Medical and policy considerations for nuclear and radiation accidents, incidents and terrorism.

PURPOSE OF REVIEW: The purpose of this review is to address the increasing medical and public concern regarding the health consequences of radiation exposure, a concern shaped not only by fear of another Chernobyl or Fukushima nuclear power facility accident but also by the intentional use of a nuclear weapon, a radiological dispersion device, a radiological exposure device, or an improved nuclear device by rogue states such as North Korea and terrorist organizations such as Al Qaeda and ISIS. RECENT FINDINGS: The United States has the medical capacity to respond to a limited nuclear or radiation accident or incident but an effective medical response to a catastrophic nuclear event is impossible. Dealing effectively with nuclear and radiation accidents or incidents requires diverse strategies, including policy decisions, public education, and medical preparedness. SUMMARY: I review medical consequences of exposures to ionizing radiations, likely concomitant injuries and potential medical intervention. These data should help haematologists and other healthcare professionals understand the principles of medical consequences of nuclear terrorism. However, the best strategy is prevention.

[Experience in health prevention work at the accident at the Chernobyl nuclear power plant].

One of the main conditions for successful completion of liquidation tasks in the consequences of the accident at the Chernobyl nuclearpowerplant is of the swipe-effective sanitary and anti-epidemic (preventive) measures. The main directions of medical services in this area include the prevention of acute radiation injuries of personnel and distant effects of ionizing radiation, prevention of epidemics of acute intestinal, respiratory and other infections in the armedforces, pro-prevention of injuries, poisonings, accidents. Medical preventive measures were performed by the Medical Service, which took part in liquidation of consequences of military units, the specialists of the Operational Group of Civil Defense, the sanitary-epidemiological units and institutions formed the Belarusian, Kiev and Odessa Military District. Sanitary-epidemiological (preventive) activities carried out during the accident at the Chernobyl nuclear power plant, provided the sanitary-epidemiological well-being of the troops, which allowed to perform their tasks.

Disaster Management and General Dental Practitioners in India: An Overlooked Resource.

OBJECTIVE: To assess General Dental Practitioners' (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management. MATERIALS AND METHODS: This study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence. RESULTS: A total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000). CONCLUSIONS: High willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.

[Experience in provision of medical services to earthquake victims in Armenia in 1988].

The most devastating catastrophe in the USSR was the Armenian earthquake occurred on 7th December 1988. The city of Leninakan and towns of Kirovokan, Spitak (the epicenter), Stepanovan were destroyed by the earthquake with a magnitude 10. Up to 25 542 people have died, more than 500 000 were homeless and 39 795 were rescued. Medical service of the Ministry of Defence of the USSR took part in rescue work. Medical service units finished their rescue work on 31st December after results of work were summed up. Lethality rate was an index of successful rescue work of the unit. Only 6% of injured rescued by the medical unit have died, meanwhile 40%-50% of injured have died in Erevan hospitals. Mortality rate in patients with crush syndrome was 8.9% (according to other authors--30-75%). 75 injured remained in hospital, 25 injured were evacuated to central military hospitals for reconstructive plastic surgery. Officers of the medical unit, embodied from the main and central hospitals, successfully completed the task and received experience in provision of medical services to earthquake victims.

[Current organization of disaster medicine]. / Organisation actuelle de la médecine de catastrophe.

The concept of disaster medicine, derivedfrom medical management of casualties caused by terrorist attacks or earthquakes, began to be taught in medical school in 1982. It adapts military intervention tactics to civilian practices, and differentiates major disasters (in which preformed teams are sent to the scene) from disasters with limited effects (predefined plans form the backbone of the rescue organization). Management of blast and crush syndromes, triage, care of numerous burn victims, on-site amputation, necrotomy, medicopsychological support, mass decontamination, and rescue management are some of the aspects with which physicians should be familiar. Predefined intervention teams and ad hoc materials have been created to provide autonomous logistic support. Regulations, ethical aspects and managerial methods still need to be refined, and research and teaching must be given a new impetus.

[Characteristics and treatment of skin and soft-tissue defects caused by 5·12 Wenchuan earthquake].

OBJECTIVE: To investigate the features and the treatment of skin and soft-tissue defects caused by 5·12 Wenchuan Earthquake. METHODS: From May 12 to June 7 in 2008, 37 injured persons (43 wounds) were treated in West China Hospital, including 20 males and 17 females with a mean age of 40 years old (range: 2 - 85). The wound locations included head (n = 2), trunk (n = 3), upper arm (n = 5), forearm (n = 5), thigh (n = 13) and lower extremity (n = 15). Their sizes ranged from 5 cm × 4 cm - 27 cm × 20 cm. In 19 cases (51.3%), the bacterial culture results of wound secretion were positive. After thorough debridement and supportive treatment, the wounds were covered by hydropathic dressings. When the infections were under control and granulation tissues grew well, the method of either skin grafting (41 wounds) or flap transposition (2 wounds) was employed to repair the wounds. The survival rate of skin flaps or free skin was used to evaluate the therapeutic efficacy. RESULTS: From Days 6-15 post-admission, the wounds were repaired by skin grafting or flap transposition. All free skin grafts and flaps achieved an excellent survival. Two flaps survived completely, 33 grafts survived > 95% and other 8 grafts > 90%. The stay of hospitalization lasted for 12 - 23 days. None of the patients had any symptom of severe systemic infections and all survived. CONCLUSIONS: Skin and soft-tissue defect wounds caused by earthquake are usually present in extremities and head. And there is a high incidence of local infections and severe contaminations. Early debridement, symptomatic supports and suturing by skin or flap transposition may repair the wounds as early as possible and contribute to a rapid recovery of patients.

European Commission project: European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation.

After disasters, the individual health and well-being of first responders and affected population are affected for years. Therefore, psychosocial help is needed. Although most victims recover on their own, a minority of survivors, members of rescue teams, or relatives develop long-term, disaster-related psychic disorders, such as post-traumatic stress disorder (PTSD). This subgroup especially should receive timely and appropriate psychosocial help. Many European countries offer post-disaster psychosocial care from a variety of caregivers (i.e., professionals and volunteers, non-governmental organizations, church or commercial organizations). Therefore, European standards for providing post-disaster psychosocial support currently is required. This article describes the project European Guideline for Target Group-Oriented Psychosocial Aftercare-Implementation, supported by the European Commission.

[Establishment of a diagnostic system in disaster medicine].

Disaster medicine is a special field of medicine which is required at unexpected times under poor medical circumstances, such as the transport of several patients at once, complex information and lack of medical staff. In order to provide accurate diagnostic information under such poor medical conditions, it is necessary to establish a well-considered and functional system to prevent malpractice in a serial process from the identification of each patient to blood sampling, its analysis and reporting, and in the process of blood transfusion, as a typical example. We have established a diagnostic system based on a manual focusing on rapidity of procedures and prevention of malpractice consisting of a distinction between priority analysis (for blood gas and blood type) and secondary analysis, the development of a blood typing method, adoption of blood sampling with heparin and so on. On the basis of the characteristics of disaster medicine, we stressed the minimization of analytical items and simplification of analytical procedures as much as possible. In order to utilize this system effectively in a disaster, it is essential to implement periodic training and revision.