EMS

Hurricane Irma

EMS-1 Major Incidents - Thu, 09/07/2017 - 10:23

Categories: EMS

Hurricane Irma Leaves at Least 10 Dead Across Northern Caribbean

EMS-1 Major Incidents - Thu, 09/07/2017 - 09:54

SAN JUAN, Puerto Rico (AP) — Fearsome Hurricane Irma cut a path of devastation across the northern Caribbean, leaving at least 10 dead and thousands homeless after destroying buildings and uprooting trees on a track Thursday that could lead to a catastrophic strike on Florida.

The most potent Atlantic Ocean hurricane ever, Irma weakened only slightly Thursday morning and remained a powerful Category 5 storm with winds of 180 mph (285 kph), according to the U.S. National Hurricane Center.

The storm was increasingly likely to rip into heavily populated South Florida early Sunday, prompting the governor to declare an emergency and officials to impose mandatory evacuation orders for parts of the Miami metro area and the Florida Keys. Forecasters said it could punish the entire Atlantic coast of Florida and rage on into Georgia and South Carolina.

"This could easily be the most costly storm in U.S. history, which is saying a lot considering what just happened two weeks ago," said Brian McNoldy, a hurricane researcher at the University of Miami, alluding to the damage caused by Hurricane Harvey.

French Interior Minister Gerard Collomb told France Info radio that eight had died and 23 injured in the country's Caribbean island territories, and he said the toll on Saint-Martin and Saint-Barthelemy could be higher because rescue teams have yet to finish their inspection of the islands.

"The reconnaissance will really start at daybreak," Collomb said.

At a news conference, Collomb also said 100,000 food rations have been sent to the islands, the equivalent of four days of supplies.

"It's a tragedy, we'll need to rebuild both islands," he said. "Most of the schools have been destroyed."

French President Emmanuel Macron's office said he will go to the islands has soon as weather conditions permit. Macron said France is "grief-stricken" by the devastation caused by Irma and called for concerted efforts to tackle global warming and climate change to prevent similar future natural disasters.

Categories: EMS

Hurricane Irma Leaves at Least 10 Dead Across Northern Carribbean

JEMS - News - Thu, 09/07/2017 - 09:54

SAN JUAN, Puerto Rico (AP) — Fearsome Hurricane Irma cut a path of devastation across the northern Caribbean, leaving at least 10 dead and thousands homeless after destroying buildings and uprooting trees on a track Thursday that could lead to a catastrophic strike on Florida.

The most potent Atlantic Ocean hurricane ever, Irma weakened only slightly Thursday morning and remained a powerful Category 5 storm with winds of 180 mph (285 kph), according to the U.S. National Hurricane Center.

The storm was increasingly likely to rip into heavily populated South Florida early Sunday, prompting the governor to declare an emergency and officials to impose mandatory evacuation orders for parts of the Miami metro area and the Florida Keys. Forecasters said it could punish the entire Atlantic coast of Florida and rage on into Georgia and South Carolina.

"This could easily be the most costly storm in U.S. history, which is saying a lot considering what just happened two weeks ago," said Brian McNoldy, a hurricane researcher at the University of Miami, alluding to the damage caused by Hurricane Harvey.

French Interior Minister Gerard Collomb told France Info radio that eight had died and 23 injured in the country's Caribbean island territories, and he said the toll on Saint-Martin and Saint-Barthelemy could be higher because rescue teams have yet to finish their inspection of the islands.

"The reconnaissance will really start at daybreak," Collomb said.

At a news conference, Collomb also said 100,000 food rations have been sent to the islands, the equivalent of four days of supplies.

"It's a tragedy, we'll need to rebuild both islands," he said. "Most of the schools have been destroyed."

French President Emmanuel Macron's office said he will go to the islands has soon as weather conditions permit. Macron said France is "grief-stricken" by the devastation caused by Irma and called for concerted efforts to tackle global warming and climate change to prevent similar future natural disasters.

Categories: EMS

Chronic Traumatic Encephalopathy (CTE): What we Know

JEMS - News - Thu, 09/07/2017 - 09:43

CHICAGO (AP) — Researchers are tackling fresh questions about a degenerative brain disease now that it has been detected in the brains of nearly 200 football players after death. The suspected cause is repeated head blows, an almost unavoidable part of contact sports.

As a new NFL season gets underway, here's a look at what's known — and what still needs to be learned — about the condition:

WHAT'S NEW?

