[Organization of medical services for the victims of the earthquake in Armenian SSR].
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Armenia↗
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The rural interhospital disaster plan: some new solutions to old problems.
The rural area is not immune to multi-casualty incidents, and the complete rural EMS System reported here includes a plan to deal with one. The Susquehanna Valley Health Care Consortium was developed with this in mind, and addresses the points pertinent to the rural setting, including the large area served, available medical care, prehospital transport, and communications. Six hospitals in five counties participate. New approaches to these problems, which emerged after three field tests, are: participants must be organized for successful triage and resuscitation; crowd and traffic control by police is mandatory; an overall commander is necessary; two-way communication by several methods must be available; an administrator should track all victims; and air evacuation capability should be arranged.
Disaster Planning↗
Implications of psychological research on stress and technological accidents.
Psychological research on stress, disasters, and human-made technological accidents have important implications for policy, planning, and legal resolution of situations caused by environmental hazards. The incidence of technological accidents and catastrophes seems to have increased, and the biobehavioral sequelae of such accidents among victims have implications for mental and physical health as well as for intervention and prevention. In this article, research on the long-term effects of human-made disasters is discussed in the context of contributions that psychological research and theory can make in decisions regarding where potential hazards are located, how they are managed, and how accidents are handled. Unique psychophysiological processes associated with toxic accidents make these stressors more potent and likely to cause long-term uncertainty and chronic stress.
Accidents↗
Terrorist homicide bombings: a primer for preparation.
Contemporary planning for disaster response to terrorist events usually assumes the use of chemical, radiological, or biological weapons. Historically, most victims of terrorist attacks are injured by the use of conventional explosives rather than weapons of mass destruction. Such attacks will likely produce victims who have suffered burn injuries along with conventional trauma. Alternately, the large number of patients sustaining conventional soft-tissue or crush injuries will benefit from burn center expertise. This study summarizes the current state of knowledge related to the management of terrorism mass casualty incidents caused by the use of conventional explosives. A review of pertinent medical, technical, and popular literature relating to terrorism and explosives, along with instruction received at Hadassah Hospital, Jerusalem, Israel on the management of mass casualty terrorism events was undertaken, and the pertinent medical and scientific literature relating to bomb delivery methods, blast mechanics, blast pathophysiology, and medical response to a terrorist bombing is presented here. Although terrorist use of chemical, radiological, or biological weapons is possible, historical analysis consistently demonstrates that the most likely terrorist weapon causing a mass casualty event is a standard explosive device detonated in a crowded area. The medical basis for management of such casualties is herein described.
Amputation, Traumatic↗
Identification of exhumed remains of fire tragedy victims using conventional methods and autosomal/Y-chromosomal short tandem repeat DNA profiling.
In a fire tragedy in Manila in December 1998, one of the worst tragic incidents which resulted in the reported death of 23 children, identity could not be established initially resulting in the burial of still unidentified bodies. Underscoring the importance of identifying each of the human remains, the bodies were exhumed 3 months after the tragedy. We describe here our work, which was the first national case handled by local laboratories wherein conventional and molecular-based techniques were successfully applied in forensic identification. The study reports analysis of DNA obtained from skeletal remains exposed to conditions of burning, burial, and exhumation. DNA typing methods using autosomal and Y-chromosomal short tandem repeat (Y-STR) markers reinforced postmortem examinations using conventional identification techniques. The strategy resulted in the identification of 18 out of the 21 human remains analyzed, overcoming challenges encountered due to the absence of established procedures for the recovery of mass disaster remains. There was incomplete antemortem information to match the postmortem data obtained from the remains of 3 female child victims. Two victims were readily identified due to the availability of antemortem tissues. In the absence of this biologic material, parentage testing was performed using reference blood samples collected from parents and relatives. Data on patrilineal lineage based on common Y-STR haplotypes augmented autosomal DNA typing, particularly in deficiency cases.
Autopsy↗
[PTSD as result of the 1997 flood--occurrence and display of distemper].
