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If you are first on the scene of a disaster, approach safely and liaise with police and ambulance officers. Carry out triage, identifying those victims who need urgent treatment and those who do not--because they are not ill enough, too ill or dead. Establish priorities of treatment within the urgent group in the airway (A), breathing (B), circulation (C) sequence. Record assessment and treatment given.
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.
A Singapore airline crash in 2000 was the first documented mass casualty incident (MCI) caused by an aircraft disaster in Taiwan. This report reviews the emergency medical preparedness of the airport and examines its effects on the medical response during this incident. The anticipated benefits from the new MCI plan and prior medical preparedness were not achieved during this disaster. Poor compliance with the new MCI plan by the airport authority was noted. Victims were not triaged and did not receive adequate field medical care. Structural problems with the MCI plan were also noted. Site medical teams responding from hospitals could not function as the plan had been designed. This article discusses factors causing the poor compliance, various problems, and related issues in medical response to the incident. As learned from this experience, a properly and practically designed MCI plan, good compliance of responders, and a strong support system of responding agencies are the most important factors for successful emergency response to any MCI.
In Gothenburg tram injuries were identified to be an important cause of traffic injuries and fatalities (48%) among pedestrians. During the summer middle-aged men, often under the influence of alcohol, were often severely injured and the injury rate was also high during the autumn. A majority (60%) of those fatally injured were under the influence of alcohol. Most injury events happened at or near a tram stop. The most serious injuries arose when the victim landed under a tram. In 1992, a runaway tram caused a major disaster, killing 10 pedestrians and injuring 30. The injury reducing measures the tram company has now started to introduce include safety railings at tram stops, side barriers on the tramcars to prevent people from falling under the tram and lower speeds near tram stops.
The terrorist destruction of the World Trade Center led to the greatest loss of life from a criminal incident in the history of the United States. There were 2,801 persons killed or missing at the disaster site, including 147 dead on two hijacked aircraft. Hundreds of buildings sustained direct damage or contamination. Forty different agencies responded with command and control exercised by an incident command system as well as an emergency operations center. Dozens of hazards complicated relief and recovery efforts. Five victims were rescued from the rubble. Up to 1,000 personnel worked daily at the World Trade Center disaster site. These workers collectively made an average of 270 daily presentations to health care providers in the first month post-disaster. Of presentations for clinical symptoms, leading clinical diagnoses were ocular injuries, headaches, and lung injuries. Mechanical injury accounted for 39% of clinical presentations and appeared preventable by personal protective equipment. Limitations emerged in the site application of emergency triage and clinical care. Notable assets in the site management of health issues include action plans from the incident command system, geographic information system products, wireless application technology, technical consensus among health and safety authorities, and workers' respite care.
A hotel fire in Copenhagen claimed 35 victims of eight different nationalities. An account is given of some major aspects of the dental identification work, including a few case reports. This disaster became professionally important because the dental expert team was allowed a completely free hand. Eight dental experts cooperated closely in recording, photographing and radiographing dental conditions in the victims and thereby became able to establish that, with adequate facilities at hand, complete dental registration of a single victim required an average of three man-hours. Three of the experts subsequently cooperated in establishing comparable antemortem data on the known missing persons, in comparing the ante- and postmortem data sets, and in completing the necessary paper work. Here, it could be shown that a further two man-hours were required per victim. In a final report to the police it was proposed that---in any future case---such number of dentists should be assigned which, allowing three man-hours per victim, would enable the dental team to finish the oral autopsy of the given number of victims within five full working days, i.e. a minimum of two dentists per 30 victims. Two dentists will accomplish complete recording in less than half the time it will take any dentist working single-handed to finish it, so that the question of cost can hardly become an obstacle. It remains for the profession to make sure that an adequate number of knowledgeable dental experts are always available.
INTRODUCTION: In large disasters, such as earthquakes and hurricanes, rapid, adequate, and documented medical care and distribution of patients are essential. METHODS: After a major (magnitude 6.7 Richter scale) earthquake occurred in Southern California, nine disaster medical assistance teams and two Veterans Administration (VA) buses with VA personnel responded to staff four medical stations, 19 disaster-assistance centers, and two mobile vans. All were under the supervision of the medical support unit (MSU) and its supervising officer. This article describes the patient-data collection system used. All facilities used the same patient-encounter forms, log sheets, and medical treatment forms. Copies of these records accompanied the patients during every transfer. Centers for Disease Control and Prevention data classifications were used routinely. The MSU collected these forms twice each day so that all facilities had access to updated patient flow information. RESULTS: Through the use of these methods, more than 11,000 victims were treated, transferred, and their cases tracked during a 12-day period. CONCLUSIONS: Use of this system by all federal responders to a major disaster area led to organized care for a large number of victims. Factors enhancing this care were the simplicity of the forms, the use of the forms by all federal responders, a central data collection point, and accessibility of the data at a known site available to all agencies every 12 hours.
