Crisis intervention following disasters: are we doing enough? (A second look)

Medical complications associated with earthquakes

Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality. Here, we review and summarise earthquake-induced injuries and medical complications affecting major organ systems.

Emergency telepsychiatry

Telepsychiatry can be used in two kinds of psychiatric emergencies: one-time clinical events and public health situations associated with mass disaster. Emergency telepsychiatry delivered by videoconferencing has the potential to improve patient care in many settings. Although experience is limited, it has been found to be safe and effective, as well as satisfactory to both emergency department staff and the psychiatric patients treated. The development of comprehensive and standardized guidelines is necessary. There has been little use of acute telemedicine in disaster situations to date. However, telemedicine is becoming part of routine emergency medical response planning in many jurisdictions. Emergency telepsychiatry has the potential to reduce emergency department overcrowding, provide much needed care in rural areas and improve access to psychiatric care in the event of a natural or man-made disaster.

Critical incident stress and challenges for the emergency workplace

A formal response to all levels of critical incidents that are potentially psychologically disturbing is needed. This response is needed for small-scale and large-scale incidents, such as natural or manmade disasters. Health care providers at all levels should be encouraged to participate in wellness programs and to understand workplace stressors. Critical incident stress debriefing teams have a valuable role in preventing posttraumatic stress disorder. Procedures for establishing response teams are presented, and future directions are discussed.