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PubMedDate not supplied

The psychological impact of the Bay Area earthquake on health professionals.

An earthquake exemplifies a natural disaster in which the potential caregivers are experiencing their own emotional response to the event. A survey of 222 health care workers in San Francisco and Marin County in the first two weeks after the Loma Prieta earthquake found them to have a moderate level of psychological symptoms as measured by the Impact of Event Scale and to frequently endorse several earthquake specific stress items. Highly reliable gender differences existed on all of the dependent variables, with women reporting more symptoms. Variation in cognitive style and the personal salience of the event are possible explanations for this difference. Disaster planning should include education about the normal range of response and support groups for symptomatic caregivers as well as victims.

Adaptation, Psychological↗
PubMed1994

Hurricane-related emergency department visits in an inland area: an analysis of the public health impact of Hurricane Hugo in North Carolina.

STUDY OBJECTIVE: To evaluate the public health impact of a hurricane on an inland area. DESIGN: Descriptive study. SETTING: Seven hospital emergency departments. PARTICIPANTS: Patients who were treated from September 22 to October 6, 1989, for an injury or illness related to Hurricane Hugo. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Over the two-week study period, 2,090 patients were treated for injuries or illnesses related to the hurricane. Of these, 1,833 (88%) were treated for injuries. Insect stings and wounds accounted for almost half of the total cases. A substantial proportion (26%) of the patients suffering from stings had a generalized reaction (eg, hives, wheezing, or both). Nearly one-third of the wounds were caused by chain saws. CONCLUSION: Hurricanes can lead to substantial morbidity in an inland area. Disaster plans should address risks associated with stinging insects and hazardous equipment and should address ways to improve case reporting.

Adolescent↗
PubMedDate not supplied

Prehospital care of tsunami victims in Thailand: description and analysis.

INTRODUCTION: On 26 December 2004 at 09:00 h, an earthquake of 9.0 magnitude (Richter scale) struck the area off of the western coast of northern Sumatra, Indonesia, triggering a Tsunami. As of 25 January 2005, 5,388 fatalities were confirmed, 3,120 people were reported missing, and 8,457 people were wounded in Thailand alone. Little information is available in the medical literature regarding the response and restructuring of the prehospital healthcare system in dealing with major natural disasters. OBJECTIVE: The objective of the study was to analyze the prehospital medical response to the Tsunami in Thailand, and to identify possible ways of improving future preparedness and response. METHODS: The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research delegation to study the response of the Thai medical system to the 2004 earthquake and Tsunami disaster. The delegation met with Thai healthcare and military personnel, who provided medical care for and evacuated the Tsunami victims. The research instruments included questionnaires (open and closed questions), interviews, and a review of debriefing session reports held in the days following the Tsunami. RESULTS: Beginning the day after the event, primary health care in the affected provinces was expanded and extended. This included: (1) strengthening existing primary care facilities with personnel and equipment; (2) enhancing communication and transportation capabilities; (3) erecting healthcare facilities in newly constructed evacuation centers; (4) deploying mobile, medical teams to make house calls to flood refugees in affected areas; and (5) deploying ambulance crews to the affected areas to search for survivors and provide primary care triage and transportation. CONCLUSION: The restructuring of the prehospital healthcare system was crucial for optimal management of the healthcare needs of Tsunami victims and for the reduction of the patient loads on secondary medical facilities. The disaster plan of a national healthcare system should include special consideration for the restructuring and reinforcement prehospital system.

Disasters↗
PubMed2002

2001 anthrax crisis in Washington, D.C.: clinic for persons exposed to contaminated mail.

An anthrax prophylaxis clinic is described. In October 2001, four workers from the U.S. Postal Service's Brentwood facility in Washington, D.C., were hospitalized with inhalational anthrax; many others may have been exposed to anthrax spores. U.S. Public Health Service (USPHS) teams were deployed to establish an anthrax prophylaxis clinic that would provide education and medication to workers and people who visited the mail facility. The temporary clinic was set up at D.C. General Hospital and was staffed primarily by health care professionals from USPHS. The protocol at the clinic involved three major phases. Phase 1 consisted of gathering information from the patient and distributing educational materials. Phase 2 involved presentations by a physician and a pharmacist concerning anthrax, followed by a question-and-answer session. In phase 3, a pharmacist selected the most appropriate prophylactic agent, dispensed the medication, counseled the patient, and referred patients with flu-like symptoms or skin lesions to a physician. Two floor plans were used to maximize the number of patients seen per hour without jeopardizing patient care. The clinic operated 14 hours a day for 14 days. The 136-member health care team included 52 pharmacists, and medication was dispensed to more than 18,000 patients. The clinic may serve as a model for pharmacists and other professionals in designing and implementing disaster plans. A multidisciplinary team established and operated a clinic to treat persons who may have been exposed to anthrax through contaminated mail.

