SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In this article some comments are made about the dental identification-work during the Tenerife-air disaster in 1977. This disaster caused the death of 335 Americans and 248 Dutchmen of which 80% could be identified. The dentitions seemed to be one of the most important criteria for identification. Forensic odontology should follow standard procedures and general practitioners should anticipate on their part in supplying antemortal data.
1. As a result of recent terrorist events, there is an immediate need for occupational nurses to review their disaster plans and to develop strategies to cope with bioterrorism in their workplaces. 2. The Centers for Disease Control and Prevention has identified three major categories of biological weapons. Category A, which is the highest priority category (and the focus of this article), includes smallpox, anthrax, botulism, plague, tularemia, filoviruses, and adenoviruses. Dealing with bioterrorism requires occupational health nurses to be familiar with these organisms, including their pathophysiology and methods of prevention, detection, and treatment. 3. Five principles can be used to guide responses to a biological attack. Incorporation of these principles into disaster planning will increase the effectiveness of responses to bioterrorism, if and when it occurs. Developing a plan of action before an event occurs will greatly enhance the likelihood that the repercussions of such an event are minimized.
Immediately after September 11, 2001, the USNS Comfort was deployed to provide relief to the rescue workers involved with the World Trade Center collapse. The members of the behavioral healthcare team had little field experience in disaster psychiatry and had to organize a response quickly. Due to the unique nature of the assignment, the behavioral care team had to take nontraditional approaches to care. Through preparation of the team to implementation of care, the team learned a great deal about disaster mental health interventions. These perspectives are compared with those in the psychiatric literature to better understand the lessons of September 11th.
A large-scale disaster exercise was conducted to assess how one large community would handle such a situation - particularly, how it would deal with 150 casualties. The planning, undertaken by a subcommittee composed of representatives of all resource groups in the city, took more than a year. The deficiencies of the disaster plan detected during the exercise, which included a lack of trained personnel and various problems of communication, are now being corrected.
When a real disaster takes place, a hospital has a chance to really test the effectiveness of its disaster plan. Here is a detailed report on what happened when such an incident occurred.
Think hard about the problems in your organization or about potential upheavals in the markets in which you operate. Could some of those problems--ones no one is attending to--turn into disasters? If you're like most executives, you'll sheepishly answer yes. As Harvard Business School professors Michael Watkins and Max Bazerman illustrate in this timely article, most of the "unexpected" events that buffet companies should have been anticipated--they're "predictable surprises." Such disasters take many forms, from financial scandals to disruptions in operations, from organizational upheavals to product failures. Some result in short-term losses or distractions, while others cause damage that takes years to repair. Some are truly catastrophic--the events of September 11, 2001, are a tragic example of a predictable surprise. The bad news is that all companies, including your own, are vulnerable to predictable surprises. The good news is that recent research helps explain why that's so and what companies can do to minimize their risk. The authors contend that organizations' inability to prepare for predictable surprises can be traced to three sets of vulnerabilities: psychological, organizational, and political. To address these vulnerabilities, the authors recommend the RPM approach. More than just the usual environmental scanning and contingency planning, RPM requires a chain of actions--recognizing, prioritizing, and mobilizing--that companies must meticulously adhere to. Failure to apply any one of these steps, the authors say, can leave an organization vulnerable. Given the extraordinarily high stakes involved, it should be every business leader's core responsibility to apply the RPM approach, the authors conclude.
