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Coordination learning in stag hunt games with application to emergency management.

Response teams for natural disaster emergencies require coordinated and self-organized efforts for rescue, medical services, damage containment, and evacuation. The unfolding of events depends on initial conditions of specific time, location, and preparedness of the response teams. This study considered a new range of emergency response situations where the perpetrator is a sentient attacker that learns with repeated exchanges. The strategy is conceptualized as a stag hunt coordination game on the part of the defense agents and a strictly competitive game with respect to the attacking adversary. Participants were 28 university students who played an iterative board game (The Creature that Ate Sheboygan) wherein a team of three Humans represented military and civil resources, against one Godzilla-type monster. The Monster gained points by destroying buildings and human combat power. The Humans gained points by wearing down the Monster's defenses and containing damage caused by the Monster. Experimental manipulations and empirical analysis showed the following: Communication outages among the Humans assisted the Monster, but the ability to communicate only equalized the Humans' chances rather than providing them with an advantage. Coordination among Humans was instant, but it fluctuated greatly as a result of the Monster's progress. Nonlinear analysis showed an asymptotic decline in coordination to a non-zero level in response to outcome uncertainty. Learning effects were noted for Humans and Monsters, but there were significant interactions with communication blackout conditions

Adult↗

Transfer regulations and cost-effectiveness analysis.

Recent scholarship on regulatory oversight has focused on cost-benefit analysis of prescriptive regulations--regulations that restrict behavior such as pollution--and their use to cure market failures, and has overlooked the vast number of transfer regulations. Transfer regulations are regulations that channel funds to beneficiaries. These regulations are authorized by statutes that establish entitlement programs like Medicare and Social Security, pay one-time distributions to victims of misfortunes such as natural disasters and the 9/11 terrorist attack, and fund pork barrel spending. Cost-benefit analysis cannot be used to evaluate transfer regulations because all transfer regulations fail cost-benefit analysis; cost-effectiveness analysis, however, can be used to evaluate transfer regulations. Although executive orders appear to require agencies to use cost-effectiveness analysis to evaluate transfer regulations that have a large economic impact, the agencies' record is dismal. Most agencies fail to perform cost-effectiveness analysis, and other agencies perform cost-effectiveness analysis incorrectly. More vigorous Office of Management and Budget and, possibly, judicial review could improve the quality of distributive regulations.

Budgets↗

[An efficacy study of a TPN kit with multivitamin additive in the HPN].

When home parenteral nutrition (HPN) is instituted, one should aim at reducing the risk of infections, simplifying the operation, and improving the patient's QOL, while considering the differences between the hospital and home. As for simplification of the operation, the problem is who and when to prepare the TPN while paying attention to the stability of multivitamins. Recently, a TPN kit that includes multivitamins and does not need a syringe or an injection needle to add vitamins to the TPN preparation was launched. Accordingly, we conducted a study to examine the simplicity of the procedure and usefulness of the product on the basis of time required to add other components to the TPN preparation, as assessed by questionnaire. The subjects of the study were medical care providers as well as patients on HPN and their families. The time required for TPN admixtures was significantly shorter compared with the conventional method. According to the questionnaire, the storability and easiness of the procedure were particularly highly appreciated. This product has the advantage that sterility can be maintained at home, that contamination with foreign bodies can be reduced, and that it can be stored at room temperature. Since it can be preserved in preparation for natural disasters and can be carried around during travel, it is expected to improve the QOL of patients on HPN and their families.

Humans↗

Preliminary medical examiner reports of mortality associated with Hurricane Charley--Florida, 2004.

On August 13, 2004, at approximately 3:45 p.m. EDT, Hurricane Charley made landfall at Cayo Costa, a Gulf of Mexico barrier island west of Cape Coral, Florida, as a Category 4 storm, with sustained winds estimated at 145 mph. Charley was the strongest hurricane to make landfall in the United States since Hurricane Andrew in August 1992. Charley created a 7-foot storm surge in Fort Myers, then traversed the state in 9 hours, continuing in a northeast direction across eight counties. This report presents preliminary data from Florida medical examiners (MEs), which indicated that 31 deaths were associated with Hurricane Charley. Deaths might be reduced through coordinated hurricane planning, focused evacuations, and advance communication to the public regarding the environmental hazards after a natural disaster.

