Long term health complaints following the Amsterdam Air Disaster in police officers and fire-fighters

The global prevalence of musculoskeletal disorders among firefighters: a systematic review and meta-analysis

This systematic review and meta-analysis study aimed to explore the global prevalence of musculoskeletal disorders (MSDs) among firefighters. A systematical search was performed in three international academic databases (Scopus, PubMed and Web of Science). Overall, 31 articles were included in this review. The pooled prevalence of total MSDs in firefighters was identified as 41% (95% confidence interval [CI] [33, 50]). The prevalence of MSDs in neck, shoulders, upper back, lower back, upper extremity and lower extremity was 9% (95% CI [7, 10]), 11% (95% CI [8, 15]), 8% (95% CI [5, 12]), 31% (95% CI [27, 34]), 13% (95% CI [9, 17]) and 16% (95% CI [14, 18]), respectively. No statistically significant relationship was observed between prevalence of MSDs and year of study, mean age, size of sample, duration of prevalence, region or income level. Demographic, occupational and medical condition factors were identified that can create these disorders among firefighters.

Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review

BACKGROUND

Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.

DESIGN

A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.

RESULTS

A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters.

CONCLUSIONS

The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk.

PROSPERO REGISTRATION NUMBER

CRD42020186074.

Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis

There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.

Can Resilience be Measured and Used to Predict Mental Health Symptomology Among First Responders Exposed to Repeated Trauma?

OBJECTIVES

To examine whether baseline measures of resilience among active first responders predicts future mental health symptomology following trauma exposure.

METHODS

Multivariate linear regression examined the associations between baseline resilience and future mental health symptomatology following repeated trauma exposure. Symptomatology at 6-month follow-up was the dependent variable.

RESULTS

The associations between baseline resilience and future posttraumatic stress disorder (PTSD) (P = 0.02) and depression (P = 0.03) symptoms were statistically significant. Those reporting higher resilience levels had lower symptomology at 6-month follow-up. Eighty percent of first-responders who screened positive for low resilience went on to develop more PTSD symptoms.

CONCLUSIONS

Examining resilience may serve as a more effective means of screening, given resilience is a malleable construct which can be enhanced via targeted interventions. Higher levels of resilience may protect the long-term mental health of first-responders, particularly in regard to future PTSD.

Mental Disorders in Firefighters Following Large-Scale Disaster

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis

Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police.

Posttraumatic stress disorder symptoms and sleep in the daily lives of World Trade Center responders

Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (β = -.13) and worse sleep quality (β = -.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (β = -.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters

Posttraumatic stress disorder (PTSD) in emergency service personnel and other trauma-exposed populations is known to be associated with a variety of physical health problems. However, little attention has been paid to the health of ageing emergency service personnel, who may be forced into early medical retirement because of a combination of these issues. Currently employed (N = 274) Australian firefighters completed a cross-sectional survey using validated, self-report measures of PTSD and somatic symptoms. Analyses examined the association between probable PTSD and a range of common somatic symptoms, and whether any association differed depending on the age of the firefighters. Firefighters with PTSD reported greater levels of neurological (p = .024), gastrointestinal (p = .015), and cardiorespiratory (p = .027) symptoms compared to those without PTSD. After adjusting for sex, age, and rank, linear regression analysis demonstrated that PTSD was significantly associated with increased total somatic symptom severity (p = .024), with PTSD accounting for 9.8% of the variance in levels of somatic symptoms. There was no interaction between age and the association between PTSD and somatic symptom severity. These results suggest that PTSD is associated with a significant increase in a wide range of somatic symptoms among firefighters, regardless of age. The implications for the identification and treatment of PTSD are discussed.

Understanding the Outcome in the Chinese Changjiang Disaster in 2015: A Retrospective Study

BACKGROUND

Rescue after a maritime disaster remains a great challenge in emergency medicine.

OBJECTIVE

We performed an overview of rescue efforts among the victims in the sunken cruise ship Eastern Star in the 2015 Changjiang River marine disaster, as well as possible preventive measures in maritime transport situations.

METHODS

The rescue records of 454 victims of the sunken ship were analyzed retrospectively. Their demographic data, rescue effects, accident inducement, and injury disposition were reviewed. A thorough analysis from the point of view of maritime traffic safety was also performed.

