A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018-2022: here be snowmobiles

BACKGROUND

Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training.

METHODS

Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms.

RESULTS

Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness.

CONCLUSIONS

These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

The role of modifiable risk factors in incident cancer in transport, rescue, and security industries

PURPOSE

Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries.

METHODS

This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature.

RESULTS

During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer.

CONCLUSIONS

Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.

Dying to help: Fatal bystander rescues in Australian coastal environments

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.

Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001-2017

The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.34; 95% CI, 0.31–0.37). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.

Buffering PTSD in Canine Search and Rescue Teams? Associations with Resilience, Sense of Coherence, and Societal Acknowledgment

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers (n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Analysis of Factors Influencing Insomnia and Construction of a Prediction Model: A Cross-sectional Survey on Rescuers

OBJECTIVE

To determine the factors influencing insomnia and construct early insomnia warning tools for rescuers to informbest practices for early screening and intervention.

METHODS

Cluster sampling was used to conduct a cross-sectional survey of 1,133 rescuers from one unit in Beijing, China. Logistic regression modeling and R software were used to analyze insomnia-related factors and construct a PRISM model, respectively.

RESULTS

The positive rate of insomnia among rescuers was 2.74%. Accounting for participants' age, education, systolic pressure, smoking, per capita family monthly income, psychological resilience, and cognitive emotion regulation, logistic regression analysis revealed that, compared with families with an average monthly income less than 3,000 yuan, the odds ratio ( OR) values and the [95% confidence interval ( CI)] for participants of the following categories were as follows: average monthly family income greater than 5,000 yuan: 2.998 (1.307-6.879), smoking: 4.124 (1.954-8.706), and psychological resilience: 0.960 (0.933-0.988). The ROC curve area of the PRISM model (AUC) = 0.7650, specificity = 0.7169, and sensitivity = 0.7419.

CONCLUSION

Insomnia was related to the participants' per capita family monthly income, smoking habits, and psychological resilience on rescue workers. The PRISM model's good diagnostic value advises its use to screen rescuer early sleep quality. Further, advisable interventions to optimize sleep quality and battle effectiveness include psychological resilience training and smoking cessation.

Long-Term PTSD Risks in Emergency Medical Technicians Who Responded to the 2016 Taiwan Earthquake: A Six-Month Observational Follow-Up Study

Although several factors associated with posttraumatic stress disorder (PTSD) in disaster rescue workers were identified in previous studies, the results were inconsistent. This study aimed to explore the prognostic factors of PTSD among disaster rescuers using different screening tools. A 6.4 magnitude earthquake struck southern Taiwan on February 6, 2016. Emergency medical technicians (EMTs) who responded to the earthquake were recruited. The initial survey was conducted one month after the earthquake using a standardized, self-reported, paper-based questionnaire. After six months, we re-evaluated the EMTs using the same questionnaire that was used in the baseline survey. A total of 38 EMT-paramedics were enrolled in the final analysis. Significant differences in PTSD scores at baseline existed between EMTs with and without certain risk factors. The interaction between survey time and risk factors was not significant, but several risk factors correlated with a nonsignificant improvement in the PTSD score after the 6-month follow-up. Perfectionism personality characteristics and several specific field experiences (managing injured patients, managing dead victims, managing dead victims who were pregnant, managing emotionally distraught families, or guilty feelings during the missions) might affect different subdomains of PTSD symptom improvement. Disaster rescuers should be followed up after their missions, regardless of their age, gender, or previous experience with disaster response. EMTs with certain personality characteristics or who are involved in specific field operations should be carefully monitored during and after disaster rescue missions.

Research on the application of mobile phone location signal data in earthquake emergency work: A case study of Jiuzhaigou earthquake

After an earthquake, the important task of emergency rescue work is to minimize casualties, but due to the suddenness of earthquake disasters, it is difficult to obtain enough disaster information immediately, especially personnel distribution and movement information. The traditional methods of obtaining disaster data are through reports from the disaster area or field investigations by the emergency rescue team; this work lags, and its efficiency is low. This paper analyzes the feasibility of using mobile phone location signal data in earthquake emergency rescue work in several respects, such as quantity, location, change rate, and epicentral distance. The results show that mobile phone location signal data can quickly obtain the situation of personnel distribution and quantity after an earthquake, and we find the change rate, distance, etc., can determine the approximate range of the earthquake impact field. Through the data distribution in different time periods, the movement of personnel after the earthquake can be obtained. Based on several situations, we can determine the basic situation of the disaster-stricken areas in times after the earthquake, especially the personnel relevant to the situation, and these data can provide a scientific basis for emergency rescue decision making.

Increased Incidence of Thyroid Cancer among World Trade Center First Responders: A Descriptive Epidemiological Assessment

An increased incidence of thyroid cancer among 9/11 rescue workers has been reported, the etiology of which remains unclear but which may, at least partly, be the result of the increased medical surveillance this group undergoes. This study aimed to investigate thyroid cancer in World Trade Center (WTC) responders by looking at the demographic data and questionnaire responses of thyroid cancer cases from the Mount Sinai WTC Health Program (WTCHP). WTCHP thyroid cancer tumors were of a similar size (p = 0.4), and were diagnosed at a similar age (p = 0.2) compared to a subset of thyroid cancer cases treated at Mount Sinai without WTC exposure. These results do not support the surveillance bias hypothesis, under which smaller tumors are expected to be diagnosed at earlier ages. WTCHP thyroid cancer cases also reported a past history of radiation exposure and a family history of thyroid conditions at lower rates than expected, with higher than expected rates of previous cancer diagnoses, family histories of other cancers, and high Body Mass Indexes (BMIs). Further research is needed to better understand the underlying risk factors that may play a role in the development of thyroid cancer in this group.

