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The role of pastoral crisis intervention in disasters, terrorism, violence, and other community crises.

The term "pastoral crisis intervention" has been defined by Everly (2000) as the functional integration of faith-based resources with traditional crisis intervention assessment and intervention technologies. Pastoral crisis intervention has been differentiated from ministry and the provision of chaplaincy services. This paper provides a public health model for integrating pastoral crisis intervention services within the larger domain of community disaster response, crisis intervention, and emergency mental health.

Community Mental Health Services↗

Crisis management briefings (CMB): large group crisis intervention in response to terrorism, disasters, and violence.

A single act of violence or terrorism can adversely affect thousands of people. Such acts will invariably engender a psychological morbidity that will far surpass any physical morbidity. Heretofore, efforts in primary and secondary prevention have focused largely upon the physical consequences of these incidents, rather than their psychological consequences. This paper describes a practical group psychological crisis intervention, the "crisis management briefing" (CMB), that may be used with large groups of individuals in the wake of terrorism, violence, disasters, and other crises. This intervention, which is one component of the Critical Incident Stress Management (CISM) crisis intervention system, is designed to mitigate the effects of these crises and requires anywhere from 45 to 75 minutes to implement. The CBM may be employed with groups ranging from 10 to 300 individuals at one time.

Crisis Intervention↗

Probability of casualties in an airport disaster.

World airline accident statistics for the period 1960 to 1970 indicate the number of seriously, but nonfatally injured is unlikely to exceed 25% of the occupant capacity of the largest aircraft using an airport. In only 1 accident out of 20 will this number be an underestimate. This estimate may be of value in medical planning for an airport disaster and in the assessment of loads on hospitals.

Accidents, Aviation↗

AmpFlSTR Profiler Plus and AmpFlSTR COfiler analysis of tissues stored in GenoFix, a new tissue preservation solution for mass disaster DNA identification.

A preliminary study was conducted to assess the capability of a new alcohol-based tissue fixative, GenoFix, to preserve DNA from biopsy tissues stored at room temperature and/or -20 degrees C in a freezer, for subsequent short tandem repeat (STR) DNA typing analysis. Fresh human smooth muscle samples were stored at room temperature in GenoFix for one month and up to one year and seven months before being processed using the megaplex STR systems, AmpFlSTR Profiler Plus and AmpFlSTR COfiler. Alternatively, muscle tissues in GenoFix were placed at -20 degrees C in a freezer for up to 3 1/2 years following two to three months in the fixative at room temperature. DNA analysis was also carried out on tissues stored in GenoFix for one month at room temperature and subsequently paraffin-embedded and stored at room temperature for four years. The AmpFlSTR Profiler Plus and AmpFlSTR COfiler STR profiles produced, using DNA extracted from all fixed tissue samples, were of very good quality. The fluorescent signals were well balanced across the nine STR loci or six loci comprised in the megaplexes surveyed and profiles showed no differences with those observed for the control blood of the respective donor patients. Continuous exposure to GenoFix at room temperature (up to one year and seven months) did not compromise the STR typing analysis of the fixed tissues. No adverse effects were noted on the STR typeability of tissues fixed with GenoFix and stored at -20 degrees C in a freezer for up to 3 1/2 years. STR profiles generated from the paraffin-embedded tissues fixed in GenoFix were of excellent quality. This preliminary study suggests that GenoFix can be used to store tissue samples at room temperature for up to one year and seven months or at -20 degrees C in a freezer for longer storage (up to 3 1/2 years). This new and odorless tissue fixative promotes tissue and DNA preservation in a very effective manner and as such may prove useful in criminal investigations or mass disaster identifications carried out in remote locations and in which a small or large number of tissue samples are collected for further analyses.

Biopsy↗

[The role of occupational pathology center in public health care in disaster zone].

The article represents results of time-matched follow-up of population residing in Myslets settlement that appeared in railway accident zone with significant phenol and oil products spread. Various health disorders diagnosed in the residents in 4 months after the accident appeared not specific, according to thorough studies by Nizhny Novgorod Research Institute for Hygiene and Occupational diseases, by RAMSc Clinic for Occupational Medicine. The authors demonstrate leading role of occupational pathology center in medical care for people in disaster zone, role of occupational therapist. Other emphasis is put on technogenous stress importance in conflict situations.

Accidents, Occupational↗

Medical relief operation in rural northern Ethiopia: addressing an ongoing disaster.

