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Hurricanes, earthquakes, and tornadoes are not the only disasters that can disrupt a patient accounts department's operations. Localized fires, power outages, vandalism, and hardware or software failure can pose even greater threats to operations. To minimize downtime and resume normal operations, disaster preparedness strategies should be part of a department's daily procedures.
Unexpected disasters, natural and manmade, continue to occur and pose challenging situations for hospitals called on to treat casualties. Hospitals in Mobile, AL, which were tested by the Amtrak crash two years ago, faced another disaster in March when a fog caused numerous multi-vehicle collisions. Downtown New York City hospitals, which handled the over a thousand persons injured in the World Trade Center bombing in February 1993, faced another bombing emergency in December 1994 when a bomb exploded in a crowded subway train. How hospitals reacted to the new emergencies and the lessons they learned from the prior incidents are the subject of this report.
This document amends 2, 90, and 99 to allocate high frequency (HF) frequencies to be used by the States, Territories, and Possessions in meeting disaster communications needs. This action is necessary to provide these entities with frequency resources needed to fulfill disaster communications requirements.
Considerable agreement exists on objectives for disaster planning in hospitals. However, different strategies have been proposed to achieve these objectives. Some of these strategies are considered from the view point of those hospital personnel directly involved in disaster plans.
INTRODUCTION: A mass casualty disaster (MCD) never has occurred in the United States, but such an event remains a fearful possibility. The purpose of this study was to establish baseline information concerning the perceptions relative to the capabilities of the United States to respond to a MCD of persons most likely to involved in the responses to such an event when it does occur. METHODS: A survey was constructed in 1995 to query the perceptions of persons in authority in federal, state, and local agencies who would participate in the medical responses to a MCD. Participants were asked to select the most likely scenario, a hurricane or earthquake, that could generate 30,000 casualties within their respective region. The survey requested respondent's perceptions as to the timing of the federal responses and the quality and sufficiency of these responses. The survey also sought information about the availability of plans to meet such a catastrophe in the region, and the frequency with which such plans have been exercised. Responses were grouped by phase of the responses and whether the respondents were employed by federal, state, or local agencies. Descriptive statistics were used to summarize the data. When appropriate, a one-tailed t-test was used to compare the responses of the groups. A p-value = 0.05 was considered statistically significant. RESULTS: A total of 104 surveys were distributed of which 88 were completed and returned (85%). Both the federal and state respondents had considerable experienced in this area. Overall, the federal respondents were more optimistic about the availability, utility, and timely arrival of federal resources to assist regions in meeting the medical needs. In each of the three phases of MCD responses evaluated (medical response, patient evacuation, and definitive care), there was concern that there were insufficient resources to meet the requirements. States and local respondents perceived that initially, they will be on their own for field rescue, life-supporting first-aid, and casualty evacuation. Respondents acknowledged that a combination of local, state, federal, and private resources eventually would be needed to meet the huge demand. Only 31% federal and 26% state/local respondents believed that there will be sufficient combined local, state, federal, and private resources to meet the requirements for the evacuation of casualties to definitive care facilities outside of the region, and another 50% acknowledged the resources would only partially meet these requirements. Sixty-eight percent of state/local respondents believed that there would be insufficient local, state, federal, and private definitive care resources to meet the requirements for definitive care. CONCLUSIONS: While three years have elapsed since the survey was conducted and there have been some improvements in preparedness and responses, concerns center around the perceived lack of resource capability or lack of ability to get the resources to the MCD scene in time to meet requirements. Such perceptions by experienced professionals warrant further review by those at all levels of government responsible for planning and responding to mass casualty disasters.
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.
The authors examine the specialty of dental hygiene and address its role in the identification of mass-disaster fatalities. Very little exists in the literature on what dental hygienists can often and what they have contributed as members of dental-identification teams. To encourage forensic dentists to seek out the valuable assistance of these highly trained professionals, the authors illustrate how their services can be used in mass disasters.
Children and adolescents exposed to trauma can suffer major adverse psychological effects including not only post-traumatic stress but also other psychological disorders. This study investigates the long-term course of general psychopathology following trauma in adolescence using a standardised diagnostic interview and comparisons with a matched control group. Young people (N= 216) who as teenagers had survived a shipping disaster-the sinking of the "Jupiter" in Greek waters-between 5 and 8 years previously and 87 young people as matched controls were interviewed. The survivors showed raised rates of diagnosis in a range of anxiety and affective disorders during the follow-up period. The highest rates were among the survivors who had developed Post-Traumatic Stress Disorder (PTSD), and those survivors who had not were generally similar to the controls. Onset of anxiety and affective disorders varied between being indefinitely close to the disaster to years later. Differences in rates of disorder between the survivor and control groups had lessened by the time of follow-up but were still apparent, due to continuing distress among the survivors still suffering from PTSD, and to a lesser extent among those who had recovered from PTSD. Generalisability of the findings are discussed.
BACKGROUND: A three month relief operation for the 25,303 people living in the municipal area of Villanueva, Nicaragua, hit by Hurricane Mitch, was carried out jointly by the staff of an international non-government organization and an Italian Regional Hospital's staff. METHODS: Health Mobile Teams joined the local health facilities (Health Centers and Health Posts) in responding to the people's urgent health problems. From their files the thirty-day post-disaster incidence of acute diarrheas (AD), respiratory tract infectious diseases (ARD), and malaria were estimated and compared with off-crisis data. New cases of leptospirosis were searched, but no control group was available. RESULTS: The incidence of AD and ARD increased significantly in comparison with pre-disaster data (6,798 vs. 2,849 per 100,000 inhabitants (p < 0.01) and 1,205 vs. 295 per 100,000 inhabitants (p < 0.01)). The increase in incidence of malaria was not explicit. Only three cases of leptospirosis were ascertained. The relief operators used the gathered data to make decisions to allocate the poorly available resources. CONCLUSIONS: The feasibility of the infectious disease surveillance and the reliability of the results under such conditions may change according to the setting. In this case study the infectious disease surveillance was feasible, and the gathered data were reliable and of some help to the relief operators in order to allocate the resources efficiently.
