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PubMed1982

Provision of mental health services during a disaster: the Cuban immigration of 1980.

The recent (1980) immigration of 125,000 Cubans to the U.S. presented health workers with a situation bearing many of the characteristics of a disaster. Some of the organizational, clinical, and ecological issues which are inherent in providing mental health care in disaster situations are discussed. Ultimately, the development of an effective response to the situation depended on an understanding not only of the individuals involved, but also on an appreciation for the characteristics of the different phases of disaster situations.

Adolescent↗
PubMed1985

Lessons learned and forgotten: the need for prevention and mental health interventions in disaster preparedness.

Human beings have been subjected to the effects of both natural and man-made disasters for centuries. How humans have coped with catastrophes has been recorded through history. This review proceeds from an examination of the efforts in legislation and disaster research through a brief history of war-time experiences and treatment of combat stress reactions. As warfare changed, so did the ability of soldiers to cope. Likewise, treatment interventions to restore soldiers to effectiveness evolved with the changes in warfare. The treatment principles developed in war and the concepts recognized from the stress literature can be integrated to understand how the treatment interventions work. Examples of the delivery of mental health services are reviewed. The lesson learned during war were often forgotten after the war. It was not until the 1970s that the need for prevention and planning for mental health interventions during and after disasters was legislated. Research efforts are now focusing on planning, implementing interventions, and following survivors/victims for posttraumatic effects.

Combat Disorders↗
PubMed2006

Psychotherapy for families in the aftermath of a disaster.

We have not seen the last of natural disasters; nor have we endured the last of the terrorist acts. This article offers clinical guidance in providing mental health services to families in the aftermath of such events. The trauma experienced by an individual victimized by a natural disaster or terror attack reverberates through an entire family. Although based in established clinical practice, intervention with survivors of disasters is a different process from other treatments. A case illustrates the key principles and central methods of family therapy with a traumatized family.

Adaptation, Psychological↗
PubMed2006

Disaster research methods: past progress and future directions.

Published results for 225 disaster studies were coded on methodological variables, severity of effects, and event year. Methods varied greatly, but cross-sectional, after-only designs, convenience sampling, and small samples were modal. Samples that were assessed before the disaster, selected for reasons of convenience, or were large tended to show less severe effects than other samples. Developing countries were underrepresented overall, but not in recent years. Certain desirable study characteristics (longitudinal designs, representative samples) have been decreasing in prevalence over time, whereas others (early first assessment) have been increasing. Innovations such as latent trajectory modeling or hierarchical linear modeling might advance the field's ability to capture the complexity of disasters, but the field still needs to attend to the fundamentals of sound epidemiologic research.

Data Interpretation, Statistical↗
PubMed1997

Psychiatric morbidity following a natural disaster: an Australian bushfire.

This study investigated the prevalence of mental health problems after a major bushfire in Australia and examined the validity of the General Health Questionnaire (GHQ) (Goldberg 1978) against the Anxiety, Affective and Post-Traumatic Stress Disorder modules of the Diagnostic Interview Schedule (DIS; Robins et al. 1981). Study 1 was carried out 12 months after the Ash Wednesday bushfires and sought to include all the victims of the fires. Study 2 was conducted 20 months after the fires and included a sample of victims who had experienced major losses in the fires. Twelve months after the fires, 42% (n = 1,526) of the victims were defined as a potential psychiatric case using the GHQ. This rate indicated a significantly greater level of morbidity than found in communities that have not experienced a natural disaster. Twenty months after the fires, 23% (n = 43) were defined as "cases". The 28-item GHQ was found to be a valid instrument for defining the presence of psychiatric disorder in a disaster-effected community. The findings demonstrated that lasting psychiatric morbidity is associated with natural disasters.

Australia↗
PubMed1994

Disaster relief work: an assessment of training effectiveness.

This study evaluates the applicability of the training and operational practices of a group of firefighters to disaster search and rescue duties. Using schema theory it is hypothesized that training effectiveness could be evaluated by assessing the incidence with which event characteristics are perceived as stressors. A comparison of the propensity of a group of firefighters and a group of predominantly nonemergency service volunteers (who were specifically trained for disaster relief work) to define event characteristics as stressors provided the means of testing the hypothesis. The results suggest that the training and experience of these firefighters did not prepare them for major disaster work. The difference in stressor susceptibility serves as a basis for identifying training and response factors that appeared to promote an adaptive response. The implications of schema theory for the design of training programs is discussed.

Adult↗
PubMed1994

Psychosocial correlates of fire disaster among children and adolescents.

