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At least 19 recordsLinked to original sources
PubMed2006

Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA.

OBJECTIVE: To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study. DESIGN AND SETTING: In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor. PARTICIPANTS: Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination. MAIN RESULTS: Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks. CONCLUSIONS: The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.

Accidents, Aviation↗
PubMed2006

The course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice.

BACKGROUND: Survivors of disaster with pre-disaster psychological problems are believed to be at risk for presenting post-disaster psychological and physical morbidity. Up till now this statement is based on cross-sectional studies with self-reported data and without pre-disaster measurement. OBJECTIVE: To monitor post-disaster health care utilization and morbidity presented in general practice after a man-made disaster by victims and controls with and without pre-disaster psychological problems. METHODS: A controlled cohort study with pre-disaster (1 year) and post-disaster (two-and-a-half years) data. Victims (N = 2518) of an exploding fireworks depot in a residential area and matched controls (N = 2512), representing patients in 30 general practices, were included. Main outcome measures were utilization measured by GP attendances, and psychological and physical problems registered by the GP using the International Classification of Primary Care. RESULTS: Only victims without pre-disaster psychological problems demonstrated a significant increase in utilization in the first half year post-disaster. Victims with pre-disaster psychological problems did not. Being a victim (OR = 6.13; 95% CI = 4.84-7.77) had a greater effect than pre-disaster psychological problems (OR = 4.96; 95% CI = 3.96-6.21) on presenting post-disaster psychological problems. Pre-disaster psychological problems had more effect (OR = 1.93; 95% CI = 1.79-2.08) than the effect of being a victim (OR = 1.25; 95% CI = 1.18-1.32) on the development of post-disaster physical symptoms. CONCLUSION: Post-disaster increases in utilization and psychological morbidity were observed. Post-disaster psychological problems were more influenced by the disaster, while post-disaster physical symptoms were more influenced by pre-disaster psychological problems. GPs should concentrate on the pre-disaster health history of victims of man-made disasters in their practices.

Accidents↗
PubMedDate not supplied

Disasters and development: Part I. Relationships between disasters and development.

This module introduces a paradigm for understanding the disaster/development interface. Specifically, the module asserts that disasters and development are linked closely in that disasters can both destroy development initiatives and create development opportunities, and that development schemes can both increase and decrease vulnerability. The module consists of four parts: Part One introduces these concepts and discusses how disasters can vary from one type of hazard to another, as well as from one type of economic condition to another. Part Two develops the paradigm in depth, and provides case examples to amplify the points made in the text. Part Three describes and discusses different methods and tools for analyzing decisions for potential investment of resources, and should enhance the reader's capacity to analyze the mitigational benefits of development alternatives in both the pre- and post-disaster context. Part Four conceptualizes the role of UN agencies, NGOs, and the affected communities in promoting development based on the concepts discussed in the module. This training module, Disasters and Development, initially was designed to introduce this aspect of disaster management to an audience of UN organization professionals who form disaster management teams, as well as to government counterpart agencies, non-governmental organizations (NGOs), and donors. The educational process has been designed to increase the audience's awareness of the nature and management of disasters, in order to lead to better performance in disaster preparedness and response. The content has been written by experts in the field of disaster management and in general follows the UNDP/UNDRO Disaster Management Manual and its principles, procedures, and terminology.

Costs and Cost Analysis↗
PubMedDate not supplied

What a disaster?! Assessing utility of simulated disaster exercise and educational process for improving hospital preparedness.

