MANAGEMENT OF UNIQUE CLINICAL ENTITIES IN DISASTER MEDICINE

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MEDICAL DISASTER TRIAGE

Triage, derived from the French trier meaning to sort, is used to categorize patients in a variety of medical settings. Baron Dominique Jean Larre,57 a surgeon to Napoleon, is credited with its invention. Triage is a concept that has been used extensively and widely in the military setting. On the battlefield the priority is to sort those casualties who may return to the battlefield from those who require treatment before resuming the engagement and those who will be unable to return to active

BLAST INJURIES

The use of explosives for commercial and terrorist purposes has made it imperative that civilian medical personnel be familiar with the physics of explosions and the types of injuries that are sustained by the victims. Explosions of chemical factories and fuel depots, as well as recent bombings in Great Britain, Northern Ireland, Beirut, and the United States have heightened the awareness that physicians and other responders need to be prepared for such an event. To be able to deal effectively

CRUSH INJURY/CRUSH SYNDROME

Entrapment of people under collapsed buildings, for periods of 4 hours or longer during seismic or manmade catastrophes, may lead to crush injuries and an increased incidence of crush syndrome. The estimated incidence is between 3% and 5%99 but may be as high as 40% in those extricated alive from collapsed multistory buildings.10 In the Tangshan earthquake in 1973, it is estimated that 20% of the victims had some degree of crush injury. This type of compression injury to large masses of

COMPARTMENT SYNDROME

Compartment syndrome develops when the pressure within a confined osseofascial space impedes neurovascular function resulting in tissue damage. This occurs when compartment size is restricted or compartment volume is increased. Compartment syndrome may be seen in victims with limb fractures, use of MAST trousers65 (usually if applied for longer than 60 minutes), vascular injuries, and crush injuries in a disaster setting. Compartment syndromes may be seen in the forearm and all portions of the

AMPUTATION

Patients may suffer from mangled extremities in several types of disaster situations. Occasionally, it may be necessary to amputate a mangled extremity in order to free an entrapped patient, or worse still, to remove a normal limb to save a life. These are decisions that are not made lightly and for which there are no clear-cut guidelines. When possible, it is advisable to have two physicians concur that field amputation is the only option.37 The urgency of the situation may dictate

PARTICULATE HEALTH PROBLEMS

Increased particulate matter in the air is a health hazard which may follow several disastrous events, particularly volcanic eruptions, earthquakes, and wildfires. Any event, however, that produces massive shifts in the surface of the earth, causes large numbers of buildings to collapse, or results in large or numerous fires has the potential to cause problems, particularly in the pulmonary and ocular systems.96 The specific nature of the materials involved may vary between incidents, but

TRAUMATIC ASPHYXIA

Traumatic asphyxia may occur whenever the chest is compressed to a degree to interfere with respiration. Traumatic asphyxia has a high mortality rate with death occurring rapidly or more slowly depending on the degree of compression.33, 41, 103 The disasters most commonly associated with traumatic asphyxiation are hurricanes, earthquakes, volcanic eruptions, avalanches, explosions, and mob panic. In the disaster situation, traumatic asphyxia results from mechanical chest compression by building

CONCLUSION

Disasters are accompanied by unique and often predictable clinical entities. Awareness of the potential for disasters in a region, accompanied by an understanding of the clinical problems likely to be encountered in each specific type of disaster, is crucial for optimal preplanning and appropriate management. Such awareness, preplanning, and training will optimize the triage process and ensure earlier management.

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  • Cited by (0)

    Address reprint requests to Lucille Gans, MD, FACEP, Department of Emergency Medicine, University of Massachusetts Medical Center, 55 Lake Avenue North Worcester, MA 01655

    *

    From the Fellowship in Prehospital and Disaster Medicine, University of Massachusetts Medical Center (LG, TK); and the Department of Emergency Medicine, University of Massachusetts Medical School (LG), Worcester, Massachusetts

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