Last updated 10th July 2024: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website https://www.cambridge.org/news-and-insights/technical-incident
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.
DePauw University operates yearly mission projects in disaster areas of Central and South America. Since 1976, 26 missions in 8 countries have been conducted. With the guidance of international health and engineering professionals, over 500 undergraduate student volunteers have managed the planning, execution, and outcome review aspects of the projects. This paper examines and summarizes the work to date, emphasizing the vital interactions between volunteers and the local health communities. We conclude that ongoing disaster relief projects such as ours serve a useful purpose in the delivery of disaster relief services.
The need to arrange the assistance beforehand and therefore prepare for the prevention of damage to people and property that may result from accidents or events of considerable magnitude occurring inside the University Hospital, “A. Gemelli,” has led to several laws of the Constitution of the Italian Republic (Article 35), the Criminal Code (Articles 437 and 451), and the Civil Code (Article 2087): The law of Feb 12, 1955, #51 (Official Gazette 54, March 7, 1955); Decree 547 of April 27, 1955 “Regulations for the prevention of industrial accidents” and Decree 302 of March 19, 1956.
The study of these assistance procedures has led to the formulation of an emergency plan divided into two basic parts: prevention of accidents, and rescue operations.
By prevention we mean: a) The training of all staff and Managing Bodies of our Faculty/Staff to take effective action in the case of an intra-hospital accident, b) The need for detailed information on the various procedures to be used depending on the gravity of the event, c) Awareness of the civil and criminal responsibilities relating to the various management and non-management levels in case of emergency.
The training plan for the whole staff, approved by the management administrative, technical and medical bodies, consists of theoretical and practical courses. These courses, which started in June 1983 are “modular.” The staff will take part in them as homogeneous groups, for a period of time which will vary, in regard to the number of hours and kind of instruction, and in relation to what each group has to learn about work safety, fire prevention and emergency measures.
Since standard cardiopulmonary resuscitation (SCPR) cannot reliably preserve the brain during resuscitation, a “New” CPR has been proposed, which seeks to augment blood flow by increasing peak intrathoracic pressure (ITP) during chest compression. This “New” CPR (NCPR) consists of a) high pressure ventilation (70-110 cmH2O) simultaneous with chest compression, b) compression rate of 40/min, c) compression duration of 60% of the compression relaxation cycle, and d) abdominal binding. Although laboratory evidence suggests that NCPR may be capable of augmenting cerebral blood flow (1), the effect on cerebral outcome remains to be demonstrated.
Although the hemodynamic superiority of open-chest CPR has long been recognized, its advantages with respect to the brain have only recently been recognized. It can reliably sustain EEC activity and pupillary light reflexes during CPR (2) as well as providing better cerebral blood flow (3,4). The objective of this two phase study was to establish the relative efficacy of standard, “new,” and open-chest CPR with respect to preserving the brain during CPR.
The objective of phase I of this study was to compare standard and “New” CPR with respect to maintenance of hemodynamic, respiratory, and cerebral variables during prolonged resuscitation. Methods: Ten 10-15 kg dogs were anesthetized with halothane and 50% N2O/O2. Catheters were placed in the carotid artery, aortic arch, right atrium, external jugular vein and the sagittal sinus. An electromagnetic flowprobe was placed on the common carotid artery. Intracranial pressure was monitored with a subdural catheter. EEG electrodes were secured to the skull.
The Somali government has had to deal with serious health problems in the refugee population, especially malnutrition, tubercolosis, malaria, schistosomiasis, and parasitic diseases, arising from changes in environment and living patterns, the process of migration itself, lack of food, and the settlement in special camps. Emergency health plans have therefore been formulated by the Ministry of Health in concert with international agencies, foreign governments, and private aid organizations. An original contribution has been made by the Department of Community Health at the Faculty of Medicine at the National University, in the field of health education and health care. A number of problems were encountered, originating from varying philosophies of intervention and from the particular cultural characteristics of the population. The authors compare their experience with the period of mass resettlement during and after the 1974-75 drought in order to arrive at recommendations for the planning of health services in similar situations.
