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Operation Shaddock was the name given to the deployment of a major field medical unit of 58 Australian Defence Force medical and other personnel to Vanimo, in northwestern Papua New Guinea. Hundreds of victims of the tsunami disaster were treated and more than 200 surgical procedures performed in a 10-day mission.
House fires are the most common disasters in our society. Disaster theorists acknowledge that complex daily living problems impede the recovery of victims. However, these problems have not been described in detail. The author conducted a qualitative study of the disruption to daily living routines caused by house fires and of the adaptation process victims undertook to reestablish effective patterns of purposeful activity. The data-gathering methods included observation on the scenes of 15 house or tenement fires and in-depth interviews with members of 10 families displaced by fires. Disruption was found to occur in the victims' use of time and comfort in their personal environment. A data analysis revealed a new process of occupational adaptation. The roles of tasks and activities were determined to be important in recovery.
PURPOSE: To evaluate the role of radiologic services in the assessment of injuries and identification of deceased victims of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City, Okla. MATERIALS AND METHODS: In cooperation with the Oklahoma University Health Sciences Center Disaster Studies Group, all victims of the Oklahoma City bombing who were treated in hospitals were evaluated. All radiologic studies performed in these patients during a 4-week period after the bombing were recorded. Major injuries incurred by the victims were noted but were not documented. In addition, assistance provided by radiologic services to the medical examiner's office for identification of deceased victims was assessed. RESULTS: On the day of the bombing, 99% (480 of 485) of the imaging studies performed were either plain radiography, primarily of the extremities and chest, or computed tomography (CT), half of which were of the head. Six deceased victims were identified solely by means of characteristics on radiographs. CONCLUSION: Almost all bombing-related radiologic studies were either plain radiography or CT. Other modalities had only limited roles. In deceased victims, plain radiography aided identification, and in many other victims it allowed localization of materials that were potential pieces of evidence.
The authors evaluated the impact of receiving social support on subsequent levels of perceived social support and psychological distress in 2 independent samples of victims of severe natural disasters: Hurricane Hugo (n = 498) and Hurricane Andrew (n = 404). A social support deterioration deterrence model was proposed that stipulated that postdisaster mobilization of received support counteracts the deterioration in expectations of support often experienced by victims of major life events. LISREL analyses of data collected 12 and 24 months after Hugo and 6 and 28 months after Andrew provided strong evidence for the hypothesized model: Perceived support mediated the long-term effects on distress of both scope of disaster exposure and postdisaster received support. Theoretical and application issues of social support are discussed.
We have not seen the last of natural disasters; nor have we endured the last of the terrorist acts. This article offers clinical guidance in providing mental health services to families in the aftermath of such events. The trauma experienced by an individual victimized by a natural disaster or terror attack reverberates through an entire family. Although based in established clinical practice, intervention with survivors of disasters is a different process from other treatments. A case illustrates the key principles and central methods of family therapy with a traumatized family.
In the aftermath of the Lockerbie air disaster, identification of the victims (plane occupants and local residents) was established by two primary methods: odontology and dactylography. Scottish law requires corroboration of evidence of identity, so both primary methods were used whenever possible, with further evidence occasionally derived from the matching of physical characteristics, personal effects and details from past medical records. Of the 270 victims, 253 were positively identified. Of these, 209 were identified with the aid of odontology.
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Cooperation between Scandinavian Victim Identification Commissions was tested thoroughly after the ship disaster at Easter 1990. The fire claimed 158 victims all killed by poisonous smoke from a fast spreading fire, which went on for 36 hours. Many of the bodies were found incinerated in burnt-out cabins. More than 100 specialists were at work for 17 days before all missing persons were identified. The whole operation was led by the Norwegian authorities in Oslo. They decided that a search for human remains should be attempted in the destroyed part of the ship by help of police technicians, forensic pathologists and forensic dentists. The placing of forensic and dental expertise at the site of the disaster made it possible to identify all victims of the fire. Eighteen forensic trained dentists supported the work: thirteen from Norway, four from Denmark and one from Iceland. Two of the Danish dentists were placed at police headquarters in Copenhagen preparing the antemortem data from the Danish passengers on the ship.
