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PubMed2000

[The mental health of school children after the Great Hanshin-Awaji Earthquake: I. Epidemiological study and risk factors for mental distress].

UNLABELLED: We conducted surveys to study the magnitude and nature of psychological consequences of school children affected by the Great Hanshin Awaji Earthquake, which occurred in Kobe on January 17th, 1995. It measured 7.2 in magnitude, killed more than 6000 people and destroyed at least 170,000 buildings and houses. The investigations were carried out 4 months following of the disaster. SUBJECTS: About 9000 school children in the 3rd grade, the 5th grade, the 8th grade living in the disaster areas. About 2000 children living in distant areas were also surveyed as control subjects. METHOD: The questionnaire was in a self-descriptive format and consisted of 10 items regarding situation and behavior when the earthquake occurred and 22 items about mental health condition. The responses were rated from 1 to 4 depending on the frequency of the symptoms, and statistically analyzed. RESULT: By factor analysis, three factors were elicited. Factor 1 was interpreted as being related to fear and anxiety, factor 2 as related to depression and physical symptoms, and factor 3 as related to pro-social tendencies. The highest mean score of factor 1 was associated with the most heavily damaged areas. Less severe damage was associated with a lower mean score, and the control areas showed the lowest score. These results show that the children in the damaged areas were strongly affected. Factor 2 shows a different pattern from factor 1. The score of heavily damaged areas is conspicuously high. However, the differences between the other areas were not significant, the control areas had scores almost the same as these of the slightly damaged areas. These results may mean that in less damaged areas than in more heavily damaged areas, there was a more remarkable "heroic phase" after the disaster, which hid depressive moods and lasted longer than in the more severely damaged areas, where people had to face stern reality in the early stages. Factor 3 shows the reverse pattern of factor 2. The slightly damaged areas had the highest score. This result also shows the influence of the "heroic stage". As for the mean scores of factors 1 and 2, younger children showed higher scores. There were no differences in the scores of factor 3 between students in the 3rd grade and 5th grade. The score of the students in the 8th grade was the lowest among all. It can be seen that adolescents generally lessen their consideration for society as a developmental stage in their growth. All of the mean scores of factors 1, 2 and 3 of females are higher than those of males. In the heavily damaged areas, factor 1 is associated with an experience of being rescued and injuries of the children themselves. Factor 2 is associated with injuries of the children themselves. In the moderately damaged areas, factors 1 and 2 are associated with injuries of the children themselves and taking in victims in the children's homes. In the slightly damaged areas, factor 1 is associated with injuries within families. Factor 2 is associated with injuries within families and taking in victims in the childrens' homes. CONCLUSIONS: School-aged children exposed to a high-magnitude natural disaster had 3 categories of emotions: "fear and anxiety," "depressive mood and physical symptoms" and "pro-social tendency." The severity of disaster, younger age, and female gender were high risk factors for distress. In the heavily damaged areas, an experience of being rescued and injuries of the children themselves had a great influence on the mental health of children. In lesser damaged areas, taking in victims in the childrens' homes and injuries within families had an influence.

Adolescent↗
PubMed2001

The World Trade Center attack. Similarities to the 1988 earthquake in Armenia: time to teach the public life-supporting first aid?

On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation equipment. This article makes the case for teaching life-supporting first aid to the public in the hope that one day, should another such incident occur, they would be able to preserve injured victims until formal rescue occurs.

Aircraft↗
PubMed2002

A method of transporting critical care mass casualties.

The use of a self-contained transport platform can aid in the efforts to care for mass casualty victims. The platform is equipped with critical care equipment and has the capabilities of documenting care electronically. It has been used in a number of different settings and has allowed health care personnel to provide more efficient, individualized care to a larger number of victims.

Beds↗
PubMedDate not supplied

A cognitive developmental approach to understanding how children cope with disasters.

TOPIC: This paper applies cognitive developmental theory to explain how preschoolers, school-age children, and adolescents process and respond to disasters. PURPOSE: To help clinicians understand the disaster experience from a child's point of view, recognize age-specific reactions, identify symptoms that may signal coping difficulties, and plan effective interventions. SOURCES: Case examples from the author's work with flood victims illustrate typical reactions for children (preschool to adolescents) within a family context, along with developmentally appropriate interventions. CONCLUSIONS: Children affected by disasters need nursing interventions geared toward their particular developmental level and sensitive to their perception of the disaster.

