The impact of avalanche rescue devices on survival

BACKGROUND

Within Europe and North America, the median annual mortality from snow avalanches between 1994 and 2003 was 141. There are two commonly used rescue devices: the avalanche transceiver, which is intended to speed up locating a completely buried person, and the avalanche airbag, which aims to prevent the person from being completely buried.

OBJECTIVE

This retrospective study aimed to evaluate whether these avalanche rescue devices had an effect on mortality.

METHODS

The study population was 1504 persons who were involved in 752 avalanches either in Switzerland from 1990 to 2000 and from 2002 to 2003 (1296 persons, 86.2%) or in Austria from 1998 to 2004 (208 persons, 13.8%).

RESULTS

Persons equipped with an avalanche airbag had a lower chance of dying (2.9% versus 18.9%; P=0.026, OR 0.09, n=1504). In persons who were completely buried, without visible or audible signs at the surface and who did not rescue themselves (n=317), we found a lower median duration of burial (25min versus 125min; P<0.001) and mortality (55.2% versus 70.6%; P<0.001, OR 0.26) in those using an avalanche transceiver than in those not using the device.

CONCLUSIONS

Our data showed that both the avalanche airbag and the avalanche transceiver reduce mortality. However, to improve the evaluation of rescue devices in the future, the data collection procedures should be reviewed and prospective trials should be considered, as the reliability of retrospective studies is limited.

Alternate site surge capacity in times of public health disaster maintains trauma center and emergency department integrity: Hurricane Katrina

BACKGROUND

Hospital surge capacity has been advocated to accommodate large increases in demand for healthcare; however, existing urban trauma centers and emergency departments (TC/EDs) face barriers to providing timely care even at baseline patient volumes. The purpose of this study is to describe how alternate-site medical surge capacity absorbed large patient volumes while minimizing impact on routine TC/ED operations immediately after Hurricane Katrina.

METHODS

From September 1 to 16, 2005, an alternate site for medical care was established. Using an off-site space, the Dallas Convention Center Medical Unit (DCCMU) was established to meet the increased demand for care. Data were collected and compared with TC/ED patient volumes to assess impact on existing facilities.

RESULTS

During the study period, 23,231 persons displaced by Hurricane Katrina were registered to receive evacuee services in the City of Dallas, Texas. From those displaced, 10,367 visits for emergent or urgent healthcare were seen at the DCCMU. The mean number of daily visits (mean +/- SD) to the DCCMU was 619 +/- 301 visits with a peak on day 3 (n = 1,125). No patients died, 3.2% (n = 257) were observed in the DCCMU, and only 2.9% (n = 236) required transport to a TC/ED. During the same period, the mean number of TC/ED visits at the region's primary provider of indigent care (Hospital 1) was 346 +/- 36 visits. Using historical data from Hospital 1 during the same period of time (341 +/- 41), there was no significant difference in the mean number of TC/ED visits from the previous year (p = 0.26).

CONCLUSIONS

Alternate-site medical surge capacity provides for safe and effective delivery of care to a large influx of patients seeking urgent and emergent care. This protects the integrity of existing public hospital TC/ED infrastructure and ongoing operations.

Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers

OBJECTIVE

This study compared the prevalence and risk factors of current probable posttraumatic stress disorder (PTSD) across different occupations involved in rescue/recovery work at the World Trade Center site.

METHOD

Rescue and recovery workers enrolled in the World Trade Center Health Registry who reported working at the World Trade Center site (N=28,962) were included in the analysis. Interviews conducted 2-3 years after the disaster included assessments of demographic characteristics, within-disaster and work experiences related to the World Trade Center, and current probable PTSD.

RESULTS

The overall prevalence of PTSD among rescue/recovery workers was 12.4%, ranging from 6.2% for police to 21.2% for unaffiliated volunteers. After adjustments, the greatest risk of developing PTSD was seen among construction/engineering workers, sanitation workers, and unaffiliated volunteers. Earlier start date and longer duration of time worked at the World Trade Center site were significant risk factors for current probable PTSD for all occupations except police, and the association between duration of time worked and current probable PTSD was strongest for those who started earlier. The prevalence of PTSD was significantly higher among those who performed tasks not common for their occupation.