INTRODUCTION: Recent events have brought disaster medicine into the public focus. Both the government and communities expect hospitals to be prepared to cope with all types of emergencies. Disaster simulations are the traditional method of testing hospital disaster plans, but a recent, comprehensive, literature review failed to find any substantial scientific data proving the benefit of these resource- and time-consuming exercises. OBJECTIVES: The objective of this study was to test the hypothesis that an audiovisual presentation of the hospital disaster plans followed by a simulated disaster exercise and debriefing improved staff knowledge, confidence, and hospital preparedness for disasters. METHODS: A survey of 50 members of the medical, nursing, and administrative staff were chosen from a pool of approximately 170 people likely to be in a position of responsibility in the event of a disaster. The pre-intervention survey tested factual knowledge as well as perceptions about individual and departmental preparedness. Post-intervention, the same 50 staff members were asked to repeat the survey, which included additional questions establishing their involvement in the exercise. RESULTS: There were 50 pre-intervention tests and 42 post-intervention tests. The intervention resulted in a significant improvement in test pass rate: pre-intervention pass rate 9/50 (18%, 95% confidence interval ((CI) = 16.1-19.9%) versus post-intervention pass rate 21/42 (50%, 95% CI = 42.4-57.6%; chi-square test, p = 0.002). Emergency department (ED) staff had a stronger baseline knowledge than non-ED staff: ED pre-test mean value for scores = 12.1 versus non-ED scores of 6.2 (difference 5.9, 95% CI = 3.3-8.4); t-test, p <0.001. Those that attended > or = 1 component had a greater increase in mean scores: increase in mean attendees was 5.6, versus the scores of non-attendees of 2.7 (difference 2.9, 95% CI = 1.0-4.9); t-test, p = 0.004. There was no significant increase in the general perception of preparedness. However, the majority of those surveyed described the exercise of benefit to themselves (53.7%, 95% CI = 45.5-61.8%) and their department (63.2%, 95% CI = 53.5-72.8%). CONCLUSIONS: The disaster exercise and educational process had the greatest benefit for individuals and departments involved directly. The intervention also prompted enterprise-wide review, and an upgrade of disaster plans at departmental levels. Pre-intervention knowledge scores were poor. Post-intervention knowledge base remained suboptimal, despite a statistically significant improvement. This study supports the widely held belief that disaster simulation is a worthwhile exercise, but more must be done. More time and resources must be dedicated to the increasingly important field of hospital disaster preparedness.

Audiovisual Aids↗
PubMedDate not supplied

Disaster modeling: medication resources required for disaster team response.

INTRODUCTION: Responses to disasters involve many factors beyond personnel, such as medical and non-medical equipment and supplies. When disaster teams respond, they must do so with sufficient amounts of medicine and supplies to manage all of the patients expected for several days before re-supply. In order for this process to be efficient and expedient, accurate and advanced planning for supplies needed by disaster workers is necessary. These supplies must provide for general medical care and for hazard-specific problems. OBJECTIVE: To develop a model that provides the framework for determining supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster teams in a civilian environment. METHODS: A community hospital was modeled to determine patient characteristics when presenting to an emergency department (ED), including patient demographics and chief complaint, medications administered during the ED visit and prescribed at discharge, and laboratory tests ordered to assess disaster team supply requirements. Data were downloaded from a patient tracking software package and abstracted from various hospital data information systems. Data from the community hospital were compared with data published from two hurricane disasters by members of the National Disaster Medical System. RESULTS: To the extent possible, the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients. CONCLUSION: This model offers a first step in preparing disaster medical teams for deployment.

Adolescent↗
PubMedDate not supplied

Advancing disaster epidemiology and response: developing a national disaster-victim database.

BACKGROUND: The need to further disaster preparedness has resulted in a call for more comprehensive disaster research. Past disaster research has, for the most part, been limited by the inability to obtain complete medical data from victims of disasters. A national disaster-victim database (NDVD) can be developed that will facilitate collection and aggregation of disaster-victim medical data from health care facilities. Three aspects of the NDVD are discussed: DATA REQUIREMENTS: Medical records of disaster victims must be standardized before being uploaded from various databases into the NDVD. Existing data dictionaries provide formats in which data elements can become standardized. Once standardized, data sets from different facilities can be pooled and subjected to analyses. Database System. The three tiers of the NDVD system are: 1) medical data are collected at the point of care, 2) medical data are entered into databases and converted into a specific format, and 3) formatted data sets are uploaded to the NDVD. In order for this system to be viable, it must not add burden to health care workers; rather, it must benefit them and their facilities. REAL-TIME COLLECTION OF MEDICAL DATA: Capturing data on victims of a disaster, during a disaster, is ideal. This would allow for more victim data to be studied as well as for more accurate data to be collected. Technologic advancement has encouraged a real-time data-collection model in St. Louis that can act as a model for NDVD implementation.

Databases as Topic↗
PubMed1993

Disaster assessment: the emergency health evaluation of a population affected by a disaster.

In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.

