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PubMed2006

Health-related quality of life of firefighters and police officers 8.5 years after the air disaster in Amsterdam.

BACKGROUND: In 1992 a cargo aircraft crashed into apartment buildings in Amsterdam. In the troublesome aftermath rumours emerged on potential toxic exposures and health consequences. The aim of this study is to assess the long-term impact of this disaster on the health-related quality of life (HRQoL) of professional assistance workers. METHODS: Historic cohort study, using questionnaires to assess occupational disaster exposure, HRQoL (SF36), and background variables, at on average 8.5 years post-disaster. Participating were the exposed professional firefighters (n = 334) and police officers (n = 834) who reported disaster-related task(s), and their non-exposed colleagues who did not report such tasks (n = 194, and n = 634, respectively). RESULTS: Multivariate logistic regression analysis showed that exposed workers reported a significantly lower physical HRQoL and vitality than non-exposed workers. Exposed police officers also reported a lower mental HRQoL. Among exposed workers, a lower HRQoL was reported significantly more often by workers who had a close one affected by the disaster; by firefighters who rescued people, cleaned-up, or witnessed the immediate disaster scene; and by police officers who supported the injured. Exposed police officers who perceived the disaster as 'not bad' reported a lower HRQoL less often than those to whom it was 'the worst ever'. CONCLUSIONS: This study demonstrates that professional disaster assistance workers are at risk for a lower HRQoL, even after years.

Accidents, Aviation↗
PubMed2004

Increased incidence of inflicted traumatic brain injury in children after a natural disaster.

BACKGROUND: The incidence of child abuse following natural disasters has not been studied thoroughly. However, parental stress and decreased social support have been linked to increased reports of child maltreatment. We hypothesized that a large-scale natural disaster (North Carolina's Hurricane Floyd) would increase the incidence of inflicted traumatic brain injury (TBI) in young children. METHODS: An ecologic study design was used to compare regions affected to those regions unaffected by the disaster. Cases of inflicted TBI resulting in admission to an intensive care unit or death from September 1998 through December 2001 in North Carolina were ascertained. Poisson regression modeling was employed to calculate rate ratios of injury for each geographic area by time period. RESULTS: Inflicted TBI in the most affected counties increased in the 6 months post-disaster in comparison to the same region pre-disaster (rate ratio 5.1, 95% confidence interval [CI]=1.3-20.4), as did non-inflicted TBI (rate ratio 10.7, 95% CI=2.0-59.4). No corresponding increased incidence was observed in counties less affected or unaffected by the disaster. The rate of inflicted injuries returned to baseline in the severely affected counties 6 months post-hurricane; however, the rate of non-inflicted injuries appeared to remain elevated for the entire post-hurricane study period. CONCLUSIONS: Families are vulnerable to an elevated risk of inflicted and non-inflicted child TBI following a disaster. This information may be useful in future disaster planning.

Age Distribution↗
PubMedDate not supplied

Disaster health education and training: a pilot questionnaire to understand current status.

In October 2004, a World Association for Disaster and Emergency Medicine (WADEM) Seminar was convened in Brusselsby the Education Committee to discuss Disaster Education and Training. During this seminar, it became apparent that there was no single tool available to assess knowledge, skills, and resources within this field. Therefore, a tool was administered to 50 of the delegates to assess if the tool would facilitate information-sharing and curriculum development in disaster health education. The WADEM Education Committee devised a reference scheme for disaster health training and education based on seven educational levels within a framework based on the Bradt model. A questionnaire was developed to answer questions regarding current practices in disaster health education and training, and the perceived barriers to creating an international system of standards, guidelines, and accreditation. The questionnaire was sent to all of the delegates and the responses were analyzed. The questionnaire was useful for information-sharing and curriculum development. Based on the respondents' experience, strategies were put forward for adopting better coordinated framework for disaster health education and training. This questionnaire should be updated and repeated annually within the WADEM. Wider use of the tool is recommended to help evaluate current educational resources in disaster health and in the wider educational field. It could facilitate the development and audit of current and future courses. An international system for education and training should lead to more efficient and coordinated health responses to disasters.

