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Establishing and training health care facility decontamination teams

ANNALS OF EMERGENCY MEDICINE 2003年第3期42卷 381-390页

作者： Hick, JL Penn, P Hanfling, D Lappe, MA O'Laughlin, D Burstein, JL Hennepin Cty Med Ctr Safety & Emergency Preparedness Minneapolis MN 55415 USA Univ Minnesota Dept Emergency Med Minneapolis MN USA EnMagine Diamond Springs PA USA Inova Hlth Syst Emergency Management & Disaster Med Falls Church VA USA George Washington Univ Dept Emergency Med Washington DC USA Fairview Southdale Healthcare Facil Minneapolis MN USA Harvard Univ Sch Med Beth Israel Deaconess Med Ctr Boston MA USA

Recent terrorist events, changes in Joint Commission on Accreditation of Healthcare Organizations requirements, and availability of grant funding have focused health care facility attention on emergency preparedness. Health care facilities have historically been underprepared for contaminated patients presenting to their facilities. These incidents must be properly managed to reduce the health risks to the victims, providers, and facility. A properly equipped and well-trained health care facility team is a prerequisite for rapid and effective decontamination response. This article reviews Occupational Safety and Health Administration (OSHA) training requirements for personnel involved with decontamination responses, as well as issues of team selection and training. Sample OSHA operations-level training curricula tailored to the health care environment are outlined. Initial and ongoing didactic and practical training can be implemented by the health care facility to ensure effective response when contaminated patients arrive seeking emergency medical care.

关键词：净化救灾计划/组织和管理危害物质卫生设施计划/组织和管理在职培训人员医院/教育防护装置安全措施恐怖主义人类

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Hospital trauma care in multiple-casualty incidents: A critical view

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 647-652页

作者： Hirshberg, A Holcomb, JB Mattox, KL Baylor Coll Med Dept Surg Houston TX 77030 USA Ben Taub Gen Hosp Joint Trauma Training Ctr Houston TX 77030 USA

During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore, the realistic admitting capacity of the hospital is determined primarily by the number of trauma teams that the hospital can recruit. Effective triage of these casualties is often not straightforward, with high over-triage rates. Simplified triage algorithms may be a practical alternative to more elaborate schemes. The concept of minimal acceptable care is the key to a staged management approach during a mass-casualty incident. Discrete-event computer simulation and war game tabletop exercises for key personnel are 2 new modalities that are supplementing the traditional mock disaster drill as effective planning and training tools.

关键词：算法计算机模拟决策树救灾计划/组织和管理急诊室医院/组织和管理策略实验性卫生保健公平提供/组织和管理医院病床数在职培训/组织和管理领导多处创伤/治疗医师的作用卫生保健质量创伤学/教育创伤学/组织和管理伤病员分拣/组织和管理工作负荷量人类

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Natural and bioterrorist/biocriminal threats to food and agriculture

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FOOD AND AGRICULTURAL SECURITY: GUARDING AGAINST NATURAL THREATS AND TERRORIST ATTACKS AFFECTING HEALTH, NATIONAL FOOD SUPPLIES, AND AGRICULTURAL ECONOMICS 1999年第1期894卷 1-8页

作者： Frazier, TW GenCon Montross VA 22520 USA

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Medical counterbioterrorism: The response to provide anthrax prophylaxis to New York City US postal service employees

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 441-446页

作者： Partridge, R Alexander, J Lawrence, T Suner, S Brown Univ Sch Med Rhode Isl Hosp Injury Prevent CtrDept Emergency Med Providence RI 02912 USA Maine Med Ctr Dept Emergency Med Portland ME 04102 USA Univ Vermont Coll Med Dept Surg Burlington VT USA Rhode Isl Dept Hlth Emergency Med Serv Children Providence RI 02908 USA Off Emergency Preparedness Dept Hlth & Human Serv Rockville MD USA

Study objective: We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. Methods: A description of the response effort is presented. Data were collected on standardized forms and included the numbers of postal employees screened and offered antibiotic prophylaxis, as well as the numbers of patients seen per worker hour by various medical professionals. Results: One hundred members of 5 disaster medical assistance teams and other health professionals were deployed to New York City within 18 hours of activation. Over a 68-hour period, 7,076 patients were evaluated, representing all postal employees in the 6 major postal facilities in New York believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen during the first 24 hours, 3,875 during the second 24 hours, and the remaining 749 during the last 20 hours of operations. An average of 161 employees were screened per hour. The antibiotic most commonly dispensed was ciprofloxacin, followed by doxycycline and amoxicillin. Conclusion: The deployment of disaster medical assistance teams and other agencies to New York City to provide prophylaxis against inhalation anthrax to US Postal Service employees provides lessons for a rapid, efficient, and effective response to acts of bioterrorism. This deployment might also serve as a scaleable model for future events requiring medical prophylaxis.

