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To evaluate the aseptic efficacy of prefilled syringes compared with ampules when used in a polluted environment similar to that at a disaster site.
Methods:
The researchers tested epinephrine, 0.1%, atropine sulfate, 0.05%, and lidocaine hydrochloride solutions, 2% (Group A) as well as lidocaine hydrochloride, 10%, sodium bicarbonate, 8.4%, and glucose solutions, 50% (Group B), that frequently are used for intravenous injection and intravenous infusion respectively in Disaster Medicine.
Each of these solutions in 10 prefilled syringes (PFSs) and 10 ampules was placed in a box of contaminated soil along with needles and empty syringes for ampules. In the box, each was taken out of its package, all syringes were connected with a needle, and empty syringes were filled with a solution. After this procedure, all syringes were taken out of the box to check their contents for bacterial contamination.
Results:
No bacterium was observed in any of the 10 Prefilled syringes samples of Group A and B solutions. In contrast, out of 10 ampule samples, six of the 10 samples containing epinephrine, nine of the 10 containing atropine sulfate, all 10 samples containing lidocaine hydrochloride, 2%, and all of the ampule samples containing Group B solutions tested positive for bacteria. A statistically significant difference was observed between the PFS and ampule samples in all six solutions.
Conclusion:
Results indicate that, in environments with airborne contaminants, the use of prefilled syringes may be useful for preventing bacterial contamination of the medicine inside.
The media system controls information resources that public health agencies may wish to use to accomplish their goals, particularly in a crisis. The resources of the public health system sometimes are prized by the media system, and this provides opportunities for public health agencies to gain access to the media. This paper reviews the goals and resources of the media system as they relate to the mission of public health agencies in the periods before, during, and after a public health crisis. The various media are reviewed with attention to the role each can play for different purposes and at different stages of a crisis. The importance of presenting health information in the form of stories is emphasized, with specific advice regarding the attributes of an effective story.
The following paper presents an argument for enhancing and encouraging the development of neighborhood-based disaster preparedness organizations, particularly as a potential medical triage and treatment resource following a disaster. First, theresearch context for the utility of non-institutional sources of post-disaster assistance is outlined, followed by the more specific instance of medical triage and treatment. An emerging model of community disaster preparedness training is described, noting the modules that address disaster medicine. Positive contributions and limitations are addressed looking to disaster and non-disaster experiences. While the potential for non-traditional resources to aid immediate post-disaster response is becoming both more common and more accepted, there are a number of recommendations that would improve the usefulness and value, including: 1) integration with existing emergency care infrastructure; 2) standardization of training; 3) use of coordinated drills between public safety organizations, hospitals, and voluntary sectors; and 4) dedication of more funding to assist in the creation and maintenance of programs. Because of the relative infancy of these community-based programs, and the infrequency of large-scale disasters, there is little, if any, pre-post research that can demonstrate a measured impact on response. More pre-disaster baseline data-gathering efforts are needed, combined with post-disaster evaluative research to understand the utility of these non-traditional resources in terms of overall response, and in particular the ability to assist in areas of disaster medicine practice. One also expects that under these kinds of [disaster] conditions, family members, fellow employees, and neighbors will spontaneously try to help each other. This was the case following the Mexico City earthquake where untrained, spontaneous volunteers saved 800 people. However, 100people lost their lives while attempting to save others. This is a high price to pay and is preventable through training.
The medical impacts of disasters have focused on the injuries, illnesses, and deaths related to the disaster. Little has been written about the impact of disasters on persons who use prescription medications or those medications that require refrigeration, or those who require health aids. The objective of this study was an evaluation of the level of utilization of prescription medications and medications that require refrigeration as well as the use of health aids by the population affected by the disaster.
Methods:
Following the Northridge earthquake of 1994, a survey of Los Angeles County households was conducted to assess the impact of the earthquake. A total of 1247 households completed the 48 minute telephone interview. As part of the interview, 10 questions assessed the utilization of medications and medical aids by household members and the effects that the earthquake had on those medications and devices. Chi-square, analysis of variance (ANOVA), and logistic regression analysis were applied.
Results:
Of the 1,212 completed interviews, 21% of the households had a family member taking a prescription medication or a medication requiring refrigeration. Associated factors included gender, race, age, household income, level of education, presence of children, and the intensity of the earthquake (by the Modified Mercalli Index). Only 3% of those that reported medication usage noted problems associated with the use of these medications.
Thirty-nine percent of the respondents indicated that someone in the household used a health aid (e.g., eyeglasses, hearing aid, etc.). Usage was related to gender, race, age, household income, level of education, presence of children, and the intensity of the shaking associated with the earthquake. Of these, 6.5% reported difficulty with these aids, usually related to loss or breakage.
Conclusions:
Although the proportions of the population requiring prescription or refrigerated medications and/or for those using health aids in Los Angeles seemingly are small, this translates to 630,000 households in which someone requires medications and 1.2 million households with a requirement for health aids. Thus, there are a huge number of persons at risk for serious medical problems related to these medications and devices that could produce profound medical problems during a disaster. However, during and following a moderate earthquake, it does not seem that the consequences will be great.
Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs) 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics.
This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated.
The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.
This paper provides an overview of disaster public health preparedness, response, and recovery activities with particular reference to examples that have occurred in California. It discusses the public health considerations from two aspects: 1) general public health effects; and 2) public and environmental health control measures. The latter discussion is divided into: 1) drinking water; 2) human wastes; 3) food; 4) personal hygiene; 5) mass care and shelter; 6) solid waste and debris; 7) hazardous materials; 8) injury prevention programs and public health information; 9) vector control; and 10) disease control and surveillance. Two tables summarize the disaster medical and health functions as they relate to public health.
