Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-19T08:19:59.942Z Has data issue: false hasContentIssue false
  • English
  • Français

Lessons Learned and Unsolved Public Health Problems After Large-Scale Disasters

Published online by Cambridge University Press:  28 June 2012

Victor S. Koscheyev ,
Gloria R. Leon  and
Ian A. Greaves
Victor S. Koscheyev*
Affiliation:
University of Minnesota, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
Gloria R. Leon
Affiliation:
Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, Minnesota
Ian A. Greaves
Affiliation:
University of Minnesota, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
*
Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Mayo Box 807, Minneapolis, MN 55455 USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

This paper examines the considerable medical and psychological problems that ensue after disasters in which massive populations are affected for extended and sometimes unknown time periods. The organization of disaster response teams after large-scale disasters is based on experiences as a medical specialist at Chernobyl immediately after this catastrophe. Optimal ways of dealing with the immediate medical and logistical demands as well as long-term public health problems are explored with a particular focus on radiation disasters. Other lessons learned from Chernobyl are explained.

Issues:

Current concerns involve the constant threat of a disaster posed by aging nuclear facilities and nuclear and chemical disarmament activities. The strategies that have been used by various groups in responding to a disaster and dealing with medical and psychological health effects at different disaster stages are evaluated. The emergence of specialized centers in the former Soviet Union to study long-term health effects after radiation accidents are described. Worldwide, there has been relatively little attention paid to mid- and long-term health effects, particularly the psychological stress effects. Problems in conducting longitudinal health research are explored.

Recommendations:

The use of a mobile diagnostic and continuously operating prehospital triage system for rapid health screening of large populations at different stages after a large-scale disaster is advisable. The functional systems of the body to be observed at different stages after a radiation disaster are specified. There is a particularly strong need for continued medical and psychosocial evaluation of radiation exposed populations over an extended time and a need for international collaboration among investigators.

Keywords

Disasternuclear disasterpublic healthradiation disaster
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 12 , Issue 2 , June 1997 , pp. 49 - 60
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Green, BL, Lindy, JD, Grace, MC et al. : Buffalo Creek survivors in the second decade: Stability of stress symptoms. Amer J Orthopsychiat 1990;60:43–54.CrossRefGoogle ScholarPubMed
2. Bolin, R: Household and Community Recovery After Earthquakes. Program on Environment and Behavior. Monograph No. 56. Institute of Behavioral Science, University of Colorado, 1994.Google Scholar
3. Goenjian, AK, Najarian, LM, Pynoos, RS et al. : Post-traumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. A J Psychiat 1994;151:6:895–901.Google ScholarPubMed
4. Sidel, V: Cleaning, up: Risk and risk reduction at military sites. Health and Environmental Digest 1993;7:1–4.Google Scholar
5. Pretto, EA Jr, Safar, P: National medical response to mass disasters in the United States: Are we prepared? JAMA 1991;266:1259–1262.CrossRefGoogle ScholarPubMed
6. United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR): Ionizing Radiation: Sources and Biological Effects. New York: United Nations Publications, 1988.Google Scholar
7. Mettler, FA, Briggs, JE: A health study of the population around Chernobyl. Impact of Science on Society 1995;163:227–237.Google Scholar
8. Guscova, AK: Medical care at radiation accidents. Journal of Disaster Medicine-Russia 1995;l:92–97.Google Scholar
9. Bissell, RA, Pretto, E, Angus, DC et al. : Post-preparedness medical disaster response in Costa Rica. Prehospital and Disaster Medicine 1995;10:36–42.Google Scholar
10. Martchenke, J, Rusteen, J, Pointer, JE: Prehospital communications during the Loma Prieta earthquake. Prehospital and Disaster Medicine 1994;10:225–231.CrossRefGoogle Scholar
11. Martchenke, J, Pointer, JE: Hospital disaster operations during the 1989 Loma Prieta earthquake, Prehospital and Disaster Medicine 1995;9:146–153CrossRefGoogle Scholar
12. Auf der Heide, E: Disaster Response: Principles of Preparation and Coordination. St. Louis: CV Mosby, 1989.Google Scholar
13. Kirsch, TD: Disaster preparedness and response as primary health care. Prehospital and Disaster Medicine 1995;10:223–224.CrossRefGoogle ScholarPubMed
14. Pretto, EA Jr, Ricci, E, Klain, M et al. : Disaster reanimatology potentials: A structured interview study in Armenia. III. Results, conclusions and recommendations. Prehospital and Disaster Medicine 1992;7:327–338.CrossRefGoogle Scholar
15. Leaning, J: TMI Emergency Planning Project: Key issues in planning the early medical response. In: Golding, D, Kasperson, JX, Kasperson, RE (eds): Preparing for Nuclear Power Plant Accidents. Boulder, CO: Westview Press, 1995, pp 213–235.Google Scholar
16. Verluise, P: Armenia In Crisis. The 1988 Earthquake. Detroit: Wayne State University Press, 1995.Google Scholar
17. Klain, M, Ricci, E, Safar, P et al. : Disaster reanimatology potential: A structured interview study in Armenia. I. Methodology and preliminary results. Prehospital and Disaster Medicine 1989;4:135–154.CrossRefGoogle Scholar
18. International Chernobyl Project Technical Report: Assessment of Radiological Consequences and Evaluation of Protective Measures. Report of the International Advisory Committee for the IAEA. Vienna: International Chernobyl Project, 1991.Google Scholar
19. VanRooyen, MJ, VanRooyen, JB, Sloan, EP et al. : Mobile medical relief and military assistance in Somalia. Prehospital and Disaster Medicine 1995;10:118–120.CrossRefGoogle ScholarPubMed
20. Pynoos, RS, Goenjian, A,Tashjian, M et al. : Post-traumatic stress reactions in children after the 1988 Armenian earthquake. Br J Psychiat 1993;163:239–247.CrossRefGoogle ScholarPubMed
21. Selidovkin, GD: Medical care in first period of radiation accidents. Journal of Disaster Medicine-Russia 1995;1–2:109–118.Google Scholar
22. Ginzberg, HM: The psychological consequences of the Chernobyl accident. International Atomic Energy Agency Study, Public Health Reports 1993;184–192.Google Scholar
23. Kramer, WM, Bahme, CW: Fire Officer's Guide to Disaster Control. 2nd ed. Saddle Brook, NJ: Fire Engineering Books and Videos.Google Scholar
24. Noji, EK: Hospital disaster preparedness in Osaka, Japan. Prehospital and Disaster Medicine 1994;9:94–95.CrossRefGoogle ScholarPubMed
25. Comfort, LK: Revisiting Kobe. Presentation at National Disaster Medicine System (NDMS) Annual Conference. San Diego, CA, 17 March, 1995.Google Scholar
26. Drabek, TE: The Professional Emergency Manager. Program on Environment and Behavior. Monograph No.44. Institute of Bahavioral Science, University of Colorado, 1987.Google Scholar
27. Baranov, AE, Densov, D, Fliedner, TM: Pre-Computer Preforma for the International Computer Database for Radiation Exposure. Case Histories. Berlin: Springer-Verlag, 1994.CrossRefGoogle Scholar
28. Lord, EJ: Minneapolis Veterans Affairs Medical Center, Personal communication, May 1995.Google Scholar
29. Noji, EK, Kelen, GD, Armenian, HK et al. : The 1988 earthquake in Soviet Armenia: A case study. Ann Emerg Med 1990;19:891–897.CrossRefGoogle ScholarPubMed
30. International Nuclear Safety Group: Summary Report on the Post-Accident. Safety Series No. 75-INSAG-1. Vienna: International Nuclear Safety Group, 1986.Google Scholar
31. Silverstein, M: Prediction Parameters for Industrial Disasters: Bhopal, Chernobyl and Hamlet, North Carolina. Rome: World Conference on Health Emergencies in Technological Disasters, May, 1992:pp 22–23.Google Scholar
32. Mitchell, JT: When disaster strikes…The critical incident stress debriefings, Journal of Emergency Services 1983;8:36–39.Google Scholar
33. Mitchell, JT: Stress: The history, status and future of critical incident stress debriefing process, Journal of Emergency Services 1988;13:47–52.Google Scholar
34. Myers, DG: Disaster Response and Recovery: A Handbook for Mental Health Professionals. Rockville, MD: CMHS, DHHS Publication No. SMA 94–3010, 1994.Google Scholar
35. Weaver, JD: Disasters: Mental Health Interventions. Sarasota, FL: Professional Resources Press, 1995.Google Scholar
36. Mozgovaya, AV: Social Consequences of the Chernobyl Catastrophe: Some Results of Sociological Research. Preliminary Paper 198. University of Delaware, Disaster Research Center, 1993.Google Scholar
37. Baum, A, Gatchel, RJ, Schaeffer, MA: Emotional, behavioral and physiological effects of chronic stress at Three Mile Island. J Consult Clin Psychol 1983;51:565–572.CrossRefGoogle ScholarPubMed
38. Davidson, LM, Baum, A: Chronic stress and posttraumatic stress disorders. J Consult and Clin Pyschol 1986;54:303–308.CrossRefGoogle ScholarPubMed
39. Collins, DL, deCarvalho, AB: The 137Cs radiation accident: Psychological, behavioral and neuroendocrine chronic stress indices. J Behav Med 1993;18:149–157.CrossRefGoogle Scholar
40. Aleksandrovski, J: Psychoneurotic disorders associated with the Chernobyl accident. Medical Aspects of the Chernobyl Accident. IA–292 1989.Google Scholar
41. Rubonis, AV, Bickman, L: Psychological impairment in the wake of disaster: The disaster-psychopathology relationship. Psychol Bull 1991;109:384–399.CrossRefGoogle ScholarPubMed
42. Bolin, R, Bolton, P: Race, Religion and Ethnicity in Disaster Recovery. Program on Environment and Behavior. Monograph No. 42, Institute of Behavioral Science, University of Colorado, 1986.Google Scholar
43. Guscova, AK, Baranov, AE, Baranova, AV et al. : Acute effects of radiation victims from the Chernobyl reactor explosion. Medical Radiology 1987;32:3–18.Google Scholar
44. Barabanova, AV: The use of dosimetric data for the assessment of the prognosis of the severity and outcome of local radiation injuries. Br J Radiology (Suppl) 1986;19:73–74.Google ScholarPubMed
45. Leon, GR, Koscheyev, VS, Gourine, AV: Radiation concerns in a non-contaminated village in the Chernobyl area. Unpublished data, 1995.Google Scholar
46. Tysb, AF, Ivanov, VK, Rastopchin, EuM: Radiation and epidemiological system analysis of the registry data on persons involved in the recovery operation. Bulletin of the All-Russia Medical and Domestic State Registry: Radiation and Risk 1992;2:69–110.Google Scholar
47. Koscheyev, VS, Martens, VK, Lartzev, MA: Peculiarities of accident consequences: Immediate and late consequences of the Chernobyl NPP accident. Collected Materials of All-Union Symposium, Russia, 1987.Google Scholar
48. Koscheyev, VS, Martens, VK, Kosenkov, AA et al. : Psychological status of Chernobyl nuclear power plant operators after the nuclear disaster. J Trauma Stress 1993;6:123–130.CrossRefGoogle Scholar
49. Moscovskii Komsomoletz: Newspaper article, Moscovskii Komsomoletz, Moscow, 24 August, 1994.Google Scholar
50. Bergstrom, S, Bochkov, NP, Leaf, A: Effects of Nuclear War on Health and Health Services. 2nd ed. Geneva: World Health Organization, 1987.Google Scholar
51. National Research Council: Health Effects of Exposure to Low Levels of Ionizing Radiation (BEIR V), Committee on the Biological Effects of Ionizing Radiation, Board of Radiation Effects, Effects Research Commission on Life Sciences, Washington DC: National Academy Press, 1990.Google Scholar
52. Shimizu, Y, Kato, H, Schull, WJ et al. : Comparison of Risk Coefficients for Site-Specific Cancer Mortality Based on the DS86 and T65DR Shielded Kerma and Organ Doses. Life Span Study Report 11, Part 1. Technical Report RERF TR 12–87. Washington DC: Hiroshima Radiation Effects Research Foundation, 1987.Google Scholar
53. National Research Council: The Effect on Populations of Exposure to Low Levels of Ionizing Radiation (BEIR III). Committee on the Biological Effects of Ionizing Radiation, Washington, DC: National Academy Press, 1980.Google Scholar
54. Sevc, J, Junz, E, Tomasek, L: Cancer in man after exposure to Rn daughters. Health Physics 1988;54:27–46.CrossRefGoogle ScholarPubMed
55. Koscheyev, VS, Leon, GR: Strategies for test battery selection for Screening large populations exposed to radiation disasters. University of Minnesota, 1994.Google Scholar