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PubMed2006

A history of biological disasters of animal origin in North America.

This paper examines past occurrences in North America relevant to the possibility of biological disasters with animal origins. With respect to naturally occurring animal disease outbreaks, North America, while not as adversely affected by epizootics as other regions, has had its fair share of such outbreaks of both 'traditional' and emerging animal diseases. The traditional category includes such diseases as anthrax, classical swine fever, bluetongue, brucellosis, foot and mouth disease, and the family of equine encephalomyelitis viruses. The emerging diseases include relatively more recent culprits such as postweaning multisystemic wasting syndrome, poultry enteritis mortality syndrome, and newly discovered examples of the transmissible spongiform encephalopathies. Additionally, several serious diseases of human beings that involve animal vectors or reservoirs occur naturally in North America or have emerged in recent decades; these include plague, hantavirus, monkeypox, West Nile virus and avian-derived influenza. At the same time, there have been very few intentional attacks on livestock using biological agents and no recorded cases in North America of animals intentionally being used to transmit disease to humans. According to the historical record, therefore, naturally occurring emerging zoonoses probably constitute the greatest threat in terms of biological disasters with animal origins. However, some of the general trends in terrorist activity, such as the intensification of activities by animal rights extremists against facilities undertaking animal research, mean that the possibility of intentional animal-related biological disasters should not be discounted.

Animal Diseases↗
PubMed2003

The aftermath of a disaster. Recovery following the volcanic eruptions in Montserrat, West Indies.

The people of Montserrat have experienced serious volcanic eruptions since the middle of 1995. These resulted in the evacuation of the capital town Plymouth in 1997. An exclusion zone was declared and two-thirds of the original population of 10,324 migrated abroad. The remainder was left to initiate the recovery process. This paper reviews the action taken to maintain and then restore the health services and the health of the people. The recovery process is now well advanced and is following a characteristic pattern described as the Post Disaster Recovery Scenario. A new hospital was set up in the North of the island and the four remaining clinics refurbished. The health service was restored to a reasonable standard by the end of 2000. A Disaster Preparedness Team is kept on full alert to deal with any emergencies. The disaster caused serious disruption to the health services and to the way of life of the people. It had a number of adverse health effects which included immediate harm to respiratory health followed by other more serious problems such as mental illness, poor nutrition and violence. These were due to the disruption caused by resettlement, overcrowding, breakdown of family life and economic hardship. The lessons learned may be of benefit to countries experiencing similar events in the future.

Adolescent↗
PubMed2004

Possible distinct molecular carcinogenic pathways for bladder cancer in Ukraine, before and after the Chernobyl disaster.

After the Chernobyl accident in 1986, the incidence of urinary bladder cancers in the Ukraine increased gradually from 26.2 to 43.3 per 100,000 people between 1986 and 2001. In the areas of low level but persistent cesium-137 (137Cs) radio-contamination, a unique atypical radiation-related urinary bladder cystitis named 'Chernobyl cystitis', a possible pre-neoplastic condition in humans, has been detected. We have previously documented high incidences of bladder lesions, including severe dysplasias and/or carcinoma in situ, in association with this cystitis and correlating with oxidative DNA damage. To further investigate the molecular mechanisms underlying bladder carcinogenesis with this specific etiology, mutation analysis of p53 gene (exon 5-8) was performed for 11 and 18 paraffin-embedded bladder cancers in Ukrainians, respectively collected before and after the Chernobyl disaster. DNAs were extracted and subjected to nested PCR-single-strand conformational polymorphism analysis followed by direct DNA sequencing, as well as p53 immunohistochemistry (IHC). The incidences of p53 gene mutation were 54.5 and 16.7% for before and after the Chernobyl disaster, respectively, the difference being statistically significant. Also a tendency for higher p53 IHC score was apparent in the earlier group of lesions. No significant difference was noted for the proportions of historical types. These results point to possible distinct molecular carcinogenic pathways of bladder cancer formation, before and after the Chernobyl disaster, on the basis of variation in p53 gene alteration.

