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In several Iranian provinces, there are large numbers of landmines that threaten the lives of many civilians. Ilam is one of the most polluted areas with 1,086 injuries from landmines between 1989 to 1999, with an overall mortality rate of 36.4%. A remarkable number of deaths occurred before the injured were conveyed to the hospital. In this survey, the effects of on trauma outcome of the use of prehospital trauma life support provided by t rained paramedics and ru ral health workers as first responders were examined.
Methods:
In an interventional, prospective study, 4,834 persons (general physicians, nurses, rural health workers, and emergency technicians, high- and low-educated people, layperson villagers, and nomads) were trained in one level of advanced (for general physicians and nurses) and four levels of basic life support courses during two years (2000–2001). Following the training, the data from 288 landmine victims who were referred to the main hospital in Ilam (trauma center) were registered prospectively (2001–2005). The effects of prehospital trauma life support training were assessed by using the Injury Severity Scale (ISS) score and prehospital physiologic severity (PSS) score.
Results:
There were 288 injuries from landmines in the Mehran region between 2002 and 2005. The mean ISS score was 20.3 with a median of 13. Forty percent were severely injured with an ISS score >15. Of the injured who received prehospital care at the Mehran Emergency Center, the mean value of the PSS scores was 6.40, which improved to 7.43 in the hospital (p = 0.01; 95% CI for difference -0.72 to -0.45), in comparison with 5.97 in the injured who were conveyed to Ilam Hospital directly (mean of ISS was approximately equal in both groups).The total mort ality rate was 27% between 2001 and 2005.
Conclusions:
Prehospital educations and training help improve PSS scores and reduce the death toll of landmine accidents in the remote areas.
Most disasters caused by natural hazards occur unexpectedly and result in the loss of life and damages to the community, both of which may impact and transform one's individual and social environments. This study seeks to describe and analyze the solitary deaths (unattended deaths) of victims of the Great Hanshin-Awaji earthquake.
Methods:
Secondary data analysis was used to analyze the characteristics of solitary death. Data were collected from obituary columns of a major local newspaper from 17 January 1995 to 16 January 1998 which focused on aspects of the disaster related to solitary death. The content included age, sex, family status, living status, job status, health situation, and the disaster victim.
Results:
There were 94 obituaries related to solitary death found in the local newspaper. Males and females accounted for 72 and 22 of the cases, respectively. The significant age groups included the 60s (33 cases) and 50s (15 cases). In 40 out of 65, cases the individual spent less than one year living in a new shelter. Ninety-three out of 94 were living alone; 80 out of 81 had health problems; and 89 out of 90 were jobless.
Conclusions:
Characteristics of victims experiencing solitary death included: living in a shelter >1 year, being male, being 60–70 years of age, unemployment, and health issues. Victims were socially vulnerable due to this myriad of problems. Disaster nursing intervention for these victims is strongly needed.
Mass-casualty incidents (MCIs) can cause a surge of psychological casualties and family/friends searching for victim information and reunification. Staff training in psychological first aid and a joint hospital-community psychosocial response plan is essential or hospitals will be overwhelmed, reducing their patient care capacity. The aim of this presentation is to outline the steps needed to develop and evaluate a psychosocial response plan template for an urban center of ≥500,000.
Methods:
Existing psychological first aid training programs and hospital-community psychosocial response plans for urban populations ≥500,000 will be surveyed. Psychosocial response staff in community and hospital settings across Canada will be surveyed to determine needs and issues. Common threads will be identified and end-users/experts will be invited to review for feasibility and sustainability. This information will be used to collabora-tively build a plan with the Toronto, Ontario psychosocial community and train and evaluate it in two large-scale exercises 29 November 2009 (mass-casualty trauma) and 30 November 2009 (pandemic), in Toronto. Data will be collected to determine the effectiveness of the plan to absorb and mitigate a MCI surge.
Expected Results: Elements needed for a sustainable psychosocial response training plan that integrates and improves daily operational skills, builds relationships and communication between community and hospitals, and develops a community plan capable of absorbing a surge in psychosocial demand in the event of a mass-casualty incident will be identified.
Conference Presentation: The results of the literature review, preliminary survey results, and an initial framework for the joint Toronto hospital-community psychosocial response plan will be presented.
Terrorist attacks are exceptional events that place paramedics in high-risk situations. When terrorist events occur, paramedics play an integral role in the response to, and management of, these events. Given that responding to terrorist events places paramedics at a high risk for a variety of health problems and injuries, it is imperative to adequately prepare for such events through the use of appropriate teaching and educational programs. These programs should be based on the direct experiences of paramedics responding to previous terrorist events.
Methods:
This research utilized a series of focus groups in New York and London to investigate how paramedics experienced working during 11 September 2001 and the London bombings. Specifically, this research focused on what concerned paramedics about responding to terrorist events, whether they would be willing to respond again, and what can be learned from these experiences in regard to disaster response training and education.
Results:
Paramedics reported a number of primary risks that concerned them during their responses to 9/11 and the London bombings. These included injury, death, potential contamination, and exposure to unknown hazards and agents. Personal protective equipment (PPE), communication networks, and reliabilty of information all were areas of concern that must be addressed by disaster planners. Paramedics reported that the most negative aspect of responding to these terrorist events was the inability to communicate with loved ones and the lack of timely and accurate information regarding updates on the situation. Personal protective equipment was not always available, and at times the wearing the PPE interfered with providing optimal patient care.
Conclusions:
Key lessons can be taken away from paramedics experiences during 9/11 and the London bombings. These include the need for dedicated communication channels, accurate and timely information, suitable training and education (including an emphasis on infectious agents), and the provision of suitable PPE conducive to optimal working conditions.