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PubMed1976

[Identification of corpses in mass disasters].

Reference is made to an air disaster causing considerable loss of life near Palermo. The type of lesions noted on the bodies is described and the criteria adopted for identification and recognition in accordance with the present legislation are explained. The reasons for mistaken identification, some of them of a most unusual nature, are listed and their prevention is discussed. An examination is also made of some recent proposals concerning the avoidance of such errors in disasters involging large numbers of persons.

Accidents, Aviation↗
PubMed1999

General practitioner preparedness to respond to a medical disaster. Part I: Skills and equipment.

OBJECTIVE: Financial constraints are leading to the downgrading or closure of many country hospitals throughout Australia. There is concern that general practitioners (GPs) could become deskilled if they lose access to a local hospital. A recent survey of Victorian rural GPs showed that rural GPs in towns without hospitals had different characteristics and working conditions from those with hospital access and backup. Campbell uncovered an apparent paradox: GPs without hospitals were more likely to have emergencies brought directly to their surgeries, and had more equipment in their surgeries, yet they had significantly lower confidence in emergency skills. METHOD: A questionnaire was sent to 100 general practitioners in two rural divisions of general practice in Victoria, Australia. They were asked to indicate their confidence in performing 18 emergency procedures. They were also asked whether they had available the necessary equipment. RESULTS: We have assessed the availability of GP emergency skills and equipment in two rural divisions of general practice--one with, the other without, local hospitals. The division without hospitals scored significantly lower in skill levels. A close correlation was found between skill levels and equipment availability. There has been a significant reduction in skill levels in both divisions over time. CONCLUSION: The skills necessary for the stabilisation of a single patient with a life threatening condition are not dissimilar from those needed to treat such a patient in a multiple victim scenario, although the approach and external pressures may be different. These skills, then, are essential to all general practice. The information sought in this survey would be important in the assessment of GP preparedness for both single-victim and multiple-victim (disaster) emergencies. The results of this study raise doubts as to the ability of at least one division to respond to a disaster.

Australia↗
PubMed1999

General practitioner preparedness to respond to a medical disaster. Part II: Ability and training.

OBJECTIVE: Part I of this paper looked at the availability of 18 individual skills in two rural Victorian divisions of general practice, one with hospitals, and the other without. It looked at the deskilling of rural general practitioners and highlights a direct relationship between skill and equipment availability, and in particular, the effect of a local hospital. METHOD: By analysing the data in Part I, this paper looks at the availability of rural GPs with the ability to perform a range of 15 pre-hospital skills and analyses the effect of retraining in selected skills. RESULTS: Part I identified needle and surgical cricothyrotomy as weaknesses requiring retraining in both divisions. Refreshing these led to a modest improvement only. In addition to the cricothyrotomies, retraining in one skill (as chosen by the GP), will increase to over 50% in both divisions, the percentage of GPs with the first nine skills only. CONCLUSIONS: We found that neither division currently has adequate numbers of GPs with the required range of skills to allow for a GP based response to a disaster. Retraining the GP in both the cricothyrotomies and two self-nominated weakest skills resulted in adequate numbers of skilled GPs. The former can be provided by mass training and the latter requires a more personalized training. A 'travelling circus' format is described as a suitable means for this retraining. It also improves networking among health professionals likely to be involved in a disaster, and offers infrastructure support for GP involvement in emergency management, a public education vehicle, and a research vehicle for the study of critical and emergency care to rural areas.

Australia↗
PubMed2005

Effects of a large-scale industrial disaster on rates of symptoms consistent with posttraumatic stress disorders among schoolchildren in toulouse.

