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PubMed2005

Disaster and associated changes in physical and mental health in older residents.

BACKGROUND: Long-term health consequences of disasters have not been studied extensively, one reason amongst others is that no pre-disaster observation is available. This study focuses on an aeroplane crash on an Amsterdam suburb. The ongoing Longitudinal Aging Study Amsterdam has one pre-disaster and several post-disaster observations, making it possible to study changes in health, taking pre-disaster health characteristics into account. METHODS: Three exposure groups are distinguished: those living within a radius of 1 km from the disaster (initial n=39), those living between a radius of 1 and 2 km from the disaster (initial n=56), and those living in the rest of the city of Amsterdam (initial n=508). Health measures include general health, health in comparison with age peers, functional limitations, disability and cognitive functioning. These measures are based on self-ratings, interviewer observations, or both. RESULTS: Older persons living closest to the disaster area are likely to experience health decline in the wake of a disaster, over and above the health decline that would occur normally with aging. The disaster-associated health decline is small, and most obvious in the ability to perform actions (such as mobility), but is not observed in either disability in daily functioning, nor in self-perceptions of health. Cognitive functioning even shows a short-term improvement. CONCLUSION: These findings suggest substantial resilience in older adults, despite their common health problems.

Accidents, Aviation↗
PubMedDate not supplied

The 1994 Northridge earthquake disaster response: the local emergency medical services agency experience.

INTRODUCTION: This paper describes the 1994 Northridge earthquake experience of the local emergency medical services (EMS) agency. Discussed are means that should improve future local agency disaster responses. METHODS: Data reported are descriptive and were collected from multiple independent sources, and can be reviewed publicly and confirmed. Validated data collected during the disaster by the Local EMS Agency also are reported. RESULTS: The experience of the Los Angeles County EMS Agency was similar to that of earthquake disasters previously reported. Communication systems, water, food, shelter, sanitation means, power sources, and medical supplies were resources needed early in the disaster. Urban Search and Rescue Teams and Disaster Medical Assistance Teams were important elements in the response to the Northridge earthquake. The acute phase of the disaster ended within 48 to 72 hours and public health then became the predominant health-care issue. Locating community food and water supplies near shelters, providing transportation to medical care, and public-health visits to shelter locations helped prevent the development of long-term park encampments. An incident command system for the field, hospitals, and government responders was necessary for an organized response to the disaster. CONCLUSION: Disaster preparedness, multiple forms of reliable communication, rapid mobilization of resources, and knowledge of available state and federal resources are necessary for a disaster response by a local EMS agency.

Disaster Planning↗
PubMed2005

The ABC's of disaster response.

The readiness of our healthcare facilities to respond to terrorist acts or naturally occurring epidemics and disasters has been at the center of public attention since September 11, 2001. The many other tragic events that have occurred throughout the world since then further reinforce the need for all healthcare facilities and medical personnel to increase their level of preparedness if they wish to optimize outcomes. Maximizing survival rates and minimizing disability during any MCI hinges on rapid, seamless, and coordinated response between first responders and first receivers. The Incident Command System and the HEICS are organizational tools that form the foundation for such a rapid and coordinated response. The ICS provides a simple and adaptable management structure that is capable of being expanded or contracted to meet the needs of a specific situation. The HEICS adapts the ICS into the hospital setting and, in addition to the benefits stated above; its use of the ICS nomenclature and terminology facilitates the communication and the sharing of resources between all agencies and health care institutions involved. A basic knowledge and understanding of the ICS principles and structure is essential for all individuals participating in a disaster response. Previous efforts at disaster preparedness have focused predominantly on the pre-hospital and rescue phase of the disaster response, but a complete and coordinated community response requires creation of integrated disaster plans. True readiness can only be achieved by testing and modifying these plans through integrated simulation drills and table top exercises. Hospital-wide drills are essential to educate all staff members as to their institutional plan and serve as the only substitute at present to first hand experience. At present, there is no evidence-based literature to define what constitutes the best medical response by medical personnel within a disaster setting. This information will likely evolve over the next several decades as we now recognize Disaster Medicine as a separate scientific and medical entity. In the interim, we can develop and modify our response plans based on the "lessons learned" from past experience. Prior events have demonstrated that general surgeons and surgical subspecialists are critical components to a successful hospital response for the vast majority of all mass casualty incidents. Thus, surgeons must take responsibility for increasing their knowledge and understanding of basic disaster management principles and must play an active role in developing their institutional disaster plans.

