Disaster medicine and public health preparedness
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Disaster Med Public Health Prep · Mar 2011
Allocation of scarce resources after a nuclear detonation: setting the context.
The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. ⋯ With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.
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Disaster Med Public Health Prep · Mar 2011
Survival interval in earthquake entrapments: research findings reinforced during the 2010 Haiti earthquake response.
Earthquakes can result in collapsed structures with the potential to entrap individuals. In some cases, people can survive entrapment for lengthy periods. The search for and rescue of entrapped people is resource intensive and competes with other postdisaster priorities. ⋯ This article presents historical evidence and reports from the 2010 Haiti earthquake. Factors that may contribute to survival after entombment are listed. Finally, a decision process for projecting viability that considers the critical factors in each incident rather than adhering to a single time frame for ceasing search and rescue activities is proposed.
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Disaster Med Public Health Prep · Mar 2011
Radiological incident preparedness: planning at the local level.
Radiological terrorism has been recognized as a probable scenario with high impact. Radiological preparedness planning at the federal and state levels has been encouraging, but translating complex doctrines into operational readiness at the local level has proved challenging. ⋯ Local governmental agencies constitute the first line of response and are critical to the success of the operation. This article is intended as a starting framework for local governmental efforts toward developing a response plan for radiological incidents in their communities.
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Disaster Med Public Health Prep · Dec 2010
Comparative StudyA modified sequential organ failure assessment score for critical care triage.
The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score. ⋯ The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.