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PubMed1985

Triage success in disasters: dynamic victim-tracking cards.

A dynamic victim-tracking card developed for use in community or hospital disaster exercises was tested during two hospital and two airport disaster drills. Use of the card in 375 "patients" allowed testing of the ability to evaluate the decisions of triage, the early medical intervention for "victims," and the ongoing treatment of patients with a changing medical status. The card was successful in simulating realistic changes that may occur in critically ill and injured patients. Of the 126 "patients" evaluated in an actual exercise, 55 (43.6%) were placed in the proper triage category. Four patients "died" as a result of poor initial evaluation and treatment. Medical decisions during hospital and community disaster exercises can be more realistically tested and more accurately documented with the use of the dynamic victim-tracking card.

Abdominal Injuries↗

PubMedDate not supplied

Criteria for the assessment of disaster preparedness.

The assessment of disaster preparedness of certain areas is to a large extent liable to subjectivity. For a modern society, however, objectivity is a prerequisite. A methodology is presented calculating the disaster preparednes of municipalities, counties, provinces, states, or even countries. Standardization of this methodology could allow comparison of disaster preparedness between these areas.

Disaster Planning↗

PubMedDate not supplied

The medical severity index of disasters.

In 1980 an international working party postulated a definition for a disaster. Later this concept was formulated into a classification and scoring system. This system has now been refined to be used prospectively during the management stage of a calamity. By calculating the medical severity index, which is the product of the casualty load and the severity of the incident, and comparing this figure with the available total capacity of the medical services, which is the medical rescue capacity, the medical transport capacity and the hospital treatment capacity, the dispatcher at the control center can fairly quickly and precisely identify if a calamity is to be regarded as a disaster or not and if the region can cope with the situation. Moreover a calculation of the hospital treatment capacity in the region could serve as a guideline for estimation of the dimensions needed for the medical rescue capacity and medical transport capacity when planning how to deal with a disaster.

Disaster Planning↗

PubMed2005

Disaster care: psychological considerations.

Disasters are tragic events that disrupt the normal functioning ofa community and overwhelm personal and community resources. The people who experience or simply witness traumatic events can be affected emotionally and develop a range of physical and emotional responses, which in turn can produce psychological, social, and physiological dysfunction. The challenge for health care providers is to recognize the range of emotions and to be able to identify when professional help is indicated. This article provides an overview of the human stress response and describes sources of stress that follow disasters, acute stress disorder, post-traumatic stress disorder, and interventions and resources used to care for victims after disasters.

Crisis Intervention↗

PubMed2006

New software for computer-assisted dental-data matching in Disaster Victim Identification and long-term missing persons investigations: "DAVID Web".

In 1997 an internally supported but unfunded pilot project at the Victorian Institute of Forensic Medicine (VIFM) Australia led to the development of a computer system which closely mimicked Interpol paperwork for the storage, later retrieval and tentative matching of the many AM and PM dental records that are often needed for rapid Disaster Victim Identification. The program was called "DAVID" (Disaster And Victim IDentification). It combined the skills of the VIFM Information Technology systems manager (VW), an experienced odontologist (JGC) and an expert database designer (JC); all current authors on this paper. Students did much of the writing of software to prescription from Monash University. The student group involved won an Australian Information Industry Award in recognition of the contribution the new software could have made to the DVI process. Unfortunately, the potential of the software was never realized because paradoxically the federal nature of Australia frequently thwarts uniformity of systems across the entire country. As a consequence, the final development of DAVID never took place. Given the recent problems encountered post-tsunami by the odontologists who were obliged to use the Plass Data system (Plass Data Software, Holbaek, Denmark) and with the impending risks imposed upon Victoria by the decision to host the Commonwealth Games in Melbourne during March 2006, funding was sought and obtained from the state government to update counter disaster preparedness at the VIFM. Some of these funds have been made available to upgrade and complete the DAVID project. In the wake of discussions between leading expert odontologists from around the world held in Geneva during July 2003 at the invitation of the International Committee of the Red Cross significant alterations to the initial design parameters of DAVID were proposed. This was part of broader discussions directed towards developing instruments which could be used by the ICRC's "The Missing" project that seeks to identify the victims of civil unrest and other atrocities. The most significant of these recommendations was that the next version of DAVID should be web-based allowing it to be used anywhere in the world and on any computer platform. The original intention that the software should be made available as freeware was strongly reiterated and endorsed. During 2005 these recommendations have been realized. This paper will describe the design parameters of the new software "DAVID web" and compare its features and performance with alternative packages.

