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PubMedDate not supplied

Mental health service use 1-year after the World Trade Center disaster: implications for mental health care.

The objective of this study was to assess prevalence and predictors of mental health service use in New York City (NYC) after the World Trade Center disaster (WTCD). One year after the attacks, we conducted a community survey by telephone of 2368 adults living in NYC on September 11, 2001. In the past year, 19.99% (95% confidence interval [CI]=18.2-21.77) of New Yorkers had mental health visits and 8.1% (95% CI=7.04-9.16) used psychotropic medications. In addition, 12.88% (95% CI=11.51-14.25) reported one or more visits were related to the WTCD. Compared to the year before, 8.57% (95% CI=7.36-9.79) had increased post-disaster visits and 5.28% (95% CI=4.32-6.25) had new post-disaster treatment episodes. Psychotropic medication use related to the WTCD was 4.51% (95% CI=3.75-5.26). Increased post-disaster medication use, compared to the year before, was 4.11% (95% CI=3.35-4.86) and new medication episodes occurred among 3.01% (95% CI=2.34-3.69). In multivariate logistic analyses, mental health visits were associated with younger age, peri-event panic attack, posttraumatic stress disorder (PTSD) and depression. In addition, WTCD-related visits had a positive "dose-response" association with WTCD event exposures (P<0.0001). WTCD-related visits also were positively associated with peri-event panic, anxiety, lower self-esteem, PTSD, and depression. All three medication measures were positively related to PTSD and depression, and negatively associated with African American status. WTCD-related medication use also was positively related to younger age, female gender, WTCD event exposures, negative life events, anxiety and lower self-esteem. Finally, while the percentage of New Yorkers seeking post-disaster treatment did not increase substantially, the volume of visits among patients apparently increased. We conclude that exposure to WTCD events was related to post-disaster PTSD and depression, as well as WTCD-related mental health service use. African Americans were consistently less likely to use post-disaster medications. Although the WTCD did have an impact on treatment-seeking among current patients, it did not substantially increase mental health treatment among the general population.

Adjustment Disorders↗
PubMed2004

Impact of disaster-related mortality on gross domestic product in the WHO African Region.

BACKGROUND: Disaster-related mortality is a growing public health concern in the African Region. These deaths are hypothesized to have a significantly negative effect on per capita gross domestic product (GDP). The objective of this study was to estimate the loss in GDP attributable to natural and technological disaster-related mortality in the WHO African Region. METHODS: The impact of disaster-related mortality on GDP was estimated using double-log econometric model and cross-sectional data on various Member States in the WHO African Region. The analysis was based on 45 of the 46 countries in the Region. The data was obtained from various UNDP and World Bank publications. RESULTS: The coefficients for capital (K), educational enrolment (EN), life expectancy (LE) and exports (X) had a positive sign; while imports (M) and disaster mortality (DS) were found to impact negatively on GDP. The above-mentioned explanatory variables were found to have a statistically significant effect on GDP at 5% level in a t-distribution test. Disaster mortality of a single person was found to reduce GDP by US$0.01828. CONCLUSIONS: We have demonstrated that disaster-related mortality has a significant negative effect on GDP. Thus, as policy-makers strive to increase GDP through capital investment, export promotion and increased educational enrolment, they should always keep in mind that investments made in the strengthening of national capacity to mitigate the effects of national disasters expeditiously and effectively will yield significant economic returns.

Journal Article↗
PubMed1995

Disaster epidemiology and disease monitoring.

Better epidemiologic knowledge of the mechanisms of death and of the types of injuries and illnesses caused by disasters is clearly essential to determining the appropriate relief medications, supplies, equipment, and personnel needed to effectively respond to such emergencies. The overall objective of disaster epidemiology is to measure scientifically and describe the health effects of disasters and the factors contributing to these effects. The results of such investigations allow disaster epidemiologists to assess the needs of disaster-affected populations, efficiently match resources to needs, prevent further adverse health effects, evaluate relief effectiveness, and plan for future disasters.

Communicable Disease Control↗
PubMed2006

Creating a regional pediatric medical disaster preparedness network: imperative and issues.

Over the past few decades, the number of disasters, both natural and human initiated has increased. As a result, since the September 11, 2001 attacks on the World Trade Center and Pentagon, there has been a new emphasis on disaster preparedness. However, the preparedness emphasis has been primarily directed toward adults and little attention has been specifically given to the needs of children. One reason for the lack of attention to pediatric needs in disaster planning is that childhood is seldom viewed as a separate and special stage of growth, fundamentally different from adulthood. The expectation during emergencies is that the care provided for adults is appropriate for children. The purpose of this paper is to examine the types of and increase in disasters and discuss the importance of specifically addressing the special needs of children in disaster planning. Further the paper argues for a regional network approach to emergency pediatric care that would increase surge capacity for children during disasters and other emergencies.

