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PubMed2005

Mental health care for ethnic minority individuals and communities in the aftermath of disasters and mass violence.

Findings from research on psychiatric epidemiology, disaster effects, discrepancies in service use, and cross-cultural psychology are reviewed to generate guidelines for culturally responsive postdisaster interventions. Ethnicity and culture influence mental health care at various points: on need for help; on availability and accessibility of help; on help-seeking comfort (stigma, mistrust), and on the probability that help is provided appropriately. There are aspects of disaster mental health practice that may ameliorate many of barriers that contribute to ethnic disparities in service use. It is proposed that interventions should give greater attention to socially engaged emotions and functioning. To promote disaster recovery, practitioners are advised to: assess community needs early and often; provide easily accessible services; work collaboratively and proactively to reduce stigma and mistrust and engage minorities in care; validate and normalize distress and help-seeking; value interdependence as well as independence as an appropriate developmental goal; promote community action; and advocate for, facilitate, or conduct treatment and evaluation research. Notwithstanding the pain and stress they cause, disasters create opportunities to de-stigmatize mental health needs and build trust between providers and minority communities.

Community Mental Health Services↗
PubMed1990

Lessons from the aftermath of Flight 232. Practical considerations for the mental health profession's response to air disasters.

The fiery crash of a DC-10 at Sioux City, Iowa, on July 19, 1989, caused a crisis of major proportions, with attendant mental health needs. Various articles have described the need for psychological response teams in such crises. The present article provides practical guidelines for the preparation of a mental health disaster plan and for the coordination of a mental health team responding to a major air disaster. Such disasters can occur in any part of the country at any time. It is hoped that the suggestions in the present article will help teams that respond to future air disasters provide more rapid, effective, and efficient delivery of services to the survivors and their families, and the families of those who are killed.

Accidents, Aviation↗
PubMed2000

Natural disasters and alcohol consumption in a cultural context: the Great Hanshin Earthquake in Japan.

AIMS: To assess changes in alcohol consumption attributable to the Great Hanshin Earthquake to test the assumption that alcohol consumption increases after natural disasters. METHODS: Quarterly alcohol sales figures were compared for three periods: before, immediately after and subsequent to the Great Hanshin Earthquake in three areas of the Hyogo prefecture: the severely affected area, the moderately affected area and the unaffected area. Possible confounding by population movement, damage to retail outlets and normal variation in sales, was assessed. FINDINGS: The quantity of alcoholic beverages consumed in the heavily damaged areas as well as throughout the prefecture decreased from the 1994 pre-disaster level, both immediately after the Great Hanshin Earthquake (January-March 1995) and 2 years after the disaster. This finding remained once possible confounding factors were taken into consideration. CONCLUSIONS: More attention should be placed on drinking in the cultural context where a disaster occurs. It may sometimes deter, rather than encourage, drinking among the affected population.

Alcohol Drinking↗
PubMed1985

The effects of stressful life events and disasters: research and theoretical issues.

The study of the relationship between adversity and physical and psychiatric illness can be researched by examining either the effect of multiple random events or the impact of a single event, such as a disaster. There has, however, been little cross-fertilisation of theory or methodology between these two areas of investigation. Disaster research has much to learn from the methodological rigour of life events research. Equally the study of disaster victims can help define the similarities and differences between distress and illness, an issue central to the validity of the concept of 'caseness' in the study of nonpatient samples. In the past, the failure to separate these phenomena may have led to exaggerated estimates of the prevalence of morbidity among disaster victims. It is also important to examine the intervening role played by distress generated by an event in causing physical and psychiatric disorder.

Affective Symptoms↗
PubMed2006

Mental health assistance to populations affected by disasters: World Health Organization's role.

In this article, the authors describe the role of the World Health Organization (WHO) in mental health post-disaster recovery. The article covers the mandate and structure of WHO, mental health activities by the WHO Department of Mental Health and Substance Abuse, WHO-supported principles and strategies in mental health post-disaster recovery, and available WHO technical assistance. The paper outlines a public mental health approach to make very basic mental health services broadly available in post-disaster countries. Using examples based on the Asian tsunami experience, suggestions for delivering mental health assistance are made. The response to mental health of disaster victims should be seen in the context of national health priorities.

Asia, Southeastern↗
PubMed2006

Psychosocial support in disaster-affected communities.

