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PubMed1991

Triage of disaster-related neuropsychiatric casualties.

Existing triage algorithms consider, for the most part, only the primary casualty with physical trauma. Algorithms fail to appreciate the primary, secondary, or tertiary neuropsychiatric casualty. Research advances on neuropsychiatric casualties must link with the mandates of emergency medical services and disaster management to improve triage sensitivity and specificity. Early recognition and management of neuropsychiatric casualties will diminish the potential for long-term consequences. Expanded triage algorithm supplements are proposed to improve the recognition of those victims at risk.

Disasters↗
PubMed2005

An Intelligent 802.11 Triage Tag for medical response to disasters.

When medical care is initiated at a mass casualty event, the first activity is the triage of victims, which is the grouping by victims severity of injury. Paper triage tags are often used to mark victims' triage status and to record information on injuries and treatments administered in the field. In this paper we describe the design and development of an"Intelligent Triage Tag" (ITT), an electronic device to coordinate patient field care. ITTs combine the basic functionality of a paper triage tag with sensors, nonvolatile memory, a microprocessor and 802.11 wireless transmission capabilities. ITTs not only display victims' triage status but also signal alerts, and mark patients for transport or immediate medical attention. ITTs record medical data for later access offsite and help organize care by relaying information on the location of the victims during field treatment. ITTs are a part of the Wireless Information System for Medical Response in Disasters (WIISARD) architecture.

Disasters↗
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↗
PubMed2001

Incentives for mitigation investment and more effective risk management: the need for public-private partnerships.

A key question facing both well-developed industrial countries and emerging economies is how to reduce future disaster losses while still providing financial protection to victims from these events. This paper proposes a strategy for the use of cost-effective risk mitigation measures coupled with insurance and/or new capital market instruments to achieve these objectives. The mix of these measures will depend on the governance structure and the institutional arrangements in the particular country. There will always be a need for a combination of policy tools and the interaction among key interested parties from both the private and public sectors in developing a disaster management strategy. Two examples, one from US and the other from Honduras, illustrate differences between strategies that countries can adopt.

Disaster Planning↗
PubMed2006

Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.

Accidents↗
PubMed1999

Victim identification and family support in mass casualties: the Massachusetts model.

The Aviation Disaster Family Assistance Act of 1996 requires the National Transportation Safety Board (NTSB), air carriers, and the American Red Cross (ARC) to provide an integrated family assistance center to offer support to family survivors of mass casualties. A central component of post-incident response is the timely identification of victims and their personal belongings. This identification process occurs through antemortem interviews with family survivors. ARC of Massachusetts Bay determined that ARC volunteers would not play a major role in conducting antemortem interviews, and deferred primary responsibility for this task to the Massachusetts Office of the Chief Medical Examiner (OCMB). This paper presents the Massachusetts model for victim identification and family support at the local level. The structure and services of this model for on-site forensic processing, the fielding of antemortem interviewers, and a comprehensive training curriculum in psychological trauma and victim identification are presented. The implications are discussed.

Aviation↗
PubMed2004

Psychotherapeutic interventions for survivors of terrorism.

Terrorist attacks combine features of criminal assaults, disasters, and acts of war. Accordingly, much of our clinical knowledge in treating this relatively new kind of traumatic event is adapted from experiences in treating victims of criminal assault, homicidal bereavement, natural and man-made disasters, war and political violence, workplace homicide, and school shootings. This paper reviews the pertinent literature on these types of trauma and combines this information with the author's own experience in treating direct and indirect victims and survivors of recent terrorist attacks. The paper describes the psychological syndromes resulting from terrorism and discusses individual and family modalities for treating victims and survivors of terrorism.

Adaptation, Psychological↗
PubMed1999

Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: results from confirmatory factor analyses.

