Previous oil spills and disasters from other human-made events have shown that mental health effects to the affected population are widespread and can be significant.

There has been concern regarding the likelihood that existing public health surveillance was not capturing the mental health effects to the population affected by the Gulf Coast oil spill. The objectives of this study were to assess the mental health needs of coastal communities in the states of Alabama and Mississippi following the Deepwater Horizon oil spill.

A cluster sampling methodology was used to assess the mental health status of coastal residents in three counties in Alabama four months following the 2010 Deepwater Horizon oil spill, and in the Gulf Coast counties in Mississippi 5.5 months after the oil spill.

A total of 469 residents of the selected areas were interviewed. Between 15.4 and 24.5% of the respondents reported depressive symptoms, with 21.4-31.5% reporting symptoms consistent with an anxiety disorder, and 16.3-22.8% reporting ≥14 mentally unhealthy days within the past 30 days. Overall, there were more negative quality of life indicators and negative social context outcomes than in the state's Behavioral Risk Factor Surveillance System (BRFSS) survey. Between 32.1% and 35.7% of all households reported decreased income since the oil spill, and 35.5-38.2% of all households reported having been exposed to oil.

The proportion of respondents reporting negative mental health parameters in the affected Alabama and Mississippi coastal communities is higher than the proportion reported in the 2008 and 2009 BRFSS state reports, suggesting that the public health response to the Deepwater Horizon oil spill should focus on mental health services in these communities.

ButtkeD , VagiS , BayleyegnT , SircarK , StrineT , MorrisonM , AllenM , WolkinA . Mental Health Needs Assessment After the Gulf Coast Oil Spill—Alabama and Mississippi, 2010. Prehosp Disaster Med.2012;27(5):1-8.

Firefighters are often exposed to stressful duty-related events and may experience extreme trauma. Such work-related stress can result in posttraumatic stress disorder (PTSD). It is therefore important to understand the traumatic stress experienced by firefighters in the course of their work and to promote appropriate intervention when necessary.

Data were collected from 118 workers (all males) in the Fire Department of Akita City, Japan who had participated in the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai) rescue effort from March 11 through March 31, 2011. Study participants completed self-report surveys at three time intervals: shortly after return from the rescue effort, approximately two weeks after return from the rescue effort, and approximately one month after return from the rescue effort. The surveys included questions of demographics, physical complaints, medical history, and the Impact of Event Scale-Revised (IES-R) Japanese version, in which a cut-off point of 24/25 was set to screen for PTSD.

A total of 117 participants undertook the initial survey with a range of 0-36 points obtained on the IES-R score. For the initial survey, two of 117 participants scored ≥25 points. For the intermediate survey phase, a range of 0-19 was obtained for 116 participants and for the final survey phase, a range of 0-11 points was obtained for 114 participants.

Contrary to expectations, the survey results showed no participant was judged to require prompt consultation for PTSD. The firefighters who participated in this study were in good mental health. However, more detailed study is required to ascertain whether these findings adequately and clearly reflect the mental health status of these participants.

FushimiM . Posttraumatic Stress in Professional Firefighters in Japan: Rescue Efforts after the Great East Japan Earthquake (Higashi Nihon Dai-Shinsai). Prehosp Disaster Med.2012;27(5):1-3.

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved.

A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences.

AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program.

The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

StokesNA , ScapigliatiA , TrammellAR , ParishDC . The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations. Prehosp Disaster Med.2012;27(5):1–6.

Mobile decontamination units are intended to be used at the accident site to decontaminate persons contaminated by toxic substances. A test program was carried out to evaluate the efficacy of mobile decontamination units.

The tests included functionality, methodology, inside environment, effects of wind direction, and decontamination efficacy.

Three different types of units were tested during summer and winter conditions. Up to 15 test-persons per trial were contaminated with the imitation substances Purasolve ethyl lactate (PEL) and methyl salicylate (MES). Decontamination was carried out according to standardized procedures. During the decontamination trials, the concentrations of the substances inside the units were measured. After decontamination, substances evaporating from test-persons and blankets as well as remaining amounts in the units were measured.

The air concentrations of PEL and MES inside the units during decontamination in some cases exceeded short-term exposure limits for most toxic industrial chemicals. This was a problem, especially during harmful wind conditions, i.e., wind blowing in the same direction as persons moving through the decontamination units. Although decontamination removed a greater part of the substances from the skin, the concentrations evaporating from some test-persons occasionally were high and potentially harmful if the substances had been toxic. The study also showed that blankets placed in the units absorbed chemicals and that the units still were contaminated five hours after the end of operations.

