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The setting was South Central Georgia after the floods of July 1994, when the Red Cross called for medical volunteers to help. This article recounts one nurse's first experience in disaster relief.
Many states require long-term care facilities to develop mandatory training sessions on several safety, infection, and biohazard-related topics. The challenge for most facilities is how to make learning exciting and new. Many training sessions are mandatory, so the challenge for educators is how to take the boredom out of going to inservice programs. This article outlines an inservice program developed at Attic Angel Place in Madison, WI. Using the popular television show Wheel of Fortune as a model, the facility developed a similar game-like training program dealing with accident prevention, fire and tornado safety, and biohazardous materials. Of the facility's 175 full- and part-time employees, 75 attended the "Wheel of Disaster."
This report describes the initial hospital and burn center management of a mass casualty incident resulting from an aircraft crash and fire. One hundred thirty soldiers were injured, including 10 immediate fatalities. Womack Army Medical Center at Fort Bragg, North Carolina, managed the casualties and began receiving patients 15 minutes after the crash. As a result of repetitive training that included at least two mass casualty drills each year, the triage area and emergency department were cleared of all patients within 2 hours. Fifty patients were transferred to burn centers, including 43 patients to the US Army Institute of Surgical Research. This constitutes the largest single mass casualty incident experienced in the 57-year history of the Institute. All patients of the US Army Institute of Surgical Research survived to hospital discharge, and 34 returned to duty 3 months after the crash. The scenario of an on-ground aircraft explosion and fire approximates what might be seen as a result of an aircraft hijacking, bombing, or intentional crash. Lessons learned from this incident have utility in the planning of future response to such disasters.
BACKGROUND: On August 14, 2003, the United States and Canada suffered the largest power failure in history. We report the effects of this blackout on New York City's healthcare system by examining the following: 1) citywide 911 emergency medical service (EMS) calls and ambulance responses; and 2) emergency department (ED) visits and hospital admissions to one of New York City's largest hospitals. METHODS: Citywide EMS calls and ambulance responses were categorized by 911 call type. Montefiore Medical Center (MMC) ED visits and hospital admissions were categorized by diagnosis and physician-reviewed for relationship to the blackout. Comparisons were made to the week pre- and postblackout. RESULTS: Citywide EMS calls numbered 5,299 on August 14, 2003, and 5,021 on August 15, 2003, a 58% increase (p < .001). During the blackout, there were increases in "respiratory" (189%; p < .001), "cardiac" (68%; p = .016), and "other" (40%; p < .001) EMS call categories, but when expressed as a percent of daily totals, "cardiac" was no longer significant. The MMC-ED reflected this surge with only "respiratory" visits significantly increased (expressed as percent of daily total visits; p < .001). Respiratory device failure (mechanical ventilators, positive pressure breathing assist devices, nebulizers, and oxygen compressors) was responsible for the greatest burden (65 MMC-ED visits, with 37 admissions) as compared with 0 pre- and postblackout. CONCLUSIONS: The blackout dramatically increased EMS and hospital activity, with unexpected increases resulting from respiratory device failures in community-based patients. Our findings suggest that current capacity to respond to public health emergencies could be easily overwhelmed by widespread/prolonged power failure(s). Disaster preparedness planning would be greatly enhanced if fully operational, backup power systems were mandated, not only for acute care facilities, but also for community-based patients dependent on electrically powered lifesaving devices.
OBJECTIVE: We describe a modified triage system used in managing a smoke inhalation mass casualty incident that we recently encountered at our community hospital. MATERIALS AND METHODS: The patients were triaged as priority 1, 2 or 3 on the basis of their symptoms, signs and circumstances at scene. In addition, the use of fibre-optic examinations of the upper airway, chest radiography and carboxyhaemoglobin levels with arterial blood gas analyses were used to aid in disposal plans. RESULTS: Of the 22 patients evacuated, 15 were triaged as priority 2 and the remaining seven as priority 3. None of the patients was identified as priority 1. All the priority 2 patients underwent further investigations. Those with mild upper airway oedema (four patients) or raised carboxyhaemoglobin levels (two patients) were admitted. Only one patient had both. Another patient who was a known asthmatic developed bronchospasm and was admitted as well. All six were admitted to the general ward with subsequent good recovery and were discharged within 3 days. The remaining nine priority 2 and seven priority 3 patients were discharged from the emergency department. CONCLUSIONS: These modified triage criteria, with selective use of fibre-optic examinations, chest radiography and arterial blood gas analyses with carboxyhaemoglobin levels, are useful in smoke inhalation mass casualty incidents without dermal burns. Systemic injury and poisoning by toxic fumes often coexist with airway burns and should not be overlooked. Lastly, disaster planning and frequent drills at both local and national levels will optimize the response to future mass casualty incidents.
