Medical response to a natural disaster: the Barrie tornado.

On May 31, 1985, a tornado devastated an area of Barrie, Ont. Following a prepared disaster plan, the staff of the local hospital managed 155 casualties, including 16 cases of multiple trauma, over 5 hours. The authors summarize the hospital''s experience and give recommendations to help the staff of other hospitals improve their disaster plans.     

Echelons of Medical Care

The mortality rate of wounded soldiers who survived long enough to leave the Crimean battlefields was nearly 20%. A similar rate can be expected in Canada among casualties evacuated from target cities if no preparations are made.From their considerable experience over the last 100 years the military medical services have developed effective techniques for caring for large numbers of casualties under adverse conditions, thereby reducing the mortality rate to 3.6%. The Emergency Health Services in Canada are employing these same techniques.The basic planning technique is the establishment of echelons or levels of medical care. It evolved from the fact that casualties usually occur at places remote from hospitals and have to be given sustaining care and shelter at staging points on the evacuation route. The opportunity was taken to institute a system of progressive care at these points, and four echelons of care became recognized. The productivity of available treatment personnel was increased by dividing the labour and by standardizing the treatment. Minor casualties should be diverted elsewhere so that serious casualties may receive better attention. The problem of the proper transportation of casualties is still unsolved in Canada.     

Blast injury research models

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

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

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

Detecting the Impacts of Socioeconomic Factors on Regional Severity of Work-Related Casualties in China

Work-related casualties always cause serious damages to regional social and economic development. China's rapid development is raising a series of concerns about work-related casualties. The self-organizing maps (SOM) approach is applied in this study to detect the impacts of socioeconomic factors on the severity of work-related casualties in 31 regions of mainland China. The results show that: (1) the regional severity of work-related casualties and socioeconomic development seem to follow an inverted U-shaped pattern (i.e., the number of work-related fatalities increases to a peak at a certain stage and then decline along with socioeconomic development); (2) the industrial and employment structure have negative correlation with the regional severity of work-related casualties, specifically, the higher percentage of tertiary industry in gross regional product (GRP) and percentage of employed persons in tertiary industry may lead to fewer numbers of work-related fatalities in one region; (3) some socioeconomic factors like education level, medical condition, and insurance coverage have negative impacts on the regional severity of work-related casualties. Furthermore, the study also shows that the SOM approach is capable of improving clustering quality and visualization effects when facing multidimensional datasets compared with traditional cluster approaches such as K-Means and hierarchical-based clustering methods.     

Role of medical teams in a community disaster plan.

In London, Ont. two mock disaster exercises have indicated the need for re-evaluating the role of medical disaster teams. To coordinate and direct these teams a medical on-site coordinating team, composed of three emergency physicians with an expanded and more clearly defined role, was formed. The role of the triage teams deployed from the hospital to assess and resuscitate casualties is reviewed in detail. In addition, the communication systems, availability and deployment of medical supplies, identification of medical personnel and tagging of casualties are discussed. Because a mass casualty episode is possible in any community, disaster planning and clear outlining of the role of medical disaster teams are needed.     

Blast injuries to the lung: epidemiology and management

Lung injury is frequently a component of the polytrauma sustained by military personnel surviving blast on the battlefield. This article describes a case series of the military casualties admitted to University Hospital Birmingham's critical care services (role 4 facility), during the period 1 July 2008 to 15 January 2010. Of the 135 casualties admitted, 107 (79.2%) were injured by explosive devices. Plain chest films taken soon after arrival in the role 4 facility were reviewed in 96 of the 107 patients. In 55 (57.3%) films a tracheal tube was present. One or more radiological abnormalities was present in 66 (68.75%) of the films. Five patients met the consensus criteria for the definition of adult respiratory distress syndrome (ARDS). The majority of casualties with blast-related lung injury were successfully managed with conventional ventilatory support employing a lung protective strategy; only a small minority received non-conventional support at any time in the form of high-frequency oscillatory ventilation. Of those casualties who survived to be received by the role 4 facility, none subsequently died as a consequence of lung injury.     

Occult Enterobacter aerogenes pneumonia diagnosed by indium 111-labeled leukocyte scan.

A major earthquake may strike while a surgeon is performing an operation in an office surgical facility. A sudden major fault disruption will lead to thousands of casualties and widespread destruction. Surgeons who operate in offices can help lessen havoc by careful preparation. These plans should coordinate with other disaster plans for effective triage, evacuation, and the treatment of casualties.     

