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Impacto Socioeconómico del “Huracán Karl” sobre instalaciones de salud en Veracruz, México con una población de 7 millones 600 mil habitantes en Septiembre del año 2010 Resumen. El huracán Karl, decimotercer ciclón tropical de la temporada de huracanes en el Atlántico de 2010, se originó en el mar Caribe e impactó en la península de Yucatán como una tormenta tropical fuerte, hasta emerger al golfo de México donde se reorganizó gradualmente hasta alcanzar la categoría 3 (huracán mayor) en la escala de Saffir-Simpson e impactó la costa oriental de México el 17 de septiembre del año 2010. Preparativos. El 16 de septiembre, el Gobierno Federal, la Comisión Federal de Electricidad, la Central Nuclear Laguna Verde, la Secretaría de Defensa Nacional, la Secretaría de Gobernación y de Marina desplegaron elementos humanos y materiales para el auxilio a la población. El Sector Salud igualmente se preparó tomando las medidas convenientes bajo el concepto de Hospital Seguro de la OPS/OMS. Impacto En el estado de Veracruz (más de 7 millones 600 mil habitantes), el Huracán Karl tocó tierra cerca de las 11:30 am del 17 de septiembre a 15 km al norte del puerto de Veracruz alcanzando una potencia de 195 km por hora. Las lluvias torrenciales del fenómeno inundaron las calles y avenidas del centro histórico del puerto, alcanzando el agua de 40 centímetros a 1 metro de altura, hacia el sur del Estado y en zonas periféricas llegó hasta los 2 metros de altura. Provocó serios daños desde su inicio a la infraestructura de salud, como la suspensión de electricidad pública, daño al sistema de distribución de agua potable, ruptura de ventanales e inundación de un hospital así como de varias Unidades de Medicina Familiar.
Landmines and improvised explosive device (IED) explosions induce bodily injuries through the primary, secondary, tertiary, and quaternary mechanisms of blast among civilians, mostly children which results in a complicated, multidimensional injury pattern. If > 80 percent of countries can ensure the security of their borders without using anti-personnel mines, surely India can too. A change in mindset and a change in defense doctrine are needed, as well as an UN-backed world body campaigning against the use of landmines to urge the Indian government to sign a global treaty to ban the weapons. An estimated four to five million anti-personnel mines exist in India, which is the sixth-largest stockpile in the world. Non-state armed groups in the central, southern, northern, and northeastern regions frequently have used anti-personnel mines and improvised explosive devices to target convoys of soldiers and civilians. Using historical, current research and related literature reviews, this study provides description about the types of explosion, the device, pattern of injury, prehospital and emergency department care, and challenges for the disaster plan. Hand amputation is the most common type of upper limb amputation (more common among the 7–18-year age group) and below-knee amputation is the most common type of lower limb amputation. Using these data, a focused disaster response for future attacks has been created. It includes the planning, monitoring, and coordination of all aspects by hospitals and the regional disaster system's plan—“upside-down” triage—the most severely injured arrive after the less injured, which bypass emergency medical services (EMS) and go directly to the nearest hospitals. Details about the nature of the explosion, potential toxic exposures and environmental hazards, and casualty location from police, fire, EMS, health department, and reliable news sources must be recorded.
Despite their low mortality rate, mine injuries have high rate of morbidity. Depending on the severity, different levels of amputation may be required for the affected extremities. A mine injury composed of an atypical condition because of thick layer of snow is described in this presentation. A 21-year-old man was taken to the emergency department because of a mine injury. He had severe pain on his right heel. He was injured in an explosion in a rural state that had 50–60 cm of snow on the ground. Vascular access was provided and cast immobilization was applied to the right foot. The patient then was carried by ambulance helicopter. Vital signs were normal. Right ankle movements were limited and painful, and there were minimal edema and hematoma on both sides of the patient's heel in physical examination. Neither motor sensorial nor vascular deficit was determined. Comminuted calcaneus fractures were observed in x-ray and in the computerized tomography. A short leg circular cast was applied during follow-up. The cast was taken off at the end of the second month, and rehabilitation began. The follow-up was complete at the end of the sixth month with complete recovery. Mine injuries are special military injuries the sometimes affect civilians. In these injuries, lower extremities often are affected and amputation may be required. This case is similar to high-falling calcaneus fractures. This may have occurred as a result of an upwards blast impact that may have been weakened because of the thickness the layer of snow. Thick layers of snow may help protect civilians from mine injuries. This potential protective affect may be useful for researchers aiming to decrease mine injuries.
