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PubMed2007

European survey on training objectives in disaster medicine.

OBJECTIVES: As part of the I SEE (Interactive Simulation Exercise for Emergencies) project, financially supported by the Leonardo da Vinci Programme 2000-2006 of the European Commission, a study was planned to assess the type of disaster and to establish the tasks to be included in an emergency exercise to be developed, according to the possible target groups, physicians, nurses, ambulance personnel, dispatchers and first responders. A secondary objective was a description of the actual computer-based training situation in the training centres. A study involving different actors or target groups has not yet been conducted. METHODS: A questionnaire was developed, validated and subsequently distributed to the training centres for the different target groups in the partner countries. Each partner had to contact and interview the person responsible for the training in disaster medicine in the training institution. Data entry and analysis was carried out using the SPSS software on Apple Macintosh. Apart from descriptive statistics of the variables, differences between groups were analysed using analysis of variance and the Kruskal-Wallis test. RESULTS: In 75 questionnaires out of a total of 206, the combination of a major road traffic accident and a chemical accident was indicated as the first choice (36.4%). These priorities were present for the different countries and all target groups. Concerning the medical procedures to be included in the training exercise, the highest priority was given to medical coordination, medical management on site, medical alert procedures, assessment of immediate needs, medical resources management, victim transport and protection and safety procedures. Only minor differences were noted between countries, different target groups and the institutions irrespective of whether they are involved in response in case of a major accident or disaster. With regard to the secondary objective, 27% of the institutions used computer-based training in disaster medicine and, of those not using computer-based training, 23% plan its use in the near future. CONCLUSIONS: The European centres surveyed, put the emphasis for disaster medicine training on a mass casualty scenario. In accordance with this choice, prehospital aspects of medical care and management were considered as priorities for training. The I SEE project will develop a template and pilot exercise, serving all countries and providing team training. Among the institutions involved in the survey, a limited number will be invited to participate in the formative evaluation of the pilot exercise.

Computer-Assisted Instruction↗
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↗
PubMed2005

An analysis of the causes and circumstances of flood disaster deaths.

The objective of this paper is to investigate and to improve understanding of the causes and circumstances of flood disaster deaths. A standardised method of classifying flood deaths is proposed and the difficulties associated with comparing and assessing existing information on flood deaths are discussed. Thirteen flood cases from Europe and the United States, resulting in 247 flood disaster fatalities, were analysed and taken as indicative of flood disaster deaths. Approximately two-thirds of the deaths occurred through drowning. Thus, a substantial number of flood disaster fatalities are not related to drowning. Furthermore, males are highly vulnerable to dying in floods and unnecessary risk-taking behaviour contributes significantly to flood disaster deaths. Based on these results, recommendations are made to prevent loss of life in floods. To provide a more solid basis for the formulation of prevention strategies, better systematic recording of flood fatalities is suggested, especially those caused by different types of floods in all countries.

Adolescent↗
PubMed1998

The Tokyo subway sarin attack: disaster management, Part 3: National and international responses.

The authors report the national and international responses to the disaster produced by the Tokyo subway sarin attack. From a worldwide historical perspective, there had never been such a large-scale disaster caused by nerve gas during peacetime. Therefore, this event should be studied from various viewpoints in cooperation with members of the international community. To this end, the Japanese government should help coordinate a large-scale and detailed investigation of the Tokyo subway sarin attack, including the long-term effects of sarin. The authors also recommend that the Japanese Self Defense Forces should be used more effectively in large-scale disasters. The system of direct control of disaster management by the Japanese government could be useful in a large-scale disaster.

Disaster Planning↗
PubMed2004

Psychological, musculoskeletal, and respiratory problems and sickness absence before and after involvement in a disaster: a longitudinal study among rescue workers.