After decontamination, the imitation substances still were present and evaporating from the contaminated persons, blankets, and units. These results indicate a need for improvements in technical solutions, procedures, and training.

RibordyP , RocksénD , DellgarU , PerssonS , ArnoldssonK , EkåsenH , HäggbomS , NerfO , LjungqvistA , GrythD , ClaessonO . Mobile Decontamination Units—Room for Improvement?. Prehosp Disaster Med.2012;27(4):1–7.

A substantial barrier to improving disaster preparedness in Australia is a lack of prescriptive national guidelines based on individual hospital capabilities. A recent literature review revealed that only one Australian hospital has published data regarding its current preparedness level.

To establish baseline levels of disaster knowledge, preparedness, and willingness to respond to a disaster among one hospital's staff, and thus enable the implementation of national disaster preparedness guidelines based on realistic capabilities of individual hospitals.

An anonymous questionnaire was distributed to individuals and departments that play key roles in the hospital's external disaster response. Questions concerned prior education and experience specific to disasters, general preparedness knowledge, perceived preparedness of themselves and their department, and willingness to respond to a disaster from a conventional and/or chemical, biological, or radiological incident.

Responses were received from 140 individuals representing nine hospital departments. Eighty-three participants (59.3%) had previously received disaster education; 53 (37.9%) had attended a disaster simulation drill, and 18 (12.9%) had responded to an actual disaster. The average disaster preparedness knowledge score was 3.57 out of 10. The majority of respondents rated themselves as “not really” prepared and were “unsure” of their respective departments’ level of preparedness. Most respondents indicated a willingness to participate in both a conventional incident involving burns and/or physical trauma, and an incident involving chemical, biological or radiological (CBR) weapons.

Australian hospital staff are under-prepared to respond to a disaster because of a lack of education, insufficient simulation exercises, and limited disaster experience. The absence of specific national standards and guidelines through which individual hospitals can develop their capabilities further compounds the poverty in preparedness.

CorriganE , SamrasingheI . Disaster Preparedness in an Australian Urban Trauma Center: Staff Knowledge and Perceptions. Prehosp Disaster Med.2012;27(5):1-7.

India has been the focal point of various disasters, and has suffered considerable losses due to the same. Manpower shortage can impede disaster management; hence, including dental professionals in disaster management in India can be crucial.

To assess willingness to participate in disaster management among Indian dental graduates; to assess the objective knowledge, attitude, behavior and perceived knowledge regarding disaster management among Indian dental graduates.

All the interns in Manipal College of Dental Sciences, Mangalore, Karnataka were included in the present study. Their willingness to participate in disaster management and their objective knowledge, attitude, behavior and perceived knowledge related to disaster management were assessed using a questionnaire.

A total of 86 study subjects participated. A majority (98.8%) of respondents were willing to participate in disaster management. Mean objective knowledge, attitude, behavior and perceived knowledge scores were 48.65%, 80.26%, 29.85% and 60.80% respectively. Males reported higher perceived knowledge than females (P = .008), and respondents residing in hostels reported higher perceived knowledge than those not residing in hostels (P = .02). Gender showed significant correlations with attitude (r = 4.076, P = .044) and behavior (r = 3.722, P = .054), and residence with behavior of respondents (r = 5.690, P = .017).

A high degree of willingness to provide assistance during disasters was observed among undergraduate dental students. High attitude coupled with low knowledge and behavior scores regarding disaster management was also observed. Gender was associated with attitude and behavior, and residence with behavior of respondents regarding disaster management. Including disaster management in dental curricula and involvement of dental professionals in disaster management might be crucial for disaster management in India.

RajeshG, PaiMBH, ShenoyR, PriyaH. Willingness to Participate in Disaster Management Among Indian Dental Graduates. Prehosp Disaster Med.2012;27(5):1-6.

Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task.

Emergency medical services (EMS) regions in the United States have varying “best practices” for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients.

The main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity.

The minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients.

A new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability.

BayramJD, ZuabiS, El SayedMJ. Disaster Metrics: Quantitative Estimation of the Number of Ambulances Required in Trauma-Related Multiple Casualty Events. Prehosp Disaster Med.2012;27(5):1-7.