Disaster Planning↗
PubMed2002

Nutritional response to the 1998 Bangladesh flood disaster: Sphere minimum standards in disaster response.

In this study we use a cross-sectional survey to evaluate the nutritional response to the 1998 Bangladesh Flood Disaster by 15 relief agencies using standards developed by the Sphere Project. The Sphere Project is a recent attempt by agencies around the world to establish universal minimum standards for the purpose of ensuring quality and accountability in disaster response. The main outcomes measured were resources allocated to disaster relief types of relief activities and percentage of agencies meeting selected Sphere food aid and nutrition indicators. Although the process of nutritional response was measured, specific nutritional and health outcomes were not assessed. This review found that self-reported disaster and nutritional resources varied widely between implementing agencies, ranging from US $58,947 to $15,908,712. The percentage of resources these agencies allocated to food aid and nutritional response also varied, ranging from approximately 6 to 99 per cent of total resources. Agencies met between 8 and 83 per cent of the specific Sphere indicators which were assessed Areas in which performance was poor included preliminary nutritional analysis; beneficiary participation and feedback; disaster preparedness during non-emergency times; monitoring of local markets and impact assessment. Agencies were generally successful in areas of core humanitarian response, such as targeting the vulnerable (83 per cent) and monitoring and evaluating the process of disaster response (75 per cent). The results here identify both strengths and gaps in the quality of humanitarian response in developing nations such as Bangladesh. However, they also raise the question of implementing a rights-based approach to disaster response in nations without a commitment to meeting positive human rights in non-disaster times.

Altruism↗
PubMed1964

SURPRISE REALISTIC MOCK DISASTERS. THE MOST EFFECTIVE MEANS OF DISASTER TRAINING.

Realism introduced in several large scale surprise mock-disaster tests proved to be a real challenge to a disaster-conscious hospital staff that had previously undergone fairly extensive disaster training and testing, utilizing conventional methods. Serious weaknesses, flaws, omissions and deficiencies in disaster capability were dramatically and conclusively revealed by use of what appeared to be a "live" disaster setting with smoke, fire, explosions; adverse weather and light conditions; realistically-simulated "casualites" especially prepared not only to look but to act the part; selected harassment incidents from well-documented disasters, such as utility failures, automobile accident on the main access route, overload of telephone switchboard, and invasion of hospital and disaster site by distraught relatives and the morbidly curious.

Disaster Planning↗
PubMed1991

The St Croix disaster and the National Disaster Medical System.

The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Disaster Planning↗
PubMed1995

Disaster medicine: current assessment and blueprint for the future. SAEM Disaster Medicine White Paper Subcommittee.

Emergency services for disaster-affected populations require the application of out-of-hospital planning, curative acute medical skills, and public health principles. SAEM can play an important role in promoting the research and educational agendas for disaster medicine through its network of EM educators at academic health centers. Testing of disaster medicine principles as part of the EM certification process will emphasize the importance of disaster medicine in the overall training of EPs. Postgraduate fellowships in disaster medicine also should be promoted and closely linked to disaster response organizations. Overall professional training must encompass the many facets described in this paper to prepare physicians to meet the challenges of disaster medicine.

Disaster Planning↗
PubMed1987

Catastrophic disasters and the design of disaster medical care systems.

The National Disaster Medical System (NDMS) is aimed at medical care needs resulting from catastrophic earthquakes, which may cause thousands of deaths and injuries. Other geophysical events may cause great mortality, but leave few injured survivors. Weather incidents, technological disasters, and common mass casualty incidents cause much less mortality and morbidity. Catastrophic disasters overwhelm the local medical care system. Supplemental care is provided by disaster relief forces; this care should be adapted to prevalent types of injuries. Most care should be provided at the disaster scene through supplemental medical facilities, while some can be provided by evacuating patients to distant hospitals. Medical response teams capable of stabilizing, sorting, and holding victims should staff supplemental medical facilities. The NDMS program includes hospital facilities, evacuation assets, and medical response teams. The structure and capabilities of these elements are determined by the medical care needs of the catastrophic disaster situation.

Disasters↗
PubMed2005

Physical and mental health shortly after a disaster: first results from the Enschede firework disaster study.