BACKGROUND: Following the recent drought in Ethiopia, the Jewish Agency, aided by the Israel Ministry of Foreign Affairs, launched a medical relief mission to a rural district in Ethiopia in May-August 2000. OBJECTIVES: To present the current medical needs and deficiencies in this representative region of Central Africa, to describe the mission's mode of operation, and to propose alternative operative modes. METHODS: We critically evaluate the current local needs and existing medical system, retrospectively analyze the mission's work and the patients' characteristics, and summarize a panel discussion of all participants and organizers regarding potential alternative operative modes. RESULTS: An ongoing medical disaster exists in Ethiopia, resulting from the burden of morbidity, an inadequate health budget, and insufficient medical personnel, facilities and supplies. The mission operated a mobile outreach clinic for 3 months, providing primary care to 2,500 patients at an estimated cost of $48 per patient. Frequent clinical diagnoses included gastrointestinal and respiratory tract infections, skin and ocular diseases (particularly trachoma), sexually transmitted diseases, AIDS, tuberculosis, intestinal parasitosis, malnutrition and malaria. CONCLUSIONS: This type of operation is feasible but its overall impact is marginal and temporary. Potential alternative models of providing medical support under such circumstances are outlined.

Adolescent↗

Use this proven system for disaster communications.

The Hospital Emergency Incident Command System (HEICS) system uses a logical management structure, defined responsibilities, and clear reporting channels to help the hospital communicate with outside emergency responders. The system is considered a benchmark for EDs to implement as an integral part of your disaster plan. Flow charts and job action sheets are used to clearly define responsibilities of individuals. The system uses the same terminology as other first responders, so communication is easier.

Benchmarking↗

Hospitals asked to review disaster packs.

As the nation somberly marked the six-month anniversary of the terrorist attacks on New York and Washington, a group of materials managers and vendors finished drafting a supply list to be used by hospitals in conjunction with a disaster readiness plan.

Disaster Planning↗

[The Red Cross and Scandinavian disaster aid].

In 1970, the League of Red Cross Societies drew up a plan for the training of delegates in international relief work. The main tasks of the delegates can be divided into: 1) disaster relief, 2) war-time relief work, 3) assistance in organising national Red Cross societies. Special training of certain categories, e. g. doctors, is now being considered. In many relief operations it would be of value to have a doctor as an administrative delegate. It should be easier for the doctor than for a non-medically trained person to decide where and when medical aid should be administered.

Disasters↗

Earthquake disasters--lessons to be learned.

Human beings do not have the ability prevent earthquakes. However, we can take measures to minimize injuries and damage by using strict building codes and constructing infrastructures in areas of less risk. A great number of buildings in Israel, including some hospitals, will not withstand a major earthquake as they were built with inadequate standards. Data collected during earthquakes show a significant rise in cardiac-related disease and stress-related medical problems in addition to conventional injuries. Public health issues are of increasing importance due to the collapse of sanitation facilities. In addition to field clinics, field hospitals should be deployed in the vicinity of the stricken area. While planning the medical response for disasters such as earthquakes, one should take into account the availability of local medical personnel. Some or most of the local staff may be unable to function. A study from the Gulf War showed that even the threat of chemical attack resulted in less staff reporting to work [33]. During the 1999 earthquakes in Turkey, many of the hospital staff opted to care for their close families instead of reporting to work at the hospital. Regular training exercises in prehospital emergency medical services for the more common multiple casualty incidents should be bolstered with additional exercises in mass casualty incidents. The basic functions in these scenarios may be quite different. Although no exercise can mimic the real event, preplanning and drills are invaluable. When an earthquake does occur, medical management includes local search and rescue teams together with emergency medical service teams if these can still function. Early deployment of local medical centers can alleviate the burden from local hospitals. Evacuation to distant medical centers is probably a major key for success. Psychological problems are abundant in such incidences, affecting also rescue and medical teams. It becomes a major issue when there are large numbers of pediatric casualties and the operations continue for more than a few days.

Disasters↗

The efficiency of an X-ray screening system at a mass disaster.

This is a study to determine the efficiency and efficacy of using an X-ray security screening system to locate both dental fragments and other foreign objects that might be commingled with fragmented remains in a mass disaster. A controlled study by the Pennsylvania Dental Identification Team (PADIT) revealed that a manual examination of simulated body bags containing commingled dental parts and foreign objects by a team of trained forensic odontologists was very effective in locating dental fragments and in finding foreign objects. Although this was effective, it was not efficient, because it was very time consuming. With the use of an X-ray security screening system, the time factor could be reduced. This study also revealed that even though this sophisticated equipment could reduce the time factor in locating commingled dental and foreign objects, a forensic odontologist should be utilized to be most effective.

