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PubMed2004

Psychiatry and terrorism: the profession's role in disaster response planning.

While America wages the "war" on terrorism and endeavors to protect the physical safety of its citizens, it is imperative to plan for the population's mental health needs in future terrorist/disaster scenarios. The importance of psychiatry's potential role in preparing the community for the psychological impact of terrorism is underscored against the historical backdrop of the field being "carved out" from the organization, delivery, and financing of health services in our society. A practical framework is offered for designing an organization's mental health disaster plan, including recommendations for strategic infrastructure and tactical response capabilities. Finally, the unique features of clinical practice with disaster victims are noted, including intra-clinician conflicts between professional/community interests and personal/family obligations during acute disaster events.

Disaster Planning↗
PubMed2004

Information technology and emergency medical care during disasters.

Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims.

California↗
PubMed2006

Principles and practical procedures for acute psychological first aid training for personnel without mental health experience.

Most authorities agree that mass disasters leave in their wake a need for some form of acute mental health services. However, a review of current literature on crisis intervention and disaster mental health reveals differing points of view on the methods that should be employed (Raphael, 1986; NIMH, 2002). Nevertheless, there appears to be virtual universal endorsement, by relevant authorities, of the value of acute "psychological first aid" (American Psychiatric Association, 1954; USDHHS, 2004; Raphael, 1986; NIMH, 2002; Institute of Medicine, 2003; WHO, 2003; DoD/VAPTSD, 2004; Ritchie, et al., 2004; Friedman, Hamblin, Foa, & Charney, 2004). Psychological first aid (PFA), as an acute mental health intervention, seems uniquely applicable to public health settings, the workplace, the military, mass disaster venues, and even the demands of more well circumscribed critical incidents, e.g., dealing with the psychological aftermath of accidents, robberies, suicide, homicide, or community violence. In this document, we shall introduce the notion of psychological first aid (PFA) as one aspect of a psychological continuum of care, offer a rudimentary definition of PFA, and provide the reader with a practicalframework for its implementation utilizing the individual psychological first aid (iPFA)format. The goal of this paper is to better prepare public health, public safety, and other disaster response personnel who do not possess formal clinical mental health degrees or specialized training to provide iPFA services to primary and secondary disaster victims.

Clinical Competence↗
PubMed1990

[The anesthesiological-resuscitation aspects and the medical problems of catastrophes].

Anaesthesiological and resuscitation service is a special component of disaster medicine. It is of paramount importance in LSFA (life-supporting first aid) training of the lay public. Lack of knowledge and inadequate application of LSFA are estimated to increase the mortality rate of disaster victims by 40%. The paper discusses quantity and quality of anaesthesiological and resuscitation aid delivered immediately at the disaster scene, during triage before and after evacuation, during transportation. Much attention is devoted to pain management and infusion therapy performed at the disaster scene and during transportation.

Anesthesiology↗
PubMed1975

Valley triage: an approach to mass casuality care.

Organizations prepared to respond to war, fire, flood, earthquake, or attack are essential for effective disaster control. "Valley Triage" the San Fernando Valley Medical Triage Team in Los Angeles, was formed to meet this need. The team is a mobile medical unit staffed by physicians and coordinated with civilian and military emergency services. It incorporates innovative means of communication, transportation, equipment, and training. The primary aim of Valley Triage is to provide on-site medical attention to disaster victims, and to coordinate their transfer to adequately staffed and equipped hospitals. Valley Triage offers a new approach to disaster management and can serve as a model for the development of other teams throughout the nation.

Communication↗
PubMedDate not supplied

Evidence of the effectiveness of health sector preparedness in disaster response: the example of four earthquakes.

In this article, evidence that health sector preparedness improves response performance in disasters was examined. Case fatality and survival data were compared for four earthquakes, in relation to health sector emergency preparedness levels. Vast differences in performance were found. The two California systems, with a high preparedness index, had low case fatality rates (about one death per 100 injuries). Kobe, Japan, with mixed levels of preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness index) had 167. Public health and health sector preparedness made a significant difference in the ability to respond effectively to meet patient needs in disasters, although it is only one of several factors that determine the health outcome of disaster victims.

Armenia↗
PubMed1986

Posttraumatic morbidity of a disaster. A study of cases presenting for psychiatric treatment.

The study of unsolicited psychiatric patients who became ill because of their experience in a natural disaster can assist in the design of future disaster research. A clinical report of 36 such patients illustrates the problems of case detection, the delayed presentation of much of the morbidity, and the need to separate stress-related symptoms which are common in disaster victims from psychiatric illness. Unless these issues are taken into account, estimates of the prevalence of psychiatric disorders after major disasters may be subject to substantial error. The role of vulnerability factors assessed to be operating in these patients suggests that exposure and losses sustained in the disaster alone are inadequate predictors of psychiatric disorder. The risk factors for the development of disaster-related psychiatric morbidity will be more accurately defined if the contribution of a range of constitutional, personality, and social factors as well as the personal impact of the disaster are investigated in future research.

