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PubMedDate not supplied

Quality management tool for mass casualty emergency responses and disasters.

INTRODUCTION AND BACKGROUND: Quality management (QM) principles generally have not been applied to multi-casualty and disaster situations. Quality management incorporates quality assurance (QA) and quality improvement (QI) supported by a management information system (MIS). Since responders to disasters and multi-casualty incidents generally operate on standing orders and/or protocols, the character of the responses lends itself to quality management methods. Standards and indicators of performance readily can be developed for these situations. OBJECTIVES: 1) to format disaster medical records as data collection instruments; 2) to develop appropriate tools that are easy to use for rapid assessments; 3) to develop a mechanism for determination of causes of injuries; and 4) to develop methods to: a) track patients; b) document response and recovery; and c) document the circumstances associated with the event. METHODS: Model tools using checklists and short, fill-in answers are provided. These tools are designed to be incorporated into the trauma or EMS registries. Emergency medical technicians, nurses, physicians, and medical students scored the same disaster scenario for the functional areas of calling the state of the disaster, triage, and field stabilization. RESULTS: Testing indicated that the checklists are completed in less than one minute, and produce objective data per patient in each functional area evaluated. In one instance, data were compiled for 38 patients from one bus accident in less than 10 minutes. The same data were reproduced, without variation, in the same amount of time, by three different providers of varied professional backgrounds.

Data Collection↗

PubMed1999

[The role of the veterinarian during natural disasters].

After a reminder of the main types of natural hazards that can lead to genuine disasters, the author examines the impact of such disasters on animal health. The conceptual approach to various groups of animals in a disaster situation is explained, as well as the direct and indirect effects of such disasters. Preparatory measures are presented within the general framework of prevention and forecasting, together with the veterinary measures to be implemented. Training of veterinarians and planning of activities are described in detail. A traditional approach to organising large-scale assistance is advocated, based on the competence of the personnel involved and a predefined hierarchical organisation. The author then describes veterinary actions to be taken in a disaster situation where emergency aid is required. Particular reference is made to providing assistance to save human lives, including search operations by dog teams for buried victims, and the subsequent phase of restoring human activities, during which assistance to animals is taken into account. Inter-ministerial co-ordination using crisis units and priority management implying real political choices are discussed. Finally, based on the example of the operational organisation of the French Civil Defence, the author describes the support available to Veterinary Services and the potential involvement of the profession, in particular veterinary officers attached to the emergency fire service.

Animals↗

PubMedDate not supplied

Risk factors, prevention and prophylaxis of dog bites for disaster response personnel in the United States.

It commonly is rumored that in large scale disasters, packs of dogs present a human health hazard because of dog bites. However, it is likely that factors other than pack behavior comprise greater risk factors for dog bites in disaster-response personnel. Important risk factors include: 1) the density of the human population, which in turn, determines the number of dogs at a disaster site; 2) territorial behavior of dogs at their site of residence, which determines the frequency with which dogs may bite; and 3) whether rabies is present at endemic or epidemic levels within the area in which the disaster is occurring, which determines the likelihood of fatal outcomes. Persons bitten by a dog should seek medical attention as contraction of rabies may result in a fatal outcome from a dog bite. It is recommended that disaster response personnel obtain pre-exposure vaccination against rabies. Vaccinated or not, they immediately should seek post-exposure treatment for rabies following potential exposure.

Animals↗

PubMed2000

The long-term psychological effects of a disaster experienced in adolescence: I: The incidence and course of PTSD.

Previous studies have shown that children and adolescents exposed to traumatic experience in a disaster can suffer from high levels of post-traumatic stress. The present paper is the first a series reporting on the long-term follow-up of a group of young adults who as teenagers had survived a shipping disaster-the sinking of the "Jupiter" in Greek waters-between 5 and 8 years previously. The general methodology of the follow-up study as a whole is described, and the incidence and long-term course of Post-Traumatic Stress Disorder (PTSD). It is the first study of its kind on a relatively large, representative sample of survivors, using a standardised diagnostic interview, and comparing survivors with a community control group. Survivors of the Jupiter disaster (N = 217), and 87 young people as controls, were interviewed using the Clinician Administered PTSD Scale (CAPS). Of the 217 survivors, 111 (51.7%) had developed PTSD at some time during the follow-up period, compared with an incidence in the control group of 3.4 % (N = 87). In the large majority of cases of PTSD in the survivors for whom time of onset was recorded, 90 % (N = 110), onset was not delayed, being within 6 months of the disaster. About a third of those survivors who developed PTSD (30%, N = 111) recovered within a year of onset, through another third (34 %, N = 111) were still suffering from the disorder at the time of follow-up, between 5 and 8 years after the disaster. Issues relating to the generalisability of these findings are discussed.

