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PubMed1993

Falls from heights: a problem not just in the northeast.

BACKGROUND: Falls from windows and balconies have long been recognized as a health hazard facing children in large, eastern cities. No study has explored this problem in western and sunbelt states. METHODS: A retrospective chart review of children admitted to a large, west coast hospital for injuries sustained secondary to a fall from a building was conducted. The health care costs for injuries secondary to falls were estimated by reviewing Los Angeles County hospital discharge data over a 3-year period. Representative cities in western and sunbelt states were surveyed about their building code regulations for windows and balconies. RESULTS: Ninety-three children fell from windows and 58 from other structures (balconies, fire escapes, and roofs). The fall victims were more likely to be male (male-female ratio, 1.6:1), younger than 3 years old, and playing at the time of the fall. In more than 70% of the cases reviewed, the child fell from a second-story window. Morbidity was significant, with two thirds of children experiencing at least one fracture and more than 30% of the children requiring the intensive care unit. The mortality rate was low (0.7%); however, 10% were left neurologically impaired. The cost for hospitalization was approximately $5000 to $8000 per child. The survey revealed a lack of building code regulations for windows or window guards in western and sunbelt states. CONCLUSIONS: Falls from windows are a significant problem for children, not only in eastern cities, but throughout the nation. Morbidity is significant, even from less than three stories, and the health care cost is high. Preventive strategies are suboptimal.

Accidental Falls↗
PubMed2006

Assessment and management of residential radon health risks: a report from the health Canada radon workshop.

Epidemiologic studies of uranium miners and other underground miners have consistently shown miners exposed to high levels of radon to be at increased risk of lung cancer. More recently, concern has arisen about lung cancer risks among people exposed to lower levels of radon in homes. The current Canadian guideline for residential radon exposure was set in 1988 at 800 Bq/m(3). Because of the accumulation of a considerable body of new scientific evidence on radon lung cancer risks since that time, Health Canada sponsored a workshop to review the current state-of-the-science on radon health risks. The specific objectives of the workshop were (1) to collect and assess scientific information relevant to setting national radon policy in Canada, and (2) to gather information on social, political, and operational considerations in setting national policy. The workshop, held on 3-4 March 2004, was attended by 38 invited scientists, regulators, and other stakeholders from Canada and the United States. The presentations on the first day dealt primarily with scientific issues. The combined analysis of North American residential radon and lung cancer studies was reviewed. The analysis confirmed a small but detectable increase in lung cancer risk at residential exposure levels. Current estimates suggest that radon in homes is responsible for approximately 10% of all lung cancer deaths in Canada, making radon the second leading cause of lung cancer after tobacco smoking. This was followed by a perspective from an UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) working group on radon. There were two presentations on occupational exposures to radon and two presentations considered the possibility of radon as a causative factor for cardiovascular disease and for cancer in other organs besides the lung. The possible contribution of environmental tobacco smoke to lung cancers in nonsmokers was also considered. Areas for future research were identified. The second day was devoted to policy and operational issues. The presentations began with a perspective from the U.S. Environmental Protection Agency, followed by a history of radon policy development in Canada. Subsequent presentations dealt with the cost-effectiveness of radon mitigation, Canadian building codes and radon, and a summary of radon standards from around the world. Provincial representatives and a private consultant were given opportunities to present their viewpoints. A number of strategies for reducing residential radon exposure in Canada were recognized, including testing and mitigation of existing homes (on either a widespread or targeted basis) and changing the building code to require that radon mitigation devices be installed at the time a new home is constructed. The various elements of a comprehensive national radon policy were set forth.

Air Pollutants, Radioactive↗
PubMed1996

Impact of Hurricane Luis on the health services of Antigua and Barbuda.

Antigua and Barbuda, located in the Caribbean, was one of the countries most affected by Hurricane Luis in 1995. Electricity, water supply and health facilities were disrupted for several weeks. Inadequate criteria at the design stages, unsound structural design, and lack of maintenance of building components, are some of the reasons that damage was so severe. The main hospitals and 6 health facilities were destroyed and flooded and most of the medical staff had to cope with their own damaged houses. Although the knowledge and materials are available to reduce the losses caused by hurricanes, building codes are not reinforced by laws and preventive maintenance to protect health care facilities from natural hazard damage is not usually budgeted for. The additional cost of making a single or two-storey health facility almost invulnerable to future catastrophe in a hurricane is only 2% in initial capital cost and becomes negligible when spread over the life of a building. The effort of UN International Decade for Natural Disasters (IDNDR) directed towards disaster mitigation should be increased over the remainder of the decade to ensure that standards are respected and building codes are mandatory.