Adult↗
PubMedDate not supplied

Preparation for a fire disaster in a long-term care facility. A staff development perspective.

An important function of any staff development program is to provide instruction in fire and disaster prevention and safety, especially in long-term care facilities where the residents are often confused or unable to remove themselves from the disaster area. However, disaster evacuation drills are seldom conducted in these facilities because of stress on the elderly. This article describes the steps involved in conducting an evacuation drill in a nursing home and the benefits of such a learning experience.

Fires↗
PubMed1993

Psychosocial care and shelter following the Bijlmermeer air disaster.

This article describes the organization of the psychosocial aid and aftercare for survivors in the context of the Bijlmermeer air disaster that took place in 1992 in Amsterdam, The Netherlands. It is based on an examination of the relevant city documents and media coverage, and on interviews with city officials and disaster workers. The aid operation was complicated by the fact that the disaster struck a socially vulnerable multicultural community. The experiences illustrate the difficulties involved in coordinating the psychosocial care and aftercare provided by different agencies, and suggest a need for ample planning and training in this respect. In addition, they point to the importance of tailoring interventions to survivors' specific needs, careful registration of survivors and helpers, and limitation of the number of shelters and the distance between them. Finally, a two-edged strategy for dealing with the news media is advocated. Survivors should be maximally protected, but at the same time the press must be regularly and appropriately briefed, in order to use their potential for disseminating information to the survivors and the public.

Accidents, Aviation↗
PubMed1998

Injuries and illnesses in working dogs used during the disaster response after the bombing in Oklahoma City.

OBJECTIVES: To determine characteristics of working dogs used during the disaster response after the bombing in Oklahoma City and risk factors for injuries and illnesses of those dogs, and to document recommendations for future disaster responses. DESIGN: Survey. STUDY POPULATION: Information for 74 working dogs used at the bombing site. PROCEDURES: Dog handlers were identified and asked to complete a questionnaire. Questions were asked about the training and use of each dog, use of paw protection, injuries and illnesses incurred, possible effects after completion of duty at Oklahoma City, and handler's experience. RESULTS: Data were obtained for all 74 dogs used at the site. Handlers of 69 of 74 (93%) dogs responded. The dogs had been extensively trained and were used 491 dog-days at the site, with 46 dogs used in search, 14 in patrol, 12 in explosive-detection duty, and 2 in search/patrol. Fifteen (22%) dogs became ill. Nineteen (28%) dogs incurred 20 injuries. Footpad injuries constituted 18 of the injuries. Only 16 of 69 (23%) dogs were provided with paw protection. Dogs were more likely to be injured when they were used in a search capacity, were used during the first 2 days after the bombing, were German Shepherd Dogs, or were older. CLINICAL IMPLICATIONS: Although working in a high-risk environment, injuries to dogs were few, and most were minor. Specific recommendations could facilitate use of dogs in disaster situations and improve safety for those dogs.

Animals↗
PubMed1992

The "Scandinavian Star" ferry disaster 1990--a challenge to forensic odontology.

With 158 victims, the fire on board the "Scandinavian Star" was one of the world's worst ferry disasters. A team of identification experts, including dentists, were employed to secure evidence for identification and to remove the victims from the ferry. Four parallel teams, each with 2 dentists, examined and autopsied the victims at the Institute of Forensic Medicine, University of Oslo. Using the INTERPOL Disaster Victim Identification forms and aided by computers, all victims were identified within 17 days. Dental identity could be established in 107 cases (68%).

Adolescent↗
PubMed2005

Public participation mechanisms in environmental disasters.