Disaster Planning↗
PubMedDate not supplied

The role of health sectors in disaster preparedness. Floods in southeastern China, 1991.

Disasters, whether natural or man-made, usually are unpredictable. Efforts to reduce morbidity and mortality from a disaster should be put forth before it occurs. A brief survey is presented of the worst flood to occur in a hundred years that affected eight provinces in Southeast China. The disaster preparedness and response for Anhui Province, the hardest hit area, is summarized. The disaster preparedness was comprehensive, and cooperation was achieved among various specialties: military forces; firefighters; civil engineers; mechanics; police; provincial governors; the medical sectors; and so forth. Among these groups, the role of medical sectors was of great importance in reducing disease that would have resulted from such a disaster. The measures undertaken by the medical sectors included development of an organization to reduce the impact of disaster; training of medical personnel in techniques of rescue and in treatment of victims in disaster areas; development of a plan to assist the leadership in decision-making and establishing support for disaster preparedness; and maintaining sufficient capacity in general hospitals for the admission of victims from disaster areas.

China↗
PubMed2005

The importance of evidence-based disaster planning.

Disaster planning is only as good as the assumptions on which it is based. However, some of these assumptions are derived from a conventional wisdom that is at variance with empirical field disaster research studies. Knowledge of disaster research findings might help planners avoid common disaster management pitfalls, thereby improving disaster response planning. To illustrate the point, this article examines several common assumptions about disasters, compares them with research findings, and discusses the implications for planning. These assumptions are that: 1. Dispatchers will hear of the disaster and send emergency response units to the scene. 2. Trained emergency personnel will carry out field search and rescue. 3. Trained emergency medical services personnel will carry out triage, provide first aid or stabilizing medical care, and--if necessary--decontaminate casualties before patient transport. 4. Casualties will be transported to hospitals by ambulance. 5. Casualties will be transported to hospitals appropriate for their needs and in such a manner that no hospitals receive a disproportionate number. 6. Authorities at the scene will ensure that area hospitals are promptly notified of the disaster and the numbers, types, and severities of casualties to be transported to them. 7. The most serious casualties will be the first to be transported to hospitals. The current status and limitations of disaster research are discussed, and potential interventions to response problems are offered that may be of help to planners and practitioners and that may serve as hypotheses for future research.

Disaster Planning↗
PubMed2005

Social and psychological resources and health outcomes after the World Trade Center disaster.

Previous studies on community disasters tend to assess non-representative samples and use nonstandard measures of well-being. Additionally, few of these studies are longitudinal in design. In this report, we examine the consequences of the World Trade Center Disaster (WTCD) within a stress model perspective to assess level of exposure to the disaster and well-being after this event, as measured by the SF12 mental health and physical health scales. Data come from a two-wave panel study of 1681 English or Spanish speaking adults living in New York City on the day of the terrorist attacks and were collected by telephone interviews 1 and 2 years after the disaster. In ordinary least-squares regression models that contained demographic characteristics, stress risk factors, and social psychological resources as independent variables, level of exposure to the disaster was associated with poorer Wave 2 physical well-being, but not psychological health. Level of disaster exposure was not related to Wave 2 physical health, however, once the Wave 1 level of physical health was controlled, suggesting that disaster exposure did not have a lasting impact on variation in physical well-being. Results also indicated that experiencing a panic attack, negative life events, or traumatic events were related to poorer physical health. Respondents who met screening criteria for possible alcohol dependence post-disaster, experienced negative life events, or experienced traumatic events, were more likely to suffer from poorer mental health compared to those who did not meet the criteria, experience negative life events or experience traumas. We discuss these findings relative to community disasters in industrialized and developing countries.

Adolescent↗
PubMedDate not supplied

Hospital disaster preparedness in Osaka, Japan.