Antigua and Barbuda↗
PubMed2001

[Recommendations for earthquake preparedness in Israel].

Earthquakes have occurred in the past in our region, along the Afro-Syrian fault line and along the eastern border of Israel. Several earthquakes had a magnitude between 6.25 and 6.5 on the Richter scale and caused severe damage to the populated areas in the Galilee, the Judean Hills and along the coastline. The last major earthquake occurred in 1927 in the Jordan Valley and caused more than 300 fatalities and extensive property damage. If we consider the present densely populated regions in the areas at risk, the occurrence of an earthquake with a magnitude of > 6.25 will constitute a major disaster, causing thousands of casualties and extensive property and economic damage. Israel is presently planning a comprehensive response to mitigate the damages by enforcing existing anti-seismic building codes, retrofitting of public buildings, including hospitals and utilizing all available manpower and material resources in case of such an event. The health sector is a vital part of the overall preparedness and response. Hospitals have to plan alternative sites for continued activity and increase the number of beds. Army medical teams will have to operate in the disaster area in conjunction and coordination with the Home Front Command rescue teams and the EMS. Public and primary health services will have to be reinforced to deal with acute and chronic health problems in the wake of the disaster. The burial of the dead and their identification will become a major logistic and emotional problem and must be planned in advance. Preparedness includes establishing contact with NGOs and agencies in countries, which may render medical assistance in such an event.

Disaster Planning↗
PubMedDate not supplied

Fire safety evaluation system for Canadian hospitals Phase I report.

This paper presents the Canadian Hospital Fire Safety Evaluation System (CHFSES) as a framework based on the project team's analysis. The CHFSES will be vigorously tested to ensure that the final product is unquestionably an effective fire safety evaluation system for hospitals in Canada. The CHFSES will be a dynamic system that can easily be modified to reflect changes in the National Building Code of Canada.

Australia↗
PubMed1987

What the codes say on life safety. Significant changes for residential care.

The fire protection requirements contained in the model building codes and the Life Safety Code are constantly being scrutinized and revised. The American Health Care Association is actively participating in the code development and revision processes of the model code organizations and NFPA to ensure that the interests of the residential care community can be considered. While the effort is being coordinated by AHCA's Residential Care Committee, all interested parties are invited to participate and have their opinions and concerns heard.

Accident Prevention↗
PubMed1984

Building fire safety--lessons learned thru litigation.

Building codes and standards are enforceable by law, but are recognized as a minimum design basis relative to fire safety. The same system that mandates these codes does not, in a court of law, judge solely by the codes. In civil litigation involving death and injury from a building fire, the jury must evaluate the design based not only on the codes but also on what is reasonable. This paper will examine the civil trial and its impact on engineers, architects involved in building design, and manufacturers who supply materials and products for such buildings. Actual case histories will be cited and recommendations for a greater information feedback from trials to practicing designers and manufacturers will be presented.

Building Codes↗
PubMed1987

Regulatory aspects of fire toxicology.

Fire creates a complex toxic environment involving flame, heat, oxygen depletion, smoke, and toxic gases. The nature of that environment is dependent upon not only the materials present but on the fire event, that is, the fire scenario. Materials have different toxic gas profiles under different conditions; therefore, toxic fire gas generation is not intrinsic to any one material. Large fires in buildings constitute a severe toxic threat regardless of the materials being burned. In the past, building codes in the United States included the phrase, "no more toxic than wood," in reference to fire gases from building materials. Such phrases have recently been deleted, because of the lack of either an accepted definition or test methodology to assess toxicity. While several states have attempted regulatory activity, the most recent approach (taken by the state of New York) has been the establishment of a data bank on toxic potency of building and furnishing materials. The utility of such a data bank without available hazard analysis methodology is open to discussion, since toxic potency data are not directly applicable to toxic hazard assessment. A number of small-scale animal exposure tests have been developed to assess the potency of the toxic combustion products from combustible materials. Criticism of these tests relates to the relevance of the combustion module (a smoke generation apparatus) and the appropriateness of the animal model, particularly for irritant gases. Recent data from more than 2000 fire fatality cases and carbon monoxide exposure cases are discussed in this paper to help put small-scale laboratory test results into perspective. Toxicity is only one of the several fire properties related to materials. All fire parameters are interrelated, that is, they are not independent variables. Thus, predicting the toxicity of burning materials is a problem without a comprehensive solution. Measures have been taken, however, to reduce the number of fires and to reduce fire severity.

