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PubMed2004

Safety, security, and preparing for disaster at sporting events.

There is a heightened awareness of terrorism in this country. There always remains the possibility of nonterrorist disasters at sporting venues. The team physician will be among the first medical responders to a disaster at a sporting venue. By being involved in the creation of an emergency action plan, learning the incident command system, understanding triage, and obtaining basic trauma life support skills, the team physician can be prepared to respond to mass casualty incidents at sporting events.

Athletic Injuries↗
PubMed2006

Enhanced pharmacy training for counter-terrorism and disaster response.

State and federal authorities in the USA have identified pharmacists as important in terrorism detection activities. However few pharmacists are trained for disaster response planning, or providing services at disaster sites. A distance training programme was created by the College of Pharmacy at the University of Kentucky, Chandler Medical Center (UKCMC) in collaboration with an academic Medical Center, urban and rural community pharmacists, experts in pharmacy and infectious disease, and two state pharmacy associations. There was a substantial improvement in bioterrorism training knowledge as judged by pre- and post-test results. During two years of training, a total of 142 licensed pharmacists received certification (approximately 4.7% of all those in Kentucky). In addition, a network of bioterrorism-trained pharmacists was created for the state.

Bioterrorism↗
PubMed2006

Health sciences librarians' reference services during a disaster: more than collection protection.

Reliable and timely professional information services are always important, but even more so during a community-wide disaster, like the aftermath of Hurricane Katrina. There are classes and literature on planning for library collection protection in local emergencies, but little about planning for reference and information services. Four accounts from South Louisiana in September of 2005 demonstrate the value of proactive and innovative services based on professional information needs analysis skills. More study of such cases could lead to the development of best practice guidelines for the planning and provision of disaster information services.

Disasters↗
PubMedDate not supplied

Radical simplification: Disaster Relief Medicaid in New York City.

In the four months following the 11 September 2001 attacks on the World Trade Center, nearly 350,000 people signed up for Disaster Relief Medicaid. The process was quick and simple; applicants completed a one-page form and got a decision on the spot or the next day. While the program's success stemmed in part from the unique circumstances facing New Yorkers in the fall of 2001, Disaster Relief Medicaid was an experiment in radical simplification that demonstrated a new way of thinking about how to design a simple, effective public health insurance program stripped of the vestiges of welfare.

Aircraft↗
PubMed2004

Respiratory symptoms and physiologic assessment of ironworkers at the World Trade Center disaster site.

STUDY OBJECTIVES: To characterize respiratory abnormalities in a convenience sample of ironworkers exposed at the World Trade Center (WTC) disaster site for varying lengths of time between September 11, 2001, and February 8, 2002. DESIGN: Cross-sectional study. SETTING: The Mount Sinai Medical Center, a large tertiary hospital. PARTICIPANTS: Ninety-six ironworkers engaged in rescue and recovery with exposure onset between September 11, 2001, and September 15, 2001, who responded to an invitation to undergo respiratory evaluation. MEASUREMENTS: Medical and exposure history, physical examination, spirometry, forced oscillation (FO), and chest radiographs. The relationships of prevalence of respiratory symptoms and presence of obstructive physiology to smoking, exposure on September 11, duration of exposure, and type of respiratory protection were examined using univariate and linear and logistic regression analyses. RESULTS: Seventy-four of 96 workers (77%) had one or more respiratory symptoms (similar in smokers [49 of 63 subjects, 78%] and nonsmokers [25 of 33 subjects, 76%]). Cough was the most common symptom (62 of 96 subjects, 65%), and was associated with exposure on September 11. Chest examination and radiograph findings were abnormal in 10 subjects (10%) and 19 subjects (20%), respectively. FO revealed dysfunction in 34 of 64 subjects tested (53%), while spirometry suggested obstruction in only 11 subjects (17%). Lack of a respirator with canister was a risk factor for large airway dysfunction, and cigarette smoking was a risk factor for small airway dysfunction. No other relationships reached statistical significance. CONCLUSIONS: Respiratory symptoms occurred in the majority of ironworkers at the WTC disaster site and were not attributable to smoking. Exposure on September 11 was associated with a greater prevalence of cough. Objective evidence of lung disease was less common. Spirometry underestimated the prevalence of lung function abnormalities in comparison to FO. Continuing evaluation of symptoms, chest radiographs, and airway dysfunction should determine whether long-term clinical sequelae will exist.

Adult↗
PubMed2004

Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster.

