Scene Of Incident Research Articles

Factors Influencing MCI Preparedness of Paramedic in XYZ Industrial City

Abstract Mass casualty incident (MCI) in industrial area is a definite threat that can result in environmental damage and loss of property and life. The causes of MCI can range from traffic accidents, industrial accidents, fires, toxic gases and terrorism. Paramedics, along with others emergency response team is among the first to reach at the incident scene to provide aid. Preparation is vital in ensuring that the response is fast, effective and efficient. The objective of the study is to analyze the relationship between knowledge, skills, attitudes and training on MCI Preparedness of paramedic in the XYZ Industrial city. Methodology of this paper is quantitative descriptive with cross sectional approach, while data analysis used the partial least square-structural equation model (PLS-SEM). 108 paramedics in XYZ industrial city involved and completed the survey. The research consist 5 latent variable models with 31 indicator variables. Data retrieval use a direct-share questionnaire. The result from data analysis revealed there is a positive and significant relationship between knowledge, skills, attitudes and training on MCI preparedness at t-value<1.96. Meanwhile, Skill has the most influence on MCI preparedness. Paramedics in the XYZ industrial city have the knowledge, skills, attitudes, training and preparedness that are in the "high category". Exogenous variables; knowledge, skills, attitudes and training explain 65.8% of the preparedness (endogenous variables). Continual commitment from paramedics and management is needed to maintain and enhance preparedness, knowledge, skills, attitudes and training in order to provide better medical emergency services. Keywords: PLS-SEM, MCI, preparedness, paramedics, industrial city.

Evaluation of trauma management in injured Iranian Hajj pilgrims in 2015 Mina stampede

Introduction: The Muslim annual pilgrimage (Hajj) ceremony in 2015 was one of the most catastrophic and tragic events of the Hajj pilgrimage in history. Thousands of pilgrims have been tragically stampeded to death and injured in the land of Mina in Mecca, Saudi Arabia, on September 25 in 2015. The last official statistics declared that at least 2,431 pilgrims died and 427 pilgrims were missed in the blocked street. Furthermore, 464 corpses were Iranian Objectives: The purpose of this study was to evaluate the treatment of the injured pilgrims by the Iranian Hajj Medical Team in Mina and assess its strengths and weaknesses in order to develop a comprehensive approach in dealing with similar events. Methods: The records of the patients were obtained from the archives of the Islamic Republic of Iran Hajj Medical Center. Firstly, the demographic data, method of triage, cause of admission, treatment methods, and referral to Mecca hospitals were extracted, and then some interviews were performed with the members of the medical team who were present at the incident scene. Finally, a protocol was proposed for the management of patients in similar incidents. Results: Out of a total of 1,633 referred patients, 567 injured pilgrims were admitted and treated during the incident. Due to the incomplete medical records, a total of 403 complete medical sheets were included in this study. Moreover, 362 cases (89.8%) improved after cooling and proper fluid replacement. They were discharged with therapeutic measures. A total of 41 injured pilgrims (10.2%) were referred to urban hospitals, and 13 cases of the referrals were due to acute respiratory distress syndrome. Furthermore, 12 subjects were referred for dialysis, and 4 cases of the referrals were due to anxiety disorders. Moreover, three cases of diabetic ketoacidosis, one case of epidural hemorrhage, one case of intracranial hemorrhage, one case of spleen hematoma, one case of sigmoid volvulus, and one case of gastrointestinal bleeding were successfully treated. The most common diagnosis was observed to be dehydration, followed by heat exhaustion and contusion. Approximately, all the victims had some degrees of the aforementioned injuries. Initial therapeutic attempts included rehydration, cooling in the cold tunnel, and correction of electrolyte imbalances. Performing a complete blood count with differential, blood urea nitrogen, sodium, and potassium tests, and urinary catheterization were determined as per case (if needed); nevertheless, fluid therapy and cooling were carried out (as primary resuscitation) for all the injured patients. Conclusions: Therapeutic efficacy was evaluated as excellent due to zero mortality. As a result, it was decided to propose a treatment method for the Hajj Medical Team as a protocol for the management and treatment of injuries caused by mass gathering (e.g., contusion and heat exhaustion) in similar events. For the implementation of the best measures in similar situations, it is compulsory to organize medical teams with trained personnel.