The aim of this planning project is to ensure prompt and efficient emergency health services to all people in the regional territory of Tuscany, and to establish suitable conditions for an efficient intervention by the National Health Service in situations brought about by unforeseen events which may have serious, often disastrous, consequences. This effort — quite demanding from an organizational and economic point of view — may be successful only if we assume that the time-space unpredictability of emergencies cannot be understood in absolute terms, but in relation to a series of conditions and situations present in everyday reality. Only by reducing to the minimum the unpredictability factor both quantitatively and qualitatively this purpose can be achieved. Risk factors should thus be accurately related to the territory's population distribution, geomorphology, and socio-health conditions.
Since emergency medical care must be carried out without delay, each response must involve all components, concomitantly or in sequence so that the intervention is not regarded as concluded at any one stage. It must be open to integration best suited to the situation. There is need for a multidisciplinary approach to emergencies from the first response to definitive care.
The model of health services planning necessary to achieve all this envisages a series of interventions — 1) to develop interconnections between intramural medicine and health services carried out in the field in order to allow rational use of existing structures, such as the emergency department; 2) to establish coordination focal points which can ensure, outside a hospital, the same level of treatment in emergency situations that will be carried out intramurally, despite the unavoidable changes in methodology; and 3) to activate information and self-training programs designed to encourage the development of a cultural and operative relationship between the health services and the needs of the community.
Airline companies, the Director of the International Paris Airport, and sanitary and administrative authorities of the Seine-Saint-Denis Dpt of SAMU were asked to organize a simulation of an aircraft crash on the site of the Charles-de-Gaulle airport. The two main purposes of this simulation were to check the efficiency of the rescue means from a technical point of view, the delays in the organization, and the coordination of services.
The scenario was an accident during take-off of a big jet. The fuselage of the plane was in three parts. There was an intense fire in the middle one. The crash happened at the end of the runway, on soft ground which was normally unapproachable for ordinary vehicles. The casualties were distributed according to aircraft accidents statistics; 200 military personnel and 30 volunteers of Civil Security participated. The victims were classified into 5 groups: 1) uninjured (30 in front and 40 in rear); 2) slightly injured (15 in frontand 15 in rear); 3) severely wounded (8 in front 4 in center, and 8 in rear); 4) critically injured (5 in front, 6 in center, and 4 in rear)); and 5) dead (95 in center).
The injured were simulated by first aid workers who had been trained and made up so as to be seen by the rescuers. Besides, they were given a tag on which was indicated the group, the types of injuries, the delay of survival without care, the necessary time for the diagnosis, and the appreciation of the victims.
The “International Red Cross” is composed of: (1) The International Committee of the Red Cross (ICRC) which focuses on war victims; (2) the LRCS; and (3) the 130 National Red Cross and Red Crescent Societies worldwide which are federated by the LRCS. The LRCS was founded to facilitate, encourage and promote the humanitarian activities of its member societies and thus contribute to the promotion of peace in the world. The LRCS considers health as one of the keys to a better world for everyone. Red Cross programs include the training of nursing personnel, the provision of health care in rural areas, the organization of assistance to the sick, aged, and handicapped, and teaching first aid skills to lay people.
The Red Cross bases its actions on seven principles: (1) Humanity; (2) Impartiality; (3) Neutrality; (4) Independence; (5) Voluntary Service; (6) Unity; and (7) Universality.
The LRCS assists national societies in improving their disaster relief preparedness through the following functions: (1) to encourage, facilitate and assist in the establishment of a national disaster relief plan; (2) to give technical assistance to national Red Cross societies by sending delegates and equipment and/or by giving cash grants; (3) to convene seminars and conferences to help exchange opinions and share experiences; (4) to train qualified personnel; and (5) to maintain contact with other international governmental and non-governmental organizations. These include the United Nations Disaster Relief Organization (UNDRO); the World Health Organization (WHO); the International Children's Fund (UNICEF); the World Meteorological Organization (WMO); the Food and Agricultural Organization/World Food Program (FAO/WFP); the UN High Commissioner for Refugees (UNHR); and the United Nations Education Scientific and Cultural Organization (UNESCO).
