Major Incident Medical

Carley, S. and Jones, K.M. Major Incident Medical Management and Support The Practical Approach in the Hospital by the Advanced Life Support Group. Malden, MA BMJ Books, 2005. 

TTie response should be consistent with the established approach as guided by the principles of major incident medical management and support (MIMMS). Figure 5.4 outlines the basic organisation of the command and control structure. Further information can be found in Chapter 2. 

MIMMS major incident medical management and support... 

Improvement Item ACEMS attempted to medical monitor other responders, but they were entering incident area without EMS coordination. Triage tags were not utilized, although they were available. The on-duty EMS supervisor must relinquish control of outside incidents and focus on major incident being responded to. 

Moles TM (1999). Emergency medical services systems and HAZMAT major incidents. Resuscitation, 42, 103-107. 

In the event of a major incident, the consequences to people will probably be less serious than predicted by the release and incident outcome models described in Chapters 2 and 3 and the effect models in Chapter 4. This is not only because of uncertainties in modeling incident outcomes or modeling limitations that may lead to conservative assumptions and results but also because of topographical and physical obstruction factors, and because of evasive actions taken by people. Evasive actions can include evacuation, escape, sheltering, and heroic medical treatment. This chapter addresses the impact of evasive actions as mitigating factors to a CPQRA study. 

No medical or therapeutic procedure comes without some risk to the patient. All possible steps are taken to ensure safely, quahty and efficacy of vaccines and immunological products (Chapter 15). The risks associated with immunization procedures must be constantly reviewed and balanced against the risks of, and associated with, contracting the disease, hi this respect, smallpox vaccination in the UK was abandoned in the mid 1970s as the risks associated with vaccination then exceeded the predicted number of deaths that would follow importation of the disease. Shortly after this, in 1980, The World Health Assembly pronounced the world to be free of smallpox. Similarly, the incidence of paralytic poliomyelitis in the USA and UK in 1996 was low but the majority of cases related to vaccine use. As the worldwide elimination of poliomyelitis approaches, there is much debate as to the value of the vaccine outside of an endemic area. 

Aging is one of the major risk factors for developing gastric ulcers because of an increased incidence of Helicobacter pylori infections and a widely spread use of non-steroidal anti-inflammatory drugs (NSAID). Co-morbidity, with the need for prophylactic medication with antiplatelet therapy, warfarin and other anticoagulants, also increases the risk of gastrointestinal bleeding and ulcerations (Murakami et al. 1968). 

Pregnancy There is an association between use of anticonvulsant drugs by women with epilepsy and an elevated incidence of birth defects in children born to these women. The great majority of mothers receiving anticonvulsant medication deliver normal infants. 

In the year 2000, poison centers in the United States responded to nearly two and half million incidents, mosdy home exposures to chemical products, animal bites, and poisonous plants. Over 50% involved children under the age of six. In all, 24,024 incidents resulted in medical outcomes deemed major , and there were 1711 deaths. Almost half (46%) stemmed from exposure to pharmaceutical products. Of the remaining exposures, the largest groups resulted from cosmetics and personal care products and household cleaners. Although the large number of incidents says more about the ubiquity of potentially hazardous products in the home than about their toxicity, the numbers also point out the extent of the potential dangers if products are toxic or if medical aid is not rapidly received. Many more deaths and serious injuries would occur if not for the rapid intervention of poison centers. 

To date, the majority of gene therapy trials undertaken aim to cure not inherited genetic defects, but cancer. The average annual incidence of cancer reported in the USA alone stands at ca. 1.4 million cases. Survival rates attained by pursuit of conventional therapeutic strategies (surgery, chemo-therapy, radio-therapy) stands at about 50%. Gene therapy will likely provide the medical community with an additional therapeutic tool with which to combat cancer within the next 10-15 years. 

Storosum JG, van Zwieten BJ, Vermeulen HDB, Wohlfarth T et al (2001) Relapse and recurrence in major depression a critical review of placebo-controUed efficacy studies with special emphasis on methodological issues European Psychiatry, 16, ill- i iS Stutchfield P, Whitaker R and Russell I, on behalf of the Antenatal Steroids for Term Elective Caesarean Section (ASTECS) Research Team (2005) Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section pragmatic randomised trial British Medical Journal, 331, 662-667... 

Formal human studies are limited and based on naturalistic exposure with an attempt to have a control group matched as closely as possible. However, there are inevitably differences in such groups, the most obvious and perhaps most important being the reason why one group is on a medication while the other is not. In other words, the illness that led to treatment with the medication (in this case a mood disorder) may itself be a risk factor for lower fetal viability, increased incidence of perinatal complications, or congenital malformations including neurodevelopmental problems, as well as major structural anomalies (e.g., cleft palate, spina bifida). 

Several key factors drive the need for automation. A national shortage of pharmacists in the face of ever-increasing prescription volumes is one major impetus. Another is the profound need to reduce the incidence of medication errors. Still another is the opportunity created by automation to enhance the role of pharmacists in patient care. Finally, consumers demand for speed and convenience further enhances the attractiveness of automation in pharmacy operations (Lewis, Albrant, and Hagel, 2002). Technology has the ability to accelerate the movement of pharmacists from the traditional dispensing focus to that of a patient-centered role. 

In an earlier study by Wolfe et al. (1985) of Air Force personnel involved in Operation Ranch Hand, a significant increase in the number of reported neonatal deaths (no additional details provided), as compared to a comparison group of Air Force military employees not stationed in Vietnam, was observed. The incidence of major defects, prematurity, learning disabilities, or infant deaths was not increased in the Ranch Hand personnel. A significant increase in the incidence of minor health effects such as birth marks, rashes, and neonatal jaundice was reported by the Ranch Hand veterans. It should be noted that the pregnancy outcomes were self-reported, and this finding was not corroborated by the follow-up study (Wolfe et al. 1995) which used birth certificates, medical records, and death certificates to assess possible relationships between paternal exposure to 2,3,7,8-TCDD and developmental effects in offspring. 

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