AIM: The occurrence and course of PTSD in the countryside environment as the result of flood in 1997 has been described. The research was experimented around four villages by Nysa Kłodzka river-basin; the area was affected by disaster unexpectedly and extremely hard. METHOD: 97 people have been tested as the straightforward witnesses of flood. They had never been treated by a psychiatrist before 1997 and they haven't experienced any other stressful event that might have been an independent reason of the occurrence PTSD. The extent of trauma, risk of shock and the length of time that those examined were in danger was identical. None of the studied had received psychological or psychiatric support after the disaster. The research was carried out by one investigator (psychiatrist) 60-63 months after the flood at the victims' houses (the psychiatrist's visit was preceded by the phone appointment). The research instrument--Composite International Diagnostic Interview CIDI: section A (referred to demographic dates) and section N (referred to PTSD). RESULTS: PTSD diagnosis was made in 30.9% of the examined group. The distempered people are mostly educated at the lowest level (49.9% with the ground education) or unemployed (39.2%). Older people were more susceptible to PTSD. PTSD diagnosis was made more often for men (39.5%) than for women (25.4), what is directly related to the lower education and a worse material status of the examined men. Full symptomatic PTSD, remaining up to 60-63 months after the flood, was confirmed in 15.5% of the studied group. CONCLUSION: The frequency and profile of PTSD occurrence (lower educated, older and the poor people) in the examined group is consistent with the other studies done. The fact that PTSD diagnosis was more frequent amongst men (39.5% vs. 25.4% in women) has been mentioned and explained above. No person in the group has confirmed the short (lasting only up to one month) term of persistence of the symptoms what is tantamount to no acute stress disorder right after the flood. It might be probably caused by the permanence of flood destruction and the prolonged exposure to the stress factor.
Adult↗
Special report. The 1994 Southern California earthquake: its continuing impact on area hospitals and some lessons it can teach all hospitals on disaster preparedness.
The massive earthquake that rocked Southern California on January 17 left area hospitals facing both an influx of patients and heavily damaged facilities. Several hospitals were forced to shut down temporarily, although in most cases not before quake victims were triaged and other patients were safely transferred to other facilities. With damage totals still being calculated and repair projects just under way, several hospitals already are evaluating their response to the quake in an effort to be even more prepared should another disaster of that magnitude occur. This special report will provide an overview of the damages suffered by several hospitals; describe the role played by administrators and staff--particularly the security department--in the aftermath of the quake; and offer advice from hospital officials on how to best prepare for an earthquake or another natural disaster and how to function most effectively in the aftermath.
California↗
Katrina, the tsunami, and point-of-care testing: optimizing rapid response diagnosis in disasters.
We assessed how point-of-care testing (POCT), diagnostic testing at or near the site of patient care, can optimize diagnosis, triage, and patient monitoring during disasters. We surveyed 4 primary care units (PCUs) and 10 hospitals in provinces hit hardest by the tsunami in Thailand and 22 hospitals in Katrina-affected areas. We assessed POCT, critical care testing, critical values notification, demographics, and disaster responses. Limited availability and poor organization severely limited POCT use. The tsunami impacted 48 PCUs plus island and province hospitals, which lacked adequate diagnostic instruments. Sudden overload of critical victims and transportation failures caused excessive mortality. In New Orleans, LA, flooding hindered rescue teams that could have been POCT-equipped. US sea, land, and airborne rescue brought POCT instruments closer to flooded areas. Katrina demonstrated POCT value in disaster responses. We recommend handheld POCT, airborne critical care testing, and disaster-specific mobile medical units in small-world networks worldwide.
Diagnosis↗
[The most dramatic train accident in Denmark: Gentofte 1897].
One of the most dramatic train accidents in Denmark happened at a railway station close to midnight on the 11th of July 1897. Forty passengers were killed and approximately 150 people were more or less seriously wounded. Three different actors involved in the accident (a stoker of the collided engine, a journalist and a physician) have later described the scenario of the disaster according to their professional backgrounds. The principles of disaster management, the emergency response including a rather quick involvement from different types of relevant professions, the triage and the prehospital treatment of victims seemed to have been adequate according to the framework at that time. The descriptions refer shortly to the psychopathological reactions following a life threatening experience which today are well defined and described as symptoms of PTSD (Post Traumatic Stress Disorder).
Accidents↗
Telemedicine in trauma and disasters--from war to earthquake: are we ready?
