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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↗
PubMed1995

Psychological consequences of the Kegworth air disaster.

BACKGROUND: The study sought to quantify psychiatric morbidity among survivors of a major air crash and to identify aetiological factors linked with post-traumatic stress disorder (PTSD). METHOD: Sixty-eight of the 79 survivors (86%) were assessed at a clinical interview within one year of the disaster. The majority also completed the General Health Questionnaire, the Impact of Events Scale (IES) and the Zung Anxiety and Depression Scales. RESULTS: Fifty-four of the study group (79%) met DSM-III-R criteria for a psychiatric disorder within one year of the disaster, of whom 27 (50%) had PTSD. Those who saw injured or dead people at the scene, or had sustained less severe injuries as measured by their Injury Severity Scores, or were under 35 years old, were significantly more likely to develop PTSD. CONCLUSIONS: High rates of psychiatric morbidity are found in survivors of transportation disasters. Further studies are needed to identify those at most risk and to evaluate the benefits of psychological intervention.

Adult↗
PubMed1996

Early traumatic stress reactions among Swedish survivors of the m/s Estonia disaster.

BACKGROUND: This study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster. METHOD: A questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS-10), Impact of Event Scale (IES), Sense of Coherence-short version (SoC-12), and the DSM-IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed. RESULTS: The response rate was 79.2% (n = 42). The participants scored an average of 3.9 on PTSS-10, 28.5 on IES ('intrusion' and 'avoidance' subscales) and 62.8 on SoC-12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS-10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions. CONCLUSIONS: This study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.

Adaptation, Psychological↗
PubMed2004

Infectious disease risks from dead bodies following natural disasters.

OBJECTIVE: To review existing literature to assess the risks of infection from dead bodies after a natural disaster occurs, including who is most at risk, what precautions should be taken, and how to safely dispose of the bodies. METHODS: Disease transmission requires the presence of an infectious agent, exposure to that agent, and a susceptible host. These elements were considered to characterize the infectious disease risk from dead bodies. Using the PubMed on-line databases of the National Library of Medicine of the United States of America, searching was done for relevant literature on the infection risks for public safety workers and funeral workers as well as for guidelines for the management of the dead and prevention of infection. A small but significant literature was also reviewed regarding the disposal of the dead and the contamination of groundwater by cemeteries. RESULTS: Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections. This indicates that the risk that dead bodies pose for the public is extremely small. However, persons who are involved in close contact with the dead-such as military personnel, rescue workers, volunteers, and others-may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and Mycobacterium tuberculosis. Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis. Disposal of bodies should respect local custom and practice where possible. When there are large numbers of victims, burial is likely to be the most appropriate method of disposal. There is little evidence of microbiological contamination of groundwater from burial. CONCLUSIONS: Concern that dead bodies are infectious can be considered a "natural" reaction by persons wanting to protect themselves from disease. However, clear information about the risks is needed so that responsible local authorities ensure that the bodies of disaster victims are handled appropriately and with due respect. This paper provides a source of information for those who are in the unfortunate position of managing those bodies.

Cadaver↗
PubMed1993

The effects of a natural disaster on child behavior: evidence for posttraumatic stress.

OBJECTIVES: A prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children. METHODS: Six months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated. RESULTS: Between the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis. CONCLUSIONS: These results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of children's exposure to extreme and traumatic situations.

Aggression↗
PubMed2004

Estimating capacity requirements for mental health services after a disaster has occurred: a call for new data.

OBJECTIVES: We sought to estimate the extended mental health service capacity requirements of persons affected by the September 11, 2001, terrorist attacks. METHODS: We developed a formula to estimate the extended mental health service capacity requirements following disaster situations and assessed availability of the information required by the formula. RESULTS: Sparse data exist on current services and supports used by people with mental health problems outside of the formal mental health specialty sector. There also are few systematically collected data on mental health sequelae of disasters. CONCLUSIONS: We recommend research-based surveys to understand service usage in non-mental health settings and suggest that federal guidelines be established to promote uniform data collection of a core set of items in studies carried out after disasters.

Adult↗
PubMed1983

Kepone: a chemical disaster in Hopewell, Virginia.

