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Medical responders are at-risk of experiencing a wide range of negative psychological health conditions following a disaster.
Published literature was reviewed on the adverse psychological health outcomes in medical responders to various disasters and mass casualties in order to: (1) assess the psychological impact of disasters on medical responders; and (2) identify the possible risk factors associated with psychological impacts on medical responders.
A literature search of PubMed, Discovery Service, Science Direct, Google Scholar, and Cochrane databases for studies on the prevalence/risk factors of posttraumatic stress disorder (PTSD) and other mental disorders in medical responders of disasters and mass casualties was carried out using pre-determined keywords. Two reviewers screened the 3,545 abstracts and 28 full-length articles which were included for final review.
Depression and PTSD were the most studied outcomes in medical responders. Nurses reported higher levels of adverse outcomes than physicians. Lack of social support and communication, maladaptive coping, and lack of training were important risk factors for developing negative psychological outcomes across all types of disasters.
Disasters have significant adverse effects on the mental well-being of medical responders. The prevalence rates and presumptive risk factors varied among three different types of disasters. There are certain high-risk, vulnerable groups among medical responders, as well as certain risk factors for adverse psychological outcomes. Adapting preventive measures and mitigation strategies aimed at high-risk groups would be beneficial in decreasing negative outcomes.
Disaster health care workers experience much greater stress providing psychological first-aid and suffer from the indirect experience of traumatic events. This study examines how disaster health care workers experience disaster mental health.
Twenty-one disaster health care workers recruited from fire stations, community mental health service centers, and disaster trauma centers in Korea participated in this study. Data were collected via in-depth interviews and qualitatively analyzed according to Colaizzi’s phenomenological approach.
Disaster health care workers’ experiences of disaster mental health can be analyzed according to 4 theme categories: (1) commitment to one’s duty as a disaster health care worker; (2) powerlessness and lack of confidence; (3) incident shock and burnout; and (4) incomplete and inadequate healing.
In order to prevent mental health problems and support the disaster health care workers, it is necessary to develop and provide effective, nationwide psychological first-aid training, as well as disaster trauma recovery programs that are tailored to Korean sociocultural context and use immersive digital health care/education technology.
Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
Numerous interventions to address posttraumatic stress (PTS) in youth exposed to mass trauma have been delivered and evaluated. It remains unclear, however, which interventions work for whom and under what conditions. This report describes a meta-analysis of the effect of youth mass-trauma interventions on PTS to determine if interventions were superior to inactive controls and describes a moderator analysis to examine whether the type of event, population characteristics, or income level of the country where the intervention was delivered may have affected the observed effect sizes. A comprehensive literature search identified randomized controlled trials (RCTs) of youth mass-trauma interventions relative to inactive controls. The search identified 2,232 references, of which 25 RCTs examining 27 trials (N = 4,662 participants) were included in this meta-analysis. Intervention effects were computed as Hedge’s g estimates and combined using a random effects model. Moderator analyses were conducted to explain the observed heterogeneity among effect sizes using the following independent variables: disaster type (political violence versus natural disaster); sample type (targeted versus non-targeted); and income level of the country where the intervention was delivered (high- versus middle- versus low-income). The correlation between the estimates of the intervention effects on PTS and on functional impairment was estimated. The overall treatment effect size was converted into a number needed to treat (NNT) for a practical interpretation. The overall intervention effect was statistically significant (g = 0.57; P < .0001), indicating that interventions had a medium beneficial effect on PTS. None of the hypothesized moderators explained the heterogeneity among the intervention effects. Estimates of the intervention effects on PTS and on functional impairment were positively correlated (Spearman’s r = 0.90; P < .0001), indicating a concomitant improvement in both outcomes. These findings confirm that interventions can alleviate PTS and enhance functioning in children exposed to mass trauma. This study extends prior research by demonstrating improvement in PTS with interventions delivered to targeted and non-targeted populations, regardless of the country income level. Intervention populations and available resources should be considered when interpreting the results of intervention studies to inform recommendations for practice.
