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PubMedDate not supplied

Sharing Pacific-Rim experiences in disasters: summary and action plan.

INTRODUCTION: The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge. DISCUSSION: Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories. CONCLUSIONS: The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.

Asia↗
PubMedDate not supplied

Principles of disaster management. Lesson 13. Organizational development.

Change in any organization is difficult. Relief organizations constantly are evolving and changing form to adapt to different needs, demands, and environment. As the phases of a disaster evolve, adjustments must be made by relief organizations to meet the changing needs. The sequential processes used to manage change include recognition and diagnosis of the problem, identification of alternatives, recognition of limiting conditions, selection of a strategy for change, and implementing and monitoring the change. The techniques used to effect change may be classified as structural, management, or technological. Changes can occur in division of labor, content of the work, relationships with other workers, supervisory and/or technical skills, operations, and decision-making hierarchy. Approaches can be mandated from the top, worked out jointly by management and personnel, or implemented by the affected personnel. Implementation of changes has two dimensions: timing and scope. Whenever changes are implemented, the impact of the changes must be monitored and the effects compared with what was expected.

Decision Making, Organizational↗
PubMedDate not supplied

Criteria for the assessment of disaster preparedness--II.

By defining the chain of medical care and the capacities of the successive phases within this chain, an attempt is made to analyze and grade the determinants of these capacities. In this way, calculations that indicate overall disaster preparedness can be expressed in a figure ranging from 1-5. The capacity of the system is taken as the lowest score obtained for the components of the system. The methodology used for this assessment of preparedness is described and an example is used to show the efficacy of this methodology.

Disaster Planning↗
PubMed2001

The effect of relocation after a natural disaster.

Twenty-five women remaining in a city devastated by an earthquake were compared with 24 relocated survivors and 25 comparison women. The women were administered a structured PTSD interview, the Hamilton Depression Scale, and SCL-90-R. The women in both exposed groups showed significantly more symptoms of avoidance, arousal, and total PTSD than the comparison group. The women in the relocated city had significantly higher depression scores than the women in the earthquake city. On the SCL-90-R, relocated women were most symptomatic and comparison group women were least symptomatic. Relocation after a disaster appears to be associated more with risk for depression than with PTSD in situations where recovery is delayed following the trauma.

Adult↗
PubMed2001

A qualitative analysis of posttraumatic stress among Mexican victims of disaster.

In unstructured interviews, 24 Mexicans described survivors' responses to disasters in Guadalajara, Jalisco (n = 9), Homestead, Florida (n = 6), and Puerto Angel, Oaxaca (n = 9). This analysis assessed the extent to which symptom descriptions corresponded to the 17 criterion symptoms of PTSD. Nineteen participants (79%) mentioned from 1 to 9 criterion symptoms. Event-related distress, hypervigilance, recurrent recollections, and avoiding reminders were described most often. Only 3 criterion symptoms were never described. Twenty participants (83%) provided 109 separate expressions that could not be classified specifically as criterion symptoms. These phrases were sorted by 9 independent Mexican volunteers and cluster analyzed. Clusters composed of ataques de nervios, depression, lasting trauma, and somatic complaints provided the best description of the data.

Adult↗
PubMed1999

The rate and risk of heat-related illness in hospital emergency departments during the 1995 Chicago heat disaster.

OBJECTIVES: To conduct an Emergency Department (ED)-based treated prevalence study of heat morbidity and to estimate the rate and risk of heat morbid events for all Chicago MSA EDs (N = 95; 2.7 million visits per year). METHODS: ED patient log data were compiled from 13 randomly selected hospitals located throughout the Chicago MSA during the 2 weeks of the 1995 heat disaster and from the same 2-week period in 1994 (controls). Measurements included: age, sex, date, and time of ED service, up to three ICD-9 diagnoses, and disposition. RESULTS: Heat morbidity for Chicago MSA hospital EDs was calculated at 4,224 (95% CI = 2964-5488) cases. ED heat morbidity increased significantly 5 days prior to the first heat-related death. In 1995, there was an increase in the estimated relative risk for the city = 3.85 and suburbs = 1.89 over the control year of 1994. CONCLUSIONS: Real time ED-based computer automated databanks should be constructed to improve public health response to infectious or noninfectious outbreaks. Rapid area-wide M&M tabulations can be used for advancing the effectiveness of community-based prevention programs, and anticipating hospital ED resource allocation.

