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.     

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.     

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.     

The Summerland Disaster.

The reception, admission, and subsequent management of casualties from the Summerland fire are described. A senior member ofthe staff assessed priorities and direceted casualties to different prearranged teams, and a nurse was allocated to each patient to aid continuity of treatment and documentation. Though regular revision and discussion of major accident procedures with all members of the hospital staff and co-ordination with other rescue workers is helpful expensive rehearsals are of limited value in a civilian incident.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

The Organization for Disaster in British Columbia

Plans are being formulated for organizing an Emergency Health Service in British Columbia. The same organization that is being created to deal with civilian casualties after an enemy attack should, it is felt, be able to assist in major natural disasters. Such an organization will have to remain ready but inactive for long periods; therefore the responsibility for planning, organizing and directing this service has been given to the Health Branch, Provincial Department of Health Services and Hospital Insurance.A committee has been struck to advise the Health Branch, and a Director and a Health Supplies Officer have been appointed. Agreement has been reached as to who is to be assigned to work in the Emergency Health Service in the event of a nuclear attack, and sites have been selected for the stockpiling of medical equipment.The Province has been divided into zones, and Emergency Health Service Directors have been appointed for each zone. Their duties include, among many others, organizing Advanced Treatment Centres and Emergency Hospitals, and developing an Emergency Public Health Service, an Emergency Blood Transfusion Laboratory and a Mortuary Service.     

The use of a GIS-based multi-criteria evaluation technique for the development of a zoning plan for a seasonally variable Ramsar wetland site in Syria: Sabkhat Al-Jabboul

Zoning is an important tool used in the management of protected areas and wetlands. It has been developed to apply conservation objectives at different levels of management where conflicting uses can be taking place. GIS is increasingly used to solve land allocation problem with techniques based on zoning, varying from simple overlays to complex multi-criteria evaluation techniques (MCE). This study presents a new approach to the development of zoning plans for Ramsar sites that exhibit major seasonal variations in conservation value and human use and threats. It employs a well-defined GIS-based MCE technique which involves both expert judgment and a set of criteria based on ecological and potential threats. A GIS model using the additive approach in MCE was developed to evaluate Sabkhat Al-Jabboul the only Ramsar site in Syria. The model was applied separately for the spring and winter to accommodate seasonal changes in the intensity and spatial distribution of conservation areas and threats across the site. Separate zoning plans were developed for each of the two main seasons. The zoning plan of the spring season, which is the birds breeding season, included three management zones; the special conservation zone, the conservation buffer zone, and the wise use zone. The winter zoning plan, where the bird feeding activity was the major activity includes two zones: a special conservation zone and a wise use zone. Thus, in cases like Sabkhat Al-Jabboul, where the wetlands are subject to significant seasonal variations, in their ecology and human utilization, it is recommended that flexible seasonal zoning plans are developed to assist in the organization of permitted activities, and to reduce the potential human impacts throughout the year.     

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。     

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.     

Are protected areas truly protected? The impact of road traffic on vertebrate fauna

The extension of road networks is considered one of the major factors affecting fauna survival. Roadkill has been documented widely and affects all taxonomic groups. Although roadkill is associated mainly with traffic density, some life-history traits of species and the area surrounding roads are expected to modify number of roadkills both taxonomically and geographically. Here we studied the number of roadkills of vertebrates in an extensive region in the northeastern Iberian Peninsula. We surveyed 820?km of 41 roads in two different seasons (spring and autumn), that differ in traffic intensity. In addition, we covered zones with distinct climatic characteristics and levels of protection of the surrounding habitats. Amphibians showed the highest number of roadkills whereas reptiles, birds and mammals had similar rates. General Linear Model tests showed no differences in roadkills by climatic region; however, differences in number of roadkills were linked to protection status, with the highest number of casualties in highly protected areas. Redundancy Analysis demonstrated that the number of amphibians and reptiles killed was associated with roads in highly protected areas whereas that of mammals and birds was linked to unprotected areas. Protected areas often receive many visitors, which in turn may increase wildlife casualties as a result of greater traffic density. We recommend that correction measures be taken to reduce the high number of vertebrate fauna killed along roads that cross protected areas.     

Cambrian spiral-plated echinoderms from Gondwana reveal the earliest pentaradial body plan

Echinoderms are unique among animal phyla in having a pentaradial body plan, and their fossil record provides critical data on how this novel organization came about by revealing intermediate stages. Here, we report a spiral-plated animal from the early Cambrian of Morocco that is the most primitive pentaradial echinoderm yet discovered. It is intermediate between helicoplacoids (a bizarre group of spiral-bodied echinoderms) and crown-group pentaradiate echinoderms. By filling an important gap, this fossil reveals the common pattern that underpins the body plans of the two major echinoderm clades (pelmatozoans and eleutherozoans), showing that differential growth played an important role in their divergence. It also adds to the striking disparity of novel body plans appearing in the Cambrian explosion.