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On September 21, 1989, Hurricane Hugo blasted into Charleston, South Carolina. Gary R. Nimocks did more than just follow the rule book to meet the needs of the disaster victims. He marshalled the forces of his department to deliver nutrition & emotional support to thousands of patients, staff & community members for weeks & even months following the storm.
OBJECTIVE: This study examined the relationship between exposure to the Exxon Valdez oil spill and subsequent cleanup efforts and the prevalence of generalized anxiety disorder, posttraumatic stress disorder (PTSD), and depressive symptoms in 13 Alaska communities. METHOD: A community survey of 599 men and women was conducted approximately 1 year after the spill occurred. Questions from the National Institute of Mental Health Diagnostic Interview Schedule were used to assess symptoms of generalized anxiety disorder and PTSD. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess levels of depressive symptoms. RESULTS: The post-spill (i.e., 1-year) prevalence of generalized anxiety disorder and PTSD for the study communities with all degrees of exposure was 20.2% and 9.4%, respectively. The prevalence of respondents with CES-D Scale scores above 16 and 18 was 16.6% and 14.2%, respectively. When compared with the unexposed group, members of the high-exposure group were 3.6 times as likely to have generalized anxiety disorder, 2.9 times as likely to have PTSD, 1.8 times as likely to have a CES-D Scale score of 16 and above, and 2.1 times as likely to have a CES-D Scale score of 18 and above. Women exposed to this event were particularly vulnerable to these conditions, and Alaska Natives were particularly vulnerable to depressive symptoms after the oil spill. CONCLUSIONS: The results suggest that the oil spill's impact on the psychosocial environment was as significant as its impact on the physical environment. The Exxon Valdez experience suggests a number of implications for the mental health needs of disaster victims, particularly in primary care settings.
AIDS advocates were pessimistic about obtaining enough funding to keep HIV patients off waiting lists for the AIDS Drug Assistance Programs (ADAPs) by the end of August, and then Hurricane Katrina hit several of the states with the worst ADAP funding situation, and changed everything again. Hurricane disaster victims have traveled to dozens of states, and those who are HIV infected have to start all over with obtaining access to some antiretrovirals. However, despite the gloomy outlook, some AIDS advocates say they hope to obtain more funding for ADAP and the Ryan White Care Act through an emergency disaster bill.
The extent to which the identification of disaster victims could be improved with the code for dental findings developed by Furness and Moore (1969) was studied. This code records the most important data for a set of teeth in 12 digits.
This paper attempts to draw together some of the current questions related to the methodology of exploring the psychological and psychiatric aspects of human response to disaster. It sets out some of the key areas in which research questions might be mounted. A range of relevant instruments are suggested. The value of a structured interview which can explore issues of relevance to disaster victims is demonstrated. Early screening measures and proposals regarding these, as well as the particular instruments for longer term follow-up and assessment of outcome, are discussed in considerable detail. The article concludes with an overview of the principal issues to be addressed in methodology research, and emphasises the need for a collaborative approach using core items so that studies embracing different disasters and different countries can have some comparative basis.
A hard- and software solution has been conceived, realized, produced and used to gather clinical information about disaster victims in the field in such a way that it makes the different efforts made by mass casualty incident management managers and first responders work more efficient, ergonomic, safe and useful for further scientific and statistic analysis.
This study investigated the prevalence of psychiatric disorders and risk factors for posttraumatic stress disorder (PTSD) and major depressive disorder among bereaved survivors of a severe earthquake in Taiwan. A total of 120 survivors received a psychiatric interview conducted by board-certified psychiatrists. The two most prevalent disorders were PTSD (37 percent) and major depressive disorder (16 percent). The risk factors for PTSD were psychosocial stressors and initial feelings of guilt. The risk factor for major depressive disorder was female gender. Only 25 percent of the survivors with PTSD and 26 percent of those with major depressive disorder sought help at primary care clinics. These results indicate a need to develop an effective outreach strategy for dealing with psychiatric disorders among disaster victims.
Three months after the devastating Chi-Chi earthquake (magnitude of 7.3 on the Richter scale) struck the central area of Taiwan, 663 victims were screened for psychiatric morbidity at a local general hospital in a community mental health program. The rate of psychiatric morbidity as defined by the 12-item Chinese Health Questionnaire as greater than 4, was 24.5%. Posttraumatic symptoms were still prevalent. The rate of posttraumatic stress disorder was 11.3%, and the rate of partial PTSD was 32.0%. Variables associated with the presence of psychiatric morbidity and posttraumatic symptoms included female gender, old age, financial loss, obsessive trait, and nervous trait. A disproportionate use of mental health services (18%) was found, suggesting an urgent need to deliver mental health care to disaster victims at local medical settings. In addition, health care professionals who work with the earthquake victims need to be promptly and efficiently trained in mental health crisis intervention.
