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IntroductionTele-critical care (TCC) has improved outcomes in civilian hospitals and military treatment facilities (MTFs). Tele-critical care has the potential to concurrently support MTFs and operational environments and could increase capacity and capability during mass casualty events. TCC services distributed across multiple hub sites may flexibly adapt to rapid changes in patient volume and complexity to fully optimize resources. Given the highly variable census in MTF intensive care units (ICU), the proposed TCC solution offers system resiliency and redundancy for garrison, operational, and mass casualty needs, while also maximizing return on investment for the Defense Health Agency.Materials and MethodsThe investigators piloted simultaneous TCC support to the MTF during three field exercises: (1) TCC concurrently monitored the ICU during a remote mass casualty exercise: the TCC physician monitored a high-risk ICU patient while the nurse monitored 24 simulated field casualties; (2) TCC concurrently monitored the garrison ICU and a remote military medical field exercise: the physician provided tele-mentoring during prolonged field care for a simulated casualty, and the nurse provided hospital ICU TCC; (3) the TCC nurse simultaneously monitored the ICU while providing reach-back support to field hospital nurses training in a simulation scenario.ResultsTCC proved feasible during multiple exercises with concurrent tele-mentoring to different care environments including physician and nurse alternating operational and hospital support roles, and an ICU nurse managing both simultaneously. ICU staff noted enhanced quality and safety of bedside care. Field exercise participants indicated TCC expanded multipatient monitoring during mass casualties and enhanced novice caregiver procedural capability and scope of patient complexity.ConclusionsTele-critical care can extend critical care services to anywhere at any time in support of garrison medicine, operational medicine, and mass casualty settings. An interoperable, flexibly staffed, and rapidly expandable TCC network must be further developed given the potential for large casualty volumes to overwhelm a single TCC provider with multiple duties. Lessons learned from development of this capability should have applicability for managing military and civilian mass casualty events.

Several changes in terrorist tactics have occurred recently. First, terrorist attack targets have changed from hard to soft targets. Second, terrorists are actively using low-tech terrorism methods that they can choose easily. Finally, terrorist attacks are evolving into complex and simultaneous terrorist events. This study endeavored to determine whether these changes affected the number of casualties from terrorist events that occurred in developed countries. Based on the rational choice theory and situational crime prevention, the variables were constructed based on two dimensions: “target factors in terrorism” and “terrorist attack factors in terrorism.” To achieve the purpose of this study, a negative binomial regression analysis was performed based on data from the Global Terrorism Database. Consequently, variables such as “exposure,” “protection capability,” “attack patterns (vehicle),” and “suicide terrorism” were verified for their statistically significant influence on “mass casualty terrorism (MCT).” This study suggests that it is necessary to design a preventive environment and arrange for personnel at each site that is vulnerable to terrorism to prevent MCT events from occurring inside facilities.

To report the types and effects of injuries to the thoracoabdominal region caused by blast and emphasize the importance of the early detection of primary blast injuries. Of the 98 patients injured as a result of a bomb explosion, 31 with thoracoabdominal injuries were included in the study. The demographic and laboratory data, operations performed, and radiological findings were obtained from the electronic records of the patients. The injuries caused by the explosion were divided into four categories as primary, secondary, tertiary, and quaternary. The patients with a new injury severity score (NISS) of ≥ 16 were considered to have critical injuries. While mortality developed in 16 (51.6%) of 31 patients included in the study, 15 (48.4%) were discharged after treatment. The mean ages of the patients in the mortality and survivor groups were 29.6 ± 4.5 and 31.1 ± 10.7 years, respectively (p > 0.005). When the two groups were examined, the rate of hypovolemic shock and NISS score were significantly higher in the mortality group (p = 0.001 and p

