The Experts below are selected from a list of 8595 Experts worldwide ranked by ideXlab platform
Christopher J Odonnell - One of the best experts on this subject based on the ideXlab platform.
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contribution of postmortem multidetector ct scanning to identification of the deceased in a Mass Disaster experience gained from the 2009 victorian bushfires
Forensic Science International, 2011Co-Authors: Christopher J Odonnell, Morio Iino, K Mansharan, J Leditscke, Noel WoodfordAbstract:CT scanning of the deceased is an established technique performed on all individuals admitted to VIFM over the last 5 years. It is used primarily to assist pathologists in determining cause and manner of death but is also invaluable for identification of unknown deceased individuals where traditional methods are not possible. Based on this experience, CT scanning was incorporated into phase 2 of the Institute's DVI process for the 2009 Victorian bushfires. All deceased individuals and fragmented remains admitted to the mortuary were CT scanned in their body bags using established protocols. Images were reviewed by 2 teams of 2 radiologists experienced in forensic imaging and the findings transcribed onto a data sheet constructed specifically for the DVI exercise. The contents of 255 body bags were examined in the 28 days following the fires. 164 missing persons were included in the DVI process with 163 deceased individuals eventually identified. CT contributed to this identification in 161 persons. In 2 cases, radiologists were unable to recognize commingled remains. CT was utilized in the initial triage of each bag's contents. If radiological evaluation determined that bodies were incomplete then this information was provided to search teams who revisited the scenes of death. CT was helpful in differentiation of human from non-human remains in 8 bags, recognition of human/animal commingling in 10 bags and human commingling in 6 bags. In 61% of cases gender was able to be determined on CT using a novel technique of genitalia detection and in all but 2 cases this was correct. Age range was able to be determined on CT in 94% with an accuracy of 76%. Specific identification features detected on CT included the presence of disease (14 disease entities in 13 cases), medical devices (26 devices in 19 cases) and 274 everyday metallic items associated with the remains of 135 individuals. CT scanning provided useful information prior to autopsy by flagging likely findings including the presence of non-human remains, at the time of autopsy by assisting in the localization of identifying features in heavily disfigured bodies, and after autopsy by retrospective review of images for clarification of issues that arose at the time of pathologist case review. In view of the success of CT scanning in this Mass Disaster, DVI administrators should explore the incorporation of CT services into their Disaster plans.
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the application of computerized tomography ct to the dental ageing of children and adolescents
Forensic Science International, 2010Co-Authors: Christopher J Odonnell, Jeremy Graham, Pamela J G Craig, G L Walker, Anthony J Hill, G N Cirillo, R M Clark, Samuel Gledhill, Michal SchneiderkolskyAbstract:Introduction: Following a Mass Disaster, the aim of the Disaster Victim Identification process is to establish the identity of the victims. The ageing screening process on victims in Victoria may now be complemented with the use of computerized tomography (CT), where previously any dental ageing analysis was performed using conventional radiographs. The aim of this study was to assess the accuracy of age estimation using the dental ageing method proposed by Moorrees, Fanning and Hunt (MFH) using CT images. Intra- and inter-rater variability between two raters, one experienced and one inexperienced, was also assessed. Materials and methods: The two raters were blinded to the ages of 96 deceased Australian children aged up to 15 years. Using three-dimensional (3D) shaded surface displays (SSD) and reformatted CT images, the age was first estimated based on prior experience alone, followed at a later date by the age estimation utilizing the MFH method. These estimates were then compared to the known chronological age. The results were statistically analyzed in a one-sample t-test, using the mean log-ratio of the estimated age to the chronological age. Results: Our findings show that the experienced rater was more accurate in age estimation than the less experienced when using prior experience (p < 0.0001). The use of reformatted CT images to perform an ageing estimate using the MFH method was found to systematically underestimate the chronological age by 10% by both raters (p = 0.784). There was no significant difference between the two raters. Intra-rater reliability was high (p = 0.135). Conclusions: CT can provide accurate estimates of dental ages. Prior experience with dental ageing and/ or CT improves the accuracy. However, with the use of validated ageing charts, inexperienced raters can also achieve accurate age estimates using CT images.
