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PubMed2004

'We Will Never Ever Forget.': the Swissair flight 111 disaster and its impact on volunteers and communities.

In collaboration with a Community Advisory Group we examined the impact of the 1998 Swissair Flight 111 disaster on volunteer responders and surrounding communities. We conducted qualitative interviews and administered a set of structured questionnaires to 13 volunteer disaster workers and conducted a focus group with community leaders. Community silence and limited help-seeking behaviour were typical reactions to the SA 111 disaster. The nature and duration of the disaster response efforts contributed to a probable 46 per cent PTSD rate in the community volunteers. Community-based, culturally appropriate followup, as well as the development of volunteer protocols for future disaster response efforts, are necessary to minimize long-term health impacts and to promote resilience among community residents and volunteers exposed to a major disaster.

Adaptation, Psychological↗
PubMedDate not supplied

What ails the Bhopal disaster investigations? (And is there a cure?).

A review of the health effects of the 1984 disaster in Bhopal, India, shows continuing morbidity of a multi-systemic nature in the exposed population. Scientific questions about epidemiologic issues are discussed with a view to understanding appropriate methods of investigation into the disaster. Other major chemical incidents were reviewed to note some of the common problems associated with public health investigations of disasters, which have included the lack of accident-related and toxicologic information, expertise, and funds. The complexity of the Bhopal crisis was underscored by the severe mortality and morbidity it entailed as well as its occurrence in a developing nation that had little experience in dealing with chemical disasters. Lessons learned from the disaster are discussed, with recommendations for disaster preparedness, long-term monitoring, rehabilitation, and treatment of the gas victims.

Accidents, Occupational↗
PubMed2005

Health status among emergency department patients approximately one year after consecutive disasters in New York City.

OBJECTIVES: Emergency department (ED) patients with disaster-related experiences may present with vague symptoms not clearly linked to the event. In 2001, two disasters in New York City, the World Trade Center disaster (WTCD) and the subsequent American Airlines Flight 587 crash, presented an opportunity to study long-term consequences of cumulative disaster exposure (CDE) on health-related quality of life (HRQOL) among ED patients. METHODS: From July 15 to October 30, 2002, a systematic sample of stable, adult patients from two EDs in New York City were enrolled. Participants completed a self-administered questionnaire. The Short Form 36 (SF-36) was used to assess overall health status. Bivariate analyses were conducted to identify individual correlates of worsening health status. Multivariate regression was performed to identify the association between various factors and overall health status, while controlling for relevant sociodemographic variables. RESULTS: Four hundred seventy-one patients (54.6% female) participated. The participation rate was 73.4%. One hundred sixty-one participants (36%) reported direct, indirect, or occupational exposure to the WTCD; 55 (13.3%) had direct, indirect, or occupational exposure to the plane crash; 33 (8.1%) had both exposures. In separate multivariate models, CDE predicted lower SF-36 scores for general health (p < 0.0096), mental health (p < 0.0033), and bodily pain (p < 0.0046). CONCLUSIONS: In the year following mass traumatic events, persons with CDE had lower overall health status than those with one or no disaster exposure. Clinicians should consider the impact that traumatic events have on the overall health status of ED patients in the wake of consecutive disasters.

Adult↗
PubMed2006

Learning from each other: The social work role as an integrated part of the hospital disaster response.

Australian social workers in health care have become important members of hospital disaster response teams. The development of the role and its integration into the mainstream disaster response has progressed over the last two decades. Recent international events have given affirmation to the importance of this role. The development of national and state based Disaster Management Plans in Australia began in the mid 1970's. Recognition of the need for experienced, skilled workers to provide emotional support, practical assistance and grief and bereavement counselling has resulted in the inclusion of social workers in several key parts of the disaster management response including the specialised area of Disaster Victim Identification. Following the Bali Bombing in October 2002, social workers worked with the Police Missing Persons Unit to provide support to families and facilitate the collection of ante mortem information. The process by which new services come about can be intricate and complex. In the field of health social work, the contribution of international programs such as the Mt Sinai Leadership Enhancement Program cannot be underestimated. As the Social Work Director of Westmead Hospital, one of the largest hospital social work departments in the country, participating in this program provided opportunities to share professional experience with international colleagues, many of whom are experts in their field. The social work role in disaster response has become internationally recognised and is an example of how collaboration and shared information and learning, can result in a profession working together to support key principles and values of practice for the benefit of those in need.

Australia↗
PubMed2002

Disasters, psychiatry, and psychodynamics.

