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American Journal of Disaster Medicine
January/February 2008, Volume 3
, Number 1


Article
Disaster management among pediatric surgeons: Preparedness, training and involvement
Nikunj K. Chokshi, MD; Solomon Behar, MD; Alan L. Nager, MD, FAAP; Fred Dorey, PhD; Jeffrey S. Upperman, MD, FAAP, FACS
January/February 2008; pages 5-14

Abstract
Introduction: Contemporary events in the United States (eg, September 2001, school shootings), Europe (eg, Madrid train bombings), and the Middle East have raised awareness of mass casualty events and the need for a capable disaster response. Recent natural disasters have highlighted the poor preparation and infrastructure in place to respond to mass casualty events. In response, public health policy makers and emergency planners developed plans and prepared emergency response systems. Emergency response providers include first responders, a subset of emergency professionals, including firemen, law enforcement, paramedics, who respond to the incident scene and first receivers, a set of healthcare workers who receive the disaster victims at hospital facilities. The role of pediatric surgeons in mass casualty emergency response plans remains undefined. The authors hypothesize that pediatric surgeons’ training and experience will predict their willingness and ability to be activated first receivers. The objective of our study was to determine the baseline experience, preparedness, willingness, and availability of pediatric surgeons to participate as activated first receivers. Methods: After institutional review board approval, the authors conducted an anonymous online survey of members of the American Pediatric Surgical Association in 2007. The authors explored four domains in this survey: (1) demographics, (2) disaster experience and perceived preparedness, (3) attitudes regarding responsibility and willingness to participate in a disaster response, and (4) availability to participate in a disaster response. The authors performed univariate and bivariate analyses to determine significance. Finally, the authors conducted a logistic regression to determine whether experience or preparedness factors affected the respondent’s availability or willingness to respond to a disaster as a first receiver. Results: The authors sent 725 invitations and received 265 (36.6 percent) completed surveys. Overall, the authors found that 77 percent of the respondents felt “definitely” responsible for helping out during a disaster but only 24 percent of respondents felt “definitely” prepared to respond to a disaster. Most felt they needed additional training, with 74 percent stating that they definitely or probably needed to do more training. Among experiential factors, the authors found that attendance at a national conference was associated with the highest sense of preparedness. The authors determined that subjects with actual disaster experience were about four times more likely to feel prepared than those with no disaster experience (p < 0.001). The authors also demonstrated that individuals with a defined leadership position in a disaster response plan are twice as likely to feel prepared (p = 0.002) and nearly five times more willing to respond to a disaster than those without a leadership role. The authors found other factors that predicted willingness including the following: a contractual agreement to respond (OR 2.3); combat experience (OR 2.1); and prior disaster experience (OR 2.0). Finally, the authors found that no experiential variables or training types were associated with an increased availability to respond to a disaster. Conclusions: A minority of pediatric surgeons feel prepared, and most feel they require more training. Current training methods may be ineffectual in building a prepared and willing pool of first receivers. Disaster planners must plan for healthcare worker related issues, such as transportation and communication. Further work and emphasis is needed to bolster participation in disaster preparedness training. Key words: disaster training, pediatric surgery, mass casualty, trauma


Article
Deploying and using volunteer health practitioners in response to emergencies: Proposed uniform state legislation provides liability protections and workers’ compensation coverage
Michealle Carpenter, JD; James G. Hodge, Jr, JD, LLM; Raymond P. Pepe, AB, JD
January/February 2008; pages 17-23

Abstract
To respond effectively to natural disasters and other public health emergencies, government resources must be augmented with the resources of volunteer organizations. Governmental actors are prepared to utilize volunteer health practitioners (VHPs) to meet patient surge capacity and provide essential public health services. However, difficult legal challenges arise regarding licensure, the scope of practice of volunteers, the relationship of volunteers to local healthcare delivery systems, disciplinary enforcement, the extent of exposure to civil liability, and how to provide compensation for volunteers injured or killed during disaster response activities. The Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) seeks to address these problems and provide a better legal environment that facilitates VHPs efforts. This article discusses two important provisions of the UEVHPA, Section 11 which provides immunity against claims for negligence, under certain circumstances, for volunteers and organizations engaged in the deployment and use of volunteers, and Section 12 which provides workers’ compensation benefits to VHPs when other sources of coverage are not available. Disaster relief organizations and healthcare provider organizations have consistently identified uncertainty and a lack of uniformity with respect to these issues as a major source of concern to volunteer practitioners and as a potential deterrent to their effective recruitment and utilization. Uniform state enactment of the UEVHPA would resolve many inconsistencies and gaps in the regulation and protection of VHPs across states. Key words: liability protection, emergencies, volunteer, workers compensation


Article
Visual disability in selected acts of terror, warfare, and natural disasters of the last 25 years: A concise narrative review
Christopher J. Gee, MD; Jeremy Bonkowske, MD; Shree K. Kurup, MD
January/February 2008; pages 25-30

Abstract
Objective: A review of ocular injury related to mass disaster over the past 25 years, including injury type, treatment, and final visual outcome. Design: Retrospective review. Main Outcome Measures: Injury types, treatment, and final visual acuity. Results: Acts of terror and war result in significant and increasingly more common ocular injury. Natural disasters were much less likely to cause lasting or permanent injury. Conclusions: Final visual acuity was rarely reported. Primary prevention is superior to treatment in acts of war and terror. Ocular injury is rarely reported by first response to natural disaster. Key words: visual acuity, ocular injury, ophthalmologic injury, mass disaster, terrorism, bioterrorism, war, earthquake, flood, volcano, hurricane, tsunami


Article
Gendered dimensions of disaster care: Critical distinctions in female psychosocial needs, triage, pain assessment, and care
Roxane Richter, EMT, MA; Thomas Flowers, DO
January/February 2008; pages 31-37

Abstract
Objective: This research highlights and identifies some critical distinctions in female disaster care including the following: socially constructed gender risk factors; gender and posttraumatic stress; women and pain (presentation and sensitivity); and postdisaster support and services, especially in the arenas of obstetrics and gynecology (breastfeeding, menstruation, contraception, rape, and sexually transmitted disease [STDs]). The research also includes a brief, anonymous survey of 50 adult female Hurricane Katrina evacuees which queried women on their usage of postdisaster health and counseling services. Conclusions: Our literature review shows a pattern of gender differentiation in all areas of the disaster process—in preparedness, response, physical and psychological impact, risk perception and exposure, recovery, and reconstruction. Some research highlights include: six disaster gender risk factors affecting vulnerability, impact and exposure; heightened risks and differing clinical manifestations of posttraumatic stress disorder and pain presentation; “pregnancy status” triage screening; as well gender-sensitive supplies and services (private breastfeeding and obstetrics and gynecology (OB/GYN) exam areas, birth control, feminine hygiene, and prenatal nutrition advocacy). The results of the small voluntary survey are presented that supports the contention that many gender-sensitive services were needed in posthurricane Katrina clinical settings, but were inadequate or nonexistent. This research not only identified issues, but emphasized feasible interventions, which could significantly reduce pain, suffering, and long-term postdisaster care costs. The research’s most important conclusions are the current dearth of gender-disaggregated disaster data, as well as the tremendous need for disaster healthcare planners and providers to take a more cognizant and proactive approach to gender-specific care in triage, psychosocial needs assessment, medical care, and advocacy. Key words: disaster, women, preparedness, gender, medical, emergency medical services (EMS), female, posttraumatic stress disorder (PTSD), triage, pain


