The identification of victims of mass disasters, and also the identification of individual remains. A method of coding teeth.
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Dental Records↗
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[Transportation of patients and victims during natural disasters and catastrophes].
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Aircraft↗
[JNA nursing volunteers caring for the Kobe earthquake victims].
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Disasters↗
Older people in disaster: a comparison of black and white victims.
This research examines differential vulnerability to environmental stressors among white and black elderly and non-elderly disaster victims. The research identifies the determinants of psychosocial recovery for those four demographic groups. A total of 431 families who were victims of a tornado were interviewed for the study. A path model of the determinants of psychosocial recovery is presented, and observations are made regarding intervention strategies for older disaster victims.
Adaptation, Psychological↗
Further validation of a quadruplex STR DNA typing system: a collaborative effort to identify victims of a mass disaster.
The relatively new, PCR-based technique of Short Tandem Repeat (STR) profiling has been used in the identification of the victims of a mass disaster. The analysis relied upon a recently developed multiplex reaction and the use of automated fluorescence technology to simulataneously analyse four tetrameric STR loci. The performance of the 'quadruplex' test was assessed by use of a collaborative study incorporating a blind trial and was demonstrated to be accurate, reliable and robust. Furthermore, the system proved to be highly successful despite the fact that many of the samples from the mass disaster scene were extremely degraded. The high success rate coupled with the discrimination power of the system enabled many severely decomposed human remains to be positively identified.
DNA↗
The application of dental methods of identification to human burn victims in a mass disaster.
This paper deals with the usefulness of dental identification in the case of 28 human burn victims of a bus accident in Spain. Postmortem forensic procedures for identification were used including general external examination, routine photographs and radiographs and complementary biological methods. Dental identification was also used and a description of the method is presented. Dental identification was established in 57% of the cases. When victims were less than 20 years of age, the success rate of identification by dental methods was higher (76% of victims in this age group). The assessment of dental age allowed the establishment of identity of four victims. We recommend that dental procedures be used in human identification after mass disasters. Odontological and radiographic procedures are powerful methods when dealing with burn victims.
Accidents, Traffic↗
Serum potassium in the crush syndrome victims of the Marmara disaster.
BACKGROUND: Hyperkalemia is a major cause of mortality in the patients who suffer from crush syndrome in the aftermath of major earthquakes. The aim of this study is to investigate the frequency and effects of hyperkalemia in the 639 victims of catastrophic Marmara earthquake that struck northwestern Turkey, in August 1999. PATIENTS AND METHODS: Within the first week of disaster, questionnaires were sent to 35 reference hospitals that treated the victims. Information on serum potassium which was provided in 595 out of 639 questionnaires was submitted to analysis. RESULTS: In the patients who were admitted within the first 3 days of the disaster (n = 401) serum potassium was 5.4 +/- 1.3 mEq/l, which was higher than in those admitted thereafter (n = 171) (4.5 +/- 1.1 mEq/l) (p = 0.02). Considering the whole series, males (p = 0.01), patients needing dialysis support (p < 0.001) and non-survivors (p = 0.001) were characterized by higher serum potassium at admission. Seventy patients' serum potassium was above 7 mEq/l, while 22 patients were hypokalemic (< 3.5 mEq/l). Admission potassium correlated with many clinical and laboratory variables indicating the severity of the trauma, and a logistic regression model with clinical and laboratory parameters upon admission, revealed potassium as the most significant predictor of dialysis needs in the victims admitted within the first 3 days (p = 0.008, OR = 3.33). Among the victims who were admitted to hospitals 1 week after the disaster, 8 had serum potassium levels above 6.5 mEq/l; among 4 of them were complicated by hyperkalemia even higher than 7.5 mEq/l. These findings undeline the importance of hyperkalemia during clinical course. CONCLUSION: The most important and fatal medical complication in crush syndrome patients is hyperkalemia. Risk of fatal hyperkalemia continues even after hospitalization. Empirical therapy at the scene is indicated especially in male victims with severe soft tissue traumas. Early detection and treatment of hyperkalemia may improve the final outcome of renal disaster victims.
Adolescent↗
Health problems of victims before and after disaster: a longitudinal study in general practice.