The largest report to date on chronic traumatic encephalopathy included 202 brains from football players at the youth, college and professional level, all donated post-mortem to a Boston brain bank. CTE was detected in all but one of the 111 NFL players studied, 90 percent of the college players and 20 percent of the high school players. It was absent in two younger players' brains.

A previous report had described the disease in an 18-year-old football player, but finding additional cases at the high school level raises new questions about the game's safety for young players.

HOW COMMON IS CTE?

The high occurrence of CTE in donated brains surprised researchers at Boston University and the VA Boston Healthcare System, whose brain bank is billed as the world's largest focusing on traumatic brain injury and CTE.

But whether CTE is truly common in sports or the general population isn't known. Most brains studied for CTE have been donated by family members because of concerns about mental symptoms that might be related to the disease — they don't come from a random population of people. Some experts think it isn't common since many athletes get repeated head blows and never develop symptoms.

WHAT CAUSES CTE?

Repeated knocks to the head are the most likely cause of CTE. Scientists believe genes probably play a role and may explain why some people with repeated head blows never develop the disease. Lifestyle habits including diet, alcohol and drugs may also somehow contribute.

HOW DO HEAD BLOWS AFFECT THE BRAIN?

Categories: EMS

Relatively Low Harvey Death Toll is 'Astounding' to Experts

EMS-1 Major Incidents - Wed, 09/06/2017 - 16:31

AUSTIN, Texas (AP) — Harvey has so far killed at least 70 people who drowned in floods, got crushed by trees and died during power outages — a surprisingly low toll that experts say reflects heeded warnings, swift action by first responders and volunteers, and no small amount of luck.

"It was astounding that we didn't have a much larger loss of life," said Phil Bedient, co-director of a Rice University effort to research severe storms and evacuations. "It is a relatively low number for as big a storm as this was."

The system intensified from an ordinary storm to a Category 4 hurricane in just over two days before striking Texas on Aug. 25 and dropping 52 inches of rain while parked over the Houston area.

Authorities and experts say lessons learned from previous disasters made a major difference. Floodgates installed around hospitals kept the power on. Search-and-rescue crews raced toward the coast ahead of time. Houston leaders did not call for a mass evacuation in an area with 6.5 million people, keeping them off highways that would ultimately be underwater.

Nor did authorities mince words on social media: Houston's police chief told people not to retreat into attics unless they could break out with an ax.

There was also luck. It helped that Harvey crashed ashore along one of the more rural stretches of the Texas coast. The storm surge reached 12.5 feet (3.8 meters) in a wildlife refuge in Aransas County, where so far the only death reported was a person killed in a fire.

"As far as we know, there were few or no storm surge fatalities," said National Hurricane Center Acting Director Ed Rappaport. "That's kind of remarkable given that it's a Category 4 landfall."

Categories: EMS

Relatively Low Harvey Death Toll is 'Astounding' to Experts

JEMS - News - Wed, 09/06/2017 - 16:31

AUSTIN, Texas (AP) — Harvey has so far killed at least 70 people who drowned in floods, got crushed by trees and died during power outages — a surprisingly low toll that experts say reflects heeded warnings, swift action by first responders and volunteers, and no small amount of luck.

"It was astounding that we didn't have a much larger loss of life," said Phil Bedient, co-director of a Rice University effort to research severe storms and evacuations. "It is a relatively low number for as big a storm as this was."

The system intensified from an ordinary storm to a Category 4 hurricane in just over two days before striking Texas on Aug. 25 and dropping 52 inches of rain while parked over the Houston area.

Authorities and experts say lessons learned from previous disasters made a major difference. Floodgates installed around hospitals kept the power on. Search-and-rescue crews raced toward the coast ahead of time. Houston leaders did not call for a mass evacuation in an area with 6.5 million people, keeping them off highways that would ultimately be underwater.

Nor did authorities mince words on social media: Houston's police chief told people not to retreat into attics unless they could break out with an ax.

There was also luck. It helped that Harvey crashed ashore along one of the more rural stretches of the Texas coast. The storm surge reached 12.5 feet (3.8 meters) in a wildlife refuge in Aransas County, where so far the only death reported was a person killed in a fire.

"As far as we know, there were few or no storm surge fatalities," said National Hurricane Center Acting Director Ed Rappaport. "That's kind of remarkable given that it's a Category 4 landfall."

Categories: EMS

Just the basic necessities

EMScapades Cartoon - Tue, 09/05/2017 - 11:06

New comics every Tuesday and Friday!

