Incidence of Dementia Before Age 65 Years Among World Trade Center Attack Responders.

Importance: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. Objective: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE). Design, Setting, and Participants: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years. Exposures: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe. Main Outcomes and Measures: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition. Results: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001). Conclusions and Relevance: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maras, Turkey earthquakes.

INTRODUCTION: On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaras, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. MATERIAL AND METHODS: Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. RESULTS: Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2-60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). CONCLUSION: In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018-2022: here be snowmobiles.

BACKGROUND: Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training. METHODS: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms. RESULTS: Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness. CONCLUSIONS: These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

Are rescue workers still at risk? A meta-regression analysis of the worldwide prevalence of post-traumatic stress disorder and risk factors.

Rescue workers (policemen, firefighters, emergency medical staff, etc.) experience intense stress due to rescuing and helping victims of accidents, terrorist attacks, violent crimes, and natural disasters. Overexposure and ineffective coping with such stressful events may lead to developing Post-Traumatic Stress Disorder (PTSD). Meta-regression procedures were applied to examine moderators such as the sample sex composition, age, working experience, occupation, country, or type of PTSD evaluation. The 9.8% PTSD prevalence found here was virtually the same compared with earlier findings from 10 years ago. There was a large heterogeneity, however, associated with geographical location and the instrument used to evaluate PTSD. The main findings revealed that rescue workers are a high-risk group with increased levels of Post-traumatic Stress Disorder (PTSD). Moreover, PTSD prevalence could depend on a great extent on geographical and cultural factors, and on the type of PTSD evaluation.

The role of modifiable risk factors in incident cancer in transport, rescue, and security industries.

PURPOSE: Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS: This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS: During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS: Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.

Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland.

OBJECTIVE: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions. METHODS: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019. RESULTS: During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %). CONCLUSIONS: Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.

Does a short intervention with vibration foam roller recover lifeguards better after a water rescue? A pilot study.

PURPOSE: The aim of this study was to analyze the effects of a recovery program based on foam roller with and without vibration on blood lactate clearance and perceived fatigue after a water rescue. METHODS: A quasi-experimental crossover design was carried out to compare passive (PR) recovery and a short protocol of foam roller (FR) and vibration foam roller (VFR) recovery after a 100 m water rescue in 7 volunteer lifeguards. Blood lactate and perceived exertion were measured before and after the rescue, and also after the 5-min recovery intervention. RESULTS: Blood lactate levels decrease significantly with foam roller (p = 0.013; effect size = 0.97) and vibration foam roller recovery (p < 0.001; effect size = 1.62). Passive recovery did not show significant differences clearing out blood lactate. Fatigue perceived decrease significantly with all the recovery methods, but foam roller has higher effects on the global fatigue and VFR on the legs. CONCLUSION: FR and VFR clear out more blood lactate and decrease fatigue more than PR, with the subsequently increase of the physical conditioning to perform another effort.

An autonomous drone for search and rescue in forests using airborne optical sectioning.

Autonomous drones will play an essential role in human-machine teaming in future search and rescue (SAR) missions. We present a prototype that finds people fully autonomously in densely occluded forests. In the course of 17 field experiments conducted over various forest types and under different flying conditions, our drone found, in total, 38 of 42 hidden persons. For experiments with predefined flight paths, the average precision was 86%, and we found 30 of 34 cases. For adaptive sampling experiments (where potential findings are double-checked on the basis of initial classification confidences), all eight hidden persons were found, leading to an average precision of 100%, whereas classification confidence was increased on average by 15%. Thermal image processing, classification, and dynamic flight path adaptation are computed on-board in real time and while flying. We show that deep learning-based person classification is unaffected by sparse and error-prone sampling within straight flight path segments. This finding allows search missions to be substantially shortened and reduces the image complexity to 1/10th when compared with previous approaches. The goal of our adaptive online sampling technique is to find people as reliably and quickly as possible, which is essential in time-critical applications, such as SAR. Our drone enables SAR operations in remote areas without stable network coverage, because it transmits to the rescue team only classification results that indicate detections and can thus operate with intermittent minimal-bandwidth connections (e.g., by satellite). Once received, these results can be visually enhanced for interpretation on remote mobile devices.