Article
Violence-related mortality and morbidity of humanitarian workers
Elizabeth A. Rowley, MIA, MHS; Byron L. Crape, PhD; Gilbert M. Burnham, MD, PhD
January/February 2008; pages 39-45

Abstract
Objectives: (1) To determine the rate of violence related deaths, medical evacuations, and hospitalizations occurring to national and expatriate staff of participating humanitarian organizations; (2) to describe the distribution of all-cause and cause specific mortality and morbidity of humanitarian workers with regard to possible risk factors. Design: Surveillance study of field-based humanitarian workers; data were regularly collected from headquarters of participating organizations via e-mail and telephone between September 2002 and December 2005. Participants: Eighteen humanitarian organizations reported on any death, medical evacuation, or hospitalization of any national or expatriate staff, for any cause, in any field location during the study period. Interventions: None. Main Outcome Measures: Risk of violence related events was calculated as the number of deaths, medical evacuations, and hospitalizations during the study period divided by the total number of field staff for organizations that had staff in those countries where events occurred to the staff of any participating organization. Distribution descriptions are presented as simple proportions. Results: Risk of violence-related deaths, medical evacuations, and hospitalizations was six per 10,000 aid worker person-years. Fifty percent of intentional violence cases were lethal. Intentional violence accounted for 55 percent of all deaths reported, followed by coincidental illness (27 percent) and accidents (15 percent). Conclusions: Aid worker deaths in this group were more frequently caused by intentional violence than either accidents or coincidental illness. The rate of six intentional violence events per 10,000 person-years can be used as a baseline by which to track changes in risk over time. Key words: conflict, humanitarian, international, security, staff, violence


Article
Suicidal bomb explosions in Sri Lanka
Rohan Ruwanpura, MD, DLM, DFM(RCPA), DMJ; Kiribathgalage Sunil Kumara, MBBS, MD, DLM; Hemamal Jayawardane, MBBS, DLM, MD, LLB; Lalantha B.L. de Alwis, MBBS, DLM, MD
January/February 2008; pages 47-51

Abstract
Injuries due to explosive devices are often seen in Sri Lanka. The involvement of suicide bombers is the peculiar feature of these bomb explosions. Analysis of injuries observed in the suicide bombers showed distinctive injury patterns consisting of detachment of the head and limbs, severe disruption of the trunk, burns at the transected tissue margins, presence of cyanide capsule in the neck, and absence of the shrapnel injuries. These findings are helpful in recognition of the perpetrator for the subsequent legal proceedings and also important in organization of preventive measures. In this context, suicide bomber could be defined as an individual carrying high explosive device, attached to his/her body and must be recognized as a separate medicolegal entity. Key words: explosion, suicide bomber, injury pattern


Article
Epidemiology of suicide after natural disasters: A review on the literature and a methodological framework for future studies
Mohsen Rezaeian, PhD, Epidemiologist
January/February 2008; pages 52-56

Abstract
On one hand, there is an association between exposure to natural disasters and becoming mentally distressed, and on the other hand, there is also a relation between being mentally distressed and committing suicide; therefore, it is possible that one finds a relation between exposure to natural disasters and committing suicide. This review, therefore, will not only seek such relations in the literature but also try to highlight the most important methodological issues of finding such connection. Key words: suicide, natural disasters, epidemiology

American Journal of Disaster Medicine
March/April 2008, Volume 3
, Number 2


Article
Guest editorial. Lessons relearned from Katrina?
Ilan Kelman, BASc, MASc, PhD
March/April 2008; pages 61-62


Article
An ounce of prevention is worth a pound of cure: Improving communication to reduce mortality during bioterrorism responses
Margaret L. Brandeau, PhD; Gregory S. Zaric, PhD; Johannes Freiesleben, PhD; Frances L. Edwards, PhD; Dena M. Bravata, MD, MS
March/April 2008; pages 65-78

Abstract
Objective: To identify communication needs and evaluate the effectiveness of alternative communication strategies for bioterrorism responses. Methods: We provide a framework for evaluating communication needs during a bioterrorism response. Then, using a simulation model of a hypothetical response to anthrax bioterrorism in a large metropolitan area, we evaluate the costs and benefits of alternative strategies for communication during a response. Results: Expected mortality increases significantly with increases in the time for attack detection and announcement; decreases in the rate at which exposed individuals seek and receive prophylaxis; increases in the number of unexposed people seeking prophylaxis; and increases in workload imbalances at dispensing centers. Thus, the timeliness, accuracy, and precision of communications about the mechanisms of exposure and instructions for obtaining prophylaxis and treatment are critical. Investment in strategies that improve adherence to prophylaxis is likely to be highly cost effective, even if the improvement in adherence is modest, and even if such strategies reduce the prophylaxis dispensing rate. Conclusions: Communication during the response to a bioterror attack must involve the right information delivered at the appropriate time in an effective manner from trusted sources. Because the response system for bioterror communication is only fully operationalized once an attack has occurred, tabletop planning and simulation exercises, and other up-front investments in the design of an effective communication strategy, are critical for effective response planning. Key words: anthrax, risk communication, bioterrorism, preparedness planning


Article
An emergency medical bag set for long-range aeromedical transportation
COL David J. Barillo, MD, FACS; LTC Evan Renz, MD, FACS; CPT Kristine Broger, RN; SSG Brandon Moak, LVN; SSG Gabriel Wright, RTT; COL John B. Holcomb, MD, FACS
March/April 2008; pages 79-86

Abstract
The global war on terror has created the need for urgent long-range aeromedical transport of severely wounded service members over distances of several thousand miles from Afghanistan or Iraq to the United States. This need is met by specialized medical transport teams such as US Air Force Critical Care Air Transport Teams (CCATT) or by the US Army Burn Flight Team (BFT). Both teams travel with multiple bags or cases of emergency equipment, which are comprehensive but cumbersome. To avoid the need to search multiple bags for equipment or drugs when an in-flight emergency occurs, many CCATT and BFT physicians also carry a personal bag of emergency supplies for rapid access. Over the last year, we have evolved and standardized an emergency equipment bag designed to provide the supplies necessary for initial management of emergencies that occur during flight and ground transport. This or a similar emergency kit would be useful for inter or intrahospital transport of critically ill or injured civilian patients, or for physicians who respond to civil emergencies, such as members of Disaster Medical Assistance Teams. Key words: burn, disaster, aeromedical transport, disaster medical assistance team,mass casualty incident


Article
HazBot: Development of a telemanipulator robot with haptics for emergency response
Jacob C. Jurmain; Andrew J. Blancero; James A. Geiling, MD; Andrew Bennett, PhD; Chris Jones, PhD; Jeff Berkley, PhD; Marc Vollenweider, PhD; Margaret Minsky, PhD; Jon C. Bowersox, MD, PhD; Joseph M. Rosen, MD
March/April 2008; pages 87-97

