Mass Casualties and Case Management.

The mass casualty statistics in the United States is numbing. Case managers must be prepared for potential disasters. This Editorial speaks to a case manager's personal experience and calls for others who have been through an experience with mass casualties, so all may better prepare: preparation is the antidote to panic.

Response Functions in Disasters: Iran Flash Flood 2016.

OBJECTIVE: Heavy rain and flash flooding left behind a trail of disaster in the western and south-western provinces of Iran in April 2016. The purpose of this study is to highlight the response functions that should be undertaken when such disasters strike. METHODS: Secondary data, such as documents, organizational reports, and forms completed during response to the flood visits, were the methods of data collection in this study. Then, collected data were analyzed according to the response functions to disasters. RESULTS: The study found that a strong disaster response function was the early warning system, by the Iran Meteorological Organization, announced 1 week before the flood. Weaker functions were the lack of coordination among response organizations and the lack of a safety officer in the Incident Command System structure during the flash flood. CONCLUSIONS: The list of the disaster response functions identified by this study should aid the decision makers and first responders in facing natural or man-made disasters and enable them to better prepare for response functions in the future disasters.

Disaster Medicine: A Comprehensive Review of the Literature From 2016.

OBJECTIVE: The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response - Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners. METHODS: MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed. A Level I review of titles and abstracts with inclusion criteria of disaster medicine, health care system, and disaster type concepts was performed. Eight reviewers performed Level II full-text review and formal scoring for overall quality, impact, clarity, and importance, with scoring ranging from 0 to 20. Reviewers summarized and critiqued articles scoring 16.5 and above. RESULTS: Articles totaling 1176 were identified, and 347 were screened in a Level II review. Of these, 193 (56%) were Original Research, 117 (34%) Case Report or other, and 37 (11%) were Review/Meta-Analysis. The average final score after a Level II review was 11.34. Eighteen articles scored 16.5 or higher. Of the 18 articles, 9 (50%) were Case Report or other, 7 (39%) were Original Research, and 2 (11%) were Review/Meta-Analysis. CONCLUSIONS: This first review highlighted the breadth of disaster medicine, including emerging infectious disease outbreaks, terror attacks, and natural disasters. We hope this review becomes an annual source of actionable, pertinent literature for the emerging field of disaster medicine.

Characterizing the Current State of Training Courses Available to US Disaster Professionals.

OBJECTIVE: The objective of this study is to characterize US-based disaster training courses available to disaster response and disaster health professionals. Its purpose is to better inform policies and decision-making regarding workforce and professional development to improve performance. METHODS: Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA) National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning Centers. An online search used 30 disaster-related key words. Data included the course title, description, target audience, and delivery modality. Levels of learning, target capability, and function were categorized by 3 expert reviewers. Descriptive statistics were used. RESULTS: There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives (CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only lower levels of learning. CONCLUSION: Despite thousands of courses available, there remain significant gaps in target audience, subject matter content, educational approaches, and delivery modalities, particularly for health and public health professionals.

A Bibliometric Profile of Disaster Medicine Research from 2008 to 2017: A Scientometric Analysis.

ABSTRACTThis study analyzed and assessed publication trends in articles on "disaster medicine," using scientometric analysis. Data were obtained from the Web of Science Core Collection (WoSCC) of Thomson Reuters on March 27, 2017. A total of 564 publications on disaster medicine were identified. There was a mild increase in the number of articles on disaster medicine from 2008 (n=55) to 2016 (n=83). Disaster Medicine and Public Health Preparedness published the most articles, the majority of articles were published in the United States, and the leading institute was Tohoku University. F. Della Corte, M. D. Christian, and P. L. Ingrassia were the top authors on the topic, and the field of public health generated the most publications. Terms analysis indicated that emergency medicine, public health, disaster preparedness, natural disasters, medicine, and management were the research hotspots, whereas Hurricane Katrina, mechanical ventilation, occupational medicine, intensive care, and European journals represented the frontiers of disaster medicine research. Overall, our analysis revealed that disaster medicine studies are closely related to other medical fields and provides researchers and policy-makers in this area with new insight into the hotspots and dynamic directions. (Disaster Med Public Health Preparedness. 2019;13:165-172).

