Disaster and military medicine最新文献

{"title":"Realtime ultrasound guided percutaneous tracheostomy in emergency setting: the glass ceiling has been broken.","authors":"Parli Raghavan Ravi,&nbsp;M N Vijai,&nbsp;Sachin Shouche","doi":"10.1186/s40696-017-0035-x","DOIUrl":"https://doi.org/10.1186/s40696-017-0035-x","url":null,"abstract":"<p><strong>Background: </strong>In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature. We report our early experience with USPCT in emergency setting.</p><p><strong>Methods: </strong>Sixteen adult patients who required access to an emergency surgical airway after failure to accomplish emergency oro-tracheal intubation were the study population. Their airway was accessed by USPCT. Recorded data included clinical and demographic data including time taken to perform the procedure and complications. Short term and long term follow ups for a period of 2 years were done for the survivors.</p><p><strong>Results: </strong>Twelve male and four female patients underwent the procedure and the average time of the procedure was 3.6 min with no failures nor conversions to surgical tracheostomy and no complications. The average oxygen saturation was 86% and average Glasgow coma scale was 8.4. This time period included the oxygen insufflation time. 10 patients were decannulated while six patients died due to the pathology of the disease itself. There were no complications in either short term or long term follow up.</p><p><strong>Conclusion: </strong>USPCT has a definitive role in emergency both in trauma and non-trauma setting. It is safe, feasible and faster in experienced hands. Use of USPCT in emergency setting has further narrowed the list of contraindications of percutaneous tracheostomy.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2017-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0035-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35227210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burning issue of white phosphorus: a case report and review of the literature.","authors":"Uri Aviv,&nbsp;Rachel Kornhaber,&nbsp;Moti Harats,&nbsp;Josef Haik","doi":"10.1186/s40696-017-0034-y","DOIUrl":"https://doi.org/10.1186/s40696-017-0034-y","url":null,"abstract":"<p><strong>Background: </strong>Burns from white phosphorus are rare and remain a challenge for clinicians. White phosphorus burns are often associated with smaller surface areas and high morbidity rates. Classed as a chemical burn, white phosphorus is used for military purposes and within industry, for the manufacture of fireworks and agricultural products.</p><p><strong>Case presentation: </strong>In this report, we discuss the case of a 40 years old female who sustained 2% Total Body Surface Area partial to full thickness burns from white phosphorus. The burns were treated conservatively with mafenide acetate on the medial calf and dorsum of foot and Flaminal Forte was used for the palmar region. The patient was discharged 22 days after admission and followed up in the outpatient clinic. Despite the use of pressure garments, hypertrophic scarring began to develop on the dorsum of her right foot.</p><p><strong>Conclusions: </strong>During peacetime, white phosphorus possess a significant danger to civilians. Awareness of the unique nature of white phosphorus among military burn clinicians should be emphasized.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2017-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0034-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35316750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allocating scarce medical resources during armed conflict: ethical issues","authors":"N. Evans, M. Sekkarie","doi":"10.1186/s40696-017-0033-z","DOIUrl":"https://doi.org/10.1186/s40696-017-0033-z","url":null,"abstract":"","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0033-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47330111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental status assessment of disaster relief personnel by vocal affect display based on voice emotion recognition.","authors":"Shunji Mitsuyoshi,&nbsp;Mitsuteru Nakamura,&nbsp;Yasuhiro Omiya,&nbsp;Shuji Shinohara,&nbsp;Naoki Hagiwara,&nbsp;Shinichi Tokuno","doi":"10.1186/s40696-017-0032-0","DOIUrl":"https://doi.org/10.1186/s40696-017-0032-0","url":null,"abstract":"<p><strong>Background: </strong>Disaster relief personnel tend to be exposed to excessive stress, which can be a cause of mental disorders. To prevent from mental disorders, frequent assessment of mental status is important. This pilot study aimed to examine feasibility of stress assessment using vocal affect display (VAD) indices as calculated by our proposed algorithms in a situation of comparison between different durations of stay in stricken area as disaster relief operation, which is an environment highly likely to induce stress.