RESULTS

Of the 454 victims, 442 (97.36%) were killed and only 12 (2.64%) survived. The survivors were classified based on their gender, rescue type, and rescue spot as follows: male (91.67%), female (8.33%); tourists (50.00%), and ship staff (50.00%), after the breakdown of the rescue spot in Jianli, Hubei province, China. The survivors were saved only during the initial 17 h after the disaster. The survivors suffering from somato- and psychotrauma were urgently treated for limb injuries, infections of the upper respiratory tract and lungs, fluid and electrolyte imbalance, and acute traumatic stress. This incident was the most severe maritime disaster since the establishment of the People's Republic of China on October 1, 1949, due to the large number of elderly victims, fast overturning speed, and severe weather.

CONCLUSIONS

Emergency rescue requires more automated and intelligent systems for maritime safety. An increased focus must be placed on public welfare and ethics, with the goal of influencing more prosocial behavior rather than the pursuit of profit.

The prevalence and associated factors of depression in policing: a cross sectional study in Sri Lanka

BACKGROUND

Policing is regarded as a high-risk profession for the development of mental health disturbances owing to various critical incidents and potential traumatic events they encounter. Exploration of mental health problems in policing in Sri Lanka, which recently concluded a civil war expanded over three decades, is a timely, yet, a neglected issue. Hence, the present study was conducted with the aim of determining the prevalence and associated factors of depression among police officers in the Kandy police division, Sri Lanka.

METHODS

A cross sectional study was conducted using a simple random sample of 750 police officers employed in the Kandy police division, Sri Lanka. A self administered questionnaire, including "Peradeniya Depression Scale" to assess depression, was used to collect data. The prevalence of depression was calculated as point prevalence with 95 % confidence intervals. Multivariable logistic regression was carried out using backward elimination method to quantify the association between depression and selected predictors identified at bivariate analysis at p < 0.10.

RESULTS

A total of 750 Police officers were invited for the study. The response rate was 94.5 % (n = 709). The mean age of the police officers in the sample was 39.6 years (SD 9.2 years). Majority of police officers (n = 591, 83.4 %) were males. The estimated prevalence of depression in the study sample was 22.8 % (95 % CI 19.9-26.1 %). However, the adjusted prevalence of depression was 10.6 % (95 % CI 6.6-15.1 %). In the multivariable analysis, of the postulated occupational factors, satisfactory welfare facilities at work place was negatively associated with depression (adjusted OR 0.5; 95 % CI 0.3-0.7; p = 0.001). Satisfaction of the opportunity to serve the public (adjusted OR 0.2; 95 % CI 0.1-0.6; p = 0.003) and satisfaction related to social status gained in policing (adjusted OR 0.5; 95 % CI 0.3-0.8; p = 0.04) were identified as significant occupational factors that lowered the likelihood of being categorized as having depression.

CONCLUSIONS

The prevalence of depression among police officers was found to be higher in comparison to other study findings in Sri Lanka. Given the modifiable nature of the significant predictors, it is recommended to design a package of interventions and implement adaptive measures to rectify the problems related to depression among police officers.

The mental health of fire-fighters: An examination of the impact of repeated trauma exposure

OBJECTIVE

Emergency workers, such as fire-fighters, are routinely exposed to potentially traumatic events. While a number of studies have examined the occurrence of post-traumatic stress disorder, the role of multiple traumas on other mental health sequelae, such as depression and alcohol misuse, among emergency workers remains unclear. This study aimed to assess the prevalence of post-traumatic stress disorder, depression and alcohol misuse in a sample of current and retired fire-fighters and examine their relationship with cumulative trauma exposure.

METHOD

A cross-sectional survey was completed by current (n = 488) and retired (n = 265) fire-fighters from Fire and Rescue New South Wales, Australia. Demographic and occupational information was collected, including the number of fatal incidents fire-fighters reported attending across years of service. Validated, self-report measures were used to determine probable caseness for post-traumatic stress disorder, depression and heavy drinking.

RESULTS

Among current fire-fighters, rates of post-traumatic stress disorder and depression were 8% and 5%, respectively, while 4% reported consumption of more than 42 alcoholic drinks per week. Retired fire-fighters reported significantly greater levels of symptomatology, with the prevalence estimates of post-traumatic stress disorder at 18% (p = 0.001), depression at 18% (p < 0.001) and heavy drinking at 7%. There was a significant positive linear relationship between the number of fatal incidents attended and rates of post-traumatic stress disorder, depression and heavy drinking.