The Knowledge Level of Dentists in Turkey About Their Potential Role on the Disaster Victims Identification (DVI) Team.

OBJECTIVE: Although dentists are valuable assets in identification teams during disaster events, forensic dentistry is not used effectively in the identification studies conducted in Turkey, and the importance of dental data is ignored. The aim of this study was to determine the level of knowledge of dentists regarding their duties and responsibilities during major disasters. METHODS: This descriptive study was conducted between December 2015 and June 2016. Registered dentists (n=20.280) of the Turkish Dental Association were invited to complete the organization's online survey. A total of 539 dentists participated in the volunteer workshop. Data were analyzed using SPSS, version 22.0 (IBM Corp, Armonk, NY). The chi-square analysis was used to evaluate the knowledge level of dentists by group regarding disaster victim identification (DVI) - the process and procedure of recovering and identifying victims of major disasters (eg, earthquake, terrorist attack). RESULTS: The dentists included in the study consisted of 320 (59.4%) females and 219 (40.6%) males with a mean age of 37.4±12.6 years. The number of specialists and general dentists were 249 (45.6%) and 297 (54.4%), respectively; 249 (69.71%) dentists who had knowledge about forensic dentistry stated that they received this information during their formal training. The percentage of dentists who were aware of the existence of an organization of a disaster response operation in Turkey was 74.2%, but only 20.5% (n=110) had knowledge about DVI. We found that 92.9% (n=104) of these dentists believed that dentists should be included in the team for the identification of disaster victims. On the other hand, only half (52.3%) of the dentists with knowledge of DVI wanted to work on the identification teams. The majority (99.1%) considered DNA analysis to be the safest method for identification. CONCLUSION: Our findings show that, although dentists know about the identification process, they do not have enough relevant knowledge. (Disaster Med Public Health Preparedness. 2019;13:533-538).

Environmentally Overburdened Gulf State Residents Lack Access to Environmental Specialty Care.

Residents in Louisiana, Mississippi, and Alabama have experienced repeated natural and man-made environmental exposures. As frequency and intensity of exposures increase, the need for environmental specialty care rises in environmentally overburdened communities. We evaluated access to environmental health expertise in these states. We determined if providers accepted private health insurance and/or self-pay mapping their location using ArcGIS. Of sixty-four physicians meeting inclusion criteria, only eleven (17%) accepted private health insurance and thirty-four (53%) accepted self-pay. The ratio of physicians with environmental expertise who accept private health insurance and/or self-pay, to the population is < 1:1,000,000. Occupational clinics employ specialty physicians to provide care to industry employees but generally not patients with non-work-related exposure. We discuss the implications of limited access to environmental specialty care. To improve the availability of specialty expertise in this region, we recommend increased funding for training physicians in environmental exposure assessment in underserved communities, especially environmental justice communities.

The Association Between Service Members' Participation in Humanitarian Aid and Disaster Relief and Mental Health Symptoms and Treatments.

INTRODUCTION: There is a scarcity of research establishing a relationship between mental illness and the U.S. military service members who participate in the field of military humanitarian assistance/disaster relief (HA/DR). One of the few studies in this area showed that participation in military HA/DR was not associated with depressive symptoms, however, the study was limited by sample size. This study examined (1) the relationship between participation in military HA/DR and mental health symptoms and military stress and (2) the relationship between HA/DR and mental health treatment and therapy. MATERIALS AND METHODS: Data from the 2011 Health Related Behaviors Survey was used. The analytic sample consisted of U.S. military service members who participated in HA/DR (the Haiti earthquake and Deepwater Horizon oil spill in the Gulf) (n = 573) compared to those who participated in non-HA/DR deployments from 2007 to 2011 (n = 986). Multivariate models were used to examine the relationship between the independent variables and dependent variables while controlling for a set of variables that may confound the relationship between the two. RESULTS: The logistic regression model found that participating in HA/DR deployments decreased the likelihood of service members reporting post-traumatic stress disorder (PTSD) symptoms by 3% (p < 0.1) and depressive symptoms by 1% (p < 0.05). Furthermore, participation decreased the likelihood of having a prescription for antidepressants during and/or 3 months after deployment by 1% (p < 0.05). Additional results showed that junior enlisted and senior enlisted members were more likely to report symptoms of PTSD than senior officers (p < 0.05). Marines were more likely to seek treatment and therapy for depression than U.S. Coastguard members (p < 0.1). CONCLUSION: Results showed that participation in HA/DR was associated with significant reductions in PTSD symptoms, depressive symptoms, and the use of antidepressants by service members. Further research needs to understand the mechanism of these associations for better planning and implementation of HA/DR and delivery of care to service members who participate in these missions.

