Objectives: The purpose of this investigation was to determine the incidence and character of pediatric emergencies on a US-based commercial airline and to evaluate current in-flight medical kits. Methods: In-flight consultations to a major US airline by a member of our staff are recorded in an institutional database. In this observational retrospective review, the database was queried for consultations for all passengers up to 18 years old between January 1, 1995, and December 31, 2002. Consultations were reviewed for type of emergency, use of the medical kit, and unscheduled landings. Results: Two hundred twenty-two pediatric consultations were identified, representing 1 pediatric call per 20,775 flights. The mean age of patients was 6.8 years. Fifty-three emergencies were pre-flight calls, and 169 were in-flight pediatric consultations. The most common in-flight consultations concerned infectious disease (45 calls, 27%), neurological (25 calls, 15%), and respiratory tract (22 calls, 13%) emergencies. The emergency medical kit was used for 60 emergencies. Nineteen consultations (11%) resulted in flight diversions (1/240,000 flights), most commonly because of in-flight neurological (9) and respiratory tract (5) emergencies. International flights had a higher incidence than domestic flights of consultations and diversions for pediatric emergencies. Conclusions: The most common in-flight pediatric emergencies involved infectious diseases and neurological and respiratory tract problems. Emergency medical kits should be expanded to include pediatric medications.

No description available.

Thesis (DR. P.H.)--University of Michigan.

Thesis (DR. P.H.)--University of Michigan.