Characteristics of surfers as bystander rescuers in Europe.

INTRODUCTION: Coastal locations contribute significantly to global drowning, with surfers frequently conducting rescues. This study explored the characteristics of surfers as bystander rescuers in Europe. METHODS: A cross-sectional online survey collected demographics (age, sex, geographical location), surfing experience, ability, lifesaving and cardiopulmonary resuscitation (CPR) training, information seeking behaviors and previous performance of a rescue. Analyses comprised descriptive frequencies, binomial logistic regression with adjusted odds ratio (AOR) (95% confidence interval [CI]) and chi-squares (p < .05). RESULTS: Europe-dwelling respondents totaled 1705 (76% male; 43% 25-34 years). Thirty-nine percent (39.2%; n = 668) had previously performed a rescue. Likelihood of having conducted a rescue significantly increased with 6 or more years of surfing experience (6-10 years [AOR = 1.96; 95%CI: 1.20-3.22]; 11-15 years [AOR = 3.26; 95%CI: 1.56-6.79]; 16 years or more [AOR = 4.27; 95%CI: 2.00-9.11]) when compared to surfers with <1 year experience. Expert/professional ability surfers were 10.89 times (95%CI: 4.72-25.15) more likely to have conducted a rescue than novice/beginners. Respondents who had received both a certified lifeguard and CPR course were significantly more likely to have conducted a rescue (AOR = 3.34; 95%CI: 2.43-4.60). CONCLUSION: Surfers who had previously conducted rescues commonly had more years of experience, higher self-rated surf ability and greater likelihood of having received certified training. However, not all surfers who have performed rescues had received training. Findings suggest surfers should receive rescue and CPR training before they start surfing at locations without trained supervision and refresh training regularly. Surfers are amenable to injury prevention information, especially online and via apps.

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort.

BACKGROUND: Over 90,000 rescue and recovery responders to the September 2001 World Trade Center (WTC) attacks were exposed to toxic materials that can impair cardiac function and increase cardiovascular disease (CVD) risk. We examined WTC-related exposures association with annual and cumulative CVD incidence and risk over 17 years in the WTC Health Program (HP) General Responder Cohort (GRC). METHODS: Post 9/11 first occurrence of CVD was assessed in 37,725 responders from self-reported physician diagnosis of, or current treatment for, coronary artery disease, myocardial infarction, stroke and/or congestive heart failure from WTCHP GRC monitoring visits. Kaplan-Meier estimates of CVD incidence used the generalized Wilcoxon test statistic to account for censored data. Cox proportional hazards regression analyses estimated the CVD hazard ratio associated with 9/11/2001 arrival in responders with and without dust cloud exposure, compared with arrival on or after 9/12/2001. Additional analyses adjusted for comorbidities. RESULTS: To date, 6.3% reported new CVD. In covariate-adjusted analyses, men's CVD 9/11/2001 arrival risks were 1.40 (95% confidence interval [CI] = 1.26, 1.56) and 1.43 (95% CI = 1.29, 1.58) and women's were 2.16 (95% CI = 1.49, 3.11) and 1.59 (95% CI = 1.11, 2.27) with and without dust cloud exposure, respectively. Protective service employment on 9/11 had higher CVD risk. CONCLUSIONS: WTCHP GRC members with 9/11/2001 exposures had substantially higher CVD risk than those initiating work afterward, consistent with observations among WTC-exposed New York City firefighters. Women's risk was greater than that of men's. GRC-elevated CVD risk may also be occurring at a younger age than in the general population.

Measuring the physiological impact of extreme heat on lifeguards during cardiopulmonary resuscitation. Randomized simulation study.

