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[Prognostic decisions in organizing rescue and other emergency accident-recovery operations in extreme situations].

The existing classifications of emergency situations have been analysed in the article. Based on their own experience, the authors propose a new approach to a problem of forecasting the activities of medical service in liquidation of the consequences of catastrophes. The classification worked out by the authors is specially tabulated, that makes it possible to take rapid prognostic decisions on organization of rescue and emergency actions.

Accidents↗

Planned emigration: the Palestinian case.

"This article examines the UN policies encouraging emigration from the Palestinian refugee camps through educating Palestinians and sending them for work abroad. Data show that emigration is more related to certain types of employment, especially skilled labor and white-collar jobs, than to employment per se. The data were collected, through personal interviews, from Dair El Balah refugee camp in Gaza Strip in 1986. There are 291 observations representing individuals who are 19 years old or over. A major conclusion of this study is that the educational policies initiated and operated by the United Nations Relief and Works Agency (UNRWA) contributed to the dispersion of about one third of the refugees in the 1960s and the 1970s."

Asia↗

Matching food security analysis to context: the experience of the Somalia food security assessment unit.

This case study reviews the experience of the Somalia Food Security Assessment Unit (FSAU) of operating a food security information system in the context of a complex emergency. In particular, it explores the linkages between selected features of the protracted crisis environment in Somalia and conceptual and operational aspects of food security information work. The paper specifically examines the implications of context characteristics for the establishment and operations of the FSAU field monitoring component and for the interface with information users and their diverse information needs. It also analyses the scope for linking food security and nutrition analysis and looks at the role of conflict and gender analysis in food security assessment work. Background data on the food security situation in Somalia and an overview of some key features of the FSAU set the scene for the case study. The paper is targeted at those involved in designing, operating and funding food security information activities.

Food Supply↗

[The scientific bases for determining the health losses of the affected population in catastrophic flooding].

The article focuses on methodological approaches to the determination of sanitary losses among population in a catastrophic flood. An emergency is considered that can arise in the destruction of the water-development project assemblies. The following items were taken account of in working out of the above approaches: population density in the territories found to be in the zone of flood: notification and evacuation of the population from the zone of catastrophe in a timely fashion, the distance from the site of formation of the wave of breaking to the populated locality, the height and velocity of the wave of breaking, time of the year and day of the catastrophe. Scientific and methodological approaches and the mathematical model "Povin'" ("Flood") developed with the aid of such approaches permit analyzing the situation having presented itself, working out administrative decisions for the territorial public health services directing bodies to be taken in the current situation, instituting measures designed to eliminate medicosanitary effects of the catastrophic flood within the shortest time possible.

Disaster Planning↗

Implementing cash for work programmes in post-tsunami Aceh: experiences and lessons learned.

Cash for work (CFW) programmes are utilised in various disaster and emergency contexts and were a prominent component of the tsunami response in Aceh province, Indonesia. This paper describes Mercy Corps' CFW programme, discusses CFW implementation experiences and provides key recommendations for similar programmes in future emergencies. For the majority of CFW participants and their households, CFW was the only source of household income and 93 per cent of household incomes were attributable to it. The CFW programme empowered displaced populations to return to their communities; 91 per cent of participants indicated that CFW facilitated their return. Other reported psychosocial benefits included providing productive activities and giving communities an opportunity to work together. Mercy Corps' experience in Aceh demonstrates that cash disbursements can be safely delivered in a widespread manner in emergencies, and that when implemented on a short-term basis, can have positive impacts at the individual and community level.

Disasters↗

UNICEF's rich history in emergency response.