CONCLUSIONS

Workers and volunteers in occupations least likely to have had prior disaster training or experience were at greatest risk of PTSD. Disaster preparedness training and shift rotations to enable shorter duration of service at the site may reduce PTSD among workers and volunteers in future disasters.

[Spectrum of patients in prehospital emergency services. What has changed over the last 20 years?]

BACKGROUND

In Germany the physician staffed emergency systems have announced an increase in rescue missions over the years. The aim of this study is to analyse the development of the spectrum of patients in an emergency system over the last 20 years in order to highlight the significant changes.

METHODS

In a retrospective study we analyzed the prehospital chart views from 2004, 1992 and 1984 with respect to patients' demography, type of rescue mission, degree of internal disease or injury (NACA), state of consciousness (GCS), as well as prehospital interventions performed by prehospital emergency physician.

RESULTS

In 2004 (3,825), the absolute number of missions was 2 and 4 times higher than 1992 (2,114) and 1984 (957), resp. In all of these investigated time periods non-trauma missions (74%; 2,812 vs. 66%; 1,390 vs. 51%; 485) were leading, followed by trauma missions (18%; 690 vs. 22%; 464 vs. 39%; 375), aborted missions (3%; 126 vs. 7%; 154 vs. 6%; 56), and dead on arrival (5%; 197 vs. 5%; 106 vs. 4%; 41). Although, the percentage of patients with NACA IV-VI (39% vs. 50%) or patients with GCS < or =8 (18% vs. 34%) was lower in 2004, the absolute number of patients in each category was higher than in 1984 (NACA IV-VI: 1,434 vs. 448, p<0.01; GCS: 672 vs. 303, p<0.01).

CONCLUSIONS

The results of this study demonstrate, that the percentage of trauma, severely ill/injured or unconscious patients is lower than in previous years. However, the higher absolute numbers of patients demonstrate that the emergency physician now encounters more critically ill/injured, unconscious and trauma patients. It does not seem necessary to question the qualifications for an emergency physician, which have previously been considered essential for the management of acute life-threatening situations.

How dangerous is BASE jumping? An analysis of adverse events in 20,850 jumps from the Kjerag Massif, Norway

BACKGROUND

Extreme sports, including BASE (building, antenna, span, earth) jumping, are rapidly increasing in popularity. Associated with risk for injuries and deaths, this activity may pose a burden on the emergency system. Hitherto, no reports exist on accidents and deaths associated with BASE jumping.

METHODS

We reviewed records of 20,850 BASE jumps from 1995 to 2005 at the Kjerag massif in Norway. Frequency of deaths, accidents, and involvement of helicopter and climbers in rescue are analyzed. Fatalities were scored for injury severity scores (Abbreviated Injury Scale score, Injury Severity Score, New Injury Severity Score) on autopsy.

RESULTS

During an 11-year period, a total of 20,850 jumps (median, 1,959; range, 400-3,000) resulted in 9 fatal (0.04% of all jumps; 1 in every 2,317 jumps) and 82 nonfatal accidents (0.4% of all jumps; 1 in every 254 jumps). Accidents increased with the number of jumps (r=0.66; p=0.007), but fatalities did not increase, nor did activation of helicopter or climbers in rescue (p>0.05). Helicopter activation (in one-third of accidents) in rescue correlated with number of accidents (r=0.76, p=0.007), but not climbers. Postmortem examination (n=7) of fatalities revealed multiple, severe injuries (Abbreviated Injury Scale score>or=3) sustained in several body regions (median, Injury Severity Score 75; range, 23-75). Most nonfatal accidents were related to ankle sprains/fracture, minor head concussion, or a bruised knee.

CONCLUSION

BASE jumping appears to hold a five- to eightfold increased risk of injury or death compared with that of skydiving. The number of accidents and helicopter activation increases with the annual number of jumps. Further analysis into the injury severity spectrum and associated hospital burden is required.

Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA

OBJECTIVE

To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study.

DESIGN AND SETTING

In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor.

PARTICIPANTS

Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination.

MAIN RESULTS

Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks.

CONCLUSIONS

The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.

