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PubMed1991

[Dental identification in ferry disaster outside Zeebrugge].

The Herald of Free Enterprise disaster on the 6th of March 1987 just outside Zeebrugge harbour was without any doubt a disaster of major proportions. The identification of the victims had to be done in three phases each of them with its own specific work and problems. As the process of identification of bodies is an exacting science, and forensic odontology is known to be among the most reliable scientific methods in mass disasters, it is easily understood that forensic odontology took an active part in all three phases of the identification process.

Disasters↗
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↗
PubMed2001

[Debriefing of hospital professional staff after fire in a bar in Volendam].

A fire disaster in a bar on New Year's Eve 2001 in Volendam, which led to 200 victims, resulted in active participation of regional hospitals, including the academic hospital of the Free University of Amsterdam. In the first hour, more than 100 members of personnel were mobilised in this hospital. Nine doctors and nurses worked as members of medical teams at the site of the disaster; the others triaged 16 patients in the emergency room and treated 13 patients in the intensive care unit. After 4.5 hours, the influx of victims stopped and accordingly the disaster plan was deactivated. During the subsequent days, debriefings were organised on request of the hospital staff and personnel involved. These concluded that specific adjustments to hospital procedures were needed, such as a total admission stop for a few days, to prevent mental burn-out of personnel and to maintain the standard quality of care. Hospital disaster plans do not usually have specific guidelines for the emotional preparation of personnel during and immediately after a disaster, nor do they include specific guidelines for the evaluation of its emotional impact in terms of the quality of care delivered. These elements should be incorporated into every disaster plan.

Adult↗
PubMed2000

Post-mortem orthopantomography--an aid in screening for identification purposes.

Ante-mortem orthopantomograms may be of great value in the identification of human remains. This x-ray technique provides an overall view of the teeth and jaws and thus of numerous individual structural characteristics within a short time. Standardised post-mortem orthopantomography has previously not been feasible in the forensic practice. The present study shows how orthopantomography can be applied to identification procedures. The reproduction of ante-mortem x-ray conditions is implemented here in the production of post-mortem x-rays, using a purpose-designed radiographic tripod. For the first time, account is taken not only of the size and structure but also of the nature of the soft tissue covering of exhibits. For post-mortem preparation of these radiographs, appropriate positioning aids, a spinal column substitute and a soft tissue filter were constructed. Individual macerated jaws as well as the complete cranium can now be positioned correctly in the upright orthopantomograph (OPG). The method presented expands the spectrum of forensic radiology for the individual case and in our opinion also offers a reliable aid for victim identification in the wake of mass disasters, aircraft crashes and terrorist attacks, where a large number of bodies have to be identified under great pressure.

Cadaver↗
PubMed2003

Assessment of exposure to a flood disaster in a mental-health study.

The lasting psychological consequences of disasters are an important public health issue, especially for determining the support needed by victims. One important question in evaluating psychological consequences remains the assessment of individual disaster-related experiences or stressors. This article proposes two approaches towards the construction of cumulative exposure indicators (CEIs) for a disaster and discusses their relevance for other disasters. In 1997, we carried out a cross-sectional study of the association between the severity of exposure to a 1992 flood in southeastern France and the prevalence of psychological symptoms 5 years later. We interviewed 500 randomly selected subjects residing in one of the most affected municipalities and constructed two CEIs: one based on relevant articles in the literature and the second based on the results of a principal component analysis (PCA) of all the items exploring exposure to the flood. We compared these CEIs with a map of flood damage and tested the association between these indicators and a score of post-traumatic stress symptoms. Most of the subjects (79.1%) had been exposed to at least one stressor besides physical presence. The two CEIs were significantly correlated with one another; comparisons with the map showed that both had good ability to discriminate between mild and severe exposure. Multiple regression analyses showed a significant exposure-effect relation, of the same level of magnitude and significance, between the post-traumatic stress disorder score and each CEI. Our results show the appropriateness of such indicators in assessing the effect of cumulative stress from natural disasters. Guidelines should be developed to improve the comparability of instruments and help standardize methods for evaluating cumulative stress from disasters insofar as possible. Further research is nonetheless necessary to assess the consistency and reproducibility of the data collected.

Adult↗
PubMed1981

Organophosphorus ester-induced delayed neurotoxicity.

In certain animals, including humans, exposure to some organophosphorus esters causes delayed neurotoxicity (OPIDN). The clinical condition becomes manifest after a delay period, first as ataxia, followed by paralysis. Lesions are characterized by degeneration of axons with subsequent secondary degeneration of myelin in the peripheral and central nervous systems. Recovery is only likely in mild cases, whereas more severe cases show symptoms of an upper motor neuron lesion in the lower limbs. The risk of use of these chemicals is related not only to human sensitivity to this syndrome, but also to the fact that in most disasters involving OPIDN, humans were the prime victims. Therefore, the neurotoxic action of a chemical is of great significance, since pesticides with this property are not recommended for use. Although OPIDN has been recognized for over a half a century, its mechanism of action is still unknown. It is believed, however, that the initial target in OPIDN is the phosphorylation of a neurotoxicity target protein in the nervous system. Study of the relationship between the chemical structure of organophosphorus esters and their neurotoxic potencies suggests that two hydrophobic areas may be present in the vicinity of the active site of the neurotoxicity protein. This article attempts to present an up-to-date overview of OPIDN. Despite the difficulties attributed to experimental variations of the reported studies, I feel that several significant points have come forth from the data.

