22 August 2024: Due to technical disruption, we are experiencing some delays to publication. We are working to restore services and apologise for the inconvenience. For further updates please visit our website: https://www.cambridge.org/universitypress/about-us/news-and-blogs/cambridge-university-press-publishing-update-following-technical-disruption
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
This journal utilises an Online Peer Review Service (OPRS) for submissions. By clicking "Continue" you will be taken to our partner site
https://mc.manuscriptcentral.com/pdm.
Please be aware that your Cambridge account is not valid for this OPRS and registration is required. We strongly advise you to read all "Author instructions" in the "Journal information" area prior to submitting.
To save this undefined to your undefined account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your undefined account.
Find out more about saving content to .
To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Stabilization and reconstruction operations in failed or failing states require a bottom-up approach, focusing on the population as the strategic center of gravity. This bottom-up approach must address the population's basic needs as defined by Dr. Abraham Maslow's “Hierarchy of Needs” and provide a long-term means of self-sufficiency, rather than creating an “aid dependent economy”. Focusing stabilization and reconstruction operations on agricultural and agricultural related projects provides relief from donor dependency, stimulates economic growth, and thwarts the power of spoilers. Military veterinary personnel are uniquely qualified to design and implement agricultural stabilization and reconstruction programs in conjunction with the host-state ministries and agencies across the full range of military operations. Early, sustained engagement by military veterinarians stimulates agricultural productivity, improves animal and human health, directly supports the population's hierarchy of needs on all levels, and accelerates stabilization operations by reducing the population's susceptibility to spoilers.
The objective of this study was to determine the accuracy of emergency physicians in detecting free fluid in the abdomen when compared to radiologists during w primary survey of trauma victims by focused assessment with sonography for trauma (FAST) scan in the emergency department.
Methods
This prospective study was performed during a primary survey of the resuscitation of non-consecutive patients in the resuscitation bay. The study subjects included emergency physicians (EP) [one emergency medicine (EM) consultant, two EM residents, one orthopedic resident, and one surgical resident] who underwent training at a three-day workshop on emergency sonography and performed 10 supervised positive and negative scans for free fluid. The FAST scans were performed by the EPs and then by the radiology resident (RR). Both were blinded to each other's sonography findings. Computed tomography (CT) scan and laparatomy findings were used as gold standard. Results were compared between both groups. Intra-observer variability among EPs and level of agreement between EPs and RRs were assessed.
Results
One hundred fifty scans performed by EPs and RRs were analyzed. The mean age of the patients was 28 [1–70] years. Out of 24 true positive patients, 18 underwent CT scan, and exploratory laparatomy was done in six patients. Intra-observer performance variation ranged from 87–97%. The sensitivity of FAST performed by EP and RR was 100%. The specificity of FAST by EPs was 95.4% vs. 98.4% by RRs. The level of agreement was 100%.
Conclusions
This study proves that FAST scan performed by EPs who are trained in short course of ultrasonography can be reliable and accurate when compared to a qualified radiologist.
Describir las Características de estudios de posgrado en el área de la salud como preparativos para la realización de Planes en caso de Desastres y la asistencia de las principales patologías de Nuestro País.
Método
Se realizó un estudio descriptivo del seguimiento de 92 Diplomados en el área de la salud durante 8 años, realizados en el “Centro Nacional de Capacitación y Educación Ernesto Giovanni Porras”, con participantes médicos, enfermeras y paramédicos de más 75 % de estados de la República Mexicana.
Desarrollo
El 12 de junio del 2002 se constituye una Asociación Civil sin fines de Lucro denominada “Desarrollo Educativo de Posgrado en el Área de la Salud e Investigación AC”, con el objetivo principal de Capacitar y Actualizar al Personal de la Salud en las principales causas de morbilidad y mortalidad, como una respuesta de mejorar la atención de estas patologías. Tres Universidades Avalan estos Diplomados.