Adolescent↗

Trauma reactions of bystanders and victims to repetitive abuse experiences.

This study investigated psychological distress as measured by the Impact of Events Scale-Revised and physiological reactivity as measured by skin conductance and heart rate in bystanders as compared to direct victims of prevalent forms of repetitive abuse (e.g., bullying). Participants (N = 77) were interviewed twice: once to recall witnessing another person be abused repeatedly over time, and again to recall similar experiences as a victim. Present levels for bystander and victim distress were not significantly different, but distress levels were significantly greater for victim experiences at the time the repetitive abuse occurred. Scores for both groups were comparable to or exceeded scores associated with natural disasters and other life threatening experiences reported in the literature. Findings suggest repetitive abuse may affect bystanders and victims in similarly serious ways at the time the events occur and later in life.

Adolescent↗

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↗

Acute illness from dry ice exposure during hurricane Ivan--Alabama, 2004.

Natural disasters such as hurricanes often impair delivery of essential services, including electricity. When normal refrigeration methods are unavailable, affected populations seek alternative means of protecting perishable foodstuffs. One alternative is to use frozen carbon dioxide (CO2) (i.e., dry ice).

Adult↗

[The symptoms of PTSD, depression and anxiety in adolescent students three and a half years after the Marmara earthquake].

OBJECTIVE: To screen the symptoms of posttraumatic stress disorder (PTSD), depression and anxiety in adolescent students three and a half years after the Marmara earthquake in Turkey. METHOD: Overall 334 students were selected from secondary schools located within Kocaeli province in Turkey, three and a half year after a severe earthquake. They were chosen to participate in this cross-sectional study by simple random sampling. The students were evaluated by the Child Posttraumatic Stress Reaction Index (CPTSD-RI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI). Additionally, an information form was filled out by the students. RESULTS: Of the 334 students we found that 1.8% had very severe, 20.4% had severe, 38.3% had moderate and 30.2% had mild symptoms of PTSD and that 22.2% had probable PTSD and 30.8% had probable depression diagnoses. The frequency and intensity of re-experiencing and hyperarousal symptoms were considerably high on CPTSD-RI. The mean grades of anxiety measures were higher than that of the normal population. A significant correlation was determined between PTSD, depression and anxiety. CONCLUSION: The symptoms of PTSD depression and anxiety may continue for years after natural disasters. Hence, prevention studies and the screening of children and adolescents after disasters are important for the mental health of the community.

Adolescent↗

[An algorithm of computerized processing of molecular-genetic data for personality identification based on the outcome of events involving numerous victims].

Computerized systems of data processing are a high-efficiency tool for the storage and processing of big volumes of molecular genetic data as well as for the forensic medical identification of personality in events involving enormous unidentified bodies coming from zones of calamity or natural disaster. Described in the paper is a sequence of actions undertaken by the expert when the DNAdacto and mDNAbase soft tools are in use. The algorithm of computer-based expert analysis of typing of chromosome and mitochondrial DNA was tested at the 124th Central laboratory of medical-criminal identification of Russia's defense ministry; it was proven to be highly effective for identification made in events with numerous unidentified bodies.

Algorithms↗

[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↗

Integration of cognitive and personality-based conceptualization and treatment of psychological trauma.

In the wake of the numerous terrorist attacks and horrific natural disasters that have occurred beginning on September 11, 2001, there has been increased interest in the effects of trauma, including posttraumatic stress disorder (PTSD). The purpose of this article is to provide an overview of a synergistic multicomponent approach to therapy that incorporates the integrated use of cognitive and personality-guided approaches to conceptualizing and treating psychological trauma. With Millon's personality classification system serving as a foundation, a case example is provided along with an explanation of the therapeutic stages beginning with establishing the therapeutic alliance to decreasing hyperarousal to restoring assumptive worldviews.

Attitude to Health↗

Building a campus crisis team.