Database Management Systems↗

PubMed2006

Mental health service use among American Red Cross disaster workers responding to the September 11, 2001 U.S. terrorist attacks.

In this article, we explored 1) the extent of mental health (MH) service use by American Red Cross disaster relief workers, both before (lifetime) and 1 year after the September 11, 2001 terrorist attacks, and 2) demographic, disaster and MH variables predicting (1-year) post-September 11 MH service use in this population. A sample of 3015 Red Cross disaster workers was surveyed 1 year after the attacks, regarding demographic characteristics, MH service use before and since the attacks, and posttraumatic stress disorder (PTSD) symptoms. Findings revealed that while 13.5% used MH services before the attacks, 10.7% used services after. Variables increasing the likelihood of MH service use after the attacks included the following: no previous MH treatment, younger age, being divorced/widowed, and higher PTSD intrusion or hyperarousal symptoms. Findings support other recent research on MH service use after the September 11 attacks.

Disasters↗

PubMed1981

Revising the rural hospital disaster plan: a role for the EMS system in managing the multiple casualty incident.

Much of the effort in disaster planning has been directed toward large-scale, war-related, or major natural disasters. We helped test a rural community's disaster plan in a simulated airport accident, and concluded that this plan was not the most effective for providing the triage and stabilization in the field that are essential to the management of this type of accident. This communication argues for the development of an alternative model of response involving the "escalation" of the everyday emergency medical services system. We believe this will provide more rapid and effective allocation of the rural community's limited medical resources in the management of the multiple casualty incident.

Aircraft↗

PubMed1983

The Hyatt Regency skywalk collapse: an EMS-based disaster response.

The Hyatt Regency skywalk collapse (July 17, 1981) provided the emergency medical services system of Kansas City, Missouri, with its greatest challenge ever. Utilizing an EMS-based, centralized, city-wide disaster plan, the rescue operation encountered 113 dead and 188 multiply traumatized patients. The rescue operation could be divided into three areas: initial response, onset triage, and delayed extrication. Success of the operation was credited to several factors, including the centralized urban location of the collapse, short patient transport times, centralized ambulance dispatch, availability of ALS vehicles and personnel to the scene, and mutual aid response. Short-comings of the rescue that became apparent on critical review of the response included poor communications at the scene, lack of physician bystander control, and the need for identification of key personnel at the site. Success in responding to the health care needs of a disaster included a flexible and well-organized disaster response plan as well as the support of a health care system capable of picking up the pieces of the psychological aftermath.

Disasters↗

PubMed1994

Disaster medical assistance teams: providing health care to a community struck by Hurricane Iniki.

STUDY OBJECTIVE: To describe the type of medical care that disaster medical assistance teams (DMATs) provided to a community struck by a major hurricane. STUDY DESIGN: A prospective study describing the use of DMAT field clinics by a population affected by a major hurricane. Data regarding the type of medical care provided to disaster victims and the acuity of each patient's medical condition were abstracted from medical charts at each field clinic. SETTING: Three DMAT field clinics that provided medical care to residents of Kauai, Hawaii, after Hurricane Iniki struck the island on September 11, 1992. RESULTS: From September 16 to 19, 1992, three DMATs provided medical care to 614 people. The patients' average age was 34 years, and 60% were male. The largest treatment categories were injury (40.4%), illness (38.6%), and preventive services (9.0%). Most illnesses and injuries were minor, and 99% of the patients were ambulatory. Only 33 patients (5.4%) were referred to another medical provider. Referrals were generally for procedures not available in DMAT field clinics rather than for life-threatening conditions. CONCLUSION: DMATs sent to assist with the medical needs of a US community struck by a major hurricane should be prepared to deliver basic medical services and primary health care. The need for these medical services will continue beyond the impact phase of a hurricane disaster.

