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PubMedDate not supplied

Preparing for the next natural disaster: learning from Katrina.

Hurricane Katrina exposed the nation's ongoing vulnerability to large-scale losses from natural disasters. The catastrophic loss of life and property has lead people to question why the United States is not better prepared for such disasters. In this Issue Brief, a leading expert on decision processes and low probability events discusses the reasons why people do not take protective measures voluntarily. In addition, he suggests ways to reduce losses through a disaster management plan that includes well-enforced building codes and land-use policies, insurance incentives, and long-term loans.

Building Codes↗
PubMed1999

US government natural disaster assistance: historical analysis and a proposal for the future.

Governments often provide grants or low-interest loans to disaster victims. Yet these programmes have proven to be quite costly. In addition, questions have been raised about associated behavioural incentives. Conceptually, government disaster insurance programmes should be more efficient, consistent and equitable than ex post facto disaster relief in the form of grants and loans. Yet the performance of government disaster insurance programmes has been mixed, at best. This article reviews the history of US federal natural disaster assistance to individuals and concludes with a recommendation for a new government role in the provision of disaster insurance.

Disaster Planning↗
PubMed2006

Military medical surge capacity in times of war and natural disaster.

BACKGROUND: The military medical services need demand-based strategies to ensure the best possible care of the injured in combat and natural disasters without compromising peacetime health care commitments at home and abroad. METHODS: A review of steps that have already been taken suggests that they are being used to their fullest extent commensurate with the public will. In fact, the situation has driven preliminary exploration of a special health care personnel draft. We believe the answer lies not in expanding the full-time, active duty US medical and nursing corps, but rather in tapping identifiable reservoirs of trained trauma care physicians, nurses, and allied health care workers in the United States and elsewhere. RESULTS: A rudimentary analysis suggests the most promising novel considerations are: developing special, trauma-trained reserve units within the US civilian trauma care community; seeking temporary attachments of an allied country's military medical officers, or a complete medical battalion; and contracting with US and foreign trauma surgeons, nurses and allied health personnel through a medical private military firm, analogous to those that have provided food, housing, transportation, and special combat units in support of our major military campaigns and peacekeeping operations. CONCLUSION: These considerations have important pros and cons that deserve in-depth evaluation by the best military and civilian trauma/critical care and organizational minds within a structured organization committed to the needs of military medicine. We believe that a Military Medical Think Tank within the Uniformed Services University's postgraduate division should be that organization.

Disasters↗
PubMed2000

Responding to a natural disaster with service learning.

This article describes a service learning experience at the University of North Carolina School of Medicine. Responding to a nearby natural disaster, the curriculum was modified to allow 71 second-year medical students to provide needed aid to affected communities and also fulfill learning objectives important to their training. The description and the lessons learned provide an example of how service learning experiences can be implemented to enrich a curriculum.

Adult↗
PubMed1991

[Mental disorders during and after natural disasters and catastrophies].

Analysis is made of mental disorders seen in 3431 victims followed up by psychiatrists in 11 large-scale catastrophies and natural disasters. Three periods of the development of the life-threatening situation were distinguished, during which one can see different states of mental disadaptation and morbid disorders. The clinical picture of such disorders is provided.

Accidents↗
PubMed2006

Tobacco use after experiencing a major natural disaster: analysis of a longitudinal study of 2063 young adults.

AIM: To identify the extent to which tobacco use is affected by experience of a natural disaster and resulting symptoms of post-traumatic stress disorder (PTSD). DESIGN: Longitudinal community survey. SETTING: Canberra, the national capital of Australia. PARTICIPATION: A random selection of 2063 young adults participating in this project lived in a region affected by a major bushfire in 2003. They were first interviewed in 1999-2000 and re-interviewed in 2003-4 after the bushfire had occurred. MEASUREMENTS: Changes in participants' level of consumption of tobacco over a 4-year period were calculated. When interviewed after the disaster, participants answered questions concerning their experience of traumatic events, their immediate emotional response during the disaster and their fire-related PTSD symptoms of re-experiencing and hyperarousal. FINDINGS: Experience of traumatic events experienced during the disaster was associated with an increase in consumption of tobacco (OR: 1.12, 95% CI: 1.03-1.21). PTSD symptoms did not contribute independently to increased tobacco use after controlling for trauma experiences. CONCLUSIONS: These findings indicate that trauma experiences can trigger increased tobacco use in young adults regardless of whether such experiences result in PTSD symptoms. Public health information provided to communities and health-care providers should note that increases in this preventable health risk may occur as a result of individuals experiencing trauma.

Adult↗
PubMed1999

Small but mighty. In the face of an impending natural disaster, you need a great plan, an electronic patient record and community cooperation.