Present national and international guidelines for resuscitation call for open-chest cardiopulmonary resuscitation (CPR) instead of standard external CPR under the following circumstances associated with pulselessness:
1) chest already open;
2) penetrating thoracic trauma;
3) suspected intrathoracic hemorrhage;
4) suspected pulmonary embolism (thoracotomy permits disruption or removal of emboli);
5) deep hypothermia (open chest allows direct warming of the heart for defibrillation); and
6) no palpable artificial pulse during standard external CPR basic life support, as is sometimes encountered in cases of barrel chest or spine deformities.
We will present evidence in support of a 7th indication, that is when standard external CPR advanced life support efforts do not result in the prompt restoration of spontaneous circulation, as may be the case after prolonged unwitnessed cardiac arrest or in patients with severe myocardial disease.
Historically, open-chest CPR has been used effectively to reverse cardiac arrest in laboratory animals since the 1980s and in patients since 1900. We conducted interviews with Drs. DelGuercio, Johnson, Stephenson and Leighninger (for Beck), who have had extensive experience with open-chest CPR. All confirmed personal experience of one of us (PS) with open-chest CPR in the 1950s, and anecdotal reports, that during direct cardiac massage, the heart usually regained color, spontaneous breathing returned, survivors had a very low incidence of neurologic deficit, and complications were almost non-existent. Stephenson's review of 1200 cases of open-chest CPR hospital-wide between 1900 and 1950 (1) report an overall recovery rate of 30%. However, after Kouwenhoven's report on closed-chest CPR in 1960 (2), open-chest CPR became a forgotten art.
In Sweden as in most countries there has been an increasing use of airborne transports for medical purposes during the last decade (Fig. 1). The majority of these transports have been made by helicopters. The climate and the geographical position of Sweden in the far north of Europe presents problems to a helicopter rescue organization. The area of Sweden is approximately 400,000 square kilometers, which is a little more than that of Italy and less than that of France. There are about 8.5 mill, inhabitants which means an average of 20 per square kilometer. The population is unevenly distributed. There are only three densely populated areas: around Stockholm, around Gothenburgh and in the southern most part of Sweden with 250 respectively 150 inhabitants per square kilometer. In the middle and in the north of Sweden there are less than 5 persons per square kilometer. In the mountain regions there are even less. Temperatures ranging from about +25°C in summertime to below - 20°C in the winter are not uncommon.
There is a nationwide alarm system with a common telephone number for all emergency situations and alarm centers, which direct a call for assistance to the proper rescue organization. Almost all medical services in Sweden are provided by regional governments. Adequately equipped and staffed hospitals exist all over the country. The roads are generally of good quality, but outside the urban areas the distance from the place of an accident or a medical emergency to a hospital is usually great.
By definition, hospitals should be among the places with the highest safety index (1). But often, on these premises, we have occasional accidents which may be dangerous and which illustrate the way hospitals are exposed to various and often undervalued risks.
The incidences of unforeseen, dangerous situations involving sudden accidents, of uncontrollable emergency conditions and also of larger catastrophes are awful. Recent accidents proved inadequate safety inside hospitals. In Parma (2) escaping gas was followed by an explosion that destroyed a division of the hospital and resulted in wounded and dead. In Mondovi, an explosion in the central heating system of the hospital caused the death of an employee. A fire that broke out in an old people's home in Southern Italy brought about the death of three persons. The first shocks of the earthquake in 1980 caused the death of many patients and staff (including six physicians) in the so called “safe” hospital of San Angelo Dei Lombardi. In the earthquake in 1976 many patients and some personnel of the hospital staff in Gemona, Friuli lost their lives (3)
Apparently these facts are not closely linked together. Some were caused by human error, others by inadequacy of buildings, age of structures, even where the disaster was due to natural causes. However all these events show the presence of the common denominator of “high risk,” typical of hospital structures (4,5). The principle dangerous situations are: (a) risks coming from the structures of the premises (no earthquake-proof principles of modular structure); and (b) risks connected with the working activities (6,7).
