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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.
Following the June 1982 war in South Lebanon, the Israel Ministry of Health sent a medical team to assess health conditions in the area, to assist in the restoration of local health services, and to provide additional medical assistance as needed in public health and specialized medical services. For the approximately 600,000 population of the area, public health sanitary conditions were restored by local authorities, with some external assistance. Sanitation and housing for the refugee camp populations were difficult to solve because of extensive damage in the camps; but United Nations activities, supported by international and Israeli sources, were effective. Epidemic conditions did not occur. Monitoring for specific infectious diseases showed increases not exceeding usual summer conditions. Child nutrition status was satisfactory. Medical needs for specialty services, not available in South Lebanon, were arranged through screening and referral to Israeli hospitals. Renal dialysis needs were met by establishing a dialysis unit using local personnel in a damaged and non-functioning government hospital. Private medical and hospital services, the bulk of health care in the area, functioned except for minor dislocations throughout the war and post-war period. Israeli medical aid, managed by a small multidisciplinary team, was designed to assist and, where necessary, augment rather than replace local health services.
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.
Wars have contributed to the progress of emergency medicine. Napoleon's surgeon Larrey introduced a new era in surgical skills. During World War I, blood transfusions and anesthesia were introduced, and during World War II, penicillin. Neither in war nor in civilian disasters can one predict the number of casualties. Thus planning should be similar.
During the early summer of 1982, Her Majesty's Armed Forces embarked upon an operation to repossess the Falkland Islands. The campaign was fought over a difficult terrain and under hostile climatic conditions, 8,000 miles from home shores. Resupply was difficult, sometimes unreliable and, during the initial battles, medical practitioners supporting combat troops had to practice ingenuity and improvisation. During the battles, 225 British Soldiers were killed and 777 wounded. Of the wounded who presented at the British Advanced Surgical Centers, only 7 subsequently died (1%). 658 battle casualties were dealt with at the various land-based surgical facilities. About 270 general anesthetics were given.
The medical successes realized in Vietnam can be attributed to several factors: rapid evacuation of casualties by helicopter or ambulances; the availability of whole blood; well-equipped field hospitals; highly skilled and well-organized surgical teams; and improved medical management. Of these important factors, rapid evacuation by helicopter contributed the most to saving the lives of the wounded. Without effective helicopter evacuation, it would have been difficult to exploit the other factors and management of medical resources would have been less efficient.
EMS in developing countries must be established as a high priority, since it is one of the key elements in making possible any realistic improvement in health care. In Egypt, the pre-hospital phase of EMS is a highly visible commitment to the welfare of the nation and is a catalyst for other health activities. Satisfying needs identified in rural health care, such as high-risk infants, trauma, and time-related health problems, will be facilitated by an effective EMS system. EMS must be adapted to fit the culture of the people and their specific needs.
In war a large number of military and civilian wounded and injured patients, and patients with disease, will increase the strain on the system of medical care. The expected distribution of injured in a conventional war can be estimated on the basis of previous war experiences, especially from World War II (1), the Korean war (5), the Vietnam war (7, 8), and the Arab-Israel wars (3). Corresponding figures for the civilian population are less readily accessible. Statistical data from previous wars as well as expected weapon development can be compared with data from various peacetime accidents and disasters. Thus, the expected distribution of injuries can be estimated (Table 1) (7).
The rescue of victims of accidents during underwater activities, and the treatment of the pathology provoked by too rapid ascent in diving, are unfortunately problems which still remain relevant today. The concept of rapid artificial recompression is at the basis of the fundamental therapeutic techniques for the early treatment of all those involved in accidents of this type. Though numerous advances have been achieved in this field, many practical limitations still prevent their complete utilization.
One of the worst hotel fires in the USA occurred at the MGM Grand Hotel in Las Vegas, Nevada, on November 21, 1980. This tragedy claimed 84 lives and injured 300 others. The toll might have been higher were it not for Air Force assistance.
Nine U.S. Air Force helicopters responded swiftly to the scene in answer to the city of Las Vegas plea for help. The call came from the Metropolitan Police Department at 7:38 a.m. and got an immediate response from the Nellis Air Force Base (AFB) Consolidated Command Post. By 7:55 a.m., the first Huey helicopter was airborne. Less than 20 minutes later it was hovering over the MGM Grand Hotel. Evacuation of survivors began immediately, according to Major Larry B. Doege, commander of Detachment 1, 57th Fighter Weapons Wing.
In summer, mountain accidents may include falls, causing contusions and open wounds; fractures and torn ligaments; external bleeding;internal bleeding in the head, thorax and abdomen; injuries to the spinal column and extremities; falling rocks causing skull injuries; and falls into crevasses causing additional hypothermia, frostbite and drowning. In winter, there are skiing accidents with fractures and torn ligaments; and avalanches resulting in asphyxia, hypothermia and frostbite. In addition, there are mountain sickness; pulmonary edema of high altitude; snow blindness; heatstroke; sunstroke; heart attack; diarrhea and vomiting; pneumonia; snakebite; drowning in torrents or lakes; and burns, explosions and cuts acquired in huts. First aid, medical support and transport to hospital may vary widely.