UNLABELLED: Englewood Community Hospital, a small, acute-care facility in the Gulf Coast area of South Florida PROBLEM: Hurricane Georges forced the staff and administrators of Englewood Community Hospital to evacuate patients and provide emergency care for the community. SOLUTION: A comprehensive disaster plan. RESULTS: Englewood staff discovered they were well-prepared for patient evacuation in times of threatening natural disasters. The MEDITECH clinical data repository allowed no disruption in access to the patients' history or current clinical profile. KEY TO SUCCESS: "Englewood Community Hospital's comprehensive, well thought-out disaster plan covered critical issues such as staffing, reimbursement, documentation, and most importantly, continuity of care during the move to another hospital."

Community-Institutional Relations↗
PubMed1993

Post-traumatic stress disorder and coping after a natural disaster.

This study examines the role of coping in the onset of post-traumatic stress disorder (PTSD) in a nonpatient population following exposure to a natural disaster. In contrast to other studies, the use of all coping strategies was found to be associated with the presence of PTSD rather than the absence of symptoms. These data suggest that coping (in this sense) represents a psychological process used to contain the distress caused by symptoms as well as to manage environmental adversity.

Adaptation, Psychological↗
PubMed1999

The politics of "natural" disaster: who made Mitch so bad?

The devastation in Central America following the 1998 hurricane (Hurricane Mitch) resulted more from economic and political policies than from "natural" disaster. Over the last 30 or 40 years, huge numbers of poor people in these countries have been forced off good, stable agricultural land onto degraded hillsides and into shanty towns constructed on floodplains--areas known to pose serious hazards of flooding and mudslides. This, together with the failure of impoverished countries to anticipate disaster through mass evacuations or to respond effectively to the hurricane's widespread damage--ensured the loss of thousands of lives.

Central America↗
PubMedDate not supplied

Risk factors for adolescent alcohol use following a natural disaster.

INTRODUCTION: On 29 March 1998, a series of category F-3 and F-4 tornadoes caused wide-spread destruction in four rural southern Minnesota counties in the United States. Extensive research has examined the impact of disaster exposure on adults' psychological functioning, including alcohol use. However, there has been little research on potential risk factors for adolescents' alcohol use following disaster exposure. HYPOTHESIS: It was hypothesized that demographic variables such as age and gender, prior drinking involvement, extent of prior trauma history, level of disaster exposure, and current disaster-related, post-traumatic stress disorder (PTSD) symptomatology would predict alcohol use among adolescents. METHODS: Six months following a natural disaster, survey data were collected from 256 adolescents assessing these factors. Risk factors for adolescents' alcohol use were identified using hierarchical, multiple regression and logistic regression analyses. RESULTS: Greater age, prior drinking involvement, and the extent of prior trauma history were significantly associated with higher levels of binge drinking. Prior trauma history and current levels of disaster-related PTSD symptomatology were significant risk factors for adolescents' report of increases in their alcohol consumption since the tornado. CONCLUSION: In general, the extent of trauma exposure was associated with greater binge drinking among adolescents. Similar to adults, post-traumatic stress symptoms experienced in the aftermath of a disaster can lead to increased alcohol consumption among adolescents.

Adolescent↗
PubMed1988

The phenomenology of posttraumatic stress disorders following a natural disaster.

This study examined the utility of the DSM-III diagnostic criteria for posttraumatic stress disorder (PTSD) in a high-risk group of 50 firefighters who had had an intense exposure to a natural disaster 8 months before being interviewed. Follow-up over the next 3 years allowed examination of the ability of these diagnostic criteria to predict a pattern of chronic posttraumatic morbidity. They predicted a pattern of chronic disorder, demonstrated by the finding that eight of the 15 subjects who had definite or borderline PTSD at 8 months remained symptomatic 3 years later. A disturbance of attention and concentration appeared to be the best predictor of chronic PTSD. The longitudinal course of posttraumatic morbidity in these 50 firefighters was compared with a matched group of 96 uninterviewed subjects 11 and 29 months after the disaster. Although the interview provoked an emotional catharsis in a number of firefighters, the long-term morbidity in the two groups was comparable. Fourteen subjects who did not have PTSD continued to experience intense imagery 8 months after the disaster. This observation raises questions about whether such thoughts and feelings have adequate specificity as diagnostic criteria for PTSD in a group that has recently been exposed to a traumatic event.

Anxiety Disorders↗
PubMed2000

Natural disasters and alcohol consumption in a cultural context: the Great Hanshin Earthquake in Japan.

