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At least 307 records · Page 17Linked to original sources
PubMed2005

Epidemiologic study of the autoimmune health effects of a cargo aircraft disaster.

BACKGROUND: In the aftermath of a cargo aircraft crash in Amsterdam in 1992, indications of autoimmune disorders appeared in some of the affected population. METHODS: This epidemiologic study sought to determine the possible long-term autoimmune health effects of the aircraft disaster on professional assistance workers. Exposed professional firefighters (n = 334) and police officers (n = 834) who performed at least 1 disaster-related task and hangar workers who sorted and investigated the wreckage (n = 241) were compared with reference groups of nonexposed colleagues who did not perform any disaster-related tasks (n = 194, n = 634, and n = 104, respectively). Data were collected a mean of 8.5 years after the disaster. Questionnaires were used to assess disaster-related tasks and 11 autoimmune-like symptoms. All serum samples were tested for the presence of antinuclear antibodies, rheumatoid factor, and antineutrophil cytoplasmic and anticardiolipin antibodies. RESULTS: Compared with nonexposed colleagues, exposed workers reported significantly more autoimmune-like symptoms. They reported the following symptoms significantly more often: tingling sensations, myalgia, loss of strength, easily fatigued, and a feeling of sand in the eyes (all groups); infection proneness (firefighters); skin abnormalities and nocturnal transpiration (police officers and hangar workers); and vasculitis-like symptoms and Raynaud discoloring (police officers). In contrast, we found no significant difference between exposed and nonexposed workers in autoantibody prevalence. CONCLUSION: Occupational exposure to the aircraft disaster resulted in an excess of long-term self-reported autoimmune-like symptoms in exposed professional assistance workers, but there was no difference between exposed and nonexposed workers in the prevalence of autoantibodies.

Accidents, Aviation↗
PubMed1994

The impact of disaster support work.

Limited available evidence suggests that disaster support work may have negative effects. This study attempts to examine the impact of disaster-related stress on helpers offering psychological support to victims of two major disasters, and to identify potential moderating factors. Sixty-seven social workers were surveyed, measures being taken of psychological symptomatology and wellbeing, personality variables, social support, life events, and various aspects of disaster support work. Comparison with normative data suggested that subjects were experiencing significant levels of stress. Two major sources of disaster-related stress were identified: role-related difficulties and contact with clients' distress. Approximately one third of the variance in helper response could be explained by variables reflecting coping style, prior life events and the aforementioned aspects of disaster support work. Follow-up data at 12 months demonstrated persisting high levels of stress.

Adaptation, Psychological↗
PubMed1999

Post-disaster service provision following proactive identification of children with emotional distress and depression.

OBJECTIVE: Proactive, school-based psychological testing for emotional distress and depression was employed 6 months after a bushfire disaster. The service provision aim was to provide children with the greatest emotional distress the relatively limited therapeutic resources available in the post-disaster environment. Specific hypotheses were tested: that the prevalence of emotional distress and depression would be elevated 6 months post disaster; that emotional distress would be correlated with traumatic events; and that depression would be related to experiences of loss. METHOD: Six months after a bushfire disaster grade 4, 5, and 6 students (n = 601) participated in screening using a test battery measuring emotional distress, depressive symptoms and trait anxiety. RESULTS: Twelve percent (n = 72) of children experienced severe emotional distress 6 months after the bushfire. Rates of depression were similar to rates in non-traumatised child community samples. Multivariate analysis suggested that emotional distress was significantly associated with trait anxiety, evacuation experience, the perception that parents may have died during the bushfire, and depressive symptoms. Depressive symptoms were associated with total distress score, trait anxiety and perception of threat to the parents. CONCLUSIONS: Substantial mental health morbidity was identified 6 months after a bushfire disaster. The usefulness of post-disaster service provision influenced by proactive screening is discussed and reasons for further research highlighted.

Adaptation, Psychological↗
PubMed2006

Disaster and subsequent healthcare utilization: a longitudinal study among victims, their family members, and control subjects.

