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PubMedDate not supplied

Near-drowning.

It can be seen that the physiologic changes occurring in near-drowning are complex. The pulmonary changes including edema, shunting, and alterations in surfactant properties cause disturbances in oxygenation and acid-base balance which can have severe consequences for the near-drowning victim if immediate and intelligent treatment is not directed toward their correction. Although blood volume, serum electrolyte, and hematologic changes are generally not severe, they must still be considered. The secondary effects, which make up the clinical situation met with in patients eventually admitted to the hospital, may result in disaster in those who appear to have recovered from the acute episode unless careful vigilance is maintained. The possession of a sound knowledge base related to these aspects is essential in the treatment and care of near-drowning victims.

Acid-Base Equilibrium↗
PubMedDate not supplied

Assessment of characteristics of intrusive thoughts and their impact on distress among victims of traumatic events.

OBJECTIVE: This study examines the psychometric properties of the Intrusive Thoughts Questionnaire (ITQ) and its utility as a predictor of distress among trauma victims. METHOD: Victims of three types of trauma, a motor vehicle accident (N = 115), a hurricane (N = 182), and recovery work after an airline disaster (N = 159), completed the ITQ along with the Impact of Event Scale (IES) and the Symptom Checklist-90, Revised (SCL-90-R), at several different time points after their exposure. RESULTS: The ITQ was a reliable and valid instrument that was positively related to concurrent measures of distress as well as a predictor of long-term stress responding. Characteristics of intrusive thoughts reflecting the extent to which they were unwanted or controllable, were identified as key determinants of distress. CONCLUSIONS: The ITQ is a useful adjunct to current measures of intrusions, allowing for greater specificity in analyses of responses to trauma. Evaluation of characteristics of intrusions indicated that frequency of intrusions was neither the only predictor of distress nor the best predictor of trauma-related outcomes.

Adolescent↗
PubMed2005

Effects of sarin on the nervous system of subway workers seven years after the Tokyo subway sarin attack.

This study was designed to assess the after effects of sarin exposure on the nervous system in victims of the Tokyo Subway Sarin Attack, which occurred on 20 March, 1995. We performed a similar study 3 yr after the disaster. This time, we newly enrolled 36 staff of the Teito Rapid Transit Authority (Tokyo Eidan subway) to assess the 7 yr after effects on the nervous system, and merged previous data including unpublished data to enhance statistical power. New subjects consisted of 23 male exposed subjects and 13 referent subjects matched for age and working types. Neurobehavioral tests for psychomotor function and memory, stabilometry, and Benton visual retention test were performed. As reported previously, the exposed group performed significantly less well in the psychomotor function test (tapping) than the referent group (117.8 +/- 1.2 vs. 105.6 +/- 1.2 msec). Using merged data, this phenomenon was also observed in a dose-dependent manner and the exposed group performed significantly less well in the backward digit span test (4.47 +/- 1.17 vs. 5.11 +/- 1.65 digits). These results indicate that chronic decline of psychomotor function and memory function still exist 7 yr after the sarin exposure.

Adult↗
PubMed2002

Science and statistical victim: modernizing knowledge in breast implant litigation.

The advent of mass torts in US federal courts in the latter third of the 20th century accelerated a process of modernization in an institution that was unprepared for standardized approaches to dispute resolution. Faced with large-scale technological disasters, in particular, courts struggled to reform both their procedures and their fact-finding approaches in order to deal with multiple claimants in consolidated proceedings. Using silicone gel breast implant litigation as a case study, this paper argues that the attempt to marry judicial concerns for individual justice with administrative concerns for speed, efficiency and economy has produced anomalous results. The testimony of the clinician and the victim has become less relevant as judicial remedies take account of injuries done to classes of plaintiffs. Subjective claims about the body are subordinated to statistical correlations between exposure and grouped complaints. At the same time, the transfer of fact-finding authority from juries to judges under new evidentiary rules has privileged the judiciary's lay knowledge and experience over that of the jury. While these transformations may hasten the processing of cases, the paper questions whether the courts can legitimately take on board the issues of risk and social justice in contemporary industrial societies.

Breast Implants↗
PubMed2003

Designation of a new training model of a local disaster medical system with tabletop exercises.