Self-management behaviors in World Trade Center rescue and recovery workers with asthma

BACKGROUND

Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown.

OBJECTIVES

To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions.

METHODS

We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance.

RESULTS

Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB.

CONCLUSIONS

Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions.

CAPSULE SUMMARY

Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.

Efficacy of the Mnemonic Device "MARCH PAWS" as a Checklist for Pararescuemen During Tactical Field Care and Tactical Evacuation

BACKGROUND

The application of Tactical Combat Casualty Care (TCCC) represents evidence-based medicine to improve survival in combat. Over the past several years, US Air Force Pararescuemen (PJs) have expanded the mnemonic device "MARCH" to "MARCH PAWS" for use during tactical field care and tactical evacuation (TACEVAC). The mnemonic stands for massive bleeding, airway, respiration, circulation, head and hypothermia, pain, antibiotics, wounds, and splinting. We undertook this performance improvement project to determine the efficacy of this device as a treatment checklist.

METHODS

The mission reports of a 16-PJ combat rescue deployment to Operation Enduring Freedom (OEF) from January through June 2012 were reviewed. The triage category, mechanism of injury, injury, and treatments were noted. The treatments were then categorized to determine if they were included in MARCH PAWS.

RESULTS

The recorded data for missions involving 465 patients show that 45%, 48%, and 7%, were in category A, B, and C, respectively (urgent, priority, routine); 55% were battle injuries (BIs) and 45% were nonbattle injuries (NBIs). All treatments for BI were accounted for in MARCH PAWS. Only 9 patients' treatments with NBI were not in MARCH PAWS.

CONCLUSION

This simple mnemonic device is a reliable checklist for PJs, corpsmen, and medics to perform TACEVAC during combat Operations, as well as care for noncombat trauma patients.

Injuries and exposures among ocean safety providers: A review of workplace injuries and exposures from 2007-2012

Research on workplace injuries and exposures in ocean safety personnel remains limited. Despite increasing beach attendance and reliance on lifeguards for protection, the most common types of injuries, equipment resulting in injuries, and environmental exposures remains unknown. This study reviewed OSHA 300 logs summarizing workers' compensation claims from 2007-2012 to identify common body parts injured, action at time of injury, equipment causing injury, and environmental exposures. A secondary phase consisted of a cross-sectional anonymous survey to determine demographics, body part injured, equipment causing injury, sun and environmental exposures, action at time of injury, and proportion of injuries reported to the department. During the 6-year period, 304 claims from the OSHA logs were reviewed, finding the lower extremity was most commonly injured with 2921 (31.9%) cumulative lost work days (104 reported injured, 34.2%) followed by the back with 1679 (18.4%) lost work days (39 reported injuries, 12.8%). Of the 304 occupational injury claims from OSHA logs, 108 incidents (35.5%) occurred during rescues, 87 (28.6%) during normal duties, and 31 (10.2%) during training. Of survey participants, 22/52 sustained an injury, with 14 filling a worker's compensation claim. The rescueboard resulted in 7/22 injuries (31.8%) while 17 (32.7%) of respondents sought care for a sun related concern with a mean of 9.3 days lost. Occupational injuries in ocean safety personnel are largely unknown. In this study, lower extremity and back injuries were the most common musculoskeletal injuries providers encountered. Rescues and moving equipment were common actions at the time of injury. With this preliminary information, jurisdictions may develop training directed at rescue techniques and safer options for moving heavy equipment.

[Air rescue missions at night: Data analysis of primary and secondary missions by the DRF air rescue service in 2014]

The advantages that are inherent to the air ambulance service are shown in a reduction in mortality of critically ill or injured patients. The air ambulance service ensures quick and efficient medical care to a patient as well as the immediate transport of patients to a suitable hospital. In addition, primary air rescue has proved to be effective as a support for the standard ground-based ambulance services in some regions of Germany during the night. Under certain conditions, such as the strict adherence to established, practiced and coordinated procedures, air rescue at night does not have a significantly higher risk compared to operations in daytime. Particular requirements should be imposed for air rescue operations at night: a strict indication system for alerting, 4-man helicopter crews solely during the night as well as pilots (and copilots) with the correct qualifications and experience in dealing with night vision devices on a regular basis. Moreover, the helicopters need to be suitable and approved for night flying including cabin upgrades and the appropriate medical technology equipment. To increase the benefits of air rescue for specific diseases and injuries, a nationwide review of the processes is needed to further develop the primary air rescue service.

Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

OBJECTIVE

To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota.

PATIENTS AND METHODS

We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September 12, 2001, through September 11, 2014, and generated expected sex- and age-specific rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs lower). Standardized incidence ratios (SIRs), which are the ratios of the observed number of cases in the FDNY group to the expected number of cases based on REP rates, and 95% CIs were calculated.

RESULTS

We identified 97 SAID cases. Overall, FDNY rates were not significantly different from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had 7.7 excess cases.

CONCLUSION

Most studies indicate that the healthy worker effect reduces the association between exposure and outcome by about 20%, which we observed in the lower WTC exposure group. Overall rates masked differences in incidence by level of WTC exposure, especially because the higher WTC exposure group was relatively small. Continued surveillance for early detection of SAIDs in high WTC exposure populations is required to identify and treat exposure-related adverse effects.

Work-related stress in healthcare workers

BACKGROUND

In the assessment of work-related stress it is crucial to find the factors that generate and increase it in order to identify categories of individuals at risk, to plan interventions for prevention, elimination or reduction of risk. The aim of the study is to assess the subjective stress in 68 workers of a large Italian company dealing with human health, through the use of a questionnaire-indicating tool, elaborated by the Italian National Institute for insurance against accidents at work (INAIL) and developed by the Health and Safety Executive (HSE).

