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PubMed2005

The long-distance tertiary air transfer and care of tsunami victims: injury pattern and microbiological and psychological aspects.

OBJECTIVE: On December 26, 2004, a giant earthquake shocked Southeast Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. More than 310,000 people have been reported dead and millions left destitute. Shortly thereafter, European governments organized airborne home transfer of most severely injured tourists using MedEvac aircraft. On arrival, patients were distributed to various medical centers. One cohort of the severely injured was admitted to the Cologne-Merheim Medical Center (Germany) for further surgical and intensive care treatment. The objective of this report was to characterize typical injury patterns along with microbiological findings and psychoemotional aspects unique to the tsunami disaster. DESIGN: Observational study. SETTING: Adult intensive care unit of a university hospital. PATIENTS: Seventeen severely injured tsunami victims were screened on arrival for characteristic injury patterns. In parallel, multifocal microbiological assessment was performed to identify pathogens responsible for high-level wound contamination. INTERVENTIONS: Standard clinical management. MEASUREMENTS AND MAIN RESULTS: The predominant pattern of injury comprised multiple large-scale soft-tissue wounds (range, 2 x 3 to 60 x 60 cm) of lower extremities (88%), upper extremities (29%), and head (18%). Additional injuries included thoracic trauma with hemopneumothorax and serial rib fractures (41%) and peripheral bone fractures (47%). A major problem associated with wound management was significant contamination. Microbiological assessment identified a variety of common (Pseudomonas 54%, Enterobacteriae 36%, Aeromonas spp. 27%) but also uncommon isolates that were often multiply resistant (multiply resistant Acinetobacter and extended-spectrum beta-lactamase-positive Escherichia coli, 18% each). Upper respiratory tract specimens contained a high rate of multiply resistant Acinetobacter species but also methicillin-resistant Staphylococcus aureus, Aeromonas hydrophilia, Pseudomonas species, and Candida albicans. Apart from these findings, all patients displayed severe signs of posttraumatic stress response. CONCLUSIONS: Individuals who survived their initial injuries and who were evacuated to Europe had traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria.

Adult↗
PubMed1992

Acute renal failure in the Armenian earthquake.

A destructive earthquake devastated northwestern Armenia on December 7, 1988. The size of the affected area (radius of 50 miles), the time of the day when it occurred (11:41 a.m.), deficiencies in the design and construction of buildings, and inadequate initial rescue and relief capabilities resulted in one of the most lethal and traumatic natural disasters of the century. A large but unknown number (estimated at 225 to 385) of the extricated victims who had sustained crush injury developed myoglobinuric acute renal failure requiring dialytic support. The limited number (8-10 dialysis machines) of antiquated dialysis facilities available locally were overwhelmed. International dialysis relief efforts resulted in meeting the immediate acute needs and provided the motivation and elements of the more efficient system for the future delivery of maintenance dialysis.

Acute Kidney Injury↗
PubMed1995

Special report. The Oklahoma City bombing: mass casualties and the local hospital response.

A morning blast at the Alfred P. Murrah Federal Building, Oklahoma City, OK, on April 19, 1995, killed 168 persons and injured more than 500 in the worst terrorist attack in U.S. history. Hospital workers, physicians, and volunteers at nine hospitals there mobilized, put their disaster emergency plans into operation, and treated 466 persons in emergency rooms--many of them later being admitted as patients. To complicate matters, two of the hospitals received bomb threats called in after the disaster. This report will look at the security plans put into force by each of the nine hospitals; the handling of the great influx of persons, including victims, relatives, friends, concerned persons, volunteers, and the news media; and the lessons hospital officials learned from their experiences.

Communication↗
PubMed1993

The power of volunteers in disaster relief.

Hurricane Andrew, one of the worst natural disasters in American history, brought out the spirit of caring in medical personnel as volunteers from all over the country came to aid the hurricane's victims. The following is an example of how one massive relief effort can make a difference in thousands of lives.

Disaster Planning↗
PubMed1996

After the shooting stops: follow-up on victims of an assault rifle attack.

OBJECTIVE: To determine long-term medical, social, and psychological outcome of survivors of a multiple-shooting mass casualty disaster. DESIGN: A case-study review was performed 42 months after injury involving chart reviews and patient interviews. PARTICIPANTS: Survivors of a multiple shooting. MAIN OUTCOME MEASURES: The need for primary operative treatment, subsequent operations, and medical treatment related to the injuries, current work status, and psychological impact of injury was determined. RESULTS: Thirteen patients required operation initially; 12 are long-term survivors. Eight have returned to work. Most of the victims reported experiencing psychological and emotional problems. CONCLUSIONS: Despite a well-functioning trauma system that maximized survival from devastating injury, considerable long-term morbidity and disability persists. Efforts at prevention of mass casualties seem to be the only potential solution.

Bone and Bones↗
PubMed1992

Seasickness in totally-enclosed motor-propelled survival craft: five offshore oil rig disasters.