Adolescent↗

PubMed2001

[Disaster medicine: lessons from Enschede and Volendam].

Two major disasters hit the Netherlands recently: on May 13th 2000, a local fireworks depot exploded in the middle of the city of Enschede and on New Year's Eve 2001, fire destroyed a pub full of people in Volendam. Lessons from the involvement of medical services in these disasters include: disaster medicine must be seen as an extension of emergency care. Hospital staff should be familiar with the procedures in case of a disaster, and regular practice on a regular basis is mandatory. Logistics, as well as individual care of the victims, differ in detail from everyday practice, notably during the first hour following the disaster. Attention should be paid to the provision of psychological aftercare soon after the event for the victims and their families, as well as for health care workers.

Disaster Planning↗

PubMedDate not supplied

[Disasters and public health: an approach from the theoretical framework of epidemiology].

Throughout the 1990-2000 period, disasters (catastrophes) caused an average of 75,000 deaths yearly, injuring an average of 256 million people a year and causing economic losses totaling more than 650 billion euros. The magnitude of this problem, its impact on public health and on the degree of development of the populations involved are of such major importance as to warrant special interest from the public health standpoint, especially as a result of what are known as complex emergencies. The objective of this study is that of reviewing the definitions, the main concepts and the basic characteristics of disaster epidemiology. An analysis is also made of the risk factors involved in disasters, the impacts on public health of the main types of disasters and the main preventive strategies in terms of the different stages of the disaster cycle.

Disasters↗

PubMed2002

Ready or not, disasters happen.

The New York State Nurses Association was--as was the entire country--plunged into disaster response mode by 9:30 am on the morning of Tuesday, September 11, 2001. Although the association had engaged in limited disaster planning prior to this event, that planning was in terms of an internal disaster such as a fire in our headquarters building. There was no plan for responding to a community catastrophe of the magnitude being experienced. The association faced unique challenges--including the fact that our New York City offices are located near ground zero--but was fortunate in having expert resource persons on staff and available to organize a response. Since September, the association has applied the lessons learned from this experience and developed a comprehensive disaster plan for the future. The purpose of this article is to share those lessons learned with the community of nursing associations in the hope that others can use the information to build effective disaster plans of their own.

American Nurses' Association↗

PubMed1976

Planning an airport disaster drill.

The authors have prepared this paper to serve as a guide for planning airport disaster drills, particularly at the major air carrier airports. Their recommendations are subject to change according to the needs of the individual airport and the particular circumstances that may be present. Basically, the recommendations are founded on the experience gained by participation in planning and carrying out five separate emergency or disaster drills (Oakland International Airport 1, San Francisco International Airport 2, Los Angeles International Airport 2). The authors also have been involved in a total of three additional disaster drills in California and have been involved in one way or another in an additional 19 airport disaster drills throughout the United States. The presentation is divided into segments according to activity. However, it should be noted that there is a cohesiveness necessary for disaster planning if the drill is to be successful.

Aerospace Medicine↗

PubMed2003

Radiation disasters and children.

The special medical needs of children make it essential that pediatricians be prepared for radiation disasters, including 1) the detonation of a nuclear weapon; 2) a nuclear power plant event that unleashes a radioactive cloud; and 3) the dispersal of radionuclides by conventional explosive or the crash of a transport vehicle. Any of these events could occur unintentionally or as an act of terrorism. Nuclear facilities (eg, power plants, fuel processing centers, and food irradiation facilities) are often located in highly populated areas, and as they age, the risk of mechanical failure increases. The short- and long-term consequences of a radiation disaster are significantly greater in children for several reasons. First, children have a disproportionately higher minute ventilation, leading to greater internal exposure to radioactive gases. Children have a significantly greater risk of developing cancer even when they are exposed to radiation in utero. Finally, children and the parents of young children are more likely than are adults to develop enduring psychologic injury after a radiation disaster. The pediatrician has a critical role in planning for radiation disasters. For example, potassium iodide is of proven value for thyroid protection but must be given before or soon after exposure to radioiodines, requiring its placement in homes, schools, and child care centers. Pediatricians should work with public health authorities to ensure that children receive full consideration in local planning for a radiation disaster.

Child↗

PubMed2003

[Study on hospitalization expenses of flood disaster areas' residents of Dongting Lake in Hunan province in 1998].

