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PubMed2001

Pre- and post-disaster negative life events in relation to the incidence and severity of post-traumatic stress disorder.

There is evidence suggesting that stressful life events may precede major psychiatric illness, such as major depression, and that the severity of a traumatic event outside the range of usual human experience may provoke post-traumatic stress disorder (PTSD). The present study was carried out to examine the effects of pre- and post-disaster stressful life events on the incidence rate of PTSD following two man-made traumatic events. An epidemiological study examining 127 victims of a flash fire in a ballroom and 55 motor vehicle accident (MVA) victims was undertaken. PTSD symptoms were assessed by means of the Composite International Diagnostic Interview and the pre- and post-disaster stressful life events by means of the Diagnostic Interview Schedule, Disaster Supplement. Binary logistic and multiple linear regression analyses were employed to examine the relationships between PTSD and pre- and post-disaster life events. There were no significant relationships between stressful life events the year prior to the traumatic event and the incidence or severity of PTSD. There were highly significant relationships between the cumulative number and event severity of post-disaster negative life events and the incidence rate and severity of PTSD. The post-disaster life events were significantly more related to the avoidance-depression dimension than to the anxiety-arousal dimension of PTSD. The most significant life events were: loss of job or income, broken relationships, serious illnesses or injuries in the victims and death or illness in close acquaintances. The results of this study show that the number and severity of additional stressful life events signal a higher risk to develop PTSD and a higher severity of the avoidance-depression dimension of PTSD symptomatology.

Accidents, Traffic↗
PubMed2003

Infectious complications after mass disasters: the Marmara earthquake experience.

The Marmara earthquake occurred on 17 August 1999. There were 639 renal victims, of whom 477 needed some form of renal replacement therapy. Although several medical complications have been reported in the literature, there has been no detailed description of infectious complications in patients with crush syndrome after earthquakes. Data from 35 hospitals considering clinical and laboratory findings, as well as infectious complications and the results of microbiological examinations, were analysed. 223 out of 639 (34.9%) patients had infectious complications, which comprised the most frequent medical problem in the renal victims. The patients who suffered from infections had a higher mortality rate than those who did not (p = 0.03). Sepsis and wound infection were the main presentation of the infectious complications. 121 (18.9%) patients suffered from sepsis; the mortality rate was higher in these patients (27.3%) than in victims who did not suffer from sepsis (12.4%, p < 0.0001). In a multivariate model, sepsis was associated with increased mortality (p = 0.0002, odds ratio 2.45, 95% confidence interval 1.52-3.96). 53 (8.2%) and 41 (6.4%) patients had wound and pulmonary infections, respectively. Most of the infections were nosocomial in origin and caused by Gram-negative aerobic bacteria and Staphylococcus spp. Infectious complications are common in renal victims of catastrophic earthquakes and are associated with increased mortality when complicated by sepsis.

Bacteremia↗
PubMed2004

Trauma reactions of bystanders and victims to repetitive abuse experiences.

This study investigated psychological distress as measured by the Impact of Events Scale-Revised and physiological reactivity as measured by skin conductance and heart rate in bystanders as compared to direct victims of prevalent forms of repetitive abuse (e.g., bullying). Participants (N = 77) were interviewed twice: once to recall witnessing another person be abused repeatedly over time, and again to recall similar experiences as a victim. Present levels for bystander and victim distress were not significantly different, but distress levels were significantly greater for victim experiences at the time the repetitive abuse occurred. Scores for both groups were comparable to or exceeded scores associated with natural disasters and other life threatening experiences reported in the literature. Findings suggest repetitive abuse may affect bystanders and victims in similarly serious ways at the time the events occur and later in life.

Adolescent↗
PubMed2004

Lessons learned from the WTC disaster: a first-person account.

Sept. 11, 2001, was a day of learning for the world. We learned oceans do not isolate the United States from acts of terrorism. Prior to hijackers flying commercial airplanes into the Pentagon and World Trade Center towers, forensic investigators had never dealt with a mass fatality incident of this magnitude on the mainland soil of the U.S. during non-wartime conditions. During the process of gearing up for the task of locating and identifying the victims, forensic dentists also learned a number of things. Established techniques for disaster management were tested to their extreme limits. Before and while this multi-functional effort was taking place, we familiarized ourselves with what techniques worked best under the immense pressure and tedious nature this job presented. Some of these accepted and now "tried and true" protocols are presented in this article.

Forensic Dentistry↗
PubMed1998

Rehabilitation research under fire.