关键词：炭疽/预防和控制抗菌药/治疗应用生物恐怖/预防和控制救灾计划/组织和管理效率组织预测卫生服务研究普查/组织和管理模型组织管理纽约市职业卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据人员配备和时间安排/组织和管理邮政转诊和会诊/组织和管理回顾性研究危险因素时间因素工作负荷量人类

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THE USE OF WIDE AREA COMPUTER-NETWORKS IN DISASTER MANAGEMENT AND THE IMPLICATIONS FOR HOSPITAL MEDICAL NETWORKS

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES-SERIES 1992年第1期670卷 202-210页

作者： BUTLER, DL ANDERSON, PS CTR INT RES COMMUN & INFORMAT TECHNOL S MELBOURNE VIC 3205 AUSTRALIA

Computer-mediated communication in various forms is already being used in all phases of disaster management--preparation, response, recovery, and long-term mitigation. However, to date wide area computer networks--particularly the Internet (the supernetwork of networks)--have been used only to a limited extent in disaster management and prevention. Some of these applications are described in this paper. Nevertheless, the high speed and ease of information transfer by computer network and the vast resources becoming available on the Internet make it inevitable that the use of computer networks to temper disasters will increase enormously in the next decade. The Internet will provide a key means through which networks initially dedicated to solely medical purposes and the individuals who use them will become involved not only in disaster response and mitigation worldwide, but in the global community and consciousness that is the Internet.

关键词：澳大利亚临床方案计算机通信网络/组织和管理救灾计划/组织和管理灾害/预防和控制卫生服务需求医院信息系统/组织和管理国际合作研究联合国美国

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Hydroxocobalamin: Improved public health readiness for cyanide disasters

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 635-641页

作者： Sauer, SW Keim, ME Ctr Dis Control & Prevent Natl Ctr Environm Hlth Atlanta GA 30341 USA Emory Univ Sch Med Dept Emergency Med Atlanta GA USA Univ Hawaii Manoa USA Med Corps Honolulu HI 96822 USA Univ Hawaii Manoa Sch Publ Hlth Honolulu HI 96822 USA

The United Stales is under the constant threat of a mass casualty cyanide disaster from industrial accidents, hazardous material transportation incidents, and deliberate terrorist attacks. The current readiness for cyanide disaster by the emergency medical system in the United States is abysmal. We, as a nation, are simply not prepared for a significant cyanide-related event. The standard of care for cyanide intoxication is the cyanide antidote kit, which is based on the use of nitrites to induce methemoglobinemia. This kit is both expensive and ill suited for out-of-hospital use. It also has its own inherent toxicity that prevents rapid administration. Furthermore, our hospitals frequently fail to stock this life-saving antidote or decline to stock more than one. Hydroxocobalamin is well recognized as an efficacious, safe, and easily administered cyanide antidote. Because of its extremely low adverse effect profile, it is ideal for out-of-hospital use in suspected cyanide intoxication. To effectively prepare for a cyanide disaster, the United States must investigate, adopt, manufacture, and stockpile hydroxocobalamin to prevent needless morbidity and mortality.