This study assesses the psychological consequences of participation in a mental health study among people recently exposed to the September 11 attacks. Using cross-sectional telephone surveys, we interviewed random samples of English-speaking or Spanish-speaking adults living in New York City during the attacks 1 year after this event. Altogether, 2,368 people completed the surveys, including a random sample of 1,173 respondents who received mental health services after the attacks. Results indicated that 15% of New Yorkers found some of the survey questions stressful, whereas 28% of those who sought treatment found this to be the case. However, less than 2% reported being upset at survey completion, and among these persons, only four people consented to speak to the study's mental health consultant. Although the majority of those expressing adverse reactions had sought postdisaster treatment, even among these subjects, only 3% were still upset at survey completion, and 2% wanted more information about counseling services. In addition, more than 70% of participants expressed positive sentiments about survey participation. Predictive models indicated that respondents who met study criteria for posttraumatic stress disorder, depression, or anxiety were more likely to find questions stressful, with people having posttraumatic stress disorder or depression the most likely to be upset and to consent to psychiatric consultation at completion. We suggest that, with the proper safeguards, research with persons exposed to a resent mass urban disaster generally can be conducted safely and effectively.
This study investigated the trajectory of traumatic stress symptoms in the aftermath of the 2004 Southeast Asian earthquake-tsunami. A total of 265 adult Thai survivors were assessed at 2 weeks and 6 months following the earthquake-tsunami. The percentages of survivors reporting traumatic stress symptoms were 22% at 2 weeks and 30% at 6 months postdisaster. Four trajectories of traumatic stress symptoms were identified: 12% of survivors presented with chronic stress symptoms, 18% had a delayed onset, 10% showed improvement, and the remaining 60% maintained a stable emotional equilibrium. Among survivors, the chronic group was the oldest, the delayed group reported the lowest level of perceived government support, and the resilient group experienced the fewest postdisaster psychiatric symptoms. Results pointed to the need to broaden the conceptualization of postdisaster stress responding as well as to establish disaster psychiatry and related mental health activities in the region.
The 4 mass disasters that have affected the Aquitaine region (France) in the previous 15 years are related through the specificity and the efficiency of dental methodology in identifying the victims. The results point to the decisive influence and the efficiency of dental methodology for identification of bodies that are burned or disfigured after an accident or a prolonged period in water.
BACKGROUND: The military medical services need demand-based strategies to ensure the best possible care of the injured in combat and natural disasters without compromising peacetime health care commitments at home and abroad. METHODS: A review of steps that have already been taken suggests that they are being used to their fullest extent commensurate with the public will. In fact, the situation has driven preliminary exploration of a special health care personnel draft. We believe the answer lies not in expanding the full-time, active duty US medical and nursing corps, but rather in tapping identifiable reservoirs of trained trauma care physicians, nurses, and allied health care workers in the United States and elsewhere. RESULTS: A rudimentary analysis suggests the most promising novel considerations are: developing special, trauma-trained reserve units within the US civilian trauma care community; seeking temporary attachments of an allied country's military medical officers, or a complete medical battalion; and contracting with US and foreign trauma surgeons, nurses and allied health personnel through a medical private military firm, analogous to those that have provided food, housing, transportation, and special combat units in support of our major military campaigns and peacekeeping operations. CONCLUSION: These considerations have important pros and cons that deserve in-depth evaluation by the best military and civilian trauma/critical care and organizational minds within a structured organization committed to the needs of military medicine. We believe that a Military Medical Think Tank within the Uniformed Services University's postgraduate division should be that organization.
BACKGROUND: Concern has been raised about the capacity of trauma centers to absorb large numbers of additional patients from mass casualty events. Our objective was to examine the capacity of current centers to handle an increased load from a mass casualty disaster. METHODS: This was a cross-sectional study of Level I and II trauma centers. They were contacted by mail and asked to respond to questions about their surge capacity as of July 4, 2005. RESULTS: Data were obtained from 133 centers. On July 4, 2005 there were a median of 77 beds available in Level I and 84 in Level II trauma centers. Fifteen percent of the Level I and 12.2% of the Level II centers had a census at 95% capacity or greater. In the first 6 hours, each Level I center would be able to operate on 38 patients, while each Level II center would be able to operate on 22 patients. Based on available data, there are 10 trauma centers available to an average American within 60 minutes. Given the available bed capacity, a total of 812 beds would be available within a 60-minute transport distance in a mass casualty event. CONCLUSIONS: There is capacity to care for the number of serious non-fatally injured patients resulting from the types of mass casualties recently experienced. If there is a further continued shift of uninsured patients to and fiscally driven closure of trauma centers, the surge capacity could be severely compromised.
The vulnerability of people with intellectual disability when services are disrupted by a major earthquake is described. The value of an accessible register and multiple networks of support at the time of a major disaster is emphasized.
Five to six months after the deaths of 95 football spectators at Hillsborough football ground, senior clinical students at Sheffield Medical School were surveyed in order to assess their degree of involvement with the disaster. Approximately one student in eight could be said to have had a high level of involvement. Students with high involvement showed higher levels of distress on both the General Health Questionnaire and the Impact of Events Scale. Only a small minority of students attended psychological debriefing groups or counselling sessions, perhaps due to the stigma attached to professional help-seeking. The results have implications for medical training and provision of support within medical schools.