Child↗
PubMed2006

Unstable ethical plateaus and disaster triage.

Disasters are defined medically as mass casualty incidents in which the number of patients presenting during a given time period exceeds the capacity of the responders to render effective care in a timely manner. During such circumstances, triage is instituted to allocate scarce medical resources. Current disaster triage attempts to do the most for the most, with the least amount of resources. This article reviews the nature of disasters from the standpoint of immediate medical need, and places into an ethics framework currently proposed utilitarian triage schema for prioritizing medical care of surviving disaster victims. Specific questions include whether resources truly are limited, whether specific numbers should dictate disaster response, and whether triage decisions should be based on age or social worth. The primary question the authors pose is whether disaster triage, as currently advocated and practiced in the western world, is actually ethical.

Disaster Planning↗
PubMed1991

Disaster management. Lessons learned.

Our experiences have taught us that practice makes perfect and that it probably is unreasonable to expect everything to be orderly, sane, and appropriate during disaster management. The best we can hope for probably is controlled chaos. We do believe that we have generated an improved plan, that the plan is known, and that it is being revised continuously. We can no longer rely on our goodwill and good intentions to manage mass casualties in a disaster. There are too many factors that can reduce our ability to provide medical care in this situation. Hospital planning is essential. The hospital should be represented on the emergency preparedness committee so it is knowledgeable about the various plans throughout the city. Each plan must be practiced and critiqued to identify potential problems. Hospital staff must be kept current on the various plans to understand the communication, authority, responsibility, security, and medical control for each plan. We have instituted a video program outlining the various tasks for each hospital department for each disaster plan. This format allows the personnel in these departments to review their responsibilities continually in a concise manner and allows practice of disaster preparedness without implementing an entire disaster drill. Table 1 provides a quick review of the areas and questions we found to be problems when implementing our disaster plan.

Accidents, Aviation↗
PubMedDate not supplied

Guidelines for the use of foreign field hospitals in the aftermath of sudden-impact disaster.

Natural and complex disasters can cause a dramatic increase in the demand for emergency medical care. Local health services can be overwhelmed, and damage to clinics and hospitals can render them useless. Many countries maintain mobile field hospitals for defense or humanitarian purposes. Dispatching these facilities to disaster-affected countries would seem an ideal response to emergency medical needs. Unfortunately, experience has shown that in the case of natural disasters, field hospitals often have not met the expectations of recipients and donor institutions. In July 2003, the World Health Organization and Pan American Health Organization sponsored a workshop in El Salvador to discuss the pros and cons of using foreign field hospitals in the aftermath of natural disasters. These guidelines are the result of that workshop. The workshop participants identified different phases when foreign field hospitals and specialized medical personnel are most useful. They can provide advanced trauma care and life support if at the disaster site within 48 hours of the impact of an event; they would provide follow-up care for trauma victims and resumption of routine medical care in the two weeks following the event; during rehabilitation and reconstruction phases (from two months to two or more years), a field hospital might serve as a temporary replacement for damaged health facilities. These guidelines propose conditions that field hospitals and their staff should meet for each of these phases. The guidelines also outline issues that authorities in donor countries and disaster-affected countries should discuss before mobilizing a field hospital.

Disaster Planning↗
PubMed2000

Psychiatric issues in medical-surgical disaster casualties: a consultation-liaison approach.

Psychiatrists can increase the efficacy of their response to disaster victims in the immediate aftermath of a disaster if they utilize a consultation-liaison approach to assessment and management of casualties. Medical-surgical disaster responders use an algorithmic, stepwise approach to assess disaster or trauma victims. This approach ensures that patients with life-threatening injuries who are not expectant are treated first. Then, secondary physical assessments ensure proper triage of other victims so that disaster response resources are used most wisely. A tertiary psychiatric assessment can assist with differential diagnosis of post-disaster neuropsychiatric symptoms and signs to ensure valuable medical-surgical resources are targeted to the correct patients. Psychiatric triage can also identify those victims most in need of early preventive and therapeutic psychiatric intervention.

Disaster Planning↗
PubMed2001

Emergency medical technicians' disaster training by tabletop exercise.

