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PubMed2006

The synthetic evaluation model for analysis of flooding hazards.

BACKGROUND: Although many previous epidemiological studies have reported the incidence of diseases, mortality rate and economic losses after natural disasters, none of these studies has been comprehensive enough. Our aim was to establish a synthetic evaluation model (SEM) that can be used to analyze flood hazards. METHODS: Initial evaluation indicators were selected using systematic and literature data analysis. These indicators were tested with single or multiple variable analyses. Final evaluation indicators and their weights were determined using the Delphi procedure. We established a SEM of flood hazards using the hierarchy method and tested the model using jack-knife analysis. RESULTS: The SEM on flood hazards consists of 6 first-rank indicators and 24 second-rank indicators. First-rank indicators were: direct casualties (w = 0.2123), the increased incidence and prevalence rate of the disease (w = 0.1715), excess mortality rate (w = 0.1745), mental injury (w = 0.1038), epidemic focus expansion (w = 0.1572) and economic loss (w = 0.1807). The agreement of the model reached 98.2% tested with the jack-knife analysis. CONCLUSION: A SEM of flood hazards was established with an agreement of 98.2%, which can be used to evaluate the hazards, and assist public health-care workers provide appropriate flood disaster management.

China↗
PubMed1985

The 1980 earthquake in Southern Italy--morbidity and mortality.

The effects on health of the 1980 earthquake in southern Italy were surveyed retrospectively. The sample population includes 3619 people living in seven villages situated near the epicentre. Deaths were one hundred times and injury rates more than five times higher in trapped than in non-trapped victims. The possibility for escape was crucial for survival and depended on the type of building. Most of the rescue and relief work was carried out within a few days by unprepared local people who concentrated assistance on people sharing the same dwelling. The results suggest that the emergency phase for medical care was limited to the three to four days after impact. During the 18 months following the quake, mortality rates in injured (13.7%) and non-injured victims (15.8%) were similar. These results point to the need to establish, in each disaster prone area, a health evaluation system on which effective disaster relief and especially the preparedness of the community can be based.

Disaster Planning↗
PubMed1993

Issues of rescue and medical care following the 1988 Armenian earthquake.

On-site emergency care and rescue efforts may be critical in preventing disability and other serious consequences of disasters. In this report we compare efforts used in the rescue and emergency medical care of 189 people (case subjects) from Kumairy (Leninakan), Armenia, who were hospitalized with serious injuries following the Armenian earthquake of 7 December 1988, with efforts used in helping 68 people (controls) from Kumairy with mild injuries who were not hospitalized. We used a standardized interview questionnaire to ascertain the circumstances of entrapment, the rescue process used, the injuries the victims sustained, and the medical care they received. Case and control subjects shared similar social and demographic characteristics; however, case subjects waited longer to be rescued and to receive medical care than did control subjects. Of the people who said they were trapped, 66.2% of the case subjects and 41.2% of the control subjects said that they were trapped for > 1 hour (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.52-5.13) whilst the OR for > 6 hours of entrapment was 3.88 (95% CI: 1.69-9.10). Of those requiring medical care, 28.6% of people who were hospitalized waited > 1 hour after rescue to receive medical care, compared with only 14.7% of the control subjects (OR = 2.32, 95% CI: 1.05-5.23). In addition to the case-control study, we collected data on general characteristics of the rescue and emergency medical care process. We found that most of the trapped people were rescued by untrained local inhabitants who most often used their hands or simple tools.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Deaths related to Hurricane Andrew in Florida and Louisiana, 1992.

BACKGROUND: Information about circumstances leading to disaster-related deaths helps emergency response coordinators and other public health officials respond to the needs of disaster victims and develop policies for reducing the mortality and morbidity of future disasters. In this paper, we describe the decedent population, circumstances of death, and population-based mortality rates related to Hurricane Andrew, and propose recommendations for evaluating and reducing the public health impact of natural disasters. METHODS: To ascertain the number and circumstances of deaths attributed to Hurricane Andrew in Florida and Louisiana, we contacted medical examiners in 11 Florida counties and coroners in 36 Louisiana parishes. RESULTS: In Florida medical examiners attributed 44 deaths to the hurricane. The mortality rate for directly-related deaths was 4.4 per 1 000 000 population and that for indirectly-related deaths was 8.5 per 1 000 000 population. In Louisiana, coroners attributed 11 resident deaths to the hurricane. Mortality rates were 0.6 per 1000 000 population for deaths directly related to the storm and 2.8 for deaths indirectly related to the storm. Six additional deaths occurred among non-residents who drowned in international waters in the Gulf of Mexico. In both Florida and Louisiana, mortality rates generally increased with age and were higher among whites and males. CONCLUSIONS: In addition to encouraging people to follow existing recommendations, we recommend emphasizing safe driving practices during evacuation and clean-up, equipping shelters with basic medical needs for the population served, and modifying zoning and housing legislation. We also recommend developing and using a standard definition for disaster-related deaths, and using population-based statistics to describe the public health effectiveness of policies intended to reduce disaster-related mortality.

