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PubMed2004

International disaster mental health.

This article distills key issues and controversies in the field of international disaster mental health. It offers perspectives from cross-cultural research and describes current controversies, including the appropriateness of bringing to bear Western structures of mental health and psychiatric diagnosis to non-Western settings. It reports early lessons learned from the field regarding what might best constitute assistance within a foreign culture and where to place emphasis. It recommends becoming involved within the relief establishment.

Culture↗
PubMed2003

Pediatric surgical emergencies in the setting of a natural disaster: Experiences from the 2001 earthquake in Gujarat, India.

BACKGROUND/PURPOSE: On January 26, 2001, a 7.9 Richter earthquake struck the Indian state of Gujarat. Over the next 6 days, the International Red Cross set up a mobile hospital in the city of Bhuj, near the epicenter. The authors describe all surgeries on children treated there during the first 4 weeks of operation. The evolution of presenting injuries is noted, the types of surgery required are classified and an effective disaster relief team composition and strategy are proposed. METHODS: Total casualties were estimated at 30,000, with 250,000 people injured. Of 1,142 inpatients treated at Nor-Finn hospital during the first 4 weeks, approximately 300 (25%) were </=17 years old. Of these, the authors report on the 62 who underwent surgery. Demographic data collected includes (where possible) age, date of presentation, injury, and surgery performed. Injuries are classified as orthopedic, soft tissue, burns, or miscellaneous. Injuries are grouped in 4 weekly time periods beginning February 1 when the hospital opened. RESULTS: Children's ages were evenly distributed. Children required surgery less often than adults. Of children needing surgery, 42% needed orthopedic attention, 42% had soft tissue trauma, 10% had burns, and 6% had miscellaneous injuries. During the hospital's first week, operations were predominantly orthopedic. During the second week, orthopedic and soft tissue injuries occurred at similar frequency. In weeks 3 and 4, soft tissue and burn surgeries were prevalent. CONCLUSIONS: More than 25% of patients requiring hospitalization were children, of whom greater than 20% needed surgery. The operations fell into 4 categories: orthopedic, soft tissue injuries, burns, and miscellaneous. There was an immediate need for orthopedic and general surgery skills followed by a delayed need for plastic surgery skills.

Adolescent↗
PubMed1976

Disaster procedures report. Report following the Moorgate train crash on 28 February, 1975.

There is no substitute for the use of intelligence and common sense both in the drawing up and interpretation of a disaster plan; for compromise in dealing with other rescue services; for ingenuity in filling the gaps in the equipment with which you find yourself provided; and, finally, perhaps most important, for self-discipline. None of us is indispensible--there are always others equally able to make decisions.

Analgesics↗
PubMed2002

Taiwanese nurses' most unforgettable rescue experiences in the disaster area after the 9-21 earthquake in Taiwan.

The purpose of this study was to reveal the most unforgettable rescue experiences of nurses at the central site of the 9-21 Taiwan earthquake during the crucial early recovery stage-the first 72h. A purposive sample of 46 nurses was obtained (40 women and 6 men, with an average age of 28). Data were collected using semi-structured interviews and analyzed by content analysis. The negative aspects of most unforgettable experiences reported by 87% of the subjects were primarily: (a) the prevalence of psychoneurotic syndromes (50%); (b) the severe destruction of geographic treasures (43%); (c) the buried-alive bodies of whole families or village populations (33%); (d) inadequate care for the children and teenagers that were left homeless (22%); (e) deterioration of the condition of patients with chronic health problems (15%); and (f) manifestation of the greedy or selfish nature of human beings (13%). Still 76% of the subjects reported the following positive aspects of their rescue experiences: (a) feeling rewarded from helping others (43%); (b) being deeply touched by residents' mutual support (33%); and (c) the good attitude and tangible help given by other health professionals (15%). This study highlights a need for long-term follow-up and attention of these nurse rescuers in the post-rescue stage. The implementation of a well designed "disaster reduction" course for the health professionals was also encouraged.

Adult↗
PubMed1980

Victim-tracking cards in a community disaster drill.

