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MASS CASUALTY TRAUMA TRIAGE PARADIGMS and PITFALLS July 2019
1 Mass Casualty Trauma Triage - Paradigms and Pitfalls EXECUTIVE SUMMARY Emergency medical services (EMS) providers arrive on the scene of a mass casualty incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group. Tagged patients arrive at the hospital and are assessed and treated according to their priority. Though this triage process may not exactly describe your agency’s system, this traditional approach to MCIs is the model that has been used to train American EMS As a nation, we’ve got a lot providers for decades. Unfortunately—especially in of trailers with backboards mass violence incidents involving patients with time- and colored tape out there critical injuries and ongoing threats to responders and patients—this model may not be feasible and may result and that’s not what the focus in mis-triage and avoidable, outcome-altering delays of mass casualty response is in care. Further, many hospitals have not trained or about anymore. exercised triage or re-triage of exceedingly large numbers of patients, nor practiced a formalized secondary triage Dr. Edward Racht process that prioritizes patients for operative intervention American Medical Response or transfer to other facilities. The focus of this paper is to alert EMS medical directors and EMS systems planners and hospital emergency planners to key differences between “conventional” MCIs and mass violence events when: • the scene is dynamic, • the number of patients far exceeds usual resources; and • usual triage and treatment paradigms may fail. -
Stage 2 Report 1/11
Drug Policy Expert Committee Stage 2 Report Drugs: Meeting the Challenge Victoria: Drug Policy Expert Committee Drugs: Meeting the Challenge Stage Two Report: November 2000 http://www.dhs.vic.gov.au/phd/dpec/index.htm Design + Production: AD[ART] DESIGN ISBN 0 642 73930 7 1 Stage 2 Report Drugs: Meeting the Challenge 2 Acknowledgements The Committee is indebted to many people and organisations for The Committee would like to acknowledge, in particular, the input, their valuable contribution to the work of the Committee advice and support of: throughout Stage Two. Their input has informed the development • The special advisors to the Committee on culturally and of this report. linguistically diverse communities, Mr Hass Dellal, Mr Phong It was clear to the Committee that the community remains rightly Nguyen; all of the Committee’s advisors, who have made an concerned about the level of drug use and its consequences. invaluable contribution to the work of the Committee; the R E The willingness of individuals and organisations to contribute Ross Trust and Professor Roger Wales who supported the time, energy and thinking to the process of consultation impressed international conference on prevention. A full list of special the Committee. advisors to the Committee is at Appendix 16. • Professor Robin Room, Director of the Centre for Social Few of the people who have assisted the Committee in their work Research on Alcohol and Drugs, Stockholm University who believe that there is a simple solution to the current problems contributed to the international conference on prevention and posed by drug use. The advice received reflected the knowledge provided information on other matters to assist the Committee. -
Freecell and Other Stories
University of New Orleans ScholarWorks@UNO University of New Orleans Theses and Dissertations Dissertations and Theses Summer 8-4-2011 FreeCell and Other Stories Susan Louvier University of New Orleans, [email protected] Follow this and additional works at: https://scholarworks.uno.edu/td Part of the Other Arts and Humanities Commons Recommended Citation Louvier, Susan, "FreeCell and Other Stories" (2011). University of New Orleans Theses and Dissertations. 452. https://scholarworks.uno.edu/td/452 This Thesis-Restricted is protected by copyright and/or related rights. It has been brought to you by ScholarWorks@UNO with permission from the rights-holder(s). You are free to use this Thesis-Restricted in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Thesis-Restricted has been accepted for inclusion in University of New Orleans Theses and Dissertations by an authorized administrator of ScholarWorks@UNO. For more information, please contact [email protected]. FreeCell and Other Stories A Thesis Submitted to the Graduate Faculty of the University of New Orleans in partial fulfillment of the requirements for the degree of Master of Fine Arts in Film, Theatre and Communication Arts Creative Writing by Susan J. Louvier B.G.S. University of New Orleans 1992 August 2011 Table of Contents FreeCell .......................................................................................................................... 1 All of the Trimmings ..................................................................................................... 11 Me and Baby Sister ....................................................................................................... 29 Ivory Jupiter ................................................................................................................. -