</p><p><strong>Methods: </strong>We used Sensibility Technology (ST) software to analyze VAD from voices of participants exposed to extreme stress for either long or short durations, and we proposed algorithms for indices of low VAD (VAD-L), high VAD (VAD-H), and VAD ratio (VAD-R), calculated from the intensity of emotions as measured by voice emotion analysis. As a preliminary validation, 12 members of Japan Self-Defense Forces dispatched overseas for long (3 months or more) or short (about a week) durations were asked to record their voices saying 11 phrases repeatedly across 6 days during their dispatch.</p><p><strong>Results: </strong>In the validation, the two groups showed an inverse relationship in VAD-L and VAD-H, in that long durations in disaster zones resulted in higher values of both VAD-L and VAD-R, and lower values of VAD-H, compared with short durations. Interestingly, phrases produced varied results in terms of group differences and VAD indices, demonstrating the sensitivity of the ST.</p><p><strong>Conclusions: </strong>A comparison of the values obtained for the different groups of subjects clarified that there were tendencies of the VAD-L, VAD-H, and VAD-R indices observed for each group of participants. The results suggest the possibility of using ST software in the measurement of affective aspects related to mental health from vocal behavior.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2017-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0032-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34911789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prevalence of medical symptoms in military aircrew.","authors":"Barak Gordon,&nbsp;Yifat Erlich,&nbsp;Erez Carmon","doi":"10.1186/s40696-017-0031-1","DOIUrl":"https://doi.org/10.1186/s40696-017-0031-1","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of medical symptoms in aviators has not been described in the medical literature.</p><p><strong>Methods: </strong>An anonymous questionnaire was handed to all Israeli Air Force aviators who went through the routine yearly examination. Because only two women filled the questionnaire, we excluded them. The questionnaire contained a list of 49 symptoms and the aviators were asked to mark symptoms that were present in the last month before the examination as well as age, estimated weekly flying hours, military service status (reserve or career) and type of aircraft (jet-fighter, helicopter or transport). A general linear model was used to determine the association between age, weekly flying hours, type of aircraft and type of service with the number of symptoms. Binary logistic regression analyses was used to assess the association of these factors with lack of symptoms, and the top five ranking symptoms.</p><p><strong>Results: </strong>Data was available for 323 male aviators. 62.5% of the aviators reported at least one symptom in the previous month. 26.9% reported three or more symptoms. 25.1% reported spinal symptoms, 22% respiratory symptoms, 21.4% fatigue, 11.5% headache and 6.5% general weakness. Career service was associated with the number of symptoms, fatigue and general weakness. Age was associated with fatigue and general weakness. Aircraft type and weekly flying hours were not associated with any symptom.</p><p><strong>Conclusions: </strong>Medical symptoms are prevalent in military aviators. Career personnel report on medical symptoms, especially fatigue, more often than reserve personnel. Further study is warranted to examine this association.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2017-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0031-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid resuscitation in haemorrhagic shock in combat casualties.","authors":"Parli R Ravi,&nbsp;Bipin Puri","doi":"10.1186/s40696-017-0030-2","DOIUrl":"https://doi.org/10.1186/s40696-017-0030-2","url":null,"abstract":"<p><p>This brief update reviews the recent literature available on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the combat casualty care (CCC) environment. A number of changes need to be incorporated in the CCC guidelines: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hetastarch is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain tactical field care settings where this option might be feasible (FSC, GH) is discussed; (4) 1:1:1 damage control resuscitation (DCR) with plasma: packed red blood cells (PRBC): platelets is preferred to 1:1 DCR with plasma: PRBC when platelets are available; and (5) the 30-min wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure has been eliminated. Also included is an order of precedence for resuscitation fluid options. There should be an emphasis on hypotensive resuscitation in order to minimize (1) interference with the body's hemostatic response and (2) the risk of complications of over resuscitation. Hetastarch is retained as the preferred option over crystalloids when blood products are not available because of its smaller volume and the potential for long evacuations in the military setting.