CONCLUSION

Fire-fighters suffer from high rates of mental disorders, with rates of post-traumatic stress disorder, depression and heavy drinking continuing to rise in a linear manner with each additional trauma exposure. The level of psychiatric morbidity among retired fire-fighters appears to be particularly high. Our findings have important implications for the ongoing debates surrounding the detection of mental disorders in high-risk occupations and for policy considerations around the welfare of current and retired emergency workers.

An Investigation Into the Relationship Between Long-term Posttraumatic Stress Disorder Symptoms and Coping in Australian Volunteer Firefighters

This study examined the relationship between coping style and long-term posttraumatic stress symptoms in an Australian sample of volunteer firefighters 84 months following a bushfire disaster. A total of 277 firefighters completed 4 questionnaires to assess patterns of psychiatric morbidity. A 2-way repeated-measures analysis of variance was conducted to investigate the effect of time and disorder on coping. Firefighters evidencing distress were more likely to use both problem- and emotion-focused methods of coping. Based on previous research, it was hypothesized that problem-focused coping strategies would be used after 84 months. The use of both problem- and emotion-focused coping may be due to the length of time following this disaster or unique characteristics of firefighters. These data suggest that present coping theories are not sufficient to account for the onset and pattern of psychiatric morbidity within a firefighter sample. The authors declare no conflicts of interest including financial, consultant, institutional, and other relationships that might lead to bias.

Social and occupational factors associated with psychological distress and disorder among disaster responders: a systematic review

BACKGROUND

When disasters occur, there are many different occupational groups involved in rescue, recovery and support efforts. This study aimed to conduct a systematic literature review to identify social and occupational factors affecting the psychological impact of disasters on responders.

METHODS

Four electronic literature databases (MEDLINE®, Embase, PsycINFO® and Web of Science) were searched and hand searches of reference lists were carried out. Papers were screened against specific inclusion criteria (e.g. published in peer-reviewed journal in English; included a quantitative measure of wellbeing; participants were disaster responders). Data was extracted from relevant papers and thematic analysis was used to develop a list of key factors affecting the wellbeing of disaster responders.

RESULTS

Eighteen thousand five papers were found and 111 included in the review. The psychological impact of disasters on responders appeared associated with pre-disaster factors (occupational factors; specialised training and preparedness; life events and health), during-disaster factors (exposure; duration on site and arrival time; emotional involvement; peri-traumatic distress/dissociation; role-related stressors; perceptions of safety, threat and risk; harm to self or close others; social support; professional support) and post-disaster factors (professional support; impact on life; life events; media; coping strategies).

CONCLUSIONS

There are steps that can be taken at all stages of a disaster (before, during and after) which may minimise risks to responders and enhance resilience. Preparedness (for the demands of the role and the potential psychological impact) and support (particularly from the organisation) are essential. The findings of this review could potentially be used to develop training workshops for professionals involved in disaster response.

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)

BACKGROUND

Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being.

METHOD

Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit.

RESULTS

In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life.

CONCLUSIONS

This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Somatic symptom reports in the general population: Application of a bi-factor model to the analysis of change

OBJECTIVE

To investigate the latent structure of somatic symptom reports in the general population with a bi-factor model and apply the structure to the analysis of change in reported symptoms after the emergence of an uncertain environmental health risk.

METHODS

Somatic symptoms were assessed in two general population environmental health cohorts (AMIGO, n=14,829 & POWER, n=951) using the somatization scale of the four-dimensional symptom questionnaire (4DSQ-S). Exploratory bi-factor analysis was used to determine the factor structure in the AMIGO cohort. Multi-group and longitudinal models were applied to assess measurement invariance. For a subsample of residents living close to a newly introduced power line (n=224), we compared a uni- and multidimensional method for the analysis of change in reported symptoms after the power line was put into operation.

RESULTS

We found a good fit (RMSEA=0.03, CFI=0.98) for a bi-factor model with one general and three symptom specific factors (musculoskeletal, gastrointestinal, cardiopulmonary). The latent structure was found to be invariant between cohorts and over time. A significant increase (p<.05) was found only for musculoskeletal and gastrointestinal symptoms after the power line was put into operation.

CONCLUSIONS

In our study we found that a bi-factor structure of somatic symptoms reports was equivalent between cohorts and over time. Our findings suggest that taking this structure into account can lead to a more informative interpretation of a change in symptom reports compared to a unidimensional approach.