Civil–military relationships are necessary in humanitarian emergencies but, if poorly managed, may be detrimental to the efforts of humanitarian organizations. Awareness of guidelines and understanding of risks relating to the relationship among deployed military personnel have not been evaluated.
Fifty-five military and 12 humanitarian healthcare workers in South Sudan completed questionnaires covering experience, training and role, agreement with statements about the deployment, and free text comments.
Both cohorts were equally aware of current guidance. Eight themes defined the relationship. There was disagreement about the benefit to the South Sudanese people of the military deployment, and whether military service was compatible with beneficial health impacts. Two key obstacles to the relationship and 3 areas the relationship could be developed were identified.
This study shows that United Kingdom military personnel are effectively trained and understand the constraints on the civil–military relationship. Seven themes in common between the groups describe the relationship. Current guidance could be adapted to allow a different relationship for healthcare workers.
To provide scientific, theoretical support for the improvement of medical disaster training, we systematically analyzed the National Disaster Life Support (NDLS) Course and established a training curriculum with feedback based on the current status of disaster medicine in China.
The gray prediction model is applied to long-term forecast research on course effect. In line with the hypothesis, the NDLS course with feedback capability is more scientific and standardized.
The current training NDLS course system is suitable for Chinese medical disasters. After accepting the course training, audiences’ capabilities were enhanced. In the constructed GM (1,1) model prediction, the developing coefficients of the pretest and the posttest are 0.04 and 0.057, respectively. In light of the coefficient, the model is appropriate for the long-term prediction. The predicted results can be used as the basis for constructing training closed-loop optimization feedback. It can indicate that the course system has a good effect as well.
According to the constructed GM model, the NDLS course system is scientific, practical, and operational. The research results can provide reference for relevant departments and be used for the construction of similar training course systems.
Education in disaster nursing and risk management is important, and developing the human resources of medical staff who participate in disaster response is also necessary. However, a practical educational model for risk management and disaster nursing has not yet been established in Japan. In the present study, a model of disaster medical education for practical risk management and disaster nursing was proposed. Seventeen expert nurses with experience in practical international disaster response (IDR) participated in this study. They were recruited from among past members of Japan disaster response medical teams. They were asked an open-ended question through a questionnaire survey: “What kind of nursing education is necessary for risk management and practical activities in disaster response?” The responses were analyzed qualitatively and an educational model was developed.
Sixty-five codes were obtained from the answers to the open-ended question, and they were categorized into 19 sub-categories and three categories. Subsequently, the “SINCHI education model” was proposed for practical disaster nursing education; it comprises six elements: (1) Simulation exercise and small-group work; (2) International nursing knowledge; (3) Nursing skills and knowledge, including disaster nursing; (4) Communication ability promotion; (5) Humanity, responsibility, and flexibility; and (6) Infection prevention and control. A sample of this education exercise model is the following: (1) preparing the list of medical staff members (2) information-gathering simulation (3) preparing the list of medical instruments, and (4) developing the plan for risk management and operation, including infection prevention and control. Disaster nursing education could be made more instructive and practical by including simulation exercises.
To increase knowledge of National Library of Medicine resources by using a train-the-trainer approach.
Workshops were held in spring 2016 to increase knowledge of 4 National Library of Medicine tools. Data were collected before the workshop and immediately, 3 months, and 1 year after the workshop. Knowledge questions were scored as 1 point per question; an aggregated knowledge score could range from 0 to 16 points. A paired t test assessed the change in knowledge from before to after the workshop.
Four workshops were hosted, with a total of 74 attendees. The response rate for the surveys ranged from 50% to 100%. Knowledge scores changed significantly from 7.2 to 11.9 (t = 15, P < .001). One year after the workshop, more of the participants reported having informally trained others (56.8%) than reported providing 1 or more formal training session (8.1%)(P < .001).
