquake is predicted, forecast, or expected with a higher than normal probability, losses are implied. We estimated the casualties (fatalities plus injured) that should be expected if earthquakes in TIPs (locations of Temporarily Increased Probability of earthquakes) defined by Kossobokov et al. (2009) should occur. We classified the predictions of losses into the categories red (more than 400 fatalities or more than 1,000 injured), yellow (between 100 and 400 fatalities), green (fewer than 100 fatalities), and gray (undetermined). TIPs in Central Chile, the Philippines, Papua, and Taiwan are in the red class, TIPs in Southern Sumatra, Nicaragua, Vanatu, and Honshu in the yellow class, and TIPs in Tonga, Loyalty Islands, Vanatu, S. Sandwich Islands, Banda Sea, and the Kuriles, are classified as green. TIPs where the losses depend moderately on the assumed point of major energy release were classified as yellow; TIPs such as in the Talaud Islands and in Tonga, where the losses depend very strongly on the location of the epicenter, were classified as gray. The accuracy of loss estimates after earthquakes with known hypocenter and magnitude are affected by uncertainties in transmission and soil properties, the composition of the building stock, the population present, and the method by which the numbers of casualties are calculated. In the case of TIPs, uncertainties in magnitude and location are added, thus we calculate losses for a range of these two parameters. Therefore, our calculations can only be considered order of magnitude estimates. Nevertheless, our predictions can come to within a factor of two of the observed numbers, as in the case of the M7.6 earthquake of October 2005 in Pakistan that resulted in 85,000 fatalities (Wyss, 2005). In subduction zones, the geometrical relationship between the earthquake source capable of a great earthquake and the population is clear because there is only one major fault plane available, thus the epicentral

  3. 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...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  5. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  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 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  9. 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...

  10. 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...

  11. 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...

  12. 46 CFR 4.05-1 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  13. 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...

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 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...

  16. 46 CFR 28.80 - Report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... accordance with paragraph (c) of this section, as soon as possible after the casualty, to the underwriter of... the casualty involves any of the following. (1) Loss of life. (2) An injury that requires professional... involved in the casualty; and (13) The monetary amount paid for an injury or a death. (d) A casualty to a...

  17. Impact of Radiation Hardness and Operating Temperatures of Silicon Carbide Electronics on Space Power System Mass

    NASA Technical Reports Server (NTRS)

    Juhasz, Albert J.; Tew, Roy C.; Schwarze, Gene E.

    1998-01-01

    The effect of silicon carbide (SiC) electronics operating temperatures on Power Management and Distribution (PMAD), or Power Conditioning (PC), subsystem radiator size and mass requirements was evaluated for three power output levels (100 kW(e) , 1 MW(e), and 10 MW(e)) for near term technology ( i.e. 1500 K turbine inlet temperature) Closed Cycle Gas Turbine (CCGT) power systems with a High Temperature Gas Reactor (HTGR) heat source. The study was conducted for assumed PC radiator temperatures ranging from 370 to 845 K and for three scenarios of electrical energy to heat conversion levels which needed to be rejected to space by means of the PC radiator. In addition, during part of the study the radiation hardness of the PC electronics was varied at a fixed separation distance to estimate its effect on the mass of the instrument rated reactor shadow shield. With both the PC radiator and the conical shadow shield representing major components of the overall power system the influence of the above on total power system mass was also determined. As expected, results show that the greatest actual mass savings achieved by the use of SiC electronics occur with high capacity power systems. Moreover, raising the PC radiator temperature above 600 K yields only small additional system mass savings. The effect of increased radiation hardness on total system mass is to reduce system mass by virtue of lowering the shield mass.

  18. Blood bank protocols for large-scale civilian casualty events: experience from terrorist bombing in Israel.

    PubMed

    Dann, E J; Bonstein, L; Arbov, L; Kornberg, A; Rahimi-Levene, N

    2007-04-01

    Terrorist attacks in crowded places cause multiple casualties that are evacuated by quick succession to nearby hospitals. The study goals were to analyse the issues of patient misidentification and excessive blood request and to develop recommendations for the management of such episodes. A retrospective analysis of nine explosion attacks was performed. In nine consecutive events, 450 casualties were reported by the National Ambulance Service, 82 of whom (18%) died on the explosion site and 368 were admitted to nearby trauma centres. Red blood cell units were typed and cross-matched for 70 patients. Seventy-three per cent of the blood supplied over the first 24 h was administered during the first 2 h. The cross-matched/transfused ratio was 2.52 +/- 1.42, reflecting the overestimation of blood requirement in mass casualty episodes. In the mass casualty setup, blood bank personnel should be alert to a potential mistransfusion or a blood collection error. Unidentified patients are subjected to errors due to only one-digit difference in their temporary identification number. Application of the system using an additional sequential four-digit number printed in bold and large size font for patients at admission reduced the possibility of misidentification. Modern technologies, including error-reduction design wristbands, barcode-based system or radiofrequency identification tags may also increase reliability of patient identification in the mass casualty setup.

  19. Radiation injuries, triage, and treatment after a nuclear terrorist attack.

    PubMed

    McGhee, Robert K; Praetzel, Daron C; Medley, Christopher C

    2005-08-01

    The treatment of injuries from a nuclear weapon or a radioactive dispersal device most likely will be in a mass casualty scenario. Radiation injuries complicate the treatment process, with increased emphasis on early intervention. The care of patients must proceed in an orderly fashion. If radiation injury occurs as part of a mass casualty, some organized method of triage, decontamination, evacuation, and treatment must be implemented. Oral and maxillofacial surgeons should plan to become integral members of the treatment team, especially considering their wide scope of training. It is important for all health care providers to become familiar with the types of injuries that can be expected after a radiologic attack and the treatment modalities that can preserve life should such a catastrophe occur.

  20. Friendly Combat Casualties and Operational Narratives

    DTIC Science & Technology

    2015-06-21

    ABSTRACT A complex relationship exists between friendly combat casualties and public support, in the context of 21st century limited wars. A myth persists... creation and communication at the strategic level. To bridge the gap, the author proposes the term “operational narrative,” as a means of...limited wars. A myth persists that Western civilian populations are casualty phobic, and as such military leaders are often risk-averse. In reality

  1. The Role of Mass Spectrometry-Based Metabolomics in Medical Countermeasures Against Radiation

    PubMed Central

    Patterson, Andrew D.; Lanz, Christian; Gonzalez, Frank J.; Idle, Jeffrey R.

    2013-01-01

    Radiation metabolomics can be defined as the global profiling of biological fluids to uncover latent, endogenous small molecules whose concentrations change in a dose-response manner following exposure to ionizing radiation. In response to the potential threat of nuclear or radiological terrorism, the Center for High-Throughput Minimally Invasive Radiation Biodosimetry (CMCR) was established to develop field-deployable biodosimeters based, in principle, on rapid analysis by mass spectrometry of readily and easily obtainable biofluids. In this review, we briefly summarize radiation biology and key events related to actual and potential nuclear disasters, discuss the important contributions the field of mass spectrometry has made to the field of radiation metabolomics, and summarize current discovery efforts to use mass spectrometry-based metabolomics to identify dose-responsive urinary constituents, and ultimately to build and deploy a noninvasive high-throughput biodosimeter. PMID:19890938

  2. United States military casualty comparison during the Persian Gulf War.

    PubMed

    Helmkamp, J C

    1994-06-01

    The United States undertook an extensive mobilization of military forces in Southwest Asia after the invasion of Kuwait by Iraq in August 1990. With this massive buildup and the short duration of the Persian Gulf War, an epidemiological comparison of military casualties was of interest. Information extracted from the Worldwide Casualty System maintained by the Department of Defense was used to describe the casualties. Of the 219 (212 men and 7 women) US casualties, 154 were killed in battle and 65 died from nonbattle causes. Thirty-five of the battle deaths were a result of friendly fire. Eighty-three percent of all casualties were white and the mean age at death for all casualties was 26.9 years. The Army had the highest proportion of both battle (58%) and nonbattle (71%) casualties and the Marine Corps had the highest battle casualty rate (0.52 per 1000 personnel) and nonbattle casualty rate (0.31).

  3. Aerosol properties and radiative forcing for three air masses transported in Summer 2011 to Sopot, Poland

    NASA Astrophysics Data System (ADS)

    Rozwadowska, Anna; Stachlewska, Iwona S.; Makuch, P.; Markowicz, K. M.; Petelski, T.; Strzałkowska, A.; Zieliński, T.

    2013-05-01

    Properties of atmospheric aerosols and solar radiation reaching the Earth's surface were measured during Summer 2011 in Sopot, Poland. Three cloudless days, characterized by different directions of incoming air-flows, which are typical transport pathways to Sopot, were used to estimate a radiative forcing due to aerosols present in each air mass.

  4. Pattern of eye casualty clinic cases

    PubMed Central

    2008-01-01

    Introduction/Background The purpose of the eye casualty clinic (ECC) is to manage patients with ocular emergencies, however a large number of patients attended the eye casualty clinic did not have an acute problem and could have been treated by their General Practitioner (GP) or referred to the eye outpatient clinic. Aim To identify the number of patients attending the ECC every day and their route of referral and to estimate the number of patients who could have be seen and managed by a competent ophthalmic nurse practitioner. Methods A retrospective analysis was conducted using the notes and history of all patients who attended the eye casualty clinic at the Princess Margaret Hospital in Swindon during two weeks in March 2006. Results The average daily attendance was 21 patients who were seen between morning and afternoon sessions in the Eye Casualty Clinic.112 (54%) patients were female. The median patient age was 50 years with an age range of 1 to 91 years. 68 (34.2%) patients attended as self referrals without GP letters as our eye casualty clinic is open to the general public from 9.00 a.m. to 5.00 p.m. A & E referred 28 (14.1%) patients of which only 3 had a General Practitioner (GP) letter and only 1 patient had a walk-in centre letter. There was insufficient information to assess whether 14 patients could have been managed by a nurse; of the remaining 195 visits, 50 (25.6%) patients could have been managed by an Ophthalmic Nurse Practitioner and 145 (74.4%) patients could not have been managed by an Ophthalmic Nurse Practitioner. Conclusion The workload of the eye casualty doctors could be decreased by 38.6% if defined categories of patients were managed by the ophthalmic nurse practitioner, appropriate referrals were directed to the General Clinic and casualty patients were not followed up inappropriately. PMID:18655718

  5. Pattern of eye casualty clinic cases.

    PubMed

    Wasfi, Ehab I; Sharma, Randeep; Powditch, Emma; Abd-Elsayed, Alaa A

    2008-07-26

    The purpose of the eye casualty clinic (ECC) is to manage patients with ocular emergencies, however a large number of patients attended the eye casualty clinic did not have an acute problem and could have been treated by their General Practitioner (GP) or referred to the eye outpatient clinic. To identify the number of patients attending the ECC every day and their route of referral and to estimate the number of patients who could have be seen and managed by a competent ophthalmic nurse practitioner. A retrospective analysis was conducted using the notes and history of all patients who attended the eye casualty clinic at the Princess Margaret Hospital in Swindon during two weeks in March 2006. The average daily attendance was 21 patients who were seen between morning and afternoon sessions in the Eye Casualty Clinic.112 (54%) patients were female. The median patient age was 50 years with an age range of 1 to 91 years. 68 (34.2%) patients attended as self referrals without GP letters as our eye casualty clinic is open to the general public from 9.00 a.m. to 5.00 p.m. A & E referred 28 (14.1%) patients of which only 3 had a General Practitioner (GP) letter and only 1 patient had a walk-in centre letter. There was insufficient information to assess whether 14 patients could have been managed by a nurse; of the remaining 195 visits, 50 (25.6%) patients could have been managed by an Ophthalmic Nurse Practitioner and 145 (74.4%) patients could not have been managed by an Ophthalmic Nurse Practitioner. The workload of the eye casualty doctors could be decreased by 38.6% if defined categories of patients were managed by the ophthalmic nurse practitioner, appropriate referrals were directed to the General Clinic and casualty patients were not followed up inappropriately.

  6. THREE-DIMENSIONAL RADIATIVE TRANSFER CALCULATIONS OF RADIATION FEEDBACK FROM MASSIVE BLACK HOLES: OUTFLOW OF MASS FROM THE DUSTY 'TORUS'

    SciTech Connect

    Roth, Nathaniel; Kasen, Daniel; Quataert, Eliot; Hopkins, Philip F.

    2012-11-01

    Observational and theoretical arguments suggest that the momentum carried in mass outflows from active galactic nuclei (AGNs) can reach several times L/c, corresponding to outflow rates of hundreds of solar masses per year. Radiation pressure on resonant absorption lines alone may not be sufficient to provide this momentum deposition, and the transfer of reprocessed IR radiation in dusty nuclear gas has been postulated to provide the extra enhancement. The efficacy of this mechanism, however, will be sensitive to multi-dimensional effects such as the tendency for the reprocessed radiation to preferentially escape along sightlines of lower column density. We use Monte Carlo radiative transfer calculations to determine the radiation force on dusty gas residing within approximately 30 parsecs from an accreting supermassive black hole. We calculate the net rate of momentum deposition in the surrounding gas and estimate the mass-loss rate in the resulting outflow as a function of solid angle for different black hole luminosities, sightline-averaged column densities, clumping parameters, and opening angles of the dusty gas. We find that these dust-driven winds carry momentum fluxes of 1-5 times L/c and correspond to mass-loss rates of 10-100 M {sub Sun} per year for a 10{sup 8} M {sub Sun} black hole radiating at or near its Eddington limit. These results help to explain the origin of high velocity molecular and atomic outflows in local ultraluminous infrared galaxies and can inform numerical simulations of galaxy evolution including AGN feedback.

  7. Medical management of radiation victims in the United States.

    PubMed

    Davids, Matthew S; Case, Cullen; Confer, Dennis L; Weisdorf, Daniel J; Weinstock, David M

    2010-06-01

    Many governmental and non-governmental agencies are involved in the planning for radiation events in the U.S. We will focus on medical management after mass casualty events, specifically the involvement of the Radiation Injury Treatment Network (RITN), a voluntary consortium of medical centers across the continental U.S. RITN and its partners have established standardized approaches for the evaluation and treatment of radiation victims, which are now available online. Efforts are underway to streamline these processes, provide training to healthcare practitioners around the country, and harmonize with similar efforts around the world.

  8. Effects of anisotropic conduction and heat pipe interaction on minimum mass space radiators

    NASA Technical Reports Server (NTRS)

    Baker, Karl W.; Lund, Kurt O.

    1991-01-01

    Equations are formulated for the two dimensional, anisotropic conduction of heat in space radiator fins. The transverse temperature field was obtained by the integral method, and the axial field by numerical integration. A shape factor, defined for the axial boundary condition, simplifies the analysis and renders the results applicable to general heat pipe/conduction fin interface designs. The thermal results are summarized in terms of the fin efficiency, a radiation/axial conductance number, and a transverse conductance surface Biot number. These relations, together with those for mass distribution between fins and heat pipes, were used in predicting the minimum radiator mass for fixed thermal properties and fin efficiency. This mass is found to decrease monotonically with increasing fin conductivity. Sensitivities of the minimum mass designs to the problem parameters are determined.

  9. 46 CFR 308.410 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties... Subsidy and Insurance, Washington, DC 20590....

  10. Predictive model for radiatively induced neutrino masses and mixings with dark matter.

    PubMed

    Gustafsson, Michael; No, Jose M; Rivera, Maximiliano A

    2013-05-24

    A minimal extension of the standard model to naturally generate small neutrino masses and provide a dark matter candidate is proposed. The dark matter particle is part of a new scalar doublet field that plays a crucial role in radiatively generating neutrino masses. The symmetry that stabilizes the dark matter also suppresses neutrino masses to appear first at three-loop level. Without the need of right-handed neutrinos or other very heavy new fields, this offers an attractive explanation of the hierarchy between the electroweak and neutrino mass scales. The model has distinct verifiable predictions for the neutrino masses, flavor mixing angles, colliders, and dark matter signals.