BACKGROUND: A new model of a local disaster medical system (LDMS) was proposed through the consensus method of expert panel meetings for county governments in Taiwan. This LDMS model adopts a local emergency medical response system (EMRS) for dealing with daily accidents as a basic structure by expanding its roles and functions. The objective of this study was to determine the feasibility of the new LDMS model by evaluating its initial phase response to simulated disasters using tabletop exercises. METHODS: Two tabletop exercises were held after the responders of the LDMS were trained according to the new model. Forty and 42 participants respectively joined the 2 tabletop exercises, which simulated an earthquake causing 400 casualties in 6 different locations in order to apply the new LDMS model. The outcome measurements of the tabletop exercises were the mean accuracy rate of victim triage and disposition, and medical interventions. RESULTS: About 92% of victims were correctly triaged, and 88% had a correct disposition. Moreover, around 86% of all victims received adequate medical interventions. All victims were dispatched to appropriate facilities or treatment areas within 45 min. CONCLUSION: The new EMRS-oriented model of this LDMS can respond quickly, efficiently, and adequately to the initial phase of a disaster during tabletop exercises. Further clinical investigations are required to prove the efficacy of the new LDMS model in real disasters or in full-scale drills.

Disaster Planning↗
PubMed1991

[The use of the principles of military field surgery in rendering medical care to the victims during catastrophes].

Despite the existing differences in medical care of war and catastrophe casualties it is possible to apply a variety of organizational and management principles of military medicine for the disaster medicine. The authors express the opinion that in case of big catastrophes the medical service could operate by means of rapid deployment units formed on the basis of territorial principle.

Armenia↗
PubMed1993

The World Trade Center disaster. Healing the unseen wounds.

1. After the bombing of the World Trade Center in New York on February 26, 1993, hospitals were flooded with individuals who manifested not only medical problems, but also psychological trauma. 2. Various coping mechanisms were used by the disaster survivors. Some people were hysterical, while others were very quiet, almost catatonic, with blank affect and fixated posture. Some individuals, who remained strong during the ordeal, collapsed when they reached the hospital. 3. In attending the victims, nurses talked with them about the traumatic incident, the fear, and the angst--a cathartic process that helps people get better sooner. Such therapy is the key to healing unseen wounds.

Adolescent↗
PubMedDate not supplied

One-year follow-up study of posttraumatic stress disorder among earthquake survivors in Turkey.

Earthquakes and their consequences present a major global public health problem. In 1998, a major earthquake struck Southern Turkey. The aims of this study were to describe longitudinally the severity and the course of posttraumatic stress disorder (PTSD) and depression among earthquake survivors in Turkey and to explore risk factors associated with psychiatric disorders. The sample of this study consists of 105 consecutive subjects who used our psychiatric service, via either outpatient clinic or home visit. PTSD was assessed by the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of depression was assessed using Beck Depression Inventory. The rates of earthquake-related Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD were 42% within 1 month and 23% within 13 months. The diagnosis of PTSD was significantly related to the presence of injury and to less social support in the initial assessment. In the follow-up assessment, although the mean total Clinician-Administered PTSD Scale severity score improved significantly, the mean Beck Depression Inventory score did not change significantly. The decrease in posttraumatic stress symptoms 13 months after the earthquake may be related to relatively good living conditions and adequate social and health services. Early mental health intervention may serve to prevent the chronicity of posttraumatic stress reactions among earthquake victims.

Adult↗
PubMed1989

Effects of personal experience on self-protective behavior.

This article seeks to further our understanding of self-protective behavior by examining the effects of a particularly powerful stimulus to action: personal experience. It reviews the effects of automobile accidents on seat belt use, criminal victimization other than rape on individual crime prevention efforts, natural hazards experience on both natural hazards preparedness and compliance with evacuation warnings, and myocardial infarction on smoking. Theories suggesting mechanisms that could link personal experience to behavior are described, and data concerning the effects of experience on some key variables in these theories are discussed. Tentative propositions are offered to resolve the many apparent discrepancies in this literature. These propositions concern the effects of experience on risk perceptions, the influence of experience on risk salience, the specificity of responses to victimization, and the duration of experience effects.

Accident Prevention↗
PubMed1991

A new technique for treating post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) symptoms are notoriously difficult to treat. The need for a simple, easily reproducible technique, that could inactivate the repetitive intrusive imagery of the traumatic event, prompted the trial of a technique originally devised for phobias. Nineteen members of the West Midlands Police Force, who qualified as PTSD sufferers, were offered the 're-wind' technique. On average only three therapeutic sessions were required per patient. During a two-year follow-up, all victims remained free of intrusive images and resumed their occupations. It is hoped that such a consistently rapid and effective technique will open the way for more victims to be treated and for controlled trials to be facilitated.

Association↗
PubMed2006

The health effects of flooding: Social research results from England and Wales.