During a disaster drill at Detroit-Wayne County Metropolitan Airport in September 1978, an attempt was made to evaluate the effectiveness of triage by tracing the routes of "victims" using a system of tracking cards. The cards were placed with the victims during make-up and collected at the receiving treatment facility. The system, despite several problems encountered in its use, provided an accurate method for evaluating the manner in which "victims" were handled during the "rescue" effort.

Color↗
PubMed2003

Perception of risk and subjective health among victims of the Chernobyl disaster.

Several studies have demonstrated that the nuclear power plant accident at Chernobyl in 1986 had a strong impact on the subjective health of the inhabitants in the surrounding regions and that the majority of these health complaints appear to be stress-related. An epidemiological survey among the adult population of the Gomel region in Belarus near Chernobyl showed higher rates of self-reported health problems, psychological distress and medical service use in this region than in a comparable unexposed region. This paper presents an analysis of data on cognitive factors that were collected in this study. The findings support the hypothesis that cognitive variables such as risk perception and sense of control play an important role as mediating factors in the explanation of the observed health differences between the exposed and non-exposed regions. A tentative model is presented to further clarify the role of risk perception in the occurrence of non-specific health complaints after such ecological disasters.

Adult↗
PubMed2003

Fire disaster in Gothenburg 1998--surgical treatment of burns.

A tragic in-door fire disaster took place on 29 October 1998 at a discotheque in Gothenburg, Sweden. Nearly 400 youths attending a Halloween party were inside the building when the fire started, killing 61 people and injuring another 213 persons. A total of 154 youths were admitted to hospital care. Twenty-three patients requiring primary reconstructive burn surgery were followed and their records from the different burn units were examined. Total body surface area (TBSA), burn depth, surgical treatment, hospital stay, and complications were studied. In contrast to what is normally encountered in burn patients, well circumscribed predominantly full-thickness burns covering 1-40% TBSA were observed while partial-thickness burns only comprised 1-7% TBSA. Exposed bone was seen in 10 out of 23 patients. Escharotomies were performed in 11 patients, in six of whom that fasciotomies had to be performed. Primary excisions and skin grafting were performed in 22 patients. Five patients acquired amputations. Eight patients required local flaps and two had free flap coverage. Thoracic surgery was performed in one patient due to endocarditis. Severe infections occurred in eight patients. Hospital stay varied between 21 and 164 days.

Adolescent↗
PubMed2003

International trauma and disaster management.

Our world has literally changed around us. Based on this reality, the AFMS changed its' way of thinking when providing care to victims in disaster situations. This course is but one of several that are provided around the world that speak one common language, helping each other and caring for our patients the best way we know how. As Kofi Annan, Secretary General of the United Nations, eloquently stated: "We are all in the same boat. There are no safe islands. There is no dividing line between domestic and international crises. There is no them, only us."

Aerospace Medicine↗
PubMed1999

Psychotic illness after prenatal exposure to the 1953 Dutch Flood Disaster.

We tested the hypothesis that maternal stress during pregnancy increases the risk of non-affective psychosis for the child. The concept of non-affective psychosis includes the ICD categories schizophrenic disorder, paranoid state and other non-organic psychosis. Data from the Dutch Psychiatric Registry were examined for an effect of the Flood Disaster of 1 February 1953. On this day, a gale caused a flood in the South-west of The Netherlands and 1835 people perished. Our study concerned the 19 villages where mortality exceeded 0.25%. The risk of non-affective psychosis for the cohort born in the period February-October 1953 was compared to the risks for the cohorts born in the corresponding periods of the previous and subsequent 2 years. The relative risk of non-affective psychosis for those exposed during gestation was 1.8 [95% Confidence Interval (CI): 0.9-3.5]. Thus, our study failed to demonstrate a significant association between prenatal exposure to maternal stress and risk of non-affective psychosis. The possible explanations for this finding are discussed.

Cohort Studies↗
PubMed2002

Recommendations for nursing requirements at a field hospital, based on the Israel Defense Forces field hospital at the earthquake disaster in Turkey--August 1999.

