Development of protocols for future disasters urgently called for

Dr. Howard Osofsky, Professor and Chair of Psychiatry at LSU Health Sciences Center New Orleans School of Medicine, is an author of a review article published in the April 7, 2011 issue of the New England Journal of Medicine that urgently calls for the development of protocols to deal with the health effects of disasters – before the next one occurs. One year after the largest and most devastating oil spill in United States history, the magnitude of the impact of the Deepwater Horizon Gulf Oil Spill on human health, the environment, and the economy remains unknown. Along with the 9/11 World Trade Center terrorist attack and Hurricane Katrina, this most recent US catastrophe underscores both the lack of knowledge about long-term effects as well as the need for better plans to improve interventions and services to deal with the consequences of such crises.

The article reports what is currently known about the toxicologic consequences of exposures in the Gulf Oil Spill as well as what is known from other spills. However, the authors note the complexity of assessing the full effects of exposures due to the presence of all five elements of a complete exposure pathway, multiple sources of contaminants, and multiple points of exposure. As well, a disproportionately large under-lying disease burden in the population of the Gulf States makes it particularly vulnerable to environmental and natural disasters. The authors report documented symptoms among some 52,000 responders from a number of sources, including self-identified health problems. Additionally, vulnerability to heat stress in the high summer temperatures in the Gulf compounded by personal protective equipment also contributed to health risks, particularly among inexperienced volunteers.

Of particular concern are the symptoms among response workers and community members after oil disasters. Calls to mental health and domestic violence hotlines in the Gulf area have increased since the oil spill, in keeping with reports of increased domestic violence, mental illness, and substance abuse after other disasters.

"Many communities affected by the Gulf oil spill were still recovering form Hurricane Katrina at the time of the Gulf oil spill, which increased the complexity of the response," notes Dr. Osofsky. "We found that 48% of students returning to schools in New Orleans, St. Bernard, and Plaquemines parishes had mental health symptoms in 2005-06. In 2009-10, before the oil spill, 30% continued to have symptoms, suggesting that a complex or repeated trauma increases vulnerability to mental health conditions."

The authors recommend a number of steps be taken now -- rapid development and implementation of protocols for baseline clinical evaluations, including respiratory functions; biospecimen banking; short and long-term medical surveillance and monitoring of workers; and development of psychosocial interventions. In addition to research, clinical and referral networks addressing immediate physical and mental health symptoms and untreated existing health conditions such as asthma and hypertension are critical, they conclude, especially for vulnerable populations.

Provided by Louisiana State University Health Sciences Center

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