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It has been cited 39 times as of 10/23 according to google scholar, the majority of these being disaster/mental health related articles.

The author of this article is Sonja D. Schmid.  Sonja has degrees in science, technology and society (STS) as well as experience in organizational theory, disaster social issues, and studied risk in relation to different societies and cultures throughout the world.

The report data covers from April 26th 1986 (the date of the disaster) to 2006 (the year the report was published).

The IAEA failed to properly prevent the Three Mile Island or Chernobyl incidents. After these events the IAEA started two conventions for notification and response to nuclear disasters. Since the Fukushima incident, the IAEA has evolved the way they approach disaster and health to include even the most outlandish scenarios and actively trains first responders how to deal with such occurrences.  (iaea.org)

Emergency response is not addressed in this article. But the information provided could be useful for disaster relief workers operating in evironments like these.

                The object of the study “Epidemics After Natural Disasters” by John T. Watson, Michelle Gayer, and Maire A. Connolly is to dispel common misconceptions about disasters and communicable diseases. Further, the study seeks to identify the real leading causes of diseases after a disaster: population displacement, clean water and facilities availability, the amount of crowding, the baseline health of the population, and the availability of healthcare to mitigate the disease risks to the population.

While most hospitals would provide stabilizing, lifesaving treatment to those that needed it, there were some that did not. This act really helps the good hospitals (the majority of them) that were already doing what this policy made law, but there were enough instances and examples of hospitals that were not, so the legislature acted. It is also important to note that this act was part of a larger bill (COBRA) that dealt with national healthcare and social security policy.

            This past spring break (2016), on a Monday night while at home, I responded to a motor vehicle accident as a Good Samaritan. The accident happened at approximately 19:00 hours on my street in Blackstone, Massachusetts. My father was on our front porch when he heard a car barreling down our back country road which has a long straight away before taking a sharp turn. Before the impact he knew that the driver would not anticipate the curve fast enough at the speed he was traveling. Sure enough, there was a loud bang and the sound of a car rolling over, which I could hear from inside the house (approximately ¼ mile from crash).

I grabbed both of my personal first aid kits and a flashlight while my father called emergency services. I walked to scene with my father and younger brother. I sped walked and arrived at the crash site first.

The vehicle was a ‘90s sedan that went straight into a telephone pole, which broke like a toothpick, and rebounded backwards and flipped 90 degrees on its left side. Parts of the car, tools, and glass were on ground, airbags deployed. There was a car seat in back, and for a moment I thought a child but it was just clothing. Front right tire was up inside front passenger compartment. Hazards flashing. Driver window was rolled down. No people in the car.

My brother and father directed traffic on either end of the crash site. They almost certainly prevented at another crash by a car who didn’t see the accident but saw my brother flag them down with his light.

I saw man standing 20’ from crash site, talking to people in a gold SUV. When I arrived I start asking medical questions and the people in the SUV leave – they were by standards who pulled up but left after I started taking over. The man in question appeared to be a lower/middle class white/Hispanic, male in his 30s. He was driving an older car with lots of tools in the back which were now all over the road. Our neighborhood is a small country community and I know he was not from our neighborhood. I assumed he was some kind of mechanic, bases on tools in car. He was wearing dirty jeans and stained hoodie. He was definitely a blue-collar worker. He may have been from downtown Blackstone which is largely lower middle class and blue collar, or he may have been from Woonsocket, Rhode Island, which is known as “the Detroit of Rhode Island”.

As I tried to obtain basic medical information from the patient, it was apparent he had an altered mental status, and did not appear to understand fully what was going on. I am not certain if it was alcohol and/or drugs as for safety reasons I did not get close enough to the patient/suspect to tell. He was ambulatory and verbal. The interesting part of our conversation was to the best of my ability as follows:

“Are you sure you’re okay? Umm yeah. Are you hurt anywhere? I’m fine. [I did visual inspection of patient using flashlight which revealed no major injuries other than minor cuts from airbag]. [He starts to edge away from scene]. You should wait for ems to check you out. Wait, you’re right! I might die?! You appear to be okay externally but things like internal bleeding, and a full assessment could reveal other problems. Naaaa [turns and starts to walk away down street]”

I attempted to convince the patient to wait on scene but he was going through several mode swings during my interactions with him from fear, anxiety, agitation, and anger. While I was talking to the patient, the first officer from the neighboring town arrived on a motor cycle. I informed the officer at the scene of the situation about the patient/suspect fleeing the scene. The officer took note of it and continued to work to secure the crash site. Another officer arrive from my town from the west. I informed the same and he stated that he would need me to make a witness statement and proceeded to the crash site. A third and fourth officer arrived together the same time as two ambulances (indicated because of rollover) from the east. One of them told me again that they would need a witness statement.