One of the most costly chemical disasters in the United States involved a small, single-product manufacturer, ironically named Life Science Products Company, which made the pesticide Kepone for Allied Chemical Corporation. Life Science operated only 16 months in 1974 and 1975, in Hopewell, Virginia, yet managed to poison its workers and pollute the environment, causing millions of dollars of damage. The case dramatically demonstrates the links between hazards inside the factory and those outside the factory, and the confused responses of both administrative and judicial systems to a chemical disaster. In the Kepone case, as in other instances of toxic contamination, the victims confronted problems of care, compensation, and clean-up. The case illustrates two major causes of a chemical disaster: organizational pathologies of public bureaucracies, and irresponsible production by private corporations.

Air Pollutants↗
PubMed2001

Risk factors for pet evacuation failure after a slow-onset disaster.

OBJECTIVE: To determine risk factors for pet evacuation failure during a flood. DESIGN: Cross-sectional survey. SAMPLE POPULATION: 203 pet-owning households in a flooded region. PROCEDURES: Persons under evacuation notice because of a flood were interviewed by use of a random telephone survey. RESULTS: 102 households evacuated with their pets, whereas 101 households evacuated without their pets. Low pet attachment and commitment scores were significantly associated with a greater chance of pet evacuation failure. Risk of pet evacuation failure and lower attachment and commitment scores were also associated with pet management practices prior to the disaster, such as dogs being kept outdoors most of the time or owners not having carriers for their cats. More than 90% of owners made housing arrangements for their pets without assistance. CONCLUSIONS AND CLINICAL RELEVANCE: Predictors of pet evacuation failure are usually present before a disaster strikes and are potentially modifiable. Mitigation of pet evacuation failure should focus on activities that reinforce responsible pet ownership and strengthen the human-animal bond, including socializing dogs, attending dog behavior training classes, transporting cats in nondisaster times, and seeking regular preventive veterinary care. Most pet owners are self-reliant in disasters, and this behavior should be encouraged.

Animal Husbandry↗
PubMed2002

Immune function and affective states following a natural disaster.

Although natural disasters sometimes strengthen community ties, it was hypothesized that the negative affect following a hurricane would lower evaluations of strangers. This hypothesis was tested by having 105 students evaluate an individual that they had just met following Hurricane Andrew. The hypothesis did not receive support, but students living in storm-damaged neighborhoods expressed more negative affect than those living in less damaged neighborhoods. Regression analyses also disclosed that severity of a disaster predicted concentrations of immunoglobulin A in saliva. The results suggest that salivary immunoglobulin A can be used to assess the health consequence of disaster exposure.

Adolescent↗
PubMedDate not supplied

Psychological adaptation of nurses post-disaster.

Disasters have the potential to cause major disruptions in lifeline services and family support systems. As caregivers, nurses are required to make difficult choices during national emergencies and may be at risk for experiencing psychological distress following a disaster. This study describes the responses of a group of nurses following Hurricane Hugo, and makes recommendations to minimize the stress placed on nurses working in a time of disaster.

Adaptation, Psychological↗
PubMed1997

Psychological aspects of disasters.

This article describes several topics necessary for understanding the psychological impact of disasters. Topics discussed include characteristics of disaster that impact psychological response, stages of response, factors influencing individual and collective trauma, and important aspects of psychological interventions. The author shares several conclusions about the nature of people, culture, and society based on his many years of work in disaster mental health.

Disasters↗
PubMed1982

A model for activity intervention in disaster-stricken communities.

Environmental disasters cause deaths, injuries, and destruction of familiar surroundings. Social networks and routines that structure daily life are often left in disarray. To surmount subsequent crises, survivors must master painful feelings, solve problems, and accomplish important tasks, even while they are confused, bereaved, and displaced. Otherwise, coping failure leads to a vicious spiral of loss of self-esteem, distrust of the environment, and abandonment of social roles. Both crisis intervention and disaster literature advocate concrete and practical treatment measures. Activity intervention can prevent and reverse the destructive downward spiral by facilitating victims' most effective coping responses. This paper reviews the pertinent literature and sets forth a theoretical model of occupational therapy in post-disaster settings.

Adaptation, Psychological↗
PubMed1989

Industrial disasters and epidemiology. A review of recent experiences.