Few emergency medical services (EMS) interventions in New Mexico have been assessed for efficacy, potential harm, or potential benefit. There is concern that many interventions added over the years may be outdated, harmful, or ineffective in the EMS setting. A formal process for reviewing the state EMS scope of practice using literature review and expert consensus is discussed. In Phase One of the project, interventions in the New Mexico EMS scope of practice were prioritized for further review by surveying a national cadre of EMS experts to evaluate EMS interventions using a utilitarian harm/benefit metric.

An electronic survey based on the 2010 New Mexico EMS Scope of Practice statute was administered from March through June, 2011. A national cadre of 104 respondents was identified. Respondents were either State EMS medical directors or EMS fellowship directors. Respondents were asked to rate the potential harm and the potential benefit of specific EMS interventions on a 5-point ordinal scale. Median harm and benefit scores were calculated.

A total of 88 completed surveys were received following 208 emailed invitations to 104 respondents (43% response rate). Twenty-two (22) highest-priority interventions (those with a harm/benefit median score ratio of >1) were identified. Seven additional second-priority interventions were also identified. These interventions will be advanced for formal literature review and expert consensus.

The New Mexico EMS Interventions Project offers a novel model for assessing a prehospital scope of practice.

MunkMD , FullertonL , BanksL , MorleyS , McDanielsR , CastleS , ThorntonK , RichardsME . Assessing EMS Scope of Practice for Utility and Risk: the New Mexico EMS Interventions Assessment Project, Phase One Results. Prehosp Disaster Med.2012;27(5):1-6.

Event planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.

A retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.

Medical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.

These two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.

BurtonJO , CorrySJ , LewisG , PriestmanWS . Differences in Medical Care Usage between Two Mass-Gathering Sporting Events. Prehosp Disaster Med.2012;27(4):1-5.

Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure.

To describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams.

Retrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011.

Clinical presentation, medical interventions and discharge destination.

Sixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations.

The deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.

DutchMJ , AustinKB . Hospital in the Field: Prehospital Management of GHB Intoxication by Medical Assistance Teams. Prehosp Disaster Med. 2012;27(4):1-5.

Although the majority of Australian intensive care paramedics use the manual intraosseous infusion technique (MAN-IO), several other semiautomatic devices now are available, such as the bone injection gun (BIG) and the semiautomatic intraosseous infusion system (EZ-IO). Given the choice of devices now available, questions have been raised regarding success rates, accuracy, decay of skills, and adverse events.

Review the literature regarding the use of intraosseous (IO) devices in the prehospital setting.

Selected electronic databases (Medline, Embase, and CINAHL) were searched, and a hand search was conducted for grey-literature that included studies from the commencement of the process to the end of May 2010. Inclusion criteria were any study reporting intraosseous insertion and/or infusion (adult and pediatric) by paramedics in the prehospital setting.

The search located 2,100 articles; 20 articles met the inclusion criteria. The review also noted that use of IO access (regardless of technique) offers a safe and simple method for gaining access to the patients’ vascular system. A number of studies found that the use of semiautomatic devices offers better and faster intraosseous access compared with the use of manual devices, and also were associated with fewer complications. The findings also suggest that the use of semiautomatic devices can reduce insertion times and the number of insertion attempts when contrasted with the use of manual insertion techniques. Despite these findings, statistically no specific IO device has proven clinical superiority.

While manual IO techniques currently are used by the majority of Australian paramedics, the currently available evidence suggests that semiautomatic devices are more effective. Further research, including cost-benefit analyses, is required at a national level to examine skill acquisition, adverse effects, and whether comparative devices offer clinically significant advantages.

OlaussenA , WilliamsB . Intraosseous Access in the Prehospital Setting: Literature Review. Prehosp Disaster Med.2012;27(5):1-5.

Following the Xynthia storm of February 2010 in France, an outreach program was initiated by the regional health authorities during the post-emergency phase to improve access to mental health care for the population exposed to the floods. The program was designed to complement routine health and social care services. It relied on a special telephone service and outreach consultations located in the town halls of the five most affected cities. The objective of this outreach service was to provide initial psychological counseling free of charge and without appointment. Another objective was to refer persons for appropriate treatment and follow-up by routine health care services. A surveillance program was developed to monitor the use of mental health services by first-time users, describe outreach service users with psychological manifestations, and provide timely information to decision makers.

Health providers working in affected towns were asked to complete an individual record sheet for each person who displayed psychological manifestations directly or indirectly linked with the storm on their first visit, and to send it to the regional health office. Participation was voluntary. Data analysis was performed monthly during the six-month surveillance period.

