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PubMed2004

[Psychosocial care following the firework disaster in Enschede; the lessons from the Bijlmer airline disaster].

When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.

Accidents, Aviation↗

PubMed1990

[The therapeutic problems of medicine in catastrophes].

There are lack of principle differences between the problems of medical aid during the military and civil disasters, and therefore one can draw a conclusion concerning the validity and necessity of using the experience of military medics in disaster medicine during peace-time. The following aspects are discussed: organization of therapeutic caring of the victims during Chernobyl's AES disaster, earthquake in Armenia and accident in chemical enterprise "Nitrogen" in Jonava. Requirements to the teams for emergency medical service have been formulated with determination of Principles of putting them into practice; the further directions of therapeutic aid improvement are outlined.

Accidents↗

PubMed1999

Care of burns victims in Europe.

There is no detailed information about the care of burns victims, in Europe, in the case of a fire disaster. Several countries have discussed how to treat burn victims, but only a little is known of their capacity to offer space to other countries in the event of a fire disaster outside the country in question. In Europe, most countries are dependent on England, France and Germany in such cases. Since "Los Alfaques", "Ramstein" and other examples of such disasters, we know how important it is to focus more on burn victims in Europe with respect to national and international cooperation.

Adult↗

PubMed1997

The Great Hanshin-Awaji Earthquake and the problems with emergency medical care.

One of the world's largest port cities, Kobe and its vicinity, was hit by a so-called "shallow and direct hit" type earthquake with a magnitude of 7.2 on the Richter scale in the early morning of January 17, 1995. A total of 6308 people were killed and approximately 35,000 people were injured. About 400,000 houses and buildings were more or less damaged, and electricity, water, and city gas supply were suspended in a wide area. Medical facilities were also greatly damaged. The destruction of roads, highways, bridges, and railways made it difficult for people to move within this area. Extraordinary traffic congestion occurred. Telephone lines were disconnected or overloaded. Thus, the modern healthy urban lives that the people had taken for granted were lost in a moment. Emergency responses to the disaster fell behind. Transportation of severely injured patients away from the disaster area to the non-affected area was not smooth because of the interruption of communications and traffic congestion. The scope of the damage from the disaster, types of injuries, characteristics of the victims, problems with emergency medical care encountered in this disaster, and revisions of countermeasures executed after the disaster are reported.

Cause of Death↗

PubMed1999

Anatomical variability of the frontal sinuses and their application in forensic identification.

The uniqueness of anatomical structures and their variations provides the basis for forensic identification of unknown deceased persons. Similar to fingerprints, each frontal sinus is so distinctive and unique that the chances of two individuals having the same morphology of the frontal sinuses is extremely remote. Radiographs, especially the occipitomental view commonly used in the assessment of paranasal pathology, provide excellent records of these sinuses. The case illustrated here is an application of the frontal sinus identification of a victim in a mass disaster.

Forensic Medicine↗

PubMed2002

Patient-centred equipoise and the ethics of randomised controlled trials.

The ethical pre-condition of randomised controlled trials is, at present, the presence of equipoise. This refers to an opinion of the investigator that there is uncertainty as to the merits of the treatments being compared. It is argued that since the decision to enrol is the potential subject's, the investigator's opinion is not ethically relevant. It is proposed instead that equipoise be patient-centred, and that a trial is in equipoise for a patient when enrolling gives them the same chance of a good outcome as not enrolling. It is shown that trial enrolment is normally easily the best strategy for achieving a good outcome, and that trials currently thought to be unethical may be in patient-centred equipoise. This is so for three reasons: (1) patients in trials receive superior care, (2) trial enrolment minimises the risk of being a victim of a therapeutic disaster and (3) health professionals make mistakes, and a 50% chance of receiving the worse treatment until a trial reports is always better than any chance of receiving the worse treatment indefinitely. It is concluded that so long as the standard of professional conduct is the furtherance of patients' objective interests randomised controlled trials are ethical.

Decision Making↗

PubMed1988

Forensic dental training in Australia.

To facilitate in the identification of victims of a major disaster a trained dental manpower reserve is required. In the state of New South Wales, Australia, an annual three-day training course has been designed to familiarize dentists from both the public and private sectors with identification techniques. The course is aimed to preserve the flexibility of personnel so that they can be utilized in a variety of roles rather than rigidly structuring the make up of a team. It is envisaged though, that in a mass disaster situation teams would be specialized into dental autopsy, antemortem or comparison roles.

Disaster Planning↗

PubMed1994

The emergency physician and patient confidentiality: a review.

Confidentiality is a promise rooted in tradition, law, and medical ethics. Emergency physicians treat a variety of patients to whom confidentiality is of vital importance: employees, celebrities, victims of violence or disaster, minors, students, criminals, drug abusers, and patients with STDs. EDs should develop methods of ensuring confidentiality for all patients. Although confidentiality is an important principle that should be respected and guarded, it is not absolute. Various laws mandate disclosure of certain patient information; in addition, an overriding moral duty may occasionally require a breach of confidentiality. As Beauchamp and Childress noted, "the therapeutic role may sometimes have to yield to one's role as citizen and as protector of the interests of others." In general, however, circumstances requiring a breach of confidentiality are rare.

