mass casualties
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2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Han-Yi Robert Chiu ◽  
Chun-Kai Hwang ◽  
Shey-Ying Chen ◽  
Fuh-Yuan Shih ◽  
Hsieh-Cheng Han ◽  
...  

AbstractEmerging infectious diseases (EIDs), including the latest COVID-19 pandemic, have emerged and raised global public health crises in recent decades. Without existing protective immunity, an EID may spread rapidly and cause mass casualties in a very short time. Therefore, it is imperative to identify cases with risk of disease progression for the optimized allocation of medical resources in case medical facilities are overwhelmed with a flood of patients. This study has aimed to cope with this challenge from the aspect of preventive medicine by exploiting machine learning technologies. The study has been based on 83,227 hospital admissions with influenza-like illness and we analysed the risk effects of 19 comorbidities along with age and gender for severe illness or mortality risk. The experimental results revealed that the decision rules derived from the machine learning based prediction models can provide valuable guidelines for the healthcare policy makers to develop an effective vaccination strategy. Furthermore, in case the healthcare facilities are overwhelmed by patients with EID, which frequently occurred in the recent COVID-19 pandemic, the frontline physicians can incorporate the proposed prediction models to triage patients suffering minor symptoms without laboratory tests, which may become scarce during an EID disaster. In conclusion, our study has demonstrated an effective approach to exploit machine learning technologies to cope with the challenges faced during the outbreak of an EID.


Author(s):  
Derrick Tin ◽  
Dennis G. Barten ◽  
Harald De Cauwer ◽  
Luc JM Mortelmans ◽  
Gregory R. Ciottone

Abstract Background: The modern concept of terrorism has its roots in the “old continent” of Western Europe, more specifically in France, during the “Reign of Terror” period of the French Revolution. At the time, this form of state terror had a positive connotation: it was a legitimate means of defending the young state. While no single accepted definition of terrorism exists today, it is universally considered an attack on both state and society. The health care impacts of terrorist attacks often extend disproportionally beyond the casualty toll, but the potential for such events to induce mass casualties remains a concern to Disaster Medicine and Counter-Terrorism Medicine (CTM) specialists. Method: Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database search functions for all events which occurred in Western Europe from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. Primary weapon type, country where the incident occurred, and number of deaths and injured were collated. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis. Results: A total of 15,306 events were recorded in Western Europe out of a total of 201,183 events world-wide between the years 1970 and 2019 inclusive. This resulted in a total of 5,548 deaths and 17,187 injuries. Explosives were used as a primary weapon/attack modality in 8,103 attacks, followed by incendiary attacks in 3,050 events and firearm use in 2,955 events. The use of chemical, biological, radiation, and nuclear (CBRN) weapons was rare and only accounted for 47 events. Conclusion: From 1970 through 2019, 9.11% of all terrorist attacks occurred in Western Europe. Compared to global trends of attack methodologies in the same study period, the use of explosives as a primary attack modality in Western Europe was similar (52.94% in Western Europe versus 48.78% Global). Firearm use was comparatively low (19.31% versus 26.77%) and the use of CBRN as an attack modality was rare (0.30% versus 0.20%). The United Kingdom, Spain, and France accounted for over 65% of all terrorist attacks and over 75% of terrorism-related deaths in Western Europe.


2021 ◽  
Vol 71 (6) ◽  
pp. 1989-92
Author(s):  
Mobeen Ikram ◽  
Saira Mahboob ◽  
Nudrat Zeba

Objective: To share our experience of handling mass casualties at remote locations with an aim to help formulate a policy regarding future training of doctors. Study Design: Case series. Place and Duration of Study: Combined Military Hospital Thal Pakistan, from Jan 2016 to Sep 2018, including three months in Forward Treatment Center in operational areas. Methodology: The injuries due to war trauma were included in our study. Resource management and changes made to accommodate the influx of mass trauma that required damage control surgery were described. Results: A total of 16 casualties from two mass casualty incidents at two medical centers were included in our study. There was no difference in triage class (p=0.96). Splinter injury limbs were most common injury. One patient required damage control surgery done at Combined Miliary Hospital with most requiring hemostasis prior to transport (8 at Combined Military Hospital versus 3 at Forward Treatment center), p=0.346. Conclusion: Most of mass casualties at our hospital were minor injuries requiring immediate first aid. In addition, the damage control resuscitation and surgery done at these remote locations may have helped prevent mortality and morbidity in the more severely injured.


2021 ◽  
pp. 002188632110665
Author(s):  
Synnøve Nesse ◽  
Inger G. Stensaker

Organizational crises, especially those of an extreme nature that include threats to survival and mass casualties, are deeply psychologically challenging for leaders. Previous research has focused on the effectiveness of leaders’ crisis management without much consideration for how leaders manage their own crisis reactions. This study was carried out in the crisis management facilities at the headquarters of a multinational energy corporation while a terrorist attack was ongoing in one of its subsidiaries. The unique access and data provide insights into how leaders react to crises and seek support by using different coping strategies. We develop a three-phase model (acceptance, psychological flexibility, and commitment) that illustrates the in-situ creation of a holding environment to support leaders in coping, not choking, under the pressure of a life-threatening crisis.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vahid Ghanbari ◽  
Ali Ardalan ◽  
Armin Zareiyan ◽  
Amir Nejati ◽  
Dan Hanfling ◽  
...  