  11. A New Mechanism for Mass Accretion Under Radiation Pressure in Massive Star Formation

    NASA Astrophysics Data System (ADS)

    Tanaka, Kei E. I.; Nakamoto, Taishi

    2010-05-01

    During the formation of a massive star, strong radiation pressure from the central star acts on the dust sublimation front and tends to halt the accretion flow. To overcome this strong radiation pressure, it has been considered that a strong ram pressure produced by a high-mass accretion rate of 10-3 M sun yr-1 or more is needed. We reinvestigated the necessary condition to overcome the radiation pressure and found a new mechanism for overcoming it. Accumulated mass in a stagnant flow near the dust sublimation front helps the mass accretion by its weight. This mechanism relaxes the condition for the massive star formation. We call this mechanism the "OMOSHI effect," where OMOSHI is an acronym for "One Mechanism for Overcoming Stellar High radiation pressure by weIght." Additionally, in Japanese, OMOSHI is a noun meaning a weight that is put on something to prevent it from moving. We investigate the generation of the OMOSHI effect using local one-dimensional radiation hydrodynamics simulations. The radiation pressure and the gravitational force are connected through the gas pressure, and to sum up, the radiation pressure is balanced or overcome by the gravitational force. We also discuss the global structure and temporal variation of the accretion flow.

  12. Coupled Fluids-Radiation Analysis of a High-Mass Mars Entry Vehicle

    NASA Technical Reports Server (NTRS)

    Palmer, Grant; Allen, Gary; Tang, Chun; Brown, Jim

    2011-01-01

    The NEQAIR line-by-line radiation code has been incorporated into the DPLR Navier-Stokes flow solver such that the NEQAIR subroutines are now callable functions of DPLR. The coupled DPLR-NEQAIR code was applied to compute the convective and radiative heating rates over high-mass Mars entry vehicles. Two vehicle geometries were considered - a 15 m diameter 70-degree sphere cone configuration and a slender, mid-L/D vehicle with a diameter of 5 m called an Ellipsled. The entry masses ranged from 100 to 165 metric tons. Solutions were generated for entry velocities ranging from 6.5 to 9.1 km/s. The coupled fluids-radiation solutions were performed at the peak heating location along trajectories generated by the Traj trajectory analysis code. The impact of fluids-radiation coupling is a function of the level of radiative heating and the freestream density and velocity. For the high-mass Mars vehicles examined in this study, coupling effects were greatest for entry velocities above 8.5 km/s where the surface radiative heating was reduced by up 17%. Generally speaking, the Ellipsled geometry experiences a lower peak radiative heating rate but a higher peak turbulent convective heating rate than the MSL-based vehicle.

  13. A NEW MECHANISM FOR MASS ACCRETION UNDER RADIATION PRESSURE IN MASSIVE STAR FORMATION

    SciTech Connect

    Tanaka, Kei E. I.; Nakamoto, Taishi

    2010-05-01

    During the formation of a massive star, strong radiation pressure from the central star acts on the dust sublimation front and tends to halt the accretion flow. To overcome this strong radiation pressure, it has been considered that a strong ram pressure produced by a high-mass accretion rate of 10{sup -3} M{sub sun} yr{sup -1} or more is needed. We reinvestigated the necessary condition to overcome the radiation pressure and found a new mechanism for overcoming it. Accumulated mass in a stagnant flow near the dust sublimation front helps the mass accretion by its weight. This mechanism relaxes the condition for the massive star formation. We call this mechanism the 'OMOSHI effect', where OMOSHI is an acronym for 'One Mechanism for Overcoming Stellar High radiation pressure by weIght'. Additionally, in Japanese, OMOSHI is a noun meaning a weight that is put on something to prevent it from moving. We investigate the generation of the OMOSHI effect using local one-dimensional radiation hydrodynamics simulations. The radiation pressure and the gravitational force are connected through the gas pressure, and to sum up, the radiation pressure is balanced or overcome by the gravitational force. We also discuss the global structure and temporal variation of the accretion flow.

  14. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  15. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing...

  16. 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,...

  17. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing...

  18. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  19. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing...

  20. 46 CFR 185.206 - Written report of marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  1. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  2. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Notice of marine casualty. 122.202 Section 122.202... THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS OPERATIONS Marine Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing...

  3. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  4. 46 CFR 122.206 - Written report of marine casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

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

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

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

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  7. 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.

  8. Mass analyzed threshold ionization (MATI) with VUV radiation

    NASA Astrophysics Data System (ADS)

    Kostko, Oleg; Kim, Sang Kyu; Wilson, Kevin R.; Leone, Stephen R.; Ahmed, Musahid

    2009-05-01

    Mass analyzed threshold ionization is a combination of threshold ionization spectroscopy with mass spectrometry. Similar to zero electron kinetic energy (ZEKE), MATI spectroscopy takes advantage of the field ionization of long lived high Rydberg states to obtain an ionization threshold and perform spectroscopy on the resulting cation. MATI at the synchrotron utilizing tunable VUV light opens up a novel way to perform spectroscopy on ions and improve the resolution in ionization energy determination in comparison with conventional photoionization efficiency curve measurements. This method is implemented at the Advanced Light Source and vibrationally-resolved MATI spectra for simple di- and polyatomic molecules (O2, N2, H2O, N2O, C2H2, and C6H6) are measured. This preliminary work allows us to test the applicability of MATI at a synchrotron and prepare for investigation of more complex systems such as mixtures of molecules, isomers and clusters.

  9. Radiation Exposure During Percutaneous Ablation of Small Renal Masses: A Multi-Institutional Multimodality Analysis.

    PubMed

    Tracy, Chad Robert; Kogan, Paul; Gupta, Amit; Gahan, Jeffrey C; Theckumparampil, Nithin P J; Elsamra, Sammy E; Okunov, Zhamshid; Sun, Shiliang; Lall, Chandana; Lobko, Igor; Landman, Jaime; Cadeddu, Jeffrey A; Kavoussi, Louis R

    2015-11-01

    To understand the effective radiation dose during percutaneous cryoablation (CA) and radiofrequency ablation (RFA) and characterize variables that may affect the individual dose. The effective radiation dose was determined by conversion of the dose-length product from CT scans performed during percutaneous CA or RFA for patients with solitary renal masses (<4 cm) at four academic centers. Radiation dose per case was compared between patients and institutions using multivariate and univariate analysis. Lifetime attributable risk of cancer was calculated for each institution and utilized to determine the number needed to harm for a range of ages at the time of exposure. One hundred twenty-three patients met the inclusion criteria with a mean age of 71 years. Sixty-nine percent of patients were male, mean body-mass index (BMI) was 29.4, and mean tumor size was 2.2 cm. The mean effective radiation dose per ablation was 40 mSv (range 3.7-147). On multivariate analysis, only BMI and institution were associated with the radiation dose. No significant difference in radiation exposure was seen for RFA or CA procedures. Radiation exposure during percutaneous ablation is similar to a multiphase CT scan. However, there is wide variability in individual treatment exposure, varying from 3.7 to 147 mSv, depending primarily on institution and BMI. Standardization of protocols is required to achieve as low as reasonably achievable levels of radiation.

  10. Radionuclide detection by inductively coupled plasma mass spectrometry: A comparison of atomic and radiation detection method

    SciTech Connect

    Smith, M.R.; Wyse, E.J.; Koppenaal, D.W.

    1991-04-01

    Radionuclide detection by mass spectrometric techniques offers inherent advantages over conventional radiation detection methods. Since radionuclides decay at variable rates (half-lives) and via various nuclear transformations (i.e. emission of alpha, beta, and/or gamma radiation) their determination via radiation detection depends not only on decay systematics but also on detector technology. Radionuclide detection by direct atom measurement, however, is dependent only on technique sensitivity and is indifferent to decay mode. Evaluation of inductively coupled plasma mass spectrometry (ICP/MS) indicates this method to be superior conventional radiation detection techniques for many radionuclides. This work discusses factors which influence detection by both methods. Illustrative applications of ICP/MS to the ultra-trace determination of several radionuclides, including {sup 129}I, are presented. 20 refs., 6 figs., 1 tab.

  11. OMOSHI Effect: A New Mechanism for Mass Accretion under the Radiation Pressure in Massive Star Formation

    NASA Astrophysics Data System (ADS)

    Tanaka, Kei; Nakamoto, Taishi

    2009-08-01

    In a massive-star formation process, a high-mass accretion rate is considered to be needed to overcome the strong radiation pressure at the dust sublimation front. We examined the accretion structure near the dust sublimation front and found a new mechanism to overcome this radiation pressure. The weight of the accumulated mass in a stagnant flow near the dust sublimation front helps with the mass accretion. We call this mechanism the ``OMOSHI effect,'' where OMOSHI is an acronym for ``One Mechanism for Overcoming Stellar High radiation pressure by weight.'' OMOSHI is also a Japanese noun meaning a weight that is put on something to prevent it from moving. This mechanism relaxes the condition for the massive star formation.

  12. Observation of mass analyzed threshold ionization using synchrotron radiation on a new-style time of flight mass spectrometer

    NASA Astrophysics Data System (ADS)

    Zhang, Song; Wang, Yanmei; Cao, Zhenzhou; Zhang, Bing; Wang, Sisheng; Kong, Ruihong; Zhao, Yujie; Shan, Xiaobing; Sheng, Liusi

    2007-04-01

    We have developed an efficient and applicable apparatus that combines mass-analyzed threshold ionization (MATI) with continuous molecular-beam mass spectrometry using tunable vacuum ultraviolet synchrotron radiation at National Synchrotron Radiation Laboratory. The new design, in which the spoiling field and the pulsed ionization field are perpendicular to each other, can obtain efficiently the ionic spectra of molecule. The MATI spectra of Ar and N2 have been recorded in the energy region between 15.5 and 17.5eV to illustrate the feasibility of this scheme. With its unique features, the important experiment considerations are potentially a powerful tool for study of information of ionization energies and ionic states of complex organic compounds.

  13. Radiative PQ breaking and the Higgs boson mass

    NASA Astrophysics Data System (ADS)

    D'Eramo, Francesco; Hall, Lawrence J.; Pappadopulo, Duccio

    2015-06-01

    The small and negative value of the Standard Model Higgs quartic coupling at high scales can be understood in terms of anthropic selection on a landscape where large and negative values are favored: most universes have a very short-lived electroweak vacuum and typical observers are in universes close to the corresponding metastability boundary. We provide a simple example of such a landscape with a Peccei-Quinn symmetry breaking scale generated through dimensional transmutation and supersymmetry softly broken at an intermediate scale. Large and negative contributions to the Higgs quartic are typically generated on integrating out the saxion field. Cancellations among these contributions are forced by the anthropic requirement of a sufficiently long-lived electroweak vacuum, determining the multiverse distribution for the Higgs quartic in a similar way to that of the cosmological constant. This leads to a statistical prediction of the Higgs boson mass that, for a wide range of parameters, yields the observed value within the 1σ statistical uncertainty of ˜ 5 GeV originating from the multiverse distribution. The strong CP problem is solved and single-component axion dark matter is predicted, with an abundance that can be understood from environmental selection. A more general setting for the Higgs mass prediction is discussed.

  14. The Tactical Combat Casualty Care Casualty Card TCCC Guidelines - Proposed Change 13-01

    DTIC Science & Technology

    2013-04-30

    Tactical (BMIS-T)—a PDA device . Neither format was felt to sufficiently meet the needs of the prehospital providers in the tactical environment. The...documentation on pain level 4 - Incorporates a section for supraglottic airway use - Provides a space for the type of supraglottic airway - Provides a...improve performance at the prehospital level of care. Tactical Combat Casualty Care (TCCC) based casualty cards, TCCC after action reports, and unit

  15. Radiative Corrections for Lepton-Proton Scattering: When the Mass Matters

    NASA Astrophysics Data System (ADS)

    Afanasev, Andrei

    2015-04-01

    Radiative corrections procedures for electron-proton and muon-proton scattering are well established under the assumption that the leptons are considered in an ultra-relativistic approximation. MUSE experiment at PSI and COMPASS experiment at CERN entered the regions of kinematics where explicit dependence of radiative corrections on the lepton mass becomes important. MUSE will consider the scattering of muons with momenta of the order 100 MeV/c, therefore lepton mass corrections become important for the entire kinematic domain. COMPASS experiment uses scattering of 100 GeV/c muons, and the muon mass effects are especially relevant in the quasi-real photo production limit, Q2 --> 0. A dedicated Monte Carlo generator of radiative events is being developed for MUSE, which also includes effects of interference between the lepton and proton bremsstrahlung. Parts of the radiative corrections are expected to be suppressed for muons due to the larger muon mass. Two-photon exchange corrections are generally expected to be small, and should be similar for electrons and muons. We classify the radiative corrections into two categories, C-even and C-odd under the lepton charge reversal, and discuss their role separately for the above experiments.

  16. 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.

  17. Military Medical Revolution: Prehospital Combat Casualty Care

    DTIC Science & Technology

    2012-01-01

    Military medical revolution: Prehospital combat casualty care Lorne H. Blackbourne, MD, David G. Baer, PhD, Brian J. Eastridge, MD, Bijan Kheirabadi...sur- vival for patients with combat-related traumatic injuries. J Trauma. 2009;66(suppl 4):S69 S76. 33. Eastridge BJ, Hardin M, Cantrell J, Oetjen

  18. Radiative Feedback from Primordial Protostars and Final Mass of the First Stars

    NASA Technical Reports Server (NTRS)

    Hosokawa, Takashi; Omukai, Kazuyuki; Yoshida, Naoki; Yorke, Harold W.

    2012-01-01

    In this contribution, we review our efforts toward understanding the typical mass-scale of primordial stars. Our direct numerical simulations show that, in both of Population III.1 and III.2 cases, strong UV stellar radiative feedback terminatesmass accretion onto a protostar.AnHII region formed around the protostar very dynamically expands throughout the gas accreting envelope, which cuts off the gas supply to a circumstellar disk. The disk is exposed to the stellar UV radiation and loses its mass by photoevaporation. The derived final masses are 43 Stellar Mass and 17 Stellar Mass in our fiducial Population III.1 and III.2 cases. Much more massive stars should form in other exceptional conditions. In atomic-cooling halos where H2 molecules are dissociated, for instance, a protostar grows via very rapid mass accretion with the rates M* approx. 0.1 - 1 Stellar Mass/yr. Our newstellar evolution calculations show that the protostar significantly inflates and never contracts to reach the ZAMS stage in this case. Such the "supergiant protostars" have very low UV luminosity, which results in weak radiative feedback against the accretion flow. In the early universe, supermassive stars formed through this process might provide massive seeds of supermassive black holes.

  19. Radiative Feedback from Primordial Protostars and Final Mass of the First Stars

    NASA Technical Reports Server (NTRS)

    Hosokawa, Takashi; Omukai, Kazuyuki; Yoshida, Naoki; Yorke, Harold W.

    2012-01-01

    In this contribution, we review our efforts toward understanding the typical mass-scale of primordial stars. Our direct numerical simulations show that, in both of Population III.1 and III.2 cases, strong UV stellar radiative feedback terminatesmass accretion onto a protostar.AnHII region formed around the protostar very dynamically expands throughout the gas accreting envelope, which cuts off the gas supply to a circumstellar disk. The disk is exposed to the stellar UV radiation and loses its mass by photoevaporation. The derived final masses are 43 Stellar Mass and 17 Stellar Mass in our fiducial Population III.1 and III.2 cases. Much more massive stars should form in other exceptional conditions. In atomic-cooling halos where H2 molecules are dissociated, for instance, a protostar grows via very rapid mass accretion with the rates M* approx. 0.1 - 1 Stellar Mass/yr. Our newstellar evolution calculations show that the protostar significantly inflates and never contracts to reach the ZAMS stage in this case. Such the "supergiant protostars" have very low UV luminosity, which results in weak radiative feedback against the accretion flow. In the early universe, supermassive stars formed through this process might provide massive seeds of supermassive black holes.

