National medical response to mass disasters in the United States: are we prepared?

Article Abstract:

Disaster medicine deals with multi-casualty incidents, such as airplane crashes, which are handled by the local emergency medical service (EMS) system, and mass disasters, such as earthquakes, in which the local EMS system is overwhelmed by the immediate needs of thousands of victims. Studies of earthquakes indicate that the ability to save lives declines rapidly following the catastrophe, and is almost zero after 24 hours. The National Disaster Medical System (NDMS) is being developed by a consortium of four government agencies with the mandate to maximize the ability to save lives by mobilizing national resources when local facilities are inadequate. NDMS is inadequate, in part because no single agency is in charge, and there is no single mechanism to begin rapid deployment. Civilian volunteer teams lack traumatology experience and do not normally work together. Victims would be transported to civilian and Veterans Affairs hospitals. Most are not trauma centers, and with occupancy of 70 to 80 percent, they would not have beds available, especially in critical care and burn units. A different model is proposed, designed for a major earthquake, but adaptable to other types of disasters. The model consists of planning and preparation to include education at all levels, from the lay public to the trauma teams, logistics with life support, designated trauma hospitals and trauma teams; lifesaving responses at all levels; and rehabilitation, including evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Evaluation, Emergency medical services, Disasters, Disaster medicine

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Glucocorticoid treatment does not improve neurological recovery following cardiac arrest

Article Abstract:

Glucocorticoids, hormones that affect carbohydrate metabolism, are released by the adrenal glands. Given as medication, glucocorticoids have long been considered useful in treating stroke and head injury. However, this study concludes that glucocorticoids did not improve survival or neurological recovery of patients with temporarily reduced blood supply to the brain (global brain ischemia), which occurred during heart attack. The patients studied were 262 initially comatose heart attack survivors who showed no response to pain immediately after blood flow to the brain was restored. Patients who received larger doses of glucocorticoids during the eight hours after their heart attack fared no better than those who received lower dosages. Thus the practice of routinely administering glucocorticoids to patients after global brain ischemia is unjustified. In addition, such treatment can result in serious complications such as infection and depletion of body protein. While this study can be criticized for failing to control potentially confounding factors, the authors point out that another, more carefully controlled study reached similar conclusions.

Complications and side effects, Heart attack, Cerebral ischemia, Blood circulation disorders, Vascular diseases

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How safe is long-term prenatal glucocorticoid treatment?

Article Abstract:

All pregnant women with a fetus at risk for congenital adrenal hyperplasia (CAH) need to be adequately informed of the risks and benefits of prenatal corticosteroid treatment. CAH is caused by an enzyme deficiency that results in excess levels of male hormones. This can cause masculinization in female fetuses. Prenatal corticosteroids can reduce the risk of masculinization, but they also have side effects that can affect both mother and baby. The most significant is low birth weight, which can predispose babies to chronic diseases later in adult life.

Abnormalities, Fetus, Ethical aspects, Prenatal care, Adrenogenital syndrome, Congenital adrenal hyperplasia

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