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Learning from each other: The social work role as an integrated part of the hospital disaster response.

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role. The development of national and state based Disaster Management Plans in Australia began in the mid 1970's. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of Disaster Victim Identification. Following the Bali Bombing in October 2002, social workers worked with the Police Missing Persons Unit to provide support to families and facilitate the collection of ante mortem information. The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field. The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning, can result in a profession working together to support key principles and values of practice for the benefit of those in need.

Australia↗

A federal perspective on EAPs and emergency preparedness.

Federal Employee Assistance Programs (EAPs) have a long history of intervention in emergency situations, and their role has expanded since September 11, 2001. There is considerable evidence on the importance of organizational factors such as social support in protecting disaster victims from the psychological effects of trauma. The authors recommend that EAPs become integrally involved in organizations' emergency planning processes, so that such supports can be built into all aspects of plans. EA professionals should function as organizational consultants, not simply as helpers who will eventually care for those affected. Two federally based case studies provide examples of EA professionals who have successfully used such an approach in their respective organizations.

Disaster Planning↗

[Blood transfusion support in rendering medical care in extreme conditions].

About 20% of accident and disaster victims need the hemotransfusion therapy. At present the method of erythrocyte long-term storage in the blood banks with glycerin high concentration is the most acceptable one. There are special medical teams (SMT) in the districts. They include the transfusiologic group with appropriate reserve of hemotransfusion materials. Most of them must be stored as untouchable reserve in the institutions of blood service and large hospitals on which the SMTs are based.

Blood Banks↗

[Survey on postmortem examination to police surgeons and emergency physicians. Possibility of physicians' assist in mass-disaster].

We conducted a questionnaire survey of police surgeons and emergency physicians, inquiring about their experience of medicolegal investigation of death and their willingness to join a death investigation team in a major disaster. The questionnaire also asked about their knowledge about and interest in the forensic specialist system established by the Japanese Society of Legal Medicine. Police surgeons were generally willing to join an investigation team only if a disaster occurred in or close to their hometown, because they could not afford more than several days away from patient care. Although many of the emergency physicians were willing to join a death investigation team, they had difficulty in doing so without permission or orders from their employer or the authorities concerned. The survey found that the percentage of aged police surgeons was increasing among those surveyed. This fact, in combination with the current emphasis of postgraduate education on specialty training, threatens to cause a substantial lack of physicians available for medicolegal investigation of death. Therefore, it is urgently necessary to establish a system of training resident and emergency physicians in medicolegal investigation of death. In addition to providing postgraduate training in medicolegal investigation of death to prospective trainees who are emergency physicians at major hospitals in potential disaster-stricken areas, the medical school should incorporate forensic medicine in postgraduate training programs so that they can actively perform death investigation on disaster victims dying before or after arrival at their hospitals. Furthermore, the forensic community should make every effort to increase the number of autopsies in each department of forensic medicine and to expand the medical examiner system throughout Japan that is currently in practice only in the Metropolis of Tokyo and Yokohama, Nagoya, Osaka and Kobe Cities in order to incorporate forensic training in the postgraduate clinical training programs that will become compulsory in 2004.

Attitude of Health Personnel↗

Preventing after-effects of disaster trauma: the information and support centre.

This paper describes the establishment and activities of the Information and Support Centres developed in Norway in the aftermath of large-scale accidents and disasters between 1980 and 1990. The function of these Centres is to provide rapid, authoritative information and psychosocial support services for the next-of-kin of disaster victims, including the families of those missing. By gathering together those affected by a particular event, the Centres provide a setting in which individuals and families can support each other. The activities of the psychosocial team include triage for mental-health emergencies, orienting survivors to immediately available local services, communication with family, friends, and community, and other forms of psychological first aid. The psychosocial team also provides linkages to local health, clergy, and other local resources that are near to the family's home and could provide continued care if necessary.

Disasters↗

A coding system for a computer aided dental identification based on the "Canobrain Programme".

