Background: Terrorism victims comprise the minority among trauma injured people, but this small population imposes a burden on the health care system. Thirty percent of the population injured in terrorist activities experienced severe trauma (injury severity score ≥16), more than half of them need a surgical procedure, and 25% of the population affected by terrorism had been admitted to intensive care. Furthermore, compared with patients with non–terrorism-related trauma, victims of terrorism often arrive in bulk, as part of a mass casualty event. This poses a sudden load on hospital resources and requires special organization and preparedness. The present study compared terrorism-related and road accident–related injuries and examined clinical characteristics of both groups of patients.

Methods: This study is a retrospective study of all patients injured through terrorist acts and road traffic accidents from September 29, 2000 to December 31, 2005, and recorded in the Israel Trauma Registry. Data on the nature of injuries, treatment, and outcome were obtained from the registry. Medical diagnoses were extracted from the registry and classified based on International Classification of Diseases coding. Diagnoses were grouped to body regions, based on the Barell Injury Diagnosis Matrix.

Results: The study includes 2197 patients with terrorism-related injuries and 30,176 patients injured in road traffic accidents. All in all, 27% of terrorism-related casualties suffered severe to critical injuries, comparing to 17% among road traffic accident–related victims. Glasgow Coma Scale scores ≤8, measured in the emergency department, were among 12.3% of terrorism victims, in contrast with 7.4% among people injured on the roads. The terrorism victims had a significantly higher rate of use of intensive care facilities (24.2% vs 12.4%). The overall inpatient death rate was 6.0% among terrorism victims and 2.4% among those injured in road traffic accidents.

Conclusions: Casualties from terrorist events are more severely injured and require more resources relative to casualties from road traffic accidents. (Disaster Med Public Health Preparedness. 2009;3:196–200)

Objective: Although a goal of disaster preparedness is to protect vulnerable populations from hazards, little research has explored the types of risks that workers face in their encounters with natural disasters. This study examines how workers are fatally injured in severe natural events.

Methods: A classification structure was created that identified the physical component of the disaster that led to the death and the pursuit of the worker as it relates to the disaster. Data on natural disasters from the Census of Fatal Occupational Injuries for the years 1992 through 2006 were analyzed.

Results: A total of 307 natural disaster deaths to workers were identified in 1992–2006. Most fatal occupational injuries were related to wildfires (80 fatalities), hurricanes (72 fatalities), and floods (62 fatalities). Compared with fatal occupational injuries in general, natural disaster fatalities involved more workers who were white and more workers who were working for the government. Most wildfire fatalities stemmed directly from exposure to fire and gases and occurred to those engaged in firefighting, whereas hurricane fatalities tended to occur more independently of disaster-produced hazards and to workers engaged in cleanup and reconstruction. Those deaths related to the 2005 hurricanes occurred a median of 36.5 days after landfall of the associated storm. Nearly half of the flood deaths occurred to passengers in motor vehicles. Other disasters included tornadoes (33 fatalities), landslides (17), avalanches (16), ice storms (14), and blizzards (9).

Conclusions: Despite an increasing social emphasis on disaster preparation and response, there has been little increase in expert knowledge about how people actually perish in these large-scale events. Using a 2-way classification structure, this study identifies areas of emphasis in preventing occupational deaths from various natural disasters. (Disaster Med Public Health Preparedness. 2009;3:201–209)

Background: Although the training of future physicians in disaster preparedness and public health issues has been recognized as an important component of graduate medical education, medical students receive relatively limited exposure to these topics. Recommendations have been made to incorporate disaster medicine and public health preparedness into medical school curricula. To date, the perspectives of future physicians on disaster medicine and public health preparedness issues have not been described.

Methods: A Web-based survey was disseminated to US medical students. Frequencies, proportions, and odds ratios were calculated to assess perceptions and self-described likelihood to respond to disaster and public health scenarios.

