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PubMed2005

Challenges of DNA profiling in mass disaster investigations.

In cases of mass disaster, there is often a need for managing, analyzing, and comparing large numbers of biological samples and DNA profiles. This requires the use of laboratory information management systems for large-scale sample logging and tracking, coupled with bioinformatic tools for DNA database searching according to different matching algorithms, and for the evaluation of the significance of each match by likelihood ratio calculations. There are many different interrelated factors and circumstances involved in each specific mass disaster scenario that may challenge the final DNA identification goal, such as: the number of victims, the mechanisms of body destruction, the extent of body fragmentation, the rate of DNA degradation, the body accessibility for sample collection, or the type of DNA reference samples availability. In this paper, we examine the different steps of the DNA identification analysis (DNA sampling, DNA analysis and technology, DNA database searching, and concordance and kinship analysis) reviewing the "lessons learned" and the scientific progress made in some mass disaster cases described in the scientific literature. We will put special emphasis on the valuable scientific feedback that genetic forensic community has received from the collaborative efforts of several public and private USA forensic laboratories in assisting with the more critical areas of the World Trade Center (WTC) mass fatality of September 11, 2001. The main challenges in identifying the victims of the recent South Asian Tsunami disaster, which has produced the steepest death count rise in history, will also be considered. We also present data from two recent mass fatality cases that involved Spanish victims: the Madrid terrorist attack of March 11, 2004, and the Yakolev-42 aircraft accident in Trabzon, Turkey, of May 26, 2003.

DNA Fingerprinting↗

PubMed1999

Management of victims of urban chemical attack: the French approach.

Since the early 1980s several disasters involving mass release of toxic substances have focused the attention of different administrations and the fire services into producing protocols and guidelines for action in civilian situations. The bomb attack in the Tokyo subway, in March 1995, made it clear that a terrorist attack using highly toxic agents is now feasible. Management of disasters in the civil sector in France is based upon two interlinked plans: the Red Plan, which covers on-site organisation, and the White Plan, which concerns the interface with hospital services. Special procedures have been developed to adapt the Red and White Plans for use in the event of toxic attack and concern the deployment of emergency responding personnel, the provision of life support and antidotes in the contaminated zone, the prevention of secondary contamination and the transport and reception of victims at the hospital. Based on the established principle of pre-hospital resuscitation and well-tried assistance plans, this doctrine allows a safe and effective response to terrorist attacks as well as to other toxic release incidents.

Decontamination↗

PubMed2004

Psychological consequences of the 1999 earthquake in Turkey.

We explored the prevalence of posttraumatic stress disorder (PTSD) and its relation to demographic characteristics and other risk factors for developing PTSD in a large sample (N = 910) of earthquake survivors living in tent city. Twenty-five percent of the sample met DSM-IV criteria for PTSD assessed with the Posttraumatic Stress Disorder Self Test (PTSD-S). Peritraumatic factors explained the most variance when the risk factors were grouped as demographics, pretraumatic, peritraumatic, and posttraumatic. The study emphasized that PTSD among the earthquake victims was as prevalent in Turkey as after disasters in other developing countries but higher than usually found after disasters in developed countries, and there was a relation between some factors-mostly peritraumatic-and PTSD.

Adult↗

PubMed2006

Posttraumatic stress disorder: clinical features, pathophysiology, and treatment.

Posttraumatic stress disorder (PSTD), classified as an anxiety disorder, has become increasingly important because of wars overseas, natural disasters, and domestic violence. After trauma exposes the victim to actual or threatened death or serious injury, 3 dimensions of PTSD unfold: (1) reexperiencing the event with distressing recollections, dreams, flashbacks, and/or psychologic and physical distress; (2) persistent avoidance of stimuli that might invite memories or experiences of the trauma; and (3) increased arousal. Traumatic events sufficient to produce PTSD in susceptible subjects may reach a lifetime prevalence of 50% to 90%. The actual lifetime prevalence of PTSD among US citizens is approximately 8%, with the clinical course driven by pathophysiologic changes in the amygdala and hippocampus. Comorbid depression and other anxiety disorders are common. General principles of treatment include the immediate management of PTSD symptoms and signs; management of any trauma-related comorbid conditions; nonpharmacologic interventions including cognitive behavioral treatment; and psychopharmacologic agents including antidepressants (selective serotonin reuptake inhibitors most commonly), antianxiety medications, mood stabilizing drugs, and antipsychotics. This review of PTSD will provide the reader with a clearer understanding of this condition, an increased capacity to recognize and treat this syndrome, and a greater appreciation for the role of the internist in PTSD.