Objective Decontamination protocols for victims of mass casualty events are well documented and emphasized to protect physicians, nurses and facilities. Decontamination practices outside of mass casualty events are unknown. This pilot study was undertaken to assess the current practices of burn patient decontamination outside of mass casualty events within level I and II trauma center emergency departments in the state of Michigan. Methods Using the Michigan Trauma Quality Improvement Project membership, a 10‐question online survey was sent to trauma program managers at all level I and II trauma centers in Michigan. Survey questions focused on institutional decontamination protocols and consistency of use. Results Survey response was 50%. Of the responding facilities, 31% did not decontaminate burn patients. Of the centers who indicated that they did decontaminate burn patients, 31% did not follow a standardized protocol. Our survey revealed that 69% of facilities used a protocol for decontamination: 45% used the protocol consistently on all burns, and 55% at physician discretion. Products used most frequently to decontaminate burn patients included water (100%) followed by soap (44%). Conclusion This pilot survey of level I and II trauma centers in the state of Michigan revealed variability in the use of burn patient decontamination protocols and consistency of use. Additional research is warranted to determine if our results are reflective of trauma centers nationally.

Purpose: To report, analyze different aspects of masscasualty incidents resulting from household fires due toexplosion of gas cylinders presented to our Burn Unit from2013 to 2017.Methods: Data of all burn mass casualty incidents fromadmitted to the Burn Emergency Unit of Ain Shams University,Cairo, Egypt; from January 2013 to December 2017 werecollected from the Burn Unit and its Intensive Care Unitrecords, reviewed and described.Results: Six incidents from flame burn caused by householdexplosion of gas cylinders took place in the past 5 years.33 victims were involved in the incidents and admitted to ourunit; male: female ratio was 2.7:1. The ages of the admittedpatients ranged from 2.6y-51y. The extent of burns rangedfrom 10-68% of TBSA affecting head and neck, torso andextremities. A total numbers of 44 operations were performedto all the patients during their stay in the form of emergencyescharotomies in 12 patients and 32 sessions of excision ofthe deep partial and full thickness burns and split-thicknessskin grafting in 19 patients. All patients survived and dischargeduneventfully except only for 4 deaths (12%) withmean hospital stay duration of 30 days. Complications thatdeveloped in the admitted cases include wound infections(12.50%), hypertrophic scars (12.50%), altered skin color(8.33%) and psychotic manifestations (6.24%).Conclusion: Retrospective analysis of the therapeuticdata of these cases demonstrates that management of massburn causalities requires pre-designed disaster planning, wellequipped center, trained personnel and these are the keyelements in successful management.

Disaster medicine refers to situations in which the need to care for patients outweighs the available resources. It is imperative for anesthesiologists to be involved at a leadership level in mass casualty/disaster preparedness planning. Mass casualty disaster plans should be clear, concise, and easy to follow. Terror events and natural disasters can differ significantly in anesthesia preparedness. Resiliency is an important aspect of the recovery phase that decreases psychological damage in the aftermath of a mass casualty event.

Objective:The aim of this study was to explore the application of the flipped classroom approach in the training of Mass Casualty Triage (MCT) to medical undergraduate students.Methods:In this study, 103 fourth-year medical students were randomly divided into a Flipped Classroom (FC) group (n = 51) and a Traditional Lecture-based Classroom (TLC) group (n = 52). A post-class quiz, simulated field triage (SFT) and feedback questionnaires were performed to assess both groups of students for their learning of the course.Results:In the post-quiz, the median (IQR) scores achieved by students from the FC and TLC groups were 42(5) and 39(5.5), respectively. Significant differences were found between the two groups. In the SFT, overall triage accuracy was 67.06% for FC, and 64.23% for TLC students. Over-triage and under-triage errors occurred in 18.43% and 14.50% of the FC group, respectively. The TLC group had a similar pattern of 20.77% over-triage and 15.0% under-triage errors. No significant differences were found regarding overall triage accuracy or triage errors between the two groups.Conclusions:The FC approach could enhance course grades reflected in the post-quiz and improve students’ satisfaction with the class. However, there was no significant difference of competency between the two groups demonstrated in the SFT exercise.

