The dental identification of fire victims.
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Burns↗
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[Forensic medicine. Experience with the bodies of victims from floods].
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Disasters↗
Risk assessment in the formulation of anaesthesia safety standards.
Risk assessment involves identifying hazards and then estimating their chance of occurrence and their severity. Risk management involves the cost-effective reduction of risk to levels perceived to be acceptable to society; risk levels set by experts may not be accepted, as perceived risk is strongly influenced by the nature of the adverse outcome and the context in which it was incurred. An understanding of the psychology of risk perception may lessen the negative impact of disasters and may better prepare the victims and their relatives. In formulating the international anaesthesia safety standards an attempt was made to base decisions on sound risk assessment and management principles. A review of the literature revealed that the hazards which posed most risks to patients were hypoxic gas mixtures, gas flow, circuit, endotracheal tube, airway and ventilation problems. These constituted one to two thirds of all incidents during anaesthesia, and account for most causes of brain damage that are dealt with by medical insurance companies. The size of the settlements provides evidence that these are viewed as very serious problems. Minimum standards were formulated with this information in mind; in recommending a sequence for equipment purchases great emphasis was placed on preventing the patient from breathing hypoxic gas mixtures, and on continuous monitoring of the adequacy of the airway, ventilation, the circulation and tissue oxygenation.
Anesthesia↗
[Earthquake-induced stress: relationships and trends noticed in health examination data from survivors of the great Hanshin-Awaji earthquake (Jan. 17, 1995)].
To determine the effects of earthquake-induced stress, health examination data that reflected lifestyle and physical health status were studied. Two groups were examined. In the first group, health examination data was collected in March 1995 after the Great Hanshin-Awaji Earthquake. The participants; 446 individuals (139 male and 307 female aged 50 to 69) were all refugees in the vicinity. Data from the first group were then compared with those from a control group. This group; 1,618 individuals (499 men and 1,119 women aged 50 to 69), were all from the same area, but were examined between April and November 1994 before the earthquake. In the first group, distributions of obese subjects and gender, as well as the mean ages of participants, and mean levels of serum total cholesterol, creatinine and gamma-glutamyltranspeptidase (gamma-GTP) had not significantly changed, although alcohol intake did decrease after the earthquake proportionately. However, subsequent to the earthquake, independent of drinking habits or obesity, mean levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and triglycerides all increased (by 54%, 18%, 27% in men and 22%, 21%, 22% in women, respectively). These data indicate that earthquake-induced stress may influence liver function and lipid metabolism; leading to increased serum transaminase and triglyceride levels. These changes suggest the potential for increased risks of various health impairments for earthquake victims.
Aged↗
Disaster relief and initial response to the earthquake and tsunami in Meulaboh, Indonesia.
The Singapore Humanitarian Assistance Support Group deployed a team of 32 medical relief workers to Meulaboh, Indonesia to provide medical assistance for victims of the 26 December earthquake and tsunami disaster. The team was deployed at a primary healthcare clinic at an internally displaced persons' (IDP) camp and at the sole hospital's emergency and surgical departments. The team saw a total of 1841 patients, 1371 at the clinic and 446 at the hospital's emergency department, and performed surgery on 24 patients. Tsunami-related trauma cases accounted for 31.8% (142) of cases at the emergency department, 1.6% (22) of cases at the clinic, and 91.7% (22) of surgeries. This paper details the difficulties and lessons learnt by the team, including the lack of important resources for healthcare delivery. Water, sanitation, hygiene, and vector control were some of the problems faced, with the goal to provide the most effective public health for the greatest number of people given the limited resources available.
Disasters↗
[Mass disasters in former East Germany--a forensic medicine retrospect].
The authors report the analysis of mass disasters, which had been dealt with by forensic experts, on the territory of the former GDR. The report comes on the initiative of the Society of Forensic Medicine and with the support of regional institutes. For the period 1960 to 1989, 20 events with 738 casualties were registered. The number of victims was particularly high in aviation and rail disasters as well as in the Zwickau mine disaster. The Forensic Institute of the Humboldt-University in Berlin was engaged in the investigation of the three airplane crashes on Berlin territory and near Berlin (Königs-Wusterhausen 1972, Berlin-Bohnsdorf 1986 and Berlin-Schönefeld 1989) as well as of the railway disaster near Lebus in 1977. As a result of the analysis, the experience gained in three decades regarding the planning, organization and realization of the identification of victims is dealt with in more detail. It emphasizes the significance of close cooperation with dentists and criminalists. Because of ethical, legal and criminalistic reasons the aim should always be a complete examination (including autopsy) of the victims as well as their identification.
Accidents, Aviation↗
A "community as resource" strategy for disaster response.
