To evaluate the effects of spinal immobilization on healthy participants.

A systematic review of randomized, controlled trials of spinal immobilization on healthy participants.

Seventeen randomized, controlled trials compared different types of immobilization devices, including collars, backboards, splints, and body strapping. For immobilization efficacy, collars, spine boards, vacuum splints, and abdominal/torso strapping provided a significant reduction in spinal movement. Adverse effects of spinal immobilization included a significant increase in respiratory effort, skin ischemia, pain, and discomfort.

Data from this review provide the best available evidence to support the well-recognized efficacy and potential adverse effects of spinal immobilization. However, comparisons of different immobilization strategies on trauma victims must be considered in order to establish an evidence base for this practice.

Assisted living facilities (ALFs) pose unique fire risks to the elderly that may be linked to specific fire safety (FS) practices.

To evaluate self-reported FS practices among ALF residents.

All residents of a small ALF were surveyed regarding actual and hypothetical FS behaviors, self-perceived fire risk, and FS preparedness.

Fifty-eight ALF residents completed the survey. Thirty-three 58%) individuals reported one or more disabilities. Seven (12%) residents ignored the fire alarm and 21 (35%) could not hear it clearly. Sixteen (28%) residents would attempt to locate the source of a fire rather than escape from the building. Only 24 (42%) residents were familiar with the building fire plan.Twenty-three (40%) people surveyed believed that they were not at risk of fire in the study facility.

Residents of an ALF may be at increased fire injury risk due to their FS practices and disabilities.

This retrospective study included 75 persons with ischemic heart disease who were admitted to the Cardiac policlinic for a control check-up immediately after the suspension of air raids. Two-thirds of them were male (average age 62 ±10). Data were obtained using a specially conceived questionnaire based on recall.

Almost 40% of patients estimated that they were very anxious the week before the attacks began, but the anxiety decreased after the beginning of the air raids. Frequency of anginal pains increased after the start of the air raids, but the difference was not statisticaly significant. The intensity of pains drastically increased in the first week of war. Consequently, the average number of pain killers consumed increased from the week before the attacks to the first week of the attacks, and it reached the highest value the week after the suspension of the attacks (1.39, 1.87, and 3.02 pain pills per week, respectively). The average weekly number of medications was 3.50 in the week prior to the air raids, increased to 5.05 during the first week of air raids, and rose to 6.06 in the week after the suspension.

The adjustment on the psychological level was rapid but physical symptoms increased. This implies that physical adaptation to stress could be slower, or that the stress of the war provoked permanent changes in physical status.

On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the “F Scale”) struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris.

A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck.

Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate= 79.2%).While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were lesssevere (median injury severity score (ISS) 1 versus 4).

For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.

To identify and describe the key communication and health protection issues surrounding a flooding emergency.

A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major floodin February 2004. This was supplemented by key informant interviews and a newspaper content analysis.

A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The majorsources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but “health” only was mentioned in 46 (7%) of the 664 flood-related articles.

Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk ofwater contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems.

Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this floodaffected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.

The blackout in North America of August 2003 was one of the worst on record. It affected eight United States states and parts of Canada for >24 hours. Additionally, two large United States cities, Detroit, Michigan and Cleveland, Ohio, suffered from a loss of water pressure and a subsequent ban on the use of public supplies of potable water that lasted four days. A literature review revealed a paucity of literature that describes blackouts and how they may affect the medical community.

This paper includes a review of after-action reports from four inner-city, urban hospitals supplemented accounts from the authors' hospital's emergency operations center (emergency operations center).

Some of the problems encountered, included: (1)lighting; (2) elevator operations; (3) supplies of water; (4) communication operations; (5) computer failure; (6) lack of adequate supplies of food; (7) mobility to obtain Xray studies; (8) heating, air condition, and ventilation; (9) staffing; (10) pharmacy; (11) registration of patients; (12) hospital emergency operations center; (13) loss of isolation facilities; (14) inadequate supplies of paper; (15) impaired ability to provide care for non-emergency patients; (16) sanitation; and (17) inadequate emergency power.

The blackout of 2003 uncovered problems within the United States hospital system, ranging from staffing to generator coverage. This report is a review of the effects that the blackout and water ban of 2003 had on hospitals in a large inner-city area. Also discussed are solutions utilized at the time and recommendations for the future.

The blackout of 2003 was an excellent test of disaster/emergency planning, and produced many valuable lessons to be used in future events.

Large-scale, terrorist attacks can happen in peripheral areas, which are located close to a country's borders and far from its main medical facilities and involve multi-national casualties and responders. The objective of this study was to analyze the terrorist suicide bombings that occurred on 07 October 2004, near the Israeli-Egyptian border, as representative of such a complex scenario.

Data from formal debriefings after the event were processed in order to learn about victim outcomes, resource utilization, critical events, and time course of the emergency response.

A total of 185 injured survivors were repatriated: four were severely wounded, 13 were moderately injured, and 168 were mildly injured. Thirty-eight people died. A forward medical team landed at the border town's airport, which provided reinforcement in the field and in the local hospital. Israeli and Egyptian search and rescue teams collaborated at the destruction site. One-hundred sixty-eight injured patients arrived at the small border hospital that rapidly organized itself for the mass-casualty incident, operating as an evacuation “staging hospital”. Twenty-three casualties secondarily were distributed to two major trauma centers in the south and the center of Israel, respectively, either by ambulance or by helicopter.

Large-scale, terrorist attacks at a peripheral border zone can be handled by international collaboration, reinforcement of medical teams at the site itself and at the peripheral neighboring hospital, rapid rearrangement of an “evacuation hospital”, and efficient transport to trauma centers by ambulances, helicopters, and other aircraft.