Category: International EM
Keywords: Emergency Management, mitigation, preparedness, response, recovery (PubMed Search)
Posted: 3/18/2015 by Jon Mark Hirshon, PhD, MPH, MD
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Whether in the U.S. or overseas, there are four main phases of emergency management:
fas.org/sgp/crs/homesec/R42845.pdf
Category: International EM
Keywords: international health, noncommunicable diseases, chronic diseases, World Health Organization (PubMed Search)
Posted: 3/4/2015 by Jon Mark Hirshon, PhD, MPH, MD
(Updated: 3/18/2015)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
Background: While much of international health focuses on communicable diseases, it is clear that noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer and diabetes, causes substantial morbidity and mortality.
Epidemiology:
Bottom line: As in developed countries, risk factors for NCDs deaths include physical in activity, tobacco use, unhealthy diabetes, harmful use of alcohol.
http://www.who.int/mediacentre/factsheets/fs355/en/
Category: International EM
Keywords: Measles, outbreak, complications (PubMed Search)
Posted: 2/19/2015 by Jon Mark Hirshon, PhD, MPH, MD
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The Centers for Disease Control continues to report increased numbers of measles patients in the US. From January 1 to February 13, 2015 there have been 141 cases. It has spread to 17 states and the District of Columbia, with 80% linked to the multistate outbreak from Disneyland.
Measles is not a benign disease!
Per the World Health Organization, there were 146,700 measles deaths globally in 2013. Most of these deaths occur in lower- and middle-income countries,
Even in the US, measles can cause serious complications and death. Complications from measles can be seen in any age group, but particularly in children <5 years of age and in adults >20 years of age.
Measles Complications:
Common:
Severe:
Long-term:
Bottom Line:
Per Dr. Anne Schuchat of the CDC: “This is not a problem with the measles vaccine not working. This is a problem of the measles vaccine not being used.”
http://www.who.int/mediacentre/factsheets/fs286/en/
http://www.cdc.gov/measles/about/complications.html
Category: International EM
Keywords: Measles, international, pediatrics, vaccination, public health (PubMed Search)
Posted: 2/4/2015 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
From January 1st to January 30th, 2015, 102 people from 14 states were reported to have measles. This one month total is greater than the annual number of U.S. cases from 2002 to 2012. Most of these cases are related to a large outbreak from a Californian amusement park. Measles can spread in communities without adequate vaccination (low herd immunity). The majority of the people in the US who get measles are unvaccinated. However, measles remains common in many parts of the world.
Bottom Line:
As noted in the recent ACEP Fact Sheet, “A very high index of suspicion for Rubeola is necessary especially among patients with an exposure history, travel to foreign or domestic areas where disease is present, and those without adequate immunization. Immediate isolation of these patients should be considered in the ED or other outpatient healthcare setting.”
1502040913_Measles_Jan_2015.jpg (67 Kb)
Category: International EM
Keywords: Tuberculosis, infectious disease, drug resistance, multidrug resistant tuberculosis (PubMed Search)
Posted: 1/21/2015 by Jon Mark Hirshon, PhD, MPH, MD
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As noted previously (UMEM Pearl of 1/7/2015), tuberculosis (TB) is a major infectious disease that occurs worldwide. Strains of tuberculosis can be resistant to one or more anti-tuberculosis medications. TB strains resistant to at least one medication have been found in all surveyed countries.
What is multidrug-resistant tuberculosis (MDR TB)?
Treatment of MDR TB
Bottom line:
As noted previously, in your emergency department have a high index of suspicion for TB and MDR TB in patients with an appropriate risk profile.
http://www.who.int/mediacentre/factsheets/fs104/en/
http://www.cdc.gov/tb/topic/drtb/default.htm
http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm
Category: International EM
Keywords: Tuberculosis, infectious disease (PubMed Search)
Posted: 1/7/2015 by Jon Mark Hirshon, PhD, MPH, MD
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Tuberculosis (TB) is a major infectious disease that occurs worldwide.
Fortunately, public health and clinical measures have had some success.
Bottom line:
http://www.who.int/mediacentre/factsheets/fs104/en/
http://www.cdc.gov/tb/topic/treatment/
Category: International EM
Keywords: Injuries, alcohol, fireworks (PubMed Search)
Posted: 12/31/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Updated: 1/7/2015)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
As you get ready to celebrate the coming of a new year, it is important to be safe while you are having a good time.
Injuries seen during holidays, such as new years, include:
If you are working, be ready to see increased alcohol and injury related visits.
If you are off and plan to celebrate, be sure to identify a designated driver or an alternate means of getting home.
Have a Happy and Safe 2015!
Category: International EM
Keywords: Influenza, 2014, CDC (PubMed Search)
Posted: 12/18/2014 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
Background: As discussed previously, influenza (flu) is a common respiratory disease that causes significant morbidity and mortality worldwide (see pearl from October 1. 2014). We are now in the midst of the current flu season.
