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PubMedDate not supplied

Disaster medicine in the 21st century: future hazards, vulnerabilities, and risk.

The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental dysequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment. The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability. An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow. The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.

Disaster Planning↗
PubMed2006

Tsunami disaster victim identification in Sri Lanka: legal aspects.

Natural hazards amounting to disasters have almost become an endemic phenomenon during past decades throughout the globe, particularly affecting less resourced countries. The capabilities of the affected nations are stretched to the maximum in most of the disasters, thereby exposing deficiencies at various levels of the disaster mitigation mechanisms. A key factor identified through the human experience of all previous disaster scenarios is the requisite of effective and integrated local, national and regional disaster management mechanisms. The national and regional legal framework in this context can supplement disaster management enormously by drafting and implementing practical legislation which can be activated in disaster situations to co-ordinate the relief missions and minimize the damage. Thus, the existing legal systems and legislation at national and regional levels should be modified accordingly to yield proper disaster management policies. However, many less resourced countries are still lacking functional disaster management mechanisms in local legislation and are consequently highly vulnerable to heavy casualties in disasters. Sri Lanka is a typical example of a state which had an ineffective disaster management mechanism, not strengthened by legislation, when the Asian tsunami struck the country in December 2004, despite having frequently been affected by natural and man-made hazards during the past three decades. The net effect was total disarray in disaster victim identification, leading to drastic and irreparable consequences.

Autopsy↗
PubMedDate not supplied

Non-institutional sources of assistance following a disaster: potential triage and treatment capabilities of neighborhood-based preparedness organizations.

The following paper presents an argument for enhancing and encouraging the development of neighborhood-based disaster preparedness organizations, particularly as a potential medical triage and treatment resource following a disaster. First, the research context for the utility of non-institutional sources of post-diaster assistance is outlined, followed by the more specific instance of medical triage and treatment. An emerging model of community disaster preparedness training is described, noting the modules that address disaster medicine. Positive contributions and limitations are addressed looking to disaster and non-disaster experiences. While the potential for non-traditional resources to aid immediate post-disaster response is becoming both more common and more accepted, there are a number of recommendations that would improve the usefulness and value, including: 1) integration with existing emergency care infrastructure; 2) standardization of training; 3) use of coordinated drills between public safety organizations, hospitals, and voluntary sectors; and 4) dedication of more funding to assist in the creation and maintenance of programs. Because of the relative infancy of these community-based programs, and the infrequency of large-scale disasters, there is little, if any, pre-post research that can demonstrate a measured impact on response. More pre-disaster baseline data-gathering efforts are needed, combined with post-disaster evaluative research to understand the utility of these non-traditional resources in terms of overall response, and in particular the ability to assist in areas of disaster medicine practice. One also expects that under these kinds of [disaster] conditions, family members, fellow employees, and neighbors will spontaneously try to help each other. This was the case following the Mexico City earthquake where untrained, spontaneous volunteers saved 800 people. However, 100 people lost their lives while attempting to save others. This is a high price to pay and is preventable through training.

Community Participation↗
PubMedDate not supplied

Accident and disaster epidemiology.

Natural disasters such as floods, earthquakes, and cyclones are responsible each year for a large number of deaths and injuries. Over recent years, the emphasis in disaster management has shifted from post-disaster improvisation to pre-disaster planning. There is a strong feeling that one should be able to prevent or mitigate the human consequences through improved preparedness. The decade 1990-99 has been proclaimed by the United Nations the International Decade for Natural Disaster Reduction (IDNDR). Epidemiology is proving an essential tool to study the health effects of disasters and to suggest appropriate control measures at each of the phases of the disaster process, from prevention to long-term rehabilitation. Case-studies have shown that rescue by the disaster-struck community is the most effective way to reduce the death toll due to earthquakes. Disaster preparedness should be part and parcel of primary health care in disaster-prone areas. Appropriate information to evaluate needs should be preferred to precipitate relief. Epidemiological surveillance should replace indiscriminate vaccination. In the long term, disaster preparedness can provide a stimulus for setting up more efficient health services.

Accident Prevention↗
PubMedDate not supplied

Assessment of major and minor events that occurred in Italy during the last century using a Disaster Severity Scale score.

