Restraint misuse is a common problem leading to increased morbidity and mortality for children involved in motor vehicle crashes. The purpose of this project was to describe the injury patterns associated with restraint misuse in the pediatric population, with particular focus on clues to significant injury that can be identified by the prehospital provider that may impact subsequent triage decisions.

This is a case series presentation that illustrates the injury patterns associated with various types of restraint misuse in infants (ages 0–1 years), toddlers (age 1–4 years), young children (ages 4–8 years), and pre-teens (ages 8–14 years). Cases were identified from the Crash Injury Research and Engineering Network (CIREN) database.

Six cases are presented that illustrate the injury patterns associated with misuse of rear-facing infant car seats (0–1 years), forward-facing child seats (1–4 years), booster seats (4–8 years), and shoulder belts (8–14 years). Prehospital assessment of appropriate restraint use is described.

Restraint misuse in children is a common problem. Emergency medical services providers need to be aware of these issues when assessing children and determining appropriate triage to a trauma center. Ongoing educational efforts also are vital to inform parents regarding the risks of inappropriate restraint use and can encourage legislators to better define appropriate restraint use for older children.

Trauma is a major cause of death and disability worldwide. A quarter of all fatalities due to injury occur due to road traffic crashes with 90% of the fatalities occurring in low- and medium-income countries. Poor compliance with the use of seat belts is a problem in many developing countries. The aim of this study was to evaluate the level of seatbelt compliance in motor vehicles in Benin City, Nigeria.

A five-day, observational study was conducted in strategic locations in Benin City. The compliance rates of drivers, front seat passengers, and rear seat passengers in the various categories of vehicles were evaluated, and the data were subjected to statistical processing using the Program for Epidemiology.

A total of 369 vehicles were observed. This consisted of 172 private cars, 64 taxis, 114 buses, 15 trucks, and four other vehicles. The seat belt compliance rate for drivers was 52.3%, front seat passengers 18.4%, and rear seat passengers 6.1%. Drivers of all categories of vehicles were more likely to use the seat belt compared to front seat passengers (p = 0.000) and rear seat passengers (p = 0.000). Drivers of private cars were more likely to use seat belts compared to taxi drivers (p = 0.000) and bus drivers (p = 0.000). Front seat passengers in private cars were more likely to use the seat belt compared to front seat passengers in taxis (p = 0.000) and buses (p = 0.000). Rear seat pas-sengers in private cars also were more likely to use seat belts compared to rear seat passengers in taxis (p = 0.000) and buses (p = 0.000).

Compliance with seat belt use in Benin City is low. Legislation, educational campaigns, and enforcement of seat belt use are needed.

International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.

The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.

A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.

There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).

This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

The objective of this study was to compare the psychiatric morbidity between the displaced and non-displaced populations of the Andaman and Nicobar Islands during the first three months following the 2004 earthquake and tsunami.

The study was conducted at the 74 relief camps in the Andaman and Nicobar Islands. Port Blair had 12 camps, which provided shelter to 4,684 displaced survivors. There were 62 camps on Car-Nicobar Island, which provided shelter to approximately 8,100 survivors who continued to stay in their habitat (non-displaced population). The study sample included all of the survivors who sought mental health assistance inside the camp. A psychiatrist diagnosed the patients using the ICD-10 criteria.

Psychiatric morbidity was 5.2% in the displaced population and 2.8% in the non-displaced population. The overall psychiatric morbidity was 3.7%. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population.The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder (PTSD) were distributed equally in both groups.

Psychiatric morbidity was found to be highest in the displaced population. However, the incidence of depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally acceptable interventions improved the community participation. Cohesive community, family systems, social support, altruistic behavior of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster.

Drug abuse is an important sociomedical problem in large metropolitan areas. Drug addicts represent a group with particularities, since they hesitate to seek medical care and often refuse hospitalization. Therefore, there is a scarcity of data on drug abuse-related calls. The burden imposed by such calls on emergency health services has not been evaluated in detail.

The objectives of this study are to: (1) assess the profile of drug abuse-related calls in a large European metropolis, including the spatiotemporal distribution, as well as the frequency and variability of cancellations; and (2) evaluate the mobilization of emergency prehospital care services in response to the calls.

