Value of Injuries in the Northridge Earthquake

The economic equivalent value of deaths and injuries in the 1994 Northridge earthquake has not previously been calculated, although number of injuries by category of treatment has. Using dollar-equivalent values for injuries accepted and used by the U.S. government for evaluating the cost-effectiveness of risk-mitigation efforts, the value of injuries in the 1994 Northridge earthquake is estimated to be $1.3 to 2.2 billion in 1994 (90$1.8 to 2.9 billion in 2005). This is equivalent to 3–4% of the estimated $50 billion (in 1994) estimated direct capital losses and direct business interruption losses. If injuries in the 1994 Northridge earthquake are representative of injuries in future U.S. events, then the economic value of future earthquake injuries—the amount that the U.S. government would deem appropriate to expend to prevent all such injuries—is on the order of$200 million per year (in 2005 constant dollars). Of this figure, 96% is associated with nonfatal injuries, an issue overlooked by current experimental research. Given the apparently high cost of this type of loss, this appears to represent an important gap in the present earthquake research agenda

Barriers to Mitigation: A Pilot Study

This pilot research was undertaken to discover barriers that prevent homeowners from mitigating earthquake hazards in their homes. There is a relatively significant body of literature on disaster mitigation, which is reviewed and summarized in this report. However, no studies address how these barriers may be overcome so that homeowners would be more proactive in mitigation. If the barriers can be identified, then future communications and policy actions that address these barriers can be taken, resulting in more widespread mitigation implementation that reduces the injury and damage potential that communities face, leading to a reduction in the post-disaster response requirement, and the time required to achieve recovery. Data came from an online survey of San José State University employees; the survey took approximately 15 minutes for respondents to complete. Questions addressed home characteristics, demographic characteristics, perceptions of earthquake risk, levels of mitigation, past experience with earthquake injury or damage, social influences on hazard and damage prevention, and reactions to various incentives. Statistical analyses were done using SPSS version 16.0. Of the total 331 respondents, 215 were homeowners and consequently used for data analysis. Of these homeowners, 79 % owned single-family homes. The sample overwhelmingly expects a major earthquake to occur within the next 10 years, and most expect to suffer earthquake-caused injuries and damage within their homes in the near future. The findings indicate the importance of earthquake expectations and the social network for influencing mitigation. Physical proximity to others who experienced earthquake damage and relational closeness to those who have taken mitigation actions were found to have a positive effect on mitigation implementation by individuals. Homeowners assumed responsibility for mitigation, and cost is generally not a concern. The most prevalent obstacles to mitigation were the feeling that the mitigation is not necessary or that it is inconvenient. Home structures and systems mitigation is far more commonplace than home contents mitigation. Mitigation of home contents was perceived as not being very important, and this perception prevents individuals from taking mitigation actions. All incentive types that were presented to respondents, which were primarily financial in nature, were reported as likely to increase mitigation. Providing advice and information was also reported to likely result in higher levels of mitigation. The development of mitigation approaches that are low-cost and simple is expected to have a positive effect on mitigation actions. In addition, codes were found to be effective at prompting mitigation – most respondents had mitigated for items that have code requirements. One outcome of this is that mitigation of structures is more widely reported than mitigation of home contents. More research is needed to explore non-financial incentives for mitigation, including incentives provided by personal relationships and how social relationships may be leveraged. There is also a need to explore whether different types of incentives (such as free labor or education) would be more or less effective at prompting particular mitigation actions (such as securing the foundation or strapping down appliances). It would be helpful to take a “bottom up” approach by conducting focus groups on these topics. Demographic effects on mitigation and barriers to mitigation also need to be explored further. There were suggestions that demography mattered, but the sample size for this survey was not sufficiently large to draw statistically valid conclusions. There is also a need to revise the survey instrument to remove some ambiguities and inadequacies that currently exist. It would be useful to explore why persons might have taken particular mitigation actions and how social networks affect their mitigation action, among other things. Heightened perceptions of earthquake threats, experience with earthquake injuries and damage, and social relationships are critical predictors of mitigation. Individuals who know others who have mitigated are more likely to mitigate; therefore improved communications, on the personal level, on the topic of mitigation can be effective. Given the perceptions of mitigating home contents, the public also needs to be made more aware of the threats posed by home contents during an earthquake

Participation and quality of life outcomes among individuals with earthquake-related physical disability: a systematic review

Objective: A literature review to evaluate quality of life and participation outcomes of individuals with earthquake-related physical injury. Data sources: A systematic review was performed using National Health Service (NHS) Centre for Reviews and Dissemination (CRD) guidelines. MEDLINE, Embase, PsychINFO, CINAHL and AMED electronic databases were searched from 1966 to January 2014. Study selection: Studies that measured quality of life or participation outcomes among individuals who acquired a physical disability as a result of an earthquake injury were included, with no limits on research design. Data extraction: The search yielded 961 potentially relevant articles after removal of duplicates. Of these, only 8 articles met the inclusion criteria. Studies were rated for quality using the Critical Appraisal Skills Programme (CASP) guidelines. Data synthesis: A narrative synthesis was performed due to the heterogeneity of the included studies. Results: Injured earthquake survivors in developing countries experience diminished participation and reduced quality of life. Small sample sizes and lack of uniformity in outcome measurement limit generalizability. No studies from developed countries were identified. Conclusion: To maximize our understanding of quality of life and participation in injured earthquake survivors, future research should consider both the functional consequences of the injury and the environmental impact of the earthquake. The research should be based on representative samples of the injured earthquake survivors and use validated condition-specific outcome measures that are clearly defined within the publications. In addition, research should include all countries that are affected by earthquakes

