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PubMedDate not supplied

When disaster strikes: responding to the needs of children.

When a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.

Child↗
PubMedDate not supplied

Disaster management following the Chi-Chi earthquake in Taiwan.

The earthquake that occurred in Taiwan on 21 September 1999 killed >2,000 people and severely injured many survivors. Despite the large scale and sizeable impact of the event, a complete overview of its consequences and the causes of the inadequate rescue and treatment efforts is limited in the literature. This review examines the way different groups coped with the tragedy and points out the major mistakes made during the process. The effectiveness of Taiwan's emergency preparedness and disaster response system after the earthquake was analyzed. Problems encountered included: (1) an ineffective command center; (2) poor communication; (3) lack of cooperation between the civil government and the military; (4) delayed prehospital care; (5) overloading of hospitals beyond capacity; (6) inadequate staffing; and (7) mismanaged public health measures. The Taiwan Chi-Chi Earthquake experience demonstrates that precise disaster planning, the establishment of one designated central command, improved cooperation between central and local authorities, modern rescue equipment used by trained disaster specialists, rapid prehospital care, and medical personnel availability, as well earthquake-resistant buildings and infrastructure, are all necessary in order to improve disaster responses.

Disaster Planning↗
PubMedDate not supplied

Analysis of medical needs on day 7 after the tsunami disaster in Papua New Guinea.

INTRODUCTION: Because of great intervening distances, international medical relief activities in catastrophic, sudden-onset disasters often do not begin until days 5-7 after the precipitating event. The medical needs of those affected and what public health problems exist in the community in the week after the tsunami disaster in Papua New Guinea(PNG) were investigated. METHODS: The Japan Medical Team for Disaster Relief (JMTDR) conducted investigative hearings at the District Office responsible for the management of the disaster, the Care Center, and the Hospitals in Aitape, Vanimo, and Wewak in PNG. RESULTS: The numbers of in-patients in the Aitape, Vanimo, and Wewak Hospitals, and in the Care Center in Aitape were 291, > 300, 68, and 104, respectively. The exact number of people affected was unknown at the Aitape District Office. There was no lack of medical supplies and drugs in the hospital, but the Care Center in Aitape did not have sufficient quantities of antibiotics. No outbreak of communicable disease occurred, despite the presence of risk factors such as the dense concentration of affected people and the constant prevalence of malaria and diarrhea. The water at Wewak General Hospital contained chlorine and was suitable for drinking, but that elsewhere contained bacteria. CONCLUSIONS: On about the 7th day after the event, the available information still was incomplete, and it was a time to shift from initial emergency activities to specialized medical care. Although no outbreak of communicable disease actually occurred, there was much anxiety about it because of the risk factors present. For effective medical care at this stage, it is essential to conduct a survey of actual medical needs that also include epidemiological factors.

Anti-Bacterial Agents↗
PubMedDate not supplied

The concept of assisted management of large-scale disasters by horizontal organizations.

Management of large-scale disasters is impeded by inadequately designed organizational infrastructure. The vertical organizational structures of most agencies responding to disasters contribute to a poorly integrated response, especially when collaboration, information sharing, and coordination are required. Horizontal (or lateral) organizations have assisted traditionally vertical civilian and military agencies by enhancing their capacity to operate successfully in complex human emergencies and large-scale natural disasters. Because of the multiagency and highly technical multidisciplinary requirements for decision-making in chemical and biological disasters, similar horizontal management options must be considered.

Disaster Planning↗
PubMedDate not supplied

Hospital disaster operations during the 1989 Loma Prieta earthquake.

OBJECTIVE: To study hospital disaster operations following a major United States disaster. DESIGN: Researchers interviewed all 51 hospital administrators and 49 of 51 emergency department (ED) charge nurses and emergency physicians who were on duty at the study hospitals during the 13-hour period immediately following the 1989 Loma Prieta earthquake. SETTING: The 51 acute-care hospitals in the six northern California counties most affected by the Loma Prieta earthquake. MEASUREMENTS: Questionnaires and in-person interviews. RESULTS: The most frequently noted problem was lack of communications within and among organizations. Hospitals received inadequate information about the disaster from local governmental agencies. Forty-three percent of hospitals had inadequate back-up power configurations, and five hospitals sustained total back-up generator failures. Twenty hospitals performed partial evacuations. CONCLUSIONS: The Loma Prieta earthquake did not cause total disruption of hospital services. Hospitals need to work with local governmental agencies and internal hospital departments to improve disaster communications.