Migration of whole populations, driven by natural calamities or war in search for safe territory, has come to the attention of International Organizations. The sanitary situation of refugee camps in Somalia which take care of the nomad populations arriving from the contested Ogaden territory, has been studied in Nov.-Dec. 1980 at the refugee camp of 3alalaksi. A study of the environment and organization of the camp was made to examine housing, water supply, sewage and alimentation. The nutritional state of refugees was recorded. The anthropometric data of 1185 children, including weight, height and arm circumference according to age and sex have provided interesting comparisons.
Rapid and repeated administration of concentrated NaHCO3 solutions during cardiopulmonary resuscitation (CPR) has become routine since the advent of modern resuscitation techniques (1), although it has been pointed out since the early 1960s that acidemia results from prolonged arrest time and that brief arrests may not require NaHCO3 administration (6,8,13). In spite of the widespread use of large amounts of NaHCO3 there is no convincing evidence that the routine use of this drug offers a clear benefit. Only a few studies have been undertaken to ascertain the role of acidosis and acidemia in survival from cardiac arrest, and the possibility of overcorrecting with NaHCO3 in CPR cases (3,4,8,11). Therefore, the intention of this study was: 1) to clarify the role of acidemia in CPR; 2) to investigate the effects of overcorrection of acidemia (leading to metabolic alkalemia; 3) to test the accurate doses of NaHCO3; 4) to examine the optimal sequence of drug administration in CPR, i.e., whether NaHCO3 or epinephrine should be administered as the first drug.
During attempts at restoring spontaneous circulation (CPCR Phase II, advanced life support) (12), and during post-CPR prolonged life support (CPCR Phase III) (12), measurements were made in dogs following resuscitation from asphyxial cardiac arrest. The model and methods used have been described in the preceding paper of this Journal. Asphyxial cardiac arrest (mechanical asystole, electromechanical dissociation) was reversed with open-chest CPR and defibrillation as necessary to 20 min max.
This new Journal, starting with volume 1, number 1, Spring 1985, is an official publication of the World Association for Emergency and Disaster Medicine (WAEDM), formerly called the Club of Mainz. The Journal is cosponsored by the League of Red Cross and Red Crescent Societies (LRCS). The Journal is owned and published by the WAEDM. There will be 4 Journal numbers per year, plus an occasional supplement.
We initiated this Journal and its predecessor (see below) because existing journals on disasters focus on sociologic and epidemiologic topics, and more on aid to uninjured survivors and rehabilitation of disaster-stricken regions, than on the resuscitation and life support of severely injured victims. Disaster medicine is not yet a science, and thus based primarily on anecdotal reports. It is in need of international communication and the acquisition of quantifiable facts. The Journal will help meet these needs by examining the potentials of resuscitation, emergency medical care and critical care (intensive care) medicine for everyday Emergency Medical Services (EMS) and for disaster medicine. The disasters to consider range from multi-casualty incidents to mass disasters and endemic disasters. Other organizations emphasize response to mass disasters after days or weeks; the WAEDM emphasizes response within minutes to hours. This Journal will benefit medical and nonmedical members of the WAEDM and the LRCS, as well as non-member specialists in anesthesiology, critical care medicine, cardiology, emergency medicine, epidemiology, forensic medicine, government medicine, infectious diseases, military medicine, nuclear medicine, nutrition, pathology, public health, resuscitology, surgery, toxicology, and traumatology.
The “Club of Mainz” for Improved Emergency and Disaster Medicine Worldwide was conceived in 1973 and founded in 1976 by about 10 reanimatologists under the leadership of the late Rudolf Frey (Crit Care Med 6:389, 1978). Its objectives are: “(1) to foster optimal resuscitation and life support methodologies worldwide; (2) to concern itself with a range from everyday emergencies to mass disasters, with appropriate consideration for differences in populations, available resources and other factors; and (3) to informally pursue the objectives by combining the resources of scientific, social and related information and experiences, together with international communication and collaboration.”
The Club of Mainz recognizes the experiences and contributions of other organizations for public health related disaster relief, which particularly helps uninjured survivors and rehabilitates regions, but wishes to add the potentials of modern resuscitation (emergency and critical care medicine), focusing on the acutely ill or injured individual victim in distress.