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contribution of multidetector ct scanning to identification of the deceased in Mass Disaster experience gained from the 2009 victorian black saturday bushfires
Pathology, 2010Co-Authors: Christopher J OdonnellAbstract:Conventional radiographic techniques are used commonly to aid forensic pathologists in establishing a biological profile of unknown individuals. Mortuary-based CT scanning has now become a standard component of death investigation. This section of the workshop will examine the ability of CT to estimate sex and age, and the detection of unique biological or physical features that might be valuable in narrowing search parameters for identification of the deceased. The specific focus will be on experience gained in heavily burnt and highly fragmented human remains as may occur in fires.
Jen Frankel - One of the best experts on this subject based on the ideXlab platform.
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virtual reality triage training provides a viable solution for Disaster preparedness
Academic Emergency Medicine, 2010Co-Authors: Pamela Andreatta, Eric Maslowski, Sean Petty, Woojin Shim, Michael Marsh, Theodore W Hall, Susan A Stern, Jen FrankelAbstract:OBJECTIVES: The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in Disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? METHODS: Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual Mass Disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live Disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). RESULTS: The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. CONCLUSIONS: Virtual reality can provide a feasible alternative for training EM personnel in Mass Disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards.
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virtual reality triage training provides a viable solution for Disaster preparedness
Academic Emergency Medicine, 2010Co-Authors: Pamela Andreatta, Eric Maslowski, Sean Petty, Woojin Shim, Michael Marsh, Theodore W Hall, Susan A Stern, Jen FrankelAbstract:ACADEMIC EMERGENCY MEDICINE 2010; 17:870–876 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives: The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in Disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? Methods: Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual Mass Disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live Disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). Results: The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. Conclusions: Virtual reality can provide a feasible alternative for training EM personnel in Mass Disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards.
Charles L. Sprung - One of the best experts on this subject based on the ideXlab platform.
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chapter 5 essential equipment pharmaceuticals and supplies recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or Mass Disaster
Intensive Care Medicine, 2010Co-Authors: Charles L. Sprung, Jozef KeseciogluAbstract:Purpose To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or Mass Disaster with a specific focus on essential equipment, pharmaceuticals and supplies. Methods Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including essential equipment, pharmaceuticals and supplies. Results Key recommendations include: (1) ensure that adequate essential medical equipment, pharmaceuticals and important supplies are available during a Disaster; (2) develop a communication and coordination system between health care facilities and local/regional/state/country governmental authorities for the provision of additional support; (3) determine the required resources, order and stockpile adequate resources, and judiciously distribute them; (4) acquire additional mechanical ventilators that are portable, provide adequate gas exchange for a range of clinical conditions, function with low-flow oxygen and without high pressure, and are safe for patients and staff; (5) provide advanced ventilatory support and rescue therapies including high levels of inspired oxygen and positive end-expiratory pressure, volume and pressure control ventilation, inhaled nitric oxide, high-frequency ventilation, prone positioning ventilation and extracorporeal membrane oxygenation; (6) triage scarce resources including equipment, pharmaceuticals and supplies based on those who are likely to benefit most or on a 'first come, first served' basis. Conclusions Judicious planning and adoption of protocols for providing adequate equipment, pharmaceuticals and supplies are necessary to optimize outcomes during a pandemic.
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chapter 1 introduction recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or Mass Disaster
Intensive Care Medicine, 2010Co-Authors: Janice L Zimmerman, Charles L. SprungAbstract:Purpose To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or Mass Disaster with focus on education of all stakeholders, specifically the emergency executive control groups, ICU staff and staff co-opted to assist with patient management. Methods Based on a literature review and expert opinion, a Delphi process was used to define the essential topics, including staff education. Results Key recommendations include: (1) define functional roles and responsibilities of the internal personnel and interface agencies or sectors; (2) determine logistic support and requirements necessary for the effective implementation of the SOPs; (3) determine what is required to maintain the SOPs; (4) recommended training and activities include: (a) personal protection techniques; (b) environmental contamination; (c) medical management; (d) laboratory specimens; (e) alert lists; (f) training of recruited staff; (g) ethical issues; (h) psychosocial issues; (i) dealing with the deceased; (j) policies for restricting visitors; (k) mechanisms for enforcing policies; (5) Training should begin as soon as possible with daily demonstrations followed by supervised practice; (6) identify the staff to participate in training programs, verify that they have participated and evaluate their knowledge subsequently. Conclusions Judicious planning and adoption of protocols for staff education are necessary to optimize outcomes during a pandemic.
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chapter 6 protection of patients and staff during a pandemic recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or Mass Disaster
Intensive Care Medicine, 2010Co-Authors: Bruce Taylor, Hugh Montgomery, Andrew Rhodes, Charles L. SprungAbstract:Purpose To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or Mass Disaster with a specific focus on protection of patients and staff.