In 2005, the Hellenic National Centre for Emergency Care received 5,836 emergency drug abuse-related calls pertaining to the metropolitan area of Athens, Greece. The analysis focused on: (1) spatiotemporal features of calls/cases; (2) step-by-step cancellation rates in the mobilization of ambulances or other means (mobile intensive care units, specially equipped motorcycles, and super-mini city cars); and (3) response time of the mobilized means. Pearson's chi-square, goodness-of-fit chi-square, and the Kruskal-Wallis tests were used as appropriate.

Drug abuse-related calls represented 2% of all emergency calls. Only one-third of these cases were transported to the Accident and Emergency Departments of area hospitals. A total of 9% of the calls were cancelled before transportation arrived; another 20% of victims could not be found when authorities arrived on-scene, and 36% of patients refused transport to the hospital. The cancellation rate is significantly higher in the evening and at night, as well as in summer and autumn. The major burden is imposed on the municipality of Athens (67% of all calls).

Drug abuse-related calls represent a significant load for emergency medical services in metropolitan Athens. However, a relatively small percentage of the drug addicts finally are transported to the hospital. Appropriately equipped motorcycles seem to be an effective means for the prehospital management of drug-abuse cases.

In the aftermath of Hurricane Katrina, widespread flooding devastated the New Orleans healthcare system. Prior studies of post-hurri-cane healthcare do not consistently offer evidence-based recommendations for re-establishing patient care post-disaster. The primary objective of this study is to examine associations between patient characteristics, chief com-plaints, final diagnoses, and medications prescribed at a post-Katrina clinic to better inform strategic planning for post-disaster healthcare delivery (e.g., charitable donations of medications and medical supplies).

This study is a retrospective chart review of 465 patient visits from 02 September 2005 to 22 October 2005 at a post-Katrina clinic in New Orleans, Louisiana that was open for seven weeks, providing urgent care services in the central business district. Using logistic regression, the relationships between patient characteristics (date of visit, gender, age, evacuation status), type of chief complaint, final diagnosis, and type of medication prescribed was examined.

Of 465 patients, 49.2% were middle-aged, 62.4% were men, 35% were relief workers, and 33.3% were evacuees; 35% of visits occurred in week five. Of 580 chief complaints, 71% were illnesses, 21% were medication refill requests, and 8.5% were injuries. Among 410 illness complaints, 25% were ears, nose, and throat (ENT)/dental, 17% were dermatologic, and 11% were cardiovascular. Most requested classes of medication refills for chronic medical conditions (n = 121) were cardiovascular (52%) and endocrine (24%).Most illness-related diagnoses (n = 400) were ENT/dental (18.2%), dermatologic (14.8%), cardiovascular (10.2%), and pul-monary (10.2%). Thirty-six percent of these diagnoses were infectious. Among 667 medications prescribed, 21% were cardiac agents, 13% pulmonary, 13% neurologic/musculoskeletal/pain, 11% antibiotics, 10% endocrine, and 9.3% anti-allergy. The likelihood of certain chief complaints, diagnoses, and medica-tions prescribed varied with patient characteristics.

Donations of certain classes of medications were more useful than others. Prevalence of select co-morbidities, the nature of patient involve-ment in recovery activities in the disaster area, and post-disaster health haz-ards may explain variations in chief complaints, diagnoses, and medications prescribed by patient characteristics.

In the aftermath of Hurricane Katrina, a significant number of faith-based organizations (FBOs) that were not a part of the formal National Response Plan (NRP) initiated and sustained sheltering operations.

The objective of this study was to examine the sheltering opera-tions of FBOs, understand the decision-making process of FBO shelters, and identify the advantages and disadvantages of FBO shelters.

Verbal interviews were conducted with FBO shelter leaders. Inclusion criteria were: (1) opening in response to the Katrina disaster; (2) oper-ating for more than three weeks; and (3) being a FBO. Enrolled shelters were examined using descriptive data methods.