Ambulatory Care Facilities↗
PubMed2006

Six months later: The effect of Hurricane Katrina on health care for persons living with HIV/AIDS in New Orleans.

Nearly 13,000 Louisiana residents with HIV/AIDS were estimated to be living in areas affected by Hurricane Katrina. Although minimal general outpatient primary care services were available within a few weeks following the hurricane in New Orleans, access to antiretroviral medications was an early problem. The largest HIV care provider, the Medical Center of Louisiana at New Orleans HIV Outpatient Program (HOP), was able to assist in obtaining medications mid-October and opened an HIV clinic the first week of November in a temporary location. Services have slowly expanded in the five months since the HOP clinic opened but remain limited. Six months following the hurricane, microbiologic studies are still unable to be performed in clinic and uninsured patients must travel at least 70 miles for subspecialty care. The authors suggest recommendations for disaster planning for other centers caring for persons with HIV/AIDS based on the New Orleans experience.

Ambulatory Care Facilities↗
PubMed2001

Were there enough physicians in an emergency department in the affected area after a major earthquake? An analysis of the Taiwan Chi-Chi earthquake in 1999.

STUDY OBJECTIVE: The purpose of this study was to evaluate physician manpower and mobilization in an urban emergency department receiving patients after a major earthquake. METHODS: Patient charts were reviewed. The workload of physicians was assessed semiquantitatively before and after a major earthquake. The physicians' mobilization in the postearthquake emergency response was assessed by using a confidential questionnaire. RESULTS: In the 3 days after the earthquake, 566 patients with earthquake-related illnesses or injuries were sent to the urban ED. Three hundred one (53.2%) patients arrived within the initial 10 hours. In the initial hours, there was no significant difference between the number of patients per physician per hour before and after the earthquake. Workloads of wound treatment and advanced life support procedures were significantly higher after the earthquake compared with before the earthquake, during the first to sixth hour and second to fifth hour, respectively. Sixty-five percent of the hospital's physicians did not assist in either the ED or in any other parts of the hospital in the initial 6 hours after the earthquake. CONCLUSION: The number of physicians in the ED was insufficient in the initial hours after the earthquake because of the sudden influx of a large number of patients. Future disaster planning must address the issue of physicians' behavior with regard to their priorities immediately after a major earthquake and include greater provision for efficient mobilization of physicians.

Disasters↗
PubMedDate not supplied

Disasters and development: Part I. Relationships between disasters and development.

This module introduces a paradigm for understanding the disaster/development interface. Specifically, the module asserts that disasters and development are linked closely in that disasters can both destroy development initiatives and create development opportunities, and that development schemes can both increase and decrease vulnerability. The module consists of four parts: Part One introduces these concepts and discusses how disasters can vary from one type of hazard to another, as well as from one type of economic condition to another. Part Two develops the paradigm in depth, and provides case examples to amplify the points made in the text. Part Three describes and discusses different methods and tools for analyzing decisions for potential investment of resources, and should enhance the reader's capacity to analyze the mitigational benefits of development alternatives in both the pre- and post-disaster context. Part Four conceptualizes the role of UN agencies, NGOs, and the affected communities in promoting development based on the concepts discussed in the module. This training module, Disasters and Development, initially was designed to introduce this aspect of disaster management to an audience of UN organization professionals who form disaster management teams, as well as to government counterpart agencies, non-governmental organizations (NGOs), and donors. The educational process has been designed to increase the audience's awareness of the nature and management of disasters, in order to lead to better performance in disaster preparedness and response. The content has been written by experts in the field of disaster management and in general follows the UNDP/UNDRO Disaster Management Manual and its principles, procedures, and terminology.

Costs and Cost Analysis↗
PubMed2001

Effect of previous experience of a hurricane on preparedness for future hurricanes.

