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.     

The medical aspects of civil defense in California

Medical care for persons injured in atomic bomb attack or other far-reaching enemy action occupies an important place in civil defense plans that have been set up in California. Preparations have been made on the basis of suppositions as to where attacks might occur and estimates of the number of casualties. State and federal funds have been allocated for aid station equipment, antibiotics, plasma, blankets and litters. In the table of organization, use of all physicians, nurses and hospitals in the state is contemplated. Communities at the center of attacks would borrow facilities and medical personnel from areas not directly affected.County medical societies in California have appointed civil defense committees to work out local plans. Each physician has a part in these plans. If he does not know what his assignment is, be ought to get in touch with his county medical society headquarters immediately.     

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.     

MEDICAL PREPAREDNESS FOR DISASTER

The Federal Civil Defense Administration has been consolidated under the President''s Reorganization Plan No. 1 of 1958 with the Office of Defense Mobilization. The new organization, the Office of Civil and Defense Mobilization, should be able to deal more efficiently with the problem of mobilization and management of all resources and production of the nation in time of disaster. As preparation for possible enemy attack, organized plans entailing training, supplies, equipment and communications for use in major peacetime disasters—floods, earthquakes, tornado damage—should be carried forward vigorously. Apathy must be overcome. From the local to the highest level all civil defense and disaster plans must be developed and kept flexible enough to be operable during any kind of emergency.Physicians must learn as much as they can about the mass care of casualties, how to survive under the most trying of circumstances. Drills in dealing with simulated disaster are of utmost importance for finding out ahead of time what must be done and the personnel and supplies needed for doing it.     

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.     

DISASTER PLANNING IN SUPPORT AREAS

It is probable that in the event of thermonuclear attack, the outlying areas to which metropolitan evacuees would be sent would have problems quite as great as the problems at the center of attack. Unless the focus of planning is altered, they could have great numbers of casualties sent to them, yet have far from adequate facilities, material and personnel to do the job.     

Preventing post-traumatic stress disorder after mass exposure to violence

Bioterrorism preparedness plans must take into account the psychosocial consequences of exposure to mass violence. If possible, post-traumatic stress disorder (PTSD), which is associated with significant morbidity and cost, should be prevented. There are, however, no effective interventions that have been scaled up to prevent PTSD following mass exposure to violence. In fact, randomized controlled trials of the most commonly used preventive intervention, psychological debriefing, suggest no efficacy, or even potential harm. Fortunately, randomized controlled trials of cognitive behavioral therapy--that is, targeting individuals who are symptomatic in the weeks after trauma--reveal significant efficacy. Given the potential for repeated mass violence exposure, public health professionals need to refine methods for screening and tracking large numbers of casualties. At the same time, the use of telephone and internet-based cognitive behavioral therapy protocols should be further tested as strategies for bringing the only effective early intervention for PTSD to scale. Research on preventive pharmacotherapy for PTSD and on the effects of media exposure on PTSD severity is also a priority.     

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.     

When your MR linac is down: Can an automated pipeline bail you out of trouble?

PurposeThe unique treatment delivery technique provided by magnetic resonance guided radiotherapy (MRgRT) can represent a significant drawback when system fail occurs. This retrospective study proposes and evaluates a pipeline to completely automate the workflow necessary to shift a MRgRT treatment to a traditional radiotherapy linac.Material and methodsPatients undergoing treatment during the last MRgRT system failure were retrospectively included in this study. The core of the proposed pipeline was based on a tool able to mimic the original MR linac dose distribution. The so obtained dose distribution (AUTO) has been compared with the distribution obtained in the conventional radiotherapy linac (MAN). Plan comparison has been performed in terms of time required to obtain the final dose distribution, DVH parameters, dosimetric indices and visual analogue scales scoring by radiation oncologists.ResultsAUTO plans generation has been obtained within 10 min for all the considered cases. All AUTO plans were found to be within clinical tolerance, showing a mean target coverage variation of 1.7% with a maximum value of 4.3% and a minimum of 0.6% when compared with MAN plans. The highest OARs mean variation has been found for rectum V60 (6.7%). Dosimetric indices showed no relevant differences, with smaller gradient measure in favour of AUTO plans. Visual analogue scales scoring has confirmed comparable plan quality for AUTO plans.ConclusionThe proposed workflow allows a fast and accurate generation of automatic treatment plans. AUTO plans can be considered equivalent to MAN ones, with limited clinical impact in the worst-case scenario.     

