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[The dentist as an expert in disasters: dental identification in the disasters with the Zeebrugge ferry].

The Herald of Free Enterprise Disaster on the 6th of March 1987 just outside Zeebrugge harbour was without any doubt a disaster of major proportions. The ferry disaster highlighted different approaches in major incident procedures in both countries involved but nevertheless the identification team which was composed of both British and Belgian specialists did perform good work. The identification of the victims had to be done in three phases each of them with its own specific work and problems. As the process of identification of bodies is an exacting science, and forensic odontology is known to be among the most reliable scientific methods in mass disasters, it is easily understood that forensic odontology took an active part in all three phases of the identification process.

Denture Identification Marking↗

Definition and classification of disasters: introduction of a disaster severity scale.

In disaster medicine, a meaningful definition of the word disaster is lacking. A simple definition, using only two criteria, is proposed. Added to this, a classification scheme is formulated. Based on this definition and classification, a disaster severity scale is introduced. The methodology used is described, and the significance of these proposals is discussed.

Disaster Planning↗

Mitigation emerges as major strategy for reducing losses caused by natural disasters. Board of Natural Disasters.

The International Decade for Natural Disaster Reduction, a United Nations program for the 1990s, focused attention on the increasing losses caused by natural hazards and promoted actions to reduce their impacts. During this period in the United States, disaster managers and other officials increased emphasis on mitigation relative to response and recovery, especially in programs of the Federal Emergency Management Agency. Many other nations and international organizations undertook similar efforts. Beyond the Decade, efforts should focus on improving risk assessments; implementing mitigation strategies; improving technologies supporting warnings and the dissemination of, and response to, warnings; improving the basis for natural disaster insurance; and assisting developing nations.

Cities↗

The federal response plan and disaster medical assistance teams in domestic disasters.

Through a variety of processes over the last 30 years, an organized federal plan has emerged for the response to domestic disasters. This plan incorporates several aspects of medical response into two areas: (1) health and medical and (2) urban search and rescue. This article discusses the development of the federal response plan with emphasis specifically on medicine. Highlighted are disaster medical assistance teams, urban search and rescue task forces, and roles and responsibilities of emergency physicians and other emergency health professionals in a federal disaster response.

Disaster Planning↗

The psychological effects of disaster work: implications for disaster planning.

The paper focuses on the psychological consequences of disaster work. The issue of identifying staff who may be more vulnerable to psychological distress is discussed as is the need for services to plan psychological screening and support for staff who will be exposed to the trauma of dealing with the aftermath of disasters. It is concluded that active steps need to be taken to incorporate psychological aspects into disaster planning. Specifically, attention should be paid to staff selection, training, use of resources, supervision, debriefing, counselling and feedback.

Counseling↗

60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research.

On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.

Age Factors↗

Emergency department organisation for disasters: a review of emergency department disaster plans in public hospitals of Singapore.

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1) staff mobilization systems (cascading vs batch mobilization); 2) staff deployment systems; 3) team organization (surgeons vs residents); 4) area management (the role of the area manager); 5) casualty volume management (accommodation vs expansion vs extension concepts). The concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned.

Disaster Planning↗

[Forensic odontological identification of disaster victims. Experience with the disaster of the Martinair DC-10 in Faro, Portugal].

Forensic odontology plays an important, often decisive role in the identification of disaster victims. In the Dutch situation, the forensic odontologist is part of the Disaster Victim Identification (DVI)-team of the Dutch National Police Force. The extensive experience with forensic odontological identification of disaster victims, gained within the Dutch DVI-team is described and illustrated with reference to the identification procedure following the Martinair DC-10 aircraft crash at Faro, Portugal, december 21st, 1992. In the identification of the total of 56 victims, forensic odontology contributed in 55 cases (98.2%) to the identification; in 40 cases there were such clear agreements that identification based on forensic odontology alone would have been sufficient. The success of the forensic odontological identification method appeared to be greatly dependent of the adequate cooperation of dentists that made their treatment data available for comparison.

Aircraft↗

Special report. Recent natural and man-made disasters: testing hospital disaster plans and security departments in real-life situations.

In 1995, hurricanes, windstroms, hailstroms, and record flooding challenged the disaster-coping capabilities of hospitals in the Florida Panhandle, New Orleans, and Texas. And, in Carrollton, GA, a severe test of a hospital's disaster plan literally dropped out of the sky. In this report, we'll present some firsthand accounts of what happened; how hospital security and emergency personnel responded; and what lessons all hospitals can learn from these unusual, but not unforeseen, occurrences.