Resultados
El diplomado con más participantes es el de Urgencias Médicoquirúrgicas (75%). La profesión más interesada corresponde a los médicos (95%), seguida por personal de Enfermería (4%), El tiempo destinado de capacitación corresponde a 250 hrs. mínimo por cada nivel. El financiamiento de los Diplomados es absorbido por el propio participante (98%), El Índice de deserción es del 20%, siendo la principal Causa por cuestiones económicas (85%) y en segundo lugar por cambio de adscripción o de jornada laboral. Lo más atractivo para el proceso de enseñanza aprendizaje corresponde a la práctica más que a la teoría (95%). La realización de estos planes mejora la capacidad funcional hospitalaria dentro del programa Hospital Seguro, y se evalúan y mejoran mediante la realización de simulacros.
Conclusiones
Los estudios de posgrado son elementos indispensables en la atención de las principales causas de morbimortalidad y en la realización de planes de Emergencia de un Hospital.
Space technology plays important role during emergency as well as non-emergency situation to provide the information that is relevant for disaster preparedness and to the rescue and emergency medical teams. During emergency situation, first and immediate information rescue and medical teams like to have is the area impacted, severity of the disaster and the population at risk. Such information is of critical nature for emergency medical teams in order to plan and mobilize the medical personnel, resources and infrastructure needed to provide effective medical services. Space based observation is the most efficient way to provide this preliminary information. Often emergency maps generated based on the space based observations are useful to the medical and rescue teams during emergency situation while detailed information from the field is still awaited. UN-SPDIER offers the platform for providing such services effectively by connecting with the end users the international and regional mechanism that provides such information. During non-emergency phase, the space technology contributes in strengthening disaster risk reduction (DRR) efforts, especially through telemedicines and Global Positioning System (GPS) technologies. These tools integrated with Geographical Information System (GIS) provide effective mechanism for predicting risks (risk mapping) and early warning. It also ensures the rapid distribution of information during catastrophic events. In recognition of these needs the United Nations General Assembly established the United Nations Platform for Space-based Information for Disaster Management and Emergency Response (UN-SPIDER). The programme aims at providing universal access to all types of space-based information by: being a Gateway to space information for disaster management support; serving as a Bridge to connect the disaster management and space communities; and being a Facilitator of capacity-building and institutional strengthening.
Non-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.
Methods
All patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.
Results
A total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.
Conclusion
This initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.
In the United States in 2010, there were 81 federal disasters, for this reason and at the request of our clinical partners, when West Coast University (WCU) started its Baccalaureate of Science in Nursing (BSN) program in 2008, it recognized the need to have a course in disaster management. The Disaster Management course was developed in concert with other parts of the curriculum such as Leadership, Physical Assessment, Critical Care courses to help students focus their assessment and intervention skills to prepare them to be future responders. As a component of the skill development, simulation exercises were developed in the simulation center within the college of nursing. To prepare students to respond to disasters, a variety of scenarios were developed to meet national patient safety goals and various types of disaster and emergency situations. In the scenarios students learn how to work as a team, follow the chain of command, assess and rapidly intervene to such medical crisis such as hemorrhaging, trauma, burns, cardiac arrest and respiratory arrest. They also learn how to delegate to the appropriate personnel as well as leadership skills. Students find this educational and reassuring to be able to practice these very high level sentinel events in a secure environment where they will get immediate feedback not only from instructors but from their peers. Preliminary research have identified students having significant improvement in their clinical skills from the first to the third exercise in regards to assessment, intervention, communication, and delegation. We have received feedback from our clinical partners that our students are better prepared than their current emergency staff in regards to disaster management and to that end we plan to work with our clinical partners to translate our class into an online course so their staff can be trained on disaster management.
In a disaster, the most important information for those in the international disaster response community is that about the exact place and scale. However, problems with communication networks and the complexity of the disaster information can make collection difficult. The United Nations Office for the Coordination of Humanitarian Affairs provides information about the situation in the affected country on its websites; Virtual On-Site Operations Coordination Center (V-OSOCC), One Response (OR) and Relief Web (RW). The positive and negative characteristics of these websites are discussed from the viewpoint of a medical non-governmental organization (NGO).
Results
V-OSOCC is a platform for disaster response personnel in around the world. Disaster coordination information is shared interactively on a mimic board. This information is sent in E-mails and SMS in real time. OR is a collaborative interagency website, designed to enhance coordination of humanitarian responses within the cluster approach. Public documents such as situation and assessment reports, maps, meeting schedules, and contact lists can be viewed. RW provides a wide range of information, not only about disasters but also about humanitarian emergencies. However, this website does not provide information such as contact lists for direct use in relief work.
