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At least 523 records · Page 29Linked to original sources
PubMed2002

Characteristics of acute stress symptoms and nitric oxide concentration in young rescue workers in Taiwan.

Disaster workers as well as victims are at increased risk for acute stress disorder (ASD). The present study was undertaken to study the course of the stress response in a group 187 young, male military personnel who served as rescue workers for 3 days after an earthquake in central Taiwan. A control group of 83 young, male military personnel who remained on the base was also studied. The initial evaluation took place within 16 days of the earthquake. Participants were interviewed using the Mini International Neuropsychological Interview. Thirty-one individuals met DSM-IV criteria for ASD at the initial evaluation. These 31 individuals were interviewed a second time 1 month after the earthquake. Plasma samples were also collected and assayed for nitric oxide (NO). The point prevalence rates of ASD 2 weeks after the earthquake in the initial evaluation were 9 and 16% in the rescue worker and control groups, respectively. At 1 month, the prevalence was substantially lower, in the range of 2-3%. Significant inverse correlations were observed between severity of stress symptoms and the plasma concentration of NO in the rescue worker group (r=-0.36 to -0.64, n=17, P<0.05). We conclude that young military personnel without formal training in rescue operations are at risk for ASD, but their risk appears to be no higher than that in a similarly composed control group of young military personnel. Longitudinal studies with plasma measures of NO are needed to clarify its potential role in the development and course of ASD and related syndromes.

Acute Disease↗
PubMed1993

Disaster assessment: the emergency health evaluation of a population affected by a disaster.

In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.

Disaster Planning↗
PubMed1993

Analysis of medical treatment at a field hospital following Hurricane Andrew, 1992.

STUDY OBJECTIVE: To determine what medical care was required of a special operations response team by a community devastated by a major hurricane. STUDY DESIGN: Retrospective analysis of 1,544 patient encounter forms generated at a field hospital set up in Homestead, Florida, after Hurricane Andrew in August 1992 and staffed by the special operations response team from Forsyth County, North Carolina. TYPE OF PARTICIPANTS: All persons presenting for treatment. RESULTS: One thousand two hundred three adult patients and 336 pediatric patients were seen by the special operations response team. Only five of the injuries treated were due directly to the hurricane, whereas 285 of the treated injuries were sustained during clean-up activities. Most of the care provided was routine medical care denied the citizens due to the loss of their physicians' offices and clinics. Supplies of tetanus toxoid, antibiotics, and insulin were depleted in 24 hours. Resupplying these items and acquiring other medication to refill prescriptions constituted a pressing problem. CONCLUSION: The primary function of medical personnel responding to an area hit by a major hurricane will be to provide general medical care. Any trauma encountered will be primarily due to clean-up activities and not due to the hurricane itself. Responding medical personnel should plan on providing their own food and water for the first 72 hours and be well stocked with antibiotics, tetanus toxoid, and insulin.

Adult↗
PubMed1991

The St Croix disaster and the National Disaster Medical System.

The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Disaster Planning↗
PubMed1987

Catastrophic disasters and the design of disaster medical care systems.

The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation.

Disasters↗
PubMed1998

The refugee crisis in Africa and implications for health and disease: a political ecology approach.

Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis: the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.

Africa↗
PubMed1999

Prehospital triage and communication performance in small mass casualty incidents: a gauge for disaster preparedness.

Because of their infrequency, disasters are difficult to train for. Emergency prehospital personnel frequently participate in small mass casualty incidents (MCIs) (3 to 50 victims). This study sought to examine prehospital performance in small MCIs in areas that are frequently mismanaged in disasters. Prospective data from the resource physician and retrospective data from tape recorded prehospital conversations were collected for a 9-month period. Clinical patient data, patient demographics, emergency medical services squad characteristics, and triage information were recorded. Forty-five consecutive MCIs were studied. Most of these were motor vehicle accidents. Prehospital providers included paid providers, nonpaid providers, and air and ground transport. The mean number of victims first identified (4.6%) was greatly different than the mean number of victims eventually transported from a scene (7.1%). Most patients were treated at a level 1 trauma center. Frequent errors included having multiple communicators on site (38%), misidentifying the number of victims (56%), and having unclear information for the resource physician (43%). Only 38% of events had prehospital triage information that was deemed appropriate in total. These results show that scene and triage errors are frequent in MCIs of small scale. This information can be used to assay a system's readiness for disasters.

