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PubMed2000

Changes in reports and incidence of child abuse following natural disasters.

OBJECTIVE: The aim of this research was to investigate if there is a higher incidence of child abuse following major natural disasters. METHODOLOGY: Child abuse reports and substantiations were analyzed, by county, for 1 year before and after Hurricane Hugo, the Loma Prieta Earthquake. and Hurricane Andrew. Counties were included if damage was widespread, the county was part of a presidential disaster declaration, and if there was a stable data collection system in place. RESULTS: Based on analyses of numbers, rates, and proportions, child abuse reports were disproportionately higher in the quarter and half year following two of the three disaster events (Hurricane Hugo and Loma Prieta Earthquake). CONCLUSIONS: Most, but not all, of the evidence presented indicates that child abuse escalates after major disasters. Conceptual and methodological issues need to be resolved to more conclusively answer the question about whether or not child abuse increases in the wake of natural disasters. Replications of this research are needed based on more recent disaster events.

Child↗
PubMed2001

Pre- and post-disaster negative life events in relation to the incidence and severity of post-traumatic stress disorder.

There is evidence suggesting that stressful life events may precede major psychiatric illness, such as major depression, and that the severity of a traumatic event outside the range of usual human experience may provoke post-traumatic stress disorder (PTSD). The present study was carried out to examine the effects of pre- and post-disaster stressful life events on the incidence rate of PTSD following two man-made traumatic events. An epidemiological study examining 127 victims of a flash fire in a ballroom and 55 motor vehicle accident (MVA) victims was undertaken. PTSD symptoms were assessed by means of the Composite International Diagnostic Interview and the pre- and post-disaster stressful life events by means of the Diagnostic Interview Schedule, Disaster Supplement. Binary logistic and multiple linear regression analyses were employed to examine the relationships between PTSD and pre- and post-disaster life events. There were no significant relationships between stressful life events the year prior to the traumatic event and the incidence or severity of PTSD. There were highly significant relationships between the cumulative number and event severity of post-disaster negative life events and the incidence rate and severity of PTSD. The post-disaster life events were significantly more related to the avoidance-depression dimension than to the anxiety-arousal dimension of PTSD. The most significant life events were: loss of job or income, broken relationships, serious illnesses or injuries in the victims and death or illness in close acquaintances. The results of this study show that the number and severity of additional stressful life events signal a higher risk to develop PTSD and a higher severity of the avoidance-depression dimension of PTSD symptomatology.

Accidents, Traffic↗
PubMed1985

Disaster training for emergency physicians in the United States: a systems approach.

Disaster strikes more frequently and with greater impact than ever before, and the demand for improved community disaster preparedness rises. The American College of Emergency Physicians (ACEP), in collaboration with the Federal Emergency Management Agency (FEMA), has responded by developing a 16-hour course that prepares emergency physicians and other emergency providers to serve as knowledgeable members of their community's disaster team. The course was developed using a standard instructional design system to cover the basic components of disaster planning and emergency medical operations, including: disaster elements, general planning and organization, victim flow, communication, evacuation modalities, field and hospital management, documentation, public relations, and application to the local community. The 35 national faculty members present the course on a geographic basis across the United States. Further considerations for emergency medicine in the disaster domain include questions of education, research and the formation of a network to coordinate with other medical, health, and nonhealth care sectors nationally and internationally.

Curriculum↗
PubMed1987

The role of the epidemiologist in natural disasters.

Natural disasters continue to be a major cause of morbidity and mortality. Natural disaster epidemiology has led not only to the scientific measurement and description of disaster-associated health effects, but also to strategies for preventing adverse health consequences and improving post-impact health care delivery. Results of epidemiologic studies of natural disasters provide clues to diagnosis, help medical care providers match resources to needs, and permit better contingency planning. Well-documented medical records are an essential resource for disaster epidemiologists. Cooperation between health care personnel and epidemiologists can help lessen the public health impacts of natural disasters.

Disasters↗
PubMed2005

The changing impact of a severe disaster on the mental health and substance misuse of adolescents: follow-up of a controlled study.