BACKGROUND: On 13 May 2000 a firework depot situated in a residential area in the Netherlands exploded. Many rescue workers were involved in the aftermath of this explosion. AIMS: To examine the longitudinal course of psychological, musculoskeletal, and respiratory problems and sickness absence among rescue workers involved. METHODS: The study population was composed of 1036 rescue workers. Data on health and sickness absence both before and after the disaster were collected from the electronic database of the rescue workers' occupational physicians. Health problems were coded according to an adapted version of the ICD-10. RESULTS: After the disaster a long term increase was found in psychological, musculoskeletal, and respiratory problems. Compared to six months before the disaster, the average length of sickness absence in the first half year after the disaster increased from 6.6 to 11.6 days, and decreased slowly in the following six month periods. CONCLUSIONS: Rescue workers involved in a disaster may experience subsequent impairment in occupational functioning.

Absenteeism↗
PubMed2003

Peritraumatic reactions associated with the World Trade Center disaster.

OBJECTIVE: The World Trade Center disaster was of unprecedented magnitude and impact in U.S. history. The authors conducted a pilot survey investigating these effects. METHOD: A questionnaire regarding the disaster was sent to responders to an advertisement. It included demographic and disaster-exposure questions and three scales applied to "during and shortly after" the disaster. RESULTS: Despite widely ranging exposure, scores for distress (Peritraumatic Distress Inventory), dissociation (Peritraumatic Dissociative Experiences Questionnaire), and posttraumatic stress (Impact of Event Scale-Revised) were markedly elevated (N=75). After covariance for exposure, the distress factor of loss of control most strongly predicted both early dissociation and posttraumatic stress. Life threat specifically contributed to arousal. Dissociation did not contribute beyond distress to posttraumatic stress, with the exception of re-experiencing. CONCLUSIONS: This survey of reactions to the World Trade Center disaster revealed high levels of early symptoms and suggested similar but independent pathways toward dissociation and posttraumatic stress.

Adult↗
PubMed1987

Mental health responses in a decade of disasters: Australia, 1974-1983.

Between 1974 and 1983, Australia experienced the Darwin cyclone, the Granville rail disaster, and the Ash Wednesday bush-fires, each of which killed more than 60 people and caused significant emotional distress. Mental health response systems developed in the wake of the disasters varied in their level of sophistication and degree of acceptance, but they generally became better orchestrated and appreciated with each disaster. Lessons learned from research and review following one disaster were often applied in responding to the next. Research and review were particularly crucial in uncovering the presence of significant morbidity, including posttraumatic stress disorder, among relief workers and children and in highlighting the need for coordination of mental health services with other relief efforts. Many jurisdictions in Australia have since modified their disaster relief plans to include mental health services.

Australia↗
PubMed1991

Technological disasters--towards a preventive strategy: a review.

Technological or man-made disasters are a growth industry. Widely publicized industrial disasters like those in Bhopal and Chernobyl are only the tip of the iceberg of human and environmental risk from technological development. Other less well publicized disasters, including the contamination of food, water and air, have affected millions of people. The 'slow' technological disasters - like air pollution, pesticides, radiation, lead, asbestos and other industrial hazards - also compromise human intellectual, behavioural and physical development. Although it can be argued that there are hazards attached to virtually every industrial activity and that it is almost impossible to remove completely the risk of technological disasters, it is possible to reduce this risk by decentralizing or deconcentrating knowledge on technological processes. Global recommendations may provide a framework for priority action, but they are obviously not applicable everywhere with the same intensity. A measurement-based approach is described that is beginning to have an effect in several developing countries.

Accidents, Occupational↗
PubMed2004

It could have been me: vicarious victims and disaster-focused distress.

College students who had experienced no personal bereavement in the September 11 terrorist attacks completed questionnaires between 3 and 5 weeks after the attacks and 5 months later. Cross-sectional and longitudinal structural equation model (SEM) analyses revealed that general distress and disaster-focused distress are discernable reactions following a collective loss. Both types of distress were higher among women and by those reporting social strain. General distress was associated with previous stressful events and mental health issues. Perceived similarity to the victims predicted disaster-focused distress and mediated the relationship between attending to media accounts of victims and disaster-focused distress. Only the disaster-focused distress reactions of survivor guilt and grief were associated with collective helping behaviors after the attacks and, for women, these behaviors were associated with greater reductions in these distress reactions over time. Discussion focuses on the importance of examining disaster-focused distress reactions following collective loss.