Adolescent↗

PubMed2003

Impacts of an environmental disaster on psychosocial health and well-being in Karakalpakstan.

The people of Karakalpakstan, along with those of the entire Aral Sea region, are facing a multitude of health problems corresponding to the drying of the Aral Sea and accompanying ecological consequences. In case studies of other environmental disasters, research has shown that environmental exposures may impact not only the physiological but also the psychosocial health of individuals. This research aims to determine the contribution of the environmental disaster to the psychosocial health of people living in Karakalpakstan, a semi-autonomous Republic in Uzbekistan. An interview survey was carried out by Médecins Sans Frontières, with the assistance of the McMaster Institute of Environment and Health, local Universities and local health care workers, on a random sample of 1118 individuals aged 18 years and older in three communities in Karakalpakstan in May/June 1999. The communities were chosen according to distance from the former seashore, urban/rural characteristics and ethnic composition. The survey included questions about perceived general health, the General Health Questionnaire, the somatic symptom checklist of the Symptom Check List-90, questions about perceptions of the environmental disaster, social support as well as socio-demographic and socio-economic characteristics. Findings show that 41% of all respondents reported environmental concern while 48% reported levels of somatic symptoms (SCL-90) associated with emotional distress, above the normalized cut-point. Significant differences in levels of emotional distress were reported between men and women as well as between ethnic groups. Environmental problems are commonly perceived to be the cause of somatic symptoms and are significantly related to self-rated health status.

Adolescent↗

PubMed1996

Disaster epidemiology.

Sound epidemiologic knowledge of the morbidity and mortality caused by disasters is essential when determining what relief supplies, equipment, and personnel are needed to respond effectively in emergency situations. All disasters are unique because each affected region of the world has different social, economic, and baseline health conditions. Some similarities exist, however, among the health effects of different types of disasters, that if recognized, can ensure that the limited health and medical resources of the affected community are well managed.

Disasters↗

PubMed1996

Operational medicine in disasters.

There are many similarities and differences between operational and disaster medicine. Over the past several years, there have been increasing requirements for the use of military and tactical law enforcement operational medicine in disaster, humanitarian assistance, and terrorist settings. Many of the TEMS techniques have a direct application to disaster medicine.

Disasters↗

PubMed1996

First aid and transportation of burned patients during mass disasters.

Twenty-eight mass burn disasters in Bulgaria with 381 injuries in the last 27 years (1968-1994) were reviewed. Mass burn disasters were classified as follows: industrial accidents, 23, with 273 injured and 103 dead; traffic accidents, 2, with 97 injured and 30 dead; domestic accidents, 2, with 11 injured and 6 dead. Organization of first aid at the disaster site and in the regional hospitals is described, as well as the time of transport of the patients to major hospitals near the site of the accident. As a priority, the injured were transported early to the biggest center for burns and plastic surgery in the capital.

Bulgaria↗

PubMed1999

Prehospital triage and communication performance in small mass casualty incidents: a gauge for disaster preparedness.

Because of their infrequency, disasters are difficult to train for. Emergency prehospital personnel frequently participate in small mass casualty incidents (MCIs) (3 to 50 victims). This study sought to examine prehospital performance in small MCIs in areas that are frequently mismanaged in disasters. Prospective data from the resource physician and retrospective data from tape recorded prehospital conversations were collected for a 9-month period. Clinical patient data, patient demographics, emergency medical services squad characteristics, and triage information were recorded. Forty-five consecutive MCIs were studied. Most of these were motor vehicle accidents. Prehospital providers included paid providers, nonpaid providers, and air and ground transport. The mean number of victims first identified (4.6%) was greatly different than the mean number of victims eventually transported from a scene (7.1%). Most patients were treated at a level 1 trauma center. Frequent errors included having multiple communicators on site (38%), misidentifying the number of victims (56%), and having unclear information for the resource physician (43%). Only 38% of events had prehospital triage information that was deemed appropriate in total. These results show that scene and triage errors are frequent in MCIs of small scale. This information can be used to assay a system's readiness for disasters.