Natural and technological disasters present significant threats to the public's health. The emergency response capabilities of government and private relief organizations are limited. With a strategy in which residents of urban areas are trained in search and rescue, first aid, fire suppression, care and shelter, emergency communications, and disaster mental health, the community becomes a "resource" rather than a "victim."
Community Health Planning↗
Disaster planning: are gerontological nurses prepared?
This article is a review of basic, but important information about disaster planning considerations for older populations. The recent hurricane experiences in the South confirmed how critical this planning is, and the importance of early evacuation in saving lives. This is highlighted when comparing the official responses during Hurricane Katrina and Hurricane Rita. Advance preparations result in more control and safety in a dangerous situation. In New Orleans, the delay in evacuation of older adults resulted in panic and confusion, without an easy solution. Those who could not be easily evacuated remained, sometimes at great cost. Gerontological nurses need to advocate for the planning and resources that would assist older adults in a safe and early evacuation if indicated. Adequate support personnel, transportation, and pre-positioned supplies should all be in place for use following a disaster event. Rescue is more costly than evacuation, in both resources and human suffering, and places both rescuers and victims at risk. Each individual, facility, and community needs disaster and evacuation plans that are widely disseminated in advance of any disaster. These plans must address the unique needs of older adults. Hurricane Katrina demonstrated the importance of evacuation before the impact of disaster. When individuals have advance notice of an impending disaster, evacuation can be conducted in a more orderly, planned way to get older adults to safety. Hurricane Rita proved that even advance evacuation is not problem-free, but is well worth the effort. Each facility needs to be prepared to be self-sustaining, to "shelter in place" for at least 72 hours. This requires having the resources and supplies to support at least minimal safe function. However, facilities in locations that could be isolated for longer periods of time should consider having even more supplies in reserve. Recent events may prompt gerontological nurses to ask themselves, their facilities, and communities--Are we prepared?
Aged↗
Mass casualty incident. Integration with prehospital care.
Mass casualty incident involves the use of limited resources for multiple casualties. The emergency physician must be familiar with both prehospital and hospital plans for mass casualty care in order to facilitate optimal care and to maintain the continuum from field care to definitive treatment. It is essential that the emergency physician become involved in the disaster planning processes to ensure that the victims receive the best care available under the circumstances and that the safety and emotional well-being of both prehospital and hospital personnel are assured. Emergency physicians involved in prehospital care should be certain that the local EMS system has adequate training and chances to update their skills and knowledge. Disaster drills of the EMS system are excellent ways to practice, to identify weaknesses, and for preplanning to enhance disaster medical care.
Disaster Planning↗
Post-preparedness medical disaster response in Costa Rica.
INTRODUCTION: The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness. HYPOTHESIS: Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent. METHODS: Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office. RESULTS: Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake. CONCLUSION: To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.
Costa Rica↗
Surgery in the air--evacuating Finnish tsunami victims from Thailand.
In connection with the Asian tsunami disaster on December 26, 2004, a specially equipped Finnair B-757 airplane capable of evacuating badly injured patients was remodeled into an ambulance airplane. The vehicle could take up to 22 severely injured or ill patients and intensive care and limited surgical procedures could be provided to the patients. The plane was manned with a civilian medical team of 37 physicians and nurses. The plane left for Thailand to evacuate the most severely injured Finnish citizens within 10 hours of the evacuation decision. A total of 14 patients including 4 critically ill (two on ventilator) were transferred to Helsinki within 32 hours of takeoff. The medical team included a general, an orthopedic and a plastic surgeon. Soft tissue wounds, some of them severely infected, were the most common injuries, followed by extremity fractures and head injuries. The surgical procedures that were performed mid-air included wound surgery, to remove necrotic tissue, and external fixation and fasciotomy for a lower extremity fracture. The facilities under these circumstances would allow performing life-saving procedures to maintain airway and breathing, and surgical procedures of the soft tissues, extremity and pelvic fractures. Cavitary surgery would require additional equipment and resources.
Air Ambulances↗
[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↗
The Ash Wednesday bushfires in Victoria.
The Ash Wednesday bushfires were one of the worst natural disasters in Australia's history. This paper documents observations of human reactions to the disaster started immediately after the bushfires. Two frameworks were used for classification of observations: biopsychosocial and temporal. Biological, psychological and social reactions in adults and children are described as they occurred before, during, immediately after, and two months after the disaster. Some reactions in animals are noted. Victims of the bushfires were seen to have reacted during the various phases of the experience in a predictable way: during the acute danger, when survival was paramount, and immediately afterward, the usual patterns of hierarchical structure within families and in the wider community broke down and new social structures emerged. These reverted to previously existing patterns in the ensuing months. Feelings of disorientation, unreality and anger at outside agencies, which were viewed as hostile and unhelpful, were commonplace. The findings have implications for the development of everyday stress reactions and clinical syndromes presenting to clinical practitioners. Lastly, the role of intervention for disaster reactions is examined and its usefulness noted.