A bioinformatic tool was developed to assist with the victim identification initiative that followed the Swissair Flight 111 disaster. Making use of short tandem repeat (STR) DNA typing data generated with AmpFlSTR Profiler Plus (PP) and AmpFlSTR COfiler(CO) kits, the software systematically compared each available STR genotype with every other genotype. The matching algorithm was based on the search for: (i) direct matches to genotypes derived from personal effects; and (ii) potential kinship associations between victims and next-of-kin, as measured by allele sharing at individual loci. The software greatly assisted parentage analysis by enabling kinship evaluation in situations where complete parentage trios were unavailable and, in some situations, with distantly related relatives. Exclusion of fortuitous kinship associations (FKA) was made possible through the recovery at the disaster site of at least one remains for every sought-after victim, and was incorporated into the kinship software. The data from the 13 combined STR loci produced 6 and 23 times fewer FKAs when compared with PP alone and AmpFlSTR Profiler (PR) alone, respectively. Identification leads or confirmations of identification were obtained for 218 victims for which DNA reference samples (personal effects and kin) had been submitted. Confirmation of an inferred kinship association was sought through frequency and likelihood calculations, as well as corroborative data from other identification modalities. The use of a simple, yet powerful, automated genotype comparison approach and the use of megaplexes with high power of discrimination (PD) values extended considerably the identification capabilities in the case of the Swissair disaster. The DNA typing identification modality proved to be a valuable component of the large arsenal of identification tools deployed in the aftermath of this disaster.
BACKGROUND: Detailed analyses on crush syndrome resulting from earthquakes is scarce. This study aimed to analyze the effect of gender on clinical course of the renal victims of the catastrophic Marmara earthquake that struck Northwestern Turkey in 1999. METHODS: Questionnaires were prepared within the first week of disaster and sent to 35 reference hospitals that treated the victims. Relationship between gender and various epidemiological, clinical, laboratory parameters, treatment modalities and outcome was then investigated. RESULTS: Of the 639 victims with renal dysfunction, 348 (54%) were males and 291 (46%) females. Mean age was 33 +/- 14 and 31 +/- 15 years in the male and female victims, respectively. At admission, males were characterized by a higher hematocrit and higher serum levels of creatinine, BUN, potassium and phosphorus, while other clinical and laboratory parameters as well as the number of fasciotomized and amputated extremities did not differ between the two genders. Males suffered from longer periods of oliguria, higher rates of sepsis and hypertension. 77.3% of the male patients needed dialysis support as compared to 71.5% in the females. The number of hemodialysis sessions and days for dialysis support were higher in the males. Last serum creatinine before discharge from the nephrology clinics was higher in male victims, while mortality rates were similar in both genders. CONCLUSION: Although males are characterized by more severe laboratory abnormalities of rhabdomyolysis, more frequently suffer from sepsis and need more intensive dialysis support, gender is not a prognostic indicator of final outcome in the renal victims of disasters.
Among 396 female flood victims participating in a five-year post-disaster survey, 31 cases were identified who developed hypertension during that time period. A case-control study of hypertension was carried out utilizing age and ponderal index as matching criteria. The purpose of the study was to assess risk factors for hypertension associated with the early recovery period. Pairwise matching yielded 29 case-control pairs for analysis. Such factors as property loss, financial difficulties, physical work, use of alcohol, and perceived distress--all associated with the recovery period--were significantly associated with hypertension. Two mental health dimensions--somatization and anxiety--and the respondent's perceived effect of the flood on health assessed at the time of the survey also demonstrated significant positive correlations with hypertension.