Abstract
Objectives: To design a remotely operated robot, “HazBot,” for bioevent disaster response; specifically, to improve existing commercial robots’ capabilities in handling fixed-facility hazmat incidents via a unique robot controller that allows the human operator to easily manipulate HazBot in disaster situations. Design: The HazBot’s design objectives were for a robot to approach a building, open doors, enter, and navigate the building. The robot’s controlling device was designed to provide features not available in current robots: dexterous manipulation and enhanced sensory (touch) feedback via “haptic” technology. The design included a companion simulator to train operators on HazBot. Results: The HazBot met its design goals to do several hazmat-related tasks in place of a human operator: to enter and navigate a building, passing debris and doors as necessary. HazBot’s controller reduced the time for inexperienced users of manipulator robots to complete a door-opening task by 55 percent. HazBot overcame previous problems in operator control of robots, via its dexterous manipulation feature, its partially implemented haptic touch feedback, and via its companion simulator. Conclusions: The HazBot system demonstrates superior capability over existing robots: it is technically sophisticated, yet moderately priced; it has dexterous manipulation to make operator tasks easier, haptic feedback, and an excellent companion simulator. HazBot is optimized for hazmat cleanups; is mobile and scaleable; can serve in multiple environments and uncontrolled conditions; and is optimal for disaster situations. It could potentially be used in other disaster situations to deliver medicine to isolated patients, evaluate such patients, assess a downed fire fighter, etc. Key words: haptics, hazmat, robotics, remote manipulation, teleoperation, telepresence, hazardous materials, explosive ordinance device, EOD, emergency response


Article
Protecting public health and global freight transportation systems during an influenza pandemic
Thomas C. Luke, MD; Jean-Paul Rodrigue, PhD
March/April 2008; pages 99-107

Abstract
The H5N1 influenza threat is resulting in global preparations for the next influenza pandemic. Pandemic influenza planners are prioritizing scarce vaccine, antivirals, and public health support for different segments of society. The freight, bulk goods, and energy transportation network comprise the maritime, rail, air, and trucking industries. It relies on small numbers of specialized workers who cannot be rapidly replaced if lost due to death, illness, or voluntary absenteeism. Because transportation networks link economies, provide critical infrastructures with working material, and supply citizens with necessary commodities, disrupted transportation systems can lead to cascading failures in social and economic systems. However, some pandemic influenza plans have assigned transportation workers a low priority for public health support, vaccine, and antivirals. The science of Transportation Geography demonstrates that transportation networks and workers are concentrated at, or funnel through, a small number of chokepoints and corridors. Chokepoints should be used to rapidly and efficiently vaccinate and prophylax the transportation worker cohort and to implement transmission prevention measures and thereby protect the ability to move goods. Nations, states, the transportation industry and unions, businesses, and other stakeholders must plan, resource, and exercise, and then conduct a transportation health assurance and security campaign for an influenza pandemic. Key words: pandemic, public, health, transportation, influenza


Article
Automated dental aging for child victims of disasters
Jules Kieser, BDS, PhD, DSc, FDSRCSEd; Jacob de Feijter, BCA; Raymond TeMoananui, MDS, DOrth, RCS
March/April 2008; pages 109-112

Abstract
In disasters, one of the major challenges is the identification of the dead. This is complicated in cases where young victims and, sometimes, young survivors are involved. Often, there are no dental treatment records that can be usefully employed and, hence, identification has to be relied heavily on ageing. Developing teeth are generally considered to be the most reliable indicators of maturation and, by extension, of chronological age at death. This is because teeth are more durable, their degree of development can be observed directly from the living or deceased individual, and tooth formation is relatively unaffected by disease, malnutrition, or endocrine disorders. Unfortunately, the calculation of dental maturation and its conversion to a useful indicator of chronological age is a time-consuming process, which can be frustrating in the face of an overwhelming demand after a disaster such as the Thai Tsunami or Hurricane Katrina. The authors report on the development of a novel, automated “point and click” graphical user interface that can be used to calculate the age of a known individual from a simple dental radiograph. The authors apply the method to three ethnic populations living in New Zealand: children of European, Maori, and Pacific Island descent. Key words: DVI, dental aging, odontology


Article
Disaster management following explosion
B. R. Sharma, MBBS, MD
March/April 2008; pages 113-119

Abstract
Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism. These attacks are virtually always directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims. To address the problem to the maximum benefit of mass disaster victims, we must develop collective forethought and a broad-based consensus on triage and these decisions must reach beyond the hospital emergency department. It needs to be realized that physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply and for this reason, emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision-making. Key words: mass disaster, explosions, blast injury, terrorist attacks, triage, disaster management, forensic evidence

American Journal of Disaster Medicine
May/June 2008, Volume 3
, Number 3


Article
Disaster medicine: A history
Geoff Williams
May/June 2008; pages 125-130


Article
The impact of natural disasters on the elderly
E. Paul Cherniack, MD
May/June 2008; pages 133-139

Abstract
Objective: To review and draw conclusions about the impact of natural disasters on the elderly from the published medical literature. Design: Articles were obtained by searching the PubMed database and Google search engines using terms such as “disaster,” “elderly,” “hurricane,” “tornado,” “earthquake,” and “flood.” More articles were obtained from the reference lists of those obtained in the initial search. Results: Forty-five journal articles were reviewed. Conclusions: Many, but not all, studies have found that older individuals are more likely to suffer adverse physical consequences. This is not surprising considering the elderly are more likely to be in worse health before disasters and less able to seek assistance afterward. The lack of agreement between studies is not surprising either, considering heterogeneity in disasters, populations, and survey methods. This heterogeneity also precludes determination as to whether older individuals have a worse or more favorable psychological outcome than younger individuals. Several investigations, however, have noted that individuals may be more resilient to some of the psychological manifestations of disasters with more frequent exposure, often including the elderly. Many suggestions have been proposed to address the potential needs of older individuals such as involving existing organizations and those with existing geriatric expertise to design disaster plans, develop education, communication systems, and warnings for people with sensory impairment, create new methods for identifying, tracking, and following older individuals, and make special arrangements to provide disaster-related aid. However, there are only anecdotal reports of the success of the application of such methods. Key words: disaster, elderly, hurricane, earthquake, flood, tornado, mental health


Article
A unique role for dental school faculty: Telephone triage training and integration into a health departments’ emergency response planning
Jill B. Fernandez, RDH, MPH; David L. Glotzer, DDS; Marc M. Triola, MD; Walter J. Psoter, DDS, PhD
May/June 2008; pages 141-146

Abstract
Objective: Dental professionals with proper training and integration into existing protocols for mobilization can be one additional re-source during catastrophic events. A pilot project on training of dental school faculty in telephone triage in the event of an avian flu pandemic is described. A partnership was established with a grant from the Department of Justice/Department of Homeland Security, between the New York City Department of Health and Mental Hygiene, and New York University to initiate a pilot program to increase the manpower resources available to the health agency should an overwhelming public health event be present in the New York City area. Methods: Eight faculties from New York University College of Dentistry were selected to receive telephone triage training consisting of 15 hours of formal presentations. This training was specifically designed to give participants a background in “outbreak investigations,” and included a mock influenza outbreak. Also, a “phone triaging” training during a surge event was practiced. Results: The training resulted in enabling alternative healthcare providers as capable personnel and one alternative source for a surge manpower pool. This was the innovative use of dental school faculty to bolster critically understaffed and overwhelmed areas in the NYCDOHMH infrastructure, such as call centers and for telephone triage, in their disaster scenarios, particularly in their response to avian flu. Conclusions: The established public health systems and medical community must understand the need to preplan for medical surge events and accept that a potential source of additional manpower could be the dental profession or other nontraditional healthcare personnel. Key words: Avian flu, surge capacity, telephone triage, dentists, syndromic surveillance, call centers