I met back up with my dad and brother who were no longer needed to control traffic with law enforcement on scene. Neighbors had started coming out to see the commotion. We were all talking near the scene while waiting for officers. Finally one of the officers asked another officer if he should go look for the suspect. He left approximately 20 minutes after my last contact. I never spoke with the arriving EMS as they came from the east and I was on the west of the accident but officers told them that the patient was missing. Eventually multiple officers and cars were out looking for patient/suspect but was not found as far as I am aware. I finally was given the chance to give my testimony which, to the best of my knowledge, mirrors this report. After reading out loud in front of the officer and my father and brother to confirm accuracy, the officer asked me something very strange. First, he asked me to add what the suspect was wearing (which I had forget to include), but then he also asked me to state that I saw the suspect drive into the telephone pole and that I smelled alcohol on the patients breath. Neither of these things were what I told any of the officers and ran counter to my testimony as written. I include the suspect’s clothing description but I did not add the second mention and stated that I had not witnessed those things. After my report I left the scene with my brother and father.

Some of the policies and procedures relevant to this case were: scene safety, dealing with aggressive/combative patients, and HIPPA did not apply to me as a bystander so I gave full testimony including medical status to the officers.

After reflecting on the education I received and didn't receive, there are a few things that would have allowed me to be better prepared for this incident. How do I convince patients to stay on scene? When do you give up? I wish my EMT class was a little better scene on safety training. Being distracted by the emergency at hand, I did not truly take into account the fact that the power lines were live and drooping with half of the telephone poll pulling on them. Only supported by the next and previous poll but not drooping more than 3’ from normal, more than 15’ from ground, and 10’ above vehicle. Reflecting on it, I did not really consider the threat as I should have, and neither did the officers on scene. I don’t understand why it took so long for police to search for the suspect who could have had major medical issues. Should I have followed suspect/patient alone? When is a citizen arrest allowed/appropriate? Should I have asked for the badge number of the officer who asked me to misrepresent the truth on an eye witness testimony? What is the process to do that anyway? If I had the answers to these questions I feel I may have been able to provide better assistance, but then again perhaps not.

Actors reffered to:

Firefights:

                Thomas Von Essen was the city's fire commissioner.

                Battalion Chief Joseph Pfeifer was the first fire chief to begin operations on 9/11. He sent companies into the towers but found he was unable to properly communicate with them.

                Deputy Assistant Chief Albert J. Turi was one of the firefighters in the towers that day who was unable to send and receive communications.

                Assistant Chief Joseph Callan was in the north tower and ordered an evacuation order after felling the floor shifting. His order was largely unheard.

                Assistant Chief Donald J. Burns was at both the 1993 bombings as well as the 9/11 attacks on the towers. On 9/11 he died leading operations in tower 2.

                Mr. Modica, a firefighter, could not reach a friend who was a few floors above him with his radio equipment over any of the channels.

                Mr. Campagna, a Firefighter, remembers getting out just before his tower fell.

Police:

                Police Commissioner (at time of article’s writting) Kelly stated that there was no link between the various first response agencies on the day.

                Bernard B. Kerik was the police commissioner on the day of the attack. He claimed that he was unaware of any communication issues during the incident.

                Sergeant Moscola was a police officer.

Government:

                Rudolph W. Giuliani was the mayor of NYC.

                Richard J. Sheirer was the former director of the city's Office of Emergency Management and a fire dispatcher when speaking of the first responder’s communication equipment he said: “We're dinosaurs”.

                Naval War College helped do and self-examination of the fire department’s command and control after the disaster.

                James Ellson was a former deputy in the city's Office of Emergency Management

Civilians:

Ms. Frederick was a civilian who barely got clear of the towers in time. She credits a firefighter for saving her life saying: “He stayed there because there were more people behind us''.

David Rosensweig was the president of the fire alarm dispatchers' union.

Sharon Premoli was an executive vice president of Beast Financial Systems.

This article relates to public health as the conditions of the island prison are a health concern of themselves and other conditions exacerbate existing health issues of inmates there. It also addresses the issues with healthcare, housing, and financial stability after release from the system.