INTRODUCTION: Epidemiological research about disasters is difficult to perform. Most often, it must be completed retrospectively, since data collection may not be feasible or possible during the disaster. Now, there is a recognized need for a standard method to assess the severity of a disaster. OBJECTIVES: The aim of this paper is to assess the severity of the disasters that occurred in Italy during the 20th century, using a Disaster Severity Scale (DSS). Another goal is to find a standard method for the classification of previous disasters, test the feasibility and reliability of the use of the DSS, and improve disaster management and planning. METHODS: Data were obtained from formal reports of the Civil Defence Unit (Italy) and were used to calculate the DSS score. Disasters were classified into major and minor disasters, according to the numbers of deaths and severity of the damage. The number of deaths was compared with the obtained DSS score. A seasonal trend for different types of events was obtained to assess if there is a relationship between the type of event and the time of the year in which it occurred, as related to the weather conditions existing at that time. RESULTS: There were enough data to calculate a DSS score for 26 major events that caused death and economic damage, and occurred in Italy between 18 March 1944 and 11 November 1999, and for 82 minor events, that occurred between October 1982 and December 1999. There were some significant peaks varying from different types of events during particular seasons, but the cause for those with the highest incidence is not clear. Events related to natural hazards were the only type of event that reached the highest DSS when considering the number of deaths, while no events associated with man-made hazards had a DSS score >8. CONCLUSION: The DSS score could be a reliable index for the assessment of events related to either natural or man-made disasters. Use of the DSS allows researchers to classify previous hazards by scoring each disaster's severity. Further studies in other countries could be useful to further validate the DSS.

Disasters↗
PubMedDate not supplied

[Mortality and morbidity from disasters in Spain].

OBJECTIVE: To analyze disaster episodes in Spain between 1950 and 2005 in order to characterize their pattern and evaluate their impact on morbidity and mortality. METHODS: We performed an observational retrospective study using the United Nations' definition of disaster. A disaster was considered as each episode, natural or technological, causing more than 15 deaths and/or more than 50 wounded persons. Epidemic and environmental disasters were excluded. RESULTS: The frequency of disasters has increased in Spain, especially during the four last decades. The frequency of disasters doubles in the second semester of the year and shows wide geographical variation. Spain has a mixed disaster pattern, with a predominance of technological disasters, which are 4.5 times more frequent than natural disasters. The most frequent type of natural disaster in Spain is flooding and most frequent technological disasters are traffic accidents.

Disasters↗
PubMed2006

School performance and social-emotional behavior of primary school children before and after a disaster.

OBJECTIVES: The purpose of this work was to evaluate the cognitive and social-emotional consequences in a general population of primary school children affected by the firework disaster in Enschede, The Netherlands, on May 13, 2000. The explosions caused tremendous damage in the surrounding neighborhood. Twenty-two people immediately died and >1000 were injured. METHODS: This retrospective study assessed school performance and social-emotional behavior before and up to 3 years after the disaster. Objectively measured school test results in spelling and arithmetic/mathematics and multi-informant social-emotional behavioral assessments were compared between exposed and nonexposed primary school children. Multivariate logistic-regression was used to assess the relationship between exposure and cognitive and social emotional functioning. RESULTS: On school performances, the children exposed to the disaster performed over a period of 3 years after the disaster as good as or better than classmates, controls, and a national reference population. Shortly after the disaster, exposed children even seemed to have better school test results than nonexposed children. Two to 3 years after the disaster, a significant effect of disaster exposure was found on social-emotional behavior. Problematic behavior was reported by teachers, parents, and the school doctor. CONCLUSIONS: This study demonstrates a limited influence of disaster exposure on school performance in primary school children. This study also shows that teachers and youth health care practitioners especially should be aware of children starting school several years after a disaster. Although very young at the time of a disaster (1-4 years of age), they may experience disaster-related problems.

Achievement↗
PubMed2005

Health problems of victims before and after disaster: a longitudinal study in general practice.

