Grief intensity,coping and psychological health among family members and friends following a terrorist attack

Abstract

This study investigates the association of psychological health with grief intensity and coping style among family members and friends of terror victims. The data was collected from 164 bereaved individuals, on average, 18?months after the bombings occurred. The results demonstrated the significant role of problem-focused social support, and religious coping in dealing with grief intensity and contributing to the psychological health. The findings may be of considerable importance in therapeutic situations by providing direction for coping with both the effects of traumatic event and a traumatic loss, and for maintaining emotional stability through reworking relationships with the deceased.     

Enhancing public health preparedness for a terrorist attack involving cyanide

The US government considers cyanide to be among the most likely agents of chemical terrorism. Cyanide differs from many other biological or chemical agents for which little or no defense is available because its individual and public health effects are largely remediable through appropriate preparedness and response. Because the toxicity of the cyanide antidote currently available in the United States renders it ill-suited for use in terrorist incidents and other situations requiring rapid out-of-hospital treatment, hydroxocobalamin--an effective and safe cyanide antidote being used in other countries--has been introduced in the United States. Unlike the other available cyanide antidote, hydroxocobalamin can be administered at the scene of a cyanide disaster, and it need not be reserved for cases of confirmed cyanide poisoning but can be administered in cases of suspected poisoning. Both of these attributes facilitate the rapid intervention necessary for saving lives. To realize the potential benefits of hydroxocobalamin, progress also needs to be realized in other aspects of readiness, including but not limited to developing plans for ensuring local and regional availability of antidote, educating emergency responders and health care professionals in the recognition and management of cyanide poisoning, and raising public awareness of the potential for a chemical weapons attack and of how to respond.     

Expect 2 waves of patients after terrorist attack

A study examining patient arrival at local EDs after the bombing of the federal building in Oklahoma has shown there are two "waves" of patients after a terrorist attack. Contrary to popular belief, after a mass casualty incident, most patients arrive by means other than ambulance transport. Because the first group of patients arriving at EDs are transporting themselves, they tend to be of less severity than the second wave of patients. While triaging patients from the first wave, you need to prepare for more serious injuries in the second.     

Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage

BackgroundA suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems.MethodsThese retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status.ResultsThe patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1–80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department.ConclusionDisaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.     

KAMEDO Report 89: terrorist attack in Bali, 2002

On 12 October 2002, two bombs exploded on the island of Bali in Indonesia, destroying two bars in the tourist district of the holiday resort Kuta Beach. The explosions killed 202 people from 21 different countries, and >300 people were injured. A team of observers conducted structured and unstructured interviews, and lessons learned from the experience were identified. This report summarizes various elements of the response including: (1) prehospital care; (2) coordination; (3) hospital response; and (4) Australia's efforts in air evacuation.     

Optimization of acute medication use following eptinezumab initiation during a migraine attack: post hoc analysis of the RELIEF study

BackgroundThe benefits of preventive treatment on the effectiveness of migraine management have rarely been examined. This post hoc analysis investigated the impact of eptinezumab on the optimization of acute medication effectiveness using the 4-item Migraine Treatment Optimization Questionnaire (mTOQ-4) to measure acute medication optimization over 4 weeks post-infusion.MethodsRELIEF was a 12-week, phase 3, multicenter, parallel-group, double-blind, placebo-controlled clinical trial conducted in patients aged 18–75 years with a ≥ 1-year history of migraine and 4–15 migraine days per month in the 3 months prior to screening. Patients were randomized 1:1 to a 30-min infusion of eptinezumab 100 mg or placebo within 1–6 h of a qualifying migraine attack. The mTOQ-6 and 6-item Headache Impact Test (HIT-6) were administered at screening visit and week 4. From the mTOQ-6, we calculated the mTOQ-4 using the following items: “2-h pain free,” “24-h relief,” “able to plan,” and “feeling in control” to measure acute medication optimization.ResultsA total of 238 patients received eptinezumab 100 mg and 226 provided week 4 data; 242 received placebo and 232 provided week 4 data. In the eptinezumab arm, the proportion of patients with moderate/maximal optimization increased from 31.4% at baseline to 58.0% (26.6 percentage point increase) at week 4. The corresponding proportions in the placebo group were 40.5% to 50.4% (9.9 percentage point increase). Eptinezumab treatment was associated with numerically larger improvements in HIT-6 at week 4. Relative improvements with eptinezumab vs. placebo from baseline to week 4 in HIT-6 were greater in those with poor treatment optimization at baseline.ConclusionsIn comparison with placebo, treatment with eptinezumab was associated with improvements in acute medication optimization as measured by mTOQ and reductions in headache impact, as measured by HIT-6. These benefits were greater in those with poor acute treatment optimization prior to preventive treatment with eptinezumab.Trial registrationClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT04152083","term_id":"NCT04152083"}}NCT04152083.     