Objective measures of knowledge and information dissemination showed that the National Library of Medicine workshop was successful and resulted in both short- and long-term gains. This workshop could be repeated with other populations to further disseminate information regarding the National Library of Medicine tools, which could help improve disaster response.
Unexpected disasters, such as earthquakes or fires, require preparation to address knowledge gaps that may negatively affect vulnerable patients. Training programs can promote natural disaster readiness to respond and evacuate patients safely, but also require evidence-based information to guide learning objectives.
There is limited evidence on what skills and bedside equipment are most important to include in disaster training and evacuation programs for critically ill infants.
An expert panel was used to create a 13-item mastery checklist of skills for bedside registered nurses (RNs) required to successfully evacuate a critically ill infant. Expert nurses were surveyed, and the Angoff method was used to determine which of the mastery checklist skills a newly graduated nurse (ie, the “minimally competent” nurse) should be able to do. Participants then rated the importance of 26 commonly available pieces of bedside equipment for use in evacuating a hemodynamically unstable, intubated infant during a disaster.
Twenty-three emergency department (ED) and neonatal intensive care unit (NICU) charge RNs responded to the survey with a mean of 19 (SD = 9) years of experience and 30% reporting personal experience with evacuating patients. The skills list scores showed an emphasis on the newly graduated nurse having more complete mastery of skills surrounding thermoregulation, documentation, infection control, respiratory support, and monitoring. Skills for communication, decision making, and anticipating future needs were assessed as less likely for a new nurse to have mastered. On a scale of one (not important) to seven (critically important), the perceived necessity of equipment ranged from a low of 1.6 (breast pump) to a high of 6.9 (face mask). The individual intraclass correlation coefficient (ICC) of 0.55 showed moderate reliability between raters and the average team ICC of 0.97 showed excellent agreement as a group.
Experts rated the ability to manage physiological issues, such as thermoregulation and respiratory support, as skills that every nurse should master. Disaster preparedness activities for nurses in training may benefit from checklists of essential equipment and skills to ensure all nurses can independently manage patients’ physiologic needs when they enter the workforce. Advanced nursing training should include education on decision making, communication during emergencies, and anticipation of future issues to ensure that charge and resource nurses can support bedside nurses during evacuation events.
Natural disasters, particularly earthquakes, in addition to physical complications, have always had psychological consequences for those affected by them. Stuttering is one of the psychological consequences of shocking events. After a 6.6 magnitude earthquake in Hojedk, Kerman, Iran, two 5-year-old children and a 4-year-old child with symptoms of discontinuous speech (including repeated sound, syllable, and words) were referred to the Kerman Welfare Organization’s rehabilitation center (Kerman, Iran). After history-taking, it became clear that the children had begun to stutter after the earthquake due to fear and stress. Considering the importance of negative emotional experiences in the onset of stuttering, it cannot really be said with certainty that the negative experience of the earthquake initiated the stuttering. Rather, the stuttering had not been present before the earthquake and appeared after the event. These cases indicate the importance of psychosocial support and speech therapy after disasters, especially for children that have higher psychological vulnerability than other age groups.
Hurricane Harvey left a path of destruction in its wake, resulting in over 100 deaths and damaging critical infrastructure. During a disaster, public health surveillance is necessary to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The Centers for Disease Control and Prevention (CDC) and American Red Cross collaborate on shelter surveillance to monitor the health of the sheltered population and help guide response efforts.
We analyzed data collected from 24 Red Cross shelters between August 25, 2017, and September 14, 2017. We described the aggregate morbidity data collected during Harvey compared with previous hurricanes (Gustav, Ike, and Sandy).
Over one-third (38%) of reasons for visit were for health care maintenance; 33% for acute illnesses, which includes respiratory conditions, gastrointestinal symptoms, and pain; 19% for exacerbation of chronic disease; 7% for mental health; and 4% for injury. The Red Cross treated 41% of clients within the shelters; however, reporting of disposition was often missed. These results are comparable to previous hurricanes.