METHODS

We studied a final sample of 68 individuals (34 drivers/rescuers and 34 video display unit (VDU) operators). The questionnaire consists of 35 items (divided into six areas) with five possible answers each, that cover working conditions considered potential causes of stress.

RESULTS

The drivers/rescuers had a better performance than the VDU operators, especially in the areas "demand", "relationships" and "role". We compared men and women in the two groups, finding that, in VDU operators, women had a better performance than men in all areas, except "role" and "changes", in which the overall scores were the same in men and women. In the drivers/rescuers women showed more critical scores in the items "relationships" and "change".

CONCLUSION

The results show that: the questionnaire-indicating tool is useful, with a demonstrated effectiveness for the occupational physician during the visits and proven validity; additional future efforts should focus on understanding the psycho-social, organizational and individual problems related to stress and the consequent implementation of preventive measures.

Isochrones as Indicators of the Influence of Traffic in Public Health: A Visual Simulation Application in Ávila, Spain

It is well known that excessive rescue times after traffic accidents negatively affect the health of those injured. There is a need to quantitatively measure the impact of unexpected events like ambulance availability, weather, floating population and congestion in those rescue times. A family of indicators based on isochrones is disguised and proposed to understand the risk of the whole population as the probability of not being assisted on time. Indicators of health risk for local towns are also defined. The indicators are calculated using a simulation model and visualized in web format. The framework of analysis is validated using Ávila (Spain) and the problem of the optimal deployment of ambulances as a test-bench.

Rescues conducted by surfers on Australian beaches

This study describes the demographics, occurrence, location, primary hazards and outcomes involved in rescues performed by surfers on Australian beaches. Conservative estimates suggest that the number of rescues conducted by Australian surfers each year is on par with the number conducted by volunteer surf lifesavers. Surfers perform a considerable number of serious rescues in both lifesaver/lifeguard patrolled (45%) and unpatrolled (53%) beach locations. Rip currents represent the major physical hazard leading to rescue (75%) and the dominant emotional response of people rescued is one of panic (85%). Most surfer rescue events occur during conditions of moderate waves and sunny, fine weather with the highest proportion of rescues occurring on quiet beaches with few people around (26%). Swimming is the activity associated with most rescue events (63%), followed by board riding (25%). Males aged 18-29 represent the largest demographic of people rescued. Surfers with prior water-safety training are more likely to perform a higher number of rescues, however ability to perform rescues is not associated with formal training, but rather number of years' experience surfing. Seventy-eight percent of surfers were happy to help, while 28% expressed feelings of annoyance or inconvenience, generally towards unwary swimmers. Results of this research suggest that 63% of surfers feel they have saved a life. This value may be enhanced through improved training of surfers in basic water safety rescue techniques.

Chronic physical health consequences of being injured during the terrorist attacks on World Trade Center on September 11, 2001

Few studies have focused on injuries from the World Trade Center disaster on September 11, 2001. Severe injury has health consequences, including an increased mortality risk 10 years after injury and the risk of mental health problems, such as posttraumatic stress disorder (PTSD). The World Trade Center Health Registry identified 14,087 persons with none of a selected group of preexisting chronic conditions before 2002 who were present during and soon after the World Trade Center attacks, 1,980 of whom reported sustaining 1 or more types of injury (e.g., a broken bone or burn). Survey data obtained during 2003-2004 and 2006-2007 were used to assess the odds of reporting a diagnosis of chronic conditions (heart disease, respiratory disease, diabetes, cancer) up to 5-6 years after the attacks. Number of injury types and probable PTSD were significantly associated with having any chronic conditions diagnosed in 2002-2007. Persons with multiple injuries and PTSD had a 3-fold higher risk of heart disease than did those with no injury and no PTSD, and persons with multiple injuries and with no PTSD had a 2-fold higher risk of respiratory diseases. The present study shows that injured persons with or without comorbid PTSD have a higher risk of developing chronic diseases. Clinicians should be aware of the heightened risk of chronic heart and respiratory conditions among injured persons.

Prevalence of disabled people involved in Spanish Civil Guard's police activity

Improving interventions with victims and offenders with disabilities requires analysis of the degree of prevalence of crimes in which these people are involved. For this purpose, data regarding interventions made by the Spanish Civil Guard between 2008 and 2010, in which 2099 people had some kind of disability, have been collected and analyzed, with particular regard to criminal offenses (felonies and/or misdemeanors). In this study, the relationship between the types of disability a person has and other variables like their connection to the incident, their gender, age, the relationship between victim and perpetrator, and the time and place of the events were all taken into consideration. The results show that most of the victims with disabilities served by the Spanish Civil Guard were male. The interventions were mainly aid and rescues. Criminal offenses were only 20% of the events.

Surf lifeguard rescues

OBJECTIVE

This study assessed the utility of lifeguard rescue data for providing information on person and situation factors to inform surf bather drowning prevention research.

METHODS

The dataset comprised 872 beach-days (daily lifeguard reports) obtained from 26 beaches over a 95-day period in Victoria, Australia.

RESULTS

The rescue rate was 128 per 100,000 in-water bathers. One or more rescues were required on 125 beach-days (14%). Rescue on a beach-day was more likely for offshore wind conditions, relatively high daily air temperatures, and high bather numbers (P < .05). Compared to female bathers, males were more frequently rescued (65%) and more likely (P < .05) to be from a younger age group (30 years or less), although being older was associated with a relatively poorer condition on rescue.

CONCLUSIONS

Although rescues are proportional to water exposure, frequencies are also influenced by situation and person factors. Bathers at relatively high risk of rescue are hypothesized to be overrepresented in amenable sea and weather conditions, and poor patient condition on rescue may be associated with exposure to a preexisting health condition.