Idioms-And-Expressions.Pdf
Idioms and Expressions by David Holmes A method for learning and remembering idioms and expressions I wrote this model as a teaching device during the time I was working in Bangkok, Thai- land, as a legal editor and language consultant, with one of the Big Four Legal and Tax companies, KPMG (during my afternoon job) after teaching at the university. When I had no legal documents to edit and no individual advising to do (which was quite frequently) I would sit at my desk, (like some old character out of a Charles Dickens’ novel) and prepare language materials to be used for helping professionals who had learned English as a second language—for even up to fifteen years in school—but who were still unable to follow a movie in English, understand the World News on TV, or converse in a colloquial style, because they’d never had a chance to hear and learn com- mon, everyday expressions such as, “It’s a done deal!” or “Drop whatever you’re doing.” Because misunderstandings of such idioms and expressions frequently caused miscom- munication between our management teams and foreign clients, I was asked to try to as- sist. I am happy to be able to share the materials that follow, such as they are, in the hope that they may be of some use and benefit to others. The simple teaching device I used was three-fold: 1. Make a note of an idiom/expression 2. Define and explain it in understandable words (including synonyms.) 3. Give at least three sample sentences to illustrate how the expression is used in context. -
James Hillier
14 City Lofts 112-116 Tabernacle Street London EC2A 4LE offi[email protected] +44 (0) 20 7734 6441 JAMES HILLIER Shadow & Bone Small Axe The Crown Television Role Title Production Company Director DCI Bill Raynott STEPHEN Hat Trick for ITV Alrick Riley Tony Leech DECEIT Story Films Niall MacCormack Jack Cocker CLOSE TO ME Viaplay / Channel 4 Michael Samuels Captain Churik SHADOW & BONE 21 Laps Entertainment / Netflix Lee Toland Krieger / Eric Heisserer Chief Inspector SMALL AXE BBC / Amazon Studios Steve McQueen Dr Stu Ford DOCTORS BBC Dan Wilson The Equerry (Series Regular) THE CROWN SEASON TWO Left Bank Pictures / Netflix Stephen Daldry Nathan Stone PRIME SUSPECT 1973 Noho / ITV David Caffrey The Equerry (Series Regular) THE CROWN SEASON ONE TVE Various Oliver Grau (Series Regular) MERLÍ SEASON 1 Left Bank Pictures / Netflix Stephen Daldry Joseph McCoy FRONTIER Raw TV Ben Chanan James Downing CASUALTY BBC Jon Sen Admiral Nelson THE BRITISH Nutopia Jenny Ash Chris LONDON’S BURNING Juniper Justin Hardy Mick SURVIVORS BBC Ian B. McDonald Sgt Christian Young (Series HOLBY BLUE SERIES TWO BBC / Kudos Martin Hutchins Regular) Damian EASTENDERS BBC Michael Kellior Sgt Christian Young (Series HOLBY BLUE SERIES ONE BBC / Kudos Martin Hutchins Regular) Keith Spalding GOLDPLATED Channel 4 Julie Ann Robinson / Robert Delamere Robert Barrie (Recurring) THE BILL Talkback Thames Bill Scot-Rider Marcus Octavius THE RISE AND FALL OF ROME: BBC Chris Spencer REVOLUTION Garret Gibbens BLACKBEARD Dangerous Films Richard Dale Darren HOLBY CITY BBC Nick Adams Jeremy -
Temperance Flat Reservoir
Upper San Joaquin River Basin Storage Investigation Temperance Flat Reservoir Surface Storage Option Technical Appendix to the Phase 1 Investigation Report A Joint Study by: Bureau of Reclamation California Department Mid-Pacific Region of Water Resources In Coordination with: The California Bay-Delta Authority October 2003 Upper San Joaquin River Basin Storage Investigation San Joaquin River looking downstream towards Millerton Lake Temperance Flat Reservoir Surface Storage Option Technical Appendix to the Phase 1 Investigation Report A Joint Study by: Bureau of Reclamation California Department Mid-Pacific Region of Water Resources In Coordination with: Prepared by: The California Bay-Delta Authority October 2003 Surface Water Storage Option Technical Memorandum TEMPERANCE FLAT RESERVOIR UPPER SAN JOAQUIN RIVER BASIN STORAGE INVESTIGATION TABLE OF CONTENTS Chapter Page ACRONYMS AND ABBREVIATIONS..................................................................... viii EXECUTIVE SUMMARY ...................................................................................... ES-1 CHAPTER 1. INTRODUCTION ............................................................................... 1-1 STORAGE OPTIONS SUMMARY.....................................................................................1-1 SUMMARY OF PREVIOUS INVESTIGATIONS................................................................1-4 POTENTIAL IMPROVEMENTS.........................................................................................1-4 RM 274 Options..............................................................................................................1-4 -
