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A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident.We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database.On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ± 4.21 hours vs 3.77 ± 2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers.Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

A brief historical account of the Halifax Explosion, one of North America's greatest mass urban trauma casualty events of the 20th century. This disaster, in Halifax, Nova Scotia, was the result of the cataclysmic explosion of a fully loaded World War I munitions ship on the densely waterfront of that city, resulting in nearly 2000 fatalities and 9000 injured. It remains a case study in response to disasters which overwhelm local medical capabilities., (Copyright © 2017. Published by Elsevier Inc.)

One hundred years ago, a massive explosion occurred in the harbor of Halifax, Nova Scotia, destroying the city and killing more than 2,000 and injuring more than 9,000. It was the worst manmade explosion the world had ever seen, not exceeded until the atomic bomb blast over Hiroshima in 1945. An urgent appeal for assistance came from the survivors, and many volunteers responded. This report describes the prompt and remarkable medical relief effort of the citizens of Massachusetts to help their Canadian neighbors.

Summary: The 1917 Halifax Explosion was an unfortunate but predictable tragedy, given the sea traffic and munitions cargo, resulting in sudden large-scale damage and catastrophic injuries, with 1950 dead and 8000 injured. Although generous support was received from the United States, the bulk of the medical work was undertaken using local resources through an immediate, massive, centrally coordinated medical response. The incredible care provided 100 years ago by these Canadian physicians, nurses and students is often forgotten, but deserves attention. The local medical response to the 1917 disaster is an early example of coordinated mass casualty relief, the first in Canada, and remains relevant to modern disaster preparedness planning. This commentary has an appendix, available at canjsurg.ca/016317-a1.

Legend holds that treating the hundreds of children injured in the Halifax explosion of December 6, 1917, compelled Dr. William E. Ladd (1880-1967) to dedicate his career to the surgical care of infants and children. However, he had made the commitment to be a pediatric surgeon several years before when he joined the voluntary staff of the Children's Hospital of Boston in 1910. In the years before Halifax, he was among the vanguard of American surgeons who brought the mortality of intussusception to 45% from 90%, and of pyloric stenosis to 15% from 60%. Among his early innovations was the contrast enema for intussusception for diagnosis and therapy. Shortly after the explosion, Dr. Ladd led a medical relief effort of 100 doctors, nurses, and orderlies from Boston. With supplies enough for a 500-bed hospital, they battled through a blizzard, downed telegraph lines, and blocked railways to reach the strickened city on December 9. The enormity of the Halifax tragedy and the dedication of Dr. Ladd and his team led to the creation myth of the birth of pediatric surgery. The record was set straight by Dr. Ladd himself in a handwritten letter to a pediatric surgeon who had asked about when he dedicated himself to the field. "The Children's was [my] very first and most permanent love," Ladd wrote. "As soon as it became feasible after the first World War, I devoted myself exclusively to pediatric surgery and have never regretted it.", (Copyright © 2017 Elsevier Inc. All rights reserved.)

This paper presents an overview of the nuclear accident that occurred at the Mayak Production Association (PA) in the Russian Federation on 29 September 1957, often referred to as 'Kyshtym Accident', when 20 MCi (740 PBq) of radionuclides were released by a chemical explosion in a radioactive waste storage tank. 2 MCi (74 PBq) spread beyond the Mayak PA site to form the East Urals Radioactive Trace (EURT). The paper describes the accident and gives brief characteristics of the efficacy of the implemented protective measures that made it possible to considerably reduce doses to the exposed population. The paper also provides retrospective dosimetry estimates for the members of the EURT Cohort (EURTC) which comprises approximately 21 400 people. During the first two years after the accident a decrease in the group average leukocyte (mainly due to neutrophils and lymphocytes) and thrombocyte count was observed in the population. At later dates an increased excess relative risk of solid cancer incidence and mortality was found in the EURTC.

Background: Given the recent interest in blast injury spurred by returning soldiers from overseas conflicts, we sought to research the early historical descriptions of blast injuries and their treatments. Consideration was given to specific descriptions of survivors of closed head injury and their treatment., Methods: A review of the medical and nonmedical literature was undertaken, with particular emphasis on pre-1800 descriptions of volcanic eruptions and mining accidents. Compilations of accounts of the Etna eruptions dating from 126 BC were translated into English, and early mining texts from the 1600s and 1700s were reviewed., Results: Accumulations of flammable gases were recorded in many medieval sources and this knowledge of toxic gas which could lead to blast injury was known in the mining community by 1316. No direct attribution of injuries to blast forces was present in the historical record examined before the 1300s, although mining accounts in the 1600s detail deaths due to blast. No specific descriptions of survivors of a closed head injury were found in the mining and volcanic eruption literature., Conclusions: Descriptions and warnings of blast forces were commonly written about in the medieval and Renaissance mining communities. Personal narratives as early as 1316 recognize the traumatic effects of blast injury. No mining or volcanic blast descriptions before 1800 detailed severe closed head injury survivors, suggesting greater mortality than morbidity from blast injury in the premodern era. This review also uncovered that there was no historical treatment or remedy recommended to survivors of blast injury. Blast explosions resulting in injury or death were frequently described, although in simplistic terminology.

