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PubMedDate not supplied

Venous thromboembolism in earthquake victims.

Sudden death from pulmonary thromboembolism following an earthquake has not been reported to date. This is a published case report of a 48-year-old woman who died suddenly of a pulmonary embolism on October 28, 2004. She lived in the Chuetu District in Japan, where a big epicentral earthquake occurred on October 23. She evacuated her house with her family and spent 4 of 5 nights in a private car. Until November 1, 8 persons who had been living out of their cars after evacuation from their houses in the District were treated for pulmonary thromboembolism. The immobility that comes with living in a car should be recognized as a risk factor for venous thromboembolism. In addition, potential preventive measures should be recommended, including provisions for emergency shelters, access to other temporary housing, public education, and the use of compression stockings.

Automobiles↗
PubMed1990

[The outcomes in crush syndrome of the extremities half a year after the earthquake in Armenia].

Squeezed syndrome affecting various segments of limbs has been identified in 245 of 500 victims randomized for examination 6 months after the earthquake. In 119 cases associated with closed fractures of long tubular bones and in 59 cases with open ones. In 124 cases duration of squeezing was up to 12 h, and in 70 cases--1 day and more. Segmental limb amputation was performed in 113 cases. In 95 cases limbs functions were retained and in 81--lost. Perspectives of more successful outcomes depend on the maximal shortening of rescue period, on rational organization of the treatment process and prolongation of recovery management of squeezed syndrome sequelae.

Arm Injuries↗
PubMed2005

Meeting the challenge of epidemic infectious disease outbreaks: an agenda for research.

Challenges arising from epidemic infectious disease outbreaks can be more effectively met if traditional public health is enhanced by sociology. The focus is normally on biomedical aspects, the surveillance and sentinel systems for infectious diseases, and what needs to be done to bring outbreaks under control quickly. Social factors associated with infectious disease outbreaks are often neglected and the aftermath is ignored. These factors can affect outbreak severity, its rate and extent of spread, influencing the welfare of victims, their families, and their communities. We propose an agenda for research to meet the challenges of infectious disease outbreaks. What social factors led to the outbreak? What social factors affected its severity and rate and extent of spread? How did individuals, social groups, and the state react to it? What are the short- and long-term effects on individuals, social groups, and the larger society? What programs can be put in place to help victims, their families, and affected communities to cope with the consequences--impaired mental and physical health, economic losses, and disrupted communities? Although current research on infectious disease outbreaks pays attention to social factors related to causation, severity, rate and extent of spread, those dealing with the "social chaos" arising from outbreaks are usually neglected. Inclusion, by combining traditional public health with sociological analysis, will enrich public health theory and understanding of infectious disease outbreaks. Our approach will help develop better programs to combat outbreaks and equally important, to help survivors, their families, and their communities cope better with the aftermath.

Attitude to Health↗
PubMed2002

Exposure and peritraumatic response as predictors of posttraumatic stress in children following the 1995 Oklahoma City bombing.

Studies have demonstrated a positive relationship between exposure and posttraumatic stress, but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of posttraumatic stress than more objective measures of exposure. We examined the role of peritraumatic response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Oklahoma City, Oklahoma, bombing. While many children reported hearing and feeling the blast and knowing direct victims, most were in school at the time of the explosion and therefore were not in direct physical proximity to the incident. Physical, interpersonal, and television exposure accounted for 12% of the total variance in our measure of posttraumatic stress when peritraumatic response was ignored. Peritraumatic response and television exposure accounted for 25% of the total variance, and physical and interpersonal exposure were not significant in this context. These findings suggest the importance of peritraumatic response in children's reactions to terrorism. These early responses can be used to help determine which children may experience difficulty over time.

Adolescent↗
PubMedDate not supplied

An argument for equipping civilian hospitals with a multiple respirator system for a chemical warfare mass casualty situation.

