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American Journal of Disaster Medicine
November/December 2006, Volume 1
, Number 1


Article
From the editor's desk. Disaster medicine: Where it stands—and where we can take it
Susan Briggs, MD, MPH, FACS
November/December 2006; pages 5-6


Article
Guest editorial. Disaster triage: Is it time to stop START?
Richard Zoraster, MD
November/December 2006; pages 7-9


Article
Sounding board. Disaster management: Who’s in charge?
Sharon Einav, MD; William P. Schecter, MD, FACS
November/December 2006; pages 10-11


Article
Legal corner. Assessing criminal liability of volunteer healthcare workers in emergencies
James G. Hodge, Jr., JD, LLM; Dhrubajyoti Bhattacharya, JD, MPH; Andrea M. Garcia, JD
November/December 2006; pages 12-17


Article
Extending injury prevention methodology to chemical terrorism preparedness: The Haddon Matrix and sarin
Shawn Varney, Lt. Col., USAF, MC; Jon Mark Hirshon, MD, MPH; Patricia Dischinger, PhD; Colin Mackenzie, MD
November/December 2006; pages 18-27

Abstract
The Haddon Matrix offers a classic epidemiological model for studying injury prevention. This methodology places the public health concepts of agent, host, and environment within the three sequential phases of an injury-producing incident—pre-event, event, and postevent. This study uses this methodology to illustrate how it could be applied in systematically preparing for a mass casualty disaster such as an unconventional sarin attack in a major urban setting. Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feedback in the data review session. Four injury prevention strategies (education, engineering, enforcement, and economics) were applied to the individual factors and event phases of the Haddon Matrix. The majority of factors identified in all phases were modifiable, primarily through educational interventions focused on individual healthcare providers and first responders. The Haddon Matrix provides a viable means of studying an unconventional problem, allowing for the identification of modifiable factors to decrease the type and severity of injuries following a mass casualty disaster such as a sarin release. This strategy could be successfully incorporated into disaster planning for other weapons attacks that could potentially cause mass casualties. Key words: Haddon Matrix, chemical terrorism, sarin, disaster preparedness, injury prevention


Article
Hospital disaster staffing: If you call, will they come?
David C. Cone, MD; Bethany A. Cummings, MA, DO
November/December 2006; pages 28-36

Abstract
Objective: To assess hospital employees’ attitudes and needs regarding work commitments during disasters. Methods: A 12-item survey was distributed to employees at nine hospitals in five states. Questions addressed willingness to work during a disaster or its aftermath, support services that could encourage employees to remain for extended hours, and conflicting emergency response obligations (e.g., being a volunteer firefighter) that might prevent employees from working at the hospital. Anonymity was assured, and approval was obtained from each hospital’s institutional review board. Results: Of the 2,004 surveys distributed, 1,711 (85 percent) were returned. Eighty-seven percent of respondents were willing to work after a fire/ rescue/collapse mass casualty incident. Respondents were otherwise less willing to work in response to a man-made disaster (biological event: 58 percent; chemical event: 58 percent; radiation event: 57 percent) than a natural disaster (snowstorm: 83 percent; flood: 81 percent; hurricane: 78 percent; earthquake: 79 percent; tornado: 77 percent; ice storm: 75 percent; flu epidemic: 72 percent) (p < 0.001 for all comparisons by c2 testing). While 44 percent of respondents would come to work in response to any of the 11 disaster types listed, 19 percent were only willing to cover four or fewer types. Long-distance phone service (694, 41 percent), e-mail access (584, 34 percent), pet care (568, 33 percent), and child care (506, 30 percent) were the most common support needs, and 365 respondents (21 percent) reported a conflicting emergency response obligation. Conclusions: The majority of hospital workers surveyed were willing to report to work in response to some types of disasters but not others, and some indicated they might not be available at all due to conflicting emergency response obligations. Key words: disasters, emergency departments, hospital personnel


Article
Social context and the health consequences of disasters
Sandro Galea, MD, DrPH; Craig Hadley, PhD; Sasha Rudenstine, BA
November/December 2006; pages 37-47

Abstract
Disasters have been and will continue to be relatively common events in the human experience, and they make important contributions to variations in population health. There is a need, therefore, for conceptual models that identify the social and ecological factors influencing post-disaster consequences on population health. This article presents one such conceptual model which links the health consequences of natural, technological, and human-made disasters to a set of nested socioecological factors. Specifically, we attempt to link post-disaster consequences to aspects of the global and local environment and to highlight the roles played by social and ecological factors, including the social infrastructure, cultural beliefs, demography, and underlying historical and geographical circumstances. Examples from existing population-based health and disaster research are used to illustrate and amplify connections drawn from the model. From an applied standpoint, the model suggests that the role of multiple contextual determinants in shaping population health is likely to be complex. Practitioners interested in mitigating the consequences of disasters should pursue strategies that improve the underlying determinants of health, as well as practicable population-based interventions that could be implemented rapidly. Key words: disasters, social context, population health, framework, environment


Article
Critical infrastructure protection: Why physicians, nurses, and other healthcare professionals need to be involved
Captain Roberta Lavin, MSN, APRN, BC; Michael B. Harrington, PhD; Elisabeth Agbor-tabi, RN, MPH; Nurit Erger, MPH
November/December 2006; pages 48-54

Abstract
What is present in nearly every US community, performs myriad services from the routine to the life saving on a daily basis, responds to every disaster, and functions 24 hours a day every day of the year? The answer, of course, is the nation’s $1.8 trillion public health and healthcare system. Protection of this system’s vast infrastructure has assumed increasing urgency since September 11, and there are at least two reasons for this. The first is that this sector must respond to every conceivable event involving risks to human life, including those traditionally within the purview of public health, so its ability to respond to these events must be preserved. The second is that elements of the sector itself face increasing threats to facilities, information systems, and workforces. These reasons alone warrant greater emphasis on protective programs than may have seemed necessary in the past, and the public health and healthcare sector should recognize that it must now understand critical infrastructure protection as well as it does healthcare management. Key words: public health, healthcare, critical infrastructure, key resource, sector-specific