Tornado injuries related to housing in the Plainfield tornado.

BACKGROUND: On 28 August 1990, a tornado in Will County, Illinois, caused 29 deaths and more than US $200 million in damage. Risk factors for impact-related morbidity and mortality were studied. METHODS: A case-control study was conducted of 26 people hospitalized or killed, and 116 injured, randomly selected people who were in houses damaged by the tornado. To obtain information on study subjects, telephone interviews were conducted, and hospital records, coroners' reports, and American Red Cross records were abstracted. Structural details on houses were collected from tax assessor records. RESULTS: Cases were more likely than controls to have been in multistorey houses than in single-storey houses (OR = 3.9; 95% CI: 1.2-13.2). The risk associated with houses built after 1972 (OR = 7.9) and those built from 1962 to 1972 (OR = 2.2) was greater than for those built before 1962 (OR = 1.0; chi 2 for trend = 12.1; P < 0.01). Being in the basement when the tornado hit was protective (OR = 0.1; 95% CI: 0.0-0.4). CONCLUSIONS: One-storey houses were safer than multistorey houses, and basements were safer than other rooms. The association of risk with the construction date of the house is a new finding and should be examined in further studies.

Issues of rescue and medical care following the 1988 Armenian earthquake.

On-site emergency care and rescue efforts may be critical in preventing disability and other serious consequences of disasters. In this report we compare efforts used in the rescue and emergency medical care of 189 people (case subjects) from Kumairy (Leninakan), Armenia, who were hospitalized with serious injuries following the Armenian earthquake of 7 December 1988, with efforts used in helping 68 people (controls) from Kumairy with mild injuries who were not hospitalized. We used a standardized interview questionnaire to ascertain the circumstances of entrapment, the rescue process used, the injuries the victims sustained, and the medical care they received. Case and control subjects shared similar social and demographic characteristics; however, case subjects waited longer to be rescued and to receive medical care than did control subjects. Of the people who said they were trapped, 66.2% of the case subjects and 41.2% of the control subjects said that they were trapped for > 1 hour (odds ratio [OR] = 2.79, 95% confidence interval [CI]: 1.52-5.13) whilst the OR for > 6 hours of entrapment was 3.88 (95% CI: 1.69-9.10). Of those requiring medical care, 28.6% of people who were hospitalized waited > 1 hour after rescue to receive medical care, compared with only 14.7% of the control subjects (OR = 2.32, 95% CI: 1.05-5.23). In addition to the case-control study, we collected data on general characteristics of the rescue and emergency medical care process. We found that most of the trapped people were rescued by untrained local inhabitants who most often used their hands or simple tools.(ABSTRACT TRUNCATED AT 250 WORDS)

Deaths and injuries due to the earthquake in Armenia: a cohort approach.

BACKGROUND: This is the first population-based study of earthquake injuries and deaths that uses a cohort approach to identify factors of high risk. As part of a special project that collected data about the population in the aftermath of the earthquake that hit Northern Armenia on 7 December 1988, employees of the Ministry of Health working in the earthquake zone on 7 December 1988, and their families, were studied as a cohort to assess the short and long term impact of the disaster. The current analysis assesses short term outcomes of injuries and deaths as a direct result of the earthquake. METHODS: From an unduplicated list of 9017 employees, it was possible to contact and interview 7016 employees or their families over a period extending from April 1990 to December 1992. The current analysis presents the determinants of 831 deaths and 1454 injuries that resulted directly from the earthquake in our study population of 32,743 people (employees and their families). RESULTS: Geographical location, being inside a building during the earthquake, height of the building, and location within the upper floors of the building were risk factors for injury and death in the univariate analyses. However, multivariate analyses, using different models, revealed that being in the Spitak region (odds ratio [OR] = 80.9, 95% confidence interval [CI]: 55.5-118.1) and in the city of Gumri (OR = 30.7, 95% CI: 21.4-44.2) and inside a building at the moment of the earthquake (OR = 10.1, 95% CI: 6.5-15.9) were the strongest predictors for death. Although of smaller magnitude, the same factors had significant OR for injuries. Building height was more important as a factor in predicting death than the location of the individual on various floors of the building except for being on the ground floor of the building which was protective. CONCLUSIONS: Considering that most of the high rise buildings destroyed in this earthquake were built using standard techniques, the most effective preventive effort for this disaster would have been appropriate structural approaches prior to the earthquake.

Disaster epidemiology: challenges for public health action.

