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PubMed2000

[The Referral Field Hospital of the Emergency Response Unit (ERU) of the German Red Cross].

INTRODUCTION: Emergency Response units (ERUs) have been developed as a part of the International Federation of Red Cross and Red Crescent Societies strategy to provide fast and effective medical and technical help to victims of disasters of any kind. ERUs provide timely, professional and organised response in a standardised and streamlined way by a balanced composition of professional staff and predesigned equipment. METHODS: The German Red Cross ERUs "Referral Hospital" and "Specialised Water" took part in the world wide humanitarian help for refugees during the Kosovo war and actually for earthquake victims in Turkey. During the Kosovo-operation the ERU "Referral Hospital" and "Specialised Water" were situated in Macedonia close to the kosovarian boarder at refugee camp Stenkovec I. The Field-Hospital was responsible for all kind of medical emergencies, for a total number of more than 50,000 refugees. RESULTS: During the mission 6225 patients were treated in our Out Patient Department; 541 were hospitalised. Among those 102 medium and major surgical procedures and 105 deliveries were performed. Surprisingly there was no increased rate of infections or perinatal deaths. CONCLUSIONS: During the Kosovo war and actually in Turkey the ERU concept prove itself to be a powerful strategy to provide fast needed medical help to victims of different kind of disasters. Humanitarian work in situations of war, internal disorder and various states of emergency in foreign countries and cultures demand flexibility and the ability to improvise while working under such conditions. The confrontation with non-combatants injured by buried landmines is underlining the growing world-wide demand for a total ban on these vile weapons.

Adult↗
PubMed2003

International trauma and disaster management.

Our world has literally changed around us. Based on this reality, the AFMS changed its' way of thinking when providing care to victims in disaster situations. This course is but one of several that are provided around the world that speak one common language, helping each other and caring for our patients the best way we know how. As Kofi Annan, Secretary General of the United Nations, eloquently stated: "We are all in the same boat. There are no safe islands. There is no dividing line between domestic and international crises. There is no them, only us."

Aerospace Medicine↗
PubMed2005

Disaster care: psychological considerations.

Disasters are tragic events that disrupt the normal functioning ofa community and overwhelm personal and community resources. The people who experience or simply witness traumatic events can be affected emotionally and develop a range of physical and emotional responses, which in turn can produce psychological, social, and physiological dysfunction. The challenge for health care providers is to recognize the range of emotions and to be able to identify when professional help is indicated. This article provides an overview of the human stress response and describes sources of stress that follow disasters, acute stress disorder, post-traumatic stress disorder, and interventions and resources used to care for victims after disasters.

Crisis Intervention↗
PubMed2005

[General surgery].

Terrorist explosions with multiple victims produce disaster situations that test health systems' ability to respond. The Gregorio Maranon University Hospital attended more than 300 victims within a few hours. Most of these victims had mild or moderate lesions, although 29 patients arrived in a serious or critical condition. In the first 24 hours, 37 major surgical interventions were performed in 34 patients. Of these, patients 7 underwent laparotomy, 2 of which were negative and one was non-therapeutic. One patient died during reintervention for damage limitation. Three angiographic embolizations were performed for bleeding of the intercostal artery, liver and liver-spleen, respectively and hemostasis was achieved in all three patients. The most common lesions and visceral injuries in particular were similar to those described in previous reports of similar situations. We reflect on our experience and discuss data from the literature.

Blast Injuries↗
PubMed1989

Disaster severity and emotional disturbance: implications for primary mental health care in developing countries.

Two months following the 1987 earthquakes in Ecuador, 150 patients in the primary health care clinics of the area were screened for emotional problems; 40% of them were emotionally distressed. Risk factors included not being married, reporting poor physical or emotional health, and having ill-defined physical complaints. The findings from this research are discussed in relation to a disaster of much greater intensity, whose victims were studied by the authors, utilizing the same instrument and research design. The comparison between these 2 groups of disaster victims revealed that: 1) the prevalence of emotional distress was smaller among the Ecuador victims, but the frequency of symptoms among the distressed was similar for both groups; 2) the symptom profiles were remarkably similar; and 3) the most frequent symptoms and the strongest predictors of emotional distress were very similar. These findings support a focused training of health care workers on selected emotional problems that are regularly present among victims of different disasters.

Adolescent↗
PubMed2003

[Psychiatric care in emergency victims].

Immediate psychiatric care are realised either in the frame of acute traumatic crisis centres or on specific psychotraumatic consultations. They are indicated for victims of disasters, collective accidents, and hostages taken as well as for rescuers themselves, so frequently exposed to extreme situations. They are also indicated for victims of numerous individual aggressions who are seen in medico-judiciary emergencies. Their purpose is to reduce clinical manifestations of stress (adapted or complicated) by a quick intervention and to prevent the risk of installation of a chronic psychotraumatic syndrome, which is the principal psychiatric complication linked to these situations. These immediate psychiatric care allow the organisation of rapid psychotherapeutic interventions, i.e. psychological debriefing.