Five mobile offshore drilling unit disasters--Alexander L. Kielland, Ocean Ranger, Vinland, Ocean Odyssey, and Rowan Gorilla I--were studied to assess the degree to which seasickness occurs and endangers the lives of occupants of totally-enclosed motor-propelled survival craft (TEMPSC). Thousands of other peacetime marine incidents were reviewed and a literature search was conducted to assess the same seasickness problem. The one reported death in the Vinland abandonment appears to be the only one that could be associated, even remotely, with seasickness. It cannot be established whether or not seasickness contributed to the cause of death in the case of the Ocean Ranger victims, but it did occur in 75% or more of TEMPSC occupants in the other four rig disasters. It has occurred both in relatively calm waters of 1-m wave height and in severe seas of 15-m heights. Evacuees in an intact TEMPSC are able to survive many hours of severe seas; consequently, they should not be rescued until the weather and sea conditions improve. Moreover, practical survival training and good leadership is a principal cornerstone in the amelioration of seasickness.

Accidents↗
PubMed1998

The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma.

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hills-borough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.

Adaptation, Psychological↗
PubMedDate not supplied

Post-flood--infectious diseases in Mozambique.

INTRODUCTION: The types of medical care required during a disaster are determined by variables such as the cycle and nature of the disaster. Following a flood, there exists the potential for transmission of water-borne diseases and for increased levels of endemic illnesses such as vector-borne diseases. Therefore, consideration of the situation of infectious diseases must be addressed when providing relief. The Japan Disaster Relief (JDR) Medical Team was sent to Mozambique where a flood disaster occurred during January to March 2000. The team operated in the Hokwe area of the State of Gaza, in the mid-south of Mozambique where damage was the greatest. METHODS: An epidemiological study was conducted. Information was collected from medical records by abstracting data at local medical facilities, interviewing in habitants and evacuees, and conducting analyses of water. RESULTS: A total of 2,611 patients received medical care during the nine days. Infectious diseases were detected in 85% of all of patients, predominantly malaria, respiratory infectious diseases, and diarrhea. There was no outbreak of cholera or dysentery. Self-reports of the level of health decreased among the flood victims after the event. The incidence of malaria increased by four to five times over non-disaster periods, and the quality of drinking water deteriorated after the event. CONCLUSIONS: Both the number of patients and the incidence of endemic infectious diseases, such as malaria and diarrhea, increased following the flood. Also, there was a heightening of risk factors for infectious diseases such as an increase in population, deterioration of physical strength due to the shortage of food and the temporary living conditions for safety purposes, and turbid degeneration of drinking water. These findings support the hypotheses that there exists the potential for the increased transmission of water borne diseases and that there occurs increased levels of endemic illnesses during the post-flood period.

Adolescent↗
PubMed2006

[An indigenous conflict as an unfavorable type of delayed mass reaction to severe emotional stress].

The disturbance of interpersonal communication and stages of social conflict in people of Sydybyl (Yakutia) and Beslan (North Ossetia) after disaster with children death are considered. The basic psychological need of persons who lost their relatives during the disaster is a search for those guilty of the tragedy. As a consequence, a community splits into two groups, "victims" and "guilty". "Victims" also singled out a group of "those who suffered less" and accused them of insufficient efforts to rescue children of "victims". It is suggested that the persistent search for guilty people represents a form of psychological defense against the unbearable feeling of their own guilt before dead children. The universal, non-related to ethnic or cultural factors, characteristics of the phenomena described are emphasized. Such type of local social conflict that may be called indigenous has a negative effect aggravating social and economic consequences of the disaster.

Affect↗
PubMed1987

Catastrophic disasters and the design of disaster medical care systems.

The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation.

Disasters↗
PubMed2002

Health ecology and environmental management in Mozambique.

A health ecology approach to infectious disease incidence recognises that the weighting and interconnectivity of influences on health vary in terms of nature and context, from place to place and over time. It helps explain inherent limitations in the prediction and management of major infectious disease events and consequently why victims of ill health and policy often lack appropriate strategies for disease avoidance and health disaster mitigation. With reference to ongoing research in Mozambique, the paper uses the approach for assessment of health insecurity and to provide a realistic framework for management of complex disease hazards.

Cholera↗
PubMed2002

[Relations between military health services and humanitarian organizations--the point of view of the International Red Cross].

The classic definition of humanitarian action is any operation conducted for the purpose of helping to reduce human suffering. This concept can be expanded to include a notion of prevention. This expanded definition has opened a wide range of applications for humanitarian assistance. Military personnel are frequently involved in relief operations after natural disasters. Military logistic support is a key factor for coping with the massive needs of victims. However military intervention in humanitarian operations during wartime poses complex problems. The ICRC intervenes during military conflict and has, for several years, expressed its concern over the growing involvement of military forces in humanitarian operations. These considerations provide the backdrop for analysis of the relationship between Military Health Corps Services and the ICRC. The purpose of this article is to evaluate the need to make a clear-cut distinction between political and humanitarian objectives and thus between the actors associated with these goals. In this regard, the role of Military Health Corps Services will be presented in function of the principles underlying any humanitarian program. This article will also discuss areas of agreement and cooperation between the ICRC and Military Health Corps Services.