BACKGROUND: Posttraumatic stress disorder (PTSD) has been studied largely among adults and in the context of intentional, collective experiences such as war and terrorism. Far less is known about PTSD among adolescents and resulting from massive industrial accidents. Such an accident in Toulouse, France, 10 days after the World Trade Center disaster, provided an opportunity to examine its effects among adolescents already sensitized by media coverage of the World Trade Center disaster. OBJECTIVES: (1) To assess the presence of symptoms consistent with PTSD (SCW-PTSD) among adolescents in Toulouse after a massive industrial accident, (2) to determine the "excess" of SCW-PTSD among those directly exposed vs those nondirectly exposed, and (3) to examine dosage effects for exposure and the cumulative effect on PTSD of accident-related experiences. DESIGN, SETTING, AND PARTICIPANTS: A survey containing questions on exposure and SCW-PTSD was administered to students aged 11 years, 13 years, 15 years, and 17 years who were enrolled in randomly selected, grade-stratified classrooms from schools for directly exposed students (n = 577) in Toulouse and nondirectly exposed students (n = 900) in the region.Main Outcome Measure The prevalence of SCW-PTSD among directly exposed and nondirectly exposed students. RESULTS: Nine months after the industrial accident, 44.6% of 11- and 13-year-old directly exposed students and 28.5% of 15- and 17-year-old directly exposed students still showed SCW-PTSD, compared with 22.1% of 11- and 13-year-old nondirectly exposed students and 4.4% of 15-year-old nondirectly exposed students. Among 11- and 13-year-olds, the likelihood of having SCW-PTSD was higher for girls who were enrolled in elementary schools, were personally injured, and had severe damage at home, as opposed to boys who were high-school students without severe damage at home or personal injury. Among the 15- and 17-year-olds, being a girl, 17 years old, and personally injured increased the likelihood of having SCW-PTSD, as opposed to 15-year-old boys who were not injured. The effects of injuries were cumulative: students injured personally and with an injured family member were more likely to have SCW-PTSD than those experiencing either personal or family injury but not both. Excess of SCW-PTSD attributable to direct exposure was 50.5% for 11-year-olds, 49.3% for 13-year-olds, and 73.5% for 15-year-olds. CONCLUSIONS: A substantial proportion of Toulouse adolescents still had SCW-PTSD 9 months after the accident. Directly exposed students were far more likely to show SCW-PTSD than those nondirectly exposed, but both groups had SCW-PTSD at rates that were higher than expected. The symptoms were associated with demographic characteristics and direct experiences of trauma. Higher rates applied to students who were personally injured with injured family members and severe damage at home. Students with these characteristics predictive of SCW-PTSD should be given prompt attention to avoid long-lasting effects.

Accidents, Occupational↗
PubMed1995

Characteristics of follicular tumors and nonneoplastic thyroid lesions in children and adolescents exposed to radiation as a result of the Chernobyl disaster.

BACKGROUND: In addition to the previously reported increase in incidence of thyroid carcinomas in Belarussian children after the Chernobyl disaster in April, 1986, benign thyroid lesions were also found to be increased in the exposed population. METHODS: A total of 60 follicular neoplasms and benign nonneoplastic thyroid lesions arising after the Chernobyl disaster in children and adolescents of 7 to 18 years of age were studied. RESULTS: The primary diagnoses in this series were follicular carcinoma in 1 (2%) case, follicular adenoma in 9 (15%), cystic adenomatoid nodule with papillae in 18 (30%), multinodular goiter in 18 (30%), diffuse hyperplasia in 2 (3%), diffuse hyperplasia with atypia and nodularity in 5 (8%), lymphocytic thyroiditis in 6 (10%), and thyroid cyst in 1 patient (2%). Additional histologic changes in thyroid glands from these patients were similar to those reported after radiation exposure, and included perifollicular fibrosis (72%), focal epithelial hyperplasia (73%), colloid accumulation (47%), follicular atrophy (33%), and cellular atypia (25%). Vascular abnormalities were found more often (75%) than previously reported in the thyroid gland after irradiation, and had a somewhat different appearance. They affected primarily medium-size arteries and were characterized by damage of the internal elastic lamina in addition to intimal fibrosis. CONCLUSIONS: The first case of thyroid follicular carcinoma in the exposed Belarussian children was diagnosed after a latent period of 6.5 years, as compared with 4 years of minimal latency for post-Chernobyl papillary carcinomas. Among benign thyroid lesions, cystic adenomatoid nodules of papillary type and diffuse hyperplasia with cellular atypia and nodularity seem to be commonly associated with radiation exposure to the thyroid gland.

