What do we know about best police practices for lost persons with dementia? A scoping review.

Aim: To examine the efficacy of strategies used by the police for missing persons with dementia. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched peer-reviewed and gray literature of existing police practices used for missing persons with dementia. Data from the studies were analyzed descriptively. Results: The literature described 16 articles and 18 websites. Strategies ranged from identification tools, successful field techniques, locating technologies and community engagement/education. Overall scientific evidence was low, with only three studies evaluating the usability and effectiveness of the suggested strategies. Conclusion: More rigorous research is required to demonstrate the efficacy of best police practices for missing persons with dementia, which in turn could assist in the development of a best practice guideline.

Aspectos logísticos y sanitarios de la atención a migrantes. La experiencia española en la operación EUNAVFOR MED SOPHIA / Logistic and sanitary aspects of attention to migrants. The Spanish experience in the EUNAVFOR MED SOPHIA operation

Actualmente, somos testigos en Europa del mayor número de desplazamientos de los que se tienen constancia en la historia, a consecuencia de la persecución, los conflictos armados, la violencia o la inestabilidad económica y social reinante en Oriente Medio y en numerosos países africanos y de Asia Meridional. Estos hechos junto a la proximidad a las costas europeas han hecho que en los últimos tiempos la ruta del Mediterráneo Central se haya convertido en la más utilizada por los migrantes para alcanzar Europa. La magnitud en cifras de este fenómeno ha llegado a ser tan elevada junto con el importante número de vidas que se han perdido en la mar han hecho que la comunidad internacional ha reaccionado de forma contundente poniendo en marcha la OPERACIÓN EUNAVFOR MED SOPHIA. El objetivo del presente artículo es proporcionar conocimientos sobre esta realidad que supone la inmigración a través de rutas marítimas, los aspectos logísticos y médicos relacionados con la atención y asistencia a migrantes a bordo de los buques de la Armada Española y revisar la bibliografía publicada sobre el tema

Currently, we are witnesses in Europe of the greatest number of displacements recorded in history, as a result of persecution, armed conflicts, violence or the economic and social instability prevailing in the Middle East and in many African countries and South Asia. These facts, together with the proximity to the European coasts have meant that in recent times the Central Mediterranean route has become the most used by migrants to reach Europe. The magnitude of this phenomenon has become so high, that together with the important number of lives that have been lost at sea, have caused that the international community reacts mightly launching the OPERATION EUNAVFOR MED SOPHIA. The objective of this article is to provide knowledge on this reality that involves immigration through maritime routes, logistics and medical aspects related to the care and assistance to migrants on board of the Spanish Navy vessels, and review the published literature on the theme

The Association Between Dissatisfaction with Debriefing and Post-Traumatic Stress Disorder (PTSD) in Rescue and Recovery Workers for the Oklahoma City Bombing.

OBJECTIVE: The purpose of this study was to investigate potential association between psychopathology and subjective evaluation of the experience of debriefing in disaster-exposed rescue and recovery workers. METHODS: Structured diagnostic interviews for DSM-III-R psychiatric disorders were conducted with 166 firefighters who served as rescue and recovery workers for the 1995 Oklahoma City bombing, who categorized their satisfaction with the debriefing on 4 levels. "Very dissatisfied" responses were examined for their association with post-traumatic stress disorder (PTSD) and with PTSD symptom groups. RESULTS: Being "very dissatisfied" with the debriefing was significantly associated with the DSM-III-R avoidance and numbing group and with PTSD. CONCLUSIONS: These findings suggest that debriefing may be an unsatisfactory intervention for people with prominent avoidance and numbing symptoms, such as those with PTSD. These individuals might be better served by referral directly to psychiatric treatment (Disaster Med Public Health Preparedness. 2018;12:718-722).

A Gap Analysis Survey of US Aircraft Rescue and Fire Fighting (ARFF) Members to Determine Highly Infectious Disease Training and Education Needs.