Assessing the internal consistency of management plans for the recovery of threatened species

Recovery planning is an important global conservation strategy for threatened species. Despite the existence of international standards for recovery planning, deficiencies and anomalies have been detected in several jurisdictions. This study evaluated the quality of recovery plans based on internal consistency as a measurement of coherent planning. We analyzed 236 plans developed by the Australian Government (1992–2006) using three criteria: (a) consistency of gaps in scientific information with prescribed research actions, (b) consistency of identified threats with prescribed threat abatement actions and (c) consistency of established plan objectives with performance evaluation criteria. These criteria were aggregated in order to calculate an index of plan consistency. We tested two hypotheses: (1) plans made for single-species would exhibit better consistency than those for multi-species; and (2) plans made under the amended legislation of the Environment Protection and Biodiversity Conservation Act (EPBCA) would exhibit better consistency than those under the rescinded Endangered Species Protection Act (ESPA). In total, over 85% of the plans consistently addressed the research needs. However, the plans addressed threats poorly (66% of all plans exhibited inconsistencies). Moreover, nearly 50% of all plans established inconsistent performance evaluation criteria. Under the ESPA, single- and multi-species plans exhibited equal consistency, but under the EPBCA, single-species plans clearly exhibited higher consistency. Our major contribution is the assessment of attributes of consistency that are paramount for effective recovery planning. Evaluation of these attributes may provide knowledge of universal utility and relevance to other biodiversity conservation efforts.     

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.     

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.     

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.     

保护地旅游公路的野生动物通道设计原则与技术参数

保护地以其丰富的生物多样性和优美的自然环境为生态旅游的开展提供了基础条件。近年来, 保护地的生态旅游与旅游道路建设得到了飞速发展。旅游公路的修建, 在促进经济发展的同时, 也带来了野生动物致死、基因隔离、栖息地丧失、生境破碎化等一系列生态问题。因此设立合适的野生动物通道作为一种有效方式, 成为缓解公路对野生动物负面影响的主要途径。本文基于动物通道相关研究, 提出通道设计应遵从针对性、科学性、持续有效性、可行性四条原则, 道路生态学与保护生物学相关理论、保护地管理法规与管理规划、关键物种或类群生态学特性与栖息地现状以及沿线地形地貌特征都应作为通道设置的参考依据; 并从通道建设的数量、位置、类型、尺寸、表面设计、配套设施以及后期监测等方面提出了通道建设的技术参数。为长期有效地发挥野生动物通道的生态功能, 建议制定通道建设技术规范, 细化通道技术参数, 积极开展科研监测, 以缓解道路对野生动物的影响。     

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.     

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.     

REPORT FROM OTTAWA

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada''s 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada''s 6396 dentists could supply 30% reinforcement. The dentist''s training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

The impact of climate change and potential distribution of the endangered white winged wood duck (Asarcornis scutulata, 1882) in Indian eastern Himalaya

The White-Winged Wood duck (Asarcornis scutulata) is an endangered forest wetland bird currently on the verge of extinction due to an array of anthropogenic pressures. It has been reported that global climate change could affect the distribution of many bird species globally. Therefore, an understanding the potential distribution of the White-Winged Wood duck in future climate scenarios could facilitate the creation of immediate conservation plans and the mitigation of subsequent threats. This is the first ever study on the distribution of White-Winged Wood Duck (WWWD) where Representative Concentration Pathway (RCP) 8.5 scenario was used to forecast the distribution of the WWWD in the Indian Eastern Himalayan region in the 2050s and 2070s. The study revealed that 1.87 % of the total area of IEH has the high potential distribution of WWWD. The state of Assam alone includes 1.68 % of the highly potential habitat in the region. It was predicted that 436.61 km² of highly potential habitat would be lost by 2070. Changes in the annual temperature range, precipitation in the wettest months (June to September), and precipitation decrease in the warmest quarter (October to December) would result in the loss of highly potential habitats. Under the influence of climate change, the habitat of WWWD in the eastern part of the region is likely to shift towards the western part. It was found that there will be a decline in potential habitat in the Indian states of Arunachal Pradesh, Assam, Nagaland, and Tripura located in the IEH under future climate scenarios. The potential of areas located at the Bhutan and Assam border would increase for supporting WWWD as this species' requires the average annual precipitation about 1000–1200 mm. However, the simultaneous anthropogenic activity would further destroy potential habitats in the future. The current study has provided baseline data on the potential distribution of WWWD in the IEH region for immediate conservation management plans.     

Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?

The committee of inquiry into the outbreak of food poisoning at Stanley Royd Hospital identified serious deficiencies in the management of the outbreak and urged all health authorities to learn from the incident and prepare adequate plans for dealing with any future outbreaks. A survey of district health authorities in England showed that most authorities do not yet have a written plan or that their plans are incomplete and inadequate. The appreciable resistance to such planning suggests that most health authorities would be unable to deal with outbreaks of food poisoning effectively and efficiently.     

Management of the natural ecosystems of the Cape Peninsula: current status and future prospects

The Cape Peninsula is an area of outstanding natural beauty and exceptional biodiversity, worthy of proclamation as a World Heritage Site. The area is dominated by fynbos vegetation, usually managed by means of prescribed burning, together with various programmes aimed at the control of invasive alien plant species. Effective management of the Peninsula is bedevilled by the fact that the area is controlled by no less than 14 different public bodies, resulting in fragmentation of effort and the lack of a standardized approach to management. Historically, many official and unofficial investigations have called for this problem to be resolved, without success. The lack of coherent, focused, and well funded fire and alien weed control management plans for the entire Peninsula is a serious deficiency. Despite this, considerable progress has been made towards the establishment of a database for the Peninsula, and the development of decision support systems that can utilize this database for rational management. Adoption of such a system would provide a powerful uniting tramework that would standardize and influence the management approaches adopted by the various controlling authorities.