|
English Abstract Links
|
Updated July 03, 2002
|
|
Terrorism
and the ethics of emergency medical care
|
|
|
| The threat of domestic and international terrorism involving
weapons of mass destruction-terrorism (WMD-T) has become an increasing
public health concern for US citizens. WMD-T events may have a major
effect on many societal sectors but particularly on the health care
delivery system. Anticipated medical problems might include the need
for large quantities of medical equipment and supplies, as well as
capable and unaffected health care providers. In the setting of WMD-T,
triage may bear little resemblance to the standard approach to civilian
triage. To address these issues to the maximum benefit of our patients,
we must first develop collective forethought and a broad-based consensus
that these decisions must reach beyond the hospital emergency department.
Critical decisions like these should not be made on an individual
case-by-case basis. Physicians should never be placed in a position
of individually deciding to deny treatment to patients without the
guidance of a policy or protocol. Emergency physicians, however, may
easily find themselves in a situation in which the demand for resources
clearly exceeds supply. It is for this reason that emergency care
providers, personnel, hospital administrators, religious leaders,
and medical ethics committees need to engage in bioethical decisionmaking
before an acute bioterrorist event. [Pesik N, Keim ME, Iserson KV.
Terrorism and the ethics of emergency medical care. Ann Emerg Med.
June 2001;37:642-646.] |
|
|
|
|
|
Executive summary: Developing
objectives, content, and competencies for the training of Emergency
Medical Technicians, Emergency Physicians, and Emergency Nurses
to care for casualties resulting from Nuclear, Biological, or Chemical
(NBC) incidents
|
|
|
| Study objective: The task force assessed the
needs, demands, feasibility, and content of training for US civilian
emergency medical responders (paramedics, nurses, and physicians)
for nuclear/biological/chemical (NBC) terrorism. |
| |
|
Methods: A task force representing key professional
organizations, stakeholders, and disciplines involved in emergency
medical response conducted an iterated instructional-design analysis
on the feasibility and content of such training with input from
educational professionals. We then analyzed 6 previously developed
training courses for their congruence with our recommendations.
|
|
|
Results: The
task force produced descriptions of learning groups, content and
learning objectives, and barriers and challenges to NBC education.
Access to training and sustainment of learning (retention of knowledge)
represent the significant barriers. The courses analyzed by the
task force did not meet all objectives and challenges addressed.
|
| |
| Conclusion: The
task force recommends training programs and materials need to be developed
to overcome the identified barriers and challenges to learning for
these audiences. Furthermore, the task force recommends incorporating
NBC training into standard training programs for emergency medical
professionals. [Waeckerle JF, Seamans S, Whiteside M, Pons PT, White
S, Burstein JL, Murray R, on behalf of the Task Force of Health Care
and Emergency Services Professionals on Preparedness for Nuclear,
Biological, and Chemical Incidents. Executive summary: developing
objectives, content, and competencies for the training of emergency
medical technicians, emergency physicians, and emergency nurses to
care for casualties resulting from nuclear, biological, or chemical
(NBC) incidents. Ann Emerg Med. June 2001;37:587-601.] |
|
|
|
|
Hydroxocobalamin: Improved
public health readiness for cyanide disasters
|
|
|
| The United States is under the constant
threat of a mass casualty cyanide disaster from industrial accidents,
hazardous material transportation incidents, and deliberate terrorist
attacks. The current readiness for cyanide disaster by the emergency
medical system in the United States is abysmal. We, as a nation, are
simply not prepared for a significant cyanide-related event. The standard
of care for cyanide intoxication is the cyanide antidote kit, which
is based on the use of nitrites to induce methemoglobinemia. This
kit is both expensive and ill suited for out-of-hospital use. It also
has its own inherent toxicity that prevents rapid administration.
Furthermore, our hospitals frequently fail to stock this life-saving
antidote or decline to stock more than one. Hydroxocobalamin is well
recognized as an efficacious, safe, and easily administered cyanide
antidote. Because of its extremely low adverse effect profile, it
is ideal for out-of-hospital use in suspected cyanide intoxication.
To effectively prepare for a cyanide disaster, the United States must
investigate, adopt, manufacture, and stockpile hydroxocobalamin to
prevent needless morbidity and mortality. [Sauer SW, Keim ME. Hydroxocobalamin:
improved public health readiness for cyanide disasters. Ann Emerg
Med. June 2001;37:635-641.] |
|
|
|
|
|
Explosions
and blast injuries
|
|
|
|
|
Powerful explosions
have the potential to inflict many different types of injuries on
victims, some of which may be initially occult. Flying debris and
high winds commonly cause conventional blunt and penetrating trauma.
Injuries caused by blast pressures alone result from complex interactions
on living tissues. Interfaces between tissues of different densities
or those between tissues and trapped air result in unique patterns
of organ damage. These challenge out-of-hospital personnel, emergency
physicians, and trauma surgeons to specifically seek evidence of
these internal injuries in individuals with multiple trauma, adjust
management considerations to avoid exacerbation of life-threatening
problems caused by the blast wave itself, and ensure appropriate
disposition of these patients in possible mass-casualty situations.
Knowledge of the potential mechanisms of injury, early signs and
symptoms, and natural courses of these problems will greatly aid
the management of blast-injured patients. [Wightman JM, Gladish
SL. Explosions and blast injuries. Ann Emerg Med. June 2001;37:664-678.]
|
|
Abstracts
