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PubMed2003

Implications of hospital evacuation after the Northridge, California, earthquake.

BACKGROUND: On January 17, 1994, an earthquake with a moment magnitude (total energy release) of 6.7 occurred in Northridge, California, leading to the evacuation of patients from several hospitals. We examined the reasons for and methods of evacuation and the emergency-management strategies used. The experience in California may have implications for hospital strategies for responding to any major disaster, including an act of terrorism. METHODS: From September 1995 to September 1996, we surveyed all acute care hospitals in Los Angeles County that reported having evacuated patients after the Northridge earthquake. Physicians, nurses, hospital administrators, and staff on duty at the hospitals during the evacuation responded to a 58-item structured questionnaire. RESULTS: Eight of 91 acute care hospitals (9 percent) were evacuated. Six hospitals evacuated patients within 24 hours (the immediate-evacuation group), four completely and two partially. All six cited nonstructural damage such as water damage and loss of electrical power as a major reason for evacuation. Five hospitals evacuated the most seriously ill patients first, and one hospital evacuated the healthiest patients first. All hospitals used available equipment to transport patients (blankets, backboards, and gurneys) rather than specialized devices. No deaths resulted from evacuation. One hospital evacuated patients after 3 days and another after 14 days because of structural damage, even though initial inspections had shown no damage (the delayed-evacuation group). Both hospitals required demolition. Some hospitals identified destinations for their evacuated patients independently, whereas others sought the assistance of the Los Angeles County Emergency Operations Center; the two strategies were equally effective. CONCLUSIONS: After even a moderate earthquake, hospitals are at risk for both immediate nonstructural damage that may force them to evacuate patients and the delayed discovery of structural damage resulting in permanent closure. Evacuation of large numbers of inpatients from multiple hospitals can be accomplished quickly and safely with the use of available resources and personnel.

California↗
PubMed2004

Cross-scale interactions, nonlinearities, and forecasting catastrophic events.

Catastrophic events share characteristic nonlinear behaviors that are often generated by cross-scale interactions and feedbacks among system elements. These events result in surprises that cannot easily be predicted based on information obtained at a single scale. Progress on catastrophic events has focused on one of the following two areas: nonlinear dynamics through time without an explicit consideration of spatial connectivity [Holling, C. S. (1992) Ecol. Monogr. 62, 447-502] or spatial connectivity and the spread of contagious processes without a consideration of cross-scale interactions and feedbacks [Zeng, N., Neeling, J. D., Lau, L. M. & Tucker, C. J. (1999) Science 286, 1537-1540]. These approaches rarely have ventured beyond traditional disciplinary boundaries. We provide an interdisciplinary, conceptual, and general mathematical framework for understanding and forecasting nonlinear dynamics through time and across space. We illustrate the generality and usefulness of our approach by using new data and recasting published data from ecology (wildfires and desertification), epidemiology (infectious diseases), and engineering (structural failures). We show that decisions that minimize the likelihood of catastrophic events must be based on cross-scale interactions, and such decisions will often be counterintuitive. Given the continuing challenges associated with global change, approaches that cross disciplinary boundaries to include interactions and feedbacks at multiple scales are needed to increase our ability to predict catastrophic events and develop strategies for minimizing their occurrence and impacts. Our framework is an important step in developing predictive tools and designing experiments to examine cross-scale interactions.

Animals↗
PubMed1994

Dealing with the flood crisis of 1993. A medical center's account.

On Saturday, 10 July 1993, Iowans were assaulted by the greatest natural disaster in the state's history when virtually all rain-swollen rivers and creeks in the Midwest spilled over their banks. In Des Moines, the Iowa Methodist Medical Center was suddenly surrounded by flood waters and stripped of power, water, computer, and telephone communication. Striving to deliver quality patient care in the face of the crisis, medical staff, administrators, and employees at the center achieved recovery in record time.

Communication↗
PubMed2003

Triage and initial treatment of burns in the Gothenburg fire disaster 1998. On-call plastic surgeons' experiences and lessons learned.

Just before midnight on the 29 October 1998 the on-call plastic surgeons were alarmed because of a fire accident thought to involve a few burned patients. Quite soon the information suggested an in-door fire disaster in which many of the 400 young people visiting a disco were caught by a rapidly spreading fire. A cross-sectional survey of the resulting overload, triage and initial treatment of burns was analysed. Two-hundred and thirteen patients were transported to the four hospitals in Gothenburg area and a total of 150 were admitted as inpatients, 73 to Sahlgrenska University Hospital. The initial organisation at the scene of the fire was seriously inadequate because of incorrect information about the number of casualties. As there was no triage officer the principle of "scoop and run" was practised, placing the major burden on the receiving hospitals. The emergency disaster plan in our hospital was not launched, because of misinformation and lack of communication. Early documentation in emergency case books was incomplete as the whole organisation was overloaded. Intubation or tracheostomy and escharotomy at the intensive care unit were not delayed. Triage for transportation to burns units was adequate.