Altruism↗
PubMed2005

[Tsunami--the death waves].

On December 26, 2004, the fourth strongest earthquake over the past century struck in the Indian Ocean off the western coast of northern Sumatra, Indonesia. Measuring 9.0 in magnitude, the earthquake triggered massive tsunamis that struck the Indian Ocean countries and Somalia, and killed more than tens of thousands and destroyed entire villages, leaving over a million homeless. Tsunamis are water waves that are caused by sudden vertical movement of a large area of the sea floor during an undersea earthquake. Tsunami speed can exceed 800 kilometers per hour, and as it reaches shallow water the height of the wave drastically increases. There are two natural warning signs of a possible tsunami: the earthquake itself and later, in the minutes preceding a tsunami strike, the sea often recedes temporarily from the coast. Despite these warning signs and despite a lag of up to several hours between the earthquake and the impact of the tsunamis, nearly all of the victims were taken completely by surprise. One of the most common myths associated with natural disasters is that dead bodies are responsible for the spread of epidemics. This article discusses the myths that often lead authorities and others to take inappropriate action, and presents valuable lessons to be learned from this catastrophic disaster.

Disasters↗
PubMedDate not supplied

The effect of disaster on the health and well-being of older women.

Relatively little attention has been paid to the post-disaster health status and well-being of older persons. The data discussed in this article were gathered through use of a retrospective cohort survey five years following a major flood in the Wyoming Valley of Pennsylvania. The subsample of women sixty-five years and older used in this analysis is composed of 122 female victims and forty-five controls from the same communities. The instruments used to measure mental status included Langner's 22-Item Scale, Zung's Self-rating Depression Scale, and a modified Self-Report Symptom Inventory (SCL-90). Additional items related to self-perceptions of health status, to influence of the flood on health and well-being, and to other issues. Significant differences occurred in self-perceptions, including state of mind after the flood (p less than .001), distress during recovery (p less than .001), quality of life after the flood (p less than .001), and frequency of thinking about the flood matters (p less than .025). Use of the instruments designed to assess mental status did not indicate greater levels of anxiety or depression in elderly victims as compared to non-victims.

Adaptation, Psychological↗
PubMed1998

Oklahoma City: disaster challenges mental health and medical administrators.

Mental health and medical administrators responded to the Oklahoma City bombing with cooperative and overlapping efforts to meet community needs in the wake of terrorism. The major agencies assisted in the immediate rescue response, organized crisis hotlines, prepared mental health professionals to counsel bereaved families and victims, organized debriefing of rescuers, assessed mental health needs of local school children, planned for longer term treatment, and coordinated research efforts to learn from the disaster. Implications to mental health administrators responding to significant acts of terrorism are discussed.

Adult↗
PubMed1977

Mobile triage team in a community disaster plan.

Experience has shown poor predisaster planning, inadequate communication and the absence of an on-scene commander to be common and recurring problems during disaster rescue efforts. A mobile onscene triage team (MOTT) operating in Sacramento has demonstrated the following advantages: immediate access; mobility; coordinated evacuation, treatment, and disposition of mass casualty victims; control of facility overload, and appropriate initial disposition to definitive care facilities. The advantages realized with this approach arise from greater community awareness and participation in a coordinated plan for medical care in disasters.

California↗
PubMedDate not supplied

Guidelines for the use of foreign field hospitals in the aftermath of sudden-impact disaster.

Natural and complex disasters can cause a dramatic increase in the demand for emergency medical care. Local health services can be overwhelmed, and damage to clinics and hospitals can render them useless. Many countries maintain mobile field hospitals for defense or humanitarian purposes. Dispatching these facilities to disaster-affected countries would seem an ideal response to emergency medical needs. Unfortunately, experience has shown that in the case of natural disasters, field hospitals often have not met the expectations of recipients and donor institutions. In July 2003, the World Health Organization and Pan American Health Organization sponsored a workshop in El Salvador to discuss the pros and cons of using foreign field hospitals in the aftermath of natural disasters. These guidelines are the result of that workshop. The workshop participants identified different phases when foreign field hospitals and specialized medical personnel are most useful. They can provide advanced trauma care and life support if at the disaster site within 48 hours of the impact of an event; they would provide follow-up care for trauma victims and resumption of routine medical care in the two weeks following the event; during rehabilitation and reconstruction phases (from two months to two or more years), a field hospital might serve as a temporary replacement for damaged health facilities. These guidelines propose conditions that field hospitals and their staff should meet for each of these phases. The guidelines also outline issues that authorities in donor countries and disaster-affected countries should discuss before mobilizing a field hospital.

Disaster Planning↗