American journal of disaster medicine
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The complexities and challenges for healthcare providers and their efforts to provide fundamental basic items to meet the logistical demands of an influenza pandemic are discussed in this article. The supply chain, planning, and alternatives for inevitable shortages are some of the considerations associated with this emergency mass critical care situation. The planning process and support for such events are discussed in detail with several recommendations obtained from the literature and the experience from recent mass casualty incidents (MCIs). ⋯ Resources highlighted within the model include allocation and use of work force, bed space, intensive care unit assets, ventilators, personal protective equipment, and oxygen. The third step is using the model to discuss in detail possible workarounds, suitable substitutes, and resource allocation. An examination is also made of the ethics surrounding palliative care within the construction of an MCI and the factors that will inevitably determine rationing and prioritizing of these critical assets to palliative care patients.
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To assess the level of pandemic preparedness at emergency departments (EDs) around the country and to better understand current barriers to preparedness in the United States represented by health professionals in the American College of Emergency Physician (ACEP) Disaster Medicine Section (DMS). METHODS, DESIGN, and ⋯ There appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals where ACEP DMS members work. This may reflect a broader underlying inadequacy of preparedness measures.
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To determine whether bioterrorism training provided increased awareness and understanding of bioterrorism and to assess physicians' beliefs about the threat of bioterrorism and how it impacts on preparedness. ⋯ Physicians in New Jersey increased their awareness and understanding of bioterrorism through training. However, concerns remain that a physician's belief in a low threat of bioterrorism translates into a low need for bioterrorism preparedness training.
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Hospitals are physical structures with the same risk as other large buildings; the physical plant is vulnerable to acts of nature and man. When hospitals need to evacuate the patient population, logistical support for patient transport will be required. However, a disaster impacting a hospital will likely also affect the surrounding community, and transport resources such as ambulances may be limited as they will also be needed to support the community response. ⋯ Information was obtained from 62 hospitals within Los Angeles County and was used to establish a tool for determining transportation requirements in the event ofa hospital evacuation. This survey demonstrated that approximately 20 percent of hospital inpatients could be discharged to home within a few hours, about 40 percent of hospital inpatients could be transported via vans, buses, or private cars; and the remaining 40 percent would need ambulance transportation for evacuation. Additionally, the survey provides information about the distribution of emergency department and intensive care unit patients and the resources they would require during a hospital evacuation.
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Train crashes represent a devastating multicasualty event. The purpose of this study was to analyze the injury severity, specific organ injuries, and cause of death in the fatalities of the 2008 Chatsworth, Los Angeles train crash. ⋯ The Metrolink train crash in 2008 in Chatsworth, Los Angeles, was the worst train crash in the history of California with 25 fatalities. The most common cause of death was due to chest injury (cardiac and aortic laceration) followed by head injury. This review could aid in improving passenger protection from head-on collision and in further development of head protection in train seats, as well as be useful in disaster planning and a benchmark for future rescue and triage operations.