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PubMed1994

Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia.

OBJECTIVE: This study was undertaken 1 1/2 years after the 1988 earthquake in Armenia to assess the frequency and severity of posttraumatic stress reactions among elderly and younger adult victims and to assess the relation of exposure, age, sex, and death of a family member to these reactions. METHOD: One hundred seventy-nine subjects of both sexes were evaluated with the Posttraumatic Stress Disorder (PTSD) Reaction Index. A subgroup of 60 individuals were also assessed for PTSD with the DSM-III-R criteria. RESULTS: There was a strong association between the presence of severe symptoms on the index and a DSM-III-R diagnosis of PTSD. Elderly and younger adult victims in cities closer to the epicenter (higher exposure) had significantly higher index scores than elderly and adult victims in more distant locations. In comparison with previous studies of natural disasters, much greater rates of chronic severe posttraumatic stress reactions were found among the highly exposed individuals. Although there was no difference in total mean score on the Posttraumatic Stress Disorder Reaction Index, a significant difference in symptom profile was found between the elderly and younger adults; the elderly scored higher on arousal symptoms and lower on intrusive symptoms. There was a positive correlation between loss of family members and severity of posttraumatic stress reaction. CONCLUSIONS: These findings indicate that after a major natural disaster with subsequent multiple adversities, a substantial proportion of the adult population may experience severe and chronic posttraumatic stress reactions. The risk factors identified in this study may prove useful in screening exposed individuals for appropriate treatment.

Adolescent↗
PubMed2001

A chemical decontamination plan for an emergency department.

How a hospital with limited resources successfully implemented an effective emergency decontamination program. While the article addresses chemical decontamination specifically, the author believes the plan would be useful in managing potential victims of bioterrorism.

Bioterrorism↗
PubMed1993

[Burn patients in major emergencies. The preparation of air-drop kits for emergency surgical-resuscitation use].

The kit described is for air-dropping for immediate use in the surgical treatment and resuscitation of burn victims in major emergencies when there is no direct access to the disaster area by rescue teams or vehicles. The kit can also be used to make up for deficiencies in medicines or medical materials in remote hospitals that have admitted people with severe burns who are not immediately transferable to other hospitals.

Aviation↗
PubMed2002

Psychosocial intervention for postdisaster trauma symptoms in elementary school children: a controlled community field study.

CONTEXT: Natural disasters negatively affect children's emotional and behavioral adjustment. Although treatments to reduce psychological morbidity following disasters are needed, it has been difficult to conduct treatment research in postdisaster environments because of the sensitivity of victims to perceived intrusiveness and exploitation. OBJECTIVE: To evaluate the efficacy of a public health--inspired intervention combining school-based screening and psychosocial treatment to identify and treat children with persistent disaster-related trauma symptoms. DESIGN: To identify children with continued high levels of trauma-related symptoms 2 years after a major disaster, we conducted a community-wide school-based screening of disaster-exposed public elementary school children. Children with the highest levels of trauma-related symptoms were randomly assigned to 1 of 3 consecutively treated cohorts. Children in the cohorts awaiting treatment served as wait-list controls. Within each cohort, children were randomly assigned to either individual or group treatment to allow comparison of the efficacy of the 2 treatment modalities. SETTING: All 10 public elementary schools on the island of Kauai (one of the Hawaiian Islands) 2 years after Hurricane Iniki. PARTICIPANTS: All 4258 children in second through sixth grade were screened. The 248 children with the highest levels of psychological trauma symptoms were selected for treatment. INTERVENTION: Children were randomly assigned to either individual or group treatment provided by specially trained school-based counselors. Treatment comprised 4 sessions. MAIN OUTCOME MEASURES: The Kauai Reaction Inventory, a self-report measure of trauma symptoms, and the Child Reaction Inventory, a semistructured clinical interview for posttraumatic stress disorder symptoms. RESULTS: After treatment, children reported significant reductions in self-reported trauma-related symptoms. This symptom reduction was maintained at the 1-year follow-up. Clinical interviews also indicated that treated children had fewer trauma symptoms compared with untreated children. CONCLUSIONS: School-based community-wide screening followed by psychosocial intervention seems to effectively identify and reduce children's disaster-related trauma symptoms and may facilitate psychological recovery. While group and individual treatments did not differ in efficacy, fewer children dropped out of the group treatment. This approach may be applicable to screening and treating children exposed to a variety of large-scale disasters.