Adaptation, Psychological↗
PubMed1997

The dental identification of victims of an aircraft accident in Malaysia.

On 15 September 1995 a Malaysian Airlines (MAS) Fokker 50 plane plunged while descending and crashed, killing thirty-four passengers aboard. The dental disaster victim identification team comprising dental surgeons from the Dental faculty, University of Malaya; Ministry of Health, Sabah; and the Malaysian Defence Forces played an active role in the identification process. Most of the bodies were badly mutilated, disfigured and severely incinerated. Problems were encountered due to inadequate facilities and space at the mortuary. Difficulties were also encountered during the procurement and deciphering of information from dental records. This disaster has however created greater awareness amongst Malaysians of the important role of forensic odontology in mass disasters.

Accidents, Aviation↗
PubMed1990

The psychological sequelae of disaster stress prospectively and retrospectively evaluated.

Aimed to document the psychological sequelae of a disaster in the adult (17-68 years) population of the Caribbean island of Puerto Rico, by surveying 912 persons (including 375 previously interviewed) with a Spanish version of the Diagnostic Interview Schedule. A rigorous methodology, which included both retrospective and prospective designs, was used, enabled by the occurrence of a catastrophic disaster only a year after a comprehensive survey was completed. Framed in a stress theoretical perspective, disaster effects for new depressive, somatic, and posttraumatic stress symptoms were identified, even after adjusting for demographic and methodologic factors. All the effects, however, were relatively small, suggesting that most disaster victims were rather resilient to the development of new psychological symptoms. Comparison of results with previous findings and its implications for both disaster and stress research are discussed, as well as the role of community psychologists in disaster action.

Adaptation, Psychological↗
PubMed1999

US government natural disaster assistance: historical analysis and a proposal for the future.

Governments often provide grants or low-interest loans to disaster victims. Yet these programmes have proven to be quite costly. In addition, questions have been raised about associated behavioural incentives. Conceptually, government disaster insurance programmes should be more efficient, consistent and equitable than ex post facto disaster relief in the form of grants and loans. Yet the performance of government disaster insurance programmes has been mixed, at best. This article reviews the history of US federal natural disaster assistance to individuals and concludes with a recommendation for a new government role in the provision of disaster insurance.

Disaster Planning↗
PubMed2000

The American Red Cross disaster mental health services: development of a cooperative, single function, multidisciplinary service model.

Not until 1989 did the Red Cross officially recognize a need for a systematic and organized plan for the mental health needs of disaster survivors. Over the next decade, the Red Cross Disaster Mental Health Services program has developed and evolved to assist both disaster victims and the Red Cross workers who serve them to cope with the overwhelming stresses encountered by both groups in the aftermath of disasters. The Red Cross now coordinates a large and diverse group of mental health professionals from fields of psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling who work together cooperatively. Cross-disciplinary conflicts are minimized by the Red Cross' generic approach to the various mental health professional specialties as functionally interchangeable in performing Red Cross duties. This article reviews the development of this process and describes one local Red Cross chapter's early experience as part of this effort.

Crisis Intervention↗
PubMed1988

Prior experience as a moderator of disaster impact on anxiety symptoms in older adults.

As participants in a panel study, 234 older adults were interviewed before, as well as after, serious flooding occurred in southeastern Kentucky. Floods are not uncommon in this area, but these were more widespread than most, and resulted in both previously exposed and newly exposed subsamples of disaster victims. Flood impact was measured at both personal and community levels. With preflood symptoms controlled, there were modest flood effects on both trait anxiety and weather-specific distress in older adults without prior flood experience, but no flood effects in older adults who had been in floods before. Thus, the study provides support for the "inoculation hypothesis" and other conceptualizations that emphasize the advantage of being familiar or experienced with a stressor that is at hand. An implication is that "experienced" victims could be a valuable resource in prevention efforts.

Aged↗
PubMed2005

The killing field of Khao Lak: forensic odontology in Thailand tsunami victim identification.

Forensic odontology is the science of dental identification. This paper describes the contribution of forensic odontology to tsunami victim identification in Thailand, with particular reference to the Singaporean victims. Thirteen Singaporeans were reported missing in Phuket following the Indian ocean tsunami on 26 December 2004. To date, 10 victims have been found and identified, eight of whom were identified by dental records. The author travelled twice to southern Thailand and spent 5 weeks there. First, in December 2004 as part of a Singapore Police Force Disaster Victim Identification team deployed in Khao Lak, and later in July 2005 at the Thai Tsunami Victim Identification Information Management Centre in Phuket.

DNA↗
PubMed2005

Psychological distress among Bam earthquake survivors in Iran: a population-based study.

