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PubMed1986

Evaluation of mental effects of disaster, Mount St. Helens eruption.

This psychiatric epidemiology study following the Mount St. Helens volcanic disaster revealed a significant morbidity for psychiatric disorders. The increased prevalence showed a dose response pattern in three population groups. The findings are reported as relative and attributable risk for the two exposed populations as compared to a control group. Patterns of significant risk are presented for sex, age, and for victims with pre-existing physical illness. The research utilized a new criteria-based interview schedule for the identification of psychiatric disorders. The methodology is reviewed in the context of the controversies and assumptions within the field of behavioral response to disaster stress. There are important implications for public health planning and intervention.

Adult↗
PubMed2005

Forensic aspects of mass disasters: strategic considerations for DNA-based human identification.

Many mass disasters result in loss of lives. Law enforcement and/or public safety and health officials often have the responsibility for identifying the human remains found at the scene, so they can be returned to their families. The recovered human remains range from being relatively intact to highly degraded. DNA-based identity testing is a powerful tool for victim identification in that the data are not restricted to any particular one to one body landmark comparison and DNA profile comparisons can be used to associate separated remains or body parts. Even though DNA typing is straightforward, a disaster is a chaotic environment that can complicate effective identification of the remains. With some planning, or at least identification of the salient features to consider, stress can be reduced for those involved in the identification process. General guidelines are provided for developing an action plan for identification of human remains from a mass disaster by DNA analysis. These include: (1) sample collection, preservation, shipping and storage; (2) tracking and chain of custody issues; (3) laboratory facilities; (4) quality assurance and quality control practices; (5) parsing out work; (6) extraction and typing; (7) interpretation of results; (8) automation; (9) software for tracking and managing data; (10) the use of an advisory panel; (11) education and communication; and (12) privacy issues. In addition, key technologies that may facilitate the identification process are discussed, such as resin based DNA extraction, real-time PCR for quantitation of DNA, use of mini-STRs, SNP detection procedures, and software. Many of the features necessary for DNA typing of human remains from a mass disaster are the same as those for missing persons' cases. Therefore, developing a missing persons DNA identification program would also provide the basis for a mass disaster human remains DNA identification program.

Advisory Committees↗
PubMed1990

Operation Nightingale: the role of BMH Dharan following the 1988. Nepal earthquake, and some observations on Third World earthquake disaster relief missions.

Following a large earthquake in Nepal, the experience of a small hospital in dealing with the resulting mass casualties is described. The value of pre-planning and effective triage of the injured is stressed, and aspects of surgical and medical care specific to earthquake victims discussed. Clinical and administrative challenges encountered in mounting a major relief exercise in a Third World setting are also described. frequent exercising of military hospitals and personnel in handling mass casualties is an applicable to civilian natural catastrophies as to battlefield medical support.

Developing Countries↗
PubMedDate not supplied

Y2K medical disaster preparedness in New York City: confidence of emergency department directors in their ability to respond.

OBJECTIVES: To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model. METHODS: Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness. RESULTS: The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management. CONCLUSIONS: Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

Attitude of Health Personnel↗
PubMedDate not supplied

Appropriateness of DSM-III-R criteria for posttraumatic stress disorder.

This research examines the DSM-IIIR criteria for posttraumatic stress disorder (PTSD). The study questions whether the psychiatric sequelae resulting from exposure to extraordinary traumatic events (stressor criterion A) do in fact differ from the sequelae resulting from exposure to more common yet stressful life experiences. The study also examines whether PTSD sequelae (criteria B-D) accurately describe the responses of victims even of extreme events fitting the DSM-III-R definition of stressor. The study included data from both St Louis victims exposed to floods and/or unsafe dioxin levels, and Puerto Rico victims of mudslides/flooding. Results showed that some of the common stressful events related more closely to PTSD symptoms than did the extraordinary events. Further, disaster exposure most strongly related to symptoms of reexperiencing (criterion B); symptoms relating to avoidance (criterion C) were particularly unreported. Results are discussed in terms of their implications for revision both of the PTSD criteria for DSM-IV, and of instruments designed to assess PTSD symptomatology.