Age Factors↗
PubMedDate not supplied

Risk factors of diarrhoea among flood victims: a controlled epidemiological study.

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.

Case-Control Studies↗
PubMed1997

When mother and baby are refugees.

War and disaster strike everyone hard, but they strike the most vulnerable people hardest. Since the Second World War more than 21 million people, most of them women and children, have died in wars and other conflicts. Countless others have perished in natural disasters. Most of the world's 50 million refugees and displaced persons are women and children. The special feature in this issue of Safe Motherhood looks especially at mothers and infants in situations of war and disaster. It describes their plight as innocent victims, as society's most vulnerable members struggling to survive in hostile surroundings, and as lonely figures trying to rebuild their lives against all odds. It particularly focuses on motherhood among women refugees. Much can be done to improve the situation of these mothers and their infants. The special feature describes steps that can be taken to make sure that motherhood is safer--and infant health more secure--even when the situation seems to be desperate. Women refugees face all kinds of disadvantages and hardships. WHO is developing guidelines on women's reproductive health during conflict and displacement to address these problems. The feature in this newsletter is based on these guidelines.

Child Welfare↗
PubMedDate not supplied

Central system of psychosocial support to the Czech victims affected by the tsunami in Southeast Asia.

The tsunami disaster affected several countries in Southeast Asia in December 2004 and killed or affected many tourists, most of them from Europe. Eight Czech citizens died, and about 500 Czechs were seriously mentally traumatized. The psychosocial needs of tourists included: (1) protection; (2) treatment; (3) safety; (4) relief; (5) psychological first aid; (6) connecting with family members; (7) transportation home; (8) information about possible mental reactions to trauma; (9) information about the normality of their reaction; (10) procedural and environmental orientation; (11) reinforcement of personal competencies; and (12) psycho-trauma therapy. The Ministry of Foreign Affairs of the Czech Republic was in charge of general emergency management. General coordination of psychosocial support was coordinated under the Ministry of Interior of the Czech Republic, which is connected to the Central Crisis Staff of the Czech Government. The major cooperative partners were: the Ministry of Foreign Affairs, the Ministry of Defence, the Ministry of Health, Czech Airlines, psychosocial intervention teams of the Czech Republic, and the Czech Association of Clinical Psychologists. The main goals of relief workers were: (1) to bring back home the maximum number of Czech citizens; (2) to provide relevant information to the maximum number of affected Czech citizens; (3) to provide relevant information to rescue workers and professionals; and (4) to prepare working psychosocial support regional network. Major activities of the Ministry of Interior (psychology section) included: (1) establishing a psychological helpline; (2) running a team of psychological assistance (assistance in the Czech airports, psychological monitoring of tourists, crisis intervention, psychological first aid, assistance in the collection of DNA material from relatives); (3) drafting and distributing specific information materials (brochures, leaflets, address lists, printed and electronic instructions); (4) communicating via the media and advertising, and (5) providing analysis and research studies. Central coordination of psychosocial support has been found as successful in the first phase after the disaster. The plans must be built for preferable cooperation in the psychosocial field in the Czech Republic. Better collaborates with journalists must exist in order to reduce secondary psycho-trauma. There is a need for intensive international cooperation in the psychosocial field and to build the network at the global level.

Crisis Intervention↗
PubMed1985

Lightning-strike disaster among children.

Thirty-eight children playing or observing a soccer game were the victims of a lightning strike which killed one other child. Interviews with the children and their families documented a number of emotional effects of this disaster, chiefly situational adjustment reactions. The most common reactions involved anxiety, particularly at times of storms. However, the most severely upset children exhibited sleep disturbances, separation anxiety, and nocturnal enuresis. One of two side-flash victims experienced depression for several months; the other experienced no significant emotional upset. Both suffered medical complications and had no memory for the incident. While all children reached at follow-up were doing quite well, those who were most upset by the incident were more likely to refuse to play soccer during the follow-up interval. Stories told to pictures of lightning revealed projections of the children's emotional upset, various defensive reactions to the incident and an increased sense of subjective probability for lightning injuries.

Adaptation, Psychological↗
PubMed1996

Relationship between lung inflammation, changes in lung function and severity of exposure in victims of the Bhopal tragedy.