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2017-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-017-0030-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated closed-loop resuscitation of multiple hemorrhages: a comparison between fuzzy logic and decision table controllers in a sheep model.","authors":"Nicole Ribeiro Marques,&nbsp;Brent J Ford,&nbsp;Muzna N Khan,&nbsp;Michael Kinsky,&nbsp;Donald J Deyo,&nbsp;William J Mileski,&nbsp;Hao Ying,&nbsp;George C Kramer","doi":"10.1186/s40696-016-0029-0","DOIUrl":"https://doi.org/10.1186/s40696-016-0029-0","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages. Fuzzy logic empowered the control algorithm to emulate human expertise. We hypothesized that the FL controller would be more effective and more efficient than the DT algorithm by responding in a more rigid, structured way.</p><p><strong>Methods: </strong>Ten conscious sheep were submitted to a hemorrhagic protocol of 25 ml/kg over three separate bleeds. Automated resuscitation with lactated Ringer's was initiated 30 min after the first hemorrhage started. The endpoint target was MAP. Group differences were assessed by two-tailed <i>t</i> test and alpha of 0.05.</p><p><strong>Results: </strong>Both groups maintained MAP at similar levels throughout the study. However, the DT group required significantly more fluid than the FL group, 1745 ± 552 ml (42 ± 11 ml/kg) versus 978 ± 397 ml (26 ± 11 ml/kg), respectively (<i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>The FL controller was more efficient than the DT algorithm and may provide a means to reduce fluid loading. Effectiveness was not different between the two strategies. Automated closed-loop resuscitation can restore and maintain blood pressure in a multi-hemorrhage model of shock.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"3 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2017-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0029-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The contribution of personal and seniority variables to the presence of stress symptoms among Israeli UAV operators.","authors":"Shiri Gal,&nbsp;Leah Shelef,&nbsp;Idit Oz,&nbsp;Nirit Yavnai,&nbsp;Erez Carmon,&nbsp;Shirley Gordon","doi":"10.1186/s40696-016-0028-1","DOIUrl":"https://doi.org/10.1186/s40696-016-0028-1","url":null,"abstract":"<p><strong>Background: </strong>The exposure to war scenes via screens, despite offering a degree of detachment, can be stressful for the operator. The aim of the current study is to examine the existence of anxiety, depression, and post traumatic stress disorder (PTSD) symptoms among unmanned aerial vehicle (UAV) Israeli operators.</p><p><strong>Methods: </strong>Participants comprised 41 UAV operators (87.2% male), aged 22-38 (<i>M</i>_age = 26.05, <i>SD</i> = 3.54). Most (78.0%) reported having viewed battlefield scenes. All participants completed a total of five questionnaires: Beck Depression Inventory, State-Trait Anxiety Inventory, and three questionnaires of PTSD: Post Trauma Questionnaire (CAPS), the Post-Traumatic Cognition Inventory (CTPI), and the Post-Traumatic Symptom Scale (PSS).</p><p><strong>Results: </strong>Mean scores of depression and anxiety were found significantly lower than diagnosis cut-off points (<i>p</i> < .001). Senior operators showed higher means for depression (5.69 vs. 2.58, <i>p</i> = .040), of stress level (PSS; 3.17 vs. 0.25, <i>p</i> = .020) and for distress intensity (3.79 vs. 0.57, <i>p</i> = 0.041) than less-experienced operators.</p><p><strong>Conclusions: </strong>Investigating and monitoring the impact of battlefield exposure in UAV operators are highly beneficial for preventing psychopathology.