Depressive Disorder↗
PubMed2000

Societal response to Hurricane Mitch and intra- versus intergenerational equity issues: whose norms should apply?

Late in the 1998 hurricane season, Central America was slammed by a devastating hurricane. Honduras, Nicaragua. El Salvador, Guatemala, and Belize were greatly impacted by Hurricane Mitch, one of the deadliest storms to affect the region in the past 200 years. The economies of each of these countries were badly affected. In the case of Honduras-at the time the fourth-poorest country in Latin America-its president suggested that 50 years of progress had been wiped out by the floods and mudslides associated with this relatively short-lived storm system. Humanitarian assistance poured into the region in the first months following the disaster. As of mid-2000, various national, bilateral, international, and nongovernmental programs were in progress or on the drawing board for recovery, reconstruction, and renewed development of the worst affected countries. Using Honduras as a case study, some of the ethical issues that abound in the decisions of whom to help, when, and how to help them in the wake of such an extreme climate-related human tragedy are examined. Should development assistance be focused on those who have been directly and adversely affected by this storm, or should the emphasis be on reducing the risk of exposure by future generations to such disasters? Is there yet another approach that seeks to protect future generations from similar harm while at the same time assisting present-day victims to get through their hardships?

Journal Article↗
PubMed2005

[Orthopedic surgery and traumatology].

Terrorist explosions cause destruction of material goods and human injury on such a scale that the provision of healthcare in available centers can be compromised. In the last few years we have witnessed terrible terrorist attacks that affect us increasingly closely. The authors describe the intervention of the Department of Traumatology of a university hospital in response to a terrorist attack that left nearly 2,000 persons wounded and 191 dead. As usually occurs in these attacks, the victims' lesions were characterized by the severity and extension of the tissue damage, including penetrating wounds, blast injuries and burns. Critical analysis of previous disasters described by our colleagues in the medical literature is useful to avoid future errors.

Abbreviated Injury Scale↗
PubMed2003

Nerve gas terrorism: a grim challenge to anesthesiologists.

IMPLICATIONS: The 1995 Tokyo subway strike proved nerve gas to be a fearsome terrorist weapon of mass destruction. Because the clear liquid is easily hidden until released, rescuers must aid nonbreathing casualties near instantly. Anesthesiologists are uniquely qualified to train these rescue squads and to manage nerve gas victims in the hospital.

Anesthesiology↗
PubMedDate not supplied

The children of Chernobyl.

During the past twelve months much media attention has been focused on the plight of the children affected by the Chernobyl nuclear disaster in the Soviet Union. The visit to Australia by several groups of these children during 1991 has heightened community interest in the innocent victims of the world's worst nuclear accident. As medical adviser for one of these visits, I saw how some of the children of Chernobyl benefited from their holiday away from radioactivity.

Accidents↗
PubMedDate not supplied

The Gulf War: the experience of a department of anesthesiology in the management of Scud missile casualties.

BACKGROUND: The pivotal role of anesthesiologists in the implementation of disaster plans is not widely appreciated. OBJECTIVE: To describe the role of anesthesiologists as managers in the operating room (OR) especially during hospital disaster management. METHODS: On 25 February 1991, King Fahd Hospital of the University in Eastern Saudi Arabia, was alerted, received, triaged, and treated the victims of a Scud missile attack on a United States military barracks which killed 28 and injured more than 100 service personnel. RESULTS: There were 47 males and 15 females admitted to the hospital. Their initial triage categories of injuries were: 1) red, 23; 2) yellow, 27; and 3) green, 7. The flow of patients through the main operating rooms occurred in two peaks: 1) treated within nine hours (60%); and 2) during the next 11 hours (40%). A total 101 units of blood and blood products were consumed. The role of the Chief of Anesthesiology was vital in the dynamics of the situation regarding appropriate deployment of staff and ensuring an orderly throughput of victims in the operating room. He also was required to keep track of resources and supply levels in the operating room, so that he could advise the hospital administration appropriately. CONCLUSION: The successful management of a large multi-casualty incident, which involved use of the operating rooms, depended upon the efficient coordination of clearly defined functions with the Chief of Anesthesiology Service as the team leader.