Disaster Planning↗

Medical planning for disaster in Israel. Evaluation of the military surgical experience in the October 1973 War, and implications for the organization of the civilian disaster services.

During its 27 years of existence, Israel has experienced four wars and dozens of mass casualty situations from various causes. This experience has led to the development of a plan for the management of mass casualties. This plan was put to the test in the October War of 1973 and proved successful. Although disasters and procedures vary widely in time and location certain principles of organization and management apply to most of them. In this paper the organization of the evacuation and management of the casualties in the October War is evaluated and its implications in the organization of civilian disaster services discussed.

Civil Disorders↗

Psychosocial sequelae of the 1989 Newcastle earthquake: I. Community disaster experiences and psychological morbidity 6 months post-disaster.

A stratified random sample of 3007 Australian adults completed a screening questionnaire 6 months after the 1989 Newcastle earthquake. Information was obtained on initial earthquake experiences and reactions, use of specific services, social support, coping strategies and psychological morbidity. This questionnaire was the first phase of the Quake Impact Study, a longitudinal project investigating the psychosocial impact of the earthquake. Two weighted indices of exposure were developed: a threat index, which measured exposure to injury or the possibility of injury; and a disruption index, which measured experiences of property damage, displacement and other losses. Levels of exposure to threat and disruption events were significant predictors of morbidity on both the General Health Questionnaire and Impact of Event Scale, as were coping style and gender. Effects of exposure to threat and disruption were largely additive, with higher exposure being associated with greater use of support services, higher perceived stressfulness and more severe psychological morbidity. Use of avoidance as a coping strategy, female gender, lower social support and being older were also associated with higher post-disaster psychological distress. It was estimated that 14.8% of the population was exposed to high levels of threat or disruption, of whom approximately 25% experienced moderate to severe psychological distress as a direct result of the disaster. It was further estimated that 18.3% of those exposed to high levels of threat were at risk of developing post-traumatic stress disorder, representing approximately 2% of the city's adult population.

Adaptation, Psychological↗

Disaster at Buffalo Creek. Children of disaster: clinical observations at Buffalo Creek.

Most of the 224 children who were survivor-plaintiffs of the Buffalo Creek disaster were emotionally impaired by their experiences. The major factors contributing to this impairment were the child's developmental level at the time of the flood, his perceptions of the reactions of his family, and his direct exposures to the disaster. The author focuses on children under 12, describing their responses to fantasy-eliciting techniques and their observed behavior after the flood compared with developmental norms for their age and reports of their previous behavior. These children share a modified sense of reality, increased vulnerability to future stresses, altered senses of the power of the self, and early awareness of fragmentation and death. These factors could lead to "after-trauma" in later life if they cannot make the necessary adaptations and/or do not receive special help to deal with the traumas.

Child↗

Risk of heat-related injury to disaster relief workers in a slow-onset flood disaster.

Heat-related injury or illness (HRI) occurs when the body can no longer maintain a healthy core temperature. During the 1993 Midwest floods, several risk factors HRI were present for workers involved in sandbagging activities. Medical claims filed by Illinois National Guard troops were used to identify injuries. HRI was the most frequently reported injury diagnosis, at 19.3% (23 of 119 injuries). HRI represented 16.0% of injuries to men and 41.7% of injuries to women. HRI can be influenced by high ambient temperatures, high humidity, and prolonged exertion, all of which were present in Illinois. Our results indicate that HRI is a potential problem in disaster relief situations. Further investigation using more detailed data is needed to confirm these findings. Implementation of a few simple preventive measures may decrease the impact of this problem.

Adult↗

Disaster at Buffalo Creek. Discussion of the Buffalo Creek disaster: the course of psychic trauma.

The specific contribution of the psychiatrist to the team study of the human disaster at Buffalo Creek focuses on the course of psychic trauma. The initial violent intrusion by the flood waters was followed by a second phase of the traumatic cycle, the physical dislocation of the survivors, with disruption of their "ground" and "surround." During this long subsequent period the level of trauma did not recede but kept rising, although at a slower pace. Distant effects of the trauma may succeed the more immediate ones. The finite psychic space of the survivors is encroached upon by traumatic memories for an indefinite period of time, leaving fewer resources available for normal effective living. The absorption and merging of traumatic stimuli into a traumatophilia poses still another potential problem. The unprecedented legal decision as to the linear effects of psychic trauma on a succession of connected individuals will need further interdisciplinary clarification.

Disasters↗