Pharmacotherapy

The intent of this book is to provide an overview of current conceptualizations of Pharmacotherapy. The book focuses on three major areas; diagnosis, treatment, and prevention for a wide array of diseases; Cognitive and Psychological disorders (Schizophrenia and Nicotine addiction), Inflammatory disorders (New Chemical anti-inflammatory and Immunotherapy), updated antihypertensive therapy and healing of ulcers with venous origin. A separate chapter is dedicated to the rationality of drug use in earthquake injuries. The last chapter deals with Imaging of potential therapeutic or diagnostic agents in animal models in the early stage of research. We hope this book is useful to a wide range of people, from students first learning about Pharmacotherapy, to advanced clinicians and researchers

A Probabilistic Casualty Model to Include Injury Severity Levels in Seismic Risk Assessment

Despite the increasing adoption of Performance-Based Earthquake Engineering (PBEE) in seismic risk assessment and design of buildings, earthquakes resulted in around 1.8 million injuries (three times the number of fatalities) over the past two decades. Several existing PBEE-based methodologies use rudimentary models that may not accurately estimate earthquake-induced casualties. Even when models are suitable for predicting the total number of fatalities and critical injuries, they may fail to adequately differentiate between different levels of injury severity. This paper draws attention to the importance of extending the seismic casualty assessment method by broadening the perspective on injury severity. To this cause, a probabilistic model is developed to predict fatalities and injuries due to earthquakes. The proposed model adopts the FEMA P-58 framework for risk assessment and considers six injury severity levels (minor, moderate, serious, severe, critical and fatal), in accordance with the Abbreviated Injury Scale (AIS). The aforementioned framework evaluates the casualty risk with five modules: seismic hazard analysis, structural analysis and response evaluation (using incremental dynamic analysis), building collapse simulation, detailed casualty assessment caused by structural, nonstructural, and content components of the building, and injury severity assessment. The injury severity assessment module assumes two modes of injury: occupants falling on the floor resulting in injury and injuries caused by unstable building contents hitting occupants as a result of sliding or overturning. The framework uses an occupant-time location model to predict the number of injuries and a set of building content fragility curves for sliding and overturning failure modes, developed by the incremental dynamic analyses. The proposed model was applied to a case study of a reinforced concrete, moment-frame office building furnished with 21 different content objects. The results show that the frequency of injuries resulting in hospitalization can be up to 30 times more than that of the fatal injuries at low shaking intensity levels and may amplify by 20 times at high intensity shaking

Nepal : Healthcare and Sanitation Issues Resulting From Frequent Natural Disasters in Nepal

This Public Health Brief calls to attention the issues plaguing Nepal as a result of both frequent natural disasters and poor healthcare infrastructure. The geographic characteristics of Nepal are shown to be a major factor in the damage and aftermath of natural disasters such as earthquakes. Due to its status as a poor and economically weakened country, Nepal must rely heavily on outside aid in order to alleviate the pressure of frequently occurring natural disasters. Despite work being done by several Non-Governmental Organizations, Nepal has a long way to go before they are able to independently manage the outcomes of disasters and achieve acceptable sanitation standards. With a cooperative relationship and continued support, significant progress can be made to help Nepal improve and eventually solidify their public health care systems

Injury epidemiology after the 2001 Gujarat earthquake in India: a retrospective analysis of injuries treated at a rural hospital in the Kutch district immediately after the disaster

The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation.To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake.Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries.Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported.The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning

Year in review 2009: Critical Care - cardiac arrest, trauma and disasters

During 2009, Critical Care published nine papers on various aspects of resuscitation, prehospital medicine, trauma care and disaster response. One article demonstrated that children as young as 9 years of age can learn cardiopulmonary resuscitation (CPR) effectively, although, depending on their size, some may have difficulty performing it. Another paper showed that while there was a trend toward mild therapeutic hypothermia reducing S-100 levels, there was no statistically significant change. Another predictor study also showed a strong link between acute kidney injury and neurologic outcome while another article described a program in which kidneys were harvested from cardiac arrest patients and showed an 89% graft survival rate. One experimental investigation indicated that when a pump-less interventional lung assist device is present, leaving the device open (unclamped) while performing CPR has no harmful effects on mean arterial pressures and it may have positive effects on blood oxygenation and CO2 clearance. One other study, conducted in the prehospital environment, found that end-tidal CO2 could be useful in diagnosing pulmonary embolism. Three articles addressed disaster medicine, the first of which described a triage system for use during pandemic influenza that demonstrated high reliability in delineating patients with a good chance of survival from those likely to die. The other two studies, both drawn from the 2008 Sichuan earthquake experience, showed success in treating crush injured patients in an on-site tent ICU and, in the second case, how the epidemiology of earthquake injuries and related factors predicted mortality