Disasters of industrial origin are usually overt, but sometimes their source is silent and their occurrence diluted in time. Thus, the ascertainment of the health impact is not the sole epidemiologic task; epidemiology is often needed to identify the disaster source; in addition, a postdisaster scenario may represent an unfortunate, unplanned experimental setting from which scientific knowledge and public health achievements can be drawn. In the aftermath of a disaster, three sets of illness determinants ought to be considered: the relevant exposure; the stressful experience of the population; the response measures. Ecological, geographic, and personal indicators might be used to ascertain individuals' exposure. Relevant health outcomes (early and long-term) are either exposure-related or stress-related (mental and physical). A cohort approach should be sought to avoid major selection/information biases and facilitate later studies. Early planning is of paramount importance to identify study goals, problems, and resource requirements.

Accidents, Occupational↗
PubMed2003

Community resilience or unidentified health risk?: health professional perceptions on the impact of the Swissair Flight 111 disaster on surrounding communities.

On September 2nd, 1998 Swissair Flight 111 crashed in Saint Margaret's Bay, Nova Scotia. Surrounding coastal communities were immediately transformed into disaster response sites. Sixteen community health professionals were interviewed that identified several types of individual and community exposure, including exposure to human remains. The interviews revealed that the coastal communities have responded with silence and stoicism. This silence has been viewed by some health professionals as resilience. The interface of a major disaster, community silence, low help-seeking behaviours, and limited disaster health responses raises the critical question whether this is a profile of resilience or a community silently enduring.

Adaptation, Psychological↗
PubMedDate not supplied

[Risk of chemical disaster as a public health problem].

This revision is aimed at providing health care personnel, particularly those who may be involved in planning and/or responding to a chemical accident, with an overview of the subject of major industrial accidents. In the introduction, a brief presentation is made of some data concerning the main industrial disasters which have occurred in the past in addition to some accidents which have occurred in our area that could have evolved into a major accident. A review is also provided of Spanish and European laws currently in effect regarding this matter, in addition to summarizing the main consequences which may result from explosions, phenomena of a thermal type and the leakage of hazardous substances, particularly stressing the third of these three cases. A brief summary is also given of the main steps to be taken for a correct risk analysis in a given geographical area. Lastly, the overall organization of the Chemical Industry Emergency Plans and the functions of the different groups taking part therein, including the main functions of the medical team, is provided. Planning and responding to an industrial disaster is markedly multi-disciplinary endeavor, and this document is aimed at providing health care professionals with an overview of the main aspects involved in order to thus contribute to a more in-depth knowledge of a subject which we consider to be of importance for health care personnel and a better-integrated response, given that were an industrial disaster to occur, we would have to deal with a serious public health care problem on the spot.

Accidents, Occupational↗
PubMed1994

Pharmacy mass casualty disaster plan implemented after the train wreck.

The involvement of a hospital pharmacy department in a mass casualty disaster revealed strengths and weaknesses of the department's disaster response plan. Effective communication and notification within the pharmacy department and the need to plan to have pharmacists in the triage area to determine patients' lost medications are important areas that the department had not practiced in disaster drills.

Accidents↗
PubMedDate not supplied

Airborne field hospital in disaster area: lessons from Armenia (1988) and Rwanda (1994).

The outcome of survivors within disaster areas largely depends upon the quick reallocation and operation of logistic and medical support systems. Enthusiastic media equipped with advanced communication systems, reveal mass human suffering in real time. But, the response period required for the organization of rescue systems is much slower and is most frustrating. In this article, we present our experience in quick deployment and operation of airborne field hospitals gained following the earthquake disaster in Armenia in 1988 and the civil war in Rwanda in 1994. Deployment of improvised, volunteer-based, military field hospitals was feasible within 24 hours after the decision was made. A multi-disciplinary structure enabled an effective, flexible mode of operation and reduced the dependency on mericulous, time-consuming assessments of requirements prior to deployment. These missions are a paradigm for the successful incorporation and integration within the capabilities of military infrastructure of volunteer professionals drafted from civil medical facilities. Such field hospitals could provide backup for primary care medical systems in disaster areas and substitute or take some pressure off of local hospitals, particularly when evacuation systems are insufficient.

Aircraft↗