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Childhood posttraumatic stress disorder and efforts to cope after Hurricane Floyd.

The authors report on the level of posttraumatic stress disorder (PTSD) experienced by fourth-grade children 6 months after Hurricane Floyd and describe the children's efforts to cope with their stress. All of the children they studied were directly affected by the hurricane, secondary to the destruction of their school by floodwaters. The homes of 37% of these children were also flooded. Ninety-five percent of the children experienced at least mild symptoms of PTSD, and 71% had symptoms that were moderate to very severe. Children who reported that their homes were flooded were 3 times more likely to report symptoms than those whose homes were not flooded, and the girls were twice as likely as the boys to report symptoms. The high PTSD prevalence rates are comparable to findings from other studies involving violence in which 94% of the victims reported experiencing symptoms. For further analyses, the authors used symptom clusters of hyperarousal, numbing/avoidance, and reexperiencing symptoms.

Adaptation, Psychological↗

Prehospital management and medical intervention after a chemical attack.

Chemical warfare agents are toxic weapons and emergency prehospital medical care providers should be well prepared, trained, and equipped to give response. Personnel need to be aware of the following medical issues regarding prehospital management of a chemical attack, event recognition, incident medical command and control, safety and protection, decontamination, isolation of the incident area (hot zone, warm zone, and cold zone), sampling and detection, psychological management, communication, triage, treatment, transportation, recovery activities and fatality management. During prehospital response, healthcare responders should provide self protection by wearing proper protective equipment and ensuring that the casualty is thoroughly decontaminated. Medical first responders are also responsible for performing triage in each zone of the incident area. Victims are triaged into four categories based on the need for medical care; immediate, delayed, minimal, and expectant. Finally, a medical emergency planning should be completed, and exercises conducted to test the system before an event occurs.

Chemical Warfare↗

Hospital preparedness for victims of chemical or biological terrorism.

OBJECTIVES: This study examined hospital preparedness for incidents involving chemical or biological weapons. METHODS: By using a questionnaire survey of 224 hospital emergency departments in 4 northwestern states, we examined administrative plans, training, physical resources, and representative medication inventories. RESULTS: Responses were received from 186 emergency departments (83%). Fewer than 20% of respondent hospitals had plans for biological or chemical weapons incidents. About half (45%) had an indoor or outdoor decontamination unit with isolated ventilation, shower, and water containment systems, but only 12% had 1 or more self-contained breathing apparatuses or supplied air-line respirators. Only 6% had the minimum recommended physical resources for a hypothetical sarin incident. Of the hospitals providing quantitative answers about medication inventories, 64% reported sufficient ciprofloxacin or doxycycline for 50 hypothetical anthrax victims, and only 29% reported sufficient atropine for 50 hypothetical sarin victims (none had enough pralidoxime). CONCLUSIONS: Hospital emergency departments generally are not prepared in an organized fashion to treat victims of chemical or biological terrorism. The planned federal efforts to improve domestic preparedness will require substantial additional resources at the local level to be truly effective.

Bioterrorism↗

Perspectives on coordination from the Office of the Assistant Secretary of Defense/Health Affairs.

Many teams from each of the different military services, as well as numerous civilian agencies, were involved in providing care to the victims, survivors, and family members of the September 11th attacks. However, the different teams initially had difficulties with communication and command and control issues. This article describes the perspective from Health Affairs on coordination of those efforts.

Aircraft↗

[Prolonged crushing of the head (the biomechanics, clinical picture, diagnosis and treatment)].

Analysis of the victims of the earthquake in Armenia made it possible to distinguish a form of trauma, unique in biomechanics and pathogenesis, which was not described earlier, namely, prolonged compression of the head (PCH). Its clinical picture is characterized by superimposition and mutual aggravation of general organismic, general brain, cerebral and extracerebral focal symptomatology. Variants of the relations of the syndrome of prolonged compression of the soft tissues of the head and the craniocerebral damages proper are described. A detailed CT characterization of PCH is given. The principles of stage treatment of victims and the indications for compelled nonoperative and surgical tactics in PCH are suggested for the first time.

