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PubMed1993

Juror stress: identification and intervention.

The impact of stressful life events has been studied extensively in the psychiatric literature. Crisis debriefing techniques have been shown to be effective in decreasing psychiatric morbidity following exposure to these stressful situations. Stress reactions and crisis debriefing have been reported in many groups including combat veterans, survivors of natural disasters and accidents, victims of violence, and law enforcement and emergency personnel who respond to such events. One group that has not been studied extensively is jurors who are exposed to potentially disturbing material introduced as evidence in trials. Stress reactions in jurors and the value of debriefing of juries have been described by us in an earlier work. This paper describes debriefing sessions with three juries exposed to emotionally distressing material during murder trials. In comparing our experiences with these sets of jurors a number of common reactions were identified. These are discussed and a model for jury debriefing is presented.

Adaptation, Psychological↗
PubMed1993

Forensic and legal issues in oral diagnosis.

The forensic odontologist has assumed a more visible role in the last decade, having been called upon repeatedly to assist both law enforcement agencies and the judicial system. It has become quite common for dentists to establish the identity of unknown bodies; to quickly and positively identify the victims of mass disasters such as airliner crashes, floods, and earthquakes; as well as to provide testimony in court concerning bite marks or other matters that require dental expertise. Litigation directed at dental defendants for failure to diagnose, properly treat, or obtain valid consent from plaintiff patients is also on the rise. In each of these fields, dentists who have been specially trained in or who have devoted their practices to the dental diagnostic sciences have been looked to widely as experts. This article discusses in detail these areas and others that affect the dental diagnostician.

Bites, Human↗
PubMed1991

Field management and critical care in mass disasters.

As previously discussed, the majority of injury cases do not necessarily involve dramatic life-saving actions, but rather very rudimentary, promptly applied precautions. For most victims of trauma, therefore, we offer reassurance and simple compassion in their time of need. One of the more important lessons to be learned here is that, beyond prehospital injury "management" or "treatment," we should always remember to provide the best possible prehospital injury care. By responding as soon as possible and by delivering reassurance and compassion to those who are injured and frightened, we are providing one of the most sacred aspects of the Hippocratic mission. Despite wonderful technologic advances and the need for aggressiveness in disaster management, these humanistic values must always be maintained by those to whom care is entrusted. Successful transport of disaster victims, whether in the prehospital phase or during interhospital transfer, requires careful attention to treatment priorities, such as simple measures for airway control and ventilation, and care to prevent further injuries by appropriate immobilization techniques. The use of fully equipped teams of multidisciplinary critical care specialists in mass disaster situations is in its infancy. It is clear that with properly adapted hardware and personnel trained to function in adverse environments while effectively delivering intensive care to a large number of patients with a variety of clinical syndromes, survival can be significantly increased for the most acutely ill.

Burns↗
PubMed1999

It's a disaster: emergency departments' preparation for a chemical incident or disaster.

Nurses in the Accident & Emergency (A&E) Department have a significant role to play in the treatment and resuscitation of victims of a chemical disaster. Chemical disasters are unique because casualties are contaminated. Nursing staff triage casualties and they have direct contact with contaminated patients, before and during decontamination. Consequently they require adequate personal protective equipment and information regarding isolation and decontamination. The use of chemicals has increased since the turn of the century. Hazardous chemical emergencies arise from accidents in production, storage, transportation and the disposal of chemical substances. Their illegal manufacture and use by terrorists makes the likelihood of a chemical disaster with mass casualties in Australia very real. Emergency departments are ill-prepared to deal with this scenario, and very few disaster plans include a comprehensive decontamination component. To achieve an effective response with the best utilisation of resources, it is vital for emergency services personnel and A&E departments to be prepared.

Accidents, Occupational↗
PubMed1998

Posttraumatic stress disorder following an air disaster: a prospective study.

OBJECTIVE: The purpose of this study was to determine predictors of posttraumatic stress disorder (PTSD) in health care workers exposed to a disaster, in order to facilitate early case identification and prevention of subsequent morbidity. METHOD: Following an air disaster, 355 military medical health care workers were studied over an 18-month follow-up period. Measures included assessment of peritraumatic reactions associated with the disaster, the frequency of other stressful events after the disaster, and standard PTSD rating scales at 6, 12, and 18 months. RESULTS: Multivariate logistic regression of data on health care workers who cared for victims of the air disaster showed that PTSD was more likely to develop in those who had not completed college, those who had worked with burn victims, those who had experienced more stressful life events in a period of approximately 6 months following the disaster, and those who experienced emotional numbness immediately after the disaster. CONCLUSIONS: Results suggest that lower levels of education, exposure to grotesque burn injuries, stressful life events following exposure, and feelings of numbness following exposure are useful predictors of subsequent development of PTSD.

