Search

Introduction: The North Shore Rescue (NSR) Advanced Medical Provider (AMP) program is composed of physicians and nurses based in North Vancouver who attend high acuity medical search and rescue (SAR) callouts in British Columbia, Canada. This study aimed to analyze the medical care provided by AMPs with appropriate comparisons to non-AMP callouts., Methods: A retrospective review of all NSR callouts from January 1, 2018, to December 31, 2022, was conducted. The analysis included AMP involvement, rescue logistics, subject demographics, activity, primary cause, provisional diagnosis, treatments, medical decision-making, and extraction means. National Advisory Committee for Aeronautics (NACA) scores were assigned by physicians to evaluate medical acuity as well as under-triage and over-triage., Results: Of the 767 NSR callouts over the 5-year span, 283 (37%) were medical, and of these, 35% ( n  = 99) involved AMPs. Seventy-five percent of AMP rescues involved traumatic injuries, and 31% involved nontraumatic medical illnesses. The mean NACA score for AMP callouts was significantly higher than non-AMP callouts (3.1 ± 1.3 vs 1.9 ± 1.3, p  < .00001). Medications were administered in 40% of AMP rescues, procedures were performed in 54%, and 37% involved advanced medical decision-making. Over-triage occurred in 33% of AMP callouts, with under-triage in 10%., Conclusions: The AMP program provides a useful service when advanced medical care in wilderness environments is needed. AMPs coordinate appropriate medical response and ensure safe, comfortable, and efficient transport to definitive care. The NSR AMP program may act as a model for the development of similar programs by other SAR teams., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: Survival probability among individuals critically buried by avalanche is highly time dependent, which was demonstrated 30 years ago. However, it remains unclear whether avalanche survival probability has changed over time., Objective: To assess the avalanche survival rate and probability as well as the rescue probability over the past 4 decades., Design, Setting, and Participants: In this cohort study, avalanche data from Switzerland that were collected by the WSL Institute for Snow and Avalanche Research (SLF) in Davos were analyzed from the winter beginning in 1981 to that beginning in 2020 and compared with data from the period 1981 to 1990. Data were analyzed from January to April 2024., Exposure: Critical avalanche burial (ie, burial involving the head and chest)., Main Outcomes and Measures: Survival rate among individuals critically buried by avalanche, survival probability, and rescue probability in relation to time buried under the avalanche., Results: The study included 1643 individuals critically buried by avalanche (mean [SD] age, 37 [13.7] years; 1090 of 1342 with known sex [81.2%] were male) among 3805 avalanches involving 7059 persons. Compared with the period from 1981 to 1990, the total survival rate over the full study period increased from 43.5% (95% CI, 38.8%-48.3%) to 53.4% (95% CI, 51.0%-55.8%). Survival probability remained high at 91% (95% CI, 80%-100%) for rescue during the first 10 minutes but then decreased to 31% (95% CI, 11%-51%) for rescue between 10 and 30 minutes. The survival rate among those buried long term (>130 minutes) increased from 2.6% (95% CI, 0.7%-6.9%) to 7.3% (95% CI, 4.8%-10.7%). The median rescue time decreased from 45 (IQR, 15-148) minutes to 25 (IQR, 10-85) minutes. Survival rates among individuals rescued from avalanche by organized rescue teams increased from 14.0% (28 of 200) to 22.9% (161 of 704)., Conclusions and Relevance: This cohort study of 1643 individuals critically buried by avalanche found that over the past 4 decades, total survival rates considerably increased and rescue times decreased. Survival rates among those buried long term (>130 minutes) also increased. These findings are likely attributable to collaborative efforts among stakeholders to enhance avalanche search-and-rescue techniques and medical interventions.

Rescue workers (policemen, firefighters, emergency medical staff, etc.) experience intense stress due to rescuing and helping victims of accidents, terrorist attacks, violent crimes, and natural disasters. Overexposure and ineffective coping with such stressful events may lead to developing Post-Traumatic Stress Disorder (PTSD). Meta-regression procedures were applied to examine moderators such as the sample sex composition, age, working experience, occupation, country, or type of PTSD evaluation. The 9.8% PTSD prevalence found here was virtually the same compared with earlier findings from 10 years ago. There was a large heterogeneity, however, associated with geographical location and the instrument used to evaluate PTSD. The main findings revealed that rescue workers are a high-risk group with increased levels of Post-traumatic Stress Disorder (PTSD). Moreover, PTSD prevalence could depend on a great extent on geographical and cultural factors, and on the type of PTSD evaluation., (© 2024 The Author(s). Stress and Health published by John Wiley & Sons Ltd.)

Introduction: On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated., Material and Methods: Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded., Results: Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2-60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001)., Conclusion: In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble., Competing Interests: Declaration of Competing Interest There is no conflict of interest., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Importance: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected., Objective: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE)., Design, Setting, and Participants: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years., Exposures: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe., Main Outcomes and Measures: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition., Results: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15 913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001)., Conclusions and Relevance: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.

Background: Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training., Methods: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms., Results: Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness., Conclusions: These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention., (© 2024. The Author(s).)