OBJECTIVE: To study the expenses of hospitalization among the population in the flood disaster areas of Dongting Lake in Hunan province in 1998. METHODS: Descriptive epidemiologic study were conducted to analyze hospitalization expenses of the residents of 55 villages in flood disaster areas in 1998; single factors analysis and logarithmic linear regression analysis were carried out to explore influencing factors about hospitalization expenses of the residents. RESULTS: The hospitalization rate was 4.59% with an average hospitalization expenses of 667.42 Yuan in the flood disaster areas' residents of Dongting Lake in 1998. Compared with populations without suffering from flood, hospitalization rate and the average hospitalization expenses of flood disaster Areas' residents of Dongting Lake in 1998 were higher and had significant difference. The average hospitalization expenses in 1998 was affected by flood types, family income, gender, age, literacy, occupation, outcome after leaving the hospital and hospital ranks. CONCLUSION: These results implied that the flood disease aggravated inhabitants' burden of disease in Dongting Lake areas; the factors influencing the average hospitalization expenses were multiple, and synthetic measures should be taken in the prevention and control of flood disaster.

Adolescent↗

PubMed2004

Coping with disasters: estimation of additional capacity of the mental health sector to meet extended service demands.

BACKGROUND: The September 11th disaster in New York City resulted in an increase in mental health service delivery as a vast network of providers responded to the urgent needs of those impacted by the tragedy. Estimates of current capacity, potential additional capacity to deliver services and of potential shortfall within the mental health sector are needed pieces of information for planning the responses to future disasters. AIMS OF THE STUDY: Using New York State data, to determine the distribution of clinical service delivery rates among programs and to examine an explanatory model of observed variation; to estimate potential additional capacity in the mental health sector; and to estimate shortfall based on this capacity and data from studies on the need and use of services post September 11th METHODS: Empirical distributions of weekly clinical service delivery rates in programs likely to be used by persons with post disaster mental health problems were obtained from available data. Three regression models were fit to explain rate variation in terms of unmodifiable program characteristics likely to impact the rates. We argue that rates could not be easily increased if any of the models had good explanatory power, and could be increased if it did not. All models had poor fit. We then assumed that the median and 75th percentile of the clinical service delivery rates were candidates for the minimum production capability of a clinician. The service rates of those clinicians whose rates fell below these quartiles were increased to the quartile value to yield estimates of potential additional capacity. These were used along with data on clinical need to estimate shortfall. RESULTS: There is substantial variation in clinical service delivery rates within impact regions and among programs serving different age populations. The estimate of the percent increase in services overall based on the median is 12% and based on the 75th percentile is 27%. Using an estimate of need of.03 suggested by available data, and a range of services (1-10) that might be required in a six month period, shortfall estimates based on the median ranged between 22-92% and for the 75th percentile from no shortfall to 86%. A less conservative estimate of need of.05 produces median shortfall ranging between 59-96% and for the 75th percentile between 10-91%. LIMITATIONS: While the program descriptor variables used in the explanatory model of rates were those most likely to impact rates, explanatory power of the model might have increased if other characteristics that are not modifiable had been included. In this case, the assumption that service production can be increased is called into question. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: In the first six months post September 11th, in New York State (NYS) 250,000 persons received crisis counseling through Project Liberty. In 1999, NYS served approximately that same number in mental health clinic programs during the entire year. The estimates of this study suggest that additional funding and personnel are needed to provide mental health services in the event of a major disaster. IMPLICATIONS FOR HEALTH POLICIES: A disaster plan is needed to coordinate the use of current and additional personnel including mental health resources from other sources and sectors.

Adult↗

PubMedDate not supplied

Disaster recovery for electronic data: are you prepared?

Disasters that affect medical data may come in many forms, but those that can harm sensitive computer information are not necessarily dramatic. Even so, the problems that can arise if data is lost can be severe. This article discusses the issues of how to recover data once an information technology disaster has occurred and how to prevent or guard against disaster. Not all disasters are preventable, but many are. Even if a disaster is not preventable, certain practices in advance can ease the process of recovery.

Computer Security↗

PubMed2005

Medical needs of tsunami disaster refugee camps.

BACKGROUND AND OBJECTIVES: In response to the massive tsunami disaster in South Asia, two Korean medical relief teams provided emergency medical care in the southern coastal area of Sri Lanka. Their findings are reported here to provide a realistic picture of medical needs created by the tsunami disaster and to enable a better-prepared medical response to future disasters of this type. METHODS: All victims of the tsunami in the area of operation of the two medical relief teams were encouraged to receive medical care. Care provided to each victim was documented in individual medical records. All medical records were reviewed and classified by age, gender, and diagnosis. RESULTS: A total of 4,710 people were treated by the two Korean medical relief teams for 9 days of operation in southern Sri Lanka. Respiratory problems were common, but diarrhea was diagnosed in an average of only 4.3 patients per day. Minor skin trauma and wound infection in the extremities were frequent as long as 3 weeks after the disaster. The proportion of skin trauma in relation to total trauma decreased as days elapsed from the disaster. CONCLUSIONS: Because of the provision of adequate quantities of potable water, the likelihood of waterborne diarrhea was low. Acute respiratory problems and chronic problems were prevalent in tsunami refugee camps. Despite concerted international relief efforts, inadequate treatment of minor skin trauma and skin infections was evident.