The majority of shelters operating in Mississippi up to three weeks post-Katrina were FBO-managed. All of the operating FBO shelters in Mississippi that met the inclusion criteria were contacted with a response rate of 94%. Decisions were made by individuals or small groups in most shelters regarding opening, operating procedures, and closing. Most FBOs provided at least one enabling service to evacuees, and all utilized informal networks for sheltering operations. Only 25% of FBOs had disaster plans in place prior to Hurricane Katrina.

Faith-based organization shelters played a significant role in the acute phase of the Katrina disaster. Formal disaster training should be ini-tiated for these organizations. Services provided by FBOs should be standard-ized. Informal networks should be incorporated into national disaster planning.

In March 2006, a few cases of bird flu were discovered in approximately 10 rural settlements in Israel. As a result, approximately one million birds were destroyed within a three kilometer radius of the settle-ments. The Israeli population was instructed to take preventive measures against the spread of the infection.

The objective of this study was to compare the frequency of use of different sources of information by the population in the affected area with the general population during the first phase of a bird flu outbreak in Israel.

A telephone survey among two randomly selected, representative samples of adults was conducted. One sample involved 500 adult Israeli resi-dents; the other sample involved 103 adult residents from the affected area during the first phase of the outbreak. The use of different sources of infor-mation by the population concerning the disease was assessed. The differences in these parameters between the affected area and the nationwide population were analyzed using a chi-square and t-test analysis. A p-value of <0.05 was considered statistically significant.

Television was a significantly more common source of information in Israel as a whole (p <0.05), whereas friends (p <0.05) and local authorities (p <0.05) were significantly more common sources of information in the affected area.

The frequency of use of the sources of information by the pop-ulation during the early phase of a bird flu outbreak is different in the affect-ed area compared with the general population in the same country. Authorities must pay attention to this phenomenon and use the correct sources of information in each area in order to achieve better exposure of the population to the recommended behaviors during an outbreak.

During the last few decades, various global disasters have ren-dered nations helpless (such as Thailand's tsunami and earthquakes in Turkey, Pakistan, Iran, and India). A lack of knowledge and resources make it difficult to address such disasters. Preparedness for a national disaster is expensive, and in most cases, unachievable even for modern countries. International collabo-ration might be useful for coping with large-scale disasters. Preparedness for international collaboration includes drills. Two such drills held by the Israeli Home Front Command and other military and civilian bodies with the nations of Greece and Turkey are described in this article.

The data were gathered from formal debriefings of the Israeli teams collaborating in two separate drills with Greek and Turkish teams.

Preparations began four months before the drills were conducted and included three meetings between Israeli and foreign officials. The Israeli and foreign officials agreed upon the drill layout, logistics, communications, resi-dence, real-time medicine, hardware, and equipment. The drills took place in Greece and Turkey and lasted four days. The first day included meetings between the teams and logistics preparations. The second and third days were devoted to exercises. The drills included evacuating casualties from a demoli-tion zone and treating typical injuries such as crush syndrome. Every day ended with a formal debriefing by the teams' commanders. The fourth day included a ceremony and transportation back home. Members in both teams felt the drills improved their skills and had an important impact on creating common language that would enhance cooperation during a real disaster.

A key factor in the management of large-scale disasters is coor-dination between countries. International drills are important to create com-mon language within similar regulations.

The objectives of the study were to develop and evaluate an “all-hazards” hospital disaster preparedness training course that utilizes a combi-nation of classroom lectures, skills sessions, tabletop sessions, and disaster exercises to teach the principles of hospital disaster preparedness to hospital-based employees.

Participants attended a two-day, 16-hour course, entitled Hospital Disaster Life Support (HDLS). The course was designed to address seven core competencies of disaster training for healthcare workers. Specific disaster situations addressed during HDLS included: (1) biological; (2) conventional; (3) radiological; and (4) chemical mass-casualty incidents. The primary goal of HDLS was not only to teach patient care for a disaster, but more important-ly, to teach hospital personnel how to manage the disaster itself. Knowledge gained from the HDLS course was assessed by pre- and post-test evaluations. Additionally, participants completed a course evaluation survey at the conclu-sion of HDLS to assess their attitudes about the course.

