Search and rescue incidents among persons 65 years and older in the USA: Examination of factors associated with death.

OBJECTIVES: Older people are vulnerable to becoming lost from home, especially if alone and in unfamiliar environments. Incidents of older persons becoming lost are frequently reported and often requiring a search and rescue (SAR) response. Becoming lost is distressing to the person concerned, their carer, and family and may result in physical injury and/or death. This study examined what factors are associated with death among older persons reported lost from home. METHODS/DESIGN: A retrospective cross-sectional study. Data were obtained from the International Search and Rescue Incident Database from 1985 to 2013. Participants comprised persons aged 65 years and older living in the United States. Individual, SAR incident, and environmental factors were analysed. The primary outcome of this study was lost person found alive or found dead on arrival. Relationships between categorical variables and outcome were summarised with contingency tables, chi-squared test p-values (or Fisher's-exact-test), and odds ratios (OR) with 95% confidence intervals (CI). Association between continuous variables and outcome were examined using multiple logistic regression. p-value of <0.05 was considered significant. RESULTS: Among the 5242 SAR incidents, 1703 met the inclusion criteria, of which 87.8% (n = 1495) were found alive and 12.2% (n = 208) were found dead. Factors associated with death included: male gender (OR 1.46; CI 1.01-2.13; p = 0.048), cognitively intact (OR 0.32; CI 0.22-0.47; p < 0.001), prolonged SAR duration (OR: 1.028; CI: 1.021-1.035; p < 0.001), found in water/wetlands (OR 7.40; CI 3.37-16.24; p < 0.001), and extreme weather (OR: 2.06; 95% CI: 1.10-3.86; p = 0.024). CONCLUSIONS: Older people have a fundamental human right to protection from preventable deaths. Findings indicate these rights are not being protected with deaths occurring frequently among older people who have become lost from home. To minimise fatalities, knowledge of factors associated with death could inform the development suitable assessment and intervention strategies for SAR teams and caregivers.

Black-Spot Toxicodendron Dermatitis With Varied Presentation.

This article describes the clinical presentation, differential diagnosis, and treatment of 2 unrelated cases with different presentations of black-spot Toxicodendron dermatitis. In the first case, a healthy 7-y-old male presented with a rash consisting of black dots with localized surrounding erythema on the left arm. The rash then progressed to a vesicular, pinpoint, raised rash spreading to the face, arms, and neck. In the second case, a 4-y-old male presented with non-pruritic, black, flat, non-erythematous lesions that did not progress. This patient's older sibling had been diagnosed with poison ivy 1 wk prior, and they attended the same child care where the poison ivy was thought to be acquired. In both cases, diagnosis of black-spot Toxicodendron dermatitis was made. The black spot of Toxicodendron dermatitis is caused by urushiol oxidation on exposure to air. The subject may or may not go on to develop allergic contact dermatitis after the exposure. Diagnosis of this dermatitis is made on clinical presentation, with careful consideration of history, distribution, and lesion morphology. When allergic dermatitis does develop as in the first case, systemic treatment with oral steroids is recommended. In both of these cases the black dots completely resolved in 2 to 3 wk. Dermatologic referral for dermoscopy and biopsy may be necessary if the dermatosis does not resolve as anticipated.

Missing Aircraft Crash Sites and Spatial Relationships to the Last Radar Fix.

BACKGROUND: Few studies have examined the spatial characteristics of missing aircraft in actual distress. No previous studies have looked at the distance from the last radar plot to the crash site. The purpose of this study was to characterize this distance and then identify environmental and flight characteristics that might be used to predict the spatial relationship and, therefore, aid search and rescue planners. METHODS: Detailed records were obtained from the U.S. Air Force Rescue Coordination Center for missing aircraft in distress from 2002 to 2008. The data was combined with information from the National Transportation Safety Board (NTSB) Accident Database. The spatial relationship between the last radar plot and crash site was then determined using GIS analysis. RESULTS: A total of 260 missing aircraft incidents involving 509 people were examined, of which 216 (83%) contained radar information. Among the missing aircraft the mortality rate was 89%; most occurred in mountainous terrain (57%); Part 91 flight accounted for 95% of the incidents; and 50% of the aircraft were found within 0.8 nmi from the last radar plot. Flight characteristics, descent rate, icing conditions, and instrument flight rule vs. visual flight rule flight could be used to predict spatial characteristics. CONCLUSIONS: In most circumstances, the last radar position is an excellent predictor of the crash site. However, 5% of aircraft are found further than 45.4 nmi. The flight and environmental conditions were identified and placed into an algorithm to aid search planners in determining how factors should be prioritized.

Use of the visual range of detection to estimate effective sweep width for land search and rescue based on 10 detection experiments in North America.

OBJECTIVE: Standard-of-practice search management requires that the probability of detection (POD) be determined for each search resource after a task. To calculate the POD, a detection index (W) is obtained by field experiments. Because of the complexities of the land environment, search planners need a way to estimate the value of W without conducting formal experiments. We demonstrate a robust empirical correlation between detection range (Rd) and W, and argue that Rd may reliably be used as a quick field estimate for W. METHODS: We obtained the average maximum detection range (AMDR), Rd, and W values from 10 detection experiments conducted throughout North America. We measured the correlation between Rd and W, and tested whether the apparent relationship between W and Rd was statistically significant. RESULTS: On average we found W ≈ 1.645 × Rd with a strong correlation (R(2) = .827). The high-visibility class had W ≈ 1.773 × Rd (also R(2) = .867), the medium-visibility class had W ≈ 1.556 × Rd (R(2) = .560), and the low-visibility had a correction factor of 1.135 (R(2) = .319) for Rd to W. Using analysis of variance and post hoc testing, only the high- and low-visibility classes were significantly different from each other (P < .01). We also found a high correlation between the AMDR and Rd (R(2) = .9974). CONCLUSIONS: Although additional experiments are required for the medium- and low-visibility search objects and in the dry-domain ecoregion, we suggest search planners use the following correction factors to convert field-measured Rd to an estimate of the effective sweep width (W): high-visibility W = 1.8 × Rd; medium-visibility W = 1.6 × Rd; and low-visibility W = 1.1 × Rd.