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Mass disasters are exceptional situations, requiring exceptional efforts of medical services and institutions, to overcome the problems and consequences of those affected. According to a commonly accepted definition, a disproportion between objectively required and actually possible aid is the main distinguishing mark. In such a situation, the target function of health systems must change as much as possible to help save injured persons lives and to avoid severe consequences, because simultaneous aid for all is temporarily impossible.
In 1981 we described the introduction and development of a coma scale for use in Head Injured patients. The scale has become adopted for routine use in the Accident and Emergency Unit at Pinderfields General Hospital, Wakefield, and at other centers, for example the Emergency Department at the Glasgow Royal Infirmary finds the scale more sensitive than its own Glasgow Coma Scale in monitoring the course of accident victims.
Triage and rescue of casualties from accidents involving hazardous materials is a challenge for many emergency medical services (EMS) personnel. With very toxic materials, the untrained and unprepared rescuer may become a victim. In addition, few hospitals in the United States have decontamination units attached to their emergency departments and emergency department personnel may become exposed if the casualty is not decontaminated. Many environmental cleanup teams, including the U.S. Environmental Protection Agency (EPA) team, are well trained in materials handling but are not immediately available when a hazardous materials spill with personal injuries occurs.
Data on resuscitation potentials immediately following major earthquakes are lacking. Published reports have been unrevealing. Retrospective interviews of surviving eyewit esses might be more revealing. The epicenter of the last major Peruvian earthquake of May 30, 1970, was off the coast, but the damage included most of central Peru including the Andean Range. A total of 80,000 people were killed, including the entire population of Yungay (25,000), buried alive by several m of an ice-mud-rock avalanche which broke off Mt. Huascaran (22,000ft.). There, resuscitation potential was zero. In nearby Huaras (pop. 30,000, alt. 12,000 ft.), 15,000 died, 90% of houses were destroyed. Interviews with lay survivors gave unclear reports.
For some time emergency ambulances have been in operation in Italy. In spite of their modern equipment, these ambulances often turn out to be unsuitable for a comfortable journey and do not have satisfactory working conditions. This is due to the lack of up-to-date standards for vehicles and equipment.
The International Veterinary Academy on Disaster Medicine had its genesis in Perth, Australia, when at the World Veterinary Congress in August 1983, Dr. Ole Stalheim extended an invitation to attend a meeting of a group under the label “World Veterinarians Against Nuclear War”. It had an auspicious beginning—we attracted some attention in the media, more indeed, than we had received during our early attempts at formation in the United States. It became apparent, however, that we were in effect replicating activities of other well-established and more financially secure groups—Physicians for Social Responsibility, the Society Against Nuclear Energy (SANE), etc. We needed greater participation to cope with “peace time” problems already confronting us as well, and it was evident that a larger veterinary audience would be reached and our services to the community enhanced if we broadened the commitment.
St. Helens is one of a group of high volcanic peaks that dominate the Cascade Range between northern California and southern British Columbia, Canada. The distribution is in a band that roughly parallels the coastline of the so-called “Ring of Fire,” a near circular array of volcanoes located on islands, peninsulas and the margins of continents that rim the Pacific Ocean.
In recent years, medical care in Sweden as in other small countries, has become increasingly dependent upon the availability of imported goods. The consequences of even limited import restrictions of drugs and supplies has necessitated special planning for such a contingency. Special difficulties in this respect would arise in the field of anesthesia and intensive care, as all drugs for general anesthesia, and almost all disposable items used in anesthesia and intensive care in Sweden, are imported. To solve this problem, it would be necessary to ration drugs and materials, increase domestic production, introduce resterilization of disposable equipment and again use nondisposable supplies. In addition, stores of drugs and supplies are being built up to be used as a reserve in case of blockade or war. The nursing standards would have to be changed, by delegation to other personnel so that nurses take a larger responsibility, and by using methods which are unusual or even unknown to the staff in service today, i.e. ether anesthesia.
Three hundred cases of polytrauma were investigated to evaluate the reliability of the Lindsey severity index. This simplified injury score can be used by paramedics or low-skilled emergency practioners to obtain a correct screening of patients and an initial prognosis on the basis of a simple injury severity scale. An evaluation by the Lindsey index was done in the field and at the emergency care unit. Results compare the final status of the patient which was obtained using the Patel score, derived from the patient's chart after his discharge. The Lindsey index demonstrated a correct assessment of the patient's status in 60% of the cases at the scene of the accident and 77% in the emergency unit. Most of the errors were due to underevaluations of the skull and spinal trauma. Patel's scale emphasizes locomotor sequellae, while skeletal injuries seldom provide life-threatening events, widely considered in the Lindsey index. Lindsey's index is a simple and reliable tool for initial assessment and a useful method of teaching.