Discussion
These websites are considered from the viewpoint of a medical NGO. V-OSOCC can share information related to urban search and rescue in real time, but there is no coordination of medical teams. Thus, each medical team has to participate in health cluster meetings on site. OR is more convenient than V-OSOCC for health cluster members because it provides more detail, with updated situation and assessment reports and meeting schedules. However, such reports do not show needs at the community level. RW is suitable for institutions such as libraries, which generally collect academic information.
Conclusion
The websites discussed here are useful for collecting disaster information; however, they do not have information about community-level needs. Therefore, needs assessment has to be undertaken within affected communities.
The Yale New Haven Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has worked in the United States with state and local health and medical organizations to evaluate critical decision making activities and to develop decision making tools and protocols to enhance decision making in a time sensitive environment. YNH-CEPDR has also worked with international organizations and US federal agencies to support situational awareness activities in simulated and real world events.
Objectives
During this session YNH-CEPDR will share the best practices from recent events such as the H1N1 response and the Haiti Earthquake. Participants will be engaged in discussions regarding overall framework for successful information collection, analysis and dissemination to support decision making based on these experiences. This session will also incorporate concepts provided by the US National Incident Management System (NIMS) and the Incident Command System (ICS), specifically through the development of Situational Reports (SitReps), Incident Action Plans (IAP) and Job Action Sheets as methods to implement the framework and concepts discussed. Participants will be led through a series of scenario-based discussions to allow application of critical decision making factors to their organization. At the conclusion of the session, participants will be able to identify next steps for enhancing the synchronization of critical decision making and information analysis within their organizations.
Sri Lanka's 28 year protracted civil conflict between the government forces and Liberation Tigers of Tamil Eelam (LTTE) in the North of country saw dramatic end by May 2009 when the military forces succeeded in crushing the LTTE. Around 300,000 people were displaced due to the conflict and they were settled in welfare villages established in the North.
Discussion
The Government of Sri Lanka working in partnership with all other actors mounted a major humanitarian response to address the needs of the war displaced population. The Ministry of Health took a leading role in coordinating the health care programs for the Internally Displaced Population(IDP).
Observations
Higher morbidity and mortality observed during early phase of settlement of IDPs was due to the results of two scenarios, one being the conflict situation and its direct consequences that have caused injuries, disabilities and mental trauma among the population. The second being the result of the collapse of the health system in conflict affected areas, long period of displacement of people and the disruption of social structures that have led to the indirect consequences of increase of infectious diseases and worsening of chronic diseases. Ministry of Health used Daily Crude Mortality Rate (DCMR) to measure the success of the response. According to the Sphere Project guidelines that developed a set of minimum standards in a disaster situation, the DCMR should be 0.25 per 10 000 population for South East Asia. The emergency threshold level is 0.5 per 10 000 per day for this region.
Conclusions
Of the number of people reaching the IDP welfare villages in early stages of emergency phase in May, DCMR averaged to 0.7. The figure settled to less than 0.5 per 10000 in June 2009. Thereafter daily DCMR remained less than 0.5 indicating success of the provision of care for IDPS.
Singapore is considered a prime target for transnational terrorism. Perpetrators may select an explosive radiation dispersal device or “dirty bomb” as their weapon of choice. Additional risks of a local radiological emergency may arise from mishaps involving visiting marine nuclear-powered vessels. Strategies and methods used to enhance preparedness to respond to radiological mass-casualty incidents (MCIs) will be described.
Methods
A core group comprising hospital emergency managers and radiology and emergency department staff spearheaded preparedness efforts. The Ministry of Health Guiding Document on managing radiological MCIs provides the principles and operational concepts to anchor the development of local protocols. Discussion sessions, site visits, drills, and exercises are conducted to improve organization performance. Expert opinion and feedback from various stakeholders and partners help shaped the overall plan.