OBJECTIVE: Despite lessons learned from the recent Ebola epidemic, attempts to survey and determine non-health care worker, industry-specific needs to address highly infectious diseases have been minimal. The aircraft rescue and fire fighting (ARFF) industry is often overlooked in highly infectious disease training and education, even though it is critical to their field due to elevated occupational exposure risk during their operations. METHODS: A 44-question gap analysis survey was distributed to the ARFF Working Group to determine where highly infectious education and training can be improved. In total, N=245 responses were initiated and collected. Descriptive statistics were generated utilizing Qualtrics Software Version 2016.17©. RESULTS: Supervisors perceived Frontline respondents to be more willing and comfortable to encounter potential highly infectious disease scenarios than the Frontline indicated. More than one-third of respondents incorrectly marked transmission routes of viral hemorrhagic fevers. There were discrepancies in self-reports on the existence of highly infectious disease orientation and skills demonstration, employee resources, and personal protective equipment policies, with a range of 7.5%-24.0% more Supervisors than Frontline respondents marking activities as conducted. CONCLUSIONS: There are deficits in highly infectious disease knowledge, skills, and abilities among ARFF members that must be addressed to enhance member safety, health, and well-being. (Disaster Med Public Health Preparedness. 2018;12:675-679).

Patología médica no traumática en pacientes rescatados en montaña / Nontraumatic medical emergencies in mountain rescues

Objetivo. Describir las características clínico-epidemiológicas de los pacientes rescatados por la unidad de rescate de montaña del 061 de Aragón que presentaron patologías médicas no traumáticas. Método. Estudio observacional retrospectivo de los rescates de montaña realizados entre julio de 2010 y diciembre de 2016. Resultados. Se analizaron 164 pacientes con patología médica de origen no traumático durante el rescate (82,3% varones). El intervalo de edad más frecuente fue de 50 a 59 años. El 36,6% presentaban patologías relacionadas con el medio, siendo la hipotermia la más frecuente. El 20,7% fue patología cardiaca y el 12,8% fueron problemas digestivos. La actividad practicada por los pacientes fue el senderismo/montañismo en un 82% de las ocasiones. Conclusiones. Se observa un aumento del número de pacientes rescatados con patología médica no traumática en los últimos años, y destaca el aumento de problemas cardiacos. El paciente tipo esperable sería un varón de entre 50 y 59 años practicando senderismo en época estival (AU)

Objective. To describe the clinical and epidemiologic characteristics of patients with nontraumatic medical problems rescued by a Spanish mountain emergency response service (061 Aragon). Methods. Retrospective observational analysis of records of mountain rescues completed between July 2010 and December 2016. Results. A total of 164 patients with nontraumatic medical emergencies were rescued; 82.3% were males. Most patients were between the ages of 50 and 59 years. Environmentally related problems, most often hypothermia, accounted for 36.6% of the emergencies. Cardiac problems led to 20.7% and digestive problems to 12.8%. Eighty-two percent of the patients were hiking or engaged in general mountain activities (other than rock climbing, canyoning, hunting, or skiing). Conclusion. Recent years have seen a rise in the number of patients requiring rescue from mountains for nontraumatic medical emergencies, particularly heart problems. The typical patient to expect would be a man between the ages of 50 and 59 years who is hiking in the summer (AU)

Epidemiological Trends in Search and Rescue Incidents Documented by the Alpine Club of Canada From 1970 to 2005.