When conflict erupts or natural disasters strike, UNICEF's challenge is to provide for the emergency needs of civilians, especially women and children, who are caught in the crossfire or plagued by the drought or swept away by the flood. When emergency situations arise, threatening to derail UNICEF's ongoing work in a country, the challenge is to adapt programmes to better address the changing needs of the affected population. UNICEF's goal in all countries undergoing emergencies is to build on the work already done to lay the foundation for long-term peace and progress. In most emergency cases, certain core interventions are applied to meet basic needs, including health (UNICEF's largest activity in emergencies), water supply and sanitation, education, nutrition, community development, advocacy and initiatives addressing the special needs of women and children. Specific programmes for unaccompanied children, women's reproductive health, child soldiers, land-mine awareness and child prisoners are also employed in many emergency situations. UNICEF works towards the day when children and women no longer face acute threats to their survival and development; but until such time as natural disasters and man-made conflict no longer pose threats to them, UNICEF remains committed to the range of activities required to ensure their protection and well-being.

Child↗

Transpedicular fixation for the treatment of isthmic spondylolisthesis in adults.

STUDY DESIGN: This study analyzed the fusion rate and clinical success rate in adult patients undergoing surgical treatment for symptomatic, low grade, isthmic spondylolisthesis. A postoperative questionnaire and grading scale were used to judge clinical success. Successful fusion was judged using radiographic criteria. OBJECTIVE: To evaluate the clinical success and fusion success in a group of adult patients undergoing instrumented posterolateral arthrodesis for symptomatic isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: Seventeen consecutive adult patients with symptomatic low grade isthmic spondylolisthesis underwent the identical surgical procedure consisting of Gill laminectomy, L5 nerve root decompression, Luque pedicle-screw plate instrumentation, and posterolateral arthrodesis at L5-S1 using autogenous iliac crest bone graft. Results were analyzed at an average 30-month follow-up. METHODS: An independent observer reviewed the results using a postoperative questionnaire to determine rates of return to work, symptom relief, and analgesic medication usage. Radiographs were evaluated to determine the fusion status. RESULTS: Seventeen patients were evaluated at an average of 30 months after the index procedure. Sixteen of 17 had solid fusions using radiographic criteria. Sixteen of 17 had satisfactory clinical results. Eight of 13 (62%) employed patients, including three of six patients with worker's compensation, returned to their usual jobs. CONCLUSIONS: An instrumented posterolateral arthrodesis in combination with a Gill procedure and L5 nerve root decompression results in a high rate of fusion, satisfactory clinical success, and a high rate of return to work.

Adolescent↗

[Facts regarding the Eschede catastrophe].

On 3 June 1998 a high-speed train (Inter City Express, ICE) collided with a bridge at a speed of 200 km/h. The bridge collapsed and the rear wagons of the train were pushed into it with the power of the rear engine. The accident caused 101 deaths and 103 injuries. Four minutes after the accident the alarm was raised, and 16 minutes after the accident the first doctor was on the scene, arriving from Cells, approx. 20 km away. In the first 4 hours after the crash 1844 people from different organisations were at the site of the accident; 461 of these were ambulance personnel and paramedics. 39 aircraft (incl. helicopters and army aircraft) were available at the scene. Many passengers with multiple injuries were stuck in the train and had to be rescued from the severely damaged wagons. Nevertheless all patients with one exception were on the way to hospitals or in the trauma centers 2 hours after accident. 95 passengers passed away on site. The casualties were distributed among 22 hospitals, 2 of them had to be transferred to other hospitals later on for medical reasons. This speaks for the correct selection of hospitals. There were many reasons for the quick rescue and the success of Eschede, namely good weather conditions, the time of the accident (normal working day) the availability of rescue by air, the great number of doctors, ambulance personnel, paramedics and search and rescue teams on site, as well as the excellent cooperation between the different organisations, mainly fire brigades, police, army, border patrol, technical assistance teams and search and rescue coordinators).

Accidents, Traffic↗

Surgical treatment of piles: prospective, randomized study of Parks vs. Milligan-Morgan hemorrhoidectomy.