Warning Light Flash Frequency as a Method for Visual Communication to Drivers

Service vehicles use flashing warning lights to indicate their presence to approaching drivers. Present standards offer ranges of flash frequencies to enhance conspicuity and avoid potential risks of photosensitive epilepsy or other issues. But, in practice, the flash frequency is not varied in specific situations. Previous studies have indicated that people interpret faster flash frequencies as more “urgent” than slower flash frequencies. Building on these findings, a laboratory study was conducted to identify whether drivers might be able to use cues from the frequency of flashing warning lights to anticipate how a service vehicle might behave in a work zone or other incident scene. The results suggest that even if they are not taught about the interpretation of different flash frequencies, drivers can differentiate between 1 Hz and 4 Hz flashing lights and learn to make accurate predictions about their meaning. The results also indicate that there are no reliable differences between 1 Hz and 4 Hz flashing in relation to a driver’s ability to detect when a service vehicle has begun to move. Based on the results, a preliminary suggestion is made to use lights flashing at 1 Hz when a service vehicle is moving forward, and 4 Hz when it is traveling in reverse.

On the possibility of luminol solution usage to detect the blood traces when examining the scene

Objective - to present a comparative analysis of the specialized literature on the possibility of using a luminol solution to detect blood traces when examining the scene of an incident. The use of this sample at the incident scene is only preliminary, since its high sensitivity connected with nonspecific properties. Information about the possibility of identifying the species, group and DNA belonging of blood traces after their treatment with a luminol solution is contradictory, therefore, its use at the scene should be careful with the preservation of intact (not treated with luminol) blood traces available for their study by traditional forensic biological methods. The possibility of laboratory determination of the properties of blood after processing its traces with a luminol solution can be proved by a special scientific and experimental forensic biological work.

First aid elements used in potentially toxic / explosive environments in the context of the covid 19 pandemic

Accidents are unplanned occurrences that result in injuries, illness, death, and loss of property and/or production. While there is no way to completely eliminate accidents, there are certain plans, preparations, and actions that can be taken to reduce them. First aid is usually a critical part in the management of acute injuries and conditions. The rescuer is the first person with medical training to arrive at the scene of a medical incident and the purpose of his actions is to maintain vital functions, to prevent the occurrence of dangerous complications for the life and health of the victim, before the intervention of medical staff. Despite current concerns about infection with the new coronavirus 2019 (COVID-19), prevention of its spread and treatment, various lesions and conditions unrelated to this virus still occur. Prompt first aid can prevent an additional burden on the health system by taking care of simple ailments at the crime scene, rather than calling the ambulance system or transporting the victim to a hospital. This paper presents first aid elements in the context of the COVID-19 pandemic, highlighting the manoeuvres that will be performed minimizing the risk of infection with the SARS-CoV-2 pathogen.

A controlled cross-over study to evaluate the efficacy of improvised dry and wet emergency decontamination protocols for chemical incidents.

The UK Initial Operational Response (IOR) to chemical incidents includes improvised decontamination procedures, which use readily available materials to rapidly reduce risk to potentially exposed persons. A controlled, cross-over human volunteer study was conducted to investigate the effectiveness of improvised dry and wet decontamination procedures on skin, both alone, and in sequence. A simulant contaminant, methyl salicylate (MeS) in vegetable oil with a fluorophore was applied to three locations (shoulder, leg, arm). Participants then received no decontamination (control) or attempted to remove the simulant using one of three improvised protocols (dry decontamination; wet decontamination; combined dry and wet decontamination). Simulant remaining on the skin following decontamination was quantified using both Gas Chromatography Tandem Mass Spectrometry (GC-MSMS) for analysis of MeS and UV imaging to detect fluorophores. Additionally, urine samples were collected for 24 hours following application for analysis of MeS. Significantly less simulant was recovered from skin following each improvised decontamination protocol, compared to the no decontamination control. Further, combined dry and wet decontamination resulted in lower recovery of simulant when compared to either dry or wet decontamination alone. Irrespective of decontamination protocol, significantly more simulant remained on the shoulders compared to either the arms or legs, suggesting that improvised decontamination procedures are less effective for difficult to reach areas of the body. There was no effect of decontamination on excreted MeS in urine over 24 hours. Overall, findings indicate that improvised decontamination is an effective means of rapidly removing contaminants from skin, and combinations of improvised approaches can increase effectiveness in the early stages of decontamination and in the absence of specialist resources at an incident scene. However, the variable control and consistency of improvised decontamination techniques means that further intervention is likely to be needed, particularly for less accessible areas of the body.

