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Curnin S. Large civilian air medical jets: implications for Australian disaster health. Air Med J 2012; 31:284-8. [PMID: 23116870 DOI: 10.1016/j.amj.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/16/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
Disasters involving multiple foreign nationals overseas will invariably necessitate an air medical response to repatriate the casualties to their respective home countries. Depending on the location of the incident and the number of casualties, foreign governments may need to perform a large-scale air medical response. This may involve using large civilian jet aircraft (LCJ) as an air medical platform. This paper provides a review of the current understanding when converting LCJs for air medical capability. This review concludes that LCJ configured for air medical capability can be used successfully in disasters. The findings indicate that standard civilian jets can be reconfigured for transporting multiple casualties. The use of these aircraft can be considered in disaster planning to complement existing military arrangements or as an alternative option. This strategy can be an inexpensive and effective option and should be considered by Australian disaster health agencies.
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Affiliation(s)
- Steven Curnin
- Faculty of Education, University of Tasmania, Australia.
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Team Echo: Observations and Lessons Learned in the Recovery Phase of the 2004 Asian Tsunami. Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x00015831] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe 26 December 2004 Tsunami resulted in a death toll of >270,000 persons, making it the most lethal tsunami in recorded history. This article presents performance data observations and the lessons learned by a civilian team dispatched by the Australian government to “provide clinical and surgical functions and to make public health assessments”. The team, prepared and equipped for deployment four days after the event, arrived at its destination 13 days after the Tsunami. Aspiration pneumonia, tetanus, and extensive soft tissue wounds of the lower extremities were the prominent injuries encountered. Surgical techniques had to be adapted to work in the austere environment. The lessons learned included: (1) the importance of team member selection; (2) strategies for self-sufficiency; (3) personnel readiness and health considerations; (4) face-to-face handover; (5) coordination and liaison; (6) the characteristics of injuries; (7) the importance of protocols for patient discharge and hospital staffing; and (8) requirements for interpreter services.Whereas disaster medical relief teams will be required in the future, the composition and equipment needs will differ according to the nature of the disaster. National teams should be on standby for international response.
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Abstract
The significance of trauma as a mechanism and cause of mortality and morbidity on a global scale is increasing. The combination of both large-scale disasters, whether natural or man-made, and the every day accidents, and intentional violence pose a grave challenge to the ability of our medical systems' ability to cope with the increasing demands of trauma care at system level as well as on individual providers. Despite significant advances in clinical practice, the economical, educational, and organisational limitations prevent us from providing the best available care to many of our patients, at least on a global scale. Fresh solutions and new paradigms are needed, and in order to approach the key issues successfully a wider scope with a look at the global perspective forming the 'environment of trauma' is required. This review updates the recent trends in trauma with emphasis on the causes and manifestations of trauma on a global scale.
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Affiliation(s)
- AK Leppaniemi
- Emergency Surgery, Department of Surgery, Meilahti hospital, University of Helsinki, Finland,
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Björnsson HM, Kristjánsson M, Möller AD. Converted charter plane for mass transport of patients after a tsunami. Air Med J 2008; 27:293-298. [PMID: 18992689 DOI: 10.1016/j.amj.2008.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 06/23/2008] [Indexed: 05/27/2023]
Abstract
After a tsunami in the Indian Ocean in December 2004, thousands of injured tourists were stranded far away from home. To transport injured Scandinavians and their relatives back to Sweden, a standard Icelandic charter plane was altered for the mission in 2 days. Orthopedic injuries and aspirations were the predominant injuries among patients transported, but all had received advanced care in Thailand. The transport to Sweden was uneventful. The possibility of including charter planes in plans for mass transport of injured patients in disaster preparedness is stressed. For a given incident, a detailed checklist can facilitate gathering vital information to ensure adequate equipment and patient care. The lessons from the preparation of the plane and the mission are reported.
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Affiliation(s)
- Hjalti Már Björnsson
- Departments of Accident and Emergency Medicine, Landspitali University Hospital, Iceland.