Accidents, Traffic↗
PubMedDate not supplied

Ground zero dermatology.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMed1995

Prepacked kits for diagnosis and treatment of tuberculosis in former Yugoslavia.

SETTING: After the outbreak of armed conflicts in the republics of former Yugoslavia in 1991, basic health services deteriorated and shortages of essential medical supplies occurred. The World Health Organization (WHO) has taken part in emergency relief operations in the area since July 1992. There was a growing concern that poor living conditions and shortages of supplies could rapidly increase the tuberculosis problem. OBJECTIVE: To provide essential supplies, WHO included support of tuberculosis control in the emergency relief operations for former Yugoslavia. DESIGN: WHO designed a prepacked kit with anti-tuberculosis drugs and material for sputum smear examination for use in combination with policy recommendations and a treatment protocol. RESULTS: The initial distribution of the kits was completed by the end of April 1994. Medium term support from May 1994 onwards has included continued distribution of kits, together with assistance in adjusting tuberculosis control programmes according to the recommended WHO policy package. CONCLUSION: Support of tuberculosis control with essential supplies and strictly focusing on priority measures is proposed as the most adequate strategy, when dealing with a developed country dependent on humanitarian assistance.

Antitubercular Agents↗
PubMed1996

An accident and emergency nurse in the besieged city of Sarajevo.

As war raged in Bosnia a team of doctors and nurses travelled into the besieged city of Sarajevo to treat some of the people injured by the war. More than half of the city's doctors had been killed or had escaped the city. This is the experience of one of the members of the team, an Accident and Emergency nurse.

Emergency Nursing↗
PubMedDate not supplied

Meningococcal meningitis among Rwandan refugees: diagnosis, management, and outcome in a field hospital.

OBJECTIVE: To study the diagnostic process, clinical course, and outcome of Rwandan refugees with meningococcal meningitis, treated in an Israeli field hospital in Goma, Zaire, in the summer of 1994. METHODS: Patient hospital charts and laboratory records were reviewed with critical evaluation of clinical presentation and diagnostic tests. Patients were treated as part of a disaster relief effort in a refugee camp experiencing several coexisting lethal epidemics. RESULTS: A total of 65 patients were identified as having group A meningococcal meningitis. Latex agglutination test for Neisseria meningitidis soluble antigen in the cerebrospinal fluid was found to be a superior diagnostic tool, as compared to Gram stain, and at least as effective as culture. The mortality rate was 14%; mortality was markedly affected by co-morbidity (e.g., dysentery, pneumonia, and malnutrition). CONCLUSIONS: The outcome of patients with meningococcal meningitis, treated in referral centers within a disaster area may be favorable, despite overwhelming coexisting epidemics, and may be comparable to that achieved in advanced medical facilities. Encephalopathy may be a diagnostic pitfall in the perspective of coexisting epidemics, requiring a high index of suspicion and routine lumbar puncture. The latex agglutination test is highly useful in achieving prompt diagnosis of meningococcal meningitis, in particular when sample handling for culture and microscopy is suboptimal.

Adolescent↗
PubMed2006

Oral cholera vaccines: use in clinical practice.

Cholera continues to occur globally, particularly in sub-Saharan Africa and Asia. Oral cholera vaccines have been developed and have now been used for several years, primarily in traveller populations. The licensure in the European Union of a killed whole cell cholera vaccine combined with the recombinant B subunit of cholera toxin (rCTB-WC) has stimulated interest in protection against cholera. Because of the similarity between cholera toxin and the heat-labile toxin of Escherichia coli, a cause of travellers' diarrhoea, it has been proposed that the rCTB-WC vaccine may be used against travellers' diarrhoea. An analysis of trials of this vaccine against cholera (serotype O1) shows that for 4-6 months it will protect 61-86% of people living in cholera-endemic regions; lower levels of protection continue for 3 years. Protection wanes rapidly in young children. Because the risk of cholera for most travellers is extremely low, vaccination should be considered only for those working in relief or refugee settings or for those who will be travelling in cholera-epidemic areas and who will be unable to obtain prompt medical care. The vaccine can be expected to prevent 7% or less of cases of travellers' diarrhoea and should not be used for this purpose.

Administration, Oral↗