Disaster Metrics: Quantitative Estimation of the Number of Ambulances Required in Trauma-Related Multiple Casualty Events

2012 ◽  
Vol 27 (5) ◽  
pp. 445-451 ◽  
Author(s):  
Jamil D. Bayram ◽  
Shawki Zuabi ◽  
Mazen J. El Sayed
Keyword(s):  
Quantitative Estimation ◽  
The United States ◽  
Time Frame ◽  
Quantitative Model ◽  
Time Interval ◽  
Publication Type ◽  
The North ◽  
Number Of Patients ◽  
Minimum Number ◽  
T1 And T2

AbstractIntroductionEstimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task.Hypothesis/ProblemEmergency medical services (EMS) regions in the United States have varying “best practices” for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients.MethodsThe main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity.ResultsThe minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients.ConclusionA new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability.BayramJD, ZuabiS, El SayedMJ. Disaster metrics: quantitative estimation of the number of ambulances required in trauma-related multiple casualty events. Prehosp Disaster Med.2012;27(5):1-7.

The Swine Flu Emergency Department: The Relationship Between Media Attention for the Swine Flu and Registrations in an Emergency Medicine Unit

2014 ◽  
Vol 29 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Sara Nelissen ◽  
Kathleen Beullens ◽  
Marc Sabbe ◽  
Jan Van den Bulck
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Time Frame ◽  
Swine Flu ◽  
Publication Type ◽  
Media Report ◽  
Media Attention ◽  
Number Of Patients ◽  
Media Reports ◽  
The Relationship

AbstractIntroductionWhen the world is faced with a new potential pandemic outbreak, the media report heavily about it. Media are an important disseminator of health threat information. This study examined potential media effects during the 2009 outbreak of A/H1N1 influenza.HypothesisTo examine the relationship between media reports of the swine flu and self-registrations in an emergency department (ED) of a tertiary hospital in Flanders, Belgium.MethodsAll articles concerning swine flu published in seven Flemish newspapers were selected during the biggest flu peak in Belgium. This number was compared with the number of patients who presented themselves with a self-diagnosis of swine flu symptoms during the same time frame. The Pearson's correlation coefficient was selected to determine the relationship. The cross-correlation function determined the direction of this relationship.ResultsA strong correlation was found between the number of potential patients (n = 308) and the number of articles in the Flemish press (n = 1657). The number of patients was the leading indicator; increases in the volume of written press followed increases in the number of patients.ConclusionMedia reporting is extensive when a new infectious disease breaks out and intensifies when it is feared that pandemic levels are reached. This was also the case with the swine flu outbreak in Flanders. These findings suggest that a rise in the number of media reports follows a rise in the number of cases, rather than the reverse.NelissenS, BeullensK, SabbeM, Van den BulckJ. The Swine Flu Emergency Department: the relationship between media attention for the swine flu and registrations in an emergency medicine unit. Prehosp Disaster Med. 2014;29(2):1-5.

scholarly journals Dynamism and competitiveness of mexican beef, a focus of market diversification

2019 ◽  
pp. 14-20
Author(s):  
Rebeca Yurani Carrillo-Ángeles ◽  
Emmanuel Cruz-Soriano ◽  
Zugaide Escamilla-Salazar
Keyword(s):  
United States ◽  
Free Trade ◽  
Bilateral Trade ◽  
Trade Agreement ◽  
Weather Conditions ◽  
The United States ◽  
Time Interval ◽  
Goods And Services ◽  
Fair Competition ◽  
The North

In Mexico, the production and export of bovine have remained competitive, placing it within the top ten countries due to its competitiveness which is based on weather conditions, the production of cereals for food and the commercial relationship with the United States. In this regard, Mexico, with the signing of the North American Free Trade Agreement (NAFTA), promotes international trade with the United States and Canada, with the objective of eliminating obstacles to trade, facilitating the cross-border circulation of goods and services, promoting fair competition in the free trade zone, increases investment opportunities, among others aims (Ministry of Economy, 1993). At the beginning of the agreement, Mexico achieved short-term macroeconomic objectives of stability, economic growth, and inflation control, however, in the long term it has not meant an increase in the standard of living of Mexicans, therefore, Mexico decided to diversify markets of export through bilateral trade agreements with other countries. As a consequence, the objective of this research is to perform an analysis of the commercial position of Mexican beef (2002-2016), obtaining the Grubel & Lloyd index and the grown rate by time interval, concluding that there is a commercial dynamism of this Mexican product.

scholarly journals Increased Use of Blood Transfusions to Manage Urological Conditions during the COVID-19 Pandemic