The paper outlines psychosocial interventions in providing care and support to disaster-affected communities. Any impact of disaster can be looked at in two ways: firstly by ascertaining the characteristics of the event itself, and secondly, how that event is appraised by those affected. Depending on different phases of the impact of the disaster, individuals will respond in different styles. Psychosocial interventions must be tailored to address the needs of the target population, with special attention paid to vulnerable groups such as children, women and the elderly. These should also be modulated according to the phase of recovery following the event occurrence because each phase will highlight different needs. The four phases of intervention, although determined separately, may show an overlap. In the initial phases, the emphasis is on social intervention that can be delivered by community-level workers. In the later phases, the psychological issues that emerge necessitate the services of trained professionals. Initial social care will need to give way to psychological care, and on occasion both will need to be combined for a considerable period. Since psychosocial care is a long-term, continuous process, disaster management and preparedness programmes must invest in training for capacity building by training community workers and primary care health professionals.

Community Mental Health Services↗
PubMedDate not supplied

Community response to disaster: the role of the workplace.

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.

Bioterrorism↗
PubMedDate not supplied

Helicopter emergency medical services roles in disaster operations.

Rotor-wing aircraft have previously proven utility in disaster operations, but recent expert reviewers have identified areas of potential improvement in integration of helicopter emergency medical services (HEMS) resources into disaster planning and management. This paper discusses salient points regarding helicopter operations in disaster management, using prior reports regarding rotor-wing aircraft utilization as a basis upon which to provide a concise review of HEMS operations in disasters.

Air Ambulances↗
PubMed1986

Disaster planning for air crashes. A retrospective analysis of Delta Airlines flight 191.

The effectiveness of previously untested disaster plans was demonstrated during the aftermath of the crash of Delta Airlines Flight 191 at D/FW International Airport on Friday, August 2, 1985. These plans, in effect for years and subjected to periodic review, were as yet untried before this first disaster at D/FW International since its opening. This paper outlines the disaster plans, the actual problems encountered, the logistics of a disaster of this kind, and insights gained from the experience.

Accidents, Aviation↗
PubMed1995

Using counselors in a multideath disaster.

In the worst possible situation, a disaster results in multiple deaths, requiring the involvement of coroner's and medical examiner's offices. Guidelines offered by the National Association of Medical Examiners and by a national funeral directors' association suggest the use of ministers and chaplains to offer "pastoral" care to family members who have lost a loved one in a disaster. This article offers an example of a disaster protocol based upon national guidelines, but using certified and licensed professional counselors to provide preventive outreach counseling to those family members. Furthermore, this protocol uses a counselor in a key position to provide psychological care to investigative and medical personnel involved in the recovery and identification portions of a disaster.

Cause of Death↗
PubMed1996

Relocation after a disaster: posttraumatic stress disorder in Armenia after the earthquake.

OBJECTIVE: To explore the relationship between exposure to the earthquake in Armenia on December 7, 1988, and relocation from the disaster zone, and the subsequent development of posttraumatic stress disorder (PTSD), depression, and behavioral difficulties in children. METHOD: The PTSD module of the Diagnostic Interview for Children and Adolescents-Revised and the Depression Self-Rating Scale were administered to 25 children, aged 11 through 13 years, who had high exposure to the earthquake and remained in the earthquake city. They were compared with a demographically similar group of 24 children exposed to the earthquake who were relocated to another city after the earthquake and 25 nonexposed children. For each child the mothers responded to the Child Behavior Checklist and the teachers responded to the Teacher's Report Form. RESULTS: The hypothesis that relocated children would present with less PTSD, depression, and behavioral problems was not confirmed. Both groups of children with high exposure to the earthquake, one remaining in the earthquake city and one relocating, demonstrated significantly higher rates of PTSD, depression, and behavioral difficulties than the comparison group. There were no differences between the relocated children and those who remained in the earthquake zone. CONCLUSION: Children who were relocated after a natural disaster did no worse than children who remained in the disaster zone. Relocation should be considered as an alternative after catastrophic natural disasters in situations where resources are so limited that rebuilding cannot take place for an indefinite period of time.

Adolescent↗
PubMed1999

Children's responses to a nuclear waste disaster: PTSD symptoms and outcome prediction.

OBJECTIVE: To examine the psychological impact of living near a nuclear waste disaster that involved ongoing threat of radioactive contamination. METHOD: Participants were an exposed sample (residence within a 5-mile radius of the nuclear plant) of 120 children (7-15 years old) and their parents and a nonexposed comparison sample of 60 children and their parents. Parent and self-ratings of the children's psychological functioning and posttraumatic stress disorder (PTSD) symptoms were obtained, along with cognitive variables. RESULTS: Minimal differences between the 2 samples were found. In the exposed sample, stress responses for the child self-reports showed several age group by gender interactions. Girls' PTSD symptoms tended to increase with age while boys' symptoms decreased, with intrusion showing the strongest effects. While child and parent PTSD symptom ratings were correlated, children reported approximately twice as many symptoms. Cognitive understanding increased with age and was greater in boys. Exposure and parent functioning significantly predicted outcome. CONCLUSIONS: Age and gender effects after disaster might best be explored as an interaction. While disaster effects were mild, the psychological health of the parents may be an important determinant of psychological health in children in this type of disaster.

