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PubMed1992

Infectious diseases following major disasters.

A recent surge in the general awareness of the extent of disasters has increased concern over the adequacy of our state of preparedness for these events. Outbreaks of infectious disease after a disaster may have significant societal impacts. In preparation, rescuers must anticipate and identify infectious risks, isolate and treat the individuals with infections, and institute measures that will prevent the further spread of infectious diseases. Epidemiological factors may contribute to the spread of infectious disease after a given disaster. A simple microbiological laboratory in the field may be helpful in attempting to direct therapy at specific infectious etiologies. Prior post-disaster experience suggests that mass immunization may not always be valuable in protecting against disease spread acutely, although immunizations may be considered in a limited number of situations. Disaster medical personnel should prepare themselves with appropriate vaccinations and remain in good health; new pathogens must not be brought in by well-meaning relief personnel. Disasters often occur in a Third-World setting where resources are limited and often compromised. Complete recovery from infectious disease outbreaks and restoration of infection control practices may take years when a Third-World population has suffered a major disaster.

Communicable Disease Control↗
PubMedDate not supplied

Risk factors for adolescent alcohol use following a natural disaster.

INTRODUCTION: On 29 March 1998, a series of category F-3 and F-4 tornadoes caused wide-spread destruction in four rural southern Minnesota counties in the United States. Extensive research has examined the impact of disaster exposure on adults' psychological functioning, including alcohol use. However, there has been little research on potential risk factors for adolescents' alcohol use following disaster exposure. HYPOTHESIS: It was hypothesized that demographic variables such as age and gender, prior drinking involvement, extent of prior trauma history, level of disaster exposure, and current disaster-related, post-traumatic stress disorder (PTSD) symptomatology would predict alcohol use among adolescents. METHODS: Six months following a natural disaster, survey data were collected from 256 adolescents assessing these factors. Risk factors for adolescents' alcohol use were identified using hierarchical, multiple regression and logistic regression analyses. RESULTS: Greater age, prior drinking involvement, and the extent of prior trauma history were significantly associated with higher levels of binge drinking. Prior trauma history and current levels of disaster-related PTSD symptomatology were significant risk factors for adolescents' report of increases in their alcohol consumption since the tornado. CONCLUSION: In general, the extent of trauma exposure was associated with greater binge drinking among adolescents. Similar to adults, post-traumatic stress symptoms experienced in the aftermath of a disaster can lead to increased alcohol consumption among adolescents.

Adolescent↗
PubMed1986

Posttraumatic morbidity of a disaster. A study of cases presenting for psychiatric treatment.

The study of unsolicited psychiatric patients who became ill because of their experience in a natural disaster can assist in the design of future disaster research. A clinical report of 36 such patients illustrates the problems of case detection, the delayed presentation of much of the morbidity, and the need to separate stress-related symptoms which are common in disaster victims from psychiatric illness. Unless these issues are taken into account, estimates of the prevalence of psychiatric disorders after major disasters may be subject to substantial error. The role of vulnerability factors assessed to be operating in these patients suggests that exposure and losses sustained in the disaster alone are inadequate predictors of psychiatric disorder. The risk factors for the development of disaster-related psychiatric morbidity will be more accurately defined if the contribution of a range of constitutional, personality, and social factors as well as the personal impact of the disaster are investigated in future research.

Adaptation, Psychological↗
PubMedDate not supplied

The Southern Region burn disaster plan.

A regional burn disaster plan for 24 burn centers located in 11 states comprising the Southern Region of the American Burn Association was developed using online and in-person collaboration between burn center directors during a 2-year period. The capabilities and preferences of burn centers in the Southern Region were queried. A website with disaster information, including a map of regional burn centers and spreadsheet of driving distances between centers, was developed. Standard terminology for burn center capabilities during disasters was defined as open, full, diverting, offloading, or returning. A simple, scalable, and flexible disaster plan was designed. Activation and escalation of the plan revolves around the requirements of the end user, the individual burn center director. A key provision is the designation of a central communications point colocated at a burn center with several experienced burn surgeons. In a burn disaster, the burn center director can make a single phone call to the communications center, where a senior burn surgeon remote from the disaster can contact other burn centers and emergency agencies to arrange assistance. Available options include diversion of new admissions to the next closest center, transfer of patients to other regional centers, or facilitation of activation of federal plans to bring burn care providers to the affected burn center. Cooperation between regional burn center directors has produced a simple and flexible regional disaster plan at minimal cost to institute or operate.