This paper examines the role of public participation mechanisms in certain major environmental disasters. It examines situations in which people's lifestyles or their lives have been directly threatened, and thus elicited citizen participation. Threatening issues often seem morally, physically, socially, economically, religiously, and otherwise unacceptable to a group. As will be presented in this paper, citizens voluntarily participate in a community activity when they see that their way of life has been threatened. An introductory historical perspective, the legal framework upon which it is based, and background information on the participatory mechanisms, all emphasizing the importance and need for empowering citizens with participatory skills so as to bring changes in the existing educational, legal, and social systems are presented. The major environmental accidents/disasters of Minamata, Japan; Bhopal, India; Seveso, Italy; Chernobyl, Ukraine; and Exxon-Valdez, Alaska are discussed, mainly to indicate the reaction, and the participatory mechanisms used by the affected communities in each of the sudden disasters that occurred. If citizens worldwide had been active participants in the environmental issues, it is quite possible that we would have experienced fewer environmental accidents.

Accidents↗
PubMed1993

Health related response to natural disasters: the case of the Bangladesh cyclone of 1991.

This paper evaluates the health related response to large natural disasters using the example of the recent Bangladesh cyclone of 1991. After providing a description of the extent of the health response, it focuses on three major issues: (i) assessment of needs (ii) coordination of major groups involved in health relief and rehabilitation efforts and (iii) appropriateness and effectiveness of the health response in terms of definable outcome criteria. The conclusions are that in the case of the Bangladesh cyclone: (a) the assessment of needs was more reactive rather than anticipatory and was not based on any systematic data gathering from the field; (b) in contrast to previous disaster situations there was excellent coordination of the major groups involved in the aid process (the government, the armed forces and non-governmental organizations) and (c) given the caveat of inadequate baseline information, it appears that the health response was prompt and effective in preventing any increase in mortality from diarrheal diseases and measles. The reasons for the deficiencies and successes of the health response are analysed and finally a list of detailed recommendations to facilitate future disaster/cyclone management and response is provided.

Bangladesh↗
PubMed2006

Nurses and emergency disasters: what is known.

Following the events of September 11, 2001, the threat of bioterrorism events has become a realistic concern for health care workers in the United States. Bioterrorism events caused by infectious agents will be challenging because nurses will need to recognize unfamiliar infections and work long hours with limited resources in stressful conditions. During a bioterrorism event caused by biologic agents, nurses will be expected to provide care to infected patients and may fear that they, or their families, could also become infected. A review of literature suggests that nurses' response to working during a bioterrorism event is not well described. The limited number of studies regarding nurses' concerns, fears, and anxieties is focused on nurses' experiences in natural disaster or war situations. Additional studies are needed to validate the appropriateness of applying findings from disaster response studies to bioterrorism events. During bioterrorism events, nurses will be expected to provide physical care and emotional and psychologic support for victims and victims' families. Realistic bioterrorism plans should incorporate strategies to support nurses and address their physical, psychologic, and emotional issues. Strategies to optimize safe working conditions and minimize psychologic trauma such as technical training regarding bioterrorism agents and debriefing opportunities should be included.

Attitude of Health Personnel↗
PubMed2005

The human factors in a disaster.

Although natural disasters are claiming fewer lives now than even as recently as 30 years ago, they remain responsible for many premature deaths, most in third-world countries. This article highlights the relationship of human factors that can be found with third-world disasters and reviews interventions that have been used to reduce illness, injuries and deaths.

Developing Countries↗
PubMedDate not supplied

The threat of communicable diseases following natural disasters: a public health response.

Natural disasters, such as the recent Indian Ocean tsunami, can have a rapid onset, broad impact, and produce many factors that work synergistically to increase the risk of morbidity and mortality caused by communicable diseases. The primary goal of emergency health interventions is to prevent epidemics and improve deteriorating health conditions among the population affected. Morbidity and mortality due to infectious diseases can be minimized providing these intervention efforts are implemented in a timely and coordinated fashion. This article presents a review of some of the major issues relevant to preparedness and response for natural disasters.

Communicable Disease Control↗
PubMedDate not supplied

Realities of disaster preparedness in rural hospitals.

