The New Mexico-1 Disaster Medical Assistance Team (NM-1 DMAT) has responded to more disasters due to hurricanes than disasters from any other type of event. To assess whether defined patient needs may be applied to future hurricanes, the patient needs after Hurricanes Andrew and Iniki were compared. The study question was, “Did patient medical needs differ after these hurricanes?”

Design: Retrospective cohort review. Subjects: All patients evaluated by NM-1 DMAT following Hurricanes Andrew and Iniki. Observations: Age, past medical history, chief complaint, diagnosis, diagnostic tests, treatments, triage level, and disposition. Age was analyzed using Student's t-test, other data were analyzed using the chisquare test.

A total of 1,056 patients were evaluated. Age distributions did not differ between events. More patients had co-morbidities after Hurricane Andrew. The only difference in chief complaint was that more patients complained of “cold” symptoms following Hurricane Iniki. The only differences in diagnoses were for upper respiratory infections, which were diagnosed more often after Hurricane Iniki. There were no differences in the administration of tetanus toxoid, antibiotics, or analgesics. Patients evaluated after Hurricane Andrew had more diagnostic tests performed and a higher illness/injury acuity. The proportion of the total number of patients conveyed to a hospital did not differ.

Patient needs were similar after Hurricane Andrew and Hurricane Iniki and may be applicable for predicting the needs of patients for future hurricanes.

Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population).

Suicide rates increased in the three calendar years (1994–1996) following the Northridge earthquake as compared to the three calendar years (1991–1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured.

Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991–1993 vs. 1994 –1996) were analyzed using a z-statistic.

There is a statistically significant difference in the rates for the years prior to the earthquake (1991–1993) when pooled and compared to the suicide rates for the years after the earthquake (1994–1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z = -3.85, p <0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84, z = -3.57, p <0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide.

It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.

To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning.

Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available.

There were 275 reported evacuation incidents from 1971–1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%).

More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.

Hospital disaster manuals and response plans often lack formal command structure; instead, they rely on the presence of key individuals who are familiar with hospital operations, or who are in leadership positions during routine, day-to-day operations. Although this structure occasionally may prove to be successful, it is unreliable, as this leadership may be unavailable at the time of the crisis, and may not be sustainable during a prolonged event. The Hospital Emergency Incident Command System (HEICS) provides a command structure that does not rely on specific individuals, is flexible and expandable, and is ubiquitous in the fire service, emergency medical services, military, and police agencies, thus allowing for ease of communication during event management.

A descriptive report of the implementation of the HEICS throughout a large healthcare network is reviewed. Results and Conclusions: Implementation of the HEICS provides a consistent command structure for hospitals that enables consistency and commonality with other hospitals and disaster response entities.

Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on-board includes an anesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions, and arctic winter darkness.

One-hundred, forty-seven ambulance and 29 search and rescue missions in the Barents Sea during 1994–1999 were studied retrospectively with special emphasis on operative conditions and medical results.

Thirty-five percent of the missions were carried out in darkness. The median time from the alarm to first patient contact was 3.3 hours and the median duration of the missions was 7.3 hours. Forty-eight percent of the missions involved ships of foreign origin. Half the patients had acute illnesses, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from industrial accidents with open and closed fractures, amputations, and soft tissue damage. Ninety percent of the patients were hospitalized; 7.5% probably would not have survived without early medical treatment and rapid transportation to a hospital.

Using a heavy search and rescue helicopter in the Barents Sea was the right decision in terms of medical gain and operative risk.

In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the costeffectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.

In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US]$150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of $400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site.

The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site.

This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.

Mass-casualty and hospital preparedness has been analyzed widely. However, information regarding the types of areas where these events occur is limited. Therefore, the characteristics of acute hazardous substances releases resulting in death/multiple-victim events occuring in rural/agricultural areas and in all other areas were studied and compared. Methods: Data reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system from 16 state health departments during 1993–2000 were used to examine factors associated with events with death/multiple victims involving acute release of hazardous substances. A death/multiple-victim event is defined as any event resulting in a death and/or at least five people being transported to a hospital.

Of a total of 43,133 events, 6,661 occurred in rural/agricultural areas. Of these, 107 were death/multiple-victim events with 632 victims, of whom 91 died and 77 were hospitalized. All other areas had 472 death/multiple-victim events with 7,981 victims, of whom 116 died and 413 were hospitalized. Death/multiple-victim events in rural/agricultural areas were more likely to be associated with transportation (Proportional Ratio (PR) = 4.1, 95% CI = 3.1–5.4) and fires and/or explosions (PR = 1.4, 95% CI = 0.95–2.0) than were death/multiple-victim events in all other areas. Among transportation-related events in rural/agricultural areas, 19 were associated with air transport—mainly crop dusters—and resulted in 18 deaths. Responders were three times more likely to be injured in rural/agricultural areas. Of responders, volunteer firefighters constituted 52% compared with 6.7% in all other areas. The most frequently released chemicals in rural/agricultural areas were ammonia, chlorine, and pesticides. In all other areas, ammonia, chlorine, hydrochloric acid, carbon monoxide, and 0-chlorobenzylidene malononitrile, a tearing agent often associated with an illegal or unauthorized act, were released most frequently.

Findings from this analysis suggest that remedial actions should address safety measures in both transportation and fixed facilities containing acute hazardous substances. These include regular maintenance of equipment, education of workers about the substances used in their facility, rigorous training and licensing of drivers and crop duster operators, and education and training of employees and first responders in the use of protective equipment. These activities may reduce the number of events, casualties, and costs associated with hazardous substance events.

Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI.

To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents.

Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings.

A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communicationrelated issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Predeployment planning was the most important factor for future incident impact minimization.

Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.