Better epidemiologic knowledge of the causes of death and types of injuries and illnesses caused by disasters is clearly essential to determine appropriate relief supplies, equipment and personnel needed to respond effectively to such situations. The overall objective of disaster epidemiology is to scientifically measure and describe the health effects of disasters and contributing factors to these effects, with the goals of assessing the needs of disaster-affected populations, efficient matching of resources to needs, further prevention of adverse health effects, evaluation of program effectiveness, and contingency planning. In addition, the epidemiologist has an important role to play in providing informed advice about the probable health effects which may arise in the future, in establishing priorities for action and in emphasizing the need for accurate information as the basis for relief decisions. This presentation outlines a number of important areas where epidemiologists can contribute to making disaster management more effective.

Natural disasters.

This article presents the health effects of some of the more important acute natural disasters and outlines requirements for effective medical response to these events (table 7). In summary, although all disasters are unique in that they affect regions of the world with differing social, economic, and health backgrounds, there are similarities among disasters, which, if recognized can optimize the management of health relief and the use of resources.

Fatality management in mass casualty incidents.

Medical involvement in mass casualty incidents requires proper planning and preparedness. In disaster situations, legal aspects concerning the dead add to the general problem of a lack of time, place and resources to maintain routine working conditions, and demand authority and competence. The aspects of planning the recovery of the dead, transportation and morgue facilities, establishment of cause of death, identification, and the final disposition of the dead are discussed. The implementation of forensic mass fatality teams is felt to be the right answer for a better planning and coordination.

Disaster epidemiology.

Sound epidemiologic knowledge of the morbidity and mortality caused by disasters is essential when determining what relief supplies, equipment, and personnel are needed to respond effectively in emergency situations. All disasters are unique because each affected region of the world has different social, economic, and baseline health conditions. Some similarities exist, however, among the health effects of different types of disasters, that if recognized, can ensure that the limited health and medical resources of the affected community are well managed.

The public health consequences of disasters.

Although disasters have exacted a heavy toll of death and suffering, the future seems more frightening. Good disaster management must link data collection and analysis to the decision-making process. The overall objectives of disaster management from the viewpoint of public health are: 1) needs assessments; 2) matching available resources with defined needs; 3) prevention of further adverse health effects; 4) implementation of disease-control strategies; 5) evaluation of the effectiveness of the application of these strategies; and 6) improvement in contingency planning for future disasters. The effects of sudden-onset, natural disasters on humans are quantifiable. Knowledge of the epidemiology of deaths, injuries, and illnesses is essential to determine effective responses; provide public education; establish priorities, planning, and training. In addition, the temporal patterns for the medical care required must be established so that the needs in future disasters can be anticipated. This article discusses: 1) the nature of disasters due to sudden-onset, natural events; 2) the medical and health needs associated with such events and disasters; 3) practical issues of disaster responses; and 4) the advance organization and management of disasters. The discussion also includes: 1) discussions of past problems in disaster management including non-congruence between available supplies and the actual needs of the affected population; 2) information management; 3) needs assessments; 4) public health surveillance; and 5) linking information with decision-making. This discussion is followed by an analysis of what currently is known about the health-care needs during some specific types of sudden-onset, natural disasters: 1) floods; 2) tropical cyclones; 3) tornadoes; 4) volcanic eruptions; and 5) earthquakes. The article concludes with descriptions of some specific public-health problems associated with disasters including epidemics and disposition of corpses. All natural disasters are unique in that the regions affected have different social, economic, and health backgrounds. But, many similarities exist, and knowledge about these can ensure that the health and emergency medical relief and limited resources are well-managed.

Haitian mass migration: Uniformed Service medical support, May 1992.

Beginning in November 1991, the United States Department of Defense established a Joint Task Force (JTF) to deal with the mass migration of Haitians. During the next 9 months, pending a determination of their immigration status, 34,000 Haitians were managed by uniformed service personnel at a temporary camp facility at the U.S. Naval Base in Guantanamo Bay, Cuba. To meet the urgent clinical and public health needs of this population, the JTF developed a camp medical system. This article describes the system of uniformed service medical support for the Haitians at the Guantanamo Bay facility during May 1992, the busiest month of the operation, when 11,400 Haitians (34% of the total) arrived.

Evaluating a fluorosis hazard after a volcanic eruption.