PROBLEMS ASSOCIATED WITH MEDICAL DISASTER CARE—Preparations in a Large Southern California Area

In the organization for dealing with medical disaster, the region is in an intermediary position, between the State Disaster Office and the operational areas. Regional functions are largely those of coordinating the activities of the areas, and are based upon directives and plans from the state level.The regional medical chief is a member of the staff of the Civil Defense coordinator and must advise him in all matters related to the health of the people, including medical and casualty care, hospitalization, public health, sanitation, preventive medicine and the special problems of biological, chemical and radiation hazards. Coordination with the other Civil Defense services is necessary.The basic medical plan is to give emergency care in the first aid stations and then evacuate casualties to hospitals when and how the situation permits. Regional function is to obtain personnel, supply, equipment and hospitalization support when required.Dispersal of danger zone populations to support areas creates many medical and public health problems among the displaced people and the residents.Survival of the nation requires altered concepts of casualty management. The least injured who have the greatest productive potential should have the highest treatment priority. Short, lifesaving surgical procedures must have precedence over long, complicated operations.No plan is any better than the individual doctors, nurses and other personnel who will put it into operation.     

Moorgate tube train disaster. Part II. Clinicopathological review.

A review of the injuries sustained by the 113 casualties of the Moorgate tube train disaster has shown the need for rapid evacuation of casualties. Recognition of the "crush syndrome" and its early consequence, hyperkalaemia, is important and a radical surgical approach is suggested. Chest injuries were common and contributed to many of the deaths.     

Hématome pharyngolaryngé asphyxiant durant l'anticoagulothérapie.

Canada has a good National Medical Stockpile valued at 21 million dollars and consisting of packaged emergency medical units ready for use in peacetime or wartime disaster. These units are available for release to provinces for pre-positioning in selected communities provided that certain storage conditions are met and that physicians and other key health workers are prepared to take operational charge of the equipment. The major packaged units are the Emergency Hospital with a capacity of 200 beds, the Advanced Treatment Centre with equipment to give emergency medical care to 500 casualties, the Casualty Collecting Unit with equipment to give first-aid care to 500 casualties, the Emergency Blood Depot, the Emergency Clinic and the Emergency Public Health Laboratory. In addition, training equipment, supplies and units are provided.The value of the stockpile has already been demonstrated in disasters occurring inside and outside Canada. Ten Emergency Hospitals have been shipped to South Vietnam for civilian use. A similar Emergency Hospital was flown to Yellowknife, N.W.T., within 24 hours of the destruction, by fire, of the Stanton Yellowknife Hospital in May 1966.     

Preparation for disaster

Standardization of county medical society plans for dealing with casualties in disasters would greatly facilitate integration with the state Civil Defense organization. Without such plans there can be no hope of coping with the great number of casualties that would come should this area be attacked. The plan of the Alameda-Contra Costa County Medical Association herein described, has been tested in actual emergency and has been found effective.     

PREPARATION FOR DISASTER—What the Individual Medical Society Can Do

Standardization of county medical society plans for dealing with casualties in disasters would greatly facilitate integration with the state Civil Defense organization.Without such plans there can be no hope of coping with the great number of casualties that would come should this area be attacked.The plan of the Alameda-Contra Costa County Medical Association herein described, has been tested in actual emergency and has been found effective.     

Recent updates on novel therapeutic targets of cardiovascular diseases

Molecular and Cellular Biochemistry - In recent times cardiovascular diseases (CVDs) are the leading cause of mortality universally, caused more or less 17.7 million casualties with 45% of all...     