Article
The impact of the Tsunami on hospitalzations at the tertiary care hospital in the Southern Province of Sri Lanka
Truls Østbye, MD, PhD; Thyagi Ponnamperuma, MBBS; Nayana Fernando, MBBS, MSc; Vathsala Abeygunawardena, MSc; W.A.A. Wijayasiri, MBBS, MSc; Jodi J. Chen, MD; Christopher W. Woods, MD, MPH
May/June 2008; pages 147-155

Abstract
Objective: Sri Lanka’s human, physical, social, and economic resources suffered a massive impact after the tsunami of December 26, 2004. To assist in preparing for future disasters, the authors sought to characterize the pattern of hospitalizations from the main impact zone in the Southern Province. Design: Retrospective chart review. Setting: Patients admitted to Teaching Hospital, Karapitiya, the only tertiary care hospital in the Southern Province. Patients,Participants: All hospital admissions on the day of and week following the tsunami, and a random sample (5 percent) of admissions from the month preceding, and the 3 months following the tsunami were coded according to the International Classification of Diseases, 10th Edition, analyzed, and geomapped. Intervention: N/A. Main Outcome Measure(s): The overall daily number of hospitalizations increased by 50 percent on the day of the tsunami and decreased in the following week. Results: Before the tsunami, injuries typically accounted for 20 percent of hospital admissions. However, injuries were markedly higher (89 percent of the total) on the day of the tsunami and remained elevated (35 percent) during the following week. After the initial peak in injuries (including near drownings), there was no increase in the frequency of infectious, cardiac, or psychiatric admissions. Conclusions: Injuries (including near drownings) were the most common cause of admissions immediately after the tsunami.The distribution of specific diagnoses differed from that seen after other natural disasters such as earthquakes and hurricanes. A central aspect of disaster relief operations and planning includes a thorough understanding of the postdisaster health effects and changes in disease patterns. Key words: Sri Lanka, Tsunami, disaster, injuries, hospitalizations, diagnosis, descriptive study


Article
The performance-level model of hospital decontamination preparedness
Scot Phelps, JD, MPH; Garrett Doering, MS
May/June 2008; pages 157-163

Abstract
Objective: Describe a multilevel model of decontamination capacity for hospitals. Design: Descriptive model. Setting: Acute care hospitals with decontamination responsibilities. Patients, Participants: None. Interventions: None. Main Outcome Measure(s): None Results: This multilevel model of defining decontamination capacity would allow more realistic assessment of current capacity, allow for fluctuating service levels depending on time of day, incorporate realistic ramp-up and ramp-down of decontamination services, allow for a defined fall-back decontamination model should decontamination processes fail, allow hospitals to define long-term decontamination service level goals, and allow better understanding of when and why to focus on low-risk/low-resource patients rather than high-risk/high-resource patients. Conclusions: This multiple-level model would allow for more realistic and effective hospital-based decontamination service models and should become part of the national decontamination paradigm. Key words: hospital, decontamination, CBRNE, WMD, performance-based, standards


Article
The impact of correctional institutions on public health during a pandemic or emerging infection disaster
Rachel D. Schwartz, PhD
May/June 2008; pages 165-170

Abstract
With the growing threat of a naturally occurring or man-made global pandemic, many public, private, federal, state, and local institutions have begun to develop some form of preparedness and response plans. Among those in the front lines of preparedness are hospitals and medical professionals who will be among the first responders in the event of such a disaster. At the other end of the spectrum of preparedness is the Corrections community who have been working in a relative vacuum, in part because of lack of funding, but also because they have been largely left out of state, federal local planning processes. This isolation and lack of support is compounded by negative public perceptions of correctional facilities and their inmates, and a failure to understand the serious impact a jail or prison facility would have on public health in the event of a disaster. This article examines the unique issues faced by correctional facilities responding to disease disasters and emphasizes the importance of assisting them to develop workable and effective preparedness and response plans that will prevent them from becoming disease repositories spreading illness and infection throughout our communities. To succeed in such planning, it is crucial that the public health and medical community be involved in correctional disaster planning and that they should integrate correctional disaster response with their own. Failure to do so endangers the health of the entire nation. Key words: pandemic, correctional disaster planning, public health, preparedness


Article
Hospital-based disaster preparedness for pediatric patients: How to design a realistic set of drill victims
Shana Ballow, DO; Solomon Behar, MD; Ilene Claudius, MD; Kathleen Stevenson, RN; Robert Neches, PhD; Jeffrey S. Upperman, MD, FAAP, FACS
May/June 2008; pages 171-180

Abstract
Objective: The purpose of this report is to describe an innovative idea for hospital pediatric victim disaster planning. Design: This is a descriptive manuscript outlining an innovative approach to exercise planning. Setting: All hospitals. Patients: In this report, we describe a model set of patients for pediatric disaster simulation. Results: An epidemiologically based set of mock victims. Conclusions: We believe that by enhancing pediatric disaster simulation exercises, hospital personnel and decision makers will be better prepared for an actual disaster event involving pediatric victims. Key words: pediatric disaster preparedness, trauma simulations, pediatric trauma


Article
International Disaster Response Law: An introduction
Lewis W. Marshall, Jr, MS, MD, JD
May/June 2008; pages 181-184

Abstract
Objective: To review the current state of International Disaster Response Law (IDRL) and identify barriers to development and future directions. Design: This study is an introduction to the current status of IDRL. Conclusions:The data suggest that globally we will have increasing incidents and costs in responding to disasters, but the development of IDRL has not kept pace. The further development and refining of IDRL is imperative on a global scale.Additional barriers to the continued development of IDRL will have to be overcome. Global international stakeholders will need to develop mechanisms to promote the advancement of IDRL while minimizing the barriers to effective preparedness and response to global international disasters. Key words: International Disaster Response Law, disaster preparedness, disaster response, treaties, conventions

American Journal of Disaster Medicine
July/August 2008, Volume 3
, Number 4


Article
Training medical staff for pediatric disaster victims: A comparison of different teaching methods
Solomon Behar, MD; Jeffrey S. Upperman, MD; Marizen Ramirez, PhD; Fred Dorey, PhD; Alan Nager, MD
July/August 2008; pages 189-199