It is common knowledge that having an individual or family disaster plan is vital for saving lives and property before, during and after a disaster. First responders have the daunting task of helping many people during a disaster. It would make their jobs easier if people had disaster plans before a disaster. However, for a variety of reasons, few people have a disaster plan. People often do not develop disaster plans due to the time required to devise a plan, a lack of knowledge of the benefits of having a plan, or the effort required for the primarily manual process of developing a disaster plan. Wilberforce University has designed a solution called Wilberforce's Information Library Boosting Emergency Recovery (WILBER) which is a customized, online tool to quickly and automatically generate disaster plans to help save lives and property as well as mitigate the impacts of a potential disaster. WILBER utilizes an interdisciplinary approach to automatically generate a basic disaster preparedness plan. The system addresses a wide range of disasters but focuses on floods, earthquakes and technological disasters such as terrorism and nuclear disasters. WILBER automatically processes locally relevant data intelligently and combines mathematical analysis; distributed computing; individual and business risk management; current and historical information from a comprehensive Geographical Information Systems (GIS) that includes imagery, infrastructure, demographic, and environmental data; and wireless sensors for real time condition assessment. Not planning for a disaster only increases the potential magnitude of a disaster. WILBER allows citizens to quickly establish immediate procedures in the event of an emergency which in turn can lessen the burden on first responders and reduces the likelihood of loss of life. This research is funded by the Department of Energy's National Nuclear Security Administration and conducted by the Wilberforce University Disaster Recovery Center in Wilberforce, Ohio, USA.
Methanol poisoning is an uncommon medical emergency linked with consumption of traditional brews made with methanol and formalin and associated with high-mortality rates.
Objectives
Healthcare workers will review the latest worldwide trends of methanol poisoning cases, explain the factors perpetuating methanol poisoning in Kenya, describe the pathophysiological concepts associated with methanol intoxication, and discuss the latest measures to combat methanol poisoning in Kenya and their worldwide applicability.
Background
Methanol intoxication is an acute illness resulting from consumption of toxic quantities of methanol. The largest tragedy occurred in September 2006 in Nicaragua. A total of 800 fell ill, 46 were killed. In the US, the last incidence was in 1951. Cases were reported in Africa, Tunisia, Tanzania, Uganda, but Kenya, it runs the most rampant. The majority of victims (79%) are young males, (22–30 years of age). Most are single, childless, and have a low-educational status. Motivating factors for intoxication include stress, idleness, peer-pressure, availability of alcohol, and curiosity.
Pathophysiology
Toxicity results from liver enzymatic metabolism of methanol to formaldehyde and formic acid causing severe metabolic acidosis. Common features include inebriation, abdominal pains, bilateral blindness, and complications, including severe renal failure and death. The goals of management include comprehensive assessment, laboratory works, and radiography. Ethanol, fomepizole, and folate are the all-important antidotes.
Recommended Measures
Kenyatta National Hospital, the main recipient of these emergencies established emergency measures other than public awareness campaigns. Nationally, policies embrace an inter-sectoral Approach - Medical Services and Public Health Ministries will avail resources and build health worker capacity in research and continuous education. Recently, local brews were legalized through the Alcoholic Drinks Control Act 2010 for quality control. Ministries of Education and Youth Affairs will coordinate and initiate youth development and support programs to create employment.
Introduction: Surveillance for health outcomes is critical for rapid responses and timely prevention of disaster-related illnesses and injuries after a disaster-causing event. The Disaster Surveillance Workgroup (DSWG) of the US Centers for Disease Control and Prevention developed a standardized, single-page, morbidity surveillance form, called the Natural Disaster Morbidity Surveillance Individual Form (Morbidity Surveillance Form), to describe the distribution of injuries and illnesses, detect outbreaks, and guide timely interventions during a disaster.
Problem: Traditional data sources can be used during a disaster; however, supplemental active surveillance may be required because traditional systems often are disrupted, and many persons will seek care outside of typical acute care settings. Generally, these alternative settings lack health surveillance and reporting protocols. The need for standardized data collection was demonstrated during Hurricane Katrina, as the multiple surveillance instruments that were developed and deployed led to varied and uncoordinated data collection methods, analyses, and morbidity data reporting. Active, post-event surveillance of affected populations is critical for rapid responses to minimize and prevent morbidity and mortality, allocate resources, and target public health messaging.
Methods: The CDC and the Georgia Department of Public Health (GDPH) conducted a study to evaluate a Morbidity Surveillance Form to determine its ability to capture clinical presentations. The form was completed for each patient evaluated in an emergency department (ED) during triage from 01 August, 2007 through 07 August, 2007. Data from the form were compared with the ED discharge diagnoses from electronic medical records, and kappa statistics were calculated to assess agreement.
Results: Nine hundred forty-nine patients were evaluated, 41% were male and 57% were Caucasian. According to the forms, the most common reasons for seeking treatment were acute illness, other (29%); pain (12%); and gastrointestinal illness (8%). The frequency of agreement between discharge diagnoses and the form ranged from 3 to 100%. Kappa values ranged from 0.23–1.0, with nine of the 12 categories having very good or good agreement.