Three situations requiring the identification process are considered, that is, (Situation 1) identification of air disaster victims, (Situation 2) identification of an unknown body, and (Situation 3) identification of a missing person. In this paper, a coding system using "Canobrain Programme" in each situation is described. It employs 3 digits and 2 letters in situation 1 or 4 digits in situations 2 and 3 to designate the status of a tooth surface and the nature of the dental materials used in any restoration. Illustrative examples of the trial of this system in situation 1 and 2 are set out.

Accidents, Aviation↗

General practitioner preparedness to respond to a medical disaster. Part I: Skills and equipment.

OBJECTIVE: Financial constraints are leading to the downgrading or closure of many country hospitals throughout Australia. There is concern that general practitioners (GPs) could become deskilled if they lose access to a local hospital. A recent survey of Victorian rural GPs showed that rural GPs in towns without hospitals had different characteristics and working conditions from those with hospital access and backup. Campbell uncovered an apparent paradox: GPs without hospitals were more likely to have emergencies brought directly to their surgeries, and had more equipment in their surgeries, yet they had significantly lower confidence in emergency skills. METHOD: A questionnaire was sent to 100 general practitioners in two rural divisions of general practice in Victoria, Australia. They were asked to indicate their confidence in performing 18 emergency procedures. They were also asked whether they had available the necessary equipment. RESULTS: We have assessed the availability of GP emergency skills and equipment in two rural divisions of general practice--one with, the other without, local hospitals. The division without hospitals scored significantly lower in skill levels. A close correlation was found between skill levels and equipment availability. There has been a significant reduction in skill levels in both divisions over time. CONCLUSION: The skills necessary for the stabilisation of a single patient with a life threatening condition are not dissimilar from those needed to treat such a patient in a multiple victim scenario, although the approach and external pressures may be different. These skills, then, are essential to all general practice. The information sought in this survey would be important in the assessment of GP preparedness for both single-victim and multiple-victim (disaster) emergencies. The results of this study raise doubts as to the ability of at least one division to respond to a disaster.

Australia↗

Disaster medical assistance teams: providing health care to a community struck by Hurricane Iniki.

STUDY OBJECTIVE: To describe the type of medical care that disaster medical assistance teams (DMATs) provided to a community struck by a major hurricane. STUDY DESIGN: A prospective study describing the use of DMAT field clinics by a population affected by a major hurricane. Data regarding the type of medical care provided to disaster victims and the acuity of each patient's medical condition were abstracted from medical charts at each field clinic. SETTING: Three DMAT field clinics that provided medical care to residents of Kauai, Hawaii, after Hurricane Iniki struck the island on September 11, 1992. RESULTS: From September 16 to 19, 1992, three DMATs provided medical care to 614 people. The patients' average age was 34 years, and 60% were male. The largest treatment categories were injury (40.4%), illness (38.6%), and preventive services (9.0%). Most illnesses and injuries were minor, and 99% of the patients were ambulatory. Only 33 patients (5.4%) were referred to another medical provider. Referrals were generally for procedures not available in DMAT field clinics rather than for life-threatening conditions. CONCLUSION: DMATs sent to assist with the medical needs of a US community struck by a major hurricane should be prepared to deliver basic medical services and primary health care. The need for these medical services will continue beyond the impact phase of a hurricane disaster.

Adolescent↗

Identification of postdisaster bereavement risk predictors.

Investigators have focused primarily on the bereavement experiences of widows and parents of deceased infants. In this study, subjects were 69 bereaved close family members and friends of deceased disaster victims and 50 control subjects. Six variables, not examined before, were entered in a series of hierarchical step-wise regression equations to determine their ability to predict health outcomes. The six variables were gender, age, concurrent life stress, perception of the prior relationship between the bereaved and deceased as central or peripheral, perception of catastrophic death as preventable or unpreventable, and perception of social support. The three health outcomes were depression, somatization, and physical health status. Results indicated that the six selected variables accounted for 48% of the variance in predicting depression, 39% in predicting somatization, and 35% in predicting physical health status in the bereaved group. Concurrent negative life stress was the most important single predictor in all three health outcomes in both groups of subjects.

Adult↗

Lessons learned from large-scale comparative dental analysis following the South Asian tsunami of 2004.