Search and Rescue in Yosemite National Park: A 10-Year Review

OBJECTIVE

To describe the general characteristics and epidemiology of search and rescue (SAR) in Yosemite National Park (YNP) and identify possible areas for intervention directed at reduction in use of these services.

METHODS

Yosemite Search and Rescue (YOSAR) personnel record every search and rescue mission on a Search and Rescue Incident Report. The information contained in these reports was used to perform a retrospective review of all SAR missions within YNP during the 10-year study period between January 1990 and December 1999.

RESULTS

YOSAR performed 1912 SAR missions, assisting 2327 individuals and recording 2077 injuries and illnesses. Popular trails in and around Yosemite Valley collectively accounted for 25% of all individuals needing SAR services. Lower extremity injuries and dehydration/hypovolemia/hunger were commonly identified reasons to need SAR services. The duration of SAR missions averaged 5 hours, used 12 SAR personnel, and cost $4400. Helicopter was the primary mode of transport in 28% of SAR incidents. There were 112 fatalities, yielding a SAR case fatality rate of 4.8%. The majority of fatalities occurred while hiking/snowshoeing, with falling the most common mechanism of lethal injury.

CONCLUSIONS

Day-hikers in and around Yosemite Valley use a large portion of SAR services, with lower extremity injuries and dehydration/hypovolemia/hunger the most common reasons. It seems reasonable to direct future intervention to prevention of these commonly identified problems in this particular population of Park visitors.

The influence of a disaster on the health of rescue workers: a longitudinal study

BACKGROUND

Rescue workers strive, after disasters, to help victims and restrict damage, often in dangerous circumstances. We examined the effect of a disaster on the physical and psychological health of rescue workers (firefighters, police officers and medical emergency services personnel) who provided assistance after the explosion of a fireworks depot in the Netherlands in May 2000.

METHODS

We carried out a 4-year longitudinal study of 1403 rescue workers employed in or near the affected neighbourhood (the study group) and a control group of 1650 uninvolved rescue workers (from another city of similar size and urbanization). Health outcomes were measured as prevalence, incidence (both measured as the percent of workers who took sick leave), frequency of the absences and number of sick days (both per 100 workers), and duration (mean length of sickness absences, in days).

RESULTS

Sick leave among the study workers increased substantially during the 18 months after the explosion. For example, the prevalence of absences attributed to psychological problems increased from 2.5% of workers during the 6 months before the disaster to 4.6% during the first 6-month period after the explosion and 5.1% during the second. That for respiratory problems rose from 5.4% predisaster to 14.9% 6-12 months afterward. In comparison with controls, immediate increases occurred in musculoskeletal, psychological, respiratory and nonspecific ill health (e.g., malaise, fatigue) during the first year postdisaster. Rates of sick leave for musculoskeletal and respiratory reasons remained elevated until 3 years postdisaster, whereas leave for psychological problems and other ill health had returned to predisaster levels by then. Neurological problems increased after a 1-year delay. No significant increase in gastrointestinal problems was observed among the study workers, in comparison with controls.

INTERPRETATION

Many health problems arise immediately after a disaster and may persist for years. Health care workers should realize, however, that some disaster-related effects may not emerge until a year or more after the event.

Psychological distress among American Red Cross disaster workers responding to the terrorist attacks of September 11, 2001

This study investigated American Red Cross disaster workers' symptoms of distress and posttraumatic stress resulting from exposure to disaster stimuli during their response to the September 11, 2001 terrorist attacks. A sample of 3055 Red Cross disaster workers was surveyed 1 year after the terrorist attacks regarding demographic characteristics, function during the response, and exposure to disaster stimuli. Participants were grouped by function and self-reported exposure, with the hypothesis that workers in Direct Services and/or those reporting to be directly exposed to disaster stimuli would experience greater levels of posttraumatic stress symptoms and distress than workers in indirect services or reporting no exposure. Findings revealed that while there were significant differences between both Function and Exposure groups on dependent measures, the multivariate eta2 was very small for both and did not meet medium effect size criteria. The results indicated that workers directly exposed to disaster stimuli reported no more distress than those who were not directly exposed.