BACKGROUND: An earthquake measuring 6.3 on the Richter scale struck the city of Bam in Iran on the 26th of December 2003 at 5.26 A.M. It was devastating, and left over 40,000 dead and around 30,000 injured. The profound tragedy of thousands killed has caused emotional and psychological trauma for tens of thousands of people who have survived. A study was carried out to assess psychological distress among Bam earthquake survivors and factors associated with severe mental health in those who survived the tragedy. METHODS: This was a population-based study measuring psychological distress among the survivors of Bam earthquake in Iran. Using a multi-stage stratified sampling method a random sample of individuals aged 15 years and over living in Bam were interviewed. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). RESULTS: In all 916 survivors were interviewed. The mean age of the respondents was 32.9 years (SD = 12.4), mostly were males (53%), married (66%) and had secondary school education (50%). Forty-one percent reported they lost 3 to 5 members of their family in the earthquake. In addition the findings showed that 58% of the respondents suffered from severe mental health as measured by the GHQ-12 and this was three times higher than reported psychological distress among the general population. There were significant differences between sub-groups of the study sample with regard to their psychological distress. The results of the logistic regression analysis also indicated that female gender; lower education, unemployment, and loss of family members were associated with severe psychological distress among earthquake victims. CONCLUSION: The study findings indicated that the amount of psychological distress among earthquake survivors was high and there is an urgent need to deliver mental health care to disaster victims in local medical settings and to reduce negative health impacts of the earthquake adequate psychological counseling is needed for those who survived the tragedy.

Adolescent↗
PubMed2006

Mental health assistance to populations affected by disasters: World Health Organization's role.

In this article, the authors describe the role of the World Health Organization (WHO) in mental health post-disaster recovery. The article covers the mandate and structure of WHO, mental health activities by the WHO Department of Mental Health and Substance Abuse, WHO-supported principles and strategies in mental health post-disaster recovery, and available WHO technical assistance. The paper outlines a public mental health approach to make very basic mental health services broadly available in post-disaster countries. Using examples based on the Asian tsunami experience, suggestions for delivering mental health assistance are made. The response to mental health of disaster victims should be seen in the context of national health priorities.

Asia, Southeastern↗
PubMed1992

Home care during the aftermath of Hurricane Hugo.

During the course of field observations for an ethnographic study of home care nurses' job stress, Hurricane Hugo struck the community, causing extensive damage. The nurses' office building was heavily damaged by wind and water, and their office was not habitable for almost a week. The author had observed the nurses' work practices over 10 weeks before the hurricane. In the aftermath of the storm, the nurses were simultaneously disaster victims and caregivers for other victims. They experienced grief, anger, and frustration about their losses, as well as conflict between their family- and work-related responsibilities. Their experiences and behaviors were consistent with those described in prior disaster research literature, lending further support to the earlier studies. A major asset for these nurses was their open, supportive work environment. They were able to accept and affirm one another's negative feelings and to provide support to each other as they dealt with their losses.

Anger↗
PubMed1993

Natural and man-made disasters: the vulnerability of women-headed households and children without families.

Since 1980, over 2 million people have died as an immediate result of natural and man-made disasters and by 1992, the refugee population registered nearly 16 million people. This article reviews the human impact of disasters as a composite of two elements: the catastrophic event itself and the vulnerability of people. It also examines the specific case of women and children in the current world emergency context. It identifies four broad policy areas that affect women and children in disaster situations and discusses them with examples and field evidence. The first policy area addresses humanitarian assistance and armed conflicts, and armed conflict and international humanitarian law, the use of food as instrument of war, mines and civilian disability, and rape and sexual violence are discussed within this context. The second problem discussed is the issue of unaccompanied and abandoned children in terms of its magnitude and implications for relief response. Thirdly, the article examines the differential risks in emergencies for mortality and morbidity, specifically for women and children. Finally, it addresses certain policies and approaches to disaster rehabilitation which effectively mirror and reinforce inherent inequities in the affected society. The article notes that: (i) the largest proportion of disaster victims today arise from civil strife and food crises and that the majority of those killed, wounded and permanently disabled are women and children; and (ii) the ability of any country to respond effectively to disasters depends on the strength of its health and social infrastructure, and its overall developmental status. It concludes by identifying seven areas where concrete measures could be taken to improve the current situation.

Adult↗
PubMed1977

Disaster-relief training and mental health.

The author describes a training program in diaster-relief agencies. The program is designed to improve their over-all understanding of disaster-relief work and to increase their sensitivity to the emotional needs of disaster victims. Based on the recommendations of a state task force report, it consists of a workshop that makes use of videotapes and learning exercises to help participants improve their listening skills, learn problem-solving techniques, become aware of behavioral signs that can alert them to victims' emotional reactions, and familiarize them with the work of other relief agencies.

Crisis Intervention↗