Armenia↗

Medico-legal investigations of the Airbus, A320 crash upon Mount Ste-Odile, France.

The authors present the medico-legal investigations and identification after the aircrash of the Airbus A320 upon the Mount Sainte-Odile (France). The identification team comprising investigators from the gendarmerie, forensic pathologists, odontologists, and scientists of the Institute from Legal Medecine rapidly retrieved and identified 85 of the 87 victims, with 17 being identified through DNA typing, three through fingerprints and the remaining through dental records and specific physical or X-ray findings. Full autopsies were performed on all fatalities to determine patterns of injury and cause of death. Results lead us to point out the importance of a multidisciplinary team of forensic practitioners especially trained for managing medico-legal investigation in mass disaster and the ability of DNA technology to solve complex identification problems.

Accidents, Aviation↗

Case report: illegal immigration via overloaded vans and the effects on a trauma system.

The Arizona-Mexico border consists of 375 square miles of rural desert where temperature extremes, excessive sun exposure, and a lack of food and water are common. The desert poses an especially deadly threat to immigrants who attempt to cross it on foot. In an effort to smuggle humans across this region, smugglers transport people in vans that are loaded beyond the recommended vehicle weight limitations. The unrestrained occupants change the vehicle's center of gravity and increase the propensity for van rollovers. Van rollovers produce multiple casualties that quickly outstrip the resources of rural providers. The purpose of this article is to describe two cases that involved multiple victims injured in van rollovers that occurred on two consecutive days. The rollovers occurred in the rural areas outside of Phoenix, Arizona, and eventually taxed the entire metropolitan Phoenix area trauma system.

Accidents, Traffic↗

Workplace trauma and the law.

The law places increasing responsibilities on organizations to protect its workforce from psychological injury. This paper looks at the development of British law relating to traumatic stress and explores a growing concern of clinicians that the law and the legal processes themselves may increase the psychological injury of victims of traumatic stress. The statutory requirement for organizations to provide effective support for employees following a traumatic incident is enshrined in law. However organizations are confused by the conflicting statements on the effectiveness of debriefing and trauma counselling.

Accidents, Occupational↗

Risk factors for acute chemical releases with public health consequences: Hazardous Substances Emergency Events Surveillance in the U.S., 1996-2001.

BACKGROUND: Releases of hazardous materials can cause substantial morbidity and mortality. To reduce and prevent the public health consequences (victims or evacuations) from uncontrolled or illegally released hazardous substances, a more comprehensive analysis is needed to determine risk factors for hazardous materials incidents. METHODS: Hazardous Substances Emergency Events Surveillance (HSEES) data from 1996 through 2001 were analyzed using bivariate and multiple logistic regression. Fixed-facility and transportation-related events were analyzed separately. RESULTS: For fixed-facility events, 2,327 (8%) resulted in at least one victim and 2,844 (10%) involved ordered evacuations. For transportation-related events, 759 (8%) resulted in at least one victim, and 405 (4%) caused evacuation orders. Fire and/or explosion were the strongest risk factors for events involving either victims or evacuations. Stratified analysis of fixed-facility events involving victims showed a strong association for acid releases in the agriculture, forestry, and fisheries industry. Chlorine releases in fixed-facility events resulted in victims and evacuations in more industry categories than any other substance. CONCLUSIONS: Outreach efforts should focus on preventing and preparing for fires and explosions, acid releases in the agricultural industry, and chlorine releases in fixed facilities.

Disasters↗

[The dynamics of the wound microflora in the victims of the earthquake in Armenia].

The data on the composition of wound microflora, as well as changes in the contamination index over the course of treatment of patients with the syndrome of prolonged compression, who were brought to the institute after the earthquake in Armenia, are presented. The authors characterize the structure of the causative agents of wound infection in the patients treated at the traumatological department of the institute over several years. The epidemiological situation in the hospital in the period when the earthquake victims were treated there is analyzed.