Accidents↗
PubMed1998

Elevated frequency of sister chromatid exchanges in lymphocytes of victims of the Tokyo sarin disaster and in experiments exposing lymphocytes to by-products of sarin synthesis.

More than 5000 passengers of Tokyo subway trains were injured with toxic chemicals including the nerve gas sarin. Most of the victims examined had marked miosis and decreased serum cholinesterase activity. To monitor the genetic aftereffects of sarin exposure, we measured sister chromatid exchanges (SCEs) of the victims using peripheral blood lymphocytes. The frequency of SCEs was significantly higher in the victims than in the control group. Analyzing results using samples of urine from the victims suggested that the victims were exposed to not only sarin per se, but by-products of sarin synthesis, i.e. diisopropyl methylphosphonate (DIMP), diethyl methylphosphonate (DEMP) and ethyl isopropyl methylphosphonate (EIMP). Thus, the in vitro SCE-inducing effect of DIMP, DEMP and EIMP was examined using human lymphocytes and we obtained positive results.

Adult↗
PubMed1997

An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural disaster.

Controlled studies of treatments effective with victims of natural disasters are almost nonexistent. This is a small study conducted under difficult conditions to test the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in treating trauma related reactions following Hurricane Andrew. The results were positive in that EMDR produced significant improvement over wait list controls in perceived posttraumatic avoidance behaviors and thoughts as measured by changes in the Impact of Event Scale and significant improvement in subjective aversive reactions to representative experiences of the hurricane. These results suggest and support other studies that EMDR can be an effective therapeutic intervention for trauma reactions.

Adaptation, Psychological↗
PubMedDate not supplied

Potential effectiveness of stored cord blood (non-frozen) for emergency use.

Bone marrow has been used for a number of years to assist patients who have accidentally received potentially lethal levels of irradiation. The intent of the transplant is to replace the victim's own bone marrow that has been injured from the irradiation or to act as temporary support to allow the patient's own marrow to recover. Following the Chernobyl disaster, some victims received bone marrow that was HLA matched or partially matched. However, donor marrows were difficult to obtain in adequate numbers; as a substitute for bone marrow, frozen fetal liver cells were used as a source of hematopoietic stem cells. The use of fetal livers, however, was unsuccessful. Human umbilical cord blood, currently considered an excellent source of hematopoietic stem cells, was not used at Chernobyl. For several years, we have been able experimentally to keep SJL/J mice alive with the use of human umbilical cord blood after the animals received lethal levels of irradiation. This finding suggests that under certain conditions human cord blood does not have to be HLA matched to facilitate rescue from irradiation. In addition, there are reports of unmatched HLA cord blood being used successfully for marrow transplantation. If human cord blood does not have to be matched for HLA, there may be emergency cataclysmic circumstances where the availability of umbilical cord blood may be of considerable value. To simulate a clinical situation such as a nuclear accident, in which human cord blood might serve as a source of stem cells for marrow transplantation, we attempted to rescue immunocompetent mice after 900 cGY of irradiation with the use of (nonfrozen) human cord blood stored in a blood bank. The blood was stored under routine conditions (3-6 degrees C) for 5 and 7 days in special bags that allow transmission of oxygen. Following lethal levels of irradiation, the cord blood was administered to the animals and a significant survival rate was obtained.

Adoptive Transfer↗
PubMed2006

A consensus process on management of major burns accidents: lessons learned from the café fire in Volendam, The Netherlands.

PURPOSE: The optimum response to the different stages of a major burns incident is still not established. The fire in a café in Volendam on New Year's Eve 2000 was the worst incident in recent Dutch history and resulted in mass burn casualties. The fire has been the subject of several investigations concerned with organisational and medical aspects. Based on the findings in these investigations, a multidisciplinary research group started a consensus study. The aim of this study was to further identify areas of improvement in the care after mass burns incidents. DESIGN/METHODOLOGY/APPROACH: The consensus process comprised three postal rounds (Delphi Method) and a consensus conference (modified nominal group technique). The multidisciplinary panel consisted of 26 Dutch-speaking experts, working in influential positions within the sphere of disaster management and healthcare. FINDINGS: In response to the postal questionnaires, consensus was reached for 66 per cent of the statements. Six topics were subsequently discussed during the consensus conference; three topics were discussed within the plenary session and three during subgroup meetings. During the conference, consensus was reached for seven statements (one subject generated two statements). In total, the panel agreed on 21 statements. These covered the following topics: registration and evaluation of disaster care, capacity planning for disasters, pre hospital care of victims of burns disasters, treatment and transportation priorities, distribution of casualties (including interhospital transports), diagnosis and treatment and education and training. ORIGINALITY/VALUE: In disaster medicine, the paper shows how a consensus process is a suitable tool to identify areas of improvement of care after mass burns incidents.