Redundancy of all technologies involved in securing, accounting, transporting, authenticating and authorizing access to patient record data is vital to ensuring against practices and procedures that might be construed as HIPAA violations or threats to patient well-being. This is particularly notable in data storage technologies, where it is critical to store multiple, redundant, synchronized copies of the electronic patient record, including all radiological imagery in all modalities, to prevent a HIPAA-related compliance issue from being raised. This involves constructing storage networks that are simple to maintain, yet have sufficient flexibility and resiliency of design to ensure future growth and increasing disaster tolerance without affecting radiological operations or patient record data access at any time, i.e., a zero-disruption storage architecture. In terms of time, the optimal set of technologies to create a zero-time recovery window involve geographically dispersed computing and storage facilities, interconnected by several redundant but logically and physically separate networks. In this architecture, patient record data is kept in multiple locations via synchronous mirroring or replication techniques, assuring realtime updating of all instances of the patient record. In addition, zero-time recovery mandates the use of online magnetic disk technologies in all locations to hold enough patient record data to perform all necessary and sufficient examinations and consultations. Hospitals are finding that using networked storage technology from vendors who have pre-qualified their technology with existing healthcare imaging applications creates secure, highly available access to data. Other facets to consider for selecting an optimal solution for radiology data storage and disaster recovery include choosing a solution that is standards-based, easy to implement and operate, and requires minimal full-time-equivalent (FTE) staff hours. For radiology applications, look for a system that removes complexity from storage management. The current need to meet HIPAA regulations actually creates a positive opportunity for hospitals to re-examine and upgrade their data management procedures to ensure less interaction by FTE staff. Electronic data can be made more secure than paper data, is much faster to retrieve, and can be viewed in multiple locations at the same time. However, these benefits are lost if a healthcare organization implements a cumbersome system that integrates poorly with existing applications and networks, and requires intensive administration.
Psychiatric reactions to disasters have not received sufficient attention because it is widely accepted that human beings can endure any kind of extreme stress. A disaster is the consequence of an extraordinary event that destroys goods, kills people, produces physical or psychological harm but, above all, which overcomes the coping possibilities of the social group. Reactions to stress occur in stages, each one characterised by a specific psychological mechanisms: pre-impact, alarm, impact, recoil, post-impact and reconciliation. The reactions can be acute or chronic, among them the post-traumatic stress disorder. Symptoms include flashbacks, difficulties in remembering, avoidance of stimuli, blunting of responses, high arousal level and obsessive ruminations. Biological, psychological and social factors play a role in the pathogenesis of these disorders.
Although having a comprehensive disaster plan in place and augmenting it with regular drills is essential in preparing for an emergency, unforeseen challenges inevitably arise when a disaster occurs. In this article, hospital officials who have experienced such emergencies share the lessons they learned from an actual event.
A bank explosion in a neighbouring country over 1000 km away resulted in ten badly burned victims being airlifted to the Burns Centre, Singapore General Hospital (BCSGH) for treatment. The severely injured included patients with 90%, 80%, 74%, 66%, 45%, 33% and 31% burns. Nine had respiratory burns (four severe, one moderate, four mild). One patient died, thus, the mortality rate for the six most severely injured was 16.7%. This differs from predicted mortality rates of 78% according to McCoy or 54% according to Thompson, Herndon et al. The factors contributing to this result were the small size of the disaster, the use of an established Burns Mass Disaster plan and an individual management policy that incorporates carefully monitored fluid resuscitation, recognition of respiratory burns with early treatment by intubation thus pre emptying complications, early surgery and a multidisciplinary approach to complications such as infection and renal failure. The average length of stay was 43 days (range 5-122 days). The cost of the hospitalisation of the ten casualties was $312,317.00.
Increasing attention to the psychological aspects of atomic disaster will help improve the ability of the citizens of this country to withstand attack and survive as a free people. Since an enemy may be expected to exploit any internal weaknesses it can find, preparation must be made against the onslaught. The ability to deal effectively with any situation, even the most awesome, depends on knowledge of what to expect, and there is no reason to believe that facts about atomic disaster are an exception to this time proven truth. The psychological aspects need to be considered from two points of view, namely, the effect on masses of people and on individuals.
The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.
The effective system for the emergency health care in the disaster or calamity situations presupposes a wide application of computer facilities. The article shows the possibilities towards the improvement of medical support with the help of the disaster medicine information dissemination system. The authors give the main functional characteristics of this system which could make it possible to optimize the health care to the wounded and to make a correct distribution of assets.
This paper describes the establishment and activities of the Information and Support Centres developed in Norway in the aftermath of large-scale accidents and disasters between 1980 and 1990. The function of these Centres is to provide rapid, authoritative information and psychosocial support services for the next-of-kin of disaster victims, including the families of those missing. By gathering together those affected by a particular event, the Centres provide a setting in which individuals and families can support each other. The activities of the psychosocial team include triage for mental-health emergencies, orienting survivors to immediately available local services, communication with family, friends, and community, and other forms of psychological first aid. The psychosocial team also provides linkages to local health, clergy, and other local resources that are near to the family's home and could provide continued care if necessary.