BACKGROUND: The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members. OBJECTIVE: The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization. RESEARCH DESIGN: We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records. SUBJECTS: Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population. MEASURES: As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status. RESULTS: Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire. CONCLUSION: Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.

Adolescent↗
PubMed2005

Determinants of response in a longitudinal health study following the firework-disaster in Enschede, The Netherlands.

Very few longitudinal health studies after disasters published data on the determinants of loss to follow up. However, these determinants provide important information for future disaster studies to improve their response and reduce selection bias. For this purpose we analyzed the data of a longitudinal health survey which was performed among residents and emergency workers, at 3 weeks (n = 3662) and at 18 months (n = 2769) after a major firework disaster in The Netherlands (Enschede, May 13, 2000). The response was lower among immigrants (54%) than among native Dutch (81%). Severe damage to the house due to the disaster (OR: 1.8; 95% CI: 1.1-3.0) and being involved as an emergency workers (OR: 2.1; 95% CI: 1.2-3.4) were associated with higher response among native Dutch, while this was not the case among immigrants. Non-western immigrants with health problems in the first study were more likely to participate in the second study (for example physical symptoms OR: 2.5: 95% CI: 1.4-4.4), while the native Dutch with these symptoms were less likely to participate (OR: 0.7; 95% CI: 0.5-0.9). In conclusion, disaster-related characteristics were associated with higher response in native Dutch. Health problems were associated with higher response among non-western immigrants and with lower response among the native Dutch.

Accidents↗
PubMed1985

Mass evacuation in disasters.

The emergency physician plays an important role in disaster planning and management. Some disasters will require the removal of a segment of the population for their own safety; this removal is referred to as mass evacuation. This aspect of disaster planning is frequently ignored or, at best, given a few short sentences in overall plans for coping with disasters. Very little has been written on this important aspect to permit one to make intelligent evacuation plans. This article summarizes previous studies on the reactions of people to, and their behavior during, actual mass evacuations. The information is used to outline important points that must be addressed by all those involved in disaster plans so that people may be removed from danger quickly, with as few problems as possible.

Communication↗
PubMed2005

Tsunami: response to a disaster.

On December 26, 2004, a devastating earthquake occurred in the Indian Ocean very near to Sumatra's coast. The Belgian Association for Pediatrics assembled a medical team of 30 volunteers from 4 hospitals to assist with disaster relief. They traveled to Indonesia, set up a rudimentary care facility, and worked with teams from many countries. In a disaster situation, critically ill children who require mechanical ventilation and inotropic support, perish for lack of equipment or adequate follow-up care. Disaster teams are told to focus on surgery, infected wounds, dehydration, and oral rehydration. This article tells one story of disaster relief efforts and proposes an established team of pediatricians to respond to disaster situations in the future.

Belgium↗
PubMed2000

Disaster psychiatry: principles and practice.

Increasingly, trauma and disasters are part of everyday life. Psychiatrists can play an important role in assisting individuals and communities to recover. They bring a unique set of skills and experiences that can be invaluable in minimizing morbidity and facilitating recovery. This paper discusses psychological, physiological, behavioral, and community responses encountered in the aftermath of a disaster. A preventive medicine model of understanding disaster response is discussed in which the psychiatrist delineates traumatic stressors and high-risk populations. The importance of psychiatric participation in disaster preparedness is emphasized. Psychiatric interventions targeted at the various longitudinal phases of disaster response are reviewed.

Disaster Planning↗
PubMed2002

A comparison of nurses' needs/concerns and hospital disaster plans following Florida's Hurricane Floyd.

