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PubMed1988

Medical evaluation of the victims of the 1986 Lake Nyos disaster.

A cloud of carbon dioxide gas, with an estimated volume of 1 km3 was released from Lake Nyos, a volcanic crater lake in Cameroon, Africa, causing 1700 to 2000 human fatalities as well as killing thousands of livestock and wild animals. At the request of the Cameroonian Government, the Office of Foreign Disaster Assistance of the U.S. Department of State sent a multidisciplinary team which included 2 forensic pathologists to assist the Government of Cameroon in investigating this natural disaster. The medical evaluation was concentrated in 3 areas: the autopsy of human and animal fatalities, examination and interview of survivors, and examination of the scene of the disaster. Toxicologic specimens were obtained at autopsy, and numerous samples of lake water were collected. The autopsy findings were consistent with asphyxia. The results of chemical analyses excluded many volatiles but not carbon dioxide as the toxic agent. The exact source of this gas continues to be a subject of a heated geologic debate, but fermentation of organic materials in the lake water has been eliminated on the basis of C14 isotope studies. This investigation underlines the value of forensic pathologists in epidemiological studies and in the examination of living persons.

Animals↗
PubMed2000

Radiation safety role in institutional disaster planning.

United States Nuclear Regulatory Commission (NRC) materials license applicants (non-nuclear power) must submit spill procedures with their application. While our counterparts in the nuclear power industry historically have concerned themselves with disaster drills and evacuation plans as a result of fire, explosion, or an act of terrorism, other licensees are looking only at minor spills of unsealed radioactive material and only at tile radiation hazard. Beyond NRC regulations, various oversight and accrediting organizations require, or at a minimum encourage, a written disaster plan outlining actions to be taken for events likely to occur in the region of the institution. Some of these organizations require drills to practice implementation of the written plan. On 5 May 1999, Mayo Clinic performed a wide-scale disaster drill involving Rochester City and Olmsted County response organizations, and several Mayo Clinic departments. Planning took several months; the drill took approximately three hours. Participants gathered at several meetings post-drill for "debriefing" sessions to discuss successes, areas for improvement, and lessons learned. There were three overriding lessons learned: critical responders need special identification to allow access to the disaster site; initial victim surveys are for gross contamination only; and access to the potentially contaminated disaster site might take weeks or months following a real event.

Decontamination↗
PubMedDate not supplied

Challenges of international disaster relief: use of a deployable rapid assembly shelter and surgical hospital.

Surgical care is an important service to provide to victims of a disaster. A specialized response team has been created by the National Disaster Medical Treatment division of the Federal Emergency Management Agency to respond when local hospital facilities are either unavailable or unusable. When a major earthquake destroyed Bam, Iran, in December 2003, the US Government mobilized the International Medical Surgical Response Team-East and deployed a team of 57 health care providers to aid in rescue and response efforts. The challenges of designing, maintaining, and keeping a Deployable Rapid Assembly Shelter/Surgical Hospital are described.

Disasters↗
PubMed2002

Ethical issues in research involving victims of terror.

Although research after an episode of terror can provide important information to improve the health and well-being of present and future victims, there are unique ethical challenges that need to be addressed. Man-made disasters have profound effects on victims, rescue workers, and their families and on others in the community; this may impair their ability to provide voluntary and uncoerced decisions about research participation. Because such potential participants in research may be vulnerable and also subject to being overburdened with redundant research, they deserve special consideration. We propose specific recommendations to assist investigators, institutional review boards (IRBs), public health officials, and political leaders to help serve the interests of future participants in terror-related research.

Crime Victims↗
PubMed2002

The Marmara earthquake: admission laboratory features of patients with nephrological problems.