OBJECTIVE: To provide a descriptive review of the epidemiology of search and rescue (SAR) incidents across Canada as documented in the Alpine Club of Canada (ACC) database. METHODS: A retrospective, cross-sectional review of SAR reports collected by the ACC with incidents dating from January 1, 1970 to June 12, 2005, was analyzed. RESULTS: The ACC database contained 1088 incidents with 1377 casualties. Casualties had 944 (68.6%; 95% CI, 64.2 to 73.1) injuries or illness, and 433 (31.4%; 95% CI, 28.6 34.6) fatalities. Males accounted for 76.1% of all casualties and 82.3% of the fatalities when sex was reported. A bimodal distribution of casualties was seen, with the peaks around February and August. Hiking and mountaineering resulted in more than half of all casualties that yielded any type of morbidity, whereas mountaineering and skiing, ski mountaineering, or snowboarding accounted for almost two thirds of all fatalities. Human error and slips and falls were the major contributors to the presumptive cause of incidents. The lower limb was the most common anatomic location of traumatic injury, accounting for 41.6% (95% CI, 37.6 to 45.9) of these injuries. Hypothermia, exhaustion, frostbite, and dehydration represented the majority of all nontraumatic conditions. British Columbia and Alberta accounted for 91.6% (95% CI, 86.0 to 97.5) of the incidents in the database. CONCLUSIONS: The study serves to illustrate trends in SAR epidemiology that may be encountered by SAR personnel within British Columbia and Alberta. Furthermore, it highlights the need for additional Canadian-based studies to better understand this area of prehospital medical encounters.

[Air rescue: current significance and practical issues]. / Luftrettung: Aktueller Stellenwert und praktische Aspekte.

Germany has a nationwide and powerful helicopter emergency medical services system (HEMS), which executes primary rescue missions and interhospital transfer of intensive care patients. In recent years the range of HEMS missions has become modified due to demographic changes and structural changes in the healthcare system. Furthermore, the number of HEMS missions is steadily increasing. If reasonably used air rescue contributes to desired reductions in overall preclinical time. Moreover, it facilitates prompt transport of patients to a hospital suitable for definitive medical care and treatment can be initiated earlier which is a particular advantage for severely injured and critically ill patients. Because of complex challenges during air rescue missions the qualifications of the HEMS personnel have to be considerably higher in comparison with ground based emergency medical services.

Investigating environmental determinants of injury and trauma in the Canadian north.

Unintentional injury and trauma rates are disproportionately high in Inuit regions, and environmental changes are predicted to exacerbate injury rates. However, there is a major gap in our understanding of the risk factors contributing to land-based injury and trauma in the Arctic. We investigated the role of environmental and other factors in search and rescue (SAR) incidents in a remote Inuit community in northern Canada using a collaborative mixed methods approach. We analyzed SAR records from 1995 to 2010 and conducted key consultant interviews in 2010 and 2011. Data showed an estimated annual SAR incidence rate of 19 individuals per 1,000. Weather and ice conditions were the most frequent contributing factor for cases. In contrast with other studies, intoxication was the least common factor associated with SAR incidents. The incidence rate was six times higher for males than females, while land-users aged 26-35 had the highest incidence rate among age groups. Thirty-four percent of individuals sustained physical health impacts. Results demonstrate that environmental conditions are critical factors contributing to physical health risk in Inuit communities, particularly related to travel on sea ice during winter. Age and gender are important risk factors. This knowledge is vital for informing management of land-based physical health risk given rapidly changing environmental conditions in the Arctic.

UK mountain rescue casualties: 2002-2006.

OBJECTIVE: To profile casualties of UK remote and rural sport and recreation rescued by Mountain Rescue Teams (MRTs). METHODS: Anonymised data regarding non-fatal casualties recorded from 1 January 2002 to 31 December 2006 were retrieved from the Mountain Rescue Committees of Scotland and England and Wales. RESULTS: Across the UK there were 6814 incidents involving 7995 people, including 550 fatal incidents. 3398 injured or ill casualties were assisted by rescue teams. Half of those rescued (50.7%) had no medical problems. 3152 casualty reports were available for analysis (Scotland 743, England and Wales 2409). The ages of those assisted ranged from 3 to 104 years, with a male predominance (60.8%). Hillwalking accounted for 75% of mountain rescues. More casualties were injured than ill (77.2% vs 10.4%). The injury reported most often was fracture (58.6%) and the lower extremity was most commonly injured (53%). Multiple injuries were relatively uncommon. The rescue scenarios in England and Wales and in Scotland were broadly similar. MRTs administered medication to more casualties in England and Wales (39.4% vs 14.5%). Helicopters assisted a greater proportion of casualties in Scotland (56.9% vs 40.5%). CONCLUSIONS: Volunteer rescue teams assisted a wide range of casualties including some with serious multiple injuries. The nature of casualty rescues undertaken in Scotland was similar to that in England and Wales. The results have implications for UK-wide rescue team training, medical professionals receiving casualties and for outdoor education safety initiatives.