Current Update: This year’s vaccine was only a partial match (<50%) for the current influenza A (H3N2) circulating virus, so there is a significant potential for a “bad” flu season with widespread disease and severe illness. Currently, influenza is now widespread throughout the US, with some states reporting more activity than others. The CDC has a weekly surveillance map that highlights current disease spread.
Bottom Line:
CDC Weekly Influenza Map: http://www.cdc.gov/flu/weekly/usmap.htm
CDC 2014-2015 Flu Season Webpage: http://www.cdc.gov/flu/about/season/index.htm
1412180413_CDC_Flu_Map_Week_49_2014.jpg (199 Kb)
Category: International EM
Keywords: Global Health, emergency care, acute care, research (PubMed Search)
Posted: 12/3/2014 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
In December 2013, Academic Emergency Medicine published the results of the 2013 consensus conference that focused on advancing global health and emergency care research.
As noted in the issue’s executive summary, “Emergency physicians are uniquely poised to address challenges in health services, health care systems development and management, and emerging global disease burdens (both communicable and noncommunicable). “
The consensus conference covered developing research in eight focus areas, including understanding of cardiac and injury resuscitation, ethics of research, health systems development, and the education of future global health leaders.
For anyone interested in global health and emergency care, this issue of Academic Emergency Medicine is an outstanding resource and roadmap to developing research. It can be found at: http://onlinelibrary.wiley.com/doi/10.1111/acem.2013.20.issue-12/issuetoc
Category: International EM
Keywords: Bioterrorism, infectious diseases (PubMed Search)
Posted: 11/20/2014 by Jon Mark Hirshon, PhD, MPH, MD
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Background: As noted in a previous pearl (November 5, 2014), the Centers for Disease Control and Prevention (CDC) classifies potential bioterrorism agents into three categories. Category B & C agents are of less priority than the previously discussed Category A agents.
Category B: Second highest priority agents. These agents:
These Agents/Diseases include:
•Brucellosis (Brucella species)
•Epsilon toxin of Clostridium perfringens
•Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)
•Glanders (Burkholderia mallei)
•Melioidosis (Burkholderia pseudomallei)
•Psittacosis (Chlamydia psittaci)
•Q fever (Coxiella burnetii)
•Ricin toxin from Ricinus communis (castor beans)
•Staphylococcal enterotoxin B
•Typhus fever (Rickettsia prowazekii)
•Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis])
•Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
Category C agents: Third highest priority agents. These include emerging pathogens, such as hantavirus and Nipah virus, which could be potentially engineered for mass dissemination in the future.
Bottom Line: While in general of less concern, bioterrorism agents in Category B & C remain of significant risk. Many of these diseases still occur in various parts of the globe including the United States.
Category: International EM
Keywords: Bioterrorism, anthrax, botulism, plague, smallpox, tularemia, viral hemmorrhagic fevers (PubMed Search)
Posted: 11/5/2014 by Jon Mark Hirshon, PhD, MPH, MD
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Background: The Centers for Disease Control and Prevention (CDC) classifies potential bioterrorism agents into three categories, with Category A the most deadly.
Category A: These are the highest priority agents/diseases because they:
Specific Category A Agents/Diseases:
Bottom Line: With the exception of smallpox, these disease still occur in various parts of the globe including the United States. As can be seen by the current Ebola epidemic in West Africa, the U.S. public health system and healthcare providers must be prepared to recognize and treat these agents.
Reference: http://www.bt.cdc.gov/agent/agentlist-category.asp
Category: International EM
Keywords: Ebola, CDC, Isolation (PubMed Search)
Posted: 10/28/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Emailed: 10/29/2014)
(Updated: 10/29/2014)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
Background:
ED Algorithm For Patients with Possible Ebola
If yes to both identification questions, then:
Bottom line:
Whether the patient has Ebola or not, a well-developed response is necessary for patient management and public health preparedness. The fear of the disease is much more widespread and impactful than the disease itself.
See the full algorithm, with more details at: http://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.pdf
1410290644_ed-algorithm-management-patients-possible-ebola.pdf (998 Kb)
Category: International EM
Keywords: Infectious diseases, isolation, quarantine (PubMed Search)
Posted: 10/16/2014 by Jon Mark Hirshon, PhD, MPH, MD
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With all the current concern about Ebola, it is important to understand what are quarantine and isolation and who can order these.
Per the Centers for Disease Control:
Federal Law allows for quarantine and isolation:
State laws allows for the enforcement of isolation and quarantine within their borders.
Bottom Line:
Category: International EM
Keywords: Influenza (PubMed Search)
Posted: 10/1/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Updated: 10/29/2014)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
INFLUENZA
What is it?
Why do we care about influenza?
Bottom line
Category: International EM
Keywords: deep venous thrombosis, plane travel, blood clots (PubMed Search)
Posted: 9/16/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Emailed: 9/17/2014)
(Updated: 9/17/2014)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
While sitting on an international flight, ever wonder what your risks are for a blood clot?