PURPOSE: To investigate the adequacy of hospital disaster preparedness in the Osaka, Japan area. METHODS: Questionnaires were constructed to elicit information from hospital administrators, pharmacists, and safety personnel about self-sufficiency in electrical, gas, water, food, and medical supplies in the event of a disaster. Questionnaires were mailed to 553 hospitals. RESULTS: A total of 265 were completed and returned (Recovery rate; 48%). Of the respondents, 16% of hospitals that returned the completed surveys had an external disaster plan, 93% did not have back-up plans to accept casualties during a disaster if all beds were occupied, 8% had drugs and 6% had medical supplies stockpiled for disasters. In 78% of hospitals, independent electric power generating plants had been installed. However, despite a high proportion of power-plant equipment available, 57% of hospitals responding estimated that emergency power generation would not exceed six hours due to a shortage of reserve fuel. Of the hospitals responding, 71% had reserve water supply, 15% of hospitals responding had stockpiles of food for emergency use, and 83% reported that it would be impossible to provide meals for patients and staff with no main gas supply. CONCLUSIONS: No hospitals fulfilled the criteria for adequate disaster preparedness based on the categories queried. Areas of greatest concern requiring improvement were: 1) lack of an external disaster plan; and 2) self-sufficiency in back-up energy, water, and food supply. It is recommended that hospitals in Japan be required to develop plans for emergency operations in case of an external disaster. This should be linked with hospital accreditation as is done for internal disaster plans.

Accreditation↗
PubMed2003

Generic evaluation methods for disaster drills in developing countries.

Disaster simulations (drills) are widely used throughout the world and are considered a fundamental tool for evaluation and improvement of local disaster response capacity. Despite this, no generally accepted methodology exists for quantitative evaluation of the medical response to a disaster drill. We therefore set out to develop and prospectively test a comprehensive method to assess both medical provider and organizational performance during a disaster simulation. Because disasters disproportionately affect the populations of developing countries, we designed these methods to be sufficiently flexible to be applicable in both the developed and the developing world. Objective outcome measures were identified for each component of disaster medical response and were incorporated into 3 data collection instruments. The derived methods were applied to a multiagency disaster simulation in Guatemala City, Guatemala. On the basis of this pilot study, suggested modifications and recommendations were made. The ability to objectively identify the specific strengths and weaknesses of an emergency medical services systems' medical response to a disaster is an important step toward optimizing system performance. On the basis of our experience, we recommend the incorporation of objective evaluation methods such as these into every disaster simulation.

Data Collection↗
PubMedDate not supplied

Lessons learned and unsolved public health problems after large-scale disasters.

BACKGROUND: This paper examines the considerable medical and psychological problems that ensue after disasters in which massive populations are affected for extended and sometimes unknown time periods. The organization of disaster response teams after large-scale disasters is based on experiences as a medical specialist at Chernobyl immediately after this catastrophe. Optimal ways of dealing with the immediate medical and logistical demands as well as long-term public health problems are explored with a particular focus on radiation disasters. Other lessons learned from Chernobyl are explained. ISSUES: Current concerns involve the constant threat of a disaster posed by aging nuclear facilities and nuclear and chemical disarmament activities. The strategies that have been used by various groups in responding to a disaster and dealing with medical and psychological health effects at different disaster stages are evaluated. The emergence of specialized centers in the former Soviet Union to study long-term health effects after radiation accidents are described. Worldwide, there has been relatively little attention paid to mid- and long-term health effects, particularly the psychological stress effects. Problems in conducting longitudinal health research are explored. RECOMMENDATIONS: The use of a mobile diagnostic and continuously operating pre-hospital triage system for rapid health screening of large populations at different stages after a large-scale disaster is advisable. The functional systems of the body to be observed at different stages after a radiation disaster are specified. There is a particularly strong need for continued medical and psychosocial evaluation of radiation-exposed populations over an extended time and a need for international collaboration among investigators.

Disasters↗
PubMedDate not supplied

[The concept of disaster and its application in Asturias].

FUNDAMENTALS: Disaster can be defined as an unusual event for which the impact exceeds the affected community ability to meet the effects using own resources. The aim of the study is review the recent disaster profile of Asturias and assess the applicability of current disaster definitions in our context. METHODS: We considered as disaster each event producing casualties and requiring intervention of the civil protection services during the period 1982-1993, excluding minor transit accidents with no participation of the civil protection services. Date, place, characteristics, mortality and morbidity impact were studied for each event and then analyzed. We studied also current availability health resources in case of disaster. RESULTS: 14 events were recorded yielding to 88 deceased and 3 injured people (6.28 deaths by event). Aviation accidents were the most frequent event (35.7%) followed by railway, mining, shipwrecks and floods. Shipwrecks had higher mortality impact (36.3% of the total deceased people). Only minor technological disasters has happened in Asturias. This prevalence pattern differs from the spanish one characterized by a double face (natural and technological disasters). CONCLUSIONS: Traditional concept of major disaster cannot be applied to the Asturias context as the exam of our recent epidemiological prevalence pattern shows. Only mayor transit accidents (aviation, railway and shipwrecks) occur and its impact can be easily managed by the current relief community resources. However, an important potential risk of technological disasters exists and it requires have ready sectorial prevention plans.