Burn Units↗
PubMedDate not supplied

Planning for burn disasters: lessons learned from one hundred years of history.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Burns↗
PubMed2002

Satellite remote sensing as a tool in Lahar disaster management.

At least 40,000 deaths have been attributed to historic lahars (volcanic mudflows). The most recent lahar disaster occurred in 1998 at Casita volcano, Nicaragua, claiming over 2,500 lives. Lahars can cover large areas and be highly destructive, and constitute a challenge for disaster management. With infrastructure affected and access frequently impeded, disaster management can benefit from the synoptic coverage provided by satellite imagery. This potential has been recognisedfor other types of natural disasters, but limitations are also known. Dedicated satellite constellations for disaster response and management have been proposed as one solution. Here we investigate the utility of currently available and forthcoming optical and radar sensors as tools in lahar disaster management. Applied to the Casita case, we find that imagery available at the time could not have significantly improved disaster response. However, forthcoming satellites, especially radar, will improve the situation, reducing the benefit of dedicated constellations.

Disaster Planning↗
PubMed2005

Evidence against disaster-induced migration: the 2004 tornado in north-central Bangladesh.

Migration is generally considered to be one of the primary responses to a natural disaster. The existing literature widely acknowledges the fact that disaster victims migrate from affected areas. This paper, though, provides empirical evidence of the non-occurrence of out-migration in the aftermath of the 14 April 2004 tornado in Bangladesh. Data collected from 291 respondents from eight tornado-affected villages suggest that no one from these locations migrated to other areas. The constant flow of disaster aid and its proper distribution by the government and non-governmental organisations (NGOs) were the main reasons why victims did not leave. This study contributes to the disaster literature by providing three important findings: disasters do not always create out-migration; emergency aid can compensate in monetary terms for damage caused by disasters; and some of the arguments made in the literature against the provision of emergency relief for disaster victims are not always valid for all countries.

Adult↗
PubMed1995

ENSO and disaster: droughts, floods and El Niño/Southern Oscillation warm events.

The connection between El Niño/Southern Oscillation (ENSO) events and precipitation and temperature variability worldwide is increasingly well understood. ENSO has been linked to droughts and flooding in some regions. This paper uses the disaster history database of the U.S. Agency for International Development's Office of U.S. Foreign Disaster Assistance to examine the link between ENSO events and droughts or floods of sufficient magnitude to trigger international disasters. Worldwide, disasters triggered by droughts are twice as frequent during year two of ENSO warm events than during other years. No such relationship is apparent in the case of flood disasters. Drought disasters occur during year two of ENSO warm events significantly more frequently than in other years in Southern Africa and Southeast Asia. No regional pattern emerges from a comparable analysis of flood disasters. Those places likely to be affected by ENSO-triggered droughts can take proactive measures to mitigate the impacts.

Atmosphere↗
PubMed1989

The stress upon rescuers involved in an oil rig disaster. "Alexander L. Kielland" 1980.

Nine months post-disaster, 134 rescuers involved in an off-shore oil rig disaster were investigated by using a structured self report questionnaire to chart their experience of coping with disaster impact stressors and their mental and physical health 9 months after the disaster. Of the 134 rescuers, 24 were categorized as professional rescuers, 101 as non-professionals and 9 could not be classified. Of the 212 victims, all oil rig workers, 89 (42%) were rescued. Seventy-six percent of the rescuers reported they had been exposed to danger during the rescue operation, and 62% found the experience to be the worst ever. Eighty to ninety percent felt they had coped fairly well with the task, and severely disturbed coping was reported to be below 10% for decision-making, ability to judge risk, capacity to function as leader, and finally ability to cooperate and act efficiently. For the non-professionals, severe disturbance in ability to plan before acting was reported by 10% and moderate disturbance was reported by 38%. The frequency of emotional stress reactions during the rescue work can be assessed from the fact that 64% to 52% reported discouragement, restlessness, uncertainty, anxiety and irritation. The stressors inherent in this type of disaster seem to satisfy the DSM III stressor criterion for post-traumatic stress disorder. Nine months after the disaster 24% reported their mental health to be poor due to the disaster impact, and only the most experienced rescuers had a low health risk compared to the others.

Adaptation, Psychological↗
PubMedDate not supplied

Applications of telemedicine and telecommunications to disaster medicine: historical and future perspectives.

