The Soho nail bomb: the UCH experience. University College Hospital.
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This paper documents the clinical course of the casualties treated at University College Hospital, following the detonation of a terrorist nail bomb in a public house in Soho, London. The need for adequate primary debridement is paramount, including consideration of definitive primary limb amputation. (+info)
Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center--New York City, September 2001.
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On September 11, 2001, a jet aircraft crashed into the north tower of the World Trade Center (WTC) in lower Manhattan. Minutes later, a second aircraft crashed into the south tower. The impact, fires, and subsequent collapse of the buildings resulted in the deaths of thousands of persons. The precise number and causes of deaths could not be assessed in the immediate aftermath of the attack; however, data were available on the frequency and type of injuries among survivors (Figure 1). In previous disasters, such information assisted in characterizing type and severity of injuries and the health-care services needed by survivors. To assess injuries and use of health-care services by survivors, the New York City Department of Health (NYCDOH) conducted a field investigation to review emergency department (ED) and inpatient medical records at the four hospitals closest to the crash site and a fifth hospital that served as a burn referral center. This report summarizes findings of that assessment, which indicated that the arrival of injured persons to this sample of hospitals began within minutes of the attack and peaked 2 to 3 hours later. Among 790 injured survivors treated within 48 hours, approximately 50% received care within 7 hours of the attack, most for inhalation or ocular injuries; 18% were hospitalized. Comprehensive surveillance of disaster-related health effects is an integral part of effective disaster planning and response. (+info)
Emerging infectious agents: do they pose a risk to the safety of transfused blood and blood products?
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The blood supply is safer than it has been at any other time in recent history, and, in the context of other health care-related adverse events, the risks associated with blood transfusion are extremely small. The current high level of safety is the result of successive refinements and improvements in how blood is collected, tested, processed, and transfused; nonetheless, blood and plasma products remain vulnerable to newly identified or reemerging infections. In recent years, numerous infectious agents-including several newly discovered hepatitis viruses, the agents of transmissible spongiform encephalopathies, and tickborne pathogens-have been identified as potential threats to the safety of blood and plasma. Continued vigilance is critical to protect the blood supply from known pathogens and to monitor for the emergence of new infectious agents. Recent terrorist activities in the United States add new considerations to maintaining the safety and supply of blood. Education of clinicians and patients regarding the benefits and risks associated with the judicious use of blood and blood products can assist in informed decision making. (+info)
Wake of September 11th attacks: implications for research, policy and practice.
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The National Consortium for African American Children (NCAAC) held a National Forum on Bioterrorism and Children on November 6, 2001 in Washington, DC. Convened in the wake of the September 11th attacks on New York City and the Pentagon, this unprecedented conference assembled a cross-section of professionals in child advocacy, health, mental health, insurance, economics, law enforcement, and media technology. The ensuing discussion focused on issues surrounding biological agents, their impact on children and youth, and the strategies needed to protect the health and mental health of children and families in the event of a large-scale bioterrorist crisis. Lessons learned as well as the implications of the terrorist acts from the tragic events of September 11th formed the backdrop for engaging dialogue among various industry executives and professionals. Accounts of personal experiences during the unprecedented tragedy of 9-11 were shared and provided a context for heightened preparedness planning for children and adults. A collaborative statement was also presented by NCAAC, the National Medical Association, the Association of Black Psychologists, and the National Black Media Coalition. This forum was hailed as a model for communities of color to join and help bolster broad-based coalition building to ensure the availability of culturally and linguistically appropriate messages, services, and support. As intended, the forum devoted significant attention to the special needs of children, their caregivers and families and provided for an invaluable interchange which is slated to evolve into a national action plan to address the imminent dangers facing our nation's children. (+info)
Psychological sequelae of the September 11 terrorist attacks in New York City.