OBJECTIVE: This study longitudinally described rates of posttraumatic stress disorder (PTSD) in two groups with different levels of severity of exposure to an earthquake in North China. The effects of diagnostic criteria on the frequency of detected PTSD were also examined. METHOD: Subjects were randomly sampled in two villages at different distances from the earthquake epicenter. A total of 181 and 157 subjects were assessed at 3 months and 9 months after the earthquake, respectively, for PTSD by using both DSM-IV and DSM-III-R criteria. The brief version of the World Health Organization Quality of Life Assessment and three subscales of the SCL-90-R were also administered at both assessment points. RESULTS: The village with a higher level of initial exposure to the earthquake and a higher level of postearthquake support had a lower frequency of PTSD than the village with a lower level of initial exposure and less postearthquake support. The rate of onset of DSM-IV PTSD within 9 months for the two villages was 19.8% and 30.3%, respectively. In both villages, the rate of onset of earthquake-related PTSD within 9 months was 24.2% by using DSM-IV criteria and 41.4% by using DSM-III-R criteria. The introduction in DSM-IV of a criterion requiring clinically significant distress or impairment in functioning for a diagnosis of PTSD was a major contributor to the lower rate of DSM-IV PTSD. CONCLUSIONS: PTSD may be as prevalent and persistent in disaster victims in China as in those elsewhere. Prompt and effective postdisaster intervention could mitigate the impact of initial exposure and reduce the probability of PTSD occurrence. Caution should be used in comparing rates of postdisaster PTSD identified by using different diagnostic criteria.
The civil chaos created by a combination of drought and hostilities in the Ogaden region of southern Ethiopia during the past five years has caused the majority of the indigenous, principally nomadic population to flee the area and seek refuge either in Somali refugee camps or in Ethiopian shelters for displaced persons. This paper compares the provision of basic food rations, selective feeding programs, primary health care, and preventive health measures between the two groups. During 1980-1981 Somalia received more international assistance per capita than Ethiopia. Large numbers of Western personnel provided health and nutrition services in Somali refugee camps, whereas no foreigners were involved in Ethiopian shelters. These disparities were largely due to inadequate publicity concerning the problems Ethiopia faces, partly resulting from real and perceived political limitations related to the Soviet presence in that country. Refugee needs in Somalia have been publicized far more adequately, partly due to that country's alignment with the West. The Ethiopians nevertheless demonstrated greater efficiency in assisting their disaster victims; camp services comparable to those in Somalia were available despite greater logistic difficulties and fewer donated resources. The effectiveness of relief operations in Somalia was reduced by political constraints on governmental agencies.
This paper presents the theory, rationale, and a working model for integrating professional resources at the time of a disaster. Red Cross and community mental health agencies have worked for too long in parallel. A collaborative approach to meeting the emotional needs of disaster victims makes optimal use of indigenous resources; provides skill and knowledge normally lacking in each agency alone; and helps provide, through early intervention, a preventive factor to thwart long term community distress. Options for maintenance of readiness, local or regional adaptation and piloting are also discussed.
In many countries forensic odontologists are members of the Disaster Victim Identification (DVI) team. As part of their post mortem (PM) tasks work on the incident site may include securing and preserving the dental material and evidence before transport to the mortuary. In the autopsy room the main aim is to register the PM dental status. Photographs and radiographs are essential documentations in addition to a conventional registration of the dental status. Abbreviations in the registration may be used if agreed with the ante mortem (AM) team. Dental age estimation may be an aid in the sorting process and especially in victims without previous dental treatment. Interpol has a form set as part of their DVI manual. Forensic odontologists working in pairs and checking each other will act as quality assurance (QA) as suggested by International Organization for Forensic Odonto-Stomatology (IOFOS). Direct entry into the computer program as part of the registration in the autopsy room may save time and manpower.
In this study, we examined the effect of trauma exposure on substance use behaviors, specifically tobacco and alcohol use, in a group of 84 individuals who sought supportive services after the 1995 Oklahoma City bombing. A self-report instrument was used to assess demographics, sensory exposure, injury, interpersonal exposure through relationship with victims, peritraumatic reaction, grief, posttraumatic stress, worry about safety, functional impairment, and changes in smoking and drinking. Those who reported increased smoking had higher scores on peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning. Those who reported increased alcohol intake had higher scores on injury, peritraumatic reaction, grief, posttraumatic stress, worry about safety, and trouble functioning. Sensory exposure and interpersonal exposure were not significantly different between those with and without increased smoking or drinking. Although no causal relationship can be assumed, our findings indicate an association of grief and posttraumatic stress with increased substance use behaviors in disaster victims.
