EMS response to an airliner crash.

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol. While multiple errors can occur during a mass-casualty event, these can be reduced by frequent simulation exercises during which various personnel practice and learn designated roles. Efficient triage, proper communication, and knowledge of the roles are important in ensuring the best possible outcome. While the triage system and response of the EMS personnel were effective for this magnitude of catastrophe, more work is needed in order to meet predetermined standards. Ways in which this can be overcome include: (1) hosting more disaster simulation exercises; (2) encouraging more involvement with first responders; and (3) strengthening the links in the local EMS system. Vigorous public education must be instituted and maintained.

Bilateral synchronous carcinoma of the male breast in a patient receiving estrogen therapy for carcinoma of the prostate: cause or coincidence?

An unusual case of bilateral, synchronous breast cancer in a male patient who had a history of long-term estrogen therapy for prostate cancer is presented. The possible role of estrogen in the development of male breast cancer is revisited.

The establishment of a Jamaican all-injury surveillance system.

The impact of injuries on the Jamaican health care system is a growing problem. Based on the successful implementation of a Violence-Related Injury Surveillance System (VRISS) in the Accident and Emergency (A&E) department of the Kingston Public Hospital (KPH), Ministry of Health (MOH) officials decided to expand the system to the Jamaica Injury Surveillance System (JISS), allowing for the surveillance of both intentional and unintentional injuries. A working group designed the expanded injury surveillance system based on the International Classification of External Causes of Injury. The expanded system allowed for the collection of data on all injuries seen in the A&E departments by adding four injury projects to the computerized A&E registration process. These were (1) unintentional injury, (2) violence-related injury, (3) suicide attempt (also known as intentional self-harm) and (4) motor vehicle-related injuries. The expanded JISS was implemented at the KPH and four additional hospitals across the island. The geographic distribution of these hospitals provided a reflection of rural and urban, highland and coastal communities and their distinctive injury profiles. Data collected at registration were printed on trauma sheets and reviewed by medical staff before being incorporated into the patient's record. Monthly reports detailing demographics and summary statistics were generated and made available at the local and national level. By monitoring the national injury profile, the JISS provides data to support needed policy changes to minimize the impact of injuries on the health services and on the health of the population.

Carcinoma of bladder - abstract

Fifty-four case records of Carcinoma Bladder seen at the Kingston Regional Hospital during the period 1974-1978 were studied. Forty-nine were primary tumour of the bladder and five were secondaries. Twenty-nine were females. The age group ranged from 40 - 82 years; peak incidence was 60-70 years. Presenting symptoms were haematuria 90 percent, dysuria 60 percent, back pain 20 percent. All females had dysuria. Cystoscopy and biopsy were performed in all cases. Hystologically they were:- transitional cell (39), squamous cell carcinoma (5), anaplastic adeno-carcinoma (2), adeno-carcinoma and transitional cell carcinoma (2), transition from transitional cell carcinoma to squamous cell carcinoma (1), secondary transitional cell carcinoma from renal pelvis (1), squamous cell carcinoma from cervix (4). Thirty-nine cases had cobalt therapy only; nine patients had per urethral electro resection of the bladder tumour followed by cobalt therapy; two had partial cystectomy and three had total cystectomy. All had cobalt therapy. One had ideal conduit and cobalt therapy for the tumour, as the lesion was not resectable. Five-year follow-up of all patients was difficult due to the shifting population. Three year survival was 60 percent. Age group; sex ratio and histological type is similar to that seen in other countries, but the majority of our patients presented with Grade III Carcinoma (AU)

Volvulus of the colon

Volvulus of the colon is a closed loop obstruction resulting from an axial rotation of the colon on its mesentry. It is one of the common causes for obstruction in Northern Iran, East Africa, Eastern Europe and India. It is probably related to the high roughage diet consumed in these communities. These diets are similar to the Jamaican diet. This retrospective study was undertaken to determine the frequency of this type of acute abdominal emergency seen at the University Hospital of the West Indies, (UHWI), Kingston, Jamaica. Colonic volvulus accounted for 8-9 percent of all intestinal obstruction seen at the UHWI between 1971-1976. All types of volvulus were seen with sigmoid volvulus being the most commonly encountered. A high incidence of compound volvulus was also noted. The high roughage diet is suggested as an etiological factor since it is similar to the diet in other countries where the incidence of volvulus is high. Colonic volvulus is an acute surgical emergency requiring prompt diagnosis and urgent treatment. (Summary)

Laparoscopic cholecystectomy in Jamaica: the initial experience

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.(AU)