Emergency Treatment Facilities Research Articles

Post-earthquake modelling of transportation networks using an agent-based model

Surface transportation systems are an essential part of urban transportation infrastructure and are susceptible to damage from earthquakes. This damage, along with the lack of prior warning of earthquake events, may lead to severe and unexpected disruption of normal traffic patterns, which may seriously impair post-disaster response. Accordingly, it is important to understand the performance of urban transportation systems immediately following an earthquake, to evaluate their capability to support emergency response, e.g., the movement of firefighters, search and rescue teams and medical personnel, and the transportation of injured people to emergency treatment facilities. For this purpose, a scenario-based methodology is developed to model the performance of a transportation network immediately following an earthquake using an agent-based model. The model accounts for the abrupt changes in destination, irrational behavior of drivers in the chaotic aftermath of a severe earthquake, unavailability of traffic information and impairment in traffic capacity due to bridge damage and building debris. An illustration using the road network of Tangshan City, China shows that the method can capture the traffic flow characteristics immediately after an earthquake and can determine the capability of the transportation network to transfer injured people to hospitals. Thus, it can provide rational support for evaluating the performance of the surface transportation system under immediate post-disaster emergency conditions.

Primary school teachers’ knowledge about and attitudes toward anaphylaxis

One in 10,000 children experiences an anaphylactic attack, every year. It has been demonstrated that 82% of these attacks occur in children of school age and that most of the attack-related deaths have occurred in schools. In this study, we aimed to investigate primary school teachers' knowledge about and attitudes toward anaphylaxis. A total of 237 teachers were questioned: 91 working in elementary state schools and 146 in private schools. A questionnaire was completed to obtain data on their knowledge of anaphylaxis and the availability of emergency treatment facilities in schools. Fifty-two percent of the teachers knew which students had an allergic disease. When questioned about agents that can potentially cause anaphylaxis, the most significant causes were thought to be pollen by 54% of the teachers, food by 47%, mites by 40%, and drugs by 30%. Of foods, eggs (30.4%) and strawberries (25.3%) were thought to be the two leading causes. The teachers' responses on what would be their initial reaction in the event of an anaphylactic reaction were: he/she would give first aid in 24.3%, notify the school nurse in 39.7%, and call the emergency services in 19.8%. Only 10% were aware of an epinephrine autoinjector, and only 4% knew where to apply it. While 28% of the teachers reported that they had been informed about anaphylaxis previously, most had formed their ideas from brochures or the media. While 25% of the teachers knew all of the symptoms of anaphylaxis, 54% knew some, and 21% none. Only 6% of the teachers reported that there was a management plan for anaphylaxis in their schools. This study shows that primary school teachers are not well informed about anaphylaxis. Teachers should be given training on the subject, and there should be a re-evaluation of school and health policies with a wider global perspective. There is an urgent need to inquire into the allergy management plans and policies in schools and to develop teacher education organizations on the subject.

Chronic Disease and Related Conditions at Emergency Treatment Facilities in the New Orleans Area After Hurricane Katrina

Disaster preparations usually focus on preventing injury and infectious disease. However, people with chronic disease and related conditions (CDRCs), including obstetric/gynecological conditions, may be vulnerable to disruptions caused by disasters. We used surveillance data collected after Hurricane Katrina to characterize the burden of visits for CDRCs at emergency treatment facilities (eg, hospitals, disaster medical assistance teams, military aid stations). In 6 parishes in and around New Orleans, health care providers at 29 emergency treatment facilities completed a standardized questionnaire for injury and illness surveillance from September 8 through October 22, 2005. Of 21,673 health care visits, 58.0% were for illness (24.3% CDRCs, 75.7% non-CDRCs), 29.1% for injury, 7.2% for medication refills, and 5.7% for routine or follow-up care. The proportion of visits for CDRCs increased with age. Among men presenting with CDRCs, the most common illnesses were cardiovascular disease (36.8%), chronic lower-respiratory disease (12.3%), and diabetes/glucose abnormalities (7.7%). Among women presenting with CDRCs, the most common were cardiovascular disease (29.2%), obstetric/gynecological conditions (18.2%), and chronic lower-respiratory disease (12.0%). Subsequent hospitalization occurred among 28.7% of people presenting with CDRCs versus 10.9% of those with non-CDRCs and 3.8% of those with injury. Our data illustrate the importance of including CDRCs as a part of emergency response planning.