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Lennquist S, Hodgetts T. Evaluation of the Response of the Swedish Healthcare System to the Tsunami Disaster in South East Asia. Eur J Trauma Emerg Surg 2008; 34:465. [PMID: 26815991 DOI: 10.1007/s00068-008-8807-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 03/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES When the tsunami in South East Asia hit the coast of Thailand on December 26, 2004, approximately 20,000 Swedish tourists were in the disaster zone. Of these, 548 died or were lost and more than 1500 were injured. The aim of this study was to evaluate the response of the Swedish health care system to the disaster in terms of assessment and support in the disaster zone, evacuation back to Sweden and continued treatment in Sweden. METHODS The evaluation was carried out based on (1) structured questionnaires to the staff of Thai hospitals, injured Swedish citizens and Swedish voluntary workers in the disaster zone; (2) semi-structured interviews with representatives of involved authorities, regional health care centres in Thailand and Sweden, hospital command centres, individuals treated for injuries and volunteer workers involved with supporting the injured; (3) on-site visits in the disaster zone; (4) analysis of reports following the tsunami. RESULTS A total of 11,000 injured were treated during the first 3 days following the tsunami at the six major hospitals in the Phang Nga, Phuket and Krabi provinces where the majority of the Swedish citizens were primarily taken care of. Of these 11,000, 3000 required hospital admission against a total bed capacity of 1400. Almost 1500 surgical operations were performed during the first 3 days across 33 operating theatres. Thai health care representatives and staff confirmed the requirement for teams from countries with many tourists in the area for practical and psychological support, interpretation, assessment for evacuation and undertaking early evacuation to home nations to release local health care resources. This need was also supported by the injured. Sweden, having the highest number of injured citizens next to the host country, was very late compared to other countries in sending assessment teams to the area and in supplying the needed support. CONCLUSIONS With increased international travelling, many countries today have large numbers of their citizens in other parts of the world. For Sweden, this has been estimated to be 400,000 at any one time, often in areas known to be risk zones for natural disasters and terrorism. This fact of modern-day life demands welldesigned plans to support both citizens in the area and the local health care in several ways: non-medical support by mediating contact between injured and local medical staff, psychological and practical support, support in evacuating own citizens from the area to release local health care and (under specific conditions) medical support. This planning has to include prepared assessment teams that can be rapidly deployed to the scene and a command structure permitting rapid and accurate decisions on a governmental level.
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Affiliation(s)
- Sten Lennquist
- Department of Surgery (Professor Emeritus), University Hospital, Linköping, Sweden. .,, Ängslyckestigen 4, 614 32, Söderköping, Sweden.
| | - Timothy Hodgetts
- Academic Department of Military Emergency Medicine, Institute of Research and Development, Birmingham, UK
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Sechriest VF, Lhowe DW. Orthopaedic care aboard the USNS Mercy during Operation Unified Assistance after the 2004 Asian tsunami. A case series. J Bone Joint Surg Am 2008; 90:849-61. [PMID: 18381323 DOI: 10.2106/jbjs.g.00821] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- V Franklin Sechriest
- Clinical Investigation Department, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 5, San Diego, CA 92134-1005, USA.
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Maegele M, Gregor S, Yuecel N, Simanski C, Paffrath T, Rixen D, Heiss MM, Rudroff C, Saad S, Perbix W, Wappler F, Harzheim A, Schwarz R, Bouillon B. One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R50. [PMID: 16584527 PMCID: PMC1550895 DOI: 10.1186/cc4868] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 02/20/2006] [Accepted: 02/26/2006] [Indexed: 12/03/2022]
Abstract
Introduction Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. Methods This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). Results Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. Conclusion Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.
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Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
- Intensive Care Unit of the Department of Traumatology and Orthopedic Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Sven Gregor
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Nedim Yuecel
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Christian Simanski
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Thomas Paffrath
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Dieter Rixen
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Markus M Heiss
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Claudia Rudroff
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Stefan Saad
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Walter Perbix
- Department of Plastic and Reconstructive Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Andreas Harzheim
- Department of Radiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Rosemarie Schwarz
- Department of Microbiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Bertil Bouillon
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
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Kost GJ, Tran NK, Tuntideelert M, Kulrattanamaneeporn S, Peungposop N. Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters. Am J Clin Pathol 2006; 126:513-20. [PMID: 16938656 DOI: 10.1309/nwu5e6t0l4pfcbd9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.
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Affiliation(s)
- Gerald J Kost
- POCT.CTR, Pathology and Laboratory Medicine, School of Medicine, University of California Davis, Davis, CA 95616, USA
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