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PubMed2003

Principles of emergency management in disasters.

The organizational and medical conduct in disaster situations is complex and presents a challenge to every manager in the prehospital setting. The handling of such situations is characterized by the need to make decisions under uncertainty in real time, with deficient medical and support forces. The approach used in mass casualty incident situations is cycles of treatment, commonly known as the "butterfly system." There are serious logistic problems involved, both industrial and structural, physical obstacles that may interfere with rescue treatment and evacuation, disruption in communications, and many other difficulties. On top of these, there are other obstacles such as interruption with the cooperation and coordination of different force, enforcement and rescue teams, the press, inquisitive people, and others. However, the most serious problem of all is the tendency in complex situations to attempt to work with fixed preformed guidelines or protocols for operation. One disaster differs from another, regarding location, number of casualties, distribution, severity, type of injury and the nature of injury, size of available rescue teams, time and equipment needs, damage to roads, distance from hospital, and other variables. One of the most important lessons learned from the management of such incidents is do not set fixed protocols but rather principles only. By applying principles adapted to the situation, managers will be able to perform better.

Disaster Planning↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Thailand.

After the Asian tsunami, the Department of Mental Health, Thailand developed a national guideline for mental health interventions in disasters based on the lessons learnt from the mental health and psychosocial relief efforts launched. We advocate the integration of social interventions for the affected community into the general mental healthcare, which in turn should be available in the general healthcare setting. This set-up of the mental healthcare delivery system, can provide the daily needs of the community and can be rapidly scaled up in times of a disaster. The organization of the delivery of mental healthcare is discussed in the paper.

Delivery of Health Care↗
PubMed2006

Mental health and psychosocial support aspects of disaster preparedness in the Maldives.

The tsunami has been instrumental in motivating the Government of the Maldives to give high priority to mental health and psychosocial support services. Moreover such services will be delivered in a co-ordinated manner in the long-term. The Maldives had particular problems in responding to the tsunami and these were a result of large geographical spread of small islands, communication difficulties and limited work force. However, voluntary organizations became active very rapidly and also responded beyond the call of duty. This, combined with clear chain of command, helped generate proper response. As a result not only was the immediate response to the tsunami well organized, clear plans for the long-term mental healthcare and delivery of services are being developed, which includes not only mental health services, but also mental health policy and legislation. Also, a disaster preparedness plan which includes mental health and psychosocial aspects is under way, indicating that a future disaster will find the Maldives better prepared to respond to it.

Disaster Planning↗
PubMedDate not supplied

A "community as resource" strategy for disaster response.

Natural and technological disasters present significant threats to the public's health. The emergency response capabilities of government and private relief organizations are limited. With a strategy in which residents of urban areas are trained in search and rescue, first aid, fire suppression, care and shelter, emergency communications, and disaster mental health, the community becomes a "resource" rather than a "victim."

Community Health Planning↗
PubMed2003

Integration of foreign and local medical staff in a disaster area: the Honduras and El Salvador experiences.

International medical aid after natural disasters may take various forms, ranging from self-sufficient military forces to single experts or specialists who function primarily as advisers. A model integrating foreign and local medical staff has not previously been reported. In response to the call for international aid by the Honduran and El Salvadorian governments in the wake of Hurricane Mitch in November 1998 and the San Salvador earthquake in January 2001, Israel sent medical supplies and 10 member teams of medical professionals to each country. The aim of the present paper is to describe the unique Israeli approach to providing healthcare in disaster areas by integrating foreign and local medical staff, and to discuss its advantages and disadvantages. The paper focuses on the experience of the two emergency medicine physicians on the team who were assigned to the Atlantida General Hospital in La Ceiba, Honduras. The same team in San Salvador subsequently applied the same approach.

Delivery of Health Care↗
PubMed2005

The east coast Big Flood, 31 January-1 February 1953: a summary of the human disaster.

The Big Flood was the worst natural disaster to befall Britain during the twentieth century, and the scale of its human impact was due to the lack of adequate disaster preparedness. The 307 deaths on land were caused by drowning or from the effects of exposure. Two-thirds occurred in four clusters along the shoreline and mainly comprised inhabitants of post-war prefabricated buildings, bungalows and chalets, with the highest mortality among the elderly. The emergency response was spontaneous and community led, with the main search and rescue completed before central government became involved. No individuals or agencies were blamed for the neglected state of the flood defences or the absence of warnings, along with the post-war shortage of adequate housing, which were the main causes of vulnerability. The media played a limited role, and television was in its infancy. Mental health impacts were either self-limiting or failed to be articulated in a society recovering from the Second World War. The major mitigating factors included the empathetic response of people, locally and nationally, as well as the availability of armed forces personnel based in East Anglia, whose actions played a decisive part in the battle against the sea. The major legacies of the Big Flood were a coastal flood forecasting system, a more scientific approach to sea defences and the building of the Thames barrier.

Computer Simulation↗
PubMed1997

The wreck of Amtrak's Sunset Limited: news coverage of a mass transport disaster.

