Casualty Incidents Research Articles

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience >50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

Vision Zero: Speed Limit Reduction and Traffic Injury Prevention in New York City

We examine the effect on the incidence of casualties and crashes of a city-wide vehicle speed limit reduction in New York City (NYC) streets. The law change, part of Mayor Bill de Blasio’s Vision Zero Action Plan to improve traffic safety, cuts the default speed limit for streets with no speed limit signs from 30 to 25 mph beginning November 7, 2014. We use a monthly panel dataset with crash statistics for the entire population of NYC streets, from July 2012 through March 2019. Several difference-in-differences regressions show a statistically significant and meaningful decline in injuries and crashes.

Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study

BackgroundThe triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan.MethodsThis study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention.ResultsThe patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4–98.3%) and a specificity of 86.7% (62.1–96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity.ConclusionsThe current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.

Outcomes after Long-Term Follow-Up of Combat-Related Extremity Injuries in a Multidisciplinary Limb Salvage Clinic

Although the incidence of casualties from the Global War on Terror is decreasing, there remains a focus on the long-term sequelae from injuries sustained in the combat. Patients with prior significant limb injuries remain at risk of future complications. This study examines our institution's experience with a multidisciplinary team approach toward this challenging patient population. A retrospective review was performed on all patients treated in a single institution Limb Preservation Clinic over a 2-year period. Those patients who sustained a combat-related injury in theater were examined. Patient demographics, mechanism of injury, amputation rates, time to amputation, and reasons for failure were examined. Ninety-four patients were evaluated in our multidisciplinary Limb Preservation Clinic over a 2-year period. Twenty patients (21%) were seen for combat-related injuries. Sixteen patients were evaluated and treated for chronic complications at a median of 13 months from their injury. All 16 patients were male with a median age of 24 years (range, 20-35). Ten patients sustained injuries secondary to a dismounted improvised explosive device (IED). All 16 patients had extensive soft tissue injuries and associated fractures. Only 2 patients sustained a vascular injury. The median number of prior surgeries to the affected limb was 8 (range, 3-19). The limb salvage rate of 37% was lower than our noncombat cohort (47%). The most common reasons for delayed amputation included chronic pain, osteomyelitis, and soft tissue infections. The high secondary amputation rates seen in this cohort underscores the need for long-term follow-up. Despite successful initial outcomes, many patients eventually progress to limb loss. Patients who sustain a dismounted IED are at greatest risk for a delayed amputation. Identifying and addressing those factors which lead to delayed amputation should be a priority for returning war veterans and focus of future studies.

The characteristics of lightning risk and zoning in Beijing simulated by a risk assessment model

Abstract. In this study, the cloud-to-ground (CG) lightning flash/stroke density was derived from the lightning location finder (LLF) data recorded between 2007 and 2011. The vulnerability of land surfaces was then assessed from the classification of the study areas into buildings, outdoor areas under the building canopy and open-field areas, which makes it convenient to deduce the location factor and confirm the protective capability. Subsequently, the potential number of dangerous lightning events at a location could be estimated from the product of the CG stroke density and the location's vulnerability. Although the human beings and all their material properties are identically exposed to lightning, the lightning casualty risk and property loss risk was assessed respectively due to their vulnerability discrepancy. Our analysis of the CG flash density in Beijing revealed that the valley of JuMaHe to the southwest, the ChangPing–ShunYi zone downwind of the Beijing metropolis, and the mountainous PingGu–MiYun zone near the coast are the most active lightning areas, with densities greater than 1.5 flashes km−2 year−1. Moreover, the mountainous northeastern, northern, and northwestern rural areas are relatively more vulnerable to lightning because the high-elevation terrain attracts lightning and there is little protection. In contrast, lightning incidents by induced lightning are most likely to occur in densely populated urban areas, and the property damage caused by lightning here is more extensive than that in suburban and rural areas. However, casualty incidents caused by direct lightning strokes seldom occur in urban areas. On the other hand, the simulation based on the lightning risk assessment model (LRAM) demonstrates that the casualty risk is higher in rural areas, whereas the property loss risk is higher in urban areas, and this conclusion is also supported by the historical casualty and damage reports.

A NATIONAL REVIEW OF AUSTRALIA'S MARITIME ENVIRONMENTAL EMERGENCY RESPONSE ARRANGEMENTS

ABSTRACT Australia's National Plan for Maritime Environmental Emergencies (‘the National Plan’) is a cooperative national strategy for the preparing, responding and recovering from maritime casualty and marine pollution incidents. A review of the National Plan was conducted between 2011 and 2012 following a series of shipping and offshore petroleum incidents which presented the most significant challenges to National Plan since its inception in 1973. The Review incorporated two streams of work – a national risk assessment modelled the current and 10 year outlook of the marine pollution threat to Australia and a capability analysis, involving consultation with over 90 stakeholder groups, identified areas for improvement in national preparedness. Forty-seven recommendations were forthcoming from the review including:Implementing a modern governance model for the National Plan, clarifying responsibilities and providing for the formal engagement of stakeholders.Alignment of planning and response systems with mainstream emergency services to improve the national response capability.Implementing a single response arrangement for maritime casualty and oil and chemical pollution.Addressing gaps in capability, including the development of a national chemical response capability, nationally accredited training and succession planning for the National Response Team. This paper describes the conduct of the Review, the significant outcomes for Australia's preparedness and the ongoing program to embed these outcomes into all levels of response planning in Australia.