Only mental health providers participated in the surveillance. A total of 227 individual files were sent from April 7 through September 19, 2010. New cases were mainly female adults, and one fifth had a past history of psychiatric illness. Depressive signs and anxiety were the most commonly reported symptoms, followed by signs of post-traumatic stress disorder. A total of five feedback reports were produced for surveillance participants (informants) and authorities.

With initiation in the post-emergency phase of a disaster and timely regular feedback, the surveillance program enabled the authors to describe the occurrence of psychological distress, monitor mental health service use by first-time users, and provide guidance to health authorities. This research showed the advantages of integrating epidemiology in the development of strategy for mental health and psychosocial support in the aftermath of natural catastrophes.

RaguenaudM-E , GermonneauP , LeseigneurJ , ChavagnatJJ , MotreffY , Vivier-DarrigolM , PirardP . Epidemiological Surveillance Linked to an Outreach Psychological Support Program after the Xynthia Storm in Charente-Maritime, France, 2010. Prehosp Disaster Med.2012;27(5):1-6.

This study was conducted to assess the type, pattern, and severity of musculoskeletal injuries, as well as the type of simple orthopedic surgical procedures, that can be performed at the site of a disaster.

This was a cross-sectional study conducted in Battagram, located in the North West Frontier Province of Pakistan after the October 2005 earthquake. Researchers arrived in the affected area during the second week after the earthquake, and remained there for one week. During this period, patients were received from distant areas of the district. These patients were admitted to a tent hospital because the district headquarters hospital was completely damaged. Those requiring orthopedic surgical intervention or closed manipulation and plaster of paris casts were included in the study.

Of 110 patients, 61 were female and 49 were male, and 140 bones were involved. In this series, 92 fractures were closed, while 48 were open. A total of 67.3% of the patients were <40 years of age. The tibia was involved in 32.1% of cases and the femur 16.4%. No cases of compartment syndrome were found. Wound debridement was performed in 35 cases. An external fixator was applied to 10 cases of open tibia fractures. Four humerus fractures and a fracture to the radius and ulna were fixed with the Rashnail method. One open femur fracture was repaired with external fixation. Pre- and post-operative antibiotics were administered in all cases. Thirty patients sustained injuries in addition to orthopedic trauma: 13 vertebral injuries, eight head injuries, six fractured ribs, three blunt injuries to the abdomen, and 10 significant soft tissues injuries without bony involvement.

After the earthquake in Battagram, young persons, especially females, were prone to orthopedic injuries, mainly involving the extremities. A comprehensive disaster plan would have helped to manage these emergencies, and further experience is needed for on-site surgical interventions.

Kaim KhaniGM , BaigA , HumailM , MemonM , QuarashiMA . Musculoskeletal Injuries Among Victims of the Battagram, Pakistan Earthquake in October 2005. Prehosp Disaster Med.2012;27(5):1-3.

An understanding of disaster medicine and the health care system during mass-casualty events is vital to a successful disaster response, and has been recommended as an integral part of the medical curriculum by the Association of American Medical Colleges (AAMC). It has been documented that medical students do not believe that they have received adequate training for responding to disasters. The purpose of this pilot study was to determine the inclusion of disaster medicine in the required course work of medical students at AAMC schools in the United States, and to identify the content areas addressed.

An electronic on-line survey was developed based upon published core competencies for health care workers, and distributed via e-mail to the education liaison for each medical school in the United States that was accredited by the AAMC. The survey included questions regarding the inclusion of disaster medicine in the medical school curricula, the type of instruction, and the content of instruction.

Of the 29 (25.2%) medical schools that completed the survey, 31% incorporated disaster medicine into their medical school curricula. Of those schools that included disaster medicine in their curricula, 20.7% offered disaster material as required course work, and 17.2% offered it as elective course work. Disaster medicine topics provided at the highest frequency included pandemic influenza/severe acute respiratory syndrome (SARS, 27.5%), and principles of triage (10.3%). The disaster health competency included most frequently was the ability to recognize a potential critical event and implement actions at eight (27.5%) of the responding schools.

Only a small percentage of US medical schools currently include disaster medicine in their core curriculum, and even fewer medical schools have incorporated or adopted competency-based training within their disaster medicine lecture topics and curricula.

> SmithJ , LevyMJ , HsuEB , LevyJL . Disaster Curricula in Medical Education: Pilot Survey. Prehosp Disaster Med.2012;27(5):1-3.