Results
Preparedness activities focused on improving surge response capability through broad categories include: 1. Staff—Radiation response teams were developed and assigned roles and responsibilities. Training and education programs were created for different staff positions, e.g., on correct usage of electronic personal dosimeters and acute radiation syndrome. 2. Stuff—Material resources such as antidotes, and expendables like floor covering were procured and stored. 3. System—These areas include: (a) activation procedures; (b) communication plans; (c) safety measures; (d) casualty transfer protocols; and (e) handling radiologically contaminated waste and materials. 4. Space—Potential care areas, such as radiation isolation rooms were designated. An algorithm was devised to guide casualty management.
Conclusions
Facility preparedness for radiological MCIs requires multidisciplinary involvement and the creation of trusting partnerships. More research is needed to identify the metrics to measure success objectively and aid protocol revisions.
Childhood is one of the most vulnerable parts in a human's life. Thus, any physical and psychological harm against children requires special attention, especially if inflicted and not accidental. Such children should be considered multi-trauma victims and managed by a multidisciplinary team and trauma algorithm. In this team of specialized carers, the pediatric surgeon will import his/her expertise on general management and treatment and simultaneously refer basic knowledge to more junior doctors that might be in charge in the future. Fifty-eight injured victims (mean age = 1.5 years of age, range = 1 day–18 years of age, male:female ratio = 1:1) were analyzed in this study. Their injuries were subcategorized into battery (13), assault (11), neglect (3), sexual abuse (2), prevention failure (6), career-related (19), and miscellaneous (5). All victims were first seen by a pediatric surgeon before receiving multidisciplinary consultations. Treatment results and modalities varied according to the complexity of the diagnoses requiring a well-trained and skilled pediatric surgeon. Accompanying post-traumatic stress disorders within the children as well as psychological distress among the parents and grandparents were quite frequent. Besides medico-surgical treatment, empathic care is essential. In the majority of cases the children, benefited from pediatric surgical care.
A destructive 7.9 magnitude earthquake struck the Sumatra Island of Indonesia on 30 September 2009. A Russian mobile hospital was implemented on 04 October in the village of Lupu-Alu, 20 km from the city of Padang.
Method
The mobile hospital consisted of 20 pneumo modules equipped with technical systems. Personnel included 9 engineers and 25 medical specialists comprised of surgeons, therapists, traumatologists, children's surgeons, a pediatrician, and anesthesiologists. An air-mobile hospital was equipped with modern medical equipment (X-ray, ultrasonic diagnostics, etc.). Work at the hospital was complicated by almost daily tropical rains. The language barrier was addressed by using local translators who spoke Russian or English languages.
Results
Medical aid was rendered to 479 patients. The intensive care department experienced the heaviest patient load (n = 11). Trauma (n = 54, 2%) and proinflammatory complications prevailed among surgical patients (n = 131). Treatment of bone fractures represented significant difficulties due to the late delivery of care. Of the 479 patients, 207 (43.2%) were children; among them, 49 (7%) had diseases of the upper airways, and 30 (4%) experienced trauma. Psychologists consulted with 52 children with post-traumatic stress syndrome. Telemedical consultations were conducted by the following specialists: (1) orthopedist (n = 2); (2) dermatologist (n = 2); (3) neurosurgeon (n = 1); and (4) plastic surgeon (n = 1).
Conclusions
Following the earthquake, medical personnel at the Russian mobile hospital in Indonesia experienced: (1) a large number of outpatients with various diseases who lacked medical care as a result of the non-functioning network of local public health services; (2) the admission of the patients with complications of trauma; (3) a significant number of children with inflammatory diseases of the upper airways; and (4) an opportunity of use telemedical consultations.
When implemented properly, universal helmet law increases helmet use substantially, bringing along a reduction in mortality and morbidity due to head injuries. Kerala has seen tremendous success in regards to various indicators for health within India. But when it comes to wearing helmets, the state lags behind others with reported rates as less as 27%.
Method
A cross-sectional survey of 300 two-wheel drivers in Thiruvananthapuram City was preformed, which looked into helmet wearing patterns, their determinants, and the risk perception among the respondents. Further, a content analysis of newspaper reports pertaining to helmet legislation from the Thiruvananthapuram edition of two leading newspapers was performed. The reports included were from the periods of July 2003 to June 2005 and July 2008 to June 2010. Lastly, in-depth interviews were conducted with informants from among the key stakeholders in helmet policy of the state.