The capacity of Red Cross shelter staff to address the acute health needs of shelter residents is a critical resource for local public health agencies overwhelmed by the disaster. However, there remains room for improvement because reporting remained inconsistent.
While the impact of disasters is strongly felt by those directly affected, they also have significant impact on the mental and physical health of rescue/relief workers and volunteers during the response phase of disaster management.
Semi-structured interviews were conducted with 11 experts in the field of disaster management from Nepal, inquiring specifically about the impact of the 2015 mega-earthquake on the mental and physical health of rescue/relief workers and volunteers. A thematic approach was used to analyze the results. These were used to assess the applicability of a previously developed conceptual framework which illustrates the hazards and risk factors affecting disaster response workers and the related hazard mitigation approaches.
The findings suggested a relationship between the type of injuries to responders and the type of disaster, type of responder, and vulnerability of location. The conceptual framework derived from literature was verified for its applicability with a slight revision on analysis of experts’ opinion based on particular context and disaster setting. Technical skills of responders, social stigma, governance, and the socio-economic status of the affected nation were identified as critical influencing factors to heath injuries and could be minimized utilizing some specific or collective measures targeted at the aforementioned variables. Some geographic and weather-specific risks may be challenging to overcome.
To prevent or minimize the hazards for disaster relief workers, it is vital to understand the variables that contribute to injuries. Risk minimization strategies should address these critical factors.
In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe.
To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy.
Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time.
One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015.
The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.
Natural disasters often damage or destroy the protective public health service infrastructure (PHI) required to maintain the health and well-being of people with noncommunicable diseases (NCDs). This interruption increases the risk of an acute exacerbation or complication, potentially leading to a worse long-term prognosis or even death. Disaster-related exacerbations of NCDs will continue, if not increase, due to an increasing prevalence and sustained rise in the frequency and intensity of disasters, along with rapid unsustainable urbanization in flood plains and storm-prone coastal zones. Despite this, the focus of disaster and health systems preparedness and response remains on communicable diseases, even when the actual risk of disease outbreaks post-disaster is low, particularly in developed countries. There is now an urgent need to expand preparedness and response beyond communicable diseases to include people with NCDs.
The developing evidence-base describing the risk of disaster-related exacerbation of NCDs does not incorporate the perspectives, concerns, and challenges of people actually living with the conditions. To help address this gap, this research explored the key influences on patient ability to successfully manage their NCD after a natural disaster.
A survey of people with NCDs in Queensland, Australia collected data on demographics, disease, disaster experience, and primary concern post-disaster. Descriptive statistics and chi-square tests with a Bonferroni-adjustment were used to analyze data.
There were 118 responses to the survey. Key influences on the ability to self-manage post-disaster were access to medication, medical services, water, treatment and care, power, and food. Managing disease-specific symptoms associated with cardiovascular disease, diabetes, mental health, and respiratory diseases were primary concerns following a disaster. Stress and anxiety, loss of sleep, weakness or fatigue, and shortness of breath were common concerns for all patients with NCDs. Those dependent on care from others were most worried about shortness of breath and slow healing sores. Accessing medication and medical services were priorities for all patients post-disaster.
The key influences on successful self-management post-disaster for people with NCDs must be reflected in disaster plans and strategies. Achieving this will reduce exacerbations or complications of disease and decrease demand for emergency health care post-disaster.
Disasters occur regularly, and frequently large numbers of patients treated with maintenance dialysis or with the recent onset of acute kidney injury are put at risk owing to the lack of access to dialysis care precipitating also a kidney failure disaster. The absence of necessary dialysis treatments can result in excessive emergency department visits, hospitalizations, morbidity, or an early death. Those with kidney failure are often evaluated in disaster medical locations or hospitals without nephrologists in attendance. Here we offer guidance for medical personnel evaluating such patients so that dialysis-dependent individuals can be properly assessed and managed with the need for urgent dialysis recognized. A disaster dialysis triage system is proposed. (Disaster Med Public Health Preparedness. 2019;13:782–790)
Introduction: A crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored. Methods: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00AM and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. Results: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P = .018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P = .17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P = .000006). Conclusion: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.