Every year many disasters cause thousands of injuries, deaths, refugees. Earthquakes and war often cause severe injuries (burns; amputations; Crush-Syndrome; gunshots; landmines; nuclear, biological or chemical warfare / hazardous material; infectious diseases; pediatric specialties). Referring to big earthquakes in the last few years up to 20.000 thousand people were killed (India 2001). 310.000 deaths were caused by war in 2001. The Mass Casualty Incident is characterized by the disbalance between victims and the normal community emergency response. Because of this a lot of different institutions and organizations are involved in coping with the disaster. This produces an extensive demand of qualified Command, Control and Communication (C3). Furthermore a lot of data has to be collected during the treatment and the injuries need special medical treatment. The use of health telematics in disaster response helps to cope with the scenario. Modern technologies provide support for building up medical aid although the normal infrastructure is destroyed. To cope with disaster scenarios there are some telematic tools which can be used: computer based Command and Control System, telemedical support, and data-resources-network/Medical Intelligence. The International Center for Telemedicine at the University of Regensburg Medical Center provides support for Health Care Professionals as a competence center for telemedicine. For the eastern part of Bavaria it develops a telemedical network with many components: The mobile emergency care system NOAH (Notfall-Organisations- und Arbeits-Hilfe) supports the Emergency Medical Service. Local Health Networks and the Clinical Network of Eastern Bavaria connect physicians and hospitals with the Regensburg Medical Center. With an online-education tool participants from all over the country can take part in trainings and courses.
Computer Communication Networks↗
What happened in 1953? The Big Flood in the Netherlands in retrospect.
During the weekend of Saturday 31 January to Sunday 1 February 1953, a storm tide raged across the northwest European shelf and flooded the low-lying coastal areas of the countries around the North Sea. The peak high waters occurred during the night and the storm surprised many people in their sleep. The resulting disaster in terms of loss of life and damage to infrastructure was enormous. In the Netherlands, 1836 people fell victim to the flood; in the UK and Belgium, the casualties were 307 and 22, respectively. The large number of fatalities in the Netherlands was related to the fact that much of the affected area is below sea-level.This paper focuses on the case of the Netherlands. It discusses the history of land reclamation, and the fact that living in low-lying areas protected by dykes, often below sea-level, is an accepted fact of life in the Netherlands. The historical approach to dyke maintenance is then outlined, and the state of the dykes in the early twentieth century and after the war is discussed. The characteristics of the storm and the flood are discussed, along with people's experiences of the first hours and days following the flood. The impact of this human stress has often been lasting--many survivors continue to live with daily memories of the flood. Attention is given to the large-scale rescue and relief efforts, the closure of the dykes during the following nine months and the concept of the Delta Plan, designed to prevent such a large-scale disaster ever happening again. Although the 1953 storm was indeed a low probability event leading to very high storm-induced water-levels, and occurred in combination with spring tide, several arguments are presented that explain why this flood turned into a disaster of such a large scale. Equally, the question is raised whether the disaster could have been prevented. The paper concludes by noting the importance of awareness and preparedness in order to prevent a future storm threat of this scale turning into a disaster of the scope of the Big Flood of 1953.
Computer Simulation↗
Frequency of post-traumatic stress disorder among relief force workers after the tsunami in Asia: do rescuers become victims?
OBJECTIVE: The objective of this study was to evaluate the frequency of posttraumatic stress disorder (PTSD) among the participants of the Turkish Red Crescent Disaster Relief Team after the Tsunami in Asia. METHODS: The Clinician Administered PTSD Scale-1 (CAPS-1) was administered to 33 of 36 team members one month after their Disaster Relief Team duty. Along with the CAPS-1 interview, demographic features, profession, previous professional experience, previous experience with traumatic events and disasters also were recorded. To be classified as present, a symptom must have a frequency score of "1" and an intensity score of "2" at the CAPS-1 interview. For a diagnosis of PTSD, at least one re-experiencing, three avoidance and numbing, and two increased arousal symptoms should be present. RESULTS: The PTSD was diagnosed in eight of the 33 (24.2%) participants. No significant difference was detected in the distribution of PTSD diagnosis according to gender, age, profession, professional experience, previous disaster experience, and/or previous experience of traumatic events. However, the severity of PTSD symptoms as measured by the CAPS-1 score was significantly higher in women, nurses, and participants with <3 previous disaster duty experiences. CONCLUSION: Post-traumatic stress disorder is prevalent within disaster teams and healthcare workers, and measures should be taken to prevent PTSD within this group.
Adult↗
Symposium--commemoration of the liberation of the Bergen-Belsen Concentration Camp and medical management of disasters study period.
