The treatment of victims with gunshot wounds has gained importance over the past 10–15 years due to continuous military conflicts and the increase in terrorist and criminal acts. Since 1992, a group of pediatric surgeons has been trained to treat gunshot wounds in both children and adults in field hospitals of the Russian Service of Disaster Medicine in Northern Caucasus.

Two working models of a Children's Field Hospital (ChFH) were reviewed. In the first model, a ChFH was implemented for 14 months (April 2001–July 2002) during a military conflict in the Chechen Republic. There were no other hospitals rendering medical aid to children in the area. In the second model, a field hospital was created for children following a terrorist act in Beslan, Northern Ossetia in 2004.

Over the 14 month period, the Chechen Republic ChFH rendered medical aid to 102 adults and 20 (16.4%) children with gunshot wounds. Self-made explosives and unexpected munitions were blamed for explosive trauma in children. Two children died in the ChFH, and one child with amputated lower limbs was transported to Moscow for prosthetics placement. Three hundred eleven children presented to ChFH, including 55 children not requiring medical aid, and 256 wounded children, who were divided into 3 groups: 5 dying; 52 wounded and requiring emergency treatment; and 199 wounded who were transported to hospitals in Vladikavkaz after receiving initial medical aid at the ChFH. In total, 47 operations were performed, including seven abdominal and chest surgeries. Re-animation aid was provided at the Intensive Care Department of the ChFH for the stabilization of the critically wounded prior to their evacuation.

In the situation of mass admissions of wounded patients, the most important considerations are triage and the arrangement of operations according to urgent indications.

The growing number of children suffering polytrauma from traffic accidents dictates the expansion of the indications for osteosynthesis. Elastic-stable intramedullary osteosynthesis (ESIN) is the optimum treatment of fractures of long bones in children.

Closed intramedullary osteosynthesis of diaphyseal femur fractures with flexible nails was performed in 74 patients (76 fractures) during 2006–2010. The patients were children ages 1–8 years. Titanium elastic nails (TEN) (Synthesis, Switzerland) were used in the procedures. AO Foundation recommendations were adhered to when selecting the size of the implant (i.e., diameter approximately 1/3 the diameter of the femur medullar canal at its narrowest part).

There was a prevalence (n = 53) of simple fractures (Ð3 by AO classification) in this group of patients. Sixteen children had Ð2-type fractures, five with spiral (Ð1), and two with slanting (Ð2) fractures. There were no type Ð1 or Ð3 complex fractures in this group. Good functional results of closed intramedullary osteosynthesis with TEN at diaphyseal fractures of the femur in children with isolated and associated damages were achieved. There were no post-operative complications. This method provided stability of osteosynthesis, which allows activating patients in the short- term, i.e., during the post-operative period.

Treating femur fractures in children with ESIN provides optimum treatment of polytrauma. Osteosynthesis without exposure to the area of damage, and the early activation of children can prevent infectious complications and contractures.

Disaster health management policies are being developed and implemented by various government and non-governmental organizations. However, there has been a lack of studies to comprehensively identify the key elements in the successful disaster health management policies.

A survey of experts was used to identify key elements of successful disaster health management policy arrangements. This research conducted 10 face-to-face interviews, together with 22 e-mail surveys to identify the key elements. The experts were selected based on the person's background and expertise in disaster health management and policy analysis.

Key elements of disaster health management policies were identified and introduced in four parts, including the characteristics of conceptual policy framework of disaster health management (risk assessment and recognition, strategic view, resilience community, inclusive and accountable, good structure with clear authority, fault tolerant, good communication, rigidity and flexibility, education and training, mutual understanding, effective funding), elements of policy development (adequate leadership, extensive consultation, clear goals and terms, easy to access and implement, locally owned and accepted, standard and flexibility, linkage with other policies, keep updated, involve all the stakeholders, regular drills as part of the policy), elements of policy implementation (well defined structure and agencies, professional disaster management body, delegate the power and coordination, maintain interests and involvement, communication, recognition of disaster risks, policy familiarity, full participation of health elements, financial support, specific measurement), and elements of policy effectiveness evaluation (advisory committee, evaluate true disasters, evaluate policies in exercises and drills, test people's knowledge, evidence of stakeholders contributing, practice and procedural change, evaluate operating procedural, scientific evidence).