Disaster Planning↗
PubMed2006

Disaster mental health preparedness plan in Indonesia.

The tsunami brought into focus many issues related to mental health and psychosocial distress. A prompt response to the disaster relies on existing disaster management plans so that appropriate interventions can be put in place in order to meet the needs of the affected populations. The response must involve both physical and psychological aspects of care. The Indonesian experience was unique in a number of ways and it allowed us to explore the lessons in order to develop strategies to maximize the resources in order to ensure that the whole affected population was cared for. Massive destruction of the physical structures and the work force made the task particularly difficult. Existing policies did not include psychosocial efforts in the plan. However, mental health and psychosocial relief efforts are now being integrated into the disaster preparedness plan of Indonesia. To further implement the plan, a strong community mental health system is being developed. This system will be able to deliver mental health and psychosocial interventions on a routine basis and could be scaled up in times of disasters.

Disaster Planning↗
PubMed2006

Mental health and psychosocial support aspects in disaster preparedness: Nepal.

To improve mental health care in Nepal, a National Mental Health Policy, Strategy and Plan of Action was approved by the Government in 1997. Nepal has high vulnerability to natural disasters compounded by a prolonged violent civil conflict affecting almost all districts of the country. Floods, landslides and earthquakes are the most regularly occurring disasters in Nepal. There is a Health Sector Emergency and Disaster Response Plan of the Ministry of Health, but mental health and psychosocial relief is not adequately addressed in this plan. In 2003 guidelines on best public health practices in emergencies for district health workers was developed in which the minimum standard and indicators include aspects of mental and social aspects of health. The experience of the complex emergency in April 2005 showed that in general the emergency preparedness plan has not been prepared well enough, but on the other hand the health system was able to cope quite well because of past training. Further strengthening of the mental health and psychosocial aspects of disaster preparedness is strongly recommended.

Disaster Planning↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Myanmar.

Myanmar as a country in South-East Asia is vulnerable to disasters including storms, floods, fire, earth fall, earthquakes, depending on the geographical nature and climate of the area. The National Health Committee (NHC) of Myanmar has formed under it an Emergency Healthcare Committee. After the Asian tsunami, the Ministry of Health (MoH) formed the National Disaster Preparedness and Response Committee which developed the National Guidelines for Disasters Preparedness and Response. The experience of dealing with the tsunami has shown that psychosocial support to the affected community not only reduces its psychological distress but can also facilitate physical rehabilitation. Thus mental health and psychosocial aspects have been included in disaster preparedness and management plans of the MoH.

Disaster Planning↗
PubMed2005

A short medical school course on responding to bioterrorism and other disasters.

The events of 9/11 highlighted the limitations of the United States health care system in responding to large-scale public health emergencies. The key for an effective response to any mass casualty event is preparedness; thus, the education of medical students has become a priority. The Association of American Medical Colleges (AAMC) recommended that the nation's medical schools should thoroughly educate students about the public health and emergency services systems to ensure coordinated responses to weapons of mass destruction or other public health threats. In response, The Texas A&M University System Health Science Center College of Medicine, partnering with the Defense Institute for Medical Operations (DIMO), developed a one-week block of required (but not graded) instruction, the "Leadership Course in Disaster Response," first given in 2003-04 to 72 second-year students and taught by six military experts from DIMO. The course goal is to (1) educate students on resources available for regional disaster response; (2) define principles of resource management in disaster response; (3) identify specific agents associated with bioterrorism; and (4) understand the psychosocial aspects of disasters. The course was well received, and the 2004-05 session was improved, based on student and faculty feedback. The authors describe the details of the course (specifically, how the course was tailored to fit the AAMC guidelines), changes in students' knowledge and attitudes, and how the course was improved.

Adult↗
PubMed2002

Healthcare system disaster preparedness, part 2: nursing executive role in leadership.

A critical responsibility of nurse executives is to lead and manage in times of crisis and disaster. Preserving open lines of communication, ensuring quality patient care, providing current education, influencing policy and financial decisions, and providing security for staff, patients, and families are among a few of the tasks that need to be monitored during a disaster situation. In part 1 (September 2002), the authors discussed the use of the nursing process as a framework to prepare for an all-hazards threat to disaster and mass casualty possibilities. In this article, part 2, the authors discuss the executive nurse's role in preparing a facility for disaster situations, including 8 areas of assessment for planning, implementation, and evaluation stages of readiness.

