In 2001, the Israeli government announced the construction of the West Bank barrier. The stated purpose of construction to prevent attacks by Palestinians on Israeli citizens. In a subsequent advisory opinion, the International Court of Justice decided the wall would block access to health care and education, and was “contrary to international law”.

The Barrier, with its limited number of gates, has been criticized by humanitarian agencies for limiting access of Palestinians to employment, health care, and education, but was defended by the Israeli government as an important security measure.

A survey of key informants was conducted in May 2004 at 78 health facilities and 121 schools in the northern West Bank districts of Jenin, Qalqilya, and Tulkarem, in order to assess the impact of the Barrier on access and use of health and educational services.

The Barrier negatively affected access to education and health care, in terms of statistically significant increases in distance and travel time to schools and health facilities. In several areas, service utilization, assessed by weekly visits to health facilities and student enrollment, was affected by barrier construction, although these findings were not statistically significant. A significant decrease in staff attendance was observed at health facilities and schools.

The Barrier may have long-term effects on access and utilization of health and educational services among Palestinians in the northern West Bank.

Open-source information consists of a range of publicly available material, includingvarious periodicals, news reports, journal publications, photographs, and maps. Although intelligence agencies regularly use open source information in developing strategically important intelligence, the disaster community has yet to evaluate its use for planning or research purposes. This study examines how open-source information, in the form of Internet news reports and public access disaster databases, can be used to develop a rapid, 72-hour case report.

Open-source information was extrapolated from several news reports on a terrorist bombing that occurred in Russia on 05 December 2003, using a self-devised “data” collection sheet, and background information collected on the nature of similar disasters using three public access databases.

The bulk of health-related information was collected in the first 13 hours after the event, including casualty demographics, immediate dead, total dead, admitted, and treated-and-released. The complex and prolonged rescue of casualties was identified, as well as the presence of unexploded ordnance. This incident also was identified as the first publicly reported suicide terrorist bombing of a commuter train.

Open-source information has the potential to be a helpful tool in reconstructing a chain of events and response. However, its use must be validated further and used appropriately. Standards for collection and analysis also must be developed.

The objective of this study was to estimate the burden of cancer in counties affected by Hurricane Katrina using population-based cancer registry data, and to discuss issues related to cancer patients who have been displaced by disasters.

The cancer burden was assessed in 75 counties in Louisiana, Alabama, and Mississippi that were designated by the Federal Emergency Management Agency as eligible for individual and public assistance. Data from the National Program of Cancer Registries were used to determine three-year average annual age-adjusted incidence rates and case counts during the diagnosis years 2000–2002 for Louisiana and Alabama. Expected rates and counts for the most-affected counties in Mississippi were estimated by direct, age-specific calculation using the 2000–2002 county level populations and the site-, sex-, race-, and age-specific cancer incidence rates for Louisiana.

An estimated 23,549 persons with a new diagnosis of cancer in the past year resided in the disaster-affected counties. Fifty-eight percent of the cases were cancers of the lung/bronchus, colon/rectum, female breast, and prostate. Eleven of the top 15 cancer sites by sex and black/white race in disaster counties had >50% of cases diagnosed at the regional or distant stage.

Sizable populations of persons with a recent cancer diagnosis were potentially displaced by Hurricane Katrina. Cancer patients required special attention to access records in order to confirm diagnosisand staging, minimize disruption in treatment, and ensure coverage of care. Cancer registry data can be used to provide disaster planners and clinicians with estimates of the number of cancer patients, many of whom maybe undergoing active treatment.

Only 4% of the United States Homeland Security funding for public safety terrorism preparedness is allotted to emergency medical services (EMS), despite the primary threat from a mass-terrorism chemical weapons attack (MTCWA) being personal injury. This study examines the preparedness of the EMS torespond to, treat, and transport victims of such attacks.

It was hypothesized that US EMS agencies lack the necessary equipment to mitigate large-scalemorbidity and mortality from a MTCWA.

Seventy after-action reports from full-scale, chemical weapons exercises conducted in large cities across the US were examined by the Office of Domestic Preparedness, Chemical Weapons Improved Response Program to ascertain if EMS responders had personal protective equipment sufficient to operate at the scene of aMTCWA.

Of the 50 after action reports that mentioned EMS personal protective equipment, only six (12%) EMS agencies equipped their staff with personal protective equipment.

Results indicate that EMS responders are not prepared to safely respond to MTCWAs, which mayresult in a significant loss of life of victims and responders.

Numerous studies have suggested that emergency medical services (EMS) providers areill-prepared in the areas of training and equipment for response to events due to weapons of mass destruction(WMD) and other public health emergencies (epidemics, etc.).