The unique experience of Disaster Psychiatry Outreach, a voluntary organization devoted to providing psychiatric assistance to people affected by disasters, provides a valuable substrate for exploring the role of psychodynamics in the human experience of disaster and trauma. This article offers a theoretical framework for such an experience that takes into account personal meaning, ego psychology and defenses, and grief work and suggests how to employ this framework in the setting of a disaster by way of examples from the events of Sept. 11. A useful clinical construct for future disaster work known as the "trauma tent" is ultimately proposed, as are novel applications of psychodynamics toward the prevention and mitigation of manmade and natural disasters.

Community-Institutional Relations↗
PubMed2007

Pediatric hospital and intensive care unit capacity in regional disasters: expanding capacity by altering standards of care.

BACKGROUND: Federal planners have suggested that one strategy to accommodate disaster surges of 500 inpatients per million population would involve altering standards of care. No data are available indicating the extent of alterations necessary to meet disaster surge targets. OBJECTIVE: Our goal was to, in a Monte Carlo simulation study, determine the probability that specified numbers of children could be accommodated for PICU and non-ICU hospital care in a disaster by a set of strategies involving altered standards of care. METHODS: Simulated daily vacancies at each hospital in New York City were generated as the difference between peak capacity and daily occupancy (generated randomly from a normal distribution on the basis of empirical data for each hospital). Simulations were repeated 1000 times. Capacity for new patients was explored for normal standards of care, for expansion of capacity by a discretionary 20% increase in vacancies by altering admission and discharge criteria, and for more strictly reduced standards of care to double or quadruple admissions for each vacancy. Resources were considered to reliably serve specified numbers of patients if that number could be accommodated with a probability of 90%. RESULTS: Providing normal standards of care, hospitals in New York City would reliably accommodate 250 children per million age-specific population. Hypothetical strict reductions in standards of care would reliably permit hospital care of 500 children per million, even if the disaster reduced hospital resources by 40%. On the basis of historical experience that as many as 30% of disaster casualties may be critically ill or injured, existing pediatric intensive care beds will typically be insufficient, even with modified standards of care. CONCLUSIONS: Extending resources by hypothetical alterations of standards of care would usually satisfy targets for hospital surge capacity, but ICU capacity would remain inadequate for large disasters.

Adolescent↗
PubMed2005

Disaster planning: are gerontological nurses prepared?

This article is a review of basic, but important information about disaster planning considerations for older populations. The recent hurricane experiences in the South confirmed how critical this planning is, and the importance of early evacuation in saving lives. This is highlighted when comparing the official responses during Hurricane Katrina and Hurricane Rita. Advance preparations result in more control and safety in a dangerous situation. In New Orleans, the delay in evacuation of older adults resulted in panic and confusion, without an easy solution. Those who could not be easily evacuated remained, sometimes at great cost. Gerontological nurses need to advocate for the planning and resources that would assist older adults in a safe and early evacuation if indicated. Adequate support personnel, transportation, and pre-positioned supplies should all be in place for use following a disaster event. Rescue is more costly than evacuation, in both resources and human suffering, and places both rescuers and victims at risk. Each individual, facility, and community needs disaster and evacuation plans that are widely disseminated in advance of any disaster. These plans must address the unique needs of older adults. Hurricane Katrina demonstrated the importance of evacuation before the impact of disaster. When individuals have advance notice of an impending disaster, evacuation can be conducted in a more orderly, planned way to get older adults to safety. Hurricane Rita proved that even advance evacuation is not problem-free, but is well worth the effort. Each facility needs to be prepared to be self-sustaining, to "shelter in place" for at least 72 hours. This requires having the resources and supplies to support at least minimal safe function. However, facilities in locations that could be isolated for longer periods of time should consider having even more supplies in reserve. Recent events may prompt gerontological nurses to ask themselves, their facilities, and communities--Are we prepared?

Aged↗
PubMed1990

Impact of a natural disaster on a psychiatric inpatient population: clinical observations.

Natural disasters do not always lead to post-traumatic stress disorders (PTSD) for their victims, although stress-related symptoms are commonly reported as results of such disasters. The impact of a natural disaster on the treatment of a hospitalized psychiatric population has never been systematically evaluated. In the fall of 1986, severe river flooding caused evacuation of a 160-bed psychiatric facility. One hundred and twenty-one hospitalized patients were taken to nearby hospital facilities, and many were separated from their primary therapists, fellow patients or both. A mail survey two months post-evacuation assessed stress-related symptoms, the patients' opinions of the impact of the flood on their treatment and functioning, and the patients' views of the evacuation procedures. Patients also responded to questions about their cognitive and affective reactions during each phase of the disaster. Clear evidence of PTSD was not found with this population; however, the findings underscore the importance of keeping patients with familiar staff and peers when possible. Differences between this study and previous disaster studies are noted, and suggestions for coping with natural disasters in inpatient or residential psychiatric facilities are offered.

