Development and application of triage and evacuation equipment for casualties at sea

Traditional triage cannot meet the needs of modern warfare. This paper describes the design of triage and evacuation equipment for casualties at sea that can quickly address mass-casualty triage and store and transmit information during battlefield treatment and medical evacuation. This equipment consists of a high-capacity medical information card, a simulated patient generator, a triage classifier and a multifunctional airbag triage vest.

Casualties' States During Destructive Earthquakes

The index of casualties is introduced for the trapped that is still alive after a destructive earthquake to indicate his (her) injury degree. In order to describe the injury-developing process controlled by three factors: the initial injury degree, the trap surroundings and the physique of the cornered, a function SFC (State-Function of Casualties) can be naturally constructed. Through parameter analysis from eight pieces of figures, it can be found that the trapped with weaker physique and worse initial injury degree and in more adverse trap surroundings deserves sooner rescue.

Ms 6.5 Earthquake Occurred in Ludian County of Yunnan Province,China,Although Forecast Issued before the Earthquake,Life Casualties and Property Losses were Still Caused Significant

1 Geography Location At 16：30 on August 3rd, 2014, Ludian County, Zhaotong City, Yunnan Province （27.1°N, 103.3°E） was hit by Ms 6.5 earthquake, with the maximum intensity is 9 and epicenter depth is around 12 km （Figs. 1 and 2）.

Nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties: Study at Kenyatta National Hospital, Kenya

The purpose of this study was to determine nurse’s knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject’s inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including;assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.

Treatment strategies for mass burn casualties

Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.

Psychological Consequences of a Mass Attack Following Multiple Gunshots and Explosions among Victims in a State in Southwest Nigeria

Introduction: On the 5th of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.

Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran

Objective： To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. Methods： Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. Results： During 52 days, Tehran was stroked by 118 A1-Hussein missiles （a modified version of Scud missile）. Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured （4.9 deaths and 18.3 injuries per missile）. During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons （24%） were excluded due to the lack of information. Among the remainders, 179 （55.8%） were maleand 142 （44.2%） were female. The mean age of the victims was 25.3 years＋19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. Conclusion： The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile at- tacks are necessary.

Research on the Drunk Driving Traffic Accidents Based on Logistic Regression Model

Most of the current studies on drunk driving accidents focus on law making and public education. However, especially in China, there is less statistical analysis on the severity of drunk driving accidents between driving under the influence of alcohol (DUI) and driving while intoxicated (DWI). 3368 drunk driving related crashes were collected from the blood-alcohol test report in a city of China at 2012 and 2013. After data pre-processing, Chi-square tests were used to analyze the association between different variables and the type of drunk driving. The logistic regression model is conducted to estimate the effect of the variables under DUI and DWI. The results show that Hour of the day, Driver’s age, Driver’s casualties and Accident area have significant correlation with drunk driving. There was a slightly decrease by 0.995 per year with age and a slightly increase by 1.014 with time in the possibility of DWI. DWI is more likely to cause death in traffic accidents (OR = 1.316) than DUI. Driver’s deaths (OR = 2.346) is more likely to happen than the injuries (OR = 1.910) under DWI cases. These findings show that more attention should be paid to strengthen controls on the DWI. It also can provide important basis for accident prevent, traffic law enforcement and traffic management.

Musculoskeletal wounds characteristic of the Second Lebanon War

The Second Lebanon War between Hezbollah and Israel broke out on July 12, 2006, and lasted until August 14, 2006. Out of the wounded Israeli soldiers, 128 were treated at the orthopedic departments of the Rambam Medical Center, Haifa, Israel. Aretrospective study was carried out on these 128 combatants. The objective of the study was to characterize musculoskeletal combat wounds with regard to age, type, location, mechanism, side and intensity. The average age of an injured soldier was 25.7 years. Most injuries (63.9%) were caused by shrapnel. The prevalence of injury to the lower limb was much higher compared with upper limb (43.4% vs. 28.3%). There was no side preference. A considerable number of soldiers had more than one injury (60%). The majority of wounds that occurred in the Second Lebanon War were orthopedic-related, particularly involving the upper and lower extremities. Fragmenting weapons were responsible for most injuries.

Potential for a pluripotent adult stem cell treatment for acute radiation sickness

Accidental radiation exposure and the threat of deliberate radiation exposure have been in the news and are a public health concern. Experience with acute radiation sickness has been gathered from atomic blast survivors of Hiroshima and Nagasaki and from civilian nuclear accidents as well as experience gained during the development of radiation therapy for cancer. This paper reviews the medical treatment reports relevant to acute radiation sickness among the survivors of atomic weapons at Hiroshima and Nagasaki, among the victims of Chernobyl, and the two cases described so far from the Fukushima Dai-Ichi disaster. The data supporting the use of hematopoietic stem cell transplantation and the new efforts to expand stem cell populations ex vivo for infusion to treat bone marrow failure are reviewed. Hematopoietic stem cells derived from bone marrow or blood have a broad ability to repair and replace radiation induced damaged blood and immune cell production and may promote blood vessel formation and tissue repair. Additionally, a constituent of bone marrow-derived, adult pluripotent stem cells, very small embryonic like stem cells, are highly resistant to ioniz-ing radiation and appear capable of regenerating radiation damaged tissue including skin, gut and lung.

Assessing Healthcare Facilities Preparedness for Mass Fatalities Incident

Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.

A safety evaluation of profound hypothermia-induced suspended animation for delayed resuscitation at 90 or 120min

Background: The successful treatment of military combat casualties with penetrating injuries is significantly dependent on the time needed to get the patient to an adequate treatment facility. Profound hypothermia induced suspended animation for delayed resuscitation(SADR) is a novel approach for inducing cardiac arrest and buying additional time for such injuries. However, the time used to safely administer circulatory arrest(CA) is controversial. The goal of this study was to evaluate the safety of hypothermia-induced SADR over 90 and 120 min time intervals.Methods: Sixteen male BAMA minipigs were randomized into two groups: CA90 group(90 min, n =8) and CA120 group(120 min, n =8). Cannulation of the right common carotid arteries and internal jugular veins was performed to establish cardiopulmonary bypass for each animal. Through the perfusion of cold organ preservation solution(OPS), cardioplegia and profound hypothermia(15℃) were induced. After CA, cardiopumonary bypass(CPB) was restarted, and the animals were gradually re-warmed and resuscitated. The animals were assisted with ventilators until spontaneous breathing was achieved. The index of hemodynamic perioperative serum chemistry values [alanine transaminase(ALT), aspartate aminotransferase(AST), creatinine(CR), lactic dehydrogenase(LDH) and troponin T(TnT)] and survival were observed from pre-operation to 7 days post-operation.Results: Fifteen animals were enrolled in the experiment, while 1 animal in CA120 group died from surgical error. All 8 animals in CA90 group recovered, with only 1 animal displaying mild disability. However, in CA120 group, only 2 animals survived with severe disability, and the other 5 animals died after 2 days post-operation. In CA90 group, the perioperative serum chemistry values increased at 1 day post-operation(ALT 84.43±18.65 U/L; AST 88.99±23.19 U/L; Cr 87.90±24.49μmol/L; LDH 1894.13±322.26 U/L; TnT 0.849±0.135 ng/ml) but decreased to normal or almost normal levels at 7 days post-operation(ALT 52.48±9.04 U/L; AST 75.23±21.46 U/L; Cr 82.69±18.41μmol/L; LDH 944.67±834.32 U/L; TnT 0.336±0.076 ng/ml).Conclusion: Profound hypothermia-induced SADR is an effective method for inducing cardiac arrest. Our results indicate that inducing CA for 90 min(at 15℃) is safer than doing so for 120 min. Our results indicate that 120 min of CA at 15℃ is dangerous and can result in high mortality and severe neurological complications. Further experimentation is needed to determine whether 120 min of CA at temperatures lower than 15℃ can lead to safe recovery.

Study on evaluation of cities' ability reducing earthquake disasters

Cities ability reducing earthquake disasters is a complex system involving numerous factors, moreover the re-search on evaluating cities ability reducing earthquake disasters relates to multi-subject, such as earthquake sci-ence, social science, economical science and so on. In this paper, firstly, the conception of cities ability reducing earthquake disasters is presented, and the ability could be evaluated with three basic elements the possible seis-mic casualty and economic loss during the future earthquakes that are likely to occur in the city and its surround-ings and time required for recovery after earthquake; based upon these three basic elements, a framework, which consists of six main components, for evaluating citys ability reducing earthquake disasters is proposed; then the statistical relations between the index system and the ratio of seismic casualty, the ratio of economic loss and re-covery time are gained utilizing the cities prediction results of earthquake disasters which were made during the ninth five-year plan; at last, the method defining the comprehensive index of cities ability reducing earthquake disasters is presented. Thus the relatively comprehensive theory frame is set up. The frame can evaluate cities ability reducing earthquake disasters absolutely and quantitatively and consequently instruct the decision-making on reducing cities earthquake disasters loss.

Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism

Both domestic and foreign terror incidents are an unfortunate outgrowth of our modern times from the Oklahoma City bombings, Sarin gas attacks in Japan, the Madrid train bombing, anthrax spores in the mail, to the World Trade Center on September 11 th, 2001. The modalities used to perpetrate these terrorist acts range from conventional weapons to high explosives, chemical weapons, and biological weapons all of which have been used in the recent past. While these weapons platforms can cause significant injury requiring critical care the mechanism of injury, pathophysiology and treatment of these injuries are unfamiliar to many critical care providers. Additionally the pediatric population is particularly vulnerable to these types of attacks. In the event of a mass casualty incident both adult and pediatric critical care practitioners will likely be called upon to care for children and adults alike. We will review the presentation, pathophysiology, and treatment of victims of blast injury, chemical weapons, and biological weapons. The focus will be on those injuries not commonly encountered in critical care practice, primary blast injuries, category A pathogens likely to be used in terrorist incidents, and chemical weapons including nerve agents, vesicants, pulmonary agents, cyanide, and riot control agents with special attention paid to pediatric specific considerations.

Long-term medical treatment of patients with severe burns at exposed sites

BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.

Profiling Casualty Severity Levels of Road Accident Using Weighted Majority Voting

To determine the individual circumstances that account for a road traffic accident,it is crucial to consider the unplanned connections amongst various factors related to a crash that results in high casualty levels.Analysis of the road accident data concentrated mainly on categorizing accidents into different types using individually built classification methods which limit the prediction accuracy and fitness of the model.In this article,we proposed a multi-model hybrid framework of the weighted majority voting(WMV)scheme with parallel structure,which is designed by integrating individually implemented multinomial logistic regression(MLR)and multilayer perceptron(MLP)classifiers using three different accident datasets i.e.,IRTAD,NCDB,and FARS.The proposed WMV hybrid scheme overtook individual classifiers in terms of modern evaluation measures like ROC,RMSE,Kappa rate,classification accuracy,and performs better than state-of-theart approaches for the prediction of casualty severity level.Moreover,the proposed WMV hybrid scheme adds up to accident severity analysis through knowledge representation by revealing the role of different accident-related factors which expand the risk of casualty in a road crash.Critical aspects related to casualty severity recognized by the proposed WMV hybrid approach can surely support the traffic enforcement agencies to develop better road safety plans and ultimately save lives.

Ultrasound diagnosis of fractures in mass casualty incidents

The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound protocols,which are used in MCIs,included extremity ultrasound examination as part of them.The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs.The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively.Nevertheless,majority of these studies were in children and they had very high heterogeneity.The portability,safety,repeatability,and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs.Its potential in managing fractures in MCIs needs to be further defined.The operator should master the technique,understand its limitations,and most importantly correlate the sonographic findings with the clinical ones to be useful.This editorial critically reviews the literature on this topic,describes its principles and techniques,and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.

Portable ultrasonography in mass casualty incidents:The CAVEAT examination

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care settings.The increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be developed.Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute triage.The protocol is two-tiered,based on the urgency and technical difficulty of the sonographic examination.In addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone fractures.Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

Dynamic Method of Seismic Casualty Assessment

The concept of Initial Casualty Matrix is introduced. Using some probability distribution functions, the initial casualty matrix of masonry is determined. The dynamic method of seismic casualty assessment is established and then applied to the Tangshan earthquake data, with some conclusions drawn.

Evaluation and Analysis of Hospital Disaster Preparedness in Jeddah

Introduction: Disaster damage to health systems is a human and health tragedy, results in huge economic losses, deals devastating blows to development goals, and shakes social confidence. Hospital disaster preparedness presents complex clinical operation. It is difficult philosophical challenge. It is difficult to determine how much time, money, and effort should be spent in preparing for an event that may not occur. Health facilities whether hospitals or rural health clinics, should be a source of strength during emergencies and disasters. They should be ready to save lives and to continue providing essential emergencies and disasters. Jeddah has relatively a level of disaster risk which is attributable to its geographical location, climate variability, topography, etc. This study investigates the hospital disaster preparedness (HDP) in Jeddah. Methods: Questionnaire was designed according to five Likert scales. It was divided into eight fields of 33 indicators: structure, architectural and furnishings, lifeline facilities’ safety, hospital location, utilities maintenance, surge capacity, emergency and disaster plan, and control of communication and coordination. Sample of six hospitals participated in the study and rated to the extent of disaster preparedness for each hospital disaster preparedness indicators. Two hazard tools were used to find out the hazards for each hospital. An assessment tool was designed to monitor progress and effectiveness of the hospitals’ improvement. Weakness was found in HDP level in the surveyed hospitals. Disaster mitigation needs more action including: risk assessment, structural and non-structural prevention, and preparedness for contingency planning and warning and evacuation. Conclusion: The finding shows that hospitals included in this study have tools and indicators in hospital preparedness but with lack of training and management during disaster. So the research shed light on hospital disaster preparedness. Considering the importance of preparedness in disaster, it is necessary for hospitals to understand that most of hospital disaster preparedness is built in the hospital system.