During the Persian Gulf war, the entire Israeli population was under the threat of chemical missiles. One of the main effects of chemical agents (e.g., organophosphorus) is respiratory distress, which requires treatment with mechanical ventilation and oxygen enrichment. In the event of a chemical missile attack, the civilian hospitals may enter a state of insufficiency for treating such victims due to the limited amount of equipment, staff and oxygen/air sources. A possible technological solution is a multiple respirator system (MRS) with a multiple oxygen enrichment system designed for use in the battlefield. The advantages of these technologies in the civilian hospital setting during a chemical mass casualty situation are: (a) rapid deployment, (b) high transportability, (c) capability of operation in any location, (d) modularity, and (e) less medical staff for operation. Two types of MRS are described and issues concerning their selection are discussed. The authorities responsible for national health policy may wish to adopt and incorporate these technologies into their hospital and emergency services preparedness system.

Centralized Hospital Services↗
PubMed2002

Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack.

This study evaluated the preparedness of Emergency Departments (EDs) in the greater Philadelphia area to evaluate and treat victims of a terrorist biological or chemical agent release. All hospitals with EDs in the survey target area were included. A survey instrument consisting of 38 questions was mailed to the physician director of each ED. Fifty-four of 62 directors returned usable surveys. This represented an overall response rate of 88.5%. Deficiencies in preparedness were identified involving physician training and education, antidote stocking, written policies, interagency agreements, and decontamination facilities. The overall level of preparedness for hospital EDs responding to this survey was low based on a set of predetermined, implicit criteria. Comprehensive plans should be developed and implemented to remedy the identified deficiencies.

Antidotes↗
PubMedDate not supplied

Fetal loss and contraceptive acceptance among the Bhopal gas victims.

The rates of fetal loss and family planning acceptance among Bhopal gas victims from 1984 to 1989 were compared to those of a control group. In all, 136 eligible women in the affected area and 139 women in the control area were interviewed. Care was taken to ensure that these women had conceived at least once during the previous five years. The The fetal loss rate among the gas-affected women was abnormally high (26.3 per cent) compared to that of women in the control area (7.8 per cent). Family planning acceptance in both areas was similar, with most women using permanent methods. In the case of temporary methods, the percentage of use was higher in the gas-affected area.

Abortion, Spontaneous↗
PubMed1999

The New South Wales Fire Brigades' critical incident stress management response to the Thredbo Landslide.

The Thredbo Landslide occurred just before midnight on Wednesday, July 30th, 1997. The first call was received by the Regional Fire Communications and subsequently to Sydney where a multiagency response to the first Urban Search and Rescue (USAR) incident in Australia occurred. After ten days, eighteen bodies had been recovered and one survivor rescued, with one of those victims a member of the Thredbo Fire Brigade. Although some 2000 emergency service personnel were involved in the overall operation, 120 firefighters were at the forefront of the "hands on" rescue throughout the incident. In New South Wales the emergency services each have their own Critical Incident Stress Management (CISM) programs which operate independently from each other, and this was the case at Thredbo. This paper will describe how the New South Wales Fire Brigades CISM Program managed the Thredbo incident for the 120 New South Wales Fire Brigades firefighters and officers who attended the rescue operation. We are pleased to share this experience and what we have learned in the hope that it might be helpful to others.

Crisis Intervention↗
PubMed2005

An assessment of telemedicine possibilities in massive casualties situations.