Chronic respiratory conditions in a cohort of metropolitan fire-fighters: associations with occupational exposure and quality of life

OBJECTIVES

To assess the prevalence of chronic respiratory conditions in metropolitan fire-fighters and to study associations between occupational exposure, use of respiratory protection and health-related quality of life (HRQoL) in fire-fighters with and without chronic respiratory conditions.

METHODS

Cross-sectional cohort analysis: Respiratory symptoms, medical conditions, occupational tasks and exposures and consistency of using respiratory protection were inquired by questionnaire. The SF12(®)V2 Health Survey was used to measure physical (PCS-12) and mental (MCS-12) HRQoL. Fire-fighters were categorised in subgroups: asthma; COPD/emphysema/chronic bronchitis; no chronic respiratory conditions; and as being 'not involved' or 'involved' in fire-fighting tasks, the latter further categorised as 'consistent' or 'inconsistent' use of respiratory protection. PCS-12 and MCS-12 scores were compared between subgroups and categories using linear regression.

RESULTS

Five hundred and seventy fire-fighters were analysed, 24 (4%) fulfilled the criteria for asthma, 39 (7%) for COPD/emphysema/chronic bronchitis. Fire-fighters with asthma were older than those in the other two subgroups and had been employed in the fire service longer. Respiratory subgroups did not differ in their involvement in fire-fighting tasks. Ninety-one percent of fire-fighters reported relevant occupational exposure in the past year. Mean PCS-12 scores for fire-fighters with no chronic respiratory conditions, asthma and COPD/emphysema/bronchitis were 52.0 (SD 6.9), 47.0 (8.5) and 48.1 (9.4). For PCS-12 (but not for MCS-12), interaction between having a chronic respiratory condition and inconsistent use of respiratory protection during fire knockdown was observed (p < 0.001).

CONCLUSIONS

Ten percent of metropolitan fire-fighters reported underlying chronic respiratory conditions. Presence of such a condition in combination with suboptimal protection from inhaled exposures may lead to poorer physical HRQoL.

Aftershocks associated with impaired health caused by the great East Japan disaster among youth across Japan: a national cross-sectional survey

Background

The Great East Japan earthquake, subsequent tsunamis and the Fukushima nuclear incident had a tremendous impact on Japanese society. Although small-scale surveys have been conducted in highly affected areas, few have elucidated the disaster’s effect on health from national perspective, which is necessary to prepare national policy and response.

Objective

The aim of the present study was to describe prefecture-level health status and investigate associations with number of aftershocks, seismic intensity, a closer geographical location to the Fukushima Nuclear Power Plant, or higher reported radiation dose in each prefecture even after adjusting for individual socioeconomic factors, by utilizing individual-level data acquired from a national cross-sectional Internet survey as well as officially reported prefecture-level data.

Methods

A Japanese government research institute obtained 12,000 participants by quota sampling and 7335 participants were eligible for the analysis in an age range between 17 and 27 years old. We calculated the percentage of people with decreased subjective health in each prefecture after the earthquake. Variability introduced by a small sample size for some prefectures was smoothed using empirical Bayes estimation with a random-intercept logistic model, with and without demographic factors. Multilevel logistic regression was used to calculate adjusted odds ratios (ORs) for change of subjective health associated with prefecture-level and individual-level factors.

Results

Adjusted empirical Bayes estimates were higher for respondents commuting in the northeast region (Iwate 14%, Miyagi 19%, and Fukushima 28%), which faces the Pacific Ocean, while the values for Akita (10%) and Yamagata (8%) prefectures, which do not face the Pacific Ocean, were lower than those of Tokyo (12%). The values from the central to the western region were clearly lower. The number of aftershocks was coherently associated with decreased health (OR 1.05 per 100 times, 95% CI 1.04-1.06; P<.001) even after adjusting for covariates (OR 1.02 per 100 times, 95% CI 1.00-1.05; 1.32 per 1000 times, 95% CI 1.03-1.71; P=.049). In contrast, seismic intensity of the initial earthquake (OR 0.87, 95% CI 0.65-1.17; P=.36), radiation dose (OR 1.16, 95% CI 0.82-1.64; P=.41), and distance from the Fukushima Nuclear Power Plant (OR 1.00, 95% CI 0.99-1.00; P=.66) were not. Change in job condition (OR 2.05, 95% CI 1.72-2.45; P<.001), female (OR 1.43, 95% CI 1.19-1.69; P<.001), higher age (OR 1.06 per year, 95% CI 1.02-1.11; P=.005), and duration of evacuation longer than 4 weeks (OR 1.44, 95% CI 1.06-1.97; P=.02) seemed to decrease perceived health status.