CONTEXT: New York City firefighters responding to the World Trade Center (WTC) disaster on September 11, 2001, were exposed to numerous hazards. A medical screening program was conducted 3 weeks after the disaster on a sample of firefighters. OBJECTIVES: To determine whether arrival time at the WTC and other exposure variables (including respirator use) were associated with symptoms and changes in pulmonary function (after exposure - before exposure). DESIGN: A cross-sectional comparison of firefighters representing the following groups: (1) firefighters who arrived before/during the WTC collapse, (2) firefighters who arrived 1 to 2 days after the collapse, (3) firefighters who arrived 3 to 7 days after the collapse, and (4) unexposed firefighters. SETTING: Fire Department of New York City (FDNY) Bureau of Health Services on October 1 to 5, 2001. POPULATION: A stratified random sample of 362 of 398 recruited working firefighters (91%). Of these, 149 firefighters (41%) were present at the WTC collapse, 142 firefighters (39%) arrived after the collapse but within 48 h, 28 firefighters (8%) arrived 3 to 7 days after the collapse, and 43 firefighters (12%) were unexposed. MAIN OUTCOME MEASURES: New/worsening symptoms involving the eyes, skin, respiratory system, and nose and throat (NT), and changes in spirometry from before to after exposure. RESULTS: During the first 2 weeks at the WTC site, 19% of study firefighters reported not using a respirator; 50% reported using a respirator but only rarely. Prevalence ratios (PRs) for skin, eye, respiratory, and NT symptoms showed a dose-response pattern between exposure groups based on time of arrival at the WTC site, with PRs between 2.6 and 11.4 with 95% confidence intervals (CIs) excluding 1.0 for all but skin symptoms. For those spending > 7 days at the site, the PR for respiratory symptoms was 1.32 (95% CI, 1.13 to 1.55), compared with those who were exposed for < 7 days. Mean spirometry results before and after exposure were within normal limits. The change in spirometry findings (after exposure - before exposure) showed near-equal reductions for FVC and FEV(1). These reductions were greater than the annual reductions measured in a referent population of incumbent FDNY firefighters prior to September 11 (p or= 450 mL in FEV(1) in those arriving during the first 48 h compared to the referent (p <or= 0.05). CONCLUSIONS: The symptoms and pulmonary function changes following exposure at the WTC demonstrate the need for improvements in respirators and their use, as well as long-term medical monitoring of rescue workers.

Adult↗
PubMed1987

Forensic dentistry in the Cerritos air disaster.

On Aug 31, 1986, 82 people were killed in the worst air disaster in the history of Los Angeles International Airport. The Los Angeles County Forensic Dentistry Team worked with the Medical Examiner-Coroner's Office, the Federal Bureau of Investigation, and other agencies during the identification process. The investigation demonstrated the importance of involving forensic anthropologists and forensic dentists along with investigative agencies in the at-scene search for evidence at disaster sites.

Accidents, Aviation↗
PubMed2005

Understanding mass panic and other collective responses to threat and disaster.

While mass panic (and/or violence) and self-preservation are often assumed to be the natural response to physical danger and perceived entrapment, the literature indicates that expressions of mutual aid are common and often predominate, and collective flight may be so delayed that survival is threatened. In fact, the typical response to a variety of threats and disasters is not to flee but to seek the proximity of familiar persons and places; moreover, separation from attachment figures is a greater stressor than physical danger. Such observations can be explained by an alternative "social attachment" model that recognizes the fundamentally gregarious nature of human beings and the primacy of attachments. In the relatively rare instances where flight occurs, the latter can be understood as one aspect of a more general affiliative response that involves escaping from certain situations and moving toward other situations that are perceived as familiar but which may not necessarily be objectively safe. The occurrence of flight-and-affiliation depends mainly on the social context and especially the whereabouts of familiar persons (i.e., attachment figures); their physical presence has a calming effect and reduces the probability of flight-and-affiliation, while their absence has the opposite effect. Combining the factors of perceived physical danger and the location of attachment figures results in a four-fold typology that encompasses a wide spectrum of collective responses to threat and disaster. Implications of the model for predicting community responses to terrorist attacks and/or use of weapons of mass destruction are briefly discussed.

Disasters↗
PubMed2006

Psychosocial care for adult and child survivors of the 2004 tsunami disaster in India.

The tsunami disaster in South Asia affected the mental health of thousands of survivors, but psychological aspects of rehabilitation are frequently overlooked in public health initiatives. From January to March 2005, teams from the National Institute of Mental Health and Neurosciences in Bangalore, India, traveled to south India and implemented a "train the trainer" community-based mental health program of psychosocial care to facilitate the recovery of child and adult survivors. Psychosocial care has applications to natural and man-made disasters in developing countries.

Adult↗
PubMed1982

Hospital organizational response to the nuclear accident at Three Mile Island: implications for future-oriented disaster planning.

The 1979 nuclear accident at Three Mile Island (TMI) near Harrisburg, Pennsylvania, caused severe organizational problems for neighboring health care institutions. Dauphin County, just north of TMI, contained four hospitals ranging in distance from 9.5 to 13.5 miles from the stricken plant. Crash plans put into effect within 48 hours of the initial incident successfully reduced hospital census to below 50 per cent of capacity, but retained bedridden and critically ill patients within the risk-zone. No plans existed for area-wide evacuation of hospitalized patients. Future-oriented disaster planning should include resource files of host institution bed capacity and transportation capabilities for the crash evacuation of hospitalized patients during non-traditional disasters.