On April 20th 2010, a large Transocean drilling rig called the Deepwater Horizon was operating in the Gulf of Mexico to drill the Macondo well, for the oil company BP. The job was six weeks behind schedule and $58 million over budget and had not been without difficulty: it was a high pressure well, 2.5 miles below the seabed. At 5.45 am, the Halliburton cementing engineer sent an email to say: 'We have completed the job and it went well'. At 9.43 pm, 16 hours later, there was a release of hydrocarbons into the well bore and the drilling rig experienced a catastrophic blowout as the high pressure oil and gas escaped onto the rig and into the ocean. The resulting explosions and fire killed 11 of the crew of 126, injured many more and created an enormous oil spill across the Gulf.

The work of Dr William E. Ladd after a devastating explosion in Halifax in 1917 has been credited with his decision to devote his subsequent career to the betterment of surgical care for children. He has been recognized as the "father of pediatric surgery" in North America. The authors present a written refutation of this causal association by Dr Ladd., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

The world's first atomic bomb was tested in New Mexico on 16 July 1945. From 1999 through 2008, scientists working for the Centers for Disease Control and Prevention gathered information relevant to past releases from Los Alamos activities, including the Trinity test. Detonation on a 30.5 m tower enhanced radioactive fallout, and terrain and wind patterns caused "hot spots" of deposition. Several ranchers reported that fallout resembling flour was visible for 4 to 5 d after the blast, and residents living as close as 19 km from ground zero collected rain water from metal roofs for drinking. Pressures to maintain secrecy and avoid legal claims led to decisions that would not likely have been made in later tests. Residents were not warned before the test or informed afterward about potential protective actions, and no evacuations were conducted. Occupied homes were overlooked on the day of the blast. Exposure rates in residential areas were recorded as high as 1.4 microC kg s (20 R h) using instruments that were crude, ill suited to field use, and incapable of effectively measuring alpha contamination from about 4.8 kg of unfissioned plutonium that was dispersed. Vehicle shielding and contamination were recognized but not corrected for. To date, the post-shot field team measurements have not been rigorously evaluated, cross-checked, adjusted, or subjected to uncertainty analysis. Evaluations of Trinity fallout published to date have not addressed internal doses to members of the public following intakes of contaminated air, water, or foods. The closing of these data gaps appears feasible with the information that has been assembled and would support placement of the Trinity event in perspective as a source of public radiation exposure and more defensible evaluation of the potential for human health effects.

The finding in 1972 of two World War II mustard gas artillery shells in crushed shell sediment dredged in the Faxaflói Bay and transported as raw material for cement production at Akranes (Western Iceland) is reported. One of the shells was wedged in a stone crusher in the raw material processing line and was ruptured. As a result dark fluid with a garlic like smell seeped out from the metal canister. The attending employees believed the metal object to be inert and tried to cut it out with a blow torch. This resulted in the explosion of the shell charge and in the exposure of four employees to mustard gas. All suffered burns on their hands and two of them in the eyes also. The second shell was detonated in the open at a distance from the factory. Emphasis is given to the fact that instant, or at least as soon as possible, cleansing and washing is the most efficient measure to be taken against the debilitating effects of mustard gas. It is also pointed out that the active principle in mustard gas (dichlorodiethyl sulphide) can easily be synthesized and none of the precursor substances are subjected to any restrictions of use. The authors conclude that mustard gas bombs may still be found in the arsenals of some military powers in spite of an international convention that prohibits the production, stockpiling and the use of chemical weapons. Terrorist groups have also seemingly tried to aquire mustard gas bombs and other chemical weapons. Therefore cases of mustard gas poisoning might still occur.

This historical study analyzes 2 disasters in Texas in the early 20th century: the 1937 school explosion in New London and the 1947 Texas City ship explosion. Disaster narratives and commemoration activities are examined as means of healing and restoration after a catastrophic event. Specifically, this article discusses contextual factors of time and place, Coastal and East Texas between 1937 and 1947, and shows how these factors shaped the ways in which people made sense of their disaster experiences. This included not only the influence of geography but also economics, social position, racial characterizations, and religious beliefs. The article also considers conflicting and biased factors that can occur regarding time and place and how these factors influenced narrative constructions.