PURPOSE: The present prospective, randomized clinical trial compares the outcome of surgical hemorrhoidectomy according to Parks and Milligan-Morgan in terms of hospital stay, duration of incapacity to work, symptom relief, length of morbidity, and patient convenience. METHODS: Thirty-four consecutive patients with third or fourth degree internal hemorrhoids were randomly allocated to the two groups. Before surgery, all patients were interviewed using a standard questionnaire, followed by rectal examination. All patients underwent a follow-up interview and examinations 1, 2, 4, 8, and 12 weeks after the operation. RESULTS: No serious postoperative complications were seen. Length of hospital stay (3.2 days for Parks hemorrhoidectomy vs. 4.6 days for Milligan-Morgan hemorrhoidectomy; 95 percent confidence interval, 0.2 and 2.6, respectively; P = 0.02) and mean duration of incapacity to work (12.3 days for Parks hemorrhoidectomy vs. 20.2 days for Milligan-Morgan hemorrhoidectomy; 95 percent confidence interval, 5.7 and 10.2, respectively; P < 0.001) differed significantly between the Milligan-Morgan and Parks patients. Until two weeks after the operation, Milligan-Morgan hemorrhoidectomy patients experienced significantly more pain. CONCLUSIONS: Our study confirms that both operations are safe, easy to perform, and lead to satisfactory results. However, the Parks procedure is the preferred option, because it minimizes patients' postoperative discomfort, is more economic, has a significantly reduced hospital stay, and has a shorter time for return to work.

Female↗

The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma.

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.

Adaptation, Psychological↗

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↗

Perceptions of work in humanitarian assistance: interviews with returning Swedish health professionals.

Health personnel volunteering for humanitarian assistance assignments work in increasingly dangerous situations and increasingly complex roles. A qualitative analysis of interviews with returning Swedish aid workers, who collectively had been on 74 missions in 32 different countries, revealed that they felt positive about their contribution, but experienced high levels of stress and frustration. They were also surprised and inadequately prepared for tasks that fell outside their professional health care training, including ones demanding pedagogic and management skills. The volunteers perceived their success on humanitarian assistance assignments as being affected not only by their own professional competence and special preparatory training, but also by many other factors. In particular, recruiting organizations could improve volunteer performance by accepting only experienced professionals, requiring special preparatory training, clarifying the exact nature of the work, and providing better support during the assignment. Further analysis of humanitarian assistance as a complex and dynamic system involving multiple 'actors' could lead to improved understanding and better performance.

Adult↗

[Catastrophy management in the large clinic. Bridges between fundamental research and rescue practice].

In consequence of a fire that had broken out in the large general hospital centre of the University of Aachen, a working team was organised to systematise the experiences gained and to work out an internal scheme for handling catastrophic events. It was the declared aim of the working group to study and come to grips with innovative concepts of self-organisation in social systems and with cognitive trouble-shooting research to assess the relevance of actions based on these factors, the purpose being to complement and widen the range of conventional concepts of managing catastrophic events and the relevant security measures. This study discovered general agreement between the reflected experiences as seen from the viewpoint of the working team on the one hand, and the theoretical considerations of cognitive trouble-shooting research and the concepts of self-organisation in complex systems on the other. The innovative potential of knowledge for the internal management of catastrophic events derived in this manner from actions can hardly be over-estimated.

Disaster Planning↗

Service use among school leavers with severe learning difficulties: the views of carers.

School leaving is a time when difficult decisions have to be taken. Difficulties are likely to be particularly complex when the school leaver has severe learning difficulties. Carers of 61 young people living in one East London Health District were interviewed about their child's experience of service use at around the time of school leaving. The timing of school leaving appears to have been well handled, and the experience of those who went on to further education was positive. The school social work service was greatly appreciated. On the debit side, many informants were critical of the quality of short-term residential care. The commonest concern was for the prompt availability of day care. As in the few other studies of this subject, the impression that services appeared uncoordinated was given by carers.

Adolescent↗

[Bioforce Development Institute approach: professional training center for humanitarian workers].

