Field Organization and Disaster Medical Assistance Teams

SUMMARY: Disasters cause an acute deterioration in all stages of life. An area affected by the disaster in which the normal activities of life are disrupted is described as a “Field” in disaster terminology. Although it is not easy to define the borders of this zone, the area where there is normally functioning society is accepted as the boundary. Disaster management is the responsibility of the local government. However, in many large disaster responses many non-governmental and international organizations play a role. A Disaster Medical Team is a trained, mobile, self-contained, self-sufficient, multidisciplinary medical team that can act in the acute phase of a sudden-onset disaster (48 to 72 hours after its occurrence) to provide medical treatment in the affected area. The medical team can include physicians, nurses, paramedics and EMTS, technicians, personnel to manage logistics, security and others. Various models of Disaster Medical Teams can be observed around the world. There is paucity of evidence based literature regarding DMTs. There is a need for epidemiological studies with rigorous designs and sampling. In this section of the special edition of the journal, field organizations in health management during disasters will be summarized, with emphasis on preparedness and response phases, and disaster medical teams will be discussed. Keywords: Field organization, disaster, medical team, DMA

Fascia iliaca compartment block in dislocated hip reduction

Femoral dislocation constitutes an orthopaedic emergency. For pain control in these cases, apart from procedural sedation, a regional block can be applied. Case report: A 26-year old male was brought to the emergency centre after being struck by a motor vehicle. Dislocation of the left femur was determined on direct radiograph. It was decided to apply a fascia iliaca compartment block instead of procedural sedation due to the risk of side effects. After sufficient anaesthesia was provided, the dislocation was successfully reduced on the first attempt with the Allis technique. Conclusion: The fascia iliaca compartment block (FICB) can be performed easily and successfully under ultrasound guidance. The pain associated with femoral dislocation is decreased and the reduction procedure can be achieved successfully. In many cases, FICB is easy to apply and carries a low risk of side effects

Bir bina çökmesi nedeniyle edinilen tecrübeler

In this study, it has been purposed to share practice of event-scene administration, search and rescue and evacuation of injured and acquired experiences carried out throughout a building collapse. After an explosion at Diyarbakır Kurdo?lu housings at 11 December 2006 about 08:20AM, five flats of an apartment that has five floors-ten flats were collapsed. Local military hospital ambulances, city ambulances, and fire-fighting vehicles arrived to event-place 10 minutes later. It has been found out that there were 13 people inside, 6 of which were children. Army rescue team arrived event-place about 01:30PM, then all non-professional persons has been sent away from region. Eight dead including five children, and five injured including one child have been taken out. Two people from close area have been also injured mildly due to the explosion. It has been found out that accident caused by boiler tank exploding. Sixth of total eight injured had only superficial wounds. Other two injured have been followed because of head trauma at first one and hepatic contusion and rib fracture at the other one. No complication observed after follow-up. Building collapses can create disaster potential according to the number of people inside and facilities of nearby region of the place accident taken place. The evaluation of the direction of building collapse during search and rescue operation would enhance possibility to reach more living in shorter time. Building collapses which can be considered as a miniature of big disaster potentials like earthquakes can be appraised as an important practical training and experience source on event-place administration, search and rescue operations and injured evacuation. We believe that share of the analysis and acquired experiences of this kind of studies would contribute interfering big disaster potentials

ACİL SERVİSLERDEKİ GERİATRİK HASTALARIN EPİDEMİYOLOJİK ÖZELLİKLERİ: ÇOK MERKEZLİ ÇALIŞMA KOŞULLARI

WOS:000372191400002Girifl: Beklenen yaflam süresinin uzamasının sonucu olarak yafllı popülasyondaki artıfl, bu yaflgrubu için daha sık sağlık bakımı verilmesini zorunlu kılmaktadır. Bu çalıflmada acil servise baflvuran 65 yafl ve üzeri hastaların genel özelliklerini, baflvuru nedenlerini, acil servis ve hastane ziyaretlerinin sonuçlarının saptanması amaçlandı. Gereç ve Yöntem: Çok merkezli, prospektif, gözlemsel çalıflma Türkiye'de 13 hastaneninacil servislerinde bir hafta süre ile gerçekleflti. Çalıflma süresi içinde akut tıbbi veya cerrahi sorunlar ile acil servise baflvuran 65 yafl ve üstü hastalar çalıflmaya dahil edildi. Altmıfl befl yafl altı ve/veya travma nedenli baflvurular ise çalıflma kapsamına alınmadı.Bulgular: Ortalama yaflı 74.87.3 yıl olan toplam 1299 hasta çalıflmaya dahil edildi. Bu hastalardan %51.9'u (n674) 65-74 yafl grubundaydı, %67.5'u (n877) hastaneden taburcu edildive %5.8'i (n75) yatıfl süreci içinde öldü. Acil serviste en sık konulan tanılar kardiyovasküler, gastrointestinal ve solunum hastalıklarıydı. Hastaneden taburcu olan ve hastane yatıflı sırasında ölenhasta grupları kıyaslandığında yafl açısından istatistiksel olarak anlamlı fark varken (p0.001), cinsiyet dağılımı (p0.259), hastane yatıfl süresi (p0.259) ve yoğun bakım ünitesi yatıfl süresi(p0.055) açısından fark tespit edilmedi. Sonuç: Yafllı nüfusunun ve genel nüfusa oranının artıflı ile birlikte yafllı hastaların acil servisbaflvuru sayısı artıyor ve gelecekte daha da artacaktır. Bu çalıflma, çalıflma merkezlerine baflvuranyafllı hastaların demografik özelliklerini ve klinik seyirlerinin sonuçlarını ortaya koymaktadır.Introduction: The increasing proportion of elderly individuals in the population due to increased life expectancy has necessitated greater provision of health care. Here we aimed to determine patient characteristics, reasons for referral, and outcomes of emergency department visits and hospitalization in patients aged ?65 years with referrals to emergency departments.Materials and Method: This prospective, multicenter observational study was conductedover one week at the emergency departments of 13 Turkey hospitals. All patients aged ?65 years who were referred to emergency departments with acute medical or surgical issues duringthe study period were included. Patients aged >65 years or those referred for trauma were excluded. Results: In total, 1299 patients with a mean age of 74.8±7.3 years were included. Of these, 51.9% (n674) were aged 65-74 years, 67.5% (n877) were discharged from the hospital,and 5.8% (n75) died during admission. The most frequently diagnosed disorders in the emergency departments were cardiovascular, gastrointestinal, and pulmonary diseases. A significantdifference in age was observed between the survival and non-survival groups (p0.001), with nosignificant differences in gender distribution (p0.259), length of stay in intensive care units(p0.605), or length of stay in hospital (p0.055).Conclusion: With an increased proportion of elderly individuals in the general population,the number of elderly patients referred to emergency departments continues to increase. Thisstudy presents the demographic features and clinical course of elderly patients referred to study centers

Serum neuron-specific enolase and S-100β levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases

29-33Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy. </span

The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p  30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality

Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal

International audienc