  20. The effect of stellar radiation on exoplanet atmospheric heating and mass loss

    NASA Astrophysics Data System (ADS)

    Ojanen, Winonah; Miller, Brendan P.; Gallo, Elena; Wright, Jason; Poppenhaeger, Katja

    2017-01-01

    Our project aims to investigate the influence of stellar activity and high-energy radiation on short-period transiting exoplanet atmospheric heating and mass loss. Mass loss in closely orbiting gaseous exoplanets could be significant enough to evaporate a significant portion of the atmosphere over the total system lifetime. A current question of interest is how Neptune-class gas giants might change over time from being exposed to intense X-ray and UV flux radiated from the star. Our research aims to estimate current and total mass loss for four Neptune-class exoplanets that have both measured radii and masses. We use computer software to reduce and analyze Chandra X-ray observations of Neptune-class exoplanets, including HAT-P-11b and archival data of GJ 436b, to calculate the high-energy incident flux for each planet. We then estimate the current-epoch mass-loss rate and construct integrated mass-loss histories. We test whether planets receiving the greatest dose of high-energy radiation also tend to be the lowest mass and the most dense, suggestive of evaporation. These observations provide essential empirical input for understanding and modeling the potential evolutionary transformation of hot gas giants into less massive and more dense remnants.

  1. Radiative corrections to the lightest neutral Higgs mass in warped supersymmetry

    SciTech Connect

    Bhattacharyya, Gautam; Ray, Tirtha Sankar

    2008-10-01

    We compute radiative correction to the lightest neutral Higgs mass (m{sub h}) induced by the Kaluza-Klein (KK) towers of fermions and sfermions in a minimal supersymmetric scenario embeded in a 5-dimensional warped space. The Higgs is confined to the TeV brane. The KK spectra of matter supermultiplets is tied to the explanation of the fermion mass hierarchy problem. We demonstrate that for a reasonable choice of extra-dimensional parameters, the KK-induced radiative correction can enhance the upper limit on m{sub h} by as much as 100 GeV beyond the 4d limit of 135 GeV.

  2. New U(1) gauge model of radiative lepton masses with sterile neutrino and dark matter

    DOE PAGES

    Adhikari, Rathin; Borah, Debasish; Ma, Ernest

    2016-02-23

    Here, an anomaly-free U(1) gauge extension of the standard model (SM) is presented. Only one Higgs doublet with a nonzero vacuum expectation is required as in the SM. New fermions and scalars as well as all SM particles transform nontrivially under this U(1), resulting in a model of three active neutrinos and one sterile neutrino, all acquiring radiative masses. Charged-lepton masses are also radiative as well as the mixing between active and sterile neutrinos. At the same time, a residual Z2 symmetry of the U(1) gauge symmetry remains exact, allowing for the existence of dark matter.

  3. Leptogenesis, radiative neutrino masses and inert Higgs triplet dark matter

    SciTech Connect

    Lu, Wen-Bin; Gu, Pei-Hong

    2016-05-18

    We extend the standard model by three types of inert fields including Majorana fermion singlets/triplets, real Higgs singlets/triplets and leptonic Higgs doublets. In the presence of a softly broken lepton number and an exactly conserved Z{sub 2} discrete symmetry, these inert fields together can mediate a one-loop diagram for a Majorana neutrino mass generation. The heavier inert fields can decay to realize a successful leptogenesis while the lightest inert field can provide a stable dark matter candidate. As an example, we demonstrate the leptogenesis by the inert Higgs doublet decays. We also perform a systematic study on the inert Higgs triplet dark matter scenario where the interference between the gauge and Higgs portal interactions can significantly affect the dark matter properties.

  4. PBH mass growth through radial accretion during the radiation dominated era

    SciTech Connect

    Lora-Clavijo, F.D.; Guzmán, F.S.; Cruz-Osorio, A. E-mail: guzman@ifm.umich.mx

    2013-12-01

    We model the radial accretion of radiation on Primordial Black Holes (PBH) by numerically solving Einstein's equations coupled to an ultrarelativistic ideal gas with equation of state p = ρ/3. We calculate the final mass of a black hole by the integration of the accreted radiation energy density during the leptonic era between t ∼ 10{sup −4}s to t ∼ 10{sup 2}s after the Big Bang. Our results indicate that small PBHs with initial masses between 10{sup −4} to 1M{sub ⊙} may grow up to hundreds of solar masses, and thus can be SMBH seeds. On the other hand, PBHs formed at t ∼ 1s with initial mass between 900 and ∼ 980M{sub ⊙}, by the time t ∼ 100s show masses of 10{sup 4} to 10{sup 6}M{sub ⊙} which are masses of seeds or already formed SMBHs. The fact that we consider only radial flow implies that our results work well as limiting cases, and it is expected that under more general scenarios the accretion rates may change significantly. Nevertheless we show that it is possible that SMBHs can be PBHs that grew due to the accretion of radiation.

  5. Radiation-tolerant, low-mass, high bandwidth, flexible printed circuit cables for particle physics experiments

    NASA Astrophysics Data System (ADS)

    McFadden, N. C.; Hoeferkamp, M. R.; Seidel, S.

    2016-09-01

    The design of meter long flexible printed circuit cables required for low-mass ultra-high speed signal transmission in the high radiation environment of the High Luminosity Large Hadron Collider is described. The design geometry is a differential embedded microstrip with 100 Ω nominal impedance. Minimal mass and maximal radiation hardness are pre-eminent considerations. Several dielectric materials are compared. To reduce mass, a cross hatched ground plane is applied. The long flexible printed circuit cables are characterized in bit error rate tests, attenuation versus frequency, mechanical response to temperature induced stress, and dimensional implications on radiation length. These tests are performed before and after irradiation with 1 MeV neutrons to 2×1016/cm2 and 800 MeV protons to 2×1016 1-MeV neutron equivalent/cm2. A 1.0 m Kapton cable with cross hatched ground plane, effective bandwidth of 4.976 gigabits per second, 0.0160% of a radiation length, and no detectable radiation-induced mechanical or electrical degradation is obtained.

  6. Geometry and mass model of ionizing radiation experiments on the LDEF satellite

    NASA Technical Reports Server (NTRS)

    Colborn, B. L.; Armstrong, T. W.

    1992-01-01

    Extensive measurements related to ionizing radiation environments and effects were made on the LDEF satellite during its mission lifetime of almost 6 years. These data, together with the opportunity they provide for evaluating predictive models and analysis methods, should allow more accurate assessments of the space radiation environment and related effects for future missions in low Earth orbit. The LDEF radiation dosimetry data is influenced to varying degrees by material shielding effects due to the dosimeter itself, nearby components and experiments, and the spacecraft structure. A geometry and mass model is generated of LDEF, incorporating sufficient detail that it can be applied in determining the influence of material shielding on ionizing radiation measurements and predictions. This model can be used as an aid in data interpretation by unfolding shielding effects from the LDEF radiation dosimeter responses. Use of the LDEF geometry/mass model, in conjunction with predictions and comparisons with LDEF dosimetry data currently underway, will also allow more definitive evaluations of current radiation models for future mission applications.

  7. Equation of Motion of an Interstellar Bussard Ramjet with Radiation and Mass Losses

    ERIC Educational Resources Information Center

    Semay, Claude; Silvestre-Brac, Bernard

    2008-01-01

    An interstellar Bussard ramjet is a spaceship using the protons of the interstellar medium in a fusion engine to produce thrust. In recent papers, it was shown that the relativistic equation of motion of an ideal ramjet and that of a ramjet with radiation loss are analytical. When a mass loss appears, the limit speed of the ramjet is more strongly…

  8. Connecting radiative neutrino mass, neutron-antineutron oscillation, proton decay, and leptogenesis through dark matter

    NASA Astrophysics Data System (ADS)

    Gu, Pei-Hong; Ma, Ernest; Sarkar, Utpal

    2016-12-01

    The scotogenic mechanism for radiative neutrino mass is generalized to include neutron-antineutron oscillation as well as proton decay. Dark matter is stabilized by extending the notion of lepton parity to matter parity. Leptogenesis is also a possible byproduct. This framework unifies the description of all these important topics in physics beyond the standard model of particle interactions.

  9. Equation of Motion of an Interstellar Bussard Ramjet with Radiation and Mass Losses

    ERIC Educational Resources Information Center

    Semay, Claude; Silvestre-Brac, Bernard

    2008-01-01

    An interstellar Bussard ramjet is a spaceship using the protons of the interstellar medium in a fusion engine to produce thrust. In recent papers, it was shown that the relativistic equation of motion of an ideal ramjet and that of a ramjet with radiation loss are analytical. When a mass loss appears, the limit speed of the ramjet is more strongly…

  10. Mesozoic mass extinctions and angiosperm radiation: does the molecular clock tell something new?

    NASA Astrophysics Data System (ADS)

    Ruban, Dmitry A.

    2012-03-01

    Angiosperms evolved rapidly in the late Mesozoic. Data from the genetic-based approach called ‘molecular clock’ permit an evaluation of the radiation of flowering plants through geological time and of the possible influences of Mesozoic mass extinctions. A total of 261 divergence ages of angiosperm families are considered. The radiation of flowering plants peaked in the Albian, early Campanian, and Maastrichtian. From the three late Mesozoic mass extinctions (Jurassic/Cretaceous, Cenomanian/Turonian, and Cretaceous/Palaeogene), only the Cretaceous/Palaeogene event coincided with a significant, abrupt, and long-term decline in angiosperm radiation. If their link will be further proven, this means that global-scale environmental perturbation precluded from many innovations in the development of plants. This decline was, however, not unprecedented in the history of the angiosperms. The implication of data from the molecular clock for evolutionary reconstructions is limited, primarily because this approach deals with only extant lineages.

  11. Explosive radiation or cryptic mass extinction? Interpreting signatures in molecular phylogenies.

    PubMed

    Crisp, Michael D; Cook, Lyn G

    2009-09-01

    How biodiversity is generated and maintained underlies many major questions in evolutionary biology, particularly relating to the tempo and pattern of diversification through time. Molecular phylogenies and new analytical methods provide additional tools to help interpret evolutionary processes. Evolutionary rates in lineages sometimes appear punctuated, and such "explosive" radiations are commonly interpreted as adaptive, leading to causative key innovations being sought. Here we argue that an alternative process might explain apparently rapid radiations ("broom-and-handle" or "stemmy" patterns seen in many phylogenies) with no need to invoke dramatic increase in the rate of diversification. We use simulations to show that mass extinction events can produce the same phylogenetic pattern as that currently being interpreted as due to an adaptive radiation. By comparing simulated and empirical phylogenies of Australian and southern African legumes, we find evidence for coincident mass extinctions in multiple lineages that could have resulted from global climate change at the end of the Eocene.

  12. VUV synchrotron radiation: a new activation technique for tandem mass spectrometry.

    PubMed

    Milosavljević, Aleksandar R; Nicolas, Christophe; Gil, Jean-Francois; Canon, Francis; Réfrégiers, Matthieu; Nahon, Laurent; Giuliani, Alexandre

    2012-03-01

    A novel experimental technique for tandem mass spectrometry and ion spectroscopy of electrosprayed ions using vacuum-ultraviolet (VUV) synchrotron radiation is presented. Photon activation of trapped precursor ions has been performed by coupling a commercial linear quadrupole ion trap (Thermo scientific LTQ XL), equipped with the electrosprayed ions source, to the DESIRS beamline at the SOLEIL synchrotron radiation facility. The obtained results include, for the first time on biopolymers, photodetachment spectroscopy using monochromated synchrotron radiation of multi-charged anions and the single photon ionization of large charge-selected polycations. The high efficiency and signal-to-noise ratio achieved by the present set-up open up possibilities of using synchrotron light as a new controllable activation method in tandem mass spectrometry of biopolymers and VUV-photon spectroscopy of large biological ions.

  13. Textbook of Military Medicine. Part 1. Warfare, Weaponry, and the Casualty. Volume 2. Medical Consequences of Nuclear Warfare

    DTIC Science & Technology

    1989-04-01

    casualty management techniques, plants were generally unsuccessful in Chernobyl which require simplified and standardized care. victims, partially ...Dose-Effect Curve Exposure Geometry: Heterogeneous Partial -Body and Nonuniform Exposure Considerations on Establishing the Human LD_ Radiotherapy...geometry (such as partial -body exposure or Modification of Dose-Response Curve nonuniform exposure), and dose rate. Radiation lethality may be a

  14. Radiative seesaw-type mechanism of fermion masses and non-trivial quark mixing

    NASA Astrophysics Data System (ADS)

    Arbeláez, Carolina; Hernández, A. E. Cárcamo; Kovalenko, Sergey; Schmidt, Ivan

    2017-06-01

    We propose a predictive inert two-Higgs doublet model, where the standard model (SM) symmetry is extended by S3⊗ Z2⊗ Z_{12} and the field content is enlarged by extra scalar fields, charged exotic fermions and two heavy right-handed Majorana neutrinos. The charged exotic fermions generate a non-trivial quark mixing and provide one-loop-level masses for the first- and second-generation charged fermions. The masses of the light active neutrinos are generated from a one-loop-level radiative seesaw mechanism. Our model successfully explains the observed SM fermion mass and mixing pattern.

  15. Westinghouse GOCO conduct of casualty drills

    SciTech Connect

    Ames, C.P.

    1996-02-01

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

  16. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty... under the Act of any major marine casualty or any casualty involving public and non-public vessels... 46 Shipping 1 2011-10-01 2011-10-01 false Marine casualty investigation by the Board....

  17. Early Acute Kidney Injury in Military Casualties

    DTIC Science & Technology

    2015-05-01

    Early acute kidney injury in military casualties Kelly D. Heegard, MD, Ian J. Stewart, MD, Andrew P. Cap, MD, PhD, Jonathan A. Sosnov, MD, Hana K...Ikizler, MD, and Kevin K. Chung, MD, San Antonio, Texas BACKGROUND: While acute kidney injury (AKI) has been well studied in a variety of patient settings...and epidemiologic study, level III. KEY WORDS: Acute kidney injury; trauma; war; lactate; Injury Severity Score. Acute kidney injury (AKI) is commonly

  18. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2003-09-23

    compiled by the Department of Defense, as tallied from DOD press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which...began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003. Statistics may be revised as circumstances are...casualty/OIF-Total.pdf]. Table 1. Operation Iraqi Freedom Fatalities as of September 22, 2003, 10:00 a.m. Fatalities March 19, 2003,to the Present May

  19. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2003-10-14

    by the Department of Defense, as tallied from DOD press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which...began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003. Statistics may be revised as circumstances are...casualty/OIF-Total.pdf]. Table 1. Operation Iraqi Freedom Fatalities as of October 14, 2003, 10:00 a.m. Fatalities March 19, 2003,to the Present May

  20. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2005-05-19

    Department of Defense, as tallied from DOD press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March...19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on those wounded, but not killed, since March 19...at the following DOD website: [http://web1.whs.osd.mil/mmid/casualty/OIF-Total.pdf]. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded

  1. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2005-04-04

    Department of Defense, as tallied from DOD press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which began on March...19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus statistics on those wounded, but not killed, since March 19...available at the following DOD website: [http://web1.whs.osd.mil/mmid/casualty/OIF-Total.pdf]. Table 1. Operation Iraqi Freedom, U.S. Fatalities and Wounded

  2. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2003-10-02

    by the Department of Defense, as tallied from DOD press releases. Table 1 provides statistics on fatalities during Operation Iraqi Freedom, which...began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003. Statistics may be revised as circumstances are...casualty/OIF-Total.pdf]. Table 1. Operation Iraqi Freedom Fatalities as of October 1, 2003, 10:00 a.m. Fatalities March 19, 2003,to the Present May 1

  3. Radiative transitions in charm-strange meson from Nf = 2 twisted mass lattice QCD

    NASA Astrophysics Data System (ADS)

    Li, Ning; Wu, Ya-Jie

    2016-07-01

    We present an exploratory study on the radiative transition for the charm-strange meson: Ds∗→ D sγ using Nf = 2 twisted mass lattice quantum chromodynamics gauge configurations. The form factor for Ds meson is also determined. The simulation is performed on lattices with lattice spacings a = 0.067 fm and lattice size 323 × 64, and a = 0.085 fm and lattice size 243 × 48, respectively. Our numerical results for radiative decay width and the experimental data overlap within the margin of error.

