Utstein-style template for uniform data reporting of acute medical response in disasters.

BACKGROUND: In 2003, the Task Force on Quality Control of Disaster Management (WADEM) published guidelines for evaluation and research on health disaster management and recommended the development of a uniform data reporting tool. Standardized and complete reporting of data related to disaster medical response activities will facilitate the interpretation of results, comparisons between medical response systems and quality improvement in the management of disaster victims. METHODS: Over a two-year period, a group of 16 experts in the fields of research, education, ethics and operational aspects of disaster medical management from 8 countries carried out a consensus process based on a modified Delphi method and Utstein-style technique. RESULTS: The EMDM Academy Consensus Group produced an Utstein-style template for uniform data reporting of acute disaster medical response, including 15 data elements with indicators, that can be used for both research and quality improvement. CONCLUSION: It is anticipated that the Utstein-style template will enable better and more accurate completion of reports on disaster medical response and contribute to further scientific evidence and knowledge related to disaster medical management in order to optimize medical response system interventions and to improve outcomes of disaster victims.

An unusual case of hyperglycemia, abdominal pain, and increased anion gap acidosis.

In this case report we try to illustrate the importance of correct diagnostic reasoning and the misleading features of point-of-care testing. This case illustrates that even though hyperglycemia, ketonuria, a raised anion gap metabolic acidosis, and acute abdominal pain almost inevitably warrant a diagnosis of diabetic ketoacidosis, other possibilities still exist and need to be excluded. In that light, we emphasize the clinical and therapeutic importance of determining serum lactate and urinary ketones in the differential diagnosis of a raised anion gap metabolic acidosis.

European survey on training objectives in disaster medicine.

OBJECTIVES: As part of the I SEE (Interactive Simulation Exercise for Emergencies) project, financially supported by the Leonardo da Vinci Programme 2000-2006 of the European Commission, a study was planned to assess the type of disaster and to establish the tasks to be included in an emergency exercise to be developed, according to the possible target groups, physicians, nurses, ambulance personnel, dispatchers and first responders. A secondary objective was a description of the actual computer-based training situation in the training centres. A study involving different actors or target groups has not yet been conducted. METHODS: A questionnaire was developed, validated and subsequently distributed to the training centres for the different target groups in the partner countries. Each partner had to contact and interview the person responsible for the training in disaster medicine in the training institution. Data entry and analysis was carried out using the SPSS software on Apple Macintosh. Apart from descriptive statistics of the variables, differences between groups were analysed using analysis of variance and the Kruskal-Wallis test. RESULTS: In 75 questionnaires out of a total of 206, the combination of a major road traffic accident and a chemical accident was indicated as the first choice (36.4%). These priorities were present for the different countries and all target groups. Concerning the medical procedures to be included in the training exercise, the highest priority was given to medical coordination, medical management on site, medical alert procedures, assessment of immediate needs, medical resources management, victim transport and protection and safety procedures. Only minor differences were noted between countries, different target groups and the institutions irrespective of whether they are involved in response in case of a major accident or disaster. With regard to the secondary objective, 27% of the institutions used computer-based training in disaster medicine and, of those not using computer-based training, 23% plan its use in the near future. CONCLUSIONS: The European centres surveyed, put the emphasis for disaster medicine training on a mass casualty scenario. In accordance with this choice, prehospital aspects of medical care and management were considered as priorities for training. The I SEE project will develop a template and pilot exercise, serving all countries and providing team training. Among the institutions involved in the survey, a limited number will be invited to participate in the formative evaluation of the pilot exercise.

Sudden drooling and supine gagging: an important emergency?

We describe a case of an eupnoeic patient complaining of a foreign body sensation in his mouth and throat, with sudden drooling and supine gagging. This condition was caused by an isolated uvular angioedema (Quincke's oedema). As this uvular hydrops did not decrease with initial standard therapy for angioedema, epinephrin was applied directly on the swollen uvula, causing it to shrink very rapidly. Isolated uvular oedema is a potentially life-threatening condition with risk of sudden upper airway obstruction, and should therefore be recognized and treated as soon as possible. As described in this case, its initial presentation can consist of gagging and drooling without dyspnoea, thus causing a real challenge for triage and diagnosis.

The problems faced by three government disaster response teams of Ankara city during the Marmara earthquake - 1999 response.

OBJECTIVES: The objectives of this study were to determine the organization/system and personal problems faced by the personnel of Ankara greater municipality Firebrigade Department (firemen), Ankara Emergency Aid and Rescue Services (ambulance personnel), Civil Defence General Directorate's Ankara Search and Rescue Unit (rescuers), who participated in the 1999 Marmara earthquake. MATERIALS AND METHODS: A total of 1132 individuals were in the universe of the study; the total rate of participation was 95.1% (1076 individuals). This study was a cross-sectional survey, in which self-administered questionnaires were used. The study was conducted in May, June and July of 2001. RESULTS: Overall, 33.1% of the personnel of three government disaster response teams (356 individuals) said that they participated in the Marmara earthquake - 1999 response. The leading most important organization/system problem they faced during the Marmara earthquake was coordination (30.8%) according to the firemen, disaster management (31.4%) according to the rescuers, and coordination (41.6%) according to the ambulance personnel. The personal problems faced during the Marmara earthquake by the firemen were food problems (56.4%), accommodation problems (62.8%), safety problems (28.2%) and health problems (71.8%); according to the rescuers they were food problems (77.1%), accommodation problems (48.6%), safety problems (74.3%) and health problems (51.4%), and according to the ambulance personnel they were food problems (47.7%), accommodation problems (58.0%), safety problems (31.7%) and health problems (26.7%). CONCLUSION: Among the organization/system problems faced by the personnel of three government disaster response teams in the Marmara Earthquake of 1999, coordination problems were the major concern. The personnel also had some personal problems such as food, accommodation, safety and health.

Hollow visceral injury after blunt lower thoracic and abdominal trauma.

The early diagnosis of hollow viscous injury after blunt abdominal trauma remains a challenge for physicians in the Emergency Department, although the early diagnosis of hollow viscous injury decreases morbidity and mortality. After a description of two cases of hollow viscous injury after blunt abdominal trauma, a literature review is performed concerning the indications and limitations of diagnostic imaging modalities. Focused abdominal sonography for trauma, computed tomography scan and diagnostic peritoneal lavage are described. On the basis of the review a proposal for maximal diagnostic accuracy is made.

Nursing issues in care for the elderly in the emergency department: an overview of the literature.

Emergency care is an important link in the chain of care for geriatric patients. Due to the specific physiological, psychological, and social needs of elderly people, the type and quantity of emergency care are different for this group of patients than for other age groups. Consequently, they have a significant impact on the health care system. Doctors and nurses working in an emergency department must be aware of this specific situation and adjust the care that they provide accordingly. Appropriate communication between health care providers and patients, a sound assessment of functional status and cognitive ability, and specific attention to verbal and written discharge guidelines are indispensable.

A proposed universal medical and public health definition of terrorism.

The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.