Prehospital and disaster medicine
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Prehosp Disaster Med · Mar 2008
ReviewEarthquakes and trauma: review of triage and injury-specific, immediate care.
Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. ⋯ However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.
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Prehosp Disaster Med · Mar 2008
Why the closest ambulance cannot be dispatched in an urban emergency medical services system.
Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety. ⋯ The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixed-deployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.
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Prehosp Disaster Med · Mar 2008
Foreign field hospitals in the recent sudden-onset disasters in Iran, Haiti, Indonesia, and Pakistan.
Foreign field hospitals (FFHs) may provide care for the injured and substitute for destroyed hospitals in the aftermath of sudden-onset disasters. ⋯ A striking finding was the lack of detailed information on FFH activities. None of the 43 FFHs arrived early enough to provide emergency medical trauma care. The deployment of FFHs following sudden-onset disasters should be better adapted to the main needs and the context and more oriented toward substituting for pre-existing hospitals, rather than on providing immediate trauma care.
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Prehosp Disaster Med · Mar 2008
Introduction of a prehospital critical incident monitoring system--pilot project results.
Hospital medical incident monitoring improves preventable morbidity and mortality rates. Error management systems have been adopted widely in this setting. Data relating to incident monitoring in the prehospital setting is limited. ⋯ The pilot project demonstrates successful implementation of an incident monitoring system within a regional, prehospital environment. The combination of incident detecting techniques has a high yield with potential to capture different error types. The large proportion of incidents in the "near miss" category allows analysis of incidents without patient harm. The majority of incidents were system related and many were mitigated by circumstance. The model used is appropriate for ongoing incident monitoring in this setting.
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With limited available hospital beds in most urban areas, there are very few options when trying to relocate patients already within the hospital to make room for incoming patients from a mass-casualty incident (MCI) or epidemic (a patient surge). This study investigates the possibility and process for utilizing shuttered (closed or former) hospitals to accept medically stable, ambulatory patients transferred from a tertiary medical facility. ⋯ With careful planning, a shuttered hospital could be reopened and ready to accept patients within 3-7 days of a MCI or epidemic.