Adult↗

PubMed2000

The April 8, 1998 tornado: assessment of the trauma system response and the resulting injuries.

BACKGROUND: On April 8, 1998, an F5 tornado touched down in two counties of Alabama producing a wide path of destruction. The presence of a regional trauma system in this area presents an opportunity to evaluate the effectiveness of the system in responding to the victims of this natural disaster. METHODS: Emergency room logs and the regional trauma system database were searched for all patients treated for injuries sustained from the tornado, and medical records were reviewed for demographic information, mode of transportation to hospital, injuries, treatment, and outcome. Fatalities were identified by means of the coroner's office. RESULTS: A total of 224 patients were evaluated at nine area hospitals, of whom 63 (28%) required admission. There were 32 deaths: 30 persons were dead at the scene, and 2 patients subsequently died at Level I trauma centers. Among patients with nonfatal injuries, 39% were managed at Level I facilities, 46% at Level III facilities, and 15% at nontrauma facilities. Forty patients (55%) seen at Level I facilities required admission compared with 15 patients (17%) at Level III facilities and 8 patients (29%) at nontrauma facilities; Level I facilities also had the highest Injury Severity Score. Of patients requiring admission, 83% were transported by emergency medical services; these patients also had the highest Injury Severity Score. CONCLUSION: The regional trauma system facilitated appropriate and efficient triage to system hospitals, routing the most severely injured patients to the Level I centers without overwhelming them with the more numerous, less severely injured patients.

Adult↗

PubMed1993

A forensic dental identification system with error tolerant algorithms and a review of the prevalence of errors occurring in dental records.

After a major disaster, identification of the victims may have to be performed by comparison of the antemortem and post-mortem dental records. Ante-mortem records often contain errors and these must be identified, and compensated for in some way. A computer system for the comparison of large numbers of ante-mortem and post-mortem dental records has been developed, using algorithms which are able to compensate for errors in the records. Data has been collected on the prevalence of errors in dental charts. These were found in 45% of a sample of 50 records. Since matches found by the system may be due to coincidence, a score is computed for each record based on its 'uniqueness'. This allows a confidence limit to be placed on any matches found between the antemortem and post-mortem records.

Algorithms↗

PubMed2000

Home-based long-term care.

Life expectancy is increasing in many parts of the world. Not only are more people living to old age, but more are also being enabled to live with disabling conditions that once might have been fatal. People who are chronically ill, those with serious disabilities, people with HIV/AIDS, mentally ill individuals, the victims of accidents and disasters, the elderly--many of these, and others, need continuing care and support. As the number of people in need of long-term care continues to grow worldwide, consideration of the best way to meet this need is receiving much more focus. The aim of such care is not simply to look after the sick but to enable those with long-term illnesses or disabilities to live their lives as fully and as rewardingly as possible. Such care is not just a social responsibility; it is a vital element in development. Institutionalization is often not the most suitable form of long-term care. The home, where the patient lives with family members, and where friends and other members of the community are not far away, is frequently more appropriate. This report by an international WHO Study Group examines the options. It points clearly to the benefits that home-based care offers to the patient, while stressing that the personal and health needs of caregivers in the home must not be compromised. Home-based long -term care has been practised by families for centuries, and family members will always remain a valuable resource for care. This report argues that it is time for health systems to take responsibility for providing caregivers in families and communities with the support they need both to help make their tasks more bearable and to bring a greater share of benefit to the patient.

Community Health Services↗

PubMedDate not supplied

[Mitochondrial DNA typing--a new level for solving identification problems in forensic medical expert identification of unidentified remains of victims of terrorist acts in Moscow and the armed conflict in the Chechen Republic].

Two large-scale episodes described in this paper reflect the first in Russia use of molecular genetic matrilinear markers (analysis of polymorphism of sequences of amplified fragments of mitochondrial DNA hypervariable locuses) in solution of a complex identification problem: forensic medical identification of unidentified fragments of victims of explosions of houses in Moscow in September, 1999, and of soldiers dead in the war conflict in the Chechen Republic in 1994-1996. The results of this work and methodological experience gained in it essentially extend the potentialities of expert studies as regards forensic medical identification of victims of large scale disasters, terroristic acts, and war conflicts.

DNA, Mitochondrial↗

PubMed1994

[A shipwreck and organization of the psychosocial support work].

During recent years attention has been drawn to the importance of psychosocial support to victims of accidents and disasters. Post-traumatic stress disorder seems to be more frequent than earlier believed, and early psychosocial assistance is thought to reduce the psychological effects of the traumatic experience. The authors describe the psychosocial work, as it was organized at Haukeland Hospital, after a shipwreck. Experiences with mobile medical teams with stress competence are also discussed.

Accidents, Traffic↗

PubMedDate not supplied

[The organizational status and tasks of sanatorium-health resort treatment and health promotion for children suffering as a result of the Chernobyl catastrophe].