  4. Thermal vacuum, cosmic microwave radiation, neutrino masses and fractal-like self-similar structure

    NASA Astrophysics Data System (ADS)

    Capolupo, Antonio; Lambiase, Gaetano; Vitiello, Giuseppe

    2017-08-01

    The behavior of thermal vacuum condensates of scalar and fermion fields is analyzed and it is shown that the condensate of Maxwell fields reproduces the characteristics of the cosmic microwave radiation. By studying fermion thermal states with the temperature of the cosmic neutrino background, we derive a value of the sum of the active neutrino masses which is compatible with its estimated lower bound. Moreover, we reveal the fractal self-similar structure of the thermal radiation and we relate it to the coherent structure of the thermal vacuum.

  5. Effect of thermal radiation on unsteady stagnation-point flow with mass transfer

    NASA Astrophysics Data System (ADS)

    Md Ali, Fadzilah; Nazar, Roslinda; Md Arifin, Norihan

    2013-04-01

    In this paper, the effect of thermal radiation on unsteady stagnation-point flow of an incompressible viscous fluid with mass transfer is studied. The governing system of partial differential equations is first transformed into a system of ordinary differential equations by a similarity transformation and is then solved numerically by the shooting method. It is found that the surface heat transfer rate reduces when the thermal radiation is applied and dual solutions exist only for negative unsteadiness parameter while positive unsteadiness parameter produces a unique solution.

  6. Casualty modeling for real-time medical training.

    PubMed

    Chi, D M; Clarke, J R; Webber, B L; Badler, N I

    1996-01-01

    We present a model for simulating casualties in virtual environments for real-time medical training. It allows a user to choose diagnostic and therapeutic actions to carry out on a simulated casualty who will manifest appropriate physiological, behavioral, and physical responses. Currently, the user or a "stealth instructor" can specify one or more injuries that the casualty has sustained. The model responds by continuously determining the state of the casualty, responding appropriately to medical assessment and treatment procedures. So far, we have modeled four medical conditions and over 20 procedures. The model has been designed to handle the addition of other injuries and medical procedures.

  7. 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. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Low-mass, intrinsically-hard high temperature radiator. Final report, Phase I

    SciTech Connect

    1990-07-15

    This paper reports on the investigation of layered ceramic/metal composites in the design of low-mass hardened radiators for space heat rejection systems. The investigation is part of the Strategic Defence Initiative. This effort evaluated the use of layered composites as a material to form thin-walled, vacuum leaktight heat pipes. The heat pipes would be incorporated into a large heat pipe radiator for waste heat rejection from a space nuclear power source. Composite materials evaluations were performed on combinations of refractory metals and ceramic powders. Fabrication experiments were performed to demonstrate weldability. Two titanium/titanium diboride composite tubes were successfully fabricated into potassium heat pipes and operated at temperatures in excess of 700C. Testing and analysis for composite tubes are described in the report. The study has verified the feasibility of using layered composites for forming thin-walled, light weight heat pipe tubes for use in hardened space radiators.

  9. Application of mass spectrometry based electronic nose and chemometrics for fingerprinting radiation treatment

    NASA Astrophysics Data System (ADS)

    Gupta, Sumit; Variyar, Prasad S.; Sharma, Arun

    2015-01-01

    Volatile compounds were isolated from apples and grapes employing solid phase micro extraction (SPME) and subsequently analyzed by GC/MS equipped with a transfer line without stationary phase. Single peak obtained was integrated to obtain total mass spectrum of the volatile fraction of samples. A data matrix having relative abundance of all mass-to-charge ratios was subjected to principal component analysis (PCA) and linear discriminant analysis (LDA) to identify radiation treatment. PCA results suggested that there is sufficient variability between control and irradiated samples to build classification models based on supervised techniques. LDA successfully aided in segregating control from irradiated samples at all doses (0.1, 0.25, 0.5, 1.0, 1.5, 2.0 kGy). SPME-MS with chemometrics was successfully demonstrated as simple screening method for radiation treatment.

  10. The mass transfer rate in X1916-053 - It is driven by gravitational radiation?

    NASA Technical Reports Server (NTRS)

    Swank, J. H.; Taam, R. E.; White, N. E.

    1985-01-01

    A 50-minute period for a binary system harboring an X-ray burster would allow several alternatives for the mass-giving secondary, including an H-shell burning-plus-He degenerate core composite model. The burst properties of X1916-053 are presently used to argue against the He degenerate as well as the He main sequence solutions and to estimate whether, for any of the other solutions, the mass transfer rate could be consistent with that expected from gravitational radiation (GR). Within an uncertainty of a factor of 2, the transfer rate for the composite model solution is consistent with gravitational radiation, but enhancement by other mechanisms should be investigated.

  11. Radiative model of neutrino mass with neutrino interacting MeV dark matter

    SciTech Connect

    Arhrib, Abdesslam; Boehm, Céline; Ma, Ernest; Yuan, Tzu-Chiang

    2016-04-26

    We consider the radiative generation of neutrino mass through the interactions of neutrinos with MeV dark matter. We construct a realistic renormalizable model with one scalar doublet (in additional to the standard model doublet) and one complex singlet together with three light singlet Majorana fermions, all transforming under a dark U(1){sub D} symmetry which breaks softly to Z{sub 2}. We study in detail the scalar sector which supports this specific scenario and its rich phenomenology.

  12. Radiative corrections to Higgs boson masses for the MSSM Higgs potential with dimension-six operators

    NASA Astrophysics Data System (ADS)

    Dubinin, M. N.; Petrova, E. Yu.

    2017-03-01

    In the framework of the effective field theory approach to heavy supersymmetry radiative corrections in the Higgs sector of the minimal supersymmetric standard model (MSSM) for the effective potential decomposition up to the dimension-six operators are calculated. Symbolic expressions for the threshold corrections induced by F - and D -soft supersymmetry breaking terms are derived, and the Higgs boson mass spectrum respecting the condition mh=125 GeV for the lightest C P -even scalar is evaluated.

  13. Soft see-saw: Radiative origin of neutrino masses in SUSY theories

    NASA Astrophysics Data System (ADS)

    Megrelidze, Luka; Tavartkiladze, Zurab

    2017-01-01

    Radiative neutrino mass generation within supersymmetric (SUSY) construction is studied. The mechanism is considered where the lepton number violation is originating from the soft SUSY breaking terms. This requires MSSM extensions with states around the TeV scale. We present several explicit realizations based on extensions either by MSSM singlet or SU(2)w triplet states. Besides some novelties of the proposed scenarios, various phenomenological implications are also discussed.

  14. Radiatively induced Lorentz-violating operator of mass dimension five in QED

    SciTech Connect

    Mariz, T.

    2011-02-15

    The first higher derivative term of the photon sector of Lorentz-violating QED, with an operator of mass dimension d=5, is radiatively induced from the fermion sector, which contains a derivative term with the dimensionless coefficient g{sup {lambda}{mu}{nu}}. The calculation is performed perturbatively in the coefficient for Lorentz violation, and, due to the fact that the contributions are quadratically divergent, we adopt dimensional regularization.

  15. Losses of Energetic Electrons in Earth's Outer Radiation Belt During Unusual Coronal Mass Ejections

    NASA Astrophysics Data System (ADS)

    Lugaz, Noé; Huang, Chia-Lin; Schwadron, Nathan; Spence, Harlan; Farrugia, Charles; Winslow, Reka

    2016-07-01

    The most extreme changes in solar wind parameters important for the coupling between the solar wind and the magnetosphere (dynamic pressure, dawn-to-dusk electric field, Alfven Mach number, plasma beta, …) occur during the passage at Earth of coronal mass ejections (CMEs). While the response of Earth's radiation belts to CMEs and CME-driven shocks has been investigated in great details, few studies have focused on what makes some CMEs and their shocks especially effective in driving losses of energetic electrons in the outer radiation belt. Here, we present specific examples of losses during the passage at Earth of a coronal mass ejection. In particular, we discuss the conditions which may result in the magnetopause to retreat earthward up to geosynchronous orbit, resulting in significant losses of energetic electrons due to magnetopause shadowing. We also present the result of a low-density magnetic ejecta which impacted Earth in January 2013. Combining interplanetary, magnetosheath, outer magnetosphere and radiation belt measurements by more than ten satellites, including the Van Allen Probes, THEMIS and Cluster, we show how a period of extremely low Mach number and dynamic pressure during the passage of the magnetic cloud resulted in dramatic losses in the outer radiation belt and a large-scale reorganization of the entire day-side magnetosphere.

  16. Laser desorption postionization mass spectrometry of antibiotic-treated bacterial biofilms using tunable vacuum ultraviolet radiation.

    PubMed

    Gasper, Gerald L; Takahashi, Lynelle K; Zhou, Jia; Ahmed, Musahid; Moore, Jerry F; Hanley, Luke

    2010-09-01

    Laser desorption postionization mass spectrometry (LDPI-MS) with 8.0-12.5 eV vacuum ultraviolet synchrotron radiation is used to single photon ionize antibiotics and extracellular neutrals that are laser desorbed both from neat and intact bacterial biofilms. Neat antibiotics are optimally detected using 10.5 eV LDPI-MS but can be ionized using 8.0 eV radiation, in agreement with prior work using 7.87 eV LDPI-MS. Tunable vacuum ultraviolet radiation also postionizes laser desorbed neutrals of antibiotics and extracellular material from within intact bacterial biofilms. Different extracellular material is observed by LDPI-MS in response to rifampicin or trimethoprim antibiotic treatment. Once again, 10.5 eV LDPI-MS displays the optimum trade-off between improved sensitivity and minimum fragmentation. Higher energy photons at 12.5 eV produce significant parent ion signal, but fragment intensity and other low mass ions are also enhanced. No matrix is added to enhance desorption, which is performed at peak power densities insufficient to directly produce ions, thus allowing observation of true VUV postionization mass spectra of antibiotic treated biofilms.

  17. Laser Desorption Postionization Mass Spectrometry of Antibiotic-Treated Bacterial Biofilms using Tunable Vacuum Ultraviolet Radiation

    SciTech Connect

    Gasper, Gerald L; Takahashi, Lynelle K; Zhou, Jia; Ahmed, Musahid; Moore, Jerry F; Hanley, Luke

    2010-08-04

    Laser desorption postionization mass spectrometry (LDPI-MS) with 8.0 ? 12.5 eV vacuum ultraviolet synchrotron radiation is used to single photon ionize antibiotics andextracellular neutrals that are laser desorbed both neat and from intact bacterial biofilms. Neat antibiotics are optimally detected using 10.5 eV LDPI-MS, but can be ionized using 8.0 eV radiation, in agreement with prior work using 7.87 eV LDPI-MS. Tunable vacuum ultraviolet radiation also postionizes laser desorbed neutrals of antibiotics and extracellular material from within intact bacterial biofilms. Different extracellular material is observed by LDPI-MS in response to rifampicin or trimethoprim antibiotic treatment. Once again, 10.5 eV LDPI-MS displays the optimum trade-off between improved sensitivity and minimum fragmentation. Higher energy photons at 12.5 eV produce significant parent ion signal, but fragment intensity and other low mass ions are also enhanced. No matrix is added to enhance desorption, which is performed at peak power densities insufficient to directly produce ions, thus allowing observation of true VUV postionization mass spectra of antibiotic treated biofilms.

  18. The study of radiation induced DNA-protein crosslinks by electrospray ionization mass spectrometry

    SciTech Connect

    Lipton, M.S.; Fuciarelli, A.F.; Springer, D.L.; Edmonds, C.G.

    1995-12-31

    The authors have used peptide-thymine and histone-thymine solutions to model protein-DNA cross-linking chemistry induced in intact chromatin by low dosage of g-irradiation. Induced thymine crosslinking to model peptide systems has been evaluated by on-line liquid chromatography-electrospray ionization mass spectrometry (ESI-MS) and tandem mass spectrometry (MS-MS) with sensitivity comparable or superior to conventional GC-MS determinations. Radiation damage at doses as low as 0.1 Gy can be detected by this method. Additionally, thymine modified H2B can also be examined by ESI-MS and tandem-MS of the intact protein and proteinase digests. Limited information on the sites of thymine crosslinking can be obtained by tandem mass spectrometry on the intact multiply charged molecular species. More detailed information on the sites of thymine-protein crosslinking is obtained by on-line LC-ESI-MS of selective proteolysis products of the modified histones. Further MS-MS experiments on the selective proteolysis products will reveal specific modified amino acids and their sequence location. These methods reveal the nature, extent and site of radiation induced modification of the oligopeptides. Studies are being extended to the examination of the radiation induced covalent interactions between histones and oligonucleotides in higher states of organization. The eventual object is to study DNA-protein crosslinking interactions in model and native genomic nucleosome systems.

