Unmanned aerial vehicle based intelligent triage system in mass-casualty incidents using 5G and artificial intelligence

BACKGROUND:Rapid on-site triage is critical after mass-casualty incidents(MCIs)and other mass injury events.Unmanned aerial vehicles(UAVs)have been used in MCIs to search and rescue wounded individuals,but they mainly depend on the UAV operator’s experience.We used UAVs and artificial intelligence(AI)to provide a new technique for the triage of MCIs and more efficient solutions for emergency rescue.METHODS:This was a preliminary experimental study.We developed an intelligent triage system based on two AI algorithms,namely OpenPose and YOLO.Volunteers were recruited to simulate the MCI scene and triage,combined with UAV and Fifth Generation(5G)Mobile Communication Technology real-time transmission technique,to achieve triage in the simulated MCI scene.RESULTS:Seven postures were designed and recognized to achieve brief but meaningful triage in MCIs.Eight volunteers participated in the MCI simulation scenario.The results of simulation scenarios showed that the proposed method was feasible in tasks of triage for MCIs.CONCLUSION:The proposed technique may provide an alternative technique for the triage of MCIs and is an innovative method in emergency rescue.

Emergency response to nuclear, biological and chemical incidents: challenges and countermeasures

Given the multiple terrorist attacks that have occurred in recent years in China, medical rescue teams and specialized incident assessment teams have been established by the government; however, medical rescue after nuclear, biological, and chemical incidents remains challenging and is often inefficient. In the present article, problems were analyzed regarding the assessment of responder countermeasures, training of professionals and the management of emergency medical incidents related to nuclear, biological and chemical attacks. Countermeasures, the establishment of response coordination, public education, practical training and exercise, and a professional consultant team or system should be the focus of emergency medical response facilities. Moreover, the government was offered professionals who are involved in managing nuclear, biological and chemical incidents.

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.

Incidents with Dioxins and PCBs in Food and Feed-Investigative Work, Risk Management and Economic Consequences

The identification of contamination sources within the food chain with polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzo-furans (PCDFs), (“dioxins”), and PCBs is difficult and complex. PCDD/PCDF can be formed as unintentional compounds in a number of chemical processes as well as in almost every combustion process. PCBs were intentionally produced chemicals that were manufactured for decades before the ban in marketing and use in many countries around 1985. The pattern of occurrence can change from the original source in particular via feedingstuffs to food of animal origin as result of bioaccumulation. A number of examples illustrate the challenging detective work and key scientific aspects for identification of the sources, for support of the risk management and for performance of monitoring programs. The contamination of milk and milk products in European countries with dioxins was caused by compound feeds containing citrus pulp pellets from Brazil which had high dioxin levels as a result of the use of heavily contaminated lime used for neutralization. The Belgian dioxin crisis was caused by a feed additive heavily contaminated with PCBs which were discharged into a recycled fat used in the production of animal feed. Guar gum from India was contaminated with sodium pentachlorophenate and dioxins. Clay was found to be possibly highly contaminated with dioxins possibly formed by geothermal processes over time;use of such clay as feed additive or for human intake led to elevated dioxin levels in food and humans. Bioanalytical screening in combination with comprehensive physicochemical investigations led to the detection of brominated flame retardants and brominated dioxins in a feed additive. Buffalo milk was contaminated in Italy presumably caused by illegal deposition of waste. High PCB levels in fuel oil for drying of breadcrumb used as a feed ingredient caused a major dioxin crisis with pork meat in Ireland. Fatty acids for technical purposes originating from a biodiesel company were used for production of feed fat which contaminated parts of the food chain in Germany. In addition to effects on human and animal health these incidents also have serious economic consequences which could be mitigated by more frequent control on food and feed. Addressing both these issues, the European Community has developed a strategy to reduce the presence of dioxins and PCBs in the environment and in feed and food comprising the establishment of maximum and action levels.