Methemoglobinemia Caused by Volatile Nitrites

We report two cases of severe methemoglobinemia caused by accidental oral ingestion of volatile nitrites. Amyl nitrite, isobutyl nitrite, and other volatile nitrites are used as aromas and video head cleaners. However, they are also inhaled and abused to achieve arousal and mood-enhancement. Case 1 was a 26-year-old female who accidentally drank one 10 ml bottle of the inhaled stimulant “KIX®”, the primary ingredient of which is amyl nitrite and experienced dizziness, vomiting, and prominent systemic cyanosis. Arterial blood gas analysis demonstrated a Met-hemoglobin value of 58.3 percent. One hour after intravenous administration of 1.0 mg/kg methylene blue, Met-hemoglobin had decreased to 17.4 percent, and cyanosis had also disappeared. Case 2 was a 45-year-old male who accidentally drank a 9 ml bottle of the inhaled stimulant “RUSH®”, the primary ingredient of which is isobutyl nitrite. After 30 minutes, the subject experienced vomiting, loss of consciousness, prominent systemic cyanosis, and urinary and fecal incontinence. Arterial blood gas analysis demonstrated a Met-hemoglobin value of 54.7 percent. One hour after intravenous administration of 1.0 mg/kg methylene blue, Met-hemoglobin had decreased to 3.8 percent, and cyanosis had also disappeared. Intravenous administration of methylene blue was effective against methemoglobinemia caused by volatile nitrite poisoning. In severe methemoglobinemia, the proportion of oxygenated hemoglobin is reduced and exposes tissues to a hypoxic state in the first hour after treatment, even if oxygen partial pressure by arterial blood gas is high. In the interest of rapid treatment, we believe that pharmacies at emergency treatment facilities should prepare aqueous solutions of methylene blue in advance.

Patient Education as a Quality Indicator in Critical Care: Ischemic Heart Disease—Recognition and Response

Medical critical care unit (MCCU) nurses at a VA medical center designed a quality assurance monitor for educating cardiac patients. Patients with a diagnosis of rule-out myocardial infarction are interviewed about their preadmission use of nitroglycerin and entry into emergency treatment facilities. The MCCU nurses teach a five-point "ischemic heart disease--recognition and response" lesson, and ascertain the patient's immediate level of understanding. If the patient returns to the MCCU at a later date, nurses record the appropriateness of his use of nitroglycerin and entry into emergency treatment facilities. Thus, both short- and long-term gains in patient knowledge are assessed. Solutions to problems encountered in the quality assurance monitor implementation process are discussed. Benefits of the project to patients, the nursing department, and other departments are identified. A sample monthly report and the monitor data collection tool illustrate the process. Future directions for patient education efforts in the MCCU are outlined.

Benzodiazepine overdosage: plasma concentrations and clinical outcome.

Plasma concentrations and their relation to clinical outcome were evaluated in 21 patients who reached emergency treatment facilities following acute overdosage with benzodiazepine derivatives. Diazepam was implicated in 18 of the 21 cases, with plasma diazepam levels ranging from 585-8,635 ng/ml. In four cases of overdosage with diazepam alone, patients were minimally sedated and were discharged within 24 h, despite diazepam doses as high as 750 mg and plasma levels as high as 4,792 ng/ml. However, concurrent ingestion of diazepam together with other central depressant drugs (such as ethanol, barbiturates, analgesics, or tricyclic antidepressants) produced serious intoxication in 5 of the remaining 14 patients, regardless of the diazepam dosage or plasma concentration. Thus the severity of poisoning following benzodiazepine overdosage is determined largely by co-ingestion of other central depressants rather than the amount of benzodiazepine ingested or its concentration in plasma.

Drug Abuse and the Emergency Room Physician

Physicians staffing emergency treatment facilities seldom are required to make hasty judgments regarding pharmacotherapy of drug abuse. Unnecessary morbidity frequently results from the use of barbiturates and major tranquilizers in the emergency room. The need for sedatives and tranquilizers should be carefully assessed before they are administered. Drug-induced agitation or panic will often subside spontaneously or in response to reassurance, obviating the need for coadministration of sedatives.

Air Travel for Patients

For many years an empirical principle has been used to determine whether or not persons with chronic illnesses should fly. It has worked well and is still valid: The person who looks, feels, acts, and smells normal and can walk a city block and climb the steps of a loading ramp can fly without likelihood of difficulty. With the development of high speed pressurized aircraft and improved ground facilities, this principle can be somewhat expanded. Several general considerations are made when a patient is being evaluated for air travel. The basic question to be answered is, can the patient travel by any means? If intensive care and emergency treatment facilities must be readily available, travel by any conveyance is contraindicated. An important aspect of this consideration is the stability of the patient's condition. If a patient flies on a commercial airline his condition should not require much more attention from the cabin personnel than that of any passenger. If the ill person needs a lot of assistance, an attendant should accompany him. While airline personnel will gladly assist ill or handicapped persons to board and deplane, they do not provide nursing or medical care. Flight attendants receive the basic Red Cross first

Elements of a comprehensive emergency medical services system

Abstract A systems approach to the provision of emergency medical services allows community leaders to plan and implement a comprehensive program to meet their specific needs. Development of an effective EMS system requires familiarity with the components of which the system is made up. Among the necessary components are recognition of an emergency situation, the provision of first aid, the ability to communicate with emergency treatment facilities, transportation in appropriate vehicles, the availability of well-trained emergency care personnel, categorization of emergency care facilities, and data collection and audit. It is imperative that dynamic, informed civic and professional leaders assume responsibility for making comprehensive emergency medical services a reality rather than a much-discussed but unfulfilled plan.