Adolescent↗
PubMed2002

Survivors of the Piper Alpha oil platform disaster: long-term follow-up study.

BACKGROUND: The long-term psychological effects of surviving a major disaster are poorly understood. We undertook a survey of survivors of the Piper Alpha oil platform disaster (1988). AIMS: To examine the role of factors relating to the trauma, the survivors and the survivors' circumstances. METHOD: Ten years after the disaster, 78% (46/59) of the survivors were located, of whom 72% (33/46) agreed to be interviewed. A further three individuals completed postal measures. RESULTS: The most stringent diagnostic criteria for post-traumatic stress disorder (PTSD) were met by 21% (7/33) of the survivors over 10 years after the disaster. Features such as physical injury, personal experience and survivor guilt were associated with significantly higher levels of post-traumatic symptoms. CONCLUSIONS: A narrow definition of factors affecting outcome will limit the potential for improving survivor well-being in the long-term after major disasters. Specific symptoms that are not included in the criteria for the diagnosis of PTSD, together with issues such as re-employment, need to be addressed.

Accidents, Occupational↗
PubMed2005

Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media.

For decades, after nearly every natural disaster, fear of disease has encouraged communities, local authorities, and governments to rapidly dispose of the bodies of the victims without first identifying them. In May 2004 this journal published the first-ever review article to comprehensively assess the scientific evidence on the infectious disease risks of dead bodies following natural disasters, along with an editorial commenting on the persistence of myths concerning the dangers allegedly posed by dead bodies. This paper assesses the impact that the review article and the editorial have had on the way that health risks from dead bodies have been reported by the media over the following year, especially focusing on the South Asian tsunami disaster of December 2004. While some media outlets have reported erroneous information, hundreds of other news stories have accurately reported that dead bodies pose no public health risk, and have explained the priority for properly identifying the deceased. Nevertheless, publication of scientific evidence alone is insufficient to bring about public health action. International agencies need to continue their work on producing standards, guidelines, and practical guidance on managing dead bodies. There needs to be a community-centered approach to informing communities about the management of the dead following disasters and the rights of individuals to be treated respectfully after death. Nongovernmental organizations should be encouraged to provide expertise and technical support in identifying and burying large numbers of dead. There also needs to be ongoing assessment of the technical processes involved in the recovery, identification, and disposal of dead bodies, as well as the effectiveness of disaster preparedness plans and communication with the affected population.

Attitude to Death↗
PubMedDate not supplied

Response of the elderly to disaster: an age-stratified analysis.

This article analyzes the effects of chronological age of disaster victims on their responses to stress effects of natural disasters. Previous research is reviewed and major findings of that research are noted. Findings regarding disaster losses, physical impacts, aid utilization patterns, kinship relations, relative deprivation, social-psychological impacts, neglect of elderly disaster victims, and differential recovery rates by age are retested on new data. Data described herein were gathered using survey techniques in two disaster stricken communities in Texas. Elderly victims' responses to the tornadoes are compared to a nonelderly (under sixty years of age) group to assess differences. Findings of previous research were, in many instances, supported although certain divergences between the current findings and preceding findings are noted, particularly in rates of recovery.

Adult↗
PubMed1987

Family functioning and overprotection following a natural disaster: the longitudinal effects of post-traumatic morbidity.

The longitudinal impact of a natural disaster on the patterns of interaction in families with latency-aged children is examined. An 11-item questionnaire was developed and two factors were isolated: irritable distress and involvement. A group of 183 disaster-affected families were contrasted with 497 families who had not been exposed to the disaster. Eight months after the disaster, the interaction in the disaster-affected families was characterised by increased levels of conflict, irritability and withdrawal. Maternal overprotection was also a common feature of the pattern of care in these families. Post-traumatic morbidity in parents was the major determinant of the observed changes in family functioning and the overprotection.

Child↗
PubMed1997

Preparedness for medical rehabilitation of casualties in disaster situations.

