bluuebunny/crossref_metadata_2025 huggingface dataset:
Homeland Security and Public Health: Role of the Department of Veterans
Affairs, the US Department of Homeland Security, and Implications for the
Public Health Community
Authors: Koenig Kristi L.
Published: August 2016

The terrorist attacks of 11 September 2001 led to the largest US
Government transformation since the formation of the Department of Defense
following World War II. More than 22 different agencies, in whole or in
part, and >170,000 employees were reorganized to form a new Cabinet-level
Department of Homeland Security (DHS), with the primary mission to protect
the American homeland. Legislation enacted in November 2002 transferred the
entire Federal Emergency Management Agency and several Department of Health
and Human Services (HHS) assets to DHS, including the Office of Emergency
Response, and oversight for the National Disaster Medical System, Strategic
National Stockpile, and Metropolitan Medical Response System. This created a
potential separation of “health” and “medical” assets between the DHS and
HHS. A subsequent presidential directive mandated the development of a
National Incident Management System and an all-hazard National Response
Plan.

While no Department of Veterans Affairs (VA) assets were targeted for
transfer, the VA remains the largest integrated healthcare system in the
nation with important support roles in homeland security that complement its
primary mission to provide care to veterans. The Emergency Management
Strategic Healthcare Group (EMSHG) within the VA's medical component, the
Veteran Health Administration (VHA), is the executive agent for the VA's
Fourth Mission, emergency management. In addition to providing comprehensive
emergency management services to the VA, the EMSHG coordinates medical
back-up to the Department of Defense, and assists the public via the
National Disaster Medical System and the National Response Plan.

This article describes the VA's role in homeland security and disasters,
and provides an overview of the ongoing organizational and operational
changes introduced by the formation of the new DHS. Challenges and
opportunities for public health are highlighted.
Use and Analysis of Field Triage Criteria for Mass Gatherings
Authors: Salhanick Steven D. , Sheahan William , Bazarian Jeffrey J.
Published: August 2016

Introduction:

Mass gatherings may result in an acute increase in the number of
people seeking medical care potentially causing undue stress to local
emergencymedical services (EMS) and hospitals. Often, temporary medical
facilities are established within the mass gathering venue. Emergency
Medical Services providers encountering patients in the field should be
equipped with effective protocols to determine transport destination
(venue facility vs. hospital).

Hypothesis:

Paramedics are capable of appropriately using triage criteria
written specifically for a particular mass gathering. The use of triage
criteria, when appliedcorrectly, decreases over-triage to the venue
facility and under-triage to the hospital.

Methods:

Paramedics triaged patients at a mass gathering to a temporary venue
facility or to a single emergency department using criteria specific for
the event. Cases were reviewed to determine if the patients transported
went to an appropriate facility and if the triage criteria were applied
appropriately. Results: Transport destination was consistent with that
dictated by the criteria for 78% of cases. Analysis of these cases shows
that the criteria had a sensitivity of 100% (95% CI = 58–100%) and a
specificity of 90% (95% CI = 73–98%) for predicting which patients
needed hospital services and which could be cared for safely in the
temporary clinic setting.

Conclusions:

Triage by paramedics at the point of patient contact may reduce
transporting of patients to hospitals unnecessarily. Patients in need of
hospital services were identified. Point-of-contact triage should be
applied in mass gatherings.
Introduction to the Special Theme Issue on Psychosocial Issues in Disasters and Terrorism
Authors: Leon Gloria , Polusny Melissa A.
Published: August 2016

In the immediate aftermath of disasters and terrorism, it is critical to rapidly respond to the physical/medical needs of survivors to reduce injuries and the loss of life. Consistent with these situational demands, the description of such events is usually in terms of the resulting number of casualties and physical injuries sustained, with little recognition of or attention to the potential psychosocial consequences that may be experienced by survivors. However, individuals exposed to natural and human-made disasters, including acts of terrorism and large-scale violence, may experience serious immediate and long-term psychological difficulties.
Disaster and Terrorism: Cognitive-Behavioral Interventions
Authors: Walser Robyn D. , Ruzek Josef I. , Naugle Amy E. , Padesky Christine , Ronell Diana M. , Ruggiero Ken
Published: August 2016