A Literature Review on Freeway Traffic Incidents and Their Impact on Traffic Operations

Congestion on the freeway is more frequent due to several traffic incidents, namely traffic accidents, debris on the road, vehicle breakdown, and collision with guardrails than any other incidents. These, in turn, affect the operational performance of the freeway by increasing queue length, volume, and density. Consequently, effective freeway management strategies can help to minimize these impacts. The study investigates and summarizes existing studies to identify the reasons for and effects of the traffic incidents. Attention is given to the available solutions of the freeway traffic incidents management. The ultimate goal of this study is to identify the gaps which are not yet addressed to improve the operational effectiveness of the freeway. This study was conducted through a comprehensive literature review of existing refereed publications, established standards, and formal guidelines. Literature was sought through the Transport Research International Documentation (TRID) database, IEEE Transactions database, and google scholar search engine. Research focusing on freeway traffic incidents is a growing concern in transportation operations, as transportation network performance depends on it. Due to the advancement of technology, emerging vehicle technologies like connected vehicles have the potential to address these problems affecting the US transportation system and revolutionize mobility in the future. The study can serve as a reference for the researchers that are involved in freeway traffic operations.

Selection and Optimization of Path Responding to Unexpected Environmental Incidents in China

By analyzing disposal status of unexpected environmental incidents by government,public and enterprise,and combining the characteristics of unexpected environmental incidents,specific measures of responding to unexpected environmental incidents are proposed from the aspects of perfecting guarantee system of emergency nomocracy,enhancing information disclosure,encouraging public participation,enhancing the construction of emergency response capability,and enhancing post-event management,to improve the ability of defending environmental risk.

Leadership Behaviors, Organizational Culture, and Incidents Reporting Practices as Perceived by Jordanian Nurses, Literature Review

Background: Safety of patients and their families is recognized as a priority for all healthcare organizations all over the world;therefore, exploring the variables that influence patient safety issues is paramount. Objective: This literature review is to detect the gab in the body of knowledge regarding issues of incidents reporting practices, leadership behaviors, and organizational culture especially in Jordanian context, as well as, to give reflection about the searched studies and to address the strength and weakness points of each study as well. The design of the current article was literature review of twenty five studies. Results: The current review revealed that most of the research studies were conducted in order to explore the perceptions of healthcare providers about patient safety issues, and clinical incidents reporting practices as well, however, there are few studies that were conducted in order to investigate the influence of leadership behaviors and organizational culture on incidents reporting practices as perceived by Jordanian hospitals’ registered nurses. Moreover, it seems that in Jordanian context, it is not fully understood the influence of leadership behaviors and organizational culture on incidents reporting practices as perceived by Jordanian hospitals’ registered nurses. Conclusion: It is imperative for researchers to fill the gap that existed in the body of knowledge regarding the variables of leadership behaviors, hospitals’ organizational culture and incidents reporting practices in order to enhance patient safety and safety practices in health care organizations. Relevance to clinical practice: Exploring the influence of leadership behaviors and organizational culture on incidents reporting practices among registered nurses in Jordan is highly recommended. Finally, the current review identifies the gap in the body of knowledge regarding the mentioned above variables.

A Survey of Bath Time Incidents Experienced by Mothers and Families of Children Aged 18 Months

Purpose: The potential dangers of infant bathing have an effect not only on the infant’s body and life but also on the formation of emotional bonds in the parent-child relationship. This study will explore actual dangers experienced by mothers and families. Method: We distributed an anonymous, self-reported questionnaire at infants’ 18-month health checkup, which was collected via postal service. 304 valid responses were received and formed our sample data. Descriptive statistical analysis was performed for each category surveyed. Inferential statistics were used to compare the dangerous incidents experienced with regard to differences between primipara/multipara and the presence/absence of guidance concerning such incidents. This study was approved by the research ethics committees of the affiliated university. Results: 70% of mothers and families experienced incidents while bathing their infants, with the most common incidents consisting of, in order of frequency, near immersion of the face, actual immersion of the face, and falling into the bath. The most common situations reported when incidents occurred were bathing the infant by oneself, the infant moving unexpectedly, or taking care of other children, in that order. Approximately 70% of mothers and families had not received instruction on the potential dangers or how to prevent them. Conclusion: This study has elucidated the dangerous situations experienced in the course of bathing infants in the home and the measures taken to prevent such situations. Instructive tools are needed which can be used to easily provide mothers and families with correct information.

Study on the Key Influence Factors of Environmental Mass Incidents by Delphi-PCA-Frequency Analysis Composite Method

In order to prevent and control environmental mass incidents,by comprehensively using literature research,case analysis and logical reasoning method,27 factors influencing environmental mass incidents were selected. Among them,15 key influencing factors were screened by Delphi-PCA-frequency analysis composite method. The key influencing factors were analyzed,and corresponding countermeasures were put forward.