Algorithms↗
PubMed1999

Posttraumatic stress disorder and identification in disaster workers.

OBJECTIVE: Disaster workers who work with deceased victims are at increased risk of posttraumatic stress disorder (PTSD). Identification with the deceased has been proposed as one of the mechanisms in this stress-illness relationship. To examine this hypothesis, this study investigated three types of identification with the dead in a group of disaster workers: identification with the deceased as oneself, identification with the deceased as a friend, and identification with the deceased as a family member. METHOD: Fifty-four volunteer disaster workers who worked with the dead following an explosion on the USS Iowa naval ship were assessed 1, 4, and 13 months after the disaster. PTSD symptoms (measured with the DSMPTSD-IV scale), intrusive and avoidant disaster-related symptoms (measured with the Impact of Event Scale), somatization and general distress (measured with the SCL-90-R), and health care utilization were assessed. RESULTS: Disaster workers who reported identification with the deceased as a friend were more likely than those who did not to have PTSD, more intrusive and avoidant symptoms, and greater levels of other posttraumatic symptoms including somatization. Disaster workers who reported identification with the deceased as a family member had greater intrusive symptoms 1 month after the disaster than those who did not. There were no differences between those who did and did not identify with the deceased as self. Health care utilization was not associated with identification. CONCLUSIONS: Identification with the deceased is a risk factor for PTSD and posttraumatic symptoms in disaster workers exposed to the dead. Identification with the dead as a friend is specifically associated with higher risk for these workers.

Adult↗
PubMedDate not supplied

Disaster preparedness: what do we do now?

Disasters are events that exceed the capacity of the people affected to recover from the adverse affects. Understanding types of disasters and components of disaster responses provides a basis for developing disaster preparedness plans. Disaster preparedness is a process for assessing risks and capacities for responding when disasters occur. Planning can mitigate damages and facilitate rapid and effective disaster response services. Health care workers, including midwives and women's health care providers, can access resources to be prepared as competent responders in disaster contexts to meet the needs of women and their communities.

Adult↗
PubMed2004

System issues for psychiatrists responding to disasters.

Psychiatric response to disasters over the last 50 years has been sporadic and inconsistent. Psychiatrists have advocated for a place in the disaster response system, and at times they have demonstrated the unique contribution they can add to disaster preparedness and response. Still, it is likely that psychiatrists are overlooked in disaster planning and response. A psychiatrist's ability to respond to disasters requires a knowledge base in the operations of the emergency management system, the responsibilities of the public health system, and the role of voluntary agencies in disaster response. This article provides the foundation for the elements involved in US disaster response and highlights the key organizations, agencies, and disaster response systems to outline the framework in which psychiatrists may bring their professional skills to the people who need them most.

Disaster Planning↗
PubMed2004

Natural and technologic hazardous material releases during and after natural disasters: a review.

Natural disasters may be powerful and prominent mechanisms of direct and indirect hazardous material (hazmat) releases. Hazardous materials that are released as the result of a technologic malfunction precipitated by a natural event are referred to as natural-technologic or na-tech events. Na-tech events pose unique environmental and human hazards. Disaster-associated hazardous material releases are of concern, given increases in population density and accelerating industrial development in areas subject to natural disasters. These trends increase the probability of catastrophic future disasters and the potential for mass human exposure to hazardous materials released during disasters. This systematic review summarizes direct and indirect disaster-associated releases, as well as environmental contamination and adverse human health effects that have resulted from natural disaster-related hazmat incidents. Thorough examination of historic disaster-related hazmat releases can be used to identify future threats and improve mitigation and prevention efforts.

Disaster Planning↗
PubMed1999

Telecommunications systems in support of disaster medicine: applications of basic information pathways.