Animals↗

Disaster alert plan for a hospital pharmacy.

A disaster alert plan for the department of pharmacy of a large hospital is described. The plan is intended to effectively and efficiently alert and mobilize pharmacy personnel in the event that the hospital should re required to deal with mass casualties.

Communication↗

Comply with new standard for disaster volunteers.

The Joint Commission on Accreditation of Healthcare Organizations has announced a new standard for giving emergency privileges to volunteer clinicians during a disaster. Emergency privileges can be granted when your facility's emergency management plan has been activated. Volunteers must present a current license, current hospital identification with license number, or have their identity verified by a staff member. Establish mutual aid agreements with other local hospitals so you know which clinicians are willing to volunteer.

Credentialing↗

Chernobyl and iodine deficiency in the Russian Federation: an environmental disaster leading to a public health opportunity.

The Chernobyl nuclear disaster of April 26, 1986, triggered a chain of devastating events that later included an unexpected increase in childhood thyroid cancer and evidence of iodine deficiency (ID) in Russia. For the Russian people the Chernobyl event had profound psychological impacts, provoking anxiety about nuclear technology and mistrust of governmental control efforts. Frequently in public health a crisis is required to create the political will to manage longstanding problems, and public health officials must rapidly mobilize to take advantage of the opportunity. In this case, ID, previously not seen as a problem in Russia, was recognized to be potentially serious, and the Russian Federation, assisted by the catalytic bi-national effort of the U.S.-Russian Joint Commission on Economic and Technological Cooperation (Gore-Chernomyrdin Commission (GCC)) established a model salt iodization policy, developed a planning process, and implemented a program to prevent ID through a systematic approach that included the people, government, and private groups using open communication, dissemination of the findings, and action plans. By 1999, political will had been mobilized and over 20% of the nation's salt was being iodized, up from about 1% in 1996. Universal iodization of salt was not a specific objective of the GCC; however, the increasing availability of iodized salt is leading to the elimination of ID, which is now a political goal in Russia. The full realization of this goal will require more time for education, marketing, and possibly legislative action.

Adolescent↗

[A simple anesthetic system with oxygen concentrator for war or disaster situation].

An oxygen concentrator is commonly used as an oxygen source in war or disaster situation. We examined the possibility of using the oxygen concentrator, capable of producing 7 l.min-1 of oxygen, for anesthetic circuit. When the oxygen concentrator is connected with an ordinary anesthetic vaporizer, the gas flow from the vaporizer is 6 l.min-1 and its vaporization is the same as when it is used with a high gas pressure. With this oxygen concentrator, it is possible to make a simple anesthetic system with an ordinary vaporizer, not a special vaporizer for draw over anesthetic system.

Anesthesia, Closed-Circuit↗

Mental health issues in disasters and terrorist attacks.

Recent events make clear that those living in the United States are at risk of exposure to a variety of potentially traumatic events, ranging from sniper and terrorist attacks to a variety of natural disasters. This paper provides a broad overview of the most common psychological reactions that can be expected in the aftermath of such events, how primary care practitioners can identify such reactions in their patients, and actions those practitioners might take.

Disasters↗

[Preparedness of health personnel in a highly industrialized health area of Asturias to respond to industrial disasters].

BACKGROUND: In order to provide a response to industrial accidents with a view to minimizing their consequences, the healthcare personnel working in areas at risk must be properly trained. This study is aimed at determining the degree of subjective perception that healthcare professional have with regard to how well-prepared they are to take action in response to an industrial accident resulting in a large number of injuries, as well as their knowledge of industrial hazards inherent to the area. METHODS: A questionnaire was designed to measure five dimensions related to the response to industrial accidents (technical knowledge, knowledge of the Area, practical skills, attitudes and training). The sample was comprised of all of the Primary Care physicians and nursing staff in the District and from the Emergency Department at the related hospital. RESULTS: The response rate was 61.2%. The results for the questions related to each dimension, on a maximum scale of 4, were: Technical skills (mu = 1.3; delta = 0.81); Knowledge of the District (mu = 0.75; delta = 0.96); Practical skills (mu = 0.9; delta = 0.8); Attitudes (mu = 3.25; delta = 0.73) and Training (mu = 0.75; delta = 0.88). Those working in hospital emergency departments and those hired under indefinite or temporary contracts scored higher than those employed under permanent contracts. CONCLUSIONS: Information and training is lacking among these healthcare professionals, contrasting with the interest shown in correcting these lacks. It is necessary for a basic training and information program to be set up in order to deal with industrial disasters in our Healthcare District.

Adult↗