Conclusion: With modifications to increase sensitivity for capturing certain clinical presentations, the Morbidity Surveillance Form can be a useful tool for capturing data needed to guide public health interventions during a disaster. A validated collection instrument for a post-disaster event facilitates rapid and standardized comparison and aggregation of data across multiple jurisdictions, thus, improving the coordination, timeliness, and accuracy of public health responses. The DSWG revised the Morbidity Surveillance Form based on information from this study.
Introduction: This paper is a report of a qualitative study of emergency and critical care nurses' perceptions of occupational response and preparedness during infectious respiratory disease outbreaks including severe acute respiratory syndrome (SARS) and influenza.
Problem: Healthcare workers, predominantly female, face occupational and personal challenges in their roles as first responders/first receivers. Exposure to SARS or other respiratory pathogens during pregnancy represents additional occupational risk for healthcare workers.
Methods: Perceptions of occupational reproductive risk during response to infectious respiratory disease outbreaks were assessed qualitatively by five focus groups comprised of 100 Canadian nurses conducted between 2005 and 2006.
Results: Occupational health and safety issues anticipated by Canadian nurses for future infectious respiratory disease outbreaks were grouped into four major themes: (1) apprehension about occupational risks to pregnant nurses; (2) unknown pregnancy risks of anti-infective therapy/prophylaxis; (3) occupational risk communication for pregnant nurses; and (4) human resource strategies required for pregnant nurses during outbreaks. The reproductive risk perceptions voiced by Canadian nurses generally were consistent with reported case reports of pregnant women infected with SARS or emerging influenza strains. Nurses' fears of fertility risks posed by exposure to infectious agents or anti-infective therapy and prophylaxis are not well supported by the literature, with the former not biologically plausible and the latter lacking sufficient data.
Conclusions: Reproductive risk assessments should be performed for each infectious respiratory disease outbreak to provide female healthcare workers and in particular pregnant women with guidelines regarding infection control and use of anti-infective therapy and prophylaxis.
Introduction: Major disasters disrupt the infrastructure of communities and have lasting psychological, economic, and environmental effects on the affected areas. The psychological status and community effects of the devastating 2007 wildfires on the Peloponnese Peninsula of Greece were assessed six months following the disaster.
Methods: Adult inhabitants, 18–65 years of age, living in villages affected by the wildfires were selected randomly and compared with a demographically similar group living in neighboring villages that were unaffected by the fires. Regions were chosen based on the extent of fire damage in that area. There were 409 participants in the fire group, and 391 in the control group. Participants completed a questionnaire that included the SCL-90-R symptom checklist, a subjective perception of health status, and a series of items assessing views about current problems, personal values, and trust in different institutions.
Results: The fire group scored significantly higher on psychological distress compared to the control group. Both groups viewed their health status in the previous year as better than at the present time. There were few significant differences between groups in the designation of regional problems, attitudes, and values. In the total sample, 41.6% listed unemployment, and 15.0% listed poverty as the most important problem in their region. The Church was indicated as the most trusted institution by 36.7% of the group and the Government by 13.3%. A total of 30.2% did not have a trusted institution.
Conclusions: The hardiness and resilience of the fire-impacted group was evident. However, an improvement in economic conditions is needed to maintain the health and enhance the quality of life of the population living in the Peloponnese region. This improvement likely would have a positive effect on the attitude of trust in government institutions.
This special report was prepared as a white paper for the First World Health Organization (WHO) Consultation on Nursing and Midwifery Contributions in Emergencies held in Geneva on 22–24 November 2006. Pertinent issues related to research of nurses and midwives were identified based on prior international conferences. Using this information, gaps between the current and proposed state of preparedness research activities were identified. Global perspective recommendations were made for consideration by the WHO and other nursing organizations. Finally, possible discussion questions were posed that were used during the consultation, but could also be used in other international nursing conferences.
Field first-aid data from the Wenchuan Earthquake in China was analyzed retrospectively in order to probe into ways to develop field first-aid operations and provide a reference for future emergency rescue. Related documents about the Wenchuan Earthquake were collected and reviewed. The state of injury and leading causes of death during the disaster were identified. The presnece of emergency medical resources on-site after the earthquake was relatively insufficient. Deaths mainly were due to cardiopulmonary arrest, severe craniocerebral injury, incurable hemorrhagic shock, and crush syndrome that caused multiple organ system dysfunction syndrome. Only by strengthening the on-site emergency medical resources, speeding-up triage, and equipping responders with professional, portable medical equipment, can field first-aid operations be delivered more efficiently.
Introduction: Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours.