Adolescent↗
PubMed1997

An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural disaster.

Controlled studies of treatments effective with victims of natural disasters are almost nonexistent. This is a small study conducted under difficult conditions to test the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in treating trauma related reactions following Hurricane Andrew. The results were positive in that EMDR produced significant improvement over wait list controls in perceived posttraumatic avoidance behaviors and thoughts as measured by changes in the Impact of Event Scale and significant improvement in subjective aversive reactions to representative experiences of the hurricane. These results suggest and support other studies that EMDR can be an effective therapeutic intervention for trauma reactions.

Adaptation, Psychological↗
PubMed1990

Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults.

In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.

Adaptation, Psychological↗
PubMed2002

Life course transitions and natural disaster: marriage, birth, and divorce following Hurricane Hugo.

Change in marriage, birth, and divorce rates following Hurricane Hugo in 1989 were examined prospectively from 1975 to 1997 for all counties in South Carolina. Stress research and research on economic circumstances suggested that marriages and births would decline and divorces would increase in affected counties after the hurricane. Attachment theory suggested that marriages and births would increase and divorces would decline after the hurricane. Time-series analysis indicated that the year following the hurricane, marriage, birth, and divorce rates increased in the 24 counties declared disaster areas compared with the 22 other counties in the state. Taken together, the results suggested that a life-threatening event motivated people to take significant action in their close relationships that altered their life course.

Birth Rate↗
PubMed1999

Australian disaster triage: a colour maze in the Tower of Babel.

BACKGROUND: The objective of this study was to review the systems of disaster triage used by Australian State and Territory ambulance services and compare their triage taxonomy, methodology and documentation with the Australian Council on Health Care Standard's (ACHCS) National Triage Scale, which is used in all Australian hospital emergency departments. METHODS: A postal survey of the State and Territory ambulance services during October 1996 was conducted. Details of the mass casualty incident (MCI) triage systems were then compared with the ACHCS National Triage Scale. Colours specified or used on a triage tag were checked for compliance with Standards Australia AS-2700 1996 Colour Standards for General Purposes. Participants consisted of those State and Territory ambulance services which would be the initial emergency medical service responders in the event of an MCI in an Australian capital city, and the ACHCS. The main outcome measure was the homology between the respective triage taxonomies, methodologies and documentation systems. RESULTS: All eight State and Territory ambulance services used a numerical and colour coded system to indicate triage priority during an MCI. There were five different triage tag designs for triage documentation, six different triage taxonomies and five different triage methodologies with minimal homology between the different triage systems and the National Triage Scale used in hospitals. Only two ambulance triage systems specifically triaged emotional disturbance. Several triage tags and their patient attachments were made from perishable materials and are thus likely to fail under field conditions. CONCLUSION: The multiplicity of triage systems used within Australia will result in avoidable confusion, thus hindering the medical response to an MCI, especially for incidents near State or Territory borders. There is little evidence to support the continued use of triage tags. Australia needs to develop a uniform system of patient triage as a national priority.

Australia↗
PubMed2002

Psychiatric morbidity and pregnancy outcome in a disaster area of Taiwan 921 earthquake.

We investigated the prevalence of minor psychiatric morbidity in a group of women who were pregnant during or immediately after a major earthquake disaster and we investigated the prognostic factors that may have influenced the perinatal outcome of the pregnancy. The study was initiated 6 months after the earthquake and enrolled 171 women in a town near the epicentre. A Post-Earthquake Questionnaire, Chinese Health Questionnaire (CHQ-12) and posttraumatic stress disorder (PTSD) symptoms checklist were completed before delivery while the perinatal data were retrieved from hospital obstetrical records. The prevalence of minor psychiatric morbidity (MPM) was 29.2%. Women with starvation experience, higher negative attitude scores about the influence of earthquake on pregnancy and more casualties among relatives were significantly correlated with high CHQ. A significant positive correlation between the MPM and PTSD scores was noticed. Among the 115 pregnancies with known perinatal outcome, there were nine (7.8%) low-birth weight neonates, defined as birth weight < or = 2500 g. Maternal history of abdominal injury, spouse casualty and instability in living condition were significantly correlated with low birth weight. Spouse casualty was the only significant factor that predicts neonatal low birth weight.

