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PubMed1997

Attitudes towards emotional expression and post-traumatic stress in survivors of the Herald of Free Enterprise disaster.

The relationship between self-reported attitudes towards emotional expression, assessed at three years after the accident, and post-traumatic symptoms, assessed at five years after the accident, was investigated in 37 survivors of the Herald of Free Enterprise disaster. It was found that lower scores on the attitudes towards emotional expression scale, indicating more negative attitudes (e.g. 'I think getting emotional is a sign of weakness') were associated with higher symptom scores. This association remained even when retrospectively assessed perceptions of helplessness during the disaster and symptoms assessed at three years were partialled out. Implications for therapeutic intervention are discussed.

Accidents, Traffic↗
PubMed1984

Major disaster planning.

In 1983 a coach crash brought a hospital's major disaster plan into operation. The surgical aspects of the plan were assessed to see how well they matched up to three major aims: saving life, relieving pain and distress, and completing primary treatment of open wounds within eight hours of the accident. The last goal was not met for most of the 21 victims, mainly children with multiple deep dirty abrasions and extensive tissue loss. Having determined that none of the victims were in immediate danger the surgeons reassessed the priorities--in several cases disturbing dressings for a third or fourth time. The total time spent in theatre (in five theatres) was 37 hours, as opposed to the original estimated 10-15 hours. The experience gained in this accident suggests that a disaster plan should indicate the number of patients a single hospital can admit and that a senior surgeon should act as a coordinator and get surgeons working as soon as patients arrive, keeping two theatres reserved for lifesaving surgery. In this way primary treatment of wounds may be completed within eight hours of injury and the risk of infection reduced.

Accidents, Traffic↗
PubMed1995

Dealing with disasters: does psychological debriefing work?

The psychological aftermath of disaster causes significant long-term psychiatric disability and suffering to victims and rescuers alike. This paper examines the effectiveness of psychological debriefing (PD), an early intervention that is widely used and claimed to reduce long-term psychiatric morbidity in the wake of disaster. Numerous factors hamper the design of methodologically sound research in this field and there is a lack of controlled studies supporting the efficacy of PD. Further research is needed to demonstrate the effectiveness of any immediate psychological intervention before significant resources are allocated to their routine provision.

Crisis Intervention↗
PubMed1991

International repatriation following overseas disasters.

The repatriation of 33 hospitalized patients to the United Kingdom following the Joigny coach accident in 1990 is described. The repatriation was undertaken by medical staff from St Bartholomew's Hospital Careflight project and EuropAssistance using a chartered McDonnell Douglas 83 aircraft. All patients were repatriated without mishap, but a number of difficulties were encountered. It is recommended that agreement is reached in advance as to the organization that should handle overseas disasters involving British citizens. The organization should have expertise in repatriation as well as close ties with the NHS. A protocol should be designed and adhered to. The initial response should involve despatching a team to the disaster country and provision of a control centre in the U.K. Special arrangements need to be made for staff and equipment. Liason with the airlines and ambulance services is essential.

Accidents, Traffic↗
PubMed1976

Disaster at Buffalo Creek. Family and character change at Buffalo Creek.

Psychiatric evaluation teams used observations of family interaction and psychoanalytically oriented individual interviews to study the psychological aftereffects of the 1972 Buffalo Creek disaster, a tidal wave of sludge and black water released by the collapse of a slag waste dam. Traumatic neurotic reactions were found in 80% of the survivors. Underlying the clinical picture were unresolved grief, survivor shame, and feelings of impotent rage and hopelessness. These clinical findings had persisted for the two years since the flood, and a definite symptom complex labeled the "Buffalo Creek syndrome" was pervasive. The methods used by the survivors to cope with the overwhelming impact of the disaster--first-order defenses, undoing, psychological conservatism, and dehumanization--actually preserved their symptoms and caused disabling character changes.

Character↗
PubMed1982

Changes in children's behavior after a natural disaster.

Five months after a severe winter storm, a survey of children whose behavior had been assessed by means of a parent rating scale during a Head Start program 6 months before the disaster showed that some problem-behavior scores had increased significantly. The subgroups of children at higher risk were boys, whose Anxiety scale scores increased, and children accepted for Head Start only because their parents said they had special needs, whose Aggressive Conduct scale scores increased. For the entire group of children, school behavior improved. The findings support previous impressions that parents deny their children's problems after a natural disaster.