Conclusions

We found nationwide differences that show decreased health status because of the Great East Japan disaster according to prefecture. The number of aftershocks, change in work conditions, being female, a higher age, and duration of the evacuation were risk factors for the population after the major earthquake, tsunamis, and nuclear incident.

Examining disaster planning models for large scale burn incidents--a theoretical plane crash into a high rise building

BACKGROUND

The escalation of global terrorist attacks has resulted in a rise of traumatic injuries. Planning for mass casualty incidents (MCIs) is critical to decrease the morbidity and mortality that ensues after large-scale terrorist attacks. This study provides criteria for the management of burn victims following large-scale disasters.

METHODS

Mass casualty outcomes from three disasters involving commercial aircraft crashes were analyzed. The three events included the El-Al cargo Aircraft crash near the Amsterdam Schiphol Airport in 1992, the World Trade Center attacks in New York and the attack against the Pentagon in Washington, DC on 9/11/01.

RESULTS

Using the data obtained from these events, the severity of injuries in patients were determined. The result is a general template that may be customized with locally or regionally specific data, in order to evaluate the preparedness of a specific burn alignment for such a scenario.

CONCLUSION

Recommendations based on the analysis of previous MCI's were put forth. Based on the needs recognized during these past events, suggestions were made to enhance the preparedness of burn units, hospitals and national agencies as well as municipal authorities.

Long-term mental health outcomes following the 2004 Asian tsunami disaster: A comparative study on direct and indirect exposure

There is inadequate information on the long-term mental health outcomes among disaster victims in low and middle income countries. It is especially so for the vast majority of victims who are indirectly exposed to disasters. To address this gap in knowledge we examined the prevalence of psychiatric morbidity, particularly anxiety, depression and post-traumatic stress disorder (PTSD) in the 2004 Asian tsunami victims in India, 4.5 y after the disaster. It was also intended to compare the mental health outcomes of the victims with direct exposure to tsunami waters and those who were indirectly exposed to tsunami disaster (people living near the sea who escaped tsunami waters but witnessed the disaster and suffered various losses). In a cross-sectional epidemiological study, 666 randomly selected victims in South India were assessed for psychiatric morbidity through the Self-Reporting questionnaire (SRQ), Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale, Self-Rating Scale for PTSD (SRS-PTSD) and suicidality screening. The disaster experience, quality of life and socio-demographic profile were also assessed. Psychiatric morbidity based on SRQ was 77.6% and estimated prevalence of anxiety symptoms (23.1%), depression (33.6%), PTSD (70.9%) and comorbidity (44.7%) suggested nature and extent of the psychiatric morbidity in the tsunami victims. The direct exposure group had a significantly greater proportion of psychiatric morbidity based on SRQ, anxiety symptoms and suicide attempts. Factors which predicted psychiatric morbidity were: lack of formal education, perception of disaster as highly stressful, damage to home and loss of livelihood and livestock. In conclusion, a large proportion of Asian tsunami victims were observed to have continuing mental health problems 4.5 y after the disaster, which highlighted the need for psychiatric services for the affected communities.

The impact of sleep complaints on physical health and immune outcomes in rescue workers: a 1-year prospective study

OBJECTIVE

The present study evaluated the extent to which sleep assessed soon after a trauma predicted subsequent physical health and immune functioning in rescue workers.

METHODS

Participants included 159 men and women who performed rescue and clean-up operations at the site of a major airplane crash. One hundred twenty-eight participants were retained for a 1-year follow-up. Self-report measures of sleep quality and psychological distress were obtained within 2 months of the crash, and a physical health questionnaire was completed at 1-year follow-up. Natural killer cell number and cytotoxicity were assessed using blood samples collected from a subset of participants (n=51) at 1-year follow-up.

RESULTS

After adjustment for sex, age, body mass index, and initial distress, initial sleep quality complaints were associated with more physical symptoms (β=.32; p<.001), poorer perceived health (β=-.27; p=.009), and increased healthcare utilization (β=.31; p=.003) on follow-up. In contrast, initial sleep quality was not associated with natural killer cell number (r=0.10; p=.55) or activity (r=0.02; p=.90). Change in sleep quality during the year after the crash was not a significant predictor of health or immune outcomes.