Accidents, Traffic↗

PubMed1998

Children's reactions to disaster.

Children's reactions to disaster are influenced by their developmental stage, as well as by situational, personal, and family factors. This review describes children's experiences during man-made and natural disasters and uses drawings and narrative to illustrate specific reactions. Mental health outcomes, including post-traumatic stress disorder, are identified, as are approaches to working with children and families after disaster.

Adaptation, Psychological↗

PubMed2003

Facing war, terrorism, and disaster: toward a child-oriented comprehensive emergency care system.

The combination of the overwhelming nature of disasters and the massive losses they engender gives rise to a complex clinical and social picture with longterm physical, psychological, and social effects on children, families, and communities. The authors suggest that to assess the damage properly, implement interventions on a large scale, keep tabs on rising needs, and restore societal function, mental health professionals must adopt an ecologic systems approach. This approach entails working within and together with related institutions (education, health, local government) and assisting other committed professionals within these institutions to mediate care. This is of utmost importance in the area of children's care because of their particular vulnerability and their special importance for families and society. For this reason, the authors suggest that emergency mental health systems be better designed and implemented while keeping children at the center of their focus. An essential component of the ecologic systems approach is improved education for mental health professionals, providing them the appropriate tools to cope with widespread disaster and the expertise to apply these tools. This approach, however, is not enough. A good outcome cannot be achieved without preparedness on the part of the other relevant institutions and the community as a whole. Greater awareness is needed among local and national authorities of the importance of metaadaptive systems and of local, national, and international networking. In the current global village that is threatened by pervasive terrorism, no community must face it alone. The challenge of a disaster to one community is a challenge to all. By working together we can lessen the devastating impact of these events, save countless lives, prevent untold suffering, and maintain hope for a better world for children.

Adolescent↗

PubMed1996

Mental health problems in the Gomel region (Belarus): an analysis of risk factors in an area affected by the Chernobyl disaster.

The epidemiology of mental problems in the Gomel region in the republic of Belarus was studied in a two-stage survey of a broad based population sample (N = 1617), using the General Health Questionnaire (12-item version) and the Munich Diagnostic Checklist for DSM-III-R. The Gomel region is one of the areas that was most severely affected by the Chernobyl nuclear disaster in 1986. In the studied population sample 64.8% had a GHQ-score above the threshold of 2. A DSM-III-R psychiatric disorder was present in 35.8%, with especially high rates for affective (16.5%) and anxiety disorders (12.6%). Dysthymia, general anxiety disorder, adjustment disorders and 'not otherwise specified syndromes' made up almost two-thirds of the observed morbidity (22.9%). A higher prevalence of mental health problems, both in terms of the GHQ and the DSM-III-R was observed among people who have been evacuated and in mothers with children under 18 years of age. These data indicate that the Chernobyl nuclear disaster may be partly responsible for the high prevalence of (milder) psychiatric disorders and psychological distress in the Gomel region, even 6 years after the event. Future studies comparing the data from Gomel region with an unexposed area will have to provide a more definite answer concerning the impact of this nuclear disaster on mental health.

Adolescent↗

PubMed1997

Psychosocial sequelae of the 1989 Newcastle earthquake: II. Exposure and morbidity profiles during the first 2 years post-disaster.

BACKGROUND: A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys. METHODS: The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five 'at risk' groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). RESULTS: Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted 'at risk' groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers. CONCLUSIONS: Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

Adult↗