Categories: EMS, Syndicated Columnists

Response Units from Israel Provide Support After Harvey

JEMS - News - Tue, 09/05/2017 - 10:02

As of Sunday afternoon, some 2,500 evacuees from Houston and the surrounding towns of Beaumont and Port Arthur had made their way to the mega-shelter set up for them at the Dallas Convention Center. At the center, all the services that evacuees would need for their long-term stay until they could return home were being provided. Police, fire and rescue services, social services, EMS and hospital teams and even day care services were all on hand at the center. In the mix of the servicemen and women and multitudes of volunteers who were located at the center to provide a helping hand, were three volunteers from the Israel Rescue Coalition and United Hatzalah’s Psychotrauma and Crisis Response Unit.

“Our team is working together with the Red Cross, the Psychological department of the hospital team that is here and with the children’s department. Today we focused primarily on working with the children who are here,” said Einat Kauffman, a Psychotherapist and Ph.D. candidate who specializes in treating grief and loss. “What really moved me was to see how fast the children understood what was happening around them. Whenever we asked them, where do you live, they responded by pointing at a bed nearby and saying “This is my bed, and over there is my parent's bed.” It was quite sad on the one hand, but simply remarkable to see how quickly they adjusted on the other.”

The work of the team members involved getting the children to release some of their frustration and anxiety via play aimed at helping them to internalize their new situation. “We worked with children from age 2 until age 11 and had them create for us how their homes looked by using play-doh and by drawing on the floor with chalk. This helped them to express their feelings of loss and we were able to work from there. Some children spoke about their pets that were lost, others talked about being separated from other family members. Our goal was to get them to open up about what they were feeling in a non-threatening and positive manner in order to be able to begin processing their feelings.”

Categories: EMS

Hospital Officials Address Arrest of Nurse who Refused to Draw Blood

JEMS - News - Tue, 09/05/2017 - 09:45

SALT LAKE CITY (AP) — Officials at a Utah hospital where a nurse was arrested after refusing to allow police to draw blood from an unconscious patient apologized that security officers didn't intervene and said Monday that they have implemented policy changes to prevent it from happening again.

The announcements mark the latest fallout from nurse Alex Wubbels' release last week of July 26 video from a Salt Lake City police officer's body camera showing him dragging her from University of Utah Hospital and handcuffing her. The officer has been put on leave, and his agency has apologized.

Hospital CEO Gordon Crabtree said changes took effect in August that allow only senior nursing supervisors to speak with law enforcement and ban conversations with police in patient care areas.

Officials spoke publicly for the first time to make it clear that the hospital took action long before Wubbels released the video, said Crabtree, who called the officer's actions out of line.

"There's absolutely no tolerance for that kind of behavior in our hospital," Crabtree said. "Nurse Wubbels was placed in an unfair and unwarranted positon. ... Her actions are nothing less than exemplary."

Meanwhile, University of Utah Police Chief Dale Brophy said none of his officers at the hospital have been disciplined but will receive additional training in the wake of the arrest.

Wubbels has said she released the video her attorneys received through a public records request partly because she was unhappy that university police didn't help her. She wasn't immediately available for comment on the hospital's announcements.

Brophy said that when he met with Wubbels and her attorney last Tuesday, he had not seen the video.

"It's like seeing a picture or actually visiting a place — it's completely different," the police chief said. "It was clear that the arrest was completely mishandled and was inappropriate and didn't need to happen. She had done everything she possibly could to make that situation work and she wasn't rewarded for that."

Categories: EMS

What Defines a High-Performing Healthcare System? Study Shows There's No Consensus.

JEMS - News - Tue, 09/05/2017 - 09:40
A new study, published in The Joint Commission Journal on Quality and Patient Safety, found there is no consensus among healthcare stakeholders regarding what defines a high-performing healthcare delivery system.   Researchers identified articles defining high performance with respect to a healthcare system or organization in PubMed and WorldCat databases from 2005 to 2015 and the New York Academy of Medicine Grey Literature Report from 1999 to 2016. Read more...

 

High Performance .  It has become, to some extent, the term we love to hate in EMS.  “High Performance EMS” has been defined by Jack Stout and Jerry Overton and articulated by the Academy of International Mobile Healthcare Integration (AIMHI) as exhibiting the following characteristics:
  • Sole provider: Exclusive market rights to furnish emergency and non-emergency ambulance service are granted to a sole and often competitively selected provider for a specific population or service area.
  • Control center operations: The ambulance provider has control of the dispatch center.
  • Accountability: HPEMS systems have performance requirements that can result in financial penalties or replacement of the provider when the requirements are not met.
  • Revenue maximization: HPEMS systems incorporate the business function into their operations, with the resulting understanding of the billing requirements and maximization of revenues from Medicare, Medicaid, and other third-party payors.
  • Flexible production strategy: HPEMS systems employ a single fleet of ALS units capable of handling any type of service request, resulting in all patients receiving the highest level of care and higher productivity levels.
  • Dynamic Resource Management (DRM): HPEMS systems use the flexible deployment technique, DRM, to move ambulances in anticipation of where that ambulance will be needed.