Occupational exposures and symptoms among firefighters and police during the carmel forest fire: the Carmel cohort study

BACKGROUND

From 2 to 5 December 2010, Israel experienced the most severe forest fire In its history, resulting in the deaths of rescue workers. Little research exists on the health risks to emergency responders during forest fires, and there is no published research to date on occupational health among firefighters in Israel.

OBJECTIVES

To describe the exposures experienced by emer gency responders to smoke, fire retardants and stress; the utilization of protective equipment; and the frequency of corresponding symptoms during and following the Carmel Forest fire.

METHODS

A cohort of 204 firfighers and 68 police who took part in rescue and fire-abating activites during the Carmel Forest fire were recruited from a representative sample of participating stations throughout the country and interviewed regarding their activities during the fire and their coinciding symptoms. Unpaired two-sample t-test compared mean exposures and symptom frequency for firefighters and police. Chi-square estimates of OR and 95%CI are provided for odds of reporting symptoms, incurring injury or being hospitalied for various risk factors

RESULTS

Of the study participants, 87% reported having at least one symptom during rescue work at the Carmel Forest fire,with eye irritation (77%) and fatigue (71%) being the most comon. Occupational stress was extremely high during the fire; the average length of time working without rest was 18.4 hours among firefighters.

CONCLUSION

Firefighter and police were exposed to smoke and ocupational stress prolonged periods during the fire. Further research is needed on the residual health effects from exposure to forest fires among emergency responders, and to identify areas for improvement in health preparedness.

A 10-year analysis of 214 HEMS backcountry hoist rescues

BACKGROUND

Few published studies on civilian helicopter emergency medical services (HEMS) hoist programs exist. This study provides a demographic analysis of hoist rescue operations performed by the only FAA Part 135 hoist-approved civilian HEMS operator in the United States.

METHODS

All persons hoisted between May 29, 2001, and May 28, 2011, were retrospectively analyzed.

RESULTS

Over a 10-year period, 212 of 214 victims were hoisted. The most common indications were fall injuries (38%) and being stranded (21%). Victim demographics showed an average age of 35 ± 17years, predominantly male (79%), often associated with trauma (66%), with a majority (68%) of all victims requiring subsequent transport to a hospital by ground ambulance (24%) or flown by Life Flight (44%). Hoists occurred most often in the afternoon (14:07 ± 3:47 hours), during the weekend (53%), in the months of May-September (71%), at an altitude of 7,488 ± 1487 feet, with the seat harness (39%) being the most common mode of victim extraction. Hoist insertion of search and rescue (SAR) personnel occurred infrequently (5%).

CONCLUSION

The results from this demographic study on hoist operations can provide important demographic information for HEMS contemplating backcountry hoist operations and programs that interface with SAR agencies.

Traumatic Brain Injuries after Mass-Casualty Incidents: Lessons from the 11 September 2001 World Trade Center Attacks

Introduction:

The 11 September 2001 terrorist attacks on the World Trade Center (WTC) resulted in thousands of deaths and injuries. Research on previous bombings and explosions has shown that head injuries, including traumatic brain injuries (TBIs), are among the most common injuries.

Objective:

The objective of this study was to identify diagnosed and undiagnosed (undetected) TBIs among persons hospitalized in New York City following the 11 September 2001 WTC attacks.

Methods:

The medical records of persons admitted to 36 hospitals in New York City with injuries or illnesses related to the WTC attacks were abstracted for signs and symptoms of TBIs. Diagnosed TBIs were identified using the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Undiagnosed TBIs were identified by an adjudication team of TBI experts that reviewed the abstracted medical record information. Persons with an undiagnosed TBI were contacted and informed of the diagnosis of potential undetected injury.

Results:

A total of 282 records were abstracted. Fourteen cases of diagnosed TBIs and 21 cases of undiagnosed TBIs were identified for a total of 35 TBI cases (12% of all of the abstracted records). The leading cause of TBI was being hit by falling debris (22 cases). One-third of the TBIs (13 cases) occurred among rescue workers.More than three years after the event, four out of six persons (66.67%) with an undiagnosed TBI who were contacted reported they currently were experiencing symptoms consistent with a TBI.

Conclusions:

Not all of the TBIs among hospitalized survivors of the WTC attacks were diagnosed at the time of acute injury care. Some persons with undiagnosed TBIs reported problems that may have resulted from these TBIs three years after the event. For hospitalized survivors of mass-casualty incidents, additional in-hospital, clinical surveys could help improve pre-discharge TBI diagnosis and provide the opportunity to link patients to appropriate outpatient services. The use and adequacy of head protection for rescue workers deserves re-evaluation.

Long-Range Rescue Helicopter Missions in the Arctic

Background:

Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on-board includes an anesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions, and arctic winter darkness.

Methods:

One-hundred, forty-seven ambulance and 29 search and rescue missions in the Barents Sea during 1994–1999 were studied retrospectively with special emphasis on operative conditions and medical results.

Results and Discussion:

Thirty-five percent of the missions were carried out in darkness. The median time from the alarm to first patient contact was 3.3 hours and the median duration of the missions was 7.3 hours. Forty-eight percent of the missions involved ships of foreign origin. Half the patients had acute illnesses, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from industrial accidents with open and closed fractures, amputations, and soft tissue damage. Ninety percent of the patients were hospitalized; 7.5% probably would not have survived without early medical treatment and rapid transportation to a hospital.

Conclusion:

Using a heavy search and rescue helicopter in the Barents Sea was the right decision in terms of medical gain and operative risk.

Exposure, probable PTSD and lower respiratory illness among World Trade Center rescue, recovery and clean-up workers

BACKGROUND

Thousands of rescue and recovery workers descended on the World Trade Center (WTC) in the wake of the terrorist attack of September 11, 2001 (9/11). Recent studies show that respiratory illness and post-traumatic stress disorder (PTSD) are the hallmark health problems, but relationships between them are poorly understood. The current study examined this link and evaluated contributions of WTC exposures.