Objective: Hazardous materials (HAZMAT) incidents, including the deliberate release of toxic chemicals, can cause a significant drain on resources as well as heightened anxiety in the community. Recent high‐profile incidents, including the 2018 illegal waste storage fire in Victoria, Australia, have highlighted the complexity but also the value of multidisciplinary approaches to HAZMAT events. This brief report examines issues from a public health perspective and reflects on the experience of such events in South Australia. Methods: The type, location and time of HAZMAT incidents for the period 2001 to 2018 (inclusive) in South Australia were compiled and classified from a database of the state Technical Advice Coordinator. Results: The profile of HAZMAT events was diverse, including fires, spills, unknown chemicals, sabotage and suicides. Incidents frequently occurred around transportation corridors and storage facilities. Public health agency involvement was most evident for known or suspected biological agents (toxins) and chemical toxicants with persistent exposures. Conclusion and implications for public health: Public health agencies are likely to have a greater future role in HAZMAT management as the complexity of incidents increases (e.g. mass casualty events and events involving vulnerable subpopulations). There is a need for a national HAZMAT surveillance database to coordinate agency responses on a national level. A unified approach to risk communication for vulnerable communities is also critical.

Dicentric analysis and the ring PCC assay as established biodosimetry methods both have limitations in the estimation of absorbed doses in suspected overexposure cases between 5 and 10 Gy. The proposed method based on calyculin A-induced PCC overcomes these limitations by scoring excess objects as the endpoint. This new scoring method can potentially serve as a faster and up-scalable approach that complements the existing methods with higher accuracy at different dose ranges. It can also potentially be performed by less skilled workers when no automated system is available in mass casualty emergency cases to assist with the triage of patients. Additionally, it offers the possibility to further reduce the sample size and PCC induction time. In this pilot study, a calibration curve for excess objects was constructed using the new scoring method for the first time and a blind validation test composed of three unknown doses was carried out. Almost all the dose estimates were within the 95% confidence limits of the actual test doses by scoring only 50-100 PCC spreads. This method was found to be more accurate than ring PCC for doses below 10 Gy.

This article is the first part of two articles on Nikolay Ivanovich Pirogov. In this article we will discuss how Pirogov developed in his early professional career his unique scientific attitude toward medical problems. He extended this scientific view already before his appointment as Professor of Applied Anatomy and Hospital Surgery at the Medical-Surgical Academy and chief surgeon of the Second Military Landforce Hospital (with 1000 beds) in 1841. After his resignation as Professor in 1860 and during his retirement he used his views and skills towards the management of mass casualties during wars or others, which eventually developed into the International Red Cross. In the second article “Nikolay Ivanovich Pirogov as an innovator in anatomy, surgery, and anaesthesiology.” we will highlight his professional career as an anatomist, surgeon and anaesthesiologist. The authors of these two parts want to emphasize that these two articles are an extract from previously published extensive articles related to Nikolay Ivanovich Pirogov. You can find these articles in the reference list under the name of the first author [20–25].

Background Terrorism-related incidents that are associated with mass casualties (mass-casualty terrorist incidents) are a medical and organisational challenge for every hospital because of the special injury patterns involved, the time of the incident, the development of the situation, the initial lack of information, the number of injured, and the number of uninjured survivors who self-refer to a hospital. Methods The Terror and Disaster Surgical Care (TDSC®) - Course was developed in order to address mass-casualty terrorist incidents and to provide surgeons with the specialist medical and surgical knowledge and skills required for these special situations. The focus of the TDSC® course is on how to provide surgical care and how to deploy scarce resources in a particular tactical situation in such a way that the number of survivors is maximised. Results The effective management of such a tactical situation must be based on priorities and first and foremost requires the standardised sorting and categorisation of the injured at the hospital. The aim of triage, or the sorting of the injured, is to immediately identify patients with life-threatening injuries in environments with strained resources. The medical management of mass-casualty terrorist incidents requires tactical abbreviated surgical care (TASC) teams that have the skills needed to perform a primary survey and to provide care for casualties who need immediate surgery (triage category 1—T1). Initial fluid therapy should be restrictive (permissive hypotension) unless contraindicated. Clotting products are replaced in a standardised manner on the basis of patient requirements, which are calculated using rapidly available surrogates (blood gas analysis). Blood products can be administered or kept available depending on risks and triage categories. The highest priority should be given to the identification and management of haemodynamically unstable patients who require immediate surgery for injuries associated with bleeding into body cavities (T1 + +). Conclusion The recommendations and approaches described here should be considered as proposals for hospitals to develop standards or modify well-established standards that enable them to prepare themselves successfully for situations (e.g. mass-casualty terrorist or shooter incidents) in which their resources are temporarily overwhelmed.