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BACKGROUND: The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. METHODS: We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. RESULTS: Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with "current" defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, two or more prior stressors, a panic attack during or shortly after the events, residence south of Canal Street, and loss of possessions due to the events. Predictors of depression were Hispanic ethnicity, two or more prior stressors, a panic attack, a low level of social support, the death of a friend or relative during the attacks, and loss of a job due to the attacks. CONCLUSIONS: There was a substantial burden of acute PTSD and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population. (+info)
Protean nature of mass sociogenic illness: from possessed nuns to chemical and biological terrorism fears.
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BACKGROUND: Episodes of mass sociogenic illness are becoming increasingly recognised as a significant health and social problem that is more common than is presently reported. AIMS: To provide historical continuity with contemporary episodes of mass sociogenic illness in order to gain a broader transcultural and transhistorical understanding of this complex, protean phenomenon. METHOD: Literature survey to identify historical trends. RESULTS: Mass sociogenic illness mirrors prominent social concerns, changing in relation to context and circumstance. Prior to 1900, reports are dominated by episodes of motor symptoms typified by dissociation, histrionics and psychomotor agitation incubated in an environment of preexisting tension. Twentieth-century reports feature anxiety symptoms that are triggered by sudden exposure to an anxiety-generating agent, most commonly an innocuous odour or food poisoning rumours. From the early 1980s to the present there has been an increasing presence of chemical and biological terrorism themes, climaxing in a sudden shift since the 11 September 2001 terrorist attacks in the USA. CONCLUSIONS: A broad understanding of the history of mass sociogenic illness and a knowledge of episode characteristics are useful in the more rapid recognition and treatment of outbreaks. (+info)
Increased use of cigarettes, alcohol, and marijuana among Manhattan, New York, residents after the September 11th terrorist attacks.
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The September 11, 2001, terrorist attacks were the largest human-made disaster in the United States since the Civil War. Studies after earlier disasters have reported rates of psychological disorders in the acute postdisaster period. However, data on postdisaster increases in substance use are sparse. A random digit dial telephone survey was conducted to estimate the prevalence of increased cigarette smoking, alcohol consumption, and marijuana use among residents of Manhattan, New York City, 5-8 weeks after the attacks. Among 988 persons included, 28.8% reported an increase in use of any of these three substances, 9.7% reported an increase in smoking, 24.6% reported an increase in alcohol consumption, and 3.2% reported an increase in marijuana use. Persons who increased smoking of cigarettes and marijuana were more likely to experience posttraumatic stress disorder than were those who did not (24.2% vs. 5.6% posttraumatic stress disorder for cigarettes; 36.0% vs. 6.6% for marijuana). Depression was more common among those who increased than for those who did not increase cigarette smoking (22.1 vs. 8.2%), alcohol consumption (15.5 vs. 8.3%), and marijuana smoking (22.3 vs. 9.4%). The results of this study suggest a substantial increase in substance use in the acute postdisaster period after the September 11th attacks. Increase in use of different substances may be associated with the presence of different comorbid psychiatric conditions. (+info)
Occupational exposures to air contaminants at the World Trade Center disaster site--New York, September-October, 2001.
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Amid concerns about the fires and suspected presence of toxic materials in the rubble pile following the collapse of the World Trade Center (WTC) buildings on September 11, 2001, the New York City Department of Health (NYCDOH) asked CDC for assistance in evaluating occupational exposures at the site. CDC's National Institute for Occupational Safety and Health (NIOSH) collected general area (GA) and personal breathing zone (PBZ) air samples for numerous potential air contaminants. This report summarizes the results of the assessment, which indicate that most exposures, including asbestos, did not exceed NIOSH recommended exposure limits (RELs) or Occupational Safety and Health Administration (OSHA) permissible exposure limits (PELs). One torch cutter was overexposed to cadmium; another worker was overexposed to carbon monoxide (CO) while cutting metal beams with an oxyacetylene torch or a gasoline-powered saw, and two more were possibly overexposed to CO. NIOSH recommended that workers ensure adequate on-site ventilation when using gas-powered equipment and use rechargeable, battery-powered equipment when possible. (+info)