Medical Lessons Learned From Chernobyl Relative to Nuclear Detonations and Failed Nuclear Reactors

2012 ◽  
Vol 6 (4) ◽  
pp. 330-334 ◽  
Author(s):  
Cham E. Dallas
Keyword(s):  
Large Scale ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Nuclear War ◽  
Clinical Procedures ◽  
Medical Response ◽  
Research Findings ◽  
Administrative Strategies ◽  
A Current ◽  
Subsequent Patient

ABSTRACTThe Chernobyl disaster in 1986 involved the largest airborne release of radioactivity in history, more than 100 times as much radioactivity as the Hiroshima and Nagasaki atomic bombs together. The resulting emergency response, administrative blunders, and subsequent patient outcomes from this large-scale radiological disaster provide a wealth of information and valuable lessons for those who may find themselves having to deal with the staggering consequences of nuclear war. Research findings, administrative strategies (successful and otherwise), and resulting clinical procedures from the Chernobyl experience are reviewed to determine a current utility in addressing the appropriate protocols for a medical response to nuclear war. As various myths are still widely associated with radiation exposure, attention is given to the realities of a mass casualty medical response as it would occur with a nuclear detonation.(Disaster Med Public Health Preparedness. 2012;6:330-334)

Lessons Learned from Cross-border Medical Response to the Terrorist Bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004

2005 ◽  
Vol 20 (4) ◽  
pp. 253-257 ◽  
Author(s):  
Adi Leiba ◽  
Amir Blumenfeld ◽  
Ariel Hourvitz ◽  
Gali Weiss ◽  
Michal Peres ◽  
...  
Keyword(s):  
Large Scale ◽  
Time Course ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Border Zone ◽  
Terrorist Attacks ◽  
Trauma Centers ◽  
Medical Response ◽  
Peripheral Areas

AbstractIntroduction:Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario.Methods:Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response.Results:A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation “staging hospital”. Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter.Conclusion:Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an “evacuation hospital”, and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.

Terrorism in France

2003 ◽  
Vol 18 (2) ◽  
pp. 92-99 ◽  
Author(s):  
Pierre Carli ◽  
Caroline Telion ◽  
David Baker
Keyword(s):  
Emergency Response ◽  
Life Support ◽  
Mass Casualty ◽  
Lessons Learned ◽  
National Plan ◽  
Medical Response ◽  
Emergency Medical ◽  
Mass Casualty Events ◽  
Psychological Assistance ◽  
Key Aspects

AbstractFrance has experienced two waves of major terrorist bombings since 1980. In the first wave (1985–1986), eight bombings occurred in Paris, killing 13 and injuring 281. In the second wave (1995–1996), six bombings occurred in Paris and Lyon, killing 10 and injuring 262. Based on lessons learned during these events, France has developed and improved a sophisticated national system for prehospital emergency response to conventional terrorist attacks based on its national emergency medical services (EMS) system, Service d' Aide Medicale Urgente (SAMU). According to the national plan for the emergency medical response to mass-casualty events (White Plan), the major phases of EMS response are: (1) alert; (2) search and rescue; (3) triage of victims and provision of critical care to first priority victims; (4) regulated dispatch of victims to hospitals; and (5) psychological assistance.Following the 1995 Tokyo subway sarin attack, a national plan for the emergency response to chemical and biological events (PIRATOX) was implemented. In 2002, the Ministries of Health and the Interior collaborated to produce a comprehensive national plan (BIOTOX) for the emergency response to chemical, biological, radiological, and nuclear events. Key aspects of BIOTOX are the prehospital provision of specialized advance life support for toxic injuries and the protection of responders in contaminated environments. BIOTOX was successfully used during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in France.

Managing Mild Casualties in Mass-Casualty Incidents: Lessons Learned from an Aborted Terrorist Attack

2007 ◽  
Vol 22 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Yuval H. Bloch ◽  
Adi Leiba ◽  
Nurit Veaacnin ◽  
Yohanan Paizer ◽  
Dagan Schwartz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Terrorist Attack ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Psychiatric Evaluation ◽  
Second Phase ◽  
Minor Trauma ◽  
Medical Specialties ◽  
Medical Response ◽  
Injured Patients