  19. Laser Desorption Postionization Mass Spectrometry of Antibiotic-Treated Bacterial Biofilms using Tunable Vacuum Ultraviolet Radiation

    PubMed Central

    Gasper, Gerald L.; Takahashi, Lynelle K.; Zhou, Jia; Ahmed, Musahid; Moore, Jerry F.; Hanley, Luke

    2010-01-01

    Laser desorption postionization mass spectrometry (LDPI-MS) with 8.0 – 12.5 eV vacuum ultraviolet synchrotron radiation is used to single photon ionize antibiotics and extracellular neutrals that are laser desorbed both neat and from intact bacterial biofilms. Neat antibiotics are optimally detected using 10.5 eV LDPI-MS, but can be ionized using 8.0 eV radiation, in agreement with prior work using 7.87 eV LDPI-MS. Tunable vacuum ultraviolet radiation also postionizes laser desorbed neutrals of antibiotics and extracellular material from within intact bacterial biofilms. Different extracellular material is observed by LDPI-MS in response to rifampicin or trimethoprim antibiotic treatment. Once again, 10.5 eV LDPI-MS displays the optimum trade-off between improved sensitivity and minimum fragmentation. Higher energy photons at 12.5 eV produce significant parent ion signal, but fragment intensity and other low mass ions are also enhanced. No matrix is added to enhance desorption, which is performed at peak power densities insufficient to directly produce ions, thus allowing observation of true VUV postionization mass spectra of antibiotic treated biofilms. PMID:20712373

  20. Differentiation of benign from malignant liver masses with Acoustic Radiation Force Impulse technique.

    PubMed

    Yu, Hojun; Wilson, Stephanie R

    2011-12-01

    The objective of the study was to determine the performance of Acoustic Radiation Force Impulse (ARFI) imaging to differentiate benign from malignant liver masses, both of hepatocellular origin and metastases, by quantification of their stiffness. This study has institutional review board approval and informed consent. Eighty-nine patients (42 female and 47 male patients) with 105 liver masses had ARFI evaluation on ultrasound, S2000 (Siemens, Mountain View, Calif). Mean age of the patients was 53.67 years (range, 27-83 years). Mean diameter of the masses was 2.77 cm (range, 1.0-13.0 cm). Final diagnoses, confirmed by imaging on contrast-enhanced computed tomography, magnetic resonance, or ultrasound or biopsy, include hepatocellular carcinoma (n = 28), metastasis (n = 13), hemangioma (n = 35), focal nodular hyperplasia (n = 15), focal fat sparing (n = 8), focal fat deposit (n = 4), and adenoma (n = 2). Receiver operating characteristic analysis was performed to evaluate the diagnostic accuracy of the ARFI measurement and to extract the optimal cutoff values in the differentiation of benign from malignant disease. Acoustic Radiation Force Impulse values showed a statistically significant difference between benign (1.73 [SD, 0.8] m/sec) and malignant masses (2.57 [SD, 1.01] m/sec) (P < 0.001). However, the area under the receiver operating characteristic curve was 0.744, suggesting only fair accuracy. For differentiation of malignant from benign masses, the sensitivity, specificity, positive predictive value, and negative predictive value were 68% (28/41), 69% (44/64), 58% (28/48), and 77% (44/57), respectively, when 1.9 m/sec was chosen as a cutoff value, reflective of a wide variation of ARFI values in each diagnosis. For differentiation of metastasis from benign masses, sensitivity, specificity, positive predictive value, and NPV were 69% (9/13), 89% (57/64), 56% (9/16), and 93% (57/61), respectively, when 2.72 m/sec was chosen as a cutoff value. Acoustic

  1. Mathematical Analysis of Space Radiator Segmenting for Increased Reliability and Reduced Mass

    NASA Technical Reports Server (NTRS)

    Juhasz, Albert J.

    2001-01-01

    Spacecraft for long duration deep space missions will need to be designed to survive micrometeoroid bombardment of their surfaces some of which may actually be punctured. To avoid loss of the entire mission the damage due to such punctures must be limited to small, localized areas. This is especially true for power system radiators, which necessarily feature large surface areas to reject heat at relatively low temperature to the space environment by thermal radiation. It may be intuitively obvious that if a space radiator is composed of a large number of independently operating segments, such as heat pipes, a random micrometeoroid puncture will result only in the loss of the punctured segment, and not the entire radiator. Due to the redundancy achieved by independently operating segments, the wall thickness and consequently the weight of such segments can be drastically reduced. Probability theory is used to estimate the magnitude of such weight reductions as the number of segments is increased. An analysis of relevant parameter values required for minimum mass segmented radiators is also included.

  2. Analysis of Mass Loss of a Polymeric Composite under Space Radiations

    NASA Astrophysics Data System (ADS)

    Khasanshin, Rashid

    2016-07-01

    Polymeric materials find ever-widening application in space technique. This is tied with the simplicity of producing the polymeric-based composites with the predetermined set of properties. However, these materials in space become the sources of volatile products that increase density of spacecraft outer atmosphere that undermines on serviceability of the on-board equipment. Therefore, study of mass loss of spacecraft materials in service conditions is a vital task. Polymeric composites are often used as thermal control coatings (TCC), which are subjected to maximum radiation exposure in service. It is known that irradiation of a PC is accompanied by intense gas formation but evolution of volatile products (VP) through the material-vacuum surface is limited by diffusion. Well-developed surface together with little thickness of a TCC film facilitate migration of radiolysis products to free coating surface. In this case outgassing and destruction of material augment permeability of the film, accelerate migration processes and make them easier. This work is devoted to studying action of separate (electron, proton, and electromagnetic), paired, and the whole set of radiations on mass loss of a pattern material in vacuum. The primary focus was on studying and interpretation of synergistic effects appearing in the course of mass loss of the pattern materials EKOM-1 and EKOM-2 polymeric composites, the widely used spacecraft TCC. Irradiation was made by 20-50-keV electrons and 20-keV protons and electromagnetic radiation in vacuum chamber of the UV-1/2 test facility. It was found that parameters characterizing the synergistic effects of mass loss of the material for fixed conditions of electron-proton and combined radiations are the functions of irradiation time. To interpret the experimental data, a physical-mathematical model of mass loss of polymeric materials in vacuum was proposed. The obtained data can be explained by diffusion fluxes associated with the gradient of

  3. Astrophysical constraints on the radiative lifetime of neutrinos with mass between 10 and 100 eV/c-squared

    NASA Technical Reports Server (NTRS)

    Kimble, R.; Bowyer, S.; Jakobsen, P.

    1981-01-01

    Upper limits to astronomical photon backgrounds are used to derive constraints on the radiative lifetime of neutrinos. With the assumption that the radiative decay dominates the decay routes available, comparisons with predicted fluxes exclude radiative lifetimes between 10 to the 13th and 10 to the 22nd-23rd sec for neutrinos which decay to lighter neutrinos and 5-50 eV photons. For a secondary neutrino mass much less than the parent neutrino mass, this photon-energy range corresponds to a parent-neutrino-mass range of 10-100 eV/c-squared.

  4. Dynamic Universe Model predicts frequency shifting in electromagnetic radiation near gravitating masses

    NASA Astrophysics Data System (ADS)

    Naga Parameswara Gupta, Satyavarapu

    2016-07-01

    In this paper, Dynamic Universe Model studies the light rays and other electromagnetic radiation passing grazingly near any gravitating mass. This change in frequency will depend on relative direction of movement between mass and radiation. Change in frequency depends on relative direction between ray and the Gravitating mass. Here in this paper we will mathematically derive the results and show these predictions. Dynamic Universe Model uses a new type of Tensor. There are no differential or integral equations here. No singularities and body to body collisions in this model. Many papers were published in USA and CANADA. See Dynamic Universe Model Blog for further details and papers Dynamic Universe Model never reduces to General relativity on any condition. It uses a different type of mathematics based on Newtonian physics. This mathematics used here is simple and straightforward. As there are no differential equations present in Dynamic Universe Model, the set of equations give single solution in x y z Cartesian coordinates for every point mass for every time step Keywords: Dynamic Universe Model, Hubble Space telescope (HST), SITA simulations , singularity-free cosmology,

  5. Iraq: Summary of U.S. Casualties

    DTIC Science & Technology

    2007-07-12

    fatalities during Operation Iraqi Freedom, which began on March 19, 2003, and is ongoing, as well as on the number of fatalities since May 1, 2003, plus...available at the following DOD website: [http://siadapp.dmdc.osd.mil/personnel/CASUALTY/castop.htm]. Table 1. Operation Iraqi Freedom, U.S. Fatalities ...and Wounded as of July 12, 2007, 10 a.m. EST Fatalities March 19, 2003,to the Present May 1, 2003, to the Present Wounded March 19, 2003, to the

  6. Episodic Mass Loss on the Timescale of Thermal Pulses: Radiative Transfer Modeling.

    NASA Astrophysics Data System (ADS)

    Speck, Angela; Nenkova, Maia; Meixner, Margaret; Eltizur, Moshe; Knapp, Gillian

    Using far-infrared observations obtained from the Infrared Space Observatory (ISO), we have discovered extremely large dust shells around two post-AGB stars (the Egg Nebula and AFGL 618; Speck, Meixner & Knapp 2001). These circumstellar shells contain the fossil record of their previous AGB mass loss. The radial profiles of these dust shells suggest that episodic mass loss has occurred with mass-loss enhancements on timescales corresponding to theoretical predictions of thermal pulses on the AGB. By modeling the dust emission, we can constrain how the mass loss varies as stars evolve on the AGB, which will constrain the mass-loss mechanisms. Furthermore this modeling allows the determination of the density distribution of the dust around the protoplanetary nebulae as a function of radius. However, modeling such large dust shells is not trivial. Previous studies of very large circumstellar shells showed that most of the outer shell is heated by the interstellar radiation field (ISRF) rather than the central star. Therefore using radiative transfer models with only the central star heating the dust is unrealistic. Furthermore, where the circumstellar shell ploughs into the surrounding interstellar medium may lead to a pile up of material at the outer edge of the dust shell. We present results of modeling the very large dust shells around the Egg Nebula and AFGL 618 using a version of the 1-d radiative transfer code DUSTY which includes external heating of the dust by the ISRF. The models require that the innermost regions has a rapid (1r3) dust density drop-off, indicative of the increased mass-loss rate towards the end of the AGB. Further out, the dust shell has an underlying 1r2 density drop-off, with two superimposed density enhancements. These results provide constraints on the spatial extent of increased density regions and therefore on the duration of increased mass-loss episodes. Furthermore, the modeling suggests that the mass loss rate was either higher in

  7. Prompt Radiation and Mass Outflows from the Stream-Stream Collisions of Tidal Disruption Events

    NASA Astrophysics Data System (ADS)

    Jiang, Yan-Fei; Guillochon, James; Loeb, Abraham

    2016-10-01

    Stream-stream collisions play an important role in the circularization of highly eccentric streams that result from tidal disruption events (TDEs). We perform three-dimensional radiation hydrodynamic simulations to show that stream collisions can contribute significant optical and ultraviolet light to the flares produced by TDEs, and can explain the majority of the observed emission. Our simulations focus on the region near the radiation-pressure-dominated shock produced by a collision and track how the kinetic energy of the stream is dissipated by the associated shock. When the mass flow rate of the stream \\dot{M} is a significant fraction of the Eddington accretion rate, ≳2% of the initial kinetic energy is converted to radiation as a result of the collision. In this regime, the collision redistributes the specific kinetic energy into the downstream gas and more than 16% of the mass can become unbound. The fraction of unbound gas decreases rapidly as \\dot{M} drops significantly below the Eddington limit, with no unbound gas being produced when \\dot{M} drops to 1% of Eddington; we find, however, that the radiative efficiency increases slightly to ≲8% in these cases of low \\dot{M}. The effective radiation temperature and size of the photosphere are determined by the stream velocity and \\dot{M}, and we find them to be a few times 104 K and 1014 cm in our calculations, comparable to the values inferred for some TDE candidates. The size of the photosphere is directly proportional to \\dot{M}, which can explain its rapidly changing size as seen in TDE candidates such as PS1-10jh.

  8. Electrospray ionization mass spectrometry for natural and radiation-induced modifications in histone proteins

    SciTech Connect

    Edmonds, C.G.; Fuciarelli, A.F.; Thrall, B.D.; Springer, D.L.

    1992-05-01

    Chick erythrocyle histone H2B was irradiated in the presence of thymine, the principle cross-linking base recognized in earlier studies, and the products were examined directly by electrospray ionization mass spectrometry (ESI-MS). Following exposure to 5 Gy of ionizing radiation the relative abundance of two unique species were increased by nearly 50% in irradiated samples over background response at the same m/z. The first corresponds to a mass increment increase similar to the expected value for thymine-H2B adduct formation (126.1 Da measured, 125.1 Da calculated). The mass increment increase for the second component (140.7 Da) was less easily explained. Additional dose-yield data are needed to confirm the significance of these changes.

  9. 46 CFR 109.415 - Retention of records after casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....415 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS OPERATIONS Reports, Notifications, and Records Reports and Notifications § 109.415 Retention of records after casualty. (a) The owner, agent, master, or person in charge of a unit for which a report of casualty is...

  10. 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 written...

  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, 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....

  13. 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....

  14. 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....

  15. 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....

  16. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Safety or Marine Inspection Office, whenever the casualty involves any of the following: (1) Each... creates a hazard to navigation, the environment or the safety of the vessel; (2) Loss of main propulsion..., agent, master, or other person in charge of any vessel involved in a marine casualty shall retain...

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

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All casualties occurring after insurance under a binder has attached shall be reported promptly to...

  18. 46 CFR 308.205 - Reporting casualties and filing claims.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All casualties occurring after insurance under a binder has attached shall be reported promptly to, and all...

  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. 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...

  1. 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...

  2. 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...

  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, 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...

  5. 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…

  6. 33 CFR 146.30 - Notice of casualties.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... as soon as possible after a casualty occurs, and by the most rapid means available, of each casualty involving the facility which results in: (1) Death; or (2) Injury to 5 or more persons in a single incident... primary lifesaving or firefighting equipment; (2) Injury causing any person to be incapacitated for...

  7. 46 CFR 197.484 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... the Officer-in-Charge, Marine Inspection, as soon as possible after a diving casualty occurs, if the casualty involves any of the following: (1) Loss of life. (2) Diving-related injury to any person causing incapacitation for more than 72 hours. (3) Diving-related injury to any person requiring hospitalization for...

  8. 46 CFR 122.202 - Notice of marine casualty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Casualties and Voyage Records § 122.202 Notice of marine casualty. (a) Immediately after addressing resultant... equipment, auxiliary power generating equipment, or bilge pumping systems; (5) Loss of life; (6) Injury that... section with respect to the death or injury of shipyard or harbor workers when such accidents are not the...

  9. 46 CFR 185.202 - Notice of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) OPERATIONS Marine Casualties and Voyage Records § 185.202 Notice of casualty. (a) Immediately after the... pumping systems; (5) Loss of life; (6) Injury that requires professional medical treatment (treatment... excluded from the requirements of paragraphs (a)(5) and (a)(6) of this section with respect to the death or...

  10. 46 CFR 185.202 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) OPERATIONS Marine Casualties and Voyage Records § 185.202 Notice of casualty. (a) Immediately after the... pumping systems; (5) Loss of life; (6) Injury that requires professional medical treatment (treatment... excluded from the requirements of paragraphs (a)(5) and (a)(6) of this section with respect to the death or...

  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... 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...

  12. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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 casualty... written report which: (1) Identifies the facility involved, its owner, operator, and person in charge; (2...

  13. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 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 casualty... written report which: (1) Identifies the facility involved, its owner, operator, and person in charge; (2...

  14. 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 written...

  15. 46 CFR 197.486 - Written report of casualty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 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 written...

  16. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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 casualty... written report which: (1) Identifies the facility involved, its owner, operator, and person in charge; (2...

  17. 33 CFR 146.35 - Written report of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Describes the casualty, including the date and time; (3) Describes the nature and extent of injury to... may be— (1) In narrative form if all appropriate parts of Form CG-2692 are addressed; (2) On Form CG-2692 for casualties resulting in property damage, personnel injury, or loss of life. (c) If filed or...

  18. 46 CFR 169.807 - Notice of casualty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... generating equipment, Coast Guard approved equipment or bilge pumping systems; (4) Loss of life; (5) Injury... of the casualty, nature and extent of injury to persons, and the damage to property. (c) In addition... or nearest the port of first arrival. Casualties must be reported on Form CG-2692. (d) The owner...

  19. Low-mass gas envelopes around accreting cores embedded in radiative 3D discs

    NASA Astrophysics Data System (ADS)

    Lega, Elena; Lambrechts, Michiel

    2016-10-01

    Planets with a core mass larger than few Earth masses and a gaseous envelope not exceeding about 10% of the total mass budget are common. Such planets are present in the Solar System (Uranus, Neptune) and are frequently observed around other stars.Our knowledge about the evolution of gas envelopes is mainly based on 1D models. However, such models cannot investigate the complex interaction between the forming envelope and the surrounding gas disc.In this work we perform 3D hydrodynamics simulations accounting for energy transfer and radiative cooling using the FARGOCA code (Lega et al., MNRAS 440, 2014). In addition to the usually considered heatingsources, namely viscous and compressional heating, we have modeled the energy deposited by the accretion of solids.We show that the thermal evolution of the envelope of a 5 Earth mass core is mainly dominated by compressional heating for accretion rates lower than 5 Earth masses per 105 years.Additionally, we demonstrate efficient gas circulation through the envelope. Under certain conditions, the competition between gas circulation and cooling of the envelope can efficiently delay the onset of runaway accretion. This could help in explaining the population of planets with low-mass gas envelope.

