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PubMed2006

Thoracic radiology of infections emerging after natural disasters.

When natural disasters demolish shelter, destroy sources of clean drinking water, and disrupt the availability of medical care, vast numbers of people are placed at increased risk of disease. The infectious diseases that propagate under these conditions are usually common ones. Occasionally, a natural disaster alters the local environment in ways that markedly increase the prevalence of a disease that is endemic to a geographic region, occurring only as isolated cases under normal conditions. Many of these infections may affect the thorax. In this article, we discuss the radiologic findings of 4 infectious diseases, coccidioidomycosis, leptospirosis, melioidosis, and Chagas disease, which may flourish after natural disasters strike areas where they are endemic.

Chagas Disease↗
PubMedDate not supplied

Preparing for burn disasters: evaluation of a continuing education training course for pre-hospital and hospital professionals in Kansas.

"Preparing for Burn Disasters: A Training Course for Pre-Hospital and Hospital Professionals in Kansas," a continuing education program designed to provide licensed health care practitioners a training opportunity for multiple burn victim incidents, emphasized the challenges that the community-wide multidisciplinary team faces when responding to burn disasters. A pre-post survey design was used to assess changes in participants' knowledge and self-rated ability, confidence, and competence to perform in a burn disaster before and after training. Participants (N = 383) were predominantly female (71.1%), 40 years or older (57.7%), nurses (52.2%), were employed in a pre-hospital care setting (38%), and had worked in healthcare for 10 years or fewer (53.6%). The percentage of correct responses pre- vs post-test increased between 30% and 65% on two-thirds of the knowledge items. On the basis of paired-samples t-test analysis, statistically significant increases in participants' overall self-ratings of ability and confidence in burn management were observed in every content area. Most participants (64%) felt competent or highly competent to manage multiple burn casualties after the training program, and most participants (58%) indicated that they intended to incorporate the newly acquired knowledge into their daily practice within 2 weeks. Evaluation results demonstrate that a successful program was designed and implemented. The curriculum and teaching methods achieved desired goals for improved knowledge, which appear to have been translated to enhanced abilities, confidence and competence in burn assessment and treatment modalities.

Adult↗
PubMed1997

Ten criteria for evaluating the management of community disasters.

The discussion herein concerns important factors in the local management of disasters. We contrast this with the related but distinct process of disaster planning. Our assumption is that what is crucial is not management per se, but good management. Thus, to assess intelligently the management of community disasters requires an answer to the question: What is good management? The results of empirical research carried out by social scientists over the past 40 years are drawn upon in considering this question. The criteria identified entail: (1) correctly recognising differences between response and agent-generated demands; (2) adequately carrying out generic functions; (3) effectively mobilising personnel and resources; (4) generating an appropriate delegation of tasks and division of labour; (5) adequately processing information; (6) properly exercising decision-making; (7) developing overall coordination; (8) blending emergent and established organisational behaviours; (9) providing appropriate reports for the news media; and (10) having a well-functioning emergency operations centre. An issue also raised in the paper is how applicable these research findings-derived mostly from developed countries-are to the developing world.

Developing Countries↗
PubMed1998

Making women visible in disasters: problematising the private domain.

Gender awareness and sensitivity in disaster research and management remains uncommon and tends to focus on the developing rather than the developed world. This paper uses a feminist oral geography to present some findings about women's experiences in two floods in Scotland. It is conceptualised around public and private (masculinised and feminised) space, problematising the private domain and presenting it, in the feminist research tradition, as a legitimate object of research. It shows the ordinary and everyday to be more opaque and complex than usually imagined and makes recommendations for their recognition and incorporation into disaster management. While there is a specific focus on the private domain of the home, this is not intended to reinforce gender stereotypes but simply to recognise the reality of many of the women interviewed. It concludes that disaster research generally has yet to advance much beyond the earliest stages of feminist studies which merely sought to make women visible in society.

Adaptation, Psychological↗
PubMed2002

Nature's impartiality, man's inhumanity: reflections on terrorism and world crisis in a context of historical disaster.