College students who had experienced no personal bereavement in the September 11 terrorist attacks completed questionnaires between 3 and 5 weeks after the attacks and 5 months later. Cross-sectional and longitudinal structural equation model (SEM) analyses revealed that general distress and disaster-focused distress are discernable reactions following a collective loss. Both types of distress were higher among women and by those reporting social strain. General distress was associated with previous stressful events and mental health issues. Perceived similarity to the victims predicted disaster-focused distress and mediated the relationship between attending to media accounts of victims and disaster-focused distress. Only the disaster-focused distress reactions of survivor guilt and grief were associated with collective helping behaviors after the attacks and, for women, these behaviors were associated with greater reductions in these distress reactions over time. Discussion focuses on the importance of examining disaster-focused distress reactions following collective loss.
BACKGROUND: Although children are the most vulnerable group in any disaster, limited information exists regarding their unique needs in complex humanitarian emergencies. OBJECTIVE: To review the experiences gained in designing and implementing a training course for international health care professionals in disaster management focused on the needs of children. METHODS: The format, content, learning objectives, teaching methods, course evaluation, and feedback of a training course on managing complex humanitarian emergencies with a focus on the special needs of children were reviewed. RESULTS: The 5-day course was first conducted at Case Western Reserve University in 1996. Since then, it has been replicated 15 times, annually in the United States, and in 7 overseas venues, including Thailand, Pakistan, Ethiopia, Nicaragua, Panama, Syria, and India. Voluntary US and international faculty used a problem-based learning method to train health care workers from developing countries in providing rapid quality care to child disaster victims. The courses were well received in every venue, as evidenced by active participation of local medical professionals, who organized logistics, recruited participants, and led the process of adapting the course to local needs. A remarkable outcome of this training course has been the development of an international group of highly motivated professionals involved in disseminating information to relief workers at a local level and providing a supportive network among themselves. CONCLUSION: A comprehensive training program targeted for health care professionals, conducted by mutually respectful local and international faculty, is an effective instrument for disseminating information and enhancing competence to help children in disasters.
Experience suggests that individuals working in the caring and psychotherapeutic professions are among those to provide mental health services to disaster victims suffering from psychological trauma following catastrophic events. Yet, few studies have focused on the emotional exhaustion from working with such clients, referred to as compassion fatigue (CF) in this study, and how CF differs from other occupational hazards, such as secondary trauma (ST) and job burnout. In the present study, we used recently validated scales to predict ST and job burnout related to providing services to those affected by the World Trade Center (WTC) attacks. Our study data were based on a random survey of 236 social workers living in New York City (NYC), over 80% of which reported being involved in post-WTC disaster counseling efforts. Our analyses indicated that controlling for demographic factors, years of counseling, and personal trauma history, ST was positively associated with WTC recovery involvement (p <. 001) and negatively associated with having a supportive work environment (p < . 01). In contrast, job burnout was negatively associated with having a supportive work environment (p < .01), but not associated with WTC involvement or WTC counseling efforts. We discuss these results in light of future conceptual and empirical research needs.
The sinking of the car ferry, Estonia, was one of the world's most devastating marine disasters of all time. Mass casualty situations tend to give rise to more mental than physical injuries among the survivors. Psychiatric crisis intervention is in the process of becoming established as one arm in the management of disaster victims. In the article is described the emergency psychiatric care which University Hospital, Abo, was able to offer survivors of the Estonia catastrophe. On the basis of the experience gained, the authors suggest that emergency psychiatric plans should be drawn up at all larger hospitals, as there is no time for careful planning in the event of a major incident.
Dental radiographs play the major role in the identification of victims in mass casualties besides DNA. Under circumstances such as those caused by the recent tsunami in Asia, it is nearly impossible to document the entire dentition using conventional x-rays as it would be too time consuming. Multislice computed tomography can be used to scan the dentition of a deceased within minutes, and the postprocessing software allows visualization of the data adapted to every possible antemortem x-ray for identification. We introduce the maximum intensity projection of cranial computed tomography data for the purpose of dental identification exemplarily in a case of a burned corpse. As transportable CT scanners already exist, these could be used to support the disaster victim identification teams in the field.