Disaster events have always been a fact of life. Success or failure of a disaster response is often determined by timely access to communication and reliable information. The rapid progress and future course in telecommunications indicate that lack of communications need no longer be the paralyzing factor in a disaster scenario. This is especially important for medical response where time is of essence to save lives. This article explores various telecommunications tools that can enhance medical response in a disaster and includes those associated with telemedicine (providing medical care from a distance through telecommunications). Disaster telemedicine systems need not be special or sophisticated-the challenge is to match the right systems with a given disaster plan or scenario. A brief history of telemedicine use for disaster relief and humanitarian assistance is presented together with a discussion of advantages, disadvantages, and near-future potential of telecommunication systems to gain a better perspective of which tools might best fit disaster medicine needs today and into the new millennium.

Disaster Planning↗
PubMed2006

Preparation and response in case of natural disasters: Cuban programs and experience.

Inadequate preparation for national disasters is frequently particularly devastating in lower income countries. The Cuba's location has a diversity of potential natural disasters, including hurricanes, non-tropical depressions, tropical storms, tropical cyclones, and severe local storms, all with intense rains and winds, earthquakes and droughts. Cuban preparation, at all levels, is geared to these predominant threats. Planning for natural disasters is integral to the political and economic life of Cuba, nationally and locally. On several occasions, United Nations (UN) officials have pointed to Cuba as a model for developing countries preparing for hurricanes and other natural disasters. A global policy for managing the risks of natural disasters could improve continuity of assistance for development and reduce the necessity of humanitarian aid. Planning in advance of disasters is a feasible way of helping people, by reducing expenses of emergencies, recuperation, and reconstruction. As climate changes accelerate, many researchers fear a period of irreversible and uncontrollable change. While the atmosphere continues to warm, it generates more intense rains, more frequent heat waves, and more ferocious storms. Thus, achieving better protection of developing countries from an increasing onslaught of natural disasters will only grow in importance. Even though Cuba's contribution to know-how has been recognized by United Nations' officials, progress toward more adequate preparation worldwide has been slow. To support other countries beyond conveying the lessons, Cuba now offers specially trained personnel to cooperate immediately with any country suffering a natural disaster.

Cuba↗
PubMed1988

Role of pediatricians in disasters and mass casualty incidents.

In disaster planning, the role of the specialist is often overlooked. That role, for the pediatrician, entails being familiar with hospital and community disaster plans and agreeing to take part in implementation of those plans by: (1) before a disaster, teaching special pediatric emergency techniques to emergency medical technicians and paramedics, being sure that pediatric supplies and equipment are available in ambulances, checking to see that pediatric needs have been considered in designated evacuation shelters, and, for disasters occurring in one's own hospital, being sure that evacuation routes are known and that means of notifying parents have been set up; (2) during a disaster, helping to determine which pediatric patients can be discharged from the hospital or transferred to another hospital if beds are needed for accident victims, and being available as needed according to the plans; and (3) after a disaster, counseling parents and children on how to cope with the stress and fear of having been involved in a disaster. The emergency pediatrician active in disaster planning has a responsibility to see that the services of pediatricians in general practice are incorporated into those plans.

Child↗
PubMed2006

The extent and impact of mental health problems after disaster.

Disasters are events that challenge the individual's ability to adapt, which carries the risk of adverse mental health outcomes including serious posttraumatic psychopathologies. While risk is related to degree of exposure to psychological toxins, the unique vulnerabilities of special populations within the affected community as well as secondary stressors play an important role in determining the nature and amount of morbidity. Disasters in developing countries and those associated with substantial community destruction are associated with worse outcome. Although acute responses are ubiquitous, few disasters lead to posttraumatic psychopathology in the majority of people exposed. However, the shortage of human resources in psychiatry, particularly in developing countries, places a considerable burden on psychiatric services even without the additional constraints imposed by disaster. Hence, disasters are events that invite a public health approach to mental health that better serves the needs of the individual and the affected community. Such an approach considers all available human resources and is intended to mitigate the effects of disaster before serious psychopathologic sequelae arise. This community mental health strategy allows peripheral mental health workers to mediate between survivors and specialized mental health professionals while assisting in removing barriers to treatment. To be effective when disaster occurs, this approach requires careful planning in conjunction with community consultation before implementation of formal disaster mitigation policies.

Community Mental Health Services↗