Crisis events can produce waves of shock, fear, and disbelief throughout a community. The university campus is a community and no stranger to crisis events. Incidents such as natural disasters, bus accidents, fire, and death on campus have demonstrated this fact. Communities, including the university, are becoming more aware of the need to develop plans to respond to these crisis events. Communities that are prepared to respond to such events may moderate the impact that the crisis has on a community. This article discusses the issues confronted by a small liberal arts university's faculty and staff as they worked together to develop and sustain a crisis response team.

Cooperative Behavior↗

Competence necessary for Japanese public health center directors in responding to public health emergencies.

OBJECTIVE: To clarify the "competencies" required of public health center directors in "public health emergency responses." METHODS: We selected as our subjects six major public health emergencies in Japan that accorded with a definition of a "health crisis." Their types were: (1) natural disaster; (2) exposure to toxic substances caused by individuals; (3) food poisoning; and (4) accidental hospital infection. Item analysis was conducted using the Incident Analysis Method, based on the "Medical SAFER Technique." RESULTS: The competencies of public health center directors required the following actions: (1) to estimate the impact on local health from the "first notification" of the occurrence and the "initial investigation"; (2) to manage a thorough investigation of causes; (3) to manage organizations undertaking countermeasures; (4) to promptly provide precise information on countermeasures, etc.; and (5) to create systems enabling effective application of countermeasures against recurrence of incidents, and to achieve social consensus. CONCLUSION: For public health preparedness, public health center directors should have the following competencies: (1) the ability to estimate the "impact" of public health emergencies that have occurred or may occur; (2) be able to establish and carry out proactive policies; (3) be persuasive; and (4) have organizational management skills.

Disaster Planning↗

Assessment of health-related needs after tsunami and earthquake--three districts, Aceh Province, Indonesia, July-August 2005.

On December 26, 2004, an earthquake measuring 9.2 on the Richter scale off the northwest coast of the island of Sumatra, Indonesia, produced a tsunami that caused the deaths of an estimated 230,000 persons in India, Indonesia, the Maldives, Somalia, Sri Lanka, and Thailand. The majority of casualties were in Aceh Province (population 4.5 million) in northern Sumatra, Indonesia, where an estimated 130,000 persons died. In addition, 500,000 persons were displaced from their homes, and 37,000 remain unaccounted for in the province. In the Aceh Province districts of Banda Aceh and Aceh Besar, an estimated 90,000 persons died; approximately 75% of health workers in Banda Aceh either died or were displaced from their homes. On March 28, 2005, a second major earthquake, measuring 8.7 on the Richter scale, caused large-scale damage to the islands of Simeulue and Nias off the western Sumatra coast; approximately 300 persons died, and thousands were displaced. The international community responded to these events with the largest relief measures ever undertaken for a natural disaster. To determine the health and nutrition status of the affected populations and to evaluate the effectiveness of relief interventions 7 months after the tsunami and 3 months after the second earthquake, Cooperative for Assistance and Relief Everywhere, Inc. (CARE) International Indonesia and CDC conducted surveys in three districts of Aceh Province (Aceh Besar, Banda Aceh, and Simeulue). This report summarizes the results of those surveys, which identified routine vaccinations and provision of toilets or latrines as particular areas for improvement and revealed no significant difference in health indicators between internally displaced persons (IDPs) and nondisplaced populations. The relief response in Aceh Province should target areas needing improvement with programs that serve both IDPs and nondisplaced persons, as measures are implemented to rebuild the public health infrastructure.

Adolescent↗

Public health response to Hurricanes Katrina and Rita--United States, 2005.

On August 29, 2005, Hurricane Katrina struck the U.S. Gulf Coast, the eye making landfall at Plaquemines Parish, Louisiana . The events that followed made Katrina the deadliest hurricane since 1928 and likely the costliest natural disaster on record in the United States. Devastating storm surge, strong winds, and heavy rains caused widespread destruction in Louisiana, Mississippi, Alabama, and Florida. Storm-induced breeches in the levee system surrounding New Orleans flooded 80% of the city. The disaster was compounded when Hurricane Rita made landfall 26 days later near the Texas-Louisiana border, forcing cessation of hurricane-response activities in New Orleans and evacuation of coastal regions of Louisiana and Texas. The economic and health consequences of Hurricanes Katrina and Rita extended beyond the Gulf region to affect states and communities throughout the United States. MMWR is highlighting the public health response to Hurricanes Katrina and Rita with two special issues. The first issue, published January 20, 2006, focused on public health activities in Louisiana. This second issue focuses on activities in other states directly or indirectly affected by the two hurricanes.