2020 ◽  
Vol 104 (11-12) ◽  
pp. 849-852
Author(s):  
Paolo Capogrosso ◽  
Luigi Candela ◽  
Piercarlo Rossi ◽  
Cristian Guarasci ◽  
Fabio Muttin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Negative Impact ◽  
Delayed Diagnosis ◽  
Time Frame ◽  
Blood Transfusions ◽  
Transfusion Rate ◽  
Deferred Treatment ◽  
The North ◽  
Number Of Patients ◽  
The Impact

<b><i>Introduction:</i></b> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to an extensive reorganization of the healthcare system in Italy, with significant deferment of the treatment of urology patients. We aimed to assess the impact of deferred treatment during the SARS-CoV-2 pandemic on the need for blood transfusions in 3 Italian urology departments. <b><i>Methods:</i></b> We reviewed hospital chart data on blood transfusions at the urology units of 3 academic centers in the north of Italy from March to April 2020. Data were compared with values from the same time frame in 2019 (March to April 2019). <b><i>Results:</i></b> We observed significant reductions of the number of patients admitted to the urology units from March to April 2020 (373 vs. 119) and the number of performed surgeries (242 vs. 938) compared to 2019. Though, the number of transfused blood units was comparable between the 2 years (182 vs. 252), we found a greater mean number of blood units transfused per admission in 2020 (0.49 vs. 0.22; <i>p</i> &#x3c; 0.0001). As a whole, the transfusion rate for hematuria was higher in 2020 than in 2019 (36 vs. 7.9%; <i>p</i> &#x3c; 0.0001). <b><i>Discussion/Conclusion:</i></b> The observed increased number of blood transfusions needed throughout the SARS-CoV-2 era could have had a negative impact on both patients and the healthcare system. It is possible to speculate that this is the consequence of a delayed diagnosis and deferred treatment of acute conditions.

Disaster Metrics: A Proposed Quantitative Model for Benchmarking Prehospital Medical Response in Trauma-Related Multiple Casualty Events

2012 ◽  
Vol 27 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Jamil D. Bayram ◽  
Shawki Zuabi
Keyword(s):  
North Atlantic ◽  
Quantitative Model ◽  
Time Interval ◽  
Extensive Literature ◽  
Golden Hour ◽  
The North ◽  
Medical Response ◽  
Proposed Model ◽  
Extensive Literature Search ◽  
Two Parameters

AbstractIntroductionQuantitative benchmarking of trauma-related prehospital response for Multiple Casualty Events (MCE) is complicated by major difficulties due to the simultaneous occurrences of multiple prehospital activities.Hypothesis/ProblemAttempts to quantify the various components of prehospital medical response in MCE have fallen short of a comprehensive model. The objective of this study was to model the principal parameters necessary to quantitatively benchmark the prehospital medical response in trauma-related MCE.MethodsA two-step approach was adopted for the methodology of this study: an extensive literature search was performed, followed by prehospital system quantitative modeling. Studies on prehospital medical response to trauma injuries were used as the framework for the proposed model. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for the study.ResultsTwo parameters, the Injury to Patient Contact Interval (IPCI) and Injury to Hospital Interval (IHI), were identified and proposed as the principal determinants of the medical prehospital response in trauma-related MCE. IHI is the time interval from the occurrence of injury to the completion of transfer of care of critical (T1) and moderate (T2) patients. The IHI for each casualty is compared to the Maximum Time Allowed described in the literature (golden hour for T1 and Friedrich's time for T2). In addition, the medical rescue factor (R) was identified as the overall indicator for the prehospital medical performance for T1 and T2, and a numerical value of one (R = 1) was proposed to be the quantitative benchmark.ConclusionA new quantitative model for benchmarking prehospital response to MCE in trauma-related MCE is proposed. Prospective studies of this model are needed to validate its applicability.Bayram J, Zuabi S. Disaster metrics: a proposed quantitative model for benchmarking prehospital medical response in trauma-related multiple casualty events. Prehosp Disaster Med. 2012;27(2):-7.

scholarly journals The Transatlantic Trade and Investment Partnership - A View from America's Trenches

2014 ◽  
Vol 42 (1) ◽  
pp. 7-29
Author(s):  
Krzysztof Bledowski
Keyword(s):  
Free Trade ◽  
Free Trade Agreement ◽  
Trade Agreement ◽  
The United States ◽  
Time Frame ◽  
Initial Time ◽  
The European Union ◽  
The North ◽  
Transatlantic Trade ◽  
Trade And Investment

Abstract Expectations run high about the cornucopia of riches which are supposed to fow from the Transatlantic Trade and Investment Partnership (TTIP). TTIP is a proposed free trade agreement between the United States and the European Union. It aims to build upon the already sweeping scope of the North American Free Trade Agreement concluded two decades earlier and the 2013 Comprehensive Economic and Trade Agreement (CETA), which removes 99 % of tariffs between the EU and Canada.1 Te TTIP negotiations were launched in July 2013 with an initial time frame of completion within two years. It is too early to pass judgment about the benefits of the deal simply because its scope is still being framed as of this writing. However, it's possible to shed light on the most likely sticking points during the negotiations, particularly those seen from the U.S. negotiating side. Likewise, it's not too early to draw up interests and concerns of U.S. business. Both are discussed in this paper. The first section takes stock of the likely scope of negotiations. The second section summarizes the view of business gleaned from a survey of corporate executives. The survey was conducted among members of the Manufacturers Alliance for Productivity and Innovation, an education forum for senior managers of large industrial companies.