The mental health effects of disaster and terrorism have moved to the forefront in the recent past following the events of 11 September 2001 in the United States. Although there has been a protracted history by mental health researchers and practitioners to study, understand, prevent, and treat mental health problems arising as a result of disasters and terrorism, there still is much to learn about the effects and treatment of trauma. Continued communication among disaster workers, first-response medical personnel, and mental health professionals is part of this process. This paper outlines current knowledge regarding the psychological effects of trauma and best cognitive-behavioral practices used to treat trauma reactions. More specifically, the information presented is a summary of Cognitive-Behavioral Therapy (CBT) interventions that are relevant for responding to and dealing with the aftermath of disasters.
Disaster Intervention: Long-term Psychosocial Benefits in Armenia
Authors: Najarian Louis M.
Published: August 2016

This paper describes a unique situation in which disaster intervention following a massive earthquake led to significant, uninterrupted, psychosocial benefits to the entire country, and an intervention program that continues to evolve. The mental health program initially provided service to the victims, and then, training to local professionals during which personnel simultaneously conducted clinical research. Members of the mental health team made a life-long commitment to the country, and continue their activities to expand its impact on public health policy. The difficult history and life circumstances of the Armenian people provided the opportunity for disaster interventions to have extensive psychosocial benefits.
The Challenges Facing Mental Health Programs for Post-Conflict and Refugee Communities
Authors: Silove Derrick
Published: August 2016

The majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs.
Using Ethnographic Methods in the Selection of Post-Disaster, Mental Health Interventions
Authors: Bolton Paul , Tang Alice M.
Published: August 2016

This paper describes a short, ethnographic study approach for understanding how people from non-Western cultures think about mental health and mental health problems, and the rationale for using such an approach in designing and implementing mental health interventions during and after disasters. It describes how the resulting data can contribute to interventions that are more acceptable to local people, and therefore, more effective and sustainable through improved community support.
Ethnic Differences in Symptoms of Post-traumatic Stress after the Exxon Valdez Oil Spill
Authors: Palinkas Lawrence A. , Petterson John S. , Russell John C. , Downs Michael A.
Published: August 2016

Introduction:

Previous studies have reported ethnic differences in the prevalence of post-traumatic stress disorder (PTSD), but the reasons for these differences remain unclear.

Hypothesis:

Ethnic differences in the prevalence of PTSD may reflect ethnic differences in (1) exposure to traumatic events; (2) appraisal of such event as traumatic; and (3) culturally-determined responses to standardized diagnostic instruments, reflecting differences in cultural meanings associated with physical symptoms and idioms of distress.

Methods:

Ethnic differences in risk factors and factor structures of PTSD symptoms were examined in 188 Alaskan Natives and 371 Euro-Americans exposed to the Exxon-Valdez oil spill in 1989.

Results:

High levels of social disruption were associated with PTSD one year after the oil spill in both ethnic groups. However, low family support, participation in spill clean-up activities, and a decline in subsistence activities were significantly associated with PTSD in Alaskan Natives, but not in Euro-Americans. Factor analysis of the Diagnostic Interview Schedule PTSD subscale revealed five factors for both ethnic groups. However, the items comprising these factors were dissimilar.

Conclusions:

These results suggest that social disruption is sufficiently traumatic to be associated with symptoms of post-traumatic stress, but that a diagnosis of PTSD must take into consideration local interpretations of these symptoms.
A Paradox and a Dilemma
Authors: Birnbaum Marvin L.
Published: August 2016

The issues surrounding “life” continue to increase in number and complexity. Those of us in the health professions believe that once a life is established, we must do all that is possible to preserve it. For most of us, this is an absolute, regardless of circumstances and setting.