Everyone is familiar with fireworks, common to festivals and celebrations across the world. At first glance, the history of science might appear to have little to do with the history of these explosive devices. However, fireworks were an important element of court culture in Europe, which relied on spectacle and festival to manifest the power of princes. From the fifteenth century, courts regularly set off fireworks around elaborate theatrical scenery and ephemeral temples, fascinating audiences with a variety of exotic motions and effects exploding in the night sky. Fireworks also intrigued natural philosophers, and over several centuries there were diverse interactions among the sciences and pyrotechny.

Background: Despite its prominence in Canadian history, there are few publications about the Halifax Explosion of 1917 that deal with the care of victims with eye injuries., Methods: Archived documents relating to the nature and treatment of eye injuries sustained during the Halifax Explosion were reviewed at the Public Archives of Nova Scotia and the Maritime Museum of the Atlantic. A review of current literature was performed., Results: Detailed accounts regarding the personal and surgical experience of 2 ophthalmologists, G.H. Cox and F.T. Tooke, were found. Several unpublished government and personal documents on eye injuries sustained during the Halifax Explosion are filed at the Public Archives of Nova Scotia. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had double enucleations. Most of the eye injuries were caused by shards of shattered glass. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. A Blind Relief Fund was established to help treat, rehabilitate, and compensate the visually impaired., Interpretation: Many of the eye injuries sustained during the Halifax Explosion were due to flying shards of glass. Details of their treatment provide insight into a unique and devastating event in Canadian medical history and demonstrate how eye injuries were managed in 1917.

Explosions, man-made and accidental, continue to require improved emergency medical responses. In the 1917 Halifax Explosion, an inordinate number of penetrating eye injuries occurred. A review of their treatment provides insight into a traumatic event with unique ophthalmological importance. Archived personal and government documents relating to the Halifax Explosion were reviewed at the Public Archives of Nova Scotia, Canada, along with a review of current literature. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had both eyes enucleated. Most of the eye injuries were caused by shards of shattered glass. A Blind Relief Fund was established to help treat and rehabilitate the visually impaired. The injured were given pensions through the Canadian National Institute for the Blind, Toronto, Ontario, Canada, which continue to this day. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. Even so, the severity and the overwhelming number of eye injuries sustained during the Halifax Explosion made it impossible for lengthy eye-saving procedures to be performed. Enucleation was often the only option.

After a wave of earthquakes in 1692 and 1693, the astronomer John Flamsteed composed an innovative explanation of their causes. He argued that they did not originate underground but were caused by explosions of nitrous and sulphurous particles in the air. Although the idea now sounds strange, Flamsteed's account was expressed in terms that were familiar to his contemporaries in the Royal Society, drawing particularly on Boyle's chemistry and air-pressure experiments. Flamsteed was more unusual in his conviction that the earth was virtually solid; this made him an opponent of structural theories offered by Thomas Burnet, Robert Hooke and Edmond Halley. Flamsteed's ideas were dismissed by Hooke as 'nonsensicall', but by the time they were published, long after his death, they appeared closer to mainstream thinking.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

The author reviews the main accidents produced for most in French chemistry laboratories in the XIXth century: explosions, burns, serious poisonings.

Dr. McCrone was an amazing individual, possessing many talents and having many interests. He especially loved applying polarized light microscopy (PLM) to answering the question-at-hand and solving problems. He applied PLM to many different fields including the identification of air pollution particles, asbestos identification, art conservation, pharmaceuticals, industry problems and forensic sciences. A field that I believe he enjoyed the most was the characterization and identification of explosives. Throughout his life he worked on, gave presentations and published articles on the characterization and identification of explosives. Also, he encouraged other scientists to give presentations and publish on the subject by providing "behind the scene" advice and/or be a co-author on a paper. He unselfishly taught others how to apply PLM and incorporate this invaluable tool into their analytical scheme.

In Japan nitrous oxide has been manufactured since 1955 at the request of General Headquarters of the Allied Forces. Two years later in 1957, a manufacturer built a small society for the study and popularization of nitrous oxide anesthesia as well as general anesthesia. The society gave more than twenty seminars for this purpose in various cities in a period of 8 years from 1957 until 1965. At the seminars, Prof. Yamamura of Tokyo University and other professors of anesthesiology gave their lectures on basic science of nitrous oxide anesthesia and demonstrated its use for surgical patients. In July 1962, a fatal accident of explosion during ether anesthesia occurred in a hospital in Tokyo, in which a 25-year-old male died due to combustion and explosion triggered by electrical cauterization during surgery of pulmonary empyema. This accident facilitated and accelerated rapid and wide spread of nitrous oxide anesthesia as well as anesthesiology in general in Japan.

