Click the PDF link for full-text versions.(You will need Adobe Reader)
Disaster and Behavioral Health
DiMaggio C, Galea S and Richardson L. Emergency department visits for behavioral and mental health care after a terrorist attack. Ann Emergency Med 2006; 5 December (Online publication in advance of print) PDF
STUDY OBJECTIVE: We assess emergency department (ED) utilization by a population whose health care encounters can be tracked and quantified for behavioral and mental health conditions in the aftermath of the terrorist attacks of September 11, 2001. METHODS: We assessed presentations to EDs by using Medicaid analytic extract files for adult New York State residents for 2000 and 2001. We created 4 mutually exclusive geographic areas that were progressively more distant from the World Trade Center and divided data into 4 periods. All persons in the files were categorized by their zip code of residence. We coded primary ED diagnoses for posttraumatic stress disorder, substance abuse, psychogenic illness, severe psychiatric illness, depression, sleep disorders, eating disorders, stress-related disorders, and adjustment disorders. RESULTS: There was a 10.1% relative temporal increase in the rate of ED behavioral and mental health diagnoses after the September 11, 2001, terrorist attacks for adult Medicaid enrollees residing within a 3-mile radius of the World Trade Center site. Other geographic areas experienced relative declines. In population-based comparisons, Medicaid recipients who lived within 3 miles of the World Trade Center after the September 11, 2001, terrorist attacks had a 20% increased risk of an ED mental health diagnosis (prevalence density ratio 1.2; 95% confidence interval 1.1 to 1.3) compared to those who were non-New York City residents. CONCLUSION: The complex role that EDs may play in responding to terrorism and disasters is becoming increasingly apparent. To the best of our knowledge, this is the first report of a quantifiable increase in ED utilization for mental health services by persons exposed to a terrorist attack in the United States.
DiMaggio C, Galea S and Madrid P. Changes in selective serotonin reuptake inhibitor prescription rates following a terrorist attack. Psychiatr Serv 2006; 57(11): 1656-1657. PDF
DiMaggio C and Galea S. The behavioral consequences of terrorism: a meta-analysis. Academic Emergency Med 2006; 13(5): 559-566. PDF
Effective postterrorism public health interventions require the recognition that behavioral consequences are, in fact, the intent of terrorists. The authors searched published and unpublished post-1980 studies that documented population-level behavioral and psychological consequences of terrorist incidents, focusing on posttraumatic stress disorder (PTSD). Results were tabulated, and random effects models were used to calculate overall effect sizes. The analysis indicates that in the year following terrorist incidents, the prevalence of PTSD in directly affected populations varies between 12% and 16%. The review also shows that this prevalence can be expected to decline 25% over the course of that year. These prevalence estimates mask great variability, depending on who is being studied, who is conducting the study, and where the event occurred. Higher rates of disease are reported for survivors and rescue workers, and higher overall rates are also reported from studies conducted in Western Europe compared with studies conducted in North America. Prior psychiatric diagnoses are strongly associated with subsequent PTSD and may be a useful triage factor, particularly when considered together with factors such as female gender and direct exposure to events as either a survivor or rescuer. The review indicates that these associations are consistent across study types and environments and represent important variables to consider when developing triage, outreach, and treatment programs.
DiMaggio C, Markenson D, Loo G, Redlener I. The willingness of US emergency medical technicians to respond to terrorist incidents. Biosecurity and Bioterrorism: Biodefense Strat Pract and Scien 2005; 3(4): 331-337. PDF
A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMT's were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p<0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR=1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates.
Jennings P, DiMaggio C and Braddley J. Avian influenza: what PAs need to know. JAAPA 2006; 19(2): 19-23. PDF
Jennings PR and DiMaggio C. A PA’s Guide to Diarrheal Illness After Katrina. Advance for Physician Assistants. September 2005. PDF
Injury-Related Reprints
DiMaggio C, Durkin M and Richardson L. The association of light trucks and vans with pediatric pedestrian fatality. Int J Injury Contr and Safety Prom 2006; PDF
The hypothesis that relative to cars, light trucks and vans (including sports utility vehicles) are more likely to result in fatal paediatric pedestrian injury was investigated. It was further hypothesized that this increased risk is a result of head injuries. The study sample consisted of 18 117 police records of motor vehicles involved in crashes in which one or more pedestrians aged 5 to 19 years old was injured or killed. Frequencies and case fatality ratios for each vehicle body type were calculated. A logistic regression analysis was conducted, with light truck or van vs. car as the exposure variable and fatal/non-fatal pedestrian injury as the outcome variable. After controlling for driver age, driver gender, vehicle weight, road surface condition and presence of head injury, 5 to 19 year-olds struck by light trucks or vans were more than twice as likely to die than those struck by cars (odds ratio (OR) 2.3; 95% CI 1.4, 3.9). For the 5 to 9 year-old age group, light trucks and vans were four times as likely to be associated with fatal injury (OR 4.2; 95% CI 1.9, 9.5). There was an association between head injury and light trucks and vans (OR 1.2; 95% CI 1.1, 1.3). It was concluded that vehicle body type characteristics play an important role in paediatric pedestrian injury severity and may offer engineering-based opportunities for injury control.
Bessey PQ, Arons RA, DiMaggio CJ and Yurt RW. The vulnerabilities of age: burns in children and older adults. Surgery 2006; 140(4): 715-7. PDF
BACKGROUND: Both children and older adults are thought to sustain burns serious enough to warrant hospitalization disproportionately more often than other age groups, but the incidence, injury characteristics, and outcome have not been precisely defined. METHODS: Patients hospitalized with a burn diagnosis were identified from hospital discharge data from California, Florida, New Jersey, and New York for the 5-year period 2000-2004. RESULTS: In those states, 60,024 residents were hospitalized with a diagnosis of burn and/or inhalation injury according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Using population data from the United States Census 2000, we found that the average annual incidence of hospitalization with a burn diagnosis in these 4 states was 155 per million (per M) (95% confidence interval,153-158). There were 13,453 children under 15 years of age: incidence, 163 per M (range, 157-169). Of these 9508 (70%) were under 5 years of age: incidence, 363 per M (range, 347-379). In contrast, there were 10,686 patients 65 years of age or older: incidence, 214 per M (range, 205-224), of whom 2091 were at least 85 years old: incidence, 347 per M (range, 314-380). The incidence of hospitalization with a burn diagnosis for patients 15 to 64 years of age was 141 per M (range, 138-145). Compared with children younger than 15 years, patients aged 65 years and older more often had flame burns (odds ratio [OR], 2.12), burns of 20% or more of body surface area (OR, 2.41), inhalation injury (OR, 2.88), respiratory failure (OR, 4.48), and death (OR, 16.53), all P < .0001. CONCLUSIONS: Older individuals are the most vulnerable to the morbidity and mortality of burns
DiMaggio C. Pedestrian Injuries and Fatalities in Nassau County, NY. Nassau Health Reports. Nassau County Department of Health. 2003; Dec: 1- 16. LINK
DiMaggio C and Durkin M. Child pedestrian injury in an urban setting: descriptive epidemiology. Academic Emergency Med. 2002; Jan 9(1): 54-62. PDF
OBJECTIVE: To describe the epidemiology of pedestrian injuries to children and adolescents (ages <20 years) in an urban setting, providing analyses of environmental and pedestrian variables. METHODS: Anonymous data were obtained for all motor vehicle crashes occurring in New York City over a seven-year period (1991-1997). RESULTS: Among 693,283 crashes, 97,245 resulted in injuries to 100,261 pedestrians, of whom 32,578 were under the age of 20. Using census counts for the denominator, the overall incidence of pediatric pedestrian injuries was 246/100,000 per year, and the case fatality rate was 0.6%. Incidence rates peaked in the 6-14-year age group, and showed a modest annual decline during the study period. Younger children were more likely to be struck mid-block and during daylight hours, whereas adolescents were more likely to be struck at intersections and at night. For younger children, there was a sharp peak in incidence during the summer months. Road and weather conditions did not appear to affect injury risk. CONCLUSIONS: These results help identify priorities for child pedestrian injury prevention and education, inform public health policy, and direct emergency medical health services resource allocation.
DiMaggio C. The challenge of injury control. JAAPA. 2000; Feb 13(2): 24-42. PDF
Clinical Roles and Training
DiMaggio C, Markenson D, Henning K, et al. Partnership for preparedness: a model of academic public health. J Public Health Manag Pract 2006; 12(1): 22-27. PDF
The New York City Department of Health and Mental Hygiene and the Columbia University Mailman School of Public Health's National Center for Disaster Preparedness undertook a collaborative project to establish a model academic health department. The goals were to increase student participation at the health department, increase faculty participation in health department activities, and facilitate health department faculty appointments at the school. As a result, 17 students were placed in full-time summer research projects designed by health department staff specifically for the project, 154 health department staff attended a series of six lectures presented by faculty, and five health department professionals applied for academic appointments at the school. The benefits of the efforts toward establishing an academic health department extend to all areas of public health practice, including those of preparedness
Markenson D, Reilly MJ, DiMaggio C. Public health department training of emergency medical technicians for bioterrorism and public health emergencies: results of a national assessment. J Public Health Manag Pract 2005; 11(6 Suppl): S68-S74.
Markenson D, DiMaggio C and Redlener I. Preparing health professions students for terrorism, disasters and public health emergencies: core competencies. Acad Med 2005; Jun 80 (6): 517-526. PDF
The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.
DiMaggio C, Markenson D and Redlener I. Preparing for disasters: what should you know and when should you know it? JAAPA. 2005 Mar; 18 (3): 40-48. PDF
Book Chapters
DiMaggio C and Galea S. "The Mental Health and Behavioral Consequences of Terrorism". Chapter 9 In Victims of Crime, 3rd Edition Ed. Davis R, Lurigio A and Herman S. Sage London 2006: pp 147- 160 PDF
DiMaggio C. Fear of Flunking… In Kenefick C. Ed. The Best of Health Professions Humor. Hanley and Belfus, Philadelphia, 2001: pp 135-136.
DiMaggio, CJ and LoVechio F. Parasitic and Exotic Illnesses. In Howell JM, Linden L, Barton D and Givre S Ed. Emergency Medicine: Review and Self-Assessment. WB Saunders, Philadelphia, 1999: pp 112 - 117.
Other Topics and Commentary
DiMaggio C. Improving trauma outcomes: control is still key. JAAPA 2003; April 16(4):9-10. PDF
DiMaggio C. Clearing the ED of smoke, confusion and a crowd. JAAPA 2001; Jun 14(6): 7-8.
DiMaggio C. Analysis of an epidemic: the case for injury research. JAAPA 2000; May 13(5): 23 - 27.
DiMaggio C. CT versus plain films in the diagnosis of intestinal obstruction. JAAPA. 2000; May 13(5): 51 - 58.
DiMaggio C. Medicine by the numbers: statistics to make a better PA. JAAPA. 1998; June 11(6): 53 - 68.
DiMaggio C. Treating lacerations: skill and good sense required. JAAPA. 1997; Aug 10(8): 16 - 32.
DiMaggio C. The clinical implications of fetal wound healing and transforming growth factor beta. Surgical Physician Assistant. 1995 July 1(7): 12-19.
DiMaggio C. Malaria in an urban emergency department: epidemiology and diagnostic features of 25 cases. Am J Emergency Med. 1991; April 9(4): 357-9.
DiMaggio C. Simple laceration repair: part 1. JAAPA. 1990; Mar 3: 388-91.
DiMaggio C. Simple laceration repair: part 2. JAAPA. 1990; 3: 484-8.
|