But, it is essential that we recognize that this value that we place on all life is not held universally. Members of some societies believe that the after-life is of greater value than is life in this earthly realm. For some, the “ultimate sacrifice” is relinquishing one's own life for a higher cause.
Long-Range Rescue Helicopter Missions in the Arctic
Authors: Haagensen Rolf , Sjøborg Karl-Åke , Rossing Anders , Ingilæ Henry , Markengbakken Lars , Steen Peter-Andreas
Published: August 2016

Background:

Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on-board includes an anesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions, and arctic winter darkness.

Methods:

One-hundred, forty-seven ambulance and 29 search and rescue missions in the Barents Sea during 1994–1999 were studied retrospectively with special emphasis on operative conditions and medical results.

Results and Discussion:

Thirty-five percent of the missions were carried out in darkness. The median time from the alarm to first patient contact was 3.3 hours and the median duration of the missions was 7.3 hours. Forty-eight percent of the missions involved ships of foreign origin. Half the patients had acute illnesses, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from industrial accidents with open and closed fractures, amputations, and soft tissue damage. Ninety percent of the patients were hospitalized; 7.5% probably would not have survived without early medical treatment and rapid transportation to a hospital.

Conclusion:

Using a heavy search and rescue helicopter in the Barents Sea was the right decision in terms of medical gain and operative risk.
Public Health Preparedness for Mass-Casualty Events: A 2002 State-by-State Assessment
Authors: Mann N. Clay , MacKenzie Ellen , Anderson Cheryl
Published: August 2016

Introduction:

The ongoing threat of a terrorist attack places public agencies under increasing pressure to ensure readiness in the event of a disaster. Yet, little published information exists regarding the current state of readiness, which would allow local and regional organizations to develop disaster preparedness plans that would function seamlessly across service areas. The objective of this study is to characterize state-level disaster readiness soon after September 2001 and correlate readiness with existing programs providing an organized response to medical emergencies.

Methods:

During the first quarter of 2002, a cross-sectional survey assessing five components of disaster readiness was administered in all 50 states. The five components of disaster readiness included: (1) statewide disaster planning; (2) coordination; (3) training; (4) resource capacity; and (5) preparedness for biological/chemical terrorism.

Results:

Most states reported the presence of a statewide disaster plan (94%), but few are tested by activation, (48%) and still fewer contain a bioterrorism component (38%). All states have designated disaster operations centers (100%), but few states have an operating communications system linking health and medical resources (36%). Approximately half of states offer disaster training to medical professionals; about 10% of states require the training. Between 22–48% of states have various contingency plans to treat victims when service capacity is exceeded. Biochemical protective equipment for health professionals is lacking in all but one state, and only 10% of states indicate that all hospitals have decontamination capabilities. States with a functioning statewide trauma system were significantly more likely to possess key attributes of a functioning disaster readiness plan.

Conclusion:

These findings suggest that disaster plans are prevalent among states. However, key programs and policies were noticeably absent. Communication systems remain fragmented and adequate training programs and protective equipment for health personnel are markedly lacking. Statewide trauma systems may provide a framework upon which to build future medical disaster readiness capacity.
Remote Site Production of Sterile Purified Water from Available Surface Water
Authors: Taylor Michael A. , Alambra Elaine F. , Anes John , Behnke Joel , Enachescu Brandusa , Fitzgerald Carolyn L. , Fortado Megan , Sizelove Mark L.
Published: August 2016