AbstractIntroduction:Mildly injured and “worried well” patients can have profound effects on the management of a mass-casualty incident. The objective of this study is to describe the characteristics and lessons learned from an event that occurred on 28 August 2005 near the central bus station in Beer-Sheva, Israel. The unique profile of injuries allows for the examination of the medical and operational aspects of the management of mild casualties.Methods:Data were collected during and after the event, using patient records and formal debriefings.They were processed focusing on the characteristics of patient complaints, medical response, and the dynamics of admission.Results:A total of 64 patients presented to the local emergency department, including two critical casualties. The remaining 62 patients were mildly injured or suffered from stress. Patient presentation to the emergency department was bi-phasic; during the first two hours following the attack (i.e., early phase), the rate of arrival was high (one patient every three minutes), and anxiety was the most frequent chief complaint.During the second phase, the rate of arrival was lower (one patient every 27 minutes), and the typical chief complaint was somatic. Additionally, tinnitus and complaints related to minor trauma also were recorded frequently.Psychiatric consultation was obtained for 58 (91%) of the patients. Social services were involved in the care of 47 of the patients (73%).Otolaryngology and surgery consultations were obtained for 45% and 44%, respectively. The need for some medical specialties (e.g., surgery and orthopedics) mainly was during the first phase, whereas others, mainly psychiatry and otolaryngology, were needed during both phases. Only 13 patients (20%) needed a consultation from internal medicine.Conclusions:Following a terrorist attack, a large number of mildly injured victims and those experiencing stress are to be expected, without a direct relation to the effectiveness of the attack. Mildly injured patients tend to appear in two phases. In the first phase, the rate of admission is expected to be higher. Due to the high incidence of anxiety and other stress-related phenomena, many mildly injured patients will require psychiatric evaluation. In the case of a bombing attack, many of the victims must be evaluated by an otolaryngologist.

Medical Response to the Tianjin Explosions: Lessons Learned

2017 ◽  
Vol 12 (3) ◽  
pp. 411-414 ◽  
Author(s):  
Jin-Jun Zhang ◽  
Tian-Bing Wang ◽  
Da Fan ◽  
Jun Zhang ◽  
Bao-Guo Jiang
Keyword(s):  
Emergency Medical Services ◽  
Early Stage ◽  
Prehospital Care ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Medical Services ◽  
Medical Response ◽  
Emergency Medical ◽  
Mass Casualty Event ◽  
The Government

AbstractBackgroundOn August 12, 2015, a hazardous chemical explosion occurred in the Tianjin Port of China. The explosions resulted in 165 deaths, 8 missing people, injuries to thousands of people. We present the responses of emergency medical services and hospitals to the explosions and summarize the lessons that can be learned.MethodsThis study was a retrospective analysis of the responses of emergency medical services and hospitals to the Tianjin explosions. Data on injuries, outcomes, and patient flow were obtained from the government and the hospitals.ResultsA total of 46 ambulances and 143 prehospital care professionals were dispatched to the scene, and 198 wounded were transferred to hospitals by ambulance. More than 4000 wounded casualties surged into hospitals, and 798 wounded were admitted. Both emergency medical services and hospitals were quick and successful in the early stage of the explosions. The strategy of 4 centralizations (4Cs) for medical services management in a mass casualty event was successfully applied.ConclusionsThe risk of accidental events has increased in recent years. We should take advantage of the lessons learned from the explosions and apply these in future disasters. (Disaster Med Public Health Preparedness. 2018; 12: 411–414)

Distribution of Casualties in a Mass-Casualty Incident with Three Local Hospitals in the Periphery of a Densely Populated Area: Lessons Learned from the Medical Management of a Terrorist Attack

2007 ◽  
Vol 22 (3) ◽  
pp. 186-192 ◽  
Author(s):  
Yuval H. Bloch ◽  
Dagan Schwartz ◽  
Moshe Pinkert ◽  
Amir Blumenfeld ◽  
Shkolnick Avinoam ◽  
...  
Keyword(s):  
Medical Management ◽  
Terrorist Attack ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Suicide Bombing ◽  
Populated Area ◽  
Medical Response ◽  
Ambulance Dispatch ◽  
To Receive

AbstractIntroduction:A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources.When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city.Methods:Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.Results:Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick.The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated.Conclusion:The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area.Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital.The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

scholarly journals Human Consequences of Multiple Nuclear Detonations in New Delhi (India): Interdisciplinary Requirements in Triage Management

2021 ◽  
Vol 18 (4) ◽  
pp. 1740
Author(s):  
Samir P. Desai ◽  
William C. Bell ◽  
Curtis Harris ◽  
Frederick M. Burkle ◽  
Cham E. Dallas
Keyword(s):  
Large Scale ◽  
Health Management ◽  
Interdisciplinary Cooperation ◽  
Urban Environments ◽  
New Delhi ◽  
Nuclear War ◽  
Thermal Burn ◽  
Oak Ridge ◽  
Medical Response ◽  
Theoretical Application