Psychological distress of rescue workers eight and one-half years after professional involvement in the Amsterdam air disaster

This study examined specific and general psychological distress 8.5 years following the 1992 cargo aircraft crash in Amsterdam. Participants included 334 occupationally exposed fire fighters and 834 occupationally exposed police officers compared with reference groups of 194 fire fighters and 634 police officers who were exposed to duty-related stressors other than the disaster. On the standardized instruments of psychological distress, exposed fire fighters reported more somatic complaints and fatigue, while exposed police officers reported higher psychological distress on all aspects. The degree and type of exposure at the disaster site and other background factors were associated with several outcomes of psychological distress levels of exposed rescue workers. The disasters' aftermath of rumors about potential health consequences due to toxic exposure likely contributed to the long-lasting psychological distress of some of the rescue workers as well.

Clinical forensic evidence in burns: rescuer burns

In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1-4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer. Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1--upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2--upper extremity/extremities and face involvement, Grade 3--upper extremity/extremities, face-neck, adjacent chest and lower extremity involvement.

A mental health program for ground zero rescue and recovery workers: cases and observations

Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.

Predictors of fatigue in rescue workers and residents in the aftermath of an aviation disaster: a longitudinal study

OBJECTIVES

Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents.

METHODS

A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up.

RESULTS

Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue.

CONCLUSIONS

These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Mental health service use among American Red Cross disaster workers responding to the September 11, 2001 U.S. terrorist attacks

In this article, we explored 1) the extent of mental health (MH) service use by American Red Cross disaster relief workers, both before (lifetime) and 1 year after the September 11, 2001 terrorist attacks, and 2) demographic, disaster and MH variables predicting (1-year) post-September 11 MH service use in this population. A sample of 3015 Red Cross disaster workers was surveyed 1 year after the attacks, regarding demographic characteristics, MH service use before and since the attacks, and posttraumatic stress disorder (PTSD) symptoms. Findings revealed that while 13.5% used MH services before the attacks, 10.7% used services after. Variables increasing the likelihood of MH service use after the attacks included the following: no previous MH treatment, younger age, being divorced/widowed, and higher PTSD intrusion or hyperarousal symptoms. Findings support other recent research on MH service use after the September 11 attacks.

Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period

OBJECTIVE

To study the influence of current trends in alpine sports on the frequency and types of injuries handled by a helicopter-based emergency medical system (HEMS) in a wilderness mountain region.

METHODS

A retrospective review of medical reports at a single emergency helicopter port (Christophorus-1 air rescue) in Innsbruck, Austria, was conducted for comparison between two 3-year periods (1998-2000 and 2001-2003).

RESULTS

Comparing the two 3-year periods, the proportion of leisure-time injuries leading to HEMS activation increased, whereas the frequency of life-threatening injuries significantly declined (P = .001). There was significant increase in injuries during mountain hiking and rock climbing (P = .002), during swimming (P = .013), and in avalanches (P = .019). Most injuries (70.1%) were recorded for skiers, and 68.3% involved tourists. During the investigation period, the high National Advisory Committee of Aeronautics scores showed a decreasing trend, whereas Glasgow Coma Scale scores and low National Advisory Committee of Aeronautics scores tended to increase (P = .048).

CONCLUSIONS

For the HEMS in this study, there has been an increasing number of calls for help from persons involved in outdoor leisure activities. As the number of life-threatening injuries declines, HEMSs more frequently serve as means of rescue rather than as providers of emergency treatment.

Fatalities among volunteer and career firefighters--United States, 1994-2004

Approximately 800,000 firefighters in the United States are volunteer firefighters and 300,000 are career firefighters. Volunteer firefighters primarily serve communities with fewer than 25,000 inhabitants, whereas most career firefighters serve communities of more than 25,000 persons. To characterize fatalities among volunteer and career firefighters, CDC analyzed data from the U.S. Fire Administration (USFA). This report summarizes the results of that analysis and, to illustrate the most common types of volunteer and career firefighter fatalities, describes two cases investigated by the National Institute for Occupational Safety and Health (NIOSH) Firefighter Fatality Investigation and Prevention Program. Fifty-three percent (610 of 1,141) of U.S. firefighters who died while on duty during 1994-2004 were volunteers, and 32% (368) were career firefighters. The remaining 15% (163) of deaths were among other firefighters (e.g., wildland, paid on-call, and part-time paid firefighters). Among volunteer firefighters, sudden cardiac death (e.g., from myocardial infarction or arrhythmia) and motor vehicle (MV) crashes during emergency response were the leading causes of fatality. Among career firefighters, sudden cardiac death and asphyxiation were leading causes of death. Adoption and enforcement of existing fire-service recommendations regarding fitness standards, mandatory medical evaluations with appropriate work restrictions, and emergency vehicle response protocols are needed to prevent these fatalities among firefighters.