The use of existing possibilities of Telemedicine Center of Kaunas University of Medicine allows the live distant consultations from high-level medical specialised centers to rural areas. On July 2004 the Telemedicine Center took part in the RESCUER/MEDCEUR project exercise. A special objective was the use of telemedicine facilities for distant consultations and sorting of victims directly at the event place. Telemedicine Center used appropriate telecommunication devices for joint activities of civil and multinational military services in critical situations such as mass casualty events. There were used ISDN lines and IP radio-connection. On the final and most intensive day of the anti-terrorism drills, the multinational force of medics at the Kairiu Training Range in Lithuania reacted to a large mass casualty event--treating hundreds of victims from a simulated train crash. Using on-line telemedicine facilities from Kaunas Medical University Hospital there were corrected the tactics of giving the first help and sorting of casualties. The most complicated initiated cases of eye trauma, neurosurgical trauma, maxilloface trauma and traumatic amputation of limbs evaluated and selected for emergent evacuation to the third level hospitals. All those cases transported to Kaunas and Vilnius Universities Hospitals by helicopters (200 and 300 km from the event place). The common use of existing military and civil telemedicine infrastructure showed the possibilities of interaction in management, giving the first help and sorting of casualties between military and civil medical services during the rescue operations.

Disaster Planning↗
PubMedDate not supplied

Effect of the Hanshin-Awaji earthquake on posttraumatic stress, lifestyle changes, and cortisol levels of victims.

In 1995, the Hanshin-Awaji area in Japan was damaged severely by a major earthquake. In this study, the authors administered questionnaires and obtained blood samples to analyze the relationships among lifestyle, psychological stress, and plasma cortisol levels of victims. The authors questioned 107 male inhabitants of Awaji Island about their lifestyles before and after the earthquake, presence of any symptoms of posttraumatic stress disorder, and demographic variables. Plasma cortisol levels were determined with enzyme immunoassay. Cortisol level was correlated strongly with change in lifestyle. The highest cortisol levels were found in the group characterized by a high posttraumatic stress disorder score and by a very profound lifestyle change. This group also contained the highest percentage of subjects who had poor health. In summary, the psychological stress induced by the Hanshin-Awaji earthquake was associated with mean cortisol level; however, this relationship was affected by adjustment of lifestyle.

Aged↗
PubMedDate not supplied

Surviving collapsed structure entrapment after earthquakes: a "time-to-rescue" analysis.

INTRODUCTION: Massive earthquakes often cause structures to collapse, trapping victims under dense rubble for long periods of time. Commonly, this spurs resource intensive, dangerous, and frustrating attempts to find and extricate live victims. The search and rescue phase usually is maintained for many days beyond the last "save," potentially diverting critical attention and resources away from the pressing needs of non-trapped survivors and the devastated community. This recurring phenomenon is driven by the often-unanswered question "Can anyone still be alive under there?" The maximum survival time in entrapment is an important issue for responders, yet little formal research has been conducted on this issue. Knowing the maximum survival time in entrapment helps responders: (1) decide whether or not they should continue to assign limited resources to search and rescue activities; (2) assess the safety risks versus the benefits; (3) determine when search and rescue activities no longer are indicated; and (4) time and pace the important transition to community recovery efforts. METHODS: The time period of 1985-2004 was selected for investigation. Medline and Lexis-Nexis databases were searched for earthquake events that occurred within this timeframe. Medical literature articles providing time-torescue data for victims of earthquakes were identified. Lexis-Nexis reports were scanned to select those with time-to-rescue data for victims of earthquakes. Reports from both databases were examined for information that might contribute to prolonged survival of entrapped individuals. RESULTS: A total of 34 different earthquake events met study criteria. Forty-eight medical articles containing time-to-rescue data were identified. Of these, the longest time to rescue was "13-19 days" post-event (secondhand data and the author is not specific). The second longest time to rescue in the medical articles was 8.7 days (209 hours). Twenty-five medical articles report multiple rescues that occurred after two days (48 hours). Media reports describe rescues occurring beyond Day 2 in 18 of 34 earthquakes. Of these, the longest reliably reported survival is 14 days after impact, with the next closest having survived 13 days. The average maximum times reported from these 18 earthquakes was 6.8 days (median = 5.75 days). The event with the most media reports of distinct rescue events was the 1999 Marmara, Turkey earthquake (43 victims). Times range from 0.5 days (12 hours) to 6.2 days (146 hours) for this event. Both databases provide little formal data to develop detailed insight into factors affecting survivability during entrapment. CONCLUSIONS: A thorough search of the English-language medical literature and media accounts provides a provocative picture of numerous survivors beyond 48 hours of entrapment under rubble, with a few successfully enduring entrapment of 13-14 days. These data are not necessarily applicable to non-earthquake collapsed-structure events. For incident managers and their medical advisors, the study findings and discussion may be useful for post-impact decision-making and in establishing and/or revising incident priorities as the response evolves.

