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Integration of disaster mental health services with emergency medicine.

Despite limited resources, emergency medical settings will be called upon to play many roles in the context of disasters and terrorist attacks that are related to preparedness, surveillance, mental health services delivery, and staff care. Such settings are a central capture site for those individuals likely to be at highest risk for developing mental health and functional problems. Because much of the potential harm to survivors of disaster or terrorism (and their families) will be related to their mental health and role functioning, preparedness requires the active integration of behavioral health into emergency medicine in every component of disaster response. There are many challenges of doing this including: (1) finding ways to integrate activities of the medical care, emergency response, and public health systems; (2) determining whether an incident has actually occurred; (3) making differential diagnoses and managing other aspects of initial medical needs; and (4) coping with the risks associated with system overload and failure. Delivery of direct mental health care must include: (1) survivor and family education; (2) identification and referral of those requiring immediate care and follow-up; (3) group education and support services; and (4) individual counseling. In order for effective response to occur, the integration of psychosocial care into disaster response must occur prior to the disaster itself, and will depend on effective collaboration between medical and mental health care providers. At workplaces, emergency medical care centers must ensure that staff and their families are properly trained and supported with regard to their disaster functions and encouraged to develop personal/family disaster plans.

Disaster Planning↗
PubMed1999

Should New South Wales hospital disaster teams be sent to major incident sites?

BACKGROUND: The aim of the present review was to assess the suitability of hospital disaster medical teams' training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. METHODS: A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. RESULTS: Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. CONCLUSION: Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter-disaster planning as the primary source of on-site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre-hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.

Air Ambulances↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Bangladesh.

The aim of this paper is to highlight the activities and observations of some NGOs and some dedicated researchers in the field of psychosocial consequences of disaster in Bangladesh, particularly in the coastal areas and the tornado-affected areas of the district of Tangile and Jamalpur during the last two decades. Some of the advantages of the non-governmental organizations' (NGOs) work in relief and development were their linkages with grass-roots people ensuring access to the community and community participation, the flexible approach of work, ability and willingness to learn from people and ability to connect people's lives with their realities. The most remarkable survey carried out by the Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV-Bangladesh) after the 1996 tornado showed, on average, that women are more affected psychologically than men; 66% of the total sample in the disaster area were psychologically traumatized and required emergency services. The study supports the ideas that any disaster will have mental health consequences. Providing scientific psychological services is essential for real recovery from such a disaster. In developing countries like Bangladesh, limitations of mental health professionals and inadequate knowledge and practice about disaster mental health among the medical and paramedical staff, may lead to delays in the psychosocial management and rehabilitation of the survivors. To respond properly to a serious type of disaster like a cyclone or a tornado or recurrent devastating flood, the disaster mental health team should be aware of the socio-economic status, local culture, tradition, language and local livelihood patterns. Integration of the team with the network of various governmental and non-governmental organizations is essential to provide mental health services effectively.

Bangladesh↗
PubMed2006

Lessons learnt in mental health and psychosocial care in India after disasters.

Different phases of intervention after any disaster bring with them specific issues that policy-makers as well as healthcare deliverers must take into account. There are some specific issues related to aid with dignity and dead-body identification that need to be taken into account. The human and material resources are important in planning and delivering mental healthcare. In India, with each successive disaster, the immediate response in the rescue and relief phase has improved and the administration is able to mobilize a large amount of resources from different sectors quickly, efficiently and in a co-ordinated manner in the immediate and short-term periods after a disaster. That psychological first aid will reduce psychiatric morbidity is now generally accepted as a key principle in interventions immediately after a disaster. In the recent events, large numbers of community-level volunteers have received short-term training and been able to provide effective psychosocial care and support. The paper presents the author's observations and provides an overview of some of the lessons learnt in mental health and psychosocial support care across the several natural and human-made disasters that have taken place in India. While significant progress has been made with respect to the rescue and relief response, there is still a lot to be achieved in the rehabilitation and rebuilding phases that follow a disaster. Disaster prevention and mitigation need global vision combined with local action. Building capacity through careful planning and training potential workers is an important step. The stakeholders must take into account local cultural and social needs.