A water purification and sterilization device was tested for its functional capabilities. Challenge water consisting of potable water augmented with bacteria, endotoxin, virus, suspended solids, and dissociable ions (sodium chloride, lead or arsenic salts) was passed through the device. The product water quality attributes were analyzed. The device demonstrated reduction in bacteria of >7 logs, endotoxin was reduced by >4 logs, virus was reduced by >4 logs, and dissociable ions were reduced by >3 logs. The product water of the device met the limits for a range of chemical entities specified by the United States Pharmacopeia and Association for the Advancement of Medical Instrumentation. The product water met the quality attributes of Sterile Water for Injection, USP, Sterile Purified Water, USP, and the Water for Dialysis. The device provides a logistical advantage in reducing the weight of transport of packaged water by 83% and the cube by 67%. It operates manually by gravity and is disposable after a single use. The device provides an effective alternative to the transport and use of packaged sterile water in remote locations by production of sterile water at the pointof-need using available water. It also is capable of producing safe drinking water following the production of clinical waters. This device has been cleared by the US Food and Drug Administration for production of three liters Sterile Purified Water, USP from Environmental Protection Agency (EPA) grade drinking water.
Suicides in Los Angeles County in Relation to the Northridge Earthquake
Authors: Shoaf Kimberley , Sauter Cary , Bourque Linda B. , Giangreco Christian , Weiss Billie
Published: August 2016

Introduction:

Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population).

Hypothesis:

Suicide rates increased in the three calendar years (1994–1996) following the Northridge earthquake as compared to the three calendar years (1991–1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured.

Methods:

Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991–1993 vs. 1994 –1996) were analyzed using az-statistic.

Results:

There is a statistically significant difference in the rates for the years prior to the earthquake (1991–1993) when pooled and compared to the suicide rates for the years after the earthquake (1994–1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z= -3.85,p<0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84,z= -3.57,p<0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide.

Conclusion:

It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.
Making A Difference
Authors: Birnbaum Marvin L.
Published: August 2016

As we enter Volume 20 of Prehospital and Disaster Medicine (PDM), many important advances have been implemented or are about to occur. What follows is a brief summary of what we are doing to make your Journal even better.
Current Status of International Emergency Medicine Fellowships in the United States
Authors: Bledsoe Gregory H. , Dey Chayan C. , Kabrhel Christopher , VanRooyen Michael J.
Published: August 2016

Objective:

A consensus panel of Emergency Physicians with experience in international health has published a recommended curriculum for a formal fellowship in International Emergency Medicine. This article reviews the current International Emergency Medicine (IEM) fellowships available to residency-trained Emergency Physicians in the United States.

Methods:

Every allopathic Emergency Medicine (EM) residency program in the United States was contacted via e-mail or telephone. Programs that reported having an IEM fellowship were asked detailed information about their program, including: (1) the number of years the program has been offered; (2) the duration of the program; (3) the number of fellows taken each year; (4) the number of fellowship graduates from each program and their current practice patterns; (5) how the fellowship is funded; and (6) whether a Masters Degree in Public Health (MPH) is offered.

Results:

All 127 allopathic EM residency programs responded. Eight (6.8%) of these programs offered IEM fellowships. Of a total of 29 graduates identified, 23 (79.3%) were employed in academic medicine. All of the fellowships offered formal public health training and were funded by a combination of clinical billing and project-specific grants and scholarships. All IEM fellowships described a curriculum that reflected the previously published recommendations.

Conclusion:

Opportunities in formal training in international health are increasing for graduates of EM residencies in the United States. The proposed curriculum for IEM fellowships seems to have been implemented and graduates of IEM fellowships seem to be applying their training in international projects.
The Use of Trained Observers as an Evaluation Tool for a Multi-Hospital Bioterrorism Exercise
Authors: Klein Kelly R. , Brandenburg Dale C. , Atas Jenny G. , Maher Ann
Published: August 2016

Introduction:

Evidence suggests that regular disaster exercises have beneficial effects on subsequent mock and actual disaster responses. The purpose of this report is to describe a multiple hospital, bioterrorism exercise, evaluated by independent observers who used an evaluation template.

Methods:

The overall tabletop exercise design included participation from 23 Joint Commission Accreditation of Healthcare Organizations hospitals, four health departments, and a representative from one federal agency. The exercise was evaluated by trained exercise observers utilizing an independently prepared, evaluation protocol.

Results:

All exercise sites successfully identified the bio-agent involved and answered after-exercise debriefing questions without much difficulty. Evaluations, in the form of an after-action report by the independent observers, commented upon the many limitations to the construct of the exercise.