Natural and man-made disasters produce large numbers of severely and multiply injured casualties, many of whom survive with severe impairments that require comprehensive and protracted rehabilitation (brain and spinal cord damage, peripheral nerve injuries, amputations). In a disaster situation, even adequately developed rehabilitation services are unable to provide care to the large number of casualties, without advance planning and preparation. Such planning has to consider expansion of available rehabilitation institutions and conversion of other facilities into settings for rehabilitation, and integrating all into a rehabilitation referral system consisting of levels of care. It should further consider strengthening community service for the provision of continuity of rehabilitation care and the preparation of guidelines for adequate management of various categories of disablements at various levels. The paper offers guidance to those in disaster-prone areas, or in anticipation of a disaster, who might wish to undertake the planning, as well as to those who need to organize available services or to set up new ones, once the disaster has occurred.

Disaster Planning↗
PubMed2004

Identity, place, and bystander intervention: social categories and helping after natural disasters.

The authors developed a Self-Categorization Theory (SCT) approach to bystander behavior. Participants were 100 undergraduates at an English university. The authors made either a European or a British identity salient. Participants then rated their likelihood of offering both financial and political help after natural disasters in Europe and South America. When European (but not British) identity was salient, participants were less likely to offer help for disasters in South America than Europe. They were also more likely to offer financial help after disasters in Europe when European non-British identity was salient. There were no differences in levels of emotional response to disasters by identity salience. Results indicate that social category relations rather than geographical proximity or emotional reaction are most important in increasing helping behavior after natural disasters.

Adult↗
PubMed1992

The professional's psychological response in disaster: implications for practice.

1. Victims typically experience recurring and distressing thoughts about a disaster and attempt to avoid thoughts and behavior associated with the event. As one works through the stressful event, the victim vacillates between intrusion and avoidance, with the magnitude of those oscillations being much stronger at first. 2. Although health-care workers may respond effectively following a disaster, they are not immune to its stresses. They must attend to the victims, regardless of their own needs, taxing even the toughest of the tough. 3. A crisis team should be established to work with the staff before disaster strikes, to be highly visible during a disaster to maintain staff support and emotional stability. They should take an active role in organizing and conducting mandatory debriefing sessions after a disaster to ward off traumatic effects.

Adaptation, Psychological↗
PubMed2003

Psychological effects of technological/human-caused environmental disasters: examination of the Navajo and uranium.

Disasters can be defined as catastrophic events that challenge the normal range of human coping ability. The technological/human-caused disaster, a classification of interest in this article, is attributable to human error or misjudgment. Lower socioeconomic status and race intersect in the heightened risk for technological/human-caused disasters among people of color. The experience of the Navajo with the uranium industry is argued to specifically be this type of a disaster with associated long-standing psychological impacts. The history of the Navajo with uranium mining and milling is reviewed with a discussion of the arduous efforts for compensation. The psychological impacts of this long-standing disaster among the Navajo are organized around major themes of: (a) human losses and bereavement, (b) environmental losses and contamination, (c) feelings of betrayal by government and mining and milling companies, (d) fears about current and future effects, (e) prolonged duration of psychological effects, (f) anxiety and depression, and (g) complicating factors of poverty and racism. The paper concludes with suggestions for culturally-appropriate education and intervention.

Anxiety↗
PubMedDate not supplied

Primary health care in war and disaster and the NorAid system.

When the infrastructure in a community is destroyed by manmade or natural disaster, even the simplest health services may be difficult to maintain. By the Alma Ata declaration, the World Health Organization (WHO) proclaimed, "Health for all by the year 2000." The program is designed to cover the basic health needs as defined by the Primary Health Care (PHC) system. Therefore, a most important issue in a disaster, is to support, maintain, and rebuild the PHC system, to secure the population's basic health services. Relevant and rapid aid is of great importance in disaster. The physical and psychological strain caused by disaster will increase the need for medical care compared to that during normal times. Child mortality and maternal complications will rise, Many of the 12 million children, who die every year, die as a result of war, refugee conditions, and/or other types of disaster. The NorAid system is equipment composed to provide PHC, with special emphasis on vulnerable groups e.g., women and children. Provided the medical skills are available, it also may function as a hospital. The system already has been used in many countries, and has been found to be relevant, practical, and relatively cheap compared to the benefits achieved.

Adolescent↗