The objective of this study was to assess the attitudes of emergency medical technicians (EMTs) toward tabletop drills to determine the effect of tabletop simulation on the EMT student perception of disaster preparedness and management. In November 1998 and April 1999, 59 firefighters underwent 260 hours of EMT intermediate level training at the National Cheng Kung University Hospital in Tainan, Taiwan. All participants had experience in field disaster exercise training before they attended this EMT training course. The EMT courses included a disaster and mass-casuality incident program. A 9-item questionnaire was completed by the 59 EMTs before (for field exercise) and after undergoing the tabletop drills. The results of the survey revealed that the field operation exercise could not provide adequate provisions to link the results of disaster exercises to appropriate changes in terms of training, equipment, supplies, and plans. Field operation failed to show the ability of others to fill in during the absence of key officials. Tabletop drilling provided better performance for these 2 issues. Tabletop exercise also provided a better chance than field exercise to evaluate the response without the use of telephones, which are not always reliable in real emergency situation. For disaster exercises, limitations of field operation drills such as communications, coordination, assignment of responsibilities, and postevent mitigation priorities were noted, and tabletop drills provided additional benefits for these settings. Large-scale effect evaluation of different drills may be necessary to design future disaster preparedness programs.

Adult↗
PubMed2006

Disasters and mental health: new challenges for the psychiatric profession.

Articles published in the Viewpoint section of this Journal may not meet the strict editorial and scientific standards that are applied to major articles in The World Journal of Biological Psychiatry. In addition, the viewpoints expressed in these articles do not necessarily represent those of the Editors or the Editorial Board.A disaster is the consequence of an extraordinary event that destroys goods, kills people, produces physical or psychological harm but, above all, which overcomes the adaptive possibilities of the social group. Disasters have strong political background and consequences. They shake the life of a community and raise questions about safety, social organization and the meaning of life. Disasters confront psychiatrists with challenges far beyond regular clinical activities or research strategies. During early interventions after a disaster, psychiatrists often have to work out of their usual clinical premises, in contact with unfamiliar professionals (i.e. rescue personnel) and with individuals who should not be considered as 'cases', and therefore without keeping regular clinical records. In the latter stages they have to confront many factors which tend to cause the clinical consequences of those affected and who developed a psychiatric condition to be chronic. Reactions to stress occur in stages, each one characterised by a specific psychological mechanism. Symptoms include flashbacks, difficulties in remembering, avoidance of stimuli, blunting of responses, high arousal level and obsessive ruminations. The strong biological and psychosocial factors which are unchained after a disaster should be recognised and chanelled. The experience of psychiatry with the bio-psycho-social model can help to understand what disasters are, how some negative aspects of them could be prevented, and how their consequences, both clinical as well as social, can be reduced.

Adaptation, Psychological↗
PubMed1999

Order in chaos: modelling medical management in disasters.

The medical aspects of disaster management, also referred to as disaster medicine, is a relatively new medical specialty, the roots of which are to be found in war surgery and traumatology. The main content of disaster medicine is based on empiricism. During the past couple of years, a mathematical approach to some aspects has been added. This may well result in the creation of some order in chaos. This modelling of medical disaster management is important not only in the preparedness phase, but also during the disaster itself and its evaluation. This may in turn result in a decrease in mortality, morbidity and disability amongst disaster casualties.

Disaster Planning↗
PubMed2006

Natural disasters and the challenge of extreme events: risk management from an insurance perspective.

Loss statistics for natural disasters demonstrate, also after correction for inflation, a dramatic increase of the loss burden since 1950. This increase is driven by a concentration of population and values in urban areas, the development of highly exposed coastal and valley regions, the complexity of modern societies and technologies and probably, also by the beginning consequences of global warming. This process will continue unless remedial action will be taken. Managing the risk from natural disasters starts with identification of the hazards. The next step is the evaluation of the risk, where risk is a function of hazard, exposed values or human lives and the vulnerability of the exposed objects. Probabilistic computer models have been developed for the proper assessment of risks since the late 1980s. The final steps are controlling and financing future losses. Natural disaster insurance plays a key role in this context, but also private parties and governments have to share a part of the risk. A main responsibility of governments is to formulate regulations for building construction and land use. The insurance sector and the state have to act together in order to create incentives for building and business owners to take loss prevention measures. A further challenge for the insurance sector is to transfer a portion of the risk to the capital markets, and to serve better the needs of the poor. Catastrophe bonds and microinsurance are the answer to such challenges. The mechanisms described above have been developed to cope with well-known disasters like earthquakes, windstorms and floods. They can be applied, in principle, also to less well investigated and less frequent extreme disasters: submarine slides, great volcanic eruptions, meteorite impacts and tsunamis which may arise from all these hazards. But there is an urgent need to improve the state of knowledge on these more exotic hazards in order to reduce the high uncertainty in actual risk evaluation to an acceptable level. Due to the rarity of such extreme events, specific risk prevention measures are hardly justified with exception of attempts to divert earth-orbit crossing meteorites from their dangerous path. For the industry it is particularly important to achieve full transparency as regards covered and non-covered risks and to define in a systematic manner the limits of insurability for super-disasters.