Culture↗
PubMed1985

Natural disaster potential and counterdisaster planning in Australia.

Counterdisaster planning for mass fatalities begins with an analysis of the types of disasters likely in a given area and the vulnerability of the area to those disasters. Mass-fatality disasters can be classified as man-made or natural. A historical list of the major man-made disasters in Australia is provided. Potential natural, disasters in Australia, such as bush fires, floods, cyclones, and earthquakes, are discussed. The Australian Bureau of Meteorology provides warnings in many of these situations. Counterdisaster planning in Australia is primarily a state responsibility. The Natural Disasters Organisation of the Federal Department of Defence operates an Australian Counter-Disaster College.

Aircraft↗
PubMed1997

An assessment of disaster risk and its management in Thailand.

Historically, Thailand has been a disaster-free country, suffering only minor losses from natural hazards through the years. Emerging as a newly industrialised nation, the kingdom now faces an increased risk of economic and public damage from manmade disasters associated with rapid development. A risk assessment was carried out on the level of disaster management. That assessment was preceded by an analysis of the traditional definitions of disaster risk, resulting in a redefinition to fit the needs of this study. This holds that the risk of disaster is the product of hazards, vulnerability and the level of management exercised over both the hazard and the vulnerable elements. The results of the risk assessment, conducted through analysis of those three components, are discussed along with impediments which may hinder good disaster or accident management. Floods, in both natural and man-made manifestations, were identified as the highest risk factor, followed by major accidents and explosions, both man-made hazards. Major recommendations arising from the study included the consolidation of disaster management responsibilities currently held by several agencies into a central co-ordinating committee, the review and restructure of related law and regulations, the conduct of provincial and country-wide hazard assessments and the creation of a 'culture of safety' in Thailand.

Developing Countries↗
PubMed2001

Disaster mitigation and preparedness: the case of NGOs in the Philippines.

The Philippines is very vulnerable to natural disasters because of its natural setting, as well as its socio-economic, political and environmental context--especially its widespread poverty. The Philippines has a well-established institutional and legal framework for disaster management, including built-in mechanisms for participation of the people and NGOs in decision-making and programme implementation. The nature and extent of collaboration with government in disaster preparedness and mitigation issues varies greatly according to their roots, either in past confrontation and political struggles or traditional charity activities. The growing NGO involvement in disaster management has been influenced by this history. Some agencies work well with local government and there is an increasing trend for collaborative work in disaster mitigation and preparedness. Some NGOs, however, retain critical positions. These organisations tend to engage more in advocacy and legal support for communities facing increased risk because of development projects and environmental destruction. Entry points into disaster mitigation and preparedness vary as well. Development-oriented agencies are drawn into these issues when the community members with whom they work face disaster. Relief organisations, too, realise the need for community mobilisation, and are thus drawn towards development roles.

Community Participation↗
PubMed1989

Disaster, stress and the doctor.

Man is unable to control for the ever-present potential of disaster. In the past practices and procedures have been developed to minimize physical risk and maximize personal safety. However, there has been little awareness of, or attention to, the stress to those involved in the care-giving process to the victims. Medical care-givers are at the forefront of post-disaster intervention. It is necessary to provide training and support for doctors engaged in post-disaster work, especially with regard to the psychosocial consequences for patients, relatives, and the medical team as a group and as individuals. Pre-disaster preparation is suggested as a situational moderator in the prevention or management of extreme strain in medical and paramedical staff. Specifically, social support in the form of team-building and supervisory support and debriefing, use of personality hardiness concepts in selection and training of staff, and general emergency preparedness should form part of a disaster preparation plan. Medical social workers and psychologists can play an important role as facilitators in disaster preparation. The importance of education and increasing awareness of disaster effects on the health team is emphasized.

Disaster Planning↗
PubMed1995

The American print news media 'construction' of five natural disasters.