Assessment of major and minor events that occurred in Italy during the last century using a Disaster Severity Scale score

INTRODUCTION

Epidemiological research about disasters is difficult to perform. Most often, it must be completed retrospectively, since data collection may not be feasible or possible during the disaster. Now, there is a recognized need for a standard method to assess the severity of a disaster.

OBJECTIVES

The aim of this paper is to assess the severity of the disasters that occurred in Italy during the 20th century, using a Disaster Severity Scale (DSS). Another goal is to find a standard method for the classification of previous disasters, test the feasibility and reliability of the use of the DSS, and improve disaster management and planning.

METHODS

Data were obtained from formal reports of the Civil Defence Unit (Italy) and were used to calculate the DSS score. Disasters were classified into major and minor disasters, according to the numbers of deaths and severity of the damage. The number of deaths was compared with the obtained DSS score. A seasonal trend for different types of events was obtained to assess if there is a relationship between the type of event and the time of the year in which it occurred, as related to the weather conditions existing at that time.

RESULTS

There were enough data to calculate a DSS score for 26 major events that caused death and economic damage, and occurred in Italy between 18 March 1944 and 11 November 1999, and for 82 minor events, that occurred between October 1982 and December 1999. There were some significant peaks varying from different types of events during particular seasons, but the cause for those with the highest incidence is not clear. Events related to natural hazards were the only type of event that reached the highest DSS when considering the number of deaths, while no events associated with man-made hazards had a DSS score >8.

CONCLUSION

The DSS score could be a reliable index for the assessment of events related to either natural or man-made disasters. Use of the DSS allows researchers to classify previous hazards by scoring each disaster's severity. Further studies in other countries could be useful to further validate the DSS.

Policemen and firefighters have increased risk for type-2 diabetes mellitus probably due to their large body mass index: a follow-up study in Japanese men

BACKGROUND

Policemen/firefighters may have increased risk for mortality from ischemic heart disease and from all causes. We compare incidence of type-2 diabetes mellitus (DM), a well-known predictor for mortality, in policemen/firefighters with that in two other worker-groups.

METHODS

A follow-up study of 5,130 healthy Japanese men aged 30-49 years at baseline consisted of three worker-groups; 3,111 clerical workers, 1,122 manual/production and transport/communication workers, and 897 policemen/firefighters. Incident DM was identified by "fasting serum glucose >or=7.00 mmol/L" or/and "under medical treatment for DM." Hazard ratio (HR) and 95% confidence interval (95% CI) for incident DM was estimated by Cox's proportional hazard models using clerical workers as a reference group (HR=1.00). Baseline age, body mass index (BMI, kg/m(2)), drinking, smoking, exercise, and education were computed as confounders.

RESULTS

During mean follow-up periods of 8.4 years, 155 clerical workers, 51 manual/production and transport/communication workers, and 74 policemen/firefighters had incident DM (5.9, 5.7, and 9.6 per 1,000 person-years, respectively; P=0.001 by chi(2)-test). Policemen/firefighters had significantly increased risk for incident DM against clerical workers (age-adjusted HR (95% CI): 1.65 (1.25, 2.18)), but the significance disappeared after adjustments for BMI (age- and BMI-adjusted HR (95% CI): 1.16 (0.87, 1.54)). Manual/production and transport/communication workers had no increased risk.

CONCLUSIONS

Policemen/firefighters have increased risk for DM probably due to their large BMI. Body weight control may be more efficient for prevention of DM and DM-related health problems in policemen/firefighters than in other workers.