Adolescent↗
PubMed1997

Deaths and injuries due to the earthquake in Armenia: a cohort approach.

BACKGROUND: This is the first population-based study of earthquake injuries and deaths that uses a cohort approach to identify factors of high risk. As part of a special project that collected data about the population in the aftermath of the earthquake that hit Northern Armenia on 7 December 1988, employees of the Ministry of Health working in the earthquake zone on 7 December 1988, and their families, were studied as a cohort to assess the short and long term impact of the disaster. The current analysis assesses short term outcomes of injuries and deaths as a direct result of the earthquake. METHODS: From an unduplicated list of 9017 employees, it was possible to contact and interview 7016 employees or their families over a period extending from April 1990 to December 1992. The current analysis presents the determinants of 831 deaths and 1454 injuries that resulted directly from the earthquake in our study population of 32,743 people (employees and their families). RESULTS: Geographical location, being inside a building during the earthquake, height of the building, and location within the upper floors of the building were risk factors for injury and death in the univariate analyses. However, multivariate analyses, using different models, revealed that being in the Spitak region (odds ratio [OR] = 80.9, 95% confidence interval [CI]: 55.5-118.1) and in the city of Gumri (OR = 30.7, 95% CI: 21.4-44.2) and inside a building at the moment of the earthquake (OR = 10.1, 95% CI: 6.5-15.9) were the strongest predictors for death. Although of smaller magnitude, the same factors had significant OR for injuries. Building height was more important as a factor in predicting death than the location of the individual on various floors of the building except for being on the ground floor of the building which was protective. CONCLUSIONS: Considering that most of the high rise buildings destroyed in this earthquake were built using standard techniques, the most effective preventive effort for this disaster would have been appropriate structural approaches prior to the earthquake.

Adolescent↗
PubMed1998

Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake.

BACKGROUND: The Northridge earthquake struck Los Angeles on 17 January 1994, originating from a previously unknown thrust fault. The earthquake measured 6.7 on the Richter scale and caused extensive damage to buildings, utilities and roadways. This report describes injuries occurring in the Northridge earthquake which resulted in death or hospital admission. METHODS: Earthquake-related deaths were identified by the Los Angeles Department of the Coroner. All 78 hospitals in Los Angeles County were screened for earthquake-related admissions and were found in 16 of them. Coroner's records and medical records from the 16 hospitals were individually reviewed to identify earthquake-related injuries and to obtain information about the injury. RESULTS: A total of 171 earthquake-related injuries was identified in Los Angeles County, 33 were fatal and 138 required hospital admission. Injury rates were approximately equal by gender and increased significantly with increasing age. Most of the fatalities were due to building collapse, and most of the hospital-admitted injuries were caused by falls or being hit by objects. Motor vehicle injuries and burns were also common causes of injury. Head and chest injuries were common among fatalities, and extremity injuries were the most common among those admitted to a hospital. CONCLUSION: Earthquakes cause injuries through many mechanisms, and a clearer understanding of these pathways can help focus prevention strategies. Research combining comprehensive surveillance with risk factor assessment can help identify behaviours and circumstances increasing the risk of injury in an earthquake.

Adolescent↗
PubMed2002

Calls for help after September 11: a community mental health hot line.

