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Fire injuries, disasters, and costs from cigarettes and cigarette lights: a global overview.

BACKGROUND: Fires cause 1% of the global burden of disease. Fire (includes explosion) disasters have immense health, social, and environmental costs. We will provide initial estimates of overall U. S. and global fire tolls from smoking. METHODS: We tabulated and summarized smoking-related fire and disaster tolls from published documents. We compared those tolls to U.S. fire, burn, and fire death rates per billion cigarettes extrapolated globally. Smoking-attributable percentages of adult and child access to cigarette lighter and match ignitions (lights), and resultant fires, burns, and deaths ignited by young children, were estimated from likely smoking-attributable lights usage. Cigarette plus cigarette lights fire tolls were multiplied times published and estimated fire costs. RESULTS: Smoking is the leading cause of residential or total fire death in all eight countries with available statistics. Smoking is a leading cause of fires in many more countries. Cigarettes cause numerous fire disasters. Cigarette lights cause an estimated 100,000 U.S. and one million global, child-playing fires per year. Cigarette lights fire injuries likely rival U.S., and possibly global, cigarette fire injury numbers. Smoking causes an estimated 30% of U. S. and 10% of global fire death burdens. Smoking's estimated U.S. and global fire costs were $6.95 (sensitivity range $5.34-22.8) and $27.2 (sensitivity range $8.2-89.2) billion, respectively, in 1998 U. S. dollars. CONCLUSIONS: Smoking likely causes large global fire tolls. U.S. fire tolls have fallen when smoking decreased. Further reducing smoking can substantially reduce fire and disaster tolls.

Accidents↗

A myth too tough to die: the dead of disasters cause epidemics of disease.

Myths abound in the practice of health care, death, and disease. Akin to the old adage of swallowing camels and straining gnats, the myth that mass fatalities cause epidemics of disease following natural or other disasters is alive and well. Despite the findings of observers, microbiologists, epidemiologists, and other scientists, even medical doctors and public health professionals lend support to the ancient belief and rush into mass graves or mass cremations the bodies of those victims of trauma in a disaster. Putting this myth to rest depends on use of information concerning the transmission of the organisms that cause disease, the sources of those organisms, and the hosts or suspected hosts that will be receptive to those organisms to result in disease. The information provided by recent investigators of disasters in the region of the Americas and comments from those who have reviewed the literature on the subject of the myth concerning the dead and epidemics following disasters have provided the basis for some concise guidelines for placing this myth in the archives of other traditions without foundation. Education of the public and the news media are the responsibility of those who are aware of the fallacies in this belief to bring about the demise of this myth.

Cadaver↗

The impact of the Amsterdam aircraft disaster on reported annoyance by aircraft noise and on psychiatric disorders.

BACKGROUND: On 4 October 1992 a plane crashed on the south-eastern (SE) borough of Amsterdam. This study examines the effects of this disaster on the reported annoyance caused by aircraft noise and on psychiatric disorders measured by the General Health Questionnaire (GHQ), in an ongoing Health Interview Survey (HIS). METHODS: In the HIS 5092 people were interviewed; 1006 before the accident and 305 in the SE borough. Odds ratios (OR) were computed comparing the period before the disaster with the 8 months thereafter. RESULTS: After aircraft crossings restarted (weeks 3-10 after the disaster) 60.0% of the respondents in the disaster borough reported annoyance, compared to 36.8% before the event (crude OR = 2.57, 95% confidence interval (Cl); 2.63-3.04). In the three subsequent 2-month periods these OR for the SE borough steadily decreased. No significant change was found either for the rest of Amsterdam or for the GHQ measure. Logistic regression modelling showed the increase to be highest immediately after the aircraft crossings restarted. (OR = 7.50, 95% Cl: 2.40-23.4). CONCLUSIONS: The results suggest that fear is related to a heightened sensitivity to noise, but indicate that this does not lead to widespread psychiatric disorders. The results further indicate that this HIS was sufficiently sensitive to show changes in annoyance caused by aircraft noise after such a severe incident.

Accidents, Aviation↗

The impact of a military air disaster on the health of assistance workers. A prospective study.

The worst peacetime disaster in United States Army history occurred on December 12, 1985 in Gander, Newfoundland. A charter airline carrying 248 soldiers home from peacekeeping duties in the Sinai Desert crashed after a refueling stop, killing all on board. After the crash, Army family assistance workers were appointed to help the surviving family members of each dead soldier. While substantial attention has been paid to the impact of sudden disasters on survivors and bereaved relatives, little is known about the health risks to those who perform helper roles. This study aimed to: a) identify the major stress areas for disaster family assistance workers; b) examine the relation between degree of exposure to these stressors and health; and c) locate risk factors, or resistance resources that might modulate any ill effects of exposure. A survey instrument assessed duration and intensity of family-helping activities and psychological well-being, psychiatric symptoms, major illness indicators, and social and personality variables at 6 months after the crash and again at the 1-year point for 131 family assistance officers. Results indicate a dose-response effect between exposure measured at time 1 and well-being, symptoms, and illness at time 2. Analysis of covariance findings also show that social supports (work supervisors, family, and friends) modulate the effects of exposure on symptoms and well-being. Social supports and the personality style of hardiness (or dispositional resilience) interact to modulate the effects of exposure on illness. These results demonstrate: a) a delayed negative impact of helper stress on family assistance workers, and b) a protective function of social supports and personality hardiness. Further research in this area should thus consider the potential influence of social/situational variables and personality dispositions in coping with disaster helper stress.