Official counts of deaths attributed to disasters are often under-reported, thus adversely affecting public health messaging designed to prevent further mortality. During the Oklahoma (USA) May 2013 tornadoes, Oklahoma State Health Department Division of Vital Records (VR; Oklahoma City, Oklahoma USA) piloted a flagging procedure to track tornado-attributed deaths within its Electronic Death Registration System (EDRS). To determine if the EDRS was capturing all tornado-attributed deaths, the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) evaluated three event fatality markers (EFM), which are used to collate information about deaths for immediate response and retrospective research efforts.
Oklahoma identified 48 tornado-attributed deaths through a retrospective review of hospital morbidity and mortality records. The Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) analyzed the sensitivity, timeliness, and validity for three EFMs, which included: (1) a tornado-specific flag on the death record; (2) a tornado-related term in the death certificate; and (3) X37, the International Classification of Diseases, 10th Revision (ICD-10) code in the death record for Victim of a Cataclysmic Storm, which includes tornadoes.
The flag was the most sensitive EFM (89.6%; 43/48), followed by the tornado term (75.0%; 36/48), and the X37 code (56.2%; 27/48). The most-timely EFM was the flag, which took 2.0 median days to report (range 0-10 days), followed by the tornado term (median 3.5 days; range 1-21), and the X37 code (median >10 days; range 2-122). Over one-half (52.1%; 25/48) of the tornado-attributed deaths were missing at least one EFM. Twenty-six percent (11/43) of flagged records had no tornado term, and 44.1% (19/43) had no X37 code. Eleven percent (4/36) of records with a tornado term did not have a flag.
The tornado-specific flag was the most sensitive and timely EFM. Using the flag to collate death records and identify additional deaths without the tornado term and X37 code may improve immediate response and retrospective investigations. Moreover, each of the EFMs can serve as quality controls for the others to maximize capture of all disaster-attributed deaths from vital statistics records in the EDRS.
Issa AN, Baker K, Pate D, Law R, Bayleyegn T, Noe RS. Evaluation of Oklahoma’s Electronic Death Registration System and event fatality markers for disaster-related mortality surveillance – Oklahoma USA, May 2013. Prehosp Disaster Med. 2019;34(2):125–131
Disasters cause severe disruption to socio-economic, infrastructural, and environmental aspects of community and nation. While the impact of disasters is strongly felt by those directly affected, they also have significant impacts on the mental and physical health of relief/recovery workers and volunteers. Variations in the nature and scale of disasters necessitate different approaches to risk management and hazard reduction during the response and recovery phases.
Published articles (2010-2017) on the quantitative and quantitative relationship between disasters and the physical and mental health of relief/recovery workers and volunteers were systematically collected and reviewed. A total of 162 relevant studies were identified. Physical injuries and mental health impacts were categorized into immediate, short-term, and chronic conditions. A systematic review of the literature was undertaken to explore the health risks and injuries encountered by disaster relief workers and volunteers, and to identify the factors contributing to these and relating mitigation strategies.
There were relatively few studies into this issue. However, the majority of the scrutinized articles highlighted the dependence of nature and scope of injuries with the disaster type and the types of responders, while the living and working environment and socio-economic standing also had significant influence on health outcomes.
A conceptual framework derived from the literature review clearly illustrated several critical elements that directly or indirectly cause damage to physical and mental health of disaster responders. Pre-disaster and post-disaster risk mitigation approaches may be employed to reduce the vulnerability of both volunteers and workers while understanding the identified stressors and their relationships.