BACKGROUND: Earthquakes are major causes of morbidity and mortality. North-western Turkey was struck by a devastating earthquake in August 1999, which caused several thousand deaths. Among the most important morbid events in survivors were acute nephrological problems. METHODS: Within the first week of the disaster, specific questionnaires asking about 63 clinical and laboratory parameters were sent to 35 reference hospitals that were treating the victims. Of the registered 639 victims, 423 were admitted within the first 3 days of the disaster; the admission laboratory data of these 423 patients are the subject of this analysis. RESULTS: In the 423 patients (233 males, mean age 31.3+/-14.4 years), time under the rubble was 10.7+/-10.4 h. Mean values at admission were as follows: serum potassium 5.4+/-1.3 mEq/l, creatine phosphokinase 58205+/-77889 IU/l, albumin 2.6+/-0.7 g/dl, phosphorus 5.2+/-1.8 mg/dl, haematocrit 35.0+/-9.3%, leukocyte count 14945+/-6614/mm(3), platelet count 183975+/-134012/mm(3), blood urea nitrogen 55.1+/-28.9 mg/dl, and creatinine 3.9+/-2.3 mg/dl. Serum potassium above 6.5 mEq/l was noted in 91 patients (22.7%), an alarming finding for risk of fatal arrhythmias. Non-survivors were characterized by higher figures of serum potassium (P=0.001), as well as lower haematocrit (P=0.028), platelets (P<0.001), and serum albumin (P=0.003). In a multivariate analysis model of admission laboratory parameters, serum creatinine (P<0.001, o.r.=2.19), potassium (P=0.001, o.r.=3.64), and phosphorus (P=0.004, o.r.=1.78) predicted dialysis needs, whereas serum albumin (P=0.028, o.r.=0.23) and creatinine (P=0.039, o.r.=0.60) were related to mortality. CONCLUSIONS: Admission laboratory data may be useful for predicting dialysis needs and survival chance of disaster victims. High incidences of some life-threatening abnormalities dictate the need for empirical therapy even in the field.

Acute Kidney Injury↗
PubMed2003

Proposal of a model for medical records for international disaster relief operations.

The triage of a large number of victims in an international disaster relief operation is very important. To ensure the correct way of registration of patients and effective triage and treatment, useful medical records are necessary. The authors proposed a model for medical records (Shinchi's Medical Record (SMR)) for international disaster relief operations for medical teams from our experience of the Honduras Disaster Relief Operation in November 1998. Our medical unit, which was part of the Japan Self-Defense Forces International Disaster Relief Operation, was confronted with many patients who needed immediate medical care. SMR was developed using only one sheet of paper including the medical record, laboratory data sheet, and prescribed drug sheet. SMR also registers urgency classes and the primary diagnosis. SMR is simple, inexpensive, and easy to prepare for many patients.

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↗
PubMed2005

Surgical and psychosocial outcomes in the rural injured--a follow-up study of the 2001 earthquake victims.

INTRODUCTION: After a major disaster in a developing country, the graphic media coverage of the dead and injured invariably leads to an influx of volunteering healthcare personnel to the disaster zone. Very few studies document the outcomes of the treatment rendered in this field setting, under compromised conditions. We revisited the rural victims of the 2001 Gujarat earthquake in an attempt to analyse their surgical outcome and the status of their physical/psychosocial rehabilitation, 2 years after the disaster. METHOD: We traced displaced victims treated for earthquake-related injuries to their new homes. A community health worker interviewed patients with an oral questionnaire in the local language about injuries, the examining physician and first aid, orthopaedic implants, amputations, wounds, disability, deformity, residual pain, occupational and economic rehabilitation, post traumatic stress disorder (PTSD) and perceptions of healthcare rendered. RESULTS: We located 133 of the 179 non-urban victims, from 11 villages. There were 10% missed injuries, 19% infection rate, restricted range of motion in 12%, non-union rate in 23% and reoperations in 30.5% patients. Fifty-one percent had resumed their previous occupation, but only 30% had recovered economically. Of 98% who had destroyed homes, 89% had their homes rebuilt. Residual sadness was the only significant PTSD symptom. CONCLUSION: This trauma outcome study highlights the shortcomings of surgeons for disaster-related work. One-tenth of the injuries were missed, suggesting that field examination at the site of disaster was more difficult than in the comfort of the hospital emergency room. Further there were inappropriately timed, aggressive implant operations, short time commitments, a lack of follow-up and a high rate of reoperations contributing to subsequent morbidity. These pointed to a need for training in disaster medicine within the curriculum of surgical residency. On the brighter side, despite poor sterility, prolonged transport times and no prehospital care, the postoperative infection rate was lower than expected. This perhaps was due to use of potent antibiotics in a previously unexposed rural population. Good physiotherapy given in the temporary shelters, by the informal carers within the family and by voluntary groups, kept up a good range of motion and reduced the final disability. PTSD was marked 3-6 months after the event, but was minimal 2 years postquake. Sadness about the event was the only residual PTSD symptom. While there were varying perceptions of satisfactory outcome, we found good coping mechanisms in place. The simple village folks were largely happy to be alive and accepted the residual deformities and cosmetic blemishes as a "small price to pay".