Rulebook-Bios-Genesis-170515.Pdf
BY A. WHAT’S THIS GAME ABOUT? One to four players start as organic compounds shortly after Earth’s formation, represented by up to three Biont tokens. The Amino Acids (Player Red) command Metabolism, the lipids (Player Yellow) create cells, the pigments (Player Green) control energy absorption and storage, and the nucleic acids (Player Blue) control templated replication.1 Their goal is a double origin of life: first asAutocatalytic Life (a metabolic cycle reproducing its own constituents yet not replicating),2 and the second as Darwinian Life (an Organism using a template to replicate in an RNA world). Warning, this is a brutal game of survival. The players may decide to cooperate rather than compete, see C3. A less brutal variant is found in C4. The Event Phase starts the turn. Each event card encapsulates 200 million years, and the game may last 21 events (about 18 turns, the first 4 billion years of Earth’s 4.6 billion year history). Each event depicts which Landforms (cosmic, ocean, coastal shelf, or continent) are active for the turn. In the Assignment Phase, players attempt to create autocatalytic life by assigning one starting Biont to one of the Refugia, placards representing suitable hatcheries for life either on Earth or in space. These sites contain “building block” cubes called Manna, which reside in either disorganized (dead) or organized (metabolically-alive) populations. You may also assign a Biont to become a Parasite, if there are any Hosts available. To be suitable, a Host must have Mutations or Organs that you can invade as a Disease. -
GRID M1CAT, Casualty and Theft
1 1 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 3 3 4 NEAR FINAL DRAFT 8/23/21 4 5 5 *211451* 6 6 7 2021 Schedule M1CAT, Casualty and Theft 7 8 Do not complete Schedule M1CAT if you completed federal Form 4684 to report a net gain from a casualty or theft on your federal income tax return. 8 9 9 10 112233333 10 FIRSTYour First Name NAME, and Initial INITXXXXX LastYOUR Name LAST NAMEXXXXXXXXXXXXXXXXXXXX Social Security Number 11 11 12 1 Description of properties, including the type, location, and date acquired for each property. Use a separate line for each property lost or damaged 12 13 from the same casualty or theft event. You must file a separate Schedule M1CAT for each casualty or theft event involving personal property. 13 14 14 15 Property A PROPERTY A DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 15 16 16 Property B 17 PROPERTY B DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 17 18 18 Property C 19 PROPERTY C DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 19 20 20 Property D 21 PROPERTY D DESCRIPTIONXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 21 22 22 23 Property A Property B Property C Property D 23 24 24 25 2 Cost or other basis (see instructions) . 2 123456789123456789123456789 12345678 25 26 3 Insurance or other reimbursement, whether or not you filed a claim 26 27 (see instructions)Note: If line 2 is more than line 3, skip line 4 . -
Think Big and Fight Smart
Our little heroes inspire us to think big and fight smart 2017 Annual Report Meet Joseph: A tenacious two-year-old on a mission. Joseph came to Cohen Children’s Medical Center when his parents noticed that he had stopped moving his legs. We saw a four-month-old boy with the world at his fi ngertips. At the time, he couldn’t speak, but our team read his symptoms loud and clear. We immediately surrounded him with specialists, who diagnosed a spinal tumor, and within 24 hours, we had him on the road to recovery. Almost two years later, he’s more than a happy, healthy toddler; he’s one of our biggest sources of inspiration. of the hospital, thanks to innovative and eff ective treatment. These stories, like the stories of so many of our patients, inspire the team at Cohen Children’s to do more. Whether it’s by adopting new treatments through research or delivering an extra dose of compassion that shows how much we understand and how much we care, our strengths make us stand out among the best children’s hospitals nationwide. It’s why we rank in nine pediatric specialties as listed in U.S. News & World Report — and our team continually strives to do better. Great care comes alive at Cohen Children’s Medical Center, and we couldn’t make it happen without the bravery of our patients and their families. As New York State’s largest provider of pediatric healthcare services, we look to our patients as the beacons of strength that is contagious, and these little faces inspire the work keep us grounded in our mission: to provide the best we do every day. -
Mass Casualty Incident (MCI) Response Module 1