The Club of Mainz was inspired by the Club of Rome, which was initiated in 1968 by the late Aurelio Peccei and some other concerned non-medical leaders and scientists. The 10 non-medical key problems identified by the Club of Rome have equivalents for disaster medicine: (1) overpopulation (starvation); (2) no long range planning; (3) destruction of the environment (destruction of people); (4) business crises; (5) competitive armament leading to wars; (6) poverty (starvation, epidemics); (7) chaotic development in science and technology; (8) antiquated institutions; (9) schisms between East and West and between North and South; and (10) lacking moral leadership.
The Emergency Medical Services (EMS) system response to a multiple victim disaster can be preplanned to identify various components, such as scene authority, communications, triage, vehicular staging, and point-of-entry of patients to area hospitals. On 1/23/82, a DC-10 airplane carrying 210 people, slid off the runway while landing at night on ice at Boston's Logan airport. The plane broke into two pieces after it slid into Boston Harbor; 33 patients required definitive medical management and were transported to 7 area hospitals. The Boston EMS system, coordinated through one Resource Trauma Center, utilizing a central communications center, was responsible for the medical component. Hospital categorization on-scene triage, patient staging, patient transportation and regionalization of resources have changed the City's plan to reflect new EMS developments.
On January 23, 1982, Boston experienced the final stages of a winter storm that began with snow followed by freezing rain. A plane with 198 passengers and 12 crew members was the last plane scheduled to land before the runway was closed for plowing and sanding. The DC-10 landed and slid off the runway into Boston Harbor. The plowing and sanding crew that was scheduled to service the runway was in position, and therefore witnessed the incident and confirmed the crash.
In 1964, the medical team at motor car races consisted of 2 physicians, including the author, several first aid workers, and 2 nurses. Only one physician stood at the trackside and sophisticated equipment was non-existant. Nevertheless, it was possible to resuscitate drivers who had suffered a cardiac arrest at the moment of impact, by simple cardiopulmonary resuscitation (CPR). In 1965, the Grand Prix mobile hospital was added. This was a Juggernaut container lorry containing a well-equipped operating room and scrub up area. It was found to be of little use in the UK, although the idea behind it was well intentioned. The problem with the unit was one of mobility. It was certainly true that the hospital could be taken from London to Paris, but it was far too big to be driven from the car park to the injured driver at the side of the track. In 1968, theBritish Racing and Sports Car Club (BRSCC) introduced the first rescue unit. This short wheel base vehicle was presented to the club by Ford as a service to motor sport. It contained all necessary fire-fighting, cutting and medical equipment. It was to reach the scene of any accident within 3 minutes. In that way a driver whose heart had stopped at the moment of impact could be resuscitated before his brain suffered irreparable damage. Apart from firemen, the rescue unit carried a physician, usually an anaesthetist skilled in resuscitation. As a result, the standard of care around the circuit became standardized after the first few minutes.
International organizations such as the World Association for Emergency and Disaster Medicine (Club of Mainz) have brought attention to the need for improved worldwide emergency medical services (EMS) systems and disaster preparedness (1). Similar concerns in the United States (US) for improved emergency medical care have resulted in the organization of emergency medicine as a new medical specialty (2). The practice of this specialty of medicine in some ways differs from the practice of emergency medicine, reanimation medicine, or resuscitology, in Europe. In the United States, emergency medicine specialists provide emergency care for the full range of emergency health conditions, including accidents and trauma, medical emergencies, toxicologic emergencies, psychiatric and social emergencies, and disasters. This care is provided primarily in hospital emergency departments and includes the immediate initial recognition, evaluation, treatment and disposition of these patients with acute illness and injury. For continuing care, patients are referred to their own physicians.
Emergency medicine physicians provide medical direction for community EMS and supervise the prehospital emergency medical care provided by non-physicians (emergency medical technicians and paramedics). Emergency physicians engage in the administration, research and teaching of all aspects of emergency medical care. They also provide consultation to governmental and nongovernmental organizations on emergency health care issues. Recently, with the basic framework of emergency medicine established, attention is being given to disaster planning and management.