Animals↗
PubMedDate not supplied

Preparing for the next natural disaster: learning from Katrina.

Hurricane Katrina exposed the nation's ongoing vulnerability to large-scale losses from natural disasters. The catastrophic loss of life and property has lead people to question why the United States is not better prepared for such disasters. In this Issue Brief, a leading expert on decision processes and low probability events discusses the reasons why people do not take protective measures voluntarily. In addition, he suggests ways to reduce losses through a disaster management plan that includes well-enforced building codes and land-use policies, insurance incentives, and long-term loans.

Building Codes↗
PubMed2001

How new NFPA code can affect security department responsibilities.

The latest edition of the "101 Life Safety Code" published by the National Fire Protection Association (NFPA) provides significant options for hospitals and other healthcare facilities during renovation and new construction projects in jurisdictions adopting the latest code and pertinent chapter. Changes in the healthcare chapters of the code effective February 11, 2000 stipulate conditions for the first time under which smoking may be approved, according to Tom Bulow, a Tucson, AZ, healthcare consultant and current chairman of the codes and standards review committee for the healthcare section of NFPA. Bulow also advises hospital officials "to expect a significant change in equipment and devices required in a hospital setting" as a result of an upcoming vote on a revision of the "NFPA 99 Health Care Facilities Code," an operational code.

Building Codes↗
PubMed2000

Sustainable regulation of construction.

The seminar examined the role building codes and regulations can have in promoting a more sustainable approach to construction, particularly through their application to non-industrial building materials. A range of building materials such as straw, bamboo, rammed earth, adobe, and cob (a mixture of clay and chopped straw) were described and illustrated by slides to show their building potential. The current codes have a prime concern to protect the health and safety of people from the built environment. They have been developed almost exclusively for mainstream industrial materials and methods of construction, which makes them difficult to use with alternative, indigenous, or non-industrial building materials, even though those materials may be considered more sustainable. The argument was put forward that with only one-third of the world population living in modern industrial buildings today, it is not sustainable to re-house the remaining rapidly expanding population in high technology dwellings. Many of the low technology building materials and methods now used by the majority of people in the world need only incremental improvement to be equal or superior to many of their industrial replacements. Since these can be more sustainable methods of building, there needs to be an acceptance of the use of alternative materials, particularly in the developing parts of the world, where they are being rejected for less sustainable industrial methods. However, many codes make it difficult to use non-industrial materials; indeed, many of the industrial materials would not meet the demands that must be now met if they were now being introduced as new materials. Consequently, there is a need to develop codes to facilitate the use of a wider range of materials than in current use, and research is needed to assist this development. Sustainable regulation should take into account the full range of real impacts that materials and systems have in areas such as resource use and depletion, toxicity of the processes that produce them, and their potential for re-use and recyclability.

Building Codes↗
PubMed2003

Childhood injuries due to falls from apartment balconies and windows.

BACKGROUND: Falls from balconies and windows are an important cause of childhood injury. This study investigated the circumstances around such falls and attempted to identify possible measures for their prevention. POPULATION: Children <15 years living in Dallas County, Texas. METHODS: Each child treated because of a fall from a building in 1997-99 had information about the injury collected, and a parent was contacted to obtain further information. For apartment related falls, an attempt was made to visit the apartment to measure windows and balcony rails. RESULTS: Ninety eight children were injured in falls from buildings during the three year period; 39 (40%) were admitted to hospital. Seventy five of the falls (77%) involved apartments, and most occurred around noon or evening meal times. Among apartment falls, 39 (52%) fell from windows, 34 (45%) from balconies, and two (3%) from unknown sites. For more than two thirds of balcony related falls, the child fell from between the balcony rails, all of which were spaced more than 4 inches (10 cm) apart. On-site measurement showed the rails were an average of 7.5 inches (19 cm) apart; all of these apartments were built before 1984. For more than two thirds of window related falls, the window was situated within 2 feet (61 cm) of the floor. CONCLUSIONS: Two factors are important in falls from apartment windows and balconies: balcony rails more than 4 inches (10 cm) apart, and windows positioned low to the floor. Current building codes do not apply to older apartments, where most of these falls occurred. Nevertheless, these factors may be amenable to environmental modifications that may prevent most of these falls.