BACKGROUND: Disasters are believed to have large effects on the mental health of adolescents but the lack of prospective pre- and post-disaster data on affected and control populations have limited our knowledge on the validity of these claims. We examined the medium-term, 12 months' effects of a severe disaster on the mental health of adolescents, and compared them to effects after 5 months. METHOD: A café fire in The Netherlands injured 250 adolescents and killed 14. We obtained data 15 months before and 12 months after the disaster about behavioural and emotional problems (using the Youth Self-Report) and substance misuse, in 124 students of an affected school of whom 31 were present at the fire (response 77.5%) and 830 other students (56.4%); mean age at baseline, 13.8 years. RESULTS: We found differences between students from the affected school and others for excessive use of alcohol (odds ratio 3.42, 95% confidence interval 2.00-5.85, p < 0.0001), but not for behavioural and emotional problems and use of other substances. Effects had decreased compared to those after 5 months. CONCLUSIONS: In the long run, the effects of disaster decrease regarding self-reported behavioural and emotional problems, but they remain regarding alcohol misuse among those present at the disaster, and their peers.

Adolescent↗
PubMedDate not supplied

Information-sharing in out-of-hospital disaster response: the future role of information technology.

Numerous examples exist of the benefits of the timely access to information in emergencies and disasters. Information technology (IT) is playing an increasingly important role in information-sharing during emergencies and disasters. The effective use of IT in out-of-hospital (OOH) disaster response is accompanied by numerous challenges at the human, applications, communication, and security levels. Most reports of IT applications to emergencies or disasters to date, concern applications that are hospital-based or occur during non-response phases of events (i.e., mitigation, planning and preparedness, or recovery phases). Few reports address the application of IT to OOH disaster response. Wireless peer networks that involve ad hoc wireless routing networks and peer-to-peer application architectures offer a promising solution to the many challenges of information-sharing in OOH disaster response. These networks offer several services that are likely to improve information-sharing in OOH emergency response, including needs and capacity assessment databases, victim tracking, event logging, information retrieval, and overall incident management system support.

Computer Communication Networks↗
PubMedDate not supplied

In the path of disasters: psychosocial issues for preparedness, response, and recovery.

The psychosocial impacts of disasters are profound. In recent years, there have been too many reminders of these impacts and the dire needs of the people involved. The purpose of this article is to present the following themes from the psychosocial literature on disasters and emergency management: (1) differential impacts of disasters according to gender and age; (2) prevention efforts to reduce racial discrimination, rape, and other forms of abuse; (3) readiness for cultural change toward prevention and preparedness; and (4) the need to involve aid beneficiaries as active partners in relief strategies, particularly during reconstruction of communities and critical systems. Psychosocial needs change throughout the disaster cycle, particularly as social support deteriorates over time. It is important to anticipate what psychosocial needs of the public, emergency responders, support staff, and volunteers might emerge, before advancing to the next stage of the disaster. Particular consideration needs to be directed toward differential impacts of disasters based on gender, age, and other vulnerabilities.

Disaster Planning↗
PubMedDate not supplied

Application of international standards to disasters: summary and action plan.

INTRODUCTION: The need for the application of international standards has been evolving over the last decade. Consistency is needed not just in how we respond, but in when we respond. The discussions in this theme reflected on the progress of standard setting both at the local level and internationally. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) requirement of standards of care for ALL disasters and core parameters, (2) process and procedure is best when there is interagency collaboration and coordination, (3) problems in disasters are management-related, not skill-related, and (4) standards of care must encompass evolving emergencies (e.g., emerging diseases, landmines). DISCUSSION: The action plans for Theme 5 included: (1) develop positions of standards for management, health and public health, education and training, research, psychosocial aspects, and disaster plans; (2) advocate for actions and task forces to deal with evolving and emerging disasters, terrorism, landmines, and emerging infections; (3) proactively work to advocate and facilitate the multidisciplinary and multiorganizational requirements for disaster management; and (4) develop a resource list of interdisciplinary institutions and activities organized by country and topic including the design and maintenance of a website. CONCLUSIONS: There is a clear need for international standards for the management of disasters. Positions and advocacy for these positions are required to define and implement such standards.

Disaster Planning↗
PubMed2000

Prevalence, characteristics, and long-term sequelae of natural disaster exposure in the general population.