INTRODUCTION: The idea for this study was inspired by the response to Hurricane Floyd. Nurses are relied upon and expected to fulfill responsible roles during disaster situations, but little is known about the needs or concerns that nurses experience when they meet expectations and function as disaster responders. METHODS: Official copies of disaster protocols from 4 area hospitals were reviewed, and 4 focus groups consisting of ED nurses from respective hospitals provided information about nurses' concerns or needs in response to Hurricane Floyd. RESULTS: Of primary importance to nurses was family safety, pet care, and personal safety while at work. Secondary concerns were basic needs such as food, water, sleep, shelter, and rest. Group commitment levels to providing care during disaster situations varied greatly. Participants requested that hospital policy revisions address work assignments, pay/financial compensation, flexibility for extenuating circumstances, pet care, family sheltering, and provision of basic needs. DISCUSSION: It is not sufficient for a few key officials and planners to know their roles and responsibilities during a disaster; the roles of everyone involved must be clearly understood. Many participants described their conflict as family commitment versus professional obligation. We identified several areas of concerns in our interviews, and those areas have been clearly defined in the revised protocols. Other areas have yet to be addressed.

Adult↗
PubMed2006

Setting priorities: global patterns of disaster risk.

Natural disasters are caused by the exposure and vulnerabilities to natural hazards of people, infrastructure and economic activities. Analysis of these factors has permitted identification of countries and areas within them where disaster-related mortality and economic losses are likely in the future. These high-risk areas are candidates for increased attention to, and investment in, disaster risk identification, reduction and transfer. Plans are underway to further identify disaster risk levels and factors on national and subnational scales in high-risk countries to create evidence for improved risk management decision-making. In this paper, I review selected recent global and regional risk analyses to highlight findings, areas for improvement and next steps in the overall process of using disaster risk information for more effective risk management and cost-effective reduction of losses.

Decision Support Techniques↗
PubMed1997

The study of natural disasters, 1977-1997: some reflection on a changing field of knowledge.

As part of a series of papers to mark the 21st year of publication of Disasters, it is opportune to consider some of the changes that have occurred in the field it has covered so diligently for the last two decades. The paper begins with a brief review of the major natural disasters during this period and assesses their impact. It then considers the problem of how to define two key concepts: natural disaster and vulnerability, which remains an open question. The latter is one of the key determinants of the former. Next comes a review of what has occurred in the disasters field since the journal began publication, including some notes on the rise in vulnerability, the information technology revolution and the dilemmas of hazard mitigation. The following two sections assess, respectively, what hoped-for developments did not occur during the period studied and what assets were lost in the name of progress. For example, on the theoretical front, academic over-specialisation has predominated, while on the practical side there has been insufficient transfer of technology to where it is needed. The paper concludes that analyses of disaster need to become more sophisticated and multi-disciplinary and must take account of several forms of context within which developments take place.

Disaster Planning↗
PubMed2006

Organisational learning and self-adaptation in dynamic disaster environments.

This paper examines the problems associated with inter-organisational learning and adaptation in the dynamic environments that characterise disasters. The research uses both qualitative and quantitative methods to investigate whether organisational learning took place during and in the time in between five disaster response operations in Turkey. The availability of information and its exchange and distribution within and among organisational actors determine whether self-adaptation happens in the course of a disaster response operation. Organisational flexibility supported by an appropriate information infrastructure creates conditions conducive to essential interaction and permits the flow of information. The study found that no significant organisational learning occurred within Turkish disaster management following the earthquakes in Erzincan (1992), Dinar (1995) and Ceyhan (1998). By contrast, the 'symmetry-breaking' Marmara earthquake of 1999 initiated a 'double loop' learning process that led to change in the organisational, technical and cultural aspects of Turkish disaster management, as revealed by the Duzce earthquake response operations.

Acclimatization↗
PubMed2006

Hospital disaster preparedness in Los Angeles County.