  20. Prevalence of tension pneumothorax in fatally wounded combat casualties.

    PubMed

    McPherson, John J; Feigin, David S; Bellamy, Ronald F

    2006-03-01

    Tension pneumothorax is a potential cause of death in victims of penetrating chest trauma, but little is known about its actual prevalence. Data that are part of the Vietnam Wound Data and Munitions Effectiveness Team study were analyzed to address this question. Radiographs of 978 casualties were examined for evidence of tension pneumothorax using standard radiologic criteria such as pleural separation, displacement of the mediastinum and diaphragm, trachea deviation, and compression of the contralateral lung. Some or all of the radiographic changes were found in 198 casualties. Autopsy evidence indicated that 79 of these casualties died solely due to a chest wound. The fatal chest injury involved only the lungs in 55 casualties and caused a tension pneumothorax in 26. Fifteen of the 26 lived long enough to receive first aid from a medic or corpsman. Tension pneumothorax was the cause of death in 3 to 4% of fatally wounded combat casualties. Some may be temporarily helped by battlefield thoracentesis.

  1. Meeting Radiation Protection Requirements and Reducing Spacecraft Mass - A Multifunctional Materials Approach

    NASA Technical Reports Server (NTRS)

    Atwell, William; Koontz, Steve; Reddell, Brandon; Rojdev, Kristina; Franklin, Jennifer

    2010-01-01

    Both crew and radio-sensitive systems, especially electronics must be protected from the effects of the space radiation environment. One method of mitigating this radiation exposure is to use passive-shielding materials. In previous vehicle designs such as the International Space Station (ISS), materials such as aluminum and polyethylene have been used as parasitic shielding to protect crew and electronics from exposure, but these designs add mass and decrease the amount of usable volume inside the vehicle. Thus, it is of interest to understand whether structural materials can also be designed to provide the radiation shielding capability needed for crew and electronics, while still providing weight savings and increased useable volume when compared against previous vehicle shielding designs. In this paper, we present calculations and analysis using the HZETRN (deterministic) and FLUKA (Monte Carlo) codes to investigate the radiation mitigation properties of these structural shielding materials, which includes graded-Z and composite materials. This work is also a follow-on to an earlier paper, that compared computational results for three radiation transport codes, HZETRN, HETC, and FLUKA, using the Feb. 1956 solar particle event (SPE) spectrum. In the following analysis, we consider the October 1989 Ground Level Enhanced (GLE) SPE as the input source term based on the Band function fitting method. Using HZETRN and FLUKA, parametric absorbed doses at the center of a hemispherical structure on the lunar surface are calculated for various thicknesses of graded-Z layups and an all-aluminum structure. HZETRN and FLUKA calculations are compared and are in reasonable (18% to 27%) agreement. Both codes are in agreement with respect to the predicted shielding material performance trends. The results from both HZETRN and FLUKA are analyzed and the radiation protection properties and potential weight savings of various materials and materials lay-ups are compared.

  2. Mass-analyzed threshold ionization (MATI) spectroscopy of atoms and molecules using VUV synchrotron radiation.

    PubMed

    Kostko, Oleg; Kim, Sang Kyu; Leone, Stephen R; Ahmed, Musahid

    2009-12-31

    Mass-analyzed threshold ionization (MATI) spectroscopy using synchrotron radiation (Advanced Light Source, Lawrence Berkeley National Laboratory) has been performed for Ar, N(2), O(2), N(2)O, H(2)O, C(2)H(2), and C(6)H(6). MATI allows for a better determination of ionization energies compared to those derived from photoionization efficiency curves traditionally used in synchrotron photoionization mass spectrometry. The separation of the long-lived Rydberg state from the directly formed prompt ion, essential for a meaningful MATI spectrum, has been accomplished by employing an arrangement of ion optics coupled to unique electric field pulsing schemes. For Ar, a number of resolved bands below the ionization energy are observed, and these are ascribed to high-n,l Rydberg states prepared in the MATI scheme. The first vibrational state resolved MATI spectra of N(2) and O(2) are reported, and spectral characteristics are discussed in comparison with previously reported threshold photoelectron spectroscopic studies. Although MATI performed with synchrotron radiation is intrinsically less sensitive compared to laser-based sources, this work demonstrates that MATI spectroscopy performed with widely tunable vacuum ultraviolet (VUV) radiation is a complementary technique for studying the ionization spectroscopy of polyatomic molecules.

  3. Mass Spectrometry-Based Metabolomics Identifies Longitudinal Urinary Metabolite Profiles Predictive of Radiation-Induced Cancer.

    PubMed

    Cook, John A; Chandramouli, Gadisetti V R; Anver, Miriam R; Sowers, Anastasia L; Thetford, Angela; Krausz, Kristopher W; Gonzalez, Frank J; Mitchell, James B; Patterson, Andrew D

    2016-03-15

    Nonlethal exposure to ionizing radiation (IR) is a public concern due to its known carcinogenic effects. Although latency periods for IR-induced neoplasms are relatively long, the ability to detect cancer as early as possible is highly advantageous for effective therapeutic intervention. Therefore, we hypothesized that metabolites in the urine from mice exposed to total body radiation (TBI) would predict for the presence of cancer before a palpable mass was detected. In this study, we exposed mice to 0 or 5.4 Gy TBI, collected urine samples periodically over 1 year, and assayed urine metabolites by using mass spectrometry. Longitudinal data analysis within the first year post-TBI revealed that cancers, including hematopoietic, solid, and benign neoplasms, could be distinguished by unique urinary signatures as early as 3 months post-TBI. Furthermore, a distinction among different types of malignancies could be clearly delineated as early as 3 months post-TBI for hematopoietic neoplasms, 6 months for solid neoplasms, and by 1 year for benign neoplasms. Moreover, the feature profile for radiation-exposed mice 6 months post-TBI was found to be similar to nonirradiated control mice at 18 months, suggesting that TBI accelerates aging. These results demonstrate that urine feature profiles following TBI can identify cancers in mice prior to macroscopic detection, with important implications for the early diagnosis and treatment. ©2016 American Association for Cancer Research.

  4. Mass-Analyzed Threshold Ionization (MATI) Spectroscopy of Atoms and Molecules using VUV Synchrotron Radiation

    SciTech Connect

    Kostko, Oleg; Kim, Sang Kyu; Leone, Stephen R.; Ahmed, Musahid

    2009-01-28

    Mass-analyzed threshold ionization (MATI) spectroscopy using synchrotron radiation (Advanced Light Source, Lawrence Berkeley National Laboratory) has been performed for Ar, N2, O2, N2O, H2O, C2H2, and C6H6. MATI allows for a better determination of ionization energies compared to those derived from photoionization efficiency curves traditionally used in synchrotron photoionization mass spectrometry. The separation of the long-lived Rydberg state from the directly-formed prompt ion, essential for a meaningful MATI spectrum, has been accomplished by employing an arrangement of ion optics coupled to unique electric-field pulsing schemes. For Ar, a number of resolved bands below the ionization energy are observed, and these are ascribed to high-n,l Rydberg states prepared in the MATI scheme. The first vibrational stateresolved MATI spectra of N2 and O2 are reported and spectral characteristics are discussed in comparison with previously-reported threshold photoelectron spectroscopic studies. While MATI performed with synchrotron radiation is intrinsically less sensitive compared to laser based sources, this work demonstrates that MATI spectroscopy performed with widely tunable VUV radiation is a complementary technique for studying the ionization spectroscopy of polyatomic molecules.

  5. Mass-Analyzed Threshold Ionization (MATI) Spectroscopy of Atoms and Molecules Using VUV Synchrotron Radiation

    NASA Astrophysics Data System (ADS)

    Kostko, Oleg; Kim, Sang Kyu; Leone, Stephen R.; Ahmed, Musahid

    2009-05-01

    Mass-analyzed threshold ionization (MATI) spectroscopy using synchrotron radiation (Advanced Light Source, Lawrence Berkeley National Laboratory) has been performed for Ar, N2, O2, N2O, H2O, C2H2, and C6H6. MATI allows for a better determination of ionization energies compared to those derived from photoionization efficiency curves traditionally used in synchrotron photoionization mass spectrometry. The separation of the long-lived Rydberg state from the directly formed prompt ion, essential for a meaningful MATI spectrum, has been accomplished by employing an arrangement of ion optics coupled to unique electric field pulsing schemes. For Ar, a number of resolved bands below the ionization energy are observed, and these are ascribed to high-n,l Rydberg states prepared in the MATI scheme. The first vibrational state resolved MATI spectra of N2 and O2 are reported, and spectral characteristics are discussed in comparison with previously reported threshold photoelectron spectroscopic studies. Although MATI performed with synchrotron radiation is intrinsically less sensitive compared to laser-based sources, this work demonstrates that MATI spectroscopy performed with widely tunable vacuum ultraviolet (VUV) radiation is a complementary technique for studying the ionization spectroscopy of polyatomic molecules.

  6. Multiple casualty terror events: the anesthesiologist's perspective.

    PubMed

    Shamir, Micha Y; Weiss, Yoram G; Willner, Dafna; Mintz, Yoav; Bloom, Allan I; Weiss, Yuval; Sprung, Charles L; Weissman, Charles

    2004-06-01

    In a 28-mo period 14 multiple-casualty terror events occurred in Jerusalem, challenging the Department of Anesthesiology and Critical Care Medicine of the city's sole Level 1 trauma center. We performed a retrospective review of the response of the department to evaluate staff activities, resource use (emergency department, operating rooms, and intensive care unit [ICU]), and patient flow. A total of 1062 people were injured in the 14 multi-casualty terror incidents. The emergency department treated 355 victims; 108 of them were hospitalized, and 58 underwent surgery during the first 8 h. Only two surgeries were performed during the first hour, and the average time to the first surgery was 124 min. Fifty-one patients were admitted to the ICU an average of 5.5 h after the terror event. After a terrorist act, multiple, simultaneous efforts were required of the anesthesiology department, including taking part in the initial resuscitation in the emergency department, anesthetizing victims for surgery and angiographies, and caring for them in the recovery room and ICU. Therefore, anesthesiology departments are greatly impacted by such events and must plan for them to maximize the use of available personnel and to have the appropriate equipment and supplies available. Anesthesiologists provide essential care to patients injured in terror events, from the initial resuscitation through therapeutic/diagnostic procedures and surgeries. Operational issues faced by a department of anesthesiology during the initial 8 h after terrorist actions were examined. Multiple, and often parallel, efforts were required of the department.

  7. Mass spectrometry-based metabolite profiling in the mouse liver following exposure to ultraviolet B radiation.

    PubMed

    Park, Hye Min; Shon, Jong Cheol; Lee, Mee Youn; Liu, Kwang-Hyeon; Kim, Jeong Kee; Lee, Sang Jun; Lee, Choong Hwan

    2014-01-01

    Although many studies have been performed on the effects of ultraviolet (UV) radiation on the skin, only a limited number of reports have investigated these effects on non-skin tissue. This study aimed to describe the metabolite changes in the liver of hairless mice following chronic exposure to UVB radiation. We did not observe significant macroscopic changes or alterations in hepatic cholesterol and triglyceride levels in the liver of UVB-irradiated mice, compared with those for normal mice. In this study, we detected hepatic metabolite changes by UVB exposure and identified several amino acids, fatty acids, nucleosides, carbohydrates, phospholipids, lysophospholipids, and taurine-conjugated cholic acids as candidate biomarkers in response to UVB radiation in the mouse liver by using various mass spectrometry (MS)-based metabolite profiling including ultra-performance liquid chromatography-quadrupole time-of-flight (TOF)-MS, gas chromatography-TOF-MS and nanomate LTQ-MS. Glutamine exhibited the most dramatic change with a 5-fold increase in quantity. The results from altering several types of metabolites suggest that chronic UVB irradiation may impact significantly on major hepatic metabolism processes, despite the fact that the liver is not directly exposed to UVB radiation. MS-based metabolomic approach for determining regulatory hepatic metabolites following UV irradiation will provide a better understanding of the relationship between internal organs and UV light.

  8. Operation Castle Cascade: managing multiple casualties from a simulated chemical weapons attack.

    PubMed

    Siegel, David; Younggren, Bradley N; Ness, Brian; Kvool, Valerie

    2003-05-01

    In the wake of the recent terrorist attack on the United States, there is an ever-increasing need for the defense against weapons of mass destruction. The use of explosive devices in combination with chemical agents could result in a community disaster with multiple traumatic and medical injuries. Military medical personnel may be the first called upon due to their unique training and equipment. Operation Castle Cascade was a large-scale exercise on a military instillation involving the apprehension of hostages and detonation of an explosive device containing dimethyl sulfate. We will provide details on the medical management of 50 patients with simulated chemical and traumatic injuries. Issues relating to on-site chemical identification, triage, decontamination, treatment, casualty collection, and transportation of casualties are addressed in this article.

  9. Bright betatronlike x rays from radiation pressure acceleration of a mass-limited foil target.

    PubMed

    Yu, Tong-Pu; Pukhov, Alexander; Sheng, Zheng-Ming; Liu, Feng; Shvets, Gennady

    2013-01-25

    By using multidimensional particle-in-cell simulations, we study the electromagnetic emission from radiation pressure acceleration of ultrathin mass-limited foils. When a circularly polarized laser pulse irradiates the foil, the laser radiation pressure pushes the foil forward as a whole. The outer wings of the pulse continue to propagate and act as a natural undulator. Electrons move together with ions longitudinally but oscillate around the latter transversely, forming a self-organized helical electron bunch. When the electron oscillation frequency coincides with the laser frequency as witnessed by the electron, betatronlike resonance occurs. The emitted x rays by the resonant electrons have high brightness, short durations, and broad band ranges which may have diverse applications.

  10. Low-mass, intrinsically-hard high-temperature radiator. Final report, Phase I

    SciTech Connect

    1990-06-15

    Thermacore, Inc. of Lancaster, Pennsylvania has completed a Phase I SBIR program to investigate the use of layered ceramic/metal composites in the design of low-mass hardened radiators for space heat rejection systems. The program is being monitored by the Los Alamos National Laboratory (LANL) for the Strategic Defense Initiative Organization (SDIO). This effort evaluated the use of layered composites as a material to form thin-walled, vacuum leaktight heat pipes. The heat pipes would be incorporated into a large heat pipe radiator for waste heat rejection from a space nuclear power source. This approach forms an attractive alternative to metal or silicon-carbon fiber reinforced metal heat pipes by offering a combination of low mass and improved fabricability. Titanium has been shown to have a yield strength too low at 875{degrees}K to be a useful radiator material. A silicon carbide fiber reinforced titanium material appears to have sufficient strength at 875{degrees}K. but cannot be welded due to the continuous fibers, and the preferred heat pipe working fluid (potassium) has been demonstrated to be incompatible with silicon carbide at 875{degrees}K. Moreover, titanium does not appear to be acceptable for radiators subjected to anticipated laser threats. As part of this effort, Thermacore performed composite material evaluations on combinations of refractory metals and ceramic powders. Layered composite tube samples with wall thicknesses as thin as 0.012 inches were developed. Fabrication experiments were performed that demonstrated the weldability of layered composites. Two titanium/titanium diboride composite tubes were successfully fabricated into potassium heat pipes and operated at temperatures in excess of 700{degrees}C. A hybrid composite tube was also fabricated into a potassium heat pipe. The tube was composed of alternating layers of niobium-1% zirconium foil and layers of a mixture of titanium powder and titanium diboride powder.

