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PubMedDate not supplied

Expanding educational opportunities in disaster response and emergency preparedness for nurses.

The past few years have witnessed a dramatic increase in the number of large-scale disaster events and the ubiquitous threat of weapons of mass destruction. These events have heightened recognition of the role of the nurse in disaster management and response. Enhanced capacity to respond to disasters and other public health emergencies will require a nursing workforce that is clinically experienced and possesses the knowledge and skills necessary to respond with confidence and authority. This article reports on how American schools of nursing have begun to address the challenge of workforce development and nurse preparedness. The University of Rochester Leadership in Health Care Systems in Disaster Response and Emergency Preparedness Program is described in detail.

Bioterrorism↗
PubMedDate not supplied

The occupational physician and chemical disasters: old problem, new threats.

Chemical disasters continue to occur, in spite of significant progress in process engineering, industrial hygiene practices, and improved enforcement of health and safety legislation. In addition to the ever-present risk of unintentional incidents, recent geopolitical events have raised the specter of chemical terrorism. Terrorists or even disgruntled employees may exploit lapses in chemical plant security and ready access to large quantities commodity chemicals, capable of causing great harm to the population if suddenly and unexpectedly released. Occupational physicians, who are uniquely equipped to understand the health hazards associated with industrial chemicals should be involved in prevention of planning for, and response to chemical disasters. Measures for improving preparedness include training and collaboration, not only with plant health and safety personnel but also with public safety and health care providers, through drills and assessment of needs and capacities. Occupational physicians should be aware that communications and other systems often fail in disasters, requiring multiple alternatives. Likewise, occupational health specialists should be prepared to deal with mass casualties, including psychological casualties which may be difficult to distinguish from those of organic etiology. Chemical disaster preparedness is an urgent and demanding responsibility for occupational physicians everywhere.

Decontamination↗
PubMed1991

Assessment of prehospital and hospital response in disaster.

The assessment of the response of a prehospital/hospital system to a disaster will prove a complex and challenging undertaking for those who attempt it. Data availability and quality will prove to be an immediate problem. Finding the time to devote to assessment is usually difficult. Identifying qualified and interested members of the required multidisciplinary team and, in particular, an individual with health services research background who can assist in all phases of the design and implementation of the project, is often difficult. Obviously, these problems will be less severe if they are addressed to some degree in the disaster plan. That is, a general protocol for assessment could be developed as part of the disaster planning effort and evaluation staff could tentatively be identified by position (e.g., emergency department medical director). The issue of data availability could be confronted and provisions made for the recording of at least minimal information on patient log forms under disaster conditions.

Disaster Planning↗
PubMed1990

The needs of a disaster medical assistance team for environmental support services.

The National Disaster Medical System (NDMS) was formed to provide medical assistance to civilian disaster areas. Disaster Medical Assistance Teams (DMAT) are subunits of NDMS and could be transported to the disaster area. For DMAT to function, a team must be able to provide for itself. The Bethesda DMAT established a Logistical Support Group within the team to provide these services. This paper identifies the mission and personnel of the Logistical Support Group.

Disaster Planning↗
PubMedDate not supplied

A nurse's experience on a disaster-preparedness team.

Taking steps to coordinate international, regional and national efforts to minimize damages caused by natural disasters, the United Nations has declared the 1990s the International Decade for Natural Disaster Reduction. To make nurses aware of how they can join these efforts, INR has dedicated this special issue on the subject, an issue that would not be complete without a description of the invaluable work contributed by Marie Farrell and other members of the EURO disaster-preparedness team who are often the first persons on the scene after a disaster in the European Region.

Disaster Planning↗
PubMed1982

An introduction to disaster: some considerations of a psychological nature.

This paper provides a review of the literature dealing with the psychological reactions of individuals and groups to disaster. The paper was intended for use by a broad readership and serves both as an introduction to the field as well as a resource document for workers already engaged in disaster planning and training. Characteristic stages of human response to disaster situations are discussed as well as the specific immediate reactions of individuals and groups. Phenomena such as "scapegoating," long-term reactions, reactions of rescue and relief personnel, psychological first aid, and disaster planning, are among the other topics examined.

Adaptation, Psychological↗
PubMed1978

[The role of medical services in combating disasters].