The aim of this study was to examine the quality of the ante-(AM) and postmortem (PM) dental data that were submitted for entry into the PLASS data system in Phuket, Thailand, following the Boxing Day (December 26) Tsunami, 2004. The investigators were two forensic odontologists who were part of the New Zealand Disaster Victim Identification team that worked at Wat Yang Yao morgue and at the Information Management Center in Phuket. Our findings underline the usefulness of dental data in human identification, but point to a number of significant sources of error. Of the 78 PM records received, only 68% of radiographs and 49% of photos confirmed the accompanying dental charting. This underlines the value, particularly of photographs of the dental arches, in quality control. It also points to a large error component, which may have been due to inexperience of the operators, fatigue, poor conditions in the temporary morgue, or the problem of tooth-colored fillings. Of the 106 AM records received, 62% were of unacceptable quality and 64% were either not accompanied by radiographs or had poor quality radiographs. These results indicate that AM data collection ideally needs to be collated and checked by a forensically trained dentist(s) in the country of origin.

Dental Records↗

Cognition during sustained operations: comparison of a laboratory simulation to field studies.

INTRODUCTION: Military operations, especially combat, expose individuals to multiple stressors, including sleep loss, food deprivation, and sustained physical activity. Civilians, such as woodland firefighters, disaster victims, and relief workers, are also exposed to such environments. Our laboratory developed a brief, intense, laboratory-based simulation of a multistressor environment which included sleep loss, continuous physical activity, and food deprivation. METHODS: During this sustained operations (SUSOPS) scenario, and a control period, cognitive performance and mood were measured in 13 volunteers. The scenario included road marches, battle drills, and land navigation. Physical activity and sleep were assessed with actigraphs. RESULTS: Significant decrements in visual vigilance, choice reaction time, and matching-to-sample, a test of short-term memory, were observed. Marksmanship was stable and physical activity significantly increased. Mood states assessed by the Profile of Mood States (POMS: Tension, Depression, Anger, Vigor, Fatigue and Confusion) also significantly deteriorated. DISCUSSION: Cognitive function declined more extensively and rapidly than physical performance. Decrements in cognitive performance were comparable to those in a field study conducted for an equivalent period of time in uncontrolled conditions. This demonstrates that decrements in cognitive function and increased physical activity, similar to those in highly stressful field environments, can be duplicated under controlled conditions. The simulated SUSOPS scenario is an appropriate paradigm for assessment of adverse effects of military and civilian multistressor environments on human performance, physiology, and interventions designed to mitigate them.

Adult↗

The role of stable isotopes in human identification: a longitudinal study into the variability of isotopic signals in human hair and nails.

Recent natural catastrophes with large-scale loss of life have demonstrated the need for a new technique to provide information for disaster victim identification when DNA methods fail to yield the identification of an individual, or in other situations where authorities need to determine the recent geographical life history of people. The latter may be in relation to the identification of individuals detained on suspicion of terrorism or in relation to people-trafficking or smuggling. One proposed solution is the use of stable isotope profiling (SIP) using isotope ratio mass spectrometry (IRMS). Exploiting the link between the isotopic signal of dietary components and the isotopic composition of body tissue, the aim of this study was to refine a non-invasive method of analysing human material such as scalp hair and fingernails using SIP and to assess the degree of natural variability in these profiles. Scalp hair and fingernail samples were collected from British and non-British volunteers at Queen's University Belfast every 2 weeks for a minimum of 8 months. Samples were analysed using IRMS to determine their isotopic composition for 13C, 15N, 2H and 18O. The results of this longitudinal study yielded information on the natural variability of the isotopic composition of these tissues. The data demonstrate the relatively low degree of natural variation in the 13C/15N isotopic abundance of scalp hair and fingernails whilst greater variations were recorded in the hydrogen and oxygen values of the same samples. The 15N and 18O values of nail are noticeably more variable than that of scalp hair from the same subject. A hypothesis explaining this trend is put forward based on the faster rate of formation of hair than of nails. This means that there is less time for the compounds forming hair to be affected by biochemical processes that could alter their isotopic signature.

Biomarkers↗

Dealing with allelic dropout when reporting the evidential value in DNA relatedness analysis.

