1/10. The efficacy of integrating "smart simulated casualties" in hospital disaster drills.INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. methods: A total of 178 physicians graduating an Advanced Trauma life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
2/10. Brief therapy of civil war-related trauma: a case study.The incidence of posttraumatic stress disorder is widespread among refugees who have been exposed to violence or torture. Many families struggle with side effects of this condition, such as recurrent nightmares, flashbacks, emotional detachment, and difficulty trusting people. Some unwittingly become involved in a pattern of alcoholism, family violence, and somatic illness that is rooted in traumatization. Service providers must often struggle with overwhelmed clients whose multiple needs make long-term therapy impractical. Thus, brief treatment appears to be especially well suited to this population. This article describes a case study using short-term psychotherapy (10 to 20 sessions) that aims to restore refugees who are in reasonable emotional health to their premorbid level of functioning. A 4-stage treatment process involving specific tools is described, and the case study is used as an illustration. Contraindications for time-limited therapy are also outlined.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
3/10. Critical incident stress debriefing following traumatic life experiences.This study was designed to explore the use of critical incident stress debriefing as a therapeutic intervention following traumatic life events. A case study approach was used to allow the researchers to adopt a more flexible and overtly involved stance. Initial contact took place 24 h following the traumatic life experiences of three women. Critical incident stress debriefing was provided and data were collected and recorded within an ethical framework. Six months following the traumatic life experiences the women were interviewed again to explore their perceptions of the intervention that was provided. The results demonstrated positive outcomes. The women concluded that the debriefing intervention provided a safe forum for them to explore their needs, process their experiences and create constructive narratives. A carefully constructed critical incident stress debriefing intervention was used within the context of its objectives and acknowledged limitations. The study was small and generalizations cannot be made to other individuals who experience similar tragedies. Nevertheless, evidence from previous research coupled with the findings from this study suggests that mental health nurses might benefit from being educated and trained in critical incident stress debriefing. Further research needs to be carried out to explore the use of different models of stress debriefing applied to special circumstances. The goal of such interventions should be to alleviate symptoms and to prevent the development of a full-blown post-traumatic stress disorder.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
4/10. Post-traumatic stress disorder following traumatic injuries in adults.The residuals of traumatic injuries from home or workplace accidents, automobile accidents, physical assault, or other unintentional human error can affect victims both physically and psychologically. Symptoms of post-traumatic stress disorder (PTSD) are common among survivors of accidents and nonsexual assaults and can impede recovery. Early identification of PTSD and timely referrals to mental health providers can greatly reduce medical expenses, disability payments, lost wages, lost work productivity, and direct mental health costs. A physician-screening tool to identify PTSD is outlined in this article and can be completed in a few minutes. Implementation of this screening following traumatic injuries can promote early diagnosis of possible psychological complications and facilitate referral to appropriate mental health professionals.- - - - - - - - - - ranking = 5keywords = stress disorder (Clic here for more details about this article) |
5/10. Women and reproductive-related trauma.Women are at higher risk for developing posttraumatic stress disorder (PTSD) than men, leading to significant psychosocial burden and healthcare-related costs. research has shown an association between the negative impact of traumatic experiences and the reproductive life cycle in women. pregnant women with a history of abuse/trauma frequently report intrusive reemergence of symptoms. Women who experience miscarriage may present with even higher prevalence rates of PTSD symptoms. Both psychologic and physiologic factors are believed to be relevant to the development of peripartum posttraumatic stress symptoms. Much less is known, however, about treatment. A case series of patients who presented with PTSD symptoms in the context of reproductive-related traumatic events (e.g., miscarriage, stillbirth) or who experienced reemergence of symptoms during pregnancy is presented, including treatment strategies.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
6/10. Psychiatric sequelae after traumatic injury: the Pittsburgh Regatta accident.Accidental injury in a child is sudden, often violent, and emotionally stressful, particularly when it is accompanied by hospitalization and rehabilitation. The following case report examines the presence of post-traumatic stress disorder and other psychiatric illnesses in five children involved in a boating accident during the 1988 Pittsburgh Regatta and considered severity of injury as well as complicating psychosocial stressors in the development of the disorders. The presence of symptoms was not related to the nature or extent of the injury but was instead the by-product of additional factors, including level of family stress, coping styles of the patient and family, positive psychiatric history in the child and/or family, and experience in effectively dealing with stressful episodes in the past.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
7/10. Traumatic neurosis and other injuries.This article examines the dynamics involved in traumatic events, providing a historical perspective and presenting symptoms and treatment of such clinical syndromes as post-traumatic stress disorder, conversion disorder, somatization disorder, and others.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
8/10. After the war in nicaragua: a psychosocial study of war wounded ex-combatants.Despite 150 wars in the Third World since 1945, there have been virtually no psychosocial studies of war wounded ex-combatants. This community study of 72 such men, on average 4.9 years post-injury, had both quantitative (General Health Questionnaire [GHQ] and clinical interview) and qualitative (personal narrative) components. Most men were coping adaptively. However their overall GHQ scores were significantly higher than an ex-combatant control group, suggesting relative psychological vulnerability (P = 0.001). 13 (18 per cent) had post-traumatic stress disorder (PTSD) though in only three was this clinically significant, two of whom were aggressive alcoholics. Social dysfunction was a better indicator of the minority who needed psychological help than a diagnosis of PTSD. The one in three with a severe physical disability were not at greater risk than the rest of the group. personal narratives illuminated the ways subjects had registered and responded to their war experiences. Identification with the social ideals being defended by the war effort had been psychologically bolstering. Ten severely disabled ex-Contra guerrillas, who had fought on the other side, were also interviewed. The availability of appropriate training/work, and thus the economic fortunes of the whole society, are likely to be major determinants of long-term psychosocial outcomes. Six illustrative personal histories are appended.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
9/10. torture and war trauma survivors in primary care practice.Close to 1 million refugees from around the world have entered the united states, fleeing repression, war, terrorism, and disease. It has been estimated that among these are thousands who have experienced torture. Many refugees and immigrants will appear in the offices of health care professionals with symptoms that may be related either directly or indirectly to torture. Both physical and psychological torture may result in long-term sequelae. Physical effects may be found in every organ system, but psychological effects are most commonly manifest in the symptoms of the post-traumatic stress disorder. For physicians to recognize how torture can affect health status, it is important to understand that history taking may be difficult and that little information may emerge that would explain the origins of scars, fractures, or disabilities. Recognizing the clues to a torture history allows physicians to assist patients in describing the trauma. In addition, knowing the subacute and chronic signs and symptoms of torture enables physicians to diagnose and treat often obscure symptoms with a much clearer understanding of the sources of the difficulty. Paying special attention to the interview process will support torture survivors in detailing often horrific events.- - - - - - - - - - ranking = 1keywords = stress disorder (Clic here for more details about this article) |
10/10. A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.BACKGROUND: Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD. methods: Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. heart rate and blood pressure were recorded on arrival at the emergency department. heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months. RESULTS: twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5 /-13.9 vs 83.3 /-10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8 /-11.9 vs 72.0 /-9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event. CONCLUSION: Elevated heart rate shortly after trauma is associated with the later development of PTSD.- - - - - - - - - - ranking = 5keywords = stress disorder (Clic here for more details about this article) |
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