International Emergency Psychiatry Challenges: Disaster Medicine, War, Human Trafficking, Displaced Persons.

Mental health disorders are a major cause of morbidity and a growing burden in low-income and middle-income countries; but there is little existing literature on the detailed epidemiology, diagnosis, and treatment in low-resource settings. Special situations with vulnerable populations, such as those created by international humanitarian emergencies, refugees or internally displaced people, and victims of human trafficking, are increasing in prevalence. These victims are often resettled in developed countries and come to the emergency department seeking care. To better care for these populations, knowledge of specialized psychosocial and cultural considerations should inform the comprehensive psychiatric assessment and treatment plan.

Deployment of Medical Relief Teams of the Indian Army in the Aftermath of the Nepal Earthquake: Lessons Learned.

In April 2015 a 7.8-magnitude earthquake hit Nepal. As part of relief operations named Operation Maitri, the Indian Armed Forces deployed 3 field hospitals in the disaster zone. Rapid deployment of mobile surgical teams to far-flung, inaccessible areas was done by helicopters. In an operational deployment spanning 1 month, a total of 7532 patients were treated and 105 surgeries were carried out on 83 patients. One-fifth of the patients were less than 18 years of age. One-third of the patients had traumatic injuries directly attributable to the earthquake, whereas the remaining patients were treated for diseases of poor sanitation and hygiene as well as chronic illness that had been neglected owing to the collapse of the local health infrastructure. Cases of traumatic injuries directly related to the earthquake were seen maximally on the 5th day after the index event but tapered off rapidly by the 10th day. Nontraumatic illness required more attention thereafter and a need was felt for separate child health and reproductive health services later in the mission. Although immediate management of injuries and surgical intervention in selected cases was possible, ensuring long-term care and rehabilitation of cases proved problematic. This was especially so for spinal injury cases. Data capturing by a paper-based system was found to be inadequate. The lessons learned from this mission have led to a reimagining of the composition of future relief operations. Apart from mobile surgical teams, on which conventional field hospitals are generally centered, a separate section for preventive medicine and child and maternal services is needed. (Disaster Med Public Health Preparedness. 2017;11:394-398).

What Kinds of Skills Are Necessary for Physicians Involved in International Disaster Response?

UNLABELLED: Introduction Physicians are key disaster responders in foreign medical teams (FMTs) that provide medical relief to affected people. However, few studies have examined the skills required for physicians in real, international, disaster-response situations. Problem The objectives of this study were to survey the primary skills required for physicians from a Japanese FMT and to examine whether there were differences in the frequencies of performed skills according to demographic characteristics, previous experience, and dispatch situations to guide future training and certification programs. METHODS: This cross-sectional survey used a self-administered questionnaire given to 64 physicians with international disaster-response site experience. The questionnaire assessed demographic characteristics (sex, age, years of experience as a physician, affiliation, and specialty), previous experience (domestic disaster-relief experience, international disaster-relief experience, or disaster medicine training experience), and dispatch situation (length of dispatch, post-disaster phase, disaster type, and place of dispatch). In addition, the frequencies of 42 performed skills were assessed via a five-point Likert scale. Descriptive statistics were used to assess the participants' characteristics and total scores as the frequencies of performed skills. Mean scores for surgical skills, health care-related skills, public health skills, and management and coordination skills were compared according to the demographic characteristics, previous experience, and dispatch situations. RESULTS: Fifty-two valid questionnaires (81.3% response rate) were collected. There was a trend toward higher skill scores among those who had more previous international disaster-relief experience (P=.03). The more disaster medicine training experience the participants had, the higher their skill score was (P<.001). Physicians reported involvement in 23 disaster-relief response skills, nine of which were performed frequently. There was a trend toward higher scores for surgical skills, health care-related skills, and management and coordination skills related to more disaster medicine training experience. CONCLUSION: This study's findings can be used as evidence to boost the frequency of physicians' performed skills by promoting previous experience with international disaster relief and disaster medicine training. Additionally, these results may contribute to enhancing the quality of medical practice in the international disaster relief and disaster training curricula. Noguchi N , Inoue S , Shimanoe C , Shibayama K , Matsunaga H , Tanaka S , Ishibashi A , Shinchi K . What kinds of skills are necessary for physicians involved in international disaster response? Prehosp Disaster Med. 2016;31(4):397-406.