Crisis Intervention↗
PubMed1988

EMS response to a ski lift disaster in the Colorado mountains.

The EMS system in a Colorado mountain community was tested by the fall of a ski lift injuring 49 people. The response was complicated by the remote location of the accident and the number of injuries. Use of a preconceived disaster plan reduced morbidity and mortality. Patients were stabilized and triaged at the disaster site, and transported to the Snake River Health Services, Inc., where a second level of triage occurred. ATLS was provided at the Snake River Health Services and patients were transported to various surgical facilities throughout Colorado. Because a disaster in a remote or rural area can more easily overwhelm available resources, physicians should ensure that a good disaster plan is in place, should be able to provide initial evaluation and stabilization of patients, and arrange transport to the nearest appropriate facility.

Aircraft↗
PubMed1996

The Kobe earthquake: the system response. A disaster report from Japan.

The Great Hanshin earthquake on 17 January 1995 caused a complete disruption of both the communications and transportation systems which, as a result, severely hampered a prompt and timely system response. The survival rate of the extricated victims was 80.4% on the first day, and 1892 victims were extricated with an overall survival rate of 40%. Very few patients were transported to hospitals outside the disaster area on the first day of the disaster. The power supply was quickly reestablished, however, it took a long time for the water supply to return to normal and this factor played a major role in limiting the clinical activities of the damaged hospitals. Crush syndrome was the most prominent medical syndrome necessitating critical care after the Kobe earthquake. The Japanese Association for Acute Medicine has since made eight new proposals for emergency medicine during mass-disasters that will hopefully improve the survival of patients in any future disasters.

Communication↗
PubMed2004

Combined external and internal hospital disaster: impact and response in a Houston trauma center intensive care unit.

OBJECTIVE: To increase awareness of specific risks to healthcare systems during a natural or civil disaster. We describe the catastrophic disruption of essential services and the point-by-point response to the crisis in a major medical center. DESIGN: Case report, review of the literature, and discussion. SETTING: A 28-bed intensive care unit in a level I trauma center in the largest medical center in the world. CASE: In June 2001, tropical storm Allison caused >3 feet of rainfall and catastrophic flooding in Houston, TX. Memorial Hermann Hospital, one of only two level I trauma centers in the community, lost electrical power, communications systems, running water, and internal transportation. All essential hospital services were rendered nonfunctional. Life-saving equipment such as ventilators, infusion pumps, and monitors became useless. Patients were triaged to other medical facilities based on acuity using ground and air ambulances. No patients died as result of the internal disaster. CONCLUSION: Adequate training, teamwork, communication, coordination with other healthcare professionals, and strong leadership are essential during a crisis. Electricity is vital when delivering care in today's healthcare system, which depends on advanced technology. It is imperative that hospitals take the necessary measures to preserve electrical power at all times. Hospitals should have battery-operated internal and external communication systems readily available in the event of a widespread disaster and communication outage. Critical services such as pharmacy, laboratories, blood bank, and central supply rooms should be located at sites more secure than the ground floors, and these services should be prepared for more extensive performances. Contingency plans to maintain protected water supplies and available emergency kits with batteries, flashlights, two-way radios, and a nonelectronic emergency system for patient identification are also very important. Rapid adaptation to unexpected adverse conditions is critical to the successful implementation of any disaster plan.

Communications Media↗
PubMed2005

Public health issues in disasters.

OBJECTIVE: This article outlines a number of important areas in which public health can contribute to making overall disaster management more effective. This article discusses health effects of some of the more important sudden impact natural disasters and potential future threats (e.g., intentional or deliberately released biologic agents) and outlines the requirements for effective emergency medical and public health response to these events. CONCLUSION: All natural disasters are unique in that each affected region of the world has different social, economic, and health backgrounds. Some similarities exist, however, among the health effects of different natural disasters, which if recognized, can ensure that health and emergency medical relief and limited resources are well managed.

Communicable Disease Control↗
PubMed2006

Critical care and disaster management.

