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PubMed2000

Psychological and physical reactions on children after the Hanshin-Awaji earthquake disaster.

Children who experienced the Hanshin-Awaji Earthquake Disaster were followed to ascertain how the psychological and physical reactions after this disaster changed. Changes observed in the symptoms of children at one and two years after the earthquake were compared between those who had lived in severely damaged area (level 7 on the Japan Meteorological Agency intensity scale) and those who had lived in mildly damaged area (less than 5 on the same scale). The survey was conducted using a questionnaire filled out by the children's parents. Two years after the earthquake, the children had returned to normal in terms of their physical conditions, even in the severely damaged area. However, symptoms of PTSD (Post-Traumatic Stress Disorder) such as persistent reexperiencing, persistent avoidance, and increased arousal were significantly more frequently found among children from the severely damaged area than among those from the mildly damaged area. To evaluate the psychological and physical reactions after the disaster is very important in order to support the children when large-scale disasters occur.

Age Distribution↗
PubMed2002

Does EMTALA apply during a disaster?

A statement from Medicare says that disaster plans for transferring triaged patients may supercede the usual EMTALA requirements, but this is true only in certain scenarios. During a disaster, it's unacceptable to transfer a patient to a more appropriate facility if doing so amounts to refusal of lifesaving care. Don't assume that patients will be diverted successfully to appropriate facilities after a large-scale disaster. The required level of documentation under EMTALA may not be possible during a disaster, but some type of documentation is necessary.

Bioterrorism↗
PubMed2003

Proposal of a model for medical records for international disaster relief operations.

The triage of a large number of victims in an international disaster relief operation is very important. To ensure the correct way of registration of patients and effective triage and treatment, useful medical records are necessary. The authors proposed a model for medical records (Shinchi's Medical Record (SMR)) for international disaster relief operations for medical teams from our experience of the Honduras Disaster Relief Operation in November 1998. Our medical unit, which was part of the Japan Self-Defense Forces International Disaster Relief Operation, was confronted with many patients who needed immediate medical care. SMR was developed using only one sheet of paper including the medical record, laboratory data sheet, and prescribed drug sheet. SMR also registers urgency classes and the primary diagnosis. SMR is simple, inexpensive, and easy to prepare for many patients.

Disasters↗
PubMed1976

Simulated aircraft disaster instructional exercise at Baltimore-Washington International Airport.

A major, simulated aircraft disaster exercise was held in September of 1974 at the Baltimore-Washington International Airport in Maryland. The significant aspects of community involvement and specialized airport emergency planning were tested during this simulation. This paper presents an evaluation of the experience of the various elements in this exercise. The critical matter of having a system of runners to substitute for a failure within the mobile command post is stressed. Also, the importance of adequate telephone facilities for communication with the fire/rescue stations and community hospitals is highlighted. Many other small and seemingly unimportant items are found to be of considerable significance during the handling of disasters. A strong case is made for periodic disaster simulations to maintain an efficient broadly-based apparatus for handling such disasters, should they occur.

Aviation↗
PubMed1992

[Mass disasters in former East Germany--a forensic medicine retrospect].

The authors report the analysis of mass disasters, which had been dealt with by forensic experts, on the territory of the former GDR. The report comes on the initiative of the Society of Forensic Medicine and with the support of regional institutes. For the period 1960 to 1989, 20 events with 738 casualties were registered. The number of victims was particularly high in aviation and rail disasters as well as in the Zwickau mine disaster. The Forensic Institute of the Humboldt-University in Berlin was engaged in the investigation of the three airplane crashes on Berlin territory and near Berlin (Königs-Wusterhausen 1972, Berlin-Bohnsdorf 1986 and Berlin-Schönefeld 1989) as well as of the railway disaster near Lebus in 1977. As a result of the analysis, the experience gained in three decades regarding the planning, organization and realization of the identification of victims is dealt with in more detail. It emphasizes the significance of close cooperation with dentists and criminalists. Because of ethical, legal and criminalistic reasons the aim should always be a complete examination (including autopsy) of the victims as well as their identification.

Accidents, Aviation↗
PubMed2003

Designation of a new training model of a local disaster medical system with tabletop exercises.

BACKGROUND: A new model of a local disaster medical system (LDMS) was proposed through the consensus method of expert panel meetings for county governments in Taiwan. This LDMS model adopts a local emergency medical response system (EMRS) for dealing with daily accidents as a basic structure by expanding its roles and functions. The objective of this study was to determine the feasibility of the new LDMS model by evaluating its initial phase response to simulated disasters using tabletop exercises. METHODS: Two tabletop exercises were held after the responders of the LDMS were trained according to the new model. Forty and 42 participants respectively joined the 2 tabletop exercises, which simulated an earthquake causing 400 casualties in 6 different locations in order to apply the new LDMS model. The outcome measurements of the tabletop exercises were the mean accuracy rate of victim triage and disposition, and medical interventions. RESULTS: About 92% of victims were correctly triaged, and 88% had a correct disposition. Moreover, around 86% of all victims received adequate medical interventions. All victims were dispatched to appropriate facilities or treatment areas within 45 min. CONCLUSION: The new EMRS-oriented model of this LDMS can respond quickly, efficiently, and adequately to the initial phase of a disaster during tabletop exercises. Further clinical investigations are required to prove the efficacy of the new LDMS model in real disasters or in full-scale drills.