Abstract
Objective: The goal of this study was to assess the effectiveness of the different types of healthcare worker training in pediatric disaster medicine knowledge over time and to analyze the effects of training type on healthcare workers’ attitude toward pediatric disaster medicine. Design: Prospective randomized controlled longitudinal study. Setting: Large, urban, tertiary academic children’s hospital. Subjects: Physicians and nurses employed at Children’s Hospital Los Angeles randomly selected from a global hospital e-mail server over a 3-week time frame were invited to participate and receive an incentive on completion. Forty-three controls and 42 intervention subjects (22 lecture _ tabletop exercise, 20 lecture only) completed the study. Subjects with disaster training in the prior 6 months were excluded. Interventions: Subjects underwent a didactic lecture or a combination of didactic lecture and tabletop exercise. Preintervention and postintervention testing took place using a 37-question multiple-choice test on pediatric disaster medical topics. Posttesting took place immediately after intervention and then 1, 3, and 6 months after the intervention. Subjects also were surveyed before and after intervention regarding their attitudes toward pediatric disaster medicine. Main outcome measures: (1) Scores on a 37-question knowledge test and (2) Likert scores on selfperceptions of knowledge, comfort, and interest in pediatric disaster medicine. Results: Regardless of intervention type, participant scores on a postintervention pediatric disaster medicine tests over a 6-month period increased and remained well above pretest means for intervention and control pretest scores. There were no differences in scores comparing type of intervention. However, subjects who underwent the tabletop simulation had a better sense of knowledge and comfort with the topics compared with those who only underwent a didactic lecture. Conclusions: Didactic lecture and tabletop exercises both increase healthcare worker’s knowledge of pediatric disaster medical topics. This knowledge seems to be retained for at least 6 months postintervention. The addition of the tabletop exercise to a standard didactic lecture may increase a learner’s sense of knowledge and comfort with disaster topics, which may in turn lead to increased staff participation in the event of an actual disaster. Key words: disaster, training, child, education, teaching methods, healthcare workers


Article
Validation of the Short Posttraumatic Stress Disorder Rating Interview (expanded version, Sprint-E) as a measure of postdisaster distress and treatment need
Fran H. Norris, PhD; Jessica L. Hamblen, PhD; Lisa M. Brown, PhD; John A. Schinka, PhD
July/August 2008; pages 201-212

Abstract
Objective: Professionals and paraprofessionals working in disaster settings need tools to identify persons with mental health needs.To validate the Sprint-E as a measure of postdisaster distress and treatment need, the authors tested (1) the concurrent validity of the measure compared with other measures of distress, (2) the sensitivity and specificity of a “3/7 rule” on the Sprint-E relative to probable PTSD diagnosis, and (3) the hypothesis that Sprint-E scores would be stable in the absence of treatment but would improve in its presence. Method: In Study 1, data were collected at the point of enrollment from 165 adults participating in a Florida treatment program implemented in response to the 2004 hurricanes. In Study 2, data were collected at points of referral, pretreatment, and intermediate treatment from 128 adults participating in a Baton Rouge Louisiana treatment program implemented in response to the 2005 hurricanes, Katrina and Rita. Results: The utility of a 3/7 rule for the Sprint-E, with 3 suggesting possible and 7 suggesting probable treatment needs, was supported in Study 1. Tested against the PTSD Checklist, the Sprint-E performed well in ROC analyses (area under the curve = 0.87); a score of 7 achieved sensitivity of 78 percent and specificity of 79 percent. In Study 2, Sprint-E scores evidenced little change between referral and pretreatment but substantial change between pretreatment and intermediate treatment. Conclusion: The Sprint-E is useful as an assessment and referral tool in situations where more in-depth assessment is not feasible and mental health services are available. Key words: disaster, PTSD, treatment, assessment, referral


Article
Hazmat disaster preparedness in Hong Kong: What are the hazardous materials on Lantau, Lamma, and Hong Kong Islands?
Frank G. Walter, MD, FACEP, FACMT, FAACT; Jimmy Tak-shing Chan, MB BS, FRCSEd; Billie Winegard, MPH; Peter B. Chase, MD, PhD, FACEP; Farshad (Mazda) Shirazi, MS, MD, PhD, FACEP; Yuk-yin Chow, MB BS, FRCSEd; Melanie de Boer, PhD; Kurt Denninghoff, MD
July/August 2008; pages 213-233

Abstract
Objective: Hazmat disaster preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study describes the identities and quantities of hazardous materials (HMs) in Hong Kong and lists what antidotes are needed for these dangerous goods (DGs). This study describes what HMs are most common in Hong Kong to prioritize disaster preparedness and training. Design: A descriptive, cross-sectional study. Setting: The Hong Kong Special Administrative Region, specifically Lantau, Lamma, and Hong Kong Islands. Sample: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). Interventions: Descriptive statistical analyses with Stata 9.2. Main Outcome Measures: Identifying and quantifying HMs in the HKFSD DGD. Results: Most HMs do not have antidotes. The most common HMs with recognized antidotes are carbon monoxide, methylene chloride, fluorides, cyanides, nitriles, hydrazine, methanol, and nitrates. The most common categories of DGs are substances giving off inflammable vapors, compressed gases, and corrosive and poisonous substances. Conclusions: Hazmat disaster preparedness and training should emphasize these most common categories of DGs.Disaster planning should ensure adequate antidotes for HMs with recognized antidotes, ie, oxygen for carbon monoxide and methylene chloride; calcium gluconate and calcium chloride for fluorides; hydroxocobalamin or amyl nitrite, sodium nitrite, and sodium thiosulfate for cyanides and nitriles; pyridoxine for hydrazine; fomepizole or ethanol for methanol; and methylene blue for methemoglobinemia produced by nitrates. Supportive care is essential for patients exposed to HMs because most DGs do not have antidotes. Keywords: disaster planning, hazardous substances, epidemiology, toxicology, emergency medicine


Article
Application of a needs-driven, competencies-based mental health training program to a post-disaster situation: The Grenada experience
Stan Kutcher, MD, FRCPC; Sonia Chehil, MD, FRCPC
July/August 2008; pages 235-240

Abstract
This report outlines an innovative approach to address post-natural disaster mental health needs in a region in which natural disasters are common—the Caribbean. Instead of traditional external vertical psychosocial interventions commonly used in this region, the authors developed and implemented a mental health interventions training program, in the island country of Grenada, which is focused on enhancing the capacity of local community-based health service providers to provide immediate and continued mental healthcare following a natural disaster. Soon after this training, a hurricane stuck the island of Grenada. A review of the self-confidence in the application of this training and the mental health intervention activities of these community health providers demonstrated that they felt able to effectively identify, intervene, and address post-disaster mental health needs within their communities and that their care of individuals affected continued beyond the immediate post-disaster period, suggesting that enhancing the capacity of local community-based health providers to deal with postnatural disaster mental health needs may be a useful model that may be applicable in other jurisdictions. Key words: mental health, post-disaster, training


Article
Use of ultrasound to assess acute fracture reduction in emergency care settings
John G. McManus, MD, MCR; Melinda J. Morton, MD, MPH; Chad S. Crystal, MD; Todd J. McArthur, MD; Jeremy S. Helphenstine, DO; David A. Masneri, DO; Scott E. Young, DO; Michael A. Miller, MD
July/August 2008; pages 241-247