BACKGROUND: We aimed to quantify the health problems and to assess the possible risk factors for developing health problems in persons affected by the explosion of a firework depot at Enschede, The Netherlands, on May 13, 2000. The explosion considerably damaged buildings in the local neighbourhood and caused 22 immediate deaths and injuries in over 1000 people. METHODS: A longitudinal study of (89% of all) victims (n = 9329) and controls (n = 7392) with pre-disaster baseline morbidity for 16 months and post-disaster data for 2.5 years was conducted using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care (ICPC). Prevalence rates for clusters of symptoms were compared between victim and control groups pre- and post-disaster. Risk factors for developing health problems were examined in hierarchical linear models. RESULTS: Two and a half years post-disaster, the prevalence of psychological problems in victims who had to relocate was about double and in the non-relocated victims one-third more than controls. Victims with pre-disaster psychological problems were at a greater risk for post-disaster psychological problems. Relocated victims showed an excess of medically unexplained physical symptoms (MUPS) especially in a period of increased media attention. Both groups of victims showed some increase of gastrointestinal (GI) morbidity 2.5 years post-disaster compared with their pre-disaster rate, and compared with the control group. CONCLUSIONS: Two and a half years post-disaster an excess of psychological problems, MUPS, and gastrointestinal morbidity was observed. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems.
Adult↗
The role of health sectors in disaster preparedness. Floods in southeastern China, 1991.
Disasters, whether natural or man-made, usually are unpredictable. Efforts to reduce morbidity and mortality from a disaster should be put forth before it occurs. A brief survey is presented of the worst flood to occur in a hundred years that affected eight provinces in Southeast China. The disaster preparedness and response for Anhui Province, the hardest hit area, is summarized. The disaster preparedness was comprehensive, and cooperation was achieved among various specialties: military forces; firefighters; civil engineers; mechanics; police; provincial governors; the medical sectors; and so forth. Among these groups, the role of medical sectors was of great importance in reducing disease that would have resulted from such a disaster. The measures undertaken by the medical sectors included development of an organization to reduce the impact of disaster; training of medical personnel in techniques of rescue and in treatment of victims in disaster areas; development of a plan to assist the leadership in decision-making and establishing support for disaster preparedness; and maintaining sufficient capacity in general hospitals for the admission of victims from disaster areas.
China↗
[The microfloral wound dynamics of the victims in the railroad disaster in Bashkiria].
The work deals with the microbial composition of burn wounds in the victims of the railroad catastrophe in Bashkiria during their stay in a hospital. The comparison of the microbial spectrum in the wounds of the burn victims of the catastrophe with the results of the monitoring of the causative agents of burn infections in patients treated at the department of thermal lesions over a period of 3 years is presented. The medicinal sensitivity of wound microflora at all stages of the hospital treatment of the patients was studied and compared with the medicinal sensitivity of microorganisms isolated from the wounds of burn patients in 1988.
Accidents, Traffic↗
Psychological intervention for victims and helpers after disasters.
Disasters can have long term and damaging effects on survivors. In addition, those who are involved in disaster work, such as rescue and medical personnel, may become hidden victims. Different kinds of psychological assistance can be provided but this must be systematic and well organized. Professional help should supplement and facilitate community, personal and social resources rather than supplant them. This paper provides guidelines for providing such help.
Counseling↗
A review of triage and management of burns victims following a nuclear disaster.
The field of combined injury is relatively unfamiliar to burn surgeons. The mortality and morbidity of combined injury victims is higher than that of the injuries separately. The secondary consequences of radiation exposure, e.g. immunosuppression, infection, bleeding and fluid and electrolyte loss, significantly affects the management plan for burn victims. Increased work loads on medical personnel and the hospital further affects the management plan and outcome adversely. Based on previous experiences and experimental studies by various authors, a plan for management of burn victims in nuclear casualties is presented for effective utilization of available resources for overloaded burn centres in emergency situations. The proper recording of the experience of such situations is stressed.
Burns↗
Symptoms of peritraumatic and acute traumatic stress among victims of an industrial disaster.
Previous studies have examined peritraumatic distress, peritraumatic dissociation, and acute stress disorder as predictors of posttraumatic stress disorder (PTSD). The authors examined whether these three predictors were associated with PTSD symptoms when considered simultaneously. Two-hundred victims of a factory explosion in Toulouse, France, were surveyed two and six months after the event with use of retrospective self-reports of peritraumatic distress, peritraumatic dissociation, and acute stress disorder. A hierarchical multiple regression predicting PTSD symptoms six months posttrauma indicated that all three constructs explained unique variance, accounting for up to 62 percent. Peritraumatic distress and dissociation and acute stress disorder appear conceptually different from one another and show promise in identifying who is at risk of PTSD.
Dissociative Disorders↗
Disaster and subsequent healthcare utilization: a longitudinal study among victims, their family members, and control subjects.
