The utility of point-of-care ultrasound in targeted automobile ramming mass casualty (TARMAC) attacks.

As terrorist actors revise their tactics to outmaneuver increasing counter-terrorism security measures, a recent trend toward less-sophisticated attack methods has emerged. Most notable of these "low tech" trends are the Targeted Automobile Ramming MAss Casualty (TARMAC) attacks. Between 2014 and November 2017, 18 TARMAC attacks were reported worldwide, resulting in 181 deaths and 679 injuries.

District of Columbia Emergency Healthcare Coalition Burn Mass Casualty Plan: Development to Exercise Date.

The District of Columbia Emergency Healthcare Coalition (DC EHC) brought together a Burn Task Force to tackle the issue of mass burn care in a metropolitan area in light of limited local burn center resources. This article outlines the development of the mass burn care plan. Using a tiered treatment approach, mass burn victims would be transported first to burn centers within the area, followed by nonburn center trauma centers, and finally to nonburn and nontrauma center acute care facilities.

A proposed emergency management program for acute care facilities in response to a highly virulent infectious disease.

To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery.

Confined space medicine and the medical management of complex rescues: a case series.

Objective: A variety of hazards can precipitate the full or partial collapse of occupied structures. The rescue of entrapped survivors in these situations can be complex, require a multidisciplinary approach, and last for many hours.

Methods: The modern discipline of Urban Search and Rescue, which includes an active medical component, has evolved to address such situations.

Patient-driven resource planning of a health care facility evacuation.

Introduction: The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old.

Extreme measures: field amputation on the living and dismemberment of the deceased to extricate individuals entrapped in collapsed structures.

Collapsed structures, typically as a result of earthquakes, may result in individuals entrapped by their limbs under heavy structural elements. In addition, access to living persons may be blocked by the deceased. Individuals are often critically ill by the time they are found, and rapid extrication is warranted.

H1N1 preventive health behaviors in a university setting.

Background: When H1N1 emerged in 2009, institutions of higher education were immediately faced with questions about how best to protect their community from the virus, yet limited information existed to help predict student preventive behaviors.

Methods: The authors surveyed students at a large urban university in November 2009 to better understand how students perceived their susceptibility to and the severity of H1N1, which preventive behaviors they engaged in, and if policies impacted their preventive health decisions.

Results: Preventive health behavior messaging had a mixed impact on students.

Emergency medicine Joint Fellowship Curriculum.

Background: The authors describe a Joint Fellowship Curriculum instituted for emergency medicine fellows in diverse fellowships. The curriculum is based on commonalities established among the varying fellowships offered within their Department of Emergency Medicine. Fellowships included in the curriculum development include Disaster/Emergency Medical Services, International Emergency Medicine, Health Policy, Ultrasonography, and Medical Toxicology.

Survival interval in earthquake entrapments: research findings reinforced during the 2010 Haiti earthquake response.

Earthquakes can result in collapsed structures with the potential to entrap individuals. In some cases, people can survive entrapment for lengthy periods. The search for and rescue of entrapped people is resource intensive and competes with other postdisaster priorities.

Accuracy of radiographic readings in the emergency department.

Objectives: A review of radiology discrepancies of emergency department (ED) radiograph interpretations was undertaken to examine the types of error made by emergency physicians (EPs).

Methods: An ED quality assurance database containing all radiology discrepancies between the EP and radiology from June 1996 to May 2005 was reviewed. The discrepancies were categorized as bone, chest (CXR), and abdomen (AXR) radiographs and examined to identify abnormalities missed by EPs.

Assessing physicians' in training attitudes and behaviors during the 2009 H1N1 influenza season: a cross-sectional survey of medical students and residents in an urban academic setting.

Background: Despite concern for hospital-based transmission of influenza, little research has been carried out on perceptions and behaviors of physicians in training with regard to influenza-like illness (ILI), especially in light of the recent H1N1 pandemic.

Objectives: We aimed to evaluate self-reported episodes of ILI among medical students and residents to determine the impact of ILI on school and clinical performance, absenteeism, and patterns of preventive measures used by this population both in and out of the healthcare setting.

Methods: We anonymously surveyed medical students and residents at an urban institution between November 3 and December 11, 2009.

Financial burden of emergency preparedness on an urban, academic hospital.

This study assessed the direct human resource costs of a hospital's emergency preparedness planning (in 2005) by surveying participants retrospectively. Forty participants (74% of the identified population) were surveyed. Using the self-reported hourly salary of the participant, a direct salary cost was calculated for each participant.

H1N1 and institutions of higher education.

Objective: Institutions of Higher Education (IHE) have been preparing for the likely resurgence of Influenza A (H1N1) virus this Fall. Amongst the multitude of factors affecting their preparatory efforts, medical considerations and evidence serve to provide the foundation for many planning decisions.

Design: The authors reviewed the relevant medical literature for evidence of effective measures to mitigate the consequences of H1N1.

The financial impact of deployments on reserve health care providers.

This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers.

Ketamine for procedural sedation and analgesia by nonanesthesiologists in the field: a review for military health care providers.

Military health care providers located in field environments frequently face situations in which procedural sedation and analgesia are necessary, without the advantage of sophisticated monitoring equipment. Ketamine is a unique agent that can be administered either intravenously or intramuscularly to produce predictable and profound analgesia, with an exceptional safety profile. We review the issues unique to ketamine and provide a practical guide for the use of ketamine for adult and pediatric patients in a field environment.