Clinical Instructor, Surgery - Emergency Medicine
Residency, University of Chicago
MD, University of Chicago
MPH, Columbia University
On January 12, 2010, a 7.0-magnitude earthquake struck Haiti. The event disrupted infrastructure and was marked by extreme morbidity and mortality. The global response to the disaster was rapid and immense, comprising multiple actors-including academic health centers (AHCs)-that provided assistance in the field and from home. The authors retrospectively examine the multidisciplinary approach that the University of Chicago Medicine (UCM) applied to postearthquake Haiti, which included the application of institutional structure and strategy, systematic deployment of teams tailored to evolving needs, and the actual response and recovery. The university mobilized significant human and material resources for deployment within 48 hours and sustained the effort for over four months. In partnership with international and local nongovernmental organizations as well as other AHCs, the UCM operated one of the largest and more efficient acute field hospitals in the country. The UCM's efforts in postearthquake Haiti provide insight into the role AHCs can play, including their strengths and limitations, in complex disasters. AHCs can provide necessary intellectual and material resources as well as technical expertise, but the cost and speed required for responding to an emergency, and ongoing domestic responsibilities, may limit the response of a large university and hospital system. The authors describe the strong institutional backing, the detailed predeployment planning and logistical support UCM provided, the engagement of faculty and staff who had previous experience in complex humanitarian emergencies, and the help of volunteers fluent in the local language which, together, made UCM's mission in postearthquake Haiti successful.
View details for DOI 10.1097/ACM.0b013e31826db6a2
View details for Web of Science ID 000310579600049
View details for PubMedID 23018336
A qualitative study of the experiences of rescue and recovery workers/volunteers at Ground Zero following the terrorist attacks of 9/11/01 is reported. Information was extracted from a semi-structured clinical evaluation of 416 responders who were the initial participants in a large scale medical and mental health screening and treatment program for 9/11 responders. Qualitative analysis revealed themes that spanned four categories- occupational roles, exposures, attitudes/experiences, and outcomes related to the experience of Ground Zero. Themes included details regarding Ground Zero roles, grotesque experiences such as smells, the sense of the surreal nature of responding, and a turning to rituals to cope after leaving Ground Zero. These findings personalize the symptom reports and diagnoses that have resulted from the 9/11 responders' exposure to Ground Zero, yielding richer information than would otherwise be available for addressing the psychological dimensions of disasters. This work shows that large scale qualitative surveillance of trauma-exposed populations is both relevant and feasible.
View details for DOI 10.1007/s11126-009-9105-7
View details for Web of Science ID 000269009100005
View details for PubMedID 19585238
Western media coverage of the violence associated with the 2003 US-led invasion of Iraq has contrasted in magnitude and nature with population-based survey reports.The purpose of this study was to evaluate the extent to which first-hand reports of violent deaths were captured in the English language media by conducting in-depth interviews with Iraqi citizens.The England-based Iraq Body Count (IBC) has methodically monitored media reports and recorded each violent death in Iraq that could be confirmed by two English language media sources. Using the capture-recapture method, 25 Masters' Degree students were assigned to interview residents in Iraq and asked them to describe 10 violent deaths that occurred closest to their home since the 2003 invasion. Students then matched these reports with those documented in IBC. These reports were matched both individually and crosschecked in groups to obtain a percentage of those deaths captured in the English language media.Eighteen out of 25 students successfully interviewed someone in Iraq. Six contacted individuals by telephone, while the others conducted interviews via e-mail. One out of seven (14%) phone contacts refused to participate. Seventeen out of 18 primary interviewees resided in Baghdad, however, some interviewees reported deaths of neighbors that occurred while the neighbors were elsewhere. The Baghdad residents reported 161 deaths in total, 39 of which (24%) were believed to be reported in the press as summarized by IBC. An additional 13 deaths (8%) might have been in the database, and 61 (38%) were absolutely not in the database.The vast majority of violent deaths (estimated from the results of this study as being between 68-76%) are not reported by the press. Efforts to monitor events by press coverage or reports of tallies similar to those reported in the press, should be evaluated with the suspicion applied to any passive surveillance network: that it may be incomplete. Even in the most heavily reported conflicts, the media may miss the majority of violent events.