  11. Detection of Radiation-Exposure Biomarkers by Differential Mobility Prefiltered Mass Spectrometry (DMS-MS)

    PubMed Central

    Coy, Stephen L.; Krylov, Evgeny V.; Schneider, Bradley B.; Covey, Thomas R.; Brenner, David J.; Tyburski, John B.; Patterson, Andrew D.; Krausz, Kris W.; Fornace, Albert J.; Nazarov, Erkinjon G.

    2010-01-01

    Technology to enable rapid screening for radiation exposure has been identified as an important need, and, as a part of a NIH / NIAD effort in this direction, metabolomic biomarkers for radiation exposure have been identified in a recent series of papers. To reduce the time necessary to detect and measure these biomarkers, differential mobility spectrometry – mass spectrometry (DMS-MS) systems have been developed and tested. Differential mobility ion filters preselect specific ions and also suppress chemical noise created in typical atmospheric-pressure ionization sources (ESI, MALDI, and others). Differential-mobility-based ion selection is based on the field dependence of ion mobility, which, in turn, depends on ion characteristics that include conformation, charge distribution, molecular polarizability, and other properties, and on the transport gas composition which can be modified to enhance resolution. DMS-MS is able to resolve small-molecule biomarkers from nearly-isobaric interferences, and suppresses chemical noise generated in the ion source and in the mass spectrometer, improving selectivity and quantitative accuracy. Our planar DMS design is rapid, operating in a few milliseconds, and analyzes ions before fragmentation. Depending on MS inlet conditions, DMS-selected ions can be dissociated in the MS inlet expansion, before mass analysis, providing a capability similar to MS/MS with simpler instrumentation. This report presents selected DMS-MS experimental results, including resolution of complex test mixtures of isobaric compounds, separation of charge states, separation of isobaric biomarkers (citrate and isocitrate), and separation of nearly-isobaric biomarker anions in direct analysis of a bio-fluid sample from the radiation-treated group of a mouse-model study. These uses of DMS combined with moderate resolution MS instrumentation indicate the feasibility of field-deployable instrumentation for biomarker evaluation. PMID:20305793

  12. Spectral and Structure Modeling of Low and High Mass Young Stars Using a Radiative Trasnfer Code

    NASA Astrophysics Data System (ADS)

    Robson Rocha, Will; Pilling, Sergio

    The spectroscopy data from space telescopes (ISO, Spitzer, Herchel) shows that in addition to dust grains (e.g. silicates), there is also the presence of the frozen molecular species (astrophysical ices, such as H _{2}O, CO, CO _{2}, CH _{3}OH) in the circumstellar environments. In this work we present a study of the modeling of low and high mass young stellar objects (YSOs), where we highlight the importance in the use of the astrophysical ices processed by the radiation (UV, cosmic rays) comes from stars in formation process. This is important to characterize the physicochemical evolution of the ices distributed by the protostellar disk and its envelope in some situations. To perform this analysis, we gathered (i) observational data from Infrared Space Observatory (ISO) related with low mass protostar Elias29 and high mass protostar W33A, (ii) absorbance experimental data in the infrared spectral range used to determinate the optical constants of the materials observed around this objects and (iii) a powerful radiative transfer code to simulate the astrophysical environment (RADMC-3D, Dullemond et al, 2012). Briefly, the radiative transfer calculation of the YSOs was done employing the RADMC-3D code. The model outputs were the spectral energy distribution and theoretical images in different wavelengths of the studied objects. The functionality of this code is based on the Monte Carlo methodology in addition to Mie theory for interaction among radiation and matter. The observational data from different space telescopes was used as reference for comparison with the modeled data. The optical constants in the infrared, used as input in the models, were calculated directly from absorbance data obtained in the laboratory of both unprocessed and processed simulated interstellar samples by using NKABS code (Rocha & Pilling 2014). We show from this study that some absorption bands in the infrared, observed in the spectrum of Elias29 and W33A can arises after the ices

  13. Uncertainty in Modeling Dust Mass Balance and Radiative Forcing from Size Parameterization

    SciTech Connect

    Zhao, Chun; Chen, Siyu; Leung, Lai-Yung R.; Qian, Yun; Kok, Jasper; Zaveri, Rahul A.; Huang, J.

    2013-11-05

    This study examines the uncertainties in simulating mass balance and radiative forcing of mineral dust due to biases in the aerosol size parameterization. Simulations are conducted quasi-globally (180oW-180oE and 60oS-70oN) using the WRF24 Chem model with three different approaches to represent aerosol size distribution (8-bin, 4-bin, and 3-mode). The biases in the 3-mode or 4-bin approaches against a relatively more accurate 8-bin approach in simulating dust mass balance and radiative forcing are identified. Compared to the 8-bin approach, the 4-bin approach simulates similar but coarser size distributions of dust particles in the atmosphere, while the 3-mode pproach retains more fine dust particles but fewer coarse dust particles due to its prescribed og of each mode. Although the 3-mode approach yields up to 10 days longer dust mass lifetime over the remote oceanic regions than the 8-bin approach, the three size approaches produce similar dust mass lifetime (3.2 days to 3.5 days) on quasi-global average, reflecting that the global dust mass lifetime is mainly determined by the dust mass lifetime near the dust source regions. With the same global dust emission (~6000 Tg yr-1), the 8-bin approach produces a dust mass loading of 39 Tg, while the 4-bin and 3-mode approaches produce 3% (40.2 Tg) and 25% (49.1 Tg) higher dust mass loading, respectively. The difference in dust mass loading between the 8-bin approach and the 4-bin or 3-mode approaches has large spatial variations, with generally smaller relative difference (<10%) near the surface over the dust source regions. The three size approaches also result in significantly different dry and wet deposition fluxes and number concentrations of dust. The difference in dust aerosol optical depth (AOD) (a factor of 3) among the three size approaches is much larger than their difference (25%) in dust mass loading. Compared to the 8-bin approach, the 4-bin approach yields stronger dust absorptivity, while the 3-mode

  14. Plasma miRNA as biomarkers for assessment of total-body radiation exposure dosimetry.

    PubMed

    Cui, Wanchang; Ma, Jinfang; Wang, Yulei; Biswal, Shyam

    2011-01-01

    The risk of radiation exposure, due to accidental or malicious release of ionizing radiation, is a major public health concern. Biomarkers that can rapidly identify severely-irradiated individuals requiring prompt medical treatment in mass-casualty incidents are urgently needed. Stable blood or plasma-based biomarkers are attractive because of the ease for sample collection. We tested the hypothesis that plasma miRNA expression profiles can accurately reflect prior radiation exposure. We demonstrated using a murine model that plasma miRNA expression signatures could distinguish mice that received total body irradiation doses of 0.5 Gy, 2 Gy, and 10 Gy (at 6 h or 24 h post radiation) with accuracy, sensitivity, and specificity of above 90%. Taken together, these data demonstrate that plasma miRNA profiles can be highly predictive of different levels of radiation exposure. Thus, plasma-based biomarkers can be used to assess radiation exposure after mass-casualty incidents, and it may provide a valuable tool in developing and implementing effective countermeasures.

  15. Cosmology favoring extra radiation and sub-eV mass sterile neutrinos as an option.

    PubMed

    Hamann, Jan; Hannestad, Steen; Raffelt, Georg G; Tamborra, Irene; Wong, Yvonne Y Y

    2010-10-29

    Precision cosmology and big-bang nucleosynthesis mildly favor extra radiation in the Universe beyond photons and ordinary neutrinos, lending support to the existence of low-mass sterile neutrinos. We use the WMAP 7-year data, small-scale cosmic microwave background observations from ACBAR, BICEP, and QuAD, the SDSS 7th data release, and measurement of the Hubble parameter from HST observations to derive credible regions for the assumed common mass scale m{s} and effective number N{s} of thermally excited sterile neutrino states. Our results are compatible with the existence of one or perhaps two sterile neutrinos, as suggested by LSND and MiniBooNE, if m{s} is in the sub-eV range.

  16. Triassic–Jurassic mass extinction as trigger for the Mesozoic radiation of crocodylomorphs

    PubMed Central

    Toljagić, Olja; Butler, Richard J.

    2013-01-01

    Pseudosuchia, one of the two main clades of Archosauria (Reptilia: Diapsida), suffered a major decline in lineage diversity during the Triassic–Jurassic (TJ) mass extinction (approx. 201 Ma). Crocodylomorpha, including living crocodilians and their extinct relatives, is the only group of pseudosuchians that survived into the Jurassic. We reassess changes in pseudosuchian morphological diversity (disparity) across this time interval, using considerably larger sample sizes than in previous analyses. Our results show that metrics of pseudosuchian disparity did not change significantly across the TJ boundary, contrasting with previous work suggesting low pseudosuchian disparity in the Early Jurassic following the TJ mass extinction. However, a significant shift in morphospace occupation between Late Triassic and Early Jurassic taxa is recognized, suggesting that the TJ extinction of many pseudosuchian lineages was followed by a major and geologically rapid adaptive radiation of crocodylomorphs. This marks the onset of the spectacularly successful evolutionary history of crocodylomorphs in Jurassic and Cretaceous ecosystems. PMID:23536443

  17. Cosmology Favoring Extra Radiation and Sub-eV Mass Sterile Neutrinos as an Option

    SciTech Connect

    Hamann, Jan; Hannestad, Steen; Raffelt, Georg G.; Tamborra, Irene; Wong, Yvonne Y. Y.

    2010-10-29

    Precision cosmology and big-bang nucleosynthesis mildly favor extra radiation in the Universe beyond photons and ordinary neutrinos, lending support to the existence of low-mass sterile neutrinos. We use the WMAP 7-year data, small-scale cosmic microwave background observations from ACBAR, BICEP, and QuAD, the SDSS 7th data release, and measurement of the Hubble parameter from HST observations to derive credible regions for the assumed common mass scale m{sub s} and effective number N{sub s} of thermally excited sterile neutrino states. Our results are compatible with the existence of one or perhaps two sterile neutrinos, as suggested by LSND and MiniBooNE, if m{sub s} is in the sub-eV range.

  18. Triassic-Jurassic mass extinction as trigger for the Mesozoic radiation of crocodylomorphs.

    PubMed

    Toljagic, Olja; Butler, Richard J

    2013-06-23

    Pseudosuchia, one of the two main clades of Archosauria (Reptilia: Diapsida), suffered a major decline in lineage diversity during the Triassic-Jurassic (TJ) mass extinction (approx. 201 Ma). Crocodylomorpha, including living crocodilians and their extinct relatives, is the only group of pseudosuchians that survived into the Jurassic. We reassess changes in pseudosuchian morphological diversity (disparity) across this time interval, using considerably larger sample sizes than in previous analyses. Our results show that metrics of pseudosuchian disparity did not change significantly across the TJ boundary, contrasting with previous work suggesting low pseudosuchian disparity in the Early Jurassic following the TJ mass extinction. However, a significant shift in morphospace occupation between Late Triassic and Early Jurassic taxa is recognized, suggesting that the TJ extinction of many pseudosuchian lineages was followed by a major and geologically rapid adaptive radiation of crocodylomorphs. This marks the onset of the spectacularly successful evolutionary history of crocodylomorphs in Jurassic and Cretaceous ecosystems.

  19. Mass Spectrometry of 3D-printed plastic parts under plasma and radiative heat environments

    NASA Astrophysics Data System (ADS)

    Rivera, W. F.; Romero-Talamas, C. A.; Bates, E. M.; Birmingham, W.; Takeno, J.; Knop, S.

    2015-11-01

    We present the design and preliminary results of a mass spectrometry system used to assess vacuum compatibility of 3D-printed parts, developed at the Dusty Plasma Laboratory of the University of Maryland Baltimore County (UMBC). A decrease in outgassing was observed when electroplated parts were inserted in the test chamber vs. non electroplated ones. Outgassing will also be tested under different environments such as plasma and radiative heat. Heat will be generated by a titanium getter pump placed inside a 90 degree elbow, such that titanium does not coat the part. A mirror inside the elbow will be used to throttle the heat arriving at the part. Plasma exposure of 3D printed parts will be achieved by placing the parts in a separate chamber connected to the spectrometer by a vacuum line that is differentially pumped. The signals from the mass spectrometer will be analyzed to see how the vacuum conditions fluctuate under different plasma discharges.

  20. 46 CFR 122.220 - Records of a voyage resulting in a marine casualty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Records of a voyage resulting in a marine casualty. 122... OPERATIONS Marine Casualties and Voyage Records § 122.220 Records of a voyage resulting in a marine casualty. The owner, agent, master, or person in charge of any vessel involved in a marine casualty for which...

  1. 46 CFR 4.40-15 - Marine casualty investigation by the Board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Marine casualty investigation by the Board. 4.40-15... MARINE CASUALTIES AND INVESTIGATIONS Coast Guard-National Transportation Safety Board Marine Casualty Investigations § 4.40-15 Marine casualty investigation by the Board. (a) The Board may conduct an...

  2. 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. 2012.

  3. Regional Modeling of Dust Mass Balance and Radiative Forcing over East Asia using WRF-Chem

    SciTech Connect

    Chen, Siyu; Zhao, Chun; Qian, Yun; Leung, Lai-Yung R.; Huang, J.; Huang, Zhongwei; Bi, Jianrong; Zhang, Wu; Shi, Jinsen; Yang, Lei; Li, Deshuai; Li, Jinxin

    2014-12-01

    The Weather Research and Forecasting model with Chemistry (WRF-Chem) is used to investigate the seasonal and annual variations of mineral dust over East Asia during 2007-2011, with a focus on the dust mass balance and radiative forcing. A variety of measurements from in-stu and satellite observations have been used to evaluate simulation results. Generally, WRF-Chem reproduces not only the column variability but also the vertical profile and size distribution of mineral dust over and near the dust source regions of East Asia. We investigate the dust lifecycle and the factors that control the seasonal and spatial variations of dust mass balance and radiative forcing over the seven sub-regions of East Asia, i.e. source regions, the Tibetan Plateau, Northern China, Southern China, the ocean outflow region, and Korea-Japan regions. Results show that, over the source regions, transport and dry deposition are the two dominant sinks. Transport contributes to ~30% of the dust sink over the source regions. Dust results in a surface cooling of up to -14 and -10 W m-2, atmospheric warming of up to 20 and 15 W m-2, and TOA cooling of -5 and -8 W m-2 over the two major dust source regions of East Asia, respectively. Over the Tibetan Plateau, transport is the dominant source with a peak in summer. Over identified outflow regions, maximum dust mass loading in spring is contributed by the transport. Dry and wet depositions are the comparably dominant sinks, but wet deposition is larger than dry deposition over the Korea-Japan region, particularly in spring (70% versus 30%). The WRF-Chem simulations can generally capture the measured features of dust aerosols and its radaitve properties and dust mass balance over East Asia, which provides confidence for use in further investigation of dust impact on climate over East Asia.

  4. Negative-mass mitigation of Coulomb repulsion for terahertz undulator radiation of electron bunches

    SciTech Connect

    Balal, N.; Magory, E.; Bandurkin, I. V.; Bratman, V. L.; Savilov, A. V.

    2015-10-19

    It is proposed to utilize the effect of negative mass for stabilization of the effective axial size of very dense and short electron bunches produced by photo-injector guns by using combined undulator and strong uniform magnetic fields. It has been shown that in the “abnormal” regime, an increase in the electron energy leads to a decrease in the axial velocity of the electron; due to the negative-mass effect, the Coulomb repulsion of electrons leads to their attraction and formation of a fairly stable and compact bunch “nucleus.” An undulator with a strong uniform magnetic field providing the negative-mass effect is designed for an experimental source of terahertz radiation. The use of the negative-mass regime in this experiment should result in a long-pulse coherent spontaneous undulator emission from a short dense moderately relativistic (5.5 MeV) photo-injector electron bunch with a high (up to 20%) efficiency and a narrow frequency spectrum.