Disaster Planning↗
PubMed1999

US government natural disaster assistance: historical analysis and a proposal for the future.

Governments often provide grants or low-interest loans to disaster victims. Yet these programmes have proven to be quite costly. In addition, questions have been raised about associated behavioural incentives. Conceptually, government disaster insurance programmes should be more efficient, consistent and equitable than ex post facto disaster relief in the form of grants and loans. Yet the performance of government disaster insurance programmes has been mixed, at best. This article reviews the history of US federal natural disaster assistance to individuals and concludes with a recommendation for a new government role in the provision of disaster insurance.

Disaster Planning↗
PubMed1996

Disasters, the environment, and public health: improving our response.

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.

Disaster Planning↗
PubMed1999

[Public health nurses' disaster responses for intractable neurological patients at home].

OBJECTIVE: This paper describes the 1995 Hanshin-Awaji Earthquake experience of the local public health nurses. The purpose of the study was to identify problems regarding assistance of intractable neurological patients at home during and after the earthquake and to discuss ways to improve future local disaster responses by public health nurses for those patients. METHODS: Approximately 2 hours of a group interview of public health nurses from 2 public health centers in Kobe City was conducted in August, 1996. Interview data was collected via audio-tape and transcribed. The data was organized according to phases of the earthquake. The acute phase of the earthquake disaster ended within 72 hours. The data was then analyzed to identify problems in assisting intractable neurological home patients in order to discuss disaster responses by public health nurses. RESULTS: There was a delay in confirming the safety of and providing needed assistance for intractable neurological patients at home by public health nurses. During the first 3 days after the earthquake, the majority of public health nurses were unable to commute to work due to the shutdown of transportation systems. In addition, nurses, who were able to come to work, were preoccupied with treating earthquake casualties and distributing medical supplies. Other factors associated with the delay included the following: lack of a registration list for intractable neurological patients at home; lack of close contacts between public health nurses and patients, and between public health nurses and patient support groups; and sparing nurses for guiding volunteers and for coordinating between shelters and hospitals. CONCLUSION: Measures to improve future disaster responses are as follows: a) teaching patients and their families how to safeguard against disaster; b) preparing registration lists; c) establishing support networks and cooperating with network members; and d) upon disaster, assigning some nurses to assess the needs of patients.

Disaster Planning↗
PubMedDate not supplied

The physician's role in Canada's disaster response system.

The most recent tragedy in Manitoba illustrates that disasters can strike any community. Within Canada, a tiered disaster response system exists. Even though physicians often play an integral role in the disaster plan, few participate in the planning process or even appreciate their potential role in the event a disaster should occur. Physician involvement would guarantee health matters be appropriately addressed resulting in reduced mortality and decreased morbidity. There are ample opportunities to become involved in disaster planning and response at all levels of government. The objective of this paper is to inform physicians about the disaster planning infrastructure that exists in Canada, show them where they may get involved, and urge them to do so.

Canada↗
PubMed2001

The design and assessment of mock mass disasters for dental personnel.

Mass disasters represent a significant challenge for dental personnel who are frequently called upon to provide identifications. Recently-published materials have highlighted the need to prepare such groups for the disaster challenge and to report inadequacies in existing preparation methods with an emphasis on team integration, organization, and the psychological and emotional effects of such work. Many studies have retrospectively reported errors that have been made in disaster situations, but few have addressed the issues proactively. In an effort to provide a prepared team of dental members, a mock disaster exercise (Operation: DENT-ID) is conducted annually in Vancouver, Canada. The present study analyzes the effectiveness of this exercise in relation to team organization, assessment of preparedness, and the emotional and psychological issues. An index of preparedness is developed and described. This index, in the form of a questionnaire, can be given to participants in mock disasters to assess the effectiveness of such exercises. While the focus of this paper is on the assessment of dental personnel, the indices and methods used can be applied to any group working within the disaster team. Results indicate that the increase in preparedness as a result of the exercise was highly significant.

Adaptation, Psychological↗
PubMedDate not supplied

Controversy and consensus in disaster mental health research.

Controversies regarding the mental health consequences of disasters are rooted both in disciplinary orientations and in the widely varied research strategies that have been employed in disaster mental health studies. However, despite a history of dissensus, there are also key issues on which researchers agree. Disasters constitute stressful and traumatic experiences. However, vulnerability to such experiences, as well as to more chronic stressors, is socially structured, reflecting the influence of socio-economic status and other axes of stratification, including gender, race, and ethnicity. Disaster events differ in the extent to which they generate stress for victims. A holistic perspective on disaster mental health would take into account not only disaster event characteristics, but also social-systemic sources of both acute and chronic stress, secondary and cumulative stressors, and victims internal and external coping capacities.

Disaster Planning↗