Analysis of the pre-incident education and subsequent performance of emergency medical responders to the Volendam caf?? fire

OBJECTIVE

At this moment, in the Netherlands, rescue workers are not given any specific standardized training in disaster response or disaster management. After the café fire in Volendam, the Netherlands, on New Year's Eve 2000, around 200 rescue workers were deployed on-site. The aim of this study is to investigate the rescue workers' experiences with regard to their level of preparation for the emergency response.

METHODS

In 2002, 30 members of the medical and paramedical personnel were requested to participate in a structured interview, focused on education, task perception, triage and registration.

RESULTS

Twenty-seven participated. Twenty-two rescue workers received previous training in emergency medicine. During the alarm phase, 11 rescue workers had a clear perception of their tasks. Twenty-four were involved in triage and injury assessment. Three rescue workers used a protocol for triage and 15 for injury assessment. Twenty-five rescue workers gave on-scene treatment and 15 used a protocol. Eight registered their findings.

CONCLUSIONS

Preparation for the emergency response lacked standardized procedures. The use of triage protocols was extremely poor, as was documentation of actions. Slightly more than half of the personnel followed treatment protocols. It is advisable that all rescue workers become familiar with the basic uniform principles and protocols regarding disaster management. A dedicated and standardized national disaster management course is needed for all rescue workers.

Communication and health protection issues arising from a flooding emergency

OBJECTIVE

To identify and describe the key communication and health protection issues surrounding a flooding emergency.

METHODS

A telephone questionnaire was used to assess health and safety information sources, information recalled, and behavioral responses among residents of the town of Feilding, New Zealand following a major flood in February 2004. This was supplemented by key informant interviews and a newspaper content analysis.

RESULTS

A total of 154 adult residents were surveyed (76% of those successfully contacted and eligible). Of the respondents, 79% recalled being provided with health and safety information from authorities. The major sources were: radio (41%), pamphlets (23%), and newspapers (20%). The regional newspaper had extensive coverage of this flooding emergency but "health" only was mentioned in 46 (7%) of the 664 flood-related articles. Of those who recalled receiving information from authorities, most (89%) perceived that it was adequate. Nevertheless, 18% actively sought out information (mainly about water safety and availability). In the post-flood period, 73% of all respondents boiled water; however, only 4% maintained boiling water or bottled water use for the necessary nine-week period. Some forms of emergency preparations did not change substantially from before the flood, compared to four months afterwards (e.g., having a radio with batteries increased from 62% to 68%). Perceived health concerns around the flooding were low, though 59% were concerned about the risk of water contamination. Actual self-reported, health consequences from the flood were rare, as only two (1%) people out of 154 reported flood-related health problems.

CONCLUSIONS

Health and safety information generally was communicated successfully and was regarded as appropriate by the population of this flood-affected town. Nevertheless, there are further improvements needed in the emergency response by both residents and authorities.

Psychological consequences of the Bam earthquake on professional and nonprofessional helpers

This study compared the psychological status of rescue personnel who had formal training (Red Crescent workers, i.e., Red Cross workers, and firefighters) with university student volunteers who had no formal training in handling traumatic situations in the Bam earthquake. One hundred student volunteers, 18 Red Crescent workers, and 36 firefighters participated in this study. Participants completed the Civilian Mississippi Scale, the General Health Questionnaire (GHQ-28), and the Anxiety Sensitivity Index. Helpers without formal training showed higher scores on posttraumatic stress disorder (PTSD) and GHQ subscales compared to trained rescue personnel. In addition, a significant number of volunteers without formal training met criteria for a possible PTSD diagnosis by scoring above the cut-off point for the Mississippi scale. Those who had higher scores on the Anxiety Sensitivity Index showed greater adverse psychological effects.

Risk and resilience in canine search and rescue handlers after 9/11

Research has suggested that rescue workers are at increased risk for psychological distress. To determine whether 9/11 deployment was a significant risk factor for canine search and rescue handlers, 82 deployed handlers were compared to 32 nondeployed handlers on measures of posttraumatic stress disorder (PTSD), depression, anxiety, acute stress, and clinical diagnoses. Deployed handlers reported more PTSD and general psychological distress 6 months after 9/11. Among deployed handlers, prior diagnoses and peritraumatic reactions were associated with psychological distress whereas social support and training were protective. Results suggest that more extensive screening and prophylactic interventions for individuals with a history of mental illness could be beneficial. Future research should examine identified risk/resilience factors prospectively, and training and intervention should be designed accordingly.