Adult↗
PubMed1994

Acute renal failure in earthquake victims in Iran: epidemiology and management.

The 1990 Iran earthquake affected two provinces with a population of 2.3 million, resulting in at least 13,888 deaths and 43,390 injured, and in 33,615 hospitalizations. 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 the Tehran University of Medical Sciences admitted 495 patients, with overall mortality of 7.5%. Of these, 30 (6%) required dialysis support, with mortality of 40%, accounting for one-third of all deaths. On admission, patients with ARF were more severely injured, with significantly higher incidence of multiple trauma, peripheral nerve damage, elevated plasma concentrations of muscle enzymes, potassium and phosphate, and abnormal urinalysis. In one of the three hospitals, patients were treated with a standardized hydration protocol coupled with a cautious approach to fasciotomy. The incidence of ARF, mortality associated with ARF, and fasciotomy were lower in this group. Our limited experience suggests that this standardized approach to prevention and treatment of ARF in earthquake victims may be helpful.

Acute Kidney Injury↗
PubMed1993

[Avalanche accidents].

Most avalanche victims die from asphyxia (68%) followed by trauma (13%). Hypothermia is a less common cause of death. Asphyxia may be caused by obstructed airways owing to aspiration of snow, an immobile thorax due to compression by the surrounding snow or lack of diffusion of oxygen through the mass of snow. Clearing airways and quick mobilization of the thorax are of utmost importance in the initial treatment. Cardiopulmonary resuscitation may be required. Unconscious victims without vital signs should be treated in the same way as victims with severe hypothermia.

Asphyxia↗
PubMed1983

The 1980 earthquake in southern Italy: rescue of trapped victims and mortality.

A retrospective survey was undertaken on the health effects of the 1980 earthquake in southern Italy. The study population included 3619 people living in 7 villages situated near the epicentre of the disaster. The overall casualty rate (dead and injured) was 19.7%. Nearly all the deaths (192/202) occurred among trapped people who died before they could be rescued. Eighty per cent of all the trapped people were extricated within 2 days, mostly without the use of sophisticated means. The probability of survival decreased sharply, the longer the time before extrication. The crude mortality during the 18 months following the earthquake was 19.0 per thousand among the injured people who received treatment, and 14.1 per thousand among non-injured people. After age standardization, there was no significant difference between these two figures and the expected mortality figures for the Italian population in normal times (14.4 per thousand). These results stress the importance of providing rescue activities in the first 48 hours after the impact. Strengthening the self-reliance of the community in disaster preparedness is suggested as the best way to improve the effectiveness of relief operations. In disaster-prone areas, training and education in methods of rescue should be an integral part of any primary health care programme.

Disasters↗
PubMed1989

Prevalence of psychiatric disorders among subjects exposed to a natural disaster.

A general practice study was carried out in 3 areas of the province of Naples, in southern Italy: Pozzuoli (PZ), a town exposed to significant seismic events in 1983, Monte Ruscello (MR), a village built to accommodate the victims of the earthquake, and Monte di Procida (MP), a town selected as a control since it is situated near PZ and was not significantly affected by the earthquake. The sociodemographic characteristics of the subjects examined were comparable in the 3 areas. The estimate of the real prevalence of psychiatric disorders according to Diamond & Lilienfeld was found to be higher in PZ and MR than in MP. Neurotic depression was the most frequent psychiatric diagnosis. The relative risk of mental disorders in subjects who reported none one or more social problems compared with those who reported none was more than 4 times greater in PZ and MR than in MP. Social problems also differed qualitatively, being more frequently related to living conditions in PZ and MR and to the primary social network in MP.

Adjustment Disorders↗
PubMedDate not supplied

Strategies in evaluation and management of Bam earthquake victims.

BACKGROUND: On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, > 43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals were created and large numbers of patients were evacuated from their homes and transported to hospitals throughout Iran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake. METHODS: This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation. RESULTS: Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months-70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of the leg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death. CONCLUSION: A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.

Adolescent↗