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PubMedDate not supplied

Terrorism, disasters, and security.

The purpose of this editorial is to explore the relationship between the new global emphasis on terrorism and the developing academic and practical fields of disaster management. It includes an appraisal of the place of terrorism among the various forms of disaster, a consideration of its relationship to risk assessment and its place in the practical handling of risks and incidents, and some reflections on the role of the private sector in security management. The influence on the current attitude toward managing the terrorism threat by the evolution of the disaster management field is considered and some of the problems with defining scenarios for counter-terrorism planning also are discussed.

Disaster Planning↗
PubMedDate not supplied

Planning for resilience in hospital internal disaster.

This article seeks to clarify the terminology and methods of planning to avert hospital internal disaster. It differentiates "crisis" from "disaster" in the in-hospital setting. Preparedness, as contrasted with mitigation, is meant to reduce the likelihood that a crisis will turn into a disaster. Though there are some recurring features of crises, allowing for preparedness through the identification of a few high-likelihood contingencies, crises are subject to numerous, overwhelming uncertainties. These include hazard uncertainty, incident uncertainty, sequential uncertainty, informational uncertainty, consequential uncertainty, cascade uncertainty, organizational uncertainty, and background uncertainty. In view of the uncertainties, the primary aim of planners should not be to try to create plans for ever more contingencies, since contingencies are far too numerous and perhaps approach infinity, but rather to create capabilities (through proper preparedness) for resilience during crisis. Resilience can be cultivated through improvements in information acquisition and dissemination, communication systems, resource management, mobility management, design for resilience, incident command, and staff versatility.

Communication↗
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↗
PubMedDate not supplied

Efficacy of critical incident monitoring for evaluating disaster medical readiness and response during the Sydney 2000 Olympic Games.

INTRODUCTION: Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI. OBJECTIVE: To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents. METHODS: Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings. RESULTS: A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communication-related issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Pre-deployment planning was the most important factor for future incident impact minimization. CONCLUSIONS: Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.

Anniversaries and Special Events↗
PubMedDate not supplied

Panel 2.12: the health sector contribution to disaster reduction.

This is a summary of the presentations and discussion of Panel 2.12, The Health Sector Contribution to Disaster Reduction, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related the health sector's contribution to disaster reduction as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) issues; (2) lessons learned; and (3) recommendations.

Disasters↗
PubMedDate not supplied

Y2K medical disaster preparedness in New York City: confidence of emergency department directors in their ability to respond.

OBJECTIVES: To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model. METHODS: Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness. RESULTS: The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management. CONCLUSIONS: Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

Attitude of Health Personnel↗
PubMedDate not supplied

Principles of disaster management lesson. 12: structuring organizations.

This lesson discusses various structures for organizations that have functional roles in disaster responses, relief, and/or management activities. It distinguishes between pyramidal and matrix structures, and notes the advantages and disadvantages of each in relation to disasters. Span of control issues are dissected including the impact of the "P" factor on the performance of disaster managers and workers including its relationship to the coordination and control function. The development of a Table of Organization and how it relates to departmentalization within an organization also is provided.

Decision Making, Organizational↗
PubMedDate not supplied

Principles of disaster management. Lesson 14. Criteria for assessing a program.

This lesson examines mechanisms that can be used for the evaluation of a program or project. The principal concern raised is whether the project has met its stated goals and objectives and whether the project has resulted in producing benefits to the affected society. Short-term (immediate) and long-term (developmental) contributions are discussed. The importance of projects contributing to increasing the absorbing capacity of the affected community for the next event is stressed. Twelve problems commonly encountered in program execution are defined. Optimal management attempts to identify potential pitfalls in advance, designing and implementing mechanisms to avoid them, and to deal with them if they should become manifest. Simply meeting the goals and objectives of the sponsoring organization is inadequate, as all responses must be coordinated and approved by the national coordinating agency. Thus, not only is the effectiveness of the project in meeting the defined goals and objectives important, but the project must be assessed in terms of the overall impact of the project on the society. Reference is made to using the structure provided by the Health Disaster Management: Guidelines for Evaluation and Research in the Utstein Style as promulgated by the Task Force on Quality Control of the World Association for Disaster and Emergency Medicine and the Nordic Society of Disaster Medicine.

Disaster Planning↗
PubMed1997

Stress reactions in disaster victims following the Bijlmermeer plane crash.

This article examined posttraumatic stress symptoms in a sample of disaster victims following the Bijlmermeer plane crash of October, 1992, in the Netherlands. Findings indicated that six months after the disaster 26% of the respondents were suffering from posttraumatic stress disorder (PTSD). The victims' PTSD was strongly associated with material damage and loss. The discussion of the results focuses on the distinction between normal and pathological stress reactions and the implications for disaster after-care.