Conclusion:

Having an independent observer group at the exercise appeared to provide a value-added benefitfor capturing subjective information and data. However, these data were not in a form conducive to statisticalanalysis. Further work is needed to create an evaluation tool that would allow for statistical analysis so that exercises can be compared and improvements can be objective.
Communication and Health Protection Issues Arising from a Flooding Emergency
Authors: Wilson Nick , McIntyre Mary , McDonald Mark , Tanner Helen , Hart Kelli , Tomlinson Reuben , Thach Thu , Campion Vicki , Lee Dominique , Morrison Frances , Andersen Erik , Bibby Susan
Published: August 2016

Objective:

To identify and describe the key communication and health protection issues surrounding a flooding emergency.

Methods:

A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major floodin February 2004. This was supplemented by key informant interviews and a newspaper content analysis.

Results:

A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The majorsources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but “health” only was mentioned in 46 (7%) of the 664 flood-related articles.

Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk ofwater contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems.

Conclusions:

Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this floodaffected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.
Comparative Analysis of Traumatic Deaths in Nigeria
Authors: Ehikhamenor Edeaghe Eni , Ojo Mike A.
Published: August 2016

Introduction:

The number of deaths due to trauma from road traffic accidents (RTAs), and from the use of firearms either for homicide or armed robbery, ethnic conflicts, and other events, such as flooding, explosions from petroleum products, and religious violence, is on the rise in Nigeria. This preliminary study is a comparative analysis of the frequency of deaths caused by RTAs and the deaths caused by the use of firearms during armed robbery. The study sought to identify the number of traumatic deaths caused by RTAs or armed robbery as well as the number of victims who sustained injuries in the process of RTA or armed robberies.

Methods:

An indigenous, non-governmental organization (NGO) network was used to abstract data for the frequency of RTAs associated with death or injuries and for deaths caused by armed robberies and was supplemented with data obtained from the Nigerian police.

Results:

For RTAs, the victims included drivers, passengers, and pedestrians. In 3,032 cases of RTAs, the total number of deaths was 1,239 (29.1%): one Nigerian dies for every three to four crashes. The total number of deaths due to RTAs was significantly higher than was the number of deaths due to the use of firearms in commission of robbery.

Police reports relative to the use of firearms during armed robberies indicate that of a total of the 652 victims who were killed, 348 (68.1%) were the armed robbers, 134 (26.2%) were bystanders, and 29 (5.7%) were policemen.

Conclusions:

The enormity of the problems of traumatic deaths from RTAs and armed robberies in a developing country has been highlighted.
Prehospital Management and Fluid Resuscitation in Hypotensive Trauma Patients Admitted to Karolinska University Hospital in Stockholm
Authors: Talving Peep , Pålstedt Joakim , Riddez Louis
Published: August 2016

Introduction:

Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated.

Methods:

This is a retrospective, descriptive study on consecutive, hypotensivetrauma patients (systolic blood pressure ≤90 mmHg on the scene of injury) admitted to Karolinska University Hospital in Stockholm, Sweden, during 2001–2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model.

Results:

In 102 (71 male) adult patients (age ≥15 years) recruited, the median age was 35.5 years (range: 27–55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16–50). The on-scene time interval was 19 minutes (range: 12–24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0–20; 21–40; 41–75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21–40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact logistic regression analysis.