Crisis Intervention↗
PubMed1998

[The analysis of the course of pregnancy, delivery and postpartum among women touched by flood disaster in Kotlin Kłodzki in July 1997].

OBJECTIVES: A natural 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 influence of flood disaster on reproductive outcomes. DESIGN: This study reviews perinatal medical problems in pregnant women during the flood disaster from Kłodzko Region in July 1997. MATERIALS AND METHODS: 47 pregnant women were investigated which injured from the flood disaster. We observed a psychosocial stress in this women. A control random group consists of 100 pregnant women in 1996. RESULTS: Reproductive outcomes include pregnancy loss in 55.3% and other severe disorders: premature delivery, missed abortion, birth asphyxia, premature rupture of membranes, intrauterine growth retardation. CONCLUSIONS: Psychosocial stress observed during the flood disaster cause many perinatal complications and pregnancy loss. Intensive perinatal medical care must usually be provided from outside the disaster area.

Adolescent↗
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↗
PubMedDate not supplied

Survey research in disaster public health.

INTRODUCTION: While much has been learned during the past three decades of research in the disaster field, there still are some major gaps in knowledge. The need for more and better research on the health aspects of disasters is especially noted. Often, research into the health aspects has been anecdotal in nature and suffers from poor documentation of human losses. However, there are valid research methodologies that can be adapted to better document losses, evaluate interventions, and set priorities for investments to reduce the burden on the health of the population caused by disasters. METHODS: A number of data sources are used to demonstrate the potential uses of surveys in disaster health. The majority of the examples reflect data collected by telephone interviews following earthquakes in California. RESULTS: By using comparable instruments, it is possible to track the changes in preparedness levels across time. Similarly, it is possible to compare injury rates or other health impacts across time, place, and disaster type. In addition, risk factors can be identified for health outcomes. For example, in the Northridge earthquake, those over age 60 years were three times more likely to be hospitalized or die as a result of injuries than were those aged 20-59 years. Interventions can be evaluated. Slightly less than half of the respondents of the El Niño study had heard messages about preparing for the on-coming weather and their preparedness levels were not significantly different from those who had not heard about preparing for the weather. CONCLUSION: Surveys are useful tools for identifying and evaluating the health impacts of disasters.

Adult↗
PubMed2003

A maritime disaster: reactions and follow-up.

In 1999, 69 people survived a maritime disaster on the Norwegian coast, during which 16 others died. Besides immediate psychosocial assistance, post-disaster intervention included psychological debriefings after one week, follow-up debriefing a month later, screening of those in need of individual help, and help for those returning to the scene of the disaster. The results of the psychometric tests showed that a considerable number of survivors scored above clinical cut-off points for extreme stress reactions. These results were compared with results from other studies of maritime disasters. Although the life threat and exposure in this disaster were extreme, the scores were lower than for the other studies, with one exception. The authors concluded the lower distress scores compared to other maritime disasters were probably impacted by the structured and caring system that was implemented to care for survivors. Almost all (93%) considered the debriefing meetings as helpful, and they were able to discriminate between different functions served by the meetings.

Adaptation, Psychological↗
PubMedDate not supplied

[Readiness of operating room for coping with mass disaster victims].

Mass disasters are sudden events which entail various damages and a large number of victims. For this purpose hospitals prepare disaster plans which give directions and define personnel duties in case of a disaster. In this paper an operating room disaster plan is presented which includes: organization of adequate and appropriate supplies; personnel duties and procedures during a disaster; and a continuous education programme in relation to the disaster plan for the staff.

Disaster Planning↗
PubMed1979

Disasters and public health.

Studies on the health effects of disasters have shown that epidemiological indices can be of value in planning preventive and relief measures and in evaluating their effectiveness. Mortality rates naturally vary considerably, but in earthquakes, for example, the number of deaths per 100 houses destroyed can give an indication of the adequacy of building techniques. Age-specific mortality rates can help to identify particularly vulnerable groups and perhaps indicate what form of education would be valuable. Except in earthquakes, the number of casualties after a disaster is usually low in relation to the number of deaths, and study of the distribution and types of lesions would help in planning the amounts and types of relief supplies and personnel required. Disasters also affect the general level of morbidity in a district because of either interruption of normal health care services or of spraying or other disease control measures. Mental health and nutrition following disasters are particular problems that require further investigation. Study of all these features of disasters has been handicapped by a lack of data, particularly concerning the health situation immediately after the impact. The provision of surveillance teams in disaster-prone areas would appear to be a field in which international cooperation could yield immense benefits.

