Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state.

INTRODUCTION: There is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy of tourniquets while wearing British military CBRN individual protective equipment (IPE). METHODS: 12 volunteers from the counter CBRN instructors' course allowed testing on 24 legs. A Combat Application Tourniquet (C-A-T) was applied to all volunteers at the level of the midthigh. 12 legs were tested while wearing CBRN IPE (both operator and simulated casualty), and the control group of 12 legs was tested while wearing conventional combat dress state (both operator and simulated casualty). The order of leg laterality and dress state were sequenced according to a prerandomised system. Efficacy was measured via use of an ultrasound probe at the popliteal artery. Tourniquets were considered effective if arterial flow was completely occluded on ultrasound imaging. Data were collected on time to successful application, failure of tourniquets and pain scores as rated by the visual analogue scale (1-10). RESULTS: There were no failures of tourniquet application in the CBRN group, and two failures (17%) in the control group. Failures were pain threshold exceeded (n=1) and tourniquet internal strap failure (n=1). The mean application time for the CBRN group was 28.5 s (SD 11.7) and 23.7 s (SD 9.8) for the conventional combat group. There was no statistically significant difference (p=0.27). The median CBRN pain score was 2.0 (IQR 2.0-3.5). The median control pain score was 4.0 (IQR 3-6). This was a statistically significant difference (p=0.002). CONCLUSION: C-A-Ts applied to simulated casualties in CBRN IPE at the midthigh are at least as efficacious as those applied to the midthigh in a conventional combat dress state. The pain experienced was less in CBRN IPE than when in a conventional combat dress state.

Toolkit for Epidemiologic Response to an Acute Chemical Release.

When a large chemical incident occurs and people are injured, public health agencies need to be able to provide guidance and respond to questions from the public, the media, and public officials. Because of this urgent need for information to support appropriate public health action, the Agency for Toxic Substances and Disease Registry (ATSDR) of the US Department of Health and Human Services has developed the Assessment of Chemical Exposures (ACE) Toolkit. The ACE Toolkit, available on the ATSDR website, offers materials including surveys, consent forms, databases, and training materials that state and local health personnel can use to rapidly conduct an epidemiologic investigation after a large-scale acute chemical release. All materials are readily adaptable to the many different chemical incident scenarios that may occur and the data needs of the responding agency. An expert ACE team is available to provide technical assistance on site or remotely. (Disaster Med Public Health Preparedness. 2016;10:631-632).

Temporal trends of acute chemical incidents and injuries­Hazardous Substances Emergency Events Surveillance, nine states, 1999-2008.

PROBLEM/CONDITION: Widespread use of hazardous chemicals in the United States is associated with unintentional acute chemical incidents (i.e., uncontrolled or illegal release or threatened release of hazardous substances lasting <72 hours). Efforts by industries, government agencies, academics, and others aim to reduce chemical incidents and the public health consequences, environmental damage, and economic losses; however, incidents are still prevalent. REPORTING PERIOD: 1999-2008. DESCRIPTION OF SYSTEM: The Hazardous Substances Emergency Events Surveillance (HSEES) system was operated by the Agency for Toxic Substances and Disease Registry (ATSDR) during January 1991-September 2009 to describe the public health consequences of chemical releases and to develop activities aimed at reducing the harm. This report summarizes temporal trends in the numbers of incidents, injured persons, deaths, and evacuations from the nine states (Colorado, Iowa, Minnesota, New York, North Carolina, Oregon, Texas, Washington, and Wisconsin) that participated in HSEES during its last 10 full years of data collection (1999-2008). RESULTS: A total of 57,975 incidents and 15,506 injured persons, including 354 deaths, were reported. During the surveillance period, several trends were observed: a slight overall decrease occurred in incidents for fixed facilities (R² = 0.6) and an increasing trend in deaths (R² = 0.7) occurred, particularly for the general public (R² = 0.9). The number of incidents increased in the spring during March-June, and a decrease occurred in the remainder of the year (R² = 0.5). A decreasing trend in incidents occurred during Monday-Sunday (R² = 0.7) that was similar to that for the number of injured persons (R² = 0.6). The highest number of incidents occurred earlier in the day (6:00 a.m.-11:59 a.m.) and then decreased as the day went on (R² = 0.9); this trend was similar for the number of injured persons (R² = 1.0). INTERPRETATION: Chemical incidents continue to affect public health and appear to be a growing problem for the general public. The number of incidents and injuries varied by month, day of week, and time of day and likely was influenced by other factors such as weather and the economy. PUBLIC HEALTH IMPLICATIONS: Public and environmental health and safety practitioners, worker representatives, emergency planners, preparedness coordinators, industries, emergency responders, and others can use the findings in this report to prepare for and prevent chemical incidents and injuries. Specifically, knowing when to expect the most incidents and injuries can guide preparedness and prevention efforts. In addition, new or expanded efforts and outreach to educate consumers who could be exposed to chemicals are needed (e.g., education about the dangers of carbon monoxide poisoning for consumers in areas likely to experience weather-related power outages). Redirection of efforts such as promoting inherently safer technologies should be explored to reduce or eliminate the hazards completely.