Positive associations between short-term exposure to ambient particulate matter (PM) pollution and cardio-respiratory morbidity and mortality have been established in epidemiologic studies. However, scientific uncertainties remain regarding which PM constituents and sources are most harmful to the exposed population. While tentative evidence of positive links between certain PM constituents and sources with specific health outcomes exists, significant heterogeneity in study findings remains. The chemical composition and emission source of air pollution vary not only temporally, but also geographically. Thus, substantial research on these characteristics under different atmospheres (e.g., Asian atmosphere) is warranted to enhance our understanding of PM-related health effects. / In Hong Kong, air pollution levels often exceed the World Health Organization’s air quality guidelines, posing serious public health threat. Although two decades of active research have associated PM mass (weights) concentration in Hong Kong with elevated risk of daily mortality and emergency hospital admissions, individual chemical constituents and sources responsible for the adverse health effects associated with PM mass have rarely been examined. This thesis attempted to reduce the current scientific uncertainty by making use of the speciation data for PM with aerodynamic diameter ≤ 10 μm (PM₁₀) to examine the associations between chemical constituents and daily cardio-respiratory emergency hospital admissions in Hong Kong between 2001 and 2008. It also capitalized on Positive Matrix Factorization (PMF) source apportionment model to create an alternative measure of PM concentrations that quantified the relative contribution of PM₁₀ sources. This enabled the assessment of health risks associated with exposure to particle mixture from specific sources. / Time-series analyses conducted in this work showed evidence of positive links of emergency hospitalizations with multiple PM₁₀ constituents for various exposure lags examined. In multipollutant models adjusting for gaseous co-pollutants, three groups of constituents were significantly associated with increased risk of cause-specific hospitalizations. They included: combustion-related constituents (i.e., elemental carbon, organic matter, potassium ion, manganese, nitrate ion, arsenic, lead), sea salt-related constituents (i.e., sodium ion, chloride ion, magnesium), and constituents related to soil/road dust (i.e., aluminum, iron). Significant associations were most evident between November to April. PMF model identified eight PM₁₀ sources: 1) vehicle exhaust, 2) soil/road dust, 3) regional combustion, 4) residual oil, 5) fresh sea salt, 6) aged sea salt, 7) secondary nitrate, and 8) secondary sulfate. Health effect analysis demonstrated that all PM₁₀ sources, except fresh sea salt, were positively associated with emergency hospitalizations. Combustion-related sources were positively associated with risk of cardiovascular hospitalizations at shorter cumulative lags than with respiratory hospitalization. Sources that primarily generate coarser particles (i.e., soil/road dust and aged sea salt) were linked to respiratory hospitalizations at shorter cumulative lags than combustion sources that emit fine particles, which were associated with respiratory hospitalization at delayed cumulative lags. / This work may help prioritize future toxicological research on the biologic mechanisms linking PM pollution to cardio-respiratory health. It also stresses the importance of regulation and reduction of traffic and other combustion-related emissions, reconfiguration of urban environment to reduce personal exposure to traffic emissions, as well as establishment of a coordinated and robust regional-scale air quality management plan. Constituent- and source-based air quality standards and policy strategies should be considered, supplementary to standards for total PM mass (e.g., PM₁₀ and PM₂.₅), to effectively protect the population from air pollution mixture. For example, policy measures aiming at controlling anthropogenic sources of coarse particles (e.g., soil/road dust, precursor gases for atmospheric conversion of aged sea salt) should be advisable. / 以往流行病學研究已經建立大氣懸浮顆粒（PM）污染短期暴露和心血管﹑呼吸系統疾病的發病率以及死亡率之間的關聯，但仍然不能確定究竟那種PM化學成分和排放源對暴露人群最有害。初步證據已經顯示了個別PM化學成分和排放源與某些疾病的相關聯，但是，現今研究結果之間依然存在顯著差異。此外，顆粒污染物的化學成分和排放源會隨地理空間不同而變化，因此有必要在不同地域的大氣環境下（如亞洲）進行研究，從而提高我們對PM影響健康的認識。 / 香港的空氣質量常超過世界衛生組織規定的可接受空氣質量標準，空氣污染已經成為一個嚴重的公共衛生問題。香港二十年的空氣污染研究已顯示PM質量濃度會增加死亡率和緊急入院的風險，然而仍然缺乏PM化學成分和排放源對健康影響的研究。本港環境保護署擁有十多年連續測量的可吸入懸浮粒子（PM₁₀）成分數據，因此本論文利用這數據與公共衛生數據來填補這個學術空白。具體的，本論文探索香港2001年至2008年間的PM化學成分與期間每日心血管和呼吸系統緊急入院的關聯。本論文還利用正交矩陣因子分解法（PMF），即大氣顆粒物的源解析技術，進行顆粒源分離，已建立替代單元以分別代表PM₁₀不同排放源的相對貢獻建立一個替代措施量化PM₁₀的成分中不同來源相對的貢獻，最終評估暴露於特定來源的PM₁₀混合成分的健康風險。 / 本文中的時間序列分析研究結果表明緊急入院率與多個PM化學成分在不同的暴露滯後時間上均存在正關聯。本論文的多種污染物時間序列的模型對氣體的共污染性進行了控制，研究發現以下三种顆粒物對某些具體疾病的緊急入院風險有顯著增加︰燃燒有關的顆粒（即︰碳元素，有機物，鉀離子，錳，硝酸根離子，砷，鉛），與海鹽有關的顆粒（即︰鈉離子，氯離子，鎂），以及與土壤/道路粉塵有關的顆粒（即︰鋁，鐵），這種相關性在寒冷的季節更為明顯（即每年的11月至4月）。PMF鑑定了八個PM₁₀的排放源或排放組合，包括︰1）汽車排氣，2）土壤/道路粉塵，3）區域燃燒產物，4）渣油，5）鮮海鹽，6）陳海鹽，7）二次硝酸鹽，和8）二次硫酸鹽。分析發現，除鮮海鹽外，其他PM₁₀的排放源與緊急入院呈正關係。研究顯示與燃燒有關的排放源能增加即時因心血管疾病緊急入院的風險，而主要含有粗顆粒的排放源能增加即時呼吸系統疾病緊急入院的風險，且在作用時間上比燃燒排放源（主要含有細顆粒）的危害更快。 / 本論文所提供的研究成果有助於重新定位未來有關空氣污染與心肺健康的生物學機制毒理學研究方向。研究結果強調監管和降低交通以及其他有關燃燒排放的重要性，利用合理城市環境結構及配置來減少居民暴露交通空氣污染的風險，以及建立區域性的空氣質量管理計劃。此外，本研究還建議除了PM質量濃度（如PM₁₀和PM₂.₅）的空氣質量標準以外，針對PM化學成分和排放源的空氣質量標準也應加以考慮，以有效地保護居民免受空氣污染的危害，例如，應考慮有關粗顆粒（如土壤/道路麈和前驅氣體）的人為來源的政策措施。 / Pun, Chit. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 108-133). / Abstracts also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Pun, Chit. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

This thesis concerns the history of humanitarian nutrition and its political implications. Drawing on aid agency archives and other historical sources, it examines how food has been delivered in emergencies, from the First World War to the present day. The approach is ethnographic: this is a study of the micro-level practices of relief, examining the objects distributed, the plans made, the techniques used. It is also historical: examining how such practices have changed over time. This thesis makes five interlocking arguments. First, I make a political point: that humanitarian action is always political, and that it is impossible to adhere to ‘classical’ humanitarian principles such as neutrality, impartiality and independence. Second, I make a sociological argument: that the activities of humanitarian nutrition have been shaped by a number of themes, which include militarism, medicine, modernity, and markets. Third, I make a historical argument: that the main features of humanitarian nutrition were solidified between the 1930s and the 1970s, and were largely in place by the time of the Biafran war. Fourth, I make a sociological argument: that these mid-century changes involved a profound redefinition of hunger and food (with hunger conceived as a biochemical deficiency, and food as a collection of nutrients). Finally, I make a normative argument, suggesting that this redefinition has not necessarily benefited the starving: the provision of food in emergencies, I argue, is often concerned with control and efficiency rather than the suffering individuals themselves.