This paper presents interview survey data by social scientists using established health measures on the health effects of flooding for residents in 30 locations in England and Wales. Firstly, it examines the extent to which flooded residents reported suffering physical and psychological health effects during and after the event. Secondly, it explores the issue of whether these effects were long-lasting by comparisons with the general population and with those at risk but not flooded. In the study, about two thirds of the flood victims were found to have scores on the General Health Questionnaire-12 scale indicative of mental health problems (scores of 4+) at their worst time after flooding. The evidence of the study also suggests that some flood victims suffered long term mental health effects as a result of their experience of flooding. The study examines the influence of a wide range of factors: characteristics of the flood event, types of property, and socio-demographic and the intervening factors such as the extent of family or community support that may explain the health effects of flooding. It finds that a complex set of social and other factors are involved and that some factors susceptible to human intervention such as having adequate flood insurance cover are important factors in the stress experienced by flood victims.

Adolescent↗
PubMed1997

Suggested guidelines for treatment of acute renal failure in earthquake victims.

The 1990 Iran earthquake affected two states with a combined population of 2,300,000. It resulted in at least 13,888 deaths, 43,390 injured, and 33,616 hospitalized. The overall mortality among hospitalized patients was 0.17%. Acute renal failure (ARF) requiring dialysis support was diagnosed in 156 patients nationwide, with a mortality rate of 14%. Three teaching hospitals of Tehran University of Medical Sciences (UMS) admitted 495 patients, with total mortality of 7.5%. Of these, 30 patients (6%) required dialysis, with a mortality of 40%, accounting for 12 of the deaths. On admission, patients with ARF were more severely injured and had significantly higher incidence of multiple trauma; peripheral nerve injury; elevated muscle enzymes, potassium, and phosphorus; and abnormal urinalysis. In one of these hospitals, patients were treated with a specific hydration protocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Based on these findings, guidelines are suggested that may be helpful in the treatment of ARF in earthquake victims.

Acute Kidney Injury↗
PubMedDate not supplied

[A primary healthcare strategy in disaster situations].

The present article describes the experience of the Cuban Medical Team in the Colombian Coffee Area after the earthquake of January 25, 1999. The interventions were directed at the areas of primary health care, primary environmental care, environmental health, and epidemiological surveillance, bearing in mind the organization of earthquake victims sheltered in emergency settlements in the affected municipality. Active epidemiological surveillance showed that the main causes of morbidity were acute diarrheic diseases, acute respiratory infections, and skin diseases. Evaluation of the settlements showed a correlation between poor environmental health conditions and associated diseases. The results of this field study could serve as a guide for health professionals in the event of disasters and displaced populations.

Colombia↗
PubMed2000

Tornado disaster in rural Georgia: triage response, injury patterns, lessons learned.

Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military helicopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris.

Adolescent↗
PubMed2000

[Trauma, traumatic stress and depression following an airline catastrophy].

OBJECTIVES: Acute stress responses following a trauma indicate a sensitivity to posttraumatic stress disorder (PTSD), and is often comorbid with depression. Earlier exposure to a traumatic event can be an additional risk factor in PTSD development. METHOD: Eight injured patients hospitalized after a major air disaster were monitored and assessed for a month. The symptoms of acute stress response (ASR), PTSD, and depression were assessed using DSM-IV criteria immediately following the accident, then each week thereafter. The Impact of Event Scale (IES) was completed on the 30th day (D30). RESULTS: Four patients presented with an ASR, and 3 of them had a PTSD at D30. Of those 3 patients with PTSD, 2 presented with an associated depression. These 2 patients had been exposed to a traumatic event before the disaster; and a significant relation was found between the history of the earlier trauma and the PTSD associated with depression. CONCLUSION: The traumatized victims with a history of earlier traumas seem more susceptible to developing a PTSD associated with depression.

Accidents, Aviation↗
PubMed1989

Accidental railway-related fatalities. The Metro Dade County experience, 1980-1984.

A study of accidental railway-related fatalities was performed using the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the years 1980-1984. The nine cases that were collected are presented here in some detail. A discussion ensues concerning the most common type of accidental railway-related fatalities, why they occur, and what future work remains in order to avoid such fatalities. Evidently, fatalities more frequently result from victims' disregard for safety--either by crossing the tracks despite warning, or by utilizing railroad trestles as a fishing pier--than from mass disaster. Future work involving forensic engineers, forensic pathologists, and lawyers along with community activists should include both public education and a design of less accessible trestles to avoid such tragedies. In conclusion, it is hoped that this article will serve as a catalyst for further research on this subject.

Accidents↗