Aggression↗
PubMed1986

Psychiatric reactions to disaster: the Mount St. Helens experience.

Following the 1980 Mount St. Helens volcanic eruption, psychiatric reactions were studied in the disaster area and in a control community. Using the new criterion-based diagnostic method for psychiatric epidemiologic research, the Diagnostic Interview Schedule, the authors found a significant prevalence of disaster-related psychiatric disorders. These Mount St. Helens disorders included depression, generalized anxiety, and posttraumatic stress reaction. There was a progressive "dose-response" relationship in the comparison of control, low-exposure, and high-exposure groups. The dose-response pattern occurred among both the bereaved and the property-loss victims.

Adolescent↗
PubMed1992

Somatic symptoms after a natural disaster: a prospective study.

The authors prospectively examined the prevalence of somatization symptoms among community respondents after a natural disaster in Puerto Rico. Exposure to the disaster was related to a higher prevalence of medically unexplained physical symptoms, particularly gastrointestinal ones (abdominal pain, vomiting, nausea, excessive gas) and pseudoneurological ones (amnesia, paralysis, fainting, unusual spells/double vision).

Disasters↗
PubMed1977

Disaster-relief training and mental health.

The author describes a training program in diaster-relief agencies. The program is designed to improve their over-all understanding of disaster-relief work and to increase their sensitivity to the emotional needs of disaster victims. Based on the recommendations of a state task force report, it consists of a workshop that makes use of videotapes and learning exercises to help participants improve their listening skills, learn problem-solving techniques, become aware of behavioral signs that can alert them to victims' emotional reactions, and familiarize them with the work of other relief agencies.

Crisis Intervention↗
PubMed1992

The certification and disposal of the dead in major disasters.

When a major disaster occurs in which there are a large number of fatalities, many tasks have to be undertaken in a very short time and under great pressure. By considering in advance the potential difficulties which may be encountered it is possible to plan ways of overcoming, or at least minimizing, some of these problems. In this paper we have ventilated some of the problems concerning the certification and disposal of the victims of a major disaster, as seen from the pathologist's point of view.

Death Certificates↗
PubMed1992

The Hillsborough football disaster and claims for 'nervous shock'.

The article investigates the scope for 'nervous shock' claims consequent on negligently inflicted injury, in the light of the Hillsborough disaster. It analyses the existing case law, including the first instance and Court of Appeal judgments in litigation arising from the disaster (for the House of Lords judgment, see Addendum). Its main purpose is to show that several of the arguments and conclusions in these judgments are driven by considerations of policy rather than principle, and primarily by a concern to prevent the 'floodgates of litigation' from opening. It is submitted that greater attention to medical perspectives on psychiatric illness would reveal that this concern is overstated and that a more principled approach would not have the adverse consequences predicted.

Civil Disorders↗
PubMed1993

Viewing human remains following disaster: helpful or harmful?

Seventy-four bereaved of the Zeebrugge Disaster completed symptom measures some 30 months following the tragedy. The group was divided into those who viewed or did not view the body and according to time of recovery, i.e. the first night, the following weeks, at the time of righting of the ship, and subsequently. For the two main groups, where body recovery was made on the first night or on the righting of the ship, intrusive and avoidant symptomatology were lower in those who viewed, but general psychological symptoms and measures of bereavement were not affected. The implications of the findings are discussed in relation to post-disaster management.

Adaptation, Psychological↗
PubMed2005

Posttraumatic stress disorder and general psychopathology in children and adolescents following a wildfire disaster.

