Revisiting the Battle of Solferino: The Worsening Plight of Civilian Casualties in War and Conflict.

The toll of civilian deaths in current wars and conflicts has been building for decades. Civilian populations, particularly since WWII, have suffered most of the consequences of armed violence and today represent the most at-risk population. This is attributed to the rise of religious and ethnic hatreds, the collapse of State structures, the battle for control of natural resources, the vast availability of weapons, the proliferation of acts of terrorism, and the spread of so-called asymmetric conflicts. Protections provided to innocent civilians under International Humanitarian Law and the Geneva Conventions have been ignored. This commentary captures the experience of the immediate care and transportation provided to military casualties of the Battle of Solferino in 1859 with civilian casualties recently documented in a Stanford-led study during the "golden hour" after injury in 13 conflicts from 1990 to 2017. Despite many advances in triage and management of war injuries over the intervening decades, the common thread of these 2 scenarios is that transport times and early resuscitation capacity and capabilities, first recognized in the 19th century wars and now accepted as global norms and markers for survival from trauma, are as unavailable today to civilians caught up in war and conflict as they were to soldiers in the 19th century.

Maximum Time-to-Rescue After the 1908 Messina-Reggio Calabria Earthquake was 20 Days: Hints for Disaster Planning?

Introduction Maximum time-to-rescue has been studied accurately for many earthquakes in the years 1985-2004. No study is available for historical quakes. Hypothesis/Problem This study aimed to evaluate long-term survivors (from the fifth day after the quake) of the Messina-Reggio Calabria earthquake (1908; Italy), which is considered, historically, to be the worst seismic event in Europe. METHODS: Accurate readings of 11 national newspapers from the fifth day after the quake looking for rescued persons and transferring, to an ad hoc form, all data relating to each rescued person. RESULTS: The maximum time-to rescue was 20 days. There were 225 survivors, among them 51 children (22.6 %). For 23 out 225 rescued persons, there was evidence of availability of foods and drinkable fluids while under the rubble. CONCLUSION: The maximum time-to-rescue under the debris following this historical earthquake far exceeds that of all other quakes that occurred in the years 1985-2004. The long survival under debris was probably due to the lack of an order to stop search and rescue. Recent strategies reducing the time for search and rescue carry the risk of missing survivors. De Santo NG , Bisaccia C , De Santo LS . Maximum time-to-rescue after the 1908 Messina-Reggio Calabria Earthquake was 20 days: hints for disaster planning? Prehosp Disaster Med. 2017;32(3):249-252.

[Tribute to the Righteous Among the Nations Polish doctors and medical students]. / Studenci medycyny oraz lekarze--polscy Sprawiedliwi wsród Narodów Swiata.

52 Polish doctors and medical students received the Righteous Among the Nations title awarded by the Yad Vashem remembrance authority in Jerusalem for having saved the life of a Jew during the Holocaust or having tried to recue a Jew who was helpless and facing death or deportation. We have an obligation to remember these Righteous doctors, who were spurred in World War II by the "banality of good", so that future generations can identify with the anonymous survivors who demonstrated such generosity, humanity, and courage and who put their own lives at risk.

[Experience in provision of medical services to earthquake victims in Armenia in 1988].

The most devastating catastrophe in the USSR was the Armenian earthquake occurred on 7th December 1988. The city of Leninakan and towns of Kirovokan, Spitak (the epicenter), Stepanovan were destroyed by the earthquake with a magnitude 10. Up to 25 542 people have died, more than 500 000 were homeless and 39 795 were rescued. Medical service of the Ministry of Defence of the USSR took part in rescue work. Medical service units finished their rescue work on 31st December after results of work were summed up. Lethality rate was an index of successful rescue work of the unit. Only 6% of injured rescued by the medical unit have died, meanwhile 40%-50% of injured have died in Erevan hospitals. Mortality rate in patients with crush syndrome was 8.9% (according to other authors--30-75%). 75 injured remained in hospital, 25 injured were evacuated to central military hospitals for reconstructive plastic surgery. Officers of the medical unit, embodied from the main and central hospitals, successfully completed the task and received experience in provision of medical services to earthquake victims.