OBJECTIVE: Lifeguard teams carry out their work in extremely hot conditions in many parts of the world. The aim of this study was to analyze the impact of high temperatures on physiological parameters during cardiopulmonary resuscitation (CPR). METHOD: A randomized quasi-experimental cross-over design was used to test physiological lifesaving demands (50 min acclimatization +10 min CPR) in two different thermal environments: Thermo-neutral environment (25 °C) vs Hyperthermic environment (37 °C). RESULTS: The data obtained from 21 lifeguards were included, this covers a total of 420 min of resuscitation. The CPR performance was constantly maintained during the 10 min. The Oxygen uptake (VO 2) ranged from 17 to 18 ml/min/kg for chest compressions (CC) and between 13 and 14 ml/min/kg for ventilations (V) at both 25 °C and 37 °C, with no significant difference between environments (p > 0.05). The percentage of maximum heart rate (%HR max) increased between 7% and 8% at 37 °C (p < 0.001), ranging between 75% and 82% of HR max. The loss of body fluids (LBF) was higher in the hyperthermic environment; LBF: (37 °C: 400 ± 187 g vs 25 °C: 148 ± 81 g, p < 0.001). Body temperature was 1 °C higher at the end of the test (p < 0.001). The perceived fatigue (RPE) increased by 37° an average of 2 points on a scale of 10 (p = 0.001). CONCLUSIONS: Extreme heat is not a limiting factor in CPR performance with two lifeguards. Metabolic consumption is sustained, with an increase in CC, so V can serve as active rest. Nevertheless, resuscitation at 37 °C results in a higher HR, is more exhausting and causes significant loss of fluids due to sweating.

Dying to help: Fatal bystander rescues in Australian coastal environments.

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.

Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017.

The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.34; 95% CI, 0.31­0.37). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.

Analysis of Factors Influencing Insomnia and Construction of a Prediction Model: A Cross-sectional Survey on Rescuers.

OBJECTIVE: To determine the factors influencing insomnia and construct early insomnia warning tools for rescuers to informbest practices for early screening and intervention. METHODS: Cluster sampling was used to conduct a cross-sectional survey of 1,133 rescuers from one unit in Beijing, China. Logistic regression modeling and R software were used to analyze insomnia-related factors and construct a PRISM model, respectively. RESULTS: The positive rate of insomnia among rescuers was 2.74%. Accounting for participants' age, education, systolic pressure, smoking, per capita family monthly income, psychological resilience, and cognitive emotion regulation, logistic regression analysis revealed that, compared with families with an average monthly income less than 3,000 yuan, the odds ratio ( OR) values and the [95% confidence interval ( CI)] for participants of the following categories were as follows: average monthly family income greater than 5,000 yuan: 2.998 (1.307-6.879), smoking: 4.124 (1.954-8.706), and psychological resilience: 0.960 (0.933-0.988). The ROC curve area of the PRISM model (AUC) = 0.7650, specificity = 0.7169, and sensitivity = 0.7419. CONCLUSION: Insomnia was related to the participants' per capita family monthly income, smoking habits, and psychological resilience on rescue workers. The PRISM model's good diagnostic value advises its use to screen rescuer early sleep quality. Further, advisable interventions to optimize sleep quality and battle effectiveness include psychological resilience training and smoking cessation.

Buffering PTSD in Canine Search and Rescue Teams? Associations with Resilience, Sense of Coherence, and Societal Acknowledgment.

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers (n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Probable Posttraumatic Stress Disorder and Lower Respiratory Symptoms Among Rescue/Recovery Workers and Community Members After the 9/11 World Trade Center Attacks-A Longitudinal Mediation Analysis.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up. METHODS: Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003-2004, 2006-2007, and 2011-2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score ≥44. RESULTS: Probable PTSD predicted LRS (R/R workers: ß = 0.88-0.98, p < .001; community members: ß = 0.67-0.86, p < .001) and LRS predicted PTSD (R/R workers: ß = 0.83-0.91, p < .001; community members: ß = 0.68-0.75, p < .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p = .001-.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p = .001-.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)-LRS relationship (indirect effect, p < .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p = .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p < .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p = .001). CONCLUSIONS: Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.