The Ammonia Leak Monitoring and Warning System Based on Wireless Sensor Network in Industrial Environments

In order to prevent the ammonia leak caused casualties incidents, this paper adopts ZigBee wireless technology to real-time monitoring of ammonia concentration. Equipped with MQ137 ammonia sensor in the terminal node, and the use of STM8 microcontroller collected the ammonia concentration data. The data will be transmitted to the coordinator through ZigBee. Using LabVIEW to design the monitoring interface of computer, and read concentration data through the serial port communication. When the ammonia concentration exceeds the preset value, the GSM module will send the location of leak in the form of short messages to staff. Through the reasonable arrangement of sensor nodes in ammonia production workshop, can effectively avoid the ammonia leak hurting the safety of people's life and property.

Spinal Cord Injuries Sustained in Road Crashes Are Not on the Decrease in France: A Study Based on Epidemiological Trends

Traumatic spinal cord injuries (SCI) are rare but extremely costly. In order to improve the modelling of inclusion criteria for studies of SCI it is necessary to determine what epidemiological trends affect SCI. Using the Rhone Registry, which contains all the casualties resulting from road crashes in the Rhône département of France and codes their injuries using the Abbreviated Injury Scale (AIS), we describe the epidemiological trends that affect spinal cord injury (SCI), major spinal trauma (MST) and severe injuries (AIS4+) to other body regions between two periods 1996-2001 and 2003-2008. Although there has been a marked decrease (35%) in the incidence of casualties after a road traffic crash, and reductions of 22% in the incidence of MST and 33% in that of severe injuries (AIS4+) (p<0.001), for SCI the incidence rate and number of casualties have remained surprisingly stable. In the second period, there was no change in the incidence of SCI resulting from road traffic crashes, nor in the associated fatality, mortality and survival rates. The incidence for car users was significantly lower in the second period. This contrasts with the incidences for motorcyclists and for the group including pedestrians and cyclists which were respectively 47% and 77% higher in the second period. The median age of the casualties, the age-adjusted incidence of SCI and the number of associated injuries were also higher in the second period. We have observed a marked reduction in the incidence of road trauma including the most severe injuries, but not SCI. The higher proportion of motorcyclists, the increase in the age of casualties and the greater presence of multiple injuries are new factors in the epidemiology of SCI after a road crash.

Health Care Emergency Management: Establishing the Science of Managing Mass Casualty and Mass Effect Incidents

Particularly since 2001, the health care industry has witnessed many independent and often competing efforts to address mitigation and preparedness for emergencies. Clinicians, health care administrators, engineers, safety and security personnel, and others have each developed relatively independent efforts to improve emergency response. A broader conceptual approach through the development of a health care emergency management profession should be considered to integrate these various critical initiatives. When based on long-standing emergency management principles and practices, health care emergency management provides standardized, widely accepted management principles, application concepts, and terminology. This approach could also promote health care integration into the larger community emergency response system. The case for a formally defined health care emergency management profession is presented with discussion points outlining the advantages of this approach.

Developing disaster management modules: a collaborative approach

Disasters, whether natural or human induced, can strike when least expected. The events of 9/11 in the US, the 7/7 bombings in the UK, and the anthrax incident in the US on 10th October 2001 indicate that there is a need to have a nursing workforce who is able to respond effectively to mass casualty events and incidents involving chemical, biological, radiological and nuclear substances. Multi-agency collaboration is one of the fundamental principles of disaster preparedness and response. It was therefore necessary to take a similar multi-agency collaborative approach to develop modules on the management of mass casualty events and incidents involving hazardous substances. The modules are offered to registered nurses and registered paramedics. They can be taken independently or as part of a BSc in nursing or health pathway, on a part-time basis. Since the commencement of the modules in September 2004, registered paramedics and registered nurses who work in a wide range of specialties have accessed them.

A method for tracking mass casualty or terrorism incidents in existing databases.

A method for tracking mass casualty or terrorism incidents in existing databases.

Review of: Mass Fatality and Casualty Incidents. A Field Guide

Abstract The author recommends that you read through this entire “field guide,” and that you ask yourself how you or your agency fits into the response to mass fatality and casualty incidents. This seemed like strange advice for a book with a “field guide” format, including numerous lists and outlines of procedures. However, having followed the author's advice, I concur with his recommendation.