Analysis of Variance↗
PubMedDate not supplied

Epidemiological evidence about the relationship between PTSD and alcohol abuse: the nature of the association.

This article uses the Bradford Hill criteria for assessing causal associations to examine the nature of the relationship between PTSD and alcohol abuse. A series of studies are presented which examine this relationship. A cross-sectional study of 2,501 subjects in a community sample examined the relationship between at-risk drinking and 11 types of traumatic events. The traumatic events associated with at-risk drinking were involvement in life threatening accidents, witnessing severe injury, rape, being the victim of serious physical assault using the CIDI. In a longitudinal study of 469 firefighters exposed to a natural disaster, PTSD was associated with both an increase and decrease in alcohol consumption and PTSD rather than exposure accounted for the changes in drinking behaviour. In three other populations, psychiatric inpatients, motor accident victims and female prisoners, the association between PTSD and alcohol abuse emphasised the clinical and public health importance of this relationship. The available evidence does nevertheless support the causal nature of this relationship. Other risk factors are necessary to predict alcohol abuse following exposure to traumatic events, although exposure to traumatic events can be caused by alcohol abuse.

Accidents↗
PubMed2005

Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media.

For decades, after nearly every natural disaster, fear of disease has encouraged communities, local authorities, and governments to rapidly dispose of the bodies of the victims without first identifying them. In May 2004 this journal published the first-ever review article to comprehensively assess the scientific evidence on the infectious disease risks of dead bodies following natural disasters, along with an editorial commenting on the persistence of myths concerning the dangers allegedly posed by dead bodies. This paper assesses the impact that the review article and the editorial have had on the way that health risks from dead bodies have been reported by the media over the following year, especially focusing on the South Asian tsunami disaster of December 2004. While some media outlets have reported erroneous information, hundreds of other news stories have accurately reported that dead bodies pose no public health risk, and have explained the priority for properly identifying the deceased. Nevertheless, publication of scientific evidence alone is insufficient to bring about public health action. International agencies need to continue their work on producing standards, guidelines, and practical guidance on managing dead bodies. There needs to be a community-centered approach to informing communities about the management of the dead following disasters and the rights of individuals to be treated respectfully after death. Nongovernmental organizations should be encouraged to provide expertise and technical support in identifying and burying large numbers of dead. There also needs to be ongoing assessment of the technical processes involved in the recovery, identification, and disposal of dead bodies, as well as the effectiveness of disaster preparedness plans and communication with the affected population.

Attitude to Death↗
PubMed2005

Analysis of rugae in burn victims and cadavers to simulate rugae identification in cases of incineration and decomposition.

The most challenging situations in Forensic Odonto-Stomatology are mass disasters, where the forensic dentist is usually confronted with charred human remains or heavily decomposed or fragmented bodies. This article determines the extent of preservation of palatal rugae for use as an alternative identification tool in such situations, using a study group comprising burn victims and cadavers simulating forensic cases of incineration and decomposition. The thermal effects and the decomposition changes on the palatal rugae of burn victims with panfacial third degree burns and human cadavers in storage were respectively assessed and graded on a new scale. Ninety three percent of burn victims and 77% of human cadavers had Grade 0 changes (normal). When changes were noted, they were less pronounced than the generalized body involvement of burns in burn victims and the generalized body decomposition of human cadavers.

Autolysis↗
PubMed2006

Improving hospital surge capacity: a new concept for emergency credentialing of volunteers.