BACKGROUND: We aimed to quantify the health problems and to assess the possible risk factors for developing health problems in persons affected by the explosion of a firework depot at Enschede, The Netherlands, on May 13, 2000. The explosion considerably damaged buildings in the local neighbourhood and caused 22 immediate deaths and injuries in over 1000 people. METHODS: A longitudinal study of (89% of all) victims (n = 9329) and controls (n = 7392) with pre-disaster baseline morbidity for 16 months and post-disaster data for 2.5 years was conducted using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care (ICPC). Prevalence rates for clusters of symptoms were compared between victim and control groups pre- and post-disaster. Risk factors for developing health problems were examined in hierarchical linear models. RESULTS: Two and a half years post-disaster, the prevalence of psychological problems in victims who had to relocate was about double and in the non-relocated victims one-third more than controls. Victims with pre-disaster psychological problems were at a greater risk for post-disaster psychological problems. Relocated victims showed an excess of medically unexplained physical symptoms (MUPS) especially in a period of increased media attention. Both groups of victims showed some increase of gastrointestinal (GI) morbidity 2.5 years post-disaster compared with their pre-disaster rate, and compared with the control group. CONCLUSIONS: Two and a half years post-disaster an excess of psychological problems, MUPS, and gastrointestinal morbidity was observed. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems.

Adult↗
PubMedDate not supplied

Post-preparedness medical disaster response in Costa Rica.

INTRODUCTION: The 1991 earthquake in the Limón area of Costa Rica presented the opportunity to examine the effectiveness of a decade of disaster preparedness. HYPOTHESIS: Costa Rica's concentrated work in disaster preparedness would result in significantly better management of the disaster response than was evident in earlier disasters in Guatemala and Nicaragua, where disaster preparedness largely was absent. METHODS: Structured interviews with disaster responders in and outside of government, and with victims and victims' neighbors. Clinical and epidemiologic data were collected through provider agencies and the coroner's office. RESULTS: Medical aspects of the disaster response were effective and well-managed through a network of clinic-based radio communications. Nonmedical aspects showed confusion resulting from: 1) poor government understanding of the roles and responsibilities of the central disaster coordinating agency; and 2) poor extension of disaster preparedness activities to the rural area that was affected by the earthquake. CONCLUSION: To be effective, disaster preparedness activities need to include all levels of government and rural, as well as urban, populations.

Costa Rica↗
PubMed2003

A strategic plan for disaster medicine in Australasia.

Disaster epidemiology reveals epidemic increases in incidence of disasters. Rare disasters with catastrophic consequences also threaten modern populations. This paper profiles natural disasters, transportation incidents, emerging infectious diseases, complex disasters and terrorism for their historical and future potential impact on Australasia. Emergency physicians are in a position to assume leadership roles within the disaster management community in Australasia. The Australasian College for Emergency Medicine is in a position to lead medical specialty advances in disaster medicine in Australasia. To optimize its impact in disaster medicine, the specialty and its College have opportunities for advances in key areas of College administration, intra and interinstitutional representation, disaster preparedness and planning, disaster relief operations, education and training programs, applied clinical research, and faculty development.

Australia↗
PubMed2004

Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers.

OBJECTIVE: The events of Sept. 11, 2001, highlighted the importance of understanding the effects of trauma on disaster workers. To better plan for the health care of disaster workers, this study examined acute stress disorder, posttraumatic stress disorder (PTSD), early dissociative symptoms, depression, and health care utilization in disaster workers. METHOD: Exposed disaster workers (N=207) and unexposed comparison subjects (N=421) were examined at 2, 7, and 13 months after an airplane crash. RESULTS: Exposed disaster workers had significantly higher rates of acute stress disorder, PTSD at 13 months, depression at 7 months, and depression at 13 months than comparison subjects. Those who were younger and single were more likely to develop acute stress disorder. Exposed disaster workers with acute stress disorder were 3.93 times more likely to be depressed at 7 months. Those with high exposure and previous disaster experience or who had acute stress disorder were more likely to develop PTSD. Similarly, those who were depressed at 7 months were 9.5 times more likely to have PTSD. Those who were depressed at 13 months were 7.96 times more likely to also meet PTSD criteria. More exposed disaster workers than comparison subjects obtained medical care for emotional problems at 2, 7, and 13 months. Overall, 40.5% of exposed disaster workers versus 20.4% of comparison subjects had acute stress disorder, depression at 13 months, or PTSD. CONCLUSIONS: Exposed disaster workers are at increased risk of acute stress disorder, depression, or PTSD and seek care for emotional problems at an increased rate.

Accidents, Aviation↗
PubMed2005

Worldwide disaster medical response: an historical perspective.

