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Rapid assessment of injuries among survivors of the terrorist attack on the World Trade Center--New York City, September 2001.

On September 11, 2001, a jet aircraft crashed into the north tower of the World Trade Center (WTC) in lower Manhattan. Minutes later, a second aircraft crashed into the south tower. The impact, fires, and subsequent collapse of the buildings resulted in the deaths of thousands of persons. The precise number and causes of deaths could not be assessed in the immediate aftermath of the attack; however, data were available on the frequency and type of injuries among survivors (Figure 1). In previous disasters, such information assisted in characterizing type and severity of injuries and the health-care services needed by survivors. To assess injuries and use of health-care services by survivors, the New York City Department of Health (NYCDOH) conducted a field investigation to review emergency department (ED) and inpatient medical records at the four hospitals closest to the crash site and a fifth hospital that served as a burn referral center. This report summarizes findings of that assessment, which indicated that the arrival of injured persons to this sample of hospitals began within minutes of the attack and peaked 2 to 3 hours later. Among 790 injured survivors treated within 48 hours, approximately 50% received care within 7 hours of the attack, most for inhalation or ocular injuries; 18% were hospitalized. Comprehensive surveillance of disaster-related health effects is an integral part of effective disaster planning and response.

Aircraft↗

Risk factors of diarrhoea among flood victims: a controlled epidemiological study.

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.

Case-Control Studies↗

Psychosocial responses to biological and chemical terrorist threats and events. Implications for the workplace.

1. Both biological and chemical weapons (BCW) could potentially be used in future terrorist attacks on U.S. workplaces and communities. 2. Threats of BCW terrorism may lead to anxiety, adverse health effects, and the exacerbation of psychiatric symptoms and syndromes in workers and managers. 3. Actual BCW attacks will likely cause both acute and chronic mental disorders in a significant number of surviving victims who may also be employees or employers. 4. Occupational health nurses can help prevent or remediate maladaptive psychological responses by educating themselves and their work forces, assisting in a risk assessment of the workplace, understanding disaster planning, and assisting management in policy formulation and psychosocial triage.

Biological Warfare↗

Workshop 6 (synthesis): linking between flood risks and land use changes.

Land use changes, such as deforestation, are increasing the world's vulnerability to flooding. Detailed knowledge of the local situation is essential for risk assessment and design of effective flood prevention measures and governs the infrastructure and engineering measures implemented. However extreme floods in large catchments can overwhelm both natural capacity and constructed flood management measures.

Agriculture↗

Land-use change and floods: what do we need most, research or management?

Land-cover change (urbanisation, deforestation, and cultivation) results in increased flood frequency and severity. Mechanisms include reduced infiltration capacity, lower soil porosity, loss of vegetation, and forest clearing, meaning lower evapotranspiration. Major research challenges lie in quantification of effects in terms of flood characteristics under various conditions, ascertaining the combined effects of gradual changes over long time periods, and developing model tools suitable for land-use management. Large floods during the 1990s gave a new focus on these problems. Reference is made to the Norwegian HYDRA research programme on human impacts on floods and flood damage. The paper concludes that land-use change effects on floods are most pronounced at small scale and for frequent flood magnitudes. Model simulations of effects of land-use change can now be used to reduce flood risk. Modern flood management strategies have abandoned the position that dams and dikes are the only answers to mitigating flood disasters. Today, the strategic approach is more often: do not keep the water away from the people, keep people away from the water. Flood management strategies should include flood warnings, efficient communication, risk awareness, civil protection and flood preparedness routines, effective land-use policies, flood risk mapping, ... as well as structural measures.

Agriculture↗

Dental participants in mass disasters--a retrospective study with future implications.

Mass casualty incidents continue to require the services of forensic dentists to determine the identity of victims. Across North America and Europe. teams of forensic dentists train, using mock disaster exercises, to prepare for such duties. It is vital that these mock exercises simulate the features of real disaster situations as far as possible. In order to inform those responsible for the design and implementation of mock exercises, a study was undertaken to determine the features of actual disasters that dental personnel had attended. Using a questionnaire, data were solicited from 38 odontologists. The average number of disasters attended by the respondents was eight, with an average casualty number of 94. Aircraft crashes were the most frequent cause of disasters that were attended by the odontologists. The authors conclude that future mock disaster exercises should replicate features of aircraft crashes as closely as possible by using commingled, fragmented, and burned remains. In addition, mock disasters should require the identification of a realistic number of individuals to ensure authenticity and the maximum logistical preparedness of participants.

Accidents, Aviation↗

Emergency preparedness guidelines for water treatment systems.

While many dialysis facilities prepare for loss of power and water in disaster situations, it is equally important to prepare for loss of quality drinking water. Natural disasters like hurricanes, floods, earthquakes, and tornadoes can affect the quality of the potable water delivered for dialysis by adding contaminants. This article presents a checklist of how to prepare the water treatment system against natural disasters and what to do after an event occurs.

Disaster Planning↗

Dialysis and disaster: San Francisco's dialysis community remembers the Loma Prieta earthquake. Interview by Susan L. Robertson.

Unlike many regions of the United States that live with seasonal disasters such as hurricanes, snow storms, or flooding from torrential rains, the greatest threat of natural disaster in California still comes from earthquakes (TransPacific Renal Network, 1998). This was proven on October 17, 1989 when the Loma Prieta earthquake rolled through northern California. Measured as 7.1 on the Richter scale, the quake's epicenter was located about 10 miles northeast of Santa Cruz along a segment of the San Andreas Fault near the town of Loma Prieta in the Santa Cruz Mountains. The impact, however, was felt throughout most of the northern portion of the state.

Adaptation, Psychological↗