Controversies regarding the mental health consequences of disasters are rooted both in disciplinary orientations and in the widely varied research strategies that have been employed in disaster mental health studies. However, despite a history of dissensus, there are also key issues on which researchers agree. Disasters constitute stressful and traumatic experiences. However, vulnerability to such experiences, as well as to more chronic Stressors, is socially structured, reflecting the influence of socio-economic status and other axes of stratification, including gender, race, and ethnicity. Disaster events differ in the extent to which they generate stress for victims. A holistic perspective on disaster mental health would take into account not only disaster event characteristics, but also social-systemic sources of both acute and chronic stress, secondary and cumulative Stressors, and victims internal and external coping capacities.
Public health officials often are critical of the way television news covers disasters, while broadcast journalists complain of a lack of cooperation from the public health sector during disaster coverage. This article summarizes the issues discussed in a session on Televised Coverage of Disasters, presented in April 1999 at the UCLA Conference on Public Health and Disasters in Los Angeles. Public health officials were asked to “talk back to their television sets” in a dialog with television journalists. Concerns included: 1) the lack of balance in television coverage that is dominated by sensational images that may frighten rather than inform the public; 2) the potential for psychological damage to viewers when frightening images are shown repeatedly in the days and weeks of the disaster; and 3) the perception that TV reporters place too much emphasis on crime, property damage, and loss of life, giving relatively low priority to disaster preparedness and to public health issues in the aftermath of a disaster. Options for improving communication between television journalists and public health professionals also are discussed.
Rapid assessments of needs and health status have been conducted by the U.S. Centers for Disease Control and Prevention (CDC) in natural disaster settings for gathering information about the status of affected populations during emergencies. A review of eight such assessments (6 from hurricanes, 1 from an ice storm, and 1 from an earthquake) examines current methods and applications, and describes the use of results by policy makers so assessments in post-disaster settings can be improved.
Objective:
Because the results of assessments greatly influence the nature of relief activities, a review can: 1) ascertain strengths and limitations; 2) examine the methods; and 3) ascertain the utility of results and their use by policy makers. This review compares assessments for similarities and differences: 1) across disaster types; 2) within similar disasters; 3) by timing when the assessments are conducted; and 4) in domestic and international settings. The review also identifies decision-making actions that result from the assessments, and suggests direction for future applications.
Methods:
Assessments reported in CDC's Morbidity and Mortality Weekly Report from 1980 through 1999 were reviewed because they applied a systematic methodology in data collection. They were compared descriptively for study characteristics and content areas.
Results:
Of 13 assessments identified from six reports, eightwere reviewed because they focused on initial assessments, rather than on repeated studies. Of the eight, six pertained to hurricanes; one to an ice storm; and one to an earthquake. Seven (88%) were performed during or after the third day post-impact (range: 1–70 days, median: 7 days). All eight addressed demographics, morbidity, and water availability; seven concerned food, sanitation, and transportation; and six queried access to medical care and electricity. Of the three assessments conducted more than 10 days post-event, two addressed vulnerable children, the elderly, pregnant and lactating women, and migrant workers; two singled storm preparation and evacuation behavior; and one concerned mental health, preventive health care, and social programs. Only one, after an earthquake, asked about disaster-related deaths in household members. Two were international assessments and both were performed at least 60 days post-event. All eight provided estimates of proportions of needs based on survey respondents; none, however, extrapolated the proportions to estimate the magnitude of needs for populations at risk. Of the eight, five confirmed a policy decision, such as accelerating delivery of food supplies.
Conclusion:
Assessments typically were conducted within 1 week after the precipitating event occurred. Most, performed within 3–10 days, focused on demographics, health status, food and water, and restoration of utilities. Three assessments, conducted >1 month later, concerned longterm planning. Only one was performed <72 hours post-event. Five assessments resulted in policy actions to guide relief activities. Increasing application of health assessments provides: 1) impetus for improving current methodologies; 2) standardizing collection instruments; 3) involving other sectors in emergency relief; and 4) ensuring useful information for decision makers.
Groups are assigned or formed to perform tasks that one person cannot accomplish alone. This lesson describes the classification of work groups, group unity, leadership, motivation, recognition, conflict resolution, and remediation associated with managing groups and their activities. Advantages associated with group process include 1) the generation of better ideas, 2) ability to assume greater risks; make fewer errors; 3) the capacity for greater knowledge and 4) information, and for some problems, production of better decisions. Groups may be formal or informal. Formal groups may be organic, task-directed, or committees. Informal groups arise when it becomes obvious that a group will work better or may be formed by a discipline within the organization or through friendships. The size of the group its status within the organization, the goals established, and the dependence of the members on the group all may affect the cohesiveness of the group. Leadership of the group must keep the group focused on the objectives and enhancement of the efficiency of its operation and the quality of the decisions made by the group. Motivation of a group often is more difficult than is that for individuals and generally positive inducements work better than do negative measures such as coercion and reprimands. Roles are often informal and conferred by the group collectively. Often norms are established within groups that help the group deal with conflict. Inadequate performance within a formal group may require changes in the leadership, removal of a member or clique within the group, reduction of group size, and/or dissolution of the group. Understanding the dynamics of groups is an essential skill required of good managers.