In the event of a large-scale terrorist attack, natural disaster, or other public health emergency, hospitals could not absorb the thousands of victims generated by the catastrophe. Even if hospitals can increase bed capacity by 20% to 30%, as some suggest, the problem of staffing these beds remains unresolved. One possibility is to rapidly increase hospital staff by providing emergency credentialing to volunteer health care professionals. Several organizations and systems currently exist that can deliver medical providers to a stricken area. Unfortunately, all of these have serious limitations that would make it difficult for hospitals to use the health care workers provided by such entities. We propose a unique concept that will allow hospitals to rapidly expand their staff with practitioners that meet their credentialing requirements. The concept is a database created by each hospital in a community that includes credentialed physicians, nurses, behavioral health professionals, and ancillary staff. The database will be limited to physicians with full privileges and all licensed hospital employees in good standing not currently facing disciplinary issues or practice restrictions. The individual databases would then be combined and stored on a single computer system housed at the county health care agency or other mutually acceptable organization, with copies sent back to participating hospitals and the state. After a large disaster, health care workers from unaffected areas, including other states, can approach affected hospitals and volunteer their services. Practitioners listed on the database could be given privileges in their specialties for 72 hours. This process is accurate, inexpensive, efficient, sustainable, and Joint Commission on Accreditation of Healthcare Organizations compliant and permits the immediate credentialing of large numbers of medical volunteers.

Credentialing↗
PubMed2002

The medical student experience with disasters and disaster response.

Medical students from New York City were integrally involved in the response by health professionals to aid the families of victims of the September 11, 2001, attacks on the World Trade Center. The present study was performed to investigate the emotional impact of this involvement on medical students from the Mount Sinai School of Medicine in New York City. One hundred fifty-seven students responded to a mail survey that explored their personal and professional involvement in the disaster as well as their psychiatric symptoms in the week after the event and at the time of the survey (3.5 months after the event). Findings suggested a differential emotional impact on female students and on students involved in less supervised and more emotionally intense activities. However, involvement in the relief effort, per se, did not contribute to psychiatric symptomatology. It may have been associated with enhanced professional self-esteem among the students. These findings have implications for future planning of psychiatric response to disasters.

Journal Article↗
PubMed2006

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Disaster Planning↗
PubMedDate not supplied

Acute psychological impact of disaster and large-scale tauma: limitations of traditional interventions and future practice recommendations.

Nearly everyone will experience emotional and psychological distress in the immediate aftermath of a disaster or other large-scale traumatic event. Although extremely upsetting and disruptive, the reaction is understood best as a human response to inordinate adversity, which in the majority of cases remits over time without formal intervention. Nevertheless, some people experience sustained difficulties. To prevent chronic post-traumatic difficulties, mental health professionals provide early interventions soon after traumatic exposure. These interventions typically take the form of single-session debriefings, which have been applied routinely following disasters. The research bearing on these traditional forms of early crisis interventions has shown that, although well-received by victims, there is no empirical support for their continued use. However, promising evidence-based, early interventions have been developed, which are highlighted. Finally, traumatic bereavement and complicated grief in survivors of disasters, an area largely neglected in the field, is discussed.

Bereavement↗
PubMed1990

[From war psychiatry to disaster and crisis psychiatry].

Psychiatry has derived much benefit from the combat experience of military medicine. The Allies' military psychiatry during the Second World War established cardinal modes of treatment, such as group therapy, the therapeutic community, and crisis intervention. The principles of field psychiatry consist in that the treatment be administered near the scene of the injury, in an early phase, be of short duration, be focused here and now, and be characterised by prognostic optimism; moreover the victim must retain his group identity. Many of these intervention techniques are now successfully used at disaster and crises in peacetime, e.g. at the recent ferry disaster on the Scandinavian Star.

Community Psychiatry↗
PubMed1992

Anatomy of a burns disaster: the Miri Bank explosion.

A bank explosion in a neighbouring country over 1000 km away resulted in ten badly burned victims being airlifted to the Burns Centre, Singapore General Hospital (BCSGH) for treatment. The severely injured included patients with 90%, 80%, 74%, 66%, 45%, 33% and 31% burns. Nine had respiratory burns (four severe, one moderate, four mild). One patient died, thus, the mortality rate for the six most severely injured was 16.7%. This differs from predicted mortality rates of 78% according to McCoy or 54% according to Thompson, Herndon et al. The factors contributing to this result were the small size of the disaster, the use of an established Burns Mass Disaster plan and an individual management policy that incorporates carefully monitored fluid resuscitation, recognition of respiratory burns with early treatment by intubation thus pre emptying complications, early surgery and a multidisciplinary approach to complications such as infection and renal failure. The average length of stay was 43 days (range 5-122 days). The cost of the hospitalisation of the ten casualties was $312,317.00.

Adult↗