Great earthquakes and medical information systems, with special reference to telecommunications.
(1/128)
The Hanshin-Awaji earthquake in January 1995 caused the greatest number of deaths and injuries in Japan since World War II. Various weaknesses of modern information systems were exposed during and after the earthquake. The authors carried out a questionnaire survey to investigate the current state of hospital information and to examine the kinds of information needed immediately after an earthquake. The survey results show that information about the ability to admit new patients and the availability of medical supplies is necessary immediately after such a disaster. These results will be useful for planning countermeasures against this kind of disaster. (+info)
Heat stress and flame protective clothing in mine rescue brigadesmen: inter- and intraindividual variation of strain.
(2/128)
A climatic exposure was conducted for the 52 rescue brigadesmen of a mine while they wore flame protective clothing. We looked for individual parameters allowing prediction of tolerated exposure times in the climate tested. Of all individual parameters, only body temperature at the end of the Stoklossa heat tolerance test and physical fitness showed significant influence on the tolerated exposure time, although not very strongly. Age, body mass, and Body Mass Index showed no significant influence on the tolerated exposure time. It was found during a longitudinal study that the tolerance time within the climate for four subjects showed considerable variations, and so it was decided neither to take the result of the heat tolerance test as admittance criterion for the mine rescue service nor to perform a ranking of brigadesmen with respect to heat tolerance by this test. (+info)
A model for improving coverage policy decisions.
(3/128)
Reasoned and defensible coverage decisions are essential for a fairer and more efficient healthcare system. Because healthcare resources are finite, coverage decisions should be informed by economic evaluations and made from a perspective that attends to the interests of both individuals and the population enrolled in a plan as a whole. Coverage decisions for all healthcare interventions should follow a 2-step procedure that consists of (1) the relatively impartial and objective assessment of an intervention's eligibility for coverage and (2) the distinctively value-laden determination (for which the enrolled population's values and preferences should take priority) to cover, conditionally cover, or not cover an intervention. (+info)
Propagation of seismic ground motion in the Kanto Basin, Japan.
(4/128)
The pattern of ground motion for a magnitude 5.7 earthquake near Tokyo was captured by 384 strong ground motion instruments across the Kanto sedimentary basin and its surroundings. The records allow the visualization of the propagation of long-period ground motion in the basin and show the refraction of surface waves at the basin edge. The refracted wave does not travel directly from the earthquake epicenter, but traverses the basin obliquely to the edge. The surface wave inside the basin propagates more slowly than that outside such that the wavefronts separate from each other, and the refracted wave heals the discrepancy in the speed of advance of the wavefronts inside and outside the basin. The refracted arrival is dominant near the edge of the Kanto basin. (+info)
Investigation of an acute chemical incident: exposure to fluorinated hydrocarbons.
(5/128)
OBJECTIVES: To assess whether attendance at the site after an incident in a sewer was associated with symptoms in emergency personnel and whether the prevalence of symptoms was associated with estimated levels of exposure to any chemical hazard. METHODS: Symptoms experienced by people attending an incident involving two dead sewer workers suggested the presence of a chemical hazard, before environmental sampling confirmed any toxic agent. Self reported symptoms, estimated exposures, and biomarkers of exposure for likely agents from all 254 people who attended the incident and a referent occupational group matching the 83 emergency personnel who went to the Accident and Emergency department (A and E) in the first 48 hours were recorded. The prevalence of symptoms and concentrations of creatine phosphokinase in serum of the 83 early patients at A and E were compared with their referent occupational group. In all workers who attended the incident, the trends in symptom prevalences and concentrations of creatine phosphokinase in serum were examined by distance from the site and predefined exposure category. RESULTS: Among all workers who attended the incident, symptoms of shortness of breath and sore throat were significantly associated with indirect estimates of exposure but not associated with concentrations of creatine phosphokinase. Freon was detected in two blood samples. The early patients at A and E reported more symptoms than their matched reference group and their median concentrations of creatine phosphokinase were higher. CONCLUSIONS: The association between symptoms and concentrations of creatine phosphokinase with attendance at the site indicated the presence of a continuing hazard at the site and led to extra precautions being taken. Comparison values from the referent occupational group prevented unnecessary medical follow up. (+info)
Human and pet-related risk factors for household evacuation failure during a natural disaster.
(6/128)
This study characterized risk factors for household evacuation failure. A random digit dial telephone survey was conducted of 397 households in Yuba County, California, in July 1997, 6 months after residents had been under evacuation notice due to flooding. Case households failed to evacuate, whereas control households evacuated. The cumulative incidence of household evacuation failure was 19.4%. Fewer households with children (25.8%) failed to evacuate than households without children (45.9%, p < 0.01). More households with pets (20.9%) than households without pets failed to evacuate (16.3%, p = 0.11). With multivariate logistic regression, the risk of household evacuation failure was lower in households with children (odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) compared with households without children. The risk of household evacuation failure increased in pet-owning households without children (odds ratio = 1.3, 95% confidence interval: 1.1, 1.5) compared with pet-owning households with children; the more pets a household owned, the higher the risk of household evacuation failure was. Impediments to pet evacuation, including owning multiple pets, owning outdoor dogs, or not having a cat carrier, explained why many households that owned pets failed to evacuate. Predisaster planning should place a high priority on facilitating pet evacuation through predisaster education of pet owners and emergency management personnel. (+info)
Rationing and life-saving treatments: should identifiable patients have higher priority?
(7/128)
Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the "rule of rescue" should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (+info)
New York City Department of Health response to terrorist attack, September 11, 2001.
(8/128)
In response to two jet aircraft crashing into and causing the collapse of the 110-storied World Trade Center (WTC) towers and the subsequent destruction of nearby portions of lower Manhattan, the New York City Department of Health (NYCDOH) immediately activated its emergency response protocol, including the mobilization of an Emergency Operations Center. Surveillance, clinical, environmental, sheltering, laboratory, management information systems, and operations were among the preestablished emergency committees. Because of its proximity to the WTC site, an emergency clinic was established at NYCDOH for triage and treatment of injured persons. NYCDOH focused its initial efforts on assessing the public health and medical impact of the attack and the resources needed to respond to it such as the care and management of large numbers of persons injured or killed by the crash; subsequent fire and building collapse; the health and safety of rescue workers; the environmental health risks (e.g., asbestos, smoke, dust, or chemical inhalation); other illnesses related to the disruption of the physical infrastructure (e.g., waterborne and foodborne diseases); and mental health concerns. Despite the evacuation and relocation of NYCDOH's headquarters, the department continued essential public health services, including death registration. (+info)