RicoTox: web sobre riesgo químico. Experiencia en la enseñanza universitaria de Toxicología Ambiental y Salud Pública / RicoTox: web about chemical risk. A university experience in the teaching of Environmental Toxicology and Public Health

RicoTox (Riesgo Químico de Tóxicos) es una página web elaborada por estudiantes de la asignatura "Toxicología Ambiental y Salud Pública" en la Facultad de Ciencias de la Universidad de Extremadura (http://www.ricotox.weebly.com). Para ello se emplea la metodología del Aprendizaje Basado en Problemas recomendada en el Espacio Europeo de Educación Superior. Los objetivos perseguidos con esta experiencia son: contribuir y hacer accesible la información disponible sobre el riesgo asociado a la manipulación inadecuada de las sustancias químicas y educar en relación a su correcta manipulación. En ella se abordan diversas sustancias químicas, aportándose información toxicológica y reguladora, casos clínicos de exposición humana y recomendaciones de uso de dichas sustancias. Desde el punto de vista docente, la metodología planteada presenta tres características: 1) motivación inicial e instrucción metodológica realizadas con el grupo completo, 2) los grupos de estudiantes trabajan fuera del horario de clases y se autorregulan autónomamente, siguiendo instrucciones aportadas al inicio de la actividad, y 3) disponibilidad completa del tutor para orientar a los estudiantes a lo largo del desarrollo de la actividad (tutorías). Esta metodología logra un nivel de desarrollo de competencias instrumentales, sistémicas y profesionales para los estudiantes muy satisfactorio (AU)

RicoTox (Chemical Risk of Toxics) is a web page whose contents have been prepared by "Environmental Toxicology and Public Health" students at the Faculty of Science, Extremadura University, Spain (http://www.ricotox.weebly.com) based on the Problem Based Learning which is a methodology recommended in the European Higher Education Area. The aims of this experience are: to build and to facilitate the access to the available information about the risk related to incorrect manipulation of chemical substances and to teach a correct manipulation of them. This web page contains toxicological and regulatory information, clinical cases of human exposure and prevention measures to guarantee a safe manipulation of the chemical substances. From an educational point of view, the stated methodology shows three characteristics: 1) initial activity of motivation and methodological instruction for the total group of students, 2) the groups of students work outside of normal school hours and they self regulate in their work following instruction provided initially 3) full availability of the master to steer students in the development of the activity (mentorship). This methodology achieves a very satisfactory level of development of instrumental, systemic and professional competences for students (AU)

The association of the original OSHA chemical hazard communication standard with reductions in acute work injuries/illnesses in private industry and the industrial releases of chemical carcinogens.