The August, 1991 eruption of Mt. Hudson (Chile) deposited ash across southern Argentina and contributed to the deaths of thousands of grazing sheep. Early ash analysis revealed high levels of fluoride, a potential ash constituent toxic to humans and animals. In order to evaluate fluorosis as the cause of sheep deaths and to examine the possibility that similar ash and airborne toxins could also have an effect on the human population, we conducted an investigation that included health provider interviews, hospital record review, physical examination of sheep, determination of sheep urine fluoride levels, and complete constituent analysis of ash samples collected at proscribed distances from the volcano. Ash deposited farthest from the volcano had highest fluoride levels; all fluoride measurements were normal after rainfall. There were no signs or symptoms of fluorosis observed in sheep or humans. Sheep deaths resulted from physical, rather than chemical properties of the ash.

The 1988 earthquake in soviet armenia: implications for earthquake preparedness.

An earthquake registering 6.9 on the Richter scale hit the northern part of the Armenian Republic of the Soviet Union on 7 December 1988, resulting in thousands of deaths and injuries. The majority of these resulted from the collapse of inadequately designed and constructed buildings. Analysis of the effects of the Armenian earthquake on the population, as well as of the rescue and medical response, has strong implications for earthquake preparedness and response in other seismically vulnerable parts of the world. Specifically, this paper will recommend a number of important endeavours deemed necessary to improve medical planning, preparedness and response to earthquakes. Strengthening the self-reliance of the community in disaster preparedness is suggested as the best way to improve the effectiveness of relief operations. In earthquake-prone areas, training and education in basic first aid and methods of rescue should be an integral part of any community preparedness programme.

Acute renal failure in natural disasters.

Sudden-impact natural disasters such as earthquakes present a serious challenge to medical personnel in both developed and less developed countries. Crush syndrome with acute renal failure has been identified as a major medical complication that occurs among people whose limbs are trapped by heavy objects during natural disasters such as earthquakes or volcanic eruptions. Rescue and field medical teams should be trained to recognize and promptly treat the problems associated with prolonged limb compression and should carry the appropriate fluids and medications to treat the complications of traumatic rhabdomyolysis. Early, aggressive volume replacement followed by forced solute-alkaline diuresis therapy may protect the kidney against acute renal failure. Better epidemiologic knowledge of the specific disaster conditions that predispose traumatic rhabdomyolysis to develop is clearly essential for those who must determine when emergency dialysis services are required in response to injuries sustained during natural disasters. Disaster health care personnel involved with providing emergency acute renal care should have a basic familiarity with disaster epidemiology in order to determine whether a given event requires their intervention. This paper includes recommendations for improving medical planning, preparedness, and response to natural disasters that cause acute renal failure.

Aseptic knee effusion associated with calcified guinea worms.

Reported is a case of aseptic knee effusion associated with the presence of a calcified guinea worm, Dracunculus medinensis, in close proximity to the joint. The patient, a native of Nigeria, presented with chronic right knee pain and swelling. He did well with symptomatic treatment including non-steroidal antiinflammatory drugs, rest, ice, and elevation of the leg. Dracunculiasis is prevalent in parts of Asia and Africa, but has been described only rarely in the United States.

Analysis of medical needs during disasters caused by tropical cyclones: anticipated injury patterns.

This paper is a summary of the data for describing the distribution of injuries among people affected by tropical cyclones that have occurred during the past 20 years. The most striking feature of the data gathered from a review of the epidemiologic literature on tropical cyclones is its lack of uniformity. The absence of an international classification and coding scheme for recording injuries sustained in cyclones also makes planning medical assistance difficult following future cyclones and hurricanes. We propose here a simple injury classification scheme comprising three components for categorizing injury data. Such a standardized disaster injury classification scheme, coupled with other types of information about injuries, will greatly aid relief officials in efficiently matching available resources to needs, in effectively managing health relief operations, and in developing strategies to prevent future cyclone-related morbidity and mortality.

Disaster epidemiology and disease monitoring.

Better epidemiologic knowledge of the mechanisms of death and of the types of injuries and illnesses caused by disasters is clearly essential to determining the appropriate relief medications, supplies, equipment, and personnel needed to effectively respond to such emergencies. The overall objective of disaster epidemiology is to measure scientifically and describe the health effects of disasters and the factors contributing to these effects. The results of such investigations allow disaster epidemiologists to assess the needs of disaster-affected populations, efficiently match resources to needs, prevent further adverse health effects, evaluate relief effectiveness, and plan for future disasters.