Results
The study found 36.8% of the respondents wear a helmet. A scale to measure risk perception was developed for the purpose of this study. The four-item scale has been found to have internal consistency with a Cronbach alpha value of 0.74. The risk perception measured by using this scale has significant relation with helmet-wearing behavior. The content analysis helped in deriving a historical perspective of the policy along with the themes of reporting. The informant interviews provided expert opinions, problem identification, and specific recommendations.
Discussion
The practice of wearing a helmet is low, and people with lower risk perception have greater tendency not to wear helmets. Other findings also show that there are gaps in policy and lack of visionary leadership as far as the policy toward helmet legislation and its implementation.
In the United States, animal search and rescue (ASAR) is becoming a recognized component of Search and Rescue (SAR).
Discussion and Observations
Urban Search and Rescue (USAR) teams have long recognized the importance of having trained animal rescuers available to handle the animals that are often with humans seeking rescue. Animals are such an important part of most U.S. families, that in many cases, if the animal isn't included in the rescue efforts, the human will refuse to evacuate. The International Fund for Animal Welfare received a grant in 2010 to develop an ASAR curriculum and to train two Type II ASAR teams in Mississippi and Louisiana. This presentation will provide an overview of that curriculum and the courses that were developed for the unique tasks, skills, and equipment needs for animal search and rescue.
Changes in gender roles, the nature of the family, marriage patterns, political shifts, the nature of work, and the increase in the number and severity of emergencies are influencing volunteering and changing it in accordance with these changes. This study in a remote rural area in the north of Thailand explores paradigms of emergency volunteering in such areas based on the concept of the multi-paradigm model of volunteering.
Methods
A sample of twenty stakeholders: leaders, village health volunteers, the director of the local administrative organization and community heads provided data during in-depth interviews. Data were analyzed using content analysis.
Results
The results showed that the paradigms of emergency volunteering existing in the community were the functionalist paradigm and the interpreted paradigm. The functionalist paradigm relies on the belief in universal truths, thus emergency volunteering should be controlled and ordered. The community also believe that as a collective entity they achieve positive outcomes and benefits from emergency volunteering. In contrast, the interpreted paradigm relies on the belief in multiple truths. Thus emergency volunteering should be understood in terms of the individual experiences that emerge for each person from emergency volunteering. Furthermore, the community also believe that emergency volunteering should be focused on extracted cues and the process of helping emergency patients.
Conclusion
The conclusion of this study is that the management of emergency volunteering in the context of remote rural communities should be well ordered and be by consensus.
Reducible open dorsal dislocation of the single finger's PIP joint is an infrequent case of orthopedic emergencies. The severity of this injury may be underestimated. These injuries are associated with long-term complications such as synovitis, stiffness, degenerative arthrosis, septic arthritis, and loss of the digit if suboptimally treated.
Case
A 90-year-old male came to the emergency department with an open dorsal PIP dislocation due to a fall on his right hand. There was a transverse skin laceration just proximal to the PIP flexion crease of his small and ring fingers. The condyles of his small finger's proximal phalanx protruded through the wound. X-rays showed a dorsal dislocation of the PIP joint without fracture. There was no neurovascular injury determined. The proximal phalanx was hyperextended slightly with gentle axial traction. After irrigation, the skin wound was closed primarily without repair of damaged structures, and systemic antibiotherapy was performed for a week. The PIP joint was immobilized for three weeks by applying the splint dorsally with the joint in 20 degrees of flexion. Active range of motion exercises were then implemented, and the patient regained full digital flexion with only a 10 degree loss of extension within eight weeks.
Discussion
Forced hyperextension with axial compression causes a dorsal dislocation of the PIP joint. Dorsal PIP dislocations are more common than volar IP dislocation. Open dorsal dislocation of the PIP joint is an infrequent case of orthopedic emergencies. Such injuries can be treated safely in the emergency department by closed reduction and extensor splinting until a definite treatment plan is made by an orthopedic hand surgeon. The complications must be taken into consideration. Early active motion leads to significantly superior results in the range of motion than static splinting, because prolonged immobilization may result in flexion contracture.