Introduction: The COVID-19 pandemic represents an uncertain challenge that could generate large numbers of patients in a short period of time. Methods: How best to manage this situation is evolving. There will not be an ideal solution so we must all work together to solve the challenge. Results: Applying principles of mass casualty medicine in triaging urology patients in need of elective and emergent surgeries is of paramount importance. Conclusions: Accordingly, there is a crucial need to find a guide to pragmatic management of urological patients during this pandemic.

espanolDesastres recientes han evidenciado la necesidad de revisar en Mexico la seguridad de la infraestructura critica del pais. En este articulo se exploran las limitantes que un hospital puede tener con el fin de incrementar su seguridad ante desastres de acuerdo con su antiguedad, dada la relativamente reciente formulacion de codigos de construccion y lineamientos para hacer los hospitales seguros frente a desastres. Por ello, el ano de construccion y el coeficiente de ocupacion se tomaron como indicadores para analizar algunos de los hospitales en proceso de certificacion en el programa Hospital Seguro en Mexico. Se observa que solo una minoria de los hospitales es de reciente construccion y queen su mayoria estos hospitales estan sujetos a una constante expansion fisica, por lo que se propone un Observatorio para identificar vulnerabilidades asociadas a la antiguedad y saturacion fisica de hospitales, para evaluar la factibilidad de recibir saldos masivos EnglishThe occurrence of recent disasters in Mexico made evident the need to assess the safety of the critical infrastructure of the health sector. Given the relatively recent development of building codes and guidelines to make hospitals safe from disasters, this article explores the obstacles to increase the safety of hospitals considering their construction period. Therefore, age and floor space ratio were used as indicators to analyze hospitals that are currently under process of certification in the Safe Hospital program in Mexico. It is observed that only a minority of hospitals are of recent construction and most of these hospitals are subject to a constant physical expansion. Therefore, an Observatory is proposed to identify vulnerabilities associated with age and gradual reduction of open space. This would be useful to evaluate the feasibility of receiving a large number of patients after a mass casualty disaster.

A mass casualty flame burn injury involving seventeen patients occurred in Benue State, Nigeria in 2019 when a petrol tanker fell, and exploded as villagers at Ahumbe were scooping the petrol. An unidentified number of people were burned to death at the scene of the incident. The study was conducted to highlight the anesthetic and surgical experience gained in the management of these cases in a temporary emergency burn unit in Benue State University Hospital (BSUTH), Makurdi. Seventeen case files of eligible patients were retrieved from the Records Department. Relevant information were extracted from the patients’ files and entered into a prepared proforma. The data collected were analyzed using SPSS version 25. A total of 17 patients’ files were evaluated. There were 13 male patient’s representing 76.5% and 4 females making up 23.5% of the study population, with male to female ratio of 3.3:1. The age bracket mostly affected was 21 to 30 years with 9 constituting 53.0% of the study population. Patients with mixed thickness burn were 12 accounting for 70.6% of the study population, full thickness and superficial burn were 3 and 2 making up 17.6% and 11.7% respectively. The least percentage total body surface area (TBSA) of burn was 8 and the highest was 91, with mean of 40.1 ±15.9. Seven patients came to our facility by way of referral from Federal Medical Centre (FMC) Makurdi, accounting for 41.2% of the study population. Most of the patients belonged to ASA II with 13 in number making up 76.5% of the study group. All the patients had meshed split thickness skin graft (SSG). A total of 19 anesthetic techniques were employed. Of these, the highest was general anesthesia (GA) with tracheal intubation and mechanical ventilation with 13 accounting for 68.4% of the study population. Of other therapies instituted, physiotherapy was done 16 times accounting for 64% of the variables. Sixteen (94.1%) patients had 100% grafts take while one (5.9%) had 97% graft take. Unfortunate as the incident of mass casualty burn injuries following the fossil-fuel explosion was, it brought about an indelible experience in the anesthetic and surgical management of these patients. The intervention by Médecins Sans Frontières (MSF) resulted in the availability of both anesthetic and surgical choices of procedures with most patients undergoing GA with tracheal intubation and mechanical ventilation and all the patients having meshed split thickness skin graft with good outcome.&nbsp