While these characteristics help explain HPEMS, there are still a couple of challenges with true adoption:

Categories: EMS

Emergency Physician Rhiana Ireland Helps Hundreds in the Wake of Harvey

JEMS - News - Fri, 09/01/2017 - 16:55

When Harvey hit, I found out that the small church near me had volunteered to take in 100 people. The church is an official Red Cross center, and the only one for League City, Texas. Initially, they were only able to send three volunteers to staff it.

This city has over 100,000 people in it.  When people searched for a place to go, this church was the only one listed for the entire city and they poured in. So I decided to offer my services as an emergency physician.

We had 200 cots, so the church agreed to take 200 people.  

Like the rain, what started in drips turned into a torrent of people: soaking wet, clutching a garbage bag of heirlooms in one hand and a shivering dog in the other.

As we began getting more and more evacuees, we were told that the Red Cross was going to turn the small shelter into an evacuation center. That meant we had to remove the cots so that capacity could double to 400. Once this was done, the Red Cross would then begin busing people out.

Soon enough, we had 780 people with us. They arrived by boat, flatbed truck, and by the busload. Some people had been in chest-deep water for hours.  Some were pulled off roofs by the “Cajun navy.”

We set up clinic areas, towel-off stations, an infant room and a dog room. The church and the small group of volunteers kept everything together.

    

Categories: EMS

Emergency Physician Rhiana Ireland Helps Hundreds in the Wake of Harvey

EMS-1 Major Incidents - Fri, 09/01/2017 - 16:55

When Harvey hit, I found out that the small church near me had volunteered to take in 100 people. The church is an official Red Cross center, and the only one for League City, Texas. Initially, they were only able to send three volunteers to staff it.

This city has over 100,000 people in it.  When people searched for a place to go, this church was the only one listed for the entire city and they poured in. So I decided to offer my services as an emergency physician.

We had 200 cots, so the church agreed to take 200 people.  

Like the rain, what started in drips turned into a torrent of people: soaking wet, clutching a garbage bag of heirlooms in one hand and a shivering dog in the other.

As we began getting more and more evacuees, we were told that the Red Cross was going to turn the small shelter into an evacuation center. That meant we had to remove the cots so that capacity could double to 400. Once this was done, the Red Cross would then begin busing people out.

Soon enough, we had 780 people with us. They arrived by boat, flatbed truck, and by the busload. Some people had been in chest-deep water for hours.  Some were pulled off roofs by the “Cajun navy.”

We set up clinic areas, towel-off stations, an infant room and a dog room. The church and the small group of volunteers kept everything together.

When we got ready to take a break, another army vehicle dropped off 40 people and pets.I watched a heavily pregnant woman, due in 11 days, waddle down the hall. We both gave a silent prayer that she wouldn't have to deliver there.

The buses to evacuate people never came, so the church opened up their school and private offices and more people poured in. Every available space was filled to capacity.  As it got dark, we began convincing other churches to open their doors up.

Categories: EMS

Training, Instinct & Careful Decision-Making Key to Active Shooter Response

EMS-1 Major Incidents - Fri, 09/01/2017 - 16:41

On April 30, 2017, crews from the San Diego Fire Department (SDFD) and American Medical Response were dispatched to a shooting at an apartment complex in La Jolla, an upscale seaside community in San Diego not typically associated with violent crime.

Early citizen reports to dispatchers didn't paint a clear picture of what crews would be called upon to manage: a hostile and dangerous active shooter incident at a poolside birthday party.

Active shooter incidents seem to have become the norm in the U.S. and other countries, occurring at soft targets such as a movie theatre in Aurora, Colo., an elementary school in Newtown, Conn., and this year's shooting at the practice for the Congressional Baseball Game in Alexandria, Va.

SDFD and the San Diego Police Department (SDPD) have an active shooter policy and has been training for these types of incidents for several years. In addition, the San Diego fire and police departments utilize a state-of-the-art active shooter training center that allows fire, EMS and law enforcement to train side by side to ensure true on-scene coordination.


