Resuscitation
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The purpose of this study was to derive an early, highly sensitive and specific prediction rule for the development of post-traumatic acute lung injury (ALI). In a prospective, non-interventional study a convenience sample of 92 adults admitted to the resuscitation room following blunt trauma was studied in order to derive this prediction rule. The study was conducted in the emergency department of a university hospital in the New Territories of Hong Kong. ⋯ The first guideline had a classification rate of 96.7% (95% confidence interval (CI), 90.8-99.3%), a sensitivity of 100% (CI 65.2-100%) and a specificity of 96.5% (CI 90.0-99.3%). The second guideline had a classification rate of 96.7% (CI 90.8-99.3%), a sensitivity of 85.7% (CI 42.1-99.6%) and a specificity of 97.7% (CI 91.8-99.7%). Practical highly sensitive and specific prediction guidelines for post-traumatic acute lung injury have been derived and now require prospective validation.
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Exposures to released hazardous materials (HAZMAT) pose an increasing threat to individual and public health, particularly in high population density. Any incident causing casualties on a scale which threaten or causes overload of the available resources of the emergency medical services (EMS) or associated systems (EMSS), constitutes a major incident (MI). Emergency services, including the EMSS, have a statutory duty to develop a comprehensive, integrated and flexible all-risk Major Incident Plan (MIP) for such an event. ⋯ In addition organisational aspects of the safe management and protection of the EMSS and personnel at the incident site, during transportation and at the receiving hospitals are considered. Safe and effective management of casualties requires adequate protection from further exposure, triage and synchronous decontamination and life support. Finally, the implications of conventional and unconventional conflict including terrorism and current unsolved problems are discussed.
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In response to a possible terrorist threat using nuclear, biological or chemical (NBC) weapons, the US government has set up a special Domestic Preparedness Program which includes a training section for paramedical and other responders to bridge the gap between a conventional HAZMAT incident and one involving NBC agents. The program, which is a partnership between six federal agencies, covers aspects of recognition and management of incidents which may not be within the normal experience of emergency medical services personnel, and builds upon their existing knowledge and training.