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In December, 1988, an American military pilot obviously losing his orientation brought down his jet fighter into a residential area of Remscheid, FRG. This paper reports on the medicolegal experiences gained during identification the victims. The officials plants for duty in case of disaster are discussed.
An earthquake exemplifies a natural disaster in which the potential caregivers are experiencing their own emotional response to the event. A survey of 222 health care workers in San Francisco and Marin County in the first two weeks after the Loma Prieta earthquake found them to have a moderate level of psychological symptoms as measured by the Impact of Event Scale and to frequently endorse several earthquake specific stress items. Highly reliable gender differences existed on all of the dependent variables, with women reporting more symptoms. Variation in cognitive style and the personal salience of the event are possible explanations for this difference. Disaster planning should include education about the normal range of response and support groups for symptomatic caregivers as well as victims.
When a body is recovered from a fire site, it is essential to determine if death occurred before or after the fire started. Foul play is suspected when there is an alternative cause of death not due to the fire. In cases of mass disaster due to fire, the forensic pathologist has an additional task of identifying the bodies. This is important in medico-legal investigations. The severity of the burnt injuries sustained may be useful in the reconstruction of the incidence. Examples will be given in this paper on the identification of the burnt victims and the forensic investigations on death by fire in mass disasters.
The postmortem examination and identification procedures performed by medical and law enforcement personnel involved in mass disaster management in Israel are reported. The Israel National Police, the Israel Defense Forces, and the L. Greenberg Institute of Forensic Medicine's experts examined 171 victims who died in 21 incidents of suicidal terrorism. The trauma sustained by the victims and perpetrators of suicidal bombings included complete body disruption and explosive, flying missile, and blast injuries. The modus operandi of the perpetrators, reconstructed from the distribution and type of injury of the victims, is discussed. Fifty-five victims perished in open space bombings and 91 inside buses. All perpetrators of these bombings died at the time of the incident regardless of their location. Identification of the victims was achieved using fingerprints, dental records, medical intervention signs, anatomic variation, genetic profile, and personal recognition. Prompt identification of the perpetrators allowed speedy apprehension of the accomplices and prevention of similar attacks. Collaboration between the different forensic, military, and law enforcement teams increased the efficiency of disaster management efforts.
Disaster planning, one of the 15 essential components of the Emergency Medical Service System Act of 1973, should be the culmination of the establishment of other components. Regions have gone to varying lengths to describe disaster plans but how realistic the plans are is questionable. New York has planned for multiple casualty incidents (MCI) to care for victims of fires, explosions, structural collapses and major transportation incidents. The irrational emotional response in mass disasters conflicts with the rational disaster plans written by health planners. Drills of disaster plans are not realistic. One solution is to designate the next serious incident, such as a fire or traffic accident, a major MCI. The ability to handle an MCI is probably the best measure of an EMS system's effectiveness.
Man is unable to control for the ever-present potential of disaster. In the past practices and procedures have been developed to minimize physical risk and maximize personal safety. However, there has been little awareness of, or attention to, the stress to those involved in the care-giving process to the victims. Medical care-givers are at the forefront of post-disaster intervention. It is necessary to provide training and support for doctors engaged in post-disaster work, especially with regard to the psychosocial consequences for patients, relatives, and the medical team as a group and as individuals. Pre-disaster preparation is suggested as a situational moderator in the prevention or management of extreme strain in medical and paramedical staff. Specifically, social support in the form of team-building and supervisory support and debriefing, use of personality hardiness concepts in selection and training of staff, and general emergency preparedness should form part of a disaster preparation plan. Medical social workers and psychologists can play an important role as facilitators in disaster preparation. The importance of education and increasing awareness of disaster effects on the health team is emphasized.
Mass disasters are associated with a large number of fatalities, with victims being visually unidentifiable in most cases. Dental identification, although being an important and valuable identification method, is subject to the availability and quality of antemortem and postmortem dental records. This paper presents a simple-to-use method of human identification using an antemortem photograph showing anterior teeth with superimposition onto a postmortem image using specific features of Adobe Photoshop. We present cases and discuss the benefits and difficulties of this method.