This paper compares the terrorist outrages of 11 September 2001 in New York City and Washington to the Lisbon earthquake of 1 November 1755. Both events occurred, literally out of the blue, at critical junctures in history and both struck at the heart of large trading networks. Both affected public attitudes towards disaster as, not only did they cause unparalleled destruction, but they also represented symbolic victories of chaos over order, and of moral catastrophism over a benign view of human endeavour. The Lisbon earthquake led to a protracted debate on teleology, which has some parallels in the debate on technological values in modern society. It remains to be seen whether there will be parallels in the reconstruction and the ways in which major disasters are rationalised in the long term. But despite the differences between these two events--which are obviously very large as nearly 250 years of history separate them and they were the work of different sorts of forces--there are lessons to be learned from the comparison. One of these is that disaster can contribute to a perilous form of self absorption and cultural isolation.

Disasters↗
PubMed1997

Disaster relief work: nurses and others in bushfire territory.

This paper describes one aspect of a study into the experiences in long-term healing of a community following the 1983 Ash Wednesday bushfire. Forty participants were interviewed, of whom 26 were residents and 14 disaster relief workers. The paper concentrates on the experiences of the latter, describing how they came to understand the bushfire affected the community and how they managed disaster work. For novices it was a profoundly difficult experience, for which they received little help and had to manage with whatever skill they drew on in their 'normal' working lives, mixed with a good deal of intuition. The paper suggests that health workers in vulnerable areas require preparation for a likely disaster; that 'outsiders' need to deal through existing community groups and individuals to gain access to those in need of their skills, and that they also require preparation for helping 'insiders' who are themselves victims of the catastrophe.

Adaptation, Psychological↗
PubMed1995

Overview of the Hanshin-Awaji earthquake disaster.

A severe earthquake struck the southern part of Hyogo prefecture at 5:46 a.m., 17 January 1995. The Kobe and Hanshin district, one of the greatest industrial and commercial areas in Japan, suffered many great disasters as a consequence of this earthquake. More than 5500 deaths, disconnection of electricity, water and gas, failure of telecommunications, collapse of highways and railroads, destruction of houses, apartment buildings and official buildings and fires in high-density housing areas brought about the biggest disasters since the 1923 Tokyo quake. Many Japanese volunteers as well as foreign volunteers helped refugees after the earthquake. The actions of the refugees and their self-possessed judgement, despite great inconveniences, in helping each other and saving aged and handicapped people, surprised many Japanese and foreigners alike. The preliminary reports in this issue describe the circumstances of child health and the medical care given after the disaster by the pediatricians who played an active role in the area affected by the earthquake.

Adolescent↗
PubMed1995

Home mechanical ventilation in the aftermath of the Hanshin-Awaji earthquake disaster.

Children who were dependent upon home mechanical ventilation (HMV), suffered in various ways from the disastrous Hanshin-Awaji earthquake disaster. The earthquake abruptly cut the supplies of water, gas and electricity, causing intense anxiety for those families. Through loss of the respirator function, some of them experienced an unexpected catastrophe. In the disaster area, there were children who were dependent upon HMV (19 cases) and children who were preparing for HMV in hospitals (nine cases). Information was gathered from questionnaires about the disaster, communication and correspondence with families. None of the 28 cases died or were injured. Nineteen cases had a variety of problems. In eight cases, respiratory support problems were acute. Nevertheless, all of them survived the crisis successfully even in the midst of such a catastrophic situation. An organization of HMV children's families, called the Baku-Baku Club, helped families with HMV problems by supplying water, food, oxygen and compressed air cylinders among other things. Additional outside batteries for portable respirators are essential equipment for HMV, especially for emergencies. A manual for clarifying the system for support in the Baku-Baku Club and a registration system for public medical service should be established in preparation for such a crisis.

Child↗
PubMed2006

Community-based disaster preparedness and climate adaptation: local capacity-building in the Philippines.