A method is suggested that allows the use of loci that have shown allelic dropout in kinship analysis as used for disaster victim identification (DVI) and missing person work (MP). This approach uses an extension of a previously published approach to modelling allelic dropout. This method may salvage some information in cases where allelic dropout is hindering DVI or MP work particularly in reconciliations involving a large number of bodies and pedigrees. It should not replace the pursuit of more complete DNA profiles by the normal rework process for such samples.

Alleles↗

Rapid, efficient dental identification of 92% of 13 train passengers carbonized during a collision with a petrol tanker.

On September 8, 1997 (day 0), an express train in Aquitaine, France, crashed into a petrol tanker, which immediately burst into flames and set the first carriage of the train on fire. We describe the dental technique and methodology which led (day 2) to the positive identification of 92% of these very heavily carbonized remains. In only 1 case, and only to be totally certain, did the investigators have recourse to use molecular biologic techniques. The use of this specific odontostomatologic technique (craniomandibular disarticulation with bone samples) and excellent collaboration with the Identification Unit for Mass Disasters Victims (CIVC) precluded recourse to any reconstructive identification.

Accidents↗

Coping behaviour after shipwreck.

A description is given of the coping behaviour of seven men who survived a shipwreck and were not rescued until 13 days later. The principal behaviours shown by the men were attachment ideation, drive to survive, modelling, prayer and hope. Particular attention is paid to the first of these, and consideration given to its likely origins in behavioural evolution. It is proposed as a hitherto inadequately recognized coping behaviour. A follow-up examination 12 to 24 months later showed that five of the seven men available had developed substantial psychiatric disorder, while by contrast one was not only well but claimed to have been enriched by the experience. Exposure to extreme adversity or disaster may have long-term effects on mental health. Further longitudinal studies of disaster victims are necessary for the design of informed after-care.

Adaptation, Psychological↗

International airport and emergency medical care.

The Nippon Medical School New Tokyo International Airport Clinic (Airport Clinic) was opened in 1992 as Japan's first 24-hour international airport clinic. To date, it has provided medical services to a total of 117,953 patients. Of these, 85,545 (72.5%) were airport employees, 28,662 (24.3%) were passengers, and 3,746 (3.2%) were others. Of the total, non-Japanese patients accounted for 8,485 (7.2%). In the year to March 31, 2001, the Clinic treated an average of 43.9 cases per day. The number of emergency patients was 2,969 or 2.3% of the total, of whom 500 (0.4%) were non-Japanese. There were 47 deaths, with age ranging from 14 to 84 (average age 64.0). The ratio of males to females who died was 28:19. Of the 47 deaths, 18 were non-Japanese. Pulmonary thromboembolism is considered to have played a role in 25 of the deaths. Based on more than 8 years of airport clinical experience, we believe that a first-class international airport should have excellent medical facilities that can provide quality emergency medical services to travelers and disaster victims.

Adolescent↗

Forensic dental and medical response to the Bali bombing. A personal perspective.

After the Bali bombing on 12 October 2002, once the survivors had been treated or evacuated, many dead, severely burned and fragmented bodies were left. Formal identification was required before any remains could be released to grieving families. Australia sent a team to assist the Indonesians in this daunting and disturbing task. The "disaster victim identification" process eventually confirmed 202 people as dead, including 88 Australians. Personal and professional relationships between the Indonesians and our team were important factors in our acceptance into the Indonesian emergency response.

Australia↗

The epidemiology of posttraumatic stress disorder: what is the extent of the problem?

Until recently, our understanding of posttraumatic stress disorder (PTSD) relied almost entirely on studies of war veterans and disaster victims. A handful of epidemiologic studies have now been conducted that investigate the natural course of PTSD as it occurs in the general population. Estimates of PTSD prevalence have tended to vary according to the diagnostic criteria used to define the disorder, assessment procedures, sample characteristics, and the definition of qualifying traumatic events. This article reviews key findings from these studies to provide insight into the burden of PTSD in the general population. Possible reasons for the observed difference in lifetime prevalence of PTSD between the sexes (a female-to-male lifetime prevalence ratio of 2:1 is typically reported) and factors thought to be associated with an increased risk for the disorder after exposure to trauma are reviewed.

Adolescent↗