Adolescent↗
PubMed2002

Disaster preparation and management for the intensive care unit.

The purpose of this report is to provide information regarding preparation for disaster management from the perspective of ICU physicians. Both a framework toward ICU preparation for disaster management and a guide to the relevant literature are presented. Our objective is to show that the understanding of disaster preparedness on multiple levels, including government, hospital, ICU, and clinician, may lead to optimal management in a disaster.

Disaster Planning↗
PubMedDate not supplied

Managing a combined burn trauma disaster in the post-9/11 world: lessons learned from the 2003 West Pharmaceutical plant explosion.

At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.

Burn Units↗
PubMedDate not supplied

Burn-injured patients in a disaster: September 11th revisited.

We sought to review the steps taken by the New York Presbyterian Healthcare System to address disaster preparedness in the wake of the terrorist attacks of September 11, 2001. We reviewed the institutional records of emergency preparedness efforts, including improvements in infrastructure, employee education and training, and participation in intramural and extramural disaster response initiatives. We used a state discharge database to review burn injury triage within New York State (1995-2004). Since September 11, 2001, significant resources have been devoted to emergency preparedness: expansion of emergency services training, education, response, equipment, and communications; participation in regional disaster response exercises; revision of hospital preparedness plans; and development of municipal and regional responses to a burn mass casualty incident. A review of state and city burn triage patterns during the period of 1995 to 2004 revealed a decline in the number of burn cases treated in New York State-based hospitals by an average of 81 +/- 24 (mean +/- SEM) fewer cases/year (P = .01), occurring primarily in hospitals outside of New York City. Additionally, there was a steady increase in the proportion of New York City burn patients treated at burn center hospitals by 1.8 +/- 0.1 % per year (P < .0001). In response to the events of September 11, 2001, this health care system and this hospital has taken many steps to enhance its disaster response capabilities.

Burn Units↗
PubMedDate not supplied

Predictors of fatigue in rescue workers and residents in the aftermath of an aviation disaster: a longitudinal study.

OBJECTIVES: Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents. METHODS: A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up. RESULTS: Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue. CONCLUSIONS: These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Accidents, Aviation↗
PubMed1997

Disasters and the information technology revolution.

This paper, the second in a series of state-of-the art reviews, examines the evolution and possible medium-term future of information technology (IT) in disaster management. Until the end of the 1970s, civilian application of IT to disaster management was confined to a few specialised departments of universities, large companies and government. Between the late 1970s and mid-1980s, microprocessor-based devices brought limited, though rapidly improving, computing capacity to a wider range of organisations and individuals. Operational applications included real-time emergency information, management decision support and programme and project planning. Extensive innovation occurred, though operational implementation was often long delayed or limited in scope. During the late 1980s, desktop systems became more powerful, more networked, more portable and generally more mature, with a range of practical emergency-related tools emerging. Computer communications emerged as a practical technology for linking emergency professionals on a global basis. From the early 1990s onwards, powerful and inter-connectable computer equipment has evolved to become an indispensable component of disaster operations worldwide. There are presently major changes under way in emergency-related global information access and networking--the implications of which have yet to be played out. The last part of the paper highlights a set of key technologies which seems likely to shape disaster planning, management and research over the next 10 years, and draws out some operational and organisational implications.

Computer Communication Networks↗
PubMed2006

Psychological assessment of children in disasters and emergencies.

Children and adolescents are among the most vulnerable members of communities affected by disasters and emergencies. There is a tremendous need for a systematic post-disaster psychological assessment of children and adolescents in order to understand better post-traumatic symptomatology in children and to identify populations that require an early intervention. This article reviews psychological instruments that are suitable for screening children and adolescents in emergency and disaster contexts for four different types of post-traumatic responses: post-traumatic stress disorder; depression; anxiety disorders; and behavioural disorders. A description of each instrument and psychometric data are provided, along with recommendations on the most appropriate instruments to be utilised in different emergency environments and a summary of previous post-disaster evaluations that have used each type. In addition to selecting apposite instruments, other important issues that should be taken into account when conducting post-emergency mental health needs appraisals of children and adolescents are discussed.

Adolescent↗