Analysis of some commonly found inhalants using gas chromatography-mass spectrometry (GC MS) – Effect of substrates on the identification of inhalants

Inhalant abuse is a serious and ever-evolving problem for our society. Inhalants are abused more commonly by teenagers and adolescents. Inhalants such as glue, paint thinners, correction fluid, and nail paint remover are easily available in the market which makes them readily abused. Out of various methods of abuse, huffing (placing a piece of cloth soaked with inhalant is placed in the mouth), bagging (placing head in a polythene bag containing inhalant), and ballooning (balloons filled with inhalant are used for inhaling vapors through the mouth) are most common. Inhalant abuse results in multiple target organ dysfunction with neuritis and brain damage due to the dissolution of the myelin sheath. In acute poisoning cases, it might cause death due to asphyxia and sudden sniffing syndrome. In such cases, various articles containing traces of inhalants could be retrieved from the scene of incidence and to detect these traces become an important facet of the investigation. However, it might be difficult due to the rapid evaporation of inhalants and the formation of reaction product species. In the present study, an attempt has been made to study the effect of three substrates (balloon, cloth, polythene) on component profiles of four paint thinners and four nail paint removers. The study suggests that although some components are retained, there is the formation of a large number of reaction product species and these must be taken into consideration before furnishing the opinion. These reaction product species might also be inhalant specific which must be further explored.

Post-mortem Iris Decomposition and its Dynamics in Morgue Conditions.

With increasing interest in employing iris biometrics as a forensic tool for identification by investigation authorities, there is a need for a thorough examination and understanding of postmortem decomposition processes that take place within the human eyeball, especially the iris. This can prove useful for fast and accurate matching of antemortem with postmortem data acquired at crime scenes or mass casualties, as well as for ensuring correct dispatching of bodies from the incident scene to a mortuary or funeral homes. Following these needs of forensic community, this paper offers an analysis of the coarse effects of eyeball decay done from a perspective of automatic iris recognition. We analyze postmortem iris images acquired for a subject with a very long postmortem observation time horizon (34 days), in both visible light and near-infrared light (860 nm), as the latter wavelength is used in commercial iris recognition systems. Conclusions and suggestions are provided that may aid forensic examiners in successfully utilizing iris patterns in postmortem identification of deceased subjects. Initial guidelines regarding the imaging process, types of illumination, and resolution are also given, together with expectations with respect to the iris features decomposition rates. Visible iris features possible for human, expert-based matching persists even up to 407 h postmortem, and near-infrared illumination is suggested for better mitigation of corneal opacity while imaging cadaver eyes (Post-mortem iris decomposition and its dynamics in morgue conditions. ArXiv pre-print, 2019).

Oględziny i dokumentacja zdarzeń o charakterze upadku z wysokości w terenie eksponowanym i jaskiniach z udziałem ratowników Grupy Jurajskiej Górskiego Ochotniczego Pogotowia Ratunkowego

The article is devoted to issues related to the use of forces and resources of mountain rescue teams during visual inspection of incident areas in exposed areas and caves. The article presents general assumptions about the organization and coordination of this type of inspection from the moment of receiving information about the event and the start of rescue operations by GJ GOPR, until the completion of collecting and securing all infor-mation and evidence as part of the inspection of the incident scene. The article contains issues related to the exchange of information between the involved entities, preparation of documentation meeting formal and legal requirements by trained GJ GOPR rescuers, securing items that may constitute evidence in subsequent proceedings, and the handling of human corpses and remains.

