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Nurses have a special role to play in strengthening the disaster reduction capacities of their communities. Below, Ailsa Holloway outlines the opportunities for nurses to cooperate with WHO and the International Decade for Natural Disaster Reduction and to apply their knowledge and skills in confronting the natural and other hazards.
Disaster epidemiology reveals epidemic increases in incidence of disasters. Rare disasters with catastrophic consequences also threaten modern populations. This paper profiles natural disasters, transportation incidents, emerging infectious diseases, complex disasters and terrorism for their historical and future potential impact on Australasia. Emergency physicians are in a position to assume leadership roles within the disaster management community in Australasia. The Australasian College for Emergency Medicine is in a position to lead medical specialty advances in disaster medicine in Australasia. To optimize its impact in disaster medicine, the specialty and its College have opportunities for advances in key areas of College administration, intra and interinstitutional representation, disaster preparedness and planning, disaster relief operations, education and training programs, applied clinical research, and faculty development.
This paper evaluates the condition (i.e. health) of a tropical cyclone warning system (TCWS) during a 'quiet period' between infrequent intense cyclones. Capacity to make pre-disaster evaluations is important--disaster warning systems need to be in sound condition before, not after, disaster. The research--part of the UK's International Decade of Natural Disaster Reduction Flagship Programme--focuses upon an evaluatory method first used on flood warning systems. The Criteria-development Matrix comprises social, organisational and institutional criteria by which a TCWS may be assessed using a five-stage development scale. This method is used to evaluate Mauritius's TCWS using in-depth interview data. Ways to enhance the method and apply it to other disaster warning systems are discussed. The TCWS in Mauritius is a relatively sound one from which others can learn. Weaknesses requiring attention for Mauritius's TCWS to progress to an advanced level of development are identified.
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.
Windstorm disasters (including storm surges) account for about one-third of all natural disasters throughout the world (by number, fatalities and economic losses), but for more than two-thirds of the corresponding insured losses. Trend analyses reveal that major windstorm disasters and the losses generated by them have increased drastically in recent decades. Risk partnership between the state, the affected population and the insurance industry assumes a key role with regard to the windstorm hazard. Scientists, engineers and insurers must work together in formulating their requirements and shaping them in such a way that politicians can derive clearly recognizable policy options (e.g. land-use, restrictions, design-code adjustments) from them. Another important aspect is stepping up the efforts being made towards curbing climate change, which will, otherwise, exacerbate the risk in the future.
This paper summarizes the results of systematic studies published in peer-reviewed journals from 1999 to 2002 addressing post-traumatic stress reactions in children after mass disasters. Children's post-traumatic reactions are considered in five different contexts--natural disasters, large-scale human-induced accidents, spree shootings, war, and terrorism. Association of these reactions with gender and age, as well as longitudinal course, is addressed. Other post-traumatic reactions in children after a mass disaster, as well as the comorbidity of these with stress reactions, are reported. With this as background, the most relevant epidemiologic investigations conducted after the World Trade Center attacks are then described. It is expected that new knowledge in the area of children's post-traumatic reactions to disasters will result from the research initiatives launched after September 11, 2001.
Disasters, natural and man-made, have a considerable impact on communities. Most recently, disasters stemming from terrorist attacks have become a leading cause of concern. The importance of work in the lives of employees, coupled with the vulnerability of workplaces as potential targets of terrorist attacks, suggests that workplaces can and should play a role in planning for, and responding to, disasters. This article addresses the role of the workplace in disasters, with an emphasis on the psychological impact of such events, by drawing upon experience and literature related to workplace violence and to other traumatic events in the workplace.
The first of a of series state-of-the-art reviews commissioned to mark Disasters' 21st anniversary, this paper considers key publications on public health aspects of natural disasters, refugee emergencies and complex humanitarian disasters over the past twenty-odd years. The literature is reviewed and important signposts highlighted showing how the field has developed. This expanding body of epidemiological research has provided a basis for increasingly effective prevention and intervention strategies.
