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Within the Stockholm region there are eleven emergency hospitals, six of which can send medical teams to the site of a disaster within fifteen minutes after an alarm. This ensures qualified first aid to the injured at the disaster site. Each team consists of the surgeon and anesthetist on duty and three nurses with special training in emergency medicine, anesthesia or intensive care. The personnel leaving the hospital are replaced by other personnel in the hospital. All members of the team are equipped with special clothing: an overall with dressings and other equipment in the pockets, a helmet and boots and warm underwear, allowing outdoor work at the low temperatures not infrequently met in the Swedish winter (Figures 1,2). Doctors and nurses have special markings, so that they are easily recognized.
There is a great clinical need for readily available volume replacement fluids with the property of oxygen transport. From the fluorocarbone emulsions only stromafree hemoglobin solutions seem to meet the essential requirements of oxygen transport and delivery at the tissue level. However, the high oxygen affinity and the short intravascular persistence have been preventing, up until now, the application of hemoglobin solutions for blood replacement.
Recently, a modified hemoglobin solution with a decreased oxygen affinity and a long intravascular persistence, has been produced by binding pyridoxalphosphate to the hemoglobin and its subsequent crosslinking. The hemodynamics and oxygen unloading capacity of this pyridoxalated polyhemoglobin have been investigated in a model of total blood exchange.
The kidney plays a fundamental role in the maintenance of the homeostasis of all body fluids; it operates as an efficient buffer system in the prevention of dehydration, hyperhydration, acid base and electrolyte imbalance and it removes toxic metabolites. It is not surprising, therefore, that post traumatic acute tubular necrosis (ATN) is characterized by a mortality that exceeds 80% in spite of the progress offered by dialysis and clinical nutrition. The mechanisms of this critical pathological condition are summarized in Figure 1.
In acute respiratory failure, an immediate restoration of respiratory functions is imperative. Depending upon the available equipment and the qualifications of the physician and nursing staff, the most suitable ventilation procedure should be selected. In every case, accurate ventilation is accomplished by Intermittent Positive Pressure Ventilation (IPPV). If emergency equipment is not available, the simplest method of achieving this is mouth-to-mouth or mouth-to-nose breathing. The efficacy of this method is limited by the low FiO2 (about 17%) and by the physical condition of the first aider; after 30 minutes of resuscitation, even an experienced and well conditioned emergency rescuer will be exhausted.
Planning of earthquake disaster prevention is of great concern in Japan, since we have frequently been subjected to serious damage due to severe earthquakes. The medical treatment after a disastrous earthquake is undoubtedly one of the most serious items to be considered.
The countermeasures against earthquake disasters, in relation to medical treatment, may be divided into two categories; a) prevention of damage to medical facilities and instruments, b) planning for emergency and disaster medicine. This paper introduces the countermeasures against earthquake disasters in relation to medical treatment in Japan.
Head injury has been demonstrated to be one of the most important lesions in polytrauma patients and of very decisive relevance to the posttraumatic prognosis. Moreover, other lesions and their sequelae (e.g. shock, thorax trauma) are known to worsen the primary cerebral injury by causing secondary brain damage due to hypotension and hypoxemia. This study considers the influence of prehospital emergency care to the posttraumatic prognosis in severe head injuries.
The concept of using Intravenous Regional Analgesia (IVRA) in the mass casualty situation is potentially an attractive alternative to the use of general anesthesia in the management of limb fractures. The purpose of this paper is to outline the history and development of the technique and emphasize important guidelines designed to increase the safety of the method.