BACKGROUND: There are no standardized measures of hospital disaster preparedness or hospital "surge capacity." OBJECTIVES: To characterize disaster preparedness among a cohort of hospitals in Los Angeles County, focusing on practice variation, plan characteristics, and surge capacity. METHODS: This was a descriptive, cross-sectional survey study, followed by on-site verification. Forty-five 9-1-1 receiving hospitals in Los Angeles County, CA, participated. Evaluations of hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity (assessed by monthly emergency department diversion status, available beds, ventilators, and isolation rooms), decontamination capability, and pharmaceutical stockpiles were assessed by survey. RESULTS: Forty-three of 45 hospital plans (96%) were based on the Hospital Emergency Incident Command System, and the majority had protocols for hospital lockdown (100%), canceling elective surgeries (93%), early discharge (98%), day care for children of staff (88%), designating victim overflow areas (96%), and predisaster "preferred" vendor agreements (96%). All had emergency medical services-compatible radios and more than three days' worth of supplies. Fewer hospitals involved law enforcement (56%) or had mutual aid agreements with other hospitals (20%) or long-term care facilities (7%). Although the vast majority (96%) conducted multiagency drills, only 16% actually involved other agencies in their disaster training. Only 13 of 45 hospitals (29%) had a surge capacity of greater than 20 beds. Less than half (42%) had ten or more isolation rooms, and 27 hospitals (60%) were on diversion greater than 20% of the time. Thirteen hospitals (29%) had immediate access to six or more ventilators. Less than half had warm-water decontamination (42%), while approximately one half (51%) had a chemical antidote stockpile and 42% had an antibiotic stockpile. CONCLUSIONS: Among hospitals in Los Angeles County, disaster preparedness and surge capacity appear to be limited by a failure to fully integrate interagency training and planning and a severely limited surge capacity, although there is a generally high level of availability of equipment and supplies.

Cross-Sectional Studies↗
PubMed2006

The pediatrician and disaster preparedness.

Recent natural disasters and events of terrorism and war have heightened society's recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not monitored carefully. The challenge of dealing with the threat of terrorism, natural disasters, and public health emergencies in the United States is daunting not only for disaster planners but also for our medical system and health professionals of all types, including pediatricians. As part of the network of health responders, pediatricians need to be able to answer concerns of patients and families, recognize signs of possible exposure to a weapon of terror, understand first-line response to such attacks, and sufficiently participate in disaster planning to ensure that the unique needs of children are addressed satisfactorily in the overall process. Pediatricians play a central role in disaster and terrorism preparedness with families, children, and their communities. This applies not only to the general pediatrician but also to the pediatric medical subspecialist and pediatric surgical specialist. Families view pediatricians as their expert resource, and most of them expect the pediatrician to be knowledgeable in areas of concern. Providing expert guidance entails educating families in anticipation of events and responding to questions during and after actual events. It is essential that pediatricians educate themselves regarding these issues of emergency preparedness. For pediatricians, some information is currently available on virtually all of these issues in recently produced printed materials, at special conferences, in broadcasts of various types, and on the Internet. However, selecting appropriate, accurate sources of information and determining how much information is sufficient remain difficult challenges. Similarly, guidance is needed with respect to developing relevant curricula for medical students and postdoctoral clinical trainees.

Child↗
PubMedDate not supplied

Psychiatric dimensions of disaster: patient care, community consultation, and preventive medicine.

The majority of persons exposed to a disaster do well and have only mild, transitory symptoms. However, some individuals develop psychiatric illness postdisaster. Such illnesses include those that are secondary to physical injury and sickenss as well as specific trauma-related psychiatric disorders such as acute stress disorder. The extent of the psychiatric morbidity and mortality that develops in individuals in the community depends on the type of disaster, the degree of injury sustained, the amount of life threat, and the duration of community disruption. In this paper we examine the posttraumatic responses of direct concern to psychiatrists working in a community exposed to a disaster. We review the epidemiology of posttraumatic responses, the interface of psychiatry and traumatic stress, the psychiatric disorders associated with trauma, and psychiatric consultation to the disaster community. Overall, psychiatric intervention after a disaster is based on the principles of preventive medicine and includes community consultation and outreach programs with the goals of identifying high-risk groups, promoting community recovery, and minimizing social disruption.

Adult↗
PubMedDate not supplied

Public health assessments in disaster settings: recommendations for a multidisciplinary approach.