Adenocarcinoma, Follicular↗
PubMed1983

1981 circus fire disaster in Bangalore, India: causes, management of burn patients and possible presentation.

The circus fire disaster claimed 92 lives and 300 others were injured. A total of 119 patients were treated in the Burns centre at Victoria Hospital. Forty-two patients were treated as outpatients and 77 cases were admitted. Fourteen patients with more than 80 per cent burns of the body surface died within 48 hours of the disaster. Three patients out of the remaining 63 cases died in the course of treatment, 32 patients were operated by escharectomy and skin grafting or flap procedures. Proper medical assessment, early fluid therapy and respiratory care saved many critical patients. Human Antitetanus toxin and Pseudomonas hyper Immune globulin seem to have a definite role in the prevention and control of infection with Clostridium tetani and Pseudomonas aeruginosa 'Furacin' was found to be a valuable topical agent.

Adolescent↗
PubMed1990

Bashkiria train-gas pipeline disaster: a history of the joint USSR/USA collaboration.

In June 1989, a methane/propane pipeline explosion destroyed two passenger trains in the Bashkirian Republic of the Soviet Union. Over 400 passengers died immediately and 806 were injured. Most of those injured suffered thermal injuries. One hundred and fifty patients were treated at Hospital 21 in Ufa, Bashkiria, by a combined Soviet-US team. Twenty-six patients underwent excision and grafting of their burn wounds. Microbiological studies indicated significant resistance to locally available antibiotics. Antibiotics provided by the US team proved useful in treating the resistant organisms. This disaster and the international response to it exemplify the need for a coordinated response to major burn disasters and the positive results of international cooperation.

Bashkiria↗
PubMed1995

Further validation of a quadruplex STR DNA typing system: a collaborative effort to identify victims of a mass disaster.

The relatively new, PCR-based technique of Short Tandem Repeat (STR) profiling has been used in the identification of the victims of a mass disaster. The analysis relied upon a recently developed multiplex reaction and the use of automated fluorescence technology to simulataneously analyse four tetrameric STR loci. The performance of the 'quadruplex' test was assessed by use of a collaborative study incorporating a blind trial and was demonstrated to be accurate, reliable and robust. Furthermore, the system proved to be highly successful despite the fact that many of the samples from the mass disaster scene were extremely degraded. The high success rate coupled with the discrimination power of the system enabled many severely decomposed human remains to be positively identified.

DNA↗
PubMed2005

Implementation of an emergency and disaster medical response training network in the Commonwealth of Independent States.

A standardized curriculum in emergency and disaster medical response for use in the former Soviet Union was implemented under an American International Health Alliance partnership program involving over 60 healthcare and educational institutions in the United States and the Commonwealth of Independent States. The core curriculum was based on U.S. standards and developed in collaboration with local faculty to address emergency and disaster medical needs specific to the region. Local faculty members were trained by U.S. partners using a train-the-trainers methodology at U.S. partner institutions. This partnership program led to the development of 16 regional training centers in 11 countries over an 8-year period. Over 39,000 healthcare workers and first responders have now been trained throughout this network of regional training centers. Wide dissemination of standardized training encourages uniform delivery of medical care within regions and may facilitate provision of mutual aid between regional jurisdictions.

Commonwealth of Independent States↗
PubMed2004

Hospitalized psychiatric patients view the World Trade Center disaster.

There is conflicting literature describing how psychiatric patients, particularly those with schizophrenia, respond to overwhelming environmental disasters, with some reports describing marked improvement in their symptoms. This view is contrary to the notion that those individuals who are most vulnerable (i.e. people with serious psychiatric illness) are at high risk for further increase in psychiatric symptoms subsequent to stressful events. Since the terrorist attack of September 11, 2001, was such a catastrophic event, the following project was undertaken to examine its consequences on a population of hospitalized and thus severely ill psychiatric patients. Medical records for 156 New York City psychiatric inpatients were examined to evaluate their psychiatric condition during the time prior to and subsequent to the September 11, 2001, terrorist attacks on the World Trade Center in New York City. We failed to find any difference between the patients who had the opportunity to directly view the disaster through windows and those who did not. However, significantly more patients with a schizophrenia spectrum diagnosis showed evidence of worsening in their symptoms than those with affective disorder or other diagnoses in response to the events of September 11.

