American journal of disaster medicine
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An active shooter in the emergency department (ED) presents a significant danger to employees, patients, and visitors. Very little education on this topic exists for healthcare workers. Using didactic and scenario-based training methods, the authors constructed a comprehensive training experience to better prepare healthcare workers for an active shooter. ⋯ Didactic lectures, combined with case-based scenarios, are an effective method to teach healthcare workers how to best manage an active shooter incident.
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Case Reports
Use of a fiber optic camera to perform a trauma assessment during a confined space rescue.
Accurate medical evaluation of victims injured during confined space rescues poses significant operational, medical, and logistical challenges for medical providers of all disciplines and experience levels. The Federal Emergency Management Agency (FEMA) teaches rescuers to begin their assessment as soon as verbal contact is obtained with the victim. While a significant amount of information can be obtained by talking to the victim, an accurate assessment of the victim's condition is often limited or impossible. Many professional rescue agencies currently use cameras to locate a victim's position or visualize obstacles that prevent the successful extraction of casualties. However, there is no published literature describing the use of a camera to complete a medical evaluation. ⋯ When evaluating a trauma patient, there is no substitution for visual inspection and physical diagnosis. The use of a fiber optic camera can assist rescuers and medical providers in obtaining the information they desire, and enable the completion of an accurate patient assessment. The camera may also provide psychological reassurance and ease anxiety, as well as generate prehospital images that can be transmitted to the receiving facility for use in preparation of the casualty. Emergency medical service providers, urban search & rescue teams, fire departments, and other professional rescuers should be trained on the use and limitations of fiber optic cameras during confined space rescues. Furthermore, regulatory agencies such as FEMA should consider integrating the use of fiber optic camera and audiovisual devices into the current training courses offered to professional rescuers.
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As the complexity and frequency of law enforcement-extended operations incidents continue to increase, so do the opportunities for adverse health and well-being impacts on the responding officers. These types of clinical encounters have not been well characterized nor have the medical response strategies which have been developed to effectively manage these encounters been well described. The purpose of this article is to provide a descriptive epidemiology of the clinical encounters reported during extended law enforcement operations, as well as to describe a best practices approach for their effective management. ⋯ A wide range of health problems are reported by extended law enforcement operations personnel. Timely and effective treatment of these problems can help ensure that the broader operations mission is not compromised. An appropriate operational strategy for managing health complaints reported during extended operations involves the deployment of a well-trained medical support team using the core concepts of tactical emergency medical support.
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Delineation of the advantages and problems related to the use of forward-site operating room-, Intensive Care Unit (ICU)-, radiography-, and mass casualty-enabled disaster vehicles for site evacuation, patient stabilization, and triage. ⋯ The successful utilization of disaster vehicles requires seamless cooperation between the hospital staffing the vehicles and the ambulance service deploying them. They are particularly effective during preplanned deployments to high-risk situations. These vehicles also potentially provide self-sufficient refuges for forward teams in hostile environments.
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Mass casualty incidents (MCIs) include natural (eg, earthquake) or human (eg, terrorism or technical) events. They produce an imbalance between medical needs and resources necessitating the use of triage strategies. Triage of casualties must be performed accurately and efficiently if providers are to do the greatest good for the greatest number. There is limited research on the validation of triage system efficacy in determining the priority of care for victims of MCI, particularly those involving chemicals. ⋯ Current literature does not provide needed evidence on the validity of triage systems for MCI in particular those involving chemicals. Well designed studies are needed to validate the reliability, sensitivity, and specificity of triage systems used for MCI including those involving chemicals.