Conclusion:

The time interval at the scene of injury exceeded PHTLS guidelines. The vast majority of the hypotensive trauma patients were fluid-resuscitated on-scene regardless of the type, mechanism, or severity of injury. A predefined fluid resuscitation regimen is not employed in hypotensive trauma victims with different types of injuries. The outcome was worsened by male gender, progressive age, and ISS >20 in the exact multiple regression analysis.
Strategies in Evaluation and Management of Bam Earthquake Victims
Authors: Emami Mohammad J. , Tavakoli Ali R. , Alemzadeh Hossein , Abdinejad Farzad , Shahcheraghi Gholamhossain , Erfani Mohammad A. , Mozafarian Kamran , Solooki Saeed , Rezazadeh Sorena , Ensafdaran Ahmad , Nouraie Hormoz , Jaberi Feriedoon M. , Sharifian Maryam
Published: August 2016

Background:

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale occurred in the city of Bam in southeastern Iran. Bam was destroyed completely, >43,000 people were killed, and 30,000 were injured. The national and international responses were quick and considerable. Many field hospitals werecreated and large numbers of patients were evacuated from their homes and transported to hospitals throughoutIran. Nearly 700 patients were transferred to Chamran hospital in Shiraz within the first 48 hours after the earthquake.

Methods:

This is a retrospective study based on the medical records of earthquake casualties dispatched to Chamran Hospital. A screening tunnel composed of multiple stations was prepared before patients entered to facilitate the large influx of patients. Each of the victims was passed through this screening tunnel and assigned into one of three groups: (1) those needing emergency surgical intervention; (2) those needing less urgent surgery; and (3) those needing elective operations, supportive care, observation, and/or rehabilitation.

Results:

Among the 708 patients, 392 were male (male/female ratio: 1.24) with a mean value of their ages of 30.5 years. (range: 1.5 months–70 years). Extremity fractures (136, 19%) were more common than were axial skeleton fractures (28, 4%). Out of the total 708 patients, 152 (21.5%) patients needed emergency operations, 26 (4%) needed less urgent surgery, and 530 (74.5%) required wound care or antibiotic therapy and other forms of supportive care. Some complications occurred, such as two patients with compartment syndromes of theleg, three required below-the-knee amputation, eight suffered acute renal failure, two developed fat emboli syndrome, and one had a brain injury that resulted in death.

Conclusion:

A comprehensive disaster plan is required to ensure a prompt disaster response and coordinated management of a multi-casualty incident. This can influence the outcomes of patients directly. A patient screening tunnel has advantages in rapid and effective evaluation and management of victims in any multi-casualty incident.
Session 1.4: Health Services Delivery: A Critical Review of Experience
Authors: Smith Jack , Fink Sheri , Hansch Steve , Yoosuf Abdul Azeez , Keng K.O.H. Peng , van Alphen Dana
Published: August 2016

This is a summary of the presentations and discussion of Session 1.4, Health Services Delivery: A CriticalReview of Experience, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to health services delivery as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessment; (2) coordination; (3) filling of gaps; (4) capacity building; and (5) lessons learned.
Panel 2.1: Assessing Impact and Needs
Authors: Aldis William , Rockenschaub Gerald , Gorokhovich Yuri , Doocy Shannon , Lumbiganon Pisake , Grunewald Francois
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.1 of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to assessing needs and measuring impact as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) assessing needs; (3) measuring impact; and (4) lessons learned and recommendations.
Panel 2.9: Repair and Recovery of Health Systems
Authors: Melgaard Bjorn , Profili Maria Cristina , Heimann Peter , Pusponegoro Aryono , O'Rourke Edward , Kolokathis Antonia , Romisch-Diouf Marie-Andrée
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.9, Repair and Recovery of Health Systemsof the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the repair and recovery of health systems as pertain to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessment; (2) coordination; (3) filling gaps; (4) capacity building; (5) what was done well, and what should have been done better; (6) lessons learned; and (7) recommendations. Recommendations included: (1) how to make health systems better prepared for coping with disasters; and (2) how to support preparedness in local communities.
Panel 2.13: The Role of Media and Communication
Authors: Habayeb Salim , Bolton Samantha , Jones Mark , Surapaneni Naveen , Dietz Robert , Pandey Harsaran Bir Kaur
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.13, The Role of Media and Communication, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the role of media and communication as pertain to the responses to the damage created by the Tsunami of 26 December 2004.
Panel 2.15: Civil-Military Cooperation in Humanitarian Health Action
Authors: Gunnarsson David , Hyer Randy , Hufstader R.D. , Hidayat Archmad , Peake James , Banerjee Anshu
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.15, Civil-Military Cooperation in Humanitarian Health Action of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to civil-military collaboration in humanitarian health actions as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) how effective civil-military cooperation can help health responses, including; (a) needs assessment; (b) coordination; (c) filling gaps; and (d) capacity (2) what was done well, and what could have been done better better; and (3) conclusions and recommendations. Conclusions and recommendations included: (1) the best coordination mechanisms for civil-military cooperation; and (2) suggested additions and improvements.
Enhancing Local Health Department Disaster Response Capacity with Rapid Community Needs Assessments: Validation of a Computerized Program for Binary Attribute Cluster Sampling
Authors: Groenewold Matthew R.
Published: August 2016

