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Pregnant females are uniquely vulnerable to morbidity and mortality associated with trauma and from secondary exposure to environmental agents during and following a terrorist attack. For clinicians and emergency management planners, there are several specific considerations for pregnant victims of terrorist events in the planning and response phases of a terrorist event.
Methods:
A review of scientific, medical, and academic literature pertaining to women and terrorist activities was performed. In addition, government reports and media accounts of terrorist attacks where women were direcdy or centrally involved as perpetrators were collected and reviewed. Common elements, themes, and similarities were analyzed by the investigator to determine trends in injury patterns, distribution of exposed individuals, and the acute and long-term health effects associated with the gravid female and her unborn child.
Results:
Several causes of morbidity and mortality among pregnant females and their unborn children as the result of terrorist attacks were discussed in the literature. Physical trauma, toxic inhalation effects, bioterrorism considerations, and psychosocial impacts were among those discussed most often. The disaster epidemiology associated with these health events is described, as well as the strategies for prevention and clinical management of this unique group of victims.
Conclusions:
A greater understanding of the types of hazards and exposures which may affect a pregnant woman or her unborn child during or following a terrorist attack can assist in developing plans for medical counterterrorism. This epidemiological information can benefit both clinicians and emergency planners in anticipating the potential health and medical needs as well as planning for potential protective actions that can be implemented before or immediately following a terrorist incident.
Emergency medical services (EMS) providers are ill-prepared in the areas of training and equipment for weapons of mass destruction (WMD) events and other public health emergencies.
Methods:
A nationally representative sample of the basic and paramedic emergency medical service providers in the United States was surveyed to assess whether they had received training in WMD and/or public health emergencies, as part of their initial provider training and as continuing medical education (CME) within the past 24 months. Providers also were surveyed as to whether their primary EMS agency had the necessary specialty equipment to respond to these specific events.
Results:
More than half of EMS providers had some training in WMD response. Hands-on training was associated with EMS provider comfort in responding to chemical, biological and radiological events and public health emergencies (OR = 3.2; 95% CI = 3.1–3.3). Only a small portion (18.1%) of providers surveyed indicated that their agencies had the necessary equipment to respond to a WMD event. The comfort level and having equipment to respond these incidents was not as highly associated as the comfort level and having had training to respond to these incidents.
Conclusions:
Lack of training and education as well as the lack of necessary equipment to respond to WMD events is associated with decreased comfort among emergency medical services providers in responding to chemical, biological, and radiological incidents. Better training and access to appropriate equipment may increase provider comfort in responding to these types of incidents.
The emotional aspects of traumatic events often are ignored for professionals involved in disaster interventions immediately with victims of emotional trauma. There is a growing body of theoretical and empirical literature that recognizes that engaging in therapeutic work with trauma survivors can and does impact the professionals involved. Compassion fatigue is the latest in an evolving concept that is known in the field of traumatology as secondary traumatic stress. Most often, this phenomenon is associated with caring for others in emotional or physical pain.
Results:
In a literature review, Beaton and Murphy (1995) assert that emergency/first responders and crisis workers absorb the traumatic stress of those they help. By doing so, they are at-risk for compassion fatigue. Among the negative consequences that often are not linked to their work, include substance abuse and relationship conflicts. Although the body of literature exploring the prevalence of compassion fatigue continues to grow, the lack of research to support the underlying theory of the concept in relation to measurement is cause for alarm.
Conclusions:
This presentation will explore a theoretical model that accounts for and predicts the emergence of compassion stress and compassion fatigue among professionals working with traumatized people as well as explicate the principals associated with accurate diagnosis,assessment, research, treatment, and prevention of compassion fatigue.
The experiences of racially/ethnically diverse residents and communities in the US in the wake of the wildfires in California, Hurricane Katrina, and other disasters have shown the serious if not fatal lack of their effective engagement in response to these events, confusion around access to and provision of emergency care, and failure to adhere to recommended services guidance and requirements. As one of the most diverse states in the country, California's experience with earthquakes and wildfires has heightened related concerns around the capacity of healthcare providers to effectively meet the needs of diverse communities. The objectives of this study were to: (1) identify barriers and challenges to meeting emergency health needs of these communities during disasters; (2) identify programs and policy gaps in the current environment; and (3) develop recommendations as well as guidance for improvement.
Methods:
Three methods were used in conducting the study. The project team reviewed and synthesized literature from California and other sources; reviewed 148 Websites; and conducted key informant interviews with 17 officials and community representatives identified through state sources/environmental review during summer/fall 2008.
Results:
Research identified four major barriers, challenges, and gaps affecting the provision of effective health care during emergencies: (1) significant lack of community engagement and trust among diverse residents, especially among immigrants who feared deportation actions; (2) cultural misunderstanding that led to misinformation and a related lack of training and education resources for emergency personnel; (3) lack of interpreter/translation services; and (4) insufficient coordination at local, regional, and state levels.
Conclusions:
Improvement will require four major actions: (1) effective collaboration between these communities; (2) emergency care providers and other key sectors; (3) resources to increase availability and access to interpreters; and (4) coordination of information and resources to minimize gaps and duplication, and greater flexibility in allocation of funds to meet local emergency medicine priorities.
The study presents the generalized results of the long-term epidemiological, clinical, biochemical, cyto-genetic, and immunological studies dedicated to the mechanisms of the development of somatic pathology in the remote period in the victims of radiation accidents. The major accidents were included, i.e., Chernobyl nuclear power plant accident, radiation accidents on ships with nuclear energy devices, nuclear weapons tests, and other accidents.
Methods:
The two databases were created at the Nikiforov Russian Center of Emergency and Radiation medicine (St. Petersburg) in order to monitor the health status of the victims of radiation accidents: (1) epidemiological database with sub-registries for leukosis, thyroid cancer and other cancers, (2) scientific clinical database.
The full range of all up-to-date and evidence-based clinical investigations was used including tomography, bio-and immunochemical methods, cancer markers and hormone levels assessment.
Results:
The epidemiological analysis showed that after five years following the exposure there is a significant rise in the incidence of somatic pathology across all age groups. After 10 years following the exposure 38% of clean-up workers already developed chronic diseases, while among those who were exposed to the dose of more than 25 cGy the incidence was more than 50%. Over 20 years of observation, the average number of diagnosed chronic diseases per clean-up worker increased from 1.4 to 10.6.
The most prevalent symptoms (>60%) are cardiovascular diseases, musculoskeletal and gastrointestinal diseases. From the results of cytogenetic and biochemical investigations the main pathological mechanism is the disturbance of microcirculation and endothelial dysfunction. In 60–80% of clean-up workers' muscular-skeletal diseases were diagnosed with the main manifestation and possible mechanism being an osteopenic syndrome.
The cytogenetic studies showed that across all age groups, the incidence of chromosome aberrations is significantly higher than in the control group. The assessment of cancer markers confirmed the elevated risk of developing cancer. This was accompanied by markedly elevated levels of hydrogen peroxide and other free-radical and lipid oxidation indicators in the blood.
Conclusions:
The results of the complex epidemiological, clinical, biochemical, cytogenetic, and immunological investigation performed on the patients exposed to ionizing radiation due to a number of radiological accidents described the mechanisms of the development of somatic pathology due to radiation exposure.