This study examined the extent of children's and adolescents' psychosocial maladjustment associated with a natural disaster, namely, wildfire. The course of psychopathology was assessed six weeks after a major wildfire destroyed 420 homes. Victims' functioning relative to a comparison group from the same community, matched for age, gender, socioeconomic status, and fire insurance was examined. The major goal of this study was to assess systematically the short-term mental health consequences of a wildfire disaster among children and adolescents. This goal was achieved through the use of standardized assessment procedures. The results of this study add useful information to the literature concerning the impact of disaster among children and adolescents and provide a methodological framework for future efforts in this area.

Adolescent↗
PubMed1994

The continuity principle: a unified approach to disaster and trauma.

The continuity principle stipulates that through all stages of disaster, management and treatment should aim at preserving and restoring functional, historical, and interpersonal continuities, at the individual, family, organization, and community levels. Two misconceptions work against this principle and lead to decisional errors: the "abnormalcy bias" which results in underestimating victims' ability to cope with disaster, and the "normalcy bias" which results in underestimating the probability or extent of expected disruption. This article clarifies these biases and details the potential contributions of the continuity principle at the different stages of the disaster.

Adaptation, Psychological↗
PubMed2001

High-frequency zone of river desiccation disasters in China and influencing factors.

In recent years, the desiccation of the lower Yellow River has raised concerns in the government, public, and scientific community in China. Long-term and widespread desiccation of rivers is a disaster with many adverse environmental implications. It has been found in this study that there exists a high-frequency zone of river desiccation disasters at 34 degrees -42 degrees N in the North China Plain. The hazardous environment is characterized by semiarid climate, widely distributed thick loess in the basin and a "hanging river bed" in the plain as well as unfavorable man-water-land coupling relationships. In this setting, the sharply increased water diversion by man since the late 1950s led to the occurrence of river desiccation disasters in the lower reaches of the river in this area.

China↗
PubMed2004

Is there an impact of global and local disasters on psychiatric inpatient admissions?

BACKGROUND: Disasters of the magnitude of September 11, 2001 have a serious public health impact. By dominating media broadcasts, this effect is not limited to the site of the disaster. We tested the hypothesis whether such extraordinary burden results in an increase of psychiatric inpatient treatment. As such we analysed all psychiatric inpatient admissions in the Canton of Zurich/Switzerland. To test the influence of proximity to a disaster, we additionally analysed the impact of a local amok run on September 27, 2001. METHODS: Psychiatric inpatient admissions in the Canton of Zurich from September 2000 to September 2002 were analysed based on the data of the psychiatric case register. ARIMA modelling was employed to describe time-series of admissions per week over the 2-year period and to identify the impact of the incidents of 9/11 and 9/27, 2001. RESULTS: Mean numbers of weekly admissions were comparable in a time span of one month before and one month after the two incidents, thus, no significant changes were detected by the ARIMA modelling. CONCLUSION: Against widespread beliefs, for patients with severe mental disorders requiring hospitalisation illness factors seem to play a more relevant role for decompensation than external psychosocial factors such as the described incidents.

Adult↗
PubMed2006

Health-related quality of life and mental health problems after a disaster: are chronically ill survivors more vulnerable to health problems?

Studies have shown that the chronically ill are at higher risk for reduced health-related quality of life (HRQL) and for mental health problems. A combination with traumatic events might increase this risk. This longitudinal study among 1216 survivors of a disaster examines whether chronically ill survivors had a different course of HRQL and mental health problems compared to survivors without chronic diseases. HRQL and mental health problems were measured 3 weeks, 18 months and 4 years post-disaster. Data on pre-disaster chronic diseases was obtained from the electronic medical records of general practitioners. Random coefficient analyses showed significant interaction effects for social functioning, bodily pain and emotional role limitations at T2 only. Chronically ill survivors did not consistently have a different course of general health, physical role limitations, and mental health problems. In conclusion, chronic diseases were not an important risk factor for impaired HRQL and mental health problems among survivors.

Adolescent↗
PubMed1996

Adolescents' perceived risk and personal experience with natural disasters: an evaluation of cognitive heuristics.

Elevated risk judgments for negative life events have been linked to personal experience with events. We tested the hypothesis that cognitive heuristics are the underlying cognitive mechanism for this relation. The availability (i.e., memory for incidents) and simulation (i.e., imagery) heuristics were evaluated as possible mediators for the relation between personal experience and risk estimates for fatal weather events. Adolescents who had experienced weather disasters estimated their personal risk for weather events. Support was obtained for the simulation heuristic (imagery) as a mediator for the relation. Availability for lightning disaster experience was also found to be a mediator for the relation between personal lightning disaster experience and risk estimate for future events. The implications for risk perception research are discussed.

Adolescent↗
PubMed1985

Evaluation of possible patient survival in a mock airplane disaster.