EMSContExt: EMS Protocol-Driven Concept Extraction for Cognitive Assistance in Emergency Response

This paper presents a technique for automated curation of a domain-specific knowledge base or lexicon for resource-constrained domains, such as Emergency Medical Services (EMS) and its application to real-time concept extraction and cognitive assistance in emergency response. The EMS responders often verbalize critical information describing the situations at an incident scene, including patients' physical condition and medical history. Automated extraction of EMS protocol-specific concepts from responders' speech data can facilitate cognitive support through the selection and execution of the proper EMS protocols for patient treatment. Although this task is similar to the traditional NLP task of concept extraction, the underlying application domain poses major challenges, including low training resources availability (e.g., no existing EMS ontology, lexicon, or annotated EMS corpus) and domain mismatch. Hence, we develop EMSContExt, a weakly-supervised concept extraction approach for EMS concepts. It utilizes different knowledge bases and a semantic concept model based on a corpus of over 9400 EMS narratives for lexicon expansion. The expanded EMS lexicon is then used to automatically extract critical EMS protocol-specific concepts from real-time EMS speech narratives. Our experimental results show that EMSContExt achieves 0.85 recall and 0.82 F1-score for EMS concept extraction and significantly outperforms MetaMap, a state-of-the-art medical concept extraction tool. We also demonstrate the application of EMSContExt to EMS protocol selection and execution and real-time recommendation of protocol-specific interventions to the EMS responders. Here, EMSContExt outperforms MetaMap with a 6% increase and six times speedup in weighted recall and execution time, respectively.

Occupational stressors among firefighters: application of multi-criteria decision making (MCDM)Techniques

BackgroundFirefighters are exposed to a wide range of occupational stressors due to the nature of their job. Multi-criteria decision-making technique (MCDM) is a method for identifying, evaluating, and preventing occupational stressors among firefighters. The purpose of this study was to identify and prioritize the occupational stressors among firefighters using the fuzzy delphi method (FDM) and fuzzy analytical hierarchy process (FAHP). MethodsThis qualitative-descriptive study was carried out in two stages. First, the most important occupational stressors of firefighters were identified and screened using a systematic review of scientific references and expert opinions based on the FDM. Then, all of the screened stressors were weighted and prioritized by the FAHP using the opinions of experts. All results were analyzed using Excel software. ResultsAmong, the 52 occupational stressors of firefighters identified in the first stage, 27 stressors were selected to enter into the FAHP. The FAHP results showed that among the four main dimensions, the weight of managerial factors (0.358) was more than other dimensions. The overall result of the study, regardless of the stressors’ main dimensions showed that the most important stressors among firefighters were financial strain due to inadequate pay, fear of explosion at incident scenes, toxic smoke, and gases produced at fires and lack of attention given to job safety by management, respectively. ConclusionAccording to the results of the study, most occupational stressors of the firefighters are caused by organizational factors. Therefore, the implementation of management strategies to reduce the occupational stress of firefighters is recommended.

Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study

BackgroundUp to one in eight trauma patients arrive at a hospital with a partially or completely obstructed airway. The UK National Institute for health and Care Excellence (NICE) practice guidelines recommend that trauma patients requiring anaesthesia for definitive airway management receive this care within 45 min of an emergency call, preferably at the incident scene. How frequently this target is achieved remains unclear. We assessed the recorded time to pre-hospital emergency anaesthesia after trauma across UK helicopter emergency medical service (HEMS) units. MethodsWe retrospectively recorded time to pre-hospital emergency anaesthesia across all 20 eligible UK HEMS units (comprising 52 enhanced care teams) from April 1, 2017 to March 31, 2018. Times recorded for emergency notification, dispatch, arrival, and neuromuscular blocking agent administration were analysed. ResultsHEMS undertook 1755 pre-hospital emergency anaesthetics for trauma across the UK during the study period. There were 1176/1755 (67%) episodes undertaken by helicopter response teams during daylight hours. The median time to pre-hospital emergency anaesthesia was 55 min (inter-quartile range: 45–70); anaesthesia within 45 min of the initial emergency call was achieved in 25% cases. Delayed dispatch time (>9 min) was associated with fewer patients receiving pre-hospital anaesthesia within 45 min (odds ratio: 7.7 [95% confidence intervals: 5.8–10.1]; P<0.0001). ConclusionsThe time to achieve pre-hospital emergency anaesthesia by UK HEMS frequently exceeds the recommended 45 min target. Reducing the time to dispatch of emergency medical teams may impact on the delivery of pre-hospital emergency anaesthesia.