Khatri KC J, Fitzgerald G, Poudyal Chhetri MB. Health risks in disaster responders: a conceptual framework. Prehosp Disaster Med. 2019;34(2):209–216
Major incidents affecting large numbers of people may increase the rate of acute cardiovascular events, even among those who are not directly involved in the incident. It is hypothesized that the MV Sewol ferry disaster (South Korea) would increase the incidence of cardiovascular events nation-wide.
Data on all adult patients (>18 years) who were diagnosed with acute cardiovascular events, including acute myocardial infarction (MI), angina, and cardiac arrhythmias, were extracted from the National Emergency Department Information System (NEDIS) from March 15 through June 17, during the years 2011-2014 (four weeks before to eight weeks after the event date). Poisson regression models were used to calculate the incidence rate ratios (IRRs) comparing the weekly changes in the occurrences of cardiovascular events from the week of the Sewol event (April 16-22, 2014) to eight weeks after the disaster (June 11-17, 2014), using the one-month period before Sewol as a reference period (March 15-April 15), adjusting for calendar years (years 2011-2014) and environmental factors.
During the study periods, cardiovascular events were identified in 73,823 patients. Compared to the reference period, the week of the Sewol disaster and the three weeks after the disaster showed a significant increase in the number of acute cardiovascular events, IRRs of 1.09 (95% CI, 1.03-1.15) and 1.08 (95% CI, 1.02-1.15), respectively (P <.01 for both). In particular, there was 21% increase in incidence of arrhythmia (IRR = 1.21; 95% CI, 1.02-1.44; P = .03) during the week of the Sewol disaster compared with the reference period.
This study showed a significant increase in the incidence of acute cardiovascular events during the week of, and the three weeks after, the Sewol ferry disaster in 2014. These additional cardiac emergencies may be triggered by emotional stressors related to the event, highlighting the public health importance of indirect exposure to a tragic catastrophe.
Kong SY, Song KJ, Shin SD, Ro YS. Cardiovascular events after the Sewol ferry disaster, South Korea. Prehosp Disaster Med. 2019;34(2):142–148
In July 2016, a mass-casualty stabbing attack took place at a facility for disabled persons located in Sagamihara City (Kanagawa Prefecture, Japan). The attack resulted in 45 casualties, including 19 deaths. The study hospital dispatched physicians to the field and admitted multiple casualties. This report aimed to review the physicians’ experiences and to provide insights for the formulation of response measures for similar incidents in the future.
This incident involved 30 emergency teams and 12 fire department teams, including those from neighboring fire departments. Five physicians from three medical institutions, including the study hospital, entered the field. The Simple Triage and Rapid Treatment (START) method was used on the field. The final field triage category count was: 20 red, four yellow, two green, and 19 black tags. All the casualties (n = 26) except for the 19 black tag casualties were transported to one of six neighboring medical institutions.
The median age of the transported casualties was 41 years (interquartile range [IQR] = 35.5 – 42.0). Three casualties (21.4%) were in hemorrhagic shock on arrival at the hospital. Twelve patients had multiple cervical stab wounds (median four wounds; IQR = 3.75 – 6.0). A total of 91.7% of these stab wounds were in mid-neck Zone II region. Of the 12 patients with cervical stab wounds, four (33.3%) required emergency surgery, and the rest were sutured on an out-patient basis. One patient had already been sutured on the field. All patients requiring emergency surgery had deep wounds, including those of the carotid vein, thyroid gland, nerves, and the trachea. Eight of the casualties were hospitalized at the study institution. Five of them were admitted to the intensive care unit. There were no deaths among the casualties transported to the hospitals.
Regional core disaster medical hospitals must take on a central role, particularly in the case of local disasters. Horizontal communication and interactions should be reinforced by devising protocols and conducting joint training for effective inter-department collaborations on the field.
Maruhashi, T, Takeuchi, I, Hattori, J, Kataoka, Y, Asari, Y. The Tsukui (Japan) Yamayuri-en facility stabbing mass-casualty incident. Prehosp Disaster Med. 2019;34(2):203–208