OBJECTIVE: To report on the use of the Post Traumatic Stress Disorder Reaction Index (PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) in identifying children and adolescents who may require psychological interventions following exposure to a wildfire disaster. METHOD: Six months after a wildfire disaster, we conducted a school-based program to screen for wildfire-related events, such as exposure to and perception of threat, posttraumatic stress disorder (PTSD), and general psychopathology. RESULTS: The screening battery was completed by 222 children (mean age 12.5 years, SD 2.48; range 8 to 18 years). Severe or very severe PTSD was reported by 9.0% of students, while 22.6% scored in the abnormal range on the Emotional Symptoms subscale of the SDQ. Younger children and individuals with greater exposure to and perception of threat experienced higher levels of PTSD and general psychopathology. Female students reported a greater perception of threat but did not report higher levels of PTSD or other symptoms. CONCLUSIONS: Screening was well received by students, parents, and staff and proved feasible in the postdisaster environment. The PTSD-RI and SDQ demonstrated different individual risk associations and functioned as complementary measures within the screening battery. The identification of children at greatest risk of mental health morbidity enabled service providers to selectively target limited mental health resources.

Adolescent↗
PubMed2003

A transcultural ethos underpinning curriculum development: a master's programme in disaster relief nursing.

This article discusses the development and implementation of a masters' degree programme in disaster relief nursing by cooperating partners in European countries. It aims to enhance the provision of aid by endorsing the role of nurses at the forefront of health care in disaster-stricken areas around the world. As an attempt to address the implications of globalization in health care, the programme was established as a recognition of the rapidly developing specialty of transcultural/transnational nursing. Innovative teaching and learning strategies used include e-learning, simulation exercises, and competency portfolio development. A rigorous evaluation of programme outcomes is ongoing.

Clinical Competence↗
PubMed2005

Disaster preparedness in Scandinavia.

Disaster preparedness in Scandinavia is being improved on the national level, with increased cooperation between the different countries following 9/11. However, focus so far has been largely directed against CBRN threats. The reduction of hospital beds along with centralisation of advanced care as well as financial strains will enforce a closer cooperation between the health boards. The federal health care authorities must have a clear-cut responsibility and mandate to coordinate the nations health care systems in peacetime disasters, and not only during war. This reorganisation has just merely begun.

Cooperative Behavior↗
PubMed1988

The aetiology of post-traumatic stress disorders following a natural disaster.

The onset of post-traumatic stress disorders in a group of firefighters who had an intense exposure to a bushfire disaster was investigated using a longitudinal research design. Contrary to expectation, the intensity of exposure, the perceived threat, and the losses sustained in the disaster, when considered independently, were not predictors of post-traumatic stress disorder. By contrast, introversion, neuroticism, and a past history and family history of psychiatric disorder were premorbid factors significantly associated with the development of chronic post-traumatic stress disorders.

Australia↗
PubMed1991

Reactions of police officers to body-handling after a major disaster. A before-and-after comparison.

This study reports the results of an unusual opportunity to follow up a group of police officers who were involved in body-handling duties following the Piper Alpha disaster, and for whom there were available data from pre-disaster assessments. In addition, after these duties, the officers were compared with a matched control group of officers who had not been involved in such work. The comparisons failed to demonstrate high levels of post-traumatic distress or psychiatric morbidity. The results are interpreted in terms of issues such as the officers' own coping strategies, and major organisational and managerial factors.

Absenteeism↗
PubMed2003

The Aberfan disaster: 33-year follow-up of survivors.

BACKGROUND: Experiencing life-threatening events often contributes to the onset of such psychiatric conditions as post-traumatic stress disorder (PTSD). Children can develop PTSD; however, there is controversy over whether PTSD symptoms decrease or persist over time. AIMS: To examine the long-term effects of surviving the 1966 Aberfan disaster in childhood. METHOD: Survivors (n=41) were compared with controls (n=72) matched for age and background. All were interviewed using the Composite International Diagnostic Interview, measures of current health and social satisfaction, and the General Health Questionnaire. The survivor group also completed the Impact of Event Scale to assess current levels of PTSD. RESULTS: Nineteen (46%; 95% CI 31-61) survivors had had PTSD at some point since the disaster, compared with 12 (20%; 95% CI 10-30) controls (OR=3.38 (95% CI 1.40-8.47)). Of the survivors,12 (29%; 95% CI 15-43) met diagnostic criteria for current PTSD. Survivors were not at a significantly increased risk of anxiety, depression or substance misuse. CONCLUSIONS: Trauma in childhood can lead to PTSD, and PTSD symptoms can persist for as long as 33 years into adult life. Rates of other psychopathological disorders are not necessarily raised after life-threatening childhood trauma.

Adult↗