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Biomedical subjects

M L Cowan

Publications and source records attributed to M L Cowan.

16 recordsLinked to original sources
PubMed1991

Crisis intervention following disasters: are we doing enough? (A second look).

During mass casualty events the consequences of psychological trauma are an important cause of morbidity among survivors and rescue personnel. Data available from military and civilian disasters over the past 70 years has shown a fairly predictable ratio of acute and severe emotional trauma associated with mass casualty events. Long-term morbidity from psychological trauma can rival or exceed that of the physical injuries of survivors. Psychological intervention reduces this morbidity, and early psychological intervention is more effective before adverse psychological symptoms have fully developed. However, the widely accepted value of early psychological intervention is not universal, with controversy over the degree of emotional trauma expected after a large-scale catastrophic mass casualty event, as well as the number of victims and the effectiveness of immediate psychological intervention. Some research even suggests that there is only a minor risk of acute emotional trauma among survivors of a major disaster. The United States faces the possibility of mass casualties from national disasters--particularly earthquakes--and conventional warfare. It has been predicted that 100,000 major injuries requiring hospitalization and 20,000 deaths would result from the maximum plausible natural disaster incident in the United States. Pentagon planners expect thousands of servicemen to be evacuated to the United States for hospitalization on a daily basis during an overseas conventional war. With these estimates of potential casualties, it is imperative that this controversy be resolved as quickly as possible. The National Disaster Medical System recently established plans to provide immediate treatment for psychological trauma to disaster survivors and rescue personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

Crisis Intervention↗
PubMed1991

Mental health issues related to the development of a national disaster response system.

With the creation of the National Disaster Medical System (NDMS), the federal government has moved to develop a national medical plan for responding to major mass casualty situations resulting from either a civilian disaster which overwhelms state and local resources or an overseas conventional conflict. To date, the mental health aspects of this plan have received little attention. This article discusses the rationale for adding a comprehensive mental health component to NDMS within the context of the complementary needs of disaster survivors and rescuers.

Disaster Planning↗
PubMed1988

Medical simulation for disaster casualty management training.

A required, role-intensive leadership simulation in emergency and disaster medicine management for fourth-year medical students is described, and the value of an extended role-playing experience discussed. The week-long (120 hours) simulation exercise is designed to provide an opportunity for Federal medical students to experience a realistic combat or disaster environment similar to environments in which they may be required to operate medical support systems. Students function in a variety of roles and have the opportunity to place into practice all emergency medical knowledge and skills acquired throughout medical school. As a prerequisite to the exercise, students successfully complete a 3-week didactic course in Operational and Emergency Medicine which includes Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS) Provider Courses. By means of disaster simulation they refine medical skills, leadership style, substantially improve clinical judgment, and deal with the complexities of problems associated with their future roles as medical officers.

Disaster Planning↗
PubMed1988

Exercise-induced changes in populations of peripheral blood mononuclear cells.

The effects of maximal treadmill exercise on changes in the expression and distribution of peripheral blood B-lymphocytes, T-lymphocytes, and natural killer cells (NK) were examined in 20 healthy men with a mean age of 32.0 +/- 1.3 yr. The percentage and absolute number of peripheral blood mononuclear cells that reacted with specific monoclonal antibodies which bind to B-cells (anti-Leu-12 and anti-human-immunoglobulin D-delta chain-specific), T-cells (OKT3), and NK cells (anti-Leu-11 and anti-Leu-7) were enumerated by a fluorescence-activated cell sorter in samples obtained before (Pre), immediately after (Post), and 1 h after a bout of exercise to exhaustion. In contrast to earlier studies, the results of this study indicate that maximal exertion effects a decrease in the percentage, but no change in the absolute number of peripheral blood B-cells (Pre: 0.21 +/- 0.01; Post: 0.31 +/- 0.02 cells x 10(-6).ml-1). In addition, a small, transient increase in the number of peripheral blood cells reacting with surface markers associated with T-lymphocytes (Pre: 1.15 +/- 0.09; Post: 2.05 +/- 0.19 cells x 10(-6).ml-1) and a striking, transient increase in lymphocytes having NK phenotype activity (Pre: 0.34 +/- 0.03; Post: 1.51 +/- 0.19 cells x 10(-6).ml-1) were noted. All of the pre-exercise values were re-established 1 h after exercise. Whether the mobilization of cells with surface markers associated with NK activity in response to maximal exertion serves any physiologic function during periods of physical stress remains to be determined.

Adult↗
PubMed1986

New concepts in triage.

The triage process is a valid concept in the initial approach to multiple casualties. Triage tags are, in theory, a reasonable adjunct to the process, but have proved to be a failure in practice. Based on the historical perspective and on the authors' experience with approximately 180 mass casualty drills and incidents, it is recommended that the "daily routine doctrine" be applied and that conventional, color-coded triage tags be replaced by a process of "geographical triage." A valid model for disaster planning is needed, and organizers must conduct drills that are based on the actual threat to the community in order to determine the most efficacious way to manage medical response.

Disaster Planning↗
PubMed1984

A personal medical emergency kit.

The professional and promotional literature is replete with advertisements for emergency kits. For many years, we have pursued the question from the perspective of immediate accessibility. This paper presents four case reports relating the authors' experience with such a small, personal emergency kit.

Adult↗
PubMedDate not supplied

Developing a regional and national burn disaster response.

The supplement on burns by the National Disaster Medical System (NDMS) requires an evaluation of burn centers' and burn hospitals' capabilities for treating seriously burned victims. The American Burn Association (ABA) and its members, as experts in burn care, should take the lead in working with local, state, and federal disaster planners. Proposals based on standards adopted by the ABA support classification of facilities (levels I, II, III), identify minimum and maximum bed availability, require minimum training for personnel (e.g., ABLS), and encourage enrollment of all burn centers and burn hospitals as contract hospitals in the National Disaster Medical System. Periodically, the ABA should verify that the burn care facilities identified in the disaster plan meet its standards. Once the burn disaster system is developed, drills should be held locally on a regular basis and nationally on an annual basis.

Burn Units↗