This paper provides an overview of disaster public health preparedness, response, and recovery activities with particular reference to examples that have occurred in California. It discusses the public health considerations from two aspects: 1) general public health effects; and 2) public and environmental health control measures. The latter discussion is divided into: 1) drinking water; 2) human wastes; 3) food; 4) personal hygiene; 5) mass care and shelter; 6) solid waste and debris; 7) hazardous materials; 8) injury prevention programs and public health information; 9) vector control; and 10) disease control and surveillance. Two tables summarize the disaster medical and health functions as they relate to public health.
Within the past 10 years, the American Red Cross has responded to dramatic disasters and terrorist events that have resulted in significant loss of life and traumatic stress responses. These disasters have included events as diverse as earthquakes, explosions, and aviation accidents.
Experience of liquidation of earthquake consequences in Armenia (1988) has shown that it is extremely necessary to create the system of management in regions of natural disaster, large accident or catastrophe before arrival of main forces in order to provide reconnaissance, to receive the arriving units. It will help to make well-grounded decisions, to set tasks in time, to organize and conduct emergency-and-rescue works. The article contains general material concerning the structure of All-Russia service of disaster medicine (ARSDM), organization of management at all levels and interaction between the components of ARSDM and other subsystems of Russian Service of Extreme Situations. It is recommended how to organize management of ARSDM during liquidation of medical-and-sanitary consequences of large-scale extreme situations.
In June 2000, the Telemedicine Center at the Brody School of Medicine, East Carolina University in Greenville, NC participated in a simulated disaster response in Pu'u Paa, Hawaii, a lava plain without running water, electricity, or human habitation. During the five-day exercise we evaluated the ability to establish telecommunications and the effectiveness of the infrastructure, services, and applications implemented for an operational global emergency response. Scaleable technologies were configured and systematically tested to determine the ability to provide medical and health care in an austere environment. A medical communications matrix was constructed and used throughout the evaluation. Results show that telemedicine can be an important contribution to humanitarian relief efforts and medical support following disasters. Additional research is needed to build upon the lessons learned from participation in this exercise.
The applications of space communications technology to various critical human needs are discussed. Satellite communications, telemetry, and biotelemetry have provided timely and crucial communications capabilities over remote distances. The use of satellite/beacon systems have been used for disaster relief as well as search and rescue operations. The combination of telemetry and electronic medical systems (telemedicine) have augmented existing health care delivery and have provided consultation links between remotely located health care specialists working with patients and physicians at a central location. This has been expanded into networks to respond to victims of disasters in need of critical medical assistance with the hope that with further work, telemedicine may become available to all nations through an international network.
Chengdu-Kunming Railway is an important transport line on southwestern China. However, this railway's safety is often threatened by debris flows. How to effectively forecast and alarm the debris flow disasters and reduce the losses is the aim to study the prevention system in this paper. The factors to cause or influence debris flow are divided into four parts--the basin environmental factors, the basin meteoric factors, the prevention work's elements and the flood-relief work's elements, and the prevention system is made up of three models--a judgment model to assess the debris flow gully's seriousness, a forecast model to predict the debris flow's occurrence and an alarm model to evaluate the debris flow's disaster. Afterwards, a concise structure chart is worked out and verified by the field data from Chengdu-Kunming Railway. This prevention system will provide beneficial reference for the debris flow's monitoring network to be executed on Chengdu-Kunming Railway.
The Employment and Training Administration (ETA) of the Department of Labor (Department) is issuing this interim final rule, effective upon publication, to clarify eligibility for disaster unemployment assistance (DUA) in the wake of the major disasters declared as a result of the terrorist attacks of September 11, 2001. To provide an opportunity for public participation in this emergency rulemaking, this interim final rule includes a post-publication comment period. The Department will publish a final rule after taking into account any comments that are received.
Nowadays a great number of applications are used to compile and transmit casualties and disasters information but there are many troubles associated with the technology as can be the communications reliability and the size and weight of the devices medical staff has to carry with. Telecommunication infrastructures support information movement among geographically dispersed locations. Recently a large family of little devices has appeared in the buyer's market. They are called Personal Digital Assistants and because of their physic and technical features, they are very useful in the emergency field. As for the communications reliability, many technologies have been developed in the last years but it is necessary to find a solution that can be used in whatever situation independently of the emergency circumstances. Facing this reality, the Spanish government funded REMAF, an ATYCA (Initiative of Support for the Technology, Security and Quality in the Industry) project. REMAF joined research groups (UPM), phone operators (Fundación Airtel Móvil) and end users (SAMUR) to build a disaster data management system conceived to use modern telemedicine systems to optimize the management in these situations, taking the advantage of the above mentioned mobile communication tools and networks.
The author participated as a forensic odontologist in the Dutch Disaster Victim Identification (DVI-)team during the period 1977-1995. In this article he describes the organization and procedure of this police unit, which is especially trained for the recovery and identification of victims. He also gives an impression of the organization and the special manner of identification of the forensic odontologists within the group of external specialists of the DVI-team. He describes the technical aspects of the identification activities of the forensic odontologists, as well as the identification problems at different sorts of mass disasters. The quality of the records obtained from the victims' dentists greatly influences the final results of dental identification.