Confined Spaces↗
PubMed1999

Life supporting first aid training of the public--review and recommendations.

Since the introduction around 1960 of external cardiopulmonary resuscitation (CPR) basic life support (BLS) without equipment, i.e. steps A (airway control)-B (mouth-to-mouth breathing)-C (chest (cardiac) compressions), training courses by instructors have been provided, first to medical personnel and later to some but not all lay persons. At present, fewer than 30% of out-of-hospital resuscitation attempts are initiated by lay bystanders. The numbers of lives saved have remained suboptimal, in part because of a weak or absent first link in the life support chain. This review concerns education research aimed at helping more lay persons to acquire high life supporting first aid (LSFA) skill levels and to use these skills. In the 1960s, Safar and Laerdal studied and promoted self-training in LSFA, which includes: call for the ambulance (without abandoning the patient) (now also call for an automatic external defibrillator); CPR-BLS steps A-B-C; external hemorrhage control; and positioning for shock and unconsciousness (coma). LSFA steps are psychomotor skills. Organizations like the American Red Cross and the American Heart Association have produced instructor-courses of many more first aid skills, or for cardiac arrest only-not of LSFA skills needed by all suddenly comatose victims. Self-training methods might help all people acquire LSFA skills. Implementation is still lacking. Variable proportions of lay trainees evaluated, ranging from school children to elderly persons, were found capable of performing LSFA skills on manikins. Audio-tape or video-tape coached self-practice on manikins was more effective than instructor-courses. Mere viewing of demonstrations (e.g. televised films) without practice has enabled more persons to perform some skills effectively compared to untrained control groups. The quality of LSFA performance in the field and its impact on outcome of patients remain to be evaluated. Psychological factors have been associated with skill acquisition and retention, and motivational factors with application. Manikin practice proved necessary for best skill acquisition of steps B and C. Simplicity and repetition proved important. Repetitive television spots and brief internet movies for motivating and demonstrating would reach all people. LSFA should be part of basic health education. LSFA self-learning laboratories should be set up and maintained in schools and drivers' license stations. The trauma-focused steps of LSFA are important for 'buddy help' in military combat casualty care, and natural mass disasters.

Cardiopulmonary Resuscitation↗
PubMed2006

Public health emergencies: nurses' recommendations for effective actions.

During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support.

Adaptation, Psychological↗
PubMed1990

[Mental disturbances in the victims of the earthquake in Armenia (based on examination data in the medical institutions of Moscow)].

As a result of examining 211 persons with severe somatic pathology (the crush syndrome, multiple fractures, spinal cord injuries, and so forth) received during the earthquake, 179 (84.8%) manifested psychopathological disorders. Of these, 70 persons (33.2%) had asthenia, consciousness disturbances, insomnia which were viewed as somatogenic, 17 persons (8.1%) with craniocerebral injury had the signs of the establishment of the psycho-organic syndrome, and in 109 persons (51%), the clinical picture was determined by psychogenically conditioned depressive, anxious-phobic and psychopathic reactions. The data obtained allow one to judge the characteristics of the mental status during the subacute period (from the first to the second week) after the earthquake.

Adolescent↗
PubMed1990

Simplified method of odontograms for individual identification.