Medicalización del espeleosocorro. Paciente politraumatizado en espeleología / No disponible

Los sanitarios que asisten heridos en medios hostiles ,como cuevas, precisan de una formación específica que sumen tres aspectos fundamentales: uno es la práctica de una medicina de urgencia de calidad a realizar en la cavidad, sin apoyos y en un medio totalmente ajeno al sanitario habitual que se define como 'difícil, hostil y aislado', otro la capacidad física y los conocimientos técnicos necesarios para poder acceder, por difícil que sea hasta el lugar donde se encuentra el accidentado, para prestarle asistencia sanitaria y, finalmente, la formación necesaria para colaborar con los equipos de rescate, plenamente integrado en ellos, haciéndose cargo al completo de los aspectos médicos y colaborando eficazmente en las tareas de rescate, sin suponer un estorbo, ni un peligro añadido para sus operativos. Es decir, que estos sanitarios deben ser buenos especialistas en medicina de urgencia, acreditados espeleólogos y aceptables rescatadores en los operativos de rescate. Algo que no es fácil de conseguir, pero que es necesario si pretendemos asumir con garantías el reto de la medicalización del rescate en cavidades(AU)

The sanitary staff that assists injured men in hostile enviroments as caves, need a specific formation that should add three fundamental aspects: one is the practice of a medicine of quality urgency to practice in the cavity, without supports and in a way completely foreign to the sanitary habitual one that is defined as 'difficult, hostile and outlying', another one is the physical capacity and the necessary technical knowledge to be able to gain access, for difficult that is up to the place where the eventful one is it, not even a danger added for his operative ones gives him sanitary and, assistance finally, the necessary formation to collaborate with the rescue teams, fully integrated to them, taking charge to the finished one of the medical aspects and collaborating effectively in therescue works, without supposing an obstacle. That is to say, that sanitary staff must be good specialists in medicine of urgency, accredited speleologists and acceptable rescuers. Something that is not easy to obtain, but that is necessary if we try to assume with guarantees the challenge of the medicalization of the rescue in cavities(AU)

[Entrapped motorists and air rescue services: analysis of tactical rescue approach, rescue techniques, and emergency medical services illustrated by a helicopter emergency medical service]. / Eingeklemmte Fahrzeuginsassen in der Luftrettung: Einsatztaktik, rettungstechnische und notfallmedizinische Analyse am Beispiel einer Rettungshubschrauberstation.

BACKGROUND: Analysis of the results and presentation of a treatment concept of a helicopter emergency medical service (HEMS) in prehospital acute care of entrapped motorists. METHODS: Consecutive patient data collection from primary rescue missions of a helicopter emergency medical service (HEMS) from the years 2000-2004. Evaluation based on data collected regarding emergency medical care, rescue techniques, and tactical rescue approach. RESULTS: A total of 359 cases of entrapped motorists were documented: 237 patients were male, 122 were female, and the average age was 37 (range: 2-82 years). The motor vehicle accidents (MVA) occurred in 21% of the cases on the highway, in 29% on a main road, in 43% on a rural road, and in 7% in city/urban areas. Concerning the vehicle types, 86% were automobiles, 5% vans, and 9% trucks. Drivers accounted for 86% of the patients, front seat passengers for 10.1%, and back seat passengers for 3.9%. The average length of motorist entrapment amounted to 17 min with an average on-scene time of 27 min for the HEMS. The total rescue time averaged 56 min. A Glasgow Coma Scale (GCS) score between 3 and 8 was recorded in 33.7% of the patients; in 24% of the cases the shock index was <1; a respiratory rate of <10/min or >20/min was documented in 25.2% of the patients. An NACA score between I and III was recorded in 34.2% of the cases, NACA IV in 18.9%, and NACA >/=V in 46.8%; 11.9% of the patients died before hospital admission. CONCLUSION: For both the emergency control center personnel and the emergency medical technicians (EMT), a case of motorist entrapment must be considered as a trigger mechanism of injury, activating a sophisticated and time-sensitive prehospital acute care and transportation service. In the German emergency medical service this involves primarily the HEMS. Even in cases of potentially critically injured entrapped motorists, the prehospital adherence to"the golden hour of shock" is made possible, despite the resulting higher personnel and equipment expenses.