  5. Determining the neutrino mass with cyclotron radiation emission spectroscopy—Project 8

    NASA Astrophysics Data System (ADS)

    Ashtari Esfahani, Ali; Asner, David M.; Böser, Sebastian; Cervantes, Raphael; Claessens, Christine; de Viveiros, Luiz; Doe, Peter J.; Doeleman, Shepard; Fernandes, Justin L.; Fertl, Martin; Finn, Erin C.; Formaggio, Joseph A.; Furse, Daniel; Guigue, Mathieu; Heeger, Karsten M.; Jones, A. Mark; Kazkaz, Kareem; Kofron, Jared A.; Lamb, Callum; LaRoque, Benjamin H.; Machado, Eric; McBride, Elizabeth L.; Miller, Michael L.; Monreal, Benjamin; Mohanmurthy, Prajwal; Nikkel, James A.; Oblath, Noah S.; Pettus, Walter C.; Hamish Robertson, R. G.; Rosenberg, Leslie J.; Rybka, Gray; Rysewyk, Devyn; Saldaña, Luis; Slocum, Penny L.; Sternberg, Matthew G.; Tedeschi, Jonathan R.; Thümmler, Thomas; VanDevender, Brent A.; E Vertatschitsch, Laura; Wachtendonk, Megan; Weintroub, Jonathan; Woods, Natasha L.; Young, André; Zayas, Evan M.

    2017-05-01

    The most sensitive direct method to establish the absolute neutrino mass is observation of the endpoint of the tritium beta-decay spectrum. Cyclotron radiation emission spectroscopy (CRES) is a precision spectrographic technique that can probe much of the unexplored neutrino mass range with { O }({eV}) resolution. A lower bound of m({ν }e)≳ 9(0.1) {meV} is set by observations of neutrino oscillations, while the KATRIN experiment—the current-generation tritium beta-decay experiment that is based on magnetic adiabatic collimation with an electrostatic (MAC-E) filter—will achieve a sensitivity of m({ν }e)≲ 0.2 {eV}. The CRES technique aims to avoid the difficulties in scaling up a MAC-E filter-based experiment to achieve a lower mass sensitivity. In this paper we review the current status of the CRES technique and describe Project 8, a phased absolute neutrino mass experiment that has the potential to reach sensitivities down to m({ν }e)≲ 40 {meV} using an atomic tritium source.

  6. CONVERGENCE STUDIES OF MASS TRANSPORT IN DISKS WITH GRAVITATIONAL INSTABILITIES. II. THE RADIATIVE COOLING CASE

    SciTech Connect

    Steiman-Cameron, Thomas Y.; Durisen, Richard H.; Michael, Scott; McConnell, Caitlin R.; Boley, Aaron C. E-mail: durisen@astro.indiana.edu E-mail: carmccon@indiana.edu

    2013-05-10

    We conduct a convergence study of a protoplanetary disk subject to gravitational instabilities (GIs) at a time of approximate balance between heating produced by the GIs and radiative cooling governed by realistic dust opacities. We examine cooling times, characterize GI-driven spiral waves and their resultant gravitational torques, and evaluate how accurately mass transport can be represented by an {alpha}-disk formulation. Four simulations, identical except for azimuthal resolution, are conducted with a grid-based three-dimensional hydrodynamics code. There are two regions in which behaviors differ as resolution increases. The inner region, which contains 75% of the disk mass and is optically thick, has long cooling times and is well converged in terms of various measures of structure and mass transport for the three highest resolutions. The longest cooling times coincide with radii where the Toomre Q has its minimum value. Torques are dominated in this region by two- and three-armed spirals. The effective {alpha} arising from gravitational stresses is typically a few Multiplication-Sign 10{sup -3} and is only roughly consistent with local balance of heating and cooling when time-averaged over many dynamic times and a wide range of radii. On the other hand, the outer disk region, which is mostly optically thin, has relatively short cooling times and does not show convergence as resolution increases. Treatment of unstable disks with optical depths near unity with realistic radiative transport is a difficult numerical problem requiring further study. We discuss possible implications of our results for numerical convergence of fragmentation criteria in disk simulations.

  7. [Combat sick and wounded casualty: classification, notions and problems].

    PubMed

    Belevitin, A B; Shelepov, A M; Rusev, I T; Prokin, I G; Stoliar, V P

    2009-08-01

    The nowdays all possible damages and diseases by the staff during a war, are systematized in a special classification of combat damages and diseases, which is based on effect of main damage factors of weapon. Analyzing existent classification and determination "sanitarium casualty", it should be pointed out that they were formed more than 50 years ago, and they have gone out of date. Theirs significs is projected not adequately in practice of medical supply. Therefore determinations of sanitarium casualty, used in practice and in documentation, are not full and not always clearly explain about which casualty is talking. Moreover, several authors (frequently it is functionary of hospital) faultily or by reason of not-understanding write and talk about sanitarium casualty, meaning wounded and ill persons, admitted to hospital and being treated there.

  8. Mass spectrometry data from proteomic analysis of human skin keratins after exposure to UV radiation

    PubMed Central

    Lee, Seon Hwa; Matsushima, Keita; Miyamoto, Kohei; Oe, Tomoyuki

    2016-01-01

    A mass spectrometry (MS)-based proteomic methodology was employed to monitor oxidative modifications in keratins, the main constituents of human skin (“Non-invasive proteomic analysis of human skin keratins: screening of methionine oxidation in keratins by mass spectrometry” [1], “UV irradiation-induced methionine oxidation in human skin keratins: mass spectrometry-based non-invasive proteomic analysis” [2]). Human skin proteins were obtained non-invasively by tape stripping and solubilized in sodium dodecyl sulfate (SDS) buffer, followed by purification and digestion using the filter-aided sample preparation method. The tryptic peptides were then analyzed by liquid chromatography (LC)/electrospray ionization (ESI)-MS, tandem MS (MS/MS), and LC/ESI-selected reaction monitoring (SRM)/MS. The MS/MS data were generated to confirm amino acid sequences and oxidation sites of tryptic peptides D290VDGAYMTK298 (P1) and N258MQDMVEDYR267 (P2), which contain the most susceptible oxidation sites (Met259, Met262, and Met296 in K1 keratin) upon UVA irradiation [2]. Subsequently, quantitative determination of the relative oxidation levels of P1 and P1 [2] was achieved by LC/ESI-SRM/MS analyses of P1 and P2 together with their oxidized forms after exposure to UVA radiation or treatment with hydrogen peroxide (H2O2). PMID:26958637

  9. Dynamical mass ejection from binary neutron star mergers: Radiation-hydrodynamics study in general relativity

    NASA Astrophysics Data System (ADS)

    Sekiguchi, Yuichiro; Kiuchi, Kenta; Kyutoku, Koutarou; Shibata, Masaru

    2015-03-01

    We perform radiation-hydrodynamics simulations of binary neutron-star mergers in numerical relativity on the Japanese "K" supercomputer, taking into account neutrino cooling and heating by an updated leakage-plus-transfer scheme for the first time. Neutron stars are modeled by three modern finite-temperature equations of state (EOS) developed by Hempel and his collaborators. We find that the properties of the dynamical ejecta of the merger such as total mass, average electron fraction, and thermal energy depend strongly on the EOS. Only for a soft EOS (the so-called SFHo), the ejecta mass exceeds 0.01 M⊙ . In this case, the distribution of the electron fraction of the ejecta becomes broad due to the shock heating during the merger. These properties are well-suited for the production of the solar-like r -process abundance. For the other stiff EOS (DD2 and TM1), for which a long-lived massive neutron star is formed after the merger, the ejecta mass is smaller than 0.01 M⊙, although broad electron-fraction distributions are achieved by the positron capture and the neutrino heating.

  10. Preliminary Design of a Combat Casualty Medical Information System.

    DTIC Science & Technology

    1983-12-20

    encoded tag worn by the individual could supply basic V2 demographic data as well as blood type and allerny information. Partable terminals could he used...to identify the casualty and establish a casualty care record. This included the marine’s name, social security number, unit, allergies, blood type , and...casting and immobilization are relevant. More extensive diagnostic pro- dedures such as complete blood counts, urinalyses, blood type and crossmatch

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

    PubMed Central

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

    2007-01-01

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

  12. Resuscitation of combat casualties: unique challenges and lessons learned.

    PubMed

    Marshall, William B

    2010-01-01

    Resuscitation and trauma anesthesia of combat casualties is very similar to trauma care in any US hospital--except for the setting. Using case examples, this article describes the principles of trauma anesthesia and resuscitation and the lessons learned regarding the modifications required when caring for a combat casualty. Examples of a massive trauma resuscitation (>10 units of packed red blood cells in 24 hours) and burn resuscitation are presented.

  13. Casualty crash types for which teens are at excess risk.

    PubMed

    Bingham, C R; Shope, J T

    2007-01-01

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

  14. Casualties, Public Opinion, and Presidential Policy during the Vietnam War.

    DTIC Science & Technology

    1985-03-01

    of his charts, reproduced here as Fig. 6, plotted the rising casualty levels in Korea against the declin- ing public support for the Korean war. Ball...relationship between U.S. casualties and public support for U.S. military int-rvention in Korea and Vietnam, and concludeb that a strong inverse...Contingencies," investigated possible configurations for a firepower projection force to be employed in the defense of Third World allies. One of the

  15. Radiative natural supersymmetry: Reconciling electroweak fine-tuning and the Higgs boson mass

    NASA Astrophysics Data System (ADS)

    Baer, Howard; Barger, Vernon; Huang, Peisi; Mickelson, Dan; Mustafayev, Azar; Tata, Xerxes

    2013-06-01

    Models of natural supersymmetry seek to solve the little hierarchy problem by positing a spectrum of light Higgsinos ≲200-300GeV and light top squarks ≲600GeV along with very heavy squarks and TeV-scale gluinos. Such models have low electroweak fine-tuning and satisfy the LHC constraints. However, in the context of the minimal supersymmetric standard model, they predict too low a value of mh, are frequently in conflict with the measured b→sγ branching fraction, and the relic density of thermally produced Higgsino-like weakly interacting massive particles (WIMPs) falls well below dark matter measurements. We propose a framework dubbed radiative natural supersymmetry (RNS), which can be realized within the minimal supersymmetric standard model (avoiding the addition of extra exotic matter) and which maintains features such as gauge coupling unification and radiative electroweak symmetry breaking. The RNS model can be generated from supersymmetry (SUSY) grand unified theory type models with nonuniversal Higgs masses. Allowing for high-scale soft SUSY breaking Higgs mass mHu>m0 leads to automatic cancellations during renormalization group running and to radiatively-induced low fine-tuning at the electroweak scale. Coupled with large mixing in the top-squark sector, RNS allows for fine-tuning at the 3%-10% level with TeV-scale top squarks and a 125 GeV light Higgs scalar h. The model allows for at least a partial solution to the SUSY flavor, CP, and gravitino problems since first-/second-generation scalars (and the gravitino) may exist in the 10-30 TeV regime. We outline some possible signatures for RNS at the LHC, such as the appearance of low invariant mass opposite-sign isolated dileptons from gluino cascade decays. The smoking gun signature for RNS is the appearance of light Higgsinos at a linear e+e- collider. If the strong CP problem is solved by the Peccei-Quinn mechanism, then RNS naturally accommodates mixed axion-Higgsino cold dark matter, where the

  16. Bursts of gravitational radiation from superconducting cosmic strings and the neutrino mass spectrum

    NASA Astrophysics Data System (ADS)

    Mosquera Cuesta, H. J.; González, D. M.

    2001-02-01

    Berezinsky, Hnatyk and Vilenkin showed that superconducting cosmic strings could be central engines for cosmological gamma-ray bursts and for producing the neutrino component of ultra-high energy cosmic rays. A consequence of this mechanism would be that a detectable cusp-triggered gravitational wave burst should be released simultaneously with the /γ-ray surge. If contemporary measurements of both /γ and /ν radiation could be made for any particular source, then the cosmological time-delay between them might be useful for putting unprecedentedly tight bounds on the neutrino mass spectrum. Such measurements could consistently verify or rule out the model, since strictly correlated behaviour is expected for the duration of the event and for the time variability of the spectra.

  17. Bursts of Gravitational Radiation from Superconducting Cosmic Strings and the Neutrino Mass Spectrum

    NASA Astrophysics Data System (ADS)

    Mosquera Cuesta, Herman J.; González, Danays Morejón

    2001-09-01

    Berezinsky, Hnatyk and Vilenkin showed that superconducting cosmic strings could be central engines for cosmological gamma-ray bursts and for producing the neutrino component of ultra-high energy cosmic rays. A consequence of this mechanism would be that a detectable cusp-triggered gravitational wave burst should be released simultaneously with the γ-ray surge. If contemporary measurements of both γ and ν radiation could be made for any particular source, then the cosmological time-delay between them might be useful for putting unprecedently tight bounds on the neutrino mass spectrum. Such measurements could consistently verify or rule out the model, since strictly correlated behaviour is expected for the duration of the event and for the time variability of the spectra.

  18. Hawking Radiation of Mass Generating Particles from Dyonic Reissner-Nordström Black Hole

    NASA Astrophysics Data System (ADS)

    Sakalli, I.; Övgün, A.

    2016-09-01

    The Hawking radiation is considered as a quantum tunneling process, which can be studied in the framework of the Hamilton-Jacobi method. In this study, we present the wave equation for a mass generating massive and charged scalar particle (boson). In sequel, we analyse the quantum tunneling of these bosons from a generic 4-dimensional spherically symmetric black hole. We apply the Hamilton-Jacobi formalism to derive the radial integral solution for the classically forbidden action which leads to the tunneling probability. To support our arguments, we take the dyonic Reissner-Nordström black hole as a test background. Comparing the tunneling probability obtained with the Boltzmann formula, we succeed in reading the standard Hawking temperature of the dyonic Reissner-Nordström black hole.

  19. Radiative neutrino mass matrix for three active plus one sterile species

    SciTech Connect

    Gaur, N.; Ghosal, A.; Ma, E.; Roy, P.

    1998-10-01

    A simple unifying mass matrix is presented for the three active and one sterile neutrinos {nu}{sub e}, {nu}{sub {mu}}, {nu}{sub {tau}}, and {nu}{sub s}, using an extension of the radiative mechanism proposed some time ago by Zee. The total neutrino-oscillation data are explained by the scheme {nu}{sub e}{leftrightarrow}{nu}{sub s} (solar), {nu}{sub {mu}}{leftrightarrow}{nu}{sub {tau}} (atmospheric) and {nu}{sub e}{leftrightarrow}{nu}{sub {mu}} (LSND). We obtain the interesting approximate relationship ({Delta}m{sup 2}){sub atm}{approx_equal}2[({Delta}m{sup 2}){sub solar}({Delta}m{sup 2}){sub LSND}]{sup 1/2} which is well satisfied by the data. {copyright} {ital 1998} {ital The American Physical Society}

  20. Equation of motion of an interstellar Bussard ramjet with radiation and mass losses

    NASA Astrophysics Data System (ADS)

    Semay, Claude; Silvestre-Brac, Bernard

    2008-11-01

    An interstellar Bussard ramjet is a spaceship using the protons of the interstellar medium in a fusion engine to produce thrust. In recent papers, it was shown that the relativistic equation of motion of an ideal ramjet and that of a ramjet with radiation loss are analytical. When a mass loss appears, the limit speed of the ramjet is more strongly reduced. However, the parametric equations in terms of the ramjet's speed for the position of the ramjet in the inertial frame of the interstellar medium, the time in this frame and the proper time indicated by the clocks on board the spaceship can still be obtained in an analytical form. The non-relativistic motion and the motion near the limit speed are studied.