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Mass Casualties (mass + casualty)
Selected AbstractsSuicide bombings: process of care of mass casualties in the developing worldDISASTERS, Issue 4 2009Masood Umer In recent times Pakistan's biggest city, Karachi, has witnessed numerous terrorist attacks. The city does not have an emergency response system and only one of the three public sector hospitals has a trauma centre. We describe the pattern of injuries and management of two terror-related mass casualty incidents involving suicide bombers in a developing nation with limited resources. The first incident occurred in May 2002 with 36 casualties, of whom 13 (36%) died immediately and 11 (30.5%) died at the primary receiving hospitals. The second incident was targeted against the local population in May 2004. The blast resulted in 104 casualties, of which 14 (13.46%) died at the site. All patients had their initial assessment and treatment based on Advanced Trauma and Life Support principles and documented on a trauma form. [source] Impact of Disaster Drills on Patient Flow in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 6 2008Nathan Timm MD Abstract Objectives:, Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-accredited hospitals must conduct disaster drills twice a year, with one incorporating a mass casualty incident to the emergency department (ED). The authors found no studies describing the potential negative impact on the quality of care real patients in the ED receive during these drills. The objective was to determine the impact that mass casualty drills have on the timeliness of care for nondisaster patients in a pediatric ED. Methods:, Since 2001, nine disaster drills involving mass casualties to the ED were conducted at the authors' institution. The authors studied 5-, 10-, and 24-hour blocks of time surrounding these events and defined quality measures as the timeliness of care in terms of length of stay (LOS) in ED, time-to-triage, and time-to-physician. Drill dates were compared with control dates (the same weekday on the following week). Paired t-tests were used to compare outcomes of interest between drill and control days. Results:, Nine drill days and nine control days were studied. There was no statistically significant difference between drill dates and control dates in average time-to-triage and time-to-emergency physician and average ED LOS. Admitted patients spent less time in the ED during drill dates. Conclusions:, Disaster drills at this institution do not appear to significantly affect the timeliness of care to nondisaster drill ED patients. Attention should be paid to the quality of care "real" patients receive to ensure that their care is not jeopardized during an artificial stress to the system during a disaster drill. [source] Problems associated with potential massive use of antimicrobial agents as prophylaxis or therapy of a bioterrorist attackCLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2002E. Navas In addition to the direct sanitary damage of a terrorist attack caused by biological weapons, the consequences of the massive stockpiling and consumption of antimicrobial agents in order to treat or prevent the disease under a potential epidemic due to pathogenic bacteria must also be considered. Bacillus anthracis, Francisella tularensis and Yersinia pestis are the bacteria most likely to be used as terrorist weapons. Tetracyclines, quinolones and aminoglycoside are the antibiotics of choice against these microorganisms. The recent terrorist attack with anthrax spores in the USA caused a substantial increase in the sales of ciprofloxacin, as thousands of citizens received antibiotic prophylaxis for either confirmed or suspected exposure to anthrax, and many others stockpiled antibiotic supplies at their homes under a panic scenario. The massive consumption of antimicrobial drugs may lead to the selection of antibiotic resistant strains, and to the appearance of undesirable side effects, such as anaphylaxis or teratogenesis. National health authorities must develop realistic protocols in order to detect, treat and prevent mass casualties caused by biological weapons. An antibiotic stockpile has to be planned and implemented, and home stockpiling of antibiotics must be strongly discouraged. [source] Understanding the Psychological Impact of Terrorism on Youth: Moving Beyond Posttraumatic Stress DisorderCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2007Annette M. La GrecaArticle first published online: 23 JUL 200 Comer and Kendall's (2007) comprehensive review of the impact of terrorism on youth organizes this important and burgeoning area of research. The present commentary focuses on youth outcomes associated with proximal contact with terrorist attacks, and highlights several important issues that merit attention. Specifically, the commentary emphasizes the importance of examining youths' postattack outcomes broadly (in addition to posttraumatic stress disorder and its symptoms), assessing traumatic grief and bereavement when mass casualties occur, and evaluating issues of comorbidity and functional impairment. Future research on the impact of terrorism on youth would benefit from adopting a developmental psychopathology perspective in understanding variables that may influence and be influenced by youths' reactions to terrorist events. Implications for research and clinical practice are discussed. [source] Forensic Dental Training in the Dental School CurriculumJOURNAL OF FORENSIC SCIENCES, Issue 3 2007Daniel C. Stoeckel D.D.S. ABSTRACT: This article reviews the literature regarding forensic education in the dental school curriculum and describes an exercise in forensic identification of victims of a mass casualty. Radiographs were made of dentate human cadavers in the gross anatomy laboratory at the Southern Illinois School of Dental Medicine. The jaws were then removed to provide "wet specimens" for the exercise. Several restorations were performed on the cadaver teeth, after which radiographs of the dissected jaws were made. One author wrote up mock dental records for each of the victims. These records included the first set or "premortem" radiographs. Students participating in the exercise were provided with a plane crash scenario, the dental records of the passengers on the manifest, the dissected jaws, and the second set or "postmortem" radiographs. Students were expected to form three teams. The first two teams evaluated the ante-mortem and postmortem dental records. The third team compared the ante-mortem and postmortem records to arrive at identification. The purpose of the exercise was twofold. It introduced dental students to forensic dentistry and emphasized the need for complete and accurate record keeping in the dental office. Several factors lessened the realism of the exercise and made it difficult to reproduce in the future. These included the uniformity of the dental records and the destruction of cadaver material following the exercise. [source] Simulation in a Disaster Drill: Comparison of High-fidelity Simulators versus Trained ActorsACADEMIC EMERGENCY MEDICINE, Issue 11 2008Brian Gillett MD Abstract Objectives:, High-fidelity patient simulation provides lifelike medical scenarios with real-time stressors. Mass casualty drills must construct a realistic incident in which providers care for multiple injured patients while simultaneously coping with numerous stressors designed to tax an institution's resources. This study compared the value of high-fidelity simulated patients with live actor-patients. Methods:, A prospective cohort study was conducted during two mass casualty drills in December 2006 and March 2007. The providers' completion of critical actions was tested in live actor-patients and simulators. A posttest survey compared the participants' perception of "reality" between the simulators and live actor victims. Results:, The victims (n = 130) of the mass casualty drill all had burn-, blast-, or inhalation-related injuries. The participants consisted of physicians, residents, medical students, clerks, and paramedics. The authors compared the team's execution of the 136 critical actions (17 critical actions × 8 scenarios) between the simulators and the live actor-patients. Only one critical action was missed in the simulator group and one in the live actor group, resulting in a miss rate of 0.74% (95% confidence interval [CI] = 0.01% to 4.5%). All questionnaires were returned and analyzed. The vast majority of participants disagreed or strongly disagreed that the simulators were a distraction from the disaster drill. More than 96% agreed or strongly agreed that they would recommend the simulator as a training tool. The mean survey scores for all participants demonstrated agreement that the simulators closely mimicked real-life scenarios, accurately represented disease states, and heightened the realism of patient assessment and treatment options during the drill with the exception of nurse participants, who agreed slightly less strongly. Conclusions:, This study demonstrated that simulators compared to live actor-patients have equivalent results in prompting critical actions in mass casualty drills and increase the perceived reality of such exercises. 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