The authors record the contributions of dentistry to the identification of the crew members who were in one of the most significant peacetime military accidents in U.S. Navy history-the April 1989 explosion in a gun turret on the battleship USS Iowa and the deaths of 47 U.S. Navy personnel. Dental identification was the primary means of identification for most because a very high percentage of the bodies were burned or fragmented. The dental-identification team's success was a direct result of its preparedness, its use of dental personnel with mass-disaster experience, and the overall excellent quality of the antemortem dental records. The dental-identification team's successful involvement in the USS Iowa tragedy was considered a model for success and therefore was instrumental in contributing to the development of the American Board of Forensic Odontology "Guidelines for the Development of a Disaster Dental Identification Team."
E-learning is a new project for education based on the adoption of new computerised, multimedia and telematic technologies. Its application has deeply changed the concept of a teacher-based teaching to a student-centred educational project. It offers a great flexibility in the educational methodology, in the administration of contents, in the synchronous and/or asynchronous interaction between teachers and students, in the organisation and in the structure of the course, in the educational plans, in the support, the tracking and the evaluation of the student. E-learning could represent a great resource and a possible revolution in the concept of education and in the field of medical education as well. In some specific fields of application, as Emergency and Disaster Medicine, where the interaction between the student, the teacher and the patient, even if of great importance, are difficult to obtain in a quiet setting and have a lot of organizing, technical and economic troubles, e-learning approach could find a fertile field of application. In this paper we present a new program of educational activities we started in the field of Emergency and Disaster Medicine together with a review of the history of the instructional design and related technologies, ranging from the development of computer aided instruction to modern e-learning applications as teaching methodologies, and their impact on pedagogic and operative aspects.
Postdisaster crisis interventions have been viewed by many as the appropriate and immediate approach to enhance psychological well-being among persons affected by large-scale traumatic events. Yet, studies and systematic reviews have challenged the effectiveness of these efforts. This article provides the first rigorous scientific evidence to suggest that postdisaster crisis interventions in the workplace significantly reduced mental health disorders and symptoms up to 2 years after the initial interventions. Until now, studies have neither focused on the effectiveness and safety of brief mental health services following disasters, or traumatic events generally, nor examined the long-term impact of these interventions across a spectrum of outcomes using a rigorous research design. The focus of this study was to examine the impact of brief mental health crisis interventions received at the worksite following the World Trade Center disaster (WTCD) among a random sample of New York adults. The data for the present study come from a prospective cohort study of 1,681 adults interviewed by telephone at 1 year and 2 years after this event. Results indicate that worksite crisis interventions offered by employers following the WTCD had a beneficial impact across a spectrum of outcomes, including reduced risks for binge drinking, alcohol dependence, PTSD symptoms, major depression, somatization, anxiety, and global impairment, compared with individuals who did not receive these interventions. In addition, it appeared that 2-3 brief sessions achieved the maximum benefit for most outcomes examined. Implications for postdisaster crisis interventions efforts are discussed.
"Triage" is a term generally referring to the social practice of sorting or categorizing. While it originally had an innocent, commercial meaning referring to sorting crops according to quality, the term quickly took on a more ominous meaning referring to classifying battlefield casualties into three groups: those too well-off to be treated and then, among those more seriously wounded, one group that will get medical attention and another that will not. The moral problem is how to distinguish between the latter two groups. The Hippocratic oath has been utterly useless in helping us do this sorting, since the oath commands the clinician to remain loyal to the individual patient and give no attention to the choice between two patients with different needs. Baker and Strosberg show that historically the British sorted following utilitarian principles, giving priority to the patients who could benefit the most even if they were not in greatest need, while the French arranged patients who could be helped in order of greatest need even if it was not maximally efficient to do so. Understanding how contemporary organ transplant policy utilizes triage can help us clarify our mass disaster triage policy. Two organ transplant examples--tissue typing for kidneys and geographical priority for allocating livers--show that American social policy, when forced to choose between allocating on the basis of efficiency or allocating on the basis of justice, will consider both principles, but give equal or dominant priority to justice--even though this priority is understood to be relatively inefficient. Since health care professionals have a recognized preference for efficiency over justice and lay people are inclined towards justice, leaving mass disaster triage policy in the hands of health professionals will predictably structure the policy in a way that conflicts with the moral priorities of the lay population. Formal public debate that recognizes the conflict between efficiency and equity--professional and lay priorities--is therefore essential.