Accidents, Aviation↗

Health effects and occupational exposures among office workers near the World Trade Center disaster site.

The extent of health effects and exposure to environmental contaminants among workers and residents indirectly affected by the September 11, 2001, attack on the World Trade Center (WTC) is unknown. The objective of this study was to evaluate concerns related to health effects and occupational exposures three months after the WTC disaster among a population of employees working in a building close to the disaster site. A cross-sectional questionnaire survey was performed of Federal employees working near the WTC site in New York City (NYC) and a comparison group of Federal employees in Dallas, Texas. An industrial hygiene evaluation of the NYC workplace was conducted. Constitutional and mental health symptoms were reported more frequently among workers in NYC compared to those in Dallas; level of social support was inversely related to prevalence of mental health symptoms. Post-September 11th counseling services were utilized to a greater degree among workers in NYC, while utilization of other types of medical services did not differ significantly between the groups. No occupational exposures to substances at concentrations that would explain the reported constitutional symptoms were found; however, we were unable to assess potential occupational exposures in the time immediately after the WTC disaster. There is no evidence of ongoing hazardous exposure to airborne contaminants among the workers surveyed. Specific causes of reported constitutional health symptoms have not been determined. Health care providers and management and employee groups should be aware of the need to address mental health issues as well as constitutional symptoms among the large number of workers in the NYC area who have been indirectly affected by the WTC disaster.

Air Pollutants, Occupational↗

Health problems in children and adolescents before and after a man-made disaster.

OBJECTIVE: The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems. METHOD: Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N=1,628) and controls (N=2,856) was possible. Health problems were classified according to the International Classification of Primary Care. RESULTS: Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status. CONCLUSIONS: Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems.

Adolescent↗

Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters.

BACKGROUND: On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work. OBJECTIVES: To examine the long term health complaints in rescue workers exposed to a disaster. METHODS: A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes. RESULTS: Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found. CONCLUSIONS: This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Accidents, Aviation↗

Life events and psychiatric disorder: the role of a natural disaster.

Examining the impact of natural disasters on psychological health provides an opportunity to study the role played by extreme adversity in the onset of psychiatric disorder. Four hundred and sixty-nine fire-fighters who had been intensely exposed to an Australian bushfire disaster completed a detailed inventory of their experiences four months later. They also completed a brief life events schedule and the 12-item General Health Questionnaire. Only 9% of the GHQ score variance could be accounted for by the disaster and other life events; the effects of the disaster appeared to be separate and additive. This is similar to the relationship between life events and psychiatric illness found in other settings. It is suggested that vulnerability is a more important factor in breakdown than the degree of stress experienced.

Adult↗

Comparison of post-disaster psychiatric disorders after terrorist bombings in Nairobi and Oklahoma City.

BACKGROUND: African disaster-affected populations are poorly represented in disaster mental health literature. AIMS: To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa. METHOD: Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182). RESULTS: Prevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol. CONCLUSIONS: Post-disaster psychopathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.

Adaptation, Psychological↗

Acting on an environmental health disaster: the case of the Aral Sea.

The Aral Sea area in Central Asia has been encountering one of the world's greatest environmental disasters for more than 15 years. During that time, despite many assessments and millions of dollars spent by large, multinational organizations, little has changed. The 5 million people living in this neglected and virtually unknown part of the world are suffering not only from an environmental catastrophe that has no easy solutions but also from a litany of health problems. The region is often dismissed as a chronic problem where nothing positive can be achieved. Within this complicated context, Medecins Sans Frontieres, winner of the Nobel Peace Prize in 1999, is actively trying to assess the impact of the environmental disaster on human health to help the people who live in the Aral Sea area cope with their environment. Medecins Sans Frontieres has combined a direct medical program to improve the health of the population while conducting operational research to gain a better understanding of the relationship between the environmental disaster and human health outcomes. In this paper we explore the health situation of the region and the broader policy context in which it is situated, and present some ideas that could potentially be applied to many other places in the world that are caught up in environmental and human health disasters.

Agriculture↗

Changes in the auditory system related to cerebral circulation in the Ukraine population after the Chernobyl disaster.

The hearing and cerebral circulation was evaluated in 100 liquidators ranging from 23 to 50 years of age 1 year and 6 to 8 years after the disaster. Also, the hearing state data was compared from 80 liquidators of the same age dwelling in clean and radionuclide-contaminated areas for 5 to 8 years. The control group consisted of 20 young healthy individuals having no history of contact with radiation. Subjective audiometry, AEP and REG was used. Testing performed indicate that under radiation, more pronounced changes occur in the central part of the acoustic analyser rather than in its receptor system. More impaired were the persons residing the radionuclide-contaminated areas. The liquidators of the ChFS accident who live in clean areas presented with better state of the cerebral circulation and bioelectric brain activity. But over the time, the REG data 6-8 years after the disaster became considerably worse, as compared to the data obtained 1 year after the disaster. It should be emphasized that individual irradiated during and after the Chernobyl disaster require a constant dynamic observation and their identified changes require periodical management. Withdrawal of the liquidators from the contaminated to the clean areas is one of the preventive measures against the hearing and cerebral circulation disorders.