Disaster Planning↗
PubMed2004

Dentists can contribute expertise in a major public health disaster.

BACKGROUND AND OVERVIEW: The time for dental professionals to educate themselves to respond to, and assist with, a catastrophic medical disaster is here. California dental healthcare workers must understand the various duties they may be asked to perform if a large-scale disaster were to occur. This article explores the various duties, which may need to be performed in the event of a medical disaster, and the duties a dentist, or dental auxiliary, may be able to complete, with minimal additional training. CONCLUSION: California dentists must be educated, at minimum, to recognize the symptoms of exposure to biological agents or naturally occurring diseases, such as avian flu and SARs, in their patients. Dentists must be further educated to correctly counsel their patients who exhibit such symptoms. Finally, dentists must alert the appropriate public health authorities of such exposure. California should consider amending the California Dental Practice Act to provide for the expansion of the definition of the practice of dentistry in the event of a declared healthcare emergency. The new definition should, at minimum, allow dentists to administer vaccines and dispense medications at a mass prophylactic distribution site. The definition could be further expanded to allow dentists to perform more complicated or invasive duties in the event of a disaster with large numbers of bodily injuries. In either event, California will also need to provide limited liability to dentists who do participate in emergency situations, similar to the Good Samaritan laws, which currently apply to physicians and surgeons. PRACTICE IMPLICATIONS: Dentists and their dental auxiliaries can augment the existing medical professionals, in responding to a declared medical emergency. In order to be ready to respond, dentists and their dental auxiliaries must receive additional training through continuing education courses developed specifically to train them in recognizing symptoms of exposure to biological agents.

Bioterrorism↗
PubMed2004

Telemedicine in trauma and disasters--from war to earthquake: are we ready?

Every year many disasters cause thousands of injuries, deaths, refugees. Earthquakes and war often cause severe injuries (burns; amputations; Crush-Syndrome; gunshots; landmines; nuclear, biological or chemical warfare / hazardous material; infectious diseases; pediatric specialties). Referring to big earthquakes in the last few years up to 20.000 thousand people were killed (India 2001). 310.000 deaths were caused by war in 2001. The Mass Casualty Incident is characterized by the disbalance between victims and the normal community emergency response. Because of this a lot of different institutions and organizations are involved in coping with the disaster. This produces an extensive demand of qualified Command, Control and Communication (C3). Furthermore a lot of data has to be collected during the treatment and the injuries need special medical treatment. The use of health telematics in disaster response helps to cope with the scenario. Modern technologies provide support for building up medical aid although the normal infrastructure is destroyed. To cope with disaster scenarios there are some telematic tools which can be used: computer based Command and Control System, telemedical support, and data-resources-network/Medical Intelligence. The International Center for Telemedicine at the University of Regensburg Medical Center provides support for Health Care Professionals as a competence center for telemedicine. For the eastern part of Bavaria it develops a telemedical network with many components: The mobile emergency care system NOAH (Notfall-Organisations- und Arbeits-Hilfe) supports the Emergency Medical Service. Local Health Networks and the Clinical Network of Eastern Bavaria connect physicians and hospitals with the Regensburg Medical Center. With an online-education tool participants from all over the country can take part in trainings and courses.

Computer Communication Networks↗
PubMed2005

Cultural diversity in the integration of disaster mental health and public health: a case study in response to bioterrorism.

Disaster leads to severe disruptions of the coping capacities of the community. Terrorism, and in particular bioterrorism, has tremendous impact on the community that is affected Cultural groups present unique issues that need to be appreciated for the effective integration of disaster mental health services with public health. The following paper identifies unique issues and challenges of cultural groups in disaster. It highlights issues such as language, cultural interpretation and expression of grief, and help-seeking behavior, as well as inherent cultural resources that can promote resilience. The implications of these cultural issues are illustrated in a potential bioterrorist event, addressing the areas of surge capacity, mass quarantine, and risk communication. Next steps are identified in promoting greater cultural competency in the integration of disaster mental health and public health, thus building greater community resilience.

Bioterrorism↗
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↗
PubMed2005

Hospital disaster medical response: aligning everyday requirements with emergency casualty care.

In this essay, we would like to pragmatically and realistically introduce three topics: (a) Within the hospital, critical care is acknowledged as an enormous cost driver that becomes even less manageable during a disaster response scenario. It is widely recognised that hospital critical care capabilities for large scale disaster response require significant increases, but an overarching plan to accomplish this goal is lacking. This plan necessarily includes equipment, personnel, training, and space expansion. Lesser degrees of illness and injury will likely be cared for in other venues. What is required to provide 'large scale' critical care? (b) During a true large scale disaster with a large casualty stream, the mandate is not to provide 'standard of care,' but rather 'sufficiency of care.' What is that, what does that mean to critical care and the hospital, and how is that determined? (c) Are there other mandated in-hospital requirements that can be appropriately and successfully leveraged for disaster medical response?