Abstract
Objective: There is a need to develop tools for the rapid diagnosis and treatment of fractures and intraosseous pathology in remote and austere environments. Several emergency and orthopedic studies have demonstrated ultrasound to be a reliable tool in diagnosing these conditions in both adult and pediatric patients. The purpose of this pilot study is to assess the ability of the ultrasound to assess in “real-time” the success of fracture reduction in adult patients in the emergency department (ED), in comparison with the accepted standard, plain film radiography, for the purposes of future application in austere environments. Design: Case series. Setting: Emergency department at an academic medical center. Patients/Participants: Convenience sample of five patients presenting to an ED with clinical evidence of fractures (three radial, one phalangeal, and one metacarpal). Interventions: A Sonosite Titan portable ultrasound system with L38/10-5: 38-mm broadband linear array transducer was used to assess prereduction and postreduction angulations and alignment. Alignment was reconfirmed with use of fluoroscopy and plain radiography. Results: The ultrasound confirmed proper reduction and realignment in all five cases, from an average prereduction angle of alignment of 37.4 degrees to an average postreduction angle of 4.4 degrees. The use of the ultrasound resulted in adequate visualization of the reduction in all cases. Regional anesthesia or sedation and limited pressure with the probe resulted in no verbalization of pain by any of the subjects. Conclusions: In this pilot study, emergency physicians demonstrated the use of ultrasound in place of traditional radiography to either confirm adequate reduction or assess the need for further manipulation. Our pilot study suggests that ultrasound has a possible future role in fracture reduction management in both the ED as well as “austere” prehospital locations. Key words: ultrasound, fracture, postreduction, orthopedic, realignment, disaster

American Journal of Disaster Medicine
September/October 2008, Volume 3
, Number 5


Article
A regional human services authority’s rapid needs assessment of evacuees following natural disasters
David E. Post, MD; Jan M. Kasofsky, PhD; Christopher N. Hunte, PhD; James H. Diaz, MD, DrPH
September/October 2008; pages 253-264

Abstract
The Atlantic hurricane season of 2005 was not an ordinary season, and Hurricane Katrina was not an ordinary hurricane. Hurricane Katrina damaged more than 93,000 square miles of Gulf of Mexico coastline, displaced more than 1 million residents from New Orleans, and flooded more than 80 percent of New Orleans for weeks, which killed more than 1,300 people, mostly New Orleanians. Inland regional state and local healthcare and human services agencies rushed to assist evacuees, most of whom were uninsured or displaced without employer healthcare coverage. The initial evacuation brought more than 350,000 evacuees seeking shelter to the greater Baton Rouge area, LA, 80 miles north of New Orleans, the closest high ground. This investigation describes the rapid needs assessment developed and conducted by the Capital Area Human Services District of the greater Baton Rouge area, a quasi-governmental human services authority, the regional provider of state funded mental health, addictive disorders, and developmental disabilities services, on a sample of 6,553 Katrina evacuees in the greater Baton Rouge area. In the event of catastrophic natural and manmade disasters, state and federal decision makers should follow the National Incident Management System and support local designated lead agencies with additional resources as requested. They must rely on designated lead agencies to use their knowledge of the locale, local resources, and relationships with other providers and volunteers to respond rapidly and efficiently to evacuee needs identified through a designated, concise tool that is singularly utilized across the impacted region by all providers to determine the needed response. Key words: disasters, natural, hurricanes, Katrina, needs assessments, postdisaster, community health, behavioral health, mental health, health services, access, community health, behavioral health, mental health


Article
Does the simple triage and rapid treatment method appropriately triage patients based on trauma injury severity score?
Rick Hong, MD; Paul R. Sierzenski, MD; Melissa Bollinger, RN; Craig C. Durie, RN; Robert E. O’Connor, MD, MPH
September/October 2008; pages 265-271

Abstract
Objectives: To correlate the simple triage and rapid treatment (START) colors to trauma injury severity scores (ISS). Design: Six volunteer healthcare providers unfamiliar with START were trained to triage. Each chart was designated a START color by a volunteer healthcare provider and the “expert” trainer. The colors and corresponding ISS were recorded. Setting: Level I trauma center at a suburban tertiary care hospital. Patients, participants: One hundred charts of patients at least 65 years old who appear in Christiana Hospital’s Trauma Registry were randomly chosen for the study, and 98 charts with complete data were included. Main outcome measure(s): Cohen’s Kappa score measures the level of agreement between the “volunteer” and “expert” reviewers. Pearson correlation determines the association between the START colors and mean ISS. Results: The Cohen’s Kappa score between the volunteer and expert reviewers was 0.9915, indicating a highly significant agreement between the reviewers on the triage category of the patients. The mean ISS for each color was as follows: green = 11, yellow = 12, red = 20, black = 24. The mean ISS increases as the acuity of the triage category increases, with a Pearson correlation of 0.969. Conclusions: The START method is a simple technique used to triage quickly a large number of patients. Healthcare providers can undergo just-in-time training to learn this technique and use it effectively. The START colors also imply a correlation with the trauma ISS, with higher ISS more likely to be triaged “red” or “black.” Key words: simple triage and rapid treatment, START, trauma injury severity score, ISS


Article
Chemical exposure preparedness for emergency departments in a midwestern city
Mark Fenzl, DO; Heath Jolliff, DO; Marcus Topinka, MD
September/October 2008; pages 273-281

Abstract
Objective: To determine if each hospital in a large Midwestern city has the resources to treat 50 patients exposed to terrorist chemical agents and/or industrial chemicals. Design: Surveys specific to each department were sent to emergency department (ED) nursing supervisors, safety officers, and pharmacy directors of each hospital. Setting: The survey was performed in a large Midwestern city (metropolitan population of 1,500,000). Participants: Nine hospitals. Main Outcome Measures: The survey measured the presence of written materials, amount of equipment, quantities of pharmaceuticals, and number of staff available in each hospital. Hospital staff also rated the preparedness of their hospital. Results: Twelve of the 27 respondents returned the survey for a response rate of 44 percent. None of the EDs had a known cooperative written plan with the police or fire departments. Three safety officers reported limited numbers of hospital security personnel and a total of 35 ventilators for respiratory failure. The four pharmacy directors reported limited sum doses of atropine (315), cyanide antidote (10 complete kits), and succimer (100). Respondents who felt qualified to evaluate the ED gave a mean score of 5.4 on a scale of 1-10 when asked how prepared they felt their ED was to treat 50 chemical exposure patients. Conclusions: Despite hospital staff rating chemical exposure preparedness as 5.4, it is unlikely that each hospital could handle 50 patients exposed to some chemicals due to lack of prearranged coordination, security, antidotes, and ventilators. Key words: disaster preparedness, hospital disaster plans, HAZMAT


Article
Humanitarian response: Improving logistics to save lives
Jessica McCoy, MS
September/October 2008; pages 283-293

Abstract
Each year, millions of people worldwide are affected by disasters, underscoring the importance of effective relief efforts. Many highly visible disaster responses have been inefficient and ineffective. Humanitarian agencies typically play a key role in disaster response (eg, procuring and distributing relief items to an affected population, assisting with evacuation, providing healthcare, assisting in the development of longterm shelter), and thus their efficiency is critical for a successful disaster response. The field of disaster and emergency response modeling is well established, but the application of such techniques to humanitarian logistics is relatively recent. This article surveys models of humanitarian response logistics and identifies promising opportunities for future work. Existing models analyze a variety of preparation and response decisions (eg, warehouse location and the distribution of relief supplies), consider both natural and manmade disasters, and typically seek to minimize cost or unmet demand. Opportunities to enhance the logistics of humanitarian response include the adaptation of models developed for general disaster response; the use of existing models, techniques, and insights from the literature on commercial supply chain management; the development of working partnerships between humanitarian aid organizations and private companies with expertise in logistics; and the consideration of behavioral factors relevant to a response. Implementable, realistic models that support the logistics of humanitarian relief can improve the preparation for and the response to disasters, which in turn can save lives. Key words: disasters, disaster planning, relief work, transportation, supply and distribution