Purpose: Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries., Methods: This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature., Results: During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer., Conclusions: Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to analyze the effects of a recovery program based on foam roller with and without vibration on blood lactate clearance and perceived fatigue after a water rescue., Methods: A quasi-experimental crossover design was carried out to compare passive (PR) recovery and a short protocol of foam roller (FR) and vibration foam roller (VFR) recovery after a 100 m water rescue in 7 volunteer lifeguards. Blood lactate and perceived exertion were measured before and after the rescue, and also after the 5-min recovery intervention., Results: Blood lactate levels decrease significantly with foam roller (p = 0.013; effect size = 0.97) and vibration foam roller recovery (p < 0.001; effect size = 1.62). Passive recovery did not show significant differences clearing out blood lactate. Fatigue perceived decrease significantly with all the recovery methods, but foam roller has higher effects on the global fatigue and VFR on the legs., Conclusion: FR and VFR clear out more blood lactate and decrease fatigue more than PR, with the subsequently increase of the physical conditioning to perform another effort., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Coastal locations contribute significantly to global drowning, with surfers frequently conducting rescues. This study explored the characteristics of surfers as bystander rescuers in Europe., Methods: A cross-sectional online survey collected demographics (age, sex, geographical location), surfing experience, ability, lifesaving and cardiopulmonary resuscitation (CPR) training, information seeking behaviors and previous performance of a rescue. Analyses comprised descriptive frequencies, binomial logistic regression with adjusted odds ratio (AOR) (95% confidence interval [CI]) and chi-squares (p < .05)., Results: Europe-dwelling respondents totaled 1705 (76% male; 43% 25-34 years). Thirty-nine percent (39.2%; n = 668) had previously performed a rescue. Likelihood of having conducted a rescue significantly increased with 6 or more years of surfing experience (6-10 years [AOR = 1.96; 95%CI: 1.20-3.22]; 11-15 years [AOR = 3.26; 95%CI: 1.56-6.79]; 16 years or more [AOR = 4.27; 95%CI: 2.00-9.11]) when compared to surfers with <1 year experience. Expert/professional ability surfers were 10.89 times (95%CI: 4.72-25.15) more likely to have conducted a rescue than novice/beginners. Respondents who had received both a certified lifeguard and CPR course were significantly more likely to have conducted a rescue (AOR = 3.34; 95%CI: 2.43-4.60)., Conclusion: Surfers who had previously conducted rescues commonly had more years of experience, higher self-rated surf ability and greater likelihood of having received certified training. However, not all surfers who have performed rescues had received training. Findings suggest surfers should receive rescue and CPR training before they start surfing at locations without trained supervision and refresh training regularly. Surfers are amenable to injury prevention information, especially online and via apps., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions., Methods: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019., Results: During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %)., Conclusions: Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions., (© 2021. The Author(s).)

Autonomous drones will play an essential role in human-machine teaming in future search and rescue (SAR) missions. We present a prototype that finds people fully autonomously in densely occluded forests. In the course of 17 field experiments conducted over various forest types and under different flying conditions, our drone found, in total, 38 of 42 hidden persons. For experiments with predefined flight paths, the average precision was 86%, and we found 30 of 34 cases. For adaptive sampling experiments (where potential findings are double-checked on the basis of initial classification confidences), all eight hidden persons were found, leading to an average precision of 100%, whereas classification confidence was increased on average by 15%. Thermal image processing, classification, and dynamic flight path adaptation are computed on-board in real time and while flying. We show that deep learning-based person classification is unaffected by sparse and error-prone sampling within straight flight path segments. This finding allows search missions to be substantially shortened and reduces the image complexity to 1/10th when compared with previous approaches. The goal of our adaptive online sampling technique is to find people as reliably and quickly as possible, which is essential in time-critical applications, such as SAR. Our drone enables SAR operations in remote areas without stable network coverage, because it transmits to the rescue team only classification results that indicate detections and can thus operate with intermittent minimal-bandwidth connections (e.g., by satellite). Once received, these results can be visually enhanced for interpretation on remote mobile devices., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Background: Over 90,000 rescue and recovery responders to the September 2001 World Trade Center (WTC) attacks were exposed to toxic materials that can impair cardiac function and increase cardiovascular disease (CVD) risk. We examined WTC-related exposures association with annual and cumulative CVD incidence and risk over 17 years in the WTC Health Program (HP) General Responder Cohort (GRC)., Methods: Post 9/11 first occurrence of CVD was assessed in 37,725 responders from self-reported physician diagnosis of, or current treatment for, coronary artery disease, myocardial infarction, stroke and/or congestive heart failure from WTCHP GRC monitoring visits. Kaplan-Meier estimates of CVD incidence used the generalized Wilcoxon test statistic to account for censored data. Cox proportional hazards regression analyses estimated the CVD hazard ratio associated with 9/11/2001 arrival in responders with and without dust cloud exposure, compared with arrival on or after 9/12/2001. Additional analyses adjusted for comorbidities., Results: To date, 6.3% reported new CVD. In covariate-adjusted analyses, men's CVD 9/11/2001 arrival risks were 1.40 (95% confidence interval [CI] = 1.26, 1.56) and 1.43 (95% CI = 1.29, 1.58) and women's were 2.16 (95% CI = 1.49, 3.11) and 1.59 (95% CI = 1.11, 2.27) with and without dust cloud exposure, respectively. Protective service employment on 9/11 had higher CVD risk., Conclusions: WTCHP GRC members with 9/11/2001 exposures had substantially higher CVD risk than those initiating work afterward, consistent with observations among WTC-exposed New York City firefighters. Women's risk was greater than that of men's. GRC-elevated CVD risk may also be occurring at a younger age than in the general population., (© 2020 Wiley Periodicals LLC.)

Objective: Lifeguard teams carry out their work in extremely hot conditions in many parts of the world. The aim of this study was to analyze the impact of high temperatures on physiological parameters during cardiopulmonary resuscitation (CPR)., Method: A randomized quasi-experimental cross-over design was used to test physiological lifesaving demands (50 min acclimatization +10 min CPR) in two different thermal environments: Thermo-neutral environment (25 °C) vs Hyperthermic environment (37 °C)., Results: The data obtained from 21 lifeguards were included, this covers a total of 420 min of resuscitation. The CPR performance was constantly maintained during the 10 min. The Oxygen uptake (VO 2) ranged from 17 to 18 ml/min/kg for chest compressions (CC) and between 13 and 14 ml/min/kg for ventilations (V) at both 25 °C and 37 °C, with no significant difference between environments (p > 0.05). The percentage of maximum heart rate (%HR max) increased between 7% and 8% at 37 °C (p < 0.001), ranging between 75% and 82% of HR max. The loss of body fluids (LBF) was higher in the hyperthermic environment; LBF: (37 °C: 400 ± 187 g vs 25 °C: 148 ± 81 g, p < 0.001). Body temperature was 1 °C higher at the end of the test (p < 0.001). The perceived fatigue (RPE) increased by 37° an average of 2 points on a scale of 10 (p = 0.001)., Conclusions: Extreme heat is not a limiting factor in CPR performance with two lifeguards. Metabolic consumption is sustained, with an increase in CC, so V can serve as active rest. Nevertheless, resuscitation at 37 °C results in a higher HR, is more exhausting and causes significant loss of fluids due to sweating., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches., Competing Interests: The authors have declared that no competing interests exist.