Life stress has been related to hypertension in various studies, but well-designed research carried out in disaster settings is scarce. Moreover, most research focuses on the primary victims and disregards effects on their caregivers. In a prospective, population-based cohort study, the authors tested the hypothesis that parents of adolescents who had been involved in the Volendam, Netherlands, pub fire on January 1, 2001 (n = 418) were more at risk of developing hypertension than parents from the same community whose children had not been involved in the fire (n = 1,462). Only residents without prior evidence of hypertension were included. The follow-up period covered 4 years (2001-2004). Assessment of hypertension was based on the records of family practitioners and pharmacies. The odds of developing new hypertension were 1.48 times higher in parents of fire victims than in control parents during the follow-up period (odds ratio = 1.48, 95% confidence interval: 1.09, 2.02). All analyses controlled for age, gender, socioeconomic status, family practice, history of chronic disease, and number of contacts with the family practitioner during follow-up. Since hypertension is an important risk factor for cardiovascular morbidity, it is important to provide interventions that help people fight the negative effects of disaster-related stress.
The results of dental identification in ten mass disasters, in which British forensic odontologists undertook the dental identification procedures, are reported. These ten disasters indicate the difficulties associated with this method and draw attention to the need for national dental associations to deal with the problem of inadequate dental records and unmarked dentures. It is suggested that, through the FDI World Dental Federation, each member country should appoint dentists, responsible for providing advice and assistance, to forensic odontologists in other countries, when nationals of the country are victims of an international disaster.
This article attempts to convey a human 'feel' for the refugee and the helper, without being oppressively expert or conveying pity. It explores differences and similarities between post-traumatic stress disorder and surviving and coping capacities, leading to an argument against biased use of western forms of psychological help and a plea for fitting in with local cultural patterns for coping with disaster. The difference between 'victim' and 'survivor' is emphasized and the problems of gratitude and envy in both helped and helper considered. In FYR Macedonia deskilled professionals became their own 'experts' as they responded imaginatively to the refugees on their doorstep. They wanted professional support, literature, supervision, consultancy and friendship, but not to be told 'how to do it'. The concept of 'resilience' is examined. Some children survive the disaster others do not. The latter suffer as refugees, whilst those initially terrified benefit from the security and predictability of camp life. An attempt is made to acknowledge normal coping capacities and allow for cultural differences in ways of coping, and so to emphasize survival rather than collapse or victimisation, while not denying the pain, terror, boredom, and frustration of being a refugee. This may lead to mental breakdown, PTSD, pathological grieving, but it does not automatically do so. There is no panacea of 'treatment', but it is essential to support and enable survivors.
Identification of and investigation into the cause of death of foreign nationals in mass disasters are generally conducted according to the jurisdiction of the country in which the disaster occurs. However, such identification can be achieved only through co-operation with the authorities of the victims' countries of residence. On October 8th 2001 at Linate airport in Milan, Italy, an MD87 SAS airplane with 110 crew members and passengers on board collided on the ground with a Cessna Citation II jet with 2 pilots and 2 passengers. The plane then caught fire after having crashed into an airport baggage hangar causing the death of 4 other victims among the groundstaff. The accident claimed a total of 118 victims of 9 nationalities. Based on our experience from investigation of the Finnish victims, we explore how current national legislations of the EU member states and varying compliance with existing recommendations may influence the medico-legal investigation of a mass disaster. Legislative measures and further harmonisation of medico-legal procedures in connection with mass disasters within the EU are needed.
When a major disaster occurs in which there are a large number of fatalities, many tasks have to be undertaken in a very short time and under great pressure. By considering in advance the potential difficulties which may be encountered it is possible to plan ways of overcoming, or at least minimizing, some of these problems. In this paper we have ventilated some of the problems concerning the certification and disposal of the victims of a major disaster, as seen from the pathologist's point of view.
Many agents that are encountered daily are liable to cause burns mass disasters. These include flames, hot water and steam, combustible gases and liquids, molten liquids, boiling liquid expanding vapour explosion, chemicals and explosives. They result in disaster when certain lacks in safety occur. The proper management of such burns victims begins with rescue. At the disaster site, triage is important to separate the living from the dead, decide on priorisation for initial treatment and then evacuation to an appropriate facility. Proper management requires team effort and should be continued en-route to hospital. Repeat triage and use of clear guidelines in the Emergency Department ensure optimal and rapid care of the casualties. Finally psychological support for victims, relatives, rescuers and health workers must not be forgotten.