This study intended to create symptom-based triage algorithms for the initial encounter with terror-attack victims. The goals of the triage algorithms include: (1) early recognition; (2) avoiding contamination; (3) early use of antidotes; (4) appropriate handling of unstable, contaminated victims; and (5) provisions of force protection. The algorithms also address industrial accidents and emerging infections, which have similar clinical presentations and risks for contamination as weapons of mass destruction (WMD).

The algorithms were developed using references from military and civilian sources. They were tested and adjusted using a series of theoretical patients from a CD-ROM chemical, biological, radiological/nuclear, and explosive victim simulator. Then, the algorithms were placed into a card format and sent to experts in relevant fields for academic review.

Six inter-connected algorithms were created, described, and presented in figure form. The “attack” algorithm, for example, begins by differentiating between overt and covert attack victims (A covert attack is defined by epidemiological criteria adapted from the Centers for Disease Control and Prevention (CDC) recommendations). The attack algorithm then categorizes patients either as stable or unstable. Unstable patients flow to the “Dirty Resuscitation” algorithm, whereas, stable patients flow to the “Chemical Agent” and “Biological Agent” algorithms. The two remaining algorithms include the “Suicide Bomb/Blast/Explosion” and the “Radiation Dispersal Device” algorithms, which are inter-connected through the overt pathway in the “Attack” algorithm.

A civilian, symptom-based, algorithmic approach to the initial encounter with victims of terrorist attacks, industrial accidents, or emerging infections was created. Future studies will address the usability of the algorithms with theoretical cases and utility in prospective, announced and unannounced, field drills. Additionally, future studies will assess the effectiveness of teaching modalities used to reinforce the algorithmic approach.

Responses to disasters involve many factors beyond personnel, such as medical andnon-medical equipment and supplies. When disaster teams respond, they must do so with sufficient amounts of medicine and supplies to manage all of the patients expected for several days before re-supply. In order for this process to be efficient and expedient, accurate and advanced planning for supplies needed by disaster workers is necessary. These supplies must provide for general medical care and for hazard-specific problems.

To develop a model that provides the framework for determining supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster teams in a civilian environment.

A community hospital was modeled to determine patient characteristics when presenting to an emergency department (ED), including patient demographics and chief complaint, medications administered during the emergency department visit and prescribed at discharge, and laboratory tests ordered to assess disaster team supply requirements. Data were downloaded from a patient tracking software package and abstracted from various hospital data information systems. Data from the community hospital were compared with data published from two hurricane disasters by members of the National Disaster Medical System.

To the extent possible, the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients.

This model offers a first step in preparing disaster medical teams for deployment.

Epidemiological research about disasters is difficult to perform. Most often, it must be completed retrospectively, since data collection may not be feasible or possible during the disaster.Now, there is a recognized need for a standard method to assess the severity of a disaster.

The aim of this paper is to assess the severity of the disasters that occurred in Italy during the 20th century, using a Disaster Severity Scale (DSS). Another goal is to find a standard method for the classification of previous disasters, test the feasibility and reliability of the use of the Disaster Severity Scale, and improvedisaster management and planning.

Data were obtained from formal reports of the Civil Defence Unit (Italy) and were used to calculate the Disaster Severity Scale score. Disasters were classified into major and minor disasters, according tothe numbers of deaths and severity of the damage. The number of deaths was compared with the obtained Disaster Severity Scale score. A seasonal trend for different types of events was obtained to assess if there is a relationship between the type of event and the time of the year in which it occurred, as related to the weather conditions existing at that time.

There were enough data to calculate a Disaster Severity Scale score for 26 major events that caused death and economic damage, and occurred in Italy between 18 March 1944 and 11 November 1999, and for 82 minor events, that occurred between October 1982 and December 1999. There were some significant peaks varying from different types of events during particular seasons, but the cause for those with the highest incidence is not clear. Events related to natural hazards were the only type of event that reached the highest Disaster Severity Scale when considering the number of deaths, while no events associated with man-made hazards had a Disaster Severity Scale score >8.

The Disaster Severity Scale score could be a reliable index for the assessment of events related to either natural or man-made disasters. Use of the Disaster Severity Scale allows researchers to classify previous hazards by scoring each disaster's severity. Further studies in other countries could be useful to further validate the Disaster Severity Scale.

Although there is a general agreement that rapid sequence intubation (RSI) is thepreferred technique for intubation in aeromedical care, several pharamacological regimens have been employed without clear evidence of which is superior.

This study was designed to compare the use of etomidate (ETOM) with that of thiopental (THIO)as an adjunctive agent used with succinylcholine (SCh) for rapid sequence intubation in an urban, aeromedicalsystem.

This was a retrospective, before-and-after study utilizing computer-assisted chart review. Adultpatients who received thiopental for rapid sequence intubation over a two-year period were compared to adult patients who received etomidate for rapid sequence intubation over a similar period, after a change in protocol, which mandated etomidate rather than thiopental for all intubations.

No difference was found in any of the primary endpoints. Stabilization time (13.1 vs. 12.9 minutes), number of intubation attempts (1.1 vs. 1.2), successful first intubation attempts (90% vs. 82%), overallsuccessful intubations (100% vs. 96%), and intubation time (18.4 vs. 21.7 seconds) were similar for all comparisons of thiopental vs. etomidate (all p >0.05).

This study found no clinically relevant differences between the use of etomidate or thiopental as adjuncts with succinylcholine for rapid sequence intubation in the aeromedical setting.

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, >43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals werecreated and large numbers of patients were evacuated from their homes and transported to hospitals throughoutIran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake.

This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation.

Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months–70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of theleg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death.

A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.

The blackout in North America of August 2003 was one of the worst on record. It affected eight United States states and parts of Canada for >24 hours. Additionally, two large United States cities, Detroit, Michigan and Cleveland, Ohio, suffered from a loss of water pressure and a subsequent ban on the use of public supplies of potable water that lasted four days. A literature review revealed a paucity of literature that describes blackouts and how they may affect the medical community.

This paper includes a review of after-action reports from four inner-city, urban hospitals supplemented accounts from the authors' hospital's emergency operations center (emergency operations center).

Some of the problems encountered, included: (1)lighting; (2) elevator operations; (3) supplies of water; (4) communication operations; (5) computer failure; (6) lack of adequate supplies of food; (7) mobility to obtain Xray studies; (8) heating, air condition, and ventilation; (9) staffing; (10) pharmacy; (11) registration of patients; (12) hospital emergency operations center; (13) loss of isolation facilities; (14) inadequate supplies of paper; (15) impaired ability to provide care for non-emergency patients; (16) sanitation; and (17) inadequate emergency power.

The blackout of 2003 uncovered problems within the United States hospital system, ranging from staffing to generator coverage. This report is a review of the effects that the blackout and water ban of 2003 had on hospitals in a large inner-city area. Also discussed are solutions utilized at the time and recommendations for the future.

The blackout of 2003 was an excellent test of disaster/emergency planning, and produced many valuable lessons to be used in future events.