Mafias on the Move

2011 ◽  
Author(s):  
Federico Varese
Keyword(s):  
United States ◽  
New York ◽  
Organized Crime ◽  
The United States ◽  
The West ◽  
Market Expansion ◽  
The North ◽  
Economic Transformations ◽  
At Will

Organized crime is spreading like a global virus as mobs take advantage of open borders to establish local franchises at will. That at least is the fear, inspired by stories of Russian mobsters in New York, Chinese triads in London, and Italian mafias throughout the West. As this book explains, the truth is more complicated. The author has spent years researching mafia groups in Italy, Russia, the United States, and China, and argues that mafiosi often find themselves abroad against their will, rather than through a strategic plan to colonize new territories. Once there, they do not always succeed in establishing themselves. The book spells out the conditions that lead to their long-term success, namely sudden market expansion that is neither exploited by local rivals nor blocked by authorities. Ultimately the inability of the state to govern economic transformations gives mafias their opportunity. In a series of matched comparisons, the book charts the attempts of the Calabrese 'Ndrangheta to move to the north of Italy, and shows how the Sicilian mafia expanded to early twentieth-century New York, but failed around the same time to find a niche in Argentina. The book explains why the Russian mafia failed to penetrate Rome but succeeded in Hungary. A pioneering chapter on China examines the challenges that triads from Taiwan and Hong Kong find in branching out to the mainland. This book is both a compelling read and a sober assessment of the risks posed by globalization and immigration for the spread of mafias.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

Die Konstruktion von Natur – Central Park neu besichtigt | The Construction of Nature – Central Park Revisited

2005 ◽  
Vol 156 (8) ◽  
pp. 288-296
Author(s):  
Vittorio Magnago Lampugnani
Keyword(s):  
New York ◽  
Hudson River ◽  
The United States ◽  
Central Park ◽  
Housing Developments ◽  
Hudson River School ◽  
The North ◽  
Man And Nature ◽  
The 19Th Century ◽  
The Relationship

In the first half of the 19th century scientific philosophers in the United States, such as Emerson and Thoreau, began to pursue the relationship between man and nature. Painters from the Hudson River School discovered the rural spaces to the north of New York and began to celebrate the American landscape in their paintings. In many places at this time garden societies were founded, which generated widespread support for the creation of park enclosures While the first such were cemeteries with the character of parks, housing developments on the peripheries of towns were later set in generous park landscapes. However, the centres of the growing American cities also need green spaces and the so-called «park movement»reached a first high point with New York's Central Park. It was not only an experimental field for modern urban elements, but even today is a force of social cohesion.

Mosquito and Tick-borne Illnesses in the United States. Guidelines for the Recognition and Empiric Treatment of Zoonotic Diseases in the Wilderness.

2019 ◽  
Vol 19 (3) ◽  
pp. 238-257
Author(s):  
Suresh Antony
Keyword(s):  
United States ◽  
Lyme Disease ◽  
Spotted Fever ◽  
Disease Process ◽  
Rocky Mountain ◽  
The United States ◽  
Health Care Facilities ◽  
Diagnostic Tools ◽  
Rocky Mountain Spotted Fever ◽  
Number Of Patients

Background:In the United States, tick-borne illnesses account for a significant number of patients that have been seen and treated by health care facilities. This in turn, has resulted in a significant morbidity and mortality and economic costs to the country.Methods:The distribution of these illnesses is geographically variable and is related to the climate as well. Many of these illnesses can be diagnosed and treated successfully, if recognized and started on appropriate antimicrobial therapy early in the disease process. Patient with illnesses such as Lyme disease, Wet Nile illness can result in chronic debilitating diseases if not recognized early and treated.Conclusion:This paper covers illnesses such as Lyme disease, West Nile illness, Rocky Mountain Spotted fever, Ehrlichia, Tularemia, typhus, mosquito borne illnesses such as enteroviruses, arboviruses as well as arthropod and rodent borne virus infections as well. It covers the epidemiology, clinical features and diagnostic tools needed to make the diagnosis and treat these patients as well.

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