OBJECTIVES: Two to three weeks after the explosion of a fireworks storage facility in a residential area (May 2000, Enschede, The Netherlands) we assessed the self-reported physical and mental health among those affected by the disaster. METHODS: A questionnaire survey was conducted among 3792 residents, passers-by, and rescue workers, who were involved in and/or affected by the disaster and were > or =18 years of age. RESULTS: At least 30% of those affected by the disaster reported serious physical and mental health problems 2-3 weeks after the explosion. Compared with reference values in the general Dutch population, high scores were found for somatic symptoms, sleeping problems, and restrictions in daily functioning due to physical and mental problems, such as anxiety, depression, and feelings of insufficiency. The strength of these differences varied between groups, based on the level of involvement and the level of being affected. CONCLUSIONS: Results indicate that the fireworks disaster had a substantial impact on the health of those affected by the disaster. The health impact was most pronounced for residents and passers-by and also for rescue workers living in the affected area, but to a lesser degree. Physical and mental health problems were strongly associated with the shocking experiences during and shortly after the disaster.

Adolescent↗
PubMed2005

[Narrative analysis on survivor's experience of Daegu subway fire disaster--the hypothetical suggestions for disaster nursing practice].

UNLABELLED: Some fifty survivors participated in the narrative therapy sessions from March 2003 to December 2004, and thirty cases were analyzed using the transcripts. Each participant's surviving story was summarized, and then interpreted and reinterpreted by the survivors themselves in collaboration with the researcher. The two main principles in narrative analysis were hermeneutical distanciation and hermeneutical circulation. RESULT AND CONCLUSION: First, nursing involvement should play active roles from the early stages of disaster incidents. Specifically, emergency nursing and flexible coping plans are to be available according to the specific properties of each case. Secondly, it is necessary to try to understand the extreme emotional experiences of disaster survival. The horror and pain people feel at an incident cannot simply be generalized, and it requires that each case be approached individually to help stop social alienation. Thirdly, more constant and long-term studies are required to set up nursing strategies for disaster survivors. Forming a trusting relationship with survivors is basic, and formally registering as participants is necessary for continuous interventions. Fourthly, we should deeply appreciate the danger and complexity of modern society and understand the complex nature of disaster. Fifthly, interdisciplinary activities and studies are necessary in combination with various other fields to establish a framework of total nursing care for disaster incidents. Lastly, it is urgently necessary to educate families and friends of the survivors and the society as a whole about life after a disaster.

Disasters↗
PubMed1998

[The disaster preparedness concerning personnel at the hospitals in the Disaster Preparedness Region II: Viborg, Ringkjøbing and Aarhus counties].

The aim of this investigation was to describe the disaster preparedness concerning hospital staff members in Viborg, Ringkjøbing and Arhus county, and to describe the outcome of the disaster medicine-courses given in the region--in theory as well as practice. In the region a questionnaire was sent to the chief doctor and chief nurse for the involved departments, and a personal questionnaire was sent to all the doctors and nurses in the region, who had participated in one or more courses in disaster medicine during the period 1990-1995. Of the total number of doctors at the involved departments, 7% of the residents, 29% of the senior residents and 56% of the consultants had taken a course in disaster medicine, as had 33% of the nurses. Only 15% had taken more than one course, and as few as 2% had had a follow-up course to the primary one given in the region. Forty-one percent had used their acquired knowledge either in theory or practice: 55% for educational purposes, 11% for disaster planning and 12% for buying equipment for the hospital. In general an easier access to follow-up is desired, and there seems to be a need to give more consideration to the priorities of the individual departments concerning the selection of participants to the courses in disaster medicine.

Clinical Competence↗
PubMed1982

Community perceptions of natural disasters and post-disaster mental health services.

This research was designed to examine the cognitive and affective responses of residential dwellers in the aftermath of a natural disaster (a flood). In a 2 X 3 factorial design, the effects of fear (High, Medium, and Low) and sex on perceptions of the disaster were assessed. The results indicated that respondents who were highly fearful of the disaster were more likely than moderate or low fear respondents to believe that: a) additional flooding would occur in their vicinity, and b) that they resided closer to the flood zone than they actually did. The policy implications of the results suggested that post-disaster mental health services might have to be extended to include residents of geographical areas not directly affected by natural or man-made disasters.

Arizona↗