The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.34; 95% CI, 0.31–0.37). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers ( n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Objective: To determine the factors influencing insomnia and construct early insomnia warning tools for rescuers to informbest practices for early screening and intervention., Methods: Cluster sampling was used to conduct a cross-sectional survey of 1,133 rescuers from one unit in Beijing, China. Logistic regression modeling and R software were used to analyze insomnia-related factors and construct a PRISM model, respectively., Results: The positive rate of insomnia among rescuers was 2.74%. Accounting for participants' age, education, systolic pressure, smoking, per capita family monthly income, psychological resilience, and cognitive emotion regulation, logistic regression analysis revealed that, compared with families with an average monthly income less than 3,000 yuan, the odds ratio ( OR ) values and the [95% confidence interval ( CI )] for participants of the following categories were as follows: average monthly family income greater than 5,000 yuan: 2.998 (1.307-6.879), smoking: 4.124 (1.954-8.706), and psychological resilience: 0.960 (0.933-0.988). The ROC curve area of the PRISM model (AUC) = 0.7650, specificity = 0.7169, and sensitivity = 0.7419., Conclusion: Insomnia was related to the participants' per capita family monthly income, smoking habits, and psychological resilience on rescue workers. The PRISM model's good diagnostic value advises its use to screen rescuer early sleep quality. Further, advisable interventions to optimize sleep quality and battle effectiveness include psychological resilience training and smoking cessation., (Copyright © 2020 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Objective: Posttraumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) often coexist among survivors of the September 11, 2001 (9/11) World Trade Center (WTC) attacks. Research in police and nontraditional responders suggests that PTSD mediates the relationship between 9/11 physical exposures and LRS, but not vice versa. We replicated these findings in WTC rescue/recovery workers (R/R workers), extended them to exposed community members, and explored the interplay between both physical and psychological 9/11 exposures, probable PTSD, and LRS over a 10-year follow-up., Methods: Participants were 12,398 R/R workers and 12,745 community members assessed in three WTC Health Registry surveys (2003-2004, 2006-2007, and 2011-2012). LRS and 9/11 exposures were self-reported. Probable PTSD was defined as a PTSD Checklist score ≥44., Results: Probable PTSD predicted LRS (R/R workers: β = 0.88-0.98, p < .001; community members: β = 0.67-0.86, p < .001) and LRS predicted PTSD (R/R workers: β = 0.83-0.91, p < .001; community members: β = 0.68-0.75, p < .001) at follow-ups, adjusting for prior symptoms and covariates. In both R/R workers and community members, probable PTSD mediated the relationship between 9/11 physical exposures (dust cloud, long duration of work) and LRS (indirect effects, p = .001-.006), and LRS mediated the physical exposure-PTSD relationship (indirect effects, p = .001-.006). In R/R workers, probable PTSD mediated the psychological exposure (losing friends or loved ones, witnessing horrific events)-LRS relationship (indirect effect, p < .001), but LRS did not mediate the psychological exposure-PTSD relationship (indirect effect, p = .332). In community members, high 9/11 psychological exposure predicted both probable PTSD and LRS at follow-ups; probable PTSD mediated the psychological exposure-LRS relationship (indirect effect, p < .001), and LRS mediated the psychological exposure-PTSD relationship (indirect effect, p = .001)., Conclusions: Probable PTSD and LRS each mediated the other, with subtle differences between R/R workers and community members. A diagnosis of either should trigger assessment for the other; treatment should be carefully coordinated.

Although several factors associated with posttraumatic stress disorder (PTSD) in disaster rescue workers were identified in previous studies, the results were inconsistent. This study aimed to explore the prognostic factors of PTSD among disaster rescuers using different screening tools. A 6.4 magnitude earthquake struck southern Taiwan on February 6, 2016. Emergency medical technicians (EMTs) who responded to the earthquake were recruited. The initial survey was conducted one month after the earthquake using a standardized, self-reported, paper-based questionnaire. After six months, we re-evaluated the EMTs using the same questionnaire that was used in the baseline survey. A total of 38 EMT-paramedics were enrolled in the final analysis. Significant differences in PTSD scores at baseline existed between EMTs with and without certain risk factors. The interaction between survey time and risk factors was not significant, but several risk factors correlated with a nonsignificant improvement in the PTSD score after the 6-month follow-up. Perfectionism personality characteristics and several specific field experiences (managing injured patients, managing dead victims, managing dead victims who were pregnant, managing emotionally distraught families, or guilty feelings during the missions) might affect different subdomains of PTSD symptom improvement. Disaster rescuers should be followed up after their missions, regardless of their age, gender, or previous experience with disaster response. EMTs with certain personality characteristics or who are involved in specific field operations should be carefully monitored during and after disaster rescue missions.