Article
Family planning in displaced populations: An unmet need among Iraqis in Amman, Jordan
Rakhi Sinha, MPH; Neerav Goyal, MPH; Adam Sirois, MPH; Natalia Valeeva, MD; Shannon Doocy, PhD
September/October 2008; pages 295-300

Abstract
Context: Studies have been done to characterize primary “urgent” health needs in displaced populations; few studies have explored specifically family planning (FP) needs. Objective: To investigates the hypothesis that there exists an unmet need for FP among Iraqi nationals in Amman, Jordan. Design: Married Iraqi individuals attending seven nongovernmental organization clinics were asked a subset of survey questions to ascertain FP health needs and access. Results: 16.1 percent (n = 76) of respondents reported need for FP services, of which 16 percent (n = 397) report having access to FP counseling, and 43 percent (n = 33) had access to contraceptives. After 30 years of age, need for FP decreased yearly 12 percent (OR = 0.88, CI = 0.84-0.92, p = 0.00). After one year of living in Amman, Jordan, the odds of needing FP services increases yearly 13 percent (OR = 1.13, CI = 1.05-1.22, p = 0.001). In addition, if the respondent has one or more children younger than 5 years in the same household, the odds of needing FP services increases by 85 percent (OR = 1.85, CI = 1.0-3.44, p = 0.05). Conclusions: This study illustrates a clear unmet need in FP services among Iraqis in Amman, Jordan, especially among the long-term displaced. Key words: Iraq, refugee, displaced populations, family planning, reproductive health


Article
Radiologic diagnosis of explosion casualties
Brian J. Eastridge, MD; Lorne Blackbourne, MD; Charles E. Wade, PhD; John B. Holcomb, MD
September/October 2008; pages 301-305

Abstract
The threat of terrorist events on domestic soil remains an ever-present risk. Despite the notoriety of unconventional weapons, the mainstay in the armament of the terrorist organization is the conventional explosive. Conventional explosives are easily weaponized and readily obtainable, and the recipes are widely available over the Internet. According to the US Department of State and the Federal Bureau of Investigation, over one half of the global terrorist events involve explosions, averaging two explosive events per day worldwide in 2005 (Terrorism Research Center. Available at www.terrorism.com. Accessed April 1, 2007). The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads, published by the Institute of Medicine, states that explosions were the most common cause of injuries associated with terrorism (Institute of Medicine Report: The Future of Emergency Care in the United States Health System: Emergency Medical Services at the Crossroads. Washington DC: National Academic Press, 2007). Explosive events have the potential to inflict numerous casualties with multiple injuries. The complexity of this scenario is exacerbated by the fact that few providers or medical facilities have experience with mass casualty events in which human and material resources can be rapidly overwhelmed. Care of explosive-related injury is based on same principles as that of standard trauma management paradigms. The basic difference between explosion-related injury and other injury mechanisms are the number of patients and multiplicity of injuries, which require a higher allocation of resources. With this caveat, the appropriate utilization of radiology resources has the potential to impact in-hospital diagnosis and triage and is an essential element in optimizing the management of the explosive-injured patients. Key words: explosion, blast, fragment, trauma, injury, radiology, diagnosis


Article
Prolonged femoral external fixation after natural disaster: Successful late conversion to intramedullary nail aboard the USNS Mercy hospital ship
V. Franklin Sechriest II, MD, CDR, MC, USN; David W. Lhowe, MD
September/October 2008; pages 307-312

Abstract
After the 9.0 magnitude earthquake and tsunami of December 26, 2004, orthopaedic injuries were a major healthcare problem in parts of South East Asia. We report our late encounter with an Indonesian patient treated acutely with external fixation of a femur fracture. We describe our procedure for conversion of prolonged external fixation (59 days) to an intramedullary nail (IMN) aboard the USNS Mercy and provide two-year follow-up. A review of current literature on conversion of femoral external fixation to IMN is included. This report highlights the potential pitfalls of external fixation of femur fractures in an austere postnatural disaster environment where orthopaedic follow- up care may be delayed or nonexistent.

American Journal of Disaster Medicine
November/December 2008, Volume 3
, Number 6


Article
Editorial Nuclear disasters: Current plans and future directions for oncologists
Thomas E. Goffman, MD, FACP
November/December 2008; pages 317-320

Abstract
Objective: To show that there is a significant role for oncologists in the event of a terrorist nuclear disaster. Professionals need data on current political issues regarding a nuclear attack already put in place by the administration and the military. Design: Review of what actually occurs during a fission bomb’s explosion helps to point out what medical care will be most needed. The author contends that those trained in the oncologies could play a major part. Setting: Modern-day America. Patients: Potential civilian survivors. Results: Large gaps noted in statewide disaster plans in the public domain. Conclusion: Oncologists must get involved now in disaster planning; statewide plans are necessary throughout the nation; the public needs to know the basics of what to do in the advent of a nuclear bomb explosion. Key words: nuclear disasters, fission bombs, civilian medical treatment, role for oncologists


Article
Healthcare vulnerabilities to electromagnetic pulse
Lenard H. Ross, Jr, MPH; F. Matthew Mihelic, MD
November/December 2008; pages 321-325

Abstract
The US healthcare system is particularly vulnerable to the effects of electromagnetic pulse (EMP) attack because of the system’s technological sophistication, but while national defense planners prepare for the considerable threat that EMP poses, there has been little or no recognition of this threat within the US healthcare community, and neither has there been any significant healthcare planning to deal with such an eventuality. Recognition of the risk presented by EMP, and advance institution of appropriate strategies to mitigate its effects on the healthcare system, could enable the preservation of much of that system’s function in the face of EMP-related disruptions, and will greatly further all-hazards disaster preparations. Key words: electromagnetic pulse, EMP, healthcare, vulnerability, nuclear


Article
Assessment tools in support of epidemiological investigation of airborne dispersion of pathogens
Ulrik Bo Pedersen, MSc; John-Erik Stig Hansen, DMCs
November/December 2008; pages 327-333

Abstract
Human health threats posed by airborne pathogens are difficult to handle for healthcare responders due to the fact that the contaminated area is not immediately recognizable. By means of wind dispersion modeling, it is possible to estimate the extent and geographical position of hazardous areas and health impact. Contemporary modeling tools can run on standard PCs, with short processing time and with easy-to-use interfaces. This enables health professionals without modeling experience to assess consequences of dispersion incidents, for example, from accidental releases from industries, shedding of pathogens from infectious animals or humans, as well as intentional releases caused by terrorist activity. Dispersion assessments can provide response managers with a chance to get on top of events. In the absence of modeling, reliable estimates of hazard areas may not be available until no earlier than the appearance of the first cases or after time-consuming sampling and laboratory analysis. In this article, the authors describe the concept of using wind dispersion assessments in epidemiological field investigations of naturally occurring disease outbreaks, as well as for bioterror scenarios. They describe the specifications of user friendly and real-time functional wind dispersion modeling systems that can serve as decision support tools during outbreak investigations and outline some of the currently available software packages. Key words: airborne dispersion, dispersion modeling, epidemiolgy, bacteria, contamination