Adult↗
PubMed2002

Preparing for disasters: Enhancing the role of pediatric nurses in wartime.

During the tragic terrorist attacks that occurred against the United States on September 11, 2001, nurses were on the front lines making a difference for patients, families, and children. As noted in the American Nurse, the official publication of the American Nurses Association, "September 11, 2001, is no longer just a day gone by. It now takes the place alongside other infamous dates like December 7, 1941, the attack on Pearl Harbor by Japan" (Trossman, 2001, p. 1). This article will focus on resources available for pediatric nurses to use when working with children and families who are either preparing for or responding to disasters.

Bioterrorism↗
PubMed2000

Air flight disaster, posttraumatic stress, and postventive rescue and response: the aftermath of the San Diego PSA 182 plane crash recovery operation, 20 years on.

San Diego in 1978 was the scene of one of the USA's most tragic and traumatic air flight disasters, when an inbound Boeing 727 collided with a small private Cessna 172. The collision occurred in the vicinity of North Park, a suburb of San Diego. All aircraft occupants were killed or injured and many residents were injured. The wreckage was mainly concentrated in an area about the size of a city block, in a temperature of 100 degrees F or more. The whole experience was unlike anything any of the professionals involved had been prepared for, and beyond anything the civilians involved could have imagined. Many sought out intervention and help and counselling, and this paper examines the implications of the event 20 years on.

Accidents, Aviation↗
PubMed2001

How do ambulance personnel experience work at a disaster site?

Working at a major accident site is a complex matter where knowledge from various fields must be put into practice. In addition, the different situations at emergency and disaster sites place a variety of demands on personnel, equipment and organization. The aim of the present study is to investigate how the ambulance personnel perceived their own action and the functioning of the whole emergency organization at a major accident site (large discotheque fire) in 1998. Working from a list obtained from the fire department, a questionnaire with 57 questions was sent to the personnel (n = 36) who had participated at the accident site either as ambulance crew members or as members of a medical team sent out from the hospital. The response rate was 80 per cent. Despite the extreme situation, most of the ambulance personnel involved were satisfied with their own preparedness as well as the medical and nursing care performed at the site. Those who where not satisfied reported that the main reason for dissatisfaction was lack of time to calm and comfort people who were not injured or had only minor injuries. The need of more medical support for the medical team members at the site was also emphasized with regard to the care of the severely injured. The ambulance service crews from the suburbs, in comparison with the local city rescue service, were, in general, less satisfied with the co-operation from other rescue units.

Adult↗
PubMedDate not supplied

The aftermath of violence: children, disaster, and posttraumatic stress disorder.

Terrorist attacks, situations of armed conflict, and all forms of catastrophe tax our abilities to cope, understand, and respond. Because of their developmental status, children are even more emotionally vulnerable to the devastating effects of a disaster. When tragedy strikes a family, community, or the nation, helping children cope and regain a sense of safety is critical. A child with posttraumatic stress disorder (PTSD) develops symptoms such as intense fear, disorganized and agitated behavior, emotional numbness, anxiety, or depression after being directly exposed to or witnessing an extreme traumatic situation involving threatened death or serious injury. Victims of repeated abuse or children who live in violent neighborhoods or war zones, or who have witnessed extensive media coverage of violent events, may experience PTSD.

Adolescent↗
PubMed2000

A case study of co-ordinative decision-making in disaster management.

A persistent problem in the management of response to disasters is the lack of co-ordination between the various agencies involved. This paper reports a case study of inter-agency co-ordination during the response to a railway accident in the UK. The case study examined two potential sources of difficulty for co-ordination: first, poorly shared mental models; and, second, a possible conflict between the requirements of distributed decision-making and the nature of individual decision-making. Interviews were conducted with six individuals from three response agencies. Analysis of reported events suggested that inter-agency co-ordination suffered through a widespread difficulty in constructing a reflexive shared mental model; that is, a shared mental representation of the distributed decision-making process itself, and its participants. This difficulty may be an inherent problem in the flexible development of temporary multi-agency organizations. The analysis focused on a distributed decision over how to transport casualties from an isolated location to hospital. This decision invoked a technique identified here as the progression of multiple options, which contrasts with both recognition-primed and analytical models of individual decision-making. The progression of multiple options appeared to be an effective technique for dealing with uncertainty, but was a further source of difficulty for inter-agency co-ordination.

Communication↗