Key elements must be considered in developing, implementing, and evaluating of disaster health management policies to ensure the success of these policies.

Australia is a vast and isolated country and often the only viable option of transporting multiple casualties is using fixed wing aircraft. A number of civilian aeromedical services and the military are responsible for the evacuation of casualties, both nationally and internationally. Due to Australia's increased operational commitments, the military can no longer be expected to provide a rapid aeromedical deployment. This situation, coupled with the limited surge capacity of Australia's civilian fixed wing aeromedical services, highlights the need for Australia to improve preparation and readiness for a large scale civilian aeromedical response.

Historically, the use of large jets configured for aeromedical use has been exclusively the domain of the military. Yet in recent years the use of large civilian jets configured for aeromedical capability has been suggested as a solution. The purpose of this paper is to explore the role of large civilian jets configured for aeromedical use in the event of a disaster with multiple casualties. This study involved an extensive literature review and an international study tour of aeromedical services that are at the forefront of using large jets in aeromedical evacuation. The findings identified that standard civilian jets can easily be reconfigured for transporting multiple casualties. It is argued that this strategy can be an inexpensive and effective option and should be included in emergency preparedness arrangements. The aim of this paper is to prompt disaster health agencies in Australia to consider the use of a civilian jet system that can be used for a disaster requiring a large scale aeromedical response.

All first responders must be prepared to respond to suicide attacks. Staging safe and effective responses to these incidents requires knowledge of a number of unique considerations.

The research presented in this presentation used reviews of open source information along with site visits to multiple suicide bombing sites in Israel and the United Kingdom to determine the important considerations for first responders responding to suicide attacks. What is presented is not a specific standard operating procedure but rather a common framework that can help to facilitate a coordinated and effective response from all agencies involved.

Civilians and private security guards can play an important role in detecting the planning and execution of suicide attacks and sometimes even in their interdiction in the imminent attack phase. The suspicions of civilians must be taken seriously and citizens should be encouraged to report these suspicions immediately. The first responding emergency services personnel must be able to effectively begin their agency's response to the attack while maintaining a strong situational awareness. Also on scene, strong frontline commanders are needed to work together to lead a coordinated response. Interagency communication and using a scaled response is of increased importance at these incidents when first responders could be targeted by the secondary attacks or an initial threat that has not yet been neutralized. First responders can take the initial steps to promote the return to normalcy that is important after terrorist attacks. In the aftermath of attacks, efforts should be made to establish a collective knowledge within the emergency services community to share lessons learned in the response.

The results of this research can help local agencies plan for suicide attack response and also provides a strong foundation for future research to further investigate responses to the varying types of suicide attacks around the world.

In the last 50 years of modern-era cardiopulmonary resuscitation (CPR), survival rates remain dismal, worldwide. International CPR guidelines recommended a compression rate of at least 100 per minute. There is little evidence documenting if and to what extent high compression rates affect the quality of chest compressions.

An objective of this study was to evaluate the effect mean compression rate (MCR) had on the overall quality of chest compressions. Investigators hypothesized that MCRs > 110 would result in a smaller percentage of adequate: compressions (PAC); depth (PAD); and recoil (PAR).

In this observational pilot study, basic life support providers were recruited from prehospital and in-hospital settings to provide 10 minutes of continuous chest compressions, based on the 2005 American Heart Association guidelines. An adequate compression was defined as a compression that was > 35 mm, had full recoil, and correct hand position. Data were recorded using the Laerdal PC Skill reporting System.

Ninety four (91.3%) of 103 participants completed 10 minutes of compressions. Rescuers represented a variety of backgrounds, average age of 35.5 ± 11.0 years. Fifty eight (56.2%) rescuers had performed CPR in the last two years, and 54 (52.4%) practiced prehospital EMS. Providers that did not complete the entire 10 minutes tended to have a higher MCR than those completing 10 minutes, 114.2 ± 19.3 vs. 105.8 ± 15.4 respectively. Within the first two minutes, rescuers with a MCR > 110 delivered 45% of their compressions adequately, compared to 60% when a rescuer's MCR was < 110. This initial disparity was primarily due to decreased PAR, not decreased PAD. After 2 minutes, higher MCRs correlated with decreased PAC, due to decreased PAD.