Although radiology has exceptional discriminatory power in the identification of individuals, it is not often used for this purpose. This under-utilization stems in part from insufficient appreciation of its potential, and in part from a lack of agreed operational protocols. Descriptions of criteria used for radiological identification are scattered in individual reports and have not been collated. The circumstances in which identification is required are various and pose different problems for which guidelines have not been established. The areas in which radiology has a high capacity for identification of age, sex or identity are reviewed and their strengths and limitations are discussed. A survey of the literature identified three different circumstances in which cadaver identification is needed, and a protocol is suggested to meet the differing requirements of these three situations. The use of these protocols and techniques in the identification of bodies recovered from the Mt Erebus disaster is described. Postmortem radiographs established the identity of 11 bodies not identified by other techniques. There is a need for greater awareness in police and forensic circles of the identifying power of radiology.
Human emissions of greenhouse gases are already changing our climate. This paper provides an overview of the relation between climate change and weather extremes, and examines three specific cases where recent acute events have stimulated debate on the potential role of climate change: the European heatwave of 2003; the risk of inland flooding, such as recently in Central Europe and Great Britain; and the harsh Atlantic hurricane seasons of 2004 and 2005. Furthermore, it briefly assesses the relation between climate change and El Niño, and the potential of abrupt climate change. Several trends in weather extremes are sufficiently clear to inform risk reduction efforts. In many instances, however, the potential increases in extreme events due to climate change come on top of alarming rises in vulnerability. Hence, the additional risks due to climate change should not be analysed or treated in isolation, but instead integrated into broader efforts to reduce the risk of natural disasters.
Climate change, although a natural phenomenon, is accelerated by human activities. Disaster policy response to climate change is dependent on a number of factors, such as readiness to accept the reality of climate change, institutions and capacity, as well as willingness to embed climate change risk assessment and management in development strategies. These conditions do not yet exist universally. A focus that neglects to enhance capacity-building and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks. Reducing vulnerability is a key aspect of reducing climate change risk. To do so requires a new approach to climate change risk and a change in institutional structures and relationships. A focus on development that neglects to enhance governance and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks.
Longitudinal findings are presented on the relationships between disaster related stresses, depression scores, and suicidal ideation among a multi-racial/ethnic sample of adolescents (N = 4,978) all of whom have been exposed to Hurricane Andrew. Regression analysis showed that being female, hurricane generated stresses, low levels of family support, pre-hurricane suicidal ideation, and post-hurricane depression scores were significant predictors of post-hurricane suicidal ideation. Path analysis revealed that being female, low socioeconomic status, pre- and post-hurricane depression, high stress scores, low family support, and pre-hurricane suicidal ideation had significant direct/indirect effects on post-hurricane suicidal ideation.
BACKGROUND: Child survivors of a catastrophic earthquake in Turkey were evaluated three and a half years after the event, and three years after a sub-group participated in a teacher-mediated intervention developed by the authors. The goal of this follow-up study was to determine the long-term effectiveness of the original intervention. METHODS: Subjects who participated in the intervention were compared with a control group of children similar in terms of demographics, risk and exposure. All children were evaluated in terms of posttraumatic, grief and dissociative symptomatology, as well as adaptive functioning (academic performance, social behavior and general conduct). RESULTS: The severity of post-traumatic, grief and dissociative symptoms of the two groups was comparable. Teachers blind to group assignment rated participating children significantly higher than the control group in terms of adaptive functioning. CONCLUSIONS: Early post-disaster intervention addressing children and their educational milieu provides children with significant symptomatic reduction, allowing the mobilization of adaptive coping, thereby enhancing their overall functioning as observed in school.
Disasters affect families as a whole, and symptoms displayed by a family member may lead to secondary traumatizations for other members of the family, especially the children. This study examines the effects of parental psychopathology and family functioning on children's psychological problems six months after the earthquake in Bolu, Turkey. Forty-nine children aged between 7 and 14 and their parents were randomly chosen from among 800 families living in a survivor camp in Bolu. Both the children and parents were assessed by trained psychiatrists and psychologists using self-report measures for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms six months after the earthquake. Family functioning in survivor families was also assessed using the Family Assessment Device (FAD). The results showed that the severity of PTSD in children was mainly affected by the presence of PTSD and the severity of depression in the father. State and trait anxiety scores of children were related to general family functioning. The constellation of PTSD symptomatology was different in fathers than in mothers: the most common type of symptoms was "externalizing" in fathers with PTSD. This study supports the notion that the mere presence of PTSD in parents may not be enough to explain the relational process in families experiencing trauma. Our findings with earthquake survivors suggest that when fathers become more irritable and detached because of PTSD symptoms, their symptoms may affect children more significantly.