Community-based disaster preparedness (CBDP) approaches are increasingly important elements of vulnerability reduction and disaster management strategies. They are associated with a policy trend that values the knowledge and capacities of local people and builds on local resources, including social capital. CBDP may be instrumental not only in formulating local coping and adaptation strategies, but also in situating them within wider development planning and debates. In theory, local people can be mobilised to resist unsustainable (vulnerability increasing) forms of development or livelihood practices and to raise local concerns more effectively with political representatives. This paper focuses on the potential of CBDP initiatives to alleviate vulnerability in the context of climate change, and their limitations. It presents evidence from the Philippines that, in the limited forms in which they are currently employed, CBDP initiatives have the potential both to empower and disempower, and warns against treating CBDP as a panacea to disaster management problems.

Community Networks↗
PubMed2003

Site management of health issues in the 2001 World Trade Center disaster.

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.

Architecture↗
PubMed1989

Disaster severity and emotional disturbance: implications for primary mental health care in developing countries.

Two months following the 1987 earthquakes in Ecuador, 150 patients in the primary health care clinics of the area were screened for emotional problems; 40% of them were emotionally distressed. Risk factors included not being married, reporting poor physical or emotional health, and having ill-defined physical complaints. The findings from this research are discussed in relation to a disaster of much greater intensity, whose victims were studied by the authors, utilizing the same instrument and research design. The comparison between these 2 groups of disaster victims revealed that: 1) the prevalence of emotional distress was smaller among the Ecuador victims, but the frequency of symptoms among the distressed was similar for both groups; 2) the symptom profiles were remarkably similar; and 3) the most frequent symptoms and the strongest predictors of emotional distress were very similar. These findings support a focused training of health care workers on selected emotional problems that are regularly present among victims of different disasters.

Adolescent↗
PubMedDate not supplied

Global climate changes, natural disasters, and travel health risks.

Whether the result of cyclical atmospheric changes, anthropogenic activities, or combinations of both, authorities now agree that the earth is warming from a variety of climatic effects, including the cascading effects of greenhouse gas emissions to support human activities. To date, most reports of the public health outcomes of global warming have been anecdotal and retrospective in design and have focused on heat stroke deaths following heat waves, drowning deaths in floods and tsunamis, and mosquito-borne infectious disease outbreaks following tropical storms and cyclones. Accurate predictions of the true public health outcomes of global climate change are confounded by several effect modifiers including human acclimatization and adaptation, the contributions of natural climatic changes, and many conflicting atmospheric models of climate change. Nevertheless, temporal relationships between environmental factors and human health outcomes have been identified and may be used as criteria to judge the causality of associations between the human health outcomes of climate changes and climate-driven natural disasters. Travel medicine physicians are obligated to educate their patients about the known public health outcomes of climate changes, about the disease and injury risk factors their patients may face from climate-spawned natural disasters, and about the best preventive measures to reduce infectious diseases and injuries following natural disasters throughout the world.

Disasters↗
PubMed2005

Refocusing disaster aid.

With new modeling techniques for estimating and pricing the risks of natural disasters, the donor community is now in a position to help the poor cope with the economic repercussions of disasters by assisting before they happen. Such assistance is possible with the advent of novel insurance instruments for transferring catastrophe risks to the global financial markets. Donor-supported risk-transfer programs not only would leverage limited disaster-aid budgets but also would free recipient countries from depending on the vagaries of postdisaster assistance. Both donors and recipients stand to gain, especially because the instruments can be closely coupled with preventive measures.

Developed Countries↗
PubMed2006

Social context and depression after a disaster: the role of income inequality.

STUDY OBJECTIVE: To examine the association between neighbourhood income inequality and depression, both overall and among those with different levels of income, in the post-disaster context. DESIGN: A representative cross sectional random digit dial telephone survey was conducted. SETTING: New York City (NYC) six months after September 11, 2001. PARTICIPANTS: 1570 respondents were interviewed, of whom 1355 provided residence information permitting their inclusion in this analysis. Past six month depression was assessed using a lay administered instrument consistent with DSM-IV criteria. Income inequality was measured with the Gini coefficient. MAIN RESULTS: The sample was demographically representative of NYC (56.2% female, 35.7% white, 6.3% Asian 24.2% African American, 29.7% Hispanic, and 4.2% other race or ethnicity) and the prevalence of past six month depression was 12.4%. In a final adjusted model, neighbourhood level income inequality was positively associated with depression but this association was not significant (beta = 7.58, p = 0.1). However, among those with low individual income (< 20,000 US dollars) there was a strong significant association between income inequality and depression (beta = 35.02, p<0.01), while there was no association among those with higher income. CONCLUSIONS: In the post-disaster context, neighbourhood level income inequality was associated with depression among persons with lower income; this group may be more socially or economically marginalized and dependent on local resources. Future research should examine potential mechanisms through which income inequality and other features of the social context may affect mental health in the post-disaster context.