Catastrophes in the health area are frequent. A template for conduct and reporting of research in disaster responses has recently been published. The WHO Rehabilitation of War Victims Project basically followed these principles in former Yugoslavia to estimate defined needs, prioritise and evaluate methods used. Around 30% of war victims reported to be wounded were found to be in need of physical rehabilitation. Priority was given to the 5% with severe disabilities caused by amputations, spinal cord injuries and traumatic brain injuries. Most of the infrastructure was destroyed and WHO supported a community based rehabilitation approach (CBR). Evaluating this type of service delivery became extremely difficult under present circumstances. Waves of refugees rolled both within the republics and over the borders demonstrating both the needs and problems listed in the template referred to. The CBR service delivery worked out satisfactorily with high patient satisfaction. Limited medical training greatly improved the situation for the personnel. Even in a disaster situation research is needed for proper decision-making and to gain experiences for future aid.

Persons with Disabilities↗
PubMed2000

Predictors of post-traumatic stress symptoms in Oklahoma City: exposure, social support, peri-traumatic responses.

Eighty-five adults seeking mental health assistance six months after the Oklahoma City bombing were assessed to determine which of three groups of variables (exposure, peri-traumatic responses, and social support) predicted development of post-traumatic stress disorder (PTSD) symptoms. Variables most highly associated with subsequent PTSD symptoms included having been injured (among exposure variables), feeling nervous or afraid (peri-traumatic responses), and responding that counseling helped (support variables). Combining primary predictors in the three areas, PTSD symptoms were more likely to occur in those reporting counseling to help and those feeling nervous or afraid at the time of the bombing. Implications of these findings are discussed for behavioral health administrators and clinicians planning service delivery to groups of victims seeking mental health intervention after terrorist attacks and other disasters.

Adult↗
PubMed2005

Knowledge, attitudes, and behavior of occupational physicians related to burn cases: a cross-sectional survey in Turkey.

The primary care of victims of burns at the workplace is provided by occupational physicians. In Turkey, the routine practice is to certify physicians for work in occupational medicine. The aim was to evaluate the knowledge, attitudes, and behavior of occupational physicians regarding burn cases. A total of 510 occupational physicians working in Ankara were surveyed by mail, and 101 (19.8%) physicians responded. Most of these physicians (n=67, 66.3%) had encountered burn cases within the prior year. The most frequent type of burn was scalds (n=55, 54.5%) followed by thermal burns (n=37, 36.6%). Of the respondents, 22 (21.8%) knew the most appropriate classification of burns. Regarding first-aid treatments prior to triage, only 4% chose the valid items. The mean rate of favourable attitudes of the participants toward first aid of different types of burn injuries was 70.8%. Only 31.7% of the physicians surveyed used up-to-date first-aid modalities. We conclude that Turkish occupational physicians have inadequate knowledge and inappropriate attitudes toward the first aid and primary care of burn victims. With the vital support of the Burn and Fire Disaster Institute at Başkent University, nationwide educational policies could be improved and assessed.

Adult↗
PubMed1991

Trauma management in a war zone: the Lebanese war experience.

Lessons learned from the Vietnam and Korean conflicts have emphasized the necessity of an organized preparedness for optimal management of casualties. The present report summarizes the experience of a tertiary care center in the present Lebanese war. Between 1975 and 1986, approximately 30,000 war casualties were treated at the American University of Beirut Medical Center (AUBMC). A disaster plan was implemented whenever more than 25 major trauma victims were received within 1 hour. In-field stabilization and emergency room (ER) thoracotomy were not employed. The results are illustrated by an analysis of 1,500 cases of abdominal trauma, (1,314 high-velocity gunshot wounds, 29 stab wounds, 157 blunt injuries). A total of 1,420 patients were operated on within 6 hours of admission and 711 within the first hour. Overall mortality was 130, 8.7%; 9.5% for gunshot wounds, 3.4% for stab wounds, and 2.5% for blunt trauma. One hundred forty-five patients or 9.7% had negative findings at laparotomy. The factors affecting mortality were hypotension on admission (26.5% for a BP less than 90 mm Hg and 2.8% for a BP higher than 90 mm Hg) and the presence of extra-abdominal injuries (14.4% with and 4.4% without). The chief causes of death were hemorrhage (3.7%), sepsis (2.1%), and ARDS (1.2%).

Abdominal Injuries↗
PubMed1996

Psychological trauma and its influence on genuine and false complaints of sexual assault.