Anxiety↗
PubMed2003

Mothers' psychological adjustment following disaster affecting their children.

The authors investigated the psychological adjustment of 37 British women whose adolescent children survived the cruise ship Jupiter's sinking in 1988, about 6 years previously. They compared these women with a group of widows (N = 18) and a group of women who had suffered no major negative life event (N= 15). Psychological adjustment of the 37 women was assessed with the Schedule for Affective Disorders and Schizophrenia Lifetime Version (SADS-L; R. L. Spitzer & J. Endicott, 1975) and various standard questionnaires. The women whose children had been involved in the disaster were found to have suffered a greater number of incidents of psychological distress in the period since the disaster than the women who had suffered no major negative life events but fewer incidents of psychological distress than the widows. The significance of these findings and clinical implications are discussed.

Adaptation, Psychological↗
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↗
PubMedDate not supplied

On population aspects of group disasters: an evolutionary view.

Simple mathematical models were constructed (using a DEC PDP 11/40 computer) to evaluate the probable significance of differences between individuals in adaptive reserve--survival time (modelled as "failure rate")--for group survival and of basic population parameters (fertility and mortality) for the gradual compensation of group size/age distribution of a population after an acute group disaster. The results indicate that reversion to prehuman biological regulative mechanisms probably occurs, and that after short-lasting group disasters the time-course for compensation (normalization) of population size and age distribution (when probable values of fertility and mortality were considered) is prolonged.

Concentration Camps↗
PubMedDate not supplied

Firefighter illnesses and injuries at a major fire disaster.

INTRODUCTION: In the summer of 1998, a series of wildfires swept across Florida. Firefighters and support personnel were imported and based in a central camp in Flagler County, Florida. Local residents were evacuated. Disaster medical assistance teams (DMATs) were deployed to provide medical support. Similar large-scale fire disasters occur frequently, but the illnesses and injuries seen have not been described. OBJECTIVES: To report the descriptive epidemiology of illnesses and injuries seen in firefighters and support personnel engaged in control and suppression of a series of wildfires. METHODS: Review of DMAT treatment records to determine the nature of illnesses and injuries seen during a 19-day deployment. RESULTS: Approximately 1,600 firefighters and support personnel were present in the camp. There were 3,404 patients seen with 3,841 complaints. An average of 179 patients was seen per day (range 47-414). A prominent bimodal pattern of presentations was noted during the course of each day. Reasons for seeking medical care included: preventive/hygiene and environmental, 33%; foot-related, 15%; rashes, 14%; ear, nose, and throat (ENT)/allergies, 9%; headache, 4%; eye irritation, 4%; gastrointestinal/abdominal complaints, 3%; cuts and penetrating injuries, 3%; strains/sprains, 2%; bites/stings, 2%; others, 1%. Eight patients (0.2%) were transferred to an emergency department for further care; 99.8% were treated on site. CONCLUSIONS: In this setting the majority of illnesses and injuries are minor. Visits related to preventive care and hygiene are common. This information can help in planning medical support operations in similar situations.

Accidents, Occupational↗
PubMed2006

Disaster-related stress as a prospective risk factor for hypertension in parents of adolescent fire victims.

Life stress has been related to hypertension in various studies, but well-designed research carried out in disaster settings is scarce. Moreover, most research focuses on the primary victims and disregards effects on their caregivers. In a prospective, population-based cohort study, the authors tested the hypothesis that parents of adolescents who had been involved in the Volendam, Netherlands, pub fire on January 1, 2001 (n = 418) were more at risk of developing hypertension than parents from the same community whose children had not been involved in the fire (n = 1,462). Only residents without prior evidence of hypertension were included. The follow-up period covered 4 years (2001-2004). Assessment of hypertension was based on the records of family practitioners and pharmacies. The odds of developing new hypertension were 1.48 times higher in parents of fire victims than in control parents during the follow-up period (odds ratio = 1.48, 95% confidence interval: 1.09, 2.02). All analyses controlled for age, gender, socioeconomic status, family practice, history of chronic disease, and number of contacts with the family practitioner during follow-up. Since hypertension is an important risk factor for cardiovascular morbidity, it is important to provide interventions that help people fight the negative effects of disaster-related stress.

