Real-time geotracking and cataloging of mass casualty incident markers in a search and rescue training simulation: Pilot study.

OBJECTIVE: Search and rescue after mass casualty incidents relies on robust data infrastructure. Federal Emergency Management Agency (FEMA's) Task Force 1 (TF1) trains its volunteers to locate and virtually tag scene incidents using a global positioning satellite (GPS) device programmed with markers for each incident (Iron Sights). The authors performed a pilot study comparing Iron Sights™ to a Wi-Fi-based real-time incident geolocation and virtual tagging dashboard (Panacea™) in creating a dynamic common operating picture. DESIGN: Twenty-nine stations were placed at a predefined scene incident, each featuring a set of varying waypoint markers using standard FEMA/TF1 nomenclature. Two volunteers performed the experiment for both the Iron Sights and Panacea systems, digitally tagging all station waypoints. SETTING: TF1 simulation training field. MAIN OUTCOME MEASURE(S): Metrics compared included GPS location precision, marker accuracy, and delay between scene sweep and common operational picture (COP) generation. RESULTS: Two hundred and sixty-one waypoints were digitally tagged after excluding three stations for missing data. The average GPS location difference for all waypoints between Iron Sights and Panacea was 3.65 m. Marker tagging accuracy between Iron Sights and Panacea was equivalent and not statistically different (78.8 percent vs 66.2 percent, respectively, p = 0.11). Waypoints were tagged in 26.59 minutes and 10.55 minutes on average, respectively. Time from scene sweep to virtual COP generation was 7.97 minutes for Iron Sights after complete scene sweep and 37 seconds for Panacea for each waypoint posting in real-time. CONCLUSIONS: Panacea generated the COP in real-time compared to a delay with Iron Sights while maintaining the same location precision and marker accuracy. This pilot trial successfully demonstrated the ability to provide real-time actionable intelligence to incident commanders during mass casualty search and rescue missions. Larger field trials are recommended to refine the system and broaden its capabilities.

Inflammatory pseudotumor of the middle ear masquerading as Bell's palsy.

We describe the case of a 28-year-old woman who presented with an acute dense left facial paralysis. Magnetic resonance imaging demonstrated enhancement of the labyrinthine portion of the facial nerve, and Bell's palsy was the presumed initial diagnosis. After 2 months without recovery despite receiving steroid and antiviral therapy, the patient underwent further workup. Computed tomographic scan demonstrated a mass lesion adjacent to the tympanic portion of the facial nerve, and electromyography showed active denervation and prominent fibrillation potentials. Surgical excision of the tumor was performed with decompression and sparing of the facial nerve. Histologically, the tumor proved to be an inflammatory pseudotumor (IPT). At the 3-year follow-up, the patient had an improvement in her facial nerve function, progressing to a House-Brackman grade III. An IPT can masquerade as Bell's palsy with sudden complete facial paralysis. Failure to obtain even slight recovery in Bell's palsy should prompt further workup, including appropriate imaging, to assess for a mass lesion. Confusion of an IPT with a nerve-based tumor on frozen section and imaging could lead to inappropriate resection and cable grafting of the facial nerve. Therefore, the relationship between an IPT and facial nerve paralysis is vital and must be recognized for treatment and to maximize postoperative facial nerve function.