OBJECTIVE: Disaster medicine and disaster medical response is a complex and evolving field that has existed for millennia. The objective of this article is to provide a brief review of significant milestones in the history of disaster medicine with emphasis on applicability to present and future structures for disaster medical response. RESULTS: Disaster medical response is an historically necessary function in any society. These range from response to natural disasters, to the ravages of warfare, and most recently, to medical response after terrorist acts. Our current disaster response systems are largely predicated on military models derived over the last 200 yrs. Their hallmark is a structured and graded response system based on numbers of casualties. In general, all of these assume that there is an identifiable "ground zero" and then proceed with echelons of casualty retrieval and care that proceeds rearward to a hospital(s). In a civil response setting, most civilian models of disaster medical response similarly follow this military model. This historical approach may not be applicable to some threats such as bioterrorism. A "new" model of disaster medical response for this type of threat is still evolving. Using history to guide our future education and planning efforts is discussed. CONCLUSION: We can learn much from an historical perspective that is still applicable to many current disaster medical threats. However, a new response model may be needed to address the threats of bioterrorism.

Disaster Planning↗
PubMedDate not supplied

Training of disaster managers at a masters degree level: from emergency care to managerial control.

The world has faced huge disasters over the last few decades and concerns have been expressed by nearly all international agencies involved that there is a scarcity of managerial skills to deal with the mitigation and management of disasters. Disaster risks are also on the increase throughout Africa and Southern Africa because of changes in the development process, settlement patterns and conflicts in the region. Emergency physicians are but one important resource in dealing with disasters. The need for a comprehensive multisectoral approach to disasters and more importantly to deal with its mitigation is becoming increasingly evident, especially in developing countries. Hence, the need for specially trained professionals in disaster management. In an effort to improve national, regional and continental capacity, and in support of the South African Disaster Management Act, the University of the Witwatersrand, Johannesburg, South Africa, has developed a Master of Public Health degree in Disaster Management. The MPH is aimed at preparing professionals from health and allied fields to play leadership roles in the management, improvement and evaluation of health and the health-care system. Emergency physicians have an important role to play in the development of disaster medicine and disaster management programmes and it is important that they engage in this activity, collaborating with colleagues of various other disciplines as appropriate. The following paper outlines the background to the programme and the current programme.

Biometry↗
PubMed2005

A multiphase disaster training exercise for emergency medicine residents: opportunity knocks.

BACKGROUND: Disaster planning is a core curriculum requirement for emergency medicine (EM) residency programs. Few comprehensive training opportunities in disaster planning incorporating the appropriate competencies have been reported. OBJECTIVES: To design, pilot, and evaluate a combination interactive Web-based disaster planning curriculum and real-time multidisciplinary full-scale disaster exercise. METHODS: Residents were assigned to groups led by a faculty mentor. Each group used an Internet-based platform to review the literature pertaining to their component of a disaster plan. The groups then used the platform to redesign an existing institutional disaster plan. Finally, they implemented their disaster plan for 80 simulated casualties resulting from a police, fire department, and emergency medical services multiple-casualty rescue exercise. All health professions then participated in a joint debriefing session. All aspects of the program were supervised by specialty EM faculty, and the exercise was evaluated using a five-point Likert scale with specific anchored descriptors. RESULTS: Sixteen residents and 17 faculty members participated in the exercise. Trained volunteers and high-fidelity simulations represented casualties varying in age from 6 months to 65 years, and in severity from ambulatory to moribund. Residents found the exercise enjoyable (4.9/5), relevant (4.6/5), and educational (4.8/5). CONCLUSIONS: Emergency medicine residency programs can benefit from participating in high-quality medical disaster exercises coordinated with local disaster response agencies. Residents report high satisfaction and learning from realistic simulations of disasters, and from collaboration with other community services.

Computer-Assisted Instruction↗
PubMed2003

Medical telematics in disaster response.