Adolescent↗
PubMed2001

Assessment of genotoxic damage by the comet assay in white storks (Ciconia ciconia) after the Doñana Ecological Disaster.

Single cell gel electrophoresis, the so-called "Comet" assay, was performed as a genotoxicity test in white storks sampled in an area heavily contaminated after the ecological disaster in south western Spain. This disaster occurred as a consequence of a massive toxic spillage of acid waste rich in heavy metals that impacted on the Doñana National Park. The importance of this protected area as a breeding and wintering site for many endangered bird species makes this analysis of DNA damage of special interest. Our results clearly show that white storks born in the contaminated area 1 year after the toxic spill bear a high burden of genetic damage as compared with control individuals. The possible implications for future survival as well as reproductive rate are discussed.

Animals↗
PubMed2006

Testing times: the emergence of the practolol disaster and its challenge to British drug regulation in the modern period.

This article analyses how practolol, the first British drug disaster of the modern, post-thalidomide regulatory period, related to the pharmaceutical industry, the medical profession and government regulation of patients' health. Drawing on comparison with the USA, it argues that, contrary to public expectation and perception, the aftermath of thalidomide did not give rise to strident British drug control, imposing the highest possible safety standards on the pharmaceutical industry. Rather, there existed a culture of reluctant regulation that was characterised by continued optimism about, and trust in the purported benefits of new drugs among manufacturers and regulators in the United Kingdom, together with commitment to the protection of the industry and its institutional support for the medical profession. In particular, British regulators were willing to allow new drugs on to the market, fully aware of uncertainty about their safety, but unwilling to be pro-active in issuing warning letters about risks and requiring 'certainty' before acting to withdraw a product. Even after the practolol disaster, the British system was unable to reform itself to construct more rigorous and pro-active monitoring of drug risks. This was because of conflicts with industry interests.

Adrenergic beta-Antagonists↗
PubMed1999

Initial results, reliability, and validity of a mental health survey of Mount Pinatubo disaster victims.

This report presents the initial results of a mental health survey of 351 tribal and non-tribal Mount Pinatubo disaster victims 6 years after they were displaced following the volcanic eruption in the Philippines on June 12, 1991. Mental illness prevalence rates in both Filipino ethnic groups were comparable to those found in a U.S. study using the same assessment instrument. Post-traumatic stress disorder (PTSD; 27.6%) and major depression (14.0%) were the two most frequent diagnoses. Diagnostic test-retest interviewer agreement was good for probable alcohol abuse (kappa = .65, agreement = 97%) and any mood disorder (kappa = .53, agreement = 91%) but was reduced for any anxiety disorder (kappa = .15, agreement = 81%) and separately evaluated PTSD (kappa = .18, agreement = 69%). Diagnostic test-retest agreement was good among typical Filipinos (mean kappa = .66, mean agreement = 93%) but was reduced among tribal aborigines (mean = .30, mean agreement = 86%). Internal consistency of the PTSD rating scale was high within and across both ethnic groups, including total scale (alpha = .91) and DSM-IV Criteria B, C, and D sub-scales (alpha = .80, 81, and .78, respectively). With the exception of probable alcohol abuse, construct and criterion validity was demonstrated among both tribal and non-tribal Filipinos for all classes of psychiatric disorders by comparing diagnostic results with respondents' views of their physical and mental health and level of functional impairment. Overall, DSM-IV mood, anxiety, alcohol use, and PTSDs with adequate reliability and construct and criterion validity were made in this culturally diverse, non-Western, disaster victim population. However, test-retest diagnostic agreement was reduced for anxiety disorders and among aboriginal respondents, and validity was not demonstrated for probable alcohol abuse.

Adolescent↗