A sample of 935 participants from the general population completed a mail-out questionnaire containing the Trauma Symptom Inventory (J. Briere, 1995) and the Traumatic Events Survey (D. M. Elliott, 1992). The lifetime self-reported prevalence of natural disasters in this sample was 22%. Although time from the last disaster to involvement in the study was an average of 13 years, previous disaster was associated with significantly higher scores on 6 of 10 symptom scales. Disaster characteristics (especially the presence of physical injury, fear of death, and property loss) were better predictors of symptomatology than was disaster type. Disaster exposure continued to predict symptomatology after controlling for interpersonal violence history, although interpersonal violence accounted for more overall symptom variance.

Adolescent↗
PubMed2003

Assessment of exposure to a flood disaster in a mental-health study.

The lasting psychological consequences of disasters are an important public health issue, especially for determining the support needed by victims. One important question in evaluating psychological consequences remains the assessment of individual disaster-related experiences or stressors. This article proposes two approaches towards the construction of cumulative exposure indicators (CEIs) for a disaster and discusses their relevance for other disasters. In 1997, we carried out a cross-sectional study of the association between the severity of exposure to a 1992 flood in southeastern France and the prevalence of psychological symptoms 5 years later. We interviewed 500 randomly selected subjects residing in one of the most affected municipalities and constructed two CEIs: one based on relevant articles in the literature and the second based on the results of a principal component analysis (PCA) of all the items exploring exposure to the flood. We compared these CEIs with a map of flood damage and tested the association between these indicators and a score of post-traumatic stress symptoms. Most of the subjects (79.1%) had been exposed to at least one stressor besides physical presence. The two CEIs were significantly correlated with one another; comparisons with the map showed that both had good ability to discriminate between mild and severe exposure. Multiple regression analyses showed a significant exposure-effect relation, of the same level of magnitude and significance, between the post-traumatic stress disorder score and each CEI. Our results show the appropriateness of such indicators in assessing the effect of cumulative stress from natural disasters. Guidelines should be developed to improve the comparability of instruments and help standardize methods for evaluating cumulative stress from disasters insofar as possible. Further research is nonetheless necessary to assess the consistency and reproducibility of the data collected.

Adult↗
PubMed1997

Acting at a disaster site: experiences expressed by Swedish nurses.

In a previous study the knowledge and views of nursing students on how they thought nurses, both in their professional role and as private persons, should act at a disaster site were evaluated. In the present study the practical functional role and experiences of nurses (n = 16) in two major disaster situations (one 'load and go' and one 'stay and play' type of emergency situation) were assessed from personal interviews along a standardized questionnaire. Nurses more routinely involved in emergency care and nurses with no or limited previous practical experience of disaster nursing were included in the study. Leadership-type actions, i.e. a systematic way of attempting to survey and to comprehend the situation, what has happened, and how many injured there may be at the site of the accident, were reported by most of the experienced nurses, while inexperienced nurses were involved mainly in the immediate care of injured according to directions given by more experienced members of the emergency team. Readiness for action, reflected by having a feeling of being prepared for work at the disaster site, was experienced more often by nurses with considerable previous experience of disaster nursing than by nurses with limited experience. Negative experiences, such as feelings of being insufficient, of unreality, mental strain, and problems in understanding the organization, were commonly mentioned by the inexperienced nurses. The present study stresses the importance, for all types of nurses, of more systematic training in disaster nursing.

Adult↗
PubMed2003

Report of the International Society of Nephrology: North American Renal Disaster Response Task Force.

This article comprises a report from the North American Renal Disaster Response Task Force (RDRTF) set up in 2001 by the International Society of Nephrology Acute Renal Failure Commission. The conclusions of the report are (1) given the rarity of renal disasters in the Americas the North American and Latin American RDRTF's should be merged; (2) for the same reason, a single RDRFT Coordination Center for the whole world should be established and it is suggested that this be in Ghent, Belgium; (3) the collaborative group set up in Europe and involving the European RDRTF and Medecins Sans Frontiers be asked to extend their rapid response service to cover acute renal disasters in the Americas south of the United States-Mexico border; (4) the combined RDRTF for the Americas should establish a list of nephrologists, nurses, and technicians who are available to assist in the acute response to renal disasters; (5) the combined RDRTF of the Americas establish an inventory of equipment, machines, and methods for their transport that would be available in the event of a disaster; and (6) the RDRTF of the Americas should undertake a large-scale educational initiative on management of renal disasters.

Advisory Committees↗
PubMed2002

Leadership in a time of disaster: being prepared for new age threats.