Background/purpose: People with different age distributions and extrication times might have distinct injury characteristics and outcomes in earthquakes., Methods: A retrospective study was conducted to analyze the casualties in the 2016 Taiwan earthquake using data from the incident registry system and the field disaster operation system. The study subjects were assigned to 4 groups by age: preschool (<5 years), school (5-17 years), adult (18-64 years), and elderly (>64 years). Classification and regression tree analysis and receiver-operating characteristic curves were utilized to examine several factors, including extrication time, age group, floor height, and structural damage, for earthquake-related mortality. A two-sided p value less than 0.05 was considered statistically significant., Results: A total of 238 enrollees were assigned to the preschool (n = 18, 7.6%), school (n = 45, 18.9%), adult (n = 169, 71.0%), or elderly (n = 6, 2.5%) groups. Among the parameters, the extrication time exhibited the strongest association with mortality. Regarding the association between the extrication time and mortality hazard in multivariate models, we found significant odds ratios (ORs) at the extrication time cutoffs of 12, 24 and 72 h (OR = 42.61, 95% confidence interval [CI]: 13.92-130.37; OR = 37.58, 95% CI: 14.77-95.60; OR = 95.16, 95% CI: 23.02-393.48, respectively, all p < 0.001). The optimal extrication time cutoff for mortality was 12 h in the preschool group and 24 h in the school and adult groups., Conclusion: Extrication time is strongly associated with earthquake-related mortality. These findings may facilitate strategic approaches for patients entrapped in damaged buildings and can contribute to future training for field search and rescues after earthquakes., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Objective: To examine fatal drowning associated with aquatic rescues and prior self-reported experience of undertaking an aquatic rescue in Australia., Methods: Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue-related fatal unintentional drowning between 1 January 2006 and 31 December 2015., Results: Twenty-three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X 2 =35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X 2 =13.5; p<0.001). Females were more likely to have rescued a child (0-4 years of age) (X 2 =29.2; p<0.001) from a swimming pool (X 2 =34.3; p<0.001). Fifty-one people drowned while performing an aquatic rescue (Males=82.4%; 25-44 years of age=53.0%; beaches=54.9%)., Conclusions: Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community-wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning. Implications for public health: There is a need to train people early in their life on how to undertake a safe rescue and provide resuscitation, including promoting regular updates, in particular if supervising children., (© 2019 The Authors.)

Objective: Mine rescue teams bear a high risk of injury. To improve medical emergency preparedness and injury prevention, this work analyzed the causes and severity of mine rescue teams' casualty incidents, the primary injuries, and the link between the causes and the occurrences of the casualty incidents., Methods: A total of 81 cases from 1953 to 2013 were used to analyze the casualty incidents of mine rescue teams based on the frequency of accidents. A panel with 4 rescue experts was set up to ensure the accuracy of the analysis., Results: The 81 casualty incidents occurred in 7 types of rescue work and were due to 6 causes. Organizational and personal factors were the leading cause, followed by rescue skill and equipment factors. Problems with decision-making and command have gradually become the primary inducement of casualty incidents in recent years, with an average death toll reaching up to 6 to 7 people. The main injuries causing death to team members were blast injury, burns, poisoning, suffocation, blunt trauma, and overwork injury. Some of the injured died because of medical emergency response failure., Conclusion: The construction of emergency medical teams and the preparedness of disaster medicine need to be improved to reduce the mortality of the injured team members. Actions according to the causes of casualty incidents should be adopted for injury prevention. (Disaster Med Public Health Preparedness. 2019;13:695-699).

Introduction: Helicopter emergency medical services (HEMS) contribute to and complement other specialized search and rescue (SAR) services. Conversely, traditional SAR services perform medical evacuation (medevac), depending on crew, training, medical equipment, and procedures for interdisciplinary cooperation. We aim to describe and compare SAR and remote medevac mission characteristics in a military SAR helicopter system to a civilian HEMS operating in the same region., Methods: Retrospective, observational study of SAR and remote medevac missions performed at a Norwegian military SAR helicopter and civilian HEMS base in the 5-y period from January 1, 2013 to December 31, 2017. Descriptive statistics and median values with interquartile range (IQR) were applied where appropriate. Comparisons were performed with the Mann-Whitney U test., Results: We included 721 missions. The SAR service performed 359 (50%) missions, of which 237 (33%) were SAR and 122 (17%) were remote medevac missions. The HEMS service performed 85 (12%) SAR and 277 (38%) remote medevac missions. Median mission time for SAR missions was 152 (IQR 100-235) min for the SAR service and 57 (IQR 34-89) min for the HEMS service. Trauma was the dominating mechanism in 48% of patients, followed by medical conditions (21%) and psychiatric disorders (9%). Medevac patients in both services had a higher median National Advisory Committee for Aeronautics score of 3 (IQR 2-4) compared to 1 (IQR 0-3) in SAR missions (P<0.05)., Conclusions: Both SAR and HEMS services perform SAR and remote medevac missions extensively and mission profiles vary., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction: The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting., Methods: An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD., Result: The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045)., Conclusions: SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y., (Copyright © 2018 Wilderness Medical Society. All rights reserved.)

After an earthquake, the important task of emergency rescue work is to minimize casualties, but due to the suddenness of earthquake disasters, it is difficult to obtain enough disaster information immediately, especially personnel distribution and movement information. The traditional methods of obtaining disaster data are through reports from the disaster area or field investigations by the emergency rescue team; this work lags, and its efficiency is low. This paper analyzes the feasibility of using mobile phone location signal data in earthquake emergency rescue work in several respects, such as quantity, location, change rate, and epicentral distance. The results show that mobile phone location signal data can quickly obtain the situation of personnel distribution and quantity after an earthquake, and we find the change rate, distance, etc., can determine the approximate range of the earthquake impact field. Through the data distribution in different time periods, the movement of personnel after the earthquake can be obtained. Based on several situations, we can determine the basic situation of the disaster-stricken areas in times after the earthquake, especially the personnel relevant to the situation, and these data can provide a scientific basis for emergency rescue decision making., Competing Interests: The authors have declared that no competing interests exist.