Data Collection↗
PubMed2004

Children's responses to natural, technological, and na-tech disasters.

This study examined the literature on children's responses to natural, technological and na-tech disasters via content analysis. Twenty two articles documenting children's responses to disasters were collected and analyzed. Children's responses were examined by (a) disaster type; (b) measurement instrument used to assess response; (c) age; and (d) administration of measures to children or their caregivers. Results indicate that it is important to ask children directly about their responses to disasters, regardless of disaster type, rather than relying on caregivers assessments. Also, witnessing scenes of destruction and/or life threatening situations elicits more stressful reactions than the type of disaster experienced. As such, the perceived threat rather than the disaster agent itself is deemed the more important factor in children's post-disaster psychopathology.

Attitude↗
PubMed1998

Suicide after natural disasters.

BACKGROUND: Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this study to determine whether natural disasters affect suicide rates. METHODS: From a list of all the events declared by the U.S. government to be federal disasters between 1982 and 1989, we selected the 377 counties that had each been affected by a single natural disaster during that period. We collected data on suicides during the 36 months before and the 48 months after the disaster and aligned the data around the month of the disaster. Pooled rates were calculated according to the type of disaster. Comparisons were made between the suicide rates before and those after disasters in the affected counties and in the entire United States. RESULTS: Suicide rates increased in the four years after floods by 13.8 percent, from 12.1 to 13.8 per 100,000 (P<0.001), in the two years after hurricanes by 31.0 percent, from 12.0 to 15.7 per 100,000 (P<0.001), and in the first year after earthquakes by 62.9 percent, from 19.2 to 31.3 per 100,000 (P<0.001). The four-year increase of 19.7 percent after earthquakes was not statistically significant. Rates computed in a similar manner for the entire United States were stable. The increases in suicide rates were found for both sexes and for all age groups. The suicide rates did not change significantly after tornadoes or severe storms. CONCLUSIONS: Our study shows that suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters.

Adolescent↗
PubMed1999

Assessing disaster-attributed mortality: development and application of a definition and classification matrix.

BACKGROUND: A useful step in developing and implementing sound policies to prevent disaster-attributed mortality is to classify the relationship between disasters and mortality. While there are classification methods for specific health outcomes, there is no standard method that includes all potential outcomes from exposure to a natural disaster. Without standards, our ability to assess health effects from disasters and implement prevention programmes is limited. METHODS: We present a method for ascertaining and classifying disaster-attributed mortality which includes a case definition, flow chart, and matrix. The matrix is used for coding, reporting, and evaluating information about manner, cause, and circumstance of disaster-attributed deaths and geographical location and time of the disaster. To illustrate its use, two readers determine and classify deaths attributed to Hurricane Andrew (1992, USA). RESULTS: Of 322 deaths investigated by the Dade County Medical Examiner's Office, our readers showed 97% (313/322) agreement on case status and 83% (35/42) agreement on case classification. CONCLUSIONS: Our definition allows for a liberal interpretation of what constitutes disaster-related circumstances and the conditions or diseases that might arise from these circumstances. The inclusion of the flow chart and matrix provides a framework for consistent case classification and reporting. It also provides information about relationships between exposures and health effects, thereby identifying prevention policy needs.

Autopsy↗
PubMed1998

Through women's eyes: a gendered research agenda for disaster social science.

Gender is a central organising principle in social life and hence in disaster-affected communities, yet gender issues are rarely examined by disaster scholars or practitioners. Building on findings from emerging and industrial nations, three key research directions are identified: How is gendered vulnerability to disaster constructed? How do gender relations shape the practice of disaster planning and response in households and organisations? How are gender relations affected over time by the social experience of disaster? The discussion suggests how analysis of the gendered terrain of disaster both develops disaster theory and fosters more equitable and effective disaster practice.

Disaster Planning↗
PubMed2001

Re-framing risk: the changing context of disaster mitigation and preparedness.