Adaptation, Psychological↗
PubMed2005

[Disaster medical response concerns us all].

The flood disaster in the region of the Oder and Elbe Rivers or the disaster in Eschede, Kaprun, or Ramstein make us aware that disasters not only occur in distant regions of the world but also in our latitudes. They do not follow any rules; no one can predict the location, time, or type of a disaster. However, this lack of concrete predictability should not lead to our being unprepared to respond to catastrophic events. Detailed examination and analysis of medical and organizational activities involved in past disasters reveal that these types of incidents always entail similar medical and logistic consequences. Dealing with disasters necessitates cooperation between numerous organizations and people. This requires clearly structured facilities for information, communication, and decision making as well as a well-defined process flow. In addition to basic planning and practicing of these processes for medical management of catastrophes-such as searching for and rescuing victims, triage, performing life-saving emergency procedures, definitive medical treatment, and transfer of patients-establishing structures for disaster preparedness is indispensable to meet the demands of mass cases of ill or wounded individuals.

Critical Care↗
PubMed1997

[Avalanche emergency. New aspects of the pathophysiology and therapy of buried avalanche victims].

A series of investigations on the pathophysiology and management of persons buried in an avalanche has been undertaken over the past few years in response to increased awareness of the importance of emergency medical treatment of avalanche victims and the fact that the high mortality rate has not decreased in spite of the improvement in rescue techniques. This paper is the very first review of the problems encountered in avalanche disasters. The developments over the past 20 years, in particular, are summarized and discussed. Furthermore, current opinions and recommendations on optimal rescue procedure, as well as the prevention of such emergencies are presented. Precise assessment of the survival probability after burial under an avalanche and recognition of the prognostic importance of an air pocket, but only limited role of hypothermia, provide the basis for new concepts governing therapy and triage by the emergency doctor. Resulting guidelines have been endorsed by the Emergency Medicine Subdivision of the International Commission of the Alpine Rescue Services (ICAR) and these recommendations are intended for implementation by organised rescue teams in order to reduce secondary deaths following successful extrication of victims from the avalanche masses. However, the chance of being rescued alive depends primarily on the rapidity of extrication, i.e. how quickly the rescue teams are alerted and transported to the disaster area in the first instance, then how quickly the victims are located and extricated. In order to reduce the mortality additional preventive measures must be introduced to avoid complete burial if possible, or appreciably hasten the rescue procedure. The very steep drop ("fatal kink") in survival probability as from 15 minutes after burial underlines the absolute necessity of the mastery of efficient rescue procedure by uninjured companions. Improvement of the technical developments for the avoidance of total burial (avalanche air bag) and optimization of the electronic location (transceiver) of buried skiers by uninjured companions are essential future requirements. Nonetheless, primary prevention remains of paramount importance in governing decision making by offpiste skiers. Correct assessment of the inherent risks according to the prevailing circumstances and strict adherence to safety rules take precedence over all other considerations.

Asphyxia↗
PubMedDate not supplied

Realities of rural emergency medical services disaster preparedness.

INTRODUCTION: Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. PROBLEM: This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness? METHODS: Data were gathered through a multi-region survey of 1801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities. RESULTS: A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention. CONCLUSION: Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

Disaster Planning↗
PubMed1988

Tangential excision of scalp burns: experience from the Bradford fire disaster.

Tangential excision of deep dermal scalp burns does not appear to be widely practised. During the Bradford Football fire victims sustained mixed depth scalp burns. These were mainly as a result of radiant heat, although falling molten bitumen was the cause of injury in a few patients. Deep dermal or full thickness burns of the scalp were tangentially excised and skin grafted. One patient did not have a graft applied after tangential excision. The early results of graft take were satisfactory. Subsequently, however, 56 per cent required further grafting; the reasons for this are discussed. Ten months after the incident there is no difference in appearance between areas of primary grafting and areas of secondary healing.

Adult↗
PubMed1985

The 1980 earthquake in Southern Italy--morbidity and mortality.

