A
NATIONAL SURVEY OF STRESS REACTIONS AFTER THE SEPTEMBER 11, 2001
TERRORIST ATTACKS
(N Engl J Med 2001;345:1507-12)
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| Background People who are not present at a traumatic
event may experience stress reactions. We assessed the immediate mental
health effects of the terrorist attacks on September 11, 2001. |
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| Methods Using random-digit dialing three to five
days after September 11, we interviewed a nationally representative
sample of 560 U.S. adults about their reactions to the terrorist attacks
and their perceptions of their children's reactions. |
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| Results Forty-four percent of the adults reported
one or more substantial symptoms of stress; 90 percent had one or
more symptoms to at least some degree. Respondents throughout the
country reported stress symptoms. They coped by talking with others
(98 percent), turning to religion (90 percent), participating in group
activities (60 percent), and making donations (36 percent). Eighty-four
percent of parents reported that they or other adults in the household
had talked to their children about the attacks for an hour or more;
34 percent restricted their children's television viewing. Thirty-five
percent of children had one or more stress symptoms, and 47 percent
were worried about their own safety or the safety of loved ones. |
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| Conclusions After the September 11 terrorist
attacks, Americans across the country, including children, had substantial
symptoms of stress. Even clinicians who practice in regions that are
far from the recent attacks should be prepared to assist people with
trauma-related symptoms of stress. |
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Hospital
preparedness for weapons of mass destruction incidents: An initial
assessment
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| Study Objective: We performed an assessment of
hospital preparedness for weapons of mass destruction (WMD) incidents
in Federal Emergency Management Agency (FEMA) Region III. |
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| Methods: Interviews of hospital personnel
were completed in 30 hospitals. Data collected included level of preparedness,
mass decontamination capabilities, training of hospital staff, and
facility security capabilities. |
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Results: No respondents believed
their sites were fully prepared to handle a biologic incident, 73%
(22/30) believed they were not prepared to manage a chemical weapons
incident, and 73% believed they were unprepared to handle a nuclear
event. If a WMD incident were to occur, 73% of respondents stated
a single-room decontamination process would be set up. Four (13%)
hospitals (all rural) reported no decontamination plans. WMD preparedness
had been incorporated into hospital disaster plans by 27% (8/30) of
facilities. Eighty-seven percent (26/30) believed their emergency
department could manage 10 to 50 casualties at once. Only 1 facility
had stockpiled any medications for WMD treatment. All facilities had
established networks of communication. No hospital had preprepared
media statements specific to WMD. Nearly one fourth (7/30) stated
that their hospital staff had some training in WMD event management.
All reported need for WMD-specific training but identified obstacles
to achieving this. Seventy-seven percent (23/30) of hospitals had
a facility security plan in place, and half were able to perform a
hospital-wide lock down. Ninety-six percent (29/30) reported no awareness
regarding the threat of a secondary device.
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| Conclusion: Hospitals in this sample do not appear
to be prepared to handle WMD events, especially in areas such as mass
decontamination, mass medical response, awareness among health care
professionals, health communications, and facility security. Further
research is warranted, including a detailed assessment of WMD preparedness
using a statistically valid sample representative of hospital emergency
personnel at the national level. [Treat KN, Williams JM, Furbee PM,
Manley WG, Russell FK, Stamper CD Jr. Hospital preparedness for weapons
of mass destruction incidents: an initial assessment. Ann Emerg Med.
November 2001;38:562-565.] |
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Comparative
analysis of multiple-casualty incident triage algorithms
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| Study Objective: We sought to retrospectively
measure the accuracy of multiple-casualty incident (MCI) triage algorithms
and their component physiologic variables in predicting adult patients
with critical injury. |
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| Methods: We performed a retrospective review
of 1,144 consecutive adult patients transported by ambulance and admitted
to 2 trauma centers. Association between first-recorded out-of-hospital
physiologic variables and a resource-based definition of severe injury
appropriate to the MCI context was determined. The association between
severe injury and Triage Sieve, Simple Triage and Rapid Treatment,
modified Simple Triage and Rapid Treatment, and CareFlight Triage
was determined in the patient population. |
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| Results: Of the physiologic variables, the Motor
Component of the Glasgow Coma Scale had the strongest association
with severe injury, followed by systolic blood pressure. The differences
between CareFlight Triage, Simple Triage and Rapid Treatment, and
modified Simple Triage and Rapid Treatment were not dramatic, with
sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85%
(95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and
specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%),
and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve
were significantly poorer predictors of severe injury. |
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| Conclusion: Of the physiologic variables used
in the triage algorithms, the Motor Component of the Glasgow Coma
Scale and systolic blood pressure had the strongest association with
severe injury. CareFlight Triage, Simple Triage and Rapid Treatment,
and modified Simple Triage and Rapid Treatment had similar sensitivities
in predicting critical injury in designated trauma patients, but CareFlight
Triage had better specificity. Because patients in a true mass casualty
situation may not be completely comparable with designated trauma
patients transported to emergency departments in routine circumstances,
the best triage instrument in this study may not be the best in an
actual MCI. These findings must be validated prospectively before
their accuracy can be confirmed. [Garner A, Lee A, Harrison K, Schultz
CH. Comparative analysis of multiple-casualty incident triage algorithms.