Al the Ukrainian Research Institute of Childhood Health-Resortology and Physiotherapy, more than 1000 children who became victims of the Chernobyl disaster were studied for their health status and time-related indices of same under the influence of the chief health-resort factors with the aid of the present-day clinical-and-laboratory, immunobiochemical, neurophysiological and radioimmunoassay techniques. The efficacies of the instituted therapies (87.9%) suggest that the above children may derive benefit from treatment at the Yevpatoriya health resort, with improvement of their health being consequent upon it. At the same time, primary tasks have been outlined, the solution of which tasks will, we believe, help in improving the diagnosis and quality of the treatments administered.

Child↗

PubMed1985

The psychological impact of disaster on rescue personnel.

Seventy-nine rescue, fire, and medical personnel and police officers who treated victims of an apartment building explosion completed a questionnaire describing their emotional and coping responses to the disaster. Eighty percent had at least one symptom of posttraumatic stress disorder (PTSD). Eight of 21 PTSD symptoms were present in at least 10% of respondents. The most frequently reported symptom, intrusive thoughts about the disaster, occurred in 74% of those working with or searching for victims at the disaster site. On-the-scene rescue workers had significantly more (P less than .02) PTSD symptoms than did inhospital staff. Fifty-two percent of the respondents reported that family members and coworkers were supportive or very supportive in meeting their emotional needs following the disaster; 36% noted that support networks were not helpful. The coping behaviors most frequently used were to remind oneself that things could be worse (57%) and to try to keep a realistic perspective on the situation (53%). Eleven percent reported seeking emotional support from others or looking to others for direction. Emergency workers responding to a contained, small-scale disaster are likely to experience mild stress responses. Planning for the emotional aspects of these events is needed.

Adaptation, Psychological↗

PubMed2003

Psychological sequelae: post-traumatic stress reactions and personality factors among community residents as secondary victims.

The aims of the present study were twofold: first, to ascertain the severity of post-traumatic stress among community residents as secondary victims exposed to a train disaster. Secondly, we aimed to identify the association between post-traumatic stress and personality variables. Seven months after the train disaster in Stafford, United Kingdom, in 1996, 66 community residents were recruited and interviewed for the study. In the interviews, residents were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ) and the Eysenck Personality Questionnaire-R Short Scale (EPQ-R). Control group data were also collected, composed of 90 community residents who lived in another city and had not been exposed to the train disaster. They were assessed using the GHQ. The results showed that 51% of the residents scored at the high IES symptom level. No significant differences were found between the community residents who lived near and further away from the crash site in terms of the IES scores. Further analyses showed that the IES scores for the present two groups of community residents were significantly lower than those of Horowitz's standardized stress clinic samples, but higher than those of Danish rescue workers involved in a train rescue operation. The GHQ results showed that 35% could be considered to be psychiatric cases. The comparisons between the GHQ scores of the present community residents with those of the control group showed that there were significant differences in somatic problems, anxiety, depression and GHQ total. With regard to personality, the community residents who lived near to the crash site were significantly more introverted but less neurotic than Eysenck's standardized samples. The community residents who lived further away were significantly more introverted but less neurotic than the standardized samples. Regression analyses revealed that neuroticism predicted intrusion, avoidance and GHQ total. The conclusion was that there can be long-term, severe post-traumatic stress effects upon community residents, as secondary victims, after exposure to a train disaster. Residents with a neurotic personality tend to be associated with post-traumatic stress reactions and general health problems.

Accidents↗

PubMed1996

Illnesses and injuries reported at Disaster Application Centers following the 1994 Northridge Earthquake.

The 1994 Northridge, California, earthquake caused extensive structural damage and disrupted lives for thousands of residents. Local resources treated those initially injured. Many victims were unable or unwilling to reenter their dwellings. Record numbers of victims spent many hours at Disaster Application Centers (DACs) applying for financial assistance and other services. This created a concern for the provision of primary health care services at these centers. Under the Federal Response Plan, registered nurses, nurse practitioners, and physician assistants from the Department of Veterans Affairs treated 17,883 patients at the DACs. This report documents the injuries and illnesses sustained by the public and response workers at the DACs. The findings demonstrate that this care eased the burden on the local health care system. This article illustrates applications for estimating health services needs and demands at similar mass gatherings that might be experienced in response to catastrophic events and in U.S. military operations involving humanitarian relief missions.

California↗

PubMed1985

Some health consequences of a natural disaster.

A survey of the health and psychosocial problems of all victims of the 1983 South Australian Ash Wednesday Bushfires was carried out 12 months after the disaster. A total of 1526 victims completed an extensive questionnaire that included the 28-item General Health Questionnaire and a self-reporting check-list of specific health problems. The data received indicated a significant increase in stress-related conditions, including hypertension, gastrointestinal disorders, diabetes, and mental illness, while the prevalence of nonstress-related conditions such as cancer or urological disease were not increased significantly. Health problems increased during the 12 months following the bushfire and diminished toward the end of that period, but a large number of difficulties remained. Certain disaster experiences, particularly the type of loss suffered, were found to be significantly related to health.

Adolescent↗