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PubMedDate not supplied

[The triage in disaster medicine: analysis of a practical exercise].

BACKGROUND: The triage is a procedure for casualties classification using some criteria (severity, survival, therapeutical delay, etc.) which is basic for the preparedness of health personnel in event of disaster. Even being a basic procedure, its teaching and training is not enough extended among health personnel. The goal of this study was assess the efficacy of teaching triage procedures in terms of its capability to carry out the examination and classification of massive casualties under different conditions of environmental difficulties. METHODS: 25 couples of health professionals (doctor and nurse) were trained during 90 minutes on triage procedures and them aleatory located at 3 groups with 12 simulated casualties at each group corresponding to 3 different levels of environmental difficulties. They were asked to perform the triage and complete the information contained at the triage card. This information was analyzed in order to see and compare the results of each group. RESULTS: All the health professionals showed high correlations between observed and expected responses for the evacuation priority variable. However, only the group of less environmental difficulty showed a significative statistical correlation (p = 0.03). No significative statistical differences were found on the diagnostic classification but the adjust level was poor for the high environmental difficulties group. CONCLUSIONS: Acceptable levels of efficacy on triage procedures can be obtained using a single teaching session of theoretical contents plus a practical exercise, specially for the casualties prioritization. On the other hand, environmental conditions looks as a variable influencing the efficacy of other acceptable results expected on this kind of technic perhaps requiring further training.

Disaster Planning↗
PubMed1993

Analysis of medical needs during disasters caused by tropical cyclones: anticipated injury patterns.

This paper is a summary of the data for describing the distribution of injuries among people affected by tropical cyclones that have occurred during the past 20 years. The most striking feature of the data gathered from a review of the epidemiologic literature on tropical cyclones is its lack of uniformity. The absence of an international classification and coding scheme for recording injuries sustained in cyclones also makes planning medical assistance difficult following future cyclones and hurricanes. We propose here a simple injury classification scheme comprising three components for categorizing injury data. Such a standardized disaster injury classification scheme, coupled with other types of information about injuries, will greatly aid relief officials in efficiently matching available resources to needs, in effectively managing health relief operations, and in developing strategies to prevent future cyclone-related morbidity and mortality.

Disaster Planning↗
PubMed1993

[Radiation accidents and radiation disasters].

Accidents and disasters involving ionizing radiation are rare. Such accidents may occur not only at nuclear power stations but also in medicine and in industry. Only fairly large radiation doses can give acute medical effects. Symptoms and signs depend on the actual dose, and on what parts of the body are irradiated. In connection with a radiation accident, the main points are to recognize in the first place that radiation may be involved, and to have some knowledge of the actual source. Risk of localized irradiation from industrial sources, especially of hands, is a problem that is often overlooked. The paper reviews the principles for action by local health officers, the pathogenesis of radiation injury and early medical management. Some information is also given on the Norwegian system of contingency preparedness against nuclear accidents.

Accidents↗
PubMed1996

Ka-boom! When disaster strikes.

When Hurricane Opal slammed Florida's gulf coast last October, Baptist Healthcare in Pensacola was in danger of a direct hit, putting the hospital's mainframe, minicomputers and telecommunications network--not to mention its patients--in peril. But Baptist had planned for just such a danger and, in the end, no harm was done. How would your hospital have fared? Here's what you can do now to make sure your hospital will keep running after disaster strikes.

Computer Communication Networks↗
PubMed1976

Major disasters: hospital admission procedures.

Triage in the accident and emergency department and the admission of all patients needing further care to one ward can form the basis of the successful hospital management of the victims of a major disaster.

Blast Injuries↗
PubMed2005

Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country.

OBJECTIVES: This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. RESULTS: PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. CONCLUSION: No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.

Adolescent↗
PubMed2006

The aftermath of disaster: children in crisis.

This article uses examples from the terrorist attacks on the World Trade Center and the hurricane disasters of Katrina and Rita to illustrate the impact of crisis in the lives of children and adolescents. The author reviews children's responses to loss and crisis. Therapeutic approaches that facilitate integration of crisis and loss are provided, including illustrations of self-care, comfort strategies, and developmental, traditional, and nontraditional methods.

