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PubMed2005

Effects of a major earthquake on blood donor types and infectious diseases marker rates.

This observational study attempted to identify the effect of a natural disaster on the safety of blood supply and donor types with the influx of donors after a severe earthquake. Blood donation rate, blood discard rate and safety of blood donations responding to the earthquake, as projected from the infectious disease marker rate, were evaluated in blood donated immediately before (1 July-17 August) and after 17 August 1999 (17 August-21 August). These were compared with the results from the corresponding periods in 1998 and 2000 for donations at a university medical centre and two regional blood centres. 8055 units of allogeneic blood were collected at two regional blood centres, and 450 units were collected at a university medical centre during 4 days. Viral marker rates were nearly the same at the former but were slightly lower at the latter. The blood discard rate was nearly twice the comparative periods at the former, but it remained unchanged at the latter. Voluntary donors replaced the replacement donors during 4 days. This analysis highlights the size of the pool of potential donors that are available as a national resource that can be motivated to give blood with the right motivation.

Biomarkers↗
PubMed2002

Effect of two consecutive earthquakes on outbreaks of alopecia areata.

The pathogenesis of alopecia areata (AA) is still unknown. We investigated whether two consecutive earthquakes in Duzce, Turkey within a 3-month interval could precipitate AA. Patients who developed AA after the first earthquake in Duzce were included in this study. The admittance rate and demographic characteristics of AA patients admitted in the same period of the previous year (BE=before earthquake group) were compared to that of AA patients admitted after the earthquake (AE=after earthquake group). The admittance rate and onset of AA after the first earthquake were investigated retrospectively. In addition, possible relationships between the earthquake and age at the first attack, severity of the disease, and ophiasis were studied. The ratio of AA patients in the BE group was 12/1,121 (0.9%), while this value was 26/1,430 (1.8%) in the AE group (p=0.07). There were no significant differences with regard to sex, age of the first attack, severity of the disease, or ophiasis between the two groups. AA appeared between 18-28 weeks after the first earthquake in 14 (53.8%) of the patients. The earthquake did not increase the admittance rate of AA significantly. This finding suggests that a stressful event such a natural disaster is not a unique factor in AA outbreaks.

Adolescent↗
PubMed1990

Relevance and resources in medical education: an African view.

The worldwide economic crisis enjoins all planners of social services to a principle of relevance and efficiency in the deployment of scarce available resources. On the continent of Africa this is more crucial for the compelling influence of natural disasters and the population explosion. In the field of medical education relevance implies commitment of training programmes to the health needs of the society and in Africa this means addressing crude birth rates of 46 per 1000, death rates of 22 per 1000, maternal mortality of 17 per 10,000, infant mortality of 112 per 1000 and a life expectancy of just under 50, statistics which represent the most dismal health indicators for the five continents of the world. The training of the African doctor should therefore ensure intimate familiarity with the environmental and sociocultural influences on health, placing a premium on capability for management of human, material and financial resources and a plan for team-work. It must also inculcate the appropriate learning strategy which emphasizes the searching and enquiring mind, applying this problem-solving attitude to the life-long practice of medicine. It is now accepted by most observers that these objectives are achievable most readily through a translation of the principles of primary health care into educational strategies. The planning of medical educational policy in Africa is thus a formidable task as it is to be done against a background of diminishing resources in real terms and the modern explosion of knowledge in science and technology. Selectivity which is sensitive to the service to which education is to be put is currently the most promising means to achieve relevance and efficiency.

Africa↗
PubMed1995

Perinatal medical support in the area surrounding the Hanshin-Awaji earthquake.