A nationally representative sample of basic and paramedic EMS providers in the United States wassurveyed to assess whether they had received training in WMD and/or public health emergencies as part of their initial provider training and as continuing medical education within the past 24 months. Providers also were surveyed as to whether their primary EMS agency had the necessary specialty equipment to respond to these specific events.

More than half of EMS providers had some training in WMD response. Hands-on training was associated with EMS provider comfort in responding to chemical, biological, and/or radiological events and public health emergencies (odds ratio (OR) = 3.2, 95% confidence interval (CI) 3.1, 3.3). Only 18.1% of providers surveyed indicated that their agencies had the necessary equipment to respond to a WMD event. Emergency medical service providers who only received WMD training reported higher comfort levels than those who had equipment, but no training.

Lack of training and education as well as the lack of necessary equipment to respond to WMD events is associated with decreased comfort among emergency medical services providers in responding to chemical, biological, and/or radiological incidents. Better training and access to appropriate equipment may increase provider comfort in responding to these types of incidents.

International mass gatherings can cause great challenges to local healthcare system and emergency medical services (EMS). Traditionally, planning has been based on retrospective reports of previous events, but there still is a need for prospective studies in order to make the process more evidence-based. The aim of this study was to analyze the success of medical preparedness, ambulance patient characteristics, emergency care, and the use of pre-hospital resources during the 2005 World Championship Games in Athletics in Helsinki, Finland.

The study was a prospective, observational study conducted within the Helsinki EMS. Data from all emergency calls at the sport venues and Games village between 05 and 14 August 2005 were collected. Data from the organizations responsible for the health care and first aid of spectators and accredited persons (e.g., athletes, coaches, the press, very important persons and personnel working in the Games area) also were collected. The Institutional Review Board of Helsinki University Central Hospital approved the study plan.

A total of 479,000 persons visited the Games. The ambulance call incidence at the Olympic Stadium was 0.50 per 10,000 people and 0.7 per 10,000 when the Games Village was included. The overall need for ambulance transportation to the emergency department was 0.52 per 10,000. No patients needed cardiopulmonary resuscitation or other immediate, life-saving procedures on-site. First aid was provided to 554 spectators (0.17per 10,000 people). The three medical organizations cared for 1,586 patients of which 25 (1.6%) were transported to a hospital by an ambulance. The number of patients needing transportation and the overall patient loadfor the healthcare system was well-anticipated. Accredited persons sought health care a total of 1,009 times.The number of patients treated was associated closely with the number of spectators (p = 0.05). The number of ambulance calls in the city increased 5.9 % as compared to the corresponding time period in the five previous years.

The medical preparedness and resources for the Games proved to be sufficient. The EMS personnel were able to provide quality emergency care. This prospective study provided new, detailed data for the medical aspects of mass gatherings and confirmed many previous observations.

Psychological distress following disaster events may increase the risk of sudden cardiac death. In 2001, the Nisqually earthquake and the 11 September terrorist attacks profoundly affected Washington state residents.

This research investigated the theory that the incidence of sudden cardiac death would increase following these disaster events.

Death certificates were abstracted using a uniform case definition to determine the number of sudden cardiac deaths for the 48-hour and one week periods following the two disaster events. Sudden cardiac deaths from the corresponding 48-hour and one-week periods in the three weeks before the events, and the analogous periods in 1999 and 2000 were designated as control times. Using t-tests, the number of sudden cardiac deaths for the periods following the disaster events was compared to those of the control periods.

In total, 32 sudden cardiac deaths occurred in the four counties affected by the Nisqually earthquake during the 48 hours after the event, compared to an average of 22 ±3.5 (standard deviation) in the same counties during the control periods (p = 0.02). No difference was observed for the one week period (94 compared to 79.2 ±12.4,p = 0.28). No difference was observed in the number of sudden cardiac deaths in the 48-hours or one-week following the terrorist attacks compared to control periods.

A local disaster caused by a naturally occurring hazard, but not a geographically remote human disaster, was associated with an increased risk of sudden cardiac death. A better understanding of the underlying mechanisms may have implications for prevention of sudden cardiac death.

In stressful situations such as the management of major incidents and disasters, the ability to work in a structured way is important. Medical management groups initially are formed by personnel from different operations that are on-call when the incident or disaster occurs.

The aim of this study was to test if performance indicators for staff procedure skills in medical management groups during simulations could be used as a quality control tool for finding areas that require improvement.

A total of 44 management groups were evaluated using performance indicators in which results could be expressed numerically during simulations.