The human casualties from simulated nuclear detonation scenarios in New Delhi, India are analyzed, with a focus on the distribution of casualties in urban environments and the theoretical application of a nuclear-specific triage system with significant innovation in interdisciplinary disaster management applicable generally to urban nuclear detonation medical response. Model estimates of nuclear war casualties employed ESRI’s ArcGIS 9.3, blast and prompt radiation were calculated using the Defense Nuclear Agency’s WE program, and fallout radiation was calculated using the Defense Threat Reduction Agency’s (DTRA’s) Hazard Prediction and Assessment Capability (HPAC) V404SP4, as well as custom GIS and database software applications. ESRI ArcGISTM programs were used to calculate affected populations from the Oak Ridge National Laboratory’s LandScanTM 2007 Global Population Dataset for areas affected by thermal, blast and radiation data. Trauma, thermal burn, and radiation casualties were thus estimated on a geographic basis for New Delhi, India for single and multiple (six) 25 kt detonations and a single 1 mt (1000 kt) detonation. Major issues related to the emergency management of a nuclear incident are discussed with specific recommendations for improvement. The consequences for health management of thermal burn and radiation patients is the worst, as burn patients require enormous resources to treat, and there will be little to no familiarity with the treatment of radiation victims. Of particular importance is the interdisciplinary cooperation necessary for such a large-scale emergency response event, which would be exemplified by efforts such as the application of a Nuclear Global Health Workforce.

scholarly journals (A145) Simulation for the Assessment and Optimization of Medical Disaster Management

2011 ◽  
Vol 26 (S1) ◽  
pp. s41-s42
Author(s):  
E.L. Dhondt ◽  
F. Van utterbeek ◽  
C. Ullrich ◽  
M. Debacker
Keyword(s):  
Decision Making ◽  
Disaster Management ◽  
Disaster Response ◽  
Large Scale ◽  
Simulation Optimization ◽  
Mass Casualty ◽  
Optimization Techniques ◽  
Evidence Based ◽  
Outcome Indicators ◽  
Medical Response

BackgroundThe ultimate goal of medical disaster management must be to predictably orchestrate transition from “standard of care” to “sufficiency of care” using evidence-based methods. However, neither descriptive reports of disaster responses nor epidemiological studies investigating disaster risk factors have been able to provide validated outcome measures as to what constitutes a “good” disaster response. Moreover, it either has been considered impossible, ethically inappropriate, or both, to identify experimental and control groups essential for hypothesis testing for the conduct of scientific randomized controlled clinical trials.ObjectiveThe aim of this study was to identify a number of performance and outcome indicators and define optimal disaster response and management decision-making for various disaster scenarios using simulation optimization.Methods and ResultsA system model of medical disaster management was designed, and victim models and performance and outcome indicators were developed. Various mass-casualty and large-scale disaster scenarios were developed, including: (1) a hospital emergency incident/disaster; (2) a CBRNE incident; (3) an airplane crash and airport disaster; (4) a mass gathering; and (5) a military battlefield mass casualty. Using “Discrete Event Driven Simulation”, multiple replications were made for different decision-making modalities, different resource allocations, and different disaster response procedures. Statistical analysis and optimization techniques were applied to achieve the best available setting of parameters of the simulation model. In such a way, the “Medical Disaster Management Simulator” runs the “missing experimental studies” in a simplified artificial simulated disaster environment.ConclusionsSimulation optimization is an adequate tool for judging and evaluating the effectiveness and adequacy of health and relief services provided during disaster medical response. Evidence-based recommendations and codes of best practice were formulated for optimal medical disaster and military battlefield management in different large-scale event scenarios as well as for teaching, training, and research in medical disaster management.

scholarly journals Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study

2020 ◽  
Vol 17 (9) ◽  
pp. 3068 ◽  
Author(s):  
Karin Hugelius ◽  
Julia Becker ◽  
Annsofie Adolfsson
Keyword(s):  
Web Of Science ◽  
The United States ◽  
Mass Casualty ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Internal Factors ◽  
Medical Response ◽  
Review Study ◽  
Resilient Response ◽  
Mind Set