Results: Of the 523 medical students who completed the survey, 17.2% believed that they were receiving adequate education and training for natural disasters, 26.2% for pandemic influenza, and 13.4% for radiological events, respectively; 51.6% felt they were sufficiently skilled to respond to a natural disaster, 53.2% for pandemic influenza, and 30.8% for radiological events. Although 96.0% reported willingness to respond to a natural disaster, 93.7% for pandemic influenza, and 83.8% for a radiological event, the majority of respondents did not know to whom they would report in such an event.

Conclusions: Despite future physicians' willingness to respond, education and training in disaster medicine and public health preparedness offered in US medical schools is inadequate. Equipping medical students with knowledge, skills, direction, and linkages with volunteer organizations may help build a capable and sustainable auxiliary workforce. (Disaster Med Public Health Preparedness. 2009;3:210–216)

Objective: The potential for deadly human stampedes to occur at any mass gathering event highlights this unique form of crowd disaster as deserving of special attention from both scientific and planning perspectives. Improved understanding of human stampedes is indispensable in the mitigation of this type of mass casualty. With relatively few peer-reviewed reports on deadly human stampedes, information from news reports and the Internet is essential to increased collective understanding. Without incorporating nontraditional sources, no other way to reasonably acquire sufficient data is available. This study analyzed human stampede events from 1980 to 2007 to identify epidemiological characteristics associated with increased mortality.

Methods: A LexisNexis search was followed by sequential searches of multiple Internet-based English-language news agencies. Date, country, geographical region, time of occurrence, type of event, location, mechanism, number of participants, number injured, and number of deaths were recorded. Bivariate analyses of number of deaths or injuries were conducted using a nonparametric Wilcoxon rank test. Multivariate regression was performed to determine the factors associated with increased number of fatalities during stampede events.

Results: A total of 215 human stampede events were reported from 1980 to 2007, resulting in 7069 deaths and at least 14,078 injuries from 213 events with available fatality information and 179 events with injury information. In bivariate analysis, stampedes occurring in the Middle East, in developing countries, outdoors, or associated with religious events had the highest median number of deaths. In multivariate analysis, events that occurred in developing countries and outdoors were associated with increased number of fatalities. Stampedes that occurred in the context of sports, religious, music, and political events, or that had a unidirectional mechanism, also increased the relative number of deaths.

Conclusions: Several epidemiological features of human stampedes associated with increased mortality are identified. Standardized collection of epidemiological data pertaining to human stampedes is strongly recommended, and further study of this recurrent, distinctive disaster is warranted. (Disaster Med Public Health Preparedness. 2009;3:217–223)

Objective: National security special events occur yearly in the United States. These events require comprehensive advance planning for health and medical contingencies in addition to law enforcement concerns. The planning for and impact of the Republican National Convention (RNC) on the City of St Paul and the Minneapolis–St Paul metropolitan area is described.

Methods: Descriptive analysis of events was provided by the authors based on their planning and operational experiences. Daily data were gathered from area hospitals, emergency medical services agencies, the National Weather Service, federal medical teams, and the Minnesota Department of Health to capture the impact of the RNC on emergency department activity, nonemergency surgery, emergency medical services run volumes, patient visits to onsite and offsite medical clinics, and general hospital occupancy in the metropolitan area.

Results: There were no epidemiological signal events. Weather was not extreme. Confrontations between protestors and law enforcement resulted in frequent use of riot-control agents. Protestors sought medical care from “street medics” and their affiliated free clinics in preference to usual medical facilities. Emergency departments close to the event venue reported decreased patient volumes. Hospitals close to the venue reported significantly decreased nonemergency surgical case volumes. Local hospitals implemented access controls and in 1 case, shut down ventilation systems due to riot-control agent deployment in the streets outside. Emergency medical services volumes were near average, with the exception of St Paul Fire Department on the day of a major protest march.

Conclusions: Planning and operational response for the RNC consumed large amounts of time and resources. The RNC had minimal patient impact on the health care system and in fact caused significant volume decreases at hospitals proximate to the venue. Although contingencies available for a mass casualty event were not needed, they must continue to be available for all such events. Health and medical preparedness and funding is not adequately detailed in the planning framework for national security special events, and this should be a focus for future events. (Disaster Med Public Health Preparedness. 2009;3:224–232)