Accidental Falls↗
PubMed2003

Disaster nephrology: medical perspective.

Disaster medicine is an extension of emergency medicine involving mass casualties and use of the best available techniques in search and rescue. To achieve the best results extensive predisaster preparedness is mandatory. Earthquakes have caused the loss of more than 1 million lives in the 20th century. Evidence-based medicine confirms that these deaths were mostly preventable based on experience in developed countries. The key to success is implementing building codes and structural reinforcement. In earthquakes as well as in collapse of buildings in bomb blasts, loss of life is either because of the direct effect of trauma or to the metabolic consequences of rhabdomyolysis and complications of its management. Hyperkalemia and infection are the commonest causes of death in victims who survive the direct effect of trauma. Acute renal failure, a grave complication of rhabdomyolysis, is mostly preventable by timely rehydration and bicarbonate therapy. Mannitol therapy can be very efficient in reducing the severity of muscle damage and its sequelae. Fasciotomy can be limb saving if it is done in the early hours, although a firm guideline is still lacking. Although each country is responsible for improving the structure of buildings and organizing an efficient disaster response, national and international organizations in developed countries should give high priority to communicating with developing countries to encourage their preparedness.

Acute Kidney Injury↗
PubMed2002

Earthquake disasters--lessons to be learned.

Human beings do not have the ability prevent earthquakes. However, we can take measures to minimize injuries and damage by using strict building codes and constructing infrastructures in areas of less risk. A great number of buildings in Israel, including some hospitals, will not withstand a major earthquake as they were built with inadequate standards. Data collected during earthquakes show a significant rise in cardiac-related disease and stress-related medical problems in addition to conventional injuries. Public health issues are of increasing importance due to the collapse of sanitation facilities. In addition to field clinics, field hospitals should be deployed in the vicinity of the stricken area. While planning the medical response for disasters such as earthquakes, one should take into account the availability of local medical personnel. Some or most of the local staff may be unable to function. A study from the Gulf War showed that even the threat of chemical attack resulted in less staff reporting to work [33]. During the 1999 earthquakes in Turkey, many of the hospital staff opted to care for their close families instead of reporting to work at the hospital. Regular training exercises in prehospital emergency medical services for the more common multiple casualty incidents should be bolstered with additional exercises in mass casualty incidents. The basic functions in these scenarios may be quite different. Although no exercise can mimic the real event, preplanning and drills are invaluable. When an earthquake does occur, medical management includes local search and rescue teams together with emergency medical service teams if these can still function. Early deployment of local medical centers can alleviate the burden from local hospitals. Evacuation to distant medical centers is probably a major key for success. Psychological problems are abundant in such incidences, affecting also rescue and medical teams. It becomes a major issue when there are large numbers of pediatric casualties and the operations continue for more than a few days.

Disasters↗
PubMed1985

Smoke detector legislation: its effect on owner-occupied homes.

Montgomery County, Maryland was the first major jurisdiction to pass a law requiring smoke detectors in all homes. Smoke detector coverage in the county was evaluated five years after the law's implementation and compared to the coverage in neighboring Fairfax County, Virginia, which has no such law. Firefighters visited 651 randomly selected owner-occupied homes and tested each detector. While a similar percentage of homes in Montgomery and Fairfax counties complied with detector codes (42 per cent vs 44 per cent, respectively), Montgomery County had a significantly lower percentage of homes with no working detectors (17 per cent vs 30 per cent) and with no detectors at all (6 per cent vs 16 per cent). In general, Montgomery County residents complied with what they believed the law required, but lacked knowledge of the law's details. New homes where building codes required detectors and homes where owners assumed that detectors were required by law were likely to have working detectors. Analyses of 12 years of fire data suggest that as a county approaches complete detector coverage, the risk of residential fire deaths decreases. An essentially unenforced law seems to be obeyed because it conforms to community values.

Data Collection↗