Identification and posttraumatic stress disorder symptoms in rescue workers in the Marmara, Turkey, earthquake

After the 1999 Marmara Turkey earthquake, 434 volunteer rescue workers and 154 soldiers who were control subjects completed the Questionnaire for Identification with Deceased Victims and the Impact of Event Scale-Revised (IES-R). Identification with the Deceased as Oneself, Identification with the Deceased as a Friend, Identification with the Deceased as a Family Member, and IES-R Intrusion, Avoidance, and Hyperarousal subscale scores were significantly higher in rescue workers. Identification-Self, Identification-Friend, and Identification-Family correlated with the IES-R subscale and total scores. The set of identification variables was significantly associated with group membership before, but not after, IES-R scores were controlled. Findings suggest that identification with deceased victims, not rescue work per se, is the risk factor of concern for posttraumatic stress disorder in rescue workers.

A Survey of Emergency Medical Services in Mountain Areas of Europe and North America

Survey of on-site treatment of patients in mountain areas of 14 countries in Europe and North America (nonresponder rate 33%) to compare emergency medical services. Around 37,535 ground rescuers and 747 helicopters are ready for evacuation of casualties and patients in mountain areas. And 1316 physicians and 50,967 paramedics take part in ground and air mountain rescue operations. In Europe, 63.2% of helicopters have a physician on board, 17.8% are staffed with a paramedic, and 19% have no medically trained personnel on board. In North America, 31.6% (p < 0.001) of helicopters are staffed with a doctor, 59.3% (p < 0.001) with a paramedic, and 9.1% (p < 0.001) have no medical personnel. The percentage of on-site treatment according to the recommendations of the International Liaison Committee on Resuscitation (ILCOR) or International Commission for Alpine Rescue (ICAR) varies among all countries (p < 0.001) and is positively related to the percentage of physician-staffed helicopters (r = 0.76, p < 0.001). Paramedics in 90.9% countries are obliged to be medically trained, but physicians only need to have a standardized training in emergency medicine in 50% (p < 0.042). On-site treatment according to ILCOR or ICAR recommendations is performed more often in countries where physicians are regularly involved in mountain rescue operations. However, no conclusions can be drawn from the data as to the efficiency of treatment. The data show a lack of medical education in specific, mountain rescue-related problems. Physicians involved should undergo suitable training.

Pulmonary disease in rescue workers at the World Trade Center site

PURPOSE OF REVIEW

The catastrophic collapse of the World Trade Center (WTC) towers on September 11, 2001 created a large-scale disaster site in a densely populated urban environment. Over the ensuing months, tens of thousands of rescue, recovery and cleanup workers, volunteers, and residents of the adjacent community were exposed to a complex mixture of airborne pollutants. This review focuses on currently described respiratory syndromes, symptoms, and physiologic derangements in WTC rescue, recovery, and cleanup workers, discusses potential long-term effects on respiratory health, and draws parallels to community findings.

RECENT FINDINGS

Detailed qualitative and quantitative analyses of airborne pollutants with their changing composition during initial rescue/recovery and subsequent cleanup have been published. Major concerns include persistent aerodigestive tract inflammatory syndromes, such as reactive airways dysfunction syndrome (RADS), reactive upper airways dysfunction syndrome (RUDS), gastroesophageal reflux disease (GERD), and inflammatory pulmonary parenchymal syndromes, as well as respiratory tract and nonrespiratory malignancies. Aerodigestive tract inflammatory syndromes have now been documented in WTC exposed occupational groups, and syndrome incidence has been linked to WTC airborne pollutant exposure intensity. Community based investigations have yielded similar findings.

SUMMARY

While it is too early to ascertain long-term effects of WTC dust exposure, current studies already demonstrate a definite link between exposure to WTC-derived airborne pollutants and respiratory disease, both in the occupational and the community setting. A better understanding of causes and effects of this exposure will help in developing appropriate preventative tools for rescue workers in future disasters.