Using the 1993 crash of Amtrak's Sunset Limited in Mobile, Alabama, this study examines the safety education provided by seven newspapers. A total of 117 news stories were analysed for five primary themes: overall story category, passenger safety theme, train personnel safety theme, train safety theme and rescue safety. Sixty-three per cent were found to contain at least one safety theme paragraph within the larger story. A total of 631 paragraphs were identified as safety theme paragraphs, 32 per cent of which were passenger safety themes, 8 per cent were train personnel safety, 31 per cent were train safety and 29 per cent were rescue safety themes. As in previous research, safety themes rarely appeared alone; more often than not, a story contained a mixture of all themes. Some safety themes appeared more frequently than others, but overall, the safety themes present a complete view of the safety issues surrounding the crash. Safety themes are embedded within a story framework which reflects the three stages of disaster news work. Images of normalcy tragically disrupted by the crash abound as do images of passengers escaping and aiding others. Disaster relief personnel and aviation officials are shown working to restore order and solve the mystery of the crash. Within this framework we can learn what to expect when a train crashes and what we might have to do in a similar situation.

Accidents, Occupational↗
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↗
PubMed2000

Casualty treatment after earthquake disasters: development of a regional simulation model.

This paper presents a new approach to the casualty treatment problem following a large-scale disaster, based on a mathematical model of how a regional health-care system responds to an earthquake event. The numbers and locations of casualties rescued alive, the scale of pre-hospital care, the post-earthquake hospital capacity, and the transport system are inputs to the model. The model simulates the movement of casualties from the stricken areas to hospitals. It predicts the number of casualties that die as well as other statistics about the health-care system response, such as waiting time before treatment. The model can be run with varying input assumptions to simulate alternative disaster response strategies. Preliminary runs demonstrate the potential of the model as a tool for planning and training.

Disaster Planning↗
PubMed2004

"We all knew that a cyclone was coming": disaster preparedness and the cyclone of 1999 in Orissa, India.

Imagine that a cyclone is coming, but that those living in the affected areas do nothing or too little to protect themselves. This is precisely what happened in the coastal state of Orissa, India. Individuals and communities living in regions where natural hazards are a part of daily life develop strategies to cope with and adapt to the impacts of extreme events. In October 1999, a cyclone killed 10,000 people according to government statistics, however, the unofficial death toll is much higher. This article examines why such a large loss of life occurred and looks at measures taken since then to initiate comprehensive disaster-preparedness programmes and to construct more cyclone shelters. The role of both governmental organisations and NGOs in this is critically analysed. The good news is that, based on an assessment of disaster preparedness during a small cyclone in November 2002, it can be seen that at community-level awareness was high and that many of the lessons learnt in 1999 were put into practice. Less positive, however, is the finding that at the state level collaboration continues to be problematic.

Community Health Services↗
PubMed2005

First-aid training and capabilities of the lay public: a potential alternative source of emergency medical assistance following a natural disaster.

Basic first-aid skills can be useful in treating minor injuries that commonly result from natural disasters in the United States. Yet there has been insufficient research on training and competence in first-aid skills among community residents. This study utilises panel data for 414 adults in Los Angeles, California, who were interviewed within three years of the 1994 Northridge earthquake and re-interviewed in 1999 after the El Ninõ winter of 1997-98. Descriptive, bivariate and multivariate analyses were performed. Results showed that 24 percent of the members of the sample had received first-aid training since their Northridge earthquake interview. First-aid training, particularly recent training, was associated with greater perceived first-aid skills, as well as with increased expected and actual employment of those skills. With the appropriate training and skill retention, lay members of the public can potentially contribute to a post-disaster medical response.

Adult↗
PubMed1995

Struggles of neonatology staff and the network system in the Hanshin-Awaji earthquake disaster.

More than 5500 people were killed in the Hanshin-Awaji earthquake disaster. Most of the neonatal intensive care units (NICU) could not offer proper services as a result of the earthquake and the Hyogo Emergency System for Neonates could not function. No one imagined that such a great disaster would occur in their home town, Kobe; however, the devastation of the quake has raised the opportunity to examine the operation of neonatal medicine in an emergency. We sent out questionnaires to perinatologists in the damaged area 2-3 months after the quake. Some hospitals in the demolished area suffered such serious damage that they could not continue work as NICU, and some in the surrounding area had problems in a number of areas, including staff, room capacity and transport methods. Under these difficult circumstances the greatest problem encountered by staff was maintaining fundamental care in NICU, that is to say keeping temperature, formula (nutrition) and prevention of infection techniques operating. In this report we discuss the effects on neonatal medicine of the earthquake in Kobe. Medical staff struggled patiently and made great efforts to recover and maintain the functioning of NICU. We believe this information will be useful for neonatology staff in other areas which may experience an earthquake in the future.

Community Networks↗
PubMed1994

The efficacy of the neo-liberal individual choice model for encouraging post-disaster change: developments in the East Cape region of New Zealand following Cyclone Bola (March 1988).