Participants included 11 physicians, 40 nurses, 23 administrators/direc-tors, and 10 other personnel (n = 84). The average score on the pre-test was 69.1 ±12.8 for all positions, and the post-test score was 89.5 ±6.7, an improve-ment of 20.4 points (p <0.0001, 17.2–23.5).Participants felt HDLS was edu-cational (4.2/5), relevant (4.3/5) and organized (4.3/5).

Identifying an effective means of teaching hospital disaster pre-paredness to hospital-based employees is an important task. However, the opti-mal strategy for implementing such education still is under debate.The HDLS course was designed to utilize multiple teaching modalities to train hospital-based employees on the principles of disaster preparedness. Participants of HDLS showed an increase in knowledge gained and reported high satisfaction from their experiences at HDLS. These results suggest that HDLS is an effec-tive way to train hospital-based employees in the area of disaster preparedness.

The decision to declare a major incident (MI) is not one to be taken lightly, but a delay in doing so may have dire consequences. The aim of this study was to ascertain what factors make specialists from a variety of pro-fessional backgrounds in the United Kingdom determine from an initial visu-al assessment of a scene that a MI should be declared.

Participants were presented with three different scenarios, which were presented pictorially. Their responses were noted.

One hundred seventy-eight professionals took part in this study. For Scenario 1 (a road traffic incident), 101 (57%) declared a MI. For a coach rollover in Scenario 2, a MI was declared by 82 (46%) people, and a MI was declared by 156 (87%) for a rail crash in Scenario 3.

Forty-six participants had attended a MI previously.The results for declar-ing a MI in this group were: (1) Scenario 1, 25 (54%); (2) Scenario 2, 25 (54%); and (3) Scenario 3, 44 (96%). Of this group, 44 had previously had training before experiencing the MI. Those who had >10 years of service in emergency services were more likely to declare a MI in Scenario 2 and 3.

The main problem with the existing system is the interpreta-tion and subjective nature of the word “major”. Specialists incorporate many individual factors into using the word. Future research should focus on the development of a system tied to more objective analysis.

Public safety at mass gatherings is the responsibility of multi-ple agencies. Injury surveillance and inter-agency communication are pivotal to ensure continued public safety.

The principal objective of this pilot study was to improve the identification of trends and patterns of injury presentations at mass gather-ings. This was achieved through an electronic process for data gathering to support timely reporting of injury data. In addition, what evolved was the devel-opment of an inter-agency communication model to support information transfer.

An Electronic Injury Surveillance System was created and piloted at two mass gatherings in South Australia. Live, real-time data were collect-ed via customized software supported by electronic report generation.

The Injury Surveillance System captured data on 181 injured patients and assisted in the identification of trends and patterns of presenta-tions. The relevant injuries and patterns of injuries were reported to the appropriate organizations based on pre-defined communication models.

The pilot study demonstrated that it was possible to perform “live”, portable injury surveillance during patient presentations at two mass gatherings. The Injury Surveillance System ensured immediate data capture. Well-defined communication systems established for this pilot also enabled early action to rectify hazards. Further development of electronic injury sur-veillance should be considered as an essential tool for managing public safety at mass gatherings.

The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of “chemical” events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway pro-tection and early intubation; (4) undressing and decontamination at the hos-pital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlo-rine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of the Israeli Guidelines for Mass Toxicological Events.

Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis Through-Components, Interactions, Results (DISAST-CIR).

The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the vic-tims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mild-ly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites.

Event management differed from the standard Israeli toxico-logical doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protec-tive gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients.

In November 2006, a Russian dissident died from radioactive Polonium-210 (210Po) poisoning in London. Providing reassuring messages during a public health incident may be ineffective for individuals with high health anxiety (hypochondriasis).

Members of the public who called a 24-hour telephone helpline were offered a follow-up call by a health protection specialist for reassurance. A psychiatrist attempted to contact those callers who were unable to be reas-sured by the health protection specialist.

Of 872 individuals contacted for reassurance, seven (0.6%) could not be reassured. The psychiatrist contacted four of these individuals. Three had a history of health-related anxiety and two attributed somatic symptoms to 210 Po exposure.

For individuals with hypochondriasis, reassurance during major public health incidents may be ineffective. Having a psychiatrist available was helpful in managing individuals with excessive health anxiety.