PURPOSE: To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster. METHODS: A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated. RESULTS: Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure. CONCLUSION In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.
Adolescent ; Adult ; Child ; Cyclonic Storms ; Disaster Planning ; Disaster Victims ; statistics & numerical data ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; epidemiology ; etiology ; Retrospective Studies ; Tertiary Care Centers ; Trauma Centers ; Trauma Severity Indices ; Young Adult

Objectives: The goal of the research was to provide local data on the varieties of posttraumatic symptomatology among survivors of Super typhoon Haiyan in a rural community in Merida, Leyte. Methodology: This is a single point non-invasive study of Filipino survivors of typhoon Yolanda who came from Merida, Leyte, involving administration of a symptom checklist i.e. Post Traumatic Stress Disorder Checklist- Civilian version (PCL-C) to assess the occurrence of posttraumatic symptoms in the selected group of volunteers with no history of psychiatric illness. The PCL-C was given as part of a community screening for symptoms of PTSD conducted three months after the typhoon. There were two ways of scoring the PTSD Checklist- Civilian version (PCL-C) - either by computing for the total severity score or by scoring each response category just like one would in the Diagnostic and Statistical Manual (DSM IV TR) criteria. The sum of all PCL-C item scores indicated the severity of Post Traumatic Stress Disorder (PTSD). A score of 30 and above represented the occurrence of PTSD. T-test was used to determine differences in the severity scores of those who met the criteria for PTSD using the total "severity scoring method" and those who did not. Results: A total of 29 respondents took part in the study where the majority were female (28/29 or 96.55%). The results showed that Filipinos suffered more re-experiencing symptoms but less avoidance symptoms compared to the DSM IV-TR criteria. Nine of 29 (31.03%) respondents were assessed as having Post Traumatic Stress Disorder (PTSD) based on the total "severity score method': However, none fulfilled the PTSD DSM IV TR criteria when the response "category scoring method" was used. Those who met the severity criteria had significantly higher scores in items 1 (Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?), 3 (Suddenly acting or feeling as if a stressful experience were happening again?), 5 (Having physical reactions when something reminded you of a stressful experience from the past?), 6 (Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?) and 13 (Trouble falling or staying asleep?). Conclusion There seems to be a difference in how the Filipinos experience trauma compared to Western models such as described in the Diagnostic Symptom Manual (DSM IV TR) criteria though caution is warranted in interpreting the results due to the small sample size and the predominance of female respondents.
Stress Disorders, Post-Traumatic ; Natural Disasters ; Cyclonic Storms

OBJECTIVE: While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance. METHODS: The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively. RESULTS: During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39). CONCLUSION: Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.
Ambulances ; Cyclonic Storms* ; Disasters ; Emergencies* ; Emergency Medical Services* ; Emergency Medicine ; Humans ; Korea

BACKGROUND: Despite its growing significance, studies on the burden of disease associated with natural disasters from the perspective of public health were few. This study aimed at estimating the national burden of disease associated with typhoons and torrential rains in Korea. METHODS: During the period of 2002–2012, 11 typhoons and five torrential rains were selected. Mortality and morbidities were defined as accentual death, injury and injury-related infection, and mental health. Their incidences were estimated from National Health Insurance Service. Case-crossover design was used to define the disaster-related excess mortality and morbidity. Disability-adjusted life years (DALYs) were directly assessed from excess mortality and morbidity. RESULTS: The burden of disease from typhoons increased with the intensity, with 107.7, 30.6, and 36.6 DALYs per 100,000 per event for strong, moderate, and weak typhoons, respectively. Burden of disease from torrential rains were 56.9, 52.8, and 26.4 DALYs per 100,000 per event for strong, moderate, and weak episodes, respectively. Mental disorders contributed more years lived with disability (YLDs) than did injuries in most cases, but the injury-induced YLDs associated with strong typhoon and torrential rain were higher than those of lower-intensity. The elderly was the most vulnerable to most types of disaster and storm intensities, and males younger than 65 years were more vulnerable to a strong torrential rain event. CONCLUSION: The intensity of torrential rain or typhoon was the strongest determinant of the burden of disease from natural disasters in Korea. Population vulnerable may vary depending on the nature and strength of the disasters.
Aged ; Cyclonic Storms* ; Disasters* ; Humans ; Incidence ; Korea* ; Male ; Mental Disorders ; Mental Health ; Mortality ; National Health Programs ; Public Health ; Rain ; Vulnerable Populations*

BACKGROUND: Despite existing disaster preparedness policies in the Philippines, there has not been any validated assessment of the quality of disaster medical response, which would require reliable aggregate data on patient diagnoses and management.

OBJECTIVE: This mixed-methods study documented the diagnoses, triage classification and case management of patients seen by Philippine EMS groups who responded to the Typhoon Haiyan disaster in the Philippines in November and December 2013, as well as difficulties associated in gathering these data, using the Utstein-style Template for Uniform Data Reporting of Acute Medical Response in Disasters as framework.