A mock disaster at Orange County's John Wayne Airport provided a basis for examining correct triage of patients and their arrival time for definitive care. The ability to triage critically injured patients in a timely fashion was found to be only slightly better than chance routing. For most of the seriously and critically injured patients, it took more than 1.5 hours to reach the hospital. Advanced life support with intravenous fluid resuscitation available on the scene would probably reduce the mortality of possible disaster victims by 50 percent. These problems are presently being addressed. In future disaster exercises, the present type of evaluation could be used to judge improvement in possible patient triage and survival.

Accidents, Aviation↗
PubMed1990

Medical teams for accidents and major disasters.

Recent major disasters within the United Kingdom have highlighted the role of mobile medical teams. A prospective study of 244 call-outs demonstrated that an experienced medical team can be mobilized rapidly and effectively in response to accidents and potential disasters. An accident flying squad reduced mortality in the severely multiply-injured patient by providing treatment at the scene of the accident in 234 patients. The argument supporting the development of flying squads for accidents and major disasters can be based on the objective evidence of their value rather than on their empirical and emotional appeal.

Accidents↗
PubMed1990

The place of exercises in disaster management.

This article sets out the personal experience of the author in three types of disaster exercise, acted out exercises carried out at Belfast International Airport, talk-through exercises carried out with personnel at the four Area Boards in Northern Ireland, and a tabletop exercise organized by the Health Emergency Planning Officer of the North West Thames Region in connection with a specific scenario at Heathrow Airport. The advantages and costs of the various exercises are discussed. In order to collect experience from different people carrying out disaster exercises and to increase the professionalism of such exercises, a national centre for disaster teaching and research is recommended.

Disaster Planning↗
PubMed1987

Community priorities following disaster: a case study from Tonga.

Disaster victims have been thought to be disoriented and irrational to express their needs. Therefore they have been largely assessed through external observers. However, this study in the South Pacific Kingdom of Tonga suggests that disaster victims were capable of prioritising their needs to guide the provision of immediate help and later rehabilitation programmes. Some inconsistencies in the experiences of this study sample compared to large developing population centres (e.g. low disease prevalence after the cyclone) highlight the need for special consideration of small island states separate from those of the developing continents. Overall, this study explored a method of giving the community an opportunity to participate in their rehabilitations after a disaster. The validity of this approach needs to be tested for other communities.

Child, Preschool↗
PubMed1987

The tragedy of San Juanico--the most severe LPG disaster in history.

During the early morning of Monday, 19 November 1984, one of the largest disasters in industrial history occurred in the Mexico City Area, causing the greatest rescue effort to assist population in an emergency ever undertaken. The tragic catastrophe started in a large LPG (Liquid Petroleum Gas) storage and distribution centre in San Juan Ixhuatepec, 20 km north of Mexico City. The facilities, owned by the Pemex State Oil Company, consisted of six spherical storage tanks (four with a volume of 1600 m3 and two with a volume of 2400 m3) and 48 horizontal cylindrical bullet tanks of different sizes. At the time of the disaster the storage tanks contained 11,000 m3 of a mixture of propane and butane. The inhabitants of San Juan Ixhuatepec numbered about 40,000, and a further 60,000 lived in the hills surrounding the village. The majority were poor country people living in one-story houses constructed of concrete pillars filled in with bricks and with roofs of iron sheets. The disaster started due to LPG leakage, probably a pipe leakage or rupture due to excess pressure. A vapour cloud built up and was slowly moved by the north-east wind towards the ground-placed flare pit located in the western part of the plant. The vapour cloud was ignited around 5:40 a.m. and was followed by an extensive fire at the plant area. The first explosion was registered on the seismograph at the University of Mexico at 05 h 44 min 52 s and was followed by a dozen explosions within the next hour, some of them of BLEVE type (Boiling Liquid Expanding Vapour Explosion) due to rupture of one or more storage tanks. Two of the explosions had an intensity of 0.5 on the Richter scale. Unburned and burning gas entered the houses south of the plant area and set fire to everything. Blast waves from the explosions not only destroyed a number of houses but also shifted several cylindrical tanks from their supports and added more gas to the fire. The smaller spheres and some of the cylinders exploded and fragments and even whole cylinders weighing around 30 tons, were scattered over distances ranging from a few to up to 1200 m.

Accidents, Occupational↗
PubMed1990

Fate of mass burn casualties: implications for disaster planning.

A survey of 11 fire disasters which have occurred since 1970, showed that incidents occurring outdoors resulted in larger numbers of hospital admissions, with more severe injuries, than incidents occurring indoors. While the majority of burn casualties sustained burns covering less than 30 per cent body surface area (BSA), outdoor disasters resulted in the admission of a significant number of patients with burns covering more than 70 per cent BSA. Expert triage may therefore minimize the requirement for specialized burn beds. However, the scarcity of burn facilities is such that involvement of distant centres may be anticipated following large disasters. While effective early management extends the time available for the dispersal of casualties, delays may be avoided by prior planning, especially if the international transfer of patients is envisaged.

Body Surface Area↗