An increased incidence of thyroid cancer among 9/11 rescue workers has been reported, the etiology of which remains unclear but which may, at least partly, be the result of the increased medical surveillance this group undergoes. This study aimed to investigate thyroid cancer in World Trade Center (WTC) responders by looking at the demographic data and questionnaire responses of thyroid cancer cases from the Mount Sinai WTC Health Program (WTCHP). WTCHP thyroid cancer tumors were of a similar size ( p = 0.4), and were diagnosed at a similar age ( p = 0.2) compared to a subset of thyroid cancer cases treated at Mount Sinai without WTC exposure. These results do not support the surveillance bias hypothesis, under which smaller tumors are expected to be diagnosed at earlier ages. WTCHP thyroid cancer cases also reported a past history of radiation exposure and a family history of thyroid conditions at lower rates than expected, with higher than expected rates of previous cancer diagnoses, family histories of other cancers, and high Body Mass Indexes (BMIs). Further research is needed to better understand the underlying risk factors that may play a role in the development of thyroid cancer in this group.

Background: Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown., Objectives: To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions., Methods: We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance., Results: Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB., Conclusions: Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions., Capsule Summary: Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.

An issue of growing importance within the field of drowning prevention is the undertaking of aquatic rescues by bystanders, who sometimes drown in the process. The main objectives of this study were to describe characteristics of bystanders making rescues in different Australian aquatic environments, identify the role of prior water safety training in conducting bystander rescues and provide insights into future public education strategies relating to bystander rescue scenarios. An online survey was disseminated via various social media platforms in 2017 and gathered a total of 243 complete responses. The majority of bystander rescues described took place in coastal waterways (76.5%; n = 186), particularly beaches (n = 67), followed by pools (17.3%; n = 42) and inland waterways (6.2%; n = 15). The majority of respondents were males (64.2%; n = 156) who rescued on average approximately twice as many people in their lifetime (6.5) than female respondents (3.6). Most rescues occurred more than 1 km from lifeguard/lifesaver services (67%; n = 163), but in the presence of others (94.2%; n = 229). The majority of bystander rescuers had water safety training (65.8%; n = 160), self-rated as strong swimmers (68.3%; n = 166), conducted the rescue without help from others (60%; n = 146), did not use a flotation device to assist (63%; n = 153), but were confident in their ability to make the rescue (76.5%; n = 186). However, most considered the situation to be very serious (58%; n = 141) and felt they had saved a life (70.1%; n = 172). With the exception of pools, most bystanders rescued strangers (76.1%; n = 185).While Australia clearly benefits from having a strong water safety culture, there is no clear consensus on the most appropriate actions bystanders should take when confronted with a potential aquatic rescue scenario. In particular, more research is needed to gather information regarding bystander rescues undertaken by those without prior water safety training., Competing Interests: The authors have declared that no competing interests exist.

ABSTRACTOn October 7, 2016, Hurricane Matthew traveled along the coasts of Florida, Georgia, and South Carolina causing flooding and power outages. The Georgia Department of Public Health (DPH) developed the Web-based Responder Safety, Tracking, and Resilience (R-STaR) system to monitor the health and safety of public health responders and to inform disaster response planning for Hurricane Matthew. Using R-STaR, responders (n = 126) were e-mailed a daily survey while deployed to document injuries or harmful exposures and a post-deployment survey on their post-deployment health and satisfaction with using R-STaR. DPH epidemiologists contacted responders reporting injuries or exposures to determine the need for medical care. Frequencies were tabulated for quantitative survey responses, and qualitative data were summarized into key themes. Five percent (6/126) of responders reported injuries, and 81% (43/53) found R-STaR easy to use. Suggestions for R-STaR improvement included improving accessibility using mobile platforms and conducting pre-event training of responders on R-STaR. Lessons learned from R-STaR development and evaluation can inform the development and improvement of responder health surveillance systems at other local and state health departments and disaster and emergency response agencies. (Disaster Med Public Health Preparedness. 2019;13:74-81).

Introduction: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation., Methods: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables., Results: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively., Conclusions: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues., (Copyright © 2018 Wilderness Medical Society. All rights reserved.)

Objective: Have World Trade Center Health Registry (WTCHR) enrollees experienced increased alcohol and drug-related mortality associated with exposures to the events of 9/11/01?, Methods: Cases involving death due to alcohol or drugs between 2003 and 2012 in New York City (NYC) were obtained through a match of the Registry with NYC Vital Records. We compared ICD-10-coded deaths where alcohol and/or drug use was the underlying cause of death to deaths from all other causes., Results: Of 1193 deaths, 66 (5.5%) were alcohol/drug-related. Adjusted odds ratios for dying from alcohol/drug-related causes were significantly elevated for enrollees who were male, age 18 to 44 years, smoked at enrollment, had 9/11-related probable posttraumatic stress disorder, were rescue/recovery workers, or sustained an injury on 9/11/01., Conclusion: Following a major disaster, alcohol and drug-related mortality may be increased.

Background: Many organizations are implementing mental health training for managers to facilitate better communication between managers and employees suffering from mental health problems. Much of this training focuses on improving managers' mental health literacy and reducing stigma. However, it is unclear whether this focus is appropriate or whether other targets, such as improving skills and confidence, should be given greater consideration., Aims: To test whether knowledge, attitudes and confidence are associated with managers' behavioural responses to mental health issues among their staff., Methods: Managers from a large Australian fire and rescue service completed a questionnaire addressing their knowledge, attitudes, confidence and behavioural responses when managing employee mental health issues. The relationship was assessed using logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated., Results: Eighty-five managers responded (response rate 66%). Managers' confidence was the strongest predictor of their behaviour. Managers who felt confident discussing mental health were significantly more likely to make contact with an employee who was suspected to be suffering from a mental illness (OR 15.79, 95% CI 3.03-82.37, P < 0.01) or was on sickness leave for mental health reasons (OR 19.84, 95% CI 2.25-175.15, P < 0.01). Non-stigmatizing attitudes towards mental illness also significantly predicted contact with a staff member off work due to mental health problems (OR 5.22, 95% CI 1.21-22.54, P < 0.05)., Conclusions: Our findings suggest that manager mental health training should focus on building their confidence and reducing stigma in order to have the greatest chance of altering workplace practices.