Accidents, Aviation↗
PubMed1990

Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults.

In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Controversy and consensus in disaster mental health research.

Controversies regarding the mental health consequences of disasters are rooted both in disciplinary orientations and in the widely varied research strategies that have been employed in disaster mental health studies. However, despite a history of dissensus, there are also key issues on which researchers agree. Disasters constitute stressful and traumatic experiences. However, vulnerability to such experiences, as well as to more chronic stressors, is socially structured, reflecting the influence of socio-economic status and other axes of stratification, including gender, race, and ethnicity. Disaster events differ in the extent to which they generate stress for victims. A holistic perspective on disaster mental health would take into account not only disaster event characteristics, but also social-systemic sources of both acute and chronic stress, secondary and cumulative stressors, and victims internal and external coping capacities.

Disaster Planning↗
PubMed2003

A more rational approach to medical disaster management applied retrospectively to the Enschede fireworks disaster, 13 May 2000.

As in any other medical discipline, developments in disaster medicine have occurred. A model for medical disaster management is briefly discussed and then applied retrospectively to the Enschede fireworks disaster (2000). Differences between the theoretical model and the actual situation are shown with respect to the number of casualties, the average severity of injury sustained, the medical rescue capacity, the medical transport capacity and hospital treatment capacity. It was concluded that the proposed model for the management of disasters with traumatically injured victims worked adequately.

Ambulances↗
PubMed2002

Response to delayed fluid therapy in crush syndrome.

BACKGROUND: Although early treatment is valuable in the prognosis of crush syndrome, the diagnosis and treatment of many victims are inevitably delayed in major disasters. PATIENTS AND METHODS: Among the 38 victims of the Marmara earthquake with crush injury, 27 were diagnosed as crush syndrome on the basis of findings of acute renal failure. Intensive intravenous fluid treatment was started in all patients on admission. Of these 27 patients, 10 required dialysis treatment while 17 did not. The laboratory data on admission were evaluated and compared between the two groups. RESULTS: The mean admission time of 27 patients was 46.5 +/- (SE) 3.08 h. There was no significant difference between the dialysis and the nondialysis groups with regard to patient's age, trapped time or admission time. A significantly higher number of patients had crush injury in more than one extremity in the dialysis group. The dialysis group had significantly lower systolic blood pressure, central venous pressure but a higher heart rate together with higher levels of serum urea nitrogen, creatinine, creatinine kinase, C-reactive protein, fibrinogen on admission compared to the nondialysis group. CONCLUSION: Our results suggest that even delayed application of aggressive specific fluid treatment under close monitoring may prevent the development of established acute renal failure.

Adolescent↗
PubMed1989

The Computer-Assisted Postmortem Identification (CAPMI) system: sorting algorithm improvements.

Refinements to the original Computer-Assisted Postmortem Identification (CAPMI) software algorithms and general data handling were suggested as a result of observations made following the Gander plane crash of 1985. The presence of highly fragmented and scattered remains following most plane crashes suggested that changes to procedure might improve CAPMI performance for use in these types of disasters. A total of 162 ante- and postmortem dental records which had been used successfully to identify victims of the Gander disaster were coded for anonymity and used for this investigation. Changes in data construction and management were made to CAPMI, according to concepts which were thought might improve system performance, and tested. Although most tested techniques improved CAPMI performance, the data suggested that replacement of "virgin" chartings with "data unknown" results in improved performance of CAPMI largely independent of other factors. Of 162 possible record matches, the original algorithm successfully listed the true record match in the top 20 possibilities 74% of the time; the tested variations on the original algorithm yielded results across a range of 38 to 83% successes, with most techniques performing better than the original algorithm. Results of this investigation have been incorporated into improved CAPMI procedures and software.

Accidents, Aviation↗
PubMed1995

Identification of bodies from the scene of a mass disaster using DNA amplification of short tandem repeat (STR) loci.

