RESUMEN
Disasters often set the stage for scientific inquiry within the field of occupational safety and health. This is especially true when the long-term consequences of exposures associated with a particular disaster are unclear. However, a responder research study can be costly and difficult to design, and researchers must consider whether the proposed study will produce useful, reliable results and is a prudent public health investment. The decision process can be segregated into various components, including scientific rationale that should be formally recognized as critical to efficiently and effectively determine whether a research study is warranted. The scientific rationale includes certain controlling or "gatekeeper" factors that should be present to proceed with research.
Asunto(s)
Técnicas de Apoyo para la Decisión , Desastres , Socorristas , Investigación sobre Servicios de Salud/organización & administración , Salud Laboral , Humanos , Proyectos de InvestigaciónRESUMEN
People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention's Terrorism Injuries: Information, Dissemination and Exchange project. There recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Medicina de Desastres/métodos , Incidentes con Víctimas en Masa , Heridas y Lesiones/microbiología , Explosiones , Infecciones por VIH/sangre , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Personal de Salud , Hepatitis B/sangre , Hepatitis B/prevención & control , Hepatitis B/transmisión , Hepatitis C/sangre , Hepatitis C/prevención & control , Hepatitis C/transmisión , Humanos , Exposición Profesional/prevención & control , Trabajo de Rescate , Tétanos/sangre , Tétanos/prevención & control , Tétanos/transmisión , Heridas y Lesiones/sangre , Heridas y Lesiones/terapiaRESUMEN
This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings or other events resulting in mass casualties. Persons wounded during such events or in conjunction with the resulting emergency response might be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass-casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma and emergency response medical communities participating in CDC's Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) project. The recommendations contained in this report represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.
Asunto(s)
Medicina de Desastres/normas , Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis C/prevención & control , Incidentes con Víctimas en Masa , Tétanos/prevención & control , Patógenos Transmitidos por la Sangre , Consejo , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/provisión & distribución , Humanos , Medición de Riesgo , Pruebas Serológicas , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/provisión & distribuciónRESUMEN
OBJECTIVES: The goals of this study were two-fold: (1) to assess the relationship between blood lead levels and neurobehavioral test performance in a nationally sample of adults from the third National Health and Nutrition Evaluation Survey and (2) to analyze the results from previously published studies of occupational lead exposure that used the same neurobehavioral tests as those included in the survey. METHODS: Regression models were used to test and estimate the relationships between measurements of blood lead and performance on a simple reaction time, a symbol-digit substitution, and a serial digit learning test in adults aged 20-59 years who participated the survey. Mixed models were used to analyze the data from the occupational studies. RESULTS: The blood lead levels of those participating in the survey ranged from 0.7 to 41.8 microg/dl. The estimated geometric mean was 2.51 microg/dl, and the estimated arithmetic mean was 3.30 microg/dl. In the survey, no statistically significant relationships were found between blood lead concentration and performance on the three neurobehavioral tests when adjusted for covariates. In the occupational studies, the groups exposed to lead consistently performed worse than control groups on the simple reaction time and digit-symbol substitution tests. CONCLUSIONS: The results from the survey and the occupational studies do not provide evidence for impairment of neurobehavioral test performance at levels below 25 microg/dl, the concentration that the Centers for Disease Control and Prevention define as elevated in adults. The average blood lead level of the exposed groups in the occupational studies was 41.07 microg/dl, less than 50 microg/dl, the minimum concentration that the Occupational Safety and Health Administration requires for medical removal from the workplace. Given the evidence of impaired neurobehavioral performance in these groups, the 50 microg/dl limit should be reevaluated.
Asunto(s)
Intoxicación del Sistema Nervioso por Plomo en Adultos/sangre , Plomo/sangre , Enfermedades del Sistema Nervioso/diagnóstico , Pruebas Neuropsicológicas , Encuestas Nutricionales , Exposición Profesional/efectos adversos , Adulto , Femenino , Humanos , Intoxicación del Sistema Nervioso por Plomo en Adultos/complicaciones , Intoxicación del Sistema Nervioso por Plomo en Adultos/fisiopatología , Masculino , Procesos Mentales , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Tiempo de Reacción , Estados UnidosRESUMEN
Autonomous detection systems (ADSs) are under development to detect agents of biologic and chemical terror in the environment. These systems will eventually be able to detect biologic and chemical hazards reliably and provide approximate real-time alerts that an agent is present. One type of ADS that tests specifically for Bacillus anthracis is being deployed in hundreds of postal distribution centers across the United States. Identification of aerosolized B. anthracis spores in an air sample can facilitate prompt on-site decontamination of workers and subsequent administration of postexposure prophylaxis to prevent inhalational anthrax. Every employer who deploys an ADS should develop detailed plans for responding to a positive signal. Responding to ADS detection of B. anthracis involves coordinating responses with community partners and should include drills and exercises with these partners. This report provides guidelines in the following six areas: 1) response and consequence management planning, including the minimum components of a facility response plan; 2) immediate response and evacuation; 3) decontamination of potentially exposed workers to remove spores from clothing and skin and prevent introduction of B. anthracis into the worker's home and conveyances; 4) laboratory confirmation of an ADS signal; 5) steps for evaluating potentially contaminated environments; and 6) postexposure prophylaxis and follow-up.