One of the shooting victims is transported by San Diego Fire Department EMTs and paramedics.
Video screenshot KFMB/CBS 8 'The Scene Came to Us'

The La Jolla Crossroads apartment complex is a multibuilding, five-story development that spans several blocks and houses thousands. The pool party—celebrating one of the resident's birthdays—had 40–50 people in attendance, but there was one stranger sitting at the pool who had evil intentions.

The birthday guest of honor walked over to the man, apologized if the party was too noisy, and invited him to join the party, offering food and drinks. The man thanked him, but declined.

Categories: EMS

How to Integrate Electronic Patient Tracking into MCI Operations

EMS-1 Major Incidents - Fri, 09/01/2017 - 14:19

Implementing electronic patient tracking in your EMS agency or fire department can be a challenge. Merely tracking patients in a mass casualty event using paper tags and forms can be overwhelming. This inherent difficulty, coupled with the use of unfamiliar technology, can be more of a deterrent than a tool to improve patient tracking.

Some localities may have tried to implement patient tracking (or resist the idea) because they don't feel such a technology will be effective. By following some basic lessons, patient tracking technologies can be implemented and become a successful addition to your mass casualty incident (MCI) response.


Two responders scan simulated MCI patients into an
electronic patient tracking system. Photos courtesy Daniel Neal
Implementing Tracking Technology

Over a two-week period, Loudoun County (Va.) Fire and Rescue (LCFR) implemented patient tracking. LCFR is a member of the Northern Virginia Emergency Response System (NVERS). One of the projects of NVERS is the implementation of region-wide electronic patient tracking. Through an Urban Area Security Initiative (UASI) grant, funding was available to implement patient tracking through the HC Patient Tracking System developed by Global Emergency Resources.

Through a four-hour training conducted twice each day, fire and EMS personnel were taught how to utilize patient tracking technology in a simulated MCI. Each session consisted of 20–30 responders presented with 25 patients at a simulated bus crash.

On-duty firefighters were reassigned from their stations to the training academy on their assigned apparatus. The patients consisted of inflatable manikins. This training followed an MCI response training from the previous year.

Categories: EMS

Three-Step Method for EMS Management of Bus Collisions

EMS-1 Major Incidents - Fri, 09/01/2017 - 13:37

Every day in every community, large vehicles travel the road filled with potential patients: some children, some elderly, some with special medical issues—all are potentially your responsibility.1,2 These mass casualties on wheels present a host of problems for EMS responders.

If you're the head of your agency, you may wonder how you can prepare your system. If you're a frontline supervisor you may wonder what tools you should have on hand to manage such an incident. If you're a field provider you may wonder what you can do to prepare yourself for response.

Bus collision incidents may be inherently complex, but the techniques to manage each part are simple so that they can be used quickly and with confidence.3

Challenges for EMS

Even minor bus collisions can present a variety of scene management issues including accident investigation, traffic flow, secondary collisions, rescue and extrication, interagency communication, hazardous materials release, cargo security, media and bystander management and, of course, patient care.4 The key to successful management of a bus collision incident is to break the larger incident into smaller, more manageable chunks.

The three primary issues responders face can be quickly categorized as: 1) lots of patients; 2) lots of problems; and 3) lots of partners. Details will vary depending on needs, resources and conditions specific to each incident, but broadly categorizing patients, problems and partners will make it easier to begin to delegate, coordinate and take action to resolve the incident.5–7

The first thing to consider at all bus collisions is the large number of potential patients. Although the number may range from fewer than 10 to more than 100, effective use of an MCI system will streamline prioritized patient assessment and treatment and continue the forward movement of patients.3,4 This forward movement will help get patients to definitive care, reconnect them with friends and loved ones and resolve the overall incident faster.

Categories: EMS

Remembering the important details

EMScapades Cartoon - Fri, 09/01/2017 - 08:45

New comics every Tuesday and Friday!

Categories: EMS, Syndicated Columnists

Innovative Approaches to Management of Mass Casualty Incidents

EMS-1 Major Incidents - Fri, 09/01/2017 - 01:12
New approaches to mass casualty care

Emergency responders are trained to recognize disasters, though some are easier to identify than others. Regardless of the cause and scope, medical providers of all types feel the impact when resources are overwhelmed.

This threshold will differ for various agencies and regions, but responders can usually predict when their capabilities will be taxed.

Mass or multiple casualty incidents (MCIs) are among the more common disasters that emergency services will manage. These events are typically related to trauma or hazardous materials, which have an acute onset and relatively short response time. However, MCIs can also result from natural disasters, bioterrorism attacks or even infections and pandemics, which alter the onset and response duration.