The accompanying paper in this issue describes work conducted during a collaborative effort to identify the victims of a mass disaster that occurred on the 19th of April 1993 near Waco, Texas. The DNA identification programme was also used partly as an exercise to further investigate the robustness and reliability of a recently developed STR quadruplex. The preceding paper provides details of the loci used and also deals with efforts to assess the applicability of STR profiling and its suitability for forensic investigations of this nature. In this paper, we present the results obtained from 61 Waco bodies. Using reference blood samples and family trees 26 positive identifications were made using a 'paternity style' analytical approach. Worked examples, representing a range of casework situations, are used to illustrate the kind of approach taken in interpretation of the data and highlight factors which affected its success. Additionally, we report on the successful application of a PCR-based gender test to 24 of the Waco bodies.

Child↗
PubMed1991

Psychological impairment in the wake of disaster: the disaster-psychopathology relationship.

The present review examines the relationship between disaster occurrence and psychopathology outcome for 52 studies that used quantitative measures of such a relationship. Descriptive and inferential techniques were used to examine relationships among four sets of variables: (a) the characteristics of the victim population, (b) the characteristics of the disaster, (c) study methodology, and (d) the type of psychopathology. A small but consistently positive relationship between disasters and psychopathology was found. The distribution of effect-size estimates was significantly heterogeneous, and this heterogeneity was partially accounted for by methodological characteristics of the research. When controlling for methodology, victim and disaster characteristics also contributed variance to the disaster-psychopathology relationship. Implications for future research are outlined in view of these results.

Adaptation, Psychological↗
PubMed1988

Some international law aspects of the Bhopal disaster.

This article explores certain international law aspects of the Bhopal disaster, namely the principles and rules of international law establishing international accountability for environmental damage; the criteria for determining the liability of the Union Carbide Company (U. S. A.) for the Bhopal disaster; the criteria for determining compensation; and the international remedies available to the Indian government in the event that Bhopal victims fail to get justice within the Indian court system. The article discusses two applicable sets of proposed international standards--the U. N. Draft Code of Conduct on Transnational Corporations, and the U. N. International Law Commission's Draft on International Liability for Injurious Consequences Arising out of Acts Not Prohibited by International Law. The scattered 'hard' and 'soft' jurisprudence of international environmental law establishes liability and accountability for environmental hazards. It makes both state and non-state entities liable to pay compensation to the victims of environmental pollution. This jurisprudence, in addition to domestic law analogies, can influence Indian courts in determining the amount of damages payable to the victims of the Bhopal disaster. The authors conclude that the Bhopal disaster has demonstrated that enforceable international standards are clearly and urgently needed for hazardous industries, especially those operating in developing countries. Such standards would eliminate, or at least narrow, the gap between standards prevailing in the developed countries and those in the Third World. Even without enforcement, international standards could provide norms for measuring the performance of individual companies engaged in hazardous activities such as the manufacture of MIC at Bhopal.

Accidents, Occupational↗
PubMed2006

One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia.

INTRODUCTION: Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. METHODS: This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). RESULTS: Multiple large flap lacerations (2 x 3 to 60 x 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. CONCLUSION: Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.

Adult↗
PubMed1976

Major disasters: hospital admission procedures.

Triage in the accident and emergency department and the admission of all patients needing further care to one ward can form the basis of the successful hospital management of the victims of a major disaster.

Blast Injuries↗
PubMed2002

PTSD, depression and help-seeking patterns following the Miyake Island volcanic eruption.

Assessing help-seeking patterns following disaster provides useful information about who needs professional help the most, who is willing to seek help, and who is reluctant to seek help. 231 Japanese evacuees from the Miyake Island volcanic eruption (2000) participated in this study (ages 20-93, average age 59.52). Ten months after the evacuation, participants were mailed questionnaires which elicited demographic data, disaster experiences, help-seeking patterns, and psychological symptoms (Post-traumatic stress disorder and depression). Help-seeking patterns were categorized as: professionals (physicians, nurses, psychotherapists/counselors, telephone consultation, social workers, priests and monks, and others); or informal (family, relatives, friends, neighbors, and others) and, (information, advice, tangible, and emotional). The findings indicate that younger and/or female victims frequently sought help from informal sources while male and/or older victims frequently sought help from professionals. Severity of PTSD and depression symptoms were positively correlated with help-seeking from physicians, but not psychologists or mental health professionals. Very high rates of utilizing medical assistance rather than mental health treatment were also identified among these disaster victims, and appeared related to cultural norms regarding shame and self disclosure of emotional distress.

Adult↗