The attack on the Pentagon on September 11, 2001 provided a Washington, DC, healthcare institution with firsthand experience in evaluating its disaster readiness. This account of one nursing leader's experience with the unexpected suggests that an actual disaster gives disaster planning new meaning because it challenges the entire institution and the community to maintain order in the midst of chaos. Included are practical lessons learned from this case study, guidelines for disaster planning, national disaster resources, and a vision for the role nursing leaders play in assuring patient care during times of disaster.

American Hospital Association↗
PubMed2006

Infectious diseases of severe weather-related and flood-related natural disasters.

PURPOSE OF REVIEW: The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure. RECENT FINDINGS: The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system. SUMMARY: Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.

Communicable Disease Control↗
PubMed1998

A review of contributions to disasters: 1977-1996.

Since the first issue in 1977. Disasters has been one of the pre-eminent refereed journals on the study and reporting of disasters. This article reviews 703 articles and reports in the journal through 1996 to provide a snapshot of the nature of the journal throughout 20 years of publication. The results indicate the most common contributions: first, were research articles by authors from the North Atlantic; second, most often dealt with natural disaster relief or impact; and third, most frequently focused on Africa. These generalisations, however, do not reflect attention paid to food-related and political disasters and greatly understate the broad diversity of material presented in the journal. To improve the topical and geographic coverage of Disasters probably requires a proactive effort to close gaps in the journal's coverage of disasters.

Authorship↗
PubMed2004

Natural disaster and mental health in Asia.

The purpose of the present article was to review the literature on disaster mental health in relation to natural disasters such as earthquakes, volcanic eruptions, typhoons and cyclones throughout Asia. Articles reviewed show that disaster psychiatry in Asia is beginning to emerge from and leave behind the stigma attached to mental health. The emergence of the acceptance of disaster mental health throughout Asia can be attributed in part to the acceptance of the notion of post-traumatic stress disorder (PTSD). This has allowed greater involvement of mental health professionals in providing ongoing support to survivors of natural disasters as well as providing greater opportunities for further research. Also, articles reviewed in the present paper commonly suggested the need for using standardized diagnostic tools for PTSD to appropriately interpret the discrepancy of results among studies. The importance of post-disaster support services and cultural differences is highlighted.

Asia↗
PubMed1998

The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response.

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. Prior to the Tokyo subway sarin attack, there had never been such a large-scale disaster caused by nerve gas in peacetime history. This article provides details related to how the community emergency medical services (EMS) system responded from the viewpoint of disaster management, the problems encountered, and how they were addressed. The authors' assessment was that if EMTs, under Japanese law, had been allowed to maintain an airway with an endotracheal tube or use a laryngeal mask airway without physician oversight, more patients might have been saved during this chemical exposure disaster. Given current legal restrictions, advanced airway control at the scene will require that doctors become more actively involved in out-of-hospital treatment. Other recommendations are: 1) that integration and cooperation of concerned organizations be established through disaster drills; 2) that poison information centers act as regional mediators of all toxicologic information; 3) that a real-time, multidirectional communication system be established; 4) that multiple channels of communication be available for disaster care; 5) that public organizations have access to mobile decontamination facilities; and 6) that respiratory protection and chemical-resistant suits with gloves and boots be available for out-of-hospital providers during chemical disasters.

Disaster Planning↗
PubMed1989

Disaster psychiatry and traumatic stress studies in Norway. History, current status and future.

The breakthrough of Norwegian disaster psychiatry and traumatic stress studies came when the "Board of Norwegian Doctors of 1957" carried out exceptionally thorough and comprehensive studies of former concentration camp prisoners. These studies convincingly demonstrated that chronic mental illnesses could develop in persons who had a harmonious childhood but who had been subject to extreme physical and psychological stress. During the seventies Norway became the first country in the world to have a University chair of disaster psychiatry. The scope of the field was broadened by the initiation of several studies on traumatic neurosis, industrial disaster and injuries. The support from the Joint Norwegian Armed Forces Medical Services, the University of Oslo, the Norwegian Research Council for Science and the Humanities, and later the Royal Norwegian Council for Scientific and Technical Research, was crucial for this development. Currently stress and disaster psychiatry has become an integrated part of the care of victims who have suffered individual or collective disaster. Disaster psychiatry is taught in medical schools and is part of the obligatory training for residents in psychiatry.

Adaptation, Psychological↗