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.
Mass-casualty triage is a critical skill. The are any systems exist to guide providers in making triage decisions, however, there is little scientific literature to validate current systems. There are no internationally agreed upon categories or color. The lack of standardization in triage can lead to confusion.
Methods:
An expert panel reviewed existing triage systems. Each member was assigned a triage system and asked to conduct an exhaustive literature review and Internet search and to develop a report to the panel. Each system had two or more members assigned to conduct a review.
Results:
The committee identified nine existing mass casualty triage systems, including two pediatric-specific systems. The systems were noted to be similar in naming and color representations, but differed on the inclusion of an expectant category. Studies that compared the various mass casualty triage systems and found that the ability to obey commands and systolic blood pressure were the best predictors were identified.
Conclusions:
The committee concluded that no one system could be embraced as a validated system. The committee decided to use the best available scientific information and consensus opinion to develop a system that could serve as a proposed national guideline. The group discussed each component until consensus was reached. The guideline incorporates pieces of most existing triage systems; it was given the name SALT Triage (sort, assess, lifesaving interventions, and treatment and/or transport). This guideline is intended for use on-scene in all-hazards events for both adults and children.
The international disaster relief operation (IDR) of Chinese Medical Teams following the earthquake in Indonesia in 2004 is described.
Methods:
Four medical teams participated the IDR between 31 December 2004 and 06 February 2005. A total of 190 medical staff including 22 doctors and 78 nurses were dispatched from China. They treated 4,483 patients. The authors examined the activities of the medical teams and also described the role of nurses in the IDR.
Results:
The role of the medical team was treating surgical wounds and performing surgical operations during the acute phase. After that, the role gradually changed to treating infectious diseases, providing safe drinking water, and preventing infectious diseases. The role of the nurses in the IDR was setting up temporary medical facilities, inside arrangement, providing health care to the medical staff, triage, removing stitches, managing commodities and medical waste, interviewing patients, and assisting with medical treatment.
Conclusions:
This was the first Chinese IDR in the 21st Century. The role of nurses in this IDR was important for the success of the IDR.
Sulfur mustard is a member of the vesicant class of chemical warfare agents that causes blistering to the skin and mucous membranes. There is no specific antidote, and treatment consists of systematically alleviating symptoms. Historically, sulfur mustard was used extensively in inter-governmental conflicts within the trenches of Belgium and France during World War I and during the Iran-Iraq conflict. Longitudinal studies of exposed victims show that sulfur mustard causes long-term effects leading to high morbidity. Given that only a small amount of sulfur mustard is necessary to potentially cause an enormous number of casualties, disaster-planning protocol necessitates the education and training of first-line healthcare responders in the recognition, decontamination, triage, and treatment of sulfur mustard-exposed victims in a large-scale scenario.
The development of syndromic surveillance systems to detect bioterrorist attacks and emerging infectious diseases has become an important and challenging goal to many governmental agencies and healthcare authorities. This study utilized the sharp increase of glow product-related calls to demonstrate the utility of poison ontrol data for early detection of potential outbreaks during the week of Halloween in 2007.
Methods:
A review was conducted of the electronic records of exposures reported to the New Jersey Poison Information and Education System NJPIES) Poison Control Hotline from 2002 through 2007 with generic code number 0201027 (glow products) set by the American Association of Poison Control Centers (AAPCC). Key information such as age, gender, time of the call, exposure reason, clinical effects, and medical outcomes along with telephone number, zip code, and county location were used in the analyses to determine the extent of the outbreak.
Results:
Analyses included a total of 139 glow product-related calls during the week of Halloween in 2007 with a single-day high of 59 calls on Halloween Day. More than 90% of the glow product exposures were in children 1–10 years of age. The glow product-related calls on Halloween Day increased from 14 calls in 2002 to 59 calls in 2007, a 321% increase during a six-year period.
Conclusions:
Poison control centers in the United States are equipped with a unique and uniform input data collection system—the National Poison Data System—that provides an important data source in the development of a comprehensive surveillance system for early outbreak detection.
A survey was distributed to determine physicians' confidence levels in recognizing potential Category-A bioterrorism disease threats (e.g., smallpox, anthrax), preferred means of obtaining continuing medical education (CME) credits, and their knowledge of the Connecticut Department of Public Health's (DPH) disease reporting requirements.
Methods:
Surveys were mailed to all physicians in the three-hospital Yale New Haven Health (YNHH) System (2,174) from January to March 2004; there were 820 respondents for a 37.7% response rate.
Results:
A total of 71% of physicians indicated that they were “not confident” that they could recognize five of the infectious agents named;they had higher confidence rates for smallpox (48.8%). Infectious diseases and emergency medicine physicians had the highest rates of confidence. Seventy-eight percent of physicians indicated conferences and lectures as their preferred CME learning modality. Nearly 72% of physicians reported a low familiarity with the DPH reporting requirements.
Discussion:
The results highlighted the breadth of perceived weaknesses among clinicians from disease recognition to reporting incidents, which signifies the need for greater training in these areas. As clinicians themselves emphasized their lack of skills and knowledge in this area, there should be a rapid development and dissemination of problem-based learning CME courses in bioterrorism preparedness.
It is clear from disaster evaluations that communities must be prepared to act independently before government agencies can cope with the early ramifications of disasters. In response to devastation to the borough of Staten Island, New York in the wake of 11 September 2001, the Richmond County Medical Society established a structure to incorporate community needs and institutions to work together for the common good. A program that brings together two hospital systems, nursing homes, emergency medical services, and the Office of Emergency Management physician leadership in a meaningful way now is in place. This approach has improved the disaster preparedness of Staten Island and demonstrated how the Medical Society can provide leadership in disaster preparedness and serve as a conduit for communication amongst entities that normally do not communicate.
It is common for international organizations to provide surgical corrective care to vulnerable populations in developing countries. However, a current worsening of the overall surgical burden of disease in developing countries reflects an increasing lack of sufficient numbers of trained healthcare personnel, and renders outside volunteer assistance more desirable and crucial than ever. Unfortunately, program evaluation and monitoring, including outcome indices and measures of effectiveness, is not measured commonly. In 2005, Operation Smile International implemented an electronic medical record system that helps monitor a number of critical indices during surgical missions that are essential for quality assurance reviews. This record system also provided an opportunity to retrospectively evaluate cases from previous missions. Review of data sets from >8,000 cases in 2005 and 2006 has provided crucial information regarding the priority of surgery, perioperative and operative complications, and surgical program development.
The most common procedure provided was unilateral cleft lip repair, followed closely by cleft palate. A majority of these interventions occurred for patients who were older than routinely provided for in the western world. The average child treated had an age:weight ratio at or below the [US] Centers for Disease Control and Prevention (CDC) 50th percentile, with a small percentage falling below the CDC 20th percentile. A majority of children had acceptable levels of hemoglobin, but the relative decreased age:weight ratio nonetheless can reflect mild malnutrition. Complications requiring medical intervention were seen in 1.2% of cases in 2005 and 1.0% in 2006. Thirty percent were reported as anesthesia complications, and 61% reported as surgical complications. One death was reported, but occurred after discharge outside the perioperative period. Complication rates are similar to rates reported in the US and UK and emphasizes the importance of standardization with uniform indices to compare quality performance and equity of care. This study offers an important example of the importance of collecting, analyzing, and reporting measures of effectiveness in all surgical settings.