Natural and man-made disasters are an ever present threat, particularly in densely populated cities. Doctors, and other people who provide medical care, plead for comprehensive action plans to ensure survival in cases of disaster. Diaster medicine represents a new, multidisciplinary and comprehensive approach. To combat disasters, however, requires knowledge of, and participation by, many disciplines within and outside the field of medicine. Guidelines, to initiate a comprehensive and coordinated anti-disaster programme, are presented. The purpose is to ensure that all resources are used with maximum effect and that all stumbling blocks to efficiency are removed.

Civil Defense↗
PubMed1995

[When a disaster is a fact. Kamedo analyses how the help was functioning].

Kamedo (Organizing Committee for Disaster Medicine Studies) has for over 30 years compiled information on disasters in Sweden and abroad, analysed the data and published the results. The Kamedo reports supply knowledge and experience in the field of disaster medicine and form a basis for disaster medicine planning, education and research. Over 60 reports have been published so far, since 1980 including summaries in English. These summaries can be obtained from Kamedo, Swedish National Board of Health and Welfare (Socialstyrelsen), S-106 30 Stockholm, Sweden (fax +46 8 783 3287).

Disaster Planning↗
PubMed2005

Liability of professional and volunteer mental health practitioners in the wake of disasters: a framework for further considerations.

Qualified immunity from civil liability exists for acts of disaster mental health (DMH) practitioners responding to disasters or acts of terrorism. This article reviews current legal regimens dictating civil liability for potentially wrongful acts of DMH professionals and volunteers responding to disasters. Criteria are proposed to inform determinations of civil liability for DMH workers in disaster response, given current legal parameters and established tort law in relevant areas. Specific considerations are examined that potentially implicate direct liability of DMH professionals and volunteers, and vicarious liability of DMH supervisors for actions of volunteer subordinates. The relevance of pre-event DMH planning and operationalization of the plan post-event is linked to considerations of liability. This article concludes with recommendations to minimize liability exposure for DMH workers in response efforts.

Allied Health Personnel↗
PubMed2000

The American Red Cross disaster mental health services: development of a cooperative, single function, multidisciplinary service model.

Not until 1989 did the Red Cross officially recognize a need for a systematic and organized plan for the mental health needs of disaster survivors. Over the next decade, the Red Cross Disaster Mental Health Services program has developed and evolved to assist both disaster victims and the Red Cross workers who serve them to cope with the overwhelming stresses encountered by both groups in the aftermath of disasters. The Red Cross now coordinates a large and diverse group of mental health professionals from fields of psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling who work together cooperatively. Cross-disciplinary conflicts are minimized by the Red Cross' generic approach to the various mental health professional specialties as functionally interchangeable in performing Red Cross duties. This article reviews the development of this process and describes one local Red Cross chapter's early experience as part of this effort.

Crisis Intervention↗
PubMed2003

International collaboration in mass disasters involving foreign nationals within the EU: medico-legal investigation of Finnish victims of the Milan Linate airport SAS SK 686 aircraft accident on 8 October 2001.

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.

Accidents, Aviation↗
PubMed2006

Post-disaster mental health problems and the utilization of mental health services: a four-year longitudinal comparative study.

This study examined mental health problems and mental health services (MHS) utilization after a fireworks disaster among adult survivors and a comparison group. The disaster took place on May 13, 2000, in the city of Enschede, The Netherlands. Victims (N=662) participated in a survey 2-3 weeks (T1), 18 months (T2) and 4 years (T3) post-disaster. The comparison group consisted of non-affected people from another city (N=526). They participated at T2 and T3. Victims used MHS more often than the comparison group in the 12-month period before T2 and T3 (OR 3.9 and 2.4). Victims with severe depression and anxiety symptoms at T2 used MHS more often than participants in the comparison group with these symptoms (OR 2.6 and 2.0). After 4 years, MHS utilization among participants in both groups with anxiety symptoms did not differ, suggesting attenuation of the observed effects. Results suggest that after a disaster survivors with mental health problems are less reluctant to use MHS than under normal circumstances.

Adolescent↗
PubMed2003

Children's mental health after disasters: the impact of the World Trade Center attack.

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.

Child↗
PubMed1987

A taxonomy of disasters and their victims.