After natural disaster, perinatal medical care must usually be provided from outside the disaster area, because most of the medical efforts inside the area focus on patients without special needs. This study reviews the emergency perinatal medical response after the great Hanshin-Awaji earthquake. In the present study, we summarize records of telephone calls and reports from the Neonatal Mutual Cooperative System (NMCS). The day of the earthquake, very little information was available to or from the disaster area. The day after the earthquake, Osaka City General Hospital (OCGH) and Osaka Medical Center and Research Institute for Maternal and Child Health were established as key facilities, and OCGH served as a center through which information passed to and from the disaster area. Most telephone calls to OCGH were placed on the second day after the earthquake by pregnant women concerned about their deliveries. Many high-risk pregnancies and newborn infants were transferred out of the disaster area over the next month. This analysis shows that although the emergency response was very rapid in this instance, the operation may be significantly improved in disasters of this magnitude: (i) if a communication mechanism able to serve a large volume is established; (ii) if helicopter transport was easily available; and (iii) if key facilities to handle communications were previously established so as to be available immediately.

Child Health Services↗
PubMed2005

Clinical impact and pathogenicity of Acinetobacter.

Members of the genus Acinetobacter have been implicated in a wide spectrum of infectious diseases. Although this organism is associated primarily with nosocomial infections, it has also been involved in cases of community-acquired infection. Before the 1970s, Acinetobacter infections were mostly post-surgical urinary tract infections in patients hospitalised in surgical units. The significant improvement in resuscitation techniques during the last 30 years has changed the types of infection caused by Acinetobacter. Since the 1980s, Acinetobacter has spread rapidly among patients in intensive care units. Today, Acinetobacter accounts for c. 9% of nosocomial infections, with most Acinetobacter infections involving the respiratory tract. Transmission via the hands of hospital staff has become the most important contributory factor in patient colonisation. Acinetobacter baumannii is the species that is involved most frequently in infections of humans, but a natural reservoir for A. baumannii outside the hospital environment has not yet been identified. Community-acquired infection and infections acquired following war or natural disasters (e.g., earthquakes) have been described. Acinetobacter causes mild-to-severe illness, but can be fatal. The severity of Acinetobacter infection depends upon the site of infection and the patient's susceptibility to infection as a result of underlying disease. The circumstances that allow Acinetobacter to assume a pathogenic role are not really well-understood. As this organism is a low-grade pathogen, the pathogenesis of Acinetobacter infections probably involves numerous factors, including virulence determinants, which have yet to be investigated.

Acinetobacter↗
PubMed1988

Recent life events and psychiatric disorder in children: the interaction with preceding extreme adversity.

This prospective study investigated the role that life events play in causing emotional and behavioural problems in a population of 240 primary school children who had recently survived a natural disaster. Life events experienced after the disaster were not found to contribute directly to the number of emotional or behavioural problems when the effect of the disaster was taken into account. This suggested that, in children, life events may not have a simple mechanically additive aetiological effect.

Adaptation, Psychological↗
PubMed1986

A methodology for estimating time-of-day variations in the size of a population exposed to risk.

Consequence models for the risk assessment of man-made or natural disasters do not ordinarily take into account time-of-day variations in the size of the exposed population. Residential census population statistics are used instead. This paper proposes and illustrates a methodology for using metropolitan travel survey data to estimate the variations in question. Variations are computed from the Washington, D.C. area sample survey statistics on the number of trips taken in and out of different census tracts throughout each workday. Four principal patterns of population variation are identified, corresponding to four types of land use: commercial, residential, shopping/entertainment, and mixed use. Some general implications for consequence analysis are discussed.

Disasters↗
PubMedDate not supplied

Psychological evaluations, referrals, and follow-up of adolescents after their exposure to Hurricane Hugo.