The world's worst chemical industrial disaster, which occurred at Bhopal on 2-3 December, 1984, resulted in considerable respiratory morbidity in the exposed population. Therefore, a study was planned to evaluate the relationship between lower respiratory tract inflammation, lung function and severity of exposure. Sixty patients exposed to methyl isocyanate and presenting with respiratory symptoms were studied using bronchoalveolar lavage (BAL) 1-7 yrs after the accident. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). An index of severity of exposure was derived retrospectively on the basis of the acute symptoms in the victims themselves or the occurrence of death among their family members. Total lung inflammatory cells (p < 0.01) and absolute numbers of macrophages (p = 0.01) and lymphocytes (p < 0.05) increased as severity of exposure increased. FEV1/FVC % (p = 0.05) was also significantly lower as severity of exposure increased. Moderately exposed subjects had significantly lower FEV1/FVC % (p < 0.05) compared to those mildly exposed. In nonsmokers, BAL neutrophils, both percentage and absolute numbers, showed significant negative correlations with FEV1 % predicted (rs = -0.350, p < 0.05; and rs = -0.374, p < 0.01, respectively). Neutrophil percentage was negatively correlated with FEV1/FVC % (rs = -0.378; p < 0.01). Absolute lymphocytes had significant negative correlations with FVC % pred (rs = -0.318; p < 0.05). Macrophages had significant positive correlations with FVC % pred (rs = 0.322; p < 0.05) and FEV1 % pred (rs = 0.433; p < 0.01). Radiographic abnormalities (International Labour Organization (ILO) classification) were associated with decline in FEV1 % pred (p < 0.05). This study suggests that pulmonary function abnormalities occur in gas-exposed subjects as a consequence of an abnormal accumulation of lung inflammatory cells (lymphocytes and neutrophils), and that the intensity of lung inflammation and reduction in pulmonary function are greater in severely exposed subjects. As it has been observed that decline in pulmonary function is associated with radiographic abnormalities, there is a suggestion that injury following toxic gas exposure can lead to irreversible lung damage.

Accidents, Occupational↗
PubMedDate not supplied

Field observations: Disaster Medical Assistance Team response for Hurricane Charley, Punta Gorda, Florida, August 2004.

The South Florida Disaster Medical Assistance Team was deployed to work with victims of Hurricane Charley in Charlotte County, Fla. Charlotte County was unique because of the higher than average number of elderly residents and the fact that all 4 local hospitals had been damaged. The Disaster Medical Assistance Team was required to modify their response, and the lessons learned from this experience are presented.

Disasters↗
PubMedDate not supplied

KAMEDO report no. 84: terrorist attacks against the World Trade Center, 11 September 2001.

On 11 September 2001, two hijacked airplanes collided with the World Trade Center in New York. Both towers collapsed, spreading smoke and debris for miles. Rescue personnel arrived rapidly, but the collapse of the towers made the scene too dangerous for these teams to rescue all those trapped inside. Although this collapse was impossible to predict, fires occurring in skyscrapers can cause the structures to collapse. When a fire erupts in the upper levels of the building, it is even more difficult for those trapped inside to escape. Communications systems were shut down. In future incidents with large numbers of injured victims, the injured should be transported to hospitals by non-traditional medical transport vehicles (taxis, cars, etc.). If future disasters occur in the vicinity of a hospital, the most severely injured victims should go to the hospital instead of congregating at assembly points. These victims often are already at hospitals before substantial aid arrives at the assembly points. On-scene care must be documented, and easy-to-read triage tags should be used. Reserve power supplies in major cities should be maintained in preparation for emergencies. Both victims and rescue personnel are susceptible to post-traumatic, psychosocial reactions.

Efficiency, Organizational↗
PubMedDate not supplied

An analysis of prehospital mortality in an earthquake. Disaster Reanimatology Study Group.

INTRODUCTION: Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy. METHODS: A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991. RESULTS: Fifty-four deaths occurred prior to hospitalization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two percent (2/9) were judged preventable if earlier emergency medical care had been available. Most injuries and deaths occurred in victims who were inside wooden buildings (p < .01) as opposed to other building types or were pinned by rubble from building collapse. Autopsies performed on a sample of victims showed crush injury to be the predominant cause of death. CONCLUSIONS: A substantial proportion of earthquake mortality in Costa Rica was protracted. Crush injury was the principal mechanism of injury and cause of death. The rapid institution of enhanced prehospital emergency medical services may be associated with a significant life-saving potential in these events.

Adolescent↗
PubMed2002

Dental participants in mass disasters--a retrospective study with future implications.

Mass casualty incidents continue to require the services of forensic dentists to determine the identity of victims. Across North America and Europe. teams of forensic dentists train, using mock disaster exercises, to prepare for such duties. It is vital that these mock exercises simulate the features of real disaster situations as far as possible. In order to inform those responsible for the design and implementation of mock exercises, a study was undertaken to determine the features of actual disasters that dental personnel had attended. Using a questionnaire, data were solicited from 38 odontologists. The average number of disasters attended by the respondents was eight, with an average casualty number of 94. Aircraft crashes were the most frequent cause of disasters that were attended by the odontologists. The authors conclude that future mock disaster exercises should replicate features of aircraft crashes as closely as possible by using commingled, fragmented, and burned remains. In addition, mock disasters should require the identification of a realistic number of individuals to ensure authenticity and the maximum logistical preparedness of participants.

Accidents, Aviation↗