Army Psychiatry in the Korean War: The Experience of 1 Commonwealth Division

This study seeks to investigate the incidence of psychiatric casualties in 1 Commonwealth Division during the Korean War. It had been hypothesized that these casualties were unusually low compared with earlier conflicts. Casualty returns and psychiatric reports were analyzed and showed that the war fell into two phases determined by the intensity of combat, which, in turn, influenced the nature of the psychiatric disorders encountered. Rates of acute combat stress were closely correlated with battle casualties, although not with total psychiatric admissions or nonbattle injuries. The limitations imposed on the psychiatric liaison service by the medical organization suggested that the incidence of psychosomatic cases, including cold injury, may have been unintentionally underreported.

Factors contributing to military casualty rates during war

Discussion of psychiatric casualty figures in military personnel tends not to distinguish between acute and chronic conditions. Combat-related stress (CRS) responds well to immediate, short-term intervention. Overall psychiatric casualties are approximately 30%. Contemplating the future in 1982, Romo &amp; Schneider suggested casualty figures might be higher. This article considers factors contributing to the incidence of psychiatric casualties.

Use of fire statistics in behavioural studies

This paper gives data on information available on casualty incidence and behaviour from fire brigade reports. The data presented appear to refute several popular beliefs about the typical casualty fire. Fire brigade data are large in volume and cover a wide range of fires but provide only limited information on each individual fire. Thus, for further information on behaviour patterns, some fires will have to be investigated in detail.

Heatstroke From Running

To the Editor.— The article by Hanson and Zimmerman (242:154, 1979) points to a new aspect of an old problem now appearing on the clinical scene, heatstroke. The present problem is with the young and healthy who collapse on hot and humid days while fun running. As we have shown 1 such incidents as heatstroke are occurring in fun runners even when environmental conditions would not ordinarily have been suspected to predispose to heat injury. Experience with Sydney's The Sun City-to-Surf Run, now in its tenth year, has resulted in a number of recommendations to prevent and treat victims of heat injury. This run now attracts 21,000 to 22,000 entrants annually, and the accumulated experience since the first race in 1971, with 2,005 entrants, to the present is with approximately 93,563 runners. 2 Since the inaugural race, when 29 runners collapsed, the incidence of heat casualties has declined mainly from rescheduling

Kibbutz civilian population under war stress.

During the Arab-Israeli war of 1973 measures had to be taken by the kibbutz civilian population in Israel to cope with the stresses of war. The measures adopted, and the specific characteristics of an organized cohesive group, appear to have succeeded in reducing the severity of the reactions to stress and in lowering the incidence of psychiatric casualties among children and adult members of the kibbutzim.

The Social Incidence of Vietnam Casualties

The Social Incidence of Vietnam Casualties

Effects of an artificial acclimatization technique on infantry performance in a hot climate.

The performance of an infantry company was first assessed on a three-day exercise in this country. Its twelve sections were then divided into two treatment groups. The experimental group, consisting of the six odd-numbered sections, was subjected to an artificial acclimatization routine consisting of physical exercises in an improvised hot chamber. The control groups consisting of the six even-numbered sections, performed the same exercises in a room of similar proportions at ambient temperatures. After approximately two weeks of these training regimes, the company was immediately flown to Aden where its performance under considerable stress was assessed during a seven-day exercise in the desert. Of eight performance tests only three indicated beneficial effects of artificial acclimatization. The most impressive difference between the two groups was in the number of casualties, most of which occurred during marching tests. Casualty incidence was three times greater in the control group, both for heat casu...

Studies of Korean war casualties. I. Psychiatric manifestations in wounded men.

Following \Vorld War I and World War II observations were occasionally made in the literature regarding the occurrence of psychiatric symptoms in the wounded. Miller noted that several years after the First World War a number of disabled veterans had become discouraged and preoccupied with their inability to compete with unhandicapped men. Earlier, these men had been singularly free from psychiatric symptoms but when the glory associated with their wounds no longer drew the acclaim of others they had become markedly discontented and increasingly disabled. Culpin reported that in some of his wounded patients latent emotional disturbances emerged during convalescence, complicating recovery. Several other writers commented on the striking absence of psychiatric symptoms in the wounded and in the earlier literature the idea was frequently expressed that a wound was a protection against combat fatigue. Ranson, in World War II, however, observed manifestations of anxiety in convalescent wounded men who anticipated return to combat. Studies of the incidence of psychiatric casualties, of wounds, and of injuries incurred in battle from causes other than enemy action led Glass to the conclusion that a considerable loss in man-power occurs in warfare from psychogenic causes other than avowed psychiatric illness. Recently, Morrison has emphasized the disturbance in the “body image” that accompanies hemiplegic and paraplegic disorders and points to the need for acceptance by the patient of his changed “self” and for acceptance of the patient by his environment.