Disaster preparedness has always been an area of major concern for the medical community, but recent world events have prompted an increased interest. The health care system must respond to disasters of all types, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. This study examines the experiences of rural hospital emergency departments with threat preparedness. Data were gathered through a nationwide survey to describe emergency department experience with specific incidents, as well as the frequency of occurrence of these events. Expanding surge capacity of hospitals and developing a community-wide response to natural or human-made incidents is crucial in mitigating long-term effects on the health care system. Analysis of preparedness activities will help identify common themes to better prioritize preparedness activities and maximize a hospital's response capabilities.

Attitude of Health Personnel↗
PubMedDate not supplied

Ukranian's Disaster Medicine Team Mission to India following the earthquake of 2001.

This article describes the basic principles around establishing a Disaster Medicine Camp and the organization of the Ukrainian Disaster Medicine Mobile Hospital, which provided medical aid to victims of the 2001 earthquake in India. All of the information was obtained through direct observation and estimates based on empirical data gathered in the field.

Disaster Planning↗
PubMedDate not supplied

An analysis of prehospital mortality in an earthquake. Disaster Reanimatology Study Group.

INTRODUCTION: Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy. METHODS: A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991. RESULTS: Fifty-four deaths occurred prior to hospitalization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two percent (2/9) were judged preventable if earlier emergency medical care had been available. Most injuries and deaths occurred in victims who were inside wooden buildings (p < .01) as opposed to other building types or were pinned by rubble from building collapse. Autopsies performed on a sample of victims showed crush injury to be the predominant cause of death. CONCLUSIONS: A substantial proportion of earthquake mortality in Costa Rica was protracted. Crush injury was the principal mechanism of injury and cause of death. The rapid institution of enhanced prehospital emergency medical services may be associated with a significant life-saving potential in these events.

Adolescent↗
PubMed2001

Australian major incident nomenclature: it may be a 'disaster' but in an 'emergency' it is just a mess.

BACKGROUND: A standardized major incident nomenclature has practical applications for medical communication and audit of the medical response to incidents. METHODS: A telephone and fax survey of major incident nomenclature in State and Territory health service emergency management plans and 'disaster' legislation was carried out on 13 August 1999. RESULTS: Within Australia there were a total of 13 different terms to describe incidents that could produce casualties: there were four definitions of the word 'disaster', eight definitions of the word 'emergency' and one definition of the word 'incident'. CONCLUSION: Australia lacks a uniform system of classifying and recording mass casualty incidents. This prevents both the independent clinical audit of the medical response to an incident and the cross-border comparison of the effectiveness of trauma systems to deal with multiple casualties. Australia's geography highlights the need to develop a nomenclature that allows medical practitioners, in isolated environments, to accurately describe an incident and the medical support that is required. The Potential Injury-Creating Event (PICE) nomenclature is a simple system to describe the functional impact of an event upon a community and the level of medical support required. It can be used to provide the basis for the uniform reporting of the medical management of major incidents within Australia.

Australia↗
PubMed2003

Disaster nephrology: medical perspective.

Disaster medicine is an extension of emergency medicine involving mass casualties and use of the best available techniques in search and rescue. To achieve the best results extensive predisaster preparedness is mandatory. Earthquakes have caused the loss of more than 1 million lives in the 20th century. Evidence-based medicine confirms that these deaths were mostly preventable based on experience in developed countries. The key to success is implementing building codes and structural reinforcement. In earthquakes as well as in collapse of buildings in bomb blasts, loss of life is either because of the direct effect of trauma or to the metabolic consequences of rhabdomyolysis and complications of its management. Hyperkalemia and infection are the commonest causes of death in victims who survive the direct effect of trauma. Acute renal failure, a grave complication of rhabdomyolysis, is mostly preventable by timely rehydration and bicarbonate therapy. Mannitol therapy can be very efficient in reducing the severity of muscle damage and its sequelae. Fasciotomy can be limb saving if it is done in the early hours, although a firm guideline is still lacking. Although each country is responsible for improving the structure of buildings and organizing an efficient disaster response, national and international organizations in developed countries should give high priority to communicating with developing countries to encourage their preparedness.

Acute Kidney Injury↗