Age Factors↗

PubMed1991

National medical response to mass disasters in the United States. Are we prepared?

Preparing for a resuscitation response to mass disasters, such as major earthquakes or industrial disasters, requires revisions of present local, regional, and national disaster plans. These should include the following: (1) life-supporting first aid and basic rescue capability of the lay public; (2) advanced trauma life support and advanced (heavy) rescue capability brought quickly to the scene from local and surrounding (regional) emergency medical services systems; and (3) trauma hospitals sending medical resuscitation teams to, and receiving casualties from, the disaster scene for resuscitative surgery and definitive care. Local and regional everyday emergency medical services systems would respond first. The armed forces should help, at least for transport and security. We propose that the National Disaster Medical System replace its civil defense model with an emergency medical services model, designed to mobilize rapid support for local emergency medical services systems from regional, state, and national resources. Coordination should be by one federal agency, such as the Federal Emergency Management Agency, which, however, needs to focus more on resuscitation through physician input.

Disaster Planning↗

PubMed1986

Airport preparedness for mass disaster: a proposed schematic plan.

With the growth in the size of airplanes and the number of flights, the potential impact on airports of airplane-related disasters involving large numbers of people is increasing. Such disasters may result from accidents or terrorist activities. Although the development of plans for coping with such situations is a prerequisite to full certification of airports by the FAA, exercising the plans through disaster drills is only a recommendation. This has resulted in a situation where only a small minority of the fully certified airports are actually ready to handle a major disaster. Presented in this paper is a proposed schematic plan for handling the medical aspects of airport disasters, including a discussion of the relevant background issues.

Accidents, Aviation↗

PubMed1979

Administrative approach to disaster preparedness in the pharmacy.

Disaster planning for a hospital pharmacy department is discussed. During a crisis, the type of behavior exhibited by hospital personnel and the community can be used to predict the situation's severity and to prepare a response. During disasters, it is important to focus on accomplishing tasks by defining employees' roles, establishing chains of communication, delegating authority to competent persons, limiting decision-making by persons other than those in command and defining the boundaries of pharmacy's involvement in the disaster. A case study of pharmacy operations during a crisis is presented, with guidelines for assessing the situation, establishing priorities, identifying resources and executing a response. Hospital pharmacy administrators must display a high degree of creativeness and responsibility during disasters, but training in the principles of disaster management can be helpful.

Behavior↗

PubMed1984

The Ash Wednesday bushfires in South Australia. Implications for planning for future post-disaster services.

Adequate disaster management depends on the incorporation of experience and research findings into future disaster plans. To assist in this process, a series of psychiatric patients examined after the Ash Wednesday bushfires in South Australia are described. The level of handicap experienced was often substantial and interfered with these people's attempts to overcome the losses they experienced in the disaster. Some people had to go to considerable lengths to seek psychiatric help because their general practitioners and bushfire relief workers did not understand the quality of their symptoms and had not arranged referral for them. The types of disorder, the time of presentation and the role played by the disaster in the onset of these disorders are described. The need for an educational and consultative psychiatric service for general practitioners and welfare workers who have contact with disaster victims is discussed.

Adult↗

PubMed1982

Regional disaster planning for hospital pharmacies.

The development of a disaster plan for hospital pharmacy services in Hartford, CT, is described. In June 1978, directors of pharmacy from 12 hospitals in the Hartford, CT, area began a project designed to ensure an uninterrupted supply of drugs and an adequate supply of pharmacy personnel during and after any natural disaster. The project initially involved standardization of components of the individual hospital pharmacies' disaster plans. A questionnaire was then completed by each director of pharmacy regarding hours of operation, telephone numbers, and pharmaceutical products usually stocked (including blood derivatives, radiologic-contrast media, and intravenous solutions). Information on inventory levels was collected later. Pharmaceutical manufactures and wholesalers in the region were contracted, and a list of routine and emergency telephone numbers was compiled. The disaster plan was completed in July 1979. The plan has been tested in a mock catastrophe drill and one natural disaster that caused relatively few injuries.

Connecticut↗