Disaster Planning↗
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↗
PubMed1988

Older people in disaster: a comparison of black and white victims.

This research examines differential vulnerability to environmental stressors among white and black elderly and non-elderly disaster victims. The research identifies the determinants of psychosocial recovery for those four demographic groups. A total of 431 families who were victims of a tornado were interviewed for the study. A path model of the determinants of psychosocial recovery is presented, and observations are made regarding intervention strategies for older disaster victims.

Adaptation, Psychological↗
PubMed1994

Trait anxiety and perception of a potential nuclear power plant disaster.

This study explored how trait anxiety interacts with various demographic variables in influencing how potential nuclear power disaster is assessed by a random sample of 150 adults (77 women, 73 men) who live near a nuclear power plant. Expectation of a future nuclear power plant disaster was positively related to high trait-anxiety elevations in women who were childless.

Adolescent↗
PubMed2005

Psychological response to disasters: focus on adolescents.

The effects of disasters may predispose many adolescents to psychological stress, which can interfere with their growth and development and disrupt their intrapsychic homeostasis. This may lead to negative long-term health outcomes and hamper normal development. Many nurses view traumatic events involving children, including adolescents, as the most frequent and stressful critical incidents. There is a need to address psychological emergency preparedness for mass disasters with the development of protocols and practice guidelines. Assessing and managing physical injuries may take priority in emergencies, but incorporating rapid, cost-effective mental health assessments for children and adolescents is essential.

Adaptation, Psychological↗
PubMed2005

Dissociation and posttraumatic stress 1 year after the World Trade Center disaster: follow-up of a longitudinal survey.

BACKGROUND: We conducted a 1-year follow-up of an original mail survey of early reactions to the World Trade Center disaster. METHOD: Of the 75 subjects originally surveyed, 58 (77%) responded. The survey included measures of dissociation (Dissociative Experiences Scale, Cambridge Depersonalization Scale, Clinician-Administered Dissociative States Scale), post-traumatic stress (Impact of Event Scale-Revised), social support (Interpersonal Support Evaluation List-short form), and a life quality measure (Quality of Life Enjoyment and Satisfaction Questionnaire-short form). We hypothesized that dissociative versus posttraumatic symptoms at follow-up could be dissected on the basis of early reactions. RESULTS: Responders and nonresponders did not differ in baseline characteristics. Exposure was not associated with dissociation or posttraumatic stress at follow-up. Of distress, dissociation, and posttraumatic stress at baseline, baseline dissociation was the strongest predictor of outcome dissociation while baseline posttraumatic stress was the strongest predictor of outcome posttraumatic stress. Of 4 peritraumatic distress factors generated in the original survey, "loss of control" and "guilt/shame" were significantly related to dissociation and posttraumatic stress at outcome, while "helplessness/anger" was only associated with posttraumatic stress at outcome. Lesser improvement in posttraumatic stress over the first year was significantly related to less social support and greater comorbid dissociation. Interim social support was associated with better life quality and fewer symptoms at outcome. CONCLUSION: There was evidence for partly independent pathways toward dissociation versus posttraumatic stress 1 year after the disaster. Feelings of guilt and shame, and persistent dissociation, were poor prognostic factors, while social support had a powerful ameliorating influence.

Adult↗
PubMed1980

Disaster: the helper's perspective.

The responses to disaster and death vary enormously, but there is much to suggest that they are not confined to those who are directly affected. The helpers, too, may be "victims" of the disaster, and it is important that their psychological needs are perceived and met. There is an indication that, if this is done, considerable psychological morbidity may be prevented.

Disasters↗
PubMed1985

Some health consequences of a natural disaster.

A survey of the health and psychosocial problems of all victims of the 1983 South Australian Ash Wednesday Bushfires was carried out 12 months after the disaster. A total of 1526 victims completed an extensive questionnaire that included the 28-item General Health Questionnaire and a self-reporting check-list of specific health problems. The data received indicated a significant increase in stress-related conditions, including hypertension, gastrointestinal disorders, diabetes, and mental illness, while the prevalence of nonstress-related conditions such as cancer or urological disease were not increased significantly. Health problems increased during the 12 months following the bushfire and diminished toward the end of that period, but a large number of difficulties remained. Certain disaster experiences, particularly the type of loss suffered, were found to be significantly related to health.

Adolescent↗
PubMed1985

Disaster preparedness. An international perspective.

Establishing a national disaster medical system requires considering the goals and appropriate expenditure levels for emergency preparedness. The United States has placed a relatively low priority on national programs for disaster response. Such programs have been controversial because of their relationship to civil defense against nuclear attack. Switzerland and the Soviet Union have long-established, elaborate medical response systems that should be studied.

Budgets↗