Oral health professionals within state-sponsored medical response teams: the IMERT perspective.

In 1999, the State of Illinois recognized the need for a trained and credentialed medical response that can respond to any disaster within the state and will bring health professionals, logistical support, supplies, and equipment to assist local providers when their resources are overwhelmed. The following article reflects on the historical background of the Illinois medical emergency response team, its team development, partnerships, activations, and future directions with the integration of oral health care professionals as a vital resource for emergency response.

[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?]. / Patientenspektrum im Notarztdienst. Was hat sich in den letzten 20 Jahren geändert?

BACKGROUND: In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes. METHODS: In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician. RESULTS: In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01). CONCLUSIONS: The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

When terror is routine: how Israeli nurses cope with multi-casualty terror.

The wave of terror that has befallen the Israeli civilian population over the past two years, striking deep into the heart of towns and cities all over the country, presents a unique challenge for the health care system in general and nursing in particular. This article has a two-fold purpose: (a) to describe discussions that took place with four focus groups consisting of emergency room nurses who had recently cared for victims of terror, and (b) to delineate recommendations for policy enhancement based upon these discussions. Qualitative analysis of the data collected from focus group discussions revealed four stages of personal and professional involvement, each one eliciting a specific response from the nurses: call up to report for duty, waiting for casualties to arrive, caring for the victims, and closure of the event. Nurses identified numerous hardships and great anxiety along with a strong sense of professional fulfillment. Recommendations for policy include: incorporating stress management and debriefing skills in post-basic ER training, designing workshops and drills in trauma care for non-ER nurses who float into the ER in the wake of a multi-casualty act of terror, and developing leadership seminars for head nurses in the ER departments.

The American Psychiatric Nurses Association responds to the September 11 tragedy.

This article describes how the American Psychiatric Nurses Association (APNA) responded to the September 11 tragedy, as an organization. Also included are anecdotes from APNA members who participated individually in the aftermath of this tragedy. Because such a traumatic event can result in psychiatric disorders, a brief synopsis of these disorders is included. The economic effects of emotional difficulties for our nation are explored, especially those related to the most serious disorder resulting from such a traumatic event, Post Traumatic Stress Disorder. Strategies that APNA is focusing on for the future, as a result of this tragedy, are presented.

Emergency response to environmental toxic incidents: the role of the occupational physician.

A survey of accidental environmental releases of hazardous chemicals conducted by the Agency for Toxic Substances and Disease Registry indicates that fixed facility events accounted for 77% of the episodes whereas 23% of the releases were related to transportation activities, such as loading or unloading materials. In nearly all the events (88%) only one chemical was released. Volatile organic compounds, chlorine, herbicides, acids and ammonia were the most common substances involved. In nearly one out of six reported events, an injury occurred. To prepare for emergencies associated with the accidental release of hazardous materials, the federal government, industry and professional organizations including the medical community have all been involved. In the United States, the Superfund Amendment Reauthorization Act (SARA) Title III passed in 1986 addresses the need to establish local emergency planning committees, to report and collect data, and a number of other matters. Professional societies, including the Joint Commission for the Accreditation of Health Care Organizations, the American College of Occupational and Environmental Medicine (ACOEM), and the American Industrial Hygiene Association, have all attempted to ensure proper education and training of those professionals called to assist in such emergencies. The occupational physician can assume numerous roles in the challenge related to emergency response, by becoming familiar with computerized information available to promptly determine the type of hazard released and its appropriate antidote, advising on the proper personal protective equipment, awareness of secondary contamination and participation on local emergency planning committees among many others. Emergency release of hazardous materials continues to occur with a frequency in the United States that deserves active vigilance and planning.