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To have or to be: ways of caregiving identified during recovery from the earthquake disaster in Taiwan.

The aim of this article is to report the results of therapy sessions conducted with survivors of an earthquake that struck Luku Township in Nantou County, central Taiwan, in September 1999. The sessions explored survivors' feelings, interactions, and interpretations of the crisis, as well as their roles in post-earthquake relief efforts. The participants were teachers and administrators from four primary schools. The results indicated three distinct forms of caring, namely: encumbered caring, connected caring, and reflected caring. The findings were used to construct a framework for caregiver self-monitoring. They also suggest that therapy groups provide an inner space that self-regulates the frustrations arising from this type of experience, for both caregivers and survivors. The intrasubjective and intersubjective dialogues within the groups are essentially reflective practices for improving services and generating new knowledge about medical ethics.

Caregivers↗

Training for overseas operational deployments and the DMCC.

Through the DMCC and similar comprehensive training, Military and NGO personnel can prepare for deployment with a greater understanding of the issues that will confront them whilst there. Progression through the modules will provide them with a greater skill set to meet the challenges that await them and allow them to be an effective and valuable member of the team.

Disaster Planning↗

The crush syndrome revisited (1940-1990).

This article reviews the local and systemic effects of crush injury. Within minutes to hours after extrication of survivors trapped under fallen masonry (and immediately following decompression of limbs), a massive volume of extracellular fluid is lost into the injured muscles, leading to circulatory failure. Solutes leaking out of damaged muscles cause a spectrum of metabolic disturbances. Chief among them are hyperkalemia and hypocalcemia which, synergistically, have a lethal cardiotoxic potential, particularly in hypotensive patients. Early volume replacement, preferably already started at the rescue site, may combat shock and correct the hyperkalemia. If urine flow is established, this regimen should be followed by a forced solute-alkaline diuresis for the prevention of myoglobinuric and uricosuric acute renal failure, which is a common and ominous late complication of crush injury. Preparation for future catastrophes occurring particularly in remote regions where an 'epidemic' of crush syndrome may be forecast, should include the setting up of a radio communications network to coordinate rescue and salvage operations and the forwarding of intravenous fluid bags and lines to the disaster site. Also, it is advisable to prepare artificial kidney devices which do not require pumps and electricity and which utilize a low dialysate volume for emergency temporary use, until conventional definitive medical facilities and services have been reestablished.

Acute Kidney Injury↗

Aftermath of a disaster: the collapse of the Hyatt Regency Hotel skywalks.

The author provides data regarding psychiatric symptoms reported by 102 persons who had experienced the collapse of two skywalks in the lobby of the Hyatt Regency Hotel in Kansas City, Mo. Those interviewed were injured victims, guests of the hotel who were not injured, and rescue workers. They were interviewed within 5 months of the disaster. Virtually all of the subjects had psychiatric symptoms; only slight differences were found among those who were victims, observers, or rescuers.

Adaptation, Psychological↗

Anticipatory stress in children and adolescents.

OBJECTIVE: Circumstances surrounding the New Madrid earthquake prediction on Dec. 3, 1990, offered a unique opportunity to study the effects of a disaster warning stage on children and adolescents. METHOD: An initial structured interview was administered to 553 third- and 10th-grade students before December 3, with follow-up interviews conducted 6-8 weeks later. RESULTS: This study documents the existence of a mild but prevalent PTSD-like reaction that arose from exposure to a prediction of disaster. CONCLUSIONS: Further study of anticipatory stress reactions is needed to provide insights into the development of methods for providing support to children during disaster warnings.

Adolescent↗

Postdisaster psychosocial intervention: a field study of the impact of debriefing on psychological distress.