METHOD

Participants were 8508 police and 12 333 non-traditional responders examined at the WTC Medical Monitoring and Treatment Program (WTC-MMTP), a clinic network in the New York area established by the National Institute for Occupational Safety and Health (NIOSH). We used structural equation modeling (SEM) to explore patterns of association among exposures, other risk factors, probable WTC-related PTSD [based on the PTSD Checklist (PCL)], physician-assessed respiratory symptoms arising after 9/11 and present at examination, and abnormal pulmonary functioning defined by low forced vital capacity (FVC).

RESULTS

Fewer police than non-traditional responders had probable PTSD (5.9% v. 23.0%) and respiratory symptoms (22.5% v. 28.4%), whereas pulmonary function was similar. PTSD and respiratory symptoms were moderately correlated (r=0.28 for police and 0.27 for non-traditional responders). Exposure was more strongly associated with respiratory symptoms than with PTSD or lung function. The SEM model that best fit the data in both groups suggested that PTSD statistically mediated the association of exposure with respiratory symptoms.

CONCLUSIONS

Although longitudinal data are needed to confirm the mediation hypothesis, the link between PTSD and respiratory symptoms is noteworthy and calls for further investigation. The findings also support the value of integrated medical and psychiatric treatment for disaster responders.

Peritraumatic distress, watching television, and posttraumatic stress symptoms among rescue workers after the Great East Japan earthquake

Background

The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.

Methodology/Principal Findings

In this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.

Conclusions/Significance

The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.

A study on rescuer drowning and multiple drowning incidents

INTRODUCTION

Drowning is a leading cause of injury related death in many countries, including Turkey, where this study originates. The aim of the study is to define and examine "rescuer" drowning and Multiple Drowning Incidents (MDIs), and suggest preventative measures against MDIs.

METHOD

The event of a person drowning can be complicated if an untrained person attempts to rescue the Primary Drowning Victim (PDV). This can result in the death of the "rescuer" as well as the PDV, which then becomes an MDI. This study categorizes these MDI incidents by examining online news media accounts in Turkey from 2005 through 2008.

RESULTS

In this 4-year period, 88 "rescuer" drowning incidents occurred in which 114 "rescuers" and 60 PDVs died from drowning in MDIs; 114 drowned "rescuers" rescued 47 PDVs before they died from drowning. Most of the "rescuers" were male and 42.1% of them were under the age of 18. Most of the drowning incidents (68.5%) occurred in fresh water (lakes/dams/water holes and rivers/creeks/streams).

CONCLUSION

In this study, risk factors for drowning deaths include gender and entering in unguarded open water. An increased awareness of such risks as well as promotion of both swimming and rescue skills in water could help reduce MDIs. Parents who live close to fresh water sources with boys under the age of 18years should be more aware of drowning risk because of their higher rates of deaths from drowning.

IMPACT ON INDUSTRY

The results of this study give the chance to policy makers and all other related people or organizations to see the whole picture of deaths by drowning and the results can be used to build up preventative strategies as swimming teaching and life guard education.

[The evaluation of the mechanism and cause of death of mine rescuers during the group accident in the Niwka-Modrzejów Coal Mine in Sosnowiec in 1998]

On February 24, 1998, in the Niwka-Modrzej6w Coal Mine in Sosnowiec, a group accident occurred and, as a result, six miners died and four others were injured. Mine rescuers, proceeding to work in out of action mining excavation, separated by an isolative dam, were using oxygen escape breathing apparatuses AU-9 type and oxygen breathing apparatuses for work WU-70 type. A comprehensive evaluation of the accident circumstances, medical papers, autopsy, histopatological and chemico-toxicological reports, technical surveys of the Central Station of Mine Rescue and the Military Institution of Chemistry and Radiometry (WIChiR), taking into consideration the microclimatic conditions in the sidewalk and testimonies of the survivors allowed for determining the cause of death in the victims. The authors emphasized special difficulties in compiling the comprehensive opinion in the reviewed case and the significant evidential value of the technical survey prepared by WIChiR that showed numerous and serious abnormalities in the performance of oxygen breathing apparatuses, which in a short time led in their users to acute respiratory insufficiency due to anoxia with its further consequences.

Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study

BACKGROUND

The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up.

METHODS

We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumour registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with overdispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria.

FINDINGS

Compared with the general male population in the USA with a similar demographic mix, the standardised incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1·10 (95% CI 0·98-1·25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1·19 (95% CI 0·96-1·47) corrected for possible surveillance bias and 1·32 (1·07-1·62) without correction for surveillance bias. Secondary analyses showed similar effect sizes.

INTERPRETATION

We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies.

FUNDING

National Institute for Occupational Safety and Health.

[Chronic and post-traumatic stress in the profession of medical rescuer worker]

THE AIM OF THE STUDY

The assessment of post-traumatic events experienced at work by medical rescuer.

MATERIAL AND METHODS

The research covered 40 individuals working as medical rescuer (20 males and 20 females) with average 35.6 years old. The rescuer were employed in the Hospital Emergency Department. The individuals were interviewed with the use of a scale, assessing the reactions of a medical rescue worker to the death of a patient being rescued. The frequency and kind of posttraumatic experiences in the job of a medical rescue worker were analyzed.

RESULTS

The most numerous group of the interviewed (40%) reported the dissociation caused by the death of a patient being rescued by them. The most frequently mentioned post-traumatic event was a physical assault, threatening the life of the interviewed person.

CONCLUSIONS

Medical rescuer are exposed to the occurrence of post-traumatic stress disorder (PTSD), which contributes to the reduced feeling of safety at workplace.