BACKGROUND: OSHA predicted the original chemical Hazard Communication Standard (HCS) would cumulatively reduce the lost workday acute injury/illness rate for exposure events by 20% over 20 years and reduce exposure to chemical carcinogens. METHODS: JoinPoint trend software identified changes in the rate of change of BLS rates for days away from work for acute injuries/illnesses during 1992-2009 for manufacturing and nonmanufacturing industries for both chemical, noxious or allergenic injury exposure events and All other exposure events. The annual percent change in the rates was used to adjust observed numbers of cases to estimate their association with the standard. A case-control study of EPA's Toxic Release Inventory 1988-2009 data compared carcinogen and non-carcinogens' releases. RESULTS: The study estimates that the HCS was associated with a reduction in the number of acute injuries/illnesses due to chemical injury exposure events over the background rate in the range 107,569-459,395 (Hudson method/modified BIC model) depending on whether the HCS is treated as a marginal or sole factor in the decrease. Carcinogen releases have declined at a substantially faster rate than control non-carcinogens. DISCUSSION: The previous HCS standard was associated with significant reductions in chemical event acute injuries/illnesses and chemical carcinogen exposures.

Accidental hazardous material releases with human impacts in the United States: exploration of geographical distribution and temporal trends.

OBJECTIVE: To investigate the circumstances and geographic and temporal distributions of hazardous material releases and resulting human impacts in the United States. METHOD: Releases with fatalities, injuries, and evacuations were identified from reports to the National Response Center between 1990 and 2008, correcting for data quality issues identified in previous studies. RESULTS: From more than 550,000 reports, 861 deaths, 16,348 injuries and 741,427 evacuations were identified. Injuries from releases of chemicals at fixed facilities and natural gas from pipelines have decreased whereas evacuations from petroleum releases at fixed facilities have increased. CONCLUSION: Results confirm recent advances in chemical and pipeline safety and suggest directions for further improvement including targeted training and inspections and adoption of inherently safer design principles.

Intoxicación por metadona en la edad pediátrica / Pediatric methadone poisoning

No disponible

Acidentes de transporte rodoviário de cargas perigosas em trânsito: em busca de um sistema de informaçäo integrador dos setores saúde e meio ambiente / Accidentes of road transports of dangerous loads in traffic

Estuda o resultado de uma pesquisa sobre um tema específico de caracter demonstrativo. Detém um raciocínio, um fio condutor que expöe, contextualiza, situa o tema com o intuito de propor uma modificaçäo que apresenta uma possibilidade de melhoria. É uma proposta de reformulaçäo de um instrumental que é capaz de gerar informaçöes suficientes para se propor intervençöes de diversos tipos, como a criaçäo de unidades de referencia para atendimento de acidentados com produtos químicos, exigências por investimentos em infra-estrutura no SCPA, informaçäo necessária para negociar que se tenha equipes ou pessoal especializado nas corporaçöes que atendem aos acidentes como o Corpo de Bombeiros e a PRF, acordos com as empresas e sindicatos para melhoria das condiçöes de trabalho e melhores treinamentos, mudança na percepçäo destes riscos, assim como permitir a formulaçäo de uma política de controle e prevençäo tanto Estadual como Nacional, ou até mesmo regionais. Intervençöes que possibilitam resultados eficazes na reduçäo de vítimas, danos ambientais e materiais. Todos os atores envolvidos saem ganhando, sendo beneficiados. O SCPA, a PRF e o Corpo de Bombeiros se equipam e treinam seus técnicos, as empresas deixam de perder produtos e atrasos de produçäo, os centros médicos podem atender as vitimas lhe dando o atendimento devido. As empresas privadas que atendem os acidentes, removendo o produto, podem continuar atuando como contratadas onde ou quando o SCPA näo possa atuar (ou por estar muito longe e o tempo de sua chegada irá agravar as conseqüências ou por estar envolvido no atendimento a outro acidente envolvendo produtos químicos). Enfim, o atendimento adequado aos acidentes é uma questço de cidadania, de melhor qualidade de vida, de saúde e de um ambiente menos degradado.

Accidentes: Programa Nacional de Prevención / Accidents: National Prevention Program

Este documento, surgido de una Reunión Nacional sobre Prevención de Accidentes, realizada en diciembre de 1992, fue diseñado con el objeto de servir de base para unificar criterios de tratamiento del tema de la accidentología y producir los lineamientos generales de un proyecto nacional consensuado. El tema se aborda desde los Riesgos, por definir que ésta es la vía más adecuada a los fines de la Prevención