Ann Emerg Med. November 2001;38:541-548.] |
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Disaster
epidemiology and medical response in the Chi-Chi earthquake in Taiwan
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| Study Objective: We examine the mortality and
morbidity associated with earthquakes in the Chi-Chi earthquake in
Taiwan in 1999. |
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| Methods: Crude casualty data were collected from
the reports of the government, local health bureaus, and 97 hospitals.
The demographic data from the annual report of the Department of Interior
were also employed for data analysis. Cross tables showing incidence
of deaths and injuries by age, sex, time, and geographic distribution
were generated to compare the mortality among different subgroups.
Multiple regression models were established to explore the risk factors
related to the mortality caused by earthquakes. |
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| Results: The following results were found: the
mortality rate increased with proximity to the epicenter, mortality
was higher among the elderly than among young people, 30% of the victims
died from head injuries caused by the collapse of dwellings, and the
peak of medical demand was 12 hours after the earthquake and significantly
increased demand for care lasted as long as 3 days. Furthermore, the
regression model indicated that 78.5% of the variation of locality-age-sex-specific
mortality was explained by the intensity of the earthquake, age, population
density, distance to epicenter, medical beds per 10,000 people, and
physicians per 10,000 people. |
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| Conclusion: The results implied that fragile
minorities, specifically the elderly and children, require special
consideration and attention in regard to disaster rescue and emergency
medical care allocation. Epidemiologic analysis can guide disaster
response and preparation. [Liang N-J, Shih Y-T, Shih F-Y, Wu H-M,
Wang H-J, Shi S-F, Liu M-Y, Wang BB. Disaster epidemiology and medical
response in the Chi-Chi earthquake in Taiwan. Ann Emerg Med. November
2001;38:549-555.] |
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Were there enough
physicians in an emergency department in the affected area after
a majorearthquake? An analysis of the Taiwan Chi-Chi earthquake
in 1999
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| Study Objective: The purpose of this study was
to evaluate physician manpower and mobilization in an urban emergency
department receiving patients after a major earthquake. |
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| Methods: Patient charts were reviewed. The workload
of physicians was assessed semiquantitatively before and after a major
earthquake. The physicians' mobilization in the postearthquake emergency
response was assessed by using a confidential questionnaire. |
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| Results: In the 3 days after the earthquake,
566 patients with earthquake-related illnesses or injuries were sent
to the urban ED. Three hundred one (53.2%) patients arrived within
the initial 10 hours. In the initial hours, there was no significant
difference between the number of patients per physician per hour before
and after the earthquake. Workloads of wound treatment and advanced
life support procedures were significantly higher after the earthquake
compared with before the earthquake, during the first to sixth hour
and second to fifth hour, respectively. Sixty-five percent of the
hospital's physicians did not assist in either the ED or in any other
parts of the hospital in the initial 6 hours after the earthquake. |
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| Conclusion: The number of physicians in the ED
was insufficient in the initial hours after the earthquake because
of the sudden influx of a large number of patients. Future disaster
planning must address the issue of physicians' behavior with regard
to their priorities immediately after a major earthquake and include
greater provision for efficient mobilization of physicians. [Chen
W-K, Cheng Y-C, Ng K-C, Hung J-J, Chuang C-M. Were there enough physicians
in an emergency department in the affected area after a major earthquake?
An analysis of the Taiwan Chi-Chi earthquake in 1999. Ann Emerg Med.
November 2001;38:556-561.] |
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