This issue of Disasters explores the roles of NGOs and other actors in disaster mitigation and preparedness and also reviews broad international trends in risk management and disaster prevention. The need to address risk, and with that the motivation to improve disaster mitigation and preparedness, has tended to fall between the cracks of grander frameworks of development co-operation and humanitarian assistance. Despite the seemingly glaring need to reduce the horrific impact of floods, droughts and wars, disaster mitigation and preparedness have neither the allure of directly 'saving lives', nor of providing an 'escape from poverty'. There are, however, signs that risk management is becoming a mainstream concern. Factors such as the need to address factors that do not fit into traditional slots on the relief-development continuum, the rising economic costs of disasters and a growing acknowledgement that aid will never cover more than a small fraction of the costs of disasters are all leading to new approaches, priorities and institutional configurations. A realisation that dealing with risk and insecurity is a central part of how poor people develop their livelihood strategies has begun to position disaster mitigation and preparedness within many poverty alleviation agendas. A number of long-standing challenges remain; most of all, the complexities of maintaining the political will that is needed to ensure that risk management becomes more than a passing fad.

Disaster Planning↗
PubMed2005

Epidemiological study air disaster in Amsterdam (ESADA): study design.

BACKGROUND: In 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, killing 43 victims and destroying 266 apartments. In the aftermath there were speculations about the cause of the crash, potential exposures to hazardous materials due to the disaster and the health consequences. Starting in 2000, the Epidemiological Study Air Disaster in Amsterdam (ESADA) aimed to assess the long-term health effects of occupational exposure to this disaster on professional assistance workers. METHODS/DESIGN: Epidemiological study among all the exposed professional fire-fighters and police officers who performed disaster-related task(s), and hangar workers who sorted the wreckage of the aircraft, as well as reference groups of their non-exposed colleagues who did not perform any disaster-related tasks. The study took place, on average, 8.5 years after the disaster. Questionnaires were used to assess details on occupational exposure to the disaster. Health measures comprised laboratory assessments in urine, blood and saliva, as well as self-reported current health measures, including health-related quality of life, and various physical and psychological symptoms. DISCUSSION: In this paper we describe and discuss the design of the ESADA. The ESADA will provide additional scientific knowledge on the long-term health effects of technological disasters on professional workers.

Accidents, Aviation↗
PubMed2001

The World Trade Center attack. Disaster preparedness: health care is ready, but is the bureaucracy?

When a disaster occurs, it is for governments to provide the leadership, civil defense, security, evacuation, and public welfare. The medical aspects of a disaster account for less than 10% of resource and personnel expenditure. Hospitals and health care provider teams respond to unexpected occurrences such as explosions, earthquakes, floods, fires, war, or the outbreak of an infectious epidemic. In some geographic locations where natural disasters are common, such as earthquakes in Japan, such disaster practice drills are common. In other locations, disaster drills become pro forma and have no similarity to real or even projected and predicted disasters. The World Trade Center disaster on 11 September 2001 provides new information, and points out new threats, new information systems, new communication opportunities, and new detection methodologies. It is time for leaders of medicine to re-examine their approaches to disaster preparedness.

Aircraft↗
PubMedDate not supplied

Constructing a World Wide Web site for disaster management and humanitarian assistance.

There is a huge need for access to information in the areas of disaster relief, disaster medicine, and humanitarian assistance. The extraordinarily rapid increase in the literature in these subject areas attests to this need. However, use of the printed word has substantial limitations that are even more profound in the developing world. Currently, the information available tends to be fragmented and sequestered by the specific interests of the organizations and governments involved. The evolving electronic methods for the storage, organization, and retrieval of information makes coordination between organizations concerned with disasters within our grasp. This paper discusses the Center of Excellence in Disaster Management and Humanitarian Assistance and describes the World Wide Web and the implications it has in disaster management and medicine. It describes methods for obtaining user input to the techniques used for the development of the world wide web for the areas of disaster management and disaster medicine. The implementation of an on-line Internet reference desk that will provide: 1) a list of "experts;" 2) a searchable disaster database; and 3) on-line simulation courses and training exercises also is discussed.

Disasters↗
PubMed2003

Rhode Island Disaster Initiative.