Social context of natural disaster Danielle Maltais, Ph.D., Simon Gauthier, M.Sc. University of Québec in Chicoutimi (UQAC), Social Sciences Department, Social Work Teaching Unit, 555 Boulevard de l'Université, Chicoutimi, Québec, Canada, G7H 2B1, danielle_maltais@uqac.ca During the last few years, several countries in North America as well as in Europe or Asia were exposed to catastrophes that can be described as macrosocial catastrophes since a large number of people were affected. The death of an important number of people during the Katrina hurricane, the 2003 summer heat wave in Europe and the 2004 tsunami in Indonesia unfortunately showed that several countries and communities, even the most developed, are very badly prepared, in the event of a natural disaster, to protect and help its citizens and more specifically vulnerable people such as the old or the poor as well as lonely or sick people, those with reduced mobility or living in unsuitable housing conditions. Natural disasters are never completely quite so because of the frequency of the disasters as well as their human, community and social consequences and the extent of the subsequent material damage. They can be regarded as the result of human factors related to the deployment of ill advised activities for the environment (hasty urbanization and industrialization, deforestation, construction in zones at risk, etc), socio-economic conflicts (wars, political conflicts, displacement of segments of the population in environments at risk) or unequal distribution of economic, social and cultural resources between individuals, communities and countries. In social work, when we examine the causes and consequences of disasters on people's health and social activities, it is important to consider the notion of individual and social vulnerability of the people as well as the concepts of human adaptation to stress and impact strength. This communication will mainly make it possible to place the consequences of natural disasters in their social context and discuss the repercussions of this concept of reality on workers training and guiding.
Poisoning is a public health problem that effects all ages, genders, and ethnicities, but certain populations are at increased risk. Unintentional poisoning disproportionately affects lower- and middle-income countries. The epidemiological pattern of poisoning can differ significantly within countries. In Thailand, national poisoning data is collected by voluntary reporting to a poison control center in the capital, Bangkok. Limited poisonings are reported from Chiang Mai, a province in Northern Thailand, though it has the highest suicide rate in the country.
Objective
The aim of this study is to describe poisoning epidemiology, examine differences between intentional and unintentional poisonings and, to develop a multivariate predictive model of intentional poisonings in Northern Thailand.
Methods
A total of 550 poisoning admissions were identified at Chiang Mai's University Hospital from 01 January 2005 to 31 December 2005. Demographic data were collected retrospectively by manual chart review. Chi-square and t-tests were used to examine differences in poisoning by intent. A step-wise logistic regression analysis was performed to develop a predictive model of intentional poisonings. Factors significantly associated with intentional poisoning were used in a logistic progression model to identify predictors of intentional poisoning.
Results
Younger age was significantly associated with intentional poisoning. There was no demonstrated difference in gender and poisoning intent. Predictors of intentional poisonings were use of chemical agents, high-risk medications (analgesics and psychiatric), unemployment, and younger age.
Conclusions
Interventions should focus on factors that put young adults and the unemployed at greater risk for intentional poisonings. Further interventions are also needed to limit access to potentially lethal doses of chemical agents and high risk medications.
Les crises récentes montrent, si besoin en était, la complexité de leur traitement. Alors que la capacité de l'Etat à gérer les situations de crise est à la fois un élément essentiel de notre politique étrangère et une nécessité de résultat, il était essentiel de se doter d'un outil gouvernemental performant. Cet outil, apte à la prévention des risques (naturels, sanitaires et technologiques) et des menaces à l'étranger, comme en matière de gestion de crises est né en juillet 2008 et a été placé sous l'autorité du Ministre des affaires étrangères et européennes. Doté de plus de cinquante agents le Centre de Crise résulte de la fusion de deux services, initialement indépendants: la sous direction de la sécurité des français à l'étranger et la délégation à l'Action humanitaire. Aujourd'hui les moyens humains et matériels de ces deux entités travaillent dans un but commun: porter assistance aux populations françaises et étrangères partout dans le monde. Compte-tenu de sa vocation à mobiliser l'ensemble des moyens de l'Etat, le Centre de Crise a été placé sous l'autorité directe du Ministre. Il entretient des liens étroits et privilégiés avec ses homologues français de la Santé et de la Sécurité civile, ainsi qu'avec ses partenaires européens, les organismes internationaux (nations unies notamment) et ses partenaires européens (MIC, SitCen).