The Bioforce Development Institute has been providing training, orientation, and expertise since its founding by Doctor Charles Merieux in 1983. Non-governmental organizations (NGO) require that applicants for humanitarian missions exhibit not only motivation and adaptability but also specific skills. Training is necessary to prepare personnel prior to departure. In addition NGO must hire salaried personnel and develop human resources with the same efficiency as any private-sector company. Personnel working for International Relief Organizations (IRO) must be competent in project management. To meet these growing needs, Bioforce offers training to logistics and administrative managers working in international humanitarian organizations.

Administrative Personnel↗

The aftermath of an industrial disaster.

An explosion in a Danish supertanker under construction in 1994 caused the death of six workers and injured 15. Six months later 270 workers took part in this study, which analyses the relationships between objective stressors, the workers' own feelings and the reactions of their families after the explosion together with training, attitude to the workplace, general out-look, and received crisis help. Traumatisation, coping style and crisis support was assessed via the Impact of Event Scale (IES), the Coping Styles Questionnaire (CSQ) and the Crisis Support Scale (CSS). Emotionally, workers and their families were strongly affected by the explosion. The IES-score was 17.6 and the invasion score 9.1. The degree of traumatisation was higher in the group who had an 'audience position' than in the group who was directly hit by the explosion. Training in rescue work did not protect against adverse effects. Rescue work had a strong impact on the involved. Social support was a significant factor, that seems to buffer negative effects. High level of social integration, effective leadership in the situation, and professional crisis intervention characterised the disaster situation. All the same, 41 per cent of the workers reached the caseness criteria by Horowitz (IES > or = 19).

Accidents, Occupational↗

Internally displaced persons.

There were estimated to be over 20 million internally displaced persons (IDPs) at the end of 1999, a number that surpasses global estimates of refugees. Displacement exposes IDPs to new hazards and accrued vulnerability. These dynamics result in greater risk for the development of illness and death. Often, access of IDPs to health care and humanitarian assistance is excluded deliberately by conflicting parties. Furthermore, the arrival of IDPs into another community or region strains local health systems, and the host population ends up sharing the sufferings of the internally displaced. Health outcomes are dismaying. From a health perspective, the best option is to avoid human displacement. WHO contributes to the prevention of displacement by working for sustainable development. Placing health high on the political agenda helps maintain stability, and thereby, reduce the likelihood for displacement. Primary responsibility for assisting IDPs, irrespective of the cause, rests with the national government. However, where the government is unwilling or unable to provide the necessary aid, the international humanitarian community must step in, with WHO playing a major role in the health sector. There is consensus among the partners of the World Health Organization (WHO) that, in emergencies, the WHO must: 1) take the lead in rapid health assessment, epidemiological and nutritional surveillance, epidemic preparedness, essential drugs management, control of communicable diseases, and physical and psychosocial rehabilitation; and 2) provide guidelines and advice on nutritional requirements and rehabilitation, immunisation, medical relief items, and reproductive health. If the vital health needs of IDPs--security, food, water, shelter, sanitation and household items--are not satisfied, the provision of health services alone cannot save lives. Community participation is essential, and community participation implies bolstering the assets and capacities of the beneficiaries.

Adult↗

An uncommon international venture.

A collaboration involving Franciscan religious communities in the United States and Cameroon, Africa, demonstrates that a spirit of mutuality and cross-cultural understanding can develop among partners in aid projects. Three United States-based communities of Franciscan women religious developed the "Common Venture" project as a way to celebrate their common history while undertaking systemic change. Wanting to have an international impact, they developed a relationship almost a decade ago with the Tertiary Sisters of St. Francis in Cameroon. The result was a collaborative project through which the sisters sought to discover the deeper meaning of their vocation and their community membership; seek resources to further the Cameroon ministry; and identify organizations to support their work. Much has been accomplished in the ensuing nine years. This Common Venture effort has inspired a "minor revolution" in aid efforts in Cameroon and beyond. It has brought education and training programs, improved health care access, supplies and medicine, medical volunteers, and other improvements to this African community. And the U.S. partners also have benefited, gaining great satisfaction from helping people in need develop long-term solutions to problems.

Cameroon↗