Amputation, Traumatic↗

Attack on America: children's reactions and parents' responses.

INTRODUCTION: When disaster strikes, as it did September 11, 2001, children react to both the actual event and their parents' distress. The purpose of this study was to find out how children were affected by these recent events and how parents responded to their children's concerns. This study is a sequel to a previous study on parents' and children's perceptions to the President Clinton situation and the Starr Report. METHOD: Eighty-eight school-aged children and 51 parents were recruited for this descriptive, qualitative study that used community-based snowball sampling. Parents and children were asked a series of questions about the attacks on the World Trade Center and Pentagon, including how they heard about it and how it made them feel. RESULTS: Children's responses indicated feelings of fear about their safety and their future; wanting to take revenge; feeling sad and disappointed; and empathy for the victims. Parents realized they had to comfort their children in spite of their own feelings of dismay. Many parents reported difficulty in reacting to their child's concerns regarding fairness and justice. DISCUSSION: Pediatric nurse practitioners need to understand parents' and children's responses to such events in order to provide optimal health care, support, and counseling within the context of normal growth and development.

Adaptation, Psychological↗

Field management of avalanche victims.

The median annual mortality from snow avalanches registered in Europe and North America 1981-1998 was 146 (range 82-226); trend stable in Alpine countries (r=-0.29; P=0.24), increasing in North America (r=0.68; P=0.002). Swiss data over the same period document 1886 avalanche victims, with an overall mortality rate of 52.4% in completely-buried, versus 4.2% in partially-, or non-buried, persons. Survival probability in completely-buried victims in open areas (n=638) plummets from 91% 18 min after burial to 34% at 35 min, then remains fairly constant until a second drop after 90 min. Likewise, survival probability for completely-buried victims in buildings or on roads (n=97) decreases rapidly following burial initially, but as from 35 min it is significantly higher than that for victims in open areas, with a maximum difference in respective survival probability (31% versus 7%) from 130 to 190 min (P<0.001). Standardised guidelines are introduced for the field management of avalanche victims. Strategy by rescuers confronted with the triad hypoxia, hypercapnia and hypothermia is primarily governed by the length of snow burial and victim's core temperature, in the absence of obviously fatal injuries. With a burial time < or =35 min survival depends on preventing asphyxia by rapid extrication and immediate airway management; cardiopulmonary resuscitation for unconscious victims without spontaneous respiration. With a burial time >35 min combating hypothermia becomes of paramount importance. Thus, gentle extrication, ECG and core temperature monitoring and body insulation are mandatory; unresponsive victims should be intubated and pulseless victims with core temperature <32 degrees C (89.6 degrees F) (prerequisites being an air pocket and free airways) transported with continuous cardiopulmonary resuscitation to a specialist hospital for extracorporeal re-warming.

Cardiopulmonary Resuscitation↗

The Brisbane floods, January 1974: their impact on health.

In the 12 months following the Brisbane flood of 1974, 234 flooded families (695 persons) and 163 non-flooded families (507 persons) were interviewed to ascertain changes in health status. We found that the number of visits to general practitioners, hospitals and specialists were all significantly increased for flooded persons in the year following the flood. Persistent psychological symptoms, which included irritability, nervous tension and depressed mood, predominated in those seeking medical care, and the consumption of sleeping tablets and psychotropic drugs rose. Increased psychological symptoms were significantly more common in female than in male flood victims and significantly more common in both sexes than increased physical complaints. There was no increase in mortality after the flood. The incidence of psychiatric symptoms was directly related to dissatisfaction with help received.

Adult↗

[Case reports of Davos avalanche accidents 1972/73-1987/88].

The main aim of this analysis was to study from different point of views the registered accidents in whom people were involved caused by avalanches during the winter-periods 1972/73 to 1987/88. As a result of this study a Swiss register for all accidents caused by avalanches was produced. The final goal of the register is to compile centralized a most complete database on all the details of either the avalanche victims or of the accidents themselves. This database is to be used for further analysis of the accidents in order to provide more background information to discuss and to improve the primary care of these patients.