Adaptation, Psychological↗
PubMed2006

Web-based methods in terrorism and disaster research.

This article provides an overview of the use of the Internet for conducting studies after terrorist attacks and other large-scale disasters. We begin with a brief summary of the scientific and logistical challenges of conducting such research, followed by a description of some of the most important design features that are required to produce valid findings. We then describe one approach to Internet surveys that, although not perfect, addresses many of the challenges well. We close with some thoughts about how the Internet-based methods available today are likely to develop further in coming years.

Data Collection↗
PubMed1993

Post-traumatic stress disorder and coping after a natural disaster.

This study examines the role of coping in the onset of post-traumatic stress disorder (PTSD) in a nonpatient population following exposure to a natural disaster. In contrast to other studies, the use of all coping strategies was found to be associated with the presence of PTSD rather than the absence of symptoms. These data suggest that coping (in this sense) represents a psychological process used to contain the distress caused by symptoms as well as to manage environmental adversity.

Adaptation, Psychological↗
PubMed1988

Prior experience as a moderator of disaster impact on anxiety symptoms in older adults.

As participants in a panel study, 234 older adults were interviewed before, as well as after, serious flooding occurred in southeastern Kentucky. Floods are not uncommon in this area, but these were more widespread than most, and resulted in both previously exposed and newly exposed subsamples of disaster victims. Flood impact was measured at both personal and community levels. With preflood symptoms controlled, there were modest flood effects on both trait anxiety and weather-specific distress in older adults without prior flood experience, but no flood effects in older adults who had been in floods before. Thus, the study provides support for the "inoculation hypothesis" and other conceptualizations that emphasize the advantage of being familiar or experienced with a stressor that is at hand. An implication is that "experienced" victims could be a valuable resource in prevention efforts.

Aged↗
PubMed1994

Psychological, psychosocial, and psychophysiological sequelae in a community affected by a railroad chemical disaster.

Psychological, psychosocial, and psychophysiological sequelae were studied in a community which had experienced a railroad chemical spill of 19,000 gallons of the toxic pesticide metam sodium. Two hundred twenty exposed residents were compared to 114 controls and paired on age, education, gender, race, and number of children. A clinical interview and physiological measurements (blood pressure, pulse, and cortisol level) were taken, the MMPI-2, IES Scale, Mood Scale, Environmental Worry, Perceived Social Support, and Perceived Control Scale and a questionnaire were administered. Results indicated greater levels of depression, anxiety, and somatic symptoms in the spill residents in addition to greater environmental worry and lower perceived social support. Spill residents had higher blood pressure and less fluctuation of cortisol levels than controls. No difference on litigation status was obtained except on the IES, Intrusion and the POMS scales. Chemical disasters are associated with a wide variety of psychological, psychosocial, and physiological distress.

Acute Disease↗
PubMed1996

Children's selective coping after a bus disaster: confronting behavior and perceived support.

Data were obtained from 675 seventh graders grieving the death of 19 and injury of 14 fellow students in a traffic accident. Frequency of confronting behaviors was inversely related to their intensity. Perceived helpfulness of the various support person categories (oneself, parents, siblings, relatives, friends, classmates, classroom teachers, guidance counselors, psychologists) was related to current stress levels, context of the disaster, and prior helping relationships. Personal loss and situational variables affected confronting behavior and stress reaction levels. Specific helpful support persons affected interest in individual and/or group treatment. Findings were consistent with a model of search and selection of helpful support persons in community-wide stressful situations.

Accidents, Traffic↗
PubMed1996

Stress debriefing and patterns of recovery following a natural disaster.

Stress debriefing has been used extensively following traumatic events; however, there is little evidence of its effectiveness. This paper reports the effects of stress debriefing on the rate of recovery of 195 helpers (e.g., emergency service personnel and disaster workers) following an earthquake in Newcastle, Australia (62 debriefed helpers and 133 who were not debriefed). Post-trauma stress reactions (Impact of Event Scale) and general psychological morbidity (General Health Questionnaire: GHQ-12) were assessed on four occasions over the first 2 years postearthquake. There was no evidence of an improved rate of recovery among those helpers who were debriefed, even when level of exposure and helping-related stress were taken into account. More rigorous investigation of the effectiveness of stress debriefing and its role in posttrauma recovery is urgently required.