On April 25, 2015, a massive 8.1-magnitude earthquake struck Nepal at 2:11 pm (Beijing time). The 68-member-strong China International Search & Rescue Team (CISAR) left for Nepal at 6 am, April 26, to help with relief work. The CISAR was the first foreign team to rescue a survivor who was trapped beneath the rubble in the Gongabu area after the earthquake. On May 8, the team fulfilled the search-and-rescue mission and returned to Beijing. During the 2 weeks of rescue work, the team treated more than 3700 victims and cleared approximately 430 buildings. In this rescue mission, 10 experienced medical officers (including nine doctors and a nurse) from the General Hospital of Chinese People's Armed Police Force (PAP) comprised the medical team of CISAR. In this report, we focus on the medical rescues by CISAR and discuss the characteristics of the medical rescue in Nepal. (Disaster Med Public Health Preparedness. 2018;12:536-538).

Objective: To investigate the association of wave height and tidal water level changes with the frequency of ocean lifeguard rescues., Methods: All ocean lifeguard rescues recorded by Newport Beach Lifeguards in 2015 and 2016 were linked by time and location to weather and ocean variables contained in other historical databases. We performed separate multivariable analyses using mixed effects negative binomial regression to evaluate the total effects of wave height, mean water level (primarily set by tidal elevation), and rising vs. falling water level, on the frequency of ocean rescue in the study location, controlling for confounding variables., Results: Newport Beach Lifeguards made 8046 rescues during the study period. In all areas of the beach, rescue frequency increased as waves got larger (IRR: 3.25; 95%CI: 2.91-3.79) but then decreased in large surf (IRR: 0.52; 95%CI: 0.37-0.73). In two sections of beach, lifeguards made more rescues during lower water levels, but in the third section of beach, made more rescues during higher water levels. Rescue frequency increased in two sections of beach with rising water levels, but did not in the other section., Conclusions: Wave height, water level, and water level direction were associated with rescue frequency, but the environmental factors included in the analysis did not fully account for most variation in rescue frequency. Other factors need to be evaluated to identify major determinants of rescue frequency., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: In light of government investment over the past decade, we explored the capacity for disaster response in Heilongjiang Province, identifying the factors that affect response capacity., Methods: We surveyed 1257 medical staff in 65 secondary and tertiary hospitals in Heilongjiang province to explore their perceptions of disaster management capacity using a cross-sectional multistage, stratified cluster sampling method., Results: All tertiary hospitals (100%) and most secondary hospitals (93%) have documented disaster management plans that are regularly reviewed. In secondary hospitals, drills were less prevalent (76.7%) but the occurrence of simulated training exercises was closer to tertiary hospitals (86.0%). We noted that 95.4% of all hospitals have leadership groups responsible for disaster preparedness capacity building, but only 10.8% have a stockpiled network of reserve supplies., Conclusions: Although response capacity has improved in Heilongjiang Province, vulnerabilities remain. We recommend that priorities should be targeted at preparedness capacity building, in terms of reliable and relevant operational response plans, the expansion of existing response mechanisms to oversee local education and scenario training, and to ensure there is sufficient access to protective equipment and materials, either held in reserve, or alternatively by activating resilient supply chain mechanisms. (Disaster Med Public Health Preparedness. 2018;12:176-183).

Introduction: The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015., Methods: This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter., Results: From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393-434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries., Conclusions: A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter., (Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions associated with 9/11-exposure. Researchers searched seven databases for literature published in English from 2002 to October 2017, coded, and included articles for health condition outcome, population, 9/11-exposures, and comorbidity. Of the 322 titles and abstracts screened, 30 studies met inclusion criteria, and of these, 28 were from three cohorts: the World Trade Center Health Registry, Fire Department of New York, and World Trade Center Health Consortium. Most studies focused on rescue and recovery workers. While many of the findings were consistent across different populations and supported by objective measures, some of the less studied conditions need additional research to substantiate current findings. In the 16 years after 9/11, longitudinal cohorts have been essential in investigating the health consequences of 9/11-exposure. Longitudinal studies will be vital in furthering our understanding of these emerging conditions, as well as treatment effectiveness., Competing Interests: The authors declare no conflict of interest.

Background: At 9:28 pm on June 1, 2015, the cruise ship "Oriental Star" sank into Yangtze River in Jianli County, with 422 people killed. When the accident occurred, the Chinese government took immediate action and dispatched more than 9000 rescuers. The risk for outbreak of schistosomiasis was increased because of the shipwreck. Obviously it is critical to carry out risk assessment as soon as possible., Methods: By means of the Delphi method, the situation was analyzed so that the government could fathom the severity of the accident. Then, through matrix and sigma-plotting (3-dimensional graphics) methods, related authorities performed risk assessment after site investigation., Results: The latest news reported that more than 9000 people were involved in the rescue. The affected river was analyzed and mapped using SigmaPlot software, according to which the possibility, harmfulness, and controllability of the accident were determined to be medium (6), medium (6), and poor (7), respectively., Conclusion: The site of the accident where the cruise ship sank and rescue operations were carried out is a schistosomiasis epidemic area with high mortality and morbidity. The chance of an outbreak of the schistosomiasis epidemic in Jianli County is quite high. To protect people in this county from the epidemic, relevant logistic services should be arranged and all remains should be cleared up carefully. (Disaster Med Public Health Preparedness. 2018;12:147-153).