2015 Nepal Earthquake: Analysis of Child Rescue and Treatment by a Field Hospital.

OBJECTIVE: To retrospectively analyze the rescue and treatment of pediatric patients by the Chinese Red Cross medical team during the Nepal earthquake relief. METHODS: The medical team set up a field hospital; the pediatric clinic consisted of 1 pediatrician and several nurses. Children younger than 18 years old were placed in the pediatric clinic for injury examination and treatment. RESULTS: During the 7-day period of medical assistance (the second to third week after the earthquake), a total of 108 pediatric patients were diagnosed and treated, accounting for 2.8% of the total patients. The earthquake-related injuries mainly required surgical dressing and debridement. No severe limb fractures or traumatic brain injuries were found. Infection of the respiratory tract, the gastrointestinal tract, and the skin were the most common ailments, accounting for 42.3%, 18.5%, and 16.7%, respectively, of the total treated patients. CONCLUSION: Two to 3 weeks after the earthquake, the admitted pediatric patients mainly displayed respiratory and gastrointestinal infections. When developing a rescue plan and arranging medical resources, we should consider the necessity of treating non-disaster-related conditions. (Disaster Med Public Health Preparedness. 2016;page 1 of 4).

Injury Patterns After the Landslide Disaster in Oshima, Tokyo, Japan on October 16, 2013.

INTRODUCTION: Landslides represent a frequent and threatening natural disaster. The aim of this study was to investigate the injury patterns observed after a landslide and to discuss how to minimize the damage caused by a landslide disaster. METHODS: A landslide occurred on Oshima Island, Japan, on October 16, 2013. A total of 49 victims with landslide-related injuries were identified and analyzed. RESULTS: The patients ranged in age from 5 to 89 years with an average age of 61.0±19.3 years. Of all patients, 69.4% were triaged as black. Of 15 patients who were treated in the nearest hospital (the only hospital on the island), 8 were triaged as red and yellow with severe chest or pelvic injury and a high Injury Severity Score (average score, 25.6; range, 4-45). Of these, 75% had chest injury and 75% had pelvic injury. The percentage of chest and/or pelvic injury was 100% in patients triaged as red or yellow. Traumatic asphyxia was diagnosed in 62.5% of these patients. CONCLUSIONS: Compression of the trunk was the main injury in patients triaged as red or yellow after this landslide disaster. Evacuation in advance, the rapid launch of emergency medical support, and knowledge of this specific injury pattern are essential to minimize the potential damage resulting from landslide disasters.

Coping Behavior and Risk of Post-Traumatic Stress Disorder Among Federal Disaster Responders.

BACKGROUND: Our knowledge about the impact of coping behavior styles in people exposed to stressful disaster events is limited. Effective coping behavior has been shown to be a psychosocial stress modifier in both occupational and nonoccupational settings. METHODS: Data were collected by using a web-based survey that administered the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian, General Coping Questionnaire-30, and a supplementary questionnaire assessing various risk factors. Logistic regression models were used to test for the association of the 3 coping styles with probable PTSD following disaster exposure among federal disaster responders. RESULTS: In this sample of 549 study subjects, avoidant coping behavior was most associated with probable PTSD. In tested regression models, the odds ratios ranged from 1.19 to 1.26 and 95% confidence intervals ranged from 1.08 to 1.35. With control for various predictors, emotion-based coping behavior was also found to be associated with probable PTSD (odds ratio=1.11; 95% confidence interval: 1.01-1.22). CONCLUSION: This study found that in disaster responders exposed to traumatic disaster events, the likelihood of probable PTSD can be influenced by individual coping behavior style and other covariates. The continued probability of disasters underscores the critical importance of these findings both in terms of guiding mental health practitioners in treating exposed disaster responders and in stimulating future research.

