Fluorocarbons, or more strictly perfluorochemical (PFC) containing plasma substitutes have a high solubility for the respiratory gases, a desirable feature for a plasma substitute. This was dramatically demonstrated by their ability to sustain life for many hours in rats almost completely devoid of red cells. The ability of PFCs to carry oxygen exceeds that of other hemodilutents and they have been shown to produce better oxygenation under conditions of hemodilution than hydroxyethyl starch, dextran solutions or stroma-free hemoglobin solutions.

In acute respiratory failure, an immediate restoration of respiratory functions is imperative. Depending upon the available equipment and the qualifications of the physician and nursing staff, the most suitable ventilation procedure should be selected. In every case, accurate ventilation is accomplished by Intermittent Positive Pressure Ventilation (IPPV). If emergency equipment is not available, the simplest method of achieving this is mouth-to-mouth or mouth-to-nose breathing. The efficacy of this method is limited by the low FiO2 (about 17%) and by the physical condition of the first aider; after 30 minutes of resuscitation, even an experienced and well conditioned emergency rescuer will be exhausted.

Perfluorochemicals (PFCs), which are also known as fluorocarbons or perfluorocarbons, are chemical substances having a high solubility for respiratory gases. At 37 degrees Centigrade pure PFCs can dissolve very large quantities of oxygen and in some instances this may amount to as much as 50 volumes %. These substances are however immiscible with blood and if introduced into the circulation in an unmodified form could cause embolic phenomena. In order to be of use as oxygen carrying blood substitutes, they are therefore emulsified in a solution containing glucose, electrolytes and an osmotic agent.

Triage and rescue of casualties from accidents involving hazardous materials is a challenge for many emergency medical services (EMS) personnel. With very toxic materials, the untrained and unprepared rescuer may become a victim. In addition, few hospitals in the United States have decontamination units attached to their emergency departments and emergency department personnel may become exposed if the casualty is not decontaminated. Many environmental cleanup teams, including the U.S. Environmental Protection Agency (EPA) team, are well trained in materials handling but are not immediately available when a hazardous materials spill with personal injuries occurs.

The International Veterinary Academy on Disaster Medicine had its genesis in Perth, Australia, when at the World Veterinary Congress in August 1983, Dr. Ole Stalheim extended an invitation to attend a meeting of a group under the label “World Veterinarians Against Nuclear War”. It had an auspicious beginning—we attracted some attention in the media, more indeed, than we had received during our early attempts at formation in the United States. It became apparent, however, that we were in effect replicating activities of other well-established and more financially secure groups—Physicians for Social Responsibility, the Society Against Nuclear Energy (SANE), etc. We needed greater participation to cope with “peace time” problems already confronting us as well, and it was evident that a larger veterinary audience would be reached and our services to the community enhanced if we broadened the commitment.

There exists strong sentiment, among emergency medical personnel and physicians alike, that the pneumatic anti-shock garment (PASG) “saves lives.” As a result, controlled studies have been criticized as the “withholding of important therapy.” The purpose of this presentation is to confirm the need for controlled clinical trials of the PASG. Despite an early report that the PASG offered no advantage in terms of the presenting emergency center Trauma Score (TS), similar disparagements have continued, particularly because survival data were not discussed. The present report is a pilot analysis of the effect of the PASG on the prehospital survival of patients arriving at an urban trauma center in the United States. In the study, sixty-eight patients were assigned randomly to control and PASG groups in a prospective investigation involving injured patients with systemic hypotension. The 32 control patients, whose mean initial systolic blood pressure (BP) was 59 ± 32 mm Hg, and the 36 PASG-treated patients, whose mean initial BP was 55 ± 31 mm Hg, were found to be well matched for age, sex, type and location of injuries, initial field TS; response, field management, and transport times; and the total amount of intravenous crystalloid infused. The results demonstrated no significant difference between the control and PASG-treated groups in terms of those pronounced dead on arrival at the trauma center (9/32 vs. 10/36). Further studies are therefore justified to determine how the PASG affects the long-term morbidity and mortality of injury victims, particularly those within certain sub-groups such as penetrating abdominal versus those with penetrating thoracic injuries. This report reaffirms the need for early responsible, scientific scrutiny of prehospital interventions.