Disasters↗

Rapid community needs assessment after Hurricane Katrina--Hancock County, Mississippi, September 14-15, 2005.

On August 29, 2005, Hurricane Katrina moved northeast from Louisiana and made its second landfall over Hancock County, Mississippi, with measured wind speeds as high as 132 mph. Katrina's strong winds and high storm surge (an estimated 27 feet in Hancock County) ravaged the Mississippi coast, making it one of the strongest storms to strike the United States during the past 100 years and likely the nation's costliest natural disaster to date. Hurricane Katrina left thousands of residents without shelter, food, water, utilities, and access to health care. To obtain information about the effects of the hurricane on residents in Hancock County, the Mississippi Department of Health (MDH) asked CDC to conduct a rapid community needs assessment in what was presumed to be the state's most severely affected county. The objectives of the assessment were to 1) identify the public health needs of the community and 2) estimate the effect of the hurricane on households to assist response and recovery activities. This report describes the results of that assessment, which indicated that more than one third of the homes had been destroyed, many in the area lacked critical household services and remained dependent on relief agencies, and some were in need of health services such as medical care and prescription refills.

Disasters↗

Mortality associated with Hurricane Katrina--Florida and Alabama, August-October 2005.

On August 25, 2005, Hurricane Katrina made landfall between Hallandale Beach and Aventura, Florida, as a Category 1 hurricane, with sustained winds of 80 mph. Storm effects, primarily rain, flooding, and high winds, were substantial; certain areas reported nearly 12 inches of rainfall. After crossing southern Florida and entering the Gulf of Mexico, the hurricane strengthened and made landfall in southeastern Louisiana on August 29 as a Category 3 hurricane, with sustained winds of 125 mph. Katrina was one of the strongest hurricanes to strike the United States during the past 100 years and was likely the nation's costliest natural disaster to date. This report summarizes findings and recommendations from a review of mortality records of Florida's Medical Examiners Commission (FMEC) and the Alabama Department of Forensic Science (ADFS). CDC was invited by the Florida Department of Health (FDOH) and the Alabama Department of Public Health (ADPH) to assess the mortality related to Hurricane Katrina. The mortality review was intended to provide county-based information that would be used to 1) define the impact of the hurricane, 2) describe the etiology of deaths, and 3) identify strategies to prevent or reduce future hurricane-related mortality. Combined, both agencies identified five, 23, and 10 deaths, respectively, that were directly, indirectly, or possibly related to Hurricane Katrina. Information from the characterization of these deaths will be used to reduce hurricane-related mortality through early community awareness of hurricane-related risk, prevention measures, and effective communication of a coordinated hurricane response plan.

Alabama↗

Rapid assessment of health needs and resettlement plans among Hurricane Katrina evacuees--San Antonio, Texas, September 2005.

Hurricane Katrina struck the coastal regions of Alabama, Florida, Louisiana, and Mississippi on August 29, 2005, resulting in one of the worst natural disasters in U.S. history. The city of New Orleans, Louisiana, was further damaged by severe flooding when major levees broke and released water from Lake Pontchartrain. Residents were evacuated to neighboring states and cities, including San Antonio, Texas. On September 3, 2005, approximately 12,700 evacuees arrived in San Antonio and were housed in four primary evacuation centers (ECs). Although many evacuees in San Antonio soon found other accommodations, as of September 16, 2005, approximately 3,700 evacuees remained in ECs awaiting resumption of public services in New Orleans. To assess evacuee needs for clinical care, public health services, and housing assistance, the San Antonio Metropolitan Health District (Metro Health) requested CDC assistance to conduct a needs assessment of heads of households in the ECs. This report summarizes the findings of that survey, which identified substantial numbers of evacuees with chronic health conditions, physical or mental disabilities, and needs for counseling and housing assistance. The findings underscore the need to augment local public health and public assistance resources to address ongoing health and housing needs of evacuee populations.

Disasters↗