Prevalence and predictors of posttraumatic stress disorder, anxiety, depression, and burnout in Pakistani earthquake recovery workers

Past research has shown a substantial prevalence of emotional disorders in professionals involved in rescue and/or relief operations following natural disasters, including earthquakes. However, no published study to date has investigated whether disaster rehabilitation and reconstruction workers involved in later phases of the earthquake response are also affected by emotional problems. A nearly complete sample of earthquake rehabilitation and reconstruction workers (N=267) involved in the response to the 2005 earthquake in Northern Pakistan filled in a set of self-report questionnaires assessing emotional problems and predictor variables approximately 24 months after the earthquake. Most participants had experienced the disaster themselves and suffered from a number of stressors during and shortly after the acute earthquake phase. A substantial subgroup of participants reported clinically relevant levels of emotional disorders, especially earthquake-related posttraumatic stress disorder (42.6%), as well as depression and anxiety (approx. 20%). Levels of burnout were low. Symptom levels of posttraumatic stress disorder were associated with the severity of the earthquake experience, past traumas, work-related stressors, low social support, and female gender. The results document a high prevalence of emotional problems in earthquake rehabilitation and recovery workers.

Occupational asthma and lower airway disease among World Trade Center workers and volunteers

The World Trade Center (WTC) disaster and its recovery work involved a range of hazardous occupational exposures that have not been fully characterized but can be reasonably assumed to have the potential to cause mucosal inflammation in the upper and lower airways. A high prevalence of lower airway disease (LAD) symptoms was reported by several early surveys. Clinical studies further categorized the diagnoses as irritant-induced asthma (of subacute onset), nonspecific chronic bronchitis, chronic bronchiolitis, or aggravated preexistent obstructive pulmonary disease in a substantial proportion of patients. Risk factors for WTC-related LAD included early (on September 11 or 12, 2001) arrival at the WTC site and work at the pile of the collapsed towers. Cigarette smoking (but not atopy) also seemed to be a risk factor for LAD. No data thus far suggest an increased incidence of neoplastic or interstitial lung disease, but ongoing surveillance is clearly necessary.

Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost

CONTEXT

Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes.

OBJECTIVE

To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study.

DESIGN

Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input.

SETTING

A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita.

PARTICIPANTS

Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination.

MAIN OUTCOME MEASURES

Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources.

RESULTS

Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately.

CONCLUSIONS

Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.

Entanglements of marine mammals and seabirds in central California and the north-west coast of the United States 2001-2005

Entanglement records for seabirds and marine mammals were investigated for the period 2001-2005. The entanglement records were extracted from databases maintained by seven organizations operating along the west coast of the United States of America. Their programmes included beach monitoring surveys, rescue and rehabilitation and regional pinniped censuses. Records of 454 entanglements were documented in live animals and in carcasses for 31 bird species and nine marine mammal species. The most frequently entangled species were Common Murres, Western Gulls and California sea lions. The entanglement materials identified were primarily fishing related. Entanglements were recorded every year suggesting that although the incidence level differs annually, entanglement is a persistent problem. It is recommended that each programme records details in standardized categories to determine entanglement material sources. Numbers of entanglements observed during these surveys are likely to be a conservative view of the actual entanglement rate taking place at sea.

[Exposure of medical rescuers to aggression at the workplace]

SUMMARY

Members of the medical rescue team are exposed to several dangerous and harmful factors, including emotional and physical stress, during their activities at the site of an accident. Basing on the literature it can be concluded that anxiety and low mood are present in each patient in a state of endangered life or health. The aim of study was to assess the incidence, sources, and types of aggression against medical rescuers depending on the place of work.

MATERIAL AND METHODS

This study was done in 126 medical rescuers working in the province of Podlaskie. Questionnaires assessing the degree and types of aggression against medical rescuers and the GHQ28 General Heath Questionnaire were used.

RESULTS

Rescuers working in emergency rooms and ambulances reported that aggression most often was in the form of raised voice (95%), threats (85%), attempted assault and dangerous situation (91%). According to respondents working at hospital emergency departments, raised voice is most often encountered (95% of respondents). Threats were made against 72%, dangerous situations were noted by 59%, and attempted assault was experienced by 44% of respondents.

CONCLUSIONS

Rescuers working in ambulances and emergency rooms were more often exposed to aggression than rescuers working at hospital emergency departments. The exception was raised voice by patients which was noted with the same frequency irrespective of the place of work. Aggression from superiors and coworkers was evidently more often experienced in ambulances and emergency rooms.

Emergency response and medical rescue in the worst hit Mianyang areas after the Wenchuan earthquake

The 12 May 2008 earthquake caused damage to 88% of the health systems in the worst hit areas of Mianyang with 326 casualties and the direct economic loss of RMB 3124 billion. Within 30 minutes of the earthquake, the Mianyang headquarters for earthquake disaster relief and the Mianyang public health headquarters for medical rescue and treatment were organized. Five medical teams were sent to Beichuang County, the worst hit Mianyang area, four hours after the earthquake. A total of 22,947 wounded and sick people were delivered to local hospitals after simple triage and rapid treatment through three stations. By 30 June, the Mianyang medical organization had received 379,600 people and admitted 21,628 inpatients. These 2772 severely wounded (including 146 with limbs amputated and 846 who died in hospital). Since 17 May, 3381 wounded had been transferred to 14 provincial and city-level hospitals across China. On 20 June, the Mianyang Rehabilitation Center for wounded and sick people was established and received 156 rehabilitation inpatients. Together with the medical team for psychological intervention, they provided psychological support for over 70,000 people. Within two hours of the earthquake, the Mianyang Organization for Health and Epidemic Control and Prevention launched the emergency response plan for major natural disasters. The organization sent emergency teams for disease prevention and control and completed disinfection and burial of corpses and disposal of carcasses, monitoring of water quality and epidemics, disinfection of environmental ruins, epidemic control in resettled areas, precautions against secondary disasters caused by the earthquake, and large-scale health education. The emergency command system for medical rescue and disease control and prevention in the Mianyang areas integrated resources, carried out unified command, and responded rapidly. Furthermore, the headquarters of medical relief co-ordinated and united the governmental and nongovernmental organizations, achieving good performance for both medical relief and epidemic control. This experience of earthquake medical relief will benefit post-disaster reconstruction, as well as the establishment of national and regional emergency response systems.