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2016-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0028-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International medical leadership, collaboration and communication.","authors":"Yael Arbel,&nbsp;Yehuda Zadik,&nbsp;Idan Nakdimon,&nbsp;Yuval Ran,&nbsp;Jacob Mendelovich,&nbsp;Tarif Bader,&nbsp;Hagay Frenkel","doi":"10.1186/s40696-016-0027-2","DOIUrl":"https://doi.org/10.1186/s40696-016-0027-2","url":null,"abstract":"<p><strong>Background: </strong>International social networking is eminent in medical practice, mainly in sharing knowledge and mutual inspiring and in social and professional bonding. Since 2006, the International Medical Course is taking place in Commander Branch at the Military Medicine Academy of the Medical Corps, Israeli Defense Forces; in which medical officers from other military forces are participating along with Israeli officers. One of the course's objectives is international networking. The purpose of this study was to assess the level of networking in the International Medical Course compared to others means of networking, and to examine which components in the course are the most important in networking formation.</p><p><strong>Methods: </strong>Questionnaires were e-mailed to the course participants. Demographic data and data regarding the networking possibilities in the international medical course was collected.</p><p><strong>Results: </strong>The answers of 35 participants (17 Majors, 12 Lieutenant-Colonels, and 6 Colonels; mean age of 44.1 years) were included in this study. Response rate was 42%. Of the participants, 24 were Israelis and 11 from other military forces. Most of the responders (88.6%) reported the course is a major networking tool, with no influence of age, sex, rank, education profession or origin. Networking potential among participants from the same origin country was significantly higher in Israeli officers in comparison to officers from other countries (<i>p</i> = 0.001). Clinical practice and research purposes were the reason for communication in one fifth of the participants.</p><p><strong>Conclusions: </strong>The International Medical Course fulfils its purpose in forming international military medical networking.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2016-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0027-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning lessons in emergency management: the 4th International Conference on Healthcare System Preparedness and Response to Emergencies and Disasters.","authors":"B Adini,&nbsp;A Ohana,&nbsp;E Furman,&nbsp;R Ringel,&nbsp;Y Golan,&nbsp;E Fleshler,&nbsp;U Keren,&nbsp;S Reisner","doi":"10.1186/s40696-016-0026-3","DOIUrl":"https://doi.org/10.1186/s40696-016-0026-3","url":null,"abstract":"<p><strong>Background: </strong>The International Preparedness & Response to Emergencies & Disasters (IPRED) conferences are conducted bi-annually in order to share insights and lessons learned from diverse crises. The aim of the article is to bring the IPRED conferences into better professional attention and to share the main insights that were presented in IPRED IV, which was held in January 2016.</p><p><strong>Main body: </strong>The major lessons learned included: <i>Planning, regional/global collaboration</i> and <i>public</i>-<i>private cooperation</i> should be implemented in developing novel technologies. <i>International humanitarian action</i> necessitates coordination between diverse actors concerning all potential threats. <i>Leadership/coordination</i> and decision-making capacities of emergency response leaders should be enhanced to ensure quality of care. <i>Ethics in disaster management</i>: Triage decisions must not discriminate against terrorists, even when attackers and victims are treated simultaneously. <i>Resilience management</i>: Establishing family and community networks increases resilience of individuals and society. <i>Training programs & exercises</i> must be evaluated considering cost-benefits. <i>Human resources</i>: Teams of experts should be transformed into expert teams. <i>Communication</i>: A common disaster-management language needs to be established. Social media is useful due to bi-directional communication. <i>Civil</i>-<i>military cooperation</i> should be established to facilitate a coordinated response including common terminologies and exercises. <i>Animal sheltering</i>: First responders and pet owners are jeopardized if animals are not included in emergency planning. Re-unification of animals with their owners should be included in response models.</p><p><strong>Conclusions: </strong>IPRED conferences provide a platform for sharing insights and lessons learned from diverse emergencies and disasters. The conferences offer a unique opportunity to share knowledge aimed at improving emergency preparedness, networking between various parties, and substantiates the knowledge and experience of all professionals who take part in the proceedings.</p>","PeriodicalId":91863,"journal":{"name":"Disaster and military medicine","volume":"2 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2016-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40696-016-0026-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34787264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}