Data indicates a higher MCR results in decreased PAC, PAD, and PAR, likely attributed to increased rescuer fatigue.

This case study presents the development of a prehospital system in Jaffna, Sri Lanka. The case then outlines the development of the system, examines its first year of operations, and investigates possible reasons for the results of the development of the prehospital system in Jaffna. Finally, the case discusses the continued operations of the system.

This case study qualitatively researches the development of the Jaffna prehospital care system by looking at indicators of success in human resources, technical knowledge and community awareness. The case study also quantitatively examines the utilization and financial performance of the system during its first year of operation.

According to indicators, the implementation of the model and its functioning can arguably be considered successful in terms of utility, and in many regards financial stability. The system has already responded to over 2,000 emergency calls in its first eleven months of operation. The main ambulance and call center has managed to operate at only a $13.50 USD loss during its first twelve months of operation. It has established quality standards by utilizing trained Emergency Medical Technicians (EMT) and ambulances featuring basic life saving equipment. The system has also integrated itself as a part of the overall health system of the community it is serving.

The system's success in development should be examined as a potential model for implementing prehospital care in a developing and middle-income country setting, while keeping in mind factors outside of the system that were integral to its developmental success.

Short intervals between stroke onset and thrombolysis determine the efficacy of this procedure. Guidelines for stroke management were introduced in 2005 in the West-Tallinn Stroke Centre and in 2008 in the Tallinn Emergency Medical Services. Since 2006, annual joint stroke meetings of pre- and in-hospital staff have been held. These meetings included analysis of time delays of thrombolyzed patients.

The aim of the study was to analyze changes in time delays in acute stroke management and adherence to treatment guidelines.

Pre- and in-hospital data of all consecutive ischemic stroke patients who received intravenous thrombolytic therapy were recorded prospectively at the Stroke Centre. Data from the implementation period of thrombolysis (2005–2008 i.e., 1st period) were compared to recent data from 2009 to 01 September 2010 (2nd period). The data from all stroke patients presenting to ambulance services were analyzed separately from 01 September 2009 to 01 September 2010. Recorded procedures were compared to current treatment guidelines.

A total of 115 patients received thrombolysis at the Stroke Centre. The Alarm Centre assigned the correct priority (C, lights and sirens) for 31% of thrombolyzed patients during the 1st period, and for 80% during the 2nd period. The mean time ambulance personnel spent at the home was 20 minutes during both periods. In-hospital door-to-needle time was < 60 minutes in 11% of patients during the 1st period, and in 56% during the 2nd period. Ambulance personnel treated 1,094 stroke patients during the study. All procedures were performed and documented correctly in 10% of visits. The most frequent deviation from guidelines was under-reported values of blood glucose. In 44.7% of patients, an ECG was performed, which is not required by guidelines.

Acute stroke management improved significantly. Adherence to recently developed stroke guidelines in the ambulance services must be improved.

In Germany, emergency medical care is provided by ambulances. Emergency physicians also are used in the German rescue system to ensure primary care. Additionally, rescue helicopters are insertable. The rescue helicopter in Dresden covers the city of Dresden and its surrounding areas, with 517,000 inhabitants and distances up to 70 km. The goal of this study was to evaluate emergency cases in helicopter rescue missions according to primary diagnoses and severity of the mission on the basis of NACA Score.

Data from all emergencies using the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central computer database (MEDAT®). Data from all emergency cases between January 2006 and July 2010 were analyzed.

There was a total of 6,310 emergencies during the study period, with a significant increase over time. The helicopter was on-scene within 10.9 minutes. In total, 54% of the patients were male. The rate of female patients > 80 years of age was 64.5%. A total of 63.4% of patients suffered life-threatening injuries or dysfunctions and a NACA score ≥ 4. A total of 7.6% of patients were classified in NACA 6 or 7. The most common cause for rescue missions was an acute coronary syndrome (20.4%). Other frequent diagnoses included brain injury (13.3%), unconsciousness (12.5%), stroke (12.9%), general cerebral convulsion (7.9%), polytrauma (6.4%), and cardiac arrest (5.0%). The rate of prehospital endotracheal intubation was 15.1%. In 1.1% of patients, a thoracic drainage was established.