Adult↗

[Analysis of severe fire disaster in five years (1989-1993) in China].

UNLABELLED: The aim of this study was to analyze epidemiological characteristics of burn caused by severe fire disaster. The results of this study showed that a total 21,228 people were burned, 10,428 cases died and RMB 3320 millions yuan were lost in those fire disasters occurring in five years (from 1989 to 1993) in this country. The principal causes of the fire disaster were faults in administration and operations against regulations. CONCLUSION: In order to prevent fire disaster propaganda should be carried out, jurisdiction should be enforced, active "law of fire control" and the program of constructive administration should be implemented. Those who are working in burn care should also participate in work of fire control and devote much attention to the investigation of burn epidemiology.

Burns↗

Enhanced kinship analysis and STR-based DNA typing for human identification in mass fatality incidents: the Swissair flight 111 disaster.

A bioinformatic tool was developed to assist with the victim identification initiative that followed the Swissair Flight 111 disaster. Making use of short tandem repeat (STR) DNA typing data generated with AmpFlSTR Profiler Plus (PP) and AmpFlSTR COfiler(CO) kits, the software systematically compared each available STR genotype with every other genotype. The matching algorithm was based on the search for: (i) direct matches to genotypes derived from personal effects; and (ii) potential kinship associations between victims and next-of-kin, as measured by allele sharing at individual loci. The software greatly assisted parentage analysis by enabling kinship evaluation in situations where complete parentage trios were unavailable and, in some situations, with distantly related relatives. Exclusion of fortuitous kinship associations (FKA) was made possible through the recovery at the disaster site of at least one remains for every sought-after victim, and was incorporated into the kinship software. The data from the 13 combined STR loci produced 6 and 23 times fewer FKAs when compared with PP alone and AmpFlSTR Profiler (PR) alone, respectively. Identification leads or confirmations of identification were obtained for 218 victims for which DNA reference samples (personal effects and kin) had been submitted. Confirmation of an inferred kinship association was sought through frequency and likelihood calculations, as well as corroborative data from other identification modalities. The use of a simple, yet powerful, automated genotype comparison approach and the use of megaplexes with high power of discrimination (PD) values extended considerably the identification capabilities in the case of the Swissair disaster. The DNA typing identification modality proved to be a valuable component of the large arsenal of identification tools deployed in the aftermath of this disaster.

Accidents, Aviation↗

A typology for the classification of disasters: implications for intervention.

A model that can be used to plan for disaster intervention services is presented. The model, which is based upon an ability to classify disasters, presents four dichotomous categories for intervention: (1) psychotherapeutic vs. educational, (2) individual vs. systems, (3) prevention vs. treatment, and (4) direct vs. indirect. The article presents a rationale for determining which intervention, or combination, would be appropriate for any given disaster, based on its classification.

Adaptation, Psychological↗

Progressive medical care in disaster situations: a critical evaluation of the current situation in the Netherlands.

An overview of the plan for medical response in the event of a disaster in the Netherlands is presented. An idealized evaluation of the response capability, as well as the probable actual ability, is reviewed. The plan involves a response to the disaster site by teams comprising a surgeon, anesthesiologist, and two specially trained nurses from 1 or many of 20 participating hospitals as well as an ambulance response from associated district ambulance posts. An overview of disaster management in general is presented.

Disaster Planning↗

An introduction to disaster medicine in Europe.

Disaster medicine, which is based primarily on military and emergency medicine, is a young branch on the old tree of medicine. It touches on various disciplines within and outside the medical field. The subject is being taught on the academic and postacademic levels at many universities throughout Europe. The first chair in disaster medicine was established in Linkoping, Sweden; the second is now in Amsterdam, The Netherlands. Some aspects of disaster medicine specifically oriented toward Europe are presented.

Disaster Planning↗

Disaster management and the emergency department: a framework for planning.

Recent changes in the Joint Commission Accrediting Hospital Organization (JCAHO) Environment of Care standards are forcing hospitals to revisit their disaster planning process. Emergency Management, a process that is familiar to municipal and industry planners is now part of hospital disaster planning. A framework for making the necessary changes to the hospital disaster plan is presented. Examples of tools that might be useful in the planning process are also included.

Disaster Planning↗

An attempt at more accurate estimation of the number of ambulances needed at disasters in The Netherlands.

A more accurate estimate of the number of ambulances needed at disasters prevents vehicles from being withdrawn unnecessarily from their "normal" duties, thereby curtailing needless expense and helping to ensure that disaster sites are not overcrowded with emergency workers impeding each other's effectiveness. This article discusses a formula for determining the number of ambulances needed at a disaster.

Ambulances↗