Adolescent↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Bangladesh.

The aim of this paper is to highlight the activities and observations of some NGOs and some dedicated researchers in the field of psychosocial consequences of disaster in Bangladesh, particularly in the coastal areas and the tornado-affected areas of the district of Tangile and Jamalpur during the last two decades. Some of the advantages of the non-governmental organizations' (NGOs) work in relief and development were their linkages with grass-roots people ensuring access to the community and community participation, the flexible approach of work, ability and willingness to learn from people and ability to connect people's lives with their realities. The most remarkable survey carried out by the Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV-Bangladesh) after the 1996 tornado showed, on average, that women are more affected psychologically than men; 66% of the total sample in the disaster area were psychologically traumatized and required emergency services. The study supports the ideas that any disaster will have mental health consequences. Providing scientific psychological services is essential for real recovery from such a disaster. In developing countries like Bangladesh, limitations of mental health professionals and inadequate knowledge and practice about disaster mental health among the medical and paramedical staff, may lead to delays in the psychosocial management and rehabilitation of the survivors. To respond properly to a serious type of disaster like a cyclone or a tornado or recurrent devastating flood, the disaster mental health team should be aware of the socio-economic status, local culture, tradition, language and local livelihood patterns. Integration of the team with the network of various governmental and non-governmental organizations is essential to provide mental health services effectively.

Bangladesh↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Bhutan.

Bhutan has taken the initiative in developing a comprehensive guideline on disaster risk preparedness and management in response to several minor disasters, namely earthquakes and flash floods in the country during the last couple of years. It is now widely accepted that the psychological symptoms of trauma resulting from devastation to lives and livelihood of affected people remain much longer and sometimes throughout their entire life span unless taken care of. Therefore, it is important to include psychosocial components of mental health protection and treatment of the affected persons in disaster risk preparedness and management to make it a comprehensive package. A four-tier system of mental health intervention and counselling has been proposed in line with the existing healthcare system and resources available in the country to make it sustainable. At the core of this programme is the mobilizing and training of volunteers from the community on psychosocial intervention, counselling and rehabilitation, backed up by three layers of trained health workers and mental health professionals.

Bhutan↗
PubMed2006

Mental health and psychosocial support after the tsunami in Thailand.

This article presents an overview of the psychosocial and mental health response after the Asian Tsunami hit Thailand in 2004. The organization and deployment of service modalities that used pre-existing community and school advisory programmes for rapid emergency response were seen as key elements of the response. Mental health programmes were provided to mitigate and ameliorate the effects of the catastrophic event. We describe these strategies and report on lessons learnt.

Child↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Thailand.

After the Asian tsunami, the Department of Mental Health, Thailand developed a national guideline for mental health interventions in disasters based on the lessons learnt from the mental health and psychosocial relief efforts launched. We advocate the integration of social interventions for the affected community into the general mental healthcare, which in turn should be available in the general healthcare setting. This set-up of the mental healthcare delivery system, can provide the daily needs of the community and can be rapidly scaled up in times of a disaster. The organization of the delivery of mental healthcare is discussed in the paper.

Delivery of Health Care↗
PubMed2006

Mental health model of care programmes after the tsunami in Aceh, Indonesia.

Before the tsunami, there was no systematic training provided for General Practitioners (GPs) and nurses in issues related to mental health and psychosocial support in times of disasters. After the tsunami, the Department of Psychiatry, Faculty of Medicine, University of Indonesia in Jakarta was contracted to organize a special two-week intensive training programme on basic psychiatry for 13 GPs from Banda Aceh Mental Hospital. To improve the nursing practice, a Professional Nursing Practice Model (MPKP) has been piloted in two wards in Banda Aceh Mental Hospital. This is a model of best practice for nursing care and management in an open ward system developed by the School of Nursing group and implemented in several mental hospitals in Indonesia. Basic training of GPs located at the primary healthcare level is being carried out based on the existing Ministry of Health curriculum for GPs. It covers 14 conditions listed in the International Classification of Diseases (ICD) Primary Care classification and has been conducted in 11 tsunami-affected districts. Currently, a total of 169 GPs have been trained. In general, there is an increasing interest among primary care doctors in mental health. Currently, community mental healthcare is provided in 11 districts in Aceh and two districts in North Sumatra by 277 Community Mental Health Nurses (CMHN) who have received basic training. Two thousand six hundred and two cases of serious mental disorders (mostly chronic psychosis) have been detected and treated by the CMHN and the doctors in Primary Health Centres (PHC). CMHN can provide a vital link between patients in the community and doctors in PHC. Two years after the earthquake and tsunami in Aceh, psychosocial intervention should continue and mental healthcare should be made available not only at Banda Aceh Mental Hospital, but also general health services, including PHC services.

Catchment Area, Health↗