In recent years the number of helicopter rescue missions increased, along with injury severity. The total number of patients with NACA 6 and 7 was extremely high, and demonstrates the need for an efficient emergency medical rescue system that includes helicopters.

Difficulties have been reported in patient distribution during mass-casualty incidents (MCIs). In this retrospective, descriptive study, the regional Patient Distribution Protocol (PDP) and the management of the patient distribution after the Turkish Airlines airplane crash on 25 February 2009 near Schiphol Airport in Amsterdam were analyzed.

Analysis of the of PDP involving the 126 surviving victims of the crash, by collecting data on Medical Treatment Capacity (MTC), number of patients received per hospital, triage classification, Injury Severity Scale (ISS) score, secondary transfers, distance from the crash site, and critical mortality rate.

The PDP holds two inconsistent definitions of MTC. The PDP was not followed. Four hospitals received 133–213% of their MTC, and five hospitals received one patient. There were 14 receiving hospitals (distance from crash: 5.8–53.5 km); thre hospitals within 20 km of the crash did not receive any patients. Major trauma centers received 89% of the “critical” casualties and 92% of the casualties with ISS score ≥ 16. They also received 10% of “minor” casualties and 29% of casualties with ISS score < 8. Only three patients were secondarily transferred, and no casualties died in, or on the way to, the hospital (critical mortality rate = 0%).

Patient distribution was effective, as secondary transfers were low, and the critical mortality rate was zero. The regional PDP could not be followed during this MCI. Uneven casualty distribution was seen in the hospitals. The regional PDP is inconsistent, and should be updated in a new cooperation between Emergency Services, surrounding hospitals and vSchiphol Airport, a high risk area, for which area-specific PDPs must be designed.

Between February 2002 and January 2004, a total of 51 terrorism-related mass-casualty incidents (MCIs) occurred in Israel.

The objective of this study was to analyze data provided in After Action Reports (AAR) held by Magen David Adom (MDA), after each MCI.

Information relating to the type of MCI, location, number of ambulances dispatched in five-minute intervals from time of notification, and number of casualties evacuated by urgency in five-minute intervals from the start of the incident was analyzed.

There were 34 MCIs in 2002, 15 in 2003, and two in 2004. More MCIs (24%) occurred on Wednesdays, and more MCIs occurred during the 05:30–08:59 (18%), 12:00–14:59 (20%), and 17.00–19.59 (24%) time slots. More MCIs occurred in the Jerusalem (24%) area, followed by Tel Aviv (16%). Twenty-six percent of the MCIs resulted from explosions in open areas, 22% in buses, 20% from shootings, and 28% from explosions in semi-closed and closed areas. The mean dispatch time of the first ambulance after notification was 48 seconds. An average of 14.25 ambulances were dispatched in the first five minutes, followed by eight, three, and three in the five-minute slots following. An ANOVA indicated a significant difference in dispatch times by towns/cities (p = 0.05). The average arrival of the first ambulance was 6.4 minutes, and evacuation of the first urgent casualty was 13.6 minutes, the last evacuation was 26.5 minutes after arrival. More urgent casualties (45%) compared to 20% non-urgent were evacuated in first 15 minutes; the majority of non-urgent victims (79%) were evacuated after 16 minutes. The mean number of dispatched ambulances ranged from 37.9 to 26 in urban versus rural areas, respectively. The number of ambulances actually used for evacuation in urban and rural areas was 55% and 44%, respectively.

Information analyzed from AAR is useful for improving Standard Operating Procedures and structuring continuing education interventions for MCIs.

Emergency medicine services (EMS) will play a key role in any response to a flu epidemic. In order to devise an effective preparedness plan for coping with pandemic, it is necessary to comprehend the factors affecting the willingness of EMS workers to respond during an outbreak.

This study aims to: (1) examine the willingness of the workers of Israeli EMS (Magen David Adom (MDA)) to come to work during a pandemic flu; and (2) identify the factors that will increase the willingness of workers to come to work and the obstacles that will keep them from working during a flu pandemic.