A news item in the newspaper, the Evening Star, for the Country, October 18, 1833, probably is the first report of a mail bomb in the United States. It is also likely to be the first defusing of a mail bomb. The device appeared to be extraordinarily sophisticated and would have likely worked had it not been for suspicions of the recipient of the bomb.

September 13 1998 marked the 150th anniversary of the accident to Phineas Gage, one of the most famous cases of survival after massive injury to the brain, and certainly the most famous case of personality change after brain damage. For this article a sample of the current literature about Gage was examined. It was found that although his case is mentioned in about 60% of introductory textbooks in psychology, there is a good deal of inaccuracy in what has been written about him. Similar inaccuracy was found in a smaller sampling of the psychiatric, medical, physiological, linguistic, and general neuroscientific literature. The main basis of the inaccuracies is an ignorance or disregard of what is contained in the primary sources about Gage, coupled with a tendency to attribute to him characteristics that belong to other cases of frontal damage. The errors and their bases are discussed in an endeavour to restore the picture of Gage to its original state. The paper includes an Appendix of verbatim quotations from the primary sources that can be compared with the later, inaccurate renditions.

Howard Gardner identified five different kinds of creative activity among eminent creators, namely, solving a well-defined problem, putting forth a general conceptual scheme, creating a product that embodies ideas, stylized innovation of an art form, and a 'high-stakes' performance in the socio-political arena. In this paper, I report that Alfred Nobel's creativity can be assigned to two mutually exclusive domains. In the scientific domain, he solved a well-defined problem of his time in the study of explosives, by patenting dynamite, creating blasting gelatin as an ideal explosive and developing a nearly smokeless blasting powder. In the socio-political domain, Nobel designed a 'unique instrument' (in the form of annual prizes, which later came to be known as Nobel prizes) to recognize merit among those who contributed to social welfare at the global scale. The influence of Nobel's mentors, Nikolai Zinin, Yuli Trapp, Theophile-Jules Pelouze, Ascanio Sobrero, John Ericcson and Immanuel Nobel in igniting Nobel's scientific creativity also deserves recognition. Personal traits that helped Nobel to sharpen his creativity include his business acumen and talent for information access using his multi-lingual skills.

Fires and explosions have occurred in the operating theatre for many years. Flammable inhalation anaesthetic agents were responsible for many incidents in the past, but these are no longer available in many countries. Other causes of fires and explosions still exist in the operating theatre and, from time to time, result in serious and occasionally fatal injury. Flammable gastrointestinal gases have been the cause of injury to patients during gastric surgery, laparoscopy and during examination of the large bowel with electrical instrumentation. Gases formed in the bladder during urological procedures have ignited, causing rupture. Alcohol-based skin cleaning agents have resulted in severe burns to the skin. Equipment used for storage and delivery of oxygen to patients has caused fires in a variety of ways. Adhesive skin drapes have resulted recently in two tragic deaths. The increasing use of laser therapy, particularly in ear, nose and throat surgery, and in oral surgery, has brought about a renewed awareness of the risk of fire. The relevant factors which should be borne in mind and the precautions which should be adopted when laser therapy is to be used in the airway are discussed.

The first recorded fire resulting from the use of an anaesthetic agent occurred in 1850, when ether caught fire during a facial operation. Many subsequent fires and explosions have been reported, caused by ether, acetylene, ethylene and cyclopropane, and there has been one reported explosion involving halothane. Although some of the earlier incidents caused more consternation than injury, many of the later ones caused much death and destruction, particularly after the practice of administering oxygen, instead of air, became established. Many incidents have never been reported and many of those which have reached publication do not record essential details. The use of flammable agents has decreased significantly in recent years and although fires and explosions from nonanaesthetic causes, for example gastrointestinal gases, skin sterilizing agents and laser surgery, may continue to occur, those from gaseous and volatile anaesthetic agents may now be of historical interest only. This article reviews some of the more relevant and enlightening reports of the past 150 yr.

In June 1989, a methane/propane pipeline explosion destroyed two passenger trains in the Bashkirian Republic of the Soviet Union. Over 400 passengers died immediately and 806 were injured. Most of those injured suffered thermal injuries. One hundred and fifty patients were treated at Hospital 21 in Ufa, Bashkiria, by a combined Soviet-US team. Twenty-six patients underwent excision and grafting of their burn wounds. Microbiological studies indicated significant resistance to locally available antibiotics. Antibiotics provided by the US team proved useful in treating the resistant organisms. This disaster and the international response to it exemplify the need for a coordinated response to major burn disasters and the positive results of international cooperation.