Aged↗
A hospital response to a soccer stadium stampede in Zimbabwe.
OBJECTIVES: When a soccer stadium stampede occurred in Zimbabwe on 9 July 2000, the hospital disaster (medical emergency) plan failed. This report describes the use of the audit technique to change the hospital's disaster preparedness. METHOD: A literature review was done to establish international standards of best practice in major medical incident response. The hospital disaster plan (major medical incident plan) was reviewed and used as local standard. Written submissions and unstructured interviews technique were used to collect information from staff present on the day and involved in the care of the stampede victims and from staff specified in the hospital disaster plan. This was presented as a report to the Hospital Clinical Audit and Quality Assurance Committee (CAQAC), with recommendations. RESULTS: The hospital's response to the disaster was suboptimal. The initial recommendations were accepted. Implementation is ongoing while discussion is drawing in other people and agencies. An integrated prehospital care system is required. The casualty department needs to develop into a modern accident and emergency department. Individual departments need to develop their own disaster plans that link into the hospital plan. A system for future audits of the hospital's performance after a disaster need to be put in place. Implementation of these recommendations is changing disaster preparedness in and out of the hospital. CONCLUSIONS: The exercise was very useful in raising awareness and the value of audit and specific issues were defined for improvement. Long term and short term goals were set. Despite the shortage of resources, change was felt to be necessary and possible.
Disaster Planning↗
Mining disasters in South Africa: the Rovic Diamond Mine disaster and the criminal liability of the mine authorities.
The South African economy depends heavily on the mining industry. Deep level mining--which is a very common occurrence in the South African Mining Industry, is fraught with dangers. It is therefore inevitable that these dangers will be a constant source of medico-legal involvement. At the end of November 1996, a mining disaster occurred at the Rovic Diamond Mine between Boshof and Dealsville. At about 1000 metres underground, a mudslide occurred and trapped 20 miners. Rescue workers could only retrieve four bodies. Due to the dangers of additional mudslides and collapse of the entire slope, the rescue workers were withdrawn. The 16 miners were later declared dead by a Court Order after a full investigation into the disaster was completed. In this discussion focus will be placed on the Rovic Mine Disaster Investigation, the post mortem examination of the four victims, the legal declaration of death of the other victims not found and the legal accountability of the mine authority.
Adult↗
Disaster medicine training in France.
We describe the disaster medicine training program that has been developed in France by the anesthesia-reanimation specialists who provide emergency medical services. The diploma course is presented twice yearly over a two-week period to physicians of all disciplines. The 71-hour didactic program covers the background of disasters, various plans and strategies, tactics and logistics, techniques, and victim assessment and treatment. This is followed by a field exercise. Graduates then participate in a full-scale mock disaster exercise that lasts two days to one week. The development of such a course illustrates the attention that nations worldwide are giving to specialized physician training in disaster preparedness.
Curriculum↗
Impact of a natural disaster on a psychiatric inpatient population: clinical observations.
Natural disasters do not always lead to post-traumatic stress disorders (PTSD) for their victims, although stress-related symptoms are commonly reported as results of such disasters. The impact of a natural disaster on the treatment of a hospitalized psychiatric population has never been systematically evaluated. In the fall of 1986, severe river flooding caused evacuation of a 160-bed psychiatric facility. One hundred and twenty-one hospitalized patients were taken to nearby hospital facilities, and many were separated from their primary therapists, fellow patients or both. A mail survey two months post-evacuation assessed stress-related symptoms, the patients' opinions of the impact of the flood on their treatment and functioning, and the patients' views of the evacuation procedures. Patients also responded to questions about their cognitive and affective reactions during each phase of the disaster. Clear evidence of PTSD was not found with this population; however, the findings underscore the importance of keeping patients with familiar staff and peers when possible. Differences between this study and previous disaster studies are noted, and suggestions for coping with natural disasters in inpatient or residential psychiatric facilities are offered.
Crisis Intervention↗
The Armero tragedy: lessons for mental health professionals.
A U.S. mental health consultant worked closely with medical personnel soon after a volcanic eruption and mud avalanche killed about 22,000 persons and devastated the area around Armero, Colombia. The consultant conducted workshops and courses on crisis intervention for health personnel operating disaster relief units and for mental health professionals, pediatric nurses, and family workers; she also provided consultations to clinic and shelter directors and case consultation with hospitalized victims. Observations of early postdisaster responses of hospitalized victims showed recurring themes such as victims' ambivalence about learning the full extent of the disaster and their own losses, delayed mourning because many bodies could not be recovered, somatic expressions of anxiety and fear, and the use of primitive defenses, such as magical thinking.
Colombia↗