INTRODUCTION: Rapid assessments of needs and health status have been conducted by the U.S. Centers for Disease Control and Prevention (CDC) in natural disaster settings for gathering information about the status of affected populations during emergencies. A review of eight such assessments (6 from hurricanes, 1 from an ice storm, and 1 from an earthquake) examines current methods and applications, and describes the use of results by policy makers so assessments in post-disaster settings can be improved. OBJECTIVE: Because the results of assessments greatly influence the nature of relief activities, a review can: 1) ascertain strengths and limitations; 2) examine the methods; and 3) ascertain the utility of results and their use by policy makers. This review compares assessments for similarities and differences: 1) across disaster types; 2) within similar disasters; 3) by timing when the assessments are conducted; and 4) in domestic and international settings. The review also identifies decision-making actions that result from the assessments, and suggests direction for future applications. METHODS: Assessments reported in CDC's Morbidity and Mortality Weekly Report from 1980 through 1999 were reviewed because they applied a systematic methodology in data collection. They were compared descriptively for study characteristics and content areas. RESULTS: Of 13 assessments identified from six reports, eight were reviewed because they focused on initial assessments, rather than on repeated studies. Of the eight, six pertained to hurricanes; one to an ice storm; and one to an earthquake. Seven (88%) were performed during or after the third day post-impact (range: 1-70 days, median: 7 days). All eight addressed demographics, morbidity, and water availability; seven concerned food, sanitation, and transportation; and six queried access to medical care and electricity. Of the three assessments conducted more than 10 days post-event, two addressed vulnerable children, the elderly, pregnant and lactating women, and migrant workers; two singled storm preparation and evacuation behavior; and one concerned mental health, preventive health care, and social programs. Only one, after an earthquake, asked about disaster-related deaths in household members. Two were international assessments and both were performed at least 60 days post-event. All eight provided estimates of proportions of needs based on survey respondents; none, however, extrapolated the proportions to estimate the magnitude of needs for populations at risk. Of the eight, five confirmed a policy decision, such as accelerating delivery of food supplies. CONCLUSION: Assessments typically were conducted within 1 week after the precipitating event occurred. Most, performed within 3-10 days, focused on demographics, health status, food and water, and restoration of utilities. Three assessments, conducted > 1 month later, concerned long-term planning. Only one was performed < 72 hours post-event. Five assessments resulted in policy actions to guide relief activities. Increasing application of health assessments provides: 1) impetus for improving current methodologies; 2) standardizing collection instruments; 3) involving other sectors in emergency relief; and 4) ensuring useful information for decision makers.

Decision Making, Organizational↗
PubMed2001

Disaster preparedness: is your unit ready?

This article brings attention to the need for disaster preparedness by individual dialysis facilities. It is recommended that each facility develop a specific plan for each type of disaster that might occur in the particular geographic location. It is also recommended that the community's disaster plan(s) be reviewed and incorporated in the planning process. This article addresses all aspects related to a natural disaster, including planning, drills, basic services, personnel, and the aftermath. Adequate preparation may lessen the destruction and negative consequences of a natural disaster.

Communication↗
PubMed1992

Disaster epidemiology: challenges for public health action.

Better epidemiologic knowledge of the causes of death and types of injuries and illnesses caused by disasters is clearly essential to determine appropriate relief supplies, equipment and personnel needed to respond effectively to such situations. The overall objective of disaster epidemiology is to scientifically measure and describe the health effects of disasters and contributing factors to these effects, with the goals of assessing the needs of disaster-affected populations, efficient matching of resources to needs, further prevention of adverse health effects, evaluation of program effectiveness, and contingency planning. In addition, the epidemiologist has an important role to play in providing informed advice about the probable health effects which may arise in the future, in establishing priorities for action and in emphasizing the need for accurate information as the basis for relief decisions. This presentation outlines a number of important areas where epidemiologists can contribute to making disaster management more effective.

Cause of Death↗