Over the period 15/16 April 1998 a commemorative dinner and study period was held to recognise the role of the medical services in the management of the victims of the Bergen-Belsen Concentration Camp. Having been presented with a framework for planning medical support to these situations, one of the London medical students at Belsen in 1945 related his own experience at this unprecedented and horrific scene. Following this, the lessons that may be drawn were examined, the key factor being the need to create order out of chaos. The system used by the military for analysing what has to be achieved in a given situation, and the deductions that can be made from the prevailing factors, called the Estimate Process, emerged as a model for planning the medical contribution to disaster relief.
Concentration Camps↗
Information-sharing in out-of-hospital disaster response: the future role of information technology.
Numerous examples exist of the benefits of the timely access to information in emergencies and disasters. Information technology (IT) is playing an increasingly important role in information-sharing during emergencies and disasters. The effective use of IT in out-of-hospital (OOH) disaster response is accompanied by numerous challenges at the human, applications, communication, and security levels. Most reports of IT applications to emergencies or disasters to date, concern applications that are hospital-based or occur during non-response phases of events (i.e., mitigation, planning and preparedness, or recovery phases). Few reports address the application of IT to OOH disaster response. Wireless peer networks that involve ad hoc wireless routing networks and peer-to-peer application architectures offer a promising solution to the many challenges of information-sharing in OOH disaster response. These networks offer several services that are likely to improve information-sharing in OOH emergency response, including needs and capacity assessment databases, victim tracking, event logging, information retrieval, and overall incident management system support.
Computer Communication Networks↗
Terrorism preparedness training for occupational health professionals.
OBJECTIVE: The objective of this study was to assess occupational health professionals' terrorism preparedness and perceptions of worksite readiness. METHODS: Questionnaire data were collected at the conclusion of an educational workshop on disaster response. RESULTS: Participants reported increased confidence in clinical skills and the ability to avoid exposure while providing care to victims of terrorist attacks as a result of the workshop. Fewer than one third (32%) of participants reported that their employer was prepared for a bioterrorism attack, and a large percentage (75%) reported feeling unprepared to provide mental health counseling after a terrorist attack. CONCLUSIONS: Relatively brief training in terrorism preparedness can increase the confidence of occupational health professionals in their ability to respond to terrorism. Adequate preparedness for the broad range of potential terrorist events may require much more intensive training than is currently being provided to occupational health professionals.
Attitude of Health Personnel↗
Ethics and triage.
A disaster is characterized by an imbalance between needs and supplies. In circumstances in which there occur mass casualties, it is not possible to provide care for all of the victims. Thus, it may be necessary to triage the casualties according to pre-established priorities. The performance of triage is associated with many ethical issues. Currently, no Europe-wide agreement on triage and ethics exists. One system based on a categorization into four groups is proposed. Triage should be avoided whenever possible, but, when it is required, there is an obligation to respect human rights and the humanitarian laws, especially with reference to the Geneva Convention of 1864 and the Universal Declaration of Human Rights of 1948. The condition of informed consent must be followed, even in mass casualty situations. Triage always must follow established medical criteria and cannot be based on any other principles. Triage implies constant re-evaluation of victims as conditions of the victims and of available resources change continuously. In order to facilitate international coordination and cooperation, a universal classification system must be adopted.
Disaster Planning↗
Civil society and the state: Turkey after the earthquake.
On 17 August 1999 Turkey was hit by a massive earthquake. Over 17,000 lives were lost and there was extensive damage to Turkey's heartland. This paper examines how various public and private institutions, including state and civil society institutions such as NGOs and the media responded to the needs of earthquake survivors. It documents the extensive involvement of NGOs in the relief efforts immediately after the disaster and examines the impact of such participation on state-civil society relations in the country. The data show that state response to the disaster went through several phases from a period of ineptitude to effective management. The paper credits the media and the NGOs for acting as advocates for survivors and forcing changes at the state level. The paper argues that an ideal response system, which fully addresses the needs of victims, can only be based on state-civil society relations that are both collaborative and adversarial.
Disasters↗
Psychiatric reactions to disaster: the Mount St. Helens experience.
Following the 1980 Mount St. Helens volcanic eruption, psychiatric reactions were studied in the disaster area and in a control community. Using the new criterion-based diagnostic method for psychiatric epidemiologic research, the Diagnostic Interview Schedule, the authors found a significant prevalence of disaster-related psychiatric disorders. These Mount St. Helens disorders included depression, generalized anxiety, and posttraumatic stress reaction. There was a progressive "dose-response" relationship in the comparison of control, low-exposure, and high-exposure groups. The dose-response pattern occurred among both the bereaved and the property-loss victims.
Adolescent↗