Introduction:

Local health departments are among the first agencies to respond to disasters or other mass emergencies. However, they often lack the ability to handle large-scale events. Plans including locally developed and deployed tools may enhance local response. Simplified cluster sampling methods can be useful in assessing community needs after a sudden-onset, short duration event.

Methods:

Using an adaptation of the methodology used by the World Health Organization Expanded Programme on Immunization (EPI), a Microsoft Access-based application for two-stage cluster sampling of residential addresses in Louisville/Jefferson County Metro, Kentucky was developed. The sampling frame was derived from geographically referenced data on residential addresses and political districts available through the Louisville/Jefferson County Information Consortium (LOJIC). The program randomly selected 30 clusters, defined as election precincts, from within the area of interest, and then, randomly selected 10 residential addresses from each cluster.

The program, called the Rapid Assessment Tools Package (RATP), was tested in terms of accuracy and precision using data on a dichotomous characteristic of residential addresses available from the local tax assessor database. A series of 30 samples were produced and analyzed with respect to their precision and accuracy in estimating the prevalence of the study attribute. Point estimates with 95% confidence intervals were calculated by determining the proportion of the study attribute values in each of the samples and compared with the population proportion. To estimate the design effect, corresponding simple random samples of 300 addresses were taken after each of the 30 cluster samples.

Results:

The sample proportion fell within ±10 absolute percentage points of the true proportion in 80% of the samples. In 93.3% of the samples, the point estimate fell within ±12.5%, and 96.7% fell within ±15%. All of the point estimates fell within ±20% of the true proportion. Estimates of the design effect ranged from 0.926 to 1.436 (mean = 1.157, median = 1.170) for the 30 samples.

Conclusions:

Although prospective evaluation of its performance in field trials or a real emergency is required to confirm its utility, this study suggests that the Rapid Assessment Tools Package, a locally designed and deployed tool, may provide populationbased estimates of community needs or the extent of event-related consequences that are precise enough to serve as the basis for the initial post-event decisions regarding relief efforts.
Back to Where It Happened: Self-Reported Symptom Improvement of Tsunami Survivors who Returned to the Disaster Area
Authors: Heir Trond , Weisæth Lars
Published: August 2016

Background:

During October and November 2005, the National Norwegian Tsunami Support Association organized a journey to the disaster area for survivors. The aim of this study was to investigate whether the Tsunami affected the participants' psychological problems.

Methods:

Twenty-nine adults and 19 children made the journey. Steps were taken to enable each individual to acquire an overall understanding of the catastrophic event. Various forms of antiphobic training were provided. At the end of the stay, 28 adults replied to a questionnaire. The questions concerned: (1) motives for traveling; (2) benefits experienced; (3) psychological problems before departure; and (4) problems at the end of the stay. Parents with children were asked to assess their children's psychological problems at the same points in time.

Results:

Considerable improvements in anxiety symptoms were reported and observed in both the adults and children. No certain cases of retraumatization occurred.