Between November 2009 and January 2010, a representative sample of MDA workers in Israel were given questionnaires asking about their knowledge and attitudes in regard to pandemic flu, and concerning factors that may influence their willingness to come to work. Data analysis included descriptive statistics, central and dispersion measures, analyzes of variance, and an exploratory factor analysis.

The study population included 365 people (290 men and 75 women), with 84% aged 20–49 years. Of the respondents, 92% expressed willingness to come to work during a flu pandemic, even if they were asked and not obligated to report to work. An increase in willingness to come to work was found to be associated with the significance of the role of the workers, the guidance that they receive from the organization, their trust in the system, their knowledge, and their feeling of being protected.

Workers' perception of the significance of their role and their trust in the system were found to be central factors in determining workers willingness to come to work during a time of an emergency.

Since September 2009, the Warsaw Ambulance Service (WAS) has enabled 23 ambulances to carry out a 12-lead electrocardiograph (ECG) transmission to the specialist in the ECG transmission center, and in return received an interpretation of sent data along with guidelines concerning further treatment and transportation. This would allow patients with myocardial infarction (MI) eligible for PCI to be transported directly to the catheterization laboratory. The aim of this study was to present the results of the first four months of operation of the ECG transmission system in WAS, and assess the frequency of its use and the amount of MI it covered. Furthermore this study, attended to the main issues that might have had a negative impact on the surveyed system.

Since September 2009, each attempt of transmission was described by a number of factors by the staff attending to ECG transmission center. Documentation created from September to December 2009 was subjected to a thorough analysis.

From September to December 2009, there was a total of 1,650 attempts of transmission, 292 (18%) of them were unsuccessful. Of 1,358 successfully transmitted ECGs, 39 (3%) suggested a ST-Segment Elevation Myocardial Infarction (STEMI) and 149 (11%) suggested a Non-ST-Elevation Myocardial Infarction (NSTEMI). The number of attempted ECG transmission carried out by individual ambulance teams per intervention was significantly different (p < 0.001) and showed a relation with a place of stationing. The proportion of unsuccessful attempts was significantly different for individual ambulance teams (p < 0.001) and was higher for ambulance teams with lower amount of attempts (p < 0.0001).

Prehospital 12-Lead ECGs help to reduce emergency medical services-to-Balloon times. It often was used as a support in case of patients without symptoms typical for MI. Motivation and personal opinion of individual ambulance teams about the system affected frequency of its use. More frequent use of the system by ambulance teams resulted in a lower percentage of unsuccessful attempts of ECG transmission.

The organization of the medical emergency system in Poland has been revised substantially since 2007. Rescuers were able to perform certain life-saving procedures and to administrate some drugs without doctor's order.

The efficiency of advanced life support (ALS) performed by emergency medical service with paramedics (without doctor) was assessed for cases of cardiac arrest (CA) in prehospital conditions. It was correlated with quantity of basic life support (BLS) procedures undertaken by casual witnesses and with the knowledge of automated external defibrillation (AED) in people without medical training.

Forty-eight cases of CA were analyzed, which took place in District Siedlce in the first three quarters of 2009. Data were collected retrospectively, from medical reports. Advanced life support procedures adhering to the guidelines of the European Resuscitation Council were investigated in terms of pharmaco-and electrotherapy. Additionally, the study of the knowledge of AED was conducted through a survey, in which 103 randomly selected persons without medical training took part.

Adrenaline and amiodarone were given by paramedics correctly in 94% of patients. Defibrillation was performed in all patients with documented ventricular fibrillation or pulseless ventricular tachycardia valid values of energy. Cardiopulmonary resuscitation was successful in 33% of the cases. At the scene of the accident BLS was performed before the arrival of ambulance in only 7% of cases. Of the respondents, 41% (non-medic) could use the AED safely, but only 13% of them knew the guidelines for using defibrillators.

Paramedics were properly implementing ALS procedures for prehospital CA. The percent of effective cardiopulmonary resuscitations may improve the early implementation of BLS, including the use of AED. It is necessary to educate people without medical training in this field.