CONCLUSIONS

These data suggest that poor sleep quality in the aftermath of trauma signals an increased risk for future adverse physical health outcomes and underscore the importance of addressing sleep complaints soon after trauma to mitigate negative impact on physical health.

Use of a web portal for support and research after a disaster: opportunities and lessons learned

Background

In this report we describe the development and use of a web portal in the aftermath of the 2004 tsunami. This large scale disaster confronted many displaced people with death, despair and need for information and support. Awareness and insight in the emotional impact of disasters can provide opportunities for surveillance and early treatment. Moreover, online support systems can contribute to community building, empowerment of victims and resilience.

Objective

We evaluate the development and use of a multilingual web portal that combined a platform for information, emotional support, self assessment and referral with research opportunities. The rapid development, use, advantages, difficulties and learning points are discussed.

Methods

A multidisciplinary working group from the University Medical Centre Utrecht, the Major Incident Hospital and the Central Military Hospital developed a web portal for tsunami victims. The webportal combined: (1) a forum aimed at community building, (2) self assessment tools that in the same time function as a reseach survey, (3) e-consultation, and (4) an information portal.

Results

Within 3 weeks after the tsunami, the working group launched an open, online service (www.TISEI.org. Tsunami Intrenational Survey on Emotional Impact) to foster community) support in the aftermath of the disaster. It combined four functionalities that were earlier previously only used separately. The portal had over 36.800 unique visitors in the first two years. At least 31% (144/464) percent of the Dutch surviving victims could be reached for a survey through the site. The TISEI-environment was available in 15 languages and visitors came from all over the world. Ninety-five percent of all visitors came from Europe or the United States. Subsequent to immediate disaster support, the web portal also served as a memorial archive for anniversary meetings and follow-up incentives. Difficulties we experienced were lack of funding, time pressure, victim-anonymisation, international collaboration and long term maintenance.

Conclusions

A multilingual website with combined modalities for emotional care and research after a natural disaster proved feasible. Web based services like www.TISEI.org in the aftermath of mass disasters can help community building and deliver low level, patient centred and easily accessible information and care. A multilingual website with combined modalities for emotional care and research after a natural disaster proved feasible. Growing Internet penetration world wide and especially the rapid expansion and influence of online communities enables delivery of care and perform research with the internetInternet as a platform. The unpredictable nature of disaster does put time pressure on the development of online solutions and influenced the yield of our site. This highlights the necessity of developing methods and (inter) national collaborations in advance, secure funding, and learn from earlier initiatives.

First Responders after Disasters: A Review of Stress Reactions, At-Risk, Vulnerability, and Resilience Factors

Disasters are widely reported, commonplace events that characteristically leave an enormous legacy of human suffering through death, injury, extensive infrastructural damage, and disorganization to systems and communities.The economic costs may be almost incalculable. Professional and civilian first responders play a vital role in mitigating these effects. However, to maximize their potential with the minimum health and welfare costs to first responders, is important to have a good understanding of the demands of such work on them, how they cope, and what enables them to fulfi ll their roles.This review will explore these themes by highlighting important findings and areas of uncertainty.

Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers

PURPOSE

We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.

METHODS

A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.

RESULTS

A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.

CONCLUSIONS

Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.

[Prevalence and factors associated with Posttraumatic Stress Disorder (PTSD) in emergency workers: a systematic literature review]

OBJECTIVE

To identify the prevalence of Posttraumatic Stress Disorder (PTSD) in emergency workers and determine the factors associated with outcomes.

METHODS

Seven databases were consulted (Medline via Pubmed, PsycINFO, LILACS, SciELO, BDENF, DISASTERS, and MEDCARIB) between September 10 and 25, 2009. The search only included articles published in Portuguese, English or Spanish between 2004 and 2009. The key-words involved terms related to emergency services/workers, Posttraumatic stress disorder, working conditions, and occupational health. Quantitative observational studies on PTSD prevalence and determinant or associated factors regarding the health of firefighters, emergency ambulance personnel, Red Cross workers, and medical emergency workers were included. Studies using samples unrelated to the purposes of this review (police officers, volunteers and emergency workers' children) or that did not include PTSD symptoms as the dependent variable in at least one of the objectives of the study were excluded.