Accidents, Aviation↗
PubMed2004

Decision-making capacity and disaster research.

The extent to which victims of a disaster are able to make capacitated and voluntary decisions to enroll in research is an important and virtually unexplored question. Although there are no compelling data to suggest that experiencing a severe trauma, in and of itself, renders all or even most individuals incapable of making autonomous decisions, the assessment of decision-making capacity (DMC) for research participation warrants serious consideration. This paper provides a framework for and procedural approach to the assessment of DMC in research with individuals exposed to disaster. Particular attention is paid to the implementation of additional safeguards to protect subjects who are vulnerable by virtue of impaired DMC. Recommendations are offered to clinical investigators, ethical review boards, and policymakers with regard to the design, review, and conduct of research in the aftermath of disaster.

Decision Making↗
PubMed2003

Establishment of a disaster-related psychological screening test.

OBJECTIVE: To create a short screening scale for the detection of posttraumatic stress disorder (PTSD) and major depressive disorder (MDE) in earthquake survivors in Taiwan. METHOD: Trained research assistants used the Disaster-Related Psychological Screening Test (DRPST) to assess 461 residents of a village that had experienced a major earthquake. The participants were also evaluated by psychiatrists using the Mini-International Neuro-psychiatric Interview (MINI). Best subset regression analysis and the receiver operating characteristics curve were used to select a subset of items and cut-off points from the DRPST. RESULTS: A seven-symptom scale and a three-symptom analogue were selected for PTSD and MDE screening, respectively. Scores of three or more on the PTSD scale and two or more on the MDE scale were used to define a group of positive cases that provide useful information for the patient cohort and will be valuable in long-term follow-up studies of the prevalence of psychiatric diseases following a natural disaster. However, higher scores could also be used to define positive cases under limited psychiatric care resources. CONCLUSION: The DRPST, which was administered for phase 1 of this two-phase study, may be used for effective and rapid screening for PTSD and MDE after an earthquake, despite the usual limitations on resources following a disaster.

Adolescent↗
PubMed2001

Disaster management in Australia: the national emergency management system.

Australia has a well-established emergency management system to manage the threats to communities from natural and technological hazards. The key elements of the system are described with particular emphasis on the impact of disasters on Australia, fundamental concepts, and principles of planning. Emergency physicians have a key role in the development of emergency plans and in the overall health response to disasters. They can enhance their understanding of local, State and national arrangements by participating in exercises and appropriate disaster medicine and emergency management courses.

Australia↗
PubMed2001

Intervention of the Renal Disaster Relief Task Force in the 1999 Marmara, Turkey earthquake.

BACKGROUND: Major earthquakes are followed by a substantial number of crush syndromes and pigment-induced acute renal failures (ARFs). The natural evolution of this problem rapidly leads to death. Today's possibilities of dialysis therapy enable saving numerous lives that otherwise would be lost. Currently, the primary problem is organizational, if huge catastrophes occur and complex therapeutic options need to be offered to a large number of victims. METHODS: Following the 1988 Spitak earthquake in Armenia, the International Society of Nephrology (ISN) established the Renal Disaster Relief Task Force (RDRTF) in order to anticipate organizational problems related to renal care in the aftermath of large natural and human-made catastrophes. The proposed concept was one of a dialysis advance team, which would assess the needs and possibilities of dialysis treatment, to be followed by supportive manpower and supplies. This article describes the organizational aspects of a rescue action that was undertaken following the Marmara earthquake, which occurred on August 17th, 1999, in northwestern Turkey. In conjunction with Médecins Sans Frontières, a team landed at Istanbul Airport less than 22 hours after the disaster, and logistic and material support as well as manpower were provided over a period of approximately one month. Specific attention was paid to the choice of the renal replacement therapy, the transport of victims and materials, the implementation of preventive rehydration, and the problem of chronic renal failure patients dialyzed in the damaged area. CONCLUSIONS: We demonstrate how previously anticipated international support may offer moral, financial, as well as logistical help to local nephrological communities confronted with serious disasters.

Acute Kidney Injury↗
PubMed2003

The organization and interventions of the ISN Renal Disaster Relief Task Force.