关键词：事故职业亚硝酸异戊酯/治疗应用解毒药/供应和分配解毒药/治疗应用化学战氰化物/中毒救灾计划/组织和管理急救医疗服务/方法急救医疗服务/标准急诊处理/方法急诊处理/标准危害物质/中毒羟钴胺/供应和分配羟钴胺/治疗应用需求估价/组织和管理中毒/药物疗法中毒/流行病学中毒/病因学公共卫生工作/标准亚硝酸钠/治疗应用恐怖主义硫代硫酸盐类/治疗应用运输美国/流行病学人类

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Bioterrorism preparedness: A survey of Nebraska health care institutions

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第1期30卷 46-48页

作者： Helget, V Smith, PW Nebraska Infect Control Network Omaha NE 68106 USA Univ Nebraska Med Ctr Omaha NE USA

In March 2001, a 6-question survey was mailed to all hospitals and long-term care facilities in Nebraska to assess preparedness for bioterrorism. Only half of the respondents at that time believed that bioterrorism was something their community was likely to experience, we found that most facilities (98%) believed that they were unprepared for a bioterrorism event. and many did not know whom to contact in the event of such an emergency. We concluded from the results of the survey that the greatest needs to facilitate preparation were policies and procedures, identification of contacts, medications, protective equipment, laboratory support, and communication.

关键词：生物恐怖民防救灾计划/组织和管理救灾计划/统计学和数值数据卫生保健调查卫生设施/组织和管理卫生设施/统计学和数值数据内布拉斯加组织方针问卷调查人类

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Surgery and community participation in a community-based programme in war situations

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TROPICAL DOCTOR 2000年第1期30卷 20-23页

作者： Makender, E Qasim, S Meo, G Alpha Civil Hosp Com Collaboraz Med Billing Sudan

The paper presents the results and the experience gained from three 'mass surgical interventions' conducted in the Alpha Civil Hospital, Billing in south Sudan in the period between October 1996 and November 1997. The results showed that surgical services can be provided safely and economically even under most difficult conditions provided professional experience plus community commitment and participation are there. Such interventions lead to the development of strong community self-reliance and willingness which are fundamental if the programme is to be sustained.

关键词：社区卫生服务/组织和管理用户参与/方法用户参与/统计学和数值数据救灾计划/组织和管理方案评价苏丹外科手术/方法外科手术/统计学和数值数据战争人类

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Convergent volunteerism

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 457-462页

作者： Cone, DC Weir, SD Bogucki, S Yale Univ Sch Med Sect Emergency Med Div Emergency Med Serv New Haven CT USA

[ Ann Emerg Med. 2003;41:457-462.]

关键词：临床工作能力/标准临床方案决策组织救灾计划/组织和管理效率组织急救医疗服务/组织和管理急救医学/经济学急救医学/组织和管理机构间关系职务说明大众媒体需求估价纽约市俄克拉何马医师的作用救援作业/组织和管理安全措施/组织和管理恐怖主义/预防和控制志愿工作者/教育志愿工作者/组织和管理人类

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Safeguarding production agriculture and natural ecosystems against biological terrorism - A US Department of Agriculture emergency response framework

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FOOD AND AGRICULTURAL SECURITY: GUARDING AGAINST NATURAL THREATS AND TERRORIST ATTACKS AFFECTING HEALTH, NATIONAL FOOD SUPPLIES, AND AGRICULTURAL ECONOMICS 1999年第1期894卷 48-67页

作者： Sequeira, R N Carolina State Univ Ctr Plant Hlth Sci & Technol Anim & Plant Hlth Inspect Serv USDA Raleigh NC 27606 USA

Foreign pest introductions and outbreaks represent threats to agricultural productivity and ecosystems, and, thus, to the health and national security of the United States. It is advisable to identify relevant techniques and bring all appropriate strategies to bear on the problem of controlling accidentally and intentionally introduced pest outbreaks. Recent political shifts indicate that the U.S. may be at increased risk for biological terrorism. The existing emergency-response strategies of the Animal and Plant Health Inspection Services (APHIS) will evolve to expand activities in coordination with other emergency management agencies. APHIS will evolve its information superstructure to include extensive application of simulation models for forecasting, meteorological databases and analysis, systems analysis, geographic information systems, satellite image analysis, remote sensing, and the training of specialized cadres within the emergency-response framework capable of managing the necessary information processing and analysis. Finally, the threat of keg. pests ranked according to perceived risk will he assessed with mathematical models and "what-if" scenarios analyzed to determine impact and mitigation practices. An infrastructure will be maintained that periodically surveys ports and inland regions for the presence of exotic pest threats and will identify trend abnormalities. This survey and monitoring effort will include cooperation from industry groups, federal and state organizations, and academic institutions.

关键词：农业消费品安全救灾计划/组织和管理生态系统机构间关系危险性评估美国美国农业部/组织和管理暴力/预防和控制人类

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