Background: Managing mass casualty or disaster incidents is challenging to any person or organisation. Therefore, this paper identifies and describes common challenges to managing such situations, using case and lessons learned reports. It focuses on sudden onset, man-made or technologically caused mass casualty or disaster situations. Methods: A management review was conducted based on a structured search in the PubMed and Web of Science databases. Results: The review included 20 case—and lessons learned reports covering natural disasters, man-made events, and accidents across Europe, the United States of Amerika (USA), Asia and the Middle East. Five common challenges were identified: (1) to identify the situation and deal with uncertainty, (2) to balance the mismatch between the contingency plan and the reality, (3) to establish a functional crisis organization, (4) to adapt the medical response to the actual and overall situation and (5) to ensure a resilient response. Conclusions: The challenges when managing mass casualty or disaster events involved were mainly related to the ability to manage uncertainty and surprising situations, using structured processes to respond. The ability to change mind set, organization and procedures, both from an organizational- and individual perspective, was essential. Non-medical factors and internal factors influenced the medical management. In order to respond in an effective, timely and resilient way, all these factors should be taken into consideration.

The next nine minutes: Lessons learned from the large-scale active shooter training prior to the STEM school shooting

2020 ◽  
Vol 15 (4) ◽  
pp. 241-249
Author(s):  
Alissa Lenz, BS ◽  
Ryan Shelton, MPS, NREMT-P ◽  
Rebecca Ryznar, PhD ◽  
Kit Lavell, BA ◽  
David Ross, DO, FACEP ◽  
...  
Keyword(s):  
Large Scale ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Active Shooter ◽  
Barriers To Success ◽  
Real Time System ◽  
Immersion Training ◽  
Collection Point ◽  
Specific Timing

Objective: As the incidence of active shooters increase, local emergency response has also changed. South Metro Fire Rescue coordinated a series of hyper-realistic active shooter simulation drills involving multiple agencies.Methods: “The Next Nine Minutes” was one of the largest active shooter drills performed to date with 904 personnel that were trained in 18 mass casualty active shooter drills. Evaluation was from point of injury to and including care in the operating room (OR), and evaluation of real-time system logistics.Results: A total of 126 patients in Cut Suits® received a total of 479 procedures such as needle decompressions, cricothyrotomies, tourniquets, wound packs, and chest tubes. Central to this exercise, law enforcement (LE) established a warm zone from the initial shooting. EMS was able to move into the facility, locate casualties, extract the first victim, move them to a casualty collection point (CCP), and transport them to safety within 12 minutes.Conclusions: Strengths and weaknesses were identified in prehospital and in-hospital care. These included what roles agencies play in a true event, specific timing in establishing areas such as the warm zone and CCP, transportation, and logistics at the accepting hospitals. Only after the barriers to success were identified and addressed did the timing of casualty movement drastically improve. Lessons learned from this training were ultimately used to save lives at the STEM School, Highlands Ranch, and Colorado Shooting. This in situ immersion training should be practiced as a whole system.

scholarly journals Medical Response to a Vinyl Chloride Release From a Train Derailment: New Jersey, 2012

2017 ◽  
Vol 11 (5) ◽  
pp. 538-544 ◽  
Author(s):  
Alice M. Shumate ◽  
Jamille Taylor ◽  
Elizabeth McFarland ◽  
Christina Tan ◽  
Mary Anne Duncan
Keyword(s):  
Vinyl Chloride ◽  
Clinical Information ◽  
Health Impact ◽  
Mass Casualty ◽  
Lessons Learned ◽  
Specific Information ◽  
Medical Conditions ◽  
Response Planning ◽  
Medical Response ◽  
Number Of Patients

AbstractObjectiveThe objective of this investigation was to examine the health impact of and medical response to a mass casualty chemical incident caused by a vinyl chloride release.MethodsKey staff at area hospitals were interviewed about communication during the response, the number of patients treated and care required, and lessons learned. Clinical information related to the incident and medical history were abstracted from hospital charts.ResultsHospital interviews identified a desire for more thorough and timely incident-specific information and an under-utilization of regionally available resources. Two hundred fifty-six hospital visits (96.2%) were at the facility closest to the site of the derailment. Of 237 initial visits at which the patient was examined by a physician, 231 patients (97.5%) were treated in the emergency department (ED) and 6 patients (2.5%) were admitted; 5 admitted patients (83.3%) had preexisting medical conditions. Thirteen of 14 asymptomatic ED patients were children under the age of 10 years. One hundred forty-five patients (62.8%) discharged from the ED were diagnosed solely with exposure to vinyl chloride.ConclusionsContinuous emergency response planning might facilitate communication and better distribution of patient surge across hospitals. Individuals with multiple medical conditions and parents and caretakers of children may serve as target groups for risk communication following acute chemical releases. (Disaster Med Public Health Preparedness. 2017;11:538–544)

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