Adolescent↗
PubMed1993

Special report. Dealing with disasters: what hospitals learned from recent crises.

In times of crisis, hospitals are relied on to provide simultaneous emergency treatment to a large number of victims of natural disasters, accidents, or other traumatic events. Sometimes the hospital itself faces a crisis situation. Hospital officials recognize that the only way to continue providing patients with the best care possible in dire circumstances is through the activation of an effective disaster plan. "Disaster planning is something that cannot be planned enough," says Louis Gasbarro, president of the International Association for Healthcare Security and Safety (IAHSS) and security and safety director at Tampa General Hospital, Tampa, FL. "There's no such thing as over-planning or over-drilling. You must have a written plan known by all people, all departments, all personnel in the building. Everyone has to know their role." This special report will look at several events that brought an influx of patients to hospitals around the country, the disaster plans that were implemented, and what hospital officials learned from those experiences.

Accidents↗
PubMed1998

Suicide after natural disasters.

BACKGROUND: Among the victims of floods, earthquakes, and hurricanes, there is an increased prevalence of post-traumatic stress disorder and depression, which are risk factors for suicidal thinking. We conducted this study to determine whether natural disasters affect suicide rates. METHODS: From a list of all the events declared by the U.S. government to be federal disasters between 1982 and 1989, we selected the 377 counties that had each been affected by a single natural disaster during that period. We collected data on suicides during the 36 months before and the 48 months after the disaster and aligned the data around the month of the disaster. Pooled rates were calculated according to the type of disaster. Comparisons were made between the suicide rates before and those after disasters in the affected counties and in the entire United States. RESULTS: Suicide rates increased in the four years after floods by 13.8 percent, from 12.1 to 13.8 per 100,000 (P<0.001), in the two years after hurricanes by 31.0 percent, from 12.0 to 15.7 per 100,000 (P<0.001), and in the first year after earthquakes by 62.9 percent, from 19.2 to 31.3 per 100,000 (P<0.001). The four-year increase of 19.7 percent after earthquakes was not statistically significant. Rates computed in a similar manner for the entire United States were stable. The increases in suicide rates were found for both sexes and for all age groups. The suicide rates did not change significantly after tornadoes or severe storms. CONCLUSIONS: Our study shows that suicide rates increase after severe earthquakes, floods, and hurricanes and confirms the need for mental health support after severe disasters.

Adolescent↗
PubMed1991

[Psychological aftereffects of the disaster at the Chernobyl NPS].

Available are the data on the trend in psychoneurological syndromes demonstrable in all the periods of developing acute radiation disease in the victims of the disaster at the Chernobyl nuclear power station. It is shown that the risk of small-dose ionizing radiation may lead to psychological dysadaptation. Psychogenias are outlined as far as their triggering factors and manifestations in members of the emergency teams are concerned.

Accidents↗
PubMed2007

Trauma systems.

The major goal of a trauma system is to enhance the community health. This occurs through a process of assessment, policy development, and ongoing assurance. This can be achieved by (1) identifying risk factors in the community and creating solutions to decrease the incidence of injury, (2) providing optimal care during the acute and the late phase of injury, including rehabilitation, and (3) maintaining the objective to decrease overall injury-related morbidity and mortality and years of life lost. Disaster preparedness also is an important function of trauma systems, and using an established trauma system network facilitates the care of victims of natural disasters or terrorist attacks.

Emergency Medical Services↗
PubMed2006

Interpreting anonymous DNA samples from mass disasters--probabilistic forensic inference using genetic markers.

MOTIVATION: The problem of identifying victims in a mass disaster using DNA fingerprints involves a scale of computation that requires efficient and accurate algorithms. In a typical scenario there are hundreds of samples taken from remains that must be matched to the pedigrees of the alleged victim's surviving relatives. Moreover the samples are often degraded due to heat and exposure. To develop a competent method for this type of forensic inference problem, the complicated quality issues of DNA typing need to be handled appropriately, the matches between every sample and every family must be considered, and the confidence of matches need to be provided. RESULTS: We present a unified probabilistic framework that efficiently clusters samples, conservatively eliminates implausible sample-pedigree pairings, and handles both degraded samples (missing values) and experimental errors in producing and/or reading a genotype. We present a method that confidently exclude forensically unambiguous sample-family matches from the large hypothesis space of candidate matches, based on posterior probabilistic inference. Due to the high confidentiality of disaster DNA data, simulation experiments are commonly performed and used here for validation. Our framework is shown to be robust to these errors at levels typical in real applications. Furthermore, the flexibility in the probabilistic models makes it possible to extend this framework to include other biological factors such as interdependent markers, mitochondrial sequences, and blood type. AVAILABILITY: The software and data sets are available from the authors upon request.