Disasters↗
PubMed1998

Oklahoma City: disaster challenges mental health and medical administrators.

Mental health and medical administrators responded to the Oklahoma City bombing with cooperative and overlapping efforts to meet community needs in the wake of terrorism. The major agencies assisted in the immediate rescue response, organized crisis hotlines, prepared mental health professionals to counsel bereaved families and victims, organized debriefing of rescuers, assessed mental health needs of local school children, planned for longer term treatment, and coordinated research efforts to learn from the disaster. Implications to mental health administrators responding to significant acts of terrorism are discussed.

Adult↗
PubMed2000

The application of dental methods of identification to human burn victims in a mass disaster.

This paper deals with the usefulness of dental identification in the case of 28 human burn victims of a bus accident in Spain. Postmortem forensic procedures for identification were used including general external examination, routine photographs and radiographs and complementary biological methods. Dental identification was also used and a description of the method is presented. Dental identification was established in 57% of the cases. When victims were less than 20 years of age, the success rate of identification by dental methods was higher (76% of victims in this age group). The assessment of dental age allowed the establishment of identity of four victims. We recommend that dental procedures be used in human identification after mass disasters. Odontological and radiographic procedures are powerful methods when dealing with burn victims.

Accidents, Traffic↗
PubMed2001

A study of posttraumatic disorders in children who experienced an industrial disaster in the Briey region.

OBJECTIVES: To study posttraumatic disorders in children who were directly and indirectly involved in an industrial disaster; to assess the respective impact of traumatism exposure, parental disorders and sociodemographic variables on the posttraumatic disorders of the children. METHODS: The children were assessed with self-administered questionnaires (STAIC, CDI, IES) and questionnaires filled in by parents (CPRS, CBCL). Parents were assessed with the GHQ-28. Forty-three exposed children were compared with 44 children who were exposed to the same risk (indirectly exposed group) and with a control group of 50 unexposed children. RESULTS: The exposed group obtained significantly higher anxiety and trauma-related scores than the control group and the threatened group, as well as higher scores of behavioural symptoms and of parental disorders. Indirectly exposed children did not have higher rates of symptoms than control children. The younger exposed children exhibited the highest psychopathological scores. Low sociodemographic status was associated with more disorders. There were no differences on questionnaire scores between girls and boys. Children's disorders correlated with disorders in both parents; but this only accounted for part of the variance, a finding which supports the hypothesis of a direct impact of the trauma on the child, irrespective of parental clinical status, SES of the family, children's age and gender. CONCLUSIONS: Children's and parent's disorders interact in a complex fashion which needs further study.

Adolescent↗
PubMed1994

The Herald of Free Enterprise disaster: the relationship of intrusion and avoidance to subsequent depression and anxiety.

Twenty-five survivors completed the Impact of Events Scale, a measure of intrusive reexperiencing and avoidant behaviour, approx. 7 months following the Herald of Free Enterprise disaster. The aim of the present study was to examine the relationship of scores on these scales to scores on the Beck Depression Inventory and the Spielberger State Anxiety Inventory at approx. 19 months subsequent to the event. Greater intrusive reexperiencing was found to be associated with greater depression and anxiety over and above the intensity of exposure and the fact of bereavement. These data are discussed with reference to a cognitive processing model of post-traumatic stress.

Anxiety Disorders↗
PubMed1995

Emotional processing in survivors of the Jupiter cruise ship disaster.

Twenty-three survivors of the Jupiter cruise ship disaster completed the Impact of Events Scale, a measure of intrusion and avoidance, as well as measures of arousal and affect at two points in time: between 3 and 7 months (Time 1) and between 12 and 14 months (Time 2) following the event. The aim of the present study was to explore the relationship between intrusion and avoidance and symptoms of depression and anxiety. The results suggest that although higher scores on intrusion and avoidance are strongly associated with poorer psychological outcome at each point in time, it is only intrusion which may be predictive of later symptoms. Avoidance would seem to be a response to early distress. These data are discussed with reference to a cognitive--emotional processing model of post-traumatic stress disorder.

Adaptation, Psychological↗