The purpose of this study was to examine the hypothesis that having experienced a major hurricane will promote better preparedness for future ones. A survey was conducted in November 1999 at Miami children's Hospital. No statistical differences were found between the population that was present in Dade County during hurricane Andrew and the one that was not; in regard of the possession of a generator at home, the obtaining of material to secure their home, the presence of hurricane shutters, the willingness to evacuate their home in case of advise. Only 37% of the families that experienced hurricane Andrew would go to a shelter versus 49% for the families that did not ( P<.05). It was concluded that we can safely reject the hypothesis that having experienced a major hurricane will promote better preparedness for future ones. Those who experienced hurricane Andrew were less willing to go to a shelter compared with the group that did not.

Child↗
PubMed1997

Disaster management in the Caribbean.

This paper identifies the main trends in approaches to disaster management in the Caribbean at both regional and national levels over the past 20 years. It highlights the main reasons why and how the region has moved from an ad hoc response to an organised approach. Finally, it suggests way in which future regional and national disaster management could be improved.

Disaster Planning↗
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↗
PubMed2004

Surgical aspects of Operation Bali Assist: initial wound surgery on the tarmac and in flight.

BACKGROUND: The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin. METHODS: A descriptive report is provided of the event and includes; resuscitation, anaesthesia, initial burns surgery management including escharotomy and fasciotomy, head injury management and importance of supplies and medical records with a description of the evacuation to Darwin. RESULTS: Operation Bali Assist involved five C130 Hercules aircraft and aeromedical evacuation medical and nursing teams managing 66 casualties in the Denpasar area and their evacuation to Royal Darwin Hospital with ketamine the most useful anaesthetic agent and cling film the most useful burns dressing. Twelve procedures were performed at the ASF including seven escharotomies, three fasciotomies and two closed reductions. One escharotomy was performed in flight. DISCUSSION: The important lessons learnt from the exercise is the inclusion of a surgeon in the aeromedical evacuation team, the importance of debridement and delayed primary closure, the usefulness of cling film as a burns dressing and the importance of continuous assessment. Future disaster planning exercises need to consider a patient age mix that might be expected in a shopping mall, rather than the young adult encountered in Bali, a more familiar age mix for Australian Defence Force medical staff.

Air Ambulances↗
PubMedDate not supplied

KAMEDO report no. 82: explosion at the fireworks warehouse in the Netherlands in 2000.

A fire and subsequent explosions occurred in a fireworks warehouse on 13 May 2000. A total of 947 persons were injured and 21 persons died, including four firefighters and one reporter. Communication networks became overloaded and impaired notification chains. The hospital disaster plan was followed, but was proved inadequate. Public information was a high priority. A counselling center was established early and was planned to continue operation for five years. The command function did not perform to expectations. Hospital triage was impaired as many responsible left the triage area. Short-term psychosocial support evolved to long-term programs. Liability issues were examined.

Efficiency, Organizational↗
PubMed1994

Disaster preparedness. Ready for earth, air, fire and water (and who knows what else)?

Already the 1990s might be described as a decade of disasters: From the devastation of hurricanes on the East Coast to the havoc of floods in the Midwest to the destruction of earthquakes and civil unrest on the West Coast, the past few years clearly show that disasters can strike anywhere--and at any time. For health facilities caught in the middle of these crises, emergency preparedness means much more than just meeting the basic requirements of the Joint Commission on Accreditation of Healthcare Organizations or complying with state and local regulations. Rather, for most health facilities, preparing for disasters is an integral part of ensuring that they can continue to provide adequate, high-quality patient care under almost any circumstances. This report, the first in a series of articles, examines how health facility managers coped once they found themselves in the midst of major disasters, what lessons they learned about emergency preparedness as a result of their experiences, and what others can learn from these difficult situations.

California↗
PubMed2006

Can it get any worse?

THE TWO FEATURE articles presented in this issue of Frontiers of Health Services Management speak to the challenges of Hurricane Katrina. The Tulane experience lists a multitude of problems, solutions, and successes, whereas the article by Drs. Rodriguez and Aguirre speaks to the impact on the infrastructure following the hurricane. In the federal report, "The Federal Response to Hurricane Katrina," the White House (2006) has labeled Katrina as "the most destructive natural disaster in U.S. history." Dr. E. L. Quarantelli (2006) might call Katrina a catastrophe. Regardless of what one calls the event, Hurricane Katrina has shown that the challenges leading up to and following a disaster/catastrophe will overwhelm everyone. People must understand that they cannot wait for a government, any government, to help them. We must be prepared to help ourselves.

Delivery of Health Care↗