PROBLEM: There is little understanding of adolescent appraisal of stress and crisis intervention for adolescents who are exposed to major stress such as that of a natural disaster. METHODS: A description of the psychological evaluations, referrals, and follow-up assessments made by nurse practitioners (NPs) and a nurse psychotherapist (NPT) of adolescents (N = 507) in two South Carolina high schools who experienced Hurricane Hugo. FINDINGS: The NPs' evaluations concluded that 63 adolescents (12%) exhibited symptoms of psychological distress. The NPs referred 36 of these adolescents to high school counselors for minor distress or school-related problems and 27 for more intensive clinical evaluation by an NPT. Of the 27 adolescents who were referred to the NPT, 10 had symptoms associated with adolescent adjustment reaction, 8 showed symptoms of depression, 5 revealed symptoms of posttraumatic stress disorder, and 4 complained of serious family problems. CONCLUSIONS: Based on these data and the mental processes described by these adolescents, the authors propose a model and suggest adolescent appraisal of stress and crisis is a critical issue to consider when intervening with adolescents who are exposed to major stressors, including those associated with a disaster.

Adolescent↗
PubMed2006

Posttraumatic stress disorder in rural primary care: improving care for mental health following bioterrorism.

CONTEXT: Recent bioterrorism attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby contributing to increased needs for mental health care, particularly for posttraumatic stress disorder, which has been estimated to occur in 28% of terrorism survivors. PURPOSE: Prior experience with natural disasters suggests that first responders typically focus on immediate medical trauma or injury, leaving rural communities to struggle with the burden of unmet mental health needs both in the immediate aftermath and over the longer term. The purpose of the present article is to draw attention to the greater need to educate rural primary care providers who will be the frontline providers of mental health services following bioterrorism, given the limited availability of tertiary mental health care in rural communities. METHODS: We reviewed the literature related to bioterrorism events and mental health with an emphasis on rural communities. FINDINGS AND CONCLUSIONS: Public health agencies should work with rural primary care providers and mental health professionals to develop educational interventions focused on posttraumatic stress disorder and other mental disorders, as well as algorithms for assessment, referral, and treatment of post-event psychological disorders and somatic complaints to ensure the availability, continuity, and delivery of quality mental health care for rural residents following bioterrorism and other public health emergencies.

Bioterrorism↗
PubMed2003

What is public health legal preparedness?

Legal preparedness has gained recognition as a critical component of comprehensive public health preparedness for public health emergencies triggered by infectious disease outbreaks, natural disasters, chemical and radiologic disasters, terrorism and other causes. Public health practitioners and their colleagues in other disciplines can prepare for and respond to such an event effectively only if law is used along with other tools. The same is true for more conventional health threats. At first glance, public health legal preparedness may appear to be only a matter of having the right laws on the books. On closer examination, however, it is as complex as the field of public health practice itself. Public health legal preparedness has at least four core elements: laws (statutes, ordinances, regulations, and implementing measures); the competencies of those who make, implement, and interpret the laws; information critical to those multidisciplinary practitioners; and coordination across sectors and jurisdictions. The process of improving public health legal preparedness has begun in earnest with respect to potentially massive public health emergencies. Elected officials, public health, legal, and law enforcement practitioners, and national security organizations have contributed to initial benchmarks for the core elements. A few gaps in legal preparedness have been identified in the context of exercises, actual public health emergencies, and through more general assessments of public health preparedness conducted by CDC and the Department of Justice. While a strong beginning has been made, this work is incomplete. Redoubled effort is needed to define practical, measurable benchmarks or standards of legal preparedness, to identify and correct shortcomings, and to review findings from regular exercises and actual public health emergencies. There is great value in having this work move forward on two converging tracks, one defined by states and localities acting on their own initiative and the other shaped by the federal government as informed by state and local experience. The TOPOFF and Dark Winter exercises exemplify the grounded, case-based approach that teaches practical lessons about benchmarks, gaps, and steps to improve public health's legal preparedness. It goes without saying that action on both tracks should be taken by collaboratives whose membership includes representatives of the many different communities integral to the design and application of laws that affect the health of the public and the effectiveness of the public health system itself. Consistent with the concept of a public health or population health system with which we began this paper, participants in both tracks should include representatives of non-governmental bodies--community-based organizations, non-profit organizations active in disaster preparedness and response, and others. This paper presents a conceptual and analytic framework those groups may apply, one that is sufficiently broad to serve as an integrating schema across sectors and jurisdictions but also sufficiently flexible to accommodate the unique features of the many community and state public health systems which, together with federal partners, comprise the U.S. public health system, in sum, a framework responsive to the exigencies of our times, faithful to the guiding principles of American federalism, and conductive to a new standard of health protection for all our citizens.