The author provides data regarding psychiatric symptoms reported by 102 persons who had experienced the collapse of two skywalks in the lobby of the Hyatt Regency Hotel in Kansas City, Mo. Those interviewed were injured victims, guests of the hotel who were not injured, and rescue workers. They were interviewed within 5 months of the disaster. Virtually all of the subjects had psychiatric symptoms; only slight differences were found among those who were victims, observers, or rescuers.
A statewide sample of 1735 Iowa residents, approximately half of whom were victims of the 1993 Midwest Floods, participated in interviews 1 year prior to, and 30 to 90 days after, the disaster. Employing a rigorous methodology including both control-group comparisons and predisaster assessments, we performed a systematic evaluation of the disaster's impact. Overall, the disaster led to true but small rises in depressive symptoms and diagnoses 60-90 days postflood. The disaster-psychopathology effect was not moderated by predisaster depressive symptoms or diagnostically defined depression; rather, predisaster symptoms and diagnoses uniquely contributed to increases in postdisaster distress. However, increases in symptoms as a function of flood impact were slightly greater among respondents with the lowest incomes and among residents living in small rural communities, as opposed to on farms or in cities. Implications for individual- and community-level disaster response are discussed.
RATIONALE: Flood disasters destroy environment of many people by causing physical as well as psychological harm. This may affect procreational behavior of the victims. DESIGN: This study examines reproductive behavior (number of live births) among the survivors from the flood disaster in Klodzko Region which took place in July 1997. The observation period was three years (1998-2000). MATERIALS AND METHODS: The harmed population consisted of 3986 subjects. The population from Klodzko Region which was exposed to flood disaster in 1997 consisted of 107,032 people. Among the injured population there were 1037 women in reproductive age. This population was studied. RESULTS: The results show significantly higher number of live births per 1000 and birth-rate in studied women as compared to the total population of a district. Psychological background of an observed phenomenon was discussed.
OBJECTIVE: To verify the official criteria of ICD-10 diagnosis of acute stress reaction (ASR) among earthquake victims. METHOD: Data on psychosocial variables and the diagnosis of ASR were collected from 91 subjects. RESULTS: The diagnosis of ASR was made in 70% of the sample. However, the restrictive duration criterion (i.e. symptoms not exceeding the first 48 h) was fulfilled only in 10%; in the remaining 60% the symptoms lasted for about another week. Thus, 60% of the sample constituted a group with protracted ASR (PASR) and 40% a group without it (n-PASR). Medical history was more frequent among PASR than n-PASR; PASR showed higher anxiety levels (both pre- and post-disaster) than n-PASR; finally, the persistence of ASR related positively to the fear of death at the time of the earthquake and pre-disaster anxiety levels. CONCLUSION: As in the vast majority of earthquake victims the ASR is protracted beyond 48 h, a revision of ICD-10 guidelines should be considered.
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The Tangshan earthquake was probably the worst catastrophe in this century. It took a death toll of 242,769, with 164,851 injured in addition. This presentation describes the organization of disaster relief work after the earthquake, the rescue of buried victims, the organization of medical resources, and the sanitation work to forestall epidemics. It also presents the author's reflections on the management of three major injuries, namely, crush syndrome, fracture of pelvis, and traumatic paraplegia, by reviewing the available data pertaining to these injuries. The author concurs with the prevailing opinion that fasciotomy plays an important role in the successful management of crush injury. It not only prevented acute renal failure subsequent to intracompartmental increase of pressure, but also the occurrence of Volkmann's ischemic contracture as a late sequela. Herbs to induce catharsis and diuresis were used to alleviate intracompartmental pressure. For the management of pelvic fractures, two newly developed treatment techniques are described. On analysis of clinical data, it is the author's opinion that traumatic paraplegia should not be given the priority of early surgery in the circumstances of mass casualties. The primary concern should be the stability and restoration of normal curvature of the spine, especially in cases of complete paraplegia. Decompression of the spinal cord through an anterolateral approach gave promising results in hyperflexion type of spinal fracture.
OBJECTIVES: Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. METHODS: A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. RESULTS: Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. CONCLUSIONS: Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.