Events that cause fear leave effects, both physical and psychological. In the last 20 years, it has been recognized that criminal assaults are also fearful events which, like war atrocities and civilian disasters, can have profound effects upon the psychological health of victims. In this paper, some of the research describing the psychological effects of crime will be reviewed, with particular emphasis on allegations of sexual assault. The impact of trauma on crime victims in relation to the prosecution process will be discussed, including the relevance of trauma to the issue of false allegations of sexual assault. The paper will conclude with some recommendations for research.

Adult↗
PubMedDate not supplied

Emergency room guidelines. Providing services to victims of toxic spills.

Guidelines for developing hospital policies and procedures to provide emergency services in cases involving chemical accident victims have been developed under the auspices of the Hospital Disaster Committee of the Seattle Area Hospital Council. The proposed guidelines are consistent with the standards of the Joint Commission on Accreditation of Hospitals, hospital internal and external disaster management plans and the recent requirements for hazard communications (Right-to-Know). Although medical care of the patient is not a primary purpose of the guidelines, some of the procedures, such as identification of the type of chemicals involved, will aid in direct patient care.

Accident Prevention↗
PubMedDate not supplied

KAMEDO Report No. 75: Fire Catastrophe in Gothenburg 29-30 October 1998.

A fire developed in a facility being used as a discotheque that resulted in death for 63 young people. The rescue operations, ambulance responses, medical care provided at the scene, hospital operations, and psychosocial responses are described. Bodies blocked the exit and many survivors had to evacuate by leaping from windows. A total of 16 ambulances were used. Survivors and people not directly involved in the incident created disturbances and some even attacked responders. Many of those who escaped early suffered mild inhalation injuries and those who escaped later, sustained more severe inhalation injuries. High levels of both carbon-monoxide and cyanide were detected at autopsy. A total of 213 persons were transported to hospitals, 85 by ambulance. Most who died at the scene had severe burn injuries, were unconscious, or suffered from fire-gas injuries. A total of 150 victims were admitted to a hospital, of which 74 (49.3%) required intensive care. Only one of the four hospitals actuated a disaster alert. Psychosocial support was complicated due the multicultural characteristics of those involved. Support to the survivors and relatives of the victims was provided by representatives of various religious organization, non-profit organizations, and by the government of Gothenburg. Many recommendations are provided to better prepare for future events.

Disasters↗
PubMed2006

Attribution of physical complaints to the air disaster in Amsterdam by exposed rescue workers: an epidemiological study using historic cohorts.

BACKGROUND: In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables. METHODS: Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks. RESULTS: Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution. CONCLUSION: This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization.

Accidents, Aviation↗
PubMedDate not supplied

Forensic dentistry: an overview for the general dentist.

This article intends to familiarize the reader with the forensic odontologist's role in identifying human remains in mass disasters as well as identifying signs of violent assault using bite mark analysis. The principles of identification may be applied to one victim or multiple victims.

Bites, Human↗
PubMedDate not supplied

Terrorism involving cyanide: the prospect of improving preparedness in the prehospital setting.

The potential for domestic or international terrorism involving cyanide has not diminished and in fact may have increased in recent years. This paper discusses cyanide as a terrorist weapon and the current state of readiness for a cyanide attack in the United States. Many of the factors that render cyanide appealing to terrorists are difficult to modify sufficiently to decrease the probability of a cyanide attack. For example, the relative ease with which cyanide can be used as a weapon without special training, its versatile means of delivery to intended victims, and to a large degree, its ready availability cannot be significantly modified through preparedness efforts. On the other hand, the impact of an attack can be mitigated through preparedness measures designed to minimize the physical, psychological, and social consequences of cyanide exposure. Although the nation remains ill-equipped to manage a cyanide disaster, significant progress is being realized in some aspects of preparedness. Hydroxocobalamin-a cyanide antidote that may be appropriate for use in the prehospital setting for presumptive cases of cyanide poisoning-currently is under development for potential introduction in the US. If it becomes available in the US, hydroxocobalamin could enhance the role of the prehospital emergency responder in providing care to victims of a cyanide disaster. Additional progress is required in the areas of ensuring local and regional availability of antidotal treatment and supportive interventions, educating emergency healthcare providers about cyanide poisoning and its management, and raising public awareness of the potential for a cyanide attack and how to respond.

Cyanides↗
PubMedDate not supplied

Emergency medical assistance team response following Taiwan Chi-Chi earthquake.