Benchmarking↗
PubMed1980

A survey concerning cattle tick control in Queensland. 2. Managerial aspects which indirectly affect tick control.

This paper reports those findings concerning property management from the 1977-78 survey of tick control in Queensland, which could effect efficient tick control and also presents a profile of the cattle industry in the tick infested areas at the time of the survey. The average property size was 400 hectares and the average number of cattle on the properties was 726.4. Larger properties tended to have crossbred Zebu cattle. The average number of paddocks per property was 7.2. The most popular stabilised crossbred Zebu breed was Santa Gertrudis but the most common type of cattle was crossbred Zebu, which was on 30% of properties. There were negligible numbers of crossbreed Zebu cattle on dairy properties. Control of other external parasites may result in additional dippings in areas where they occur. Although fence maintenance appears to be carried out regularly it is clear that the effectivness of tick control measures, such as pasture spelling and dipping which depend on clean musters, could be affected by the occurrence of fire, floods and other natural disasters on half the properties in the tick infested areas. There is no evidence from results in the survey that attention to other farming activities (mainly cropping) prevents producers from paying sufficient attention to tick control. In fact cropping often provides the opportunity for producers to rotate cattle around pastures. Producers appear to consider the cost of tick control is a burden and they expect assistance from the Government to reduce these costs. They do not appear to have considered how they can reduce the costs themselves.

Animals↗
PubMed2005

Toward inherently secure and resilient societies.

Recent years have seen a number of challenges to social stability and order, ranging from terrorist attacks and natural disasters to epidemics such as AIDS and SARS. Such challenges have generated specific policy responses, such as enhanced security at transportation hubs and planned deployment of a global tsunami detection network. However, the range of challenges and the practical impossibility of adequately addressing each in turn argue for adoption of a more comprehensive systems perspective. This should be based on the principle of enhancing social and economic resiliency as well as meeting security and emergency response needs and, to the extent possible, developing and implementing dual-use technologies that offer societal benefits even if anticipated disasters never occur.

Adaptation, Psychological↗
PubMed1995

Raising the dead: war, reparation, and the politics of memory.

All societies attach a different range of meanings to war than to natural disasters, and questions of societal recognition, reparation, and justice are generally central. Most modern conflict has been grounded in the use of terror to control and silence whole populations. Those abusing power typically refuse to acknowledge their dead victims, as if they had never existed and were mere wraiths in the memories of those left behind. This denial, and the impunity of those who maintain it, must be challenged if survivors are to make sense of their losses and the social fabric is to mend. For the names and fate of the dead to be properly lodged in the public record of their times also illuminates the costs that may flow from the philosophies and practices of the Western led world order, ones which health workers should be in a position to influence.

Human Rights↗
PubMed2005

Prehospital care in Indonesia.

BACKGROUND: Indonesia is a huge, diverse, and developing country that until recently had no public ambulance service let alone a system of prehospital care. It commonly experiences many natural disasters, manmade conflicts, and violence as well as the daily emergencies seen worldwide. CURRENT SYSTEM: Hospitals of varying standards are widespread but have no system of emergency ambulance or patient retrieval. Indonesia's only public emergency ambulance service, 118, is based in five of the biggest cities and is leading the way in paramedic training and prehospital care. CHALLENGES AND DEVELOPMENTS: There are many challenges faced including the culture of acceptance, vast geographical areas, traffic, inadequate numbers of ambulances, and access to quality training resources. Recently there have been a number of encouraging developments including setting up of a disaster response brigade, better provision of ambulances, and development of paramedic training. CONCLUSIONS: An integrated national regionalised hospital and prehospital system may seem fantastic but with the enthusiasm of those involved and perhaps some help from countries with access to training resources it may not be an unrealistic goal.