A taxonomy of disasters is presented in which the two major axes of causes and elements are considered adequate for plotting on one grid the different kinds of disaster that occur. Then the disaster victims are differentiated into six groups according to the type of their involvement, their function, their culpability, their self control and certain extraneous factors. The purpose is to integrate different studies of disaster, to elicit common concerns, to offer common remedies, and to generate further research.

Disasters↗
PubMed1982

Disease epidemiology and earthquake disaster. The example of Southern Italy after the 23 November 1980 earthquake.

This paper describes aspects of the epidemiological situation following the November 1980 earthquake disaster in Campania and Basilicata, southern Italy. First, population displacements and the fluctuating state of homelessness after the catastrophe are described. Secondly, the level of medical provision prior to the disaster is assessed and damage caused by the earthquake to the medical care and sanitation infrastructures is outlined. Thirdly, the publicity given by news media to the threat of disease is examined and compared with the official government reaction, which took the form of emergency medical provision and intervention against the supposed threat of disease. The national epidemiological surveillance system, which was set up during the aftermath of the disaster, is outlined and some of its results, describing the post-impact epidemiological situation in the disaster zone, are examined. Despite the chaotic situation following the earthquake and the publicity given to the threat of disease outbreaks, there were no serious epidemics and the hospital system was able to cope with the aftermath. The government program of vaccinating survivors and relief volunteers can therefore be seen as an over-reaction to the prevailing situation, although continuing disease surveillance was probably a wise precaution.

Communicable Disease Control↗
PubMed1988

Some international law aspects of the Bhopal disaster.

This article explores certain international law aspects of the Bhopal disaster, namely the principles and rules of international law establishing international accountability for environmental damage; the criteria for determining the liability of the Union Carbide Company (U. S. A.) for the Bhopal disaster; the criteria for determining compensation; and the international remedies available to the Indian government in the event that Bhopal victims fail to get justice within the Indian court system. The article discusses two applicable sets of proposed international standards--the U. N. Draft Code of Conduct on Transnational Corporations, and the U. N. International Law Commission's Draft on International Liability for Injurious Consequences Arising out of Acts Not Prohibited by International Law. The scattered 'hard' and 'soft' jurisprudence of international environmental law establishes liability and accountability for environmental hazards. It makes both state and non-state entities liable to pay compensation to the victims of environmental pollution. This jurisprudence, in addition to domestic law analogies, can influence Indian courts in determining the amount of damages payable to the victims of the Bhopal disaster. The authors conclude that the Bhopal disaster has demonstrated that enforceable international standards are clearly and urgently needed for hazardous industries, especially those operating in developing countries. Such standards would eliminate, or at least narrow, the gap between standards prevailing in the developed countries and those in the Third World. Even without enforcement, international standards could provide norms for measuring the performance of individual companies engaged in hazardous activities such as the manufacture of MIC at Bhopal.

Accidents, Occupational↗
PubMed1983

Delayed-impact infectious disease after a natural disaster.

Most recent studies of natural disasters have shown little increase in post-disaster infectious disease. The result has been a de-emphasis of the disease control portion of many disaster relief programs. This study demonstrates a significant increase in four out of the five diseases studied following two hurricanes in the Dominican Republic, with the major impact of the increases coming several months after the disaster. Posited reasons for the increase in infectious diseases are: (a) overcrowding of makeshift refugee centers with insufficient sanitary facilities, and (b) flood-caused water transmission of pathogens.

Communicable Diseases↗
PubMedDate not supplied

Disaster preparedness of home health care agencies in San Diego County.

A questionnaire was sent to 53 home health care agencies in San Diego to assess their state of disaster readiness. Thirty agencies returned completed questionnaires. Of these, 90% have written disaster plans, but only 33% conduct regular drills to practice their written plans. A 24-h telephone number is available to patients at 96% of the agencies. One-fourth of the agencies serving ventilator-dependent patients do not make utility companies aware of their special needs. Of 11 hospital-sponsored agencies, 18% include backup agreements with other agencies, while 79% of non-hospital-sponsored agencies have planned such backup. The majority (92%) of "private-for-profit" agencies have backup arrangements, but only 38% of the public or nonprofit agencies have such arrangements. Additionally, 31% of the home health care agencies do not feel they would be able to meet the needs of their clients in the event of a disaster. Specific recommendations for such agencies in developing disaster plans, and exercising them, are made.

California↗