Inside a mobile medical unit in Texas.
Photo courtesy Nick Sloan

Consequently, MCIs can challenge providers with an immediate influx of patients or through more prolonged events, some of which may generate a slower onset but continuous stream of patients.

EMS agencies, other emergency responders and hospitals are critical to a community during an MCI and must continue to function and manage daily operations.

Although EMS agencies and emergency responders will be challenged, hospitals are the most likely sites to become overwhelmed with patients seeking care from an MCI. With innovative planning, preparation and collaboration, some of the impact of these mass casualty events may be mitigated.

Regardless of the MCI type (acute or gradual onset), patients can generally be classified as high acuity or low acuity. Keeping these two classes in mind, alternative care options should be considered to help lessen the impact on a community's emergency services and hospitals.

Categories: EMS

Inside EMS Podcast: Why did you become a caregiver?

FR1 and EMS Podcasts - Thu, 08/31/2017 - 10:53
Inside EMS Podcast: Why did you become a caregiver? by FR1 and EMS1 Podcasts
Categories: EMS, Podcasts

Building Collapse in India Leaves at Least 16 Dead

JEMS - News - Thu, 08/31/2017 - 09:43

MUMBAI, India (AP) — Torrential rains caused a five-story apartment building to collapse Thursday in the west Indian financial capital of Mumbai, killing 16 people and possibly burying more than a dozen more under debris, police said.

Rescuers, residents and police officers managed to pull 30 injured people from the rubble. Still, more than a dozen were missing and feared trapped beneath a huge mound of mud, broken concrete slabs and twisted steel girders.

The building was one of thousands in Mumbai that are more than 100 years old, with foundations that have been weakened by years of heavy monsoon rains. Last month, another four-story building toppled in the city's suburb of Ghatkopar, killing 17.

Thursday's tragedy occurred in a congested area of Mumbai's southern Bhendi Bazaar area, following the city's heaviest rainfall in 15 years.

Authorities were advising people living in an adjacent building to vacate after it developed cracks following Thursday's early morning collapse.

It was not immediately clear how many people might be trapped in the toppled building.

"We are asking people to check if their family members are safe and accounted for," officer Manoj Sharma said at the scene.

The building had housed nine families in apartments above a first-floor nursery school, but the collapse occurred before the toddlers had arrived for the day, police said.

Nearby resident Amina Sheikh tightly held her 4-year-old grandson's hand as they watched the rescue efforts from a safe distance.

"This is my grandson. He used to go to school in that building," she said, tearfully pointing at the rubble.

She had been getting the boy ready for school Thursday morning when she heard a loud boom and saw the building had crashed down. It was "an hour before his class began. That's why my grandson's life was saved," she said.

Categories: EMS

Building Collapse in India Leaves at Least 16 Dead

EMS-1 Major Incidents - Thu, 08/31/2017 - 09:43

MUMBAI, India (AP) — Torrential rains caused a five-story apartment building to collapse Thursday in the west Indian financial capital of Mumbai, killing 16 people and possibly burying more than a dozen more under debris, police said.

Rescuers, residents and police officers managed to pull 30 injured people from the rubble. Still, more than a dozen were missing and feared trapped beneath a huge mound of mud, broken concrete slabs and twisted steel girders.

The building was one of thousands in Mumbai that are more than 100 years old, with foundations that have been weakened by years of heavy monsoon rains. Last month, another four-story building toppled in the city's suburb of Ghatkopar, killing 17.

Thursday's tragedy occurred in a congested area of Mumbai's southern Bhendi Bazaar area, following the city's heaviest rainfall in 15 years.

Authorities were advising people living in an adjacent building to vacate after it developed cracks following Thursday's early morning collapse.

It was not immediately clear how many people might be trapped in the toppled building.

"We are asking people to check if their family members are safe and accounted for," officer Manoj Sharma said at the scene.

The building had housed nine families in apartments above a first-floor nursery school, but the collapse occurred before the toddlers had arrived for the day, police said.

Nearby resident Amina Sheikh tightly held her 4-year-old grandson's hand as they watched the rescue efforts from a safe distance.

"This is my grandson. He used to go to school in that building," she said, tearfully pointing at the rubble.

She had been getting the boy ready for school Thursday morning when she heard a loud boom and saw the building had crashed down. It was "an hour before his class began. That's why my grandson's life was saved," she said.

Categories: EMS

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