In 1985, five international 'natural' disasters received prominent print news media coverage in the United States. Content analyses of selected print news media accounts of these five disasters were conducted. The purported evidence of alleged cause-effect relationships describing and explaining these disasters as 'objective' realities was evaluated in the light of the subjective selection of explanatory factors, themes, frameworks, and value assumptions which underlie the media's analysis and 'construction' of these events as 'natural' disasters. Analysis of the American print news media coverage of these disasters indicated an emphasis upon the dramatic, descriptive, climatological or geological qualities of these events rather than upon causal explanations emphasizing the role of human acts or omissions in the development of these disasters. The print news media 'constructed' these events as 'natural' disasters despite clear evidence of their hybrid, natural-human origins.

Bangladesh↗
PubMed1996

Disaster management and government intervention in PNG: the case of Lae.

This paper describes government intervention in two flood disasters in Lae before and after the establishment of the Papua New Guinea disaster management body. It first describes the objectives behind the establishment of this, and second, it examines the organisational response to the 1983 and 1992 disasters in Lae. Disaster response in terms of relief operations is generally prompt and spontaneous but can at best be described as haphazard, unsystematic and often uncoordinated. Both national and provincial disaster committees are, in many aspects, ill equipped in terms of capabilities, skills and resources. Many disaster operations are unable to ensure an immediate return of the victim's lives to normality--the ultimate objective of any disaster management.

Disaster Planning↗
PubMed2006

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Disaster Planning↗
PubMed2004

Function and response of nursing facilities during community disaster.

OBJECTIVES: We sought to describe the role and function of nursing facilities after disaster. METHODS: We surveyed administrators at 144 widely dispersed nursing facilities after the Los Angeles Northridge earthquake. RESULTS: Of the 113 (78%) nursing facilities that responded (11 365 beds), 23 sustained severe damage, 5 closed (625 beds), and 72 lost vital services. Of 87 nursing facilities implementing disaster plans, 56 cited problems that plans did not adequately address, including absent staff, communication problems, and insufficient water and generator fuel. Fifty-nine (52%) reported disaster-related admissions from hospitals, nursing facilities, and community residences. Nursing facilities received limited postdisaster assistance. Five months after the earthquake, only half of inadequate nursing facility disaster plans had been revised. CONCLUSIONS: Despite considerable disaster-related stresses, nursing facilities met important community needs. To optimize disaster response, community-wide disaster plans should incorporate nursing facilities.

Community Health Planning↗
PubMed1992

Acute renal failure in natural disasters.

Sudden-impact natural disasters such as earthquakes present a serious challenge to medical personnel in both developed and less developed countries. Crush syndrome with acute renal failure has been identified as a major medical complication that occurs among people whose limbs are trapped by heavy objects during natural disasters such as earthquakes or volcanic eruptions. Rescue and field medical teams should be trained to recognize and promptly treat the problems associated with prolonged limb compression and should carry the appropriate fluids and medications to treat the complications of traumatic rhabdomyolysis. Early, aggressive volume replacement followed by forced solute-alkaline diuresis therapy may protect the kidney against acute renal failure. Better epidemiologic knowledge of the specific disaster conditions that predispose traumatic rhabdomyolysis to develop is clearly essential for those who must determine when emergency dialysis services are required in response to injuries sustained during natural disasters. Disaster health care personnel involved with providing emergency acute renal care should have a basic familiarity with disaster epidemiology in order to determine whether a given event requires their intervention. This paper includes recommendations for improving medical planning, preparedness, and response to natural disasters that cause acute renal failure.

Acute Kidney Injury↗
PubMed2002

Dental participants in mass disasters--a retrospective study with future implications.

Mass casualty incidents continue to require the services of forensic dentists to determine the identity of victims. Across North America and Europe. teams of forensic dentists train, using mock disaster exercises, to prepare for such duties. It is vital that these mock exercises simulate the features of real disaster situations as far as possible. In order to inform those responsible for the design and implementation of mock exercises, a study was undertaken to determine the features of actual disasters that dental personnel had attended. Using a questionnaire, data were solicited from 38 odontologists. The average number of disasters attended by the respondents was eight, with an average casualty number of 94. Aircraft crashes were the most frequent cause of disasters that were attended by the odontologists. The authors conclude that future mock disaster exercises should replicate features of aircraft crashes as closely as possible by using commingled, fragmented, and burned remains. In addition, mock disasters should require the identification of a realistic number of individuals to ensure authenticity and the maximum logistical preparedness of participants.