This article describes first the organization of the ISN Renal Disaster Relief Task Force-European branch founded by the ISN Commission on ARF. The task force aims at rapid dialysis intervention in case of acute disasters associated with a high number of ARF cases caused by crush syndrome. The organization involves European volunteers consisting of nephrologists, dialysis nurses, and technicians willing to go to disaster areas as far as India, the Middle East, and North Africa to assist the local nephrologic communities. In addition, an important role in the organization is played by Médecins sans Frontiières, the industry, and several nurses' and technicians' associations. The major intervention of the task force was at the occasion of the Marmara earthquake in Turkey in 1999. Additional more recent and minor interventions occurred in India and Algeria.

Advisory Committees↗
PubMed2006

[Persistent dissociation as predictor of posttraumatic stress disorder in psychosocial disaster workers].

BACKGROUND: The author prospectively examined the power of persistent dissociation in predicting acute and chronic posttraumatic stress disorder symptoms (PTSD) in psychologists, psychotherapists, crisis intervention teams and clergymen after a disaster. METHODS: 135 psychosocial disaster workers were assessed (6 weeks and 6 months after the catastrophe) with the Acute Stress Disorder Scale (ASDS), the Posttraumatic Stress Diagnostic Scale (PDS) and the German short version of the Dissociative Experience Scale (FDS-20). Correlational analysis and a hierarchical multiple regression analysis were conducted. RESULTS: Persistent dissociation and acute stress symptoms were correlated with later acute and chronic PTSD diagnosis. Together, persistent dissociation und acute stress symptoms accounted for 74 % (m)/36 % (w) of the acute and 58 % (m)/44 % (w) of the variance in PTSD symptoms. CONCLUSIONS: The results support that persistent dissociation is a main predictor of acute and chronic posttraumatic stress symptoms in disaster workers.

Adult↗
PubMed1975

Planning for a pediatric disaster -- experience gained from caring for 1600 Vietnamese orphans.

The sudden arrival of 1600 Vietnamese orphans in San Francisco required the rapid development of a co-ordinated disaster plan, including the overnight establishment of a 1000-bed pediatric field hospital. The plan required rapid identification and involvement of lay and governmental resources, acute medical triage and provision of ongoing medical care and basic nurturing services and eventual discharge to adoptive families. Because one third of the orphans were under six months of age, conventional nursery resources were insufficient, and a "warehouse" model was implemented. This process required development of a specialized transportation and communication system, the services of 800 physicians, 1400 nurses, and 3200 volunteers and 162 back-up acute hospital beds. Disaster planning in most sizable American cities has focused on the problems of adults. Because of the unusual problem presented by infants and small children, we recommend that cities carefully evaluate their disaster planning with special reference to the needs of children.

Adoption↗
PubMed2001

Hydroxocobalamin: improved public health readiness for cyanide disasters.

The United States is under the constant threat of a mass casualty cyanide disaster from industrial accidents, hazardous material transportation incidents, and deliberate terrorist attacks. The current readiness for cyanide disaster by the emergency medical system in the United States is abysmal. We, as a nation, are simply not prepared for a significant cyanide-related event. The standard of care for cyanide intoxication is the cyanide antidote kit, which is based on the use of nitrites to induce methemoglobinemia. This kit is both expensive and ill suited for out-of-hospital use. It also has its own inherent toxicity that prevents rapid administration. Furthermore, our hospitals frequently fail to stock this life-saving antidote or decline to stock more than one. Hydroxocobalamin is well recognized as an efficacious, safe, and easily administered cyanide antidote. Because of its extremely low adverse effect profile, it is ideal for out-of-hospital use in suspected cyanide intoxication. To effectively prepare for a cyanide disaster, the United States must investigate, adopt, manufacture, and stockpile hydroxocobalamin to prevent needless morbidity and mortality.

Accidents, Occupational↗
PubMed2003

Holding civic medicine accountable: will Morreim's liability scheme work in a disaster?

In Holding Health Care Accountable, E. Haavi Morreim differentiates between duties of expertise and resource duties, arguing for tort liability respecting the former and contract liability respecting the latter. Though Morreim's book addresses ordinary clinical medicine, her liability scheme may also be relevant elsewhere. Focusing on disaster medicine, and especially the medical management of violent mass disasters (e.g., where terrorists have deployed weapons of mass destruction), I argue in this essay that Morreim's classification of duties still fits, but that it is difficult to hold government powers accountable for their many resource and expertise duties. This difficulty is compounded by political arrangements that foist under-funded mandates for disaster services on healthcare providers. As a result of such arrangements, hospitals and clinicians are prone to liability for expenditures and clinical interventions that are beyond their scope. This problem can be mitigated, I argue, by examining and clarifying the apparent social compact between society and healthcare.

Bioterrorism↗