General Background:
It is estimated that the risk for a deep venous thrombosis (DVT) is 3-12% on a long-haul flight. However, the real incidence is difficult to evaluate, due in part to the lack of consensus about 1) diagnostic tests, and 2) the appropriate time frame to relate a venous thromboembolic event (VTE) to travel.
Risks Factors for VTEs on long-haul flights:
Bottom Line:
http://www.cdc.gov/ncbddd/dvt/travel.html
Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med 2011 Apr;6(2):113-6.
Category: International EM
Keywords: Hyperthermia, heat stroke, environmental (PubMed Search)
Posted: 9/1/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Emailed: 9/3/2014)
(Updated: 9/3/2014)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
Hyperthermia can be defined as a core body temperature > 38.5ºC. In contrast to fever, the body’s temperature rises uncontrollably and the body is not able to dissipate the heat. There can be many causes of hyperthermia, including from environmental exposure.
There are two main environmental heat illnesses, heat exhaustion and heat stroke.
Heat exhaustion:
Heat stroke
Bottom line:
Management of the hyperthermic patient. Calvello EJ, Hu K, Khoujah D. Br J Hosp Med (Lond). 2011 Oct;72(10):571-5
Cooling Techniques for Hyperthermia by Schraga ED, Kates LW. Available at: http://emedicine.medscape.com/article/149546-overview
Category: International EM
Keywords: hyperthermia, hypothermia, environmental, international (PubMed Search)
Posted: 8/12/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Emailed: 8/20/2014)
(Updated: 8/20/2014)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
General Background:
Heat transfer is important to understand, especially when evaluating and treating someone who is hyperthermic or hypothermic. Are they really hot (or cold) from exposure, or is there an underlying metabolic or toxicological cause?
Mechanisms of Heat Transfer:
There are 4 main methods of heat transfer:
Bottom line:
When evaluation someone for hyper- or hypothermia from a potential environmental exposure, be sure to obtain the history about where they were found and the circumstances in which they were found. This can help you develop your diagnostic differential.
Reference: Pathophysiology, management and complications of hypothermia. Lantry J, Dezman Z, Hirshon JM. Br J Hosp Med (Lond). 2012 Jan; 73(1):31-7.
Category: International EM
Keywords: hypothermia, cold, environmental (PubMed Search)
Posted: 8/9/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Updated: 8/14/2024)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
General Information:
Hypothermia is when the body’s core temperature is less than 35º C. Often thought as a winter disease, it can occur in nearly any climate or weather condition. However, a number of cold related conditions can occur without a drop in core body temperature.
Specific Cold Related Conditions:
Bottom line:
Remember that cold related injuries can occur without core hypothermia. Don’t forget the tetanus and antibiotics, as indicated.
Pathophysiology, management and complications of hypothermia. Lantry J, Dezman Z, Hirshon JM. Br J Hosp Med (Lond). 2012 Jan; 73(1):31-7.
Category: International EM
Keywords: Ebola, hemorrhagic fever, international (PubMed Search)
Posted: 7/30/2014 by Jon Mark Hirshon, PhD, MPH, MD
(Updated: 8/14/2024)
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
General Information:
Ebola is a deadly hemorrhagic fever of the virus family Filoviridae.
Clinical Information:
Treatment and Public Health
Bottom Line:
While the likelihood of general dissemination to the general U.S. population is very low, U.S. healthcare workers need to be aware and alert for the signs and symptoms of Ebola for patients recently returned from West Africa.
References: http://www.cdc.gov/ebola
Current CDC advisory: http://emergency.cdc.gov/han/han00363.asp
Category: International EM
Keywords: Smallpox, public health, infectious diseases (PubMed Search)
Posted: 7/19/2014 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD
· Smallpox (Variola):
o Only eradicated human infectious disease.
o Prior to the advent of vaccination, it killed an estimated 400,000 Europeans annually and was a major cause of blindness.
· Major potential as a bioterrorism agent:
o Now only supposed to exist in two laboratories in the world (at the CDC in Atlanta, Georgia and in the Vector Institute in Koltsovo, Russia).
· Recently, previously unknown vials of active virus from the 1950s were found in a NIH laboratory in Maryland.
· Clinical Presentation:
o Incubation is usually 10-12 days (range 7-17 days)
o Signs and symptoms include:
§ Febrile (38.8-40.0C) prodome lasting 1-4 days, headache, myalgia (esp. back/spinal pain), pharyngitis, chills, abdominal pain
§ Rash: classically round and well circumscribed. May be confluent or umbilicated. The rash evolves slowly: macules to papules to pustules to scabs.
· It is important to differentiate smallpox from chicken pox (Varicella):
o Smallpox: Significant prodrome. Centrifugal rash (trunk to extremities). Can involve soles and palms. Lesions are in the same stage of development on any one part of the body.
o Chickenpox: Minimal prodrome. Centripetal rash (extremities to trunk). Seldom on soles and palms. Asynchronus evolution of rash.
Bottom Line:
Smallpox is a global public health emergency and requires immediate reporting. If the clinical presentation is unclear, discuss with local infectious disease experts or public health officials.