View details for PubMedID 18935953
Disaster workers responding to the events of September 11th were exposed to traumatic events. No study has systematically investigated the diverse mental health status and needs of the heterogeneous population of disaster workers responding to the events of September 11th.Using PubMed and Medline and the search terms of "September 11, 2001" or "September 11" or "9/11"or "WTC" or "World Trade Center", the authors reviewed all articles that examined the mental health outcomes of workers at one of the three September 11th crash sites or the Fresh Kills landfill in New York City.In total, 25 articles met study inclusion criteria, often using different methodologies. The articles described varying degrees of mental health symptomatology, risk factors for adverse mental health outcomes, and utilization of mental health services.The mental health needs of workers exposed to the events of September 11th ranged from little to no care to pharmacotherapy. A range of risk factors, including exposures at the WTC site and occupational activities, impacted on these needs but the role of specific mental health interventions was less clear. These findings suggest the need for a future program for disaster workers consisting of an accessible mental health treatment service supported by comprehensive postdisaster surveillance and emphasis on pre-disaster mental wellness. A number of areas for further consideration and study were identified, including the need for a more diverse exploration of involved responder populations as well as investigation of potential mental health outcomes beyond post-traumatic stress disorder (PTSD).
View details for DOI 10.1002/msj.20026
View details for Web of Science ID 000257364300008
View details for PubMedID 18500712
The relationship between homicide and suicide has been studied extensively, but with conflicting results. The primary objective of this study was to examine the correlation between homicide and suicide rates in a large cross-sectional sample of UN member states.The study used age-standardized data on homicide and suicide for 65 international locales compiled by the World Health Organization. Weighted correlation coefficients between homicide and suicide rates were computed by sex, income level, and geographic region.The overall correlation between homicide and suicide rates was weak and statistically insignificant (rho = -0.08, P = 0.5178). However, when analysed by geographic region the data revealed two distinct patterns: homicide and suicide rates were positively correlated in European countries (rho = 0.89, P < 0.0001), but negatively correlated in the Asia Pacific Region (rho = -0.97, P < 0.0001), and the Americas (rho = -0.62, P < 0.005).The strength and direction of the relationship between homicide and suicide vary significantly with geographic region. The divergent geographic patterns in the relationship between homicide and suicide might be due to regional differences in social and cultural variables.
View details for DOI 10.1093/ije/dyi079
View details for Web of Science ID 000231360300027
View details for PubMedID 15851396
Suicide is the 11 th leading cause of death in the United States. The objective of this study is to document the characteristics of aviation-related suicides and suicide attempts.Aviation accidents reported by the National Transportation Safety Board between 1983 and 2003 were screened for cases in which suicide was listed as a probable cause. For each suicide case, two accidents were randomly selected as controls, matched on sex of pilot, type of flight, state, and year of occurrence. Mantel-Haenszel summary Chi-square tests were used to compare cases to controls. Conditional logistic regression modeling was performed to assess the association of pilot and flight characteristics with suicide-related crashes.During the 21-yr study period, 37 pilots committed or attempted suicide by aircraft, with 36 resulting in at least one fatality. All the cases were men and involved general aviation flights. Toxicological test results revealed that 24% of the cases had used alcohol and 14% had used other illicit drugs. Underlying factors included domestic and social problems (46%), legal trouble (40%), and pre-existing psychiatric conditions (38%). Compared with controls, suicide cases involved younger pilots (p < 0.05), were less likely to have another occupant (p < 0.0001), were more destructive to the aircraft (p < 0.0001), and were more likely to have occurred away from the airport (p < 0.0001).Aviation crashes caused by suicide differ from unintentional aviation accidents in pilot characteristics, crash circumstances, and outcomes.
View details for Web of Science ID 000230861400001
View details for PubMedID 16110685