INTRODUCTION: On 21 September, 1999, an earthquake measuring 7.3 on the Richter scale, struck central Taiwan near the town of Chi-Chi. The event resulted in 2,405 deaths and 11,306 injuries. Ad hoc emergency medical assistance teams (EMATs) from Taiwan assumed the responsibility for initiating early assessments and providing medical care. OBJECTIVE: To determine whether the EMATs served a key role in assisting critically injured patients through the assessment of number and level of hospitals responding, training background, timeliness of response, and acuity of patient encounters. METHODS: Local and national health bureaus were contacted to identify hospitals that responded to the disaster. A comprehensive questionnaire was piloted and then, sent to those major medical centers that dispatched EMATs within the first 72 hours following the quake. In-depth interviews also were conducted with team leaders. RESULTS: A total number of 104 hospitals/clinics responded to the disaster, including nine major medical centers and 12 regional hospitals. Each of the major medical centers/regional hospitals that dispatched EMATs during the first 72 hours following the quake were surveyed. Also, 20 individual team leaders were interviewed. Seventy-nine percent of the EMATs from the hospitals responded spontaneously to the scene, while only 21% were dispatched directly by national or local health authorities. Combining the phases of the disaster response, it is estimated that only 7% of EMATs were providing on-site care within the first 12 hours following the earthquake, 17% within < 18 hours, and 20% within < 24 hours. Thus, 80% of these EMATs required > 24 hours to respond to the site. Based on a ED I-IV triage system (Level-I, highest acuity; Level-IV, lowest acuity), the vast majority of patient encounters consisted of Level-III and Level-IV patients. Fewer than 16% of teams encountered > 10 Level-I patients, and < 28% of teams evaluated > 10 Level-II patients. CONCLUSIONS: 1. The response from EMATs was impressive, but largely uncoordinated in the absence of a pre-existing dispatching mechanism. 2. Most of the EMATs required > 24 hours to reach the disaster sites, and generally, did not arrive in time of affect the outcome of victims with preventable deaths. Therefore, there is an urgent need to strengthen local prehospital care. 3. A central governmental body that ensures better horizontal and vertical integration, and a comprehensive emergency management system is required in order to improve future disaster response and mitigation efforts.

Disaster Planning↗
PubMed1994

[Disasters. Assistance plans].

A disaster is defined as a unseasonable event that provoke such an amount of victims that the health care capacity of the community is exceeded. The aim of this paper is to review the health attention during an emergency period, whose pre-hospital and hospital services are inherent to critical care medicine. The reduction in victim's morbidity and mortality depends on the opportuneness and efficacy of pre-hospital care. Trained personnel is required to establish command posts, perform the rescue, categorize seriousness of victims to receive priority health care and transport to better equipped health centers. At the hospitals an emergency team must elaborate, publish and periodically review emergency care plans and eventually coordinate actions with other community organizations. The diverse phases of the plan must be specified, including preparatives, alerting of involved services, victim care, and reestablishment of normal duties when the emergency situation ceases. As complement, the hospital must have security and evacuation plans to face own emergency situations such as fires, explosions and inundations.

Disaster Planning↗
PubMedDate not supplied

Developing a regional and national burn disaster response.

The supplement on burns by the National Disaster Medical System (NDMS) requires an evaluation of burn centers' and burn hospitals' capabilities for treating seriously burned victims. The American Burn Association (ABA) and its members, as experts in burn care, should take the lead in working with local, state, and federal disaster planners. Proposals based on standards adopted by the ABA support classification of facilities (levels I, II, III), identify minimum and maximum bed availability, require minimum training for personnel (e.g., ABLS), and encourage enrollment of all burn centers and burn hospitals as contract hospitals in the National Disaster Medical System. Periodically, the ABA should verify that the burn care facilities identified in the disaster plan meet its standards. Once the burn disaster system is developed, drills should be held locally on a regular basis and nationally on an annual basis.

Burn Units↗
PubMed2005

Management on tsunami causing posttraumatic stress disorder: a case report.

On December 26, 2004, tsunamis hit Southeast Asia and caused serious damage and loss of lives. In Thailand, six provinces (Ranong, Phang-Nga, Phuket, Krabi, Trang, and Satun) were impacted. The present study reports the psychiatric assessments such as Thai GHQ-60 and IES. It also reports management techniques of both cognitive behavior therapy and medication. Those were provided to a Thai female patient who was 54 years old. The patient responded to treatment quickly because of early management. The tsunami victim with Posttraumatic Stress Disorder (PTSD) is not an individual. A mass of people who faced or witnessed the tsunami are vulnerable to get PTSD any time during 6 months after trauma. These early management techniques are useful and practical for a mass of victims and survivors.

Disaster Planning↗