Symptom-based, algorithmic approach for handling the initial encounter with victims of a potential terrorist attack

OBJECTIVES: This study intended to create symptom-based triage algorithms for the initial encounter with terror-attack victims. The goals of the triage algorithms include: (1) early recognition; (2) avoiding contamination; (3) early use of antidotes; (4) appropriate handling of unstable, contaminated victims; and (5) provisions of force protection. The algorithms also address industrial accidents and emerging infections, which have similar clinical presentations and risks for contamination as weapons of mass destruction (WMD). METHODS: The algorithms were developed using references from military and civilian sources. They were tested and adjusted using a series of theoretical patients from a CD-ROM chemical, biological, radiological/nuclear, and explosive victim simulator. Then, the algorithms were placed into a card format and sent to experts in relevant fields for academic review. RESULTS: Six inter-connected algorithms were created, described, and presented in figure form. The "attack" algorithm, for example, begins by differentiating between overt and covert attack victims (A covert attack is defined by epidemiological criteria adapted from the Centers for Disease Control and Prevention (CDC) recommendations). The attack algorithm then categorizes patients either as stable or unstable. Unstable patients flow to the "Dirty Resuscitation" algorithm, whereas, stable patients flow to the "Chemical Agent" and "Biological Agent" algorithms. The two remaining algorithms include the "Suicide Bomb/Blast/Explosion" and the "Radiation Dispersal Device" algorithms, which are inter-connected through the overt pathway in the "Attack" algorithm. CONCLUSION: A civilian, symptom-based, algorithmic approach to the initial encounter with victims of terrorist attacks, industrial accidents, or emerging infections was created. Future studies will address the usability of the algorithms with theoretical cases and utility in prospective, announced and unannounced, field drills. Additionally, future studies will assess the effectiveness of teaching modalities used to reinforce the algorithmic approach.     

P.r.n. medication use in a psychiatric high-dependency unit following the introduction of a nurse-led activity programme

This paper describes the introduction of a daily activity programme with clients who require psychiatric intensive care in two locked high-dependency units (HDUs). To evaluate the programme, a crossover study between the two units was undertaken with a convenience sample of clients. Baseline data of pro re nata (p.r.n.) medication dispensed to patients were collected for a period of 2 weeks from both locked units before the introduction of the programme. The programme was conducted for a period of 1 month in alternate locked units. Both non-intervention and active programme data were collected throughout the 6-month period of the study. Findings from the study demonstrated that an activity-based nursing intervention was effective in reducing the number of p.r.n. medications dispensed in a HDU compared with control conditions. The effects were statistically significant in one of the units and absent in the other. This study shows that a purposeful activity programme for severely disturbed psychiatric clients in a HDU setting can be effective in reducing disturbed behaviour and therefore the need for p.r.n. medication.     

Subdural hematoma mimicking a transient ischemic attack due to antihypertensive medication.

An elderly man had two completely reversible episodes of aphasia, each occurring after taking his antihypertensive medications. He was subsequently found to have a subdural hematoma. The association between subdural hematomas (and other intracranial mass lesions) and reversible neurologic deficits is discussed, as is the pathophysiology of the phenomenon. In addition, the relationship between the effects of the patient's antihypertensive medications and the neurologic deficits in the setting of a subdural hematoma is explored.     

Significance of a Level-2, "selective, secondary evacuation" hospital during a peripheral town terrorist attack

INTRODUCTION: Mass-casualty incidents (MCIs) can occur outside of major metropolitan areas. In such circumstances, the nearest hospital seldom is a Level-1 Trauma Center. Moreover, emergency medical services (EMS) capabilities in such areas tend to be limited, which may compromise prehospital care and evacuation speed. The objective of this study was to extract lessons learned from the medical response to a terrorist event that occurred in the marketplace of a small Israeli town on 26 October 2005. The lessons pertain to the management of primary and secondary evacuation and the operational practices by the only hospital in the town, which is designated as a Level-2 Trauma Center. METHODS: Data were collected during the event by Home Front Command Medical Department personnel. After the event, formal and informal debriefings were conducted with EMS personnel, the hospitals involved, and the Ministry of Health. The medical response components, interactions (mainly primary triage and secondary distribution), and the principal outcomes were analyzed. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology. RESULTS: The suicide bomber and four victims died at the scene, and two severely injured patients later died in the hospital. A total of 58 wounded persons were evacuated, including eight severely injured, two moderately injured, and 48 mildly injured. Forty-nine of the wounded arrived to the nearby Hillel Yafe Hospital, including all eight of the severely injured victims, the two moderately injured, and 39 of the mildly injured. Most of the mildly injured victims were evacuated in private cars by bystanders. Five other area hospitals were alerted, three of which primarily received the mildly injured victims. Two distant, Level-1 Trauma Centers also were alerted; each received one severely injured patient from Hillel Yafe Hospital during the secondary distribution process. Emergency medical services personnel were able to treat and evacuate all severely and moderately injured patients within 17 minutes of the explosion. A total of 12 of the 21 ambulances arriving on-scene within the first 20 minutes were staffed by EMS volunteers or off-duty workers. CONCLUSION: When a MCI occurs in a small town that is in the vicinity of a Level-2 Trauma Center, and located a > 40 minute drive from Level-1 Trauma Centers, the Level-2 Trauma Center is a critical component in medical management of the event. All severely and moderately injured patients initially should be evacuated to the Level-2 Trauma Center, and given advanced, hospital-based resuscitation. The patients needing care beyond the capabilities of this facility should be distributed secondarily to Level-1 Trauma Centers. To alleviate the burden placed on the local hospital, some of the mildly injured victims can be evacuated primarily to more distant hospitals. The ability to control the flow of mildly injured patients is limited by the large percentage of them arriving by private cars. The availability of EMS in small towns can be augmented significantly by enrolling off-duty EMS workers and volunteers to the rescue effort. Level-2 hospitals in small towns should be prepared and drilled to operate in a "selective evacuation" mode during MCIs.