Albert Behnke: nitrogen narcosis.

As early as 1826, divers diving to great depths noted that descent often resulted in a phenomenon of intoxication and euphoria. In 1935, Albert Behnke discovered nitrogen as the cause of this clinical syndrome, a condition now known as nitrogen narcosis. Nitrogen narcosis consists of the development of euphoria, a false sense of security, and impaired judgment upon underwater descent using compressed air below 3-4 atmospheres (99 to 132 feet). At greater depths, symptoms can progress to loss of consciousness. The syndrome remains relatively unchanged in modern diving when compressed air is used. Behnke's use of non-nitrogen-containing gas mixtures subsequent to his discovery during the 1939 rescue of the wrecked submarine USS Squalus pioneered the use of non-nitrogen-containing gas mixtures, which are used by modern divers when working at great depth to avoid the effects of nitrogen narcosis.

Evacuating damaged and destroyed buildings on 9/11: behavioral and structural barriers.

INTRODUCTION: Evacuation of the World Trade Center (WTC) twin towers and surrounding buildings damaged in the September 11, 2001 attacks provides a unique opportunity to study factors that affect emergency evacuation of high rise buildings. Problem The goal of this study is to understand the extent to which structural and behavioral barriers and limitations of personal mobility affected evacuation by occupants of affected buildings on September 11, 2001. METHODS: This analysis included 5,023 civilian, adult enrollees within the World Trade Center Health Registry who evacuated the two World Trade Center towers and over 30 other Lower Manhattan buildings that were damaged or destroyed on September 11, 2001. Multinomial logistic regression was used to predict total evacuation time (<30 to ≤60 minutes, >1 hour to <2 hours relative to ≤30 minutes) in relation to number of infrastructure barriers and number of behavioral barriers, adjusted for demographic and other factors. RESULTS: A higher percentage of evacuees reported encountering at least one behavioral barrier (84.9%) than reported at least one infrastructure barrier (51.9%). This pattern was consistent in all buildings except WTC 1, the first building attacked, where >90% of evacuees reported encountering both types of barriers. Smoke and poor lighting were the most frequently-reported structural barriers. Extreme crowding, lack of communication with officials, and being surrounded by panicked crowds were the most frequently-reported behavioral barriers. Multivariate analyses showed evacuation time to be independently associated with the number of each type of barrier as well as gender (longer times for women), but not with the floor from which evacuation began. After adjustment, personal mobility impairment was not associated with increased evacuation time. CONCLUSION: Because most high-rise buildings have unique designs, infrastructure factors tend to be less predictable than behavioral factors, but both need to be considered in developing emergency evacuation plans in order to decrease evacuation time and, consequently, risk of injury and death during an emergency evacuation.

Individual testimonies of nursing care after the atomic bombing of Nagasaki in 1945.

PURPOSE: To describe the situation with respect to nursing care conducted immediately before and after the atomic bombing of Nagasaki in 1945. METHODS: Nurses who were registered nursing staff in Nagasaki at the time of the bombing volunteered to participate in this research. Individual interviews were conducted to obtain information concerning the nursing activities in affected areas. The collected information was compared with official documents regarding the atomic bombing of Nagasaki and findings of current studies of disaster situation nursing. RESULT: Five participants indicated that starting on the day of the bombing, nursing care activities changed from moment to moment according to the condition of radiation victims, the condition of affected areas, and the relief systems in place. Under these conditions, nurses attempted to provide nursing care to victims of the bombing through any means possible. CONCLUSION: The participants in the present study communicated a single message: that nursing care must be flexible in critical situations. Triage and cooperation with other types of medical professionals were also identified as important factors in nursing care.

[The experience of 183 medical special forces of the Volga-Urals Military District in the elimination of the health effects of the emergency in the Republic of Indonesia].