Background School violence continues to afflict our educational institutions. In response, an institutional initiative was launched to train educators and school support staff in life-saving skills aimed at hemorrhage control. Methods The American College of Surgeons Committee on Trauma “Stop the Bleed” (STB) Program was promoted as a quality improvement initiative to schools within the geographic catchment area of this Level I Trauma Center. Participants were given the opportunity to take precourse, and postcourse confidence inventories using a Likert Scale. Statistical analysis of the 324 precourse to postcourse evaluations measuring change in confidence was used to evaluate improvement in readiness of school systems to respond in mass casualty incidents. Results Students enrolled in the STB Program were offered the opportunity to assess their confidence precourse and postcourse in reference to 7 questions. Precourse and postcourse Likert Scale inventories were compared and analyzed to assess the strength of the improvement in confidence using Student’s t-test, where P < .05 is statistically significant. Students demonstrated improvement ( P < .006) that was statistically significant across all 7-question relating to enhance confidence postcourse compared with the precourse. Discussion This STB quality initiative has demonstrated a statistically significant improvement in the confidence of teachers and school personnel to render lifesaving care in the event of a mass casualty or isolated incident of life-threatening hemorrhage. These results support the validity of the training in making a difference in this subpopulation of responders.

With increasing interest in employing iris biometrics as a forensic tool for identification by investigation authorities, there is a need for a thorough examination and understanding of postmortem decomposition processes that take place within the human eyeball, especially the iris. This can prove useful for fast and accurate matching of antemortem with postmortem data acquired at crime scenes or mass casualties, as well as for ensuring correct dispatching of bodies from the incident scene to a mortuary or funeral homes. Following these needs of forensic community, this paper offers an analysis of the coarse effects of eyeball decay done from a perspective of automatic iris recognition. We analyze postmortem iris images acquired for a subject with a very long postmortem observation time horizon (34 days), in both visible light and near-infrared light (860 nm), as the latter wavelength is used in commercial iris recognition systems. Conclusions and suggestions are provided that may aid forensic examiners in successfully utilizing iris patterns in postmortem identification of deceased subjects. Initial guidelines regarding the imaging process, types of illumination, and resolution are also given, together with expectations with respect to the iris features decomposition rates. Visible iris features possible for human, expert-based matching persists even up to 407 h postmortem, and near-infrared illumination is suggested for better mitigation of corneal opacity while imaging cadaver eyes (Post-mortem iris decomposition and its dynamics in morgue conditions. ArXiv pre-print, 2019).

The Christian Medical and Dental Associations (CMDA) was founded in 1931 and is made up of the Christian Medical Association (CMA) and the Christian Dental Association (CDA) CMDA has a current membership of over 19,000 physicians, dentists, and other allied health professionals During and in direct response to the pressing urgencies of the COVID-19 universal pandemic of 2020 the President of CMDA commissioned a special task force to provide current and future Christian reflection and guidance on triage and resource allocation policies during pandemics and other forms of crisis surge medical conditions (e g , mass casualty situations) This is a condensed version of the CMDA special task force position statement © 2020 Center for Health in Mission All rights reserved

Zusammenfassung Zielsetzung In einem Krankenhaus mit integriertem überregionalen Traumazentrum wurden die aktuellen Materialvorhaltungen für Großschadensereignisse und die damit verbundenen Kosten analysiert. Methodik Das vorgehaltene Material wurde systematisch mittels Checklisten erfasst und die damit verbundenen Kosten ermittelt. Ferner wurden der personelle Aufwand für die Planung des Materialbedarfs sowie die Materialpflege quantifiziert. Zusätzlich wurden noch teilstandardisierte Interviews mit internen Entscheidungsträgern geführt. Ergebnisse Die Kostenanalyse ergab einen Gesamtbetrag für das aktuell vorgehaltene Material im Wert von rund 18 500 € und personelle Gesamtkosten in Höhe von jährlich rund 1200 €. Schlussfolgerung Hochgerechnet auf alle deutschen Traumazentren ergeben sich Vorhaltekosten von ca. 12 Millionen €. Mittels der Ergebnisse wurde eine Grundlage für Verhandlungen mit den für die Notfallvorsorge zuständigen Bundesländern geschaffen.