Background: Multiple comorbidities have been reported among rescue/recovery workers responding to the 9/11/2001 WTC disaster. In this study, we developed an index that quantifies the cumulative physiological burden of comorbidities and predicts life expectancy in this cohort., Methods: A machine learning approach (gradient boosting) was used to model the relationship between mortality and several clinical parameters (laboratory test results, blood pressure, pulmonary function measures). This model was used to construct a risk index, which was validated by assessing its association with a number of health outcomes within the WTC general responder cohort., Results: The risk index showed significant associations with mortality, self-assessed physical health, and onset of multiple chronic conditions, particularly COPD, hypertension, asthma, and sleep apnea., Conclusion: As an aggregate of several clinical parameters, this index serves as a cumulative measure of physiological dysregulation and could be utilized as a prognostic indicator of life expectancy and morbidity risk., (© 2017 Wiley Periodicals, Inc.)

Background: Injuries remain a major contributor of morbidity and mortality worldwide, with drowning accounting for 7% of all injury-related deaths with rates of between 4 and 8 per 100,000. The African region has death rates comparable to most low-income countries. Non-fatal drowning in Africa remains unquantified but it is estimated to be ten times higher than the fatal drowning rate. Timely search and rescue, initial resuscitation and rapid transportation to definitive care play a crucial role in preventing injury- related morbidity and mortality. The National Sea Rescue Institute (NSRI) of South Africa is a non-profit organisation responsible for ~97% of maritime search and rescue operations in South Africa (including inland navigable waters). The aim of the study was to describe the epidemiology of operations performed by the NSRI of South Africa over a 5-year period., Materials and Methods: The NSRI operational database was analysed from 1 January 2010 to 31 December 2014. Summary statistics are presented., Results: The NSRI launched 3281 operations over the study period. Marked seasonal variation were noticeable with peak periods in December and January, corresponding to the South African summer holiday season. Water-based operations (67.6%) were the most frequent operation performed. The NSRI assisted 3399 individuals of which 77% were male. The mean age of rescued persons was 42 years. Eight hundred and thirty-six (25%) individuals had non-fatal injuries or illnesses requiring medical assistance. Medical emergencies (35%), traumatic injuries (32.8%), and non-fatal drownings (23%) were the most common types of injury and illness. The majority of the 184 (18%) deaths recorded were due to drowning (75%)., Conclusions: Injury and illness, specifically drowning utilise a large proportion of search and rescue services. The results suggest further preventative measures and public health strategies be implemented to minimise traumatic and medical incident severity and subsequent casualties at sea.

Pasquier, Mathieu, Louis Marxer, Hervé Duplain, Vincent Frochaux, Florence Selz, Pierre Métrailler, Grégoire Zen Ruffinen, and Olivier Hugli. Indications and outcomes of helicopter rescue missions in alpine mountain huts: A retrospective study. High Alt Med Biol 18:355-362, 2017., Aims: This retrospective study describes the rescue indications and outcome of patients rescued by helicopter from mountain huts in the Swiss Alps. The hospital course and operational data were also studied., Results: Among 14,872 helicopter rescue missions undertaken during the 10-year study period, 309 (2.1%) were performed from mountain huts at a mean altitude of 2794 ± 459 m. The mean age of the patients was 43 ± 16 and 66% were male. Thirty-four percent of the patients had a National Advisory Committee for Aeronautics score ≥3. Most (89%) patients were transported to hospital and only 12 (3.9%) patients had to stay more than 48 hours. Hospital diagnoses were extremely varied. Trauma accounted for 50% and altitude diseases for 7% of the cases. A winching procedure was performed 18 times and 19 missions included a night flight., Conclusions: Helicopter rescue missions in mountain huts are a small part of all rescue missions. Our study provides a better understanding of medical emergencies arising in mountain huts. The diagnoses encountered are extremely varied in their type and severity. Hut keepers should be prepared for these situations as they will often have to act as first responders in the case of medical problems.

Objective: To examine the association between 9/11-related exposures and self-reported hearing problems among 16,579 rescue/recovery workers in the World Trade Center (WTC) Health Registry., Methods: Using Registry Waves 1 (2003 to 2004) and 2 (2006 to 2007), we modeled the association between two metrics of 9/11-related exposures and hearing difficulties., Results: The prevalence of incident, persistent hearing problems was 4.4%. In a fully adjusted model, workers with higher environmental hazards scores were twice as likely (interquartile range OR 2.1; 95% confidence interval [CI] 1.8, 2.5) to report hearing problems. Based on the same fully adjusted model, workers unable to hear in the dust cloud were 2.3 (95% CI 1.8, 3.0) times more likely to report hearing problems as compared with workers not in the dust cloud., Conclusions: We observed a consistent association between WTC-related exposures and self-reported hearing problems among rescue/recovery workers.

Objective: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity., Methods: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures., Results: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons)., Conclusions: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.

Research on workplace injuries and exposures in ocean safety personnel remains limited. Despite increasing beach attendance and reliance on lifeguards for protection, the most common types of injuries, equipment resulting in injuries, and environmental exposures remains unknown. This study reviewed OSHA 300 logs summarizing workers' compensation claims from 2007-2012 to identify common body parts injured, action at time of injury, equipment causing injury, and environmental exposures. A secondary phase consisted of a cross-sectional anonymous survey to determine demographics, body part injured, equipment causing injury, sun and environmental exposures, action at time of injury, and proportion of injuries reported to the department. During the 6-year period, 304 claims from the OSHA logs were reviewed, finding the lower extremity was most commonly injured with 2921 (31.9%) cumulative lost work days (104 reported injured, 34.2%) followed by the back with 1679 (18.4%) lost work days (39 reported injuries, 12.8%). Of the 304 occupational injury claims from OSHA logs, 108 incidents (35.5%) occurred during rescues, 87 (28.6%) during normal duties, and 31 (10.2%) during training. Of survey participants, 22/52 sustained an injury, with 14 filling a worker's compensation claim. The rescueboard resulted in 7/22 injuries (31.8%) while 17 (32.7%) of respondents sought care for a sun related concern with a mean of 9.3 days lost. Occupational injuries in ocean safety personnel are largely unknown. In this study, lower extremity and back injuries were the most common musculoskeletal injuries providers encountered. Rescues and moving equipment were common actions at the time of injury. With this preliminary information, jurisdictions may develop training directed at rescue techniques and safer options for moving heavy equipment.

