Prehospital and disaster medicine
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Prehosp Disaster Med · Feb 2014
A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident.
The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. ⋯ This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.
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Prehosp Disaster Med · Feb 2014
Médecins sans frontières experience in orthopedic surgery in postearthquake Haiti in 2010.
During January 2010, a 7.0 magnitude earthquake struck Haiti, resulting in death and destruction for hundreds of thousands of people. This study describes the types of orthopedic procedures performed, the options for patient follow-up, and limitations in obtaining outcomes data in an emergency setting. ⋯ The number of fractures described in this report represents one of the larger orthopedic cohorts of patients treated in a single center in the aftermath of the 2010 earthquake in Haiti. The emergent surgical care described was carried out in difficult conditions, both in the hospital and the greater community. While outcome and complication data were limited, the proportion of patients attending follow-up most likely exceeded expectations and may reflect the importance of the rehabilitation center. This data demonstrates the ability of surgical teams to perform highly-specialized surgeries in a disaster zone, and also reiterates the need for access to essential and emergency surgical programs, which are an essential part of public health in low- and medium-resource settings.
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Prehosp Disaster Med · Feb 2014
Reconsidering policy of casualty evacuation in a remote mass-casualty incident.
Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation. ⋯ In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
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Prehosp Disaster Med · Feb 2014
Comparative StudyUse of a hooked cutting device compared with scissors for the emergency exposure of critically ill and injured patients.
The initial assessment of critical patients includes prompt identification of life-threatening conditions. Any device or technique that can aid in this process may ultimately save lives. This study examined whether clothing could be removed faster with the use of a hooked cutting device as compared with the commonly-used heavy-duty, blunt-tipped, serrated scissors. ⋯ The hooked device was 69% faster at removing clothing than traditionally-used scissors. Though simple in concept, these implications can be life saving, particularly in conditions of uncontrolled, life-threatening external hemorrhage.
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Prehosp Disaster Med · Feb 2014
Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.
The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality. ⋯ In the appropriate setting, the use of the municipal "911" ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.