RESULTS

30 articles were selected by reading the titles and abstracts. 17 complete articles were reviewed and analyzed. Studies adopted different research designs, instruments and diagnostic criteria for statistical analysis. The prevalence of the disease ranged from absence of reported cases to a rate of 38.5%. Socio-demographic, biological and psychological characteristics, morbidity, exposure to occupational and non-occupational traumatic events, and work and job features were associated with the prevalence of PTSD in emergency workers.

CONCLUSION

Individual and contextual variables are considered as factors associated with PTSD, which explains the multidimensional nature of the outcome studied.

The public health dimension of disasters--health outcome assessment of disasters

A broad range of health problems are related to disasters. Insight into these health problems is needed for targeted disaster management. Disaster health outcome assessment can provide insight into the health effects of disasters. During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam (2007), experts in the field of disaster epidemiology discussed important aspects of disaster health outcome assessment, such as: (1) what is meant by disaster health outcome assessment?; (2) why should one conduct a disaster health outcome assessment, and what are the objectives?, and (3) who benefits from the information obtained by a disaster health outcome assessment? A disaster health outcome assessment can be defined as a systematic assessment of the current and potential health problems in a population affected by a disaster. Different methods can be used to examine these health problems such as: (1) rapid assessment of health needs; (2) (longitudinal) epidemiological studies using questionnaires; (3) continuous surveillance of health problems using existing registration systems; (4) assessment of the use and distribution of health services; and (5) research into the etiology of the health effects of disasters. The public health impact of a disaster may not be immediately evident. Disaster health outcome assessment provides insight into the health related consequences of disasters. The information that is obtained by performing a disaster health outcome assessment can be used to initiate and adapt the provision of health care. Besides information for policymakers, disaster health outcome assessments can contribute to the knowledge and evidence base of disaster health outcomes (scientific objective). Finally, disaster health outcome assessment might serve as a signal of recognition of the problems of the survivors. Several stakeholders may benefit from the information obtained from a disaster health outcome assessment. Disaster decision-makers and the public health community benefit from performing a disaster health outcome assessment, since it provides information that is useful for the different aspects of disaster management. Also, by providing information about the nature, prevalence, and course of health problems, (mental) health care workers can anticipate the health needs and requirements in the affected population. It is important to realize that the disaster is not over when the acute care has been provided. Instead, disasters will cause many other health problems and concerns such as infectious diseases and mental health problems. Disaster health outcome assessments provide insight into the public health impact of disasters.

Offering a medical examination following disaster exposure does not result in long-lasting reassurance about health complaints

OBJECTIVE

This study tested the hypothesis that large-scale provision of individual medical examination will reduce persistent anxiety about health and subjective health complaints after involvement in an aviation disaster with alleged exposure to hazardous chemicals.

METHOD

Three measurements were performed: during the medical examination, 6 weeks later during consultation with the physician and 12 weeks after the first examination. Rescue workers (n=1736) and residents (n=339) involved in the disaster participated. Standardized questionnaires on health complaints and concerns were administered.

RESULTS

Both groups reported increased health anxiety and somatic sensitivity after 12 weeks. Residents reported more posttraumatic stress symptoms, whereas rescue workers seemed to have gained a better quality of life and were somewhat reassured. Participants who attended the consultation with the physician showed increased reassurance scores after 6 weeks, but their worries had increased again on follow-up. However, nonattendees reported more health anxiety on follow-up. More participants judged participation to have had a positive impact, instead of a negative impact, on their health.

CONCLUSION

Our study does not indicate that a large-scale medical examination offered after involvement in a disaster has long-lasting reassuring effects and suggests that such examination may have counterproductive effects by sensitizing participants to health complaints.

Prolonged Respiratory Symptoms in Clean-up Workers of thePrestigeOil Spill

RATIONALE

The wreckage of the oil tanker Prestige in November 2002 produced heavy contamination off the coast of Galicia, Spain.

OBJECTIVES

To evaluate the prevalence of respiratory symptoms in local fishermen more than 1 year after having participated in clean-up work.

METHODS

Questionnaires including qualitative and quantitative information about clean-up activities and respiratory symptoms were distributed among associates of 38 fishermen's cooperatives. Both postal and telephone follow-up was performed. The association between participation in clean-up work and respiratory symptoms was evaluated using multiple logistic regression analyses, adjusted for sex, age, and smoking status.