Adult↗
PubMed1986

Recognizing the role of bereavement and reactive depression in modern psychiatry.

In the modern world the recognition, understanding and treatment of bereavement in recent widows, widowers, those who experienced severe medical and surgical trauma, and victims of disasters is essential for all physicians, rescue workers such as the International Red Cross, and the community in general. This paper reviews the consequences of personal encounters with catastrophic events, as well as methods of immediate and long-term management. Similarly, the dynamic manifestations and treatment of psychologic dissonance in the family of victims, the community, and survivors are addressed. Of special interest are the problems of rescue workers, witnesses and reporters involved in disasters.

Adjustment Disorders↗
PubMed1999

Emotional sequelae of disasters: a primary care physician's guide.

Disasters are a common cause of psychological trauma and distress, especially for women victims, who are more likely to develop several types of psychological problems. This paper examines the important role of the primary care physician in addressing the emotional and psychological needs of disaster victims. The phases of a disaster are discussed, as are common disaster-related somatic complaints. The paper then outlines a brief intervention for use with disaster victims that can be performed in a primary care physician's office, addresses appropriate patient referral, and outlines the mental health resources commonly available after a disaster.

Community Mental Health Services↗
PubMed2006

Ethical considerations for clinical photography in the global South.

Clinical photography is an important tool for teaching practitioners and field workers about the clinical manifestations of famine and undernutrition, particularly with respect to the Global South. Current international guidelines for clinical photography are not consistently applied or enforced, which has led to violations of privacy and rights, particularly for patients and victims of disaster in the Global South. Combining existing clinical photography guidelines from the North with ongoing clinical ethics debates in the South, this paper explores approaches to establishing photography guidelines throughout the world that will be sensitive to the privacy and dignities of all patients and victims of emergencies.

Clinical Trials as Topic↗
PubMed1991

Applications of space communications technology to critical human needs: rescue, disaster relief, and remote medical assistance.

The applications of space communications technology to various critical human needs are discussed. Satellite communications, telemetry, and biotelemetry have provided timely and crucial communications capabilities over remote distances. The use of satellite/beacon systems have been used for disaster relief as well as search and rescue operations. The combination of telemetry and electronic medical systems (telemedicine) have augmented existing health care delivery and have provided consultation links between remotely located health care specialists working with patients and physicians at a central location. This has been expanded into networks to respond to victims of disasters in need of critical medical assistance with the hope that with further work, telemedicine may become available to all nations through an international network.

Communication↗
PubMed2002

WinID2 versus CAPMI4: two computer-assisted dental identification systems.

Disasters produce victims that require identification. Comparing antemortem and postmortem dental records provides an important means of identification. Computers have assisted this process. Currently, the principal computer programs are CAPMI4 and WinID2. The present study compared these programs on a sample of 100 simulated victims and 105 simulated postmortem fragments. CAPMI4 provided 48 correct matches and WinID2 provided 71 correct matches. In addition, comparisons were made within WinID2 to determine which of its three dental data sets was the most successful for suggesting correct matches.

Computer Simulation↗
PubMed1998

The Oklahoma City bombing: the roles of the dental teams ... and the lessons learned.

The Oklahoma City bombing is considered by most historians the worst act of domestic terrorism ever to have occurred in the United States. The response to the disaster, however, is considered by most experts in the field as being the best; creating what is known as the "Oklahoma Standard". The roles of the dental teams in the resolution were pivotal and until now, the recognition of these roles have not been described, due to this being considered a case of mass murder. The purpose of this paper is to give an overview of the preparations, the initial responses, the roles of the dental teams in the resolution, the preparations for the criminal trials, and some of the lessons that were learned.

Crime Victims↗
PubMed1997

Sarin poisoning on Tokyo subway.

On the day of the disaster, 641 victims were seen at St. Luke's International Hospital. Among those, five victims arrived with cardiopulmonary or respiratory arrest with marked miosis and extremely low serum cholinesterase values; two died and three recovered completely. In addition to these five critical patients, 106 patients, including four pregnant women, were hospitalized with symptoms of mild to moderate exposure. Other victims had only mild symptoms and were released after 6 hours of observation. Major signs and symptoms in victims were miosis, headache, dyspnea, nausea, ocular pain, blurred vision, vomiting, coughing, muscle weakness, and agitation. Almost all patients showed miosis and related symptoms such as headache, blurred vision, or visual darkness. Although these physical signs and symptoms disappeared within a few weeks, psychologic problems associated with posttraumatic stress disorder persisted longer. Also, secondary contamination of the house staff occurred, with some sort of physical abnormality in more than 20%.

Adolescent↗