Human Sensor Web Crowd Sourcing Security Incidents Management in Tanzania Context

Security incidents affecting information systems in cyberspace keep on rising. Researchers have raised interest in finding out how to manage security incidents. Various solutions proposed do not effectively address the problematic situation of security incidents. The study proposes a human sensor web Crowd sourcing platform for reporting, searching, querying, analyzing, visualizing and responding to security incidents as they arise in real time. Human sensor web Crowd sourcing security incidents is an innovative approach for addressing security incidents affecting information systems in cyberspace. It employs outsourcing collaborative efforts initiatives outside the boundaries of the given organization in solving a problematic situation such as how to improve the security of information systems. It was managed by soft systems methodology. Moreover, security maturity level assessment was carried out to determine security requirements for managing security incidents using ISO/IEC 21827: Systems security engineering capability maturity model with a rating scale of 0 - 5. It employed descriptive statistics and non-parametric statistical method to determine the significance of each variable based on a research problem. It used Chi-Square Goodness of Fit Test (X2) to determine the statistical significance of result findings. The findings revealed that security controls and security measures are implemented in ad-hoc. For managing security incidents, organizations should use human sensor web Crowd sourcing platform. The study contributes to knowledge base management learning integration: practical implementation of Crowd sourcing in information systems security.

Analysis of Critical Incidents during Anesthesia in a Tertiary Hospital

Introduction: Critical incident monitoring is important in quality improvement as it identifies potential risks to patients by analyzing adverse events or near-misses. Methods: This study analyses the reported incidents in a tertiary hospital over a 4-year period. Results: A total of 441 incidents were reported out of 98,502 anesthetics performed during the study period. Of these incidents, 67 resulted in no harm caused, 116 with unanticipated ICU admissions and 20 mortalities. The odds of having a critical incident increased with ASA status: from an odds ratio of 2.08 (95% CI: 1.58 to 2.74) for ASA 2 patients compared to ASA1, to OR of 13.70 (5.91 to 31.74) in ASA 5 compared to ASA 1. Critical incidents also have higher odds occurring out of hours (OR 1.7 (1.45 to 2.23) compared to daytime hours (08:00-17:00). They occurred most commonly in maintenance phase (142, 32.7%), followed by induction (120, 27.6%). The most common types of incidents include airway and respiratory (110, 24.9%) followed by drug related incidents (67, 15.2%). Human error was attributed as a significant contributing factor in 276 incidents (61.5%) followed by patient factors in 112 incidents (25.4%). Mitigating factors such as vigilance by staff involved were significant in 136 incidents (30.3%). Conclusion: Higher ASA status appears to be the most important factor associated with actual or potential patient harm in our study. Also significant, was time of incident, with incidents more likely out of hours. Critical incident reporting is a valuable part of quality assurance. We should continue to invest in incident reporting, incident analysis and improvement plans.

Research on Government Emergency Management Strategy Based on Public Health Incidents

It is the government's basic responsibility to ensure public health safety.However,due to the influence of the environment and human beings,some public health incidents are still inevitable,endangering public health and undermining social stability.However,any public health incident is traceable,and there will be a process from latent period to outbreak.Therefore,the government needs to grasp the key points of health incidents,strengthen emergency management,and ensure social stability and public safety.

Practical approach to determining traffic congestion propagation boundary due to traffic incidents

A practical approach for predicting the congestion boundary due to traffic incidents was proposed. Based on the kinematic wave theory and Van Aerde single-regime flow model, a model for estimating the congestion propagation speed for the basic road segment was developed. Historical traffic flow data were used to analyze the time variant characteristics of the urban traffic flow for each road type. Then, the saturation flow rate was used for analyzing the impact of the traffic incident on the traversing traffic flow at the congestion area. The base congestion propagation speed for each road type was calculated based on field data, which were provided by the remote traffic microwave sensors(RTMS), floating car data(FCD) system and screen line survey. According to a comparative analysis of the congestion propagation speed, it is found that the expressway, major arterial, minor arterial and collector are decreasingly influenced by the traffic incident. Subsequently, the impact of turning movements at intersections on the congestion propagation was considered. The turning ratio was adopted to represent the impact of turning movements, and afterward the corresponding propagation pattern at intersections was analyzed. Finally, an implementation system was designed on a geographic information system(GIS) platform to display the characteristics of the congestion propagation over the network. The validation results show that the proposed approach is able to capture the congestion propagation properties in the actual road network.