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recommendations for intensive care unit and hospital preparations for an influenza epidemic or Mass Disaster summary report of the european society of intensive care medicine s task force for intensive care unit triage during an influenza epidemic or Mass Disaster
Intensive Care Medicine, 2010Co-Authors: Charles L. Sprung, John L. Hick, Michael D. Christian, Janice L Zimmerman, Gavin M Joynt, B L Taylor, Guy A Richards, Christian Sandrock, Robert Cohen, Bruria AdiniAbstract:To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics. Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers’ practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a ‘first come, first served’ basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff. Mortality, although inevitable during a severe influenza outbreak or Disaster, can be reduced by adequate preparation.
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Chapter 2. Surge capacity and infrastructure considerations for Mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or Mass Disaster.
Intensive care medicine, 2010Co-Authors: John L. Hick, Michael D. Christian, Charles L. SprungAbstract:To provide recommendations and standard operating procedures for intensive care unit (ICU) and hospital preparations for a Mass Disaster or influenza epidemic with a specific focus on surge capacity and infrastructure considerations. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including surge capacity and infrastructure considerations. Key recommendations include: (1) hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas; (2) hospitals should have appropriate beds and monitors for these expansion areas; hospitals should develop contingency plans at the facility and government (local, state, provincial, national) levels to provide additional ventilators; (3) hospitals should develop a phased staffing plan (nursing and physician) for ICUs that provides sufficient patient care supervision during contingency and crisis situations; (4) hospitals should provide expert input to the emergency management personnel at the hospital both during planning for surge capacity as well as during response; (5) hospitals should assure that adequate infrastructure support is present to support critical care activities; (6) hospitals should prioritize locations for expansion by expanding existing ICUs, using postanesthesia care units and emergency departments to capacity, then step-down units, large procedure suites, telemetry units and finally hospital wards. Judicious planning and adoption of protocols for surge capacity and infrastructure considerations are necessary to optimize outcomes during a pandemic.
Pamela Andreatta - One of the best experts on this subject based on the ideXlab platform.
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Outcomes From Two Forms of Training for First-Responder Competency in Cholinergic Crisis Management
2016Co-Authors: Pamela Andreatta, James M. Madsen, J. Klotz, Mc-fs Usa, Col Charles, G. HurstAbstract:ABSTRACT Military and civilian first responders must be able to recognize and effectively manage Mass Disaster casualties. Clinical management of injuries resulting from nerve agents provides different challenges for first responders than those of conventional weapons. We evaluated the impact of a mixed-methods training program on competency acquisition in cholinergic crisis clinical management using multimedia with either live animal or patient actor examples, and hands-on practice using SimMan3G mannequin simulators. A purposively selected sample of 204 civilian and military first responders who had not previously completed nerve agent training were assessed pre- and post-training for knowledge, performance, self-efficacy, and affective state. We conducted analysis of variance with repeated measures; statistical significance p < 0.05. Both groups had significant performance improvement across all assessment dimen-sions: knowledge> 20%, performance> 50%, self-efficacy> 34%, and affective state> 15%. There were no significant differences between the live animal and patient actor groups. These findings could aid in the specification of training for first-responder personnel in military and civilian service. Although less comprehensive than U.S. Army Medical Research Institute of Chemical Defense courses, the training outcomes associated with this easily distributed program demonstrate its value in increasing the competency of first responders in recognizing and managing a Mass casualty cholinergic event
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outcomes from two forms of training for first responder competency in cholinergic crisis management
Military Medicine, 2015Co-Authors: Pamela Andreatta, Jessica J. Klotz, James M. Madsen, Charles G. Hurst, Thomas B. TalbotAbstract:ABSTRACTMilitary and civilian first responders must be able to recognize and effectively manage Mass Disaster casualties. Clinical management of injuries resulting from nerve agents provides different challenges for first responders than those of conventional weapons. We evaluated the impact of a mixed-methods training program on competency acquisition in cholinergic crisis clinical management using multimedia with either live animal or patient actor examples, and hands-on practice using SimMan3G mannequin simulators. A purposively selected sample of 204 civilian and military first responders who had not previously completed nerve agent training were assessed pre- and post-training for knowledge, performance, self-efficacy, and affective state. We conducted analysis of variance with repeated measures; statistical significance p 20%, performance > 50%, self-efficacy > 34%, and affective state > 15%. Th...