The urgency of the crisis following a nuclear attack staggers the imagination. We would have thousands or millions of survivors making a desperate struggle to survive. Safe water supplies and waste-disposal systems would be gone. In some areas, there would be little or no food or shelter. Yet California has already manned a medical arsenal that is second to none in the United States. We have stored 115 emergency hospitals at strategic points, and through the county medical associations we have appointed cadres including physicians, nurses and technicians. Plans have been made for workers who will assist in setting up the hospitals and first aid stations. In our future operations we will continue to place strong emphasis on the medical phase of our program of disaster care.The program would be just as essential in the event of major natural disaster as nuclear war. Our objective is a simple one. We are seeking to preserve the human resources which are necessary for recovery.California's medical profession, with the allied professions of nursing and technical skills, has a vital interest in continuing operations to the maximum extent even under the most trying conditions.
With more survivors of air crashes involving jumbo jets, an improved plan for life-saving emergency care at the crash site is discussed. The concept of airlifting predesignated Trauma Teams to the crash site from large medical centers within a radius of 100 miles is discussed. The "work-shop" for these teams is described in detail, providing an operating and intensive care facility at the scene of the disaster. It is shown how this kind of planning can be applied to natural disasters with multiple casualties as well as to airport disasters.
This commentary on the World Trade Center attack is written from the perspective of a New York City critical care service, with a long history of activity in disaster management, which is located at the Montefiore Medical Center/Albert Einstein College of Medicine. The paper describes some of the local concerns of the service in the first hours, the reality of dispersal of victims throughout the New York City hospital system, and some of the resources made available and their utilization. In general, the US Critical Care Medicine System receives massive resources in terms of gross national product expenditure when compared with other developed countries. A large capacity is subsequently in place to provide care to critically ill patients resulting from manmade as well as natural disasters. It was the nature of the World Trade Center attack in terms of the ratio of injured survivors to dead victims that did not allow the full capacity and capability of the system to engage.
Ecology has a key role in our understanding of the benefits that humans obtain from ecosystems (i.e. ecosystem services). Ecology can also contribute to developing environmentally sound technologies, markets for ecosystem services and approaches to decision-making that account for the changing relationship between humans and ecosystems. These contributions involve basic ecological research on, for example, the resilience of ecosystem services or relationships of ecosystem change to natural disasters. Much of the necessary work involves interdisciplinary collaboration among ecologists, social scientists and decision makers. As we discuss here, ecology should help formulate positive, plausible visions for relationships of society and ecosystems that can potentially sustain ecosystem services for long periods of time.
INTRODUCTION: Rapid assessments of needs and health status have been conducted by the U.S. Centers for Disease Control and Prevention (CDC) in natural disaster settings for gathering information about the status of affected populations during emergencies. A review of eight such assessments (6 from hurricanes, 1 from an ice storm, and 1 from an earthquake) examines current methods and applications, and describes the use of results by policy makers so assessments in post-disaster settings can be improved. OBJECTIVE: Because the results of assessments greatly influence the nature of relief activities, a review can: 1) ascertain strengths and limitations; 2) examine the methods; and 3) ascertain the utility of results and their use by policy makers. This review compares assessments for similarities and differences: 1) across disaster types; 2) within similar disasters; 3) by timing when the assessments are conducted; and 4) in domestic and international settings. The review also identifies decision-making actions that result from the assessments, and suggests direction for future applications. METHODS: Assessments reported in CDC's Morbidity and Mortality Weekly Report from 1980 through 1999 were reviewed because they applied a systematic methodology in data collection. They were compared descriptively for study characteristics and content areas. RESULTS: Of 13 assessments identified from six reports, eight were reviewed because they focused on initial assessments, rather than on repeated studies. Of the eight, six pertained to hurricanes; one to an ice storm; and one to an earthquake. Seven (88%) were performed during or after the third day post-impact (range: 1-70 days, median: 7 days). All eight addressed demographics, morbidity, and water availability; seven concerned food, sanitation, and transportation; and six queried access to medical care and electricity. Of the three assessments conducted more than 10 days post-event, two addressed vulnerable children, the elderly, pregnant and lactating women, and migrant workers; two singled storm preparation and evacuation behavior; and one concerned mental health, preventive health care, and social programs. Only one, after an earthquake, asked about disaster-related deaths in household members. Two were international assessments and both were performed at least 60 days post-event. All eight provided estimates of proportions of needs based on survey respondents; none, however, extrapolated the proportions to estimate the magnitude of needs for populations at risk. Of the eight, five confirmed a policy decision, such as accelerating delivery of food supplies. CONCLUSION: Assessments typically were conducted within 1 week after the precipitating event occurred. Most, performed within 3-10 days, focused on demographics, health status, food and water, and restoration of utilities. Three assessments, conducted > 1 month later, concerned long-term planning. Only one was performed < 72 hours post-event. Five assessments resulted in policy actions to guide relief activities. Increasing application of health assessments provides: 1) impetus for improving current methodologies; 2) standardizing collection instruments; 3) involving other sectors in emergency relief; and 4) ensuring useful information for decision makers.