BACKGROUND: In recent years, there has been a great deal of attention paid to preparing the healthcare system to handle disasters, in particular terrorist events. Most of the attention has focused on the first responders and the initial emergency management. Depending on the nature of the disaster, however, large numbers of patients may be critically ill. DISCUSSION: In a contagious event, there may be a continuous stream of new patients requiring critical care support, overwhelming our current intensive care unit capacity. Planning needs to start now to develop processes that will enable us to expand our intensive care unit capacity, and likely adapt our standard of care, in the event that a natural or man-made disaster results in two, three, or more times the number of critically ill patients than our system can currently handle. Using the processes and resources we are currently using to improve patient safety can provide a framework for developing the necessary processes. CONCLUSION: The Society of Critical Care Medicine (SCCM) can provide valuable expertise and educational programs to facilitate the needed disaster management planning.

Critical Care↗
PubMed2006

Managing extreme natural disasters in coastal areas.

Extreme natural hazards, particularly the hydro-meteorological disasters, are emerging as a cause of major concern in the coastal regions of India and a few other developing countries. These have become more frequent in the recent past, and are taking a heavy toll of life and livelihoods. Low level of technology development in the rural areas together with social, economic and gender inequities enhance the vulnerability of the largely illiterate, unskilled, and resource-poor fishing, farming and landless labour communities. Their resilience to bounce back to pre-disaster level of normality is highly limited. For the planet Earth at crossroads, the imminent threat, however, is from a vicious spiral among environmental degradation, poverty and climate change-related natural disasters interacting in a mutually reinforcing manner. These, in turn, retard sustainable development, and also wipe out any small gains made thereof. To counter this unacceptable trend, the M.S. Swaminathan Research Foundation has developed a biovillage paradigm and rural knowledge centres for ecotechnological and knowledge empowerment of the coastal communities at risk. Frontier science and technologies blended with traditional knowledge and ecological prudence result in ecotechnologies with pro-nature, pro-poor and pro-women orientation. The rural communities are given training and helped to develop capacity to adopt ecotechnologies for market-driven eco-enterprises. The modern information and communication-based rural knowledge centres largely operated by trained semi-literate young women provide time- and locale-specific information on weather, crop and animal husbandry, market trends and prices for local communities, healthcare, transport, education, etc. to the local communities. The ecotechnologies and time- and locale-specific information content development are need-based and chosen in a 'bottom-up' manner. The use of recombinant DNA technology for genetic shielding of agricultural crops for coastal regions against abiotic stress (induced by the water- and weather-related natural disasters), strengthens the foundations of sustainable agriculture undertaken by the resource-poor small farm families.

Disaster Planning↗
PubMed2001

Disaster warning and evacuation responses by private business employees.

When people are advised that their place of employment is threatened with disaster, how do they respond? Interviews with employees (n = 406) of 118 businesses affected by one of seven recent disasters provide the first answers to this question. Multivariate analyses document the key variables that best predict variation are: 1) emergent perceptions of risk; 2) time of evacuation from work; 3) time of evacuation from home; 4) multiple evacuations; and 5) tension between work and family commitments. When warned of impending disaster, most employees initially responded with denial. Gradually, however, emergent perceptions of risk intensified especially among those living in communities in which the least amount of disaster planning had occurred or who resided in a mobile home or apartment. Highest levels of work and family tensions during these evacuations were reported by racial minority employees who had children living at home. Policy implications for these and other findings are discussed so as to pin-point changes business managers should make that will enable them to provide the leadership and compassion expected by employees.

Adolescent↗
PubMed2001

Disaster mitigation and preparedness on the Nicaraguan post-Mitch agenda.

Nicaragua provides an example of how a major disaster, in this case Hurricane Mitch, can transform the national agenda for disaster mitigation and preparedness. Hurricane Mitch was a reminder of how extremely disaster prone Nicaragua is, and also how neoliberal reforms have weakened governmental response capacity. In the face of critiques of how governmental policies had affected preparedness and response, discussions of this transformation became a highly politicised process where the debate over alternative development models tended to overshadow the original calls to strengthen risk management. Progress can be seen in some areas, such as disaster mitigation through environmental management. This study of NGO roles, and their relations with other key actors, draws attention to the need to anchor improved risk management in local-level NGO-government collaboration. Structures are being put into place to achieve this aim, but dependence on donor financing raises questions regarding the longer-term sustainability of these efforts.

Community Participation↗