Although unprepared for a disaster of the magnitude of September 11th, New York City's mental health system responded immediately. Within weeks, Project Liberty, a recovery program funded by the Federal Emergency Management Agency (FEMA), was in operation. The program provides free education, outreach, and crisis counseling services for those affected by the disaster and its aftermath. LifeNet, a 24-hour, 7-day-a-week mental health information and referral hotline, is a key component of Project Liberty. In this article, we describe the operation of LifeNet and examine the volume of calls to the hotline during the 6 months following the terrorist attacks on the World Trade Center. We describe the demographics of the callers and the kinds of disaster-related mental health problems that callers presented. The data indicate a clear pattern of increasing calls from October through March for all demographic subgroups except seniors. Callers complaining of symptoms of posttraumatic stress and symptoms of anxiety, panic, and phobia increased over time. Bereavement-related calls increased as well. The number of callers who reported symptoms of depression and substance abuse/dependence did not show as clear-cut an increase over time. We looked at the volume of LifeNet calls in relation to the Project Liberty media campaign and suggest that the campaign has had a positive effect on call volume and that its impact is likely to continue over time.

Community Mental Health Services↗
PubMed1997

Status and development of critical incident stress management services in the United Kingdom National Health Service and other emergency services combined: 1993-1996.

Surveys conducted amongst members of the Association of NHS Occupational Physicians indicate few changes in the status and development of Critical Incident Stress Management Services (CISMS) in the United Kingdom National Health Service between 1993 and 1996. Limited CISMS are confirmed by the majority of respondents in the two surveys with developments having typically occurred within long-established staff care services such as counselling. In 1996 NHS provision is typically based on the independent use of own resources. A 1996 comparison of NHS with pooled returns from Ambulance Services, Fire Brigades and Social Services Departments indicates few variations in status, provision and levels of expertise in the delivery of CISMS. Other emergency services co-operate to a greater extent with each other than does the health care sector. Occupational Health Department responders confirm availability of expertise resources to provide CISMS, but low priority status frustrates delivery of CISMS. Survey results indicate the NHS is at risk of not fulfilling its duty to care for staff after major incidents. The establishment of regional centres of CISMS excellence with local and national responsibilities is advocated.

Ambulances↗
PubMed2000

Major chemical incidents: bridging the occupational--public health gap.

Increasing awareness and concern about possible long-term health effects of exposure to chemicals after major chemical incidents has opened up a new area of public health activity. However, progress is hampered by a lack of low level exposures in potentially highly susceptible subgroups of the populations, and by a lack of expertise in public health. The challenge is to extend the toxicological and epidemiological experience developed in the occupational setting to the community level. To better define the problem population surveillance of acute chemical hazards, first set up in Wales, has been extended throughout the UK, and is also being piloted internationally. Further work is needed to address specific problems of the epidemiological follow-up of populations exposed, the assessment of the psychological consequences at the community level, and risk perception and communication. Organisational arrangements for the public health management of incidents and their sequelae must move beyond short-term funding and market competition and must incorporate the expertise of the occupational disciplines.

Chemical Industry↗
PubMed2004

Public health impacts of floods and chemical contamination.

INTRODUCTION: Flooding accounts for about 40 per cent of all natural disasters that occur worldwide. In 2002-2003 many counties in England experienced severe floods. Floods are particularly important in public health terms as they may have multiple environmental consequences. METHODS: Details of floods reported to Chemical Hazards and Poisons Division, London [CHaPD(L)] were analysed and a literature review was undertaken to identify published reports of flood-related chemical incidents that have had an impact on public health. RESULTS: Epidemiological evidence shows that chemical material may contaminate homes and that in some cases flooding may lead to mobilization of dangerous chemicals from storage or remobilization of chemicals already in the environment, e.g. pesticides. Hazards may be greater when industrial or agricultural land adjoining residential land is affected. Less evidence exists to support the hypothesis that flooding that causes chemical contamination has a clear causal effect on the pattern of morbidity and mortality following these flooding events. CONCLUSION: In the light of this evidence, a checklist/pro forma for public health response to and investigation of flooding events that may result in chemical contamination was needed. This is available from CHaPD(L).

Causality↗
PubMed1994

Identification in the Lockerbie air disaster.

In the aftermath of the Lockerbie air disaster, identification of the victims (plane occupants and local residents) was established by two primary methods: odontology and dactylography. Scottish law requires corroboration of evidence of identity, so both primary methods were used whenever possible, with further evidence occasionally derived from the matching of physical characteristics, personal effects and details from past medical records. Of the 270 victims, 253 were positively identified. Of these, 209 were identified with the aid of odontology.

Accidents, Aviation↗