Discussion:

The improvements can be understood in the light of psychodynamic, cognitive, and behavioral theory approaches. The duration of the improvement in symptoms remains to be documented. There appears to be grounds for encouraging traumatized patients to return to a disaster area as part of the treatment process if they so wish.
KAMEDO Report No. 77 Sinking of the MS Sleipner, 26 November 1999
Authors: Brändström Helge , Sedig Karin , Lundälv Jörgen
Published: August 2016

The catamaran HS Sleipner struck a rock and sunk in bad weather and heavy seas on 26 November 1999. Rescue efforts were provided by helicopters and other ships. A total of 68 victims were rescued alive and 16 died, mostly by drowning. Problems were encountered with evacuation, life jackets, and life rafts. Most of those rescued alive suffered from hypothermia. Response times for rescue helicopters should be improved. Emphasis should be placed on correct manifest lists of passengers and crew. Special emphasis must be placed on media relations and cross-boundary issues. Exercises should focus on cooperation and coordination.
KAMEDO Report No. 78 Nuclear Accident in Japan,1999
Authors: Joussineau Siegfried , Riddez Louis
Published: August 2016

A break in safety locks resulted in the release of high quantities of gamma and neutron radiation directly exposed three workers and indirectly exposed as many as 310,000 other persons. The two persons who received the highest doses ultimatley succumbed due to the latent effects of the radiation on the skin and mucous membranes. Improved protection of workers and responders as well as dosimeters are needed in areas where such events may occur. Careful attention must be paid to providing accurate information to the media and to the provision of competent psychosocial support.
KAMEDO Report No. 80 Train Accident in England, 1999
Authors: Hedelin Annika , Örtenwall Per , Ortgren Per-Olof , Riddez Louis
Published: August 2016

The train crash that occurred in London in 1999 resulted in 31 dead and almost 300 injured persons. Mobilized resources allowed for the application of normal treatment principles. Available resources were in excess of what was needed. The procedures implemented were judged as adequate. Responses followed the management plan formulated over many years and experiences. The rotating command procedures used worked well. Multiple communications systems were used, including landline telephones, mobile telephones, and radios. Plans should include caring for both adults and children. Well-planned psychosocial services and functional compute services are essential components.
KAMEDO Report No. 83 European Union Summit in Göteborg, 2001
Authors: Fellenius Eva , Lindberg Håkan , Hedelin Annika , Örtenwall Per , Riddez Louis
Published: August 2016

A European Union (EU) Summit in Göteborg, Sweden, was held 15–16 June 2001. This meeting presented various security and medical concerns to city officials. In preparation for a large meeting such as the EU Summit, a plan should be established that includes basic facts, management organization, and guidelines. Clear communication beteween city agencies also must be established. Hospital inventories should be recorded daily and reported to medical staff. A command center must be in place for police and medical command. An emergency medical provider should ride in each police vehicle, so in case of a riot situation, victims can be treated quickly. An information officer should be assigned with the task of providing information regarding the injured to the media.
Building Just-in-Time Lectures during the Prodrome of Hurricanes Katrina and Rita
Authors: Linkov Faina , Ardalan Ali , Dodani Sunita , Lovalekar Mita , Sauer Francois , Shubnikov Eugene , LaPorte Ronald
Published: August 2016

Hurricane Katrina, followed by Hurricane Rita, were some of the most destructive and costliest hurricanes in US history. In addition to causing death and destruction, Hurricanes Katrina, Rita, and Wilma gave rise to an epidemiology of fear.1 Despite the fact that the odds of dying in a hurricane remains low compared to that of motor vehicle crashes, tornadoes, and fires,2–3 the fear of hurricanes was reinforced by disturbing images on television. Often, these images replaced rational thinking. Teachers and public health educators worldwide only had limited materials to educate their students on the risk and risk factors for hurricanes and disasters, demonstrating how poorly the scientific community was prepared to deliver basic scientific facts about hurricanes.
Prevalence of Radioactive Signals from Surveillance of an Emergency Department
Authors: Guyette Frank , Suyama Joe , Rosen Jerry , Allswede Michael
Published: August 2016

Introduction:

Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.

Objective:

The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).

Methods:

A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).

Results:

A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.

Conclusion:

The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.