Disaster management utilizes diverse technologies to accomplish a complex set of tasks. Despite a decade of experience, few published reports have reviewed application of telemedicine (clinical care at a distance enabled by telecommunication) in disaster situations. Appropriate new telemedicine applications can improve future disaster medicine outcomes, based on lessons learned from a decade of civilian and military disaster (wide-area) telemedicine deployments. This manuscript reviews the history of telemedicine activities in actual disasters and similar scenarios as well as ongoing telemedicine innovations that may be applicable to disaster situations. Emergency care providers must begin to plan effectively to utilize disaster-specific telemedicine applications to improve future outcomes.

Disasters↗
PubMed1998

Posttraumatic stress disorder following an air disaster: a prospective study.

OBJECTIVE: The purpose of this study was to determine predictors of posttraumatic stress disorder (PTSD) in health care workers exposed to a disaster, in order to facilitate early case identification and prevention of subsequent morbidity. METHOD: Following an air disaster, 355 military medical health care workers were studied over an 18-month follow-up period. Measures included assessment of peritraumatic reactions associated with the disaster, the frequency of other stressful events after the disaster, and standard PTSD rating scales at 6, 12, and 18 months. RESULTS: Multivariate logistic regression of data on health care workers who cared for victims of the air disaster showed that PTSD was more likely to develop in those who had not completed college, those who had worked with burn victims, those who had experienced more stressful life events in a period of approximately 6 months following the disaster, and those who experienced emotional numbness immediately after the disaster. CONCLUSIONS: Results suggest that lower levels of education, exposure to grotesque burn injuries, stressful life events following exposure, and feelings of numbness following exposure are useful predictors of subsequent development of PTSD.

Accidents, Aviation↗
PubMed2006

Characteristics of medical surge capacity demand for sudden-impact disasters.

OBJECTIVES: To describe the characteristics of the demand for medical care during sudden-impact disasters, focusing on local U.S. communities and the initial phases of sudden-impact disasters. METHODS: Established databases and published reports were used as data sources. Data were obtained to describe the baseline capacity of the U.S. medical system. Information for the initial phases of a sudden-impact disaster was sought to allow for characterization of the length of time before a U.S. community can expect arrival of outside assistance, the expected types of medical surge demands, the expected time for the peak in medical-care demand, and the expected health system access points. RESULTS: The earliest that outside assistance arrived for a community subject to a sudden-impact disaster was 24 hours, with a range from 24 to 96 hours. After sudden-impact disasters, 84% to 90% of health care demand was for conditions that were managed on an ambulatory basis. Emergency departments (EDs) were the access point for care, with peak demand time occurring within 24 hours. The U.S. emergency care system was functioning at relatively full capacity on the basis of data collected for the study that showed that annually, 90% of EDs were boarding admitted inpatients, and 75% were diverting ambulances. CONCLUSIONS: As part of planning for sudden-impact disasters, communities should be expected to sustain medical services for 24 hours, and up to 96, before arrival of external resources. For effective medical surge-capacity response during sudden-impact disasters, there should be a priority for emergency medical care with a focus on ambulatory injuries and illnesses.

Disasters↗
PubMed1993

The epidemiology of disasters and adverse reproductive outcomes: lessons learned.

A disaster has been defined as a disruption of human ecology that exceeds the capacity of the community to function normally. Little is known about the adverse effects of natural disasters on reproductive outcomes. Important lessons can be derived from several disasters caused by human factors, such as the Minamata Bay disaster. Adverse reproductive outcomes include infertility, early pregnancy loss, stillbirths, congenital malformations, and serious developmental disabilities such as cerebral palsy and mental retardation. Recent disasters like the Chernobyl and Bhopal explosions have provided important lessons on the need for accurate and sound information about the risk of prenatal exposures for adverse reproductive outcomes. To study questions of adverse reproductive outcomes and disasters requires a well-planned approach. It should include early development of surveillance for adverse reproductive outcomes, analytic studies on the risk of disasters from direct and indirect effects, sensitive methods to measure early pregnancy loss, and long-term follow-up programs to assess outcomes such as developmental disabilities.

Animals↗
PubMed1999

Emergency management of disasters involving livestock in developing countries.