Long-Term PTSD Risks in Emergency Medical Technicians Who Responded to the 2016 Taiwan Earthquake: A Six-Month Observational Follow-Up Study.

Although several factors associated with posttraumatic stress disorder (PTSD) in disaster rescue workers were identified in previous studies, the results were inconsistent. This study aimed to explore the prognostic factors of PTSD among disaster rescuers using different screening tools. A 6.4 magnitude earthquake struck southern Taiwan on February 6, 2016. Emergency medical technicians (EMTs) who responded to the earthquake were recruited. The initial survey was conducted one month after the earthquake using a standardized, self-reported, paper-based questionnaire. After six months, we re-evaluated the EMTs using the same questionnaire that was used in the baseline survey. A total of 38 EMT-paramedics were enrolled in the final analysis. Significant differences in PTSD scores at baseline existed between EMTs with and without certain risk factors. The interaction between survey time and risk factors was not significant, but several risk factors correlated with a nonsignificant improvement in the PTSD score after the 6-month follow-up. Perfectionism personality characteristics and several specific field experiences (managing injured patients, managing dead victims, managing dead victims who were pregnant, managing emotionally distraught families, or guilty feelings during the missions) might affect different subdomains of PTSD symptom improvement. Disaster rescuers should be followed up after their missions, regardless of their age, gender, or previous experience with disaster response. EMTs with certain personality characteristics or who are involved in specific field operations should be carefully monitored during and after disaster rescue missions.

Extrication time and earthquake-related mortality in the 2016 Taiwan earthquake.

BACKGROUND/PURPOSE: People with different age distributions and extrication times might have distinct injury characteristics and outcomes in earthquakes. METHODS: A retrospective study was conducted to analyze the casualties in the 2016 Taiwan earthquake using data from the incident registry system and the field disaster operation system. The study subjects were assigned to 4 groups by age: preschool (<5 years), school (5-17 years), adult (18-64 years), and elderly (>64 years). Classification and regression tree analysis and receiver-operating characteristic curves were utilized to examine several factors, including extrication time, age group, floor height, and structural damage, for earthquake-related mortality. A two-sided p value less than 0.05 was considered statistically significant. RESULTS: A total of 238 enrollees were assigned to the preschool (n = 18, 7.6%), school (n = 45, 18.9%), adult (n = 169, 71.0%), or elderly (n = 6, 2.5%) groups. Among the parameters, the extrication time exhibited the strongest association with mortality. Regarding the association between the extrication time and mortality hazard in multivariate models, we found significant odds ratios (ORs) at the extrication time cutoffs of 12, 24 and 72 h (OR = 42.61, 95% confidence interval [CI]: 13.92-130.37; OR = 37.58, 95% CI: 14.77-95.60; OR = 95.16, 95% CI: 23.02-393.48, respectively, all p < 0.001). The optimal extrication time cutoff for mortality was 12 h in the preschool group and 24 h in the school and adult groups. CONCLUSION: Extrication time is strongly associated with earthquake-related mortality. These findings may facilitate strategic approaches for patients entrapped in damaged buildings and can contribute to future training for field search and rescues after earthquakes.

Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey.

OBJECTIVE: To examine fatal drowning associated with aquatic rescues and prior self-reported experience of undertaking an aquatic rescue in Australia. METHODS: Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue-related fatal unintentional drowning between 1 January 2006 and 31 December 2015. RESULTS: Twenty-three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X2 =35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X2 =13.5; p<0.001). Females were more likely to have rescued a child (0-4 years of age) (X2 =29.2; p<0.001) from a swimming pool (X2 =34.3; p<0.001). Fifty-one people drowned while performing an aquatic rescue (Males=82.4%; 25-44 years of age=53.0%; beaches=54.9%). CONCLUSIONS: Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community-wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning. Implications for public health: There is a need to train people early in their life on how to undertake a safe rescue and provide resuscitation, including promoting regular updates, in particular if supervising children.