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The identification of cadavers of unknown persons is important from a humanitarian point of view but also for legal reasons and in connection with insurance. Various identification techniques are available today, such as fingerprinting, DNA profiling and the comparison of dental structures. Not all methods of identification are equally useful in practice and the ultimate identification is often made possible only by a combination of several techniques. Sometimes, the identification procedure cannot be completed successfully because one has no idea whatsoever who it might be and there is therefore no material available for comparison. In the Netherlands, identification is in principle a task of the police. In case of a mass disaster in the Netherlands, or abroad when Dutch citizens are involved, a special Disaster Identification Team is activated, consisting mainly of police officers supplemented by external experts. Major disasters in which such a team has been involved in the past are the air crash in Faro (Portugal) in 1992 (56 victims), the air crash in Eindhoven in 1996 (32 victims) and the explosion of the fireworks plant in Enschede in 2000 (21 victims).
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This study aims to observe longitudinal change of quality of life (QOL) and psychological well-being in a community sample affected by an earthquake and to examine the relationship between QOL and disaster exposure, post-disaster support and other related variables. The subjects, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and three subscales of a symptoms checklist at 3 months (n=335) and 9 months (n=253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post-disaster help reported poorer QOL and psychological well-being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post-disaster well-being from 3 months to 9 months. The results confirm that post-disaster variables could be as important to post-disaster psychosocial outcomes as variables of pre-disaster vulnerability and disaster per se. A comprehensive and prospective assessment of disaster effects is imperative for the better organization of disaster relief programs and psychosocial interventions.
On December 14, 1985, the Teller chairlift at the Keystone, Colorado, ski area collapsed, throwing 60 of the 372 people aboard to the ground from heights up to 50 feet. Initial triage and management of the victims was carried out by the local ski patrol, the on-duty physician at the area's Snake River Health Services Clinic, and by volunteer physicians and nurses present at the scene. Thirty-three people required immediate evacuation to hospitals, most of them being transported 75 miles by helicopter air ambulance to level I and II trauma centers in the Denver metropolitan area. Eighteen of these air-evacuated patients were in serious or critical condition. Less seriously injured victims were treated at local medical facilities. The scene evacuation was carried out by helicopter and ground vehicles in accordance with an existing disaster plan coordinated by the Colorado Trauma Institute (CTI). The unique problems posed by a mass casualty incident in a remote mountain location are emphasized by this tragedy. Patient salvage due to the efficacy of a regionally organized trauma system is clearly demonstrated.
Projective stories were used to assess the defense mechanisms of 27 preadolescent boys who were victims of a lightning strike in which one boy died. Denial, projection, and identification, in combination, were found to be inversely related to clinical upset, as was the age and sex-appropriate individual defense of projection. In addition, low-defensive boys' self-reports of fears agreed more often with their parents' reports of sleep and somatic disturbances than did high-defensive boys' self-reports. The findings provide support for the validity of the Defense Mechanism Manual (Cramer, 1982) and raise the issue of defense mechanisms as moderator variables in self-report questionnaires.
The 1994 Northridge, California earthquake has proven to be one of the most costly disasters in United States history. Federal and state assistance programmes received some 681,000 applications from victims for various forms of relief. In spite of the flow of US$11 billion in federal assistance into Los Angeles and Ventura counties, many victims have failed to obtain adequate relief. These unmet needs relate to the vulnerability of particular class and ethnic groups. In response to unmet needs, a number of non-governmental organisations (NGOs) have become involved in the recovery process. This paper, based on evidence collected from hundreds of in-depth interviews with the people involved, examines the activities of several community-based organisations (CBOs) and other NGOs as they have attempted to assist vulnerable people with unmet post-disaster needs. We discuss two small ethnically diverse communities in Ventura County, on the periphery of the Los Angeles metropolitan region. The earthquake and resultant disaster declaration provided an opportunity for local government and NGOs to acquire federal resources not normally available for economic development. At the same time the earthquake created political openings in which longer-term issues of community development could be addressed by various local stakeholders. A key issue in recovery has been the availability of affordable housing for those on low incomes, particularly Latinos, the elderly and farm workers. We discuss the successes and limitations of CBOs and NGOs as mechanisms for dealing with vulnerable populations, unmet needs and recovery issues in the two communities.