On the 17th of August 1999, an earthquake of 7.4 magnitude on the Richter Scale struck the Marmara region in Turkey causing a massive casualties event with an estimated 2,680 deaths and 5,300 injuries just at the city of Adapazari alone. A field hospital was set up by the Israel Defense Forces at Adapazari in order to provide temporary medical services until regular medical forces recovered. The aim of the paper is to overview the requirements of the nursing staff at a field hospital based on our experience and analysis of the nursing activity at the field hospital at Adapazari. The methods implemented include interviewing all nurses and many of the doctors who took part in the field hospital as well as a review of medical literature about disasters. We found an inverted nurse:phycisian ratio of 1:1.77, as opposed to a 2.5-3:1 ratio in regular civilian hospitals. The nurses in our field hospital had to work longer and more intensive shifts than in a regular hospital. They had to overcome language barriers and cultural differences, and faced difficult hygiene conditions. Our overview analysis of results brought up several recommendations. Firstly, although it is not possible to predictthe number and types of casualties, it is necessary to provide an adequate number of nurses (1-1.5:1 nurse:physician ratio). Furthermore, the nurses should be specialized and rotated as needed. Secondly, the language and cultural barriers should not be undermined despite the abundance of translators. Finally, the hygiene status in a field hospital requires management by nurses with active participation of all members.

Communication Barriers↗
PubMed2004

Major burn disasters: lessons to be learned from previous incidents and a need for a national plan.

The current concerns regarding possible terrorist actions throughout the world have to be considered to be now even more relevant to the UK. To date, there seem to be no official plans for Scotland other than those "major disaster incident" ones for each major hospital. These are not specifically designed to cope with a large-scale incident in which the majority of cases are burns. Such an event could swamp the local casualty and Burn Units. A model for possible consideration, based on a Dutch proposal, is put forward as being one that could be usefully applied to Scotland or, indeed, the UK.

Burn Units↗
PubMed1994

Post-traumatic stress disorder: supportive evidence from an eighteenth century natural disaster.

Post-traumatic stress disorder was first recognized as a diagnostic category embracing reactions in response to overwhelming environmental stress 'outside the range of usual human experience' in DSM-III (APA, 1980). Such abnormal stressors are by no means a product of the twentieth century but have featured, sporadically, in all societies from the earliest civilizations. Longitudinal investigations of traumatic stress have rarely gone further back than the nineteenth century, and have been concerned, almost exclusively, with adverse effects following railway accidents and military combat. The present study, utilizing a mid-eighteenth century medical source, presents an analysis of the impact of a natural disaster on members of a peasant family trapped in an avalanche in the Italian Alps in 1755.

Disasters↗
PubMedDate not supplied

Vicarious traumatization: potential hazards and interventions for disaster and trauma workers.

Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization. The authors review self-care strategies as well as training and organizational considerations that may be beneficial for individuals and organizations to address.

Disasters↗
PubMedDate not supplied

Using ethnographic methods in the selection of post-disaster, mental health interventions.

This paper describes a short, ethnographic study approach for understanding how people from non-Western cultures think about mental health and mental health problems, and the rationale for using such an approach in designing and implementing mental health interventions during and after disasters. It describes how the resulting data can contribute to interventions that are more acceptable to local people, and therefore, more effective and sustainable through improved community support.

Anthropology, Cultural↗
PubMedDate not supplied

Overview of the Tsunami disaster.

This is the text for the Opening Address for the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The frightening reality of the costs (human and material) must be balanced by what has been and can be learned that, if applied, can make the world more resilient for the next event. At the time of this Conference, we are moving from response to recovery. The immediate conclusion relates to the consequences of the realization of a truly interdependent world. Given the huge resources made available, there is an increased need for accountability. Several factors will bear heavily on the outcomes: (1) risk of loss of momentum; (2) ensuring that no gaps in services occur; (3) ensuring that already marginalized communities do not become forgotten or even more marginalized; (4) support and respect of national leadership; (5) commit to enhanced coordination; and (6) develop mechanisms for joint and shared assessments. The available resources must be used to stablize the livelihoods of people for years. Lastly, the reliability and sustainability of the important contributions of the military and the commercial private sectors for future events must be established.

Disasters↗