The 1917 Halifax Explosion: the first coordinated local civilian medical response to disaster in Canada.

SUMMARY: The 1917 Halifax Explosion was an unfortunate but predictable tragedy, given the sea traffic and munitions cargo, resulting in sudden large-scale damage and catastrophic injuries, with 1950 dead and 8000 injured. Although generous support was received from the United States, the bulk of the medical work was undertaken using local resources through an immediate, massive, centrally coordinated medical response. The incredible care provided 100 years ago by these Canadian physicians, nurses and students is often forgotten, but deserves attention. The local medical response to the 1917 disaster is an early example of coordinated mass casualty relief, the first in Canada, and remains relevant to modern disaster preparedness planning. This commentary has an appendix, available at canjsurg.ca/016317-a1.

Consequences of the radiation accident at the Mayak production association in 1957 (the 'Kyshtym Accident').

This paper presents an overview of the nuclear accident that occurred at the Mayak Production Association (PA) in the Russian Federation on 29 September 1957, often referred to as 'Kyshtym Accident', when 20 MCi (740 PBq) of radionuclides were released by a chemical explosion in a radioactive waste storage tank. 2 MCi (74 PBq) spread beyond the Mayak PA site to form the East Urals Radioactive Trace (EURT). The paper describes the accident and gives brief characteristics of the efficacy of the implemented protective measures that made it possible to considerably reduce doses to the exposed population. The paper also provides retrospective dosimetry estimates for the members of the EURT Cohort (EURTC) which comprises approximately 21 400 people. During the first two years after the accident a decrease in the group average leukocyte (mainly due to neutrophils and lymphocytes) and thrombocyte count was observed in the population. At later dates an increased excess relative risk of solid cancer incidence and mortality was found in the EURTC.

The crowd-out effect of a mass casualty incident: Experience from a dust explosion with multiple burn injuries.

A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident.We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database.On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ±â€Š4.21 hours vs 3.77 ±â€Š2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers.Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

The Halifax Explosion of 1917: the oculist experience.

BACKGROUND: Despite its prominence in Canadian history, there are few publications about the Halifax Explosion of 1917 that deal with the care of victims with eye injuries. METHODS: Archived documents relating to the nature and treatment of eye injuries sustained during the Halifax Explosion were reviewed at the Public Archives of Nova Scotia and the Maritime Museum of the Atlantic. A review of current literature was performed. RESULTS: Detailed accounts regarding the personal and surgical experience of 2 ophthalmologists, G.H. Cox and F.T. Tooke, were found. Several unpublished government and personal documents on eye injuries sustained during the Halifax Explosion are filed at the Public Archives of Nova Scotia. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had double enucleations. Most of the eye injuries were caused by shards of shattered glass. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. A Blind Relief Fund was established to help treat, rehabilitate, and compensate the visually impaired. INTERPRETATION: Many of the eye injuries sustained during the Halifax Explosion were due to flying shards of glass. Details of their treatment provide insight into a unique and devastating event in Canadian medical history and demonstrate how eye injuries were managed in 1917.

Making fire work: pyrotechnics and natural philosophy.

Everyone is familiar with fireworks, common to festivals and celebrations across the world. At first glance, the history of science might appear to have little to do with the history of these explosive devices. However, fireworks were an important element of court culture in Europe, which relied on spectacle and festival to manifest the power of princes. From the fifteenth century, courts regularly set off fireworks around elaborate theatrical scenery and ephemeral temples, fascinating audiences with a variety of exotic motions and effects exploding in the night sky. Fireworks also intrigued natural philosophers, and over several centuries there were diverse interactions among the sciences and pyrotechny.