Mass Casualty Incident (MCI) Response Module 1 (Hamilton County Fire Chief's Association, 2013) 1 Objectives Purpose: This module will educate staff on mass casualty triage incident response, including how to: • Define mass casualty triage • Determine considerations for adults and pediatrics • Understand the importance of a patient tracking system • Recognize and implement the patient admission/ discharge MCI triage process • Determine how to appropriately handle the deceased in a large-scale MCI • Recognize the range of incidents that may cause MCIs 2 MCI Basics 3 What is an MCI? • A mass casualty incident (MCI) is an incident where the number of patients exceeds the amount of healthcare resources available. • This number varies widely across the country, but is typically greater than 10 patients. 4 Types of MCI Notifications • During a large scale incident such as a mass casualty, it is important to have a mass notification system. Successful mass notification systems will: . Internally: alert staff to activate MCI protocols and prepare for a potential surge of patients . Externally: increase community awareness 5 Assisting in MCI Response Considerations for hospital staff in an MCI: • Some patients may arrive to the hospital without having been assessed/ triaged at the scene • MCI response requires efficiency and coordination • Non-clinical personnel (including hospital volunteers) can assist in moving patients to designated areas based on level of care • Help gather patient information in the emergency treatment area • Staff should review patients in clinical assignment for any potential discharges/ transfers to make room for potential MCI admissions, a process known as “surge discharge” (Chung S, 2019) 6 Triage Basics Definition of MCI Triage Triage means “to sort.” Triage in an MCI is the assignment of resources based on the initial patient assessment and consideration of available resources. -
Casualty Accumulation Risk
Casualty Accumulation Risk October 2015 Authors: Brad Fischtrom (AIG) Luc de Lignières (Axa) Tim Jandeck (Generali) Michael Brauner (Munich Re) Guillaume Ominetti (Scor) Eric Schuh, Andrea Scascighini and Sabrina Wulf (Swiss Re, workgroup lead) CRO Forum Secretariat: Kuba Szczygielski Contents 1 Executive summary 6 2 Understanding casualty accumulation risk 8 2.1 Defining casualty accumulation risk 11 – Classic clash 11 – Serial aggregation 12 – Systemic loss 12 2.2 Examples of historical accumulation losses 13 – Asbestos 13 – Deepwater Horizon oil spill 14 – The medical malpractice crisis in France 15 – Economic, societal and legal environments 15 2.3 Casualty accumulation matters in an interconnected and fast evolving society 16 – Cyber 18 – Pandemic 20 – Nanotechnology 20 – E-cigarettes 21 – Concussions 21 – Climate change 22 2.4 Embedding casualty risks in the overall accumulation risk 23 – Crossing the lines of business 23 – Accumulation with the asset side of the balance sheet 24 3 Assessing the potential effects of uncontrolled casualty accumulation 25 3.1 Why is casualty accumulation risk more challenging to assess and model than property catastrophe accumulation risk? 25 – Impact on insurers 26 3.2 Scenario-based modelling 27 – The unfolding of a liability disaster 27 – The scenario approach to quantification 28 – Mapping scenarios to portfolio exposures 28 3.3 A forward-looking approach 28 – Limitations of current actuarial techniques 28 – Studying loss generation: from natural catastrophe modelling to liability exposures 29 -
Fatal Fire Investigation
Fatal Fire Investigation Report of the Hampshire Fire and Rescue Service investigation into the deaths of Firefighters Alan Bannon and James Shears in Flat 72, Shirley Towers, Church Street, Southampton, SO15 5PE, on Tuesday 6 April 2010 Copyright of Hampshire Fire and Rescue Service Copyright of Hampshire Fire and Rescue Service 1 Foreword The primary duty of all fire and rescue services is to save life. In Hampshire this responsibility is central to how we operate such that the people we select and train, the equipment we buy and use, and the procedures we follow are focussed on that defining obligation. This report details the response to a fire which led to the deaths of two of our colleagues. The facts of the report and particularly the actions of all HFRS staff are framed by that duty to save life. On the night of 6 April 2010 many lives of the public were at risk in Shirley Towers, Church Street, Southampton, a 16 storey high rise block of residential flats. The scene faced by fire crews that night was frantic and frightening such that the efforts to tackle this difficult and dangerous fire required the courage, stamina and skill of all those involved. As an organisation we have dedicated considerable resources to this report, both in honour of our colleagues and also in a genuine desire to learn from these events. We have then ensured this learning has been turned into tangible actions in order to improve the way we tackle such incidents. We hope this will assist others, as well as ourselves, in understanding what caused the loss of Alan Bannon and James Shears and to do all we can to prevent such tragedies occurring in the future.