Disaster Management and General Dental Practitioners in India: An Overlooked Resource.

OBJECTIVE: To assess General Dental Practitioners' (GDPs) in India willingness to participate in disaster management and their previous training pertaining to disaster management, and to assess GDP objective knowledge, attitude, and behavior regarding disaster management. MATERIALS AND METHODS: This study was a cross-sectional survey conducted on all GDPs of Jodhpur, Rajasthan, India. Willingness to participate, perceived knowledge, perceived effectiveness, objective knowledge, attitude, and behavior regarding disaster management were assessed through questionnaire method. Information also was collected regarding age, gender, religion, and residence. RESULTS: A total of 142 out of 180 GDPs participated in the study, representing a response rate of 79%. A majority (85%) of respondents were willing to participate in disaster management. Mean score for knowledge was 12.21%, for attitude was 33.56%, for behavior was 14.50%, and for perceived effectiveness was 9.08%. Significant correlations were observed between qualification and perceived effectiveness (P=.003), and between attitude and years of practice (P=.04). Willingness to participate in disaster management and age showed significant association (P=.000). CONCLUSIONS: High willingness and attitude to participate in disaster management was observed among respondents. Low knowledge and behavior scores were observed among GDPs.

Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Disaster Response App.

The Substance Abuse and Mental Health Services Administration (SAMHSA) in the Department of Health and Human Services offers extensive disaster behavior health resources to assist disaster survivors in preparing for, responding to, and recovering from natural and manmade disasters. One of SAMHSA's most innovative resources is the SAMHSA Behavioral Health Disaster Response App (SAMHSA Disaster App). The SAMHSA Disaster App prepares behavioral health responders for any type of traumatic event by allowing them to access disaster-related materials and other key resources right on their phone, at the touch of a button. The SAMHSA Disaster App is available on iPhone, Android, and BlackBerry devices.

Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities.

BACKGROUND: Surgeons in high-income countries increasingly are expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions. METHODS: A retrospective review of all surgical procedures performed at Médecins Sans Frontières Brussels facilities from June 2008 to December 2012 was performed. Individual data points included country of project; patient age and sex; and surgical indication and surgical procedure. RESULTS: Between June 2008 and December 2012, a total of 93,385 procedures were performed on 83,911 patients in 21 different countries. The most common surgical indication was for fetal-maternal pathologies, accounting for 25,548 of 65,373 (39.1%) of all cases. The most common procedure was a Cesarean delivery, accounting for a total of 24,182 or 25.9% of all procedures. Herniorrhaphies (9,873/93,385, 10.6%) and minor surgeries (11,332/93,385, 12.1%), including wound debridement, abscess drainage and circumcision, were also common. CONCLUSION: A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of Médecins Sans Frontières's operative procedures provides valuable insight into the types of operations with which an aspiring volunteer surgeon should be familiar.

[Trauma surgery catastrophe aid following the earthquake in Haiti 2010--a report on experiences: injury patterns, special challenges, prospects]. / Unfallchirurgische Katastrophenhilfe nach dem Erdbeben in Haiti 2010--Ein Erfahrungsbericht: Verletzungsmuster, besondere Herausforderung, Aussichten.

The earthquake in Haiti in January 2010 resulted in more than 220,000 deaths and over 300,000 injured and was one of the greatest mass casualties in recent history. "Doctors Without Borders" started a medical relief response immediately after the earthquake, building up to the biggest disaster relief activity in the organization's history. Roughly 173,000 medical consultations and more than 11,700 surgical interventions were performed in 26 medical facilities during the first 4 months. A particular challenge was the sheer number of patients in a situation with a completely destroyed medical infrastructure. While the initial phase mainly focused on life saving surgery, the second phase concentrated on reconstructive surgery of the extremities. Crucial for effective patient care is an ability to act early and employ surgical techniques which are adapted to the overall situation. The following article is a personal report of the early emergency response from the viewpoint of two orthopedic trauma surgeons, who have surgical careers in Germany and also frequently volunteer for "Doctors Without Borders".