Article
A qualitative analysis of the central values of professional paramedics
David M. Sine, CSP, ARM; Norvell Northcutt, PhD
November/December 2008; pages 335-343

Abstract
Biomedical ethics decisions are often made after reflection, deliberation, and after a process of communication, reveal the values and interests of the patient or the patient’s family. However, acute and rapid changes in the patient, the very public view of the care provided, and a need for rapid decision making by paramedics in a prehospital setting make protracted deliberation and reflection a practical impossibility. As paramedics provide care for patients, they regularly make value-laden choices that affect the type of care, how care is provided, and to whom care is provided. These choices transcend the technical judgment and professional skills necessary for provision of emergency care in prehospital settings. This article identifies, describes, and organizes a number of central values of professional paramedics and discusses how values may be considered by paramedics when resolving conflicting values. Key words: ethics, emergency care, paramedics, central values, qualitative analysis


Article
Resource loss, coping, alcohol use, and posttraumatic stress symptoms among survivors of Hurricane Katrina: A cross-sectional study
Vimal Kishore, PhD; Katherine P. Theall, PhD; William Robinson, PhD; Jamilia Pichon, MSW; Richard Scribner, MD, MPH; Emily Roberson, MPH; Sandy Johnson, PhD
November/December 2008; pages 345-357

Abstract
Objective: To assess the impact of Hurricane Katrina on the faculty, staff, and students at a university located in New Orleans, LA . Design: A cross-sectional,Web-based survey . Setting: A local college university in New Orleans, LA. Participants: A total of 364 faculty, staff, and students surveyed during mid July 2006 to September 2006. Main Outcome Measures: Posttraumatic stress disorder (PTSD) symptoms, coping, resource loss, and substance use . Results: The study revealed substantial degree of resource loss and consequences due to Katrina. Approximately 22 percent of respondents had PTSD symptoms one year post-Katrina. Positive coping was strongly protective of PTSD symptoms in our sample. Alcohol and drug consumption, on the other hand, was associated with greater PTSD symptoms. Coping, alcohol use, and personal and family injury were also associated with resource loss. Conclusions: Survivors of a disaster need mental health and substance use services and resources well beyond the first year post disaster, and the student population should be factored in any evacuation planning. Key words: hurricane, coping, loss, PTSD, alcohol


Article
Environmental disasters: Preparing for impact assessments and operational feedback
Pierre Verger, MD; Denis Bard, MD, PhD; Christine Noiville, PhD; Reza Lahidji; The French Committee for Prevention and Precaution
November/December 2008; pages 358-368

Abstract
On March 24, 2006, the French Minister of Environment asked the Committee for Prevention and Precaution (CPP), an independent multidisciplinary committee created in 1996, to conduct a methodological analysis of operational feedback of natural and technological disasters to determine if France is equipped to collect the information and data necessary for the assessment, and optimal management of a disaster and its consequences. The Committee’s analysis was based on the testimony it heard from 13 experts—scientists and representatives of associations and advocacy groups—and its review of the literature, including operational feedback reports. Its response to the Minister focused on the assessment of the health, social, environmental, and economic impacts of disasters and on their operational feedback (defined as the systematic analysis of a past event to draw lessons for the management of the risk), as practiced in France. It presents the results of the literature review about the consequences of disasters, expert’s views on the current utility and limitations of impact assessments and operational feedback, the CPP’s discussion of these results, and its recommendations to improve impact assessment and operational feedback of disasters. These recommendations cover preparation for and activation of data collection and operational feedback, financial provisions, coordination of stakeholders, education and training in disaster preparedness, and the distribution and use of data from operational feedback. Key words: disasters, emergency preparedness, expert opinion, risk assessment, prevention and control


Article
Trend analysis of disaster health articles in peer-reviewed publications pre- and post-9/11
Gabor Kelen, MD; Lauren M. Sauer, BA
November/December 2008; pages 369-376

Abstract
Objective: The aim of this study was to determine which journals publish medical disaster-related work, their individual focus, and publication volume preand post-9/11. Methods: PubMed and Google Scholar were searched using key words to identify peer-review journals (print or electronic) publishing medical and public health disaster-related manuscripts. All medical journals with an average volume of at least five disaster-related publications per year over the 11-year study period (1996-2006) were selected. Identified journals were categorized as either general or specialty medical, or disaster health dedicated. All disaster-related articles in each journal were identified and classified according to 11 subtopics. Results: Of 16 journals meeting entry criteria, 10 were disaster dedicated. Of these, only six existed pre-9/11. Only six general journals (JAMA, American Journal of Public Health, The Lancet, New England Journal of Medicine, Annals of Emergency Medicine, Academic Emergency Medicine) had sufficient publications for analysis. Of the 2,899 disaster articles identified, 1,769 (61 percent) were from the dedicated journals. Publications increased by 320 percent in the general/subspecialty journals and 145 percent for disaster-specific journals in the 5-year period post-9/11 (2002-2006) versus the previous 5-year period (1996-2000). Among the dedicated journals, Journal of Prehospital and Disaster Medicine published the most (21 percent), followed by Disaster Prevention and Management: An International Journal (18 percent). Among the general/subspecialty journals, The Lancet published the most (33 percent), followed by JAMA (28 percent) and Annals of Emergency Medicine (18 percent). These journals published the most pre- and post- 9/11. Bioterrorism (36 percent) and Preparedness (18 percent) were the most frequent topic areas for the general/ subspecialty journals, while General Disasters (38 percent) and Preparedness (27 percent) were of the highest interest for the dedicated journals. The greatest increase in the proportion of publications pre- and post-9/11 was by the New England Journal of Medicine (2,340 percent) and Academic Emergency Medicine (1,275 percent). Individual journals appear to emphasize particular subtopic areas. Conclusions: Interest in publishing medical disaster-related articles has increased tremendously since 9/11 in both general/subspecialty journals as well as disaster-dedicated medical journals. Some journals focus on certain topics. Details of this study should help authors identify appropriate journals for their manuscript submissions. Key words: disaster medicine, research methodology, publications, trend analysis


Article
Public health preparedness for maritime terrorist attacks on ports and coastal waters
John J. Wassel, MD
November/December 2008; pages 377-384

Abstract
Objective: To assess the risk of mass casualties and necessary public health and provider preparation relating to maritime terrorist attacks on the US ports. Design: Articles were obtained by searching PubMed database, Google, and Google Scholar search engines using terms such as “maritime security,” “maritime terrorism,” “port security,” “terrorist attacks on the US ports,” “terrorist nuclear attacks,” “terrorist attacks on liquefied natural gas tankers,” and “terrorist attack on high occupancy ships.” Setting: US ports and coastal waters. Results: Seventy-six journal articles were reviewed. Conclusions: Morbidity and mortality high for nuclear terrorist attack; mortality low but morbidity potentially high for radiological attacks. It would be more difficult for terrorist attack on natural gas tankers to cause high mortality and/or morbidity . Key words: terrorism, ports, nuclear, dirty bomb, natural gas tanker