The lowest scores were given to documentation and to the introduction of new staff members. The highest score was given the utilization of technical equipment.

Staff procedure skills can be measured during simulations exercises. A logging system may lead to enhancing areas requiring improvement.

The effect of the severe acute respiratory syndrome (SARS) outbreak on the willingness of laypersons to provide bystander cardiopulmonary resuscitation (CPR) using standard CPR (SCPR) or compression-only CPR (CCPR) was evaluated.The preferred type of SCPR in the post-SARS era was assessed.

A descriptive study was conducted through telephone interviews. Persons who attended a CPR coursefrom January 2000 through February 2003 answered a structured questionnaire. The respondents' willingnessto perform SCPR or CCPR during a witnessed cardiac arrest of an average adult stranger or that of a family member in the pre-SARS and the post-SARS era was surveyed.

Data for 305 respondents were processed. For the scenario of cardiac arrest of an average stranger, more respondents would perform CCPR than SCPR in the pre-SARS era (83.6% vs. 61.3%, p <0.001) and in the post- SARS era (77.4% vs. 28.9%, p <0.001). In the scenario of the cardiac arrest of a family member, more would perform CCPR than SCPR in the pre-SARS era (92.8% vs. 87.2%, p <0.001) and in the post-SARS era (92.8% vs. 84.9%, p <0.001). After SARS, more respondents were unwilling to perform SCPR (p <0.001) and CCPR (p <0.001) on strangers. After SARS, more respondents were unwilling to perform SCPR on a family member (p = 0.039), but there was no difference in the preference to perform CCPR (p = 1.000).

Concerns about SARS adversely affected the willingness of respondents to perform SCPR or CCPRon strangers and to perform SCPR on family members.Compression-only CPR was preferred to SCPR to resuscitate strangers experiencing cardiac arrest after the emergence of SARS.

The demography of healthcare workers (HCWs) and non- HCWs seeking medical care at emergency departments after a non-percutaneous potential exposure to human immunodeficiency virus (HIV) duringcardiopulmonary resuscitation (CPR), the types and body locations of their exposures, the time elapsed from exposure to emergency department presentation, and usage of HIV-post-exposure prophylaxis (PEP) for these exposures are described.

A retrospective study of emergency department patients who were exposed to blood or body fluids during CPR in Rhode Island from January 1995–June 2001 was performed.The demography, characteristics of the exposure, and HIV-PEP usage for these patients were compared, and the elapsed time from exposure to evaluation inthe emergency department was calculated.

Of the 39 patients exposed to non-percutaneous blood or body fluid during CPR, 22 were healthcareworkers (HCWs) and 17 were non-HCWs. Thirty-four patients sustained mucous membrane exposures. Most of the patients (69.2%) were exposed to saliva or sputum (p <0.001), experienced a mouth exposure (71.8%; p <0.0001) and presented to the emergency department within one day of their exposure (84.4%; p <0.0001).Three HCWs and no non-HCWs were offered HIV-PEP for their CPR exposure. Of the three HCWs offered PEP, two actually received it.

Nearly half of the patients who presented with non-percutaneous exposures acquired during CPR were not HCWs. Most of the exposures were to saliva or sputum and occurred on their mucous membranes. Continuing education programs on maintaining universal precautions to prevent blood or body fluid exposures and appreciating the benign nature of most non-percutaneous exposures possible during CPR are needed.

No widely accepted, specialized medical training exists for police officers confronted with medical emergencies while under conditions of active threat. The purpose of this study was to assess medical decisionmaking capabilities of law enforcement personnel under these circumstances.

Web-based surveys were administered to all sworn officers within the county jurisdiction.Thirty-eight key actions were predetermined for nine injured officer scenarios, with each correct action worth one point.Descriptive statistics and t-tests were used to analyze results.

Ninety-seven officers (65.1% response rate) responded to the survey. The majority of officers (68.0%) were trained to the first-responder level. Overall mean score for the scenarios was 15.5 ±3.6 (range 7–25). A higher level of medical training (EMT-B/P versus first responder) was associated with a higher mean score (16.6 ±3.4, p = 0.05 vs. 15.0 ±3.6, p = 0.05).Tactical unit assignment was associated with a lower score compared with nonassigned officers (13.5 ±2.9 vs. 16.0 ±3.6, p = 0.0085).No difference was noted based upon previous military experience. Ninety-two percent of respondents expressed interest in a law enforcement-oriented advanced first-aid course.

Tactical medical decision-making capability, as assessed through the nine scenarios, was sub-optimal. In this post 9/11 era, development of law enforcement-specific medical training appears appropriate.