INTRODUCTION: Every year many disasters cause thousands of injuries, deaths, refugees. Depending on the kind of disaster (train/plane accident, flood, earthquake) not only an acute emergency medicine treatment but also general and family medicine and hospital treatment have to be safeguarded over a longer time-period in the disaster area. PROBLEM: Regarding to a lot of organizations, institutions and disaster teams taking part in the disaster assistance is there any lack of work or data flow in the medical treatment? METHODS: From the ODRA flood 1997, the high speed train crash in ESCHEDE 1998, the DANUBE flood 1999 and the ELBE flood in 2002 experience reports were collected. They were analysed with emphasis on data and work flow in the medical treatment and its command system: Standardised command structure? Communication problems? Used communication lines? Language problems? Medical Intelligence distribution? Use of Patient Tracking System? Triage problems? RESULTS: The use of spoken radio communication causes transmission mistakes or misunderstandings and radio-overload and need connection-set-up-time for each call. Manual distribution of same data for many receivers using different communication lines causes a time shift in the up-to-date-information. Language problems during the ODRA flood between German and Polish people led to longer reaction times. Up-to-date triage results as well as up-to-date transportation and hospital information are necessary for medical evacuation. Compared with other reports about these disasters the quality of disaster management depends on the quality of communication and information. CONCLUSION: The use of health telematics in disaster response helps to cope with the scenario. Modern technologies provide support for building up medical aid although the normal infrastructure is destroyed. To cope with disaster scenarios there are some telematic tools which can be used:--Computer-based Command and Control System--Telemedical support --Data-ressources-network /Medical Intelligence. A further study is recommended to evaluate the real impact of using these telematic tools in a disaster.

Disaster Planning↗
PubMed2006

[Establishment of snow disaster remote sensing monitoring and damage estimation systems in Altai pastoral region of Xinjiang].

It is of significance to establish an integrated evaluation system of snow disaster in northern pastoral areas. Based on the NOAA satellite digital images, field observation data, and maps of grassland type and seasonal pastureland, this paper selected the winter and spring pasturelands in Aletai region of Xinjiang as the main area of snow disaster-remote sensing monitoring. With affecting factors of economy and the characteristics of natural resource distribution comprehensively analyzed, and using 3S techniques and field survey information, a fundamental information processing model for integrated evaluation of snow disaster was built up, and snow disaster-spatial evaluation indices and damage level systems were constructed. Natural and social systems and 20 indices were selected in snow disaster evaluation indicator system. Four principal factors, i.e., snow cover area, snow depth on grassland, persistence days of low temperature, and livestock death rate, were used as the grading indices of snow disaster damage level, and the models of snow disaster identification and loss estimatation were set up to quantitatively analyze snow disaster. The results indicated that the system could accurately reflect the details of snow hazard grade and the situation of a disaster in temporal and spatial scales, which would help to carry out the dynamic monitoring and scientific estimatation of big area's snow disaster in pastoral region.

China↗
PubMed1976

The epidemiology of disasters.

Over the last few years there has been an increasing awareness that some kind of disaster management should be possible. The emphasis is now moving from post-disaster improvisation to predisaster preparedness. The League of Red Cross Societies has increasingly encouraged predisaster planning in countries at risk. A new United Nations agency - United Nations Disaster Relief Office (UNDRO)- has been set up with headquarters in Geneva. Coordination and exchange of information between agencies engaged in disaster relief are becoming the rule rather than the exception, and a number of groups have started with the specific objective of making professional expertise available to disaster management. A number of private initiatives have been taken, meetings have been organized, research centers set up, and research projects launched. The study of disasters needs to be approached on a multidisciplinary basis, the more so since the health component is only one part of the broad disaster problem and, perhaps not the major one. Social scientists, psychologists, administrators, economists, geographers, have been or are conducting a number of studies on natural disasters. These studies have provided new insights and have proved most useful in preparing for disasters and increasing the effectiveness and acceptance of relief operations. This is a vital and challenging field, wide open for research. It is now time for epidemiologists and community health scientists to enter the fray and provide much needed information on which a rational, effective and flexible policy for the management of disasters can be based.

Cholera↗
PubMedDate not supplied

Nursing students' perceptions about disaster nursing.

Man-made or natural disasters are occurring more frequently in the United States and around the world. It is important that all nurses in all specialties be prepared to care for people affected by disasters. This article reports a descriptive study that sought to explore nursing students' perceptions about disaster nursing and to use the findings to suggest recommendations for building the discipline of disaster nursing. Results of this study indicate that nursing students had the following gaps of knowledge regarding disaster nursing: (1) an incomplete definition of disaster nursing; (2) lack of recognition about the importance of knowing community resources, having mock disaster drills, and utilizing disaster planning models; and (3) lack of perception that all nurses could play a significant role in disaster situations. The authors recommend that disaster nursing be taught by nursing faculty as a specialty in nursing programs.

Adult↗