Objectives: A consortium of Boston teaching hospitals instituted a two-week moratorium on citywide diversion from 02 October 2006 to 15 October 2006. The hypothesis was that there would be no significant difference in measures of hospital and emergency medical services (EMS) efficiency compared with the two weeks immediately prior.
Methods: A total of nine hospitals and the municipal emergency medical services in Boston submitted data for analysis. The following mean daily hospital measures were studied: (1) emergency department volume; (2) number of emergency department admissions; (3) length of stay (LOS) for all patients; and (4) number of elopements. Mean EMS at-hospital time by destination and the percent of all Boston EMS transports to each hospital destination were calculated. The median differences (MD) were calculated as “before” minus “during” the study period and were compared with paired, Wilcoxon, non-parametric tests. Additional mean EMS measures for all destinations included: (1) to hospital time; (2) number of responses with transport initiated per day; (3) incident entry to arrival; and (4) at-hospital time.
Results: The LOS for admitted patients (MD = 0.30 hours; IQR 0.10,1.30; p = 0.03) and number of daily admissions (MD = -1.50 patients; IQR -1.50, -0.10; p = 0.04) were significantly different statistically. The results for LOS for all patients, LOS for discharged patients, ED volume, EMS time at hospital by destination, number of elopements, and percent of Boston EMS transports to each hospital revealed no statistically significant differences. The difference between the study and control periods for mean EMS to hospital time, at-hospital time, and incident entry to arrival was a maximum of 0.6 minutes. The vast majority of EMS respondents to an online survey believed that the “no diversion” policy should be made routine practice.
Conclusions: The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The “no diversion” policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.
Introduction: Access to the vascular system of the critically ill or injured adult patient is essential for resuscitation. Whether due to trauma or disease, vascular collapse may delay or preclude even experienced medical providers from obtaining standard intravenous (IV) access. Access to the highly vascular intramedullary space of long bones provides a direct link to central circulation. The sternum is a thin bone easily identified by external landmarks that contains well-vascularized marrow. The intraosseous (IO) route rapidly and reliably delivers fluids, blood products, and medications. Resuscitation fluids administered by IV or IO achieve similar transit times to central circulation. The FAST-1 Intraosseous Infusion System is the first FDA-approved mechanical sternal IO device. The objectives of this study were to: (1) determine the success rate of FAST-1 sternal IO device deployment in the prehospital setting; (2) compare the time of successful sternal IO device placement to published data regarding time to IV access; and (3) describe immediate complications of sternal IO use.
Methods: All paramedics in the City of Portsmouth, Virginia were trained to correctly deploy the FAST-1 sternal IO device during a mandatory education session with the study investigators. The study subjects were critically ill or injured adult patients in cardiac arrest treated by paramedics during a one-year period. When a patient was identified as meeting study criteria, the paramedic initiated standard protocols; the FAST-1 sternal IO was substituted for the peripheral IV to establish vascular access. Time to deployment was measured and successful placement was defined as insertion of the needle, with subsequent aspiration and fluid flow without infiltration.
Results: Over the one-year period, paramedics attempted 41 FAST-1 insertions in the pre-hospital setting. Thirty (73%) of these were placed successfully. The mean time to successful placement was 67 seconds for 28 attempts; three of the 31 insertions did not have times recorded by the paramedic. Paramedics listed the problems with FAST-1 insertion, including: (1) difficulty with adhesive after device placement (3 events); (2) failure of needles to retract and operator had to pull the device out of the skin (2 events); and (3) slow flow (1 event). Emergency department physicians noted two events of minor bleeding around the site of device placement.
Conclusion: This is the first study to prospectively evaluate the prehospital use of the FAST-1 sternal IO as a first-line device to obtain vascular access in the critically ill or injured patient. The FAST-1 sternal IO device can be a valuable tool in the paramedic arsenal for the treatment of the critically ill or injured patient. The device may be of particular interest to specialty disaster teams that deploy in austere environments.
Introduction: This study compares self-reported Activities of Daily Living
(ADL) and Instrumental Activities of Daily Living (IADL) status among elderly survivors of
the 2003 Bam Earthquake before, two months after, and five years after the event, and
explores related determinants.
Methods: A two-stage cluster survey was conducted on 210 elderly survivors
in the earthquake-stricken area five years after the event.
Results: Both ADL and IADL scores decreased two months after earthquake
compared to prior status (p <0.001). No differences were observed
between two months and five years after the event (p >0.05).
Access to medical services were not related to level of ADL or IADL (p =
0.52 and p = 0.74, respectively). Elderly survivors with lower functional
capability in terms of ADL experienced more problems in access to relief items
(p = 0.04), but no similar association was found for IADL
(p = 0.26).
Conclusion: The Bam earthquake adversely affected functional capacity of the
elderly. Disaster responders must take into account functional capacity of elders when
planning for medical and relief operations.