In 1981 we described the introduction and development of a coma scale for use in Head Injured patients. The scale has become adopted for routine use in the Accident and Emergency Unit at Pinderfields General Hospital, Wakefield, and at other centers, for example the Emergency Department at the Glasgow Royal Infirmary finds the scale more sensitive than its own Glasgow Coma Scale in monitoring the course of accident victims.

The kidney plays a fundamental role in the maintenance of the homeostasis of all body fluids; it operates as an efficient buffer system in the prevention of dehydration, hyperhydration, acid base and electrolyte imbalance and it removes toxic metabolites. It is not surprising, therefore, that post traumatic acute tubular necrosis (ATN) is characterized by a mortality that exceeds 80% in spite of the progress offered by dialysis and clinical nutrition. The mechanisms of this critical pathological condition are summarized in Figure 1.

This brief examination of casualty patterns suggests that differences may exist in the numbers of immediately dead and critical patients, depending on the nature of the disaster. More data must be collected from future disasters to more accurately define relationships between critical patients and total numbers injured. Such characterization is essential for hospital disaster planning because critical patients require great resources and optimal hospital functioning.

Knowledge of casualty patterns can make disaster planning more practical, disaster drills more realistic, and disasters less disastrous.

The Emergency Medical Service System in Tokyo has been developed through the cooperative efforts and achievements of many. EMS in Tokyo consists of three parts: 1) the network system of emergency hospitals; 2) the transportation system of emergency patients (Ambulance System); and 3) the communications system (Emergency Medical Information System). Emergency services are controlled by the Japanese Ministry of Home Affairs and the Ministry of Health and Welfare. The former is in charge of ambulance and rescue services located in the fire department, the latter has to do with medical affairs.

The traditional hospital disaster plan is complex and inefficient. Implementation during an actual or perceived crisis usually results in the mobilization of the entire hospital staff and multiple medical resources. This “all or none” phenomenon is costly in terms of manpower and supplies. Furthermore, there is protracted disruption of normal hospital services during disaster plan activation for training or real emergencies.

The arrangements for dealing with Major Accidents in the United Kingdom are set out in the Health Circular (HC(77)1) which places the onus for planning on Health Districts—each district serving a population of no greater than 200,000. The Metropolitan Area of West Yorkshire, served by the West Yorkshire Metropolitan Ambulance Service, the West Yorkshire Metropolitan Police and the West Yorkshire Fire Service, takes in nine such districts and covers an area of 794,000 square miles and a population of just over two million. West Yorkshire is traversed by two motorways and a major trunk road.

In recent years, medical care in Sweden as in other small countries, has become increasingly dependent upon the availability of imported goods. The consequences of even limited import restrictions of drugs and supplies has necessitated special planning for such a contingency. Special difficulties in this respect would arise in the field of anesthesia and intensive care, as all drugs for general anesthesia, and almost all disposable items used in anesthesia and intensive care in Sweden, are imported. To solve this problem, it would be necessary to ration drugs and materials, increase domestic production, introduce resterilization of disposable equipment and again use nondisposable supplies. In addition, stores of drugs and supplies are being built up to be used as a reserve in case of blockade or war. The nursing standards would have to be changed, by delegation to other personnel so that nurses take a larger responsibility, and by using methods which are unusual or even unknown to the staff in service today, i.e. ether anesthesia.

For some time emergency ambulances have been in operation in Italy. In spite of their modern equipment, these ambulances often turn out to be unsuitable for a comfortable journey and do not have satisfactory working conditions. This is due to the lack of up-to-date standards for vehicles and equipment.