METHODS: Three hundred (300) individuals vetted by EMS organizations were invited to answer a survey modeled after the Utstein-style template, and submit tallies of patients seen. Out of 52 responses received, policy recommendations were subsequently generated on concerns assessed by the template using the nominal group technique.

RESULTS: The submitted data yielded a total of 41,202 patients with information on age, sex, and diagnosis; 19,193 with triage classification; and 27,523 with information on case management. The focus group discussion underlined the absence of a standard communication and information management system. Participants recommended establishing such a system and highlighted the role of the Department of Health - Health Emergency Management Bureau in coordinating disaster medical response efforts and information management.

CONCLUSION: This study underlines the importance of effective communication, and multisectoral coordination, to generate reliable data and thus, facilitate resource allocation for disaster medical response.

Human ; Cyclonic Storms ; Disaster Medicine ; Emergency Medical Services ; Relief Work

INTRODUCTION: Typhoon Haiyan, or Typhoon "Yolanda" in the Philippines, caused catastrophic damage last November 8, 2013 in the islands of Leyte. As of April 17, 201, NDRRMC confirmed 6,300 fatalities across the country and around 5,877 were from Eastern Visayas. The actual death toll remained unclear although it is being claimed to be about 10,000 in Tacloban City alone.

OBJECTIVE: This study aimed to determine the transmission of notifiable diseases under PIDSR as to increase in morbidity, deaths and case fatality rates among patients consulted and/or admitted at EVRMC before and after ST Yolanda.

MATERIALS AND METHODS: This is a descriptive study which included all patients who sought consultation and/or admission in EVRMC with clinical diagnosis of any notifiable disease under the PIDSR reference list.

RESULTS: A cumulative total of 8,299 patients with notifiable diseases sought and/or admission between November 2012 - October 2013 and November 2013 - October 2014. Of which, 3,873 or 46.67% were cases before Super Typhoon Yolanda while 4,426 or 53.33% were cases a year after. Patients below 14 years old were mostly affected after the disaster. There were few patients, 70 years old and above who sought consultation and/or admission. As to occurrence between sexes, there were more females affected than males after the disaster which comprised of 51.4% of the total. As to geographic distribution, there were more cases coming from the 1st district of Leyte including Tacloban City comprising 61.58% compared to its occurrence prior to the disaster.  As to the number of cases under Category I, an increased cases of measles from 2 cases to 356 or an increase of 99.44% after the disaster. Notifiable diseases under Category II comprised 91.53% of the total post disaster with an increase of 12.5% from the total cases the previous year. Acute watery diarrhea had the highest number of patients affected then, was followed by Dengue fever,  27.43% and Acute bloody diarrhea, 2.35%. Chikungunya increased from 10 cases the previous year to 33. As to deaths, there was no increase under Category I but, under Category II, an increase of 26.1% after the typhoon was observed. Among these, were Acute watery diarrhea, Dengue fever, Influenza like illness and Measles after disaster.

CONCLUSION: During calamities, everything is affected, from infrastructure, agriculture and most of all the people. Transmission of different infectious diseases occur because of displacement of the population, lack of safe water supply and sanitation facilities and, lack of available health care services.

Human ; Male ; Female ; Cyclonic Storms ; Sanitation ; Philippines ; Influenza, Human ; Disasters ; Chikungunya Fever ; Cities ; Measles ; Dengue ; Water Supply ; Diarrhea ; Agriculture ; Islands

OBJECTIVE: This study aimed to determine the prevalence of Acute Stress Disorder and Post Traumatic Stress Disorder among residents of Barangay Tumana, Marikina exposed to Typhoon Ondoy in September 2009 and Habagat rains in August 2012.

METHODOLOGY: The Acute Stress Disorder Scale (ASDS) and Impact of Events Scale-Revised (IESR) were administered to 212 subjects. Trauma history was also obtained. When screened positive for Acute Stress Disorder (ASD) and/or Post Traumatic Stress Disorder (PTSD), a confirmatory diagnosis was done through psychiatric clinical interview.

RESULTS: The study showed a prevalence rate of 10% for ASD and 5% for PTSD. Co-morbid ASD and PTSD were seen in 4% of the subjects. Frequency and type of prior traumatic events were not significantly different among subjects who were positive or negative for ASD/PTSD diagnoses.

CONCLUSION: There was a significant prevalence of ASD/PTSD diagnoses among residents exposed to Typhoon Ondoy and Habagat, thus the need for developing a means of early detection and immediate therapeutic intervention in Filipino communities exposed to natural disasters.