In summary, RIDI is a multi-year research project to identify and develop solutions to some of the challenges posed by disaster response, with a focus on WMD incidents. September 11, 2001, changed the RIDI timeline with increased pressure to produce tangible results and recommendations rapidly. Phase 1 was an effort to identify problems and potential solutions through vulnerability assessment, literature review and expert panel discussion. Many disaster response "solutions" may fail because of a rush to use untested equipment or processes. RIDI is working cooperatively with other Rhode Island disaster experts to avoid these failures. Informed by Phase 1, RIDI Phase 2 will carefully and progressively test potential "solutions" during research trial disaster drills. Only after research can RIDI identify best practices in disaster response. As RIDI progresses to Phase 3, the demonstration project phase, specific improvements are expected in Rhode Island's readiness for disaster. A main feature of Phase 3 is use of a RIDI demonstration vehicle to bring identified solutions to the scene as requested by Rhode Island EMS agencies. Together with others working to improve Rhode Island readiness for disaster threats, RIDI hopes to improve the outcome for patients and providers in Rhode Island as they face the current disaster threats.

Computer Systems↗
PubMed1997

[Management competency of persons registered as disaster nurses in the Pretorian Civil Defense].

The essential management role of the disaster nurse during disaster action was outlined, researched and described. Her competency to execute effectively disaster relief tasks before, during and after a disaster occurring outside a hospital, was studied. Management tasks were identified which nurses should have mastered regarding disaster situations occurring outside hospital boundaries. Research data were gathered by means of a questionnaire on the biographic detail of disaster nurses registered with Civil Defence in Pretoria, in order to recommend a course specifically aimed at fulfilling their requirements. The research project identified requirements of the disaster nurse for appropriate further training, practise and guidance regarding the identified management tasks. It became evident that training is required in most of the tasks, and a training course for nurses in disaster management was designed.

Adult↗
PubMed1997

Psychological factors affecting health after toxicological disasters.

Exposure to toxic substances in the environment is an ever more common event, that may cause physical as well as psychological harm. When an entire community is exposed, the term 'toxicological disaster' is used. The mere threat of such an event may be a source of stress, associated with changes in mental health, physical health, and changes in health-related behaviors. A review is presented of the literature about the effects of the stressful experience of toxicological disasters on health and health-related behaviors. Three questions are examined: (a) do toxicological disasters represent a specific type of stressor, different from other stressors?; (b) which stress-mediated health effects have been observed in the aftermath of toxicological disasters? and (c) is there evidence for a higher vulnerability in certain identifiable risk groups? On the basis of the available literature, it is concluded that toxicological disasters may have profound effects on subjective health, especially on symptom reporting, and on a number of psychophysiological parameters. Evidence for a substantial impact of disaster-related stress on either physical or psychiatric morbidity remains inconclusive. In this respect toxicological disasters do not appear to differ from other stressors. There is some evidence that toxicological disasters may have a more pronounced effect on health-related behaviors, especially on reproductive behavior (number of births and abortions). Women, and especially those who have young children to care for, appear to be more at risk for the observed health effects. The evidence for a higher vulnerability in other risk groups (e.g., former psychiatric patients remains inconclusive.

Adaptation, Psychological↗
PubMed1989

A study of behavioural responses to an industrial disaster.

Based upon 7 response variables we categorized the impact behaviour of 123 industrial employees who had been exposed to a disastrous factory explosion and had survived without suffering severe injuries. The subjects were personally examined and the data controlled by cross-interviews shortly after the disaster. In the analysis the subjects were divided into a high stress (n = 64) and a medium stress exposure group (n = 59) based upon their closeness to the explosion centre. The 7 variables were cognitive function, inadequate behaviour, help received, leadership, cooperative activity, absolute and relative rescue efforts. While about 50% of the total number reported some disturbance in their cognitive control, and 34% of the high stress exposure group experienced a near total loss of cognitive control, severe inadequate behaviour did not occur. Modelling and corrective social interactions may have played an important role in this. Still, 20% of the high stress exposure group had some behavioural response that increased the risk to their life or that of others. The 7 scores were added to an index and cut-off points established to separate 3 different groups of behavioural responses: 29% of the high stress group displayed Maladaptive Disaster Behaviour; inhibited behaviour and uncontrolled flight behaviour dominated in this group. Adaptive Disaster Behaviour was rated in 34% and Optimal Disaster Behaviour in 37%. The following background variables correlated strongly to Optimal Disaster Behaviour: high level of disaster training/experience, male sex, age above 40, maritime occupational background, above average intellectual ability, a life history without mental health problems. A discriminant analysis with 8 variables predicted correctly whether the response would be Optimal or less than that in 84% of the 121 subjects tested in the analysis. A high level of disaster training/experience yielded an overall correct prediction rate of 63.6%, and a sensitivity of 81%, specificity of 85.9% and positive predictive power of 70.7% in predicting Optimal Disaster Behaviour.