Accidents, Aviation↗
PubMed2002

Mass disasters. Part 1. Role of the general dentist.

In this article, the first of two on the involvement of dentists in a mass disaster, the focus is primarily on mass disasters in general, some common characteristics and types of disasters, those agencies or individuals involved in the management of a disaster, the different phases of a disaster and the position of the forensic dental identification team (FDIT). Part 2 will deal with the functions, responsibilities and jurisdiction of the FDIT during the various phases of a disaster and more specifically immediately after the disaster.

Disaster Planning↗
PubMed1997

Rescue worker and population protection in large-scale contamination disasters.

We discuss disaster preparedness and emergency response to large-scale disasters. Our particular focus is disaster management and protection of disaster response personnel in situations involving chemicals and radiation. We describe a unit system that protects rescuers working in the epicenter of a disaster, and we examine effective protective clothing and procedures for enhancing human performance in extreme environmental conditions. We also present on outline of patient triage in response to radiation disasters. Finally, we describe recent efforts underway in Minnesota to prepare for managing large-scale disasters.

Disaster Planning↗
PubMed1996

Disaster preparedness: institutional capacity building in the Americas.

Latin American and Caribbean countries are prone to natural, technological and "complex" disasters. This vulnerability to catastrophic events led the region to undertake the long journey away from an ad hoc response towards institutional preparedness and, more recently, to disaster prevention and mitigation. This article attempts to outline the definitions and basic principles of institutional emergency preparedness, including reliance on the more effective use of existing resources, rather than establishment of special stockpiles and equipment; the critical importance of general participation and awareness; and the interrelationship of the health sector with others and the potential for leadership. How to assess the level of preparedness is discussed. Stress is placed on the fact that preparedness is traditionally confused with the existence of a written disaster plan. Preparedness should be seen as a never-ending, complex process that can only be assessed through an in-depth review of coordination, planning, training and logistic elements. There is also a fundamental distinction between preparedness, i.e., "getting ready to respond" and disaster prevention/mitigation, which aims to reduce the health impact. The latter calls for the collaboration of engineers, architects, planners and economists with the health sector. It is illustrated by the regional initiative in the Americas to reduce the physical vulnerability of hospitals to earthquakes and hurricanes. In spite of the encouraging achievements, much remains to be done. Weak areas include preparedness for technological disasters, and a true inter-country preventive approach to common disasters across borders. Electronic communications through the Internet will also help to suppress borders and boundaries, contributing to a truly collective approach to emergency preparedness and disaster relief coordination.

Caribbean Region↗
PubMed2005

Systems modeling in support of evidence-based disaster planning for rural areas.

The objective of this communication is to introduce a conceptual framework for a study that applies a rigorous systems approach to rural disaster preparedness and planning. System Dynamics is a well-established computer-based simulation modeling methodology for analyzing complex social systems that are difficult to change and predict. This approach has been applied for decades to a wide variety of issues of healthcare and other types of service capacity and delivery, and more recently, to some issues of disaster planning and mitigation. The study will use the System Dynamics approach to create computer simulation models as "what-if" tools for disaster preparedness planners. We have recently applied the approach to the issue of hospital surge capacity, and have reached some preliminary conclusions--for example, on the question of where in the hospital to place supplementary nursing staff during a severe infectious disease outbreak--some of which we had not expected. Other hospital disaster preparedness issues well suited to System Dynamics analysis include sustaining employee competence and reducing turnover, coordination of medical care and public health resources, and hospital coordination with the wider community to address mass casualties. The approach may also be applied to preparedness issues for agencies other than hospitals, and could help to improve the interactions among all agencies represented in a community's local emergency planning committee. The simulation models will support an evidence-based approach to rural disaster planning, helping to tie empirical data to decision-making. Disaster planners will be able to simulate a wide variety of scenarios, learn responses to each and develop principles or best practices that apply to a broad spectrum of disaster scenarios. These skills and insights would improve public health practice and be of particular use in the promotion of injury and disease prevention programs and practices.

Decision Making↗