A computerized method of codifying dental lesions and treatment is presented to enable faster identification of victims of catastrophes. Each tooth is assigned a bidigital value. The first digit refers to the root and designates whether it is found to be perfect, damaged and/or treated, or absent. The second digit refers to the crown and is assigned according to the number of surfaces showing lesions or treatment. For the identification of corpses, missing individuals whose record reveals values less than or equal to those of the subject in every tooth (or of each quadrant in cases of doubt) are selected for consideration from the data base. Individuals who have even one tooth with a value greater than that of the subject are eliminated.

Dental Records↗
PubMedDate not supplied

Social contexts of trauma and healing.

The social contexts in which the mass trauma of thousands of people occur and in which their recovery should progress have qualities that distinguish it in important ways from individualised trauma in which a person is a victim of a violent attack, rape or a traffic accident. Organised violence, such as wars, oppression by dictatorships and massive terrorist attacks are extreme cases in which hundreds or thousands of people are exposed to trauma in a short period of time. As such, it has multiple consequences that extend beyond the affected individuals and the symptoms they suffer. Although the symptoms may be similar, the social contexts in which individual victimisation and exposure to organised violence happen are very different. The social milieu in which the survivors of individual trauma and survivors of mass trauma are embedded is likewise different, with important consequences for recovery. Understanding the social context of the trauma helps create the right social intervention for healing at social and personal levels.

Adult↗
PubMed1996

Sudden cardiac death triggered by an earthquake.

BACKGROUND: The earthquake that struck the Los Angeles area at 4:31 a.m. on January 17, 1994, was one of the strongest earthquakes ever recorded in a major city in North America. Once the life-threatening situation was over, the Northridge earthquake, so called because its epicenter was near Northridge, California, just north of Los Angeles, provided investigators an unusual opportunity to examine the relation between emotional stress and sudden cardiac death. METHODS: We reviewed the records of the Department of Coroner of Los Angeles County for the week before the earthquake, the day of the earthquake, the six days after the earthquake, and corresponding control periods in 1991, 1992, and 1993. RESULTS: On the day of the earthquake, there was a sharp increase in the number of sudden deaths from cardiac causes that were related to atherosclerotic cardiovascular disease, from a daily average (+/- SD) of 4.6 +/- 2.1 in the preceding week to 24 on the day of the earthquake (z = 4.41, P < 0.001). Sixteen victims of sudden death had symptoms, usually chest pain, or died within the first hour after the initial tremor. Only three sudden deaths occurred during or immediately after unusual physical exertion. During the six days after the earthquake, the number of sudden deaths declined to below the base-line value, to an average of 2.7 +/- 1.2 per day. CONCLUSIONS: The Northridge earthquake was a significant trigger of sudden death due to cardiac causes, independently of physical exertion. This finding, along with the unusually low incidence of such deaths in the week after the earthquake, suggests that emotional stress may precipitate cardiac events in people who are predisposed to such events.

Adult↗
PubMed1993

Preparing for terror.

Terrorists enjoy their exposure in the international press. Their acts and treats of violence are heralded in headlines and broadcast throughout the world. They purposely inflict damage in public places where there are large numbers of victims, with the potential for a great deal of destruction and debris. They intend to inflict economic loss, instill fear and disrupt everyday life, while at the same time believing their need to maim and kill is justified. Is it no wonder that the World Trade Center was a highly prized target? You must remember that terrorism involves the perpetrator's willful, calculated choice to use innocent victims as targets, and that the terrorist's acts are deliberate, systematic murders to inspire fear for political or criminal ends. As Brian Jenkins stated back in 1983, "terrorism is never a short-term event...you never really get over it...and its effects can't be buried or forgotten." Thus, our responsibility, as EMS providers, is to recognize the threat and refuse to be lulled into a sense of complacency. The United States is at risk, and our greatest threat may even come from our own ranks: political crusaders, activists, hate groups, drug merchants and gangs. The criminals, zealots, fanatics and extremists of the world will continue to believe their crusades and turf battles can be won through terrorist acts. It's up to us to respond effectively to the aftermath.

Disaster Planning↗