Human ; Prevalence ; Stress Disorders, Traumatic, Acute ; Stress Disorders, Post-traumatic ; Cyclonic Storms

Following natural disasters, rapid health needs assessments are required to quickly assess health status and help decision making during the recovery phase. The Korean Centers for Disease Control and Prevention (KCDC) developed the Public Health Assessment for Emergency Response (PHASER) Toolkit which was optimized for a weather disaster in Korea. The goal of this study is to assess public health needs following the 2012 typhoons Bolaven and Tembin in both urban and rural areas in Korea. We conducted pilot trials using the PHASER toolkit to assess health needs following typhoons Bolaven and Tembin in Paju and Jeju during summer 2012. We sampled 400 households in Jeju and 200 households in Paju using a multistage cluster sampling design method. We used a standardized household tracking sheet and household survey sheet to collect data on the availability of resource for daily life, required health needs, clinical results and accessibility of medical services. The primary outcomes were clinical results and accessibility of medical service after the typhoons. We completed surveys for 190 households in Paju and 386 households in Jeju. Sleeping disorders were identified in 6.8% (95% confidence interval [CI], 2.8%–10.8%) surveyed in Paju and 17.4% (95% CI, 12.8%–22.0%) in Jeju. We used the PHASER toolkit to assess healthcare needs rapidly after 2 typhoons in Korea. Sleeping disorders were frequently identified in both Paju and Jeju following the 2 typhoons.
Centers for Disease Control and Prevention (U.S.) ; Cyclonic Storms* ; Decision Making ; Delivery of Health Care ; Disasters ; Emergencies* ; Family Characteristics ; Korea* ; Mental Health Services ; Methods ; Needs Assessment* ; Public Health* ; Weather

OBJECTIVES: This study was conducted to estimate the prevalence of psychosocial problems among residents of four flood-prone barangays in Manila located along the Maricaban-Malibay creek in Pasay City and were reported to have experienced 10-15 feet-deep flood waters simultaneously caused by Typhoon Maring and the southwest monsoon in August 2013.
METHODOLOGY: A stratified two-stage random cluster sampling method, adapted from the Community Assessment for Public Health Emergency Response (CASPER) Toolkit, was employed in the syudy. The first stage of sampling used street clusters, with more or less of the same size, as the primary sampling unites (PSU) and households as secondary sampling units (SSU) to select the households that will be included in the survey. Since the clusters were more or less of the same size, they ahd equal chances of being selected in the study if the probability of selection is proportionate to size (PPS). Seven houses were then randomly chosen from the 30 selected clusters. All of the househol heads from the 210 selected households were given several copies of the self-administered questionnairescalled the Self-Reporting Questionnaire-20 (SRQ-20), a screening tool developed by WHO, to determine the psychosocial condition of the household members 12-65 years.
RESULTS: The prevalence of psychosocial distress in this population was estimated at 17% (95%CI=13.7-20.3%). The residents of the study barangays were in their rehabilitation phase i.e., three months post disaster when data was collected for this study. The study also characterized the households in the sample according to socio-economic status, presence of members with special needs, and presence of children 0-5 years ol. In the aftermath of the disaster, 46.84% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms,25.89% on depressive thoughts and 40.91% on depressive moods.There was a higher prevalence of these 4 factors among females, those separated, with low socioeconomic status and low educational attainment.
CONCLUSION: The estimated prevalence of psychosocial distress was 17% (95%CI=13.7%-20.3%), In the aftermath of the disaster, 46.8% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms, 25.9% on depressive thoughts and 40.9% on depressive moods.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Prevalence ; Cyclonic Storms ; Floods ; Medically Unexplained Symptoms ; Family Characteristics ; Social Class ; Disasters ; Probability

OBJECTIVES: This study was conducted to estimate the prevalence of psychosocial problems among residents of four flood-prone barangays in Manila located along the Maricaban-Malibay creek in Pasay City and were reported to have experienced 10-15 feet-deep flood waters simultaneously caused by Typhoon Maring and the southwest monsoon in August 2013.
METHODOLOGY: A stratified two-stage random cluster sampling method, adapted from the Community Assessment for Public Health Emergency Response (CASPER) Toolkit, was employed in the syudy. The first stage of sampling used street clusters, with more or less of the same size, as the primary sampling unites (PSU) and households as secondary sampling units (SSU) to select the households that will be included in the survey. Since the clusters were more or less of the same size, they ahd equal chances of being selected in the study if the probability of selection is proportionate to size (PPS). Seven houses were then randomly chosen from the 30 selected clusters. All of the househol heads from the 210 selected households were given several copies of the self-administered questionnairescalled the Self-Reporting Questionnaire-20 (SRQ-20), a screening tool developed by WHO, to determine the psychosocial condition of the household members 12-65 years.
RESULTS: The prevalence of psychosocial distress in this population was estimated at 17% (95%CI=13.7-20.3%). The residents of the study barangays were in their rehabilitation phase i.e., three months post disaster when data was collected for this study. The study also characterized the households in the sample according to socio-economic status, presence of members with special needs, and presence of children 0-5 years ol. In the aftermath of the disaster, 46.84% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms,25.89% on depressive thoughts and 40.91% on depressive moods.There was a higher prevalence of these 4 factors among females, those separated, with low socioeconomic status and low educational attainment.
CONCLUSION: The estimated prevalence of psychosocial distress was 17% (95%CI=13.7%-20.3%), In the aftermath of the disaster, 46.8% of the respondents had positive answer on the group of questions about decreased energy, 49.8% on somatic symptoms, 25.9% on depressive thoughts and 40.9% on depressive moods.

Human ; Male ; Female ; Depression ; Anxiety ; Stress Disorders, Post-traumatic ; Cyclonic Storms ; Floods