Does Direct Helicopter Retrieval Improve Survival of Severely Injured Trauma Patients From Rural Western Australia?

ObjectiveIn remote Western Australia, mortality from major trauma is more than 4 times higher than mortality rates from major trauma in the capital city of Perth. The objective of this study was to determine whether direct helicopter emergency medical service (HEMS) retrieval from an incident scene within the zone 50 to 250 km of Perth to a tertiary hospital improves survival in severely injured trauma patients. Direct HEMS retrieval was compared with indirect retrieval whereby patients were transferred by ambulance to a nearby rural hospital before retrieval to a tertiary hospital in Perth. MethodsA retrospective analysis (2006-2015) was undertaken of all Western Australia trauma registries, and coronial data were collected for all major trauma patients who died before retrieval to a tertiary hospital in Perth. ResultsA total of 1,374 major trauma patients (indirect retrieval = 1,031 and direct HEMS = 343) met the study inclusion criteria. There was a 51% increased risk of death in the indirect patients compared with the direct HEMS patients (15.3% vs. 10.2%, P ≤ .001). ConclusionDirect HEMS retrieval from the incident scene to a tertiary hospital substantially improves the chances of survival for severely injured trauma patients in rural locations in the zone 50 to 250 km of Perth.

Super-resolution compressive spectral imaging via two-tone adaptive coding

Coded apertures with random patterns are extensively used in compressive spectral imagers to sample the incident scene in the image plane. Random samplings, however, are inadequate to capture the structural characteristics of the underlying signal due to the sparsity and structure nature of sensing matrices in spectral imagers. This paper proposes a new approach for super-resolution compressive spectral imaging via adaptive coding. In this method, coded apertures are optimally designed based on a two-tone adaptive compressive sensing (CS) framework to improve the reconstruction resolution and accuracy of the hyperspectral imager. A liquid crystal tunable filter (LCTF) is used to scan the incident scene in the spectral domain to successively select different spectral channels. The output of the LCTF is modulated by the adaptive coded aperture patterns and then projected onto a low-resolution detector array. The coded aperture patterns are implemented by a digital micromirror device (DMD) with higher resolution than that of the detector. Due to the strong correlation across the spectra, the recovered images from previous spectral channels can be used as a priori information to design the adaptive coded apertures for sensing subsequent spectral channels. In particular, the coded apertures are constructed from the a priori spectral images via a two-tone hard thresholding operation that respectively extracts the structural characteristics of bright and dark regions in the underlying scenes. Super-resolution image reconstruction within a spectral channel can be recovered from a few snapshots of low-resolution measurements. Since no additional side information of the spectral scene is needed, the proposed method does not increase the system complexity. Based on the mutual-coherence criterion, the proposed adaptive CS framework is proved theoretically to promote the sensing efficiency of the spectral images. Simulations and experiments are provided to demonstrate and assess the proposed adaptive coding method. Finally, the underlying concepts are extended to a multi-channel method to compress the hyperspectral data cube in the spatial and spectral domains simultaneously.

Biological mechanisms and individual variation in fibrinolysis after major trauma

ObjectiveTo understand more about the individual variation in the time course of fibrinolysis following major injury and to assess the potential for stratification of trauma patients for tranexamic acid (TXA)...

HIT-NET – system informatyczny umożliwiający integrację i wizualizację wyników trafień (HIT) w bazach DNA i daktyloskopijnych w powiązaniu z danymi kryminalnymi dotyczącymi przestępstw i ich sprawców

Information is an extremely important element of a successful fight with and prevention of crime. Comprehensive use of the information collected by the Police on crimes, their perpetrators and traces left at incident scenes is a guarantee of crime detection and, as a result, an improvement in the level of safety and public order. The originators of the HIT-NET system appreciate the great potential in the databases operating in the Police, in particular forensic databases. The basis of the concept of the designed IT system was to provide an effective IT tool allowing to indicate the relationship between hits found in DNA and fingerprint databases, and then link them with criminal data. The system being under creation makes it possible to find relationships as well as analyse and graphically visualise the identified networks of connections between people, traces and crimes, together with their presentation on a map.