Disasters↗
PubMedDate not supplied

Designing a National Disaster Medical System.

The National Disaster Medical System (NDMS) is a partnership of private and public sectors to provide care to the victims of great disasters. The system is being developed as a voluntary cooperative effort of four major Federal agencies, State and local governments, and the American professional and hospital communities. A medical response component will include 150 disaster medical assistance units capable of clearing or staging operations in a disaster. Each unit will comprise three 29-person teams containing physicians, nurses, medical technicians, and support personnel and will include a 16-person unit command and support element. An evacuation component will be founded on the military aeromedical evacuation system, augmented by civilian aircraft and other transportation resources. A hospital component will enroll 100,000 pre-committed beds in hospitals throughout the nation. The system is designed to care for up to 100,000 casualties arising from a massive peacetime disaster or an overseas conventional military conflict. The National Disaster Medical System will be implemented over a period of 3 to 5 years. The authors recommend that all parts of the American health care community join in support of the system.

Disaster Planning↗
PubMed1980

Minimizing the psychological effects of a wartime disaster on an individual.

In this paper, the psychological reactions of individuals and groups to a wartime disaster, such as nuclear explosion, are presented. The psychological literature on disasters is discussed. The presentation attempts to emphasize viewing the victims of a disaster as individuals responding in a normal way to an overwhelming experience, rather than labeling them as psychiatric patients. The various phases of a disaster are discussed with particular emphases on the preventive measures and leadership roles which may be taken by the physician. The development and treatment of situational psychoses, as well as neurotic reactions, are examined and the dynamics especially of long-lasting neurotic problems explored. The paper concludes by making specific recommendations regarding the establishment of disaster plans and training programs at each military facility. It is suggested that the use of such plans may help minimize the psychological effects of a wartime disaster on the individual.

Disasters↗
PubMed1996

SUMA (Supply Management Project), a management tool for post-disaster relief supplies.

Frequently in the wake of disasters, large amounts of humanitarian supplies arrive from multiple sources within the country or from abroad. Only a portion of these donations actually responds to specific requests from the affected country. A significant part consists of unsolicited donations whose value--in terms of meeting immediate, life-threatening needs--is questioned by many disaster managers. In 1990, WHO initiated a supply management project, known as "SUMA", to provide national authorities with a management tool and the skills to sort and inventory large amounts of relief supplies in a short period of time. It is a technical cooperation programme to assist the local coordinating agency to get an accurate picture of what is potentially available in the affected area, and to sort the most valuable relief items from those of doubtful usefulness. National authorities have developed their SUMA teams in many situations, both in Latin America and the Caribbean; this article describes three of these experiences. A flood in Costa Rica, in 1995, where the Red Cross assumed national responsibility for managing relief supplies donated locally. The earthquake in Paéz, Colombia, also in 1995, where the National Disaster Committee activated SUMA for all supplies sent to the disaster area, with the exception of specialized health shipments channelled through the Ministry of Health. In Haiti, in 1994, a complex disaster was compounded by a tropical storm. All civilian supplies arriving at the airport were processed by the SUMA team which included customs officers among its members. The traditional problem of unsorted and inappropriate supplies, noted in most international disasters, seems to have been negligible, a trend which can perhaps be credited to 20 years of preparedness activities in Latin America and the Caribbean. The superficial analysis of the data underlines the potential for operational research on the standardized databases generated by SUMA.

Colombia↗
PubMed1960

Medical planning for disaster. Brief resume of accomplishments in California 1950-1959.

Extensive accumulation and dispersal of medical supplies and equipment has been carried out in this state since 1950. Although such medical supplies and equipment are inadequate for an all out war type disaster their addition to the medical disaster preparedness program represents a great contribution and efforts must be made to continually supplement them.All hospitals must have a disaster plan which is well understood and which must be tested by actual test exercises at least once each year. Preparations for major disasters of all types are costly and time-consuming but represent one of the best possible investments which we can make as insurance against the loss of thousands of casualties. It is the responsibility of each physician to prepare himself and his family in anticipation of being exposed to natural or man-made disasters.

California↗