Accidents, Occupational↗
PubMed2005

[Disaster medical response concerns us all].

The flood disaster in the region of the Oder and Elbe Rivers or the disaster in Eschede, Kaprun, or Ramstein make us aware that disasters not only occur in distant regions of the world but also in our latitudes. They do not follow any rules; no one can predict the location, time, or type of a disaster. However, this lack of concrete predictability should not lead to our being unprepared to respond to catastrophic events. Detailed examination and analysis of medical and organizational activities involved in past disasters reveal that these types of incidents always entail similar medical and logistic consequences. Dealing with disasters necessitates cooperation between numerous organizations and people. This requires clearly structured facilities for information, communication, and decision making as well as a well-defined process flow. In addition to basic planning and practicing of these processes for medical management of catastrophes-such as searching for and rescuing victims, triage, performing life-saving emergency procedures, definitive medical treatment, and transfer of patients-establishing structures for disaster preparedness is indispensable to meet the demands of mass cases of ill or wounded individuals.

Critical Care↗
PubMed2005

Disaster nursing curriculum development based on vulnerability assessment in the pacific northwest.

Disasters caused by naturally occurring or deliberately caused infections, toxic chemical spills, radiologic releases, or other catastrophic events are likely to challenge the US health care system and pose special risks to vulnerable groups. Despite these threats in the environment,most US nursing programs lack disaster nursing content. This article describes disaster nursing competencies needed in Washington State based on standards, local geographic and population vulnerabilities,expert review, and surveys of nursing students and practicing nurses. Disaster nursing competencies included the following categories: (1)providing for patient care needs; (2) practicing safely; (3) preparing,implementing, and evaluating institutional and community protocols in preparation for a disaster; (4) reporting and communicating; and (5)accessing up-to-date information. Practicing nurses and student nurses indicated a strong need for disaster nursing content; the greatest perceived need was for content related to caring for injured or ill patients and practicing safely during a disaster.

Curriculum↗
PubMedDate not supplied

Nursing in sudden-onset disasters: factors and information that affect participation.

INTRODUCTION: Little has been reported regarding the minimum conditions, information, and knowledge essential for dispatching nurses to join in sudden-onset disaster events from the viewpoint of nurses. This paper explores the issues and concerns that nurses faced when asked to respond to the 1995 Great Hanshin-Awaji Earthquake event in Japan. METHODS: A standardized written survey tool was developed using input from four nurses who had responded to the disaster event. Questionnaires that included both "yes" and "no" answers and multiple-choice answers were developed and sent to 823 nurses who worked in four hospitals. RESULTS: A total of 477/823 (58.0%) questionnaires were completed and returned. Of the respondents to the questionnaire, 309 (62.1%) were qualified nurses, and 148 (37.9%) were students. Sixty-nine (15%) of the total 477 respondents participated in the disaster response to the Great Hanshin-Awaji Earthquake. Primary among respondents' concerns were that they should wait for their superiors or institutions to direct them to go "somewhere" and to do "something", and how far away from home would they be required to travel. Home responsibilities conflicting with disaster response were a common concern for respondents. CONCLUSION: Managers should consider including the following conditions in disaster dispatch plans: (1) the dispatches should be made part of nursing duties; (2) the disaster plan should be constructed with organizations near disaster sites; and (3) clear directions regarding destination and expected activities should be provided to nurses.

Adult↗