Failing to Plan is Planning to Fail: Capturing the Pre-incident Planning Needs of Firefighters

In a fire suppression operation, seconds can mean the difference between a fatality or successful incident management. There have not been many recent studies that examine the information, tools, and technologies firefighters rely upon to gather facts about the incident scene before arrival. We conducted an international, web-based survey in which 50 firefighters of varying ranks characterized the benefits and challenges of using pre-incident plans, documents that assist firefighters in understanding information about a facility during an emergency. Our analysis showed that despite demographic differences in regions and the size of the population served, most departments reported severe challenges in accessing and retrieving planning information. Based upon participant feedback, we shed light on the problems with existing user interfaces and provide a path forward for the human factors community to build robust technology for first responders operating in dangerous and unpredictable environments.

A forensic analysis of the Florida International University pedestrian bridge collapse using incident video footages

On March 15, 2018, a Florida International University (FIU) pedestrian bridge near Miami, Florida collapsed during construction. The abrupt failure resulted in casualties and garnered worldwide attention. In the present study, a preliminary forensic analysis of this incident was carried out using limited evidence collected from the collapse scene videos recorded by bystanders. This study is limited in its scope in that it is confined to the examination of how the sequence of failures unfolded by interpreting the rough measurements extracted from the videos through the prism of a physics-based (finite element) model of the bridge. The study does not attempt to explore why this incident may have happened. Nevertheless, by identifying how the collapse occurred, it may be possible to better understand the root causes of this unfortunate incident by combining this information with other, more detailed forensic data. Incidentally, this study provides a new avenue for structure collapse analysis by exploiting incident scene videos and wreckage photos obtained from the public domain.

CognitiveEMS

This paper presents our preliminary results on development of a Cognitive assistant system for Emergency Medical Services (CognitiveEMS) that aims to improve situational awareness and safety of first responders. CognitiveEMS integrates a suite of smart wearable sensors, devices, and analytics for real-time collection and analysis of in-situ data from incident scene and delivering dynamic data-driven insights to responders on the most effective response actions to take. We present the overall architecture of CognitiveEMS pipeline for processing information collected from the responder, which includes stages for converting speech to text, extracting medical and EMS protocol specific concepts, and modeling and execution of an EMS protocol. The performance of the pipeline is evaluated in both noise-free and noisy incident environments. The experiments are conducted using two types of publicly-available real EMS data: short radio calls and post-incident patient care reports. Three different noise profiles are considered for simulating the noisy environments: cafeteria, people talking, and emergency sirens. Noise was artificially added at 3 intensity levels of low, medium, and high to pre-recorded audio data. The results show that the i) state-of-the-art speech recognition tools such as Google Speech API are quite robust to low and medium noise intensities; ii) in the presence of high noise levels, the overall recall rate in medical concept annotation is reduced; and iii) the effect of noise often propagates to the final decision making stage and results in generating misleading feedback to responders.

After the gun: examining police visits and intimate partner violence following incidents involving a firearm.

Laws have been enacted to keep firearms out of the hands of abusers. In this study, we examined one such effort-removal of a firearm at the scene of intimate partner violence (IPV)-to assess the subsequent occurrence and number of IPV incidents responded to by police and subsequent risk of injury to the victim. Using the 28,977 IPV calls in one large U.S. city to which officers responded during the 2013 calendar year, we identified 220 first-time incidents in which offenders used (i.e., brandished, pistol whipped, shot) a pistol, revolver, rifle, or shotgun. Officers reported removing a firearm from 52 (24%) of the offenders. After using full propensity score matching to control for potential confounders, logistic and Poisson regressions were used to assess differences between those from whom a firearm was removed and those whose firearm was not removed. Firearm removal at the scene of an IPV incident appears to increase the likelihood of subsequent IPV reports to police and suggestive evidence that subsequent injury to the victim might increase as well. The offender shifting from threats with a firearm to physical violence and a change (an increase as well as a decrease) in victim willingness to summon police may account for the findings.