The government of New Zealand instituted a new policy of disaster response in an attempt to bring about change and development in the relatively remote agricultural region which was struck by a severe cyclone in March 1988. The new policy involved a change from payment for restoration to compensation for loss. This new policy was based on the neo-liberal position that individual choice should prevail in decision making and that significant change will result from this adherence to an individual decision making approach. The new policy did not accomplish any significant degree of change in the intended areas of land ownership and land use. Most of the farmers used the compensation funds to carry out on-farm restoration work which facilitated the resumption of pre-cyclone farming activities. It is argued that the efficacy of a neo-liberal individual choice model for accomplishing post-disaster change and development is limited and that a more institutionally and organisationally based approach would be much more effective and efficient.

Agriculture↗
PubMed1995

Developing decentralized capacity for disaster prevention: lessons from food security and nutrition monitoring in Malawi.

Lack of sufficient analytical capacity in most of the countries of sub-Saharan Africa has been frequently mentioned as a major factor limiting the effectiveness of drought management interventions. In this article we describe an approach used in Malawi for the past three years to develop a decentralized capacity to analyse drought management and disaster prevention programmes. A conceptual framework is presented which identifies the areas in which capacity strengthening is required and lessons from the Malawi experience are presented. Various issues relating to the efficiency of capacity building programmes are discussed. We argue that continuous dialogue between development researchers and decision-makers, and between trainers in academic institutions and donor agencies, is essential for achieving the goals of improved capacity for drought management and disaster prevention.

Disaster Planning↗
PubMed2006

El Niño platforms: participatory disaster response in Peru.

Climate change is expected to lead to greater extremes (droughts and floods) in river regimes around the world. While the number of major calamities is predicted to rise, the efforts of the public sector, experts and local stakeholders are badly coordinated. Consequently, aid does not reach target groups, resulting in unnecessary losses. Hence, there is a need for more participatory and integrative approaches. To ensure a more concerted response to climate-induced disasters, stakeholders could coordinate and negotiate within Multi-Stakeholder Platforms. Such roundtables are increasingly being established for vision-building and integrated water resource management, but could be employed in disaster management as well. After discussing the advantages and disadvantages of participation, this article trace the rise of and the problems facing two 'El Niño' platforms: one in Ica, a city on the Peruvian coast that flooded unexpectedly in January 1998, and one in Ayacucho, which saw a climate change-induced drought around the same time. The issue of internal and external legitimacy receives particular emphasis.

Community Networks↗
PubMed2006

Responding to the Boxing Day tsunami disaster in Aceh, Indonesia: Western and South Australian contributions.

OBJECTIVE: To describe the Western and South Australian response to the Boxing Day tsunami disaster in Aceh, Indonesia. METHOD: Reports from three of the responders. RESULTS: Comment has been made on organising a response, the first team to Banda Aceh, the second team to Banda Aceh, and lessons learned. CONCLUSIONS: These experiences have identified areas in which we could be better prepared for the next international disaster response.

Attitude of Health Personnel↗
PubMed2026

Epigenome-wide analysis of DNA-methylation signatures following climate-related disasters.

BACKGROUND: Floods and tropical cyclones (TCs), two of the most frequent and costliest climate-related disasters worldwide, have been linked to sustained health risks extending beyond acute hazards. However, evidence on the underlying epigenetic mechanisms remains scarce. We aimed to characterize DNA methylation patterns associated with exposure to floods and TCs of varying intensities. METHODS: We collected peripheral blood samples from 479 women (132 twin pairs and 215 of their sisters) across Australia. Blood-derived DNA methylation profiles were assessed using the Illumina HumanMethylation450 BeadChip array. Daily flood and TC exposure data for the 6&#xa0;years preceding each blood draw were obtained from the Dartmouth Flood Observatory and the International Best Track Archive for Climate Stewardship, respectively, and linked to participants based on residential addresses. Using a within-sibship analytical framework that accounted for shared familial factors and other relevant covariates, we examined associations between flood and TC exposures of varying intensities and site-specific methylation at each cytosine-guanine dinucleotide (CpG). Differentially methylated regions (DMRs) were identified using a combination of the comb-p and DMRcate algorithms. RESULTS: There were 164 CpGs and 219 DMRs associated with flood and TC exposures (Bonferroni-adjusted p value&#x2009;<&#x2009;0.05), mapping to 242 genes enriched in pathways related to inflammation and immune regulation. These genes have been implicated in a wide range of human diseases or phenotypes. The number of differentially methylated CpGs increased with more recent and higher-intensity exposures. Intensity-dependent gene regulation was observed, with genes such as AMT and C22orf45 consistently implicated across various exposure levels, whereas RNF39 and ACY3 emerged only at higher intensities. CONCLUSIONS: Exposures to floods and TCs were associated with differentially DNA methylated signals across the human genome, exhibiting intensity-dependent patterns. The identified signals and related gene pathways may shed light on the biological mechanism underlying the profound health effects of climate-related disasters.

Humans↗
PubMed2000

Disaster medicine: an emerging specialty.

The diverse nature of natural and man-made disasters demands a wide range of medical skills and resources from any attendant clinician. Working in a hostile environment may also require armed protection. This article considers the types of disasters, their medical requirements and the training of doctors wishing to be involved in this field of medicine. It includes a description of the Diploma in the Medical Care of Catastrophes.

Disaster Planning↗