Abstract Background Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage. Methods This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage. Conclusion A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.


Author(s):  
Tracey Varker ◽  
Kari McGregor ◽  
David J. Pedder ◽  
Ros Lethbridge ◽  
Genevieve Grant ◽  
...  

Abstract Objective: Intentional vehicular assaults on civilians have become more frequent worldwide, with some resulting in mass casualties, injuries, and traumatized witnesses. Health care costs associated with these vehicular assaults usually fall to compensation agencies. There is, however, little guidance around how compensation agencies should respond to mental and physical injury claims arising from large-scale transport incidents. Methods: A Delphi review methodology was used to establish expert consensus recommendations on the major components of “no fault” injury claim processes for mental and physical injury. Results: Thirty-three international experts participated in a 3-round online survey to rate their agreement on key statements generated from the literature. Consensus was achieved for 45 of 60 (75%) statements, which were synthesized into 36 recommendations falling within the domains of (1) facilitating claims, (2) eligibility rules, (3) payments and benefits for clients, (4) claims management procedures, (5) making and explaining decisions, (6) support and information resources for clients, (7) managing scheme staff and organizational response, (8) clients with special circumstances, and (9) scheme values and integrity. Conclusions: The recommendations present an opportunity for agencies to review their existing claims management systems and procedures. They also provide the basis for the development of best practice guidelines, which may be adapted for application to compensation schemes in different contexts worldwide.


BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e051802
Author(s):  
Yang Peng ◽  
Hai Hu

ObjectiveThe use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.DesignData in the Huaxi Earthquake Casualty Database were analysed retrospectively.SettingThis study was conducted in China.ParticipantsData on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.Primary outcome measureThe receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.ResultsThe ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.ConclusionAll methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.


Author(s):  
Miguel Rodriguez‐Arrastia ◽  
Manuel García‐Martín ◽  
Esperanza Villegas‐Aguilar ◽  
Carmen Ropero‐Padilla ◽  
Luis Martin‐Ibañez ◽  
...  

2021 ◽  
pp. injuryprev-2021-044281
Author(s):  
Jing Li ◽  
Yaru Qin ◽  
Zhen Wang ◽  
Yanli Xin

BackgroundCoal mine gas explosion injury has caused mass casualties, which have resulted in widespread concern.MethodsIn order to prevent gas explosion injury in coal mine, 24Model is proposed to analyse the risk in this paper. 24Model is a human-oriented and organisation-oriented risk analysis method. Based on the 24Model, we propose a general procedure for analysing the causes of injury within the organisation.ResultsA coal mine gas explosion case was analysed using the 24Model and the proposed analysis method, and the evolution of injury and the interaction of various causes was showed, and 6 unsafe conditions, 25 unsafe acts, 13 safety knowledge, 13 safety management systems and 13 safety cultures were obtained.ConclusionCase analysis results show that by using the 24Model and analysis method the proposed effect can help employees to clearly see the evolution and identify the causes of the injury, to better understand the logical relationship with the causes of the injury, improve the effectiveness of training and effectively prevent similar injury. The case study provides a practical procedure for injury investigation and analysis, and thus, preventive measures can be made according to the various causations at different levels.


Author(s):  
Siddharth Rao P. S. ◽  
Sumayya Nazneen Sayyada ◽  
Souri Reddy Pyreddy

Background: Road traffic accidents (RTAs) are a major cause of misery, disability and death globally, with a disproportionate number occurring in developing countries. With COVID-19 reaching pandemic proportion, a nationwide lockdown was announced on 24 March 2020 which resulted in the complete closure vehicular movement. This study aimed to assess the impact of lockdown on the number of RTAs brought to our rural tertiary care teaching hospital situated on National highway number 65.Methods: Medico-legal records were reviewed retrospectively at Kamineni institute of medical sciences hospital. The cases were classified into two groups. The pre-lockdown group included cases reporting to casualty from 1 April 2019 to 31 July 2019. The lockdown group included cases reporting to casualty from 1 April 2020 to 31 July 2020. Patient demographics, type of injury, time of injury, mode of injury were collected for all cases and analysed using simple mathematical tools.Results: There was a significant decrease in the total number of RTAs during lockdown phases 1 and 2 and during unlocking phases 1 and 2 by 52.1%. Bike skid was the most common mode of injury. The highest number of RTAs was observed between 6 am to 6 pm and the most commonly affected gender was male especially in the age group of 15-45 years.Conclusions: RTA numbers can be reduced by strict implementation of traffic rules and better road infrastructure. One positive effect of the measures implemented to control the spread of COVID-19 was the reduction of traffic accidents and mass casualties.


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