Accidents↗

A brush fire forensic case.

In Italy, every summer forest fires attract public attention due to the number of victims, the intensity of the fires, the areas devastated, the environmental damage and the loss of property. Excluding some fires by natural causes, other causes are related to the social, economic, and productive profile of the territory. The erroneous expectation is that wooded areas destroyed by fire can then be used for private interests. Often, a fire, started to clear a small area, can completely change the expected result, producing disaster, loss of property, destruction of entire forests and resident fauna, and kill innocent people. In this case report, the reconstruction of an arson scene, the analytical techniques and the results obtained are illustrated in this paper, with the aim of sharing with other research laboratories the current knowledge on forest fire.

Firesetting Behavior↗

[The pathogenesis of pulmonary edema after being buried by an avalanche].

A case of pulmonary edema in a rescued avalanche victim is described. The pathogenesis of this complication involves respiratory and hemodynamic factors which are responsible for the development of a hydrostatic pressure gradient between capillaries and alveoli. The resulting transsudation requires some time after the victim has been buried and probably the appearance of pulmonary edema directly precedes death. This might be one of the reasons why pulmonary edema has rarely been observed. However, such an event can, theoretically, be considered part of the pathophysiological processes in buried avalanche victims. In addition to the usual emergency treatment, therapy should, in the light of this theoretical consideration, also be directed towards normalization of the pressure relationship. This can be accomplished by decreasing the pressure in the lung capillaries and increasing the pressure in the alveoli.

Disasters↗

[Evaluation of the psychological consequences of environmental catastrophes: a feasibility study based on the 1992 floods in the Vaucluse].

Scientific studies of environmental disasters, whether human or natural in origin, have shown that the psychological impact of such events may be considerable and long-lasting. Several natural disasters have occurred in France, but their impact on public psychological health has not been assessed. In September 1992, there was a major flood in southeast France (Vaucluse), which caused 38 deaths. Four years later, we performed a pilot cross-sectional study to assess the feasibility of a larger epidemiological study to assess the psychological impact of this flood. Two affected towns were chosen for this study: Vaison-la-Romaine (VLR), where the flood was very sudden and 29 people were killed, and Bédarrides, where the water level rose more slowly. In Bédarrides, households were randomly selected from a list of victims (n = 100) and in Vaison-la-Romaine, households were randomly selected from the telephone directory (n = 140). Exposure to the flood was assessed by a series of questions, the answers to which were used to calculate an exposure score. The questionnaire also included psychometric scales for post-traumatic stress disorder (QE-PTSD), anxiety (Spielberger State-Trait Anxiety Inventory) and depression (Beck Depression Inventory). In Bédarrides, the participation rate was high: 69% of the selected households were successfully contacted and found to be eligible for inclusion and 74% agreed to a face-to-face interview. In Vaison-la-Romaine, 51% of the selected households were contacted and eligible and 50% agreed to the face-to-face interview. Our survey showed that exposure was multidimensional and that it was possible to calculate an exposure score suitable for the analysis of exposure-effect relationships. The PTSD scale was completed well by the interviewees, several of whom did not fill in the depression and anxiety scales correctly. However, analysis of the responses obtained showed that these tools had a high level of internal consistency. Cross-correlations between the various psychological scales used in this study were highly significant (p < 10-4). There was some degree of association between some psychometric scales and exposure. This pilot study shows that a cross-sectional study of the long-term psychological consequences of an environmental disaster could be carried out several years after the event but that the feasibility of such a study depends ultimately on its acceptance by the public and the relevant authorities. It underlines the need to collect exposure data immediately after the event and enabled us to identify and to adapt the tools required for this kind of evaluation. It should encourage public health decision-makers to support such evaluation and to improve the psychological and social support available to people exposed to floods.

Anxiety↗