Ambulances↗
PubMed2005

Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake.

OBJECTIVES: This study aimed to provide an overview of morbidity and mortality among patients admitted to the Hospital of the Medicine Faculty of Uludag University, Bursa, Turkey, after the 1999 Marmara earthquake. METHODS: Retrospective analysis of the medical records of 645 earthquake victims. Patients' demographic data, diagnosis, dispositions, and prognosis were reviewed. RESULTS: A total of 330 patients with earthquake related injuries and illness admitted to our hospital were included and divided into three main groups: crush syndrome (n = 110), vital organ injuries (n = 57), and non-traumatic but earthquake related illness (n = 55). Seventy seven per cent of patients were hospitalised during the first three days after the earthquake. The rate of mortality associated with the crush syndrome, vital organ injury, and non-traumatic medical problems was 21% (23/110), 17.5% (10/57), and 9% (5/55), respectively. The overall mortality rate was 8% (50/645). CONCLUSIONS: In the first 24-48 hours after a major earthquake, hospital emergency departments are flooded with large numbers of patients. Among this patient load, those patients with crush syndrome or vital organ injuries are particularly at risk. Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality. It is hoped that this review of the challenges met after the Marmara earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disasters.

Adolescent↗
PubMed1990

Assessing injury severity during general war. Will the Military Triage system meet future needs?

The injuries likely to occur during a future general war will differ in severity and number from those experienced during recent short campaigns, terrorist incidents and natural disasters. If general war should break out in Europe, casualty numbers will lean towards the First World War rather than the Second in scale. Medical assets can expect, at least temporarily, to be overwhelmed with casualties. To deal with this problem, casualty management will be staged through five echelons or lines of medical support. The principal problem that will face medical attendants at the forward lines will be the sorting of casualties by priority so that those unable to tolerate delay in treatment will be evacuated rapidly before the less severely injured. Sorting will be achieved by the application of a crude scoring system known as Military Triage. We examine this concept and discuss its likely effectiveness in a scenario characterised by limited medical resources and a high flow of casualties. With the widespread introduction of modern and complex injury severity scoring systems into civilian trauma practice it is timely to examine their potential role in augmenting or replacing the current Military Triage system.

Disaster Planning↗
PubMed2003

Consensus statement on the early management of crush injury and prevention of crush syndrome.

Crush Syndrome remains rare in European practice. It is however common in areas of civil disorder and where the normal structures of society have given way to civil war or natural disaster. Western Doctors are becoming increasingly involved in such situations and there is no reason to believe that instances due to more conventional causes, such as collapse in the elderly or road traffic accidents will cease. For all these reasons it is important that clinicians who deal infrequently with crush syndrome have access to appropriate guidelines. This consensus report seeks to provide such advice.

Crush Syndrome↗
PubMed1997

History of the crush syndrome: from the earthquakes of Messina, Sicily 1909 to Spitak, Armenia 1988.

Man-made or massive natural disasters may be followed by 'epidemics' of the muscle crush syndrome. The first descriptions of the crush syndrome were in the German-language literature following the earthquake of Messina in 1909 and World War II. On the threshold of World War II, the English-language literature was still unaware of the crush syndrome. During the London Blitz in 1940, Bywaters clearly delineated the pathogenesis of the crush syndrome and established guidelines for the management of casualties. The experience from the war in southern Lebanon in 1982 showed that early volume repletion can prevent acute renal failure in casualties with the crush syndrome. Following the major earthquake at Spitak in 1988, massive international relief effort helped to rescue and salvage many casualties. International preparedness contingency plans will increase the survival of future casualties suffering from crush injury.

Armenia↗