Community Health Planning↗
PubMed1990

[Disaster planning in Danish hospitals].

With the object of obtaining insight into establishing of disaster planning in Danish hospitals, an investigation was carried out in the departments responsible. The insight of the house officer on duty and his immediate description for disaster planning were employed as indications of the level of establishment of disaster planning. This investigation indicates a low level of establishment of disaster planning and reveals the need for further training and information on this subject.

Denmark↗
PubMed1979

Role of medical teams in a community disaster plan.

In London, Ont. two mock disaster exercises have indicated the need for re-evaluating the role of medical disaster teams. To coordinate and direct these teams a medical on-site coordinating team, composed of three emergency physicians with an expanded and more clearly defined role, was formed. The role of the triage teams deployed from the hospital to assess and resuscitate casualties is reviewed in detail. In addition, the communication systems, availability and deployment of medical supplies, identification of medical personnel and tagging of casualties are discussed. Because a mass casualty episode is possible in any community, disaster planning and clear outlining of the role of medical disaster teams are needed.

Disaster Planning↗
PubMed1980

The role of crisis intervention in an airport disaster plan.

The impact of disasters on the psychological adjustment of individuals is discussed. In most cases the traditional "mental illness model" is not appropriate for viewing problems resulting from crisis. Rather, the psychological symptoms are viewed as transitional and are qualitatively different from traditional mental disorder. Severe crisis state, often produced by cataclysmic events, can be lessened in magnitude and reduced in time by crisis intervention treatment as soon as possible following the disaster. The primary goals of crisis intervention are symptom relief and development of stress management attitudes. The applicability of the crisis intervention approach for managing the psychological problems of a major aircraft disaster are discussed. The crisis intervention plan for the Minneapolis-St. Paul Airport Disaster Program is discussed.

Adaptation, Psychological↗
PubMed1995

Health professional's role in disaster planning: a strategic management approach.

1. The Strategic Management for Total Quality in Health Care model incorporates strategic management methods and total quality principles to enhance management of complex, interdisciplinary projects. 2. The purpose of disaster planning is to provide an effective and efficient plan to prevent personal injury and limit property damage and capital losses, as well as return to full production after a disaster. 3. Participation in disaster response planning provides health professionals with an opportunity to demonstrate the benefits they can provide for meeting their company's business needs. 4. Disaster planning is a complex, interdisciplinary project that requires a strategic management framework to facilitate development of high quality, cost effective programs.

Disaster Planning↗
PubMed1998

Disaster management knowledge attitude & practice of urban slum dwellers.

A KAP study was done in the area of Disaster Management in urban slums of Pune City. The Youth Organisations' members and the members of Mahila Mandals were the study subjects. It was found that there was marked improvement in the knowledge and attitudes of these subjects towards disasters. It is recommended that members of Mahila Mandals and members of Youth Organisations can act as 'frontline workers' in the situations of disasters after imparting some training in disaster management.

Adolescent↗
PubMed2002

Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study.

Effective psychological intervention is needed to help children recover from disaster-related posttraumatic stress disorder (PTSD). This controlled study evaluated the effectiveness of a brief intervention for disaster-related PTSD. At one-year follow-up of a prior intervention for disaster-related symptoms, some previously treated children were still suffering significant trauma symptoms. Using a randomized lagged-groups design, we provided three sessions of Eye Movement Desensitization and Reprocessing (EMDR) treatment to 32 of these children who met clinical criteria for PTSD. The Children's Reaction Inventory (CRI) was the primary measure of the treatment's effect on PTSD symptoms. Associated symptoms were measured using the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Treatment resulted in substantial reductions in both groups' CRI scores and in significant, though more modest, reductions in RCMAS and CDI scores. Gains were maintained at six-month follow-up. Health visits to the school nurse were significantly reduced following treatment. Psychosocial intervention appears useful for children suffering disaster-related PTSD. Conducting controlled studies of children's treatment in the postdisaster environment appears feasible.

Affect↗
PubMed2006

Posttraumatic stress in aging World War II survivors after a fireworks disaster: a controlled prospective study.

Little is known about the effects of cumulative trauma and whether traumatized individuals are more vulnerable. In 2000, a fireworks disaster created the possibility to examine this issue among World War II survivors who were part of an ongoing longitudinal study. Between 1998 and 2000 posttraumatic stress increased in disaster exposed respondents as opposed to the control group. War-related reexperiencing and avoidance also increased. The strongest increase occurred in disaster-exposed respondents who had low levels of wartime stress and a slight decrease occurred in those who had high wartime exposure. This unique controlled observation suggests that disasters do increase the levels of posttraumatic stress, and that reactivation of previous traumatic events generally occurs. However, the vulnerability hypothesis was not supported.

Aged↗