The Vitalograph bag resuscitator with the old and new reservoirs, the PMR 1, the PMR 2, and the Laerdal bag resuscitator were studied at various oxygen flowrates and ventilation patterns, with and without oxygen reservoirs, to determine fractional delivered oxygen (FDO2) and function of patient valves. The Vitalograph with the new or the old reservoir and the PMR 1 cannot deliver high oxygen concentrations (FDO2 > 0.90) and should not be used when high FDO2 is important. The PMR 2 and the Laerdal cannot deliver high oxygen concentrations without a reservoir attached; but with a reservoir and oxygen flowrates of 101/min the Laerdal does achieve FDO2 > 0.98, and at 15 1/min the PMR 2 does achieve > 0.90.
The effect of positive inotropic agents on circulation and ventricular fibrillation threshold are not fully understood during the influence of metabolic acidosis during circulatory arrest. This is the same case with alkalosis, caused by the over-correction of sodium bicarbonate. Furthermore, the role of calcium during CPR is not clear.
Therefore, we investigated the influence of metabolic acidosis and alkalosis with and without the administration of the positive inotropic substances epinephrine and calcium upon contractility and ventricular fibrillation threshold.
Diazepam is a commonly used drug for suicidal attempts. The antagonistic effect of physostigmine in these patients is poorly understood.
We studied the interaction of large doses of diazepam and either physostigmine or galanthamine hydrobromide using dose-response curves in 21 cats. After establishing dose-response curves for diazepam, half of the animals received 0.02 mg/kg of physostigmine intravenously. Two minutes later 8, 10, 12, or 14 mg/kg of diazepam was administered intravenously. After 2, 5, and 10 min, animals were evaluated for their response to noise and pain stimuli. The other half of animals were given 0.2 mg/kg of galanthamine intravenously and evaluated for diazepam effect using the same criteria. Sufficient number of days were allowed for the animals to recover from diazepam.
Introduction: Standard closed-chest CPR (SCPR) produces only 6–30% of normal blood flow. It is unlikely that this can sustain the viability of the brain for more than a few minutes in most CPR attempts, although in occasional cases of human resuscitation external CPR for up to two hours has been followed by recovery of consciousness. Thus various methods have been employed to improve this low perfusion state. It has been shown that abdominal compression by hand or MAST-suit can augment carotid artery blood flow during CPR but causes complications. Openchest CPR (OCCPR) has also been proven to be hemodynamically superior to SCPR. Since neurologic recovery has been studied after prolonged periods of total circulatory arrest but not after prolonged periods of CPR, we compared the prolonged use of SCPR and OCCPR in terms of ability to sustain signs of cerebral function during CPR and permit cerebral recovery after CPR.
The Solent is that stretch of seaway separating the Hampshire Dorset coast from the Isle of Wight. It is one of the busiest sea routes in the United Kingdom. Approximately 134 shipping movements take place weekly into the Docks and Naval Base at Portsmouth, the Docks and Ocean Terminal in Southampton and the nearby Esso Oil Refinery. During the height of the summer season there are numerous local Ferry Services to and from the mainland and the Isle of Wight, which is a popular summer resort, and at weekends as many as 35,000 pleasure craft may be afloat. Major collision is rare and reflects the high standard of seamanship, local pilotage and strict port control, but the possibility of disaster is ever present in such a congested seaway.
To meet this eventuality the Solent and Southampton Water Marine Emergency Plan was developed from preexisting Southampton and Portsmouth schemes in the early 1960's. Since that time it has been put into action on three occasions for episodes of fire at sea, with good effect.
On October 10, 1980, the town of El-Asnam (130,000 inhabitants) and villages within a 50 km radius (229,000 inhabitants) were 80% destroyed by an earthquake of intensity 7.5 on the Richter scale (Figure l). The first unofficial estimates reported 50,000 dead and 100,000 injured. These numbers were probably based on data from the Agadir earthquake of February 29, 1960, when 12,000 out of the 30,000 inhabitants were killed. The official figures now list for the El-Asnam earthquake 2,600 dead and 8,250 injured. That was nevertheless a sufficiently heavy toll to fully justify the volume of relief that came from practically all over the world. The relief of Baden-Wurttenberg was organized by the German Air Rescue Guard of Stuttgart, in collaboration with the German Red Cross in Karlsruhe, as well as with physicians from Karlsruhe, Stuttgart and Tubingen. In a very short time the necessary aircraft (Merlin IV/Metro and BAC 1–11) for the transport of material and personnel from the German Headquarters were ready for takeoff.
Ether is almost a unique anesthetic agent, because it may be given to traumatized patients without any additional oxygen supply. But the significantly high stage of excitement during ether anesthesia can be dangerous, especially in disaster situations.
In the Netherlands, Crul developed a training program for application of ether anesthesia combined with droperidol as adjuvant. Incited by Crul's clinical training method, we studied, in comparison with Guedel's Table, the behavior of clinical signs during induction of ether anesthesia, using droperidol, diazepam or ketamine as adjuvants. We controlled especially the duration of induction, as well as the intensity of clinical signs in the stage of excitement.