The article is based on personal experience of the authors with assistance in the aftermath of the tsunami in the Republic of Indonesia, which killed about 120 thousand (December 26, 2004 at 255 km to the west coast of Sumatra). In the disaster area were sent to 183 medical detachments for special purposes of the Volga-Urals Military District, reinforced brigade of specialized medical care of military medical institutions under the central government and the Moscow Military District. As the authors noted, in the aftermath of a disaster like the tsunami, at first put forward preventive measures among displaced persons. The experience gained by the Medical Service of the Armed Forces of the Russian Federation in the aftermath of natural disaster in the Republic of Indonesia, is used to plan future humanitarian operations abroad with the assistance of military medical specialists from Russia.

Health Resort Opatija Volunteer Fire Brigade and Rescue Society.

Not only the health service but also several other humanitarian institutions and societies were active in Abbazia÷Opatija, the most important town on the once Austrian Riviera, the town that was also known as the Austrian Nice. The most important of the societies was The Health Resort Opatija Volunteer Fire Brigade and Rescue Society. The authors of this article have been particularly interested in the society's founding and its activity until it moved into the new building at 6, St. Florjan's Street in 1910. The fast urbanisation and the development of the industry raised the need of the well organised activity of putting out fires. The German gymnastics societies were the first to include the education and the skills development of the volunteer firemen into their programmes. The first volunteer fire brigades appeared in Austria after 1863. The huge fire that broke out in Vienna in 1881 showed that the fast and efficient rescuing demanded a well prepared organization of a team of rescuers. Based on the initiative of the chimney sweep Franz Drescher and The South Railway Company, the volunteer fire brigade was founded in Opatija already in 1886. The founding of the volunteer rescue society was based on the idea given by dr. Jaromir Mundy, the permanent guest in Opatija and a friend of prof. dr. Theodor Billroth, in 1894. The intertwining activity of the both societies resulted in their formal joining. The head physician became dr. Franz Tripold, the chief commander was Franz Doberlet junior. For his special merits, the general assembly of the Health Resort Opatija Volunteer Fire Brigade and Rescue Society appointed him the honourable commander of the society in 1903 and he received a special photo album with the photos of the volunteer firemen and the rescuers' practice. The Emperor Franz Joseph I Jubilee Fire Station, the Rescue Station And the Sanatorium (Kaiser Franz Joseph I Jubiläums - Feuerwehrrüstungshaus, Rettungsstation und Erholungsheim) was given to the use on 1st October 1910. Since then, the two societies worked at this same location. The Volunteer Fire Brigade Opatija has been located in this building ever since.

Mountain research and rescue on Denali: a short history from the 1980s to the present.

Alaska's Denali (Mt. McKinley), 6194 m, is the highest and perhaps most celebrated peak on the North American continent. The cold and stormy nature of this mountain just 3° of latitude south of the Arctic Circle enhances its legend as a challenging peak. It has been the desired objective of over 1000 summit aspirants per climbing season for the last 20 years. As mountaineering traffic on the peak increased in the 1960s and 1970s, an increase in deaths and helicopter evacuations followed suit. These were largely owing to altitude illness, cold injuries, and trauma. By the late 1970s and early 1980s, the U.S. National Park Service (NPS) began exploring potential solutions regarding the problems with rescue scenarios in remote and hostile surroundings. The NPS eventually placed a team equipped with communications and medical supplies high on the mountain to remedy the problem. This seasonal high altitude camp, established in 1982, carried out clinical research, preventive education, and rescue work. Although this operation has undergone substantial changes since 1982, it continues to serve Denali climbers each season and has likely reduced the frequency of serious accidents, death, and helicopter rescues. In addition, a parallel increase in NPS infrastructure, medical research, and mountain rescue on this peak has contributed to an increased benefit for climbers and others, which has served (and continues to serve) a wide range of interests, from the safety concerns of mountaineers to high altitude-related scientific discoveries advantageous to the scientific community.

One hundred years of railway disasters and recent trends.