MEASUREMENTS AND MAIN RESULTS

Between January 2004 and February 2005, data were obtained from 6,780 fishermen (response rate, 76%). Sixty-three percent had participated in clean-up operations. Lower respiratory tract symptoms (LRTS) were more prevalent in clean-up workers: odds ratio (OR), 1.73; 95% confidence interval (CI), 1.54-1.94. This association was consistent for men and women, for different fishermen's cooperatives, and for different types of respiratory symptoms, and remained after excluding those who reported anxiety or believed that the oil spill had affected their health (OR, 1.57; 95% CI, 1.37-1.80). The risk of LRTS increased with the number of exposed days, exposed hours per day, and number of activities (linear trend, P < 0.0001). The excess risk of LRTS decreased when more time had elapsed since last exposure: OR, 2.33, 1.69, and 1.24 for less than 14 months, 14-20 months, and more than 20 months, respectively.

CONCLUSIONS

Participation in clean-up work of oil spills may result in prolonged respiratory symptoms that last 1 to 2 years after exposure.

Use of health care and drugs by police officers 8.5. years after the air disaster in Amsterdam

This study examined the use of health care by police officers after the air disaster in Amsterdam. On average 8.5 years post-disaster, involved police officers (n = 834, who reported disaster-related tasks), and their non-involved colleagues (n = 634) completed questionnaires on disaster involvement and health care in the preceding 12 months. Logistic regression showed that involved police officers more often used drugs on their own initiative, sleeping pills or tranquillisers, and consulted a general practitioner or medical specialist, a paramedical specialist, and a privately practicing psychologist or psychiatrist. Thus, even after years, police officers involved in disaster work may use more self-initiated health care.

Post-disaster physical symptoms of firefighters and police officers: role of types of exposure and post-traumatic stress symptoms

OBJECTIVES

To examine the relationships between exposure to the air disaster in Amsterdam and multiple physical symptoms among firefighters and police officers, and to explore the role of post-traumatic stress symptoms (PTSS) herein.

DESIGN

Historic cohort study.

METHODS

On average 8.5 years post-disaster, exposed professional firefighters (N=334) and police officers (N=834) and their nonexposed colleagues (N=194 and N=634, respectively) completed questionnaires on disaster exposure and current symptoms. Logistic regression with adjustment for background characteristics was used to compare exposed and nonexposed workers. PTSS were added to these models, as was the interaction between exposure and PTSS, to explore potential mediating and modifying effects, respectively.

RESULTS

Exposed workers reported multiple physical symptoms significantly more often. Multiple physical symptoms seemed to have particularly affected the exposed firefighters who rescued people, and the exposed police officers who supported injured victims and workers, who were involved in the identification of or search for victims and human remains, who witnessed the immediate disaster scene or had a close one affected by the disaster. These exposure effects were essentially independent of PTSS, and no significant interactions between exposure and PTSS were found.

CONCLUSIONS

In conclusion, the excess in post-disaster multiple physical symptoms in exposed workers could not be attributed to PTSS.

Health-related quality of life of firefighters and police officers 8.5 years after the air disaster in Amsterdam

BACKGROUND

In 1992 a cargo aircraft crashed into apartment buildings in Amsterdam. In the troublesome aftermath rumours emerged on potential toxic exposures and health consequences. The aim of this study is to assess the long-term impact of this disaster on the health-related quality of life (HRQoL) of professional assistance workers.

METHODS

Historic cohort study, using questionnaires to assess occupational disaster exposure, HRQoL (SF36), and background variables, at on average 8.5 years post-disaster. Participating were the exposed professional firefighters (n = 334) and police officers (n = 834) who reported disaster-related task(s), and their non-exposed colleagues who did not report such tasks (n = 194, and n = 634, respectively).

RESULTS

Multivariate logistic regression analysis showed that exposed workers reported a significantly lower physical HRQoL and vitality than non-exposed workers. Exposed police officers also reported a lower mental HRQoL. Among exposed workers, a lower HRQoL was reported significantly more often by workers who had a close one affected by the disaster; by firefighters who rescued people, cleaned-up, or witnessed the immediate disaster scene; and by police officers who supported the injured. Exposed police officers who perceived the disaster as 'not bad' reported a lower HRQoL less often than those to whom it was 'the worst ever'.

CONCLUSIONS

This study demonstrates that professional disaster assistance workers are at risk for a lower HRQoL, even after years.

Attribution of physical complaints to the air disaster in Amsterdam by exposed rescue workers: an epidemiological study using historic cohorts

BACKGROUND

In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables.

METHODS

Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks.

RESULTS

Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution.

CONCLUSION

This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization.