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Effectiveness of public health in organized response to non-natural environmental disasters |
James M, Nazar M, Sanchez-Sweatman O |
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Authors' objectives To determine the effectiveness of local public health teams in preventing morbidity and mortality, and providing timely and appropriate interventions in organised emergency response to acute non-natural environmental hazards.
Searching The following databases were searched: MEDLINE and HealthSTAR from 1996 to November 1998; EMBASE from 1985 to November 1998; TOXLINE from 1965 to September 1998; BIOSIS Previews from 1969-November 1998; ENVIROLINE from 1975 to November 1998; Environmental Bibliography from 1974 to November 1998: NIOSH from 1973 to 1998; and NTIS from 1964 to December 1998.
The search terms were: 'emergency response', 'disaster response', 'environmental response', 'hazardous materials response', 'preventative medical', 'preventative emergency medical', 'disaster personnel', 'public health', 'community health agency', 'team', 'office', 'organisation', 'group', 'authority', 'personnel', 'service', 'mass disaster', 'environmental disaster', 'toxic combustion', 'toxic incident', 'chemical incident', 'chemical fire', 'simulated disaster', 'chemical release', 'chemical spill', 'hazardous incident', 'environmental contamination', 'environmental disasters', 'effective', 'evaluation', 'outcome', 'impact', 'measure'; and NOT 'natural disaster', 'radioactive', 'flood', 'hurricane', 'typhoon', 'industrial', 'domestic fire'. The Boolean logic is available from the authors on request.
The core journals handsearched from the first issue of 1993 to October 1998 were: American Journal of Public Health; American Journal of Epidemiology; American Journal of Health Promotion; Canadian Journal of Public Health; Health Education and Behaviour; Health Promotion International; and Journal of Epidemiology and Public Health.
Study selection Study designs of evaluations included in the reviewArticles were included if they evaluated an intervention or any of its components. Studies rated as weak in the validity assessment were excluded.
Specific interventions included in the reviewStudies were included if they described an intervention in relation to an acute non-natural environmental hazard or incident involving organised emergency response, which may or may not include a public health team as part of the response. Specific exclusions were radioactive incidents, civil disobedience, industrial accidents limited to occupational exposure, hurricanes, earthquakes, volcanic eruptions and the like, house fires, and fires without potential hazardous chemical release.
Participants included in the reviewThe included articles had to look at an intervention which was aimed at protecting the general public or high-risk sub-populations. The management of industrial accidents limited to occupational exposure was excluded.
Outcomes assessed in the reviewThe pre-specified outcomes of interest were mortality, morbidity, risk perception and psychosocial impact on the general public.
How were decisions on the relevance of primary studies made?An initial list of articles was reviewed by one reviewer for general relevance to the topic. Subsequently, two reviewers independently reviewed a subset of 71 articles for relevance, according to the study selection criteria.
Assessment of study quality Validity was assessed according to the criteria established by the Effective Public Health Practice Project for selection bias, design, control of confounders, blinding, appropriate data collection methods, withdrawals and drop-outs. An overall rating of weak, moderate or strong was assigned to each study. The validity of all relevant papers was assessed independently by two reviewers.
Data extraction Papers that did not satisfy the selection criteria, but which the reviewer considered had either methodological merit or an innovative approach, were identified for consideration in a table of excluded studies.
Methods of synthesis How were the studies combined?The excluded studies were presented in a narrative synthesis.
How were differences between studies investigated?Differences between the studies were discussed in the narrative summary.
Results of the review None of the retrieved studies sufficiently met the pre-specified review inclusion and quality criteria.
There were no high-quality evaluations of interventions by public health teams. A small number of studies describing the response to such incidents and risk assessments of environmental and potential health impacts were identified. Two studies included health impact but did not use a design with comparisons; three excluded studies had appropriate designs which could be applied to non-natural disaster epidemiology and evaluation; and three studies had merit for further evaluation for policy consideration.
Authors' conclusions From the evidence reviewed, it is not possible to draw firm conclusions about the most appropriate composition of emergency response teams, or how other resources should best be deployed.
CRD commentary The inclusion criteria used in this review were appropriate to the initial review question. The search for relevant evidence was reasonably thorough: it included searches of several electronic databases and handsearches of selected relevant journals, although unpublished studies were not sought. The authors suggest that this, and the exclusion of natural disasters, may have limited the evidence base. The validity assessment was carried out by two reviewers independently using predefined criteria, though neither details of, nor a reference for these criteria were given. No studies relevant to the review question were identified, but basic information from the more informative excluded studies was tabulated and summarised in the narrative. The authors appropriately discussed the limitations of their review in terms of the scope of the review question, limitation in their search strategy, and potential publication bias.
Implications of the review for practice and research Practice: The authors did not state any implications for practice.
Research: The authors state several implications for future research. These include the use of case-control and time-series designs to evaluate short-term health outcomes; prospective follow-up of populations of interest; and identification of schema and resources for contaminant data collection that are feasible in an emergency situation, and are appropriate for input into the risk assessment.
Funding Ontario Ministry of Health, Public Health Branch, PHRED Program.
Bibliographic details James M, Nazar M, Sanchez-Sweatman O. Effectiveness of public health in organized response to non-natural environmental disasters. Dundas, ON, Canada: Ontario Ministry of Health, Region of Hamilton-Wentworth, Social and Public Health Services Division. Effective Public Health Practice Project. 1999 Indexing Status Subject indexing assigned by CRD MeSH Disaster Planning; Disasters; Emergencies; Emergency Medical Services; Public Health AccessionNumber 12002008013 Date bibliographic record published 30/11/2002 Date abstract record published 30/11/2002 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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