Background: Navy medical personnel have been recording en route care (ERC) missions through Search and Rescue (SAR) reports since the 1970's. Our objective was to report clinical ERC cases treated by Navy operational assets from January 2012 to January 2015., Methods: The Search and Rescue Model Manager office collects SAR reports for all patient transports involving Navy personnel and equipment. From these reports, descriptive statistics to include total number of patients transported, percentages of Advanced Life Support versus Basic Life Support transports, time of transport, and type of ERC provider for the transport were collected. Data reported as median (interquartile range) or percentages., Results: During a 3-year period, 428 patients were transported. Transport time was 54 (30-78) minutes. Missions were staffed by more than one provider 22% of the time. Individual providers included 76% Search and Rescue Medical Technicians, 25% Flight Surgeons, and 21% Other. Patients required ALS transport 54% of the time. Less than half (48%) of the patients were trauma related., Conclusion: In our review of 428 SAR reports from Navy ERC (2012-2015), we found that 76% of the missions were performed by Search and Rescue Medical Technicians and 54% met Advanced Life Support transport criteria., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Objectives: The research purpose was to analyze data concerning chemical incidents in Poland collected in 1999-2009 in terms of health hazards., Material and Methods: The data was obtained, using multimodal information technology (IT) system, from chemical incidents reports prepared by rescuers at the scene. The final analysis covered sudden events associated with uncontrolled release of hazardous chemical substances or mixtures, which may potentially lead to human exposure. Releases of unidentified substances where emergency services took action to protect human health or environment were also included., Results: The number of analyzed chemical incidents in 1999-2009 was 2930 with more than 200 different substances released. The substances were classified into 13 groups of substances and mixtures posing analogous risks. Most common releases were connected with non-flammable corrosive liquids, including: hydrochloric acid (199 cases), sulfuric(VI) acid (131 cases), sodium and potassium hydroxides (69 cases), ammonia solution (52 cases) and butyric acid (32 cases). The next group were gases hazardous only due to physico-chemical properties, including: extremely flammable propane-butane (249 cases) and methane (79 cases). There was no statistically significant trend associated with the total number of incidents. Only with the number of incidents with flammable corrosive, toxic and/or harmful liquids, the regression analysis revealed a statistically significant downward trend. The number of victims reported was 1997, including 1092 children and 18 fatalities., Conclusions: The number of people injured, number of incidents and the high 9th place of Poland in terms of the number of Seveso establishments, and 4 times higher number of hazardous industrial establishments not covered by the Seveso Directive justify the need for systematic analysis of hazards and their proper identification. It is advisable enhance health risk assessment, both qualitative and quantitative, by slight modification of the data collection system so as to enable the determination of released chemical concentration and exposed populations. Int J Occup Med Environ Health 2017;30(1):95-110., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Rescue after a maritime disaster remains a great challenge in emergency medicine., Objective: We performed an overview of rescue efforts among the victims in the sunken cruise ship Eastern Star in the 2015 Changjiang River marine disaster, as well as possible preventive measures in maritime transport situations., Methods: The rescue records of 454 victims of the sunken ship were analyzed retrospectively. Their demographic data, rescue effects, accident inducement, and injury disposition were reviewed. A thorough analysis from the point of view of maritime traffic safety was also performed., Results: Of the 454 victims, 442 (97.36%) were killed and only 12 (2.64%) survived. The survivors were classified based on their gender, rescue type, and rescue spot as follows: male (91.67%), female (8.33%); tourists (50.00%), and ship staff (50.00%), after the breakdown of the rescue spot in Jianli, Hubei province, China. The survivors were saved only during the initial 17 h after the disaster. The survivors suffering from somato- and psychotrauma were urgently treated for limb injuries, infections of the upper respiratory tract and lungs, fluid and electrolyte imbalance, and acute traumatic stress. This incident was the most severe maritime disaster since the establishment of the People's Republic of China on October 1, 1949, due to the large number of elderly victims, fast overturning speed, and severe weather., Conclusions: Emergency rescue requires more automated and intelligent systems for maritime safety. An increased focus must be placed on public welfare and ethics, with the goal of influencing more prosocial behavior rather than the pursuit of profit., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The application of Tactical Combat Casualty Care (TCCC) represents evidence-based medicine to improve survival in combat. Over the past several years, US Air Force Pararescuemen (PJs) have expanded the mnemonic device "MARCH" to "MARCH PAWS" for use during tactical field care and tactical evacuation (TACEVAC). The mnemonic stands for massive bleeding, airway, respiration, circulation, head and hypothermia, pain, antibiotics, wounds, and splinting. We undertook this performance improvement project to determine the efficacy of this device as a treatment checklist., Methods: The mission reports of a 16-PJ combat rescue deployment to Operation Enduring Freedom (OEF) from January through June 2012 were reviewed. The triage category, mechanism of injury, injury, and treatments were noted. The treatments were then categorized to determine if they were included in MARCH PAWS., Results: The recorded data for missions involving 465 patients show that 45%, 48%, and 7%, were in category A, B, and C, respectively (urgent, priority, routine); 55% were battle injuries (BIs) and 45% were nonbattle injuries (NBIs). All treatments for BI were accounted for in MARCH PAWS. Only 9 patients' treatments with NBI were not in MARCH PAWS., Conclusion: This simple mnemonic device is a reliable checklist for PJs, corpsmen, and medics to perform TACEVAC during combat Operations, as well as care for noncombat trauma patients., (2017.)