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.

Risk Factors for Anesthesia-Related Airway Patient Safety Incidents:A Single-Center Retrospective Case-Control Analysis from 2009 to 2022

Objective Airway-related patient safety incident(PSI)has always been the top concern of anesthesiologists because this type of incidents could severely threaten patient safety if not treated immediately and properly.This study intends to reveal the composition,prognosis,and to identify risk factors for airway related incidents reported by anesthesiologists.Methods All airway related PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and May 2022 were collected from the PSI reporting system.Patients with airway incidents reported were matched 1:1 with controls based on sex and type of surgery.Univariable and multivariable analysis were performed to find risk factors associated with airway incident occurrence,and to evaluate influence of airway PSIs on patient prognosis.Results Among 1,038 PSIs voluntarily reported by anesthesiologists during the study period,281 cases(27.1%)were airway-related incidents,with an overall reporting incidence of 4.74 per 10,000 among 592,884 anesthesia care episodes.Only ASA physical status was found to be significant independent predictor of these airway PSIs(P=0.020).Patients with airway PSIs reported had longer extubation time(0.72±1.56 d vs.0.16±0.77 d,95%CI:0.29 to 0.82,P<0.001),longer ICU length of stay(LOS)(1.63±5.71 d vs.0.19±0.84 d,95%CI:0.57 to 2.32,P=0.001),longer post operative LOS(10.56±13.09 d vs.7.59±10.76 d,95%CI:0.41 to 5.53,P=0.023),and longer total in-hospital LOS(14.99±15.18 d vs.11.62±11.88 d,95%CI:0.46 to 6.27,P=0.024).Conclusions This single-center retrospective case-control study describes the composition of airway-related PSIs reported by anesthesiologists within thirteen years.Airway incidents might influence patient prognosis by elongating extubation time and LOS.Airway PSI data were worth analyzing to improve patient safety.

The Stava Valley Tailings Dams Disaster:A Reference Point for the Prevention of Severe Mine Incidents

On July 19,1985,at Stava near Tesero(Italian Alps),two reservoirs collapsed,causing the death of 268 people and the destruction of many buildings.The two adjacent basins were constructed for the decantation and storage of fine-grained waste material,which was pumped from a nearby fluorite mine.The consequence of the failure was a vast flowslide that found its way downstream along the Stava valley destroying many houses in the village of Stava,eventually reaching Tesero,where more property was wrecked or severely damaged.The Stava valley disaster was one of the most tragic of its kind.This paper aims to give a contribution on the technical aspects related to the causes of this catastrophic event.It also describes alternative technical solutions for the proper management of mining waste disposal and environmental protection proposed by the Stava 1985 Foundation for disseminating knowledge and awareness on how to make these geotechnical structures safer and more profitable and avoid other similar disasters that still keep occurring every year around the world.

Evaluation and Outcome of Surgeon-Reported Incidents regarding Surgical Patient Safety

Background: We retrospectively analyzed incident reports from surgeons to learn about surgical patient safety and improve surgical quality. Material and Methods: For the 10 years and 3 months between February 2007 and May 2017, 236 incident reports from surgeons were collected. The impact levels of the incidents for patients were represented by a degree of adverse influence to a patient (level 0, 1, 2, 3a, 3b, 4a, 4b, and 5). The outcome of the incident reports was evaluated by the profile, cause, surgery-relation, and factor. Results: The level of incidents resulted in level 0 (n = 18, 7.6%), level 1 (n = 28, 11.9%), level 2 (n = 16, 6.8%), level 3a (n = 44, 18.6%), level 3b (n = 94, 39.8%), level 4a (n = 1, 0.4%), level 4b (n = 6, 2.5%), level 5 (n = 15, 6.4%) and others (n = 14, 5.9%). The profiles of the surgery-related incidents (n = 84) showed other unexpected events (15.7%, n = 37), second surgery within 24 hours (9.3%, n = 22), and unexpected excessive bleeding (6.8%, n = 16). The cause of the sur-gery-related incidents involved hemorrhage (n = 45, 53.6%). Except for complications and accidental diseases (n = 77, 32.6%), the occurrence factor of the incidents cited factors of personal behavior (n = 85, 36.0%), human factors (n = 37, 15.7%), environmental equipment (n = 6, 2.5%), and others (n = 31, 13.1%). Conclusions: The perioperative incidents submitted by surgeons were comparatively proved to be a higher influence level for patients such as unexpected events or surgery and second surgery within 24 hours. An incident reporting system is crucial for surgeons to ensure both surgical patient safety and to improve surgical quality. An aggressive reporting attitude should become useful to enhance safety awareness on a facility-wide basis.