Different disasters have similar consequence on the health and welfare of livestock. Numerous geophysical disasters can exacerbate epizootics, resulting in the deaths of many animals and the reduction of production efficiency. These disasters also present a considerable threat of spoilage of processed foods, endangering public health. Furthermore, large-scale disasters involving animals can modify the long-term stability of national economies, the environment and social structures. The authors discuss the vulnerability of the livestock industry to natural disasters and the impact of floods, droughts and transboundary diseases and pests on national economies. Examples are given on how some losses can be avoided, evaluated and compensated. The role of the veterinarian is presented in relation to work conducted by other relief organisations in cases of emergency. In developing countries, mitigation programmes should focus on strengthening global animal health services. Preparedness needs to be community based, with education provided in a timely manner. Effective recovery from disasters should be based on mitigation programmes, including international trade and mutual aid agreements between neighbouring countries to supply appropriate goods and environmentally and culturally appropriate breeds of livestock. Disaster relief for the care of livestock should be recognised as a form of humanitarian assistance, given the benefits to be derived for public health and the socio-economic implications of successful intervention.

Animal Diseases↗
PubMedDate not supplied

The efficacy of integrating "smart simulated casualties" in hospital disaster drills.

INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. METHODS: A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.

Adult↗
PubMed1989

Crisis management and disaster planning: some recent lessons.

Two recent disasters--Hurricane Hugo and the San Francisco-Oakland area earthquake--put a number of hospitals (and their disaster plans) to the text this fall. In future issues, we will present details on how hospitals faced those emergencies. The need for crisis management and disaster planning, however, is not limited to natural disasters like hurricanes, earthquakes, tornadoes, or floods. Man-made disasters, both internal and external, can occur virtually at any time. These include accidents, terrorists bombs, fires, explosions, and toxic chemical spills. In this report, we will present the key elements of a crisis management plan, as well as some expert pointers on what to include in a disaster plan. We will give you details on how two hospitals fared when a major air crash occurred in their community. We will tell you some of the things they would do differently, and we will also describe how an interagency disaster planning committee responded.

Accident Prevention↗
PubMedDate not supplied

How to talk to the media: televised coverage of public health issues in a disaster.

Public health officials often are critical of the way television news covers disasters, while broadcast journalists complain of a lack of cooperation from the public health sector during disaster coverage. This article summarizes the issues discussed in a session on Televised Coverage of Disasters, presented in April 1999 at the UCLA Conference on Public Health and Disasters in Los Angeles. Public health officials were asked to "talk back to their television sets" in a dialog with television journalists. Concerns included: 1) the lack of balance in television coverage that is dominated by sensational images that may frighten rather than inform the public; 2) the potential for psychological damage to viewers when frightening images are shown repeatedly in the days and weeks of the disaster; and 3) the perception that TV reporters place too much emphasis on crime, property damage, and loss of life, giving relatively low priority to disaster preparedness and to public health issues in the aftermath of a disaster. Options for improving communication between television journalists and public health professionals also are discussed.

California↗
PubMed1994

Burns mass disasters in Singapore--a three decade review with implications for future planning.

OBJECTIVE: The main objective of this paper is to review three decades (1962-1991) of data relating to burns mass disasters in Singapore. DESIGN: Records of the Burns Centre, Singapore General Hospital were reviewed retrospectively. Only patients admitted were analysed in three separate groups in relation to the cause of the burns mass casualties and place of occurrence. SETTING: Patient selection was based on O'ya's criteria of burns mass disaster and were grouped into separate decades: Group A (1962-71), Group B (1972-81) and Group C (1982-91). INTERVENTION: Data collected will provide useful information on high risk sources, patterns and trends of burns mass disasters in Singapore. MAIN OUTCOME MEASURE: The data will provide the facts and will have implications for future planning and organisation of burn treatment facilities. RESULTS: There were 17 burns mass casualties and 257 patients admitted. The largest single admission was 76 in 1978. Group A had four, Group B had two and Group C had eleven disasters. Explosions (66%) and fires (30%) were the main causes of burns. The predominant place of occurrence in Group A patients was outdoor injuries (78%), Group B was work environment (100%) and Group C was evenly spread out: work environment (55%), indoors (36%) and outdoor (9%). Shipyards and fires were the largest sources of burns mass disasters. Other potential sources identified include hazardous materials, petrochemical industries, aviation industries, mass rapid transit train system, high rise fires, shopping complexes and imported disasters. CONCLUSION: The recommendation is to plan and reorganise burn treatment facilities. This is to cope with existing pattern, frequency and projected patterns of burn mass disasters which have occurred in other highly urbanised and populated countries.

Burns↗