Aim and objectives: To describe the ideal doctors' shift handover process in a systematic fashion, and to identify tasks that should be performed, but are not consistently done. To understand the types of communication problems that may occur during the handover process, their causes, their likelihood of occurrence and their effect on patient safety. Method: Three studies were conducted in two, Scottish Acute Medical Units. A Hierarchical Task Analysis was performed and data was collected by means of interviews and focus groups. Observations of doctors' actual shift handover process were compared against the description of doctors' ideal handover process. To examine potential failures modes, a Healthcare Failure Modes and Effects Analysis was performed using focus group interviews. Results: The handover process entailed the pre-handover, the handover, and the post- handover phases. Multiple critical steps in the process were omitted by outgoing shift doctors. The pre-handover was particularly vulnerable to information omission, with over 50% of its critical tasks not being performed across a total of 62 observations. Nonetheless, most of these omissions were typically caught during the handover meeting, especially if incoming doctors participated in pre-handover activities. Post-handover activities involved prioritizing and delegating clinical tasks. However these were observed not to happen consistently due to multiple interruptions. Thirty-four failure modes were identified, with eight of them posing a significant risk to patient safety. The studies found that interruptions, patient workload, and a lack of standardised procedures were the biggest causes for information loss during the handover process. Conclusions: There are key critical tasks necessary for an ideal doctors' shift handover process. A simple, handover process checklist may ensure critical handover tasks have been achieved prior to any shift change. Interruptions, patient workload, peer trust, and a lack of standard operating procedures are areas that future handover research should examine.

Approved for public release; distribution is unlimited / Complex Humanitarian Emergencies are usually military conducted activities where participants must be able to react to a very dynamic and unfriendly environment. National and international participating forces require cooperation and coordination between civilian and military entities. The continuous need to share huge amounts of information requires a technological framework to allow legacy and new hardware and software interconnection, rapid network installation and flexible bandwidth availability. To improve the speed and the quality of the decision-making a scientific approach must be applied to the process. Maximizing both the effectiveness and efficiency in decision-making can be obtained by developing decision support systems capable of providing access to existing databases and expert systems. Databases usually contain raw information available for retrieval and processing according to the needs of the decision makers. Expert systems embed human expertise and allow the propagation of scarce expert resources throughout an organization to increase the consistency and quality of the decisions. Sharing access to these types of information within a Complex Humanitarian Emergency environment provides for better situational awareness and improves the decision-making process. This thesis will gather and combine the information from different sources and will suggest a model for integrating remote databases and expert sources with situational awareness tools. / Lieutenant Colonel, Romanian Air Force

CHDS State/Local / Responders at the Federal, state, and local level are critical to Homeland Defense and Security (HLDS). Building from the recently published RAND and National Institute of Occupational Safety and Health (NIOSH) report on responder safety, this thesis explores the issues associated with creating a safety risk management capability that will enable HLDS responders to better protect themselves from harm and enhance their readiness. Risk management experiences within the military were benchmarked with emphasis upon lessons learned from the U.S. Coast Guard and the U.S. Navy. This revealed that Operational Risk Management (ORM), a risk-based decision-making tool that systematically balances risk and mission completion, and Crew Resource Management (CRM), a human factors-based team coordination training, should be the primary components focused upon to build the safety risk management capability. Development of ORM and CRM capabilities for HLDS responders will require strong national and local leadership, innovative measurement tools, clear accountability, and should be implemented via the national preparedness model outlined in Homeland Security Presidential Directive 5 (HSPD- 5) and HSPD-8. ORM and CRM, if successfully established, can provide HLDS responders with the safety risk management capability that enables them to safely and effectively provide their vital services to the Nation. / Chief - Afloat & Marine Safety, US Coast Guard (USCG)

CHDS State/Local / This thesis reviews various readiness assessment tools used by military units and the civilian First Responder community. Most civilian readiness assessment tools have fallen short of adequately predicting a response team's probability of mission success or failure. This thesis will explore the use of model-based vulnerability analysis techniques and FT++ software as potential tools that could be adopted by first response organizations to predict a unit's operational performance. / National Disaster Medical System Emergency Coordinator, DHS / FEMA