BACKGROUND AND OBJECTIVES The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs). MATERIALS AND METHODS Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report. STATISTICS Mann-Whitney test. RESULTS Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P

A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from passenger to pilot when it comes to MCI planning. When involved at the hospital-wide planning stage, they can offer valuable expertise on how radiology can improve triage accuracy and at what cost in terms of time and resources and thereby contribute a pragmatic understanding of radiology’s role and value during MCIs. By taking ownership of MCI planning in their own departments, radiologists can ensure that the radiology department can respond quickly and effectively to unforeseen emergencies. Well-designed radiology protocols will save lives in an MCI setting.

This study focuses on the casualty-load distribution problem that arises when a mass casualty incident (MCI) necessitates the engagement of multiple medical facilities. Employing discrete event simulations, the study analyzed different MCI response regimes in Lahore, Pakistan, that vary in terms of the level of casualty-load distribution and the required coordination between the incident site and the responding hospitals. Past terrorist attacks in this major metropolitan area were considered to set up experiments for comparing delays in treatment under the modeled regimes. The analysis highlights that the number of casualties that are allowed to queue up at the nearest hospital before diverting the casualty traffic to an alternate hospital can be an important factor in reducing the overall treatment delays. Prematurely diverting the casualty traffic from the incident site to an alternate hospital can increase the travel time, while a delay in diversion can overload the nearest hospital, which can lead to overall longer waiting times in the queue. The casualty distribution mechanisms based only on the responding hospitals’ available capacity and current load can perform inefficiently because they overlook the trade-off between the times casualties spend in traveling and in queues.

Responding to mass casualty incidents in a tunnel environment is problematic not least from a prehospital emergency medical services (EMS) perspective. The aim of this review was to 1) categorize preconditions for emergency response in tunnel environments based on Haddon’s matrix and 2) identify specific EMS knowledge of providing prehospital care. Twenty eight articles, reports and book chapters were selected for further analysis. Firstly, sorting the data from each included article was done according to Haddon’s matrix. The result covers human factors, technical factors, physical environmental factors and socioeconomic environmental factors all related to preconditions for emergency response. To describe the EMS’s knowledge the data was also sorted according to command and safety, communication, assessment, and triage treatment and transport, also known as CSCATT. Few studies, especially of high quality, actually provide detailed information regarding emergency response to tunnel incidents and those that do, often have a main focus on management by the rescue service. While many incidents studied were caused by fires in tunnels, thus requiring rescue service in action, the subsequent EMS response issues that have taken place appear to have been given limited attention. To optimize the survival rates and health of the injured, as well as to provide a safe and effective work environment for the emergency services, there is a need to explore the event phase.

Introduction Virtual reality (VR) is a recent topic in healthcare education. Little is known about the factors affecting the immersion and the sense of presence in VR. This study aimed to understand the elements that influence the sense of presence among undergraduate healthcare students and postgraduate (PG). Methods Undergraduate healthcare students (n = 42) and PG (n = 19) were immersed in a mass casualty incident–immersive simulation. Participants completed questionnaires before (immersion propensity, stress) and after immersion (sense of presence, stress, cybersickness, and satisfaction). The qualitative component of the study provided the context for the quantitative results. Results The sense of presence was high among both groups but higher among PG (p = .02) and was positively correlated to immersion propensity (r = 0.36; p Conclusion In accordance with the results, the mass casualty incident–immersive simulation induced a high level of sense of presence and a low level of cybersickness. The sense of presence was correlated with the individual immersion propensity.