Adolescent↗
PubMedDate not supplied

Short-term effect of natural disasters on coronary heart disease risk factors.

In this analysis of the data from a longitudinal study on coronary heart disease risk factors, it was found that participants screened a few weeks after a major disaster (earthquake) had a higher heart rate, serum cholesterol levels, and serum triglyceride levels than matched participants that were screened shortly before the catastrophic event. The two groups of participants did not differ with regard to their characteristics at the baseline examination carried out 5 years previously. The lack of difference in blood pressure between exposed and nonexposed participants could be explained by the lag-time between the earthquake and the blood pressure measurements. We conclude that the acute stress associated with major disasters can influence risk factors for coronary heart disease. Permanent elevation of these risk factors due to the disruption of the social environment of the individuals affected by major disasters might be responsible for the apparent long-term adverse effects on cardiovascular mortality discussed previously in the literature.

Body Weight↗
PubMed2000

The Herald of Free Enterprise disaster. Lessons from the first 6 years.

A substantial body of data has been collected on survivors of the Herald of Free Enterprise disaster over the first 6 years. These data show the psychological effects to be considerable, and although they appear to decrease over time, 6 years later there remains a substantial minority that remains highly distressed. Our research has also pointed to those factors that appear to be important in determining the severity and chronicity of symptoms. Levels of crisis support early on seem to be protective. Not everyone has access to supportive others, and these people would seem to be at increased risk of disturbance. But even if crisis support is potentially available from family and friends, not everyone is in a position to draw on these resources. Those individuals who possess negative attitudes toward emotional expression might be less likely to seek out support. Evidence would suggest that modifying such attitudes might be an important component of intervention. A further target for intervention would seem to be the causal attributions made by survivors. It was found that those who perceived the causes of events during the disaster as internal and controllable were at greatest risk of psychological disturbance. The data gathered in the wake of this disaster suggest that intervening early with respect to these three components (crisis support, attitude to emotional expression, and attributional style) is highly likely to mitigate against long-term distress.

Adaptation, Psychological↗
PubMed2005

The Bhopal disaster and its aftermath: a review.

On December 3 1984, more than 40 tons of methyl isocyanate gas leaked from a pesticide plant in Bhopal, India, immediately killing at least 3,800 people and causing significant morbidity and premature death for many thousands more. The company involved in what became the worst industrial accident in history immediately tried to dissociate itself from legal responsibility. Eventually it reached a settlement with the Indian Government through mediation of that country's Supreme Court and accepted moral responsibility. It paid $470 million in compensation, a relatively small amount of based on significant underestimations of the long-term health consequences of exposure and the number of people exposed. The disaster indicated a need for enforceable international standards for environmental safety, preventative strategies to avoid similar accidents and industrial disaster preparedness. Since the disaster, India has experienced rapid industrialization. While some positive changes in government policy and behavior of a few industries have taken place, major threats to the environment from rapid and poorly regulated industrial growth remain. Widespread environmental degradation with significant adverse human health consequences continues to occur throughout India.

Accidents, Occupational↗
PubMed2001

The World Trade Center attack. Lessons for disaster management.

As the largest, and one of the most eclectic, urban center in the United States, New York City felt the need to develop an Office of Emergency Management to coordinate communications and direct resources in the event of a mass disaster. Practice drills were then carried out to assess and improve disaster preparedness. The day of 11 September 2001 began with the unimaginable. As events unfolded, previous plans based on drills were found not to address the unique issues faced and new plans rapidly evolved out of necessity. Heroic actions were commonplace. Much can be learned from the events of 11 September 2001. Natural and unnatural disasters will happen again, so it is critical that these lessons be learned. Proper preparation will undoubtedly save lives and resources.

Aircraft↗