AIMS: To assess changes in alcohol consumption attributable to the Great Hanshin Earthquake to test the assumption that alcohol consumption increases after natural disasters. METHODS: Quarterly alcohol sales figures were compared for three periods: before, immediately after and subsequent to the Great Hanshin Earthquake in three areas of the Hyogo prefecture: the severely affected area, the moderately affected area and the unaffected area. Possible confounding by population movement, damage to retail outlets and normal variation in sales, was assessed. FINDINGS: The quantity of alcoholic beverages consumed in the heavily damaged areas as well as throughout the prefecture decreased from the 1994 pre-disaster level, both immediately after the Great Hanshin Earthquake (January-March 1995) and 2 years after the disaster. This finding remained once possible confounding factors were taken into consideration. CONCLUSIONS: More attention should be placed on drinking in the cultural context where a disaster occurs. It may sometimes deter, rather than encourage, drinking among the affected population.

Alcohol Drinking↗
PubMed2000

Prevalence, characteristics, and long-term sequelae of natural disaster exposure in the general population.

A sample of 935 participants from the general population completed a mail-out questionnaire containing the Trauma Symptom Inventory (J. Briere, 1995) and the Traumatic Events Survey (D. M. Elliott, 1992). The lifetime self-reported prevalence of natural disasters in this sample was 22%. Although time from the last disaster to involvement in the study was an average of 13 years, previous disaster was associated with significantly higher scores on 6 of 10 symptom scales. Disaster characteristics (especially the presence of physical injury, fear of death, and property loss) were better predictors of symptomatology than was disaster type. Disaster exposure continued to predict symptomatology after controlling for interpersonal violence history, although interpersonal violence accounted for more overall symptom variance.

Adolescent↗
PubMed1994

Natural disasters: how to resume operations and prioritize your infrastructure.

Earthquakes! Floods! Hurricanes! How is a managed care organization to cope with both delivering health care to its members and maintaining the integrity of its organization? This first article of a two-part series, prompted by the recent spate of natural disasters, discusses how a managed care organization can recompose itself so that it may optimally deliver care to the many people in need after such a catastrophe.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Perfect storm: organizational management of patient care under natural disaster conditions.

Managing uncertainty is an essential attribute of organizational leadership and effectiveness. Uncertainty threatens optimal decision making by managers and, by extension, reduces the quality of patient care. Variation in the work flows of everyday patient caregiving reflects management's steps to control uncertainty, which include strategies for contending with potential disaster scenarios. Little exists in the literature that reveals how management's strategic response to controlling uncertainty in a real disaster event differs from strategies practiced in disaster simulations, with the goal of protecting patient care. Using organization theory, this article presents the application of uncertainty management to the catastrophic flooding of a major teaching hospital. A detailed description of management's strategies for patient rescue and evacuation is provided. Unique aspects of managing uncertainty stemming from a natural disaster are highlighted. Recommendations on organization responses to disasters that optimize patient care, safety, and continuity are offered to managers.

Continuity of Patient Care↗
PubMed2001

[Problems encountered during natural disasters: a questionnaire study].

Human being has been encountering huge natural mass disasters since the dawn of existence. In the earthquake both Marmara region on August 17 1999 and Duzce region on November 12 1999, according to official records, 18.287 people were dead and 46.857 were injured. The purpose of this study is to get information by bilateral interviews with those who witnessed this big earthquake in different districts and to contribute in forming a prepared "disaster administration" consciousness for the prospective disasters, under the basis of these information. This study was made by interviewing with 262 people, 82 of whom witnessed the earthquake in the city of Yalova, 90 in Izmit, Bolu and Golcuk and 90 in Istanbul, used a questionnaire form consisted of multi choice and commentary questions. It is of very importance to diffuse educational programmes to increase social consciousness and sensibility about earthquake. Some projects to meet the basic requirements like communication, rescue, accommodation, nutrition and urgent medical support must be developed and embodied. Measures enabling to determine the identities of those who lose their lives in the earthquake must be determined and organized with the collaboration of forensic medical units.

Adolescent↗
PubMed1987

Exploring the impact of a natural disaster on the health and psychological well-being of older adults.

The failure of researchers to consider the temporal dimensions of the stress process may be at least partially responsible for the disappointing empirical findings from research on stress and health. We argue that careful consideration must be given to the time lag between the occurrence of a stressor and initial symptom development, as well as the length of time that is required for symptoms to abate. Using a synthetic cohort design, we examine the length of time needed for symptoms to dissipate following a natural disaster (Hurricane Alicia). Findings from a random community survey of older adults suggest that the major effects of the storm diminish in about 16 months. Significant gender differences were found in this adjustment process. The implications of these findings for stress research are discussed.

Adaptation, Psychological↗
PubMed1982

Changes in children's behavior after a natural disaster.

Five months after a severe winter storm, a survey of children whose behavior had been assessed by means of a parent rating scale during a Head Start program 6 months before the disaster showed that some problem-behavior scores had increased significantly. The subgroups of children at higher risk were boys, whose Anxiety scale scores increased, and children accepted for Head Start only because their parents said they had special needs, whose Aggressive Conduct scale scores increased. For the entire group of children, school behavior improved. The findings support previous impressions that parents deny their children's problems after a natural disaster.

Aggression↗