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virtual reality triage training provides a viable solution for Disaster preparedness
Academic Emergency Medicine, 2010Co-Authors: Pamela Andreatta, Eric Maslowski, Sean Petty, Woojin Shim, Michael Marsh, Theodore W Hall, Susan A Stern, Jen FrankelAbstract:OBJECTIVES: The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in Disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? METHODS: Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual Mass Disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live Disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). RESULTS: The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. CONCLUSIONS: Virtual reality can provide a feasible alternative for training EM personnel in Mass Disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards.
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virtual reality triage training provides a viable solution for Disaster preparedness
Academic Emergency Medicine, 2010Co-Authors: Pamela Andreatta, Eric Maslowski, Sean Petty, Woojin Shim, Michael Marsh, Theodore W Hall, Susan A Stern, Jen FrankelAbstract:ACADEMIC EMERGENCY MEDICINE 2010; 17:870–876 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives: The objective of this study was to compare the relative impact of two simulation-based methods for training emergency medicine (EM) residents in Disaster triage using the Simple Triage and Rapid Treatment (START) algorithm, full-immersion virtual reality (VR), and standardized patient (SP) drill. Specifically, are there differences between the triage performances and posttest results of the two groups, and do both methods differentiate between learners of variable experience levels? Methods: Fifteen Postgraduate Year 1 (PGY1) to PGY4 EM residents were randomly assigned to two groups: VR or SP. In the VR group, the learners were effectively surrounded by a virtual Mass Disaster environment projected on four walls, ceiling, and floor and performed triage by interacting with virtual patients in avatar form. The second group performed likewise in a live Disaster drill using SP victims. Setting and patient presentations were identical between the two modalities. Resident performance of triage during the drills and knowledge of the START triage algorithm pre/post drill completion were assessed. Analyses included descriptive statistics and measures of association (effect size). Results: The mean pretest scores were similar between the SP and VR groups. There were no significant differences between the triage performances of the VR and SP groups, but the data showed an effect in favor of the SP group performance on the posttest. Conclusions: Virtual reality can provide a feasible alternative for training EM personnel in Mass Disaster triage, comparing favorably to SP drills. Virtual reality provides flexible, consistent, on-demand training options, using a stable, repeatable platform essential for the development of assessment protocols and performance standards.
Peter Gill - One of the best experts on this subject based on the ideXlab platform.
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further validation of a quadruplex str dna typing system a collaborative effort to identify victims of a Mass Disaster
Forensic Science International, 1995Co-Authors: Tim Clayton, C. P. Kimpton, Jonathan Whitaker, Deborah L Fisher, D A Lee, Mitchell M Holland, Victor W Weedn, Christopher Maguire, Joseph A Dizinno, Peter GillAbstract:Abstract The relatively new, PCR-based technique of Short Tandem Repeat (STR) profiling has been used in the identification of the victims of a Mass Disaster. The analysis relied upon a recently developed multiplex reaction and the use of automated fluorescence technology to simultaneously analyse four tetrameric STR loci. The performance of the ‘quadruplex’ test was assessed by use of a collaborative study incorporating a blind trial and was demonstrated to be accurate, reliable and robust. Furthermore, the system proved to be highly successful despite the fact that many of the samples from the Mass Disaster scene were extremely degraded. The high success rate coupled with the discrimination power of the system enabled many severely decomposed human remains to be positively identified.
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short tandem repeat typing of bodies from a Mass Disaster high success rate and characteristic amplification patterns in highly degraded samples
BioTechniques, 1995Co-Authors: J P Whitaker, C. P. Kimpton, Emma S Millican, T. J. Downes, T M Clayton, A J Urquhart, Peter GillAbstract:We have used a PCR-based DNA-typing method, involving the coamplification of four tetrameric short tandem repeat loci, in the analysis of a large number of severely degraded tissue samples taken from the scene of a Mass Disaster in which bodies were exposed to extreme thermal, physical and chemical insult. Analysis of the amplified DNA in a number of the samples revealed uniquely sized artifact PCR products resulting from the amplification of degraded genomic DNA as well as characteristic patterns in the amounts of PCR products generated from differently sized loci. This system has proved to be very reliable and robust, and we were successful in typing all of the four loci in 66% of the samples tested and at least one locus in 83% of the cases. A PCR-based sex test also proved to be very effective when applied to the degraded samples.