This study examined the extent of children's and adolescents' psychosocial maladjustment associated with a natural disaster, namely, wildfire. The course of psychopathology was assessed six weeks after a major wildfire destroyed 420 homes. Victims' functioning relative to a comparison group from the same community, matched for age, gender, socioeconomic status, and fire insurance was examined. The major goal of this study was to assess systematically the short-term mental health consequences of a wildfire disaster among children and adolescents. This goal was achieved through the use of standardized assessment procedures. The results of this study add useful information to the literature concerning the impact of disaster among children and adolescents and provide a methodological framework for future efforts in this area.
Much of the effort in disaster planning has been directed toward large-scale, war-related, or major natural disasters. We helped test a rural community's disaster plan in a simulated airport accident, and concluded that this plan was not the most effective for providing the triage and stabilization in the field that are essential to the management of this type of accident. This communication argues for the development of an alternative model of response involving the "escalation" of the everyday emergency medical services system. We believe this will provide more rapid and effective allocation of the rural community's limited medical resources in the management of the multiple casualty incident.
Planned and involuntary resettlement after natural disasters has been a major policy in post-disaster reconstruction in developing countries over the past few decades. Studies show that resettlement can result in significant adverse impacts on the resettled population. Conversely, a well-planned and managed resettlement process can produce positive long-term development outcomes. This article presents the results of a case study undertaken 11 years after the 1990 Manjil earthquake in Iran. During the reconstruction period, a policy of involuntary planned resettlement was pursued extensively. The socioeconomic changes that occurred as a consequence of this policy of involuntary resettlement are analysed. Data were collected via a questionnaire survey that involved a sample of 194 relocated households (grouped into a settlement that later became a town). The paper shows that relocated families face difficult socioeconomic challenges after relocation and regrouping. This is especially true with respect to employment, income, the empowerment of women and lifestyle issues.
Concerned by the increasing number and extent of disasters, the international community declared the period from 1990-2000 an international decade for natural disaster reduction (IDNDR). The "United Nations Disaster Relief Organisation" (UNDRO) was restructured into the "Department of Humanitarian Affairs" (DHA) to study ways and means of improving the co-ordination of international relief operations at the site of a disaster. This included the establishment of the "United Nations Disaster Assessment and Co-ordination Stand-by Team" (UNDAC) and the "On-site Operations Co-ordination Centre" (OSOCC) concept. Surgical relief teams had to implement new concepts regarding mission indication, guidelines, ethical code of conduct and measures of improved prevention, rehabilitation, reconstruction and sustainable development.
This paper examines the relationship between community preparedness and response to natural disaster and their level and pattern of community development. This is done by investigating preparation and response to the 1997 Red River Flood by three rural communities in Manitoba, Canada. The communities were selected because of their different ethnic mix and associated level and pattern of community development. The hypothesis was supported that the level and pattern of community development affect community capacity to respond to flooding. Communities characterised by higher levels of physical, human and social capital were better prepared and more effective responders to the flood. However, where the pattern of community development was characterised by high levels of social capital, decision-making processes were complicated.