Cognitive Behavioral Therapy↗

PubMedDate not supplied

Effects of elevated temperatures on various restorative materials: an in vitro study.

In cases of mass disasters associated with fire, identification of the burnt victims can be a real challenge to the forensic team. Teeth and their restorations play a significant role to aid in the identification process, as various restorative materials have varying resistance to high temperatures. A study was undertaken to evaluate the changes taking place on teeth restored with amalgam, composites, glass ionomers, heat cure acrylic, and ceramics. The specimens were placed in a furnace and heated to predetermined temperatures of 200, 400, 600, 800, and 1000 degrees C and the changes were examined using a digital camera and stereomicroscope. Our observations show that while some restorations were able to withstand elevated temperatures, others were reduced to an unrecognizable mass at relatively low temperatures.

Acrylic Resins↗

PubMed1991

GC-NPD and GC-MS analysis of preserved tissue of Bhopal gas disaster: evidence of methyl carbamylation in post-mortem blood.

Twenty-five preserved autopsy blood samples of Bhopal toxic gas exposed victims were analysed by gas chromatography (GC) coupled with either Nitrogen-Phosphorous detector (NPD) or mass spectrometer (MS) for the presence of methyl carbamyl valine in terms of valine methyl hydantoin (VMH). 84% of these samples showed a positive test for VMH on GC-NPD and the identity of the peaks were further confirmed on GC-MS. The concentration of VMH in the gas-affected positive blood samples ranged from 2.56 to 51.28 nanomoles. These results indicate entry of methyl isocyanate (MIC), one of the constituents of the toxic cloud caused by the disaster, into the blood stream of victims who had inhaled gas.

Accidents, Occupational↗

PubMed1991

[A medical registry of the victims at the centers of catastrophes].

The article discusses the practical significance of medical registry in liquidation of catastrophe consequences. On the basis of summarized experience the authors propose a conception of statistic registry for cases of disaster medicine. They worked out a variant of a record card for the victims of catastrophes. There is a principal scheme for formation of registry information in aid posts and medical establishments.

Disasters↗

PubMedDate not supplied

[PTSD as a result of a natural disaster].

A review of modern conceptions that may help in diagnosing of PTSD in the victims of flood in Poland in July 1997 was made. Diagnostic, epidemiological and prognostic problems in the development of the disorder were discussed.

Disasters↗

PubMedDate not supplied

Planning for burn disasters: lessons learned from one hundred years of history.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Burns↗

PubMed1995

Dealing with disasters: does psychological debriefing work?

The psychological aftermath of disaster causes significant long-term psychiatric disability and suffering to victims and rescuers alike. This paper examines the effectiveness of psychological debriefing (PD), an early intervention that is widely used and claimed to reduce long-term psychiatric morbidity in the wake of disaster. Numerous factors hamper the design of methodologically sound research in this field and there is a lack of controlled studies supporting the efficacy of PD. Further research is needed to demonstrate the effectiveness of any immediate psychological intervention before significant resources are allocated to their routine provision.

Crisis Intervention↗

PubMed1996

The experience of psychiatric residents with disaster support: a descriptive report.

This study was designed to explore the experiences and reactions of psychiatric residents who provided support to victims at the Oklahoma City bombing site. Participants were seven residents who were surveyed eight months following the disaster. Results describe respondents' perceptions of stress and support factors at the time of participation as well as post-disaster symptoms. In the aftermath, only one respondent reported stress symptoms suggestive of a psychiatric diagnosis. Respondents reported a decrease in symptoms one month after the disaster. The majority acknowledged that they would participate in disaster relief in the future. These data confirm the importance of proper preparation, support, and debriefing for medical personnel attending a disaster as well as the probability that symptomatic reactions will be time-limited for most individuals.

Adult↗

PubMed1978

Managing the psychosocial factor in disaster programs.

In developing disaster plans, hospital administrators are not always aware that the psychosocial needs of victims and their families can be greater than their medical needs. The author outlines a program to deal with the psychosocial factor in disasters, emphasizing the role of the social work department.

Adaptation, Psychological↗

PubMed2006