Algorithms↗
PubMed1987

Scene investigation, identification, and victim examination following the accident of Galaxy 203: disaster preplanning does work.

Galaxy Airlines Flight 203 crashed following takeoff from Reno-Cannon International Airport on 21 Jan. 1985. Sixty-eight persons on board the aircraft perished in the initial crash and resultant fire which followed. Two victims expired as a result of crash injuries within subsequent days and one passenger survived. A community disaster response plan was in place and had been practiced by local government agencies before this incident. The successes of this preplanned response, as well as methods of actual recovery, identification, and examination of the victims is presented.

Accidents, Aviation↗
PubMed2005

Lessons learned from a nightclub fire: institutional disaster preparedness.

BACKGROUND: On February 20, 2003, a nightclub fire caused a multiple casualty disaster, with 215 victims requiring treatment at area hospitals. In this report, we describe the events, the surgical response at our trauma center, and the lessons learned in institutional disaster preparedness. METHODS: Information regarding the fire was obtained from public access media and state governmental and hospital reports. Patient information was obtained through review of our trauma registry, patient records, and questionnaires sent to regional hospitals. RESULTS: Four hundred thirty-nine patrons were in the building at the time of the fire, of whom 96 died at the scene. One hundred people ultimately died. Two hundred fifteen patients were evaluated at area hospitals: 64 at our trauma center and 151 at 15 other area facilities. Seventy-nine patients were admitted: 47 to our center and 32 to other hospitals. Eight patients were transferred from Rhode Island Hospital (RIH) to other Level I trauma centers. Twenty-eight (60%) of the patients admitted to RIH were intubated for inhalation injury. For patients admitted to RIH, the extent of the total body surface burn was less than 20% in 33 patients (70%), 21% to 40% in 12 patients (26%), and greater than 40% in 2 patients (4%). The average age was 31 years (range, 18-43 years). Previous disaster planning drills facilitated a quick institutional response directed by a surgeon. The trauma floor of the hospital, which normally consists of a 10-bed trauma intensive care unit (ICU), an 11-bed step-down unit, and a 22-bed medical-surgical floor, was cleared of patients and converted into a 21-bed burn ICU and a 34-bed acute burn ward. Surgical residents were mobilized into teams assigned to the emergency department, ICUs, and surgical floors. In addition to the in-house trauma attending already present, four additional surgical staff members were called in to help man the emergency department and burn wards. Two operating rooms became dedicated burn rooms where 23 cases were performed the first week. In total, 43 operative procedures and 9 bedside tracheostomies were performed over 8 weeks. Over the first 4 weeks, 132 bronchoscopies were performed for diagnostic purposes and pulmonary toilet. There were no deaths. CONCLUSION: Disaster planning as well as personnel and institutional commitment resulted in an optimal response to a multiple casualty incident. Still, lessons were learned that will further improve readiness for future disasters.

Adolescent↗
PubMed1980

Disaster: the helper's perspective.

The responses to disaster and death vary enormously, but there is much to suggest that they are not confined to those who are directly affected. The helpers, too, may be "victims" of the disaster, and it is important that their psychological needs are perceived and met. There is an indication that, if this is done, considerable psychological morbidity may be prevented.

Disasters↗
PubMed1992

The "Scandinavian Star" ferry disaster 1990--a challenge to forensic odontology.

With 158 victims, the fire on board the "Scandinavian Star" was one of the world's worst ferry disasters. A team of identification experts, including dentists, were employed to secure evidence for identification and to remove the victims from the ferry. Four parallel teams, each with 2 dentists, examined and autopsied the victims at the Institute of Forensic Medicine, University of Oslo. Using the INTERPOL Disaster Victim Identification forms and aided by computers, all victims were identified within 17 days. Dental identity could be established in 107 cases (68%).

Adolescent↗
PubMed1990

Are we ready for the next disaster?

The time, location and number of injuries sustained in major disasters are unpredictable. The medical response is usually swift and appropriate, but manpower and resources may be quickly stretched to their limits. The hypothesis is advanced that optimal medical management of the victims of major disasters requires the development of a trauma system in the UK, and greater emphasis on education and research in trauma and critical care.

Disaster Planning↗