The mass casualty statistics in the United States is numbing. Case managers must be prepared for potential disasters. This Editorial speaks to a case manager's personal experience and calls for others who have been through an experience with mass casualties, so all may better prepare: preparation is the antidote to panic.

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: (1) The psychological toll on physicians: “I wonder if I'm broken”; (2) the importance of and need for mass casualty shooting preparedness: “[We need to] recognize this as a public health concern and train physicians to manage it”; (3) massive media attention: “The media onslaught was unbelievable”; and (4) commitment to advocacy for a public health approach to firearm violence: “I want to do whatever I can to prevent some of these terrible events.”

An autobiographical account of the author's experience of mass casualty trauma blends his own insights with relevant extant research on its experience and treatment. A conceptualization of this narrative account is offered, including a brief overview of the current treatment literature, culminating in a discussion of experiences that facilitated healing. As a prosumer currently treating such concerns, this may help to link the narratives of professionals and patients, alike. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Introduction In the course of their pre-deployment training, military students in the United Arab Emirates (UAE) are instructed on sieve triage, which is used on the battlefield. The objective of this study is to test the retention of knowledge immediately after delivery of the triage course, at Day 30 and Day 60 in military personnel with no previous sieve-triage knowledge and with an undifferentiated professional background. Method Data were collected using a questionnaire based on a survey toolkit designed by the University of Washington Public Health and distributed randomly amongst military personnel after delivery of sieve triage training. The students were randomly selected in consecutive cohorts over a six-week period. Results A total of 456 participants were included in the study. Most of the participants were soldiers (80%); other professions included were officers (9%), nurses (1%), paramedics (1%), and others (9%). The overall mean score for the cohort was 96.81 at Day 0; 87.37 at Day 30; and 76.1 at Day 60. The mean scores depict a decreasing trend for the combined as well as the individual cohorts with the highest mean score at Day 0 and the lowest at Day 60. The mean scores reduced significantly at Day 30 (MD: -9.43; 95% CI: -10.73 to -8.14) and at Day 60 (MD: -20.71; 95% CI: -22.01 to -19.42) compared to Day 0. The mean difference remained significant at Day 30 (MD: -9.42; 95% CI: -10.7 to -8.14) and Day 60 (MD: -20.69; 95% CI: -21.97 to -19.41) compared to Day 0 when adjusted for age and profession. Conclusion Knowledge retention from the delivery of sieve triage training among UAE military personnel decreased after 60 days. Therefore, there is a need for regular and periodic refresher courses and training, especially for topics that are not applied regularly.

A rapid and sudden death in a single incident like mass casualty poses challenge for health care facilities.Especially in such cases, identification of the deceased is the most important task for investigating policeofficers and doctors. The present study is a seriesof death of five young adult male workers,who died in atragic fire which broke out in the confined space at under construction plant. All the bodies were renderedunidentifiable from facial recognition due to charring and blackening. Theprimary identification of thedeceased was established based upon partially burnt clothes and personal belongings. The autopsyfindings being superficial to deep burns, charring and blackening, soot particles inrespiratory tract weresimilar in all the five victims. The bloodpreserved for estimation ofcarboxy-haemoglobin level showedpositive results in all the five cases. Soot in trachea and increased carboxy-haemoglobin level in bloodsuggested that the persons were alive at the time of incident. In all the five cases, death was caused dueto suffocation by inhalation of carbon monoxide gas associated with thermal injuries. Role of forensicexperts is to help in the identification of victims and to determine manner and cause of death.

Emergency Radiology is a clinical practice and an academic discipline that has rapidly gained increasing global recognition among radiology and emergency/critical care departments and trauma services around the world. As with other subspecialties, Emergency Radiology practice has a unique scope and purpose and presents with its own unique challenges. There are several advantages of having a dedicated Emergency Radiology section, perhaps most important of which is the broad clinical skillset that Emergency Radiologists are known for. This multi-society paper, representing the views of Emergency Radiology societies in Canada and Europe, outlines several value-oriented contributions of Emergency Radiologists and briefly discusses the current state of Emergency Radiology as a subspecialty.