OBJECTIVE: Following a catastrophic natural disaster, the authors evaluated whether brief psychological intervention (debriefing 6 months later) reduced disaster-related psychological distress as measured by the Impact of Event Scale. METHOD: Two groups of subjects who had been exposed to Hurricane Iniki in Hawaii were assessed before and after participating in a multihour debriefing group. The intervention aimed to provide ventilation of feelings, normalization of responses, and education about normal psychological reactions to the disaster in a context of group support. To provide a partial control for the passage of time, the pretreatment assessment of the second group was concurrent with the posttreatment assessment of the first group. RESULTS: A repeated measures analysis of variance indicated that Impact of Event Scale scores were reduced in both groups after the treatment. CONCLUSIONS: There is preliminary empirical support for the effectiveness of postdisaster psychological intervention and for the feasibility of treatment research in postdisaster environments.

Adult↗

Involvement in the criminal justice system among recipients of mental health services after September 11.

OBJECTIVE: This study examined the relative risk of arrest among recipients of mental health services in Washington, D.C., during the 23 months before and the 13 months after the terrorist attacks of September 11, 2001, with the purpose of identifying any change in involvement with the criminal justice system after the attacks. METHODS: Analysis of anonymous data sets provided by the local mental health and police departments provided measures of risk of arrest, relative to that of the general population, for the approximately 5,000 people receiving mental health services each month. Interrupted time-series analysis was used to measure change in relative risk during the 36-month study period. RESULTS: Significant increases were noted in relative risk of arrest after September 11, 2001, among male, nonwhite young-adult recipients of mental health services. Significant change was evident for eight of the 12 age, gender, and racial groups used in this analysis. CONCLUSIONS: Disaster planning and response should include attention to involvement with the criminal justice system among recipients of mental health services. Future research should focus on the nature of the relationship between terrorism and arrest among service recipients.

Adolescent↗

Did Project Liberty displace community-based medicaid services in New York?

OBJECTIVE: This study analyzed how the introduction of Project Liberty services after the September 11, 2001, terrorist attacks affected agencies' provision of community-based Medicaid mental health services in the New York metropolitan area. METHODS: Provision of Medicaid mental health services was tracked between January 2000 and June 2003 for provider agencies participating in Project Liberty (N=164) and for a comparison group of mental health provider agencies that did not participate in this program (N=94). RESULTS: Overall, participation in Project Liberty did not significantly affect the volume of Medicaid services provided. However, for agencies with one site, a statistically significant difference was seen; compared with agencies in the comparison group, agencies that participated in Project Liberty claimed a mean+/-SE decrease of $4.66+/-3.57 less in Medicaid services per month per Project Liberty visit. CONCLUSIONS: Project Liberty permitted rapid expansion of the total volume of services provided by community-based organizations without interfering with the provision of traditional services, although a modest effect was seen for smaller agencies. Although the results do not imply that "supply side" planning for disaster needs would not improve system response, they do imply that implementation of flexible "demand side" financing can call forth a large volume of new services rapidly and without interfering with other community services.

Community Mental Health Services↗

Innovations: child & adolescent psychiatry: Training in developmental responses to trauma for child service providers.

Youths most at risk of exposure to community violence are often those who are least likely to receive the attention of mental health professionals. The column describes the development and testing of training about trauma for school personnel and other community providers of children's services. The curriculum was developed with input from focus groups of school nurses. The one-day training sessions address nine areas: normal responses to stress, abnormal responses to stress, posttraumatic stress disorder and acute stress disorder, stage theories of loss and grief, risk and protective factors, crisis and disaster planning, resilience, mental health referral sources, and self-care techniques.

Acute Disease↗

Psychological aftermath of the King's Cross fire.

The King's Cross fire occurred at the end of the evening rush hour, on 18 November 1987. King's Cross station is within the department's health district and we felt a responsibility to respond to the psychological aftermath. The unique features of our intervention were the degree of inter agency coordination, the use of a systematic outreach and screening programme, the collection of psychotherapy outcome measures and the development of an ongoing clinic. The work represents a sustained attempt to assess the nature and prevalence of post-traumatic reactions and the most medically and economically effective form of intervention. In this paper we describe the way our team responded to the high level of psychological distress that we found, we present some preliminary results, outline two therapeutic trials, and refer to the longterm consequences for the work of our department.

Disaster Planning↗