INTRODUCTION: Globally, railway transport is increasing steadily. Despite the adoption of diverse safety systems, major railway incidents continue to occur. Higher speeds and increased passenger traffic are factors that influence the risk of mass-casualty incidents and make railway crashes a reality that merits extensive planning and training. METHODS: Data on railway disasters were obtained from the Centre for Research on the Epidemiology of Disasters (CRED), which maintains the Emergency Events Database (EM-DAT). This descriptive study consists of 529 railway disasters (≥10 killed and/or ≥100 non- fatally injured) from 1910 through 2009. RESULTS: The number of railway disasters, people killed, and non-fatally injured, has increased throughout the last hundred years-particularly during the last four decades (1970-2009), when 88% of all disasters occurred. In the mid-20th century, a shift occurred, resulting in more people being non-fatally injured than fatally injured. During 1970-2009, 74% of all railway disasters occurred in Asia, Africa, and South and Central America, combined. The remaining 26% occurred in Europe, North America, and Oceania, combined. Since 1980, railway disasters have increased, especially in Asia and Africa, while Europe has had a decrease in railway disasters. The number killed per disaster (1970-2009) was highest in Africa (n = 55), followed by South and Central America (n = 47), and Asia (n = 44). The rate was lowest in North America (n = 10) and Europe (n = 29). On average, the number of non-fatal injuries per disaster was two to three times the number of fatalities, however, in the African countries (except South Africa) the relation was closer to 1:1, which correlates to the relation found in more developed countries during the mid-20th century. The total losses (non-fatally and fatally injured) per disaster has shown a slight decreasing trend. CONCLUSIONS: Despite extensive crash avoidance and injury reduction safety systems, railway crashes occur on all continents, indicating that this type of incident must be accounted for in disaster planning and training. Better developed safety, crashworthiness, and rescue resources in North America and Europe may be factors explaining why the number of crashes and losses has stabilized and why the average number of people killed per disaster is lowest on these continents.

[Historical aspects of formation of Disaster Medicine Service of the Ministry of Defence of the Russian Federation].

International and domestic experience of recent years is convincing evidence that military medical staff can and should be an important part of the national system of emergency medical assistance in emergency situations. The article is concerned with the participation of military medical personnel in Russia and the USSR in the aftermath of natural and technological disasters in the twentieth and twenty-first century. Historical background and 20 years of experience in the formation of Disaster Medicine Service of the Ministry of Defense of the Russian Federation.

Learning from recovery after Hurricane Mitch.

This paper reviews how Nicaragua has recovered from Hurricane Mitch of October 1998. In particular, it examines how the assumptions and claims that were made during initial recovery planning have proven relevant in light of subsequent development. One must consider the response to Hurricane Mitch from the perspective of the broader trends that have driven recovery, including household, community and government initiatives and the wider economic context. Recovery efforts have not 'transformed' Nicaragua. In fact, market upheavals and livelihood changes in rural areas have had a more profound impact on poverty profiles than recovery programmes. Social protection programmes have been piloted, but patron-client ties and relations with aid providers are still more reliable sources of support in a time of crisis. Risk reduction has become more deeply integrated into the rural development discourse than was the case before the disaster, but risk reduction initiatives continue to place undue emphasis on hazard response rather than addressing vulnerability.

The League of Nations' rescue of Armenian genocide survivors and the making of modern humanitarianism, 1920-1927.

The essay centers of the efforts by the League of Nations to rescue women and children survivors of the 1915 Armenian Genocide. This rescue -- a seemingly unambiguous good -- was at once a constitutive act in drawing the boundaries of the international community, a key moment in the definition of humanitarianism, and a site of resistance to the colonial presence in the post-Ottoman Eastern Mediterranean. Drawing from a wide range of source materials in a number of languages, including Turkish, Armenian, and Arabic, the essay brings the intellectual and social context of humanitarianism in initiating societies together with the lived experience of humanitarianism in the places where the act took form. In so doing, it draws our attention to the proper place of the Eastern mediterranean, and its women and children, in the global history of humanitarianism. The prevailing narrative of the history of human rights places much of its emphasis on the post-World War II era, the international reaction to the Holocaust, and the founding of the United Nations. yet contemporary human rights thinking also took place within practices of humanitarianism in the interwar period, and is necessarily inseparable from the histories of refugees, colonialism, and the non-West.