Assessing road effects on bats: the role of landscape, road features, and bat activity on road-kills

Recent studies suggest that roads can significantly impact bat populations. Though bats are one of the most threatened groups of European vertebrates, studies aiming to quantify bat mortality and determine the main factors driving it remain scarce. Between March 16 and October 31 of 2009, we surveyed road-killed bats daily along a 51-km-long transect that incorporates different types of roads in southern Portugal. We found 154 road-killed bats of 11 species. The two most common species in the study area, Pipistrellus kuhlii and P. pygmaeus, were also the most commonly identified road-kill, representing 72 % of the total specimens collected. About two-thirds of the total mortality occurred between mid July and late September, peaking in the second half of August. We also recorded casualties of threatened and rare species, including Miniopterus schreibersii, Rhinolophus ferrumequinum, R. hipposideros, Barbastella barbastellus, and Nyctalus leisleri. These species were found mostly in early autumn, corresponding to the mating and swarming periods. Landscape features were the most important variable subset for explaining bat casualties. Road stretches crossing or in the vicinity of high-quality habitats for bats—including dense Mediterranean woodland (“montado”) areas, water courses with riparian gallery, and water reservoirs—yielded a significantly higher number of casualties. Additionally, more road-killed bats were recorded on high-traffic road stretches with viaducts, in areas of higher bat activity and near known roosts.     

Contribution of general practitioner hospitals in England and Wales.

A survey of a one-in-seven sample of general practitioner hospitals in England and Wales, performed to determine the contribution they make to overall hospital work load and the attitudes of the general practitioners working in them, showed that 3% of acute hospital beds in England and Wales were in general practitioner hospitals, which provided initial hospital care for up to 20% of the population. Altogether 16% of general practitioners and 22% of consultants were on the staffs, and they coped with more than 13% of all casualties, 6% of operations, and 4% of x-ray examinations. Nearly a million casualties were treated at no cost to the National Health Service. Twenty new district general hospitals would be needed to cope with the work load currently dealt with by general practitioner hospitals. The results of this survey indicate that these smaller hospitals deal efficiently and cheaply with their work load, and that morale is high. General practitioner hospitals could have an important part to play in providing certain types of care, but there are no financial incentives to enable general practitioners to realise this potential fully.     

Exercise London: a disaster exercise involving numerous casualties

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

Immediate fatal outcome vs. fatal outcome within the first 48 hours following a severe traffic trauma--analysis of the possible effect of alcohol intoxication on the outcome

This paper is a retrospective analysis of data on 278 persons with fatal outcomes in traffic accidents in Osjecko--baranjska County, Croatia, during a five-year period. The observed sample of casualties was divided according to the time of fatal outcome into three groups: immediately deceased (139 or 50.0%), deceased within the first 48 hours (84 or 30.2%) and deceased after 48 hours (55 or 19.8%). A comparison of data was made for the first two groups of casualties, based on the level of alcohol intoxication, and an analysis of the possible influence of alcohol intoxication on an early outcome of severe trauma, which was defined as immediate fatal outcome and fatal outcome within the first 48 hours following the trauma. Casualties from the group of immediately deceased had a significantly higher average blood alcohol level than casualties from the group of persons deceased within the first 48 hours (shown through arithmetic mean of 0.81 g/kg vs. 0.33 g/kg, p =0.000). A binary logistic regression analysis showed that every increase in blood alcohol level by 1 g/kg also increased the odds of an immediate fatal outcome by 1.92 times (p=0.004). CONCLUSION: Beside increased risks of traffic accidents, the collected data showed that alcohol intoxication of accident participants also increases their chances of an immediate fatal outcome.     

鸟类交通致死原因的种间行为差异分析(英文)

鸟类和其他动物经常死于车撞, 每年因车撞而死亡的个体可达数百万只。为什么有的物种比其他物种更易于死于车撞的问题,迄今未研究过。该文推测物种本身所具有的冒险行为可能是这些物种的某些个体更常死于车撞的一个原因。此外,不同物种个体在公路上的行为、个体数量、栖息地偏好、繁殖社会性以及健康状况都可能是影响个体车撞风险的潜在因素。2001—2006 年,对丹麦一个农村地区进行定期统计取样, 得到该地区不同种鸟类个体被车撞死事件发生的频率,以及周边环境中 50 种鸟类的个体数量数据, 并利用这些数据来检验我们的预测。车撞频率随鸟类个体数量线性增加和位于道路上或者低空飞越道路的个体所占比例增加,这两个因素几乎无法解释鸟类车撞频率差异。在考虑到丰富度这个因素后,发现那些鸟类惊飞距离短、面对潜在危险而更具有冒险性的物种个体更易遭遇车撞而亡。另外, 独居的物种、疟原虫感染率高的物种及因体型大而拥有大法氏囊的物种个体死于车撞的频率更高。这些发现表明, 一系列反映冒险行为、视敏度和健康状况的因子导致某些鸟类物种易受到车撞影响。