Strategic supporting role of a regional state-level hospital during medical rescue after Wenchuan earthquake

Shortly after the Wenchuan earthquake, the administrative leaders of West China Hospital accurately defined the role of the hospital during the medical rescue work as the treatment center for seriously wounded people, the support center for local hospitals and clinics in the disaster areas in Sichuan Province, and the logistics support center for medical teams from other provinces. Integrated leadership of management and efficient multidepartment co-ordination and co-operation were emphasized. The hospital was immediately transformed from regular mode into a double-track emergency mode. Scientific allocation and dispatch of resources were ensured to meet the changing demand from all levels of rescue work. Three stages were defined based on the conditions of wounded people delivered to the hospital, with different main focuses for each stage. Because of the multidisciplinary co-operation and concerted efforts of a large number of experts from other provinces and countries, an effective and efficient medical rescue service was offered to all wounded people. Until 2 June 2008, 2618 injured people from the disaster area have been treated, of whom 1751 were admitted to the inpatient department, 1135 were seriously wounded, 127 were admitted into the intensive care unit, 1239 underwent surgery, and 77 were treated with haemodialysis. There was an inpatient mortality less than 0.7%. Moreover, even during such a period, routine medical service was offered to patients other than people wounded in the disaster.

Biomonitoring of perfluorochemicals in plasma of New York State personnel responding to the World Trade Center disaster

The collapse of the World Trade Center (WTC) on September 11, 2001 resulted in the release of several airborne pollutants in and around the site. Perfluorochemicals including perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA), which are used in soil- and stain-resistant coatings on upholstery, carpets, leather, floor waxes, polishes, and in fire-fighting foams were potentially released during the collapse of the WTC. In this pilot study, we analyzed 458 plasma samples of New York State (NYS) employees and National Guard personnel assigned to work in the vicinity of the WTC between September 11 and December 23, 2001, to assess exposure to perfluorochemicals released in dust and smoke. The plasma samples collected from NYS WTC responders were grouped based on estimated levels of exposure to dust and smoke, as follows: more dust exposure (MDE), less dust exposure (LDE), more smoke exposure (MSE), and less smoke exposure (LSE). Furthermore, samples were grouped, based on self-reported symptoms at the time of sampling, as symptomatic and asymptomatic. Eight perfluorochemicals were measured in 458 plasma samples. PFOS, PFOA, perfluorohexanesulfonate (PFHxS), and perfluorononanoic acid (PFNA), were consistently detected in almost all samples. PFOA and PFHxS concentrations were approximately 2-fold higher in WTC responders than the concentrations reported for the U.S. general population. No significant difference was observed in the concentrations of perfluorochemicals between symptomatic and asymptomatic groups. Concentrations of PFHxS were significantly (p < or = 0.05) higher in the MDE group than in the LDE group. Concentrations of PFNA were significantly higher in the MSE group than in the LSE group. Significantly higher concentrations of PFOA and PFHxS were found in individuals exposed to smoke than in individuals exposed to dust. A significant negative correlation existed between plasma lipid content and concentrations of certain perfluorochemicals. Our initial findings suggest that WTC responders were exposed to perfluorochemicals, especially PFOA, PFNA, and PFHxS, through inhalation of dust and smoke released during and after the collapse of the WTC. The potential health implications of these results are unknown at this time. Expansion of testing to include all archived samples will be critical to help confirm these findings. In doing so, it may be possible to identify biological markers of WTC exposure and to improve our understanding of the health impacts of these compounds.

[Smoking and passive exposure to tobacco smoke among members of medical rescue teams]

In Poland approximately 33% adults are active smokers. Both active smoking and passive exposition to tobacco smoke leads to serious diseases and causes many other problems. This is why the decrease of smoking prevalence seems to be one of the most important targets of contemporary medicine. In this task the attitude of medical staff plays a great role (prevention, education, behaviour of a medical employee as a positive example). The research was carried out among 48 employees of Regional Station of Ambulance Service in Poznan (16 physicians, 19 medical rescuers and 13 nurses). The group comprised 21 women and 27 men. The investigative tool was a questionnaire concerning smoking, passive exposition to tobacco smoke and attitude of the examined persons towards smoking. We found that smoking prevalence in the investigated group considerably exceeds the average values for Polish population (particularly the number of smoking women) whereas passive exposition to tobacco smoke affects everyone in this group. In the opinion of the examined people the main factors inducing and maintaining tobacco smoking are: addiction, pleasure connected with smoking or influence of someone's company. In a case of medical personnel tobacco smoking (similarly to other behaviours which are harmful for someone's health) weakens the authority of a health care provider as an example of health promotion.

The impact of avalanche rescue devices on survival

BACKGROUND

Within Europe and North America, the median annual mortality from snow avalanches between 1994 and 2003 was 141. There are two commonly used rescue devices: the avalanche transceiver, which is intended to speed up locating a completely buried person, and the avalanche airbag, which aims to prevent the person from being completely buried.

OBJECTIVE

This retrospective study aimed to evaluate whether these avalanche rescue devices had an effect on mortality.