BACKGROUND: The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members. OBJECTIVE: The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization. RESEARCH DESIGN: We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records. SUBJECTS: Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population. MEASURES: As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status. RESULTS: Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire. CONCLUSION: Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.
Adolescent↗
Elevated frequency of sister chromatid exchanges of lymphocytes in sarin-exposed victims of the Tokyo sarin disaster 3 years after the event.
We previously reported that the frequency of sister chromatid exchanges (SCEs) among victims of the Tokyo subway sarin disaster was significantly higher than that of controls 2-3 months after the disaster. It has been reported that the victims were also exposed to the by-products generated during sarin synthesis, i.e., diisopropyl methylphosphonate (DIMP), diethyl methylphosphonate (DEMP) and N,N-diethylaniline (DEA) during the disaster and we previously found that DIMP, DEMP and DEA induced a significant SCE increase in human lymphocytes in vitro. To monitor the genetic aftereffects of the sarin exposure, SCEs of peripheral blood lymphocytes were measured in fire fighters and police officers involved in the disaster 3 years after the event. We found that the frequency of SCEs was still significantly higher in the exposed subjects than the controls, suggesting a risk of the genetic aftereffects of the sarin exposure. We further found a significant positive correlation between the frequency of SCEs and the inhibition of serum cholinesterase activity in the exposed subjects, suggesting that the elevated frequency of SCEs is related to the sarin exposure. On the other hand, there was no significant difference in natural killer activity between the exposed and the controls.
Adult↗
Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake.
BACKGROUND: The clinical course of acute renal failure (ARF) related to crush syndrome is very complex, because of co-existing surgical and/or medical complications. After the devastating Marmara earthquake that struck Turkey in August 1999, 639 patients were identified with nephrological problems, whose clinical findings have been the subject of this analysis. METHODS: Specific questionnaires asking about 63 variables were sent to 35 reference hospitals that treated the victims. Clinical findings of the renal victims were analysed. RESULTS: At admission, high fever was noted in 31.8% of the patients; the temperature of non-survivors was higher (P=0.027). Mean blood pressure was higher in survivors (P=0.004) and dialysed victims (P <0.001). Most (61.4%) patients were oligo-anuric; oliguria lasted for 10.8+/-7.2 days. Thoracic and abdominal traumas were associated with a higher risk of mortality. 397 fasciotomies and 121 amputations were performed in 790 traumatized extremities. Fasciotomies were associated with sepsis (P<0.001) and dialysis needs (P<0.0001), while amputations were associated with mortality (P<0.0001). Medical complications, which were associated with dialysis needs (P<0.0001) and mortality (P<0.0001), were observed in 51.5% of patients. In a multivariate analysis model of medical complications, disseminated intravascular coagulation (DIC) (P<0.0001, OR=5.81), and adult respiratory distress syndrome (ARDS) (P=0.0001, OR=4.53) were predictors of mortality. CONCLUSIONS: In the aftermath of catastrophic earthquakes, clinical findings of the renal victims can predict the final outcome. While fasciotomies indicate dialysis needs, extremity amputations, abdominal and thoracic traumas are associated with higher rates of mortality in addition to DIC and ARDS.
Acute Kidney Injury↗
Coping with traumatic loss: an interview with the parents of TWA 800 crash victims and implications for disaster mental health professionals.
The stories of survivors of traumatic events can be instructive to professionals who provide crisis intervention and/or psychotherapy to the bereaved. This paper provides excerpts from an interview with a middle-age married couple who lost two children in the 1996 explosion of TWA 800 over Long Island Sound. Their story illustrates important methods of coping with grief and sheds light on the value to survivors of recovering victims' remains. This case study is followed by a discussion about some elements of the interview that are helpful to an understanding of the grief process.
Adaptation, Psychological↗
The stress of post-disaster body handling and victim identification work.
Personnel involved with the recovery and identification of bodies following the Mount Erebus aircrash were interviewed and tested. They gave information about the stressors of the assignment and their reactions to them. The outcome revealed that about a third of the subjects experienced some transient problems initially, and about one-fifth after three months. At a 20-month follow-up there was still some evidence of subjects being under stress. In this study, disaster stress was seen as a complex interaction between environmental and task stressors, job competency, perceptual and emotional defenses, management and follow-up support. It was suggested that levels of stress might be reduced if emotional de-briefing were introduced as a routine matter, alongside logistic de-briefing at the end of any similar operation. The procedure would help to ventilate any negative feelings there might be and to offer additional help should it be needed.
Adult↗