The effects on health of the 1980 earthquake in southern Italy were surveyed retrospectively. The sample population includes 3619 people living in seven villages situated near the epicentre. Deaths were one hundred times and injury rates more than five times higher in trapped than in non-trapped victims. The possibility for escape was crucial for survival and depended on the type of building. Most of the rescue and relief work was carried out within a few days by unprepared local people who concentrated assistance on people sharing the same dwelling. The results suggest that the emergency phase for medical care was limited to the three to four days after impact. During the 18 months following the quake, mortality rates in injured (13.7%) and non-injured victims (15.8%) were similar. These results point to the need to establish, in each disaster prone area, a health evaluation system on which effective disaster relief and especially the preparedness of the community can be based.

Disaster Planning↗
PubMed2001

Vicarious stress: patterns of disturbance and use of mental health services by those indirectly affected by the Oklahoma City bombing.

This study explored the intermediate psychological effects of terrorism on adults not directly affected by the Oklahoma City bombing by examining the course of PTSD and subthreshold PTSD symptoms over time and whether treatment affected this course. The respondents were interviewed at 3-mo. intervals for 18 mo. following an initial 6-mo. survey. Analysis suggested avoidance, re-experiencing, and increased arousal symptoms in this population were limited over time, declining with or without treatment between 6 and 9 mo. Conversely, victimization symptoms remained high without mental health intervention for the first year after the disaster. The study also examined the nature and occurrence of comorbidity in groups seeking and not seeking treatment.

Adult↗
PubMedDate not supplied

Care provided by VA mobile clinic staff during Northridge earthquake relief.

INTRODUCTION: From 25 January 1994 to 02 February 1994, staff aboard four Veterans Affairs Mobile Clinics treated Northridge earthquake victims. This study examined the types of conditions treated by Clinic staff during the disaster. METHODS: A descriptive case series using 1,123 ambulatory encounter forms was undertaken. Case-mix was assessed by classifying diagnoses into 120 possible diagnostic clusters. RESULTS: Forty-five percent of patients were infants or children and 60% were female. The primary diagnoses were characterized by acute conditions: 1) upper respiratory infection (34.6%); 2) stress reactions (11.9%); 3) otitis media (10.1%); and injuries (8%). Two-thirds of the infants and children either had an upper respiratory infection (46.4%) or otitis media (20.1%). Increasing age indicated an increased likelihood of stress and anxiety reactions. CONCLUSIONS: The results provide additional information for agencies involved in planning for and responding to disasters. Based on the types of conditions diagnosed at the VA mobile clinics (i.e., a high prevalence of acute conditions, including stress and anxiety reactions, and the large numbers of children), staff trained in primary care, mental health, and pediatrics should be considered for relief missions that begin several days after an event resulting in a disaster.

Adolescent↗
PubMed1998

Victims of war. Surgical principles must not be forgotten (again)!

Severe injuries to the limbs are common in wars and natural disasters, and most of them occur in developing countries with weak health-care systems. The International Committee of the Red Cross (ICRC) has gained a vast amount of experience in treating the war-wounded in this context. Basic principles for wound management, safe and simple methods for fracture-holding and amputation techniques adapted to missile and explosive injuries have proven successful. More than 81,000 amputees have been fitted with artificial limbs in ICRC workshops since 1979, but the needs are far greater. In an attempt to limit the effects of war, the ICRC promotes compliance with international humanitarian law, supports preventive activities such as the campaign to ban anti-personnel landmines, and strives to raise awareness of the implications of fast-developing weapon technologies.

Amputation, Traumatic↗
PubMed1991

The St Croix disaster and the National Disaster Medical System.

The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Disaster Planning↗
PubMed2005

Clinical review: SARS - lessons in disaster management.

Disaster management plans have traditionally been required to manage major traumatic events that create a large number of victims. Infectious diseases, whether they be natural (e.g. SARS [severe acute respiratory syndrome] and influenza) or the result of bioterrorism, have the potential to create a large influx of critically ill into our already strained hospital systems. With proper planning, hospitals, health care workers and our health care systems can be better prepared to deal with such an eventuality. This review explores the Toronto critical care experience of coping in the SARS outbreak disaster. Our health care system and, in particular, our critical care system were unprepared for this event, and as a result the impact that SARS had was worse than it could have been. Nonetheless, we were able to organize a response rapidly during the outbreak. By describing our successes and failures, we hope to help others to learn and avoid the problems we encountered as they develop their own disaster management plans in anticipation of similar future situations.

Communicable Disease Control↗