METHODS

The study population was 1504 persons who were involved in 752 avalanches either in Switzerland from 1990 to 2000 and from 2002 to 2003 (1296 persons, 86.2%) or in Austria from 1998 to 2004 (208 persons, 13.8%).

RESULTS

Persons equipped with an avalanche airbag had a lower chance of dying (2.9% versus 18.9%; P=0.026, OR 0.09, n=1504). In persons who were completely buried, without visible or audible signs at the surface and who did not rescue themselves (n=317), we found a lower median duration of burial (25min versus 125min; P<0.001) and mortality (55.2% versus 70.6%; P<0.001, OR 0.26) in those using an avalanche transceiver than in those not using the device.

CONCLUSIONS

Our data showed that both the avalanche airbag and the avalanche transceiver reduce mortality. However, to improve the evaluation of rescue devices in the future, the data collection procedures should be reviewed and prospective trials should be considered, as the reliability of retrospective studies is limited.

Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina

BACKGROUND

Hospital surge capacity has been advocated to accommodate large increases in demand for healthcare; however, existing urban trauma centers and emergency departments (TC/EDs) face barriers to providing timely care even at baseline patient volumes. The purpose of this study is to describe how alternate-site medical surge capacity absorbed large patient volumes while minimizing impact on routine TC/ED operations immediately after Hurricane Katrina.

METHODS

From September 1 to 16, 2005, an alternate site for medical care was established. Using an off-site space, the Dallas Convention Center Medical Unit (DCCMU) was established to meet the increased demand for care. Data were collected and compared with TC/ED patient volumes to assess impact on existing facilities.

RESULTS

During the study period, 23,231 persons displaced by Hurricane Katrina were registered to receive evacuee services in the City of Dallas, Texas. From those displaced, 10,367 visits for emergent or urgent healthcare were seen at the DCCMU. The mean number of daily visits (mean +/- SD) to the DCCMU was 619 +/- 301 visits with a peak on day 3 (n = 1,125). No patients died, 3.2% (n = 257) were observed in the DCCMU, and only 2.9% (n = 236) required transport to a TC/ED. During the same period, the mean number of TC/ED visits at the region's primary provider of indigent care (Hospital 1) was 346 +/- 36 visits. Using historical data from Hospital 1 during the same period of time (341 +/- 41), there was no significant difference in the mean number of TC/ED visits from the previous year (p = 0.26).

CONCLUSIONS

Alternate-site medical surge capacity provides for safe and effective delivery of care to a large influx of patients seeking urgent and emergent care. This protects the integrity of existing public hospital TC/ED infrastructure and ongoing operations.

Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers

OBJECTIVE

This study compared the prevalence and risk factors of current probable posttraumatic stress disorder (PTSD) across different occupations involved in rescue/recovery work at the World Trade Center site.

METHOD

Rescue and recovery workers enrolled in the World Trade Center Health Registry who reported working at the World Trade Center site (N=28,962) were included in the analysis. Interviews conducted 2-3 years after the disaster included assessments of demographic characteristics, within-disaster and work experiences related to the World Trade Center, and current probable PTSD.

RESULTS

The overall prevalence of PTSD among rescue/recovery workers was 12.4%, ranging from 6.2% for police to 21.2% for unaffiliated volunteers. After adjustments, the greatest risk of developing PTSD was seen among construction/engineering workers, sanitation workers, and unaffiliated volunteers. Earlier start date and longer duration of time worked at the World Trade Center site were significant risk factors for current probable PTSD for all occupations except police, and the association between duration of time worked and current probable PTSD was strongest for those who started earlier. The prevalence of PTSD was significantly higher among those who performed tasks not common for their occupation.

CONCLUSIONS

Workers and volunteers in occupations least likely to have had prior disaster training or experience were at greatest risk of PTSD. Disaster preparedness training and shift rotations to enable shorter duration of service at the site may reduce PTSD among workers and volunteers in future disasters.

[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?]

BACKGROUND

In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes.

METHODS

In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician.

RESULTS

In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01).

CONCLUSIONS

The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

How dangerous is BASE jumping? An analysis of adverse events in 20,850 jumps from the Kjerag Massif, Norway

BACKGROUND

Extreme sports, including BASE (building, antenna, span, earth) jumping, are rapidly increasing in popularity. Associated with risk for injuries and deaths, this activity may pose a burden on the emergency system. Hitherto, no reports exist on accidents and deaths associated with BASE jumping.

METHODS

We reviewed records of 20,850 BASE jumps from 1995 to 2005 at the Kjerag massif in Norway. Frequency of deaths, accidents, and involvement of helicopter and climbers in rescue are analyzed. Fatalities were scored for injury severity scores (Abbreviated Injury Scale score, Injury Severity Score, New Injury Severity Score) on autopsy.

RESULTS

During an 11-year period, a total of 20,850 jumps (median, 1,959; range, 400-3,000) resulted in 9 fatal (0.04% of all jumps; 1 in every 2,317 jumps) and 82 nonfatal accidents (0.4% of all jumps; 1 in every 254 jumps). Accidents increased with the number of jumps (r=0.66; p=0.007), but fatalities did not increase, nor did activation of helicopter or climbers in rescue (p>0.05). Helicopter activation (in one-third of accidents) in rescue correlated with number of accidents (r=0.76, p=0.007), but not climbers. Postmortem examination (n=7) of fatalities revealed multiple, severe injuries (Abbreviated Injury Scale score>or=3) sustained in several body regions (median, Injury Severity Score 75; range, 23-75). Most nonfatal accidents were related to ankle sprains/fracture, minor head concussion, or a bruised knee.

CONCLUSION

BASE jumping appears to hold a five- to eightfold increased risk of injury or death compared with that of skydiving. The number of accidents and helicopter activation increases with the annual number of jumps. Further analysis into the injury severity spectrum and associated hospital burden is required.