Development of a System to Support Surgical Safety-I and Safety-II. Implementation of Resilient Surgical Healthcare for Bleeding Incidents in Thoracic Surgery

Background: Since bleedings in surgery are infrequent and inexperienced, we always try to proceed with surgery assuming a crisis situation, adhere to routine procedures and its standardization. We focus on the bleeding accidents and reveal how to implement a resilient healthcare theory. By clarifying the Safety-I and Safety-II, we developed a system to support surgical safety based on the surgeon’s individual, team, and organization. Material and Methods: We searched 25 cases of bleeding incidents in thoracic surgery, which were obtained from the database of the Project to Collect Medical Near-Miss/Adverse Event Information of the Japan Council of Quality Health Care in April 2018. Retrospectively, we analyzed 13 hemorrhage cases in our department between July 2002 and March 2020. We studied their surgical factors such as procedures, sites and causes of bleeding, response, treatment, and outcomes. Results: The causes of bleeding included damage of the adhesion detachment, insertions of automatic sutures and forceps, detachment of ultrasonic scalpel, vascular taping, removal of resected lung, lymph node dissection, exfoliation of the infiltrated adventitia of vessels, pull-out of vessel, gauze attachment with staple cut-line of vessel, thoracoscopic collision, infectious vascular rupture, detachment of vascular ligature, and suction tube hit. We summarized the variation in the usual controllable and unexpected uncontrollable bleeding and learned how to respond and treat them. We built up the balanced combination of Safety-I and Safety-II in the daily routine work in normal surgery, the patient’s individual factors, the massive bleeding, and its life-threatening crisis. Conclusions: We can learn how to prevent and respond to bleeding accidents by developing a system to support surgical safety (Safety-I and Safety-II). We can flexibly respond to unexpected bleeding disturbances under constraints by adjusting the surgeon’s individuals, team, and organization.

Survey on Blood Transfusion Practices among Medical and Paramedical Staff in the Pediatric Unit of the Mohammed VI University Hospital in Marrakesh, Morocco

Blood transfusion is a complex activity, involving many actors. As a high-risk activity, it necessitates the implementation of specific methods for effective control. The safety of blood transfusion is significantly influenced by the beliefs of healthcare workers and organizational factors, constituting two major considerations. We conducted a cross-sectional, descriptive, and analytical survey to examine the knowledge and practices related to transfusion among the medical and paramedical staff at the Pediatric Department (Mother-Child) of CHU Mohammed VI from September 1, 2022, to December 31, 2022. Among the 135 staff members interviewed, only 41% had received training in blood transfusion. A majority (65.2%) of the staff noted that a mismatch in cross-matching led to transfusion complications. Two-thirds (66.7%) identified chills as the primary clinical sign of potential accidents. Regarding elements to monitor during a reaction, hemolysis (78.5%) and temperature (76.3%) were most commonly mentioned. Surprisingly, more than half (53.3%) of the personnel interviewed did not conduct post-transfusion monitoring. This survey highlighted significant deficiencies in knowledge and practices related to transfusion. To address these issues, we recommend implementing guidelines and providing tailored training for the staff, aiming to rectify these deficiencies and enhance overall practices.

INTELLIGENT SECURITY SYSTEMS ENGINEERING FOR MODELING FIRE CRITICAL INCIDENTS:TOWARDS SUSTAINABLE SECURITY

An intelligent security systems engineering approach is used to analyze fire and explosive critical incidents, a growing concern in urban communities. A feed-forward back-propagation neural network models the damages arising from these critical incidents. The overall goal is to promote fire safety and sustainable security. The intelligent security systems engineering prediction model uses a fully connected multilayer neural network, and considers a number of factors related to the fire or explosive incident including the type of property affected, the time of day, and the ignition source. The network was trained on a large number of critical incident records reported in Toronto, Canada between 2000 and 2006. Our intelligent security systems engineering approach can help emergency responders by improving cr^tical incident analysis, sustainable security, and fire risk management.