Factor analytic studies of trauma victims' posttraumatic stress disorder (PTSD) have offered conflicting hypotheses about how to conceptualize PTSD into symptom categories. The present study used confirmatory factor analyses of self-reported PTSD symptomatology from 5,664 child and adolescent victims of Hurricane Hugo to compare 10 models of PTSD dimensionality. PTSD was best represented by a 2nd-order PTSD factor that manifests in 3 symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal). This model was cross-validated on 3 age groups (late childhood, early adolescence, and late adolescence), and results indicated factorial invariance across groups. PTSD symptoms varied in relative centrality to the underlying dimensions of PTSD, which differed in their relations with anxiety and degree of traumatic exposure. Implications for classification criteria and an empirically supported theory of PTSD are discussed.

Adolescent↗
PubMed1998

Suicide bombers in Israel.

Between 1993 and 1995, 14 suicidal terrorist bombings took place in Israel; 86 victims perished in these attacks, which were carried out by militant Palestinian organizations that oppose peace treaties between the state of Israel and the Palestinian people. The modus operandi of the perpetrators was detonating, in a public area, an explosive device carried on or in close proximity to the terrorist's body. We reviewed the postmortem examinations and identification procedures performed by the medical and law enforcement personnel involved in mass disaster management. The types of injuries sustained by the victims and perpetrators include body disruption, explosive injuries, flying missile injuries, and blast injuries. Blunt trauma directly produced by the explosion and flying missile injuries account for 80.1% of the wounds. The number of fatalities was more closely related to the type of the attack rather than to the amount and type of explosives used. Swift identification of all victims and perpetrators was obtained through collaboration between the different professional teams involved: forensic scientists, law enforcement agencies, and secret service investigators. Based on the analysis of the data obtained from the necroscopic examinations, we observed that most of the wounds sustained fall within the realm of blunt force injuries; emergency medical facilities that might be faced with similar situations should prepare accordingly. Collaboration between the various forensic and law enforcement teams results in swift resolution of disaster management. Prompt identification of the perpetrators allows the authorities to apprehend any accomplices and to prevent similar attacks.

Adult↗
PubMed1991

Antecedents of posttraumatic stress disorder: wasn't being raped enough? A brief communication.

Many rape victims, like those traumatized by war, accidents, and natural disasters, are able to recover from their ordeal with supportive, crisis-oriented treatment. For others, however, symptoms may persist and require more intensive treatment. Hypnosis allows a modulated re-experiencing and abreaction of the traumatic event that can help to provide the victim with a relieving sense of mastery, and it fosters a receptive context for reassurance and interpretation regarding the irrational or exaggerated thoughts and feelings involved. 2 case examples are presented in which earlier conflicts appeared to play a role in perpetuating the patients' symptoms. Detecting and addressing these antecedents resulted in complete alleviation of long-standing problems through relatively brief treatment using hypnosis.

Adult↗
PubMed2001

Dental identification after two mass disasters in Croatia.

AIM: To determine the usefulness of dental methods in the identification of victims in the railway accident in Zagreb (August 30, 1974) and midair collision of a British and a Slovenian airplane near Vrbovec (September 10, 1976). METHODS: There were 152 people killed in the railway accident, and 176 fatalities in the plane crash (63 in the British and 113 in the Slovenian plane). Individual victim identification and autopsy forms, and group identification reports were analyzed. RESULTS: Of the railway accident victims, 111 were identified. Dental characteristics, along with clothes, personal descriptions, personal documents, fingerprints, and jewelry, proved to be decisive in 5% of the cases. All 63 passengers and crew members from the British plane were identified; in 33% of the victims dental features, along with other characteristics, were decisive. From the Slovenian plane 103 victims were identified, 14% exclusively by teeth and 16% by teeth in combination with other characteristics. Ten bodies remained unidentified. CONCLUSION: The reasons for the small number of dental identifications in the victims of the railway accident were incomplete or unavailable antemortem data provided by relatives and friends of the deceased, and the predominant orientation toward other forensic identification methods. The significant number of dental identifications in the plane crash is explained by the provision of complete and accurate antemortem odontological data. Dental characteristics proved to be particularly valuable in the identification of carbonized victims.

Accidents, Aviation↗
PubMedDate not supplied

Ukranian's Disaster Medicine Team Mission to India following the earthquake of 2001.

This article describes the basic principles around establishing a Disaster Medicine Camp and the organization of the Ukrainian Disaster Medicine Mobile Hospital, which provided medical aid to victims of the 2001 earthquake in India. All of the information was obtained through direct observation and estimates based on empirical data gathered in the field.

Disaster Planning↗
PubMed1983

Kepone: a chemical disaster in Hopewell, Virginia.

One of the most costly chemical disasters in the United States involved a small, single-product manufacturer, ironically named Life Science Products Company, which made the pesticide Kepone for Allied Chemical Corporation. Life Science operated only 16 months in 1974 and 1975, in Hopewell, Virginia, yet managed to poison its workers and pollute the environment, causing millions of dollars of damage. The case dramatically demonstrates the links between hazards inside the factory and those outside the factory, and the confused responses of both administrative and judicial systems to a chemical disaster. In the Kepone case, as in other instances of toxic contamination, the victims confronted problems of care, compensation, and clean-up. The case illustrates two major causes of a chemical disaster: organizational pathologies of public bureaucracies, and irresponsible production by private corporations.

Air Pollutants↗
PubMedDate not supplied

Psychological and psychopathological reactions in Honduras following Hurricane Mitch: implications for service planning.

BACKGROUND: Posttraumatic stress disorder (PTSD) and other psychopathological outcomes have not been sufficiently studied in community-based samples in Latin America. This study explored various psychopathological reactions and their respective risk factors two months after Hurricane Mitch struck Honduras in October 1998. METHODS: In the Honduran capital of Tegucigalpa, 800 respondents age 15 and older were selected from residential areas of high, middle, or low socioeconomic status that had suffered either high or low impact from the devastating effects of the hurricane. The Composite International Diagnostic Interview was used to diagnose PTSD. Depression, alcohol misuse, and grief reaction were examined using screening instruments, and the Self-Reporting Questionnaire was used to measure demoralization. The Impact of Event Scale was administered to ascertain the severity of the posttraumatic reaction. RESULTS: PTSD was present in 10.6% of the sample. Respondents from the high-impact residential areas were more distressed, had higher scores on the grief inventory, and showed greater severity in PTSD symptoms. The respondents from the high-impact residential areas also had higher prevalence rates of major depression, alcoholism, and prior emotional problems. The best explanatory model for the risk of developing PTSD included the degree of exposure based on reported traumatic events, and associated increased demoralization. Among the persons with PTSD, its severity was predicted by being female and by the degree of exposure to hurricane-related traumatic events. CONCLUSIONS: Out of a total population of 3.3 million adults (age 15 and older) in Honduras, it is estimated that over 492,000 of them may have developed PTSD due to Hurricane Mitch. Adequate health disaster preparedness and response requires full acknowledgement of the multiple psychological effects that victims experience.

Adult↗
PubMed2003

Suicides after the 1999 Taiwan earthquake.

BACKGROUND: The impact of a disaster on extreme post-traumatic responses of the victims, such as suicide, remains unclear. We conducted this study to investigate the risk of committing suicide between victims and non-victims after the 1999 Taiwan earthquake. METHODS: This population cohort study linked the National Health Insurance files, family registration, and death certificates. It consists of the 3 432 705 residents aged >/=15 years of central Taiwan, 1998-2000. They were stratified into victims (n = 301 327) and non-victims (n = 3 131 378). Victims refer to those who lost co-resident family members, were injured, or experienced property loss during the earthquake. Non-victims refers to all others. The suicide rate was calculated for the period 2-15 months after the earthquake. Adjusted odds ratios were estimated with logistic regression. RESULTS: After adjusting for residential location, age, gender, major disease status, and level of urbanization, we found that victims were 1.46 times more likely than non-victims to commit suicide following an earthquake (95% CI: 1.11, 1.92). CONCLUSIONS: Given the large study population and individual information available to identify victim status